Six Questions: An interview with Brad Barkley, Co-Author of Jars of Glass

Today’s interview is with Brad Barkley, co-author of Jars of Glass. From the summary:

Chloe and Shana want the same thing?for everything to go back to normal, the way it was before their mom went to the hospital. But both sisters know that things can never be the same. While Chloe wants their mom to come home so they can be a family again, Shana never wants to see their mother. And while Shana is trying to escape her problems by hiding under a new persona, Chloe is left trying to be the responsible one. Then things go from bad to worse, and the sisters are forced to band together and redefine what it means to be a family.

I really appreciate that this book takes a different look at what it’s like to have a family member with a mental illness. It also bounces between the two perspectives of the two sisters, which is different than usual.

1) Do you think that personal experience with mental illness is necessary to write a story like this?

I don’t think it’s necessary, no, as long as you are a writer who is willing to do your research and use your imagination. I mean, people write novels about the Civil War or living on Mars without having had any experience of that. But it might be a moot question. You know, one of the tricks that fortune tellers are taught is to say to customers, “You are related to someone in the military,” and you go away thinking, Wow, how did she know that? But the thing is, everyone, pretty much, is related to someone in the military. I think it’s the same thing here; pretty much everyone has had someone in their life with some kind of mental illness, either themselves or someone else. Sadly, mental illness casts a wide net.

2) This book is written from a slightly different perspective than most of the ones I’ve seen with mental illness – it deals with what it’s like to have a family member who struggles. What sort of point were you trying to drive home by creating a world like this?

In my mind, novels are not written to “drive home a point,” but rather to explore the lives of characters. Or to put it another way, not to provide answers but to ask interesting questions. The question here might be, “How does it affect your growing up if your parent is mentally ill?” Or, “How does it affect relationships with the people around you?” And not just in general, but specifically for these two girls. The “point” of any novel, I think, is to let us inside other people and their lives, to create empathy and understanding for other people.

3) What sort of feedback did you get from people who had been through similar situations?

We had letters and emails from teens saying that the book really helped them. But they don’t get too into the specifics of that. They feel a real closeness for the book, but the people who wrote that book are still strangers, so they aren’t going to go into too much detail. But it is gratifying to know that someone in a similar situation has felt like they were understood or that they had a voice because this book spoke for them.

4) The book goes back and forth between the perspective of two sisters; that obviously provides two different perspectives. What made you select these two specific perspectives from the point of view of the two sisters?

I wrote this with my co-author, so I really only had a hand in selecting the perspective of the older sister (the “even” chapters in the book, in Shana’s voice). Again, I think we wanted to explore a relationship between two siblings (both of us have a sibling), who are in many ways very different from each other, yet still love each other. As you write, characters kind of insist upon who they are, and my job is mostly to type and stay out of the way.

5) As you were writing from two perspectives, were there every moments where you thought, “Oh, damn, that’s not something that character X would say, that’s what Y would say”? In other words, was it confusing to write two different emotions, dialogue patterns, personalities, etc?

Well, that is part of the difficulty or fun of writing with a co-author. Of course, I “invented” one sister, and my co-author “invented” the other one, but I would have to constantly write her character into my scenes, and vice-versa. So we came up with one rule: we each have full veto power over our own character. In other words, I could say to Heather, “Nah, Shana would never say that,” or Heather could say to me “Chloe would never do that,” and then we would figure it out. But, over the course of three books, we only had to invoke that rule twice that I recall, so we were pretty intuitive about all the characters in the book and who they were.

6) Anything that you would change about this book, now that it has been years since publication?

It never occurs to me to think of books that way, or even short stories. I’m sure I could read through with a pen in my hand and a few things would make me cringe, and I would start marking this or that change. But a book is a finished work. It is complete in itself, and it’s also kind of a time capsule of where you were in life when you wrote it, and who you were, and all the ways you have moved on. Even if you could change it, why would you want to?

Suicide rates are rising in girls – with the highest rise among ages 10-14

I guess I should warn you ahead of time, but this entry has some absolutely brutal statistics. For those who may be disturbed by such content, please note that the following blog entry will review information on suicide, including methods.

A new study which appeared in JAMA examined whether or not the gap between suicide in boys and girls was narrowing. Broadly speaking, while women are more likely to attempt suicide, men are more likely to complete it. This is for a variety of reasons, but the most obvious one is that men typically use more violent means to commit suicide, and are thus less likely to be saved by medical professionals.

The results of the JAMA study were disturbing. It examined 85,051 suicides of children and teenagers, ages 10-19, between 1975 and 2016. The most painful result:

Following a downward trend until 2007, suicide rates for female youth showed the largest significant percentage increase compared with male youth (12.7% vs 7.1% for individuals aged 10-14 years

From the conclusion of the study:

A significant reduction in the historically large gap in youth suicide rates between male and female individuals underscores the importance of interventions that consider unique differences by sex. Future research examining sex-specific factors associated with youth suicide is warranted.

Further examination of the data reveals that the rate at which women were using hanging and suffocation for suicide were approaching the same rates as men. In other words, girls are starting to use more lethal means to kill themselves, a highly disturbing trend, and one that will lead to additional deaths.

A key and tragic consideration to keep in mind when it comes to suicides is that, for every death by suicide, there are an estimated 25 attempts. A rise in use of more lethal means of suicides means that more suicide attempts will result in death.

To put the above statistic another way: If every suicide attempt led to a death, we’d lose approximately 1,175,000 people every year.

Unfortunately, none of this information is all that surprising, though it is deeply disturbing to know that more 10 year olds are killing themselves at accelerating rates. A study which came out last months showed that the number of children going to the emergency room doubled between 2007-2015. Suicide is the 2nd leading cause of death of 15-34 year olds in America, and rates of mental illness are rising among young adults faster than any other age group.

Clearly, our young people are under more pressure than ever before, and clearly, we are failing them if we don’t do a better of job of addressing this crisis.

Back to the study above. One of the things I’d like to focus on – at least when it comes to trying to reduce this gap – is means reduction. If young girls are starting to use more violent means for suicide, we must do a better job of determining why, and what, if anything, we can do about it. There are public policy options when it comes to guns, but I’m not sure what you can do, if anything, when it comes to suffocation or hanging.

We have to do something. The only way to guarantee failure is not try anything.

Six Questions: An interview with Laura Silverman, Author of You Asked for Perfect

Today’s interview is with Laura Silverman, who wrote You Asked For Perfect, the story of a super smart, LGBT teenager who is trying to learn to navigate his life in a high pressure world. From the summary:

Senior Ariel Stone is the perfect college applicant: first chair violinist, dedicated volunteer, active synagogue congregant, and expected valedictorian. And he works hard―really hard―to make his success look effortless. A failed calculus quiz is not part of his plan. Not when he’s number one. Not when his peers can smell weakness like a freshman’s body spray.

Ariel throws himself into studying. His friends will understand if he skips a few plans, and he can sleep when he graduates. But as his grade continues to slide, Ariel realizes he needs help and reluctantly enlists a tutor, his classmate Amir. The two have never gotten along, but Ariel has no other options.

Ariel discovers he may not like calculus, but he does like Amir. Except adding a new relationship to his long list of commitments may just push him past his limit.

1) Do you think that experiencing mental illness is a requirement for any author who deals with this topic?
I don’t think it’s a requirement, but I do think if a writer is ever writing outside of their own personal experience, it should be done with a great amount of both research and empathy.
2) Your book obviously deals with a gay teenager, a group which faces enormous mental health pressures. Can you talk a little about writing a character with mental health challenges from that perspective?
Ariel is a bisexual teen, but his anxiety in the book is related to academic pressure not his sexuality. I wanted to write a book about the extreme academic pressure teens deal with today, as I believe it’s something so many teens experience but is rarely written about.
3) As I type this questions, your book is number one in “Teen & Young Adult Jewish Fiction.” What has your experience been like in terms of the interaction between religion and mental health?
I grew up in a very supportive Jewish community and wanted to reflect that in this novel. Ariel’s Jewish community is a place of comfort and warmth for him. Although services certainly take up more time in his busy schedule, adding additional stress, overall his Jewish community is an incredibly supportive aspect of his life. And his rabbi is actually one of the people who helps him the most throughout the book.
4) Your book addresses many of the societal pressures which teenagers face today. What do you think any of us can do to try to tamp down those pressures?
I think we need to send the message that grades do not define you. There’s so much pressure to excel in school and get into top universities, but while education is important, it should be about the learning experience not about top SAT scores and AP credits.
5) Many of the reviews of You Asked For Perfect note that you seem to perfectly capture what it’s like to be a teenager in a high pressure environment. How did you do that??
I went to one of those high schools! Although my experience wasn’t as intense as my protagonist Ariel, I experienced the exhaustion of taking multiple AP classes, taking extra electives, the pressure to excel, the fear of scoring a low grade. I also did a lot of research for the book. I talked to high achieving students about their experiences and watched documentaries and read books.
6) If you could do it again – anything you’d do differently?
With the book? I wouldn’t change a thing!

Report: Netflix’s 13 Reasons Why tied to rise in suicides

13 Reasons Why started as a book and then made it’s way to a Netflix series. From the summary:

Clay Jensen returns home from school to find a strange package with his name on it lying on his porch. Inside he discovers several cassette tapes recorded by Hannah Baker—his classmate and crush—who committed suicide two weeks earlier. Hannah’s voice tells him that there are thirteen reasons why she decided to end her life. Clay is one of them. If he listens, he’ll find out why.

Clay spends the night crisscrossing his town with Hannah as his guide. He becomes a firsthand witness to Hannah’s pain, and as he follows Hannah’s recorded words throughout his town, what he discovers changes his life forever.

The series on Netflix generated no shortage of controversy when it graphically depicted the suicide of Hannah. At the time, there was concern that the depiction of suicide may encourage other vulnerable young adults to do the same.

A new report suggests those fears were well founded.

The brutal findings, courtesy of a study conducted by the Journal of the American Academy of Child and Adolescent Psychiatry:

The Netflix show “13 Reasons Why” was associated with a 28.9% increase in suicide rates among U.S. youth ages 10-17 in the month (April 2017) following the shows release, after accounting for ongoing trends in suicide rates, according to a study published today in Journal of the American Academy of Child and Adolescent Psychiatry…The number of deaths by suicide recorded in April 2017 was greater than the number seen in any single month during the five-year period examined by the researchers.

The study notes that suicide rates spiked during the promotion for 13 Reasons Why and in the aftermath of its immediate release, and spiked particularly among young males. Homicide rates – which are influenced by similar cultural and sociological factors – did not show a spike during the same time.

As this Vox article notes, this increase is likely tied to the concept of suicide contagion – the idea that one suicide will encourage more. At least one suicide expert advised Netflix not to release the show:

His fears sprang from the problem of suicide contagion, which is what it’s called when media attention focused on one prominent suicide leads other people who are struggling with suicidal ideation to try to kill themselves. It’s a danger that young people are especially vulnerable to.

To be fair, there are certain concerns with the conclusion of this study. This includes the it’s design (which makes it impossible to rule out other sources) and the fact that boys drove the rise in suicide (girls would have been more expected, given the fact that the lead character is a girl).

This tragic result reiterates an important point: The media and entertainment industries have a moral obligation to be careful with how they discuss and depict suicide. gives some helpful advice. These include:

  • Avoid glamorizing the death, sensational headlines and showing pictures of grieving and weeping families.
  • Describing the suicide as sudden or “without warning.”
  • Treating suicide as any other crime.
  • Showing or describing the method of death in graphic detail.
  • Using appropriate language, including “died by suicide,” “completed” or “killed himself” INSTEAD of “successful/unsuccessful.”

I never watched 13 Reasons Why, but from what I have read, the show’s depiction of Hannah’s suicide violates all of these rules.

Between the research already done and the study which came out last week, it’s clear that 13 Reasons Why is contributing to an ongoing massive spike in suicide rates – and one that is particularly acute among young adults.

The show should be pulled off the air.

The positives of depression

Yeah, I get that the title of this entry makes no sense at first blush. But I mean what I’m about to say: There’s a lot of positives about having depression. The trick, of course, is finding it.

I started thinking about this concept after my wife sent me an op-ed by Kevin Dean, a nonprofit officer in Memphis, who discussed his own experience with depression. One of the things he mentioned is the concept of “depressive realism,” which is the idea that those with depression are better at viewing others and make decisions and observations which are more realistic than those without it.

The evidence for depressive realism is conflicting. But what isn’t up for debate is the concept that depression can make a positive difference on someone’s life.

How? Well, a few thoughts, garnered from my own experience and that of others who have shared there’s.

First – a concept I’ve spoken about regularly – is the idea that depression can make you more resilient. Resilience, at least as I am describing it here, is the idea that having depression makes you realize that you can survive anything. I mean, obviously, having depression sucks. It sucks away joy, interferes with your social relationships and your perception of the entire world. At the same time, people who live and thrive with depression – and there are many of us – have come to the inescapable conclusion that you CAN live and thrive with this disease. If you can survive your own mind working against you, you can survive anything. That, in and of itself, can teach resilience.

Second – depression can teach empathy stronger than many other experiences. If you have depression, you know how painful that experience can be. That, in turn, makes you more sympathetic to the rest of those who suffer. From a HealthTalk article on the subject:

Sophie said in the past it was hard to know what to do when friends were having problems, but depression has made her “more empathic towards people who are going through it as well.” Jeremy says he has learned to put himself “in other people’s shoes.” Several people described becoming less likely to “judge those who have mental illness” because they realize that “no one is exempt” from depression and everyone is deserving of compassion.

Along the same lines, it also makes you more compassionate. You know what you look for if you are depressed: People who are kind. Good listeners. Understanding. As a end result, you know that these are the qualities you need to possess and demonstrate, because you want to show others the same positive attributes which have been showed to you.

I’d also make the argument that depression has forced me to have a more productive life. It was in high school and college that I realized I could stave depression off, to an extent, but sublimating it. My depression has been kept at bay with a rigid schedule that keeps me busy. Productivity forces the mind to stay active and not ruminate. I’ve become a gym nut and have gone there 4-6 times a week for the past six years, because keeping up my physical health keeps me in better mental and emotional condition.

This schedule has enabled me to do things I would never have been able to do otherwise: Hold public office, write books, etc. Are there downsides to this? Yes. I feel like I am constantly being chased. But depression and mental illness has made me be a more successful person. It’s driven me. I can’t deny this positive effect.

Are there more? Heck yeah, and if you’ve got more to share, I’d love to hear from you below.

The chief reason I’m writing this entry is this: There’s positives and joy to everything, even depression. If you can find it, and recognize the good, you can let go of a lot of the bitterness and sadness that comes with depression. Find the positive. Find the good. You’ll be happier.

Six Questions: Interview with Amelinda Berube, author of The Dark Beneath the Ice

As you likely know from reading this blog, I’m an author and wrote Redemption, a sci-fi, young adult, mental health book. I remain fascinated by the connection between literature and mental health, with a special emphasis on books which appeal to young adults.

To that end, I’ve got a slew of Six Question interviews coming. I’m going to start with a haunting, atmospheric book: The Dark Beneath The Ice, by Amelinda Berube. If you want an e-book, it’s only $2.99 until the end of April!

From the summary:

Black Swan meets Paranormal Activity in this compelling ghost story about a former dancer whose grip on reality slips when she begins to think a dark entity is stalking her.

Something is wrong with Marianne.

It’s not just that her parents have finally split up. Or that life hasn’t been the same since she quit dancing. Or even that her mother has checked herself into the hospital.

She’s losing time. Doing things she would never do. And objects around her seem to break whenever she comes close. Something is after her. And the only one who seems to believe her is the daughter of a local psychic.

But their first attempt at an exorcism calls down the full force of the thing’s rage. It demands Marianne give back what she stole. Whatever is haunting her, it wants everything she has—everything it’s convinced she stole. Marianne must uncover the truth that lies beneath it all before the nightmare can take what it thinks it’s owed, leaving Marianne trapped in the darkness of the other side.

And here are six questions for Amelinda!

1) Do you think personal experience with mental illness – either yourself or someone close to you – is required to write an authentic book on the subject, even fiction?

I’d say personal experience isn’t necessarily required, but your job is a lot harder and riskier without it, and you have to approach it with the appropriate care, simply because you don’t know what you don’t know.

I drew on a lot of my own anxieties in writing The Dark Beneath the Ice, especially after going on medication, which made some of the spirals I’d been stuck in really obvious in retrospect. But when it came to hallucinations or being unable to distinguish between nightmare and reality – or the treatment of those symptoms, for that matter – I was in deeper water than I’d ever navigated myself, and I worried that I might unwittingly fall into inaccurate and damaging clichés. Input from mental health professionals and a sensitivity reader was really crucial.

2) Your book obviously mixes the supernatural with mental illness. Was it a challenge to blend the two?

On one hand, the two of them do seem like a natural fit. Mental illness was historically mistaken for supernatural influence, after all, especially when it comes to possession, which was central to The Dark Beneath the Ice. And faced with supernatural events, I think a lot of us in modern North America would probably reach for a psychological explanation – especially if you’re already prone to doubting yourself.

But there are also potential pitfalls in mixing the two together, as summed up neatly in an excellent article I was lucky enough to come across. Basically, the danger is in taking one side or the other: either it’s the mental illness that’s real, so the supernatural is all in your character’s head, or it’s the supernatural that’s real, so your character was never really mentally ill. It ends up being dismissive of mental illness either way.

So my objective, in putting mental illness and the supernatural together, was to walk the line between them without toppling over on either side. Done properly, fantasy and real-world elements can reinforce each other (think Pan’s Labyrinth, where the fantasy lends the war story an urgent, terrifyingly emotional edge and the war story grounds the fantasy in reality). That’s the effect I was hoping to achieve here.

3) Many of the reviews of your book referred to the haunting atmosphere. When you’re writing, can you talk a little about how atmosphere effects the overall story when it comes to mental illness?

Atmosphere is a huge part of what makes a spooky book, as far as I’m concerned, because it’s all about how the book makes you feel. As a reader, you ought to be feeling a creeping dread of what’s to come well before anything scary actually happens. Atmosphere is what accomplishes that.

In this story, I think that creepy feeling – the weight of fear and doubt and dread – was also really appropriate to the headspace our heroine was in, and her headspace is ultimately what the book is all about. If I got the atmosphere right, if I got the feeling of my character’s thoughts right, maybe it might give a reader some insight into, empathy for, or company in the experience of mental illness, whether that’s exhausting hamster-wheel thought spirals or frightening dissociative experiences.

4) One of the things I’ve noticed is that there aren’t a ton of books which combine mental illness and supernatural elements – why do you think that is?

That’s an interesting observation, especially because the combination seems alive and well on screen (Netflix’s Haunting of Hill House, for example). Maybe there’s more awareness of mental illness and therefore more hesitation to mix it with the supernatural, for fear of trivializing it? Or maybe the obvious outcomes of the combination (it’s “really” mental illness or it’s “really” supernatural) feel too clichéd or “done” by this point?

5) When writing this books mental illness elements, were you thinking of how the book would be perceived by those with mental illness? Did that specific factor play a role in your writing?

Yes, absolutely; that’s something I worried a lot about. The importance of representation and the effect of bad representation is, fortunately, a huge discussion in young adult fiction right now. It was also obvious, looking back on my own peer group as a teenager, that a lot of my audience would be dealing with mental health crises of their own. So I was very conscious of the need to approach the topic with care and respect, to examine the messages I was sending, and to seek lots of feedback.

I’ve come across a few reviews from readers who said that the book’s depiction of mental illness really spoke to them, and that means the world to me. I worked so hard to make sure the book wouldn’t hurt people that it never really occurred to me to consider it might actually connect with some of them. Letting yourself be seen in a piece of writing is pretty terrifying, but as it turns out, it’s incredibly rewarding too.

6) If you could do it again, anything you’d do differently in this story?

This book went through so many revisions that by the time I was going through the final galleys, I had a surprising, deep-down certainty that I’d turned the idea into the very best book I could. So, weirdly enough, I think I’m satisfied with it? I’m always willing to consider criticism, but I feel like the book did what I wanted to, and I learned a lot from writing it – both in general and about myself. I can’t ask for much more than that!

Feeling sad? Maybe get a puppy or a kitten

Alright, alright, I know that my entry earlier in the week was a bit of a bummer. Well, let me qualify that: It could be a bummer on the surface, since it was about my recently deceased dog. But if you look beyond just the words I wrote, you’ll see that the overarching theme of the entry was more than just sadness. I’m obviously heartbroken that Molly is gone, but the point of my entry wasn’t just how sad it was: It was how much joy the dog gave us for ten wonderful years.

Obviously, I’m not the only one who felt that way about their pet, and there’s real science there.

The Anxiety & Depression Association of America calls it “The Pet Effect”:

 It’s also no surprise that 98% of pet owners consider their pet to be a member of the family. Not only are people happier in the presence of animals, they’re also healthier. In a survey of pet owners, 74% of pet owners reported mental health improvements from pet ownership, and 75% of pet owners reported a friend’s or family member’s mental health has improved from pet ownership.

And let’s be clear here – the benefits of pet ownership go beyond one survey and beyond the notion of just feeling good. According to a meta-analysis of 17 studies, pet ownership was associated with major mental health improvements. According to the meta-analysis itself, 15 of the 17 studies reported positive mental health benefits of pet ownership (though 9 actually also reported negative benefits as well).

The study then broke the benefits of pet ownership into broader themes. These included:

  • Providing comfort, emotional support and companionship, as well as mitigating worry and stress. This was particularly true for veterans suffering from PTSD. Pets also provide a role as companions and comforters and were perceived by humans to be replacement family members, and friends capable of listening without judgement.
  • Encouraging physical activity and distracting someone from their negative symptoms. One study went as far as finding that people with pets were more likely to get out of their house for mental health care than those who didn’t have pets. Furthermore, the distraction of a pet was found to help alleviate ruminative symptoms by encouraging humans to stay more in the present.
  • Encouragement of social interaction. Pets encouraged humans to interact more with others and better integrate their humans to the community.
  • Pets provide their humans with a sense of self worth and identity. For many, a pet is another reason to live – its something that you love and care for, and becomes a positive part of who you are.

Pets can create negative symptoms too, of course. They are financial costs (potentially significant ones – also, again, GET PET INSURANCE) and may create a burden in terms of housing.

So, if you’re down, should you get a pet? Well, yeah, maybe. It’s not a cure all. Nothing is a cure all. But if you are ready for the responsibility (and it is a major responsibility, trust me), having a two or four legged companion may ease your suffering and give you joy and love.

Six ways that humanity once treated mental illness (which would probably kill you today) – Part 2

Hello! On Monday, I published Part 1 of a historical look at the ways in which mental illness was once treated. Here’s Part 2. It’s not any better.

4. Fever therapy

Some general basics here: You don’t just get a fever because your body hates you. Fevers occur when your body has an infection, and your temperature raises to fight off the foreign germ invaders.

Keep this in mind, and allow me to introduce you to Hilda, a patient who was suffering from what the early 20th century referred to as “general paresis of the insane,” (or GPI) caused by advanced syphilis. Hilda was confined to a psychiatric clinic in Austria when she came down with a pretty serious fever. She recovered from the fever…and her psychosis.

How they thought it worked

Hilda’s doctor, Dr. Julius Wagner-Jauregg, attributed Hilda’s sudden recovery to the fever. Using other GPI patients, Wagner-Jauregg began to experiment by injecting patients with a slew of other illnesses, including streptococcal bacteria (strep throat), tuberculin (tuberculosis) and malaria (freakin malaria).

However, for many, the therapy actually worked:

“Patients who previously behaved bizarrely and talked incoherently now were composed and conversed normally with Dr. Wagner-Jauregg. Some patients even appeared cured of their syphilis entirely. Here in the twenty-first century it may not seem like a favorable bargain to trade one awful disease for another, but at least malaria was treatable with quinine, a cheap and abundant extract of tree bark.”

Fever therapy (also known as Pyrotherapy) was used as late as the 1930s, when special machines were constructed to induce a fever.

But, actually….

The therapy did work…for GPI. And GPI only. And it did have the nasty side effect of giving someone whatever deadly illness they were injected with, complete with a 15% chance of…death.

The problem, of course, is that this wasn’t understood. Pyrotherapy (side note: this is the greatest name ever, because it sounds like you are being healed with fire) worked by killing the microorganisms which caused GPI, but there was no such equivalent for other forms of mental illness.

Meanwhile, pyrotherapy was used to treat a variety of different psychiatric disorders, including depression and schizophrenia. New, exciting ways were brought in to treat fevers to, expanding to everything from typhoid to electric blankets. Observations at the time showed that the therapy could work in very limited circumstances, but most of the time, there was no improvement.

As for Wagner-Jueregg? He, too, won a Noble prize. Apparently, they are not as hard to get as one would previously expect!

5. Hydrotherapy

Nothing’s calmer than a nice, relaxing bath to destress you after a long, tough day, right? Well, what about being soaked in icy cold towels and made to stay in a bath overnight?

Wait, what?

How they thought it worked

According to this 2015 Psychology Today article, in older times, mental illness was thought about in “spiritual terms” – and water was seen as an antidote. As a result, water became to be viewed as a common cure to a variety of mental illnesses. This became particularly prominent in the 18th century, when two types of hydrotherapies became prominent:

• The douche (shower), in which a “constant torrent of water could either cool the heat of madness or rouse the melancholic.”
• The balenum (bath), which was just meant to calm someone down.

With the rise of psychiatric hospitals, the practice became more prominent and a variety of different pieces of equipment were developed for the practice, including bath boxes, dunking devices (I don’t think they mean those carnival games) and more.

While this all sounds relatively harmless, in it’s more extreme forms, the therapy could be downright cruel and dangerous. According to one review, in some cases, “A patient could expect a continuous bath treatment to last from several hours to several days, or sometimes even over night.”

But, actually….

The therapy faded from prominence in the early 20th century as other bad ideas replaced this one (insulin shock, electroshock and more).

Here’s the thing though: While forcing someone to do anything against their will is almost always a bad thing, taking a bath can be good for your mental health, so this therapy wasn’t entirely off base! According to this Guardian article, taking a bath can increase your core temperature. This, in turn, is associated with a “moderate but persistent” mood increase.

So, hop on into the tub! Just…don’t strap yourself in. Bad call there.

6. Trephination

Trephination is the fun-filled process by which a hole was cut in someone’s skull. It is one of the oldest forms of therapy, with evidence for the practice dating all the way back to 6500 BCE. Its use wasn’t just confined to mental illness; no no, that would at least limit those who suffered from this God-awful practice. Instead, trepanning was used for a variety of illnesses, including seizures, migraines and head wounds, as well as pain.

Is was used as recently as the Renaissance, around which time one can assume that it began to occur to practitioners that cutting a big ole hole in someone’s skull was not necessarily the greatest practice.

How they thought it worked

Similar to hydrotherapy above, trephination was used because of a different understanding of mental illness. The hole cut in one’s skull would allow for bad spirits to get out, or good spirits to get in. This, in turn, would relieve mental illness.

At the same time, trephination had other uses. Skull discs would be collected and used as good luck charms or amulets, and in ancient Egypt, the scrapings of a skull were used to make potions (hey, why let a good thing go to waste!)

What is even more remarkable is that these operations did not kill everyone on the spot. There is ample evidence that many survived the procedure, as evidenced by skull regrowth among those who had the operation.

But, actually….

Do I really need a “but, actually” section here? Drilling holes in the skulls of people is, generally speaking, a bad practice, m’kay?

Now, that being said, there are exceptions to every rule, and skull-holes has those exceptions as well. In limited instances, such as in the case of brain injury, and specifically epidural and subdural hematomas.
Of course, skull removal is never used for mental illness at this point. Thank God.

Six ways that humanity once treated mental illness (which would probably kill you today) – Part 1

In the course of doing research on mental illness and treatments, I have come across some absolutely wild methods of treating mental illness from older times. Some had roots in science of the moment – others were just really, really bad guesses. Most were very cruel, but in all fairness, it’s easy to say that now.

Anyway, here’s a look at six ways which humanity once treated mental illness. Today is Part 1, and Part 2 will publish Thursday.

1. Electroshock therapy

You may know shock therapy from plays like One Flew Over the Cookoo’s Nest or that episode of Quantum Leap which gave me nightmares for years:

How they thought it worked:

With shock therapy, the premise was simple: They hooked you up to a machine and sent as many as volts as possible into your screaming, aching body. The electrocution would induce a seizure; this, in turn, was thought to improve mental illness like depression and schizophrenia.

The therapy wasn’t usually quite as ugly as portrayed in popular media, but according to Jonathan Sadowsky, who wrote a book on electroshock therapy, it wasn’t too far off: Electroshock therapy was often used in mental hospitals to “control difficult patients and to maintain order on wards.”

Oh, and not for nothing, but electroshock therapy was also used as a way to “cure” homosexuality. Yeah.

But, actually…

The idea behind the practice was sound; it’s the execution of shock therapy that caused the damage. Even in the 1960s, there was ample evidence that electroshock therapy could be successful. However, patients who underwent the practice at the time were often did not give informed consent (agree to the treatment with a full understanding of its potential risks and benefits) and reported the process to be terrifying and painful. Severe memory loss and brain dysfunction often occurred as a result of the treatment.

Thankfully, this practice has been reformed significantly. It’s still used for severely and treatment resistant depression, as well as a few other select disorders. According to the Mayo Clinic, patients are placed under general anesthesia (as opposed to being very awake and very much in pain) and a small electrical current is sent straight to their brain, resulting in a small seizure. And, unlike prior versions, ECT has shown real promise in fighting depression, with success rates as high as 83%.

2. Insulin Shock therapy

Getting electrocuted not enough fun for you? My friend, allow me to introduce you to insulin shock therapy, the process by which patients were intentionally overdosed with insulin and sent into a coma. Yes, that’s right, it’s diabetes…on purpose.

How they thought it worked:

The therapy was first discovered by accident in 1927 by Dr. Manfred Sakel, who injected a morphine-addicted woman with insulin and noticed a remarkable recovery. Said Dr. Sakel:

“My supposition was that some noxious agent weakened the resilience and the metabolism of the nerve cells … a reduction in the energy spending of the cell, that is in invoking a minor or greater hibernation in it, by blocking the cell off with insulin will force it to conserve functional energy and store it to be available for the reinforcement of the cell.”

Over the course of a two month period, schizophrenics were injected with a massive dose of insulin until they slipped into a coma. Patients were selected based on those who had a good prognosis for recovery and were thought to have the physical strength to endure the therapy.

Studies in the 1930s and 40s showed that as many as 70% of people showed improvement with insulin shock.

But, actually…

A paper in 1953 by Dr. Harold Bourne debunked the therapy, noting that any recoveries likely occurred because the patients were already on their way to a recovery. Further studies with randomly selected patients showed that insulin therapy showed absolutely zero difference with medication…except, you know, the self-induced diabetes coma.

The therapy disappeared from the United States by the 1970s.

3. Lobotomies

Not sure what the word “lobotomy” means? Well, let’s look at its origins: “lobe” means part of the brain, and “tomy” is a medical suffix for cutting. So, that means…

…oh. Oh, dear.

Yes, a lobotomy is just that: Removing a piece of the brain in order to make the rest of it function better.

Clearly, the logic here is wanting. Broken arm? Cut it off. Twisted your ankle? Time to amputate!

How they thought it worked:

Back in the day (as recently as the 1950s), lobotomies were used for the treatment of a variety of mental illnesses, including schizophrenia and bipolar disorders (then called manic depression). It was invented in by Dr. Antonio Egas Moniz in 1935. Fun fact: Moniz was awarded to Nobel Prize for Medicine in 1949 for the lobotomy – a move so out of step with reality that there was an unsuccessful effort to revoke the Prize from Moniz.

In the first lobotomies, known as “ice-pick lobotomies” (yes, really):

“As those who watched the procedure described it, a patient would be rendered unconscious by electroshock. Freeman would then take a sharp ice pick-like instrument, insert it above the patient’s eyeball through the orbit of the eye, into the frontal lobes of the brain, moving the instrument back and forth. Then he would do the same thing on the other side of the face.”

In the end, an estimated 50,000 lobotomies were performed in the United States.

But, actually…

According to Dr. Barron Lerner, a medical historian and professor, “The main long-term side effect was mental dullness,” which included damage to a person’s “personality, inhabitations, empathy and ability to function on their own.” Another contemporary source found that a mere 1/3 of people benefitted, while 1/3 had no change, and 1/3 were made worse. So, a cure with a 1:1 chance of doing more harm than good. Neat.

Some patients did show an improvement in their mental illness. But many showed an overall loss in emotions. It got so bad that the Soviet Union – not exactly known as a vanguard of human or civil rights – banned the practice in 1950. Fortunately, as a result of increasing concerns over the operation and the advent of successful anti-psychosis drugs, lobotomies largely fell out of favor in the 1950s.

Religion and suicide

About two weeks ago, I was able to participate in a Jewish Federation event on mental health and stigma. The participants included myself, a psychologist, the head of our local NAMI Chapter and a Rabbi. Much of the information I heard during this presentation was things that I had heard before, but the newest perspective actually came from the Rabbi, who discussed what happens with Jews who do die by suicide.

Apparently, in Judaism (like many other religions), a strict interpretation of suicide views the action as a major sin, and those Jews should not be buried in a Jewish cemetery. Thankfully, this Rabbi believes (like many others) that those who do die by suicide are clearly ill at the time of their death; thus, they should not be “punished” for that action and should be allowed to be buried in a Jewish cemetery.

This entire conversation had me thinking about suicide and religion. Are there differences in suicide rates by religion? What about those with no religion – do they have higher or lower suicide rates? How can religion help or hurt someone’s mental health?

The relationship, as best I can tell, is complicated. According to a 2016 study on the subject:

We found that past suicide attempts were more common among depressed patients with a religious affiliation (OR 2.25, p=.007). Suicide ideation was greater among depressed patients who considered religion more important (Coeff. 1.18, p=.026), and those who attended services more frequently (Coeff. 1.99, p=.001). We conclude that the relationship between religion and suicide risk factors is complex, and can vary among different patient populations.

This study would obviously suggest that religion and suicide are positively correlated. But, as a 2017 article from the American Sociological Association notes, the real relationship is more complicated – and that largely depends on where in the world you are discussing:

A Michigan State University sociologist reports in The Journal of Health and Social Behavior that religious participation affects suicide rates differently around the world, and in Latin America particularly, high religious involvement is associated with low suicide rates.

In contrast, in East Asia, where residents are reportedly more secular, higher levels of religious involvement are connected to higher suicide rates. A one percent increase in religious participation is associated with a one percent increase in suicide rates in East Asia.

Statistics for the United States generally follow with the statistics for Latin America, although the link between religious participation and low suicide rates is not as pronounced in the United States.

An interesting 2017 article from the Huffington Post makes a similar argument but from a reverse perspective: That it is atheists, not religiously affiliated people, who have a “suicide problem.”

When I started this entry, I was curious to see what religions have higher or lower rates of suicide. I now see that it’s not that simple. Religion and suicide are related, and that makes sense, of course. On one hand, religion can give people additional joy, purpose and value. Fear of divine punishment can also serve as a powerful motivator to keep people from killing themselves. However, religion can also alter perspectives and force negative value judgments.

My conclusion: The relationship between religion and suicide is complicated and depends on a variety of factors.

As always, let us know what you have to say in the comments below!