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For my mental health news article, I came across this article about how trauma-sensitive yoga can help an individual suffering from physical or emotional symptoms caused by trauma (Castaneda, 2017). The focus of this type of yoga is to provide a safe environment for the individuals by making them feel safe and taking control of their choices on how to execute poses or whether or not to attempt in certain pose. It is a trauma informed class where instructors are formally trained on how to approach or conduct the class by acknowledging and eliminating potential triggers in the environment.

This trauma-informed yoga has a meditative component that helps change the way individual’s react to triggers by providing skills targeted to take control of their physical and emotional symptoms that are prompted by certain triggers (Castaneda, 2017). It allows the participants to learn how to cope with their unwanted thoughts and memories and channel them through relaxation techniques. Ashtanga yoga has been shown to provide a positive outlook in survivors of complex childhood trauma by improving emotional regulation and body acceptance (LaChiusa, 2016). An article by Nolan (2016) provided a narrative review of studies to evaluate the efficacy of trauma-sensitive yoga as an treatment for women suffering with PTSD, particularly with intimate partner violence. It reported that this treatment reduced symptoms of PTSD and other co-occurring conditions, such as anxiety and depression by focusing on peaceful embodiment.

The news article brought enlightenment to potential treatment for those who experience physical and emotional symptoms of trauma. The stigma that this population endures is the idea that they may not be accepted back into society and will forever have a label of “tainted” due to the lack of self-worth and shaming.  It challenges the stigma against trauma survivors by shedding light to ways that may help positively change the survivors’ perspective on their body acceptance, ultimately improving their self-worth and self-esteem. By taking control of their mind and how they react to triggers, it can enhance quality of life, reduce stigma against society, and love for themselves again.

References

Castaneda, R. (2017). How yoga helps survivors of trauma. Retrieved from http://health.usnews.com/wellness/mind/articles/2017-03-29/how-yoga-helps-survivors-of-trauma

LaChiusa, I. (2016). The transformation of Ashtanga yoga: Implicit memory, dreams, ad consciousness for survivors of complex trauma. Neuroquantology: An Interdisciplinary Journal of Neuroscience and Quantum Physics, (2), 255. doi:10.14704/np.2016.14.2.941

Nolan, C. (2016). Bending without breaking: A narrative review of trauma-sensitive yoga for women with PTSD. Complimentary Therapies in Clinical Practice, (24), 32-40.

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Lack of sleep could contribute to mental health problems, researchers reveal

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Lack of sleep could contribute to mental health problems, researchers reveal

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This article challenges mental health stigma because it seeks to educate the reader of the harmful effects that insomnia, or the lack of sleep in general, may have on an individual’s psychological well-being. Research has found that a lack of sleep may be linked with depression, paranoia, psychosis, and anxiety (Davis, 2017).  The article highlighted how cognitive behavioral therapy (CBT) may be effective in treating insomnia, thereby, alleviating these symptoms.

There is further support in the link between mental health consequences and sleep deprevation, according to “Sleep and mental health” (2009), which stated, in [a] longitudinal study of teenagers … for example, sleep problems preceded anxiety disorders 27% of the time, while they preceded depression 69% of the time. It was determined that the link between mental health issues and sleep deprivation could be explained by its effects on the amygdala (Swaminathan, 2007). The amygdala is responsible for the processing of emotions, and with sleep deprivation and, “...seemed to be "rewired," coupling instead with a brain stem area called the locus coeruleus, which secretes norepinephrine, a precursor of the hormone adrenaline that triggers fight-or-flight type reactions” (Swaminathan, 2007).

To further explore how insomnia affects mental health, a research was conducted at 26 universities, which included 3,700 student participants (Davis, 2017) (not all of these students experienced the mental health issues mentioned). These individuals were divided into two groups, where one group had six sessions of CBT aimed at diminishing insomnia, and the other group did not receive treatment at all. These participants reported their progress at 10 and 22 weeks (Davis, 2017). Following these assessments, “ insomnia in the CBT group was found to have fallen by almost half 10 weeks into the study, while both anxiety and depression dropped by a fifth, and paranoia and hallucinations fell by 25% and 30% respectively” (Davis, 2017). The researcher of the study concluded that insomnia diminished by 50% with the utilization of CBT (Davis, 2017).

Even though not all of the students who participated in the study experienced positive psychiatric symptoms (hallucinations and delusions), or the other mental health issues mentioned, it was still concluded that CBT improved sleep, which therefore improved overall mental health.

The author recognizes that mental health is stigmatized, even though it should not. He wants individuals to be open about seeking help in order to improve their symptoms. He suggests that since insomnia is not stigmatized, speaking about sleep issues may be a good start in addressing mental health issues. The author’s takeaway message challenges mental health as a stigma because he does not believe it is something to be ashamed of, but rather, addressed in order to solve the issue at hand.

References

Davis, N. (2017, September 6). Lack of sleep could contribute to mental health problems, researchers reveal. Retrieved from https://www.theguardian.com/society/2017/sep/06/lack-of-sleep-could-contribute-to-mental-health-problems-researchers-reveal

Swaminathan, N. (2007, October 23). Can a lack of sleep cause psychiatric disorders? Retrieved from https://www.scientificamerican.com/article/can-a-lack-of-sleep-cause/

Sleep and mental health. (2009, July). Retrieved from https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health

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When Athletes Share Their Battles with Mental Illness

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When Athletes Share Their Battles with Mental Illness

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This article was a fantastic read about 8 athletes that have struggles with a mental illness. They share their story and most of them speak about stigma. In the world of sports, having/speaking about a mental illness is frowned down upon. One of the athletes in this article puts it into perspective by saying famous athletes are supposed to be looked up to, be macho, and the most strong-willed of them all. Of course anyone can be ridiculed for having a mental illness, but I never would have thought about the reality of Pro Stars. Several of them mentioned their teammates going to a therapist for a bum knee or broken ankle but there is a stigma for these tough players to seek professional health for an "invisible illness". It seems there wasn't an established resource for many sports players until recently. Some of the interviewees mentioned teams creating a psychology department to battle the effects of Pro Sports.
Imagine being the best at something and then getting injured or experiencing competitive failure right in front of the public's eye? What about overtraining and exhausting your mind, body, and soul? That's what some of these individuals went through and fortunately these 8 were brave enough or honest enough or determined to make a difference and speak out about what it's like to have a mental illness and how it can bring you to the darkest places. But one awesome thing this article did was highlight the amazing feats these players experienced and I feel that is one of the best ways to battle against stigma. We need to show that yes, people suffer and they also suffer in more ways than they should with all the scrutiny mental illness stigma brings, but there is hope. There is change but there needs to be more change. We are all human and we all struggle in our own ways. There doesn't need to be shame and thankfully these athletes each found a way to dedicate themselves to correcting the way society views mental health.

References
Gleeson, S. & Brady, E. (2017) When athletes share their battles with mental illness. USA Today. Retrieved from https://www.usatoday.com/story/sports/2017/08/30/michael-phelps-brandon-marshall-mental-health-battles-royce-white-jerry-west/596857001/

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'Bad mother' Stigma Preventing Women Seeking Help for Postnatal Depression

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'Bad mother' Stigma Preventing Women Seeking Help for Postnatal Depression

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In this article, Bodkin (2017) reports that women often hide postnatal depression because they fear being labelled a “bad mother”.  The author challenges stigma surrounding postpartum depression (PPD) by condemning contributing external factors such as negative experiences with unsympathetic and unhelpful hospital staff. However, it is mentioned that the six-week postnatal check is an important opportunity for a mother and her doctor to discuss mental health and wellbeing. According to the American Psychological Association (2017), most women who are diagnosed with PPD experience symptoms within the first few weeks after giving birth. Discussions surrounding the symptoms of PPD are warranted far before the six-week mark so new mothers can recognize the symptoms and seek help. I also struggle with a quote in this article made by by Dr. Judy Shakespeare. She states that it is unhelpful for doctors to tell women struggling with PPD that what they are feeling is “normal”. I think this kind of verbiage perpetuates negative feelings for women who already feel alienated and are struggling with the symptoms of PPD.

References:

American Psychological Association. (2017). Postpartum depression. Retrieved September 12, 2017, from http://www.apa.org/pi/women/resources/reports/postpartum-depression.aspx

Bodkin, H. (2017, September 4). ‘Bad mother’ stigma preventing women seeking help for postnatal depression. Retrieved September 12, 2017, from http://www.telegraph.co.uk/news/2017/09/04/bad-mother-stigma-preventing-women-seeking-help-postnatal-depression/

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When a Woman took Sick Days for Mental Health

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When a Woman took Sick Days for Mental Health

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This article found on CNN challenges stigma in the workplace. Madalyn Parker sent an email to her entire work team stating that she would be taking a few days off work to focus on her mental health. When she returned to work she was surprised to see that the CEO responded to her email, thanking her for reminding everyone of the importance of using sick days to care for their mental health. Madalyn posted the exchange to Twitter where tens of thousands of people "liked" and "retwitted" the positive message. This opened up a conversation where people began to share their negative experiences of times when employees were threatened to lose their jobs if they continued to use sick days for mental health.

The CEO, Ben Congleton (2017), said to CNN that caring for our brains should not be different than caring for our bodies and that mental health is just as important as physical health (Schmidt). Along with this article, CNN also posted a short video explaining some of the effects trauma has on not only changing the way people think, but the actual structure of our brains.

Mayo Clinic advises those with a mental illness to seek education about their condition and connect with others who have a mental illness in order to gain self-esteem and overcome self judgement (2017). This news article opened the door for many with a mental illness to find a sense of support and may have encouraged more people to prioritize their mental wellbeing and change the way they think about it. This article acknowledges the presence of stigma when it comes to mental health and attempts to change that by educating others about mental illness and providing an example of supportive work relationships.

References

Mayo Clinic. (2017). Mental health: Overcoming the stigma of mental illness. Mayo Clinic., Retrieved from http://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477

Schmidt, R. (2017). When a woman took sick days for mental health, her email sparked a larger discussion. CNN. Retrieved from http://www.cnn.com/2017/07/12/health/mental-health-response-from-company-ceo-trnd/index.html

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Parents of mass shooter James Holmes to discuss mental health at Penn State Beaver

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Parents of mass shooter James Holmes to discuss mental health at Penn State Beaver

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COLLAPSE

Kennedy’s article (2017) challenges mental health stigma by promoting opportunities for people who want to take part in changing society’s stigma. Kennedy describes how the parents of James Holmes, the person who is responsible for the shooting in a Colorado movie theatre in 2012, are trying to make a difference and prevent similar acts of violence from occurring in the future.  Arleen and Bob Holmes continue to advocate for mental illness to be more openly talked about in society so parents can be more educated and aware in order to treat those that need it earlier on in life.  “By discussing mental illness early on, parents and educators can potentially prevent acts of violence by connecting teens with appropriate treatment” (Kennedy, 2017). This article informs readers that the Holmes’ will be attending the “System Failures of Mental Health Symposium” that focuses on the failures of mental health treatment in America and what to do about it.  Kennedy also provides information for those interested and a link to register and attend. The conference encourages anyone to participate—therefore, challenging in hopes to change mental health stigma.

Reference

Kennedy, K. (2017, September 12). Parents of mass shooter James Holmes to discuss mental health at Penn State Beaver. Retrieved from http://www.timesonline.com/timestoday/parents-of-mass-shooter-james-holmes-to-discuss-mental-health/article_df57b47a-974b-11e7-ba37-6fe1d7449818.html

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Public Hospitals Treat Greater Share of Mental Health Patients

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Public Hospitals Treat Greater Share of Mental Health Patients

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This article looks at New York’s public and private hospitals and how they treat patients with mental illnesses.  It reports that treatment for mental health has been moving more towards the city’s public hospital system due to the financial pressure in some private hospitals. Mueller reports the number of beds in public hospitals allotted for psychiatric patients was more than 3 times that in private hospitals.  This statistic makes it appear as if mental health’s importance and image is not improving.

This article mentions stigma and notes that stigma is an issue because it extends and affects government funding and priorities in hospitals.  The article recognizes the effect of stigma in mental health and how it is effecting unfair opportunities – higher costs and emergency visits leading to limited personalized attention.  The article is shining a light on stigma in mental health and calls for change in finding “serious alternatives” to costly hospital visits.  It is mentioned that culture of the hospitals is to get mentally ill patients in and out, causing a lack of time and reflection on the healthcare practitioners side. This leads to misunderstanding of the patient’s needs and in a greater sense, keeps us from finding possible underlying causes of mental illness.  This article advocates for a change in the mental health industry and needing improvement in patient treatment.

Mueller, B. (2017, August 23). Public Hospitals Treat Greater Share of Mental Health Patients. The New York Times, pp. A15. Retrieved from https://www.nytimes.com/2017/08/22/nyregion/new-york-mental-health-hospitals.html?rref=collection%2Ftimestopic%2FMental%20Health%20and%20Disorders&action=click&contentCollection=health&region=stream&module=stream_unit&version=latest&contentPlacement=15&pgtype=collection

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The article discusses how "the mental health crisis has filled jails to bursting with mentally ill people who would be more effectively dealt with through treatment" (Board, 2017). The article meant to get inmates with a mental health problem help, however, in the article as a means to grab and hold the reader's attention the imagery they used to describe the prison 'bursting with mentally ill people' only proves to further stigmatize them.

The article goes on to explain how Trump agrees there is an issue but the focus is less on the needs of the people and more on the cost that those people incur when they are being taken care of by the jail and prison system (board, 2017).
The article goes on to detail how mentally ill people are jailed because their behaviors are 'annoying' to officers and new acts have been put in by congress that will serve to train officers to identify signs of untreated mental illness, expand treatment for individuals returning to society, and to reduce the number of imprisoned mentally ill people (Board, 2017).

Throughout this article it is achingly clear that the verbiage used can only support the continuation of stigma attached to 'mentally ill people' as this article likes to say. The article does try to stick up for individuals that need psychiatric care saying that they shouldn’t be cut off from the public health systems however there mode of transferring that information to the public only proves to further the stigma attached to individuals who suffer from a mental issue.

Resources

Board, T. E. (2017, February 27). Mental Illness, Untreated Behind Bars. Retrieved September 12, 2017, from https://www.nytimes.com/2017/02/27/opinion/mental-illness-untreated-behind-bars.html?mcubz=0

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In Houston, Children are Likely to Experience Trauma from Hurricane Harvey

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In Houston, Children are Likely to Experience Trauma from Hurricane Harvey

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In this article, the author discusses the ways that children experience trauma following natural disasters. While schools are typically thought of as places to receive an education, the author argues that they become influential in other areas of a child's life during times of hardship. Children deal with trauma in different ways. Some children have a hard time concentrating, act out during class, or fail to behave cooperatively.

The authors also recommend that teachers address the recent events from the very beginning that children return to school, and recognize that many kids have experienced trauma. They advocate creating a safe place for children and staff to reflect on recent events. Lastly, the authors emphasized that children are resilient, when given a person to support them.

This article challenges stigma in two ways. First, it brings awareness to the effects of trauma on a person's mental health. Since stigma is often a result of ignorance or misunderstanding, then having a greater understanding of the causes of mental health concerns is the first step in addressing these concerns in others. Secondly, the authors offer suggestions for supporting children with mental concerns. Providing readers with a call to action and feasible steps to talk to these children is a great way to create a supportive social environment. "An affirming social environment is associated with successful recovery" (Brown & Stoffel, 2011, p. 407). These principles likely can be applied to more than just children, as social support is key to recovery with all people.

References
Brown, C. & Stoffel V. (2011). Occupational Therapy in Mental Health: A vision for participation. Philadelphia. F.A. Davis.

NPR. (2017). In Houston, Children Are Likely To Experience Trauma From Hurricane Harvey. Retrieved from http://www.npr.org/2017/09/11/550218492/in-houston-children-are-likely-to-experience-trauma-from-hurricane-harvey

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How to Train Your Brain to Be More Optimistic

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How to Train Your Brain to Be More Optimistic

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https://www.nbcnews.com/better/health/how-train-your-brain-be-more-optimistic-ncna795231

By consciously altering your thought processes, you can literally re-wire your brain...experts believe that optimism is a trait that can be learned pretty easily" (Steinhilber, 2017). This article discusses the benefits of being optimistic and that anyone can become an optimist if they trained themselves to be one. This article further perpetuates the stigma for conditions such as anxiety, depression, or bipolar disorder as being a condition that is not as serious. Such conditions can be seen as controllable or not as significant and that the individual simply needs to make a quick "re-wiring" of their brain to get back on track. This article provides individuals with great tips on how they can alter their thinking in certain situations, but mental health conditions should not be taken any less lightly because of this information.

References:
Steinhilber, B. (2017). How to train your brain to be more optimistic: The glass is half full - here's how to see it that way. Retrieved online on 12 September,  2017 from https://www.nbcnews.com/better/health/how-train-your-brain-be-more-optimistic-ncna795231

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'The Psychic Toll of Trump's DACA Decision' 

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'The Psychic Toll of Trump's DACA Decision' 

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This recent article from the New York Times explains how Trump’s decision to end the Deferred Action of Childhood Arrivals (DACA) program may have a huge impact on the mental health of immigrant families. Villavicencio chronicles her own childhood as both a child of immigrant parents from Ecuador and DACA. Villavicencio explains, “Undocumented life in America is hard on the mind and body. Poverty, precarious employment, poor access to health care, discrimination, and truma from the migration itself lead to disorders like depression, anxiety and post-traumatic stress disorder” (Villavicencio, 2017). She adds that immigrants have limited access to mental health care, and stigma, panic, chronic exhaustion, low moods are high.

Since Trump’s election, “Experts on immigration mental health say they have already seen a spike” (Villavicencio, 2017). Undocumented parents are pulling their children from schools. With an increase of fear and anxiety, undocumented college students, “Have shown physical and emotional manifestations of stress: chronic headaches, toothaches, ulcers” (Villavicencio, 2017). With trump’s heartbreaking decision to end the DACA program, anxiety, stress and mental health issues will continue to rise.

This article addresses the stigma associated with mental illness in the undocumented immigrant population. The author shares her own experiences, such as her own father hiding the fact that his father died to not disrupt her mental health. Likewise, she shares the stories of other undocumented immigrants who all live with mental illness. I think this article brings awareness to not only the hardships that undocumented immigrants have, but the affects they can have on mental health. Unfortunately, I do not think this article will ever reach the president, but it would be insightful for government officials to read to better understand stigma within this population.

References: Villavicencio, K. (2017, September 8). The Psychic Toll of Trump's DACA Decision . New York Times. Retrieved from https://www.nytimes.com/2017/09/08/opinion/sunday/mental-health-daca.html?rref=collection%2Ftimestopic%2FMental%20Health%20and%20Disorders&action=click&contentCollection=health®ion=stream&module=stream_unit&version=latest&contentPlacement=4&pgtype=collection

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Hurricane Harvey and Irma: The mental health impact of major disasters

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Hurricane Harvey and Irma: The mental health impact of major disasters

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This news article discusses the recent occurrences of Hurricane Harvey and Irma on those who have been affected. They focused on how these natural disasters can have an impact on the mental and behavioral health of the hurricane survivors (Houston & First, 2017). They included research which found that the most commonly studied mental health problem is PTSD, due to the life-threatening experiences of these natural disasters. Additional issues that may arise are challenges in fixing damages or homelessness. Difficulty with finding new housing, challenges with replacement of lost/damaged items, and financial issues are stressors which can negatively impact these survivors’ mental health. At the end of the article, the reporters discussed the process of recovery from the hurricanes.

I think this article challenges stigma because the reporters are creating awareness of certain mental health concerns that may result from the hurricanes (i.e. PTSD, depression, anxiety). According to Brown & Stoffel (2011), “The effects of stigma can be buffered by positive social support” (p. 407). This article supports that claim by advocating for communities to work together to rebuild their neighborhoods and to provide support and resources to those who have been severely affected.

References

Brown, C. & Stoffel V. (2011). Occupational Therapy in Mental Health: A vision for participation. Philadelphia. F.A. Davis.

Houston, J.B. & First, J. (2017, September 12). Hurricane Harvey and Irma: The mental health impact of major disasters. Business Standard. Retrieved September 12, 2017 from http://www.business-standard.com/article/international/hurricane-harvey-and-irma-the-mental-health-impact-of-major-disasters-117091200314_1.html

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When major disasters like Hurricanes Harvey and Irma hit, the first priority is to keep people safe. This process can involve dramatic evacuations, rescues and searches.

However, after the initial emergency passes, a much longer process of recovering and rebuilding begins. For individuals, families and communities, this can last months or even years. This work often begins at the same time as the national media starts packing up and public attention shifts to the next major news story.

At the University of Missouri's Disaster and Community Crisis Center, we study disaster recovery, rebuilding and resilience. Much of our research shows that natural disasters can have a meaningful impact on survivors' mental and behavioral health. These issues typically emerge as people try to recover and move forward after the devastation.

Health and disasters

Immediately after a natural disaster, it's normal to experience fear, anxiety, sadness or shock. However, if these symptoms continue for weeks to months following the event, they may indicate a more serious psychological issue.

The disaster mental health problem most commonly studied by psychologists and psychiatrists is post-traumatic stress disorder, which can occur after frightening events that threaten one's own life and the lives for family and friends.

Following a disaster, people might lose their jobs or be displaced from their homes. This can contribute to depression, particularly as survivors attempt to cope with loss related to the disaster. It's not easy to lose sentimental possessions or face economic uncertainties. People facing these challenges can feel hopeless or in despair.

Substance use can increase following disasters, but usually only for individuals who already used tobacco, alcohol or drugs before the disaster. In a study of Hurricane Katrina survivors who had been displaced to Houston, Texas, approximately one-third reported increasing their tobacco, alcohol and marijuana use after the storm.

There's also evidence that domestic violence increases in communities experiencing a disaster. After Hurricane Katrina, another study found that, among women in Mississippi who were displaced from their homes, domestic violence rates increased dramatically. Perpetrators may feel a loss of control following the disaster and turn to abusive behavior to try to gain that control back in their personal relationships.

Disaster recovery

While many disaster survivors show resilience, studies have shown mental and behavioral health issues cropping up weeks, months and even years after a disaster.

Rebuilding can be a long process, with a series of ups and downs. Survivors may bounce back after a few months, or they may experience ongoing stressors, such as financial issues or problems finding permanent housing. Disaster anniversaries or other reminders - like a heavy rainstorm months after a hurricane - may also trigger reactions.

In addition, early disaster recovery efforts often focus on physical reconstruction. Psychological recovery may end up on the back burner.

Individuals and organizations working to help disaster survivors need to remember that disasters can affect many aspects of survivors' lives. As a result, several different community systems need to be working together as part of recovery efforts.

Researchers sometimes call the multi-agency disaster response and recovery network that is needed to help individuals cope with a disaster a "system of care." A disaster system of care will include disaster groups like FEMA and Red Cross. It should also involve agencies representing public health, mental health, schools, local government, social services, local businesses and workforce development, faith-based organizations and local media.

For example, combating domestic violence after a disaster will require collaboration among disaster organizations, domestic violence groups, law enforcement, local media and more. Resources intended to help women and families experiencing domestic violence - such as legal aid or transportation assistance - should be included in disaster response programs.

Communities should also help disaster survivors get reconnected: to their friends and family, to new people in the community and to the place they may be temporarily staying while displaced. Social capital and support may be the most important resources for individuals coping with disasters. Community events, such as neighborhood dinners, might help foster connections. Social media platforms can help bring together neighbors who are displaced and waiting to return home.

Finally, a variety of mental health interventions - such as psychological first aid, crisis counseling and cognitive behavioral therapy - can help those who have experienced a disaster. These programs can be delivered through many community systems, including mental health agencies, schools and more.

If you're in the U.S. and seeking help, a free Disaster Distress Helpline is available for disaster survivors.

J. Brian Houston, Associate Professor of Communication and Public Health, University of Missouri-Columbia and Jennifer First, Disaster Mental Health Program Manager, Disaster and Community Crisis Center, University of Missouri-Columbia

This article was originally published on The Conversation. Read the original article.

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J. Brian Houston & Jennifer First | The Conversation

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Hurricane Harvey and Irma: The mental health impact of major disasters

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When major disasters like Hurricanes Harvey and Irma hit, the first priority is to keep people safe. This process can involve dramatic evacuations, rescues and searches. However, after the initial emergency passes, a much longer process of recovering and rebuilding begins. For individuals, families and communities, this can last months or even years.

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Expansion of Health Care Services for Children 

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Expansion of Health Care Services for Children 

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This article is making efforts to change/challenge the current stigma that are associated with mental illnesses. The article is about New York public children’s hospitals expanding their mental health programs. This shows that change is being made to provide more mental health services. Currently there are more services for individuals who have physical conditions, and this puts individuals with a mental condition as a minority because they do not have the same opportunities as those with physical conditions. This is also challenging the community to learn to be more accepting and understanding of mental conditions, and that these conditions even exist in children (Wang, 2017). The are also expanding their TEACH program which strives to educate professionals both in the medical field as well in the school systems to 1. provide better care for the children in need of services (Wang, 2017), and 2. to educate the parents on how to best provide the care and support that the child needs and deserves (Wang, 2017).

This also seems to support goals typical of public health, as it seems like the idea behind opening more services for children is trying to address the condition early enough to allow the children to not have to deal with the barriers that are typical of adults with mental conditions (Wang, 2017). It seems like part of the mission of the expansion of these health services is to help individuals that deal with other social issues, and common stressors associated with mental health including stressors from life, and getting health care services (Wang, 2017). This is a change that targets that lack of services that are provided for individuals with mental illnesses. This shows that advocacy toward providing more services for the MH community is being made and is working.

Overall the article seems to “challenge” the current stigma, but mostly shows that these stigmas have been recognized and that there are individuals out there that are making an effort to create change about the current mental health situation.

Wang, V. (September 5, 2017). City Hospital System is Expanding Children’s Mental

Health Programs. New York Times. https://www.nytimes.com/2017/09/05/nyregion

/city-hospital-system-is-expanding-childrens-mental-health-programs.html?rref=collection%2Ftimestopic%2FMental%20Health%20and%20Disorders&action=click&contentCollection=health®ion=stream&module=stream_unit&version=latest&contentPlacement=1&pgtype=collectionReply%20Quote

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Rady Children's to create unique psychiatric emergency department for kids

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Rady Children's to create unique psychiatric emergency department for kids

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http://www.sandiegouniontribune.com/news/health/sd-me-rady-psych-20170912-story.html

This recent article explains the exciting new department that is being added to the Rady Children’s Hospital, the nation’s first pediatric psychiatric emergency department. There is a national problem with a huge increase in average number of psychiatric emergency patients, now up to four hundred a month (Sisson, 2017). According to a study done by Pittsenbarger, Manniz, & Stevenson (2014) the most common psychiatric diagnosis seen in the emergency rooms were anxiety states/panic disorder, depression, drug abuse, and conduct disorders.

Previously many of the psychiatric emergency patients would have to wait in regular emergency room beds for days. Now with the new department, immediate evaluation and treatment plan is possible.

What’s exciting about this article is that 6 million philanthropic donations were made specifically for this new project, which is exceptional because large sums of money are not usually donated to mental health.

This article challenges the stigma of mental health conditions. It shows that people want to support those who have mental illness and give them a place in emergency situations. It gives children a safe place to receive treatment. Hopefully this new department will encourage children to get the help that they need by giving them an alternative place to go besides the emergency room or hotline to call. This article also creates an awareness that psychiatric emergencies of children are on the rise and more initiative needs to be taken around the country.

Reference

Sisson, P. (2017). Rady Children's to create unique psychiatric emergency department for kids. The San Diego Union-Tribute. Retrieved from http://www.sandiegouniontribune.com/news/health/sd-me-rady-psych-20170912-story.html

Pittsenbarger, Z. E., Mannix, R., & Stevenson, M. D. (2014). Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses. Academic Emergency Medicine, (1), 25.

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The Long-Term Health Consequences of Hurricane Harvey

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The Long-Term Health Consequences of Hurricane Harvey

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This article is an informative piece that discusses the long term affects of natural disasters, most notably inspired from the recent hurricane in Texas. Carroll & Frakt (2017) starts out by stating that some time after hurricanes or floods calms, those that went through the disaster will still be going through their own recovery. As physical injuries and illnesses starts to heal, people may battle long term symptoms of trauma of post traumatic stress disorder and depression. The article continues to share systematic reviews on how natural disaster affects health and another systematic review on long term consequences. Statistics found that there is “a surge in mental health diagnoses in populations that experience floods” but only 2% received mental health counseling of a quarter of those that lived with someone who needed it (Carroll & Frakt 2017).

I think in a way, this article challenges stigma because it creates awareness of mental illness conditions, in that it is a real thing and anyone in the world can possess it. The article also shares that research recommends to monitor communities for mental health problems and providing services that is needed for them (Carroll & Frakt 2017). According to Brown & Stoffel (2011), “although negative attitudes about mental illness still exist, the general public has increased its level of understanding mental illness” (pp. 403). And though this news article is not educating on how to fight stigma, the authors are, in some form, promoting understanding about mental health to its audience.

References
Brown, C. & Stoffel V. (2011). Occupational Therapy in Mental Health: A Vision for Participation. Philadelphia. F.A. Davis.

Carroll, A.E., & Frakt, A. (2017, August 31). The Long-Term Health Consequences of Hurricane Harvey. Retrieved September 12, 2017, from https://www.nytimes.com/2017/08/31/upshot/the-long-term-health-consequences-of-hurricane-harvey.html

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Homeless Forced to Seek Shelter Ahead of Hurricane Irma

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Homeless Forced to Seek Shelter Ahead of Hurricane Irma

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The LA Times article, “Miami shelters homeless against their will as Irma closes in”, by Adriana Gomez Licon, discuses the decision to detain homeless people who refused to move into a shelter during the hurricane Irma. Miami officials made the decision to give homeless people the choice of going to a shelter voluntarily or they will be taken into a mental evaluation hold against their will for 72 hours. This decision was backed by a psychiatrist(Licon, 2017).

The officials detained individuals by using the Baker Act, which is, “a law that enables authorities to institutionalize patients who present a danger to themselves or others” (Licon, 2017, p. 1). According to the officials, if homeless people make the decision that they do not want to go to the shelter, then they are causing danger to themselves and therefore, do not have the ability to make this decision for themselves. Nisar stated, "A person who has a history of mental illness and who is staying in harm's way, and doesn't have a logical cohesion of what is right or what is wrong at that point, is a harm to himself, and at that point we can Baker Act them for his own protection," (Licon, 2017, p. 1).

I found this article be very stigmatizing because the message behind the article is that people with mental illness cannot make decisions for themselves. Stigma is disregarding an individual because if a characteristic (Brown & Stoffel, 2011). In this case the homeless people's free will was disregarded because of their mental health. I do not claim to know what was right in this situation; although, I do think it is important to make the effort to keep everyone safe no matter what socioeconomic situation that they are in. A homeless man who was detained stated, "You are trying to make me go somewhere I don't want to go," (Licon, 2017, p. 1). Is this taking away the civil rights of people with mental illness? Are they giving people living in a home the same ultimatum?

References:
Brown, C. & Stoffel V. (2011). Occupational Therapy in Mental Health: A vision for participation. Philadelphia. F.A. Davis.

Licon, A. (2017). Miami shelters homeless against their will as Irma closes in. latimes.com. Retrieved 12 September 2017, from http://www.latimes.com/nation/ct-miami-homeless-removed-irma-20170908-story.html

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On what is likely the last clear day in Florida before Hurricane Irma's monster wind and rain, social workers and police officers are giving Miami's estimated 1,100 homeless people a stark choice: Come willingly to a storm shelter, or be held against their will for a mental health evaluation.

With the outer edge of the storm approaching Friday, these officials - backed by a psychiatrist and observed by an Associated Press team - rolled through chillingly empty downtown streets as dawn broke over Biscayne Bay, searching for reluctant stragglers sleeping in waterfront parks.

"We're going out and every single homeless person who is unwilling to come off the street, we are likely going to involuntarily Baker Act them," said Ron Book, chairman of the Miami-Dade Homeless Trust.

Invoking the "Baker Act" - a law that enables authorities to institutionalize patients who present a danger to themselves or others - is not something law enforcement does lightly, but officers detained at least six people by Friday afternoon. Under the law, they can be held up to 72 hours before the state would have to go to court to prolong their detention.

By then, Irma's howling winds and terrifying storm surge should be somewhere north of the city.

"I am not going to sign suicide notes for people who are homeless in my community. I am just not going to do it," Book added. "That's why you have a Baker Act. It's there to protect those who can't otherwise protect themselves."

Book's group was working closely with police, who acknowledged that the effort is unusual: Officials said it is the first time Miami has invoked the law for hurricane preparedness.

About 70 people willingly climbed into white vans and police squad cars Friday, joining others who already arrived at shelters. About 600 others were thought to remain outside somewhere, exposed to the storm, despite mandatory evacuation orders for more than 660,000 people in areas that include downtown Miami and coastal areas throughout the county.

One older man pushing his belongings in an empty wheelchair in Bayfront Park tried to wave them off.

"I don't want nothing," he said, insulting a social worker.

"So you are cool with dying in the streets?" he asked.

"Get out of my goddamn face," he responded.

"What's your name?" asked Dr. Mohammad Nisar, a psychiatrist who was looking for evidence of mental illness, a necessary factor for a Baker Act detention.

"None of your damn business!"

Police officer James Bernat intervened.

"We are here to help you. Listen to me. You are being very aggressive. We are trying to help you," Bernat said. "It's very dangerous out here."

"You are trying to make me go somewhere I don't want to go," he insisted.

Finally, the man was handcuffed without a struggle and taken to Jackson Memorial Hospital for a 72-hour psychiatric evaluation.

"A person who has a history of mental illness and who is staying in harm's way, and doesn't have a logical cohesion of what is right or what is wrong at that point, is a harm to himself, and at that point we can Baker Act them for his own protection," Nisar explained later.

Friday's encounters alone weren't enough to justify their involuntary detention - Nisar said social workers and officers on the team already know these men and can testify to prior signs of mental illness to support each case.

Also, the law requires a court order to keep them detained against their will after 72 hours, and public defenders have pushed back against such requests, citing court rulings that the Baker Act can lead to unconstitutional curtailments of individual liberty.

But those hearings won't happen until Monday at least - and by then, Irma's wrath will have moved on from Miami.

Ron Honberg, a senior policy adviser for the National Alliance on Mental Illness, said there is always potential for a slippery slope that would violate people's civil rights, but this storm seems extraordinarily dangerous.

"I think sometimes situations arise that are so dire that safety consideration supersedes everything else," he said. "But you don't want this to be used on people who don't have a mental illness."

After driving more than 400 people to shelters, the Homeless Trust said it would continue searching for stragglers until winds reach 45 mph , sometime Saturday afternoon.

"I am not happy to have to do it," said Steven Nolan, whose face has weathered many days of Florida sunshine. "But I'd rather be in there than out here when the storm hits."
Contributors include Josh Replogle in Miami

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Miami shelters homeless against their will as Irma closes in

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On what is likely the last clear day in Florida before Hurricane Irma's monster wind and rain, social workers and police officers are giving Miami's estimated 1,100 homeless people a stark choice: Come willingly to a storm shelter, or be held against their will for a mental health evaluation.

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"How to Train Your Brain to Be More Optimistic"

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"How to Train Your Brain to Be More Optimistic"

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This NBC News article, by Brianna Steinhilber, provides recommendations on how to be more optimistic in life (Steinhilber, 2017). Although I appreciate the article's emphasis on finding purpose in life, I do not necessarily agree that one can train themselves to be optimistic by doing so. I am sure that some people can learn optimism as this article says is possible, but this does not mean that everyone has the capability to do so. The article states, "Yes, shifting your perspective is as easy as consciously thinking happy thoughts" (Steinhilber, 2017). Do you think Jan, our speaker from NAMI, would agree with this statement? The article goes further to say that constructing an optimistic viewpoint reduces feelings of depression and anxiety (Steinhilber, 2017). But what if it is the other way around and mental health conditions, such as depression, are actually what prevent optimism from occurring? I think that this article discounts the fact that some people cannot easily control how they think, and it supports the stigma that pessimism is a bad characteristic  that should be fixed in individuals. For example, the article states that positive individuals are able to adapt and thrive, which implies that individuals with a negative mindset cannot adapt and thrive as well, thus, supporting the stigma that negativity is a weakness (Steinhilber, 2017). Although this articles mentions the importance of acknowledging the negative, it states that being negative in the long run can hinder you. I do not feel that positivity and negativity is black and white. I think a person has a spectrum of personality traits that come out depending on the situation. I appreciate the good intentions of this article, and I like how it explains the environment's impact on a person's outlook on life, however, overall, I feel that the article supports some stigma on mental health (Steinhilber, 2017). By implying one's outlook on life is controllable, this may make people who are unable to do so feel stigmatized as being weak or uncapable. Additionally, the article supports the stigma that optimistic are people are more well equipped to live a happy life than people who gravitate towards pessimism (Steinhilber, 2017). I do not feel this is true for everyone, nor can it be assumed.

Reference:
Steinhilber, B. (2017, August 24). How to Train Your Brain to Be More Optimistic [The glass is half full — here’s how to see it that way.]. Retrieved September 12, 2017, from https://www.nbcnews.com/better/health/how-train-your-brain-be-more-optimistic-ncna795231

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Leia Karwowski "When Athletes Share Their Battles With Mental Illness"

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Leia Karwowski "When Athletes Share Their Battles With Mental Illness"

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This article includes stories about well-known athletes speaking out about their mental health condition. Athletes have been found to be at an increased for mental illness, (Gleeson & Brady, 2017). Athletes like Michael Phelps are challenging the stigma of mental health illness. As famous athletes, individuals are expected to have a great life than many will envy, (Gleeson & Brady, 2017). It is discussed that you cannot separate mental health from sports and the competition aspect of it, (Gleeson & Brady, 2017). The athletes in this article are hoping to break the stigma of mental health by sharing their story and raising awareness. A quote by baseball player Rick Ankiel really stood out to me. He stated, “There’s such a stigma, especially with men, that you can’t falter, and that you shouldn’t get help,” (Gleeson & Brady, 2017) The stigma of mental health stops people from seeking help. This article challenges that stigma by speaking out that it is okay to receive help and that a mental health illness does not make you “weak” as an athlete.

Reference:

Gleeson, S., & Brady, E. (2017, August 30). When athletes share their battles with mental illness. Retrieved September 12, 2017, from https://www.usatoday.com/story/sports/2017/08/30/michael-phelps-brandon-marshall-mental-health-battles-royce-white-jerry-west/596857001/

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I Needed Someone To See Me': One Refugee's Story Of Recovery

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I Needed Someone To See Me': One Refugee's Story Of Recovery

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Question: Does it support or challenge stigma?

Curry’s article (2017) challenges the stigma associated with refugees and the tremendous struggle they endure in their war-torn homelands that leave them with severe post-traumatic stress disorder, and trauma induced anxiety and depression. Munos, Brown & Stoffel (2011) define stigma as “the marginalization of an individual due to an attribute he or she has.” Stigmatization in this article is clearly addressed, and the author and his subject attempt to paint a picture of a population that is misunderstood and is being asked to uproot and move across the world, physically, culturally, and occupationally.

The NPR story outlines an individual, Ahmad’s, journey to Germany as a Syrian refugee. He now works for IPSO (International Psychosocial Organization) counseling refugees in over 4 languages. He attempts to address the mental health problems that accompany refugees, and asks his peers to open up. Ahmad says, “Mental health problems...are stigmatized in many of the cultures that refugees come from. People are afraid to ask for help, and refugees often worry counselors might be reporting on them to the managers at the shelter or to the government agencies with the power to grant them asylum or not — and that they bring with them a fear and mistrust of authorities and government from the places they're fleeing” (Curry, 2017). Ahmad goes on, “regardless of their accomplishments or abilities back home, they're starting from scratch. In Syria, they were famous surgeons, school principals, leaders of their community...here they're just another refugee. People leave behind a lot of dignity” (Curry, 2017).

This story rings especially true to the ears of an occupational therapist student. Refugees are deprived of their activities of daily living when transplanted to a new country, community, environment, and culture. They leave behind an identity and walk into a world where their role, rituals, activities, and occupations are often decided for them, systematically imposed upon them, or are left feeling unidentified. But, even though these things may be true, an individual is so much more than these facts. And I think that is where the stigma comes in. This article attempts to break that stigma by pointing out that these people are humans with hopes, dreams, fears, strengths, and boundless potential. Maybe in their new environment, there can be a support system to reintroduce routine and occupation, and bring them closer to the baseline of their occupational selves whom they embodies in their previous lives.

Reference:

Curry, A. (2107, September 6). ‘I Needed Someone To See Me': One Refugee's Story Of Recovery. Retrieved September 12, 2017, from: http://www.npr.org/sections/goatsandsoda/2017/09/06/548624782/the-counselor-whos-walked-many-miles-in-a-refugees-shoes

Munoz, J. P., Stoffel, V., & Brown, C. (2011). Occupational Therapy in Mental Health: A Vision for Participation. Philadelphia: F.A. Davis.

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This Is What It Feels Like to Survive a Terrorist Attack as a Young Teen

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This Is What It Feels Like to Survive a Terrorist Attack as a Young Teen

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This article is about a young lady who lived through 9/11 as a middle-schooler and then developed PTSD as a result. She relates her story to the recent bombings in Manchester that occurred outside the Ariana Grande concert, as many of the victims present were children and teeangers, and wants to share her similar experiences about how she deals with PTSD. She feels many of the children and teens who experienced the Manchester bombings may develop the same struggles that she goes through as well, and wants to share her coping strategies. She suffers from PTSD, anxiety, depression and panic attacks as she still feels like her brain is in a constant state of alarm and never feeling safe, even many years later.

Furthermore, the author then goes into detail about how to support a teen with PTSD and the severity of providing resources for those experiencing side effects from trauma. Children that have been exposed to a traumatic event are at an extremely higher rate to develop at least one symptom of acute stress response within a few weeks of the incident, also placing them at a high risk to develop long term PTSD (Brown & Stoffel, 2011).

The author’s story is significant in how we as a society view teen PTSD as ‘just a phase’ that all teenagers go through mood swings and being irritable is typical at a certain age. She states she was misdiagnosed with ADHD and bipolar and given medication, that it wasn’t until she was 19 years old that she learned she was suffering from PTSD. Her story of her struggle with PTSD challenges the stigma of teen PTSD in an advocating way to inspire other children and adolescents who are feeling the same about how to get support and who to call for help. As well to educating adults on what PTSD and mental illnesses looks like for a young person and how to support them through it, rather than write it off as a typical phase that all teenagers go through.

References
Brown, C. & Stoffel V. (2011). Occupational Therapy in Mental Health: A Vision for Participation. Philadelphia. F.A. Davis. ISBN: 978-0-8036-1704-9

Hovitz, H. (2017, May 25). This Is What It Feels Like to Survive a Terrorist Attack as a Young Teen. Retrieved September 12, 2017, from http://www.health.com/anxiety/teen-ptsd-manchester-terrorist-attacks

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This Is What It Feels Like to Survive a Terrorist Attack as a Young Teen

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Helaina Hovitz lived through 9/11 as a middle-schooler and developed post-traumatic stress disorder as a result. Here's what she wants people to know after the Manchester bombing.

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The mental health impact of major disasters like Harvey and Irma

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The mental health impact of major disasters like Harvey and Irma

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The article that I selected talks about the impact that natural disasters causes on a community. At first the main focus when a natural disaster is imminent is to make sure that everyone that could be involved is safe but the article goes on to state that the greatest damage isn't only to the buildings and infrastructure. Once the rebuilding and recovery begins in the devastated area the focus of the media then turns towards the next "big" thing and all attention about recovery and needed help for the area that just experienced a natural disaster is forgotten.

The articles continues to mention the types of mental health conditions that occur after a natural disaster such as PTSD, but it mentions that other conditions develop from loss of job or a lack of abilities to cope with loss. Studies have shown that in areas that have recently experienced a natural disaster there is an increase of alcohol and drug abuse which has caused an increase in domestic violence cases (Houston, 2017).

In the text, by Brown and Stoffel, 2011, the definition of a stigma is “an attribute that is deeply discrediting,” which many would portray these areas that have higher domestic violence rates and attribute it to the use of drugs and alcohol. However, the thing that they are missing is that the people that are involved with these cases could have lingering mental health conditions such as depression, PTSD from the natural disasters.

I think that the authors of this article challenge the stigma that is associated with mental health issues. The authors make a point and recognize that natural disasters are devastating in more than just ruining and destroying property. Natural disasters impact a community by displacing people and removing them from their jobs, careers and purposeful and meaningful occupations which then causes them to be at risk for mental health issues. It is interesting to see the link between these two things and see how it all trickles down effects more than what is visible and easy to notice.

References
J. Brian  & Jennifer M.  University of Missouri-Columbia. (2017, September 12). The mental health impact of major disasters like Harvey and Irma. Retrieved September 12, 2017, from
https://theconversation.com/the-mental-health-impact-of-major-disasters-like-harvey-and-irma-83764

Brown, C. & Stoffel V. (2011). Occupational Therapy in Mental Health: A vision for participation. Philadelphia F.A. Davis

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In the news article “How to Spot Depression, Anxiety in Hurricane Survivors,” Dr. Max Wachtel of KUSA Colorado discusses the emotional effects of surviving a hurricane. I believe this article challenges the stigma our society has towards mental illness; Wachtel says there is no need to “fix” the feelings that arise from a natural disaster. Stigma holds the individual accountable for his/her mental illness and results in marginalization (Brown & Stoffel, 2011). In the case of a natural disaster, it is completely normal to feel stressed, hopeless, and anxious and the individual should not be put to blame for feeling this way. Wachtel provides signs and symptoms of depression and anxiety – prolonged feelings of fear, loss of motivation, mood swings, increased heart rate, sadness – and normalizes these symptoms. The reader is reminded to be mindful of friends and family who may be feeling this way and to be empathetic and patient towards those that may not recover as quickly. Take the initiative to offer help, provide emotional and physical support by accompanying someone to a therapy appointment, and remind them that asking for support okay.

An interesting line I read was when Wachtel (2017) says, “let them know they are not going crazy – everyone feels the way they do right now” (para. 5). I think this quote is interesting because of his word choice of “crazy” and I believe he could have used a different word, perhaps something along the lines of “let them know they are not alone” (I realized after re-reading the article that he uses this exact line a few paragraphs later, so perhaps he could have omitted the “crazy” sentence altogether). The word “crazy” has a negative connotation in this context, and a reader may misinterpret it and think that having depression outside of a natural disaster is labeled as “crazy” and abnormal. We should work to remove the stigma that is associated with mental health outside of natural disasters; this article emphasizes that it is okay to feel this way due to hurricanes, but we should remind readers that these feeling are okay and accepted even without a hurricane.

References

Brown, C. & Stoffel V. (2011). Occupational Therapy in Mental Health: A vision for participation. Philadelphia. F.A. Davis.

Wachtel, M. (2017, September 9). How to spot depression, anxiety in hurricane survivors. 9NEWS. Retrieved from http://www.9news.com/news/health/dr-max-how-to-spot-depression-anxiety-in-hurricane-survivors/472681667

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KUSA - I am constantly amazed at the resiliency of the human spirit. Most people who experience an intense trauma do not develop a long-term mental health issue. They have an understandable level of depression or anxiety as a result of a major disaster such as Hurricane Harvey or Irma, but those problems tend to dissipate after a few weeks.

Some individuals, though, are not so lucky. It is not a matter of weakness-the strong survive and the weak develop major depression or PTSD. That is just not the case. Sometimes, people are genetically predisposed to developing a mental illness. Sometimes, people who have a pre-existing condition experience a worsening of symptoms. Other times, it merely hits one person harder than another.

Regardless of the long-term outcome, most people who are dealing with Harvey or Irma will experience a significant level of short-term stress. It is not uncommon to see people break down into tears, to lose motivation to complete tasks, or to be scared to go outside. Some people will have panic attacks. Others will get angry. Most people will experience the physiological effects-an increase in heart rate, high blood pressure, the familiar tingle of an adrenaline-fueled body. This will make people tired quickly. It will make them grouchy. It will make them sad.

Most of these symptoms are largely unavoidable in the run-up to or the wake of a tragedy. You don't need to try to 'fix' yourself. You don't need to try to 'fix' anyone else, either. You need to be comfortable facing whatever negative emotions arise in you or others and to know that it is a wave that will pass.

If you are empathic toward others, it will help them. Let them know they are not going crazy-everyone feels the way they do right now. You also don't want to excuse bad behavior-there is a difference between feeling angry and acting out in an angry manner.

Just by being nice to each other, most people will weather this storm.

For a small but significant few, these temporary feelings will turn into something more serious. People are prone to developing Depression, Anxiety, or Acute Stress Disorder, the precursor to PTSD, after a major natural disaster. The symptoms start in the same manner as the normal negative emotions everyone is feeling. But, they last longer, and they tend to worsen over time.

If you see a friend or loved one who is struggling with the aftermath longer than others, or if his or her symptoms are getting worse instead of getting better, it is important to act. Let this person you care about know he/she is not alone and that help is available. In the wake of natural disasters, community mental health centers, the state, and the federal government all offer special mental health services for disaster victims, sometimes for free or a reduced cost. Help your friend get connected with these services. Drive your brother, or sister, or mother, or father to their first appointment. Sit with them as they struggle. Let them know they are not alone.

The human spirit is resilient. We are often stronger than we think we are, and we can handle almost anything. Sometimes something hits us harder than expected, and we need help, though. There is nothing wrong with that.

There is no shame in asking for help. In fact, it is one of the bravest actions a strong person can take.
Max Wachtel, Ph.D. is the 9NEWS Psychologist and a forensic psychologist from Colorado. He is the recent author of Sociopaths and Psychopaths: A Crisis of Conscience and Empathy. He can be found at http://www.maxwachtel.com.
© 2017 KUSA-TV

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Dr. Max: How to spot depression, anxiety in hurricane survivors

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KUSA - I am constantly amazed at the resiliency of the human spirit. Most people who experience an intense trauma do not develop a long-term mental health issue. They have an understandable level of depression or anxiety as a result of a major disaster such as Hurricane Harvey or Irma, but those problems tend to dissipate after a few weeks.

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http://www.9news.com/news/health/dr-max-how-to-spot-depression-anxiety-in-hurricane-survivors/472681667
In this article how to spot mental illness in a hurricane survivor and the way natrual disasters impact mental health is discussed. In some ways this article challenges stigma. This is because it pointedly says that some people will develop mental illnesses after a hurricane and some people might not, but it is not a matter if people are strong or weak. They make it very clear that the development of mental illness has to do with factors like genetic predisposition and not personal strength. One case in which this article supports stigma is when it encourages readers to comfort survivors who are experiencing high levels of stress by telling them that, "they are not going crazy" (Wachtel, 2017). This usage of the word crazy is not appropriate in this article because if someone who was having more severe symptoms read it, it might make them feel marginalized. This is a very important area to challenge stigma in because of the current damage caused by hurricanes. Also, according to the U.S. Department of Veteran's Affairs over 50% of those affected my natural disasters show clinically significant distress or psychopathology (US Department of Veterans Affairs, 2015).

Reference
US Department of Veterans Affairs. (2015, July 30). Mental health effects following  disaster: Risk and resilience factors. Retrieved 10 September 2017 from https://www.ptsd.va.gov/professional/pages/effects-disasters-mental-health.asp

Wachtel,  M. (2017, Septepmber 9). Dr. Max: How to spot depression, anxiety in hurricane survivors. Retrieved 10 September 2017 from http://www.9news.com/news/health/dr-max-how-to-spot-depression-anxiety-in-hurricane-survivors/472681667

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https://www.nytimes.com/2017/08/17/upshot/preventing-teen-suicide-what-the-evidence-shows.html

A recent article I found on the New York Times webpage about preventing teen suicide challenges stigma because it provides
evidence-based ways to prevent suicide from the WHO in terms of the media, government, society, and health care system. The concerns about glamorizing suicide in the media, how social media disconnects teenagers from reality, access to guns, and the lack of access and delivery of mental health care are challenging the U.S.'s society and healthcare system (Carroll, 2017). This article does not provide any labels to this mental health concern. Therefore, this article is challenging the stigma that comes along with suicide by coming up with ways to prevent teen suicide. It does not blame the person suffering from a mental illness, but naming the external factors that may be contributing to teen suicide.

Reference:
Carroll, A. (2017). Preventing Teen Suicide: What the Evidence Shows. Retrieved September 10, 2017, from https://www.nytimes.com/2017/08/17/upshot/preventing-teen-suicide-what-the-evidence-shows.html

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Napportunity for the Destigmatization of Mental Illness

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Napportunity for the Destigmatization of Mental Illness

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In effort to complete this assignment I found three other noteworthy articles, but felt drawn to this one.  I truly wanted to share the message found in this article because of how it addressed both mental health and occupation.  Though the article is just the musings of a small town TV show, I stumbled upon while searching current mental health artifacts, I really appreciate the message being broadcast.  For one I think that we truly underestimate the importance of nap-time as a country, especially given the research that backs the positive effects of power naps, but moreover I appreciate that open conversation about depression and suicide is being normalized.  With respect to stigma I feel that this article does a great job at subtly challenging the stigma of mental illness, with the values of the local organizations; I Understand and Comfort Research, which believe suicide and it’s prevalence of 121 successful suicide attempts, to be a preventable through treatable mental health conditions.  Furthermore the organizations promote the idea that mental health impacts every aspect of a life, essentially supporting the PEO model of occupational therapy, and suggest that nap allows for an opportunity to engage in some much needed self care.

Reference:

Linnert, E. (2017). Hundreds nap in GR to raise funds for mental health. WOODTV.com. Retrieved 10 September 2017, from http://woodtv.com/2017/09/06/hundreds-nap-in-gr-to-raise-funds-for-mental-health/

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I found this article posted on the New York Times website. It is an opinion piece of the author’s firsthand accounts with addiction in the food service industry. The individual goes into how the environment of a restaurant can foster alcoholism and drugs due to accessibility (Bronson, 2017). They also mention that the way the service industry operates contributes to abuse. Such as the low pay, inconsistent schedules and lack of medical coverage offered are additional stressors. Problems with addiction are not only present in the service staff, but occurs within management positions. The article supports stigmatization for people who have problems with abuse of alcohol and drugs. The stigma typically accompanied with alcohol abuse and drugs by the public, are that they are unpredictable, dangerous and are to blame for their condition (Munoz, Brown & Stoffel, 2011). The accounts of this individual did not readily inform the reader about the causes of addiction. Information such as addiction has genetic influences as well as environmental influences was not mentioned. Also, that certain individuals will be more prone to addiction given the availability (Mojarad, Jouybari & Sanagoo, 2016). I do not feel that the article meant to blame the individual for the addiction. The author wished to point out the environmental causes that influence addiction in the industry. However, by the author mentioning that they were able to avoid drugs and alcohol gives the article a feeling that addiction is a choice. I feel that the author's message wasn't accurately portrayed and that it perpetuates stigmatization of individuals with substance abuse issues. The title of the articles also does not help decrease stigmatization. The title is "Why Waiters Drink. And Why It Matters," which the title is indicating that alcohol abuse is a choice and that its justified.

The article link:

https://www.nytimes.com/2017/08/21/opinion/why-waiters-drink-and-why-it-matters.html?rref=collection%2Ftimestopic%2FAlcohol%20Abuse&action=click&contentCollection=timestopics®ion=stream&module=stream_unit&version=latest&contentPlacement=1&pgtype=collection

References

Bronson, B. (2017, August 21) Why Waiters Drink. And Why It Matters. Retrieved September 09, 2017, from https://www.nytimes.com/2017/08/21/opinion/why-waiters-drink-and-why-it-matters.html?rref=collection%2Ftimestopic%2FAlcohol%20Abuse&action=click&contentCollection=timestopics®ion=stream&module=stream_unit&version=latest&contentPlacement=1&pgtype=collection

Mojarad, F. A., Jouybari, L., & Sanagoo, A. (2017). Drug abuse among nurses: A neglected challenge. Journal of Nursing and Midwifery Sciences, 4(1), 1-2. doi:10.18869/acadpub.jnms.4.1.1

Munoz, J. P., Stoffel, V., & Brown, C. (2011). Occupational Therapy in Mental Health: A Vision for Participation. Philadelphia: F.A. Davis.

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“Your Instagram Posts May Hold Clues to Your Mental Health”                                      For my current news article, I chose one published in the New York Times that discusses the outcome of a recent study conducted by a postdoctoral researcher at Harvard University and professor at the University of Vermont. The research study suggests that the photos shared on Instagram may “hold clues to your mental health” since Instagram users with a history of depression tended to post photos that were “bluer, darker and grayer on average”. Using a machine-learning tool to find photographic patterns, study participants who were diagnosed with depression used fewer filters and when filtered, typically chose one that created a black-and-white effect. I believe that the article demonstrates a support of stigma as it not only suggests attributes of mental health that are deeply discrediting, but also backs the negative aspects of the labeling theory of stigma (Brown & Stoffel, 2011). The study outcomes provide information that further compromises the public image of mental illness by correlating the darker effects of personal photos as characteristics of individuals with depression. They fail to address other possible factors for darker filers—trends in black-and-white photos, professional photography technique, etc. It puts into question whether biases and stigma were already at play when the study was conducted. The study is quite segregating as well and identifies individuals diagnosed with mental illness as unhealthy, compared to participants who are not diagnosed with a mental illness as healthy. By labeling these distinct groups it leads to a self-fulfilling prophecy of how individuals with depression are viewed (Brown & Stoffel, 2011). Individuals living with mental illness may still lead healthy lives in spite of their diagnosis whereas an individual not living with a mental illness may be unhealthy.                                        Brown, C., & Stoffel, V. C. (2011). Occupational Therapy in Mental Health: A Vision for Participation. Philadelphia, PA: F. A. Davis Company.    https://www.nytimes.com/2017/08/10/science/instagram-mental-health-depression.html?rref=collection%2Ftimestopic%2FMental%20Health%20and%20Disorders

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“Your Instagram Posts May Hold Clues to Your Mental Health”                                      For my current news article, I chose one published in the New York Times that discusses the outcome of a recent study conducted by a postdoctoral researcher at Harvard University and professor at the University of Vermont. The research study suggests that the photos shared on Instagram may “hold clues to your mental health” since Instagram users with a history of depression tended to post photos that were “bluer, darker and grayer on average”. Using a machine-learning tool to find photographic patterns, study participants who were diagnosed with depression used fewer filters and when filtered, typically chose one that created a black-and-white effect. I believe that the article demonstrates a support of stigma as it not only suggests attributes of mental health that are deeply discrediting, but also backs the negative aspects of the labeling theory of stigma (Brown & Stoffel, 2011). The study outcomes provide information that further compromises the public image of mental illness by correlating the darker effects of personal photos as characteristics of individuals with depression. They fail to address other possible factors for darker filers—trends in black-and-white photos, professional photography technique, etc. It puts into question whether biases and stigma were already at play when the study was conducted. The study is quite segregating as well and identifies individuals diagnosed with mental illness as unhealthy, compared to participants who are not diagnosed with a mental illness as healthy. By labeling these distinct groups it leads to a self-fulfilling prophecy of how individuals with depression are viewed (Brown & Stoffel, 2011). Individuals living with mental illness may still lead healthy lives in spite of their diagnosis whereas an individual not living with a mental illness may be unhealthy.                                        Brown, C., & Stoffel, V. C. (2011). Occupational Therapy in Mental Health: A Vision for Participation. Philadelphia, PA: F. A. Davis Company.    https://www.nytimes.com/2017/08/10/science/instagram-mental-health-depression.html?rref=collection%2Ftimestopic%2FMental%20Health%20and%20Disorders

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- Kellie Nguyen

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The article “Ahead Of Hurricane Irma, Miami Detained Homeless People Against Their Will” explains how police officers detained homeless people to keep them safe from the hurricane. It also discussed the law and ethical concerns of the law that allowed police to arrest the homeless people. Florida Mental Health Act of 1971 allows police to “involuntarily detain individuals who may have a mental illness or could pose a significant threat to themselves or others” (Waldron & Murdock, 2017). While the intention was to keep people safe from massive hurricane, which it successfully did, it also further strengthened the homeless population’s stigma of and connection with mental health challenges. Many people who are homeless may have mental challenges, but it is not helpful or correct to assume that everyone who is homeless also has a mental illness.	This law is intended for individuals who are going through a mental health crisis or challenge where they are not safe to themselves or others. Someone going through a mental health crisis should get medical or psychiatric help, not police help. The law does not explain that it can be used for police to detain someone so they can go get medical help, psychiatric help, or help from their family. It may be used this way but the law could also be used in a manner that only makes the situation worse.  The law is also used for people with trouble with mental illness, which assumes that everyone who is homeless has a mental illness. I do not think this was the intention and instead the intention was to keep people safe, but it does not allow a population to make decisions for themselves, decisions which they may be capable of making. 

# data[].attributes.subject
The article “Ahead Of Hurricane Irma, Miami Detained Homeless People Against Their Will” explains how police officers detained homeless people to keep them safe from the hurricane. It also discussed the law and ethical concerns of the law that allowed police to arrest the homeless people. Florida Mental Health Act of 1971 allows police to “involuntarily detain individuals who may have a mental illness or could pose a significant threat to themselves or others” (Waldron & Murdock, 2017). While the intention was to keep people safe from massive hurricane, which it successfully did, it also further strengthened the homeless population’s stigma of and connection with mental health challenges. Many people who are homeless may have mental challenges, but it is not helpful or correct to assume that everyone who is homeless also has a mental illness.	This law is intended for individuals who are going through a mental health crisis or challenge where they are not safe to themselves or others. Someone going through a mental health crisis should get medical or psychiatric help, not police help. The law does not explain that it can be used for police to detain someone so they can go get medical help, psychiatric help, or help from their family. It may be used this way but the law could also be used in a manner that only makes the situation worse.  The law is also used for people with trouble with mental illness, which assumes that everyone who is homeless has a mental illness. I do not think this was the intention and instead the intention was to keep people safe, but it does not allow a population to make decisions for themselves, decisions which they may be capable of making. 

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Brown, C., Stoffel, V., & Munoz, J. P. (2011). Occupational therapy in mental health: a vision for participation. Philadelphia: F.A. Davis Co.

Waldron, T., & Murdock, S. (2017, September 12). Ahead Of Hurricane Irma, Miami Detained Homeless People Against Their Will. Retrieved September 12, 2017, from http://www.huffingtonpost.com/entry/miami-detains-homeless-irma_us_59b7f7e8e4b031cc65ccf70b

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https://futurism.com/scientists-can-now-target-the-area-of-the-brain-that-causes-schizophrenics-to-hear-voices/

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In this article scientists found promising results in a pilot study that used neurofeedback to treat patients with treatment resistant depression. The study made use of two groups (an experimental and a control) both of which consisted of twelve individuals who suffered from major depressive disorder despite having received treatment. Participants of the experimental group received beta/sensorimotor and alpha/theta training on each visit whereas the control received no such training. Through the use of self reported depression questionnaires (administered 1, 4 and 12 weeks into the study) neurofeedback was found to positively affect interpersonal relationships, family and work life for the experimental group, whereas there was no significant change for the control. This article challenges stigma as it provides research that shows positive outcomes may be possible not only for those who are depressed but also for those whom other forms of treatment have failed. . Furthermore the research itself suggests that the better the individual gets at accessing certain brain waves, the greater the positive psychological effects on the individual. This can provide the individual with something to work towards (one that provides the potential for mastery) which is a critical component in reducing self stigma (Brown & Stoffel, 2011, p.405)

# data[].attributes.subject
In this article scientists found promising results in a pilot study that used neurofeedback to treat patients with treatment resistant depression. The study made use of two groups (an experimental and a control) both of which consisted of twelve individuals who suffered from major depressive disorder despite having received treatment. Participants of the experimental group received beta/sensorimotor and alpha/theta training on each visit whereas the control received no such training. Through the use of self reported depression questionnaires (administered 1, 4 and 12 weeks into the study) neurofeedback was found to positively affect interpersonal relationships, family and work life for the experimental group, whereas there was no significant change for the control. This article challenges stigma as it provides research that shows positive outcomes may be possible not only for those who are depressed but also for those whom other forms of treatment have failed. . Furthermore the research itself suggests that the better the individual gets at accessing certain brain waves, the greater the positive psychological effects on the individual. This can provide the individual with something to work towards (one that provides the potential for mastery) which is a critical component in reducing self stigma (Brown & Stoffel, 2011, p.405)

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References

Brown, C., Stoffel, V., & Munoz, J. P. (2011). Occupational therapy in mental health: a vision for participation. Philadelphia: F.A. Davis Co.

European College of Neuropsychopharmacology. (2017, September 4). Pilot study shows that neurofeedback may help treatment-resistant depression. ScienceDaily. Retrieved September 9, 2017 from
https://www.sciencedaily.com/releases/2017/09/170904093440.htm

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In July 2015, something was very wrong with my ex-husband, Peter. His behavior over the preceding 18 months had been erratic and odd. He could be angry and threatening one minute, remorseful and generous the next. His voice mail messages and texts had become meandering soliloquies that didn't make sense, veering from his work travails, to car repairs, to his pet mouse, Snowball.

I thought maybe the stress of his job as a lawyer had finally gotten to him, or that he was bipolar. He had been working more than 60 hours a week for 20 years, ever since he started law school and worked his way into a partnership in the intellectual property practice of Wilson Sonsini Goodrich & Rosati, a prominent law firm based in Silicon Valley.

Then, for two days, Peter couldn't be reached. So I drove the 20 minutes or so to his house, to look in on him. Although we were divorced, we had known each other by then for nearly 30 years. We were family.

I parked in Peter's driveway, used my key to open the front door and walked up to the living room, a loftlike space with bamboo floors bathed in sunlight.

"Peter?" I called out.

Silence. A few candy wrappers littered a counter. Peter worked so much that he rarely cooked anymore, sustaining himself largely on fast food, snacks, coffee, ibuprofen and antacids. I headed toward the bedroom, calling his name.

The door was ajar. A few crumpled and bloodied tissues were scattered on the bedsheets. And then I turned the corner and saw him, lying on the floor between the bathroom and the bedroom. His head rested on a flattened cardboard box.

In my shock, I didn't see the half-filled syringes on the bathroom sink, or the spoon, lighter and crushed pills. I didn't see the bag of white powder, or the tourniquet, or the other lighter next to the bed. The police report from that day noted several safes around the bedroom, all of them open and spilling out translucent orange pill bottles.

Peter, one of the most successful people I have ever known, died a drug addict, felled by a systemic bacterial infection common to intravenous users.

Of all the heartbreaking details of his story, the one that continues to haunt me is this: The history on his cellphone shows the last call he ever made was for work. Peter, vomiting, unable to sit up, slipping in and out of consciousness, had managed, somehow, to dial into a conference call.

The Map of Peter's Descent

None of this made sense. Not only was Peter one of the smartest people in my life, he had also been a chemist before becoming a lawyer and most likely understood how the drugs he was taking would affect his neurochemistry.

In my attempt to fathom what happened to him and how I - and everyone else in his world - missed it, I set out to create a map of Peter's life the year before he died. (To protect the privacy of our children and Peter's extended family, I'm not using his surname.)

I studied his texts to drug dealers, and I compared the timing of those with dates and times of A.T.M. withdrawals he made. I needed to see the signs I hadn't known were signs. The nonsensical conversations. The crazy hours he kept. The nights he told our children he was running out to get a soda, only to disappear.

Human beings are physically and emotionally complex, so there is no simple answer as to why Peter began abusing drugs. But as a picture of his struggle took shape before my eyes, so did another one: The further I probed, the more apparent it became that drug abuse among America's lawyers is on the rise and deeply hidden.

One of the first things I learned is that there is little research on lawyers and drug abuse. Nor is there much data on drug use among lawyers compared with the general population or white-collar workers specifically.

One of the most comprehensive studies of lawyers and substance abuse was released just seven months after Peter died. That 2016 report, from the Hazelden Betty Ford Foundation and the American Bar Association, analyzed the responses of 12,825 licensed, practicing attorneys across 19 states.

Over all, the results showed that about 21 percent of lawyers qualify as problem drinkers, while 28 percent struggle with mild or more serious depression and 19 percent struggle with anxiety. Only 3,419 lawyers answered questions about drug use, and that itself is telling, said Patrick Krill, the study's lead author and also a lawyer. "It's left to speculation what motivated 75 percent of attorneys to skip over the section on drug use as if it wasn't there."

In Mr. Krill's opinion, they were afraid to answer.

Of the lawyers that did answer those questions, 5.6 percent used cocaine, crack and stimulants; 5.6 percent used opioids; 10.2 percent used marijuana and hash; and nearly 16 percent used sedatives. Eighty-five percent of all the lawyers surveyed had used alcohol in the previous year. (For comparison sake, about 65 percent of the general population drinks alcohol.)

Nearly 21 percent of the lawyers that said they had used drugs in the previous year reported "intermediate" concern about their drug use. Three percent had "severe" concerns.

The results can be interpreted two ways, said Mr. Krill, who is also a licensed drug and alcohol counselor and whose consulting firm, Krill Strategies, works with law firms on drug abuse and mental health issues. "One is that a significantly smaller percentage of attorneys in the study are using drugs as compared to alcohol. We don't think that's true."

"Alcohol is legal," Mr. Krill said, not to mention socially acceptable. "So admitting you drink too much is not directly at odds with your role as a licensed attorney."

Illicit drug use, however, is illegal. "I think the incidence of drug use and abuse is significantly underreported," he said.

In the government's most recent National Survey on Drug Use and Health report on substance abuse by industry, professional services (which include the legal profession) ranked ninth out of 19 industries in terms of illicit drug use. The entertainment industry ranked higher on the list; finance and real estate ranked lower.

The A.B.A.'s Commission on Lawyer Assistance Programs' most recent national report identified alcohol as the No. 1 substance-abuse problem for lawyers. The second most commonly abused substance was prescription drugs.

"We see two major trends in the legal profession," said Warren Zysman, the clinical director of the EARS Recovery Program in Smithtown, N.Y., a medically supervised chemical dependency program, and the former chief executive of Addiction Care Interventions, a rehabilitation center in Manhattan for professionals, including lawyers. "One is the opioid addiction, and the other is use of benzodiazepines like Xanax."

In recent years, he said, "we're seeing a significant rate of increase specifically among attorneys using prescription medications that become a gateway to street drugs." It used to be mostly alcohol, he said, "but now almost every attorney that comes in for treatment, even if they drink, they are using drugs, too - Xanax, Adderall, opiates, cocaine and crack."

Opioids and stimulants often go hand in hand with alcohol. In fact, drugs are sometimes used to combat the symptoms of alcohol withdrawal.

Brian Cuban, a lawyer in recovery for alcohol and drug addiction and the author of the memoir "The Addicted Lawyer: Tales of the Bar, Booze, Blow and Redemption," would regularly show up for work drunk and do a few lines of cocaine to be able to perform. "I was doing coke in the bathroom in the morning to recover from hangovers," he said. "Cocaine got me back on focus."

In addition to having a private practice at the time, Mr. Cuban was working for his well-known brother, the businessman Mark Cuban, who threatened to fire Brian if he didn't get sober. "I kept thinking: 'I'm not going to rehab. I'm a lawyer, lawyers don't go to rehab, they aren't in 12-step programs,'" he said. "Of course, half the people I know in my 12-step program are lawyers."

Lisa Smith, a lawyer and recovering alcoholic and drug addict, said the only way she was able to perform in her marketing job at the firm Pillsbury Winthrop in the early 2000s was by using cocaine to deal with alcohol withdrawal symptoms. "I was drinking during the day and at night," said Ms. Smith, now deputy executive director of the law firm Patterson Belknap Webb & Tyler in New York and author of the memoir " Girl Walks Out of a Bar." "I did coke because it would allow me to straighten up enough to show up to work in the afternoon."

Professional stress also plays a role, said Dr. Daniel Angres, an associate professor of psychiatry at Northwestern University Feinberg School of Medicine. "Law firms have a culture of keeping things underground, a conspiracy of silence," he said. "There is a desire not to embarrass people, and as long as they are performing, it's easier to just avoid it. And there's a lack of understanding that addiction is a disease."

That stress became particularly acute as the economy sank after the 2008 financial crisis. Jobs became more scarce. The pressure grew to not take time off from work.

At Peter's memorial service in 2015 - held in a place he loved, with sweeping views of the Pacific - a young associate from his firm stood up to speak of their friendship and of the bands they sometimes went to see together, only to break down in tears. Quite a few of the lawyers attending the service were bent over their phones, reading and tapping out emails.

Their friend and colleague was dead, and yet they couldn't stop working long enough to listen to what was being said about him.

Peter himself lived in a state of heavy stress. He obsessed about the competition, about his compensation, about the clients, their demands and his fear of losing them. He loved the intellectual challenge of his work but hated the combative nature of the profession, because it was at odds with his own nature.

Long before law school, when Peter was still in his early 20s and wearing his hair in a long ponytail, his passions were science, philosophy and music. One of his idols was the astronomer Carl Sagan. Another was Jimi Hendrix. He gave me books like "Siddhartha" and "Letters to a Young Poet" and played bass guitar in bands from college onward, even while a lawyer.

When he was a graduate student in chemistry, we spent whole weekends lying on the floor playing records for each other, talking about why we loved them and what memories a particular song snatched from the recesses of our minds.

After graduation, Peter worked for two small pharmaceutical companies but found the profession tedious and low paying. Having grown up in a low-income family, he didn't want to worry about paying the bills again. So he decided to use his chemistry background to become a patent lawyer.

When he graduated from law school, the starting salary of his first job in law was five times what he had earned as a chemist. But our lives were not suddenly easy. Although we had enough money, Peter's work schedule gave him little time to enjoy the fruits of his labor.

One Christmas Day early in his career, Peter's boss phoned from a ski lift in Aspen, Colo., to make sure Peter was going to finish a brief by that evening. He did, skipping dinner.

"I can't do this forever," Peter often told me. "I can't keep going like this for the next 20 years."

'Rewarded for Being Hostile'

According to some reports, lawyers also have the highest rate of depression of any occupational group in the country. A 1990 study of more than 100 professions indicated that lawyers are 3.6 times as likely to be depressed as people with other jobs. The Hazelden study found that 28 percent of lawyers suffer depression.

"Yes, there are other stressful professions," said Wil Miller, who practices family law in the offices of Molly B. Kenny in Bellevue, Wash. He spent 10 years as a sex crimes prosecutor, the last six months of which he was addicted to methamphetamines. "Being a surgeon is stressful, for instance - but not in the same way. It would be like having another surgeon across the table from you trying to undo your operation. In law, you are financially rewarded for being hostile."

Peter battled his own brand of melancholy, something I found attractive in a tragically poetic, still-waters-run-deep kind of way. He used to tell me he wasn't someone who ever really felt happy. He had moments of being "not unhappy," he said, but his emotional range was narrow.

When something great happened, he didn't jump for joy. When something sad happened, he didn't break down and cry. The only times I ever saw tears in his eyes were in the hospital, right after each of our children was born.

Yet for almost a decade as an associate at various law firms, Peter displayed no photos of his children or me in his office. When I asked him why - particularly when other lawyers seemed to have photos in theirs - Peter told me he didn't want the partners to see him as "distracted by my family."

In many ways, Peter's personality and abilities read like a wish list of qualities for a lawyer. Trained as a scientist, he approached problems in a deliberative, logical way. He was intelligent, ambitious and most of all hard-working, perhaps because his decision to go to law school was such an enormous commitment - financially, logistically and emotionally - that he could justify it only by being the very best.

And he was. In law school he was editor of the law review and No. 1 in his class. He gave the speech at graduation.

He also had a single-minded focus that could border on obsessive. I remember when he became consumed with Bach's harpsichord concertos, assembling a library of every one he could find. He read about them, listened to lectures about them and even found a mathematical representation of a particular piece on YouTube, which he had us all watch. That level of focus was well suited for deep dives into the new drug formulations, medical devices and technologies with which he had to constantly and quickly familiarize himself.

The Law School Effect

Some research shows that before they start law school, law students are actually healthier than the general population, both physically and mentally. "There's good data showing that," said Andy Benjamin, a psychologist and lawyer who teaches law and psychology at the University of Washington. "They drink less than other young people, use less substances, have less depression and are less hostile."

In addition, he said, law students generally start school with their sense of self and their values intact. But, in his research, he said, he has found that the formal structure of law school starts to change that.

Rather than hew to their internal self, students begin to focus on external values, he said, like status, comparative worth and competition. "We have seven very strong studies that show this twists people's psyches and they come out of law school significantly impaired, with depression, anxiety and hostility," he said.

Academics often study law students because students are considered a bellwether for the profession. "They are the canaries in the coal mine," Dr. Benjamin said.

Wil Miller, the lawyer and former methamphetamine addict, said that in his experience, law school encouraged students to take emotion out of their decisions. "When you start reinforcing that with grades and money, you aren't just suppressing your emotions," he said. "You're fundamentally changing who you are."

Research studying lawyers' happiness supports this notion. "The psychological factors seen to erode during law school are the very factors most important for the well-being of lawyers," Lawrence Krieger, a professor at Florida State University College of Law, and Kennon Sheldon, a professor of psychology at the University of Missouri, wrote in their 2015 paper " What Makes Lawyers Happy? " Conversely, they wrote, "the factors most emphasized in law schools - grades, honors and potential career income - have nil to modest bearing on lawyer well-being."

After students began law school they experienced "a marked increase in depression, negative mood and physical symptoms, with corresponding decreases in positive affect and life satisfaction," the professors wrote.

Students also shed some of their idealism. Within the first year of law school, students' motivation for studying law and becoming lawyers shifted from "helping and community-oriented values to extrinsic, rewards-based values."

Young lawyers in treatment at the Center for Network Therapy, an ambulatory detox facility in Middlesex, N.J., frequently tell Dr. Indra Cidambi, the medical director, that the reality of working as a lawyer does not match what they had pictured while in law school. She has found that law students often drink and use drugs until they start their first job. After that, Dr. Cidambi said, "it's mostly alcohol, until they are established as senior associates or partners and they move back to opiates."

"These aren't the majority of lawyers," she added. "But there are quite a number abusing drugs, and once they get to heroin, it's very hard to break it."

'That's Impossible'

For the last two years of his life, every time Peter and I were together - whether it was back-to-school night, our son's cross country meets or our daughter's high school graduation - people would ask me if he was O.K. They asked if he had cancer, an eating disorder, a metabolic disorder, AIDS. But they never asked about drugs.

Drugs didn't cross my mind, either. Not even the day I found his body, surrounded by drug paraphernalia, and called 911.

That day in Peter's house, the emergency medical workers told me right away that it was probably a drug overdose. I remember saying, "That's impossible." After all, I said, he was a partner at a law firm. He had an Ivy League education.

"How could that be?" I asked one of them. "He was so smart."

ID around her neck and clipboard on her lap, she nodded at me with a look of understanding. "We see a lot of this now," she said, meaning wealthy, accomplished men and women who start out with pain pills and graduate to amphetamines or heroin.

As I cleared out Peter's house after he died, I found receipts from medical-supply companies that had delivered things like bandages and tourniquets to his office address. Yet I don't think addiction crossed the mind of anyone he worked with, either.

Law firms are often reluctant to discuss substance abuse with their lawyers. The reason is not a malicious one, said Terry Harrell, a lawyer, substance abuse counselor and chairwoman of the A.B.A. Commission on Lawyers Assistance Programs. Law-firm leadership, she said, doesn't really know what signs to look for when it comes to addiction. And when it's happening, she said, they are so busy themselves, "they just don't see it."

When asked what the American Bar Association is doing to help combat mental health and substance abuse, Linda Klein, its president, said the A.B.A.'s requirement for continuing professional development and education "recommends that lawyers be required to take one credit of programming every three years that focuses on mental health or substance abuse disorders." She added that "by requiring lawyers to attend such programs periodically, the hope is that these concerns will be reduced."

It's difficult, though, to imagine that one class every three years would have prevented Peter - or anyone else - from becoming an addict. Real change, experts and recovering addicts say, needs to happen at the law-firm level, but that is complicated by an entrenched culture of privacy combined with an allegiance to billable hours.

Ms. Smith, formerly of Pillsbury Winthrop, says she doesn't know what her previous firm knew or didn't know about her substance abuse. "They never said a thing to me," she said. "And during that entire time I was an addict, I didn't get a single negative performance review."

Edward Flanders, managing partner in Pillsbury's Manhattan office, said the firm was not aware of Ms. Smith's substance abuse issues when she was there. Ms. Smith spoke about her experience to the firm's New York City employees in March.

"Hearing about her experience was pretty eye-opening for the firm, and it's not something we want anyone else to have to go through alone," Mr. Flanders said.

Recalling Missed Signals

I've spent the past two years marinating in this mess, trying my best to navigate things like the byzantine probate process and my children's broken hearts. I firmly believe that law-firm culture, particularly at big firms, has to become more compassionate and more aware of the signs that one of their own is struggling.

Looking back, I can see the signs I missed.

There was the time our son broke his wrist playing soccer four years ago and was prescribed Vicodin; Peter rifled through my medicine cabinet looking for the leftovers. "I use them for my back," he said.

There was the holiday concert in which our son's band was performing where Peter showed up late and jittery, looking so thin that I noticed his head seemed too big for his neck. After the show I walked with him to his car, and he complained that he was getting pushback from his firm about working from home so much.

"I'm more productive at home, but they have to see me, physically, in the office," he said. "They don't think I'm working if I'm not there."

They were right.

And there was the time in early 2015 when my son told me Peter had received a shipment from Amazon that he had opened at the dining room table, pulling out boxes of syringes, bandages, cotton balls and wound cleanser. Peter explained it away as simply stocking up on medical supplies.

My son was puzzled by that. But by then his father's behavior had become so strange, this almost seemed normal. "I just put my headphones on," my son told me, "and said, 'I have to do homework.'"

Years ago, when Peter was still a relatively new associate, he would joke that the perfect drug for him would be the combination of an antidepressant, a pain reliever and a stimulant. When I cleaned out his house, I found the ingredients for it: Vicodin, Tramadol, Adderall, cocaine, Xanax, crystal meth and a kaleidoscope of pills I couldn't identify, but not for lack of trying.

Yet even as addiction was taking over his life, Peter continued working. In the notebooks he used to keep track of injection times and dosages, he also made cryptic notes about client calls and meetings, lists of things needed to prepare documents, filing deadlines.

Being a patent lawyer is intellectually grueling work, and Peter was good at it - really good at it - for a long time. Perhaps the arrogance that grows from a profession in which your advice is worth $600 an hour is what allowed him to believe he didn't need to ask for help, that he could kick this on his own. Just another item on his lengthy to-do list.

In fact, while cleaning out his house I found a list of New Year's resolutions Peter wrote in December 2014, tucked into the bottom of a dresser drawer. "Run three races, spend more time with kids," his note to himself read.

And in red marker, the word "quit."

Correction: July 23, 2017

Correction: July 24, 2017

# data[].attributes.attachment_link.description
In July 2015, something was very wrong with my ex-husband, Peter. His behavior over the preceding 18 months had been erratic and odd. He could be angry and threatening one minute, remorseful and generous the next. His voice mail messages and texts had become meandering soliloquies that didn't make sense, veering from his work travails, to car repairs, to his pet mouse, Snowball.

# data[].attributes.attachment_link.readable_text
Changes in the brain's structure that could be the result of depression have been identified in a major scanning study.

Alterations were found in parts of the brain known as white matter, which contains fibre tracts that enable brain cells to communicate with one another by electrical signals.

White matter is a key component of the brain's wiring and its disruption has been linked to problems with emotion processing and thinking skills.

The study of more than 3000 people -- the largest of its type to date -- sheds light on the biology of depression and could help in the search for better diagnosis and treatment.

Scientists at the University of Edinburgh used a cutting-edge technique known as diffusion tensor imaging to map the structure of white matter.

A quality of the matter -- known as white matter integrity -- was reduced in people who reported symptoms indicative of depression. The same changes were not seen in people who were unaffected.

Depression is the world's leading cause of disability, affecting around a fifth of UK adults over a lifetime. Symptoms include low mood, exhaustion and feelings of emptiness.

Experts say the large number of people included in the sample -- 3461 -- means that the study findings are very robust.

Participants were drawn from UK Biobank, a national research resource with health data available from 500,000 volunteers.

The study forms part of a Wellcome Trust initiative called Stratifying Resilience and Depression Longitudinally (STRADL), which aims to classify subtypes of depression and identify risk factors.

Heather Whalley, Senior Research Fellow in the University of Edinburgh's Division of Psychiatry, said: "This study uses data from the largest single sample published to date and shows that people with depression have changes in the white matter wiring of their brain.

"There is an urgent need to provide treatment for depression and an improved understanding of it mechanisms will give us a better chance of developing new and more effective methods of treatment. Our next steps will be to look at how the absence of changes in the brain relates to better protection from distress and low mood."

The work -- published in Scientific Reports -- was carried out in collaboration with the University of Glasgow.

Journal Reference:

Xueyi Shen, Lianne M. Reus, Simon R. Cox, Mark J. Adams, David C. Liewald, Mark E. Bastin, Daniel J. Smith, Ian J. Deary, Heather C. Whalley, Andrew M. McIntosh. Subcortical volume and white matter integrity abnormalities in major depressive disorder: findings from UK Biobank imaging data. Scientific Reports, 2017; 7 (1) DOI: 10.1038/s41598-017-05507-6

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psychology research; mental health research; nervous system; brain tumor; depression; mental health; neuroscience; brain injury

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Depression changes structure of the brain, study suggests

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Changes in the brain's structure that could be the result of depression have been identified in a major scanning study. Alterations were found in parts of the brain known as white matter, which contains fibre tracts that enable brain cells to communicate with one another by electrical signals.

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MacDermott

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The ways some "healthy voice hearers" cope might be able to help people with psychotic disorders.

Sarah Jung

Jessica Dorner was lying in bed at her cousin's house when her grandmother, a "pushy lady" in an apron who had been dead for several years, appeared in front of her. "I know you can see me," Jessica heard her say, "and you need to do something about it."

It was a lonely time in Jessica's life. She was living away from home for the first time, and she thinks her grandmother was drawn by some sense of that. She eventually told her parents what happened, and according to her they were concerned, but not overly panicked. "My parents are probably the least judgmental people I know," she said.

As Jessica tells it, over the next two years, spirits visited her every now and again. Her brother-in-law's deceased father began forming before her, ghostlike, just as her grandmother did. And while the experiences were intense and at times made her feel "crazy," she said, they were infrequent, and insists that they were never a real source of suffering.

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Jessica later moved back home and got a job as a pharmacy technician, all the while figuring out how to cope with what was happening to her. At a co-worker's suggestion, she went to the Healing in Harmony center in Connecticut. In 2013, she says, she enrolled in classes there that taught her to use her "gift." A self-described psychic medium, Jessica tells me she hears voices that other people do not (in addition to sometimes seeing people others do not see), at varying intensity, and mostly through her right ear.

Meeting others like her at the center gave Jessica a sense of relief. "Just being around people who are going through similar things-that helps a lot, because I could talk to anybody about those things and not feel like I was crazy," she said.

It was through a friend from the center that Jessica ended up in the lab of Philip Corlett and Albert Powers, a psychologist and a psychiatrist at Yale. In a study published last fall in Schizophrenia Bulletin, Powers and Corlett compared self-described psychics with people diagnosed with a psychotic disorder who experience auditory hallucinations.

"A lot of the time, if someone says they hear voices, you immediately jump to psychotic illness, bipolar disorder, schizophrenia," Corlett said. But research suggests hearing voices is not all that uncommon. A survey from 1991-the largest of its kind since-found that 10 to 15 percent of people in the U.S. experienced sensory hallucinations of some sort within their lifetime. And other research, as well as growing advocacy movements, suggest hearing voices isn't always a sign of psychological distress.

The researchers at Yale were looking for a group of people who hear voices at least once a day, and had never before interacted with the mental-health-care system. They wanted to understand, as Corlett put it, those who do not suffer when "the mind deviates from consensual reality."

What Corlett calls consensual reality-the "normative shared experience we all agree on"-is probably not something you spend too much time thinking about. But you know when it's being violated. The sky is blue, the sun is hot, and as Corlett points out, most would generally agree that people don't receive extrasensory messages from one another.

Jessica was quite frank with me about the way some people may view her. "We know these experiences are weird and they're seen as weird," she said. "You just can't go into a room and say 'Hey, I'm a psychic medium' and people are gonna accept you."

Finer points of what counts as reality can change over time, and vary based on geography or culture. For centuries people walked the earth believing the sun orbited around them, which today would be considered unreasonable. Who decides that consensus, and where along its boundaries voice hearers fall, depends on a wide range of circumstances.

The anthropologist Tanya Luhrmann, who has studied voice hearing in psychiatric and religious contexts, has written that "historical and cultural conditions ... affect significantly the way mental anguish is internally experienced and socially expressed." Noting that there is no question psychiatric distress and schizophrenia are "real" phenomena that call for treatment, Luhrmann adds that "the way a culture interprets symptoms may affect an ill person's prognosis." Every psychiatrist I spoke to shared the belief that unusual behavior should only enter into the realm of diagnosis when it causes suffering.

On the other hand, Luhrmann tells me "it's a terribly romantic idea" to overinterpret the effects of culture. To say, for instance, that "anybody who would be identified with schizophrenia in our culture would be a shaman in Ecuador" is, in her mind, a clear mistake: "Flagrant psychosis" exists in some form in every culture where anthropologists have looked.

In the past decade, researchers have taken a greater interest in the experience of hearing voices outside the context of psychological distress. In his book The Voices Within, the psychologist Charles Fernyhough traces the way thoughts and external voices have been understood by science and society throughout time.*

Reflecting on Fernyhough's book, Jerome Groopman notes that in the early parts of the Bible, the voice of God gave direct commands to Adam, Abraham, and Noah. It spoke to Moses through the Burning Bush, going by the Book of Esther, making itself known again to the apostle Paul in the New Testament. Socrates, who wrote nothing down, heard a "sign" from childhood. The voices of three saints guided Joan of Arc as she rebelled against the English. Groopman cites Martin Luther King, Jr.'s autobiography, in which he describes "the quiet assurance of an inner voice" telling him to "stand up for righteousness."

The social context in which these people lived can impact how they're seen. It's impossible to say how the prophet Ezekiel was understood within his cultural moment. But in most places today, if a person claimed-as Ezekiel does-that he ate a scroll because the Lord commanded him to do so, some eyebrows might be raised. In a community where a personal, verbal relationship with God is normal, the reception may be different.

Powers and Corlett's work orbits the idea that schizophrenia is, as Powers put it, an "outmoded" label that describes a cluster of different symptoms rather than a single unified condition, he says.

"Goodness knows what psychosis actually is," Luhrmann said. "There are clearly different kinds of events in the domain we call psychosis," and when it comes to the relationship between voice hearing and psychosis, she says, "there's so much we don't understand."

Many now antiquated psychiatric diagnoses reified fear, misunderstanding, or prejudice toward people at society's margins. At the time of the women's suffrage movement in London, hysteria was leveled as a charge against women who broke social codes. A Mississippi psychiatrist in the 19th century proposed that slaves who attempted escape suffered from "drapetomania." And until 1973, homosexuality was considered a disease of the mind rather than an accepted way of being in the United States-and was only fully removed from the Diagnostic and Statistical Manual of Mental Disorders in 1987.

In his book Hallucinations, the late Oliver Sacks details a controversial experiment in which eight participants showed up at hospitals throughout the U.S. in the early '70s and complained only of "hearing voices." All of them were immediately diagnosed with a psychotic disorder and hospitalized for two months, despite reporting no other medical symptoms, family history, or signs of personal distress. The single symptom, Sacks writes, was seen as cause enough.

People with psychiatric disorders do hear auditory hallucinations in relatively high numbers. According to Ann Shinn, a psychiatrist at Harvard Medical School and McLean Hospital, 70 to 75 percent of people with schizophrenia or schizoaffective disorder and between one-third and one-tenth of people with bipolar disorder report hearing voices at some point in their life.

In the case of voice hearing, culture may also play a role in helping people cope. One study conducted by Luhrmann, the anthropologist, found that compared to their American counterparts, voice-hearing people diagnosed with schizophrenia in more collectivist cultures were more likely to perceive their voices as helpful and friendly, sometimes even resembling members of their friends and family. She adds that people who meet criteria for schizophrenia in India have better outcomes than their U.S. counterparts. She suspects this is because of "the negative salience" a diagnosis of schizophrenia holds in the U.S., as well as the greater rates of homelessness among people with schizophrenia in America.

The influence of social context was part of what motivated Corlett and Powers: The two were interested in whether the support of a social group can help them understand where disorder and difference intersect. When they set out to design their study, they needed an otherwise healthy group of people who hear voices on a regular basis, and whose experiences are accepted in their social group.

Next, they needed to find some psychics. Corlett told me he got the idea to reach out to a Connecticut-based organization for psychics after noticing the ads for psychics and tarot-card readers on his daily bus route. When the two interviewed those participants, they noticed something striking: The psychics described hearing hearing voices of similar volumes, frequencies, and timbres as the patients. Powers and Corlett took this to mean that the psychics were actually hearing something. The two also vetted their participants with the same techniques that forensic psychiatrists use to determine whether a person is pretending to experience psychiatric symptoms, giving them more reason to believe what they were told.

Compared to their diagnosed counterparts, more of the psychics described the voices as a force that "positively affects safety." And all of the psychics attributed the voices to a "god or other spiritual being." The patients, meanwhile, were more likely to consider their voices a torment caused by a faulty process in their brain. Many of them described the voices as "bothersome," and also claimed that the first time they told anyone what they were hearing, they received a negative response.

Just like Jessica, the psychics were more likely to say that they received a positive reaction the first time they spoke about their experience. Jessica's mother, Lena, told me she maintained a supportive, nonjudgmental attitude toward her daughter's accounts, just as she did when her other daughter converted to Scientology. She waited for Jessica to bring them up and discussed them with an open mind. She says she was happy Jessica found the center, adding that her only concern was that Jessica's experiences did sometimes seem to be distressing her and leaving her "drained."

When Jessica tells me about the people and things she hears, she describes a range of experiences rather than one consistent phenomenon. Her most meaningful episodes of voice hearing are those like the visits she had from her grandmother and her brother-in-law's father. But she also describes things like hearing the number a friend is thinking, and the persistent and vivid presence of a childhood imaginary friend (her mother told me Jessica demanded the table be set for him at every meal). To Jessica, these experiences differ in degree rather than kind from the ghosts of the dead who appear in front of her with persistent messages for her and for others. Though these might not all fit into the popular conception of a psychic, she understands them to exist along that same continuum.

In his book, Fernyhough describes a series of experiments meant to provide evidence for the connection between inner speech and hearing voices. In one, participants were played recordings of other people's speech alongside recordings of their own, disguised and distorted, and told to mark whether the voice was their own or someone else's. Those who experienced hallucinations were more likely to misidentify their own altered voices. A much older experiment found a kind of unconscious ventriloquism among a group of people with schizophrenia: When participants began to hear voices, researchers noted "an increase in tiny movements in the muscles associated with vocalization." The voices they heard came, in some sense, from their own throats.

These experiments suggest that auditory hallucinations are the result of the mind failing to brand its actions as its own. Watching what the brain does during these hallucinations may clarify how that works, and what differences in the brain create these experiences.

"When your brain signals to generate a movement," Shinn, the psychiatrist at Harvard, told me, "there is a parallel signal [known as an efference copy] that basically says 'this is mine, it's not coming from outside.'" This helps creates the sense of where a person is in space, that their hand belongs to them and it is moving from point A to B. In this way, the body labels its motions, and a possible parallel may exist for speech and thought. When people hear voices, they may be hearing 'unmarked' thoughts they do not recognize as their own.

Beyond that, Shinn told me, what is understood about the experiences of people who hear voices is limited. She sees Corlett and Powers's study as part of a growing interest in the lives of "healthy voice hearers"-an interest spurred, in part, by the Hearing Voices Movement. A network of advocacy groups, the Hearing Voices Movement presents an alternative to the medical approach based on the belief that the content of a person's voices can reflect the hearer's mental and emotional state. The groups encourage an approach in which, with the help of a facilitator or counselor, hearers listen to, speak back to, and negotiate with the messages they hear in hopes of learning to cope.

The hearing-voices advocate Eleanor Longden has said she considers her voices "a source of insight into solvable emotional problems" rooted in trauma rather than "an aberrant symptom of schizophrenia." As Longden tells it, that's how her own experiences with voices were understood when she first sought treatment for anxiety. Her psychiatrist told her how limited her life would be by her voices, she says, and the voices grew more adversarial.

Many mental-health-care providers-Shinn, Corlett, and Powers included-seem receptive to the Hearing Voices Movement's critiques, including an overemphasis on medication and an imperative for patient-focused treatment. Shinn credits the network with encouraging an approach that treats voice hearing as more than a checklist item adding up to a diagnosis of schizophrenia, and helping to reduce the stigma attached the experience of voice hearing.

But "there are certainly a lot of people for whom that will not be enough," she says. For some patients, voices can be impossible to reason with, and the burden of other symptoms of psychosis-disordered thought, delusions, the inability to feel pleasure-can be too great. And Powers and Corlett expressed concerns that the Hearing Voices Network may promote a false divide: the idea that the voices' perceived roots in trauma-rather than some accident of biology-means hearers should avoid medication. Biology and experience, they say, can't be so neatly separated. (Longden has written that "many people find medication helpful," and that the International Hearing Voice Network advocates for "informed choice.")

While Powers and Corlett don't believe the psychics and patients are experiencing the exact same thing, the two are cautiously hopeful that about a potential lesson in the greatest difference between those groups: the ability to control the voices they hear, which is something the psychics, including Jessica, showed in greater number than their counterparts. "When I'm in certain situations, I'm not open," Jessica said. For instance, when she's at work, the voices "can come in," she says, they "can hang out, but I'm not gonna talk right now. ... I still have to live this human life."

While learning control was a major part of Jessica's experience, so was learning to summon the voices she heard. Before training as a medium, she heard voices sporadically, she says, and began to hear them every day only after intentionally practicing at the center. Powers and Corlett acknowledge this general trend in their study: The psychics they spoke tended to seek out and cultivate the voice-hearing experiences.

In her work, Luhrmann has come across groups of people who-unlike Jessica-hear voices only as a result of practice. She gives the example of tulpamancers: people who create tulpas, which are believed to be other beings or personalities that co-exist along inside a person's mind along with their own. "Somebody in that community estimated to me that one-fifth of the community had frequent voice hearing experiences with their tulpas, that their tulpas talked in a way that was auditory or quasi auditory," Luhrmann said, a practice that she was told takes two hours a day to develop."That's connected to work. Psychosis is not connected to effort. It happens to people."

Longden, the Hearing Voices Network advocate, describes how she later learned to extract metaphorical meaning from the sometimes disturbing messages the voices had for her. Once when the voices warned her not to leave the house, she thanked them for making her aware that she was feeling unsafe, and firmly reassured the voices-and by extension, herself-that they had nothing to fear.

Though Jessica has a different understanding of her voices' source, it's hard not to hear echoes of Longden's account when she speaks about the sense of control she's developed. Longden talks to the voices as aspects of herself that call for a response, while Jessica addresses them as visitors who need to learn the rules.

Instead of tying these experiences to a discrete diagnosis, Powers and Corlett imagine a new kind of frame for voice hearing. Drawing a parallel with Autism Spectrum Disorder, the two are interested in the extent to which the psychics they saw "might occupy the extreme end of a continuum" of people who hear voices. "Much of what we perceive and believe about the world is based on our expectations and our beliefs," Corlett said. "We can see hallucinations as an exaggeration of that process, and the psychics as a sort of way-station on that continuum, and slowly but surely we can creep towards a better understanding of the clinical case and therefore better treatment. We haven't had new treatment mechanisms in schizophrenia for many years now."

The two freely admit the gaps between their ambitions and what they know so far. The study is preliminary, qualitative work-a follow-up brain-imaging study is in the works-and they did only interview a small number of people. Psychics, they say, are not so easy to come by.

Luhrmann speculates that most of the psychics are experiencing something separate from psychosis: "I think it's also true that there are people who have psychosis who manage it such that they don't fall ill and avoid this stigma and who really function effectively." This difference aside, she says, "it may still be possible to learn from people who have more control over their voices. .... to think about how to teach people."

At least as subtext, Powers and Corlett's study might suggest a kind of chicken-or-egg question: Were the psychics insulated from suffering because they were socialized to accept and cope with their voices, and were the psychotic patients suffering because they weren't? The better question is: to what extent were the two groups experiencing the same thing?

Shinn believes the fact that far fewer diagnosed participants were employed at the time of the study (25 percent, versus 83 percent of the psychics), and that the diagnosed participants experienced more symptoms of psychosis, suggests that they were suffering beyond the point of being useful comparisons. She thinks, rather, that a "constellation" of symptoms-not just auditory hallucinations or the stigma associated with auditory hallucinations-explain the difference in functionality. "The Powers study provides interesting results with potentially helpful clinical implications," she added, "but they compare very different groups."

Shinn, Powers, and Corlett are all adamant that people who hear voices and experience psychological distress shouldn't turn away from conventional psychiatric treatment, and that a "symptom"-in this case, voice hearing-only calls for clinical attention if it is a cause of suffering. But for those who are distressed, the level of understanding of their experience and the treatments available to them are still lacking. As Powers notes, many of psychiatry's more effective drug treatments were developed by accident. Shinn likens the current body of knowledge of schizophrenia to a group of people describing different parts of an elephant while looking through a high-power lens: There are robust bodies of work on the trunk, the tail, and the ear, but no clear picture of the entire animal.

Shinn's all too aware of the ways in which the diagnosis can overshadow the patient. "There have been psychiatrists," she says, "who will tell a patient: You have a diagnosis of schizophrenia and you need to modify or adjust your goals in life, forget grad school, forget that Wall Street career," Shinn said. "And that absolutely can be compounding and impairing. I don't disagree that that's a problem."

As Luhrmann put it: "Are those cultural judgments the cause of the illness? Absolutely not. Do those cultural judgments make it worse? Probably."

Jessica doesn't live near the center anymore. While she'd love to find fulltime work as a medium, she says, she's focusing on her graduate studies to become a dietitian for now.

Still, she's grateful for the community she found at the center, she says, and for the help they gave her. "I cannot imagine having no control over this," she told me. "I don't know, if I never went to the center, maybe I'd be diagnosed with schizophrenia."
*This article originally stated that Charles Fernyhough hears voices himself. We regret the error.

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Psychics Who Hear Voices Could Be On to Something

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The ways some "healthy voice hearers" cope might be able to help people with psychotic disorders. Jessica Dorner was lying in bed at her cousin's house when her grandmother, a "pushy lady" in an apron who had been dead for several years, appeared in front of her.