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Silent Wars: Helping Vets Fight Mental Health Battles At Home

By Evan Bick
Guest Contributor

The movies have it wrong. Combat, at least in my experience, was not non-stop or action-packed. Those who have experienced it know that modern warfare usually involves a lot of starting and stopping. Long stretches of quiet, even boredom, can be broken in an instant.

I was deployed to Iraq as an infantry platoon leader in 2008-2009. During that time, there may not have been constant action but there was tension — my fellow soldiers and I were on edge most of time, soldiers among civilians, going on patrols in the northwest corner of Baghdad.

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

On our first day in the city, the leaders from the unit we were replacing took us on a walk through their area of responsibility. We saw the sidelong glances from civilians as Americans walked through their streets, hidden behind rifles and sunglasses, and weighed down by cumbersome body armor. We also saw an area filled with stark contrasts — stucco houses with gated courtyards in one neighborhood, and refugee camps for Iraqis displaced by ethnic violence in the next.

Deployment is a challenging experience even when it’s boring. Whether you are patrolling ‘outside the wire’ or working behind the scenes, the sense of danger is real and omnipresent. While deployed, soldiers typically work far longer hours, and with less opportunity for relaxation than they experience at their home station. Isolation from loved ones, of course, is an important challenge both for the deployed soldier and family members back home.

Even with all those challenges, the bigger battle for many veterans begins when they return home. Without a unit that shared in your experience of war, you can feel lost — more lost than you would ever feel on patrol. It’s easy to get trapped inside your own head, and to dwell on what did not go well, and what you should have done differently. The quick reflexes and adrenaline that may have helped keep you alive overseas are probably no longer helpful.

Strategies that kept you and your fellow soldiers safe, like driving fast and straight down the middle of a road, become dangerous, and loud noises or crowds may make some part of you feel like you’re back in the desert. Continue reading

When You’re Dealing With A Stressed-Out High School Junior: 5 Tips

By Steve Schlozman, MD
Guest Contributor

(Miguel Angel/Flickr)

(Miguel Angel/Flickr)

Sometimes things are so obvious we fail to take notice.

For example, if I tell you that high school students who plan on attending college are under a lot of pressure, your response might sound like, well, a 17-year-old:

“Duh,” you might say, “What else is new?”

This is not new, of course, but the pressure continues to get exponentially worse. Students from all walks of life are increasingly overscheduled, academically burdened and socially overwhelmed. We pile all this stuff on top of the already treacherous waters of adolescence, and it’s no wonder kids feel emotionally battered.

I started thinking more about this when a friend of mine from high school called about his 9th grade daughter.

“She’s 14,” my friend said, “And they’re telling her in the fifth week of school about college. Did we worry about college in 9th grade?”

No way.

I used to think that the pressure on high school teens was largely a regional issue. I was raised in the Midwest, so of course things weren’t quite so high-stress compared to here in Boston. But my friend was calling from Colorado, and this is therefore not a regional issue. What is clear, is that this pressure is not good for our kids.

Let’s look at some of the data:

•According to the Department of Education, there are around 2,675 nonprofit four-year undergraduate colleges in the United States.

•Although the number of students in high school continues to slowly decline, the number of students applying to college is steadily increasing. In 2011, there were about 20.4 million students enrolled in college, and that number is projected to reach about 23 million by 2020.

•One out of four teenagers submitted college applications in 2011, at an average of around $40 per application

•In 2001, the typical college admitted around 71 percent of its applicants. By 2011, this number dropped to around 65 percent. I could go on. The common application increases the overall number of applications that students complete, schools look to college acceptance rates as a means of measuring their success and they therefore pass this pressure onto their students, and students themselves are more and more led to view the junior year of high school as something akin to academic and extracurricular boot camp. I’ve seen students get freaked out even before the first week of 11th grade.

This this kind of systemic stress is not good for anyone. A 2008 study found that the increased rate of academic dishonesty on high school campuses stemmed, at least according to some students, from the increasingly high achievement bar that the students themselves experienced. This of course does not excuse cheating, but it is worth noting that both cheating and academic and social pressures seem to have grown in concert with one another. Continue reading

Curb Your Hysteria: Talking Rationally To Kids About Ebola Risk

A man diagnosed with Ebola this week is being treated at Texas Health Presbyterian Hospital in Dallas. (AP)

A man diagnosed with Ebola this week is being treated at Texas Health Presbyterian Hospital in Dallas. (AP)

By Gene Beresin, MD and Steve Schlozman, MD

On Sept. 30 the first case of Ebola was diagnosed in the United States. The patient, who is currently being treated in Dallas, had recently traveled to Liberia, and was back in this country for a few days before symptoms began.

Understandably, the coverage of this news is pervasive. Although it seemed inevitable that a case in the U.S. would eventually emerge, the story still ignites a fair bit of hand-wringing among just about everyone who has learned of it.

Additionally, our country has experienced some novel infections that have ignited increased concerns in recent weeks. Enterovirus D-68 has made its way across the nation, causing severe cold-like symptoms, and, in some children with conditions such as asthma, the need for hospitalization. There’s also a potentially new contagion on the horizon that appears to cause varying degrees of muscular paralysis, and may or may not be related to Enterovirus D-68.

But, as public health officials are eager to stress, a nuanced and thoughtful approach to these issues has been as necessary as it has been fleeting. Experts agree that our medical infrastructure is well-equipped to handle even a virus as scary as Ebola, and some doctors are quick to point out that viruses like respiratory syncytial virus (RSV) and influenza are much more likely to cause harm than these new ones.

This raises a critical point:

Ebola, as scary as it is, poses a relatively minor threat to the United States; and the current cases of Enterovirus D-68 are far out-numbered by the RSV and influenza cases we experience on a yearly basis. And the currently unknown contagion that appears to cause paralysis has only happened in a very small population of kids.

So why the massive reaction in the media and among worried parents? Intellectually, at least at this point, all indications point to little danger for our children and ourselves. Why, then, do we get so frightened?

Well, let’s start with this confession: We’re frightened.

Sort of.

We know, intellectually, that the threat is minor. But, when has intellect played a leading role in the emotionally driven process of threat assessment? And, especially with regard to infectious disease, when has anyone other than the most statistically driven scientists been able to preserve perspective? We’re not saying that we should massively worry, or even that we’ll be changing our instructions to our kids or our patients on how to behave with these new bugs dancing around.

What we’re saying is that germs, especially new germs, are scary. We have a long and probably evolutionarily derived tendency to fear disease, and when new ones rear their heads, we get alarmed.

Germs In Hollywood

As a society, we think about germs a lot — and nowhere, perhaps, does that play out more than in Hollywood. The 1954 novella “I am Legend” has been made into no less than three movies (“The Last Man on Earth,” “The Omega Man” and the more recent movie of the same title as the written work). You can rattle off other movies as well — there’s “Dawn of the Dead” (in 1978 and again in 2004), “Outbreak,” “Carriers,” “Contagion,” “The Crazies” (in 1973 and again in 2010),

“Quarantine” (and “Quarantine 2″) and most recently “World War Z.” You get the picture. Continue reading

Why To Exercise Today: To Beat Back The Toxic Stress Of Life

frodrig/flickr

frodrig/flickr

Apparently all manner of stress — whether it’s bad morning traffic, or the death of someone you love — can harm your health in deep and profound ways. That’s according to a soon-to-be published study by researchers at Oregon State University. But the key, as NPR reports, is how you manage your stress:

Chronic stress is hazardous to health and can lead to early death from heart disease, cancer and of other health problems. But it turns out it doesn’t matter whether the stress comes from major events in life or from minor problems. Both can be deadly.

And it may be that it’s not the stress from major life events like divorce, illness and job loss trickled down to everyday life that gets you; it’s how you react to the smaller, everyday stress.

The most stressed-out people have the highest risk of premature death, according to one study that followed 1,293 men for years.

OK, so wouldn’t it be great to take little pill for combatting all of this health-undermining stress; something that allowed you to just laugh at all the bad drivers in Boston rather than screaming obscenities and giving everyone the finger?

Well, apparently, there’s something even better!

NPR quotes Dr. Robert Waldinger, a psychiatrist at Massachusetts General Hospital and Harvard University, who offers what appears to be the closest thing to a secret, stress-busting heavy weapon: exercise. Continue reading

Project Louise: The Dog Ate My Homework

(Girl.In.the.D via Flickr)

(Girl.In.the.D via Flickr)

Hmm, was that me last week, waxing rhapsodic about that great “back to school” feeling? So, here we are, near the end of my kids’ first week back at school, and I have to say: What was I smoking?

Yeah, it’s lovely to get out the pencil cases and pick out the first-day outfit and meet the teachers and see old friends and try to spot new ones. But it’s also a flat-out crazy week of adjusting to new routines, getting back in the groove, filling out more paperwork than anyone should have to deal with in this electronic age and, oh yeah, getting to work more or less on time.

Unsurprisingly, I find all this a bit stressful. (Can I get an amen?) And that’s why it seemed like such a great idea last week to promise that I would interview an expert on stress, and then let you all know all the great things I learned.

Only here’s the thing: I was too stressed out to get it done. Sure, I could tell you that her book didn’t arrive in the mail as quickly as it was supposed to (which it didn’t), and that therefore I didn’t get back in touch with her publisher to set up the interview before the long weekend (which I didn’t), and that then I came up with a backup plan (which I did) to interview someone else (which I didn’t), but essentially that all boils down to the adult equivalent of “the dog ate my homework.”

So, look, I’m sorry, and I promise – I swear – I more than swear, I’ve told my editor! – to have real information on dealing with stress next week. But meanwhile, let’s just talk about stress for a quick minute. I’ve told you some of mine, but here’s a more complete list:

  • Taking care of a teenager and a 6-year-old
  • Working full-time-plus at a job that requires evenings out fairly often, and even the odd weekend
  • Trying to hold the family finances together in spite of some real (and private) challenges
  • Resolving some seemingly intractable problems in a key relationship (also private, so I wouldn’t even mention it but it’s a huge stressor)
(Wikimedia Commons)

(Wikimedia Commons)

  • Learning to navigate this strange new electronic world we all live in – and, for example, figuring out those lines between public and private, to say nothing of taming an email inbox that daily threatens to crash from its own weight; this sounds trivial compared to everything else, but it’s surprising how much angst it causes
  • Wondering how I’m ever going to fix up the “charming,” “needs TLC” old wreck I live in, enough to either be happy in it or put it on the market
  • Fretting about my health, not just the tired old song-and-dance you’ve been hearing about my weight and cholesterol and so forth, but also that funny-looking mole on my back
  • And did I mention the three dogs and the gecko?

Continue reading

Survey: Transgender Discrimination In Mass. Public Spots, Health Effects Seen

(Codep08/Compfight)

(Codep08/Compfight)

By Qainat Khan
WBUR

On a break from her job near South Station, Vivian Taylor was on her way in to use the station’s ladies’ room when a man suddenly blocked her way, she recalls.

“Where do you think you’re going?” he asked her, threateningly.

“I didn’t want to have a confrontation while I was at work, but it was a very unsettling experience,” said Taylor, a transgender woman who served in Iraq in 2009 and 2010. “For about the next half hour, that fella just stood there — as if he was on guard — standing there glaring at me in front of the door to the bathroom.”

A survey out today suggests Taylor’s experience is not uncommon. The results, based on 452 responses, show that almost two-thirds of transgender and gender non-conforming Massachusetts residents experienced discrimination last year in public places, including transportation, retail and health care settings.

The survey, conducted by The Fenway Institute at Fenway Health and the Massachusetts Transgender Political Coalition, found that respondents who reported discrimination had an 84 percent increased risk of adverse physical symptoms associated with stress — such as headaches, upset stomachs and pounding hearts — and a 99 percent increased risk of emotional symptoms compared to respondents who reported no such discrimination in the past year.

“It’s a hard thing to have to go through the world just having to be that conscious of your own safety,” Taylor, who was a respondent on the survey, said. “That’s a very stressful experience, to just always know that it’s possible that somebody is going to come after you for no other reason than what you look like, or how you dress, or what your voice sounds like.”

The survey also found that 20 percent of respondents postponed or did not seek health care because of prior discrimination in a medical setting. Five percent of respondents said a health care provider refused to provide them with care because of their gender identity. Continue reading

Newton Deploys Relaxation Experts To Help De-Stress Community

Screen shot 2014-04-07 at 1.45.34 PM

As of today, the high-achieving suburb of Newton begins a new effort to combat stress in teens: helping their parents relax.

The town is hosting four seminars for parents to help them “relax and reboot” and learn some strategies to better take care of themselves and their stressed-out teenage kids.

In case you live in Newton and are thinking of attending, sorry. They’re already full. But the town is offering several related programs, including An Open Conversation on April 30 for parents to talk about “how we define success in a high achieving community and how that impacts the stress on our teens.”

National statistics suggest that teenage stress is at an all-time high, with kids apparently adopting adult-levels of stress, according to the latest American Psychological Association report on stress in America.

In Newton, the issue is particularly poignant because three Newton high school students took their own lives during the current school year.

But even before the suicides, Newton had decided to take a somewhat novel approach. It applied for and received a “mental health and well-being” grant — $30,000 over three years — to, in effect, allow students, parents and teachers to take a massive exhale and figure out ways, large and small, to take the edge off growing up.

One solution was to contract with the Benson Henry Institute of Mind-Body Medicine, based at Massachusetts General Hospital, and offer the stress-reduction sessions.

The town was already aware of its stress-related problems: Continue reading

Stress Eating: It’s More Complicated Than It Looks

Nearly half the American population admits to managing stress with food. (See, also: Thanksgiving.)

Eating as a stress-reducer, though, has been linked to unintended weight gain and largely condemned. But, oddly, people who lose their appetite when stressed are seen as fortunate, and their behavior is often dismissed as benign.

New research out of Germany suggests that neither situation is so clear-cut. A study just published in Psychological Science suggests that maybe stress-eating isn’t so awful after all, particularly when it comes along with a positive social interaction.

Researchers from the University of Konstanz, Germany, recruited self-identified stress-eaters (called “stress hyperphagics”) as well as people who skip meals when stressed (“stress hypophagics”). The study subjects were randomly given either positive social feedback (“social inclusion”), or experienced rejection (“social exclusion”). They were then presented with different flavors of ice cream under the guise of a “taste test,” so the subjects weren’t aware that the researchers were measuring the amount of ice cream they consumed.

icecream

As expected, stress-eaters consumed significantly more ice cream than stress-skippers after experiencing social stress. But after a positive social experience, the behavior patterns were reversed. Not only did stress-eaters consume significantly less ice cream, but stress-skippers ate a lot more. Take these two situations together, and the average calorie consumption of stress-eaters and stress-skippers was about the same.

It seems, according the the study, that rather than labeling people as “stress-eaters” and “stress-skippers,” people who alter their food intake according to their emotional state could more appropriately be called “mood-dependent eaters.”

So what does it all mean? “According to our findings, neither munchers nor skippers are considered at risk to gain weight by default,” says lead researcher Dr. Gudrun Sproesser. Continue reading

The Checkup: Meltdown U. And Mental Health Tips For Parents Of College Kids

For all those freshman just settling into dorm life this fall, college can be exhilarating, mind-blowing, the best years of their lives. But many parents don’t realize that their children are also facing a potential double whammy. Not only must new students navigate an entirely unfamiliar social, emotional and intellectual landscape, but they’re also entering a time in their lives — the ages between 18 and 21 — when many mental illnesses, from anxiety to depression to eating disorders, peak.

This week, The Checkup, our podcast on Slate, explores the mental health of college students. Here’s one sobering statistic: up to 50% of college-age kids have had or will have some kind of psychiatric disorder. That’s why we’re calling this episode “Meltdown U.” (To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.)

The Checkup

Consider some more scary numbers:

–80% of college students who need mental health services won’t seek them

–50% of all college students say they have felt so depressed that they found it difficult to function during the last school year

–Suicide is the second leading cause of death among college-age youth – over 1000 deaths per year.

–The rate of student psychiatric hospitalizations has tripled in the past 20 years.

We asked Dr. Eugene Beresin, M.D., a child psychiatrist at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School, to offer some guidance on what parents should know about helping their college-age kids cope with the high stress of undergraduate life. Here’s his advice: Continue reading

Long After Recession’s End, Deep Layoff Scars May Remain

In this June, 2010, photo, Frank Wallace, who has been unemployed since May of 2009, is seen during a rally organized by the Philadelphia Unemployment Project. (AP Photo/Matt Rourke)

(Matt Rourke/AP)

I went back to visit my old parking lot at The Boston Globe this week. For more than six years, I commuted to the Globe along the crawling traffic of the Southeast Expressway, travel mug in hand. But what I remember most about that parking lot is crying in it.

It was 2009. The Globe was in a major financial crisis, like much of the country. Brian McGrory, then the Metro editor, had just called me in to his office to warn me that I was almost certainly about to lose my job.

I held it together in his office, but then when I came out into the parking lot to call my best friend, I felt a wave of shame and insult engulf me. I knew better, but for just that moment, I felt — worthless.

Carey Goldberg stops back at The Boston Globe, where she was laid off in 2009. (George Hicks/WBUR)

Carey Goldberg stops back at The Boston Globe, where she was laid off in 2009. (George Hicks/WBUR)

Well, that’s no surprise, right? Everybody knows it hurts to lose your job. But what has caught me by surprise is that even though my family didn’t suffer much financially from my layoff, and even though I tend to be pretty upbeat and resilient, and even though I’ve landed well, it still hurts. More than four years later, I’m still not fully over it.

At work, I feel hypervigilant — as if nothing I do is ever enough, or good enough, to feel safe. At home, making life plans fills me with anxiety.

Which makes me wonder: Are these feelings normal? And if so, what does that mean for the roughly one-quarter of American workers who were laid off at some point during the recent recession?

These days, the Dow is hitting record highs. Housing is hot again in many spots. More and more, the Great Recession of 2009 is becoming just a bad memory. Except that, like other bad experiences, for many of us it may have left emotional scars that last.

So are we going to end up something like the forever frugal survivors of the Great Depression?

“One of the things you find about depression babies, as we call them — that is, people who came of age in the great depression — is that they retained a characteristic skepticism about good times. They never believed them,” said Prof. Bruce Schulman, an American historian who is chair of the Boston University history department.

“They were the people like my grandparents who always reused teabags. Even when they went out to a restaurant at a prosperous time, to celebrate a great occasion, [they] would take the teabag and drain it out and wrap it up and put it in their purse.” It is a generation, Schulman said, that tries always to be prepared for crisis.

Of course, the depression was far worse than the recent recession. But extensive research shows that whether one-third of the population is out of work or only one-tenth, layoffs at any time can have deep and long-lasting effects.

Harvard Business School professor Sandra Sucher says that though virtually everyone faces tough experiences, layoffs can be an unusually damaging kind of life event.

Harvard Business School professor Sandra Sucher

Harvard Business School professor Sandra Sucher. (Courtesy)

“It approaches my financial health, in the sense of what my income is,” she said. “It approaches and is disruptive to my physical health; it can disrupt my mental health and my sense of self; and I think for so many of us, work is a central part of our identity, and so when that is disrupted, that is actually something that layers on top of all these known effects.”

Let’s begin with the financial impact of a layoff, which Sucher says can persist indefinitely.

“One study of workers displaced in a 1981 recession found that they experienced a 30 percent decline in their income at the time of the layoff,” she said. “Twenty years later, they were still earning 20 percent less than employees who were not laid off.”

Now for health. The stress of a layoff shoots up your risk of high blood pressure and heart disease. Your risk of depression doubles; your risk of alcoholism quadruples; your risk of committing violence or suicide also rises. Continue reading