Right Now – Welcoming the Unwelcome ~ Pema Chodron
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Tag Archives: mental health
The Overdose Crisis: Let’s Keep Talking
With National Addictions Awareness Week coming up, my mind has been on the overdose crisis again. Actually, the crisis is something I think about all the time since I work in this field as a mental health and substance use counsellor in our local community.
As a team, we’ve lost many people to overdose. I watch the amazing team I work with struggle with the pain of lost lives. We know the hearts and souls of these folks who have become statistics in the media; these are folks who have shared their stories, hopes, dreams, and some of their darkest and most traumatic moments with us.
The clients I work with come from families just like ours. I know none of them want to live this way, to be a slave to a substance that, at any moment, could end their life. I see posts from Moms Stop The Harm about young Canadian men and women who we’ve lost to overdose. Families who have lost their sons, daughters, brothers, sisters, grandchildren…. Moms and dads who fought to bring their child back from the brink of addiction; families who had no idea their loved one was experimenting with substances until it was too late.
It’s also hits to home for me because I am a parent and I can’t help but worry about the five amazing children we (my partner and I) have. They are always on my mind. I can’t help but think “what if”… are they safe? And what about their friends? These kids have grown up in our home too… some of them have been a part of our lives since they were toddlers. These thoughts hang over me like a dark cloud some days.
And what pains me the most is how people are portrayed in the media: often it’s an “us and them” position that fuels a detached indifference. I see it reflected in the political will put into increasing awareness, and in developing and funding programs whether it be for treatment or prevention efforts.
I was disappointed – but not surprised – to see the indifference in the United States media. The number of overdose deaths that have occurred in the United States gets the odd headline and only when the CDC puts out their reports. The numbers are staggering: over 72,000 people have died of overdose deaths in 2017 and most of those are from opioids. That is almost double the rate of deaths caused by motor vehicle accidents in the U.S., which, by the way, receives a lot more “oh my goodness, we must do something about these staggering numbers” type media coverage. When I was googling to find information on the opioid crisis in the states, only a couple articles came up (and not overly informative). I found scads of articles on the “worrisome picture” of MVAs.
In Canada, we seem to be doing marginally better. With 10% of the population of the United States, we lost just under 4000 people to overdose deaths (according to a Canadian Govt website) in 2017. We’ve been hit harder here in British Columbia, probably because of our proximity to China where the synthetic illicit opioids (fentanyl, carfentanyl) are mostly likely coming from. We’ve also had more meaningful media coverage. Our governments and health authorities are working towards solutions to mitigate the crisis and keep people alive, but it’s frustrating when the barriers to treatment programs persist. People trying to access services are expected to prove that they are “treatment ready” or be “group appropriate” (these statements infuriate me).
We always seem to be one step behind, fighting fear, judgement and stigma. It’s a complex issue and there’s simply not a silver bullet or a magic wand, but I know we can do better.
References
CNBC. Traffic deaths edge lower, but 2017 stats paint worrisome picture. 15 Feb 2018. https://www.cnbc.com/2018/02/14/traffic-deaths-edge-lower-but-2017-stats-paint-worrisome-
National report: Apparent opioid-related deaths in Canada. (released September 2018). https://www.canada.ca/en/public-health/services/publications/healthy-living/national-report-apparent-opioid-related-deaths-released-september-2018.html
NIDA. Overdose Death Rates. August 2018. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
The Guardian. US drug overdose deaths rose to record 72,000 last year, data reveals. 16 Aug 2018. https://www.theguardian.com/us-news/2018/aug/16/us-drug-overdose-deaths-opioids-fentanyl-cdc
Head Injury: The Silent Killer — The Tragedy of “Makin’ it to the Show”
The reality of achieving your dream in hockey sometimes ends with consequences that are just not worth price of admission. Sasha Lakovic is coming out to the public in hopes that his story can help others and raise awareness of living with the long term consequences of concussions.
Sasha, your courage to tell your story with such honesty and vulnerability is so inspiring. I listened to you speak from your heart and in turn you touched mine. I cried.
Evolution: A Return to the Past to Adapt for the Future
My reflections in this article are inspired by an academic discussion forum where we only scratched the surface of a number of issues related to disordered eating. I wrote about the disordered eating in men having some uneven characteristics in contrast to women’s disordered eating. I also wrote about intuitive eating as being a complementary technique to other therapeutic strategies and treatments. And, I briefly wrote about Shan Guisinger’s (2003) evolutionary “adapted to flee famine” hypothesis.
I find the lack of attention on male eating disorders somewhat disturbing since the participants of Ancel Keyes’ famous 1944 Minnesota Experiment were mentally and physically fit young men (Kalm & Semba, 2005), and the results of the project revealed some very unexpected and telling behaviors which reflect the consequence, not the trigger of disordered eating along with other physical and mental health repercussions. The initial object of Keyes’ research was to answer the question of what the effects of starvation would be on citizens who were starved during World War II and why these victims of starvation would continue to restrict and refuse to eat even when food was offered. Keyes and his team needed a control from which they could compare issues of starvation: they observed the physical and psychological effects of starvation and refeeding under normal conditions using 36 physically and mentally healthy soldiers (“conscientious objectors” of the war) who volunteered to participate in a semi-starvation/refeeding project. The men were restricted to 1800 calories a day and were expected to walk (on a treadmill) for 22 miles (or 35.4 km) each week for a total of six months, followed by a refeeding process. The project generated unanticipated complications and some astonishing results. Keyes and his colleagues observed the following effects: food preoccupation, obsessiveness, depression, apathy, irritability, intolerance to cold, diminished endurance and strength (Kalm & Semba, 2005). During the refeeding, a number of participants were preoccupied and concerned with weight gain and appearance. They also experienced depression, anxiety, obsessive-compulsive behaviors during the refeeding, psychopathology that was not present at the start of the project. This study demonstrated that symptoms of disordered eating are a consequence of a prolonged semi-starved environment.
Another issue in disordered eating to which disserves attention is societal pressures for both men and women. Physical appearance, specifically attractiveness, has always been the nucleus for women’s issues. Physical appearance for both men and women has changed over the past 100 years or so. Truly, the images women must achieve—to be thinner and thinner—permeates our western culture, and we can observe the impact on our present-day traditional cultures as well. Moreover, appearance and attractiveness, broadly speaking, has also been an issue for men, but our understanding of what is attractive moves from physical beauty to brute strength and status in their community. There seems to be higher rates of disordered eating among gay men, probably due to the body image norms being more closely aligned to contemporary norms for women (Kaplan & Sadock, 2007). Our definition for what is attractive continues to be influenced by an ever-changing culture; yet anorexic behavior appears to go beyond these simplistic influences of contemporary western culture. Guisinger (2003) notes the self-starvation behavior, which purports to reflect a person’s desire to be thin in today’s culture was referenced as “holy anorexia,” a pious sacrifice for women in the medieval period (p. 757). Hence, appearance and attractiveness only tell part of the story.
One particular theoretical paradigm I continue to return to is the evolutionary perspective, especially in relation to the diatheses and etiology of eating disorders. This particular hypothesis transcends diachronic and synchronic cultural influences, and is consistent with starvation mechanisms observed in other animals. As Guisinger points out, what might be an evolutionary advantage in one environment can very much be pathological in another. According to the American Psychiatric Association (see the Harris Center, 2009 October, 19) the lifetime prevalence of anorexia nervosa among women ranged from 0.3% to 3.7% anorexia nervosa and the high heritability of the disorder—over 50% with a genetic link—surpassed major depression (38%) and obsessive-compulsive behavior (36%). Further, a comprehensive twin study conduct by Bulik and her team (2006) concluded, “Anorexia nervosa is familial, with significantly elevated relative risks for AN, bulimia nervosa, and eating disorders not otherwise specified in family members. The relative risk of AN in family members of males with AN is even higher (>20)” (p. 305). They also determined that the presence of neuroticism may be predictive for clinical eating disorders.
The difficulty with evolutionary theories will always be in testing the theory itself, and in terms of research application, it has received little attention. However, its focus on the biological response of the body in terms of survival mechanisms is gaining momentum in the field, not only for research, but also for treatment strategies. The Stockholm Solution, developed over a decade ago at the Karolinska Institute in Stockholm, Sweden is one such treatment (Journeyman Pictures, 2005). According to this obscure Australian documentary, this particular treatment program was developed over decade ago, on the premise that starvation and lack of caloric intake over an extended period of time are at the root of the development of anorexia. The physicians who established the clinic claim a 75% success rate within the first year of treatment and 90% of their patients maintaining a healthy lifestyle for at least 5 years after they complete treatment (Journeyman Pictures, 2005).
Becker (2004), in her analysis of the effects of American television on the body image of Fijian adolescent girls, concludes that media imparts a host of risk factors on vulnerable traditional cultures not yet exposed to the particular messages of our contemporary culture. Becker focuses on body image and the subsequent disordered eating behavior, but her concerns extend to overall vulnerability of adolescents in traditional cultures such as Fiji. Moreover, other factors arise from her research such as a fantasy life glorified by North American culture (i.e. television, media, and Hollywood). However, according to Becker, the images in the media are only partly responsible for these changing attitudes. She writes,
The increased prevalence of disordered eating in ethnic Fijian schoolgirls is not the only story—or even the most important one—that can be pieced together from the respondents’ narratives on television and its impact. Nor are images and values transmitted through televised media singular forces in the chain of events that has led to an apparent increase in disordered eating attitudes and behaviors. The impact of media coupled with other sweeping economic and social change is likely to affect Fijian youth and adults in many ways. (p. 554)
Disordered eating behavior is extremely complicated with its biological vulnerabilities coupled with psychological and social considerations, all of which we must be conscious. Only a small percentage of the population develop disordered eating even though the social pressures and messages to be thin have a broader stroke on society. I believe the vulnerabilities (diatheses) associated with the risk for developing anorexia can be explained, at least in part, by Guisinger’s “adapted to flee famine” hypothesis. What concerns me, as always, is the misinterpretation or misuse of the work of researchers, a tendency for professionals not trained in the field as well as for the general public (ironically, perpetuated by the role of the media). The issues related to the shift in Fijian culture are much more complicated and it can be alluring to fall into faulty post hoc reasoning as we to look for a simplistic root cause of a particular issue. Becker is certainly not doing so, and we, as mental healthcare professionals, need to be mindful of the limitations of any research and be conscious of our own biases where we might favor one paradigm or treatment strategy over another.
I often wonder if, as professionals and as a society, we are too attached to the notion of eating disorders as psychological. We are hardwired for survival, after all. Shouldn’t we consider eating disorders as a medical condition where the body is responding to its environment (an environment of scarcity) (Guisinger, 2003; Journeyman Pictures, 2005)? I think there is a discrepancy between what we observe and implement in the field (practice) and what is being explored in research (academia). It often takes some time for these two intellectual spheres to come together effectively. Research will often garner more credibility and weight in the media unfortunately, which can perpetuate certain “mythologies” about mental illness, which we have seen with eating disorders. Like Guisinger, I question how we come to these conclusions. As researchers, we need to ask the right questions. Guisinger asks, “are we on the right path?” As practitioners, we need to scrutinize the research as well as our own practice, and treat the whole person.
**To learn more about this devastating disorder, you can link to a couple websites listed below…
References
Becker, A. (2004). Television, disordered eating, and young women in Fiji: Negotiating body image and identity during rapid social change. Culture, Medicine and Psychiatry, 28, 533–559.
Bulik, C. M., Sullivan, P.F., Tozzi, F., Furberg, H., Lichtenstein, P., & Pedersen, N. L. (2006). Prevalence, heritability, and prospective risk factors for anorexia nervosa. Archives of General Psychiatry, 63, 305-312.
Davison, G., Blankstein, K., Flett, G., & Neale, J. (2010). Abnormal Psychology, (4th ed.). Mississauga, Ont: John Wiley & Sons Canada.
Guisinger, S. (2003). Adapted to flee famine: Adding an evolutionary perspective on anorexia nervosa. Psychological Review, 110, 745-761.
Harris Center. (2009, October 16). Retrieved from http://www2.massgeneral.org/harriscenter/about_an.asp
Journeyman Pictures [Producers]. (2005). The Stockholm Solution: New Therapies for Eating Disorders. Retrieved from http://www.youtube.com/watch?v=xEKpFRPjKcQ
Kalm, L. M. & Semba, R. D. (2005). They starved so hat other be better fed: Remembering Ancel Keys and the Minnesota experiment. American Society of Nutritional Sciences, 135, 1347-1352.
Kaplan, B. J., & Sadock, V. A. (2007) Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
A Canadian Perspective: A National Tragedy
I have been reflecting on the state of Canada’s mental health in the wake of the death of Amanda Todd, which has sparked a flurry of reactions nationwide. There has been an outcry of support for her family, criticism for the attention she is receiving, and deliberation about bullying and the necessity for harsher penalties. Amanda was a troubled teenager, and we need to keep in mind how a person’s experiences in those formative years affect later mental health. Screening for a proper diagnosis can be complicated with the comordity of anxiety, depression and bipolar disorder. There is an increased risk of suicide when depressed individuals have comorbid anxiety, which Amanda seemed to have. Other disorders, such as personality disorders, schizophrenia will attempt suicide when no depression is present. Socioeconomic and demographic variables make screening even more complex. Finally, bullying behavior is also a risk factor for mental health disorders, including depression, anxiety, and post-traumatic stress symptoms and personality disorder traits.
The Centre for Addiction and Mental Health (CAMH) recently shared a link on their Facebook page of article on Amanda Todd’s death and the absence of discussion regarding her mental health. Facebook and other social media networks are not always reliable material academically speaking, it does demonstrate the shifting atmosphere of our communities and the new fashionable method for our culture to share and connect. Ironically, it is also the latest “fashionable” bullying tactic; it is how Amanda was bullied and persecuted. I find it curious that CAMH would share this particular article; not only did it spark yet more controversy, it moved me to write about it. The article is an opinion piece by Diane Weber Bederman (2012), which draws attention to how, once again, mental health issues are eclipsed by issues of social justice. The one currently in the media that rings the loudest is the government’s cry for the need for more education around bullying and consequently overshadowing any associated mental health features. As Bederman writes:
Barbara Kay in the National Post wrote about the decision by the Supreme Court of Canada to force Internet providers to provide the names of online bullies. Andrea Woo in the Globe and Mail reported that the RCMP is now involved and that the B.C. government will increase spending on anti-bullying education. That’s great. But where are the cries for better mental health care? We are not discussing mental illness. I sometimes think we are avoiding the discussion by hiding behind bullying. (Bederman, 2012).
As disturbing as her commentary might be for some, Bederman’s assertions generated a conversation that most of us are unwilling or afraid to have. There is no doubt that bullying is a very serious issue and as I read Bederman’s argument, I began to question my own objectivity. I confess, even I was caught up in the horror of Amanda Todd’s death and the events that led up to her taking her own life. What comes to mind as I read the article is how easy it is for us to get distracted by hysteria of such a horrific event? For me, it is a reminder for us as professionals to maintain our objectivity whenever possible, and recognize just how quickly we can be drawn into an emotionally charged situation. We simply can’t do our jobs effectively when we are filled with self-righteousness.
Bederman is right to question where are focus lies. Do we need to increase bullying awareness? I believe we do, but so far, we have failed in teaching the proper skills to the victims of bullying, the bully, and the silent bystanders. Our current system is flawed. We create sophisticated and systematic diversions, which draw our attention away from any issues that might reflect mental health. In Amanda Todd’s case, there has been a spontaneous and mindless reaction to throw more money at anti-bullying programs. In the meantime, the more essential issues, such as risk factors for mental health (anxiety, depression, and so on) and associated socio-economical disadvantages will be neglected. Do we need to legislate and creating more stringent laws for bullies? I believe there needs to be consequence’s for that kind of behavior; however, I also believe we fall into tautological reasoning when our automatic reaction is to focus on the behavior as the final and absolute root cause of the behavior. We minimize, dismiss or ignore other important factors that may affect both the bully and the victim.
Was Amanda Todd’s suicide more about mental health than the bullying as Bederman suggests? This is a more complicated question. I will not, nor can I, speak for Amanda Todd specifically. The research indicates that there is a higher prevalence of suicidal ideation in teens who are bullied (Hinduja & Patchin, 2010). Unfortunately, as a society, we are too quick to protect the victim and punish the persecutor. Hinduja and Patchin (2010) also reviewed a number of studies in the literature that demonstrated suicidal ideation in both boys and girls who bully is actually higher than the victims of bullying. They stress the importance of acknowledging that any form of bullying alone is unlikely to lead to suicide: “cyberbullying… tends to exacerbate instability and hopelessness in the minds of adolescents already struggling with stressful life circumstances” (p. 217). Their recommendation is for future research to explore the vulnerabilities, stressors and diatheses that contribute to suicidal ideation and suicide, issues such as low self-esteem, hopelessness and depression.
Perhaps Amanda had personality dimensions that would make her more susceptible to the harmful effects of bullying. Aaron Beck proposed that certain personality styles—sociotropy (dependency and approval from others) and autonomy (a high-achieving self-critical personality construct)—are both associated with depression. While there are problems generalizing from this particular assertion, I would argue these personality dimensions, along with other diatheses, such as biological and genetic vulnerabilities, and feelings of hopelessness and helplessness that emerge in the research on bullying (Klomek, Sourander , & Gould, 2011; Hinduja & Patchin, 2010) are robust predictors of depression, suicidality, as well as other mental illness.
What is most concerning for me is the hostility towards the bully that always seems to persist. Even though there are some inconsistencies in the research regarding depression and suicidality in those who bully, there is enough research to demonstrate higher incidences of suicidal ideation in bullies than in individuals who are not involved in bullying behavior (Klomek, et al., 2011). Recently, Klomek and colleagues (2011) examined the effects of high school bullying on later depression and suicidality which indicates that bullying behavior (as victim or perpetrator) in conjunction with depression and suicidality indicates potential for future concurrent disorders in adulthood. They recommend including assessing for early bullying behavior for adults being assessed for suicidal ideation. Their research is in its infancy and more examination into the impact bullying behavior has on adult psychopathology is needed.
My concern is always for both the bully and the victim. Moreover, the issues of bullying and mental health need attention equally. Mental health is already so stigmatized, and looking to place blame with the bully in isolation undermines the need for compassion, acceptance and attention those who are struggling with mental illness. I also worry that it excuses the community of their responsibility in these tragedies. I certainly will not diminish the terror Amanda Todd encountered on a daily basis; this person was responsible for intimidating her and provoked a mob-like mentality within her community and everyone involved will need to be accountable for his/her actions. Nevertheless, each and every one of us played some small part in this tragedy. We need to be more proactive and vocal about bullying behavior. And it is no longer acceptable to simply stand by and pretend we don’t notice, or to say, “it’s none of my business” when a friend, family member or colleague is struggling with any aspect of life, whether it’s a mental health issue or the result of the actions of others. We all played a part in creating a culture of disconnection and it will take each and every one of us to repair our community. Amanda Todd was not the first and she won’t be the last, so let’s get to work and build a culture of compassion and connection.
References
Bederman, D. B. (2012, October, 17). Amanda Todd’s death was more about mental health than bullying. thestar.com. Retrieved from http://www.thestar.com/opinion/editorialopinion/article/1273041–amanda-todd-s-death-was-more-about-mental-health-than-bullying
Davison, G., Blankstein, K., Flett, G., & Neale, J. (2010). Abnormal Psychology, (4th ed.). Mississauga, ON: John Wiley & Sons Canada, LTD.
Hinduja, S., & Patchin, J. W. (2010). Bullying, cyberbullying, and suicide. Archives of Suicide Research, 14, 206-221. doi:10.1080/13811118.2010.494133
Klomek, A. B., Kleinman M., Altschuler, E., Marrocco, F., Amakawa L., & Gould, M. S. (2011). High school bullying as a risk for later depression and suicidality. Suicide and Life-Threatening Behavior, 41, 501-516. doi: 10.1111/j.1943-278X.2011.00046.x
Klomek, A. B., Sourander , A. & Gould, M. S. (2011, February 10). Bullying and suicide: Detection and intervention. Psychiatric Times, 28(2). Retrieved from http://www.psychiatrictimes.com/suicide/content/article/10168/1795797
The State of Canada’s Mental Health: How *Well* Are We?
As a part of an ongoing progressive assignment for my one of my graduate studies courses in psychopathology, I have been composing a “learning journal,” which is supposed to reflect upon some of the subject matter in the course, specifically the readings. The textbook required for the course was Abnormal Psychology (4th Ed.) by Davison, Blankstein, Flett, & Neale (2010). I was struck by the amount and quality of Canadian content and by the breadth of the “A Canadian Perspective” sections, so much so, that it compelled me write. Canada has a lot to add to the intellectual landscape and I am pleased to see a textbook that is willing to emphasize our strengths and even challenge our limitations, including some of our darker historical moments. Thoughtfully, I would like to share some of my humble reflections…
A Canadian Perspective on Mental Health
It is important to recognize the differences that Canada has from the United States culturally and politically. However subtle they might seem, these differences guide how we think and function ethically as individuals and as a nation, and have provided a template for the various social systems and services in which we all access, both as clients and as professionals. I first began reflecting on these differences as I read Hood and Johnson’s Assessment in counseling: A guide to the use of psychological assessment procedures (2007), which is culturally specific to the United States; these differences between our two nations becomes even more glaringly obvious as the authors point to the need for cultural sensitivity when performing aptitude and cognitive assessments on “African Americans,” “Latinos/Latinas,” “American Indians,” and “Asian Americans” (pp. 213-215). Canada’s ethnic diversity looks quite different from the United States, and how we, as a nation, identify with that diversity is distinct from our neighbours south of the border. What is most striking for me is how different our aboriginal populations are from those south of the border. Even more complex is the diversity of our own indigenous populations in terms of geographical and historical considerations. So many of our aboriginal populations suffer intergenerational trauma and working directly with these clients, I witnessed the devastating effects of this intergenerational violence, and the recovery is long and arduous.
We fancy our nation as a multicultural mosaic with one in six Canadians reported as having immigrated to Canada from other nations (Government of Canada, 2006, as seen in Davison, et al., 2010) and an ethos of Canadian culture focused on “acculturation… , tolerance, diversity, and equity” (p. 72). The landscape of our social system, including mental health, becomes even more complex and challenging for policy-makers and healthcare professionals to navigate as they attempt to accommodate our newly immigrated citizens along with the unique needs of our aboriginal populations in the shadow of the cultural genocide inflicted upon our First Nations people: the sixties scoop, Residential schools, the white paper policy (Kesler, Crey, & Hanson, 2009; The Aboriginal Justice Implementation Commission, 1999). Today, Canadian Aboriginal people represent a disproportionately high rate of mental health problems (Davison, et al., 2010). However, my experience with our aboriginal population has taught me that even though as an ethnic group they have history and culture as First Nations, Metis etc, as individuals each one of them has a unique story, which has shaped their worldview: They are a nation of storytellers and we need to be still and listen.
Another consideration that comes to mind regarding mental health in Canada is the changing shape of the deinstitutionalization of our mental health system. While we cheer the changes that take place, the majority of Canadians only see the surface. What they don’t see is the potential for casualties of the shifting paradigms. Many individuals caught within the system have terrible setbacks in their progress or worse, they slip out of the system completely with devastating consequences. I worked with vulnerable women in a supportive living environment, specifically women who struggled to recover from addictions as well as other comorbid disorders (anxiety, depression, PTSD, bipolar disorder, schizoaffective disorder, personality disorders, dissociative disorders), and due to financial constraints, the program was forced to close. One of the effects of this closure was the instability it caused and high risk these women had of having symptoms return or experiencing a full relapse of their particular mental health issue. As Davison et al. (2010) point out, mental health advocacy is a delicate balancing act: “an ongoing concern is the need to banc the rights of the mentally ill individuals with the rights of the community to be protected from them if they are a danger” (15). The safety of the community was never my priority. My job was to provide counselling, support and guidance to my clients. I wasn’t ignorant of how my clients would potentially effect society conceptually, but practically, my focus was the needs of my clients and how society impacted them, how the system impacted them.
I have gone from working directly with clients (either one-on-one or in a group setting) to working behind the scenes in community planning, specifically with the federal Homelessness Partnering strategy projects in my local community. It has given me a very different lens from which to view our community’s issues related to homelessness, mental health and addictions. In my humble opinion, these three issues, which are typically separated on a policy level, are very much integrated and interacting continuously for the individual who is suffering with these concerns. Even at a macro-level, the diathesis-stress paradigm (Ingram, & Luxton, 2005) can be a valuable tool for developing and implementing programs: there is no one specific piece that can always be counted upon to be the catalyst, and we have to be able to anticipate changes within the system to prepare for the fallout when programs are closed. Our intention should be to minimize any negative consequences and stressors on both the clients and the community.
Reading the Canadian perspectives section, “The mental hospital in Canada: The twentieth century and into the new millennium” (Davison, et al. , 2010) reminds me of some of the persistent issues we deal with at a policy level which often get overlooked at the clinical level. In my experience, this disparity can cause tension within the system, especially when funding is diminishing at an alarming rate. Sadly everyone suffers: the funders and policy makers are attacked for being heartless “bean counters”; the organizations become bloated with individuals needing services, which places incredible stress on the frontline workers (institutional and community care, health professionals); and the clients don’t always receive adequate services to improve their circumstances. One chronic community issue that we deal with in Kelowna is how to manage our mentally ill and addicted homeless population as a community (meaning can we meet the safety needs of the general public) while still trying to support the client’s right for autonomy, choice, safety and dignity. According to Davison, et al. (2010), community treatment orders (CTOs) are a tool that can be used to ensure treatment compliance for the individual, but the actual implementation of these orders is controversial and most professionals would not necessarily be willing to enforce them for a variety of ethical and moral reasons, and rightly so.
No system is perfect, and Davison, et al. (2010) cite Sussman’s observations of the appalling conditions that existed in mental health institutions and community care facilities over the past century. Accordingly, it seems appropriate that we should champion the closures of the substandard institutions, and in the abstract, reintegrating our clients back into the community is an ideal solution for the system and the client; however, even when communities do have strategic plans in place (and that is only in the most ideal of circumstances), there will always be gaps to fill. The Centre for Addiction and Mental Health (CAMH) has embarked on an incredibly challenging restructuring of their mental health care model with the intent of eliminating stigma, improving care, and integrating clients (who will no longer be known as “patients”) back into the community (Davison, et al, 2010, pp. 392-393). What a fabulous idea! My concern—as it will always be—is the maintenance of such a program. What begins idealistically as innovative, fresh and funky often becomes the bane of our existence once the fashion wears out. Optimistically, the creaters have a well-developed strategic plan for the reconstruction and program implementation which will bring many opportunities to resolve any complications that might surface over the estimated 26-year period (Davison, et al., 2010). Personally, I am optimistic, even in the face of systemic, political or societal obstacles that are bound to transpire.
References
The Aboriginal Justice Implementation Commission (1999, November). “Child welfare.” Report of the Aboriginal Justice Inquiry of Manitoba: Aboriginal Justice Implementation Commission. Retrieved from http://www.ajic.mb.ca/volumel/chapter14.html#6
Davison, G., Blankstein, K., Flett, G., & Neale, J. (2010). Abnormal Psychology, (4th ed.). Mississauga, ON: John Wiley & Sons Canada, Ltd.
Hood, A. B., & Johnson, R. W. (2007). Assessment in counseling: A guide to the use of psychological assessment procedures, (4th ed.). Alexandria, VA: American Counseling Association.
Ingram, R., & Luxton, D. D. (2005). Vulnerability-stress models. In B. L Hankin & J. R. Z Abella (Eds.). Development of psychopathology: A vulnerability-stress perspective. (pp. 32-46). Thousand Oaks, CA: Sage Publications.
Kesler, L., Crey, K., Hanson, E. [First Nations Studies Program] (2009). The white paper 1669. Retrieved from http://indigenousfoundations.arts.ubc.ca/home/government-policy/the-white-paper-1969.html
Suicide: In a Moment, an Act of Desperation….
I would like to share a recent personal experience. I was on facebook recently where I encountered a status post of a very old friend: “Well it has been 1 month since My Lover, My best friend left me to be in peace. I miss her, I will Always love her. Good bye Jenny**”. My blood ran cold. These are life-long friends of mine from my youth. We had lost touch years ago and reconnected on facebook but we had not yet really reconnected in the flesh. I did see Jenny a few years ago while I was visiting a client in the psychiatric unit at our local hospital. It was then I learned she suffered with bi-polar disorder. I was astounded that I was only just learning this. She was so ashamed (it was evident by her visceral response) and she was so uncomfortable while we spoke. Our conversation broke off with an awkwardness and she stopped contacting me via email. I respected her choice, but I was also alarmed at the deep shame she was feeling about having her bi-polar disorder discovered.
After I saw her husband’s status post, I was compelled to email a mutual friend who told me that Julia hung herself. I was devastated. Even though, we had lost touch over the past 15 or so years, I grieved. I grieved for her husband, who had been struggling with her mental health in silence all these years; I grieved for the lost friendship and time that we will never get back; I grieved for the pain and shame for my friend who took her own life out of desperation. She was so desperate for peace and this was the only course of action she could map out in her tortured mind.
She never really cried “suicide” (although she had many desperate attempts in the past 10 years). Her husband couldn’t predict it, and her psychiatric never saw it coming either. She simply acted in a moment (her husband had stepped out for what would be considered only a moment…) and in that moment, she was gone.
Suicide is one of those very difficult and intimate subjects that we can never wrap our heads around. So many people who threaten suicide are crying out for help (and every cry needs to be acted upon with swiftness and veracity); but more often, the ones who do take their own lives, do it in silence, and we are caught off guard.
And I will never be able to completely make sense of it, although I often believe that I am not meant to. I must simply love her unconditionally in this moment and accept….
**I have changed her name out of respect for her and her family.
Re-defining Happiness
Sometimes your joy is the source of your smile, but sometimes your smile is the source of your joy. ~Thich Nhat Hanh
I had always struggled with the idea of happiness, both personally and professionally. When I started working with people who struggle with addictions and mental health issues, I heard them say over and over again, “I just want to be happy!” And every time those words were uttered (and I heard them almost daily) I would shudder.
There was something about the way they would say it, something in their eyes that would say, “Save me!” when those words were spoken. There was a sound of desperation in their voices. It didn’t take me long to understand that they were pleading–even though they didn’t really know it–for me to “fix” the pain they carried around. What an unattainable task for all of us—that mythical “happily ever-after”—yet it beguiles each and everyone of us at some point in our lives. Even though I saw happiness (a different kind of happiness than they had previously known) just within their reach, they were shrouded with the horrors of their past trauma and anxiety for the future they desired but could never touch.
Thich Nhat Hanh would claim happiness through a mindful practice of awareness, gratitude, compassion and acceptance. What I have come to realize is that Happiness is a spiritual journey, a journey of the soul which moves beyond certainty, a journey beyond time and space. It seems new-agey-woo-hoo, but I have come to understand that the spirit demands the release of logic and evidentiary practice.
Now, for me, happiness is a state of mind. Joy is the feeling we experience when we adopt a Happiness approach regardless of how we feel in the moment. Moving Happiness from a feeling state to a thoughtful state freed me to feel a host of emotions and still *be happy.*
What a relief to know that I could feel many things: I could grieve and still have happiness; I could be angry and still have happiness. I didn’t have to feel happy to be happy.
Today, I strive for a practice that brings me closer to being comfortable with uncertainty, loving what is, and letting go of judgment. It is a daily practice and, at times, a moment to moment struggle.
Disparate Moments 