Dialectical Behaviour Therapy (DBT)

dbt

Dialectical Behaviour Therapy is a specialized type of talking therapy under the general category of Cognitive Behavioural Therapy (CBT).  This kind of CBT was developed by psychologist, Marsha M. Linehan, in the 1980’s  to especially focus on treating Borderline Personality Disorder (BPD) and has since proven to be a valuable treatment for this particular mental illness.

What does “Dialectic” in DBT mean?

The word dialectic in the term Dialectical Behaviour Therapy refers to the unification or synthesis of two opposing positions, concepts, or realities.  DBT seeks to meld two key concepts that naturally oppose each other:  acceptance and change.

Acceptance refers to coming to terms with who you are—your emotions, experiences, and natural responses.  Change means altering your responses and thoughts toward more positive behaviour and coping strategies in order to reach personal and social goals in becoming a more integrated individual.

People with Borderline Personality Disorder have very heightened negative emotions.  As a result, they are often acutely emotionally unstable and have a tendency toward inflicting self harm and attempting suicide.  DBT seeks to help BPD patients accept their personal liabilities and to help them acquire new behavioural skills to replace their ineffective and damaging responses for achieving emotional stability and personal goals.

Four Stages of Treatment with Dialectic Behaviour Therapy

The end goal of all four stages is to mould the patient toward making their own paradigm shift from feelings of worthlessness to:  I am worth as much as everyone else; life is worth living.

Stage 1:  Achieving Behavioural Control

At the start of therapy, the patient’s condition may be dangerously low—in psychological misery, out of control, and therefore may be self-destructive with drug and alcohol use, sexual promiscuity, or binge eating.  They may also be suicidal with a history of attempts or still at the contemplation stage.  The objective of Stage 1 therapy is to assist the patient into gaining command of his spiralling out-of-control thoughts and behaviour.

Stage 1 is all about setting and achieving three main goals:

  1. Stop suicidal or self-harming behaviour
  1. Rid the patient of obstacles or behaviour that prevent or interfere with therapy — the patient may justify to himself why he does not need to go on with therapy or his family may be embarrassed about his condition and prevent him from getting needed treatment.
  1. Addressing issues that lower patient’s quality of life — Problems like depression, unstable relationships, or being expelled from school may be issues distressing the patient to a volatile degree.

At this stage, the therapist tries to equip the patient with emotion-managing skills so that the patient can disengage from dangerous behaviour and gain some mastery over his negative thought patterns.

Stage 2:  Emotional Experiencing

Although Stage 1 behaviour control has been achieved, the patient continues to suffer quietly.  Their emotional turmoil is usually due to past trauma and invalidated feelings.  For those with Post Traumatic Stress Disorder (PTSD), past trauma is explored and analysed and its accompanying negative beliefs and behaviours, verified.  PTSD is treated at this stage.

The goal of stage 2 is to move the patient past suffering with inhibited emotions and on to a level where they experience their emotions in full.  At this second stage, the therapy involves the following:

  1. The patient is encouraged to remember and accept the traumatic event.
  2. Reduction of stigmatization
  3. Reduction of self-blame
  4. Lowering incidences of negative intrusive and denial syndromes

Stage 2 goals can only be achieved once negative behaviour is under control.

Stage 3:  Learning to Live

Stage 3 focuses on building self-esteem, owning one’s behaviour, creating trust and value for one’s self, and goal setting.  The patient is gradually led toward coming to terms with happy and unhappy events in life, thus enabling him to live life normally.

Stage 4:  Building Capacity for Joy

Some people stop at stage 3 but for others, stage 4 is an important part of recovery.  Stage 4 is all about spiritual fulfilment which helps the patient feel connected to humanity as a whole.  The goal at this stage is to help the patient go beyond just living day to day and be able to incorporate the ability to experience joy and freedom.

DBT-Skills

Scientific evidence has proven Dialectical Behaviour Therapy to be effective in lowering rates of suicides, self-harm, dropouts in treatment, depression, hospitalization, and substance abuse.  DBT has indeed helped many patients to improve functioning and relationships in their personal and social lives.

Seasonal Affective Disorder (SAD)

winter blues

Seasonal Affective Disorder, properly appellated with an acronym SAD, is a type of depression that occurs at the same season each year.  Winter is the most common time for SAD and that is why this emotional phenomenon is also known as winter depression or the winter blues.

The symptoms of depression usually begin sometime during late autumn when days become shorter and continue toward winter.  This low mood takes an upturn when  spring and summer come along.  Unfortunately, SAD may return the next autumn or winter season to begin its cycle.

Causes of SAD

Scientists are not sure what causes Seasonal Affective Disorder but the theory is that the lack of sunlight during autumn and winter’s shortened periods may have some effect on the brain’s hypothalamus which in turn has something to do with:

  • upsetting one’s circadian rhythm which throws your sleep-wake pattern off-kilter
  • lowering the levels of serotonin in the brain.  Serotonin is a hormone that affects one’s mood, sleep, and appetite
  • increasing the production of the hormone, melatonin, which makes one more drowsy than usual

Symptoms of SAD

SAD is a subtype of major depression, the only difference is that it comes and goes with the trigger season.  The symptoms can range from mild to severe, in which case the symptoms may hamper the person’s day-to-day activities.  Symptoms of SAD include:

  • chronic low mood or sadness
  • irritability
  • feelings of hopelessness, despair, guilt
  • plunging self-esteem
  • anxiety
  • lethargy and drowsiness during daytime
  • disinterest in day-to-day activities or even hobbies.  A person with SAD may suddenly take no pleasure from his usual interests
  • sleeping longer hours and still feeling exhausted upon waking
  • insomnia
  • carbohydrate cravings
  • weight gain
  • weakened immune system

Who are Most at Risk?

There seems to be more women patients of SAD than there are men.  People who live far from the equatorial region which have shorter daylight hours are prone to the condition.  It is however interesting to know that Iceland has a very low incidence of seasonal affective disorder.  The theory is that Icelanders eat a voluminous of fish, about 90 kg.  per year, compared to Canadians who average only 24 kg. per year and have a high incidence level of SAD.

SAD is also hereditary so people with the genes may develop the condition.

Additionally, age is a factor for susceptibility as well.  People between the ages of 15-55 are at higher risk of developing SAD than other age groups.

Treatment for SAD

Different treatment strategies are available for Seasonal Affective Disorder.  These are:light therapy

  • Light therapy – a light box is employed for the patient’s needed exposure to light.  This special lamp is made of fluorescent lights that are brighter than indoor bulbs but not as bright as
    natural sunlight.  UV lights, tanning lights, and heat lamps cannot be used to substitute for light boxes.
  • Cognitive Behavioural Therapy (CBT) or other talking therapies.  Counselling can help one understand SAD, manage its symptoms, and help prevent future recurrences.
  • Lifestyle modifications – implementing an exercise regimen, changes in diet, adjustment in sleeping schedules, and the like to maximise exposure to sunlight and manage stress
  • Antidepressant Medication – these include SSRIs such as Paxil and Zoloft or bupropion (Wellbutrin) and venlafaxine (Effexor).
  • Vitamin D supplementation – Another theory of cause for SAD is that the sufferer may not have enough Vitamin D because of insufficient absorption of Ultraviolet-B by the skin.  In this case, Vitamin D supplements may then be included as part of the therapy.
  • Negative air ionization — Releasing a sufficient density of negatively charged particles into the air while a patient is asleep has led to almost a 50% improvement in the condition.

Clinical Negligence

Inspector. Graphics are my artwork. Thanks. Red leather Clinical Negligence law book with gold embossed type and stylised syringe logo, with a judge’s gavel.

What is Clinical Negligence?

Under the laws of the U.K., clinical negligence, also referred to as medical negligence, occurs when a healthcare professional has been found in breach of a duty of care which has caused the patient to suffer physical or psychological injury or even death.  Healthcare professionals do not just refer to medical practitioners such as surgeons, cardiologists, and gynaecologists.  The term also encompasses dentists, midwives, nurses, physical therapists, psychiatrists, and other people with occupations under the healthcare profession.

In order for clinical negligence to be recognized in court, there are three things that must be proven:

  • Liability or Breach of Duty
  • Causation
  • Damage

Breach of Duty

If a healthcare professional’s care for a patient has fallen below the standards of care required by his field and can be proven in the court of law as such, then he is guilty of a breach of duty.  A certain test used by the court, “The Bolam Test” serves as a scrutiny on whether the defendant’s patient care actions have been subpar and clearly have not met the standards known to a body of practitioners also skilled in the same field.

Breach of Duty may arise from:

  • wrong diagnosis or failure of diagnosing condition
  • failure of warning or giving proper information about the risks of treatment suggested
  • failure to get proper consent to treatment
  • prescribing or giving the wrong medications
  • careless surgical procedures; mistakes while doing a procedure or operation
  • delayed referral to other specialists

Causation

It is not enough to prove that the healthcare professional has not been meeting his field’s standards of practice.  It must also be proven that the damage or injury to the patient has arisen from the practitioner’s negligence or breach of duty.  In practice, this is more difficult to establish than the fact that the accused professional has not met his field’s standards in patient care.

For instance, the aggrieved patient may be able to prove that his psychiatrist made a wrong diagnosis but he may find that he may have to work harder to prove that his worsening depression is a direct result of that error and not part of an already existing mental illness.  In this case, the court may agree that there has been a breach of duty but no causation or resulting damage; thereby, no compensation may be given.

In rare cases where the healthcare provider may admit a breach of duty, this is not enough to neither establish a clinical negligence case nor expect the accused to be liable for any damages.  It must be proven first that damage clearly arose from that breach of duty before liability can be established.

Damage

When breach of duty and causation has been proven, the claimant must prove the existence of the damage against which a claim can be made.  Damage refers to physical injuries, psychiatric injuries, and financial losses such as loss of income.  Psychiatric injury refers to a recognised psychiatric impairment such as PTSD (post traumatic stress disorder), clinical depression, and anxiety disorder.  Normal emotional upsets and grief are not psychiatric disorders and are therefore not considered damages for which claim can be made.

Other Factors to Consider When Pursuing a Claim

Clinical negligence is not easy to establish and court proceedings may take some time to resolve the issue.  A High Court claim may take as long as six years.

There is a time limit for applying legal action for clinical negligence.  The time limit is 3 years unless stipulated in the Limitation Act 1980.  Getting your solicitor’s services way before the three year application period is over will give him time to review your case properly and gather the necessary documentation.

The cost for a clinical negligence case is prohibitive so one has to be financially prepared when filing this particular lawsuit.  Most clinical negligence cases can no longer claim the benefits of legal aid under the Legal Aid, Sentencing, and Punishment of Offenders Act 2012.  Legal aid is only available in clinical negligence cases where a child suffers from a neurological damage which results in her being severely disabled during childbirth, pregnancy, or the 8-week postnatal period.

 

The Achievable State of Well-Being

Well-being (1)

We all try to achieve well-being; but, for many people this state of balanced health and happiness is an elusive prize.  Even governments realize the need to measure their nation’s well-being as a factor of national health.  How does one define well-being and why is it important?

What Well-Being Is

Merriam-Webster’s Dictionary simply defines well-being as “the state of being happy, healthy, or prosperous. “  One’s well-being or welfare does not only imply the absence of illness but it is a complex combination of a person’s state of satisfaction socially, psychologically, emotionally, and physically.

A person’s general well-being is based on the state of health of two aspects:  the physical and the mental.  A person must be healthy both physically and mentally for his well-being to be in peak form.

An individual’s well-being may be in stasis for some time and then change gradually or suddenly.  Well-being may also vary from month to month or even from day to day.  To illustrate:  Chris may be dominating the gym, topping workouts for three months, and feeling self-confident and chippy.  A sudden death in the family however throws this equilibrium off balance, finding Chris shocked, grieving, and unable to muster the same motivation to work out as he previously did.  Chris goes through an emotional upheaval and becomes depressed.  Because he does not feel like working out much anymore, Chris gains weight, loses muscle tone, and starts down a gradual physical spiral.  In other words, Chris’ well-being takes a turn for the worse.  In this case, the deterioration of his mental well-being has led to that of his physical well-being as well.  This points to the fact that the welfare of both mind and body are connected; therefore, what affects one certainly affects the other.

Factors Influencing Well-Being

There is a multitude of factors that contribute positively or negatively to one’s well-being.  The degree to which these common factors are present may indicate one’s state of welfare:

  • Sense of purpose and relevance to others                                     aspects of well-being
  • Self-worth; self-confidence
  • General perception of life; level of optimism or pessimism
  • Possession of realistic and achievable aims
  • Financial security
  • Balanced nutrition
  • Sufficient regular exercise
  • Adequate rest and recreation
  • Fulfilling career
  • Spiritual life
  • Sense of belongingness
  • Freedom
  • Family relationships
  • Friendships and work relations
  • Ability to adapt to change

Many of these factors affect one another.  The level of one may dictate the levels of others.  For instance, having enough money allows one to experience more of life through travelling or taking up another hobby, thereby increasing one’s opportunities for recreation, self-growth, more friendships, and a higher sense of freedom.  Some factors may even compensate for the lack of other must-haves.  Being a successful mother may offset the lack of a working career and significantly higher income.

It actually depends how the person perceives the mix of factors he possesses by which he gauges his overall life satisfaction or well-being.  He may be a millionaire with a lot of power and freedom; but he may lack satisfying familial relations or friends he can trust.  In this case, he may regard his well-being as negative and may even envy a person of average means but with family and friends to rely on.

Maintaining Your Well-Being

Although life always throws us those proverbial left hooks, one must always try to achieve a positive sense of well-being in order to be happy.  The key word then is balance.  Try to achieve a balance between your mental and physical states.  Remember, your mental well-being depends on your physical one and vice-versa.

Mental Well-Being Maintenance

  • Build relationships

No man is an island and therefore everyone needs someone.  If you build constructive relationships with positive and supportive people, you are more likely to have a better self perception, a network of people you can talk to, and a lesser chance of feeling lonely and depressed.

Maintain the relationships you already have or have built.  Relationships need to be worked on or you lose touch.  Give time to connect with family and with people you consider as friends.

  • Keep Learning

There is always something new to learn and discover so make it a mission to do so.  Keep your mind spry by reading, learning new skills, and discovering new concepts.  Knowing more may push you to achieve more or see things in a different light.  In any case, any self-improvement goes toward boosting self-esteem and mental well-being.

  • Give Unto Others

A kind word, gesture, or token can make someone happy and you as well.  Giving of one’s self has a positive mental impact in terms of making one feel needed and relevant.  Joining a cause or humanitarian group could buoy your sense of well-being by opening you up to more friendships and helping you tap that innate well of good feelings when helping others.

  • Be Mindful

Mindfulness is being presently aware of everything around you.  Sometimes we forget how beautiful life is so we take a lot of things for granted.  We forget to see the beauty of a tree or how pleasant water feels when we drink.  Our mind is always on a million other things except for what is happening in the moment.  Being mindful is a practice that can help you approach challenges and increase your mental state of well-being.

Physical Well-Being Maintenance

Practice a lifestyle of:

  • good nutrition
  • regular exercise
  • adequate sleep

These are the foundations of good physical health.  It is worth including the habits of good hygiene and safe sex as additions to these tenets.

Every aspect of your life contributes to your well-being.  It is essential to find that balance and try to maintain it.  Of course, life changes can always throw you off-kilter, but one must always learn or know how to get back on that wagon of general contentment, happiness, engagement, enjoyment, and health…well-being.

The Exercise and Mental Health Connection

exercise lifts moods

The mind-body connection is so intertwined that one’s well-being hinges on the health of both of these major areas of the human organism.  An ailing body poses a psychological impact on the otherwise healthy mind.  Likewise, an unhealthy mind also impacts a person’s physical health.  For an individual to be considered in top form, both mind and body must be in good shape.

A person who wishes to achieve a balanced state of well-being in both mind and body should have a good level of physical activity as part of his lifestyle priorities.  People with jobs that demand some cardiovascular and muscle toning movements daily, such as fire fighting; construction work; and farming, are lucky to have some measure of fitness incorporated into their lifestyle.  Exercise does not just mean sports-related activities such as running, cycling, or weight lifting.  It also encompasses everyday movements that get tasks done like walking to the store, scrubbing floors, and lifting grocery bags.  The lowly house chores demand daily muscle movement and cardiovascular toning if one just does some manual cleaning.  For instance, floor scrubbing by hand can work your core area and back muscles.  Taking out heavy garbage bags and moving furniture also works on your gluts, thighs, arm, core, and back muscles.  You just have to know the proper form of deadlifting heavy weights so that you avoid any injury.

What Physical Activity Can Do For Your Mind

Many people underestimate the power of physical activity.  There is more to exercise than just muscle strengthening and cardiovascular endurance.  The human body is hard-wired to move frequently and the brain responds to these movements.  The amount of physical activity we do daily does have an impact on our brains.  Daily high levels of physical movements equate to more psychological positivity while an almost daily sedentary lifestyle may play an indirect or direct role in accelerating the degree of mental health issues over time.

Exercise Maintains Our Cardiovascular Health through the Sympathetic Nervous System

Research at the Wayne State University School of Medicine in Michigan discovered physical changes in brains of rats which were kept sedentary for three months.  These rats’ neurons acquired extra branches that connected to the sympathetic nervous system, part of the brain that controls our involuntary functions like breathing, heart pumping, constriction of blood vessels, and digestion.  Too many neuron branches apparently overstimulate the nervous system.  Because this system regulates the heart and blood vessels, an overactive sympathetic nervous system can spell hypertension and other cardiovascular illnesses.  It can also cause depression, anxiety, and disturbed sleep, among other things.  This just goes to show how dangerous long periods of physical inactivity can become.

Regular Exercise Improves Mental Healthbenefits-of-exercises1

Those who suffer from depression or anxiety disorder stand to gain a lot from a regular exercise regimen.  There is much scientific evidence that physically active people have significantly lower incidences of anxiety and depression than sedentary people.  Regular exercise helps minds cope with stress and maintain good moods.  A ten-minute brisk walk may even help alleviate a low mood, albeit temporary, much like a quick fix for a headache does.

According to a study, people who regularly do vigorous exercise may be 25% less likely to develop depression or anxiety disorder in the next five years.  Exercise can actually form part of a therapy for some people who respond quite positively to it.  For mild depression, exercise may even take the place of antidepressants as a treatment alternative.

Physical activity stimulates the brain towards the production of endorphins, those feel-good hormones that give one, the “runner’s high.”  Endorphins are natural sedatives and analgesics which reduce one’s perception of pain, tamp down stress, boost self-esteem, and improve sleep.  Regular exercise then improves mood and maintains it with the constant flow of “euphoric” endorphins.

Regular Physical Activity Promotes Good Sleep

One of the most telling symptoms of depression and anxiety is sleep deprivation.  A stressed person usually has a difficult time keeping to a healthy sleeping pattern.  Sleep deprivation contributes to fatigue, a form of stress, which exacerbates very low moods, worry, nervousness, and irritability.  It also impairs memory, perception, and other cognitive functions.

Regular exercise however has proven to be beneficial to insomniacs in the long term.  A study revealed that people with sleep problems reported improved sleep and rest after participating in a four-month long regular exercise program.  The key word here is regular because one just cannot expect better sleep patterns after one or two bouts of physical activity.  Steady sessions of exercise however builds up the body’s propensity toward better sleeping patterns.  This is why many physically active people tend to have better sleep quality than sedentary ones.  Better sleep quality translates to better mood states and reduced degrees of anxiety and depression.

Getting the Habit to Move

One has to incorporate some extra physical activity into his daily routine.  Instead of riding a car to work, have you thought of walking or biking to it?  How about getting that usual cup of coffee from a cafe a little further down your usual route?  Once you make a habit out of some extra activities, it would not be that hard to get moving more everyday.

 

Depression: When Sadness Becomes More Than Itself

depression

Clinical depression is a growing concern in the Western World.  It has become a common debilitating mental disease with one in five persons in the U.K. having had depression at some point in their lives.  It hits all age groups, income levels, and communities.  Its growth is accelerating to the point that it could become one of the most incapacitating conditions in the developed world by 2020, second only to heart disease.

Normal bouts of sadness are natural occurrences.  Death of a loved one, for instance, may cause one, grief.  In a mentally healthy individual, the intensity may last for a short time and taper off eventually to a steady acceptance.  Grief that spirals into clinical depression however will stay with the individual for the long haul and could disrupt his daily functions.

Depression Is a Real Illness

A person with a depressive disorder is truly sick.  Much like a physical illness in which an organ or its system is weakened, so it is with depression of which its compromised organ is the brain.  Diabetes, for instance, is a physical disease that involves the impaired function of the metabolic system to handle the hormone, insulin.  Likewise, the condition of depression involves an impairment of the nervous system manifesting with the imbalance of certain brain chemicals; low production of neurons and nerve cell connections; and impaired nerve cell growth and nerve circuit functions.

Many factors can trigger depression.  Life events can traumatize people into a depression.  Our biological makeup such as genetics and brain chemistry are major factors as well.  Serious medical illnesses such as cancer and Parkinson’s disease can also lead a person into a depressive state.  Some medications used to treat physical illnesses may have depression as its side effect.

The State of Depression Varies for Each Person

The degree, frequency, and length of depressive symptoms are as individualized as the person afflicted by it.  Symptoms vary from person to person with the variety dependent on age, gender, culture, and other factors.  Some people feel only a few symptoms while others are burdened by many.  In addition, there are people, especially children and adolescents, who do not even recognize the symptoms of depression.  Men feel it differently than women and have different coping strategies as well.

Symptoms of Depression

The tell-tale signs of depression include but are not limited to the following:

  • Sad or anxious mood that does not go away for a long time
  • Chronic empty feeling
  • Thoughts of suicide; attempts at suicide
  • Increased pessimism; hopelessness
  • Restlessness
  • Irritability
  • Insomnia or oversleeping
  • Decreased cognitive functions.  Depressed person has trouble remembering or making sound judgements or decisions.
  • Physical aches, pains, and other symptoms, such as headaches, palpitations, and stomach aches which do not test positive for any physical illness
  • Feelings of very low self-worth, inferiority, and guilt
  • Chronic reduced energy levels; exhaustion; fatigue
  • Fast weight changes and appetite changes
  • Loss of interest in things previously enjoyed; loss of interest in anything and anyone
  • Markedly reduced libido

Some people may not be aware of their depressed state because symptoms can come gradually to them.  They may have kept themselves busy to avoid feeling sad or hurt.  Eventually the strain does catch up to them and they start to exhibit some of the above symptoms.  Physical pains however without any physical cause may also signal that a person has a psychological issue.

Treatment for Depression

The good news is that depression, even severe cases, can be treated; however, diagnosis and treatment is best at the early stages where recovery is faster.  When you suspect yourself of being depressed, seek professional help as soon as possible.  Expect treatment to include talking therapies with your psychiatrist.  Antidepressant medication may also be prescribed if your situation warrants it.

What You Can Do to Help Yourself

Aside from seeking professional help, there are a number of ways by which you can help yourself feel better.  First thing you can do is take charge of your physical health.  As the mind and body are tied together, whatever affects the body affects the mind and vice-versa.  You can start by:

  • Eating a well balanced diet everyday
  • Beginning and sticking seriously to an exercise program
  • Avoid alcohol, caffeine, smoking, and illicit drugs.  These substances just worsen depression.
  • Fixing your sleeping patterns.  Getting a good night’s rest everyday is crucial to your recovery.

Your emotional state needs nurturing as well:

  • Find a trusted friend or family member you can talk to about your issues and emotional condition.
  • Approach depression with a plan.  Write down what you think is causing the problem and the positive ways you can fight your negative state.
  • Join a support group of people with the same problem.
  • Avoid making any major life decisions until you can handle big changes.
  • Avoid piling up more work to perpetually take your mind away from your issue.  You need to set aside time to go over the problem so you can eventually come to terms with it.

stronger than depression

Learn all you can about depression in order to understand the condition better.  The road to recovery may be a shorter path if you simply work positively toward achieving that healing goal.

Parenting With a Mental Health Problem

parenting with mental illness 1

Being a parent is no easy task and definitely not for the fainthearted.  Parenting becomes even more difficult if the parent himself or herself is disadvantaged with the added liability of having a mental health problem.

How does Mental Illness Affect Parenting?

Many children live with a parent who may have had a short-term mental illness or is currently suffering an ongoing one in which alcoholism, drug dependency, or depression is a fact of life.  U.K. statistics show that about 50% to 66% of parents with severe, long-term illnesses such as schizophrenia, bipolar, and personality disorder live with one or more kids under the age of 18.  These estimates intimate that about 17,000 children and adolescents are subject to living conditions under a mentally ill parent.

With a mental illness to deal with, many parents are under tremendous pressure to carry out their daily roles as nurturers, not to mention other roles such as workers, partners, friends, and the like that they struggle to fulfill.  Their troubling mental health, if not treated and supported, will often disrupt the stability of their children’s lives and their relationship with them.  Since parents with a mental problem can be unpredictable, their children may not know how to deal with sudden emotional crisis or how to come to terms with the emotional issues that come along with it.

A parent with mental disorder may feel that they have to put the needs of their children first which is exactly what any parent is compelled to do, whether they have or do not have any mental disabilities.  For mentally disadvantaged parents, doing so however may entail curtailed hospital stays and putting the brakes on medication expenses and intake.  As this may seem like a good thing to do in the short run, skipping or avoiding treatments may backfire on your capability as a parent, upending the balance of your relationship with your children.  Untreated depression, for instance, may make it very difficult or almost impossible for a parent to be emotionally engaged in their children’s lives  so much so that parent-child communication can become impaired.

How Does a Parent’s Mental Health Problems Affect Their Children?

Because the effects of mental illnesses are varied and sometimes unpredictable in individuals, so are the effects these have on the children under an afflicted parent.  Although genetics and home life pose high risks for mental illness on children with mentally unhealthy parents, not all children grow up to inherit the problem or be so negatively affected.  Just because a child’s parent has mental illness, it is not enough to conclude that the child will become mentally affected as well.

A child’s mental health under a mentally unwell parent will hinge on the following factors:

  • severity and length of time of the parent’s mental illness
  • age of the child during the onset of the parent’s illness
  • how the parent’s mental condition affects his behaviour and how this behaviour affects the child
  • degree of stress arising from the parent’s behaviour
  • degree to which the parent’s symptoms interfere with positive parenting such as parental interest and participation in the child’s daily life

With the above factors in mind, it is correct to surmise that a parent’s negative behaviour as a result of mental illness, however, can have many troublesome effects on a child.  Some kids withdraw emotionally, become anxious, and find focusing on schoolwork next to impossible.  Most of them are ashamed of their parent’s illness, consequently finding it distressing to talk about their problems and get the help they need.  Children also may become excessively worried about “getting infected” by the illness and may start to develop emotional problems.  The risk of these children acquiring mental illness is further escalated when poverty, bad living conditions, and chronic instability form the framework of their lives.

What Can a Mentally Ill Parent Do?

When a parent is mentally unwell, it is tough to make children, particularly very young children, understand and make sense of their parent’s behaviour.  Why does Mommy seem so happy for a whole week and then so despondent the next?

parenting with mental illnessOne of the best things a mentally ill parent can do is provide clear facts and information of their condition.  Children need to know what to expect from their ill parent’s conduct.  This will help mitigate the anxiety and confusion children often feel when faced with an adult’s bewildering behaviour.

The sick parent may also educate their kids on what they may find helpful and unhelpful in times when their illness strikes.  Kids can feel like they are contributing to their parent’s attempts to get well.  Bringing in another adult to take on the major part of the caregiving burden is a necessity to avoid placing a huge burden of caregiving on the children.

Parents may draw up a plan for childcare before a situation arises where they need to be hospitalized or are unable to do their responsibilities.  This plan should detail the child’s daily routine, likes, and dislikes and entrusted to a responsible child caregiver.  This way, the child can have a sense of continuity, security, and stability when the care giving is simply continued as is.

Above all, a mentally unwell parent must seek the proper professional treatment.  This way, the right decisions and support may be received, important factors that will greatly help both parent and child cope well with living problems from mental health issues.

Hypomania and Mania:  What is the Difference?

Hypomania, mania, and depression are all symptoms of bipolar disorder.  A bipolar disorder does not necessarily entail extreme emotional swings from mania to depression.  There is a moderate emotional and mental state in between termed hypomania.

What is Hypomania?

bipolar_type2

Hypomania is felt as a much lesser degree of mania.  It is a state in which a person has all the symptoms of mania but with less the severity and the impairment that mania usually creates.  A hypomanic person is on a “high” which puts him in a condition in which he feels more self-assured, energetic, expansively generous, sensual, and the like.  On the flip side, hypomania can also bring on irritability, distracted thinking, racing thoughts, anger, and a dissociative feeling from the world.

Although the positive side of hypomania sounds like a good thing (and indeed it does feel great), it nevertheless will inevitably dip into depression or escalate into mania if a hypomanic person’s bipolar disorder remains undiagnosed.

Just as mania and depression are mental states that may last for some time, hypomania can last anywhere from weeks to years.  Since the hypomanic condition does not really impair a person’s ability to function, hypomania may not be easily recognized enough to require a serious diagnosis or check.

Hypomania is more common in people with Bipolar II disorder.  Bipolar II differs from Bipolar I in the severity of the upswing moods.  Bipolar II patients do not experience extreme “elation” or “euphoria” typifying mania which often debilitates normal functioning, usually to a dangerous degree as to require hospitalization.  Instead, they experience the dampened version of mania in which recognizable symptoms are present but do not pose as much impairments to judgement as mania does with dangerous behaviour that is highly destructive to one’s self and others.

What is Mania?

manic episode

Mania is the state in which symptoms such as recklessness, irritability and aggression, super-inflated self-esteem and self-importance, and heightened senses are manifested in such extreme degree that resulting behaviour poses a significant threat to the bipolar patient’s safety and that of others.  A manic patient’s symptoms debilitate him and usually impair normal functioning and reasoning so much so that sometimes, hospitalization may be required.  A person who has impulsively thrown all his life’s savings on a sports car he can ill afford may be having a manic episode.

Symptoms of Hypomania and Mania

Both hypomanic and manic periods exhibit more or less these same symptoms:

  • Very energetic
  • Increased self confidence
  • Increased aggression and irritability
  • Feelings of intense happiness or “high”
  • Increased sense of entitlement or self-importance
  • Reduced concentration or focus; high distractibility
  • Decreased inhibitions
  • Increased sexual urges
  • Thoughts and ideas coming in fast
  • Increased sociability and social congress
  • Indulgence in daring behaviour, sometimes bordering on recklessness
  • Sharper sense of smell, taste, sight, and other senses

The Difference

While hypomania and mania share the same symptoms, the major difference between them is degree of severity.  Where mania takes these symptoms to a feverish pitch, hypomania simply coasts with these so that hypomanics actually feel great and are even grateful for this state as a relief from depression.  To illustrate, where a woman in a manic state may damagingly splurge on 20 handbags, a hypomanic one may still exhibit some reasonable financial judgement by buying only five handbags at her shopping spree.

If hypomania just weren’t part of a disorder, a majority of us would actually enjoy being in this state of mind.  With more energy and an increased feeling of purpose, hypomania can put us on a creative and productive high.  It may come with a certain degree of crankiness and feelings of disconnectedness; yet for people with bipolar disorder, hypomania is a much better condition to be in than having to ride depression and mania.

Hypomania however can morph into a full blown manic period or crash into a depression; so treatment must be sought to help to stave off the other undesirable mental states.

Treatment

The trouble with getting treatment for people in a hypomanic period is that they feel too good to believe they are sick enough to need help.  Professional help, however, is vital to stabilize the extremities of mental states of people with bipolar disorder.

There are several approaches to treating hypomania and mania.  Talking therapies such as Cognitive Behavioural Therapy (CBT), psychotherapy, and Mindful-Based Cognitive Therapy (MCBT) form one approach. Medications to help prevent a hypomanic’s from sliding into mania or depression is another.   Such drugs which should be prescribed by a psychiatrist, not just a GP, are antipsychotics, common of which are:

  • risperidone (Risperdal).
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)

Bear in mind that medications, prescribed or otherwise, usually carry side effects about which one must always discuss with their psychiatrist.

Workplace Discrimination against Employees with Mental Health Problems

workplace discrimination

People with mental health problems may often exhibit behaviour that triggers bullying and other discriminatory behaviour in the workplace.  If you have a mental health problem, it is important that you know your rights, although applying them may not be easy.

Mental health issues are particularly in the gray area of human rights protection because the law only recognizes a disability if this can be proven under this definition:  “a physical or mental impairment which has a substantial and long term adverse effect on his [or her] ability to carry out normal day to day activities.”  The difficult thing about proving a mental health problem as a disability is the fact that bipolar disorder, anxiety, depression, and the like may take on “invisible” symptoms.  Not many people will exhibit all-out signs of their conditions in a social setting much less a workplace setting.  People in these settings are trying their hardest to function normally to keep their jobs and dignity intact.  Mild behaviour may manifest, if ever, which is not enough to let others see the full-blown picture of an employee’s affliction.

The Equality Act

The Equality Act is a law passed in the U.K. to protect people with disabilities against discrimination at work.  If you are a regular employee, a contract worker, or an apprentice, this law protects you from being discriminated on the job, dismissed, made redundant, and even when applying for work.  Volunteers however are not covered by this Act.

A mental health disorder is considered a disability, although your particular condition must be proven in court as such.  If so, it is covered by the Equality Act which deals with:

  • Direct discrimination — you are treated badly at work because of your mental health issue or other employees are treated more favourably than you because of your disability.  This may involve all job stages including recruitment, employment, and dismissal including dismissal from redundancy.  Companies or employers are not allowed to make you take a pre-employment questionnaire concerning your health before a job offer.
  • Indirect discrimination — rules or practices that put workers with mental health illnesses at a disadvantage.  For example, obligatory shifting of work schedules to night hours which may affect sleeping patterns of employees with clinical depression.
  • Harassment/ victimisation — In a situation in which a worker with mental health disability is bypassed for a promotion in favour for someone with good mental health but with much less competence is an example of victimisation.
  • Employer’s duty to make reasonable adjustments for your disability — some workplace practices applicable to your job are not adjusted for your disability or no aids to help you adapt to the job have been made available
  • Discrimination arising from disability — arises when an employee is “punished” or meted out a consequence borne from his inability to perform his job for a short period of time because of his mental illness.  For instance, if an employee needed to take three days off from the job because of depression, disciplinary action against this employee may take the form of discrimination.

The Equality Act actually offers a broad range of protection against discrimination.  It also protects against discrimination of age, gender, race, religion, civil status, sexual orientation, and pregnancy.

Should You Tell Your Employer?

Should you tell your boss or your colleagues at work?  The answer is ambiguous at best and it would depend on you, your situation, and the type of people you choose to reveal your illness to.  If company rules and practices have been unknowingly discriminatory to you and is affecting your working abilities, it may be best to be upfront with your boss or human resources.  Of course, you may not need to tell all; but a certain amount of information which can help them understand your needs may have to be disclosed.

Be prepared for both positive and negative reactions.  Negative reactions may stem from their concern that the job you are being paid for may not be performed properly.  In addition, many mental health illnesses are often misunderstood so that your boss or colleague’s idea of say, bipolar disorder, may be that of an acute case which may be many levels far away from your own.

Set a good time and the right venue to talk to your employer about your condition.  Timing is important, especially when you are dropping a bomb.  Expect a lot of questions or even none at all. Your news may shock so different people have differing ways of accepting the news and working around it.

Remember, the aim in disclosing your illness is to help you get some reasonable concessions so you can perform your job better.  For instance, if you have anxiety problems, you might be able to wrangle a periodic work-from-home compromise.  Or if you have depression, permission for a once-a-day check-in with your mental health provider during work hours may be sanctioned.

 

Having mental illness does not give anyone the right to discriminate against you.  Understanding and a reasonable bit of work flexibility is all that may be needed to help you do your job well.

end mental health discrimination

 

Emotional Issues in College Life

Girl, at table, having trouble studying

The transition from high school to college is one of the milestones that mark one’s transition from childhood to adulthood.  For emotionally healthy young people, the transition is a challenge, positively met with plans, goals, and tests of their newfound independence.  For those with some emotional instability, the transition may compound brewing stress and anxiety, a crippling disadvantage that may outweigh any educational gains hoped for.  Before a student can take on the more demanding life college brings on, he must be in good physical, mental, and emotional shape to cope with inevitable triumphs and pitfalls coming his way from a new environment.

Common Mental Health Problems in College Students

Stress in college is the overwhelmingly huge trigger for mental health problems that may have been absent, hidden, or controlled during high school.  A May 20, 2013 article in the Guardian states, “Those who do experience mental health problems cite coursework deadlines (65%) and exams (54%) as triggers of distress.  Financial difficulties (47%), pressures about “fitting in” (27%) and homesickness (22%) also contribute to mental ill health.”

Common symptoms of mental illnesses plaguing a significant percentage of college students are:

  • Depression — the most pervasive problem among the other mental issues.  Depression can be dangerous as it carries the high risk of suicidal tendencies.  Depression should not be left untreated.  Students afflicted with depression must be aware of the triggers and symptoms and seek professional help in school if available or outside.
  • Anxiety Disorders — Seventy five percent of people who have had panic attacks, social phobias, obsessive-compulsive disorders, and the like have had anxiety symptoms before the age of 22.  Anxiety can be debilitating when it morphs into extreme worry based on unrealistic perceptions.
  • Eating Disorders — Anorexia, bulimia, and binge eating are common eating disorders that affect more female than male students.
  • Self-Harm  — Cutting, burning, or banging one’s head for the purpose of inflicting pain are signals of deeper emotional disorders.
  • Substance Abuse — The abuse of alcohol, prescription drugs, or recreational drugs is also a pervasive phenomenon.  Even mentally healthy individuals may fall prey to a drug habit when they start using drugs to stay awake for exams or simply to have fun.  The danger of substance abuse is addiction, sexual promiscuity without safety measures, and even sexual assault.
  • Sleep Deprivation — Drugs, depression, or simply a radical change in lifestyle of which college life can bring on, can trigger insomnia.  Bad sleep habits and chronic sleep loss can exacerbate any mental or physical health condition and even dampen coping mechanisms of mentally healthy individuals.  Insomnia is also a symptom of depression and anxiety.  Students need to factor in their sleep as an important necessity, one as vital as food is.

What Parents Should Know

Any adolescent can develop a mental health problem.  The problem is, parents often think these problems happen to other people’s children, not their own.  It is important to ascertain that your child has the emotional and mental capability to weather the ups and downs of being on their own in college.

Studies are showing that the greatest impediment to success in college is emotional instability caused by depression, anxiety, and eating disorders.  For the majority of emotionally challenged students, emotional instability can spell missed opportunities in their academic and social milieu.  For some whose mental health is in a more dangerous or debilitating condition, their lives could be at stake if their issues remain unaddressed.  Suicide is one of the leading causes of death among the college populace.

It is important to catch the first signs of a deteriorating mental health so that symptoms can be easily reversed.  In such a case, communication, lifestyle changes, and treatment must be addressed in order to effect positive changes and boost coping mechanisms.

college mental issues

What Colleges Should Know

Colleges should be sensitive and alert to the fact that one in five of their student population may likely be suffering some form of mental health issue; but, only a rare few of their students actually avail of the university’s counselling services.  In fact, only a handful would probably admit that they are suffering from anxiety, depression, an eating disorder, impulse control issues, personality disorders, substance addiction, or other mental health problems.

In this regard, universities may need to seriously look into their current student services that aim to address mental health problems.  Are counselling services diverse enough to meet differing personal and psychological needs?  Expanding institutional services or creating partnerships and referral services outside the school to include those such as women’s health centres, spiritual or religious organizations, substance abuse clinics, and the like may be of huge help in boosting student morale and health.