Deciphering the Signal

Pain is an important signal. We feel something hot and pull our hand away. A knee hurts and we ice it. Pain is the body’s way of telling us to pay attention to something and give it some attention. But what if pain also tells us about our emotions? Mad in America recently published my essay entitled “Learning to Speak the Subtle Language of Pain.” My hope is that someone with an experience like mine will find comfort and resonance in my story.

The River of Uncertainty

Here’s an excerpt: “It gradually dawned on me that my back pain was another mask that depression wore. Instead of crying and feeling overwhelmed or giving up, my body was sending distress signals to help me realize that I was in a difficult spot.”

The Last Trip to Paris

I planned my recent trip to Paris with the wistful notion that it would be a grand farewell to my favorite city. After all, I reasoned, this trip would mark my third to Paris in four years–and my fourth trip overall if I wanted to count my college visit in 1972. “You’re getting older, Ann,” I told myself, “there are many more places you want to experience while you still can.”

river view
The Seine and the Eiffel Tower

I planned accordingly–making sure to visit the places I absolutely wanted to see one more time–La Musee D’Orsay with lunch in the 5th floor cafe, a couple of hours with Monet’s Waterlillies in L’Orangerie, a last look at Notre Dame, and lunch at L’As du Fallafel in the Marais, per my son’s recommendation. And of course, a visit to La Durree on the Champs Elysees for their fabulous macarons.

I felt excited and vaguely uneasy at the same time. As I visited each place on my itinerary, I grew more and more enamored with Paris. Would this really be my last visit? Riding the Metro home each night to my B & B near the Eiffel Tower, I wanted to freeze the hands of the clock so that I could savor Paris even longer.

And as I visited L’Orangerie and saw Monet’s fabulous Waterlilies again, I was saddened by the buzz in the room and the constant selfie-taking tourists who blocked everyone’s view of the panels.

In contrast, I simply stood in front of a panel, and focused–trying to breathe in its beauty and the rich depth of the colors. I didn’t even try to take a picture-as I had the year before. I knew the colors would be a vague shadow of the beauty before me, and I heard this line from “Postscript” by Seamus Heaney: “Useless to to think you’ll…capture it more thoroughly.”

Winged Victory in the Louvre

And on my last day in Paris, where I simply savored every bite of food and every grand view, I knew I was foolish as well. Foolish to limit myself to any idea of not returning to Paris. And foolish to rush through my days, as I so often do. Instead, I want to pause and let the experience “catch my heart off guard and blow me open.” I’m working on it…and imagining another visit to Paris.

Postscript by Seamus Heaney~from The Spirit Level

And some time make the time to drive out west
Into County Clare, along the Flaggy Shore,
In September or October, when the wind 
And the light are working off each other
So that the ocean on one side is wild
With foam and glitter, and inland among stones
The surface of a slate-gray lake is lit
By the earthed lightening of a flock of swans,
Their feathers ruffed and ruffling, white on white,
Their fully-grown headstrong-looking heads
Tucked or crested or busy underwater.
Useless to think you’ll park and capture it
More thoroughly. You are neither here nor there,
A hurry through which known and strange things pass
As big soft buffetings come at the car sideways
And catch the heart off guard and blow it open. 

A Lesson from France

When I decided to go to a language school in France this year, I had two goals: to become more fluent and to improve my vocabulary. I was excited about attending Coeur de France, a French immersion school tucked away in Sancerre, a tiny town in the middle of the Loire Valley. 

Coeur de France
Sancerre, France

The school experience began smoothly when I met Marianne, the woman who ran the school and made decisions about placement in the classes. “You speak much better than your test scores led me to believe,” she told me when I showed up for the first day of class. “I’m placing you in a higher-level class.” 

I was thrilled! Yes, confirmation from the “principal” that my French was better than I thought. But after two-and-a-half days of verb tenses that I’d never learned and pronouns I’d never even seen, both my teacher and Marianne moved me to a “more comfortable level” where I could keep up with the grammar. “I haven’t studied French grammar in over 40 years,” I told them,” but still, I felt close to tears and the word FAILURE drummed inside my head. 

French grammar books

The new class moved at a slower pace and the other students struggled more with conversation than I did, but at least I could keep up with the grammar. Still, I knew the class was too easy for me and resigned myself to its less than perfect fit. “Just relax,” I told myself, “you’re in France!” Despite my diligent attention to homework and commitment to using French with all of my classmates–in and out of class–I felt my goal of becoming more fluent slipping away every day. 

As I rode on the train towards Paris a few days later, I managed to dispel  my  funk of disappointment. I quickly realized that I needed to adjust my goal of increased fluency.  I had learned many new words, and I understood more of the language. Plus, I noticed a great leap in my ability to read in French.

But the biggest lesson for me was how much time, effort, and psychic energy it would require to really become fluent. And I knew more deeply than ever before that I wanted to take that energy and put it into my writing. 

My Parisian hosts, Genvieve and Claude, confirmed what I’d suspected about the focus on grammar–I already knew the four main verb tenses that you use in conversation and could use them reasonably well. “Your French is improving,” they both assured me. “You speak much better than last year when you stayed with us, and better than the first visit as well.” 

Sitting at cafes, sipping espresso, and musing in my journal nearly every day led me to a solid realization about how I’d managed to re-learn French after 40 years.  The program I’d used so successfully–Behind the Wheel French–had two elements that my classes in Sancerre lacked–repetition and practice. 

I practiced the verb tenses over and over in different contexts as I listened to the instructor and spoke French during my frequent jaunts in the car. I read the accompanying book every day to refresh myself. And I realized why I’d felt so frustrated at the language school–every day was a new lesson with little to no review or practice of what we’d learned from the day before. And as a teacher, I knew that repletion and practice were essential components for retention.  

So, while my classmates may have benefited from the approach used in the school, I knew I needed a different kind of instruction. And as I interacted with my “French family” and the many people I encountered in Paris, I felt batter about my command of basic French. I functioned well in simple conversations, and the rest of the time, I simply said, “Repetez still vous plait, plus lentement.” Can you please repeat that more slowly? 

happy on the plaza
Ann at Place de la Concorde


Homage to My Mother

Dorothy Wetzler Bracken designed and painted this dress as a student at Maryland Institute College of Art in the 1930s. Although she graduated in 1935 with a degree in costume design, she was never able to pursue her artistic talents. Mom kept her dreams to herself until the late 90s when I discovered a portfolio of her designs and she confessed, “I always wanted to be a fashion designer.”

            Dorothy’s story could have been a happy one—she married, had many friends, and eventually had five children. “I was thrilled every time I found out I was pregnant,” she often told me. Yet, postpartum depression plagued Mom following nearly every birth. After her fifth child arrived, Mom was hospitalized, received electroconvulsive therapy treatments, took copious amounts of psychiatric drugs, but sadly, she never recovered.   

            Because I always managed to recover from my own depressions, I puzzled over Mom remaining trapped in chronic depression for over 40 years. Until I found Dad’s collection of old insurance and medication records, newspaper and magazine articles, and letters to doctors stashed in my sister’s attic. 

            Those records told the story of my father’s futile attempts to get help from Mom’s doctors, most of whom only saw her twice a year despite a suicide attempt, hospitalizations, accidents (probably due to overmedication), and many electroconvulsive therapy treatments. Most troubling of all were the lists of Mom’s prescriptions that Dad had saved: Thorazine, barbiturates, antidepressants, amphetamines, and benzodiazepines. 

            Mom’s doctors were practicing polypharmacy: giving a patient more than one drug to treat a condition. The same thing that happened to me with opioids in the late 90s; the same thing—with different drugs—that’s happening now. And oftentimes the chemical load becomes so great that it’s impossible to tell what’s actually going on for a patient vs. the interactions of the medications. Now I know at least one reason Mom never got well. 

Reflections on the Philadelphia Writers Conference 2019

What happens when you get over 125 writers together in one place and give them prompts, papers and pens?  I found out when I attended the Philadelphia Writers Conference for the first time about a two weeks ago.

Schedule and cover image
Schedule and cover image from Philadelphia Writers Conference

I attended several workshops and was really inspired by the one on using color that was facilitated by the wonderful Philly poet Yolanda Wisher.  After reading a masterful poem called “Blue” by Yusef Komunyakaa, we all tried our hand at a similar piece after selecting a line of his as a jumping off point.  Wow!  The five of us went in all different directions, and I felt like I’d been given a jolt of lightening energy to infuse my work with freshness. Yolanda gave us paint chips to take home and assigned us the task of writing a poem with words like rust, pilgrimage foliage, and aztec brick—I’m still working on that poem. And Sunday morning was a pairing of watercolors and poetry—here’s a picture of the final product.

Color Workshop
Painting and poem from Yoland Wisher’s Poetry Color Study workshop

Another high point of the conference came with a workshop led by the keynote speaker and prolific author Jonathan Maberry. He showed us how to create a pitch for agents that would generate a request for a proposal or a manuscript. All I can say is that I rewrote my pitch immediately and two out of three agents I met with asked for a proposal. All three complimented the pitch. Thank you, Jonathan.

Asali Solomon gave an impressive welcoming speech which encouraged all of us to write about the macro issues of the day using the micro lens of our own experiences. Sandy Shea, of the Philadelphia Inquirer, led us in a thoughtful workshop on how to craft an op-ed for publication, and lastly, Jenn McCreary led us in a fabulous workshop on the political nature and uses of erasure poetry.

Brovo is all I can say. Well worth the time and money to go to Philly for the workshops alone. The planning committee is taking a year off to regroup and plan for updates, but they’ll be back in 2021. So will I!

There’s Healing in Your Story

When I went through training in journal and poetry therapy, one of the mantras threaded through our work was “Change your story, change your life.” We spent a lot of time rewriting stories and talking about how shifting the narrative could result in a more positive outcome.  That’s why I wrote my post for Mad in America about overmedication and recovery–I couldn’t change my mother’s story, but I was determined to change mine.

The post details my story of overmedication and its harm, along with my  mother’s story. When I found my father’s records about her illness, I was shocked to see that Mom received very little therapy over the years, but year after year, psychiatrists prescribed barbiturates, amphetamines, Thorazine, and antidepressants. People tell me that wouldn’t happen now–but my story, 35 years later, parallels Mom’s. Mom and I suffered needlessly because of overmedication, and I hope to be a voice for change so others don’t experience the same fate.

I hope you will read my post, “The Answers in the Attic: A Mother-Daughter Story of Overmedication and Recovery.”

Creating Community One Stone at a Time

I first experienced Zen sculptures about ten years ago when I visited Sedona, AZ and walked along a riverbank that was crowded with such towers. Each of us on the trip built one, but recently, I haven’t thought much about them until I went to Thoreau’s cabin site near Walden Pond. Visitors had built rock towers around the periphery of his cabin’s foundation, and I was quick to add one of my own.

Zen rocks, Brian Potts, photo credit

One morning afterI returned from visiting Walden, I was walking in my neighborhood and passed a large, flat rock that is in a median strip in front of an apartment complex about a block from my home.  On a whim, I picked up a few stones and built a Zen tower.  For the first couple of months, I was the only one building towers, sometimes every day, and sometimes I’d build two.  Building the towers became a vehicle for mindfulness because  I walked the same route nearly every day, and it was easy to let the scenery slip past.

But like a seed that takes awhile to germinate, one day I noticed there was a tower that some unseen friend had built. Hooray! I thought, someone connected with me and is joining in the fun. By early October, when I was about to leave for a two-week trip to Europe, there were three towers on the main rock and one tower on each of the rocks in the back of the median.  I smiled. The idea was catching on and gaining a life of its own.

The rock towers were still there when I returned.

Close-up of Zen rocks, Brian Potts, photo credit

Why is this important to me?

Sometimes when I think of how busy all of us are and how much we’re isolated in spending time with our screens, I lament that we’re losing a sense of community. I never see my neighbors in the apartments and have never met anyone who lives there. I know a few people in my immediate area, but I rarely see the folks who live on my street, and I’ve never told anyone about my Zen project. But I am a firm believer in the power of positive energy and shared consciousness. And now I have proof of my connection–or at least my idea’s connection–with my unseen neighbors. We’re truly in this together–one stone at a time. One idea at a time. One good deed at a time.


Armistice Day After My Visit to Flanders Field

A powerful reminder

I recently visited Bruges in Belgium, a small and charming city that is very close to the town of Ypres and Flanders Field, the site of the Western Front during The Great War.  I wanted to see the sites as a way to participate in  commemorating the 100th anniversary of the Armistice. I knew I’d see cemeteries and statues, but I had no idea how I’d feel as I spent the day with my tour guide, Philippe, and my companions for the day–four people from Ireland, two from Canada, and one from Italy. All of them had lost grandfathers during the war. My two grandfathers did not enlist, probably due to their ages. Still, as an American, I felt that it was important for me to witness the ground where so much sacrifice and destruction occurred over 100 years ago.

The truly awful fact is that The Great War, or World War I, still lives in Europe, especially in the small, quiet towns of France and Belgium.

Unexploded shells from WWI

The war lives in the unexploded shells that farmers find when they plow their fields.
The war lives in the sinkholes that trap people because they’ve built over an old trench. The war lives in the chemical weapons that are still lethal after 100 years.
The war lives in the Canadian, British, Australian, New Zealand, German, and Irish cemeteries that cover former battle fields.
The war lives in the red poppies that decorate the grave sites and fill the fields in the spring.

One of the youngest men to die in The Great War

Poet and author Madeline Mysko used a piece from The Sun archives that declares Nov. 11, 1918 “the greatest day in the history of the world!” But the reporter wisely spells out the deeper meaning of victory for the readers:

“It was a victory not so much of material things: of ships and rifles, and cannon, and gas, and men’s lives, as it was a victory of the spirit, a spirit that even in the darkest of days did not acknowledge defeat, the spirit that never would admit that might was right or that brutality and savagery could triumph over humanity and kindliness and love and the decent things of life.”

In Europe, they call November 11th Armistice Day, literally a day to celebrate the cessation of  force, stopping the use of weapons.  We have sacrificed greatly in our many wars, but those wars do not live on our soil.  I wonder if the destruction and pain of war, the futility of force to solve problems, would be more real for us as Americans if we found unexploded shells in our fields?  If our children fell into sink holes when they played tag in the yard?

May we pause and reflect this Armistice Day.

A memorial of poppies

Reblogging:Why Mandating Mental Health Education in Schools is a Band-Aid on a Gaping Wound

I resonated with the post below by Leah Harris because I used to teach in high schools where kids were routinely referred for mental health services. Most of the time, the kids were suffering emotionally either because of family issues, trauma, or bullying, none of which are the sole-problem of the person manifesting the symptoms of depression and distress. And none of which can be solved by giving a kid an antidepressant. I think that Leah makes excellent points about the many facets of mental health, including societal pressures and imbalances,  to educate all of us so that we can better care for both our kids and ourselves.
Speaking Truth to Power: Leah writes about holistic, community-based approaches to support those experiencing emotional distress and extreme states; storytelling as a vehicle for personal liberation, human rights, and social justice; and connections between creativity, activism, spirituality, and social change.

“Oh, the conversations to be had to undo the ‘mental health education’ my son is likely to get at school.” I posted these words on Facebook in response to recent news that mental health education will now be required in the Virginia and New York public school systems. I have a child in the Virginia public schools, where this education will be mandated for 9th and 10th graders.

I am guessing some readers might ask: “What’s wrong with teaching young people about mental health? Shouldn’t we bring this issue out of the shadows and talk about it at school?”

I understand the desperate desire to do something — anything. The statistics are horrifying and getting worse: the number of American children contemplating or attempting suicide has tripled between 2008 and 2015, according to a study published in the journal Pediatrics. In 2016, suicide rose from the 3rd to the 2nd leading cause of death for young people in the U.S. Recent statistics show Black youth taking their lives at twice the rate of their white counterparts. Studies indicate that as many as fifty percent of trans and gender non-conforming youth have attempted suicide.

Given this state of emergency, isn’t it our responsibility to educate youth about their mental health?

Don’t get me wrong: of course I care deeply about the mental and physical health of children, including my own son’s. I don’t want students to suffer in silence and shame. But I am very concerned about just how this topic will be taught in schools.

Currently, there is a master narrative about mental health and suicide that dominates in our society. According to this medical model narrative, mental illnesses are genetically-based, biological brain diseases caused by “chemical imbalances” in the brain. Suicide is often said to be caused by these “brain diseases.” But this master narrative has been debunked time and again, even within the medical profession itself.

In an insightful talk called “Capitalism Makes us Crazy,” physician and internationally-renowned trauma expert Gabor Mate provides the best deconstruction of the medical model that I’ve yet encountered. In this talk, he notes: “What we see is a society that literally makes people sick… What the medical model does, whether with mental illness or physical illness, it makes two separations. It separates the mind from the body, so that what happens emotionally is not seen to have an impact on our physical health… and number two, it separates individuals from their environment. So that we try to understand individuals in separation from their actual lives.” He goes on to say that “those separations are socially imposed, they’re culturally defined, and scientifically they are completely invalid…”

I am afraid that it is this invalid and shaming narrative that students will be taught — a medicalized, individualistic view that locates “brokenness” completely in their “chemically-imbalanced” brains and not at all in the world that shapes those developing brains and the bodies that house them.

I come at this issue not just as a suicide prevention advocate, and not even just as a concerned parent. I myself was a suicidal young person, having made several attempts to take my life before the age of 18. When I think about what would have helped me, it would not have been a message that something was wrong with my brain. Or that my intense anger, fear, and sadness were simply “disorders” and not understandable responses to the world I inhabited, the trauma that I had experienced. I already felt bad, wrong, and flawed enough. My mental health diagnoses only served to pathologize my pain instead of helping me to make sense of it and to find ways to heal.

We continue to perpetuate the myth that “mental illness is an illness like any other.” We perpetuate it in well-meaning “anti-stigma campaigns” that actually increase stigma and discrimination against people experiencing emotional distress. We perpetuate it in well-funded programs like Mental Health First Aid that teach people “skills” such as how to identify mental illnesses and rank them in order of seriousness, while excluding any discussion of the social conditions that cause young people to suffer from extreme distress and suicidal thinking in the first place.

The apolitical master narrative largely ignores the fact that trauma and toxic stress are an inescapable part of daily life for many young people in the U.S. The landmark 1997 Adverse Childhood Experiences (ACE) Study, which surveyed 17,000 Californians and has since been replicated in almost every state in the U.S., found that ACEs were remarkably common, with two-thirds of the adult respondents having experienced at least one ACE, and 12.5% experiencing 4 or more ACEs. ACEs are shown to have a causative link with nearly every major public health problem in America, including depressionsuicidesubstance use, and decreased life expectancy.

When young people are exposed to adversity in regular “doses,” this causes a cascade of neurophysiological stress responses that affect the body, influence health, and shape behavior. And this toxic stress is not distributed equally: youth living in systemic poverty, youth of color, queer and gender non-conforming youth, and youth with psychiatric and/or physical disabilities are more like to suffer the impacts. Impacts that are often punished or pathologized in our educational, health care, child welfare, and juvenile justice systems.

Mandating mental health education for youth without addressing the root causes of their distress, and without naming our deeply problematic collective response, is like slapping a band-aid on a gaping wound. Such initiatives conveniently take the onus off of schools, communities, and states to take concrete actions to promote the well-being of young people and their families.

So how could we really make a difference, beyond lip service and serving up outdated and individual-blaming theories of mental health in our schools?

Acknowledge that available services for students may do more harm than good, and create supports that actually help. In nearly all of our states, available resources and services for young people in distress are inadequate at best and harmful at worst. We are always encouraging young people to ask for help, but what happens when they do? Let’s just say hypothetically that due to receiving mental health education, a teen discloses suicidal thoughts or even a plan to end their lives to a teacher or a school counselor. And let’s say that this young person actually accesses some form of professional help as a result.

What most parents don’t know is that the vast majority of mental health professionals in the U.S. do not receive any training on how to respond compassionately and appropriately to suicidal people of any age, let alone youth. As of 2017, only 10 states mandated any kind of suicide prevention training for mental health or health care professionals. Interestingly, Virginia and New York are not among these states.

So what will happen to this student struggling with suicide? The school counselor or community mental health professional, likely untrained to support the student, and also worried about liability concerns, will encourage inpatient hospitalization — that is, if beds are even available. Yet research shows that psychiatric hospitalization and re-hospitalization can increase feelings of hopelessness in youth and can cause what is called “iatrogenic” harm, or harm caused by the treatment itself. According to a 2016 study published in Psychiatric Services, psychiatric hospitalization and “rapid rehospitalization” exacerbated suicidal thoughts in a significant percentage of young people taking part in the study. Numerous other studies and meta-analyses bear out the same conclusion in adults: psychiatric hospitalization is associated with an increased risk of suicide — even in those who were not admitted for suicidal thinking or behavior.

And the harms perpetrated on kids in distress are sharply divided among racial lines. Youth of color who turn to substances to cope with their pain — at the same rates as their white counterparts — are far more likely to have that distress criminalized, setting them up for a lifetime cycle that fuels the school-to-prison pipeline and benefits the corporations that profit from it. Nationally, Native American youth are “30 percent more likely than Caucasian youth to be referred to juvenile court than have charges dropped,” according to Gabriel Galanda, a Washington-state youth advocate fighting the opening of a new kids’ jail in King County, Washington. While we have rightly focused on how the school to prison pipeline affects boys of color, girls of color who have experienced sexual abuse or are survivors of sex trafficking are also disproportionately “treated” within the juvenile justice system, where they rarely receive the trauma-specific services and supports they need, and are further traumatized by their incarceration.

In the context of teaching mental health in schools, we comfortably avoid talking about the realities of historical trauma, ongoing trauma, and systemic oppression faced by children of color. We never talk about chronically-underfunded schools and lack of support for educators as factors negatively influencing students’ mental health. We never talk about the fact that there seems to be plenty of funding for kids’ prisons, as well as the adult prisons distressed youth of color are often funneled into.

Adults need to get honest about the harm our systems and institutions cause to students every day, often in the name of “help.” If we are really willing to do something to reverse this harm, here are just a few ideas that are worth considering.

Create trauma-sensitive school cultures — everywhere, and for every child. We know now more than ever about how trauma and toxic stress impact students in a variety of ways, and that the environments in which children live and learn can affect their health — for better, and for worse. The previously-mentioned Pediatrics study that found a sharp increase in suicidal thoughts and behaviors in young people between 2008–2015 also found a seasonal trend that was disturbing and telling. Visits to emergency rooms for suicide rose in midfall and midspring and dropped to their lowest point in the summer, when school was out. The study’s authors themselves note that this trend speaks to “the stress and the strain” that students experience at school.

Schools need to take a look at their cultures and assess whether they are supporting young people or hurting them. This may seem like an impossible task, but with the political will, it is possible and happening right now in handfuls of schools around the country, with dramatic and positive results. Check out the documentary Paper Tigers, which tells the story of Lincoln High School, a school that instituted a trauma-responsive, restorative-justice based culture and saw as a result a significant decrease in dropouts and suspensions.

This intentional change in school culture was not just focused on educational outcomes, but on building relationships of trust and respect between students and their educators. These kinds of relationships can make all the difference in the trajectory of a young person’s life. We know from the latest advances in neuroscience, as well as plain common sense, that connection is a powerful social determinant of health. Neuroscientist Stephen Porges speaks of “connectedness as a biological imperative.” According to the Harvard Center for the Developing Child, “The single most common factor for children who develop resilience is at least one stable and committed relationship with a supportive parent, caregiver, or other adult.” I myself was very lucky to have supportive educators who met me where I was at, who believed in me even when I was trapped in a cycle of distress, suicide, and institutionalization, who saw me beyond the labels I had been given.

Eleanor Longden, a psychologist and advocate who was diagnosed with schizophrenia as a young person, also speaks to the importance of relationships: “Primarily, I was very fortunate to have people who never gave up on me — relationships that really honoured my resilience, my worth and humanity, and my capacity to heal. I used to say that these people saved me, but what I now know is that they did something even more important: they empowered me to save myself.”

Virginia has taken some preliminary steps to create pockets of trauma-informed culture change in a handful of Richmond schools, but why are these changes in school culture not being mandated and implemented in every school and every district in the state? New York State’s Department of Education has developed a plan to improve school climates, but it seems to be in a very preliminary phase. How much longer will it take until every child in America has access to schools that truly support and nurture them?

Educate students, teachers, and families about the effects of toxic stress and adversity on health, as well as the factors that build resilience. I support the kind of health education that is based on the latest findings in neuroscience, including the effects of ACEs, stress, and toxic stress on the body and mind, as well the factors that can increase resilience and healing.

Collective education about ACEs was a cornerstone of the approach taken at Lincoln High School, featured in the Paper Tigers documentary. This kind of education, emphasizing that students’ mental health difficulties are understandable responses to ongoing toxic stress and adversity, fosters the compassion and empathy that young people so desperately need for themselves, each other, and from their educators, families, and communities. We need to stop telling young people what is wrong with them and support them in understanding what has happened and is happening to them.

We also need to teach students that adversity, while affecting us in significant ways, is not destiny. The brain is neuroplastic, or able to heal itself, especially when we are exposed to the right kinds of social support, and learn strategies for regulating our chronically-stressed nervous systems. We need to underscore that healing is always possible, and affirm the many ways in which young people manage to cope and survive in the face of incredible adversities.

Teach students, educators, and families practical mind-body skills to manage stress and intense emotions. In its most recent report on rising suicide rates in the U.S., the Centers for Disease Control and Prevention (CDC) noted that suicide is “more than a mental health concern,” and is often driven by various forms of stress. Therefore, one of the CDC’s recommendations included “teaching people coping and problem-solving skills” to deal with the stressors they face. Currently, there are just a handful of organizations around the country, including the Niroga Institute in Oakland and the Holistic Life Foundation based in Baltimore, that are teaching students these strategies for managing stress. These skills should be as foundational in our schools as STEM competencies.

Niroga Institute has created a Dynamic Mindfulness curriculum, which has been the subject of rigorous research and has led to such outcomes as “lower levels of perceived stress and greater levels of self-control, school engagement, emotional awareness, distress tolerance and altered attitude towards violence.” Similar research conducted on the Holistic Life Foundation’s Stress Reduction and Mindfulness Curriculum found a reduction in “rumination, intrusive thoughts and emotional arousal. A qualitative assessment with middle school students following our intervention showed experiences in improved impulse control and emotional regulation.”

I want to make it clear that these interventions are not designed to teach students to meditate or breathe their pain away, but to help them to feel more in control of their brains and bodies, even in the midst of the very real challenges they face.

Connect young people to in-person and online peer-to-peer support resources. While “mental health education” programs will likely teach young people about how to identify signs of emotional distress in themselves and their peers, it’s unclear if they will be taught anything about peer-to-peer support, a non-clinical approach that is based on the idea that those of us “who have been there” are in an ideal position to support one another. Genuine peer support, as developed over the last several decades, is based on the values of empathy and mutual aid in all of our relationships. Research shows that youth who had access to peer support after significant stressors enjoyed better mental health than those who did not. A 2017 Australian study found that “teens who were with (or were communicating online with) friends in the time immediately following a stressful event reported lower levels of sadness, jealousy, and worry — and higher levels of happiness — than those alone or with adults. Whether they were with friends in-person or online didn’t seem to matter.”

Young people are informally providing peer support to one another all the time. I remember that when I was locked up in various psych hospitals and facilities as a teen, the connection with other young people who understood firsthand what I was going through helped me more than anything else.

And there are promising new strides being made towards formally implementing more peer-based support in schools. A new organization, The Adolescent Peer Support League (APSL), is starting a “National Conversation” on the need for peer support. APSL advocates for a “peer-based support system for high school students where their peers can assist and counsel them. Our ultimate goal is to see these programs implemented in high schools across the nation, providing easily-accessible, systematic mental health support to teenagers. Through these programs, students will be able to utilize the support of their peers in order to guide themselves towards better mental health.”

And peer support is not just for young people who may struggle with low-level depression or anxiety — it can be also be extremely helpful for people experiencing even the most intense forms of distress, including experiences of voice hearing or visions that are often labeled as “psychosis.” Teachers and schools counselors can avail themselves of information about national and international peer support networks for young people experiencing extreme states, such as the online support groups offered by the Hearing Voices Network USA.

Engage the leadership of young people and youth-led organizations as community partners in developing programs and educational curricula. While three high school students were involved in advocating for the legislation mandating mental health education in Virginia, it’s not clear as to how they or other students will be involved in shaping the curriculum’s content. And I found no information about whether students or youth-led organizations will be involved in either developing or rolling out the mental health curricula in New York State. By “involvement,” I want to be clear that I don’t mean inviting one token young person to a meeting and asking them to “sign off” on something already developed. I mean involving young people in meaningful ways, as leaders and partners in this vital work of health education and consciousness-raising, both in school and in their communities.

All too often, we disregard the lived experience of young people in our efforts to “educate” them. But there are state and national youth-led organizations focusing on the intersection of social justice and health that we should be looking to as leaders and visionaries in this work. One such organization is Youth in Mind, a California-based nonprofit that recently took a diverse group of young people on a civil rights journey across the South to learn from history and to connect with civil rights leaders. They are currently presenting on their experiences and learnings across California, and are working to develop a Bill of Rights for young people living with mental health challenges.

The Bill of Rights idea came out of listening sessions that YIM conducts across California every two years. The most recent listening session uncovered both disturbing and hopeful information. Susan Manzi, executive director of YIM, told me, “What we found as a common theme was that every civil right of young people was being violated. Many had no idea what their rights were, they could not access supports and treatment, and could not access peer-to-peer support. More youth are getting diagnosed, but not being properly informed about their diagnosis. They are being given medications, with no explanation of how to take them safely, such as possible interactions with alcohol and drugs.” Manzi added, “Young people are big thinkers. They haven’t been conditioned as much as adults to self-censor. They were screaming ‘revolution!’ in the rooms.”

We also have a tremendous amount to learn from Native and Indigenous youth organizations in the U.S. and Canada. While Canada’s Native Youth Sexual Health Network (NYSHN) does not focus on mental health specifically, they look at health from a much-needed historical and intersectional perspective. Their principles and values deserve equal attention in mental health, where young people’s brains and bodies are so often blamed and policed in the name of help and safety.

NYSHN’s “What We Believe” statements represent the kinds of values that should guide mental health education in schools and in the community. For example, NYSHN’s “Support Not Stigma, Support Not Shame” statement says: “We address issues from places of support and meeting people where they are at, instead of approaches that may blame/shame people based on what happens with their bodies or for harms that may come to their lives.” They emphasize the importance of youth telling their stories instead of being told what’s wrong with them: “By creating our own stories and expressing ourselves through various forms of multi-media and arts, we are able to not only push back on demeaning and/or stereotyping mainstream narratives, but also collectively create new visions.” It is these stories that we need to center and elevate in education. Stories of truth, of new possibilities for the future.

If we truly cared about the mental and physical health of young people, we would support the development of grassroots, youth-led strategies for education and responses to distress that do not create further harm and that promote healing. Manzi emphasizes that schools should own up to the truth: that they can’t — and shouldn’t — do it all when it comes to mental health education. “There are great educators out there. I want them to have more support and to build capacity through coalition-building and community engagement. They can bring in community members to show other perspectives, and they should engage in ‘move-aside leadership’ sometimes.”

And most importantly, if we really cared about the mental health of young people, we would double down on addressing destructive social forces such as child poverty, white supremacy, structural violence, the ongoing impacts of settler colonialism, and rape culture that harm students and their families intergenerationally. We would create conditions and environments where students feel safe to live, learn, and create. We would foster communities and cultures everywhere where young people are uplifted to love and honor themselves, one another, and the Earth. To explore their unique gifts and callings. To feel empowered as changemakers. And to share their revolutionary passions with a world that so desperately needs them.

*Acknowledgement and gratitude to Suzan Manzi of Youth in Mind for participating in an interview for this essay, as well as Anjali Nath of Liberation Spring for introducing me to the work of the Native Youth Sexual Health Network via the podcast “Decolonizing the Roots of Rape Culture” by Dr. Sarah Hunt.

Reblogging: The Many Origins of Depression by Dr. Kelly Brogan

Kelly Brogan is a psychiatrist practicing in New York city who approaches depression in a holistic fashion. Not only does she listen to your symptoms, but she takes a wide-angle view of a patient’s life to help each person find the appropriate treatments. I have done a lot of reading on the causes of depression, and based on what I’ve learned, I completely reject the notion of brain-based chemical imbalances. Depression, from all that I have learned, is a much more complex reaction to life-situations than a simple chemical imbalance. I agree with what Kelly says near the end of this article,”…taking a one-size-fits-all antidepressant is like turning off the smoke alarm and ignoring the fire.”  Read on to discover the myriad of causes for the fires inside.

What Is Depression?

Is depression a flat mood, an inability to participate in ‘normal life activities,’ or unexplained bouts of sadness? In spite of its singular clinical classification, depression looks different for each person. Like Leo Tolstoy noted in his famous novel Anna Karenina, “All happy families are alike; each unhappy family is unhappy in its own way.”

While all happy families aren’t necessarily alike, this adage speaks truth in terms of depression. Each person’s depressive symptoms – remember, depression is a symptom, not a disease – depend on their unique circumstances, bodily health, emotional history, and held beliefs. As the serotonin model of depression continues to lose its hold on mainstream psychiatry, a theory of depression as evolutionary mismatch has emerged. In this theory, depression is the result of modern living; we did not evolve in the context of environmental toxins, isolated living, and near-constant stress. Some argue that depression is a response to this mismatch, also called paleo-deficit disorder, and depression is simply a message from our bodies trying to protect us from the madness of the modern world.

However, even the evolutionary mismatch theory of depression relies on the dangerous assumption that all depression is the same: that depression is one disease, with one origin and a universal set of symptoms. Anyone who has been affected by depression will challenge this assumption. Depression can be caused by a constellation of factors that cause chronic inflammation – inflammatory foods, medications like the birth control pill, reduced sunlight exposure, and loneliness, to name a few – and manifest differently in different people. Some of the symptoms that qualify a person for a diagnosis of depression seem downright paradoxical: increased and decreased appetite, insomnia or fatigue, motor agitation or impairment. Even in one person, different depressive symptoms can appear at different times.

A recent scientific review article entitled ‘Depression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions’ attempts to re-classify depression into twelve subtypes.1 For each of these subtypes, researchers propose different causes for depressive symptoms, as well as potential reasons that these subtypes evolved and purposes they serve. In this framework, depression may be (1) an beneficial adaptation that effectively addresses a specific problem (2) an adaptation that does not solve the problem (3) a byproduct of other adaptations or (4) a general pathological state that serves no purpose and is harmful.

The proposed twelve subtypes of depression

Twelve Causes of Depression, Explained by Scientists

In infection-induced depression, symptoms result from underlying inflammation. This classification is supported by studies showing that anti-inflammatory agents reduce symptoms of depression.2 Further, the ‘sickness behavior’ of chronic inflammation, including social withdrawal, might worsen depression.

Long-term stress activates the immune system, leading to chronic inflammation that creates depressive symptoms. Why would stress activate the immune system? For a good reason, actually – in our evolutionary history, stress meant a higher chance of being wounded, and our immune systems ramped up to protect from infections that could result from those wounds. But nowadays, stress is rarely caused by true danger. Instead, stress comes from working long hours (against circadian rhythms), feeling pressured to meet deadlines, and financial worries.3 The response of inflammation to stress seems to be an evolutionary mismatch; the immune response that served us for centuries is no longer beneficial.

In the ancestral world, loneliness literally meant death. If you were separated from the tribe, you were vulnerable to predators and other forces of nature. Loneliness is a powerful and protective message that impels us to seek the company of others, which was crucial to survival for many generations. While loneliness is admittedly less dangerous now, this fear remains imprinted on us and leads to loneliness-induced depression.

People who have experienced significantly traumatic events are more likely to be diagnosed with depression, which researchers call trauma-induced depression. In fact, one study of almost 700 randomly-selected patients with depression found that 36% of them were also diagnosed with post-traumatic stress disorder (PTSD),4 and a large meta-analysis of 57 studies revealed that the comorbidity of depression and PTSD was 52%.5 Like those suffering from loneliness, people with PTSD show elevated levels of pro-inflammatory markers.6

Depressive symptoms can result from conflicts in modern hierarchies, such as the workplace, social groups, and families. Humans and social animals establish hierarchies, and those at the top enjoy many benefits. Therefore, we all want to be at a comfortable hierarchical position to meet our needs. If we don’t reach our desired place in the hierarchy, our self-esteem suffers.

Hierarchy conflicts, such as unemployment,7 bullying,8 and striving for unreachable career goals9 are all associated with depression.

Grief is a common driver of depression diagnoses. Up to 20% of people who lose a loved one and are grieving are saddled with the label of depression. Even in animals, losing a mate, sibling, or offspring leads to depressive symptoms. 10

Similarly, romantic rejection can cause depressive symptoms. Researchers found that after two months, 40% of people who had been left by their romantic partners showed symptoms of clinical depression.11 The sadness following a breakup may indicate true love and disappointment, and these feelings might also help make more aligned choices in future romantic relationships.

Six months after childbirth, 10-15% of women are diagnosed with postpartum depression. Symptoms of postpartum depression include crying, hopelessness, anger, and loss of interest in the new baby. Many studies indicate that mothers who feel that they are receiving inadequate childcare support from the father or her family are more likely to be diagnosed with postpartum depression.12 That is, a mother’s feelings of overwhelm, tiredness, and depletion are often categorized as postpartum depression. It has been hypothesized that the symptoms of postpartum depression may serve as a signal that the mother requires more support.

Seasonal Affective Disorder (SAD), also called seasonal depression, is a mood disorder that strikes a person at the same time each year, usually in the winter. A person diagnosed with SAD exhibits general fatigue, decreased libido, and increased appetite for starchy foods. SAD is more frequent in people with evening chronotypes, and light therapy can help resolve the symptoms.

Chemically-induced depression is a subtype of depression that results from substance abuse, such as alcohol or cocaine, or a side effect of medications like benzodiazepines. Yes, a side effect of anti-anxiety and antidepressant medications may be more depression. This type of depression appears to resolve when people stop ingesting the drugs or alcohol.13 Furthermore, as many people who feel sad self-medicate with alcohol, alcohol abuse may confound other drivers of depressive symptoms.

Interestingly, evidence is piling up that environmental toxicants, such as heavy metals, neurotoxic compounds, plastics, and pesticides may cause depressive symptoms.14 15

Being diagnosed with a disease like Alzheimer’s, migraine, and cancer increases the risk of also being diagnosed with depression. In fact, almost two-thirds of women who suffer from breast cancer are also diagnosed with depression.16 Of course, the diagnosis of cancer is traumatic and causes many types of anxieties, ranging from financial to emotional, and cancer treatments may cause further injury that adds to the stress burden.

Overall, depression is a meaningless label until you find its personal meaning.

This peer-reviewed article presents 12 research-backed possibilities that could be root cause drivers of depressive symptoms – and there are likely more than twelve. Scientific evidence continues to show that depression is a sign of imbalance, not an inherited genetic condition that you are powerless to change. Imbalances can be caused by inflammatory foods, toxins, medications, life events like trauma, and stress – and taking a one-size-fits-all antidepressant is like turning off the smoke alarm and ignoring the fire. Release the fear and move into curiosity. Commit to lean into your symptoms, realizing that they’re only messages, reduce your toxic exposures, turn down the noise, and explore the root cause of these symptoms for true healing.


  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16