mental health

RECENT POSTS

Study: Soldiers Enter Military With Higher Rates Of Mental Illness

As suicide rates among soldiers climbed to new highs four years ago, researchers prepared surveys for the largest study to date of mental health risk within the military.

The study’s new findings, published as three papers in JAMA Psychiatry, show that soldiers who join the military come in with much higher rates of mental illness than the general public and that most suicides can be traced to these pre-enlistment conditions.

Researchers organized 327 meetings at Army installations across the country in 2011. A total of 5,428 soldiers — some in large auditoriums, some in small field offices — filled out questionnaires that they knew would be matched to their administrative records.

Almost 85 percent reported a mental health problem that began before they entered the military — with particularly high rates of impulsive behavior, trouble controlling anger and substance abuse.

Lead author Ronald Kessler, a professor of health care policy at Harvard Medical School, said many men and women reported developing new conditions while in the service. The soldiers’ anxiety, depression and PTSD were layered onto their existing problems. Continue reading

Study: Bullying Toll May Linger For Years, Leading To ‘Substantially’ Worse Health

(trix0r/flickr)

(trix0r/flickr)

Researchers at Children’s Hospital Boston report that children who have been bullied suffer not only the immediate blow of humiliation or worse, but that the toll of such childhood insults may linger for years — particularly if the bullying re-occurs — and lead to dramatically worse mental and physical health.

The negative impacts of chronic bullying may accumulate and snowball, researchers report, with ongoing bullying associated with greater depression symptoms in kids and lower self-worth over time.

From the study, “Peer Victimization in Fifth Grade and Health in Tenth Grade,” published in the journal Pediatrics:

We analyzed data from 4297 children surveyed at 3 time points (fifth, seventh, and tenth grades) in 3 cities. We used multivariable regressions to test longitudinal associations of bullying with mental and physical health by comparing youth who experienced bullying in both the past and present, experienced bullying in the present only, experienced bullying in the past only, or did not experience bullying.

RESULTS: Bullying was associated with worse mental and physical health, greater depression symptoms, and lower self-worth over time. Continue reading

Newton Suicides: Is High-Achiever School Culture Breaking Our Kids?

Nearly 400 parents attended a community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

Nearly 400 parents attended a community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

Dr. Gonzalo Bacigalupe is the president of the American Family Therapy Academy and a professor in the Department of Counseling and School Psychology at the University of Massachusetts Boston. He’s also a Newton dad, and writes here about the need to address the toxic effects of high-stress school culture and its possible role in recent teen suicides.

In Newton there have been three suicides in less than four months among our high school kids. To us, it feels like an epidemic. In general, the response of the school system has been to provide grief counselors plus meetings to air the sadness and share what the school is doing or plans to do in the future. Experts talk about suicide and psychological problems; they tell us, parents, what we already know: support your kids and be mindful of their mood and behaviors. The message: this is either a mental health problem or a parental issue.

But the school system is not taking responsibility for the stress the kids feel day after day because of the tremendous pressure the Newton high school culture exerts to achieve academically, participate in multiple extracurricular activities, and/or play competitive sports — never just for fun, always to score the best.

Of course, some students put pressure on themselves, and some feel pressure from their parents and peers. But the school system must hold itself accountable for the pressure it puts on its students.

The official message accepts this situation as an individual or family problem, rather than part of a collective narrowness and craze about achievement.

“Who could ever imagine that we’d be back here again under similar circumstances?” asked Newton Public Schools Superintendent David Fleishman Tuesday night as he welcomed nearly 400 parents to another community forum on teen suicide.

In the fall of 2013, some of us did tell him that this could happen again if systemic measures were not taken. I personally wrote him a long letter and forwarded the message to the principal of Newton South High School. In response, I received a thank-you note in which promises were made about the school doing more to support our children.

So just what is the culture of Newton’s public high schools? Despite the communal expressions of grief, this past Monday, the day of the funeral of Roee Grutman, many of his classmates, friends and acquaintances (this is a small high school) did not participate in this important event because most of the school kept all academic activities unchanged, including, for example, mid-year exams.

Despite the message to teachers about allowing students to miss classes, some teachers conducted business as usual. Many students may not have felt free to stand their ground and attend the funeral. They were deprived of participating in a collective healing that cannot be replaced by a session with a school counselor or a mental health practitioner. I know this; I am a psychologist, a family therapist, a public health researcher and a specialist in trauma response. Continue reading

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