New Day Campaign Events: Art and Healing

I’m honored to participate in two events as part of Peter Brunn’s New Day Campaign using the arts to heal addiction and mental illness.  Here are some details. Hope to see you there!

Artist Information Session

Maryland State Arts Council
175 W. Ostend Street #E, Baltimore MD, 21230

September 12, 2018, 3:30 – 5:00pm

Are you a visual artist, performer, writer, or other sort of creative person who wants to challenge stigma associated with mental illness or substance use? Do you care about making a difference with your art and words? Here is your chance to learn how to become involved with the New Day Campaign’s Dusk & Dawn series of programs in 2018-2019: join us for a gallery reception from 3:30-4:00pm, followed by a presentation and question and answer session with New Day Campaign founder and director, Peter Bruun.

The Art of Being Well

Baltimore County Arts Guild
1101 Maiden Choice Lane, Baltimore MD, 21229

December 2, 2018, 4:00 – 6:30pm

An exploration on the therapeutic power of art making (and making art about what ails us), and a look at the related but different clinical practice of art therapy. Please join poet and author Ann Bracken, writer and spoken word artist Kondwani Fidel, art therapists Sharon Strouse and Peggy Kolodny, and the artists who exhibit in We the People: New Day Campaign in an event combining performance, readings, and conversation. Reception with light appetizers and refreshments and a hands-on therapeutic art activity begins at 4:00pm; program and conversation begins at 5:00pm.

 

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.

References:

  • 1 https://www.ncbi.nlm.nih.gov/pubmed/29051086
  • 2 https://www.ncbi.nlm.nih.gov/pubmed/18073775
  • 3 http://europepmc.org/abstract/med/12821012
  • 4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219856/
  • 5 https://www.ncbi.nlm.nih.gov/pubmed/23696449
  • 6 https://www.ncbi.nlm.nih.gov/pubmed/19780999
  • 7 https://www.ncbi.nlm.nih.gov/pubmed/28359031
  • 8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926772/
  • 9 http://onlinelibrary.wiley.com/doi/10.1111/j.2044-8341.1970.tb02109.x/full
  • 10 http://press.uchicago.edu/ucp/books/book/chicago/H/bo12233936.html
  • 11 https://www.ncbi.nlm.nih.gov/pubmed/2016673
  • 12 http://www.sciencedirect.com/science/article/pii/S1090513899000161?via%3Dihub
  • 13 https://www.ncbi.nlm.nih.gov/pubmed/16930163
  • 14 https://www.ncbi.nlm.nih.gov/pubmed/18621076
  • 15 https://www.ncbi.nlm.nih.gov/pubmed/26987761
  • 16 http://www.europsy-journal.com/article/S0924-9338(07)01398-3/abstract

Upcoming Classes and Events

Still time to register for the memoir and poetry class at the Howard County Library. See details below.  I’ve included links for registration and directions for your convenience. Hope to see you there!  Feel free to email me at anniebluepoet@gmail.com if you have any questions. Happy June, everyone!

Exploring Boundaries: The Intersection of Memoir and Poetry
Howard County Library: East Columbia Branch, Marvin Room
June 26, 2018  6:30-8:30pm
Click here to register

Have you considered writing a memoir but are wondering where to begin? Join memoirist and poet Ann Bracken for a workshop that will give you a head-start on some vital and universal themes in memoir.

Feeling: New Day Campaign Event in Harford County, MD
June 30, 2018  2:00-5:00pm
Word of Faith Outreach
1301 Loflin Road, Aberdeen MD, 21001

Driven by the belief that pain shared is pain lessened, this event flips pain on its head, and offers an upbeat, joyous occasion to know and feel our connections with one another and hold on to hope. Featured presenters include spoken word artist Kondwani Fidel, poet Ann Bracken, singer Simone A. Speed, and others.

More Than “Three Hots and a Cot”

Three hots and a cot. A casual phrase, but one that provokes an immediate, visceral reaction for me. The first time I ever heard anyone use the phrase was when I taught freshman composition at a local community college. I had assigned my students  an article to read about prison reform or unjust sentencing, and the class was discussing the author’s ideas. One young man defended the existing state of prisons and concluded by saying something along these lines, “Look, they get three hots and a cot, TV, and a workout room. In lots of ways, life in prison is better than where those people come from.”

The River of Uncertainty

Those people. The very anonymity of the description renders imprisoned people faceless shells of who they actually are. And for the past three years, I’ve volunteered in a local prison and gotten to know a lot of “those people.” Getting to know several of the men and women who are incarcerated in our state prisons has erased any stereotypes I previously held of who they might be. And the food and living conditions in our prisons are far from being better than where anyone came from, at least in my experience.

So when I heard a new friend use the phrase “three hots and a cot” in relation to patients in a psychiatric hospital, I was shocked into silence. To be fair, this woman, a physician’s assistant, was talking about the need for in-patient psych facilities run by the state as opposed to our current situation that leaves many people wandering the streets or being imprisoned. But again, the phrase was casually tossed into the conversation where she advocated for “three hots and a cot, a safe place to regroup, counseling, and meds for two to three weeks to help people get back on their feet.”

My reaction was instinctive, but I was mute. I listened and pondered what I could say. “Better than putting those people in prison, which is what we do now,” one woman said. And while I agree that we have a need for more care for people who suffer from trauma-induced emotional distress (I refuse use the term depression because of what it connotes), I know that the solution is not as simple as providing in-patient facilities for emergency care. And I wondered if any of the women in my circle had ever been psychiatric patients themselves. Like I had been. Like my mother had been. But I was silent.

I didn’t want to get emotional–passionate, really–with my response. This is what I wanted to say:

No, we can’t just medicate people, hospitalize them for a week or so (if you are very, very lucky) and then discharge them without addressing the environment that they will be returning to.  Have any of you ever read about what psych drugs can do to people over the long-term? Do you know about the dangers and difficulties  of discontinuing psych drugs once you start? Do you know there is no scientific proof that a lack of serotonin or an excess of dopamine causes depression, schizophrenia, or bipolar disorder? Do you know that sometimes taking  antidepressants can actually cause bipolar disorder?

And how about this admission (excerpted from “More on the Chemical Imbalance Theory” on the Mad in America website) from Dr. Ronald Pies, a highly-regarded psychiatrist?

The “little white lie” is, of course, a reference to the 2014 article by the very eminent and influential psychiatrist Ronald Pies, MD.  In that article, Dr. Pies characterizes the chemical imbalance theory as “…this little white lie…”

Dr. Pies has also insisted – arguably delusionally – that psychiatry never promoted the chemical imbalance theory of mental illness.  In a 2011 article he  wrote:

“In truth, the ‘chemical imbalance’ notion was always a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists.”

But Dr. Pies’ words haven’t filtered down into mainstream knowledge. Part of the reason I didn’t speak up is because I meet so much resistance when I present the information about lack of evidence for the chemical imbalance theory  and the harm that can come from psychiatric drugs. But I am convinced, based all the books and articles that I’ve read over the past five or more years. And I’m convinced by my own life-experiences and the experiences of other people that I know.

Because I know that there is a desperate need for compassionate, community-based care,  I’ll be posting a blog on what would I advocate for in the next few weeks. In the meantime, here is a poem of mine, recently published on the Mad in America website, about my experience visiting a friend in a local psychiatric hospital and recalling my own experience.

A Therapeutic Environment

I bring a small basket of flowers
for my friend in the psych unit,
the nurse buzzes me in.
She silently yanks
the plastic card-holder,
then chides me,
It has a pointy end.
My friend tells me later,
“No one gets flowers here.”

My friend wears
blue paper pajamas—the only thing that will fit over her cast—
until I bring new sweatpants
“No drawstrings,” she tells me. “The nurses will take them out.”
Other patients wander
as if in an endless maze
blankets over their heads,
eyes trained on the ground.

The nurses stare into computer screens
behind thick walls of safety glass
—barricaded against what danger?
Perhaps mindful that one day they too
might be lost
like the wandering “others”
in the blue paper pajamas.

My friend is hospitalized
because she tried
to hang herself. She had stopped eating.
Has your appetite returned? I ask.
“We had fish sticks for lunch.
They were so hard I couldn’t chew them.”

She recites the meds in her psych-cocktail—
Lexapro, Topomax, Prozac, and Zanax.
She shrugs and whispers
“I don’t feel any better,
and the weekend doctor
wants me to add Ritalin.”

We move into the dayroom
and I step across a stream of time
to the same place I left in 1997.
The same tattered furniture,
the same dull green walls,
punctuated by a lone picture hanging
crooked and uncentered.

Board games thrown on the shelves—
lids with no bottoms,
scattered pieces from the “Game of Life.”
“No one bothers
to start a puzzle—
we can’t find all the pieces,”
my friend tells me.
A bin of crayons
sits on the shelf,
but there’s no paper.

When I see the flip chart,
I flash back 18 years and remember
the goals’ group twice a day,
but still no art classes.
No dance, no movement
except the aimless wandering
of the blanket people.
No way to shape the confusion
churning inside.
No play dough.
No glue.

Two nursing assistants
fill chairs on the perimeter of the room.
They poke their heads up quickly,
like prairie dogs scanning for predators,
then return to the games
on their mobile phones.

References for further reading:

See The Hidden Epidemicby Robert Whitakerfor more information on the history of developing psychiatric drugs, long-and-short-term effects, trends in rates of mental illness and disability, and alternative treatments.

See Psychiatry Under the Influenceby Robert Whitaker & Lisa Cosgrove for an exploration of the mutually-beneficial relationship between the pharmaceutical industry and the psychiatric community, including medical schools and professional development.

See Prozac Backlashby Joseph Glenmullenfor research on the clinical trials related to antidepressants and the numerous side-effects that patients experience. The book also includes a section on alternative treatments for emotional distress (depression).

 

 

Reblogging: Are You Better Off Medication-Free?

A few weeks back, I posted my story of being overmedicated and getting off of pain medication and psychiatric drugs.  So when I read the blog post below, I thought it was a good follow-up to my story. I, too, was a victim of polypharmacy, which is why this post resonated with me. What is polypharmacy?  Here is a definition that is included in Dr. Brogan’s post below:

Polypharmacy is ambiguously defined as the prescription of 2-11 or more medications, simultaneously, 6 encompassing more than half of the American population. 7

For those of you who are interested in exploring this topic further, Dr. Brogan includes links to a lot of good resources. If you what to read my story of overmedication, here  is the link to the blog post–How Methadone Saved My Life–and if you prefer to listen,  here is a link to the the audio of my performance at Stoop Stories.

Deprescribing: Are You Better Off Medication Free?

I know that strategic medication tapering can be a ticket to an authentic experience of yourself. I get feedback like this, every week:

Is Gloria some kind of freak anomaly of someone who could possibly feel better off medication? You can see that part of her process was shifting out of a mindset that she was fundamentally broken, in need of medication as some sort of normalcy prop. I believe deeply in personal reclamation through a rewriting of this story of the broken self. But what if medications actually contribute to a poorer quality of life, not because of their metaphysical role in self-identity and outsourcing of power, but simply because of their toxicity, particularly in combination?

The Problem With Pills

We know that it’s not a matter of opinion, (despite what the NY Post would have you think!), that medications – properly prescribed – are the third leading cause of death in this country. 1 This does not include the quarter of a million deaths from medical errors 2 3and overdose, which in 2016 killed more than the entire Vietnam War. 4

These reasons and more are why I was delighted to read Poly-deprescribing to treat polypharmacy: efficacy and safety 5 in the journal Therapeutic Advances in Drug Safety. This longitudinal, prospective trial addresses the major symptom of our fragmented, specialist-driven, the left-hand-doesn’t-know-what-the-right-is-doing-health care system: polypharmacy.

Polypharmacy is ambiguously defined as the prescription of 2-11 or more medications, simultaneously, 6 encompassing more than half of the American population. 7

The author, Garfinkel, states that the epidemic of polypharmacy is driven by:

(1) the increased number of doctors/specialists and clinical guidelines; (2) the lack of evidence-based medicine (EBM) and knowledge regarding drug–disease–patient interactions in polymedicated; (3) barriers/ fears of medical doctors to deprescribe.

His study was conducted on patients >66 years old taking >6 prescriptions (never mind the 666!), and this intrepid clinician endeavored to offer them the opportunity to discontinue more than 3 of their meds, strategically assessing quality of life parameters.

Getting Free, One Med At A Time

After approximately four years, Garfinkel found that: Overall, 57.4% of PDP patients/ families reported an improvement as early as 1 month after the intervention. In 82.8% health improvements occurred within 3 months of the intervention and among 68% improvement persisted for more than 2 years.

Like the parable of the blind men and the elephant, feeling and describing only their part, neglecting the comprehensive appreciation of the whole animal, Garfinkel states:

…all too often specialists who treat patients ‘by their book’ have but one aim, to deal with their one aspect of the disease spectrum; no in depth consideration of the ultimate effects of medications they prescribe combined with other consultant’s interventions on patients’ overall welfare.

He also references the domino effect of prescription toxicity leading to new diagnoses and new medications, stating:

“The problem is further aggravated due to ‘prescription cascades’ where symptoms resulting from ADEs are perceived as representing ‘new diseases’.”

So, it turns out that when real life studies assess the effects of medications, stopping them – several if not all of them – can lead to a better quality of life.

I love his hopeful message, in conclusion:

Conclusions: This self-selected sample longitudinal research strongly suggests that the negative, usually invisible effects of polypharmacy are reversible. Poly-deprescribing] is well tolerated and associated with improved clinical outcomes, in comparison with outcomes of older people who adhere to all clinical guidelines and take all medications conventionally. Future double-blind studies will probably prove beneficial economic outcomes as well.

The study doesn’t particularly reference psychiatric medications (in fact, he references starting them during the study window), which, in my opinion, are the most difficult chemicals on the planet to detox from. While I acknowledge that the physiologic relief from discontinuing a medication may, itself, result in near-immediate improvement in quality of life, psychiatric medication taper seems to ask something more of patients intending for a medication-free life. The taper process asks for healing. Physical, emotional, and spiritual…and this healing does more than improve quality of life…it sets you free.

References:

  • 1 https://www.ncbi.nlm.nih.gov/pubmed/25355584
  • 2https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us
  • 3 https://www.ncbi.nlm.nih.gov/books/NBK225187/
  • 4 https://www.vox.com/policy-and-politics/2017/6/6/15743986/opioid-epidemic-overdose-deaths-2016
  • 5 http://journals.sagepub.com/doi/abs/10.1177/2042098617736192
  • 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/
  • 7 https://newsnetwork.mayoclinic.org/discussion/nearly-7-in-10-americans-take-prescription-drugs-mayo-clinic-olmsted-medical-center-find/

How Methadone Saved My Life: a Stoop Story

I told the following story as part of Baltimore’s Stoop Stories at the Senator Theater. The theme of the show was On Drugs: Dependence, Destruction, and Salvation. Thank you to Jessica Myles Henkin and Laura Wexler for inviting me to share my story with the audience. This story is part of my memoir-in-search-of-a-publisher Noncompliant. More stories about the role of drugs and alcohol in my life can be found in my first poetry collection, The Altar of Innocence. 

Stoop Stories 2018
The Senator Theater

In the fall of 1993, I went out to lunch with my husband and a friend but came home with a massive migraine headache. I’d had a similar headache once before, and it had cleared up with the help of acupuncture. I prayed that this one would do the same. But the headache hung on for a couple of months despite several acupuncture treatments, meditation, and lots of prayer. Tylenol wasn’t budging the pain, and after a while, I began to feel emotionally depressed. I figured that was pretty normal, given the horrific, daily pain I was enduring. It was getting tougher and tougher to keep the condition from my husband, but every time I got sick, he’d yell at me and get very angry. I pretended that everything was normal and prayed for relief.

I had no family history of migraines and typically only got a headache once or twice a year, so I knew that this headache was more than a physical problem. I’d had a history of what I called physical depressions–intense physical pain that had no discernible cause.  Yet eventually, once I’d seen several doctors about the back pain, or the pelvic pain, or the stomach aches, I’d realize that there was an emotional root to my distress. I was 41 years old at the time, so I knew myself pretty well. But when I finally consulted a doctor about the headache pain, he just smiled as I told my story and related my theory. Then he gave me an antidepressant.

Fast forward to 1996. By that time, I’d consulted a parade of psychiatrists who’d prescribed grab-bags full of medication. Nothing had worked, for either the headache or the depression. My newest psychiatrist insisted that I consult a headache specialist. At my first appointment, I told her (a nurse practitioner) about my theory of physical depression, and followed up my explanation with my dilemma. “I don’t know what I’m stressed about. We have a lovely home, we’re well-off financially, our kids are great…..Yes, my marriage is difficult, and at times even painful, but it’s been this way for ages. And I’m coping.”

She immediately prescribed me MS-Contin (powdered morphine), Prednisone, and Migranol nasal spray. After a month or so, that regimen had failed to make a dent in the pain, she added DHE which I injected into my thighs.  I stayed on these pain meds for several months, adding them to the numerous psychiatric meds I was taking. Several months passed, and when the MS-Contin failed to relieve my pain, my nurse practitioner prescribed a new drug-OxyContin. She assured me that it was safe, and I used it in increasing doses over the next couple of years.

 

Grab-bag of antidepressants and pain meds

In 1997, after four long years that included hospitalizations, numerous combinations of drugs, and several rounds of ElectroConvulsive Therapy, my depression finally abated. My psychiatrist insisted on keeping me on maintenance meds, which I took in addition to all of the painkillers. Things had deteriorated so badly in my marriage that I no longer wanted to stay with my husband. But as long as I had the migraine pain, I knew I couldn’t work.  The migraine kept me locked in my marriage, and I was determined to find a way to get better.

At that time, I thought I was handling the drugs pretty well, and no one else thought there was a problem. Both my psychiatrist and my headache doctor said it was fine to take the combination of serious drugs they prescribed. The pharmacists never batted an eye when I picked up my prescriptions. The only person who could see how much the meds affected me was my daughter who was 14 or 15 at the time. She’d observe me cautiously at every stop light and notice how my jaw would unhinge right before I fell asleep. Then she’d yell at me to wake up.

In the fall of 1999, I had my first car accident. I swerved five times across three lanes of traffic on Rte. 70 before finally crashing into a guardrail. I wasn’t hurt—like the proverbial drunk who maims someone and walks away unscathed. My car was banged up a bit, but fixable.  More importantly, I hadn’t hurt anyone.  But by January of 2000, I had a second, much more serious car accident. I was driving on Rte. 40 out of the city to visit my parents on a warm January afternoon. There was a black van in front of me that slowed down. The next thing I knew, I had an air bag pinning me to my seat and smoke filling my nostrils. A man in a black leather jacket pounded on my window. I rolled down the window, still dazed, and said, Oh, God, I’m so drugged.”  That man, who turned out to be the van-driver, answered: “Lady, don’t ever say that again.”

He got me and my car off the road and onto a parking lot where he checked me over and made sure I was all right. He waited while I called my father to come and help me, and when I turned to thank the van-driver, he was gone. To this day, I think he was an angel sent to save me.

By the time of the accident, I was taking about seven or eight daily medications. For the migraine–Methadone, Migranol nasal spray, DHE injections, and I had a stash of injectable Demerol for the really bad days. My psychiatrist had me on maintenance meds to keep me out of depression: WellbutrinElavil, Topamax (a mood regulator) and Valium. But I wasn’t high. I was numb.

Western Medicine had failed me. The deep shame that I felt for taking Methadone combined with the shock of the second auto accident forced me to confront my life with fresh eyes. It was time for radical action, so I called an energy healer who’d been recommended by a friend. I told her my story and finished by saying I just want my life back. Can you help me?  Her answer: “I can almost guarantee I’ll get rid of the pain, but I cannot guarantee what else might happen. Are you ready?”

We began working together twice a week right after the phone call. Leah did distance energy healing, and she lived in White Marsh, a suburb east of Baltimore. I lived in Western Howard County, about 50 miles away. I’d call her up and discuss my medications, my relationship, and any other happenings in my life. Then we’d hang up, and I’d lie in my bed for about an hour while she cleared my chakras and balanced all of my bodily systems. All of this work required a suspension of disbelief on my part, but I was finally getting better, and I did whatever Leah recommended.

Leah was one of the few people to affirm my suspicions of the headache being a form of physical depression, and she worked on me as a whole person. She taught me tools for shielding myself in dangerous or difficult situations and explained to me how to keep my energetic vibration at a higher level. I grew stronger in every area, and my pain gradually decreased. We were able to taper my medications, and Leah began to supplement my healings with flower essences, again designed to strengthen my vibrations and assist me on an energetic level. As I got stronger, I tolerated less and less control from my husband and fewer disparaging remarks. I set firm boundaries and stood my ground with him.

By May of 2000, only about four months into our work together, I was completely headache- free and off of all my pain medications. There was one final incident between my husband and myself, and I decided to end the marriage after 25 years. With my new-found strength and confidence, I knew that I could take care of myself and earn a living.

Since May of 2000, I’ve been off of all pain medications and am migraine-free. Since 2002, I’ve been off of the antidepressant and mood regulator, but it took me a few more years to break free of anti-anxiety meds and an older antidepressant that was prescribed for my initial headache. That being said, I have remained  have remained depression-free. I know that any mysterious pains  are probably signals that I’m in some kind of stressful situation. I trust the signs that my body gives me and know to pay attention to my body-mind-spirit balance. If I cannot resolve any issues with mysterious pain by using meditation, and homeopathic remedies, I schedule time to work with my energy healer.  And I keep the flower essences close by!

 

Stoop Stories: On Drugs: Dependence, Destruction, and Salvation

I’m thrilled to be one of the storytellers for the upcoming Stoop Stories in Baltimore at the Senator Theater on April 19th at 8pm. I have a story to tell that will probably surprise many of you, and I want to tell it because I believe very much in the power of the mind-body connection. Come to the event on April 19th and hear some great stories of courage and triumph.

Thanks to Jessica Myles Henkin and Laura Wexler for their excellent coaching and support in our presentations.

Here’s a teaser for my story:

All Ann Bracken wanted was a life without pain.  A continuous migraine banged away in her head for seven years. The numerous hospitalizations failed.
Her doctor offered her one last drug: methadone.  But when Ann crashed her car twice after falling asleep, she rejected the methadone, the doctors, and the hospitals. She decided to heal herself. This story is an excerpt from Noncompliant,her memoir in search of a publisher.

More stories about the role of drugs and alcohol in my life can be found in my first poetry collection, The Altar of Innocence. 

Tickets and information: click here

Reblogging: Little Patuxent Review’s Reading at the Writer’s Center

Hope to see lots of folks there for this special event!

Annual Reading on March 17 at The Writer’s Center in Bethesda

Rucker cover

Little Patuxent Review will host its annual reading of fiction, nonfiction, and poetry at 2 p.m. on March 17 at The Writer’s Center in Bethesda. The reading will feature contributors to our most recent issue, including five members of the Black Ladies Brunch Collective, as well as LPR editors and Ian Anderson, the editor of Mason Jar Press, an independent press in Baltimore.

A reception will follow the reading. Our lineup:

  • Daien Guo, fiction
  • Ann Bracken, interview with artist Paul Rucker
  • Steven Leyva, poetry
  • Maria Termini, nonfiction (read by Desirée Magney)
  • Ian Anderson, fiction

And from the Black Ladies Brunch Collective:

  • Saida Agostini, poetry
  • Anya Creightney, poetry
  • Teri Ellen Cross Davis, poetry
  • Tafisha A. Edwards, poetry
  • Katy Richey, poetry

The Writer’s Center in Bethesda is at 4508 Walsh St, Chevy Chase, MD 20815.