mental health

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New Podcast: Kids, Contact Sports And ‘Getting Your Bell Rung’

(Clappstar/Flickr Creactive Commons)

(Clappstar/Flickr Creative Commons)

If my son ever wants to play tackle football, my response will consist of four simple words: “Over my dead body.” (With perhaps the addendum: “Your brain is too precious to turn it into swiss cheese.”)

Thankfully, he has expressed no interest. But what if he did? And what about the concussion risks of other sports?

Happily, our regular CommonHealth contributors, Drs. Gene Beresin and Steven Schlozman, Massachusetts General Hospital child psychiatrists and excellent mental health communicators, have just created their first “What’s On Your Mind?” podcast. And their five-minute conversation addresses this very topic: Should my kid play contact sports? The podcast series is part of their public outreach mission at the new Clay Center for Young Healthy Minds.

Listen to the full podcast here. How often do you get to hear one psychiatrist call another “a shrimp”? But mainly, the information comes from solid sources — the CDC, concussion experts — and the upshot is clear: Kids shouldn’t start contact sports until age 14, according to the latest recommendations, because neck muscles get much stronger in adolescence and that helps protect the brain from impact. And the biggest takeaway: If a child take a significant head hit — if he “gets his bell rung,” as Dr. Schlozman’s football coach used to put it — he should be sure to sit out at least the rest of the game. Every concussion raises the risk for another concussion. When can he get back in? “Leave it up to their physician,” Dr. Schlozman says.

But all these new findings and warnings about concussions do not mean kids should avoid sports altogether. “They’re a huge part of growing up,” says Dr. Schlozman, who, at age 12, wandered over and sat on the opposing team’s bench after his own bell had been rung. “And as long as we’re careful, there’s no reason not to have fun.”

From the blog post that accompanies the podcast: Continue reading

Third Teen Suicide In Newton: What Can You Say?

Newton South (Wikimedia Commons)

Newton South (Wikimedia Commons)

Tonight at the Newton South High School auditorium, school officials and mental health experts will try to offer some guidance on how to talk to children about suicide and how best to support kids and families reeling from the news of a third teen suicide in this community since the start of the school year.

Tonight’s gathering comes after reports that 17-year-old Roee Grutman, a popular Newton South junior, committed suicide earlier this month. (According to the state Executive Office of Public Safety & Security, Grutman’s death was a result of “asphyxia by hanging.”)

Grutman’s death follows two other suicides: Katherine Stack, a Newton South sophomore, took her own life in October, shortly after Karen Douglass, a Newton North senior, also committed suicide.

At a memorial service for Grutman last night, hundreds of classmates and family members gathered to remember the “bright, articulate, compassionate” young man, The Boston Globe reports:

“One after another, the speakers at Monday’s service told of a young man who lit up a room when he walked in, and despite his schedule busy with honors classes and sports, always had time for a friend.”

According to parents in the Newton South community, many children are still in shock (as are their parents and teachers) and struggling to comprehend the string of suicides in general, and in particular, the death of a boy who appeared to be so well-adjusted, socially connected and stable.

“I think the kids are beside themselves,” said Elizabeth Knoll, whose 17-year-old daughter, Anya Graubard, is also a Newton South junior and was friends with Roee. “My daughter was gray and pale and tightlipped for the last two days.” (Knoll says Anya gave her permission to be named here.)

Knoll said in Newton — where many kids have been classmates since the age of 4 — Grutman’s out-of-the-blue suicide is particularly excruciating. “No one among his family or friends…could see anything like this coming,” Knoll said. “It’s impossible to make any sense of it.” Continue reading

A Phrase To Renounce For 2014: ‘The Mentally Ill’

nytsmallvert

(Carey Goldberg/WBUR)

I wince every time I read it. So does the president-elect of the American Psychiatric Association, Dr. Paul Summergrad, he says.

I saw it most recently in The New York Times, in the headline pictured above and a recent masthead editorial: “Equal Coverage For The Mentally Ill.” It’s all over, from The Boston Globe — “New Era for the Mentally Ill“ – to The Wall Street Journal — “Crime and The Mentally Ill.” Just about any media outlet you care to name.

What’s so bad about “the mentally ill”? Isn’t it reasonable shorthand in the usual headline space crunch?

In a word, no, says Dr. Summergrad, psychiatrist-in-chief at Tufts Medical Center and chair of psychiatry at Tufts University School of Medicine. He sees two main problems with it. First, the definite article, “the.”

“Imagine if I said that about any other group. It suggests that people who suffer with these conditions are somehow other than us, and can be put in a discrete and often stigmatized category. It creates a sense of otherness that is not the reality, statistically, of these illnesses.”

Any other group? I try a thought experiment, the headline “Equal coverage for the women.” Weird. “New era for the gays.” Offensive. “Crime and the blacks.” I get the point.

The term creates ‘a notion that it’s a uni-modal type of thing.  We need a more inclusive and more granular language.’

Second, Dr. Summergrad said, “there’s the denotation of what mental illness means, but there’s also the connotation. When people ask me, is it really possible that 25 percent of the population is mentally ill, what do they mean by that question?”

“That they think of it as something very extreme?’” I hazarded.

“Exactly, they mean that somebody has a form of very severe psychotic illness. But the reality is, what is a mental disorder? From a clinical standpoint, it means a disorder in various forms of mental functioning: thought, speech, emotion, behavior.”

And those disorders are myriad and mixed and often of general medical origin, with a range of “everything from Autism Spectrum Disorders to Attention Deficit Hyperactivity Disorder, through Obsessive-Compulsive Disorder, anxiety disorders, post-partum depression, recurrent depressive illness, dementing illnesses which have profound effects not only on memory but on behavior. Parkinson’s disease has high rates of very severe anxiety and depression.”

So the term “the mentally ill” creates not just a notion of separateness and otherness, Dr. Summergrad said, but also “a notion that it’s a uni-modal type of thing. And I think we need a more inclusive and more granular language.”

I’d add a third argument against “the mentally ill,” gleaned several years ago when I was writing a Boston Globe story about people who recover enough from their own mental illnesses to become “peer specialists” who help others with similar challenges. Continue reading

Home For The Holidays, Facing Empty Chairs At The Table

(Courtesy Gene Beresin)

A tribute to Tony Davenport, a dear college friend of Dr. Beresin’s who died of cancer in 2004.(Photo courtesy Dr. Beresin)

By Dr. Gene Beresin and Dr. Steve Schlozman
Guest contributors

Here we are as in olden days
Happy golden days of yore
Faithful friends who are dear to us
Gather near to us once more

Through the years
We all will be together
If the Fates allow…

From: “Have Yourself a Merry Little Christmas”

Here we are in the Holiday season. It’s inescapable.

The sounds of cheer, good spirits, happiness are all around us – on the television, in the best wishes of friends and colleagues, in the many cards we all receive in the mail, in the sometimes terribly annoying music in virtually every store you march into, on the pop-ups on your computer, and, most importantly, at home.

We’ve all heard talk about the stress of the holidays, but there is a special kind of seasonal pain that is almost never discussed: Family gatherings accentuate the absences.

We miss those who are no longer with us. There is usually an empty chair or two at the holiday table. And that pain can be pretty intense at times. A child who has died, a grandparent who has departed…those wounds take time to heal. Must we maintain our holiday cheer? The songs of the season don’t really give us instructions.

Just a light for someone still loved.

So, of course we feel sad. In fact, we can indulge these feelings as a kind of nostalgia. The term comes from two Greek words, nóstos, denoting homecoming, and álgos, meaning ache. Yet the feeling of nostalgia is not necessarily painful. It is the sentimental feeling of missing the happiness of times gone by – a kind of longing for the loved ones we miss and the times we spent with them.

It’s really a bunch of feelings. A happy and sad emotional jumbling.

And this need not be a bad thing. It maintains our connection with the past. It reminds us of the bonds we feel for those who played an important role in our lives. And, in fact we often replay in our minds those times we spent with those who are absent: a father’s jokes, a grandparent’s laugh, the pranks of a sibling. Continue reading

Coakley: Mental Health Care Is Next Great Mass. Challenge

Attorney General Martha Coakley

Attorney General Martha Coakley

As WBUR’s Martha Bebinger reported, Massachusetts attorney general (and gubernatorial candidate) Martha Coakley is calling for the state to build “a behavioral health system for the 21st century.” Coakley spoke this morning to the Massachusetts Association of Health Plans. She recalled her brother, Edward, who began to struggle with depression at 17 and committed suicide at 33. We asked her office for the prepared text of her speech; it is excerpted below.

“…Which brings us to the third great challenge that I would like to pose to everyone today – improving access to quality behavior health care for everyone who needs it.

This is no small challenge.

There are millions of families dealing with the effects of mental illness across our country.

According to the National Institute on Mental Health, one in four adults suffers from a mental disorder in any given year. It’s probably higher.

And in a time when soldiers have returned from two separate wars, studies have shown that 20% of returning Iraq and Afghanistan veterans report symptoms of PTSD or major depression. It’s also most likely higher.

On Veterans Day, I learned that there are 22 suicides a day by veterans.

Some of you may know that my family dealt with the impact of mental illness.

My younger brother Edward was a brilliant person – he was smart, funny, a great pianist. He also suffered from depression, onset around 17 or so.

He struggled with it for much of his adult life, and my family struggled with how to help him.

When he was 33 years old, he committed suicide.

My parents had died just 1 and 3 years earlier. It was difficult for me and my sisters.

It is why I know first-hand – as many of you do – that behavior health care is as vital to the treatment of many patients as physical health care. Continue reading

Memories Of A Veteran’s Son: Living With Undiagnosed PTSD

Victor E. Beresin, DDS, was discharged as a Major from the Army, having been promoted to Captain, and won the Bronze Star for his work on the battleship in the Pacific. (Courtesy Gene Beresin)

Victor E. Beresin, DDS, was discharged as a major from the Army, having been promoted to captain, and won the Bronze Star for his work as a medic on a battleship in the Pacific. (Courtesy Gene Beresin)

By Dr. Gene Beresin
Guest Contributor

Waking my dad early in the morning was terrifying. I learned not to do it – not an easy thing for a very young kid.

When I crept into my parents’ bedroom across the hall, I found that if I jumped into bed from my mom’s side, it all went just fine. But if I even tapped my dad and woke him from a sound sleep, he jumped a mile high, looking absolutely terrified, screaming, “What is it! What’s happening? What’s going on?”

It was damn scary. I learned quickly to go to the right side of the antique maple bed, never to the left.

And if I woke Dad from a nap in his study (he would often crash on the tiny bed there, working endlessly on lectures, slides and writing his books) he would jump and scream just as loudly. I stayed away and let my mom do it.

There were also the bouts for a week or two of shaking, sweating, and turning beet red, up night after night – events I recall once or twice during my childhood. Mom said not to worry; he was just having some kind of reaction to an illness he got in the war. “Malaria,” she said. “It will pass.”

Don’t worry? My dad was convulsing. He looked like he was going to die.

No one ever told us about PTSD. The term was not even a term back then. It was the 1950’s, and later the 60’s. My generation only knew that our dads had fought in “the war,” and that now they were home.

In fact, my dad loved to watch World War II movies. We watched them together ritually, just as we watched football games. I knew he hated the Nazis, and I was glued to the screen. As I got older, I started asking questions. Continue reading

I’m Finally Thin — But Is Living In A Crazymaking Food Prison Really Worth It?

(nataliej/Flickr)

(nataliej/Flickr)

I am not fat. At just over 5 feet tall and 101 pounds, I’m actually closer to thin. It shocks me to even write this, but after a zaftig childhood and a curvy-bordering-on-chunky early adulthood, I find myself, in middle age, after two kids, to have reached my “ideal” weight.

But lately I wonder if it’s really worth it.

From the outside, thin is surely better. Other moms tell me I look great. I can consider bikinis. I appear far younger than my actual age and, with a perky, teen-sounding BMI of 19.9, I fit in my daughter’s Forever 21 tops.

But peek inside my brain: it’s alarming.

(Rachel Zimmerman/WBUR)

(Rachel Zimmerman/WBUR)

I spend an inordinate, and frankly embarrassing amount of time thinking about food, planning meals and strategizing about how to control my weight. It’s on my mind pretty much every waking hour of every day and the details are painfully banal: how many pumpkin seeds in my nonfat yogurt; will a green smoothie pack on an extra ounce or two; can I eat dinner early so my weight the next morning will be optimally low?

If I don’t exercise (Every. Single. Day.) I get depressed. If I stray from my short list of accepted foods, I can spiral out of control. My life is bound by a strict system of controls and rigid rules (maintained with a pack-a-day gum-chewing habit) that keep my weight in line. These include daily digital scale checks that set my mood each morning: 102.9 is bad news; 100.4 gets me high. Trivial? Yes. A shamefully first-world problem? Absolutely. But, sadly, true.

And widespread. A new report on women and body image conducted by eating disorder experts at the University of North Carolina makes clear the scope of the problem: a mere 12 percent of middle-aged women are “satisfied” with their body size. (An earlier study put the number at 11 percent.) What’s worse, perhaps, is that even those relatively content ladies are troubled by specific body parts: 56 percent, for instance, don’t like their stomachs. Many dislike their skin (79 percent unsatisfied) or faces (54 percent unsatisfied) or any other parts that suggest, in Nora-Ephron-neck-hating-fashion, they are aging.

The author as a not-quite-svelte child, in an undated photo from the 1970s.

The author as a not-quite-svelte child, in an undated photo from the 1970s.

The very first sentence of the study, published in the highly un-sexily titled Journal of Women and Aging, makes clear that women who are happy in their own skin are a rare, exotic breed; specimen worthy of study by a crack team of anthropologists. The report begins:

We know strikingly little about the intriguing minority of women who are satisfied with their body size. Defined as having a current body size equal to their ideal size, body satisfaction is endorsed by only about 11% of adult American women aged 45–74 years.

If you dig a little deeper into the study you’ll find that this “body satisfaction” is fragile. Women were asked if they’d remain satisfied if they gained five pounds. The answer (duh): “No.”

And these so-called “satisfied” women seem to spend a huge amount of energy maintaining. Continue reading

The Last Bill JFK Signed — And The Mental Health Work Still Undone

President John F. Kennedy in 1962 (Wikimedia Commons)

President John F. Kennedy in 1962 (Wikimedia Commons)

On Oct. 31, 1963, President John F. Kennedy signed a bill meant to free many thousands of Americans with mental illnesses from life in institutions. It envisioned building 1,500 outpatient mental health centers to offer them community-based care instead. The bill would be the last piece of legislation Kennedy would ever sign; he was assassinated three weeks later.

To mark the law’s 50th anniversary, former Congressman Patrick Kennedy and others are convening at the Kennedy Library today to discuss how to improve mental health care now. Here, Vic DiGravio, president of the Association for Behavioral Healthcare, which represents Massachusetts community mental health clinics, comments on the law’s effects — and what remains to be done.

By Vic DiGravio
Guest contributor

Fifty years ago, when President John F. Kennedy signed the Community Mental Health Act into law, the quality of life for hundreds of thousands of men, women and children in Massachusetts and across America was stunted and grim. For the most part, daily life was a gray tableau behind locked institutional doors, marked by inadequate treatment, primitive medications and isolation from family, friends and the community.

Patients in locked facilities were subject to retaliation if they complained about conditions. Family members were frequently discouraged from inquiring about care. Massachusetts and other states operated a patchwork of in-patient state hospitals that served as little more than systemic quarantine facilities.

In the final bill he signed into law before his death, President Kennedy called for society to embrace a new vision for people with mental health disorders and developmental disabilities, one in which the “cold mercy of custodial care would be replaced by the open warmth of community.”

Since then, perhaps no other field of health has changed as much and affected as many people as positively as the treatment of people with mental illness. The shift from in-patient to community-based care has created a more humane, effective and dignified network of support and treatment for men, women and children.

The three largest mental health providers in the nation today are jails.

In Massachusetts, we created a network of private community-based agencies to serve people where they work and live. Many of these organizations are members of the Association for Behavioral Healthcare. These organizations serve over 750,000 men, women and children each year.

On Wednesday, October 23, hundreds of behavioral health-care advocates, providers, researchers and policy makers will gather at the Kennedy Library in Boston, led by JFK’s nephew and former Rhode Island Congressman Patrick Kennedy, to commemorate the signing and discuss the need for a renewed commitment to support the millions of Americans and their families affected by mental illness, intellectual disabilities and addiction disorders.

The Community Mental Health Act reflected a bold new vision for the treatment of mental illness, but much remains to be done to fulfill that promise.

WHile the legislation did usher in positive and hopeful changes for millions of people with serious illnesses such as schizophrenia, progress stalled because of funding challenges and continuing stigma. Continue reading

Huh? Hunger Hormone May Be Key To Stress Effects On Mental Health

Dr. Ki Goosense and .....

Dr. Ki Goosens and Technical Associate Junmei Yao examine a piece of human brain at the McGovern Institute for Brain Research. They are looking for stress-sensitive genes that are abnormally activated in the amygdala — a brain region that regulates emotion — in people who committed suicide. (Courtesy Justin Knight Photography and McGovern Institute)

(Click the play button above for the audio version of this story.)

Neuroscientist Ki Goosens does her research with black and white rats, but what she has discovered could be very relevant to humans — including her own family.

In the last eight years, three family members have become suicidal in the wake of a “major life stressor” like divorce.

“For years, they were fine, and then it triggers some cascade of vulnerability,” she said. “So I feel a sense of urgency in trying to come up with new ways to think about how we can block the ability of stress to worsen mental illness, to trigger mental illness.”

Goosens and her team at MIT’s McGovern Institute for Brain Research have just published what could be a major lead: A hormone called ghrelin — known as the hunger hormone and made in the stomach — may be a key to post-traumatic stress disorder and other stress-related mental illnesses.

The research is still early, but it raises the possibility that drugs that block ghrelin could be used to block some of the mental harm done by chronic stress.

‘I’m a neuroscientist. I study the brain. But you sort of go where the data take you.’

Goosens and her collaborators at Mass. General Hospital are now planning two studies on ghrelin in humans: One will determine whether ghrelin levels are elevated in people with anxiety disorders; the other will block ghrelin signaling in hopes of preventing stress-related relapses of depression.

Goosens never expected to be using a hunger hormone to understand stress: “If you had asked me five years ago if I would be doing something related to the stomach, I would’ve said, ‘No way, you’re crazy. I’m a neuroscientist! I study the brain,’” she said. “But you sort of go where the data take you.”

She originally set out to explore how stress affects the activity of genes in the amygdala, a part of the brain that processes emotions. Continue reading

Why I Left Medicine: A Burnt-Out Doctor’s Decision To Quit

By Diane Shannon
Guest Contributor

When I introduce myself as a physician who left clinical practice, non-physicians ask me why I left. They’re generally intrigued that someone who sacrificed many years and many dollars for medical training would then change her mind. But physicians, almost universally, never ask me why I left. Instead, they ask me how. They call and email me with logistical questions, wanting to learn the secret of how I managed the transition out of clinical medicine (read “escape”).

Earlier this month I attended a conference on physician well-being at the Massachusetts Medical Society where I heard an alarming statistic: the suicide rate among women physicians is more than two times that of women in the general population.

Diane Shannon, plagued by constant worry about patients, and fear of medical errors, gave up her career as a physician. (Courtesy)

Dr. Diane Shannon — plagued by constant worry about her patients and fear of medical errors — walked away from a career as a physician. (Courtesy)

It may be dramatic and self-serving to frame my career change as a way to avoid suicide, but I can attest that medicine was not conducive to my health. As an internist, working in adult outpatient clinics around Boston, I had trouble leaving my work at work. I’d go for a run and spend the entire 30 minutes wondering if I’d ordered the right diagnostic test. I suffered from chronic early morning wakening, even on my weekends off. I startled easily. I found it impossible to relax. I worried constantly that I’d make a mistake, like ordering the wrong dosage of a medication, or that a system flaw, like an abnormal lab report getting overlooked, would harm a patient. I no longer remembered the joy I’d felt when I first began medical school, and I couldn’t imagine surviving life as a doctor.

I no longer believe it was weakness or selfishness that led me to abandon clinical practice. I believe it was self-preservation. I knew I didn’t have the stamina and single-mindedness to try to provide high-quality, compassionate care within the existing environment. Perhaps, due to temperament or timing, I was less immune than others to the stresses of practicing medicine in a health care system that often seemed blind to humanness, both mine and my patients’.

That’s not to say that I don’t miss practicing medicine. I do. I miss engaging in meaningful interactions and being of service, reassuring an elderly woman that we could make her emphysema easier to endure, bearing witness to a cancer patient’s grace in the face of death, supporting a college student facing an unexpected pregnancy. I miss spending my days in deeply meaningful work. Continue reading