We’re Working Nurses to Death.

By: Jason Silverstein

Nurses do the work that neither hospitals nor patients could live without, which comes at an ever-increasing physical and emotional cost, as they are expected to aid sicker patients for longer hours with less support.

Otherwise, nursing could easily be the best job in the United States—the Bureau of Labor Statistics estimates more than 400,000 new jobs will be created by 2024. In five states, the average pay clears $85,000, with nursing jobs in California crossing into six figures.

Those numbers are no surprise to those who are aware of how much older the nation’s old are, and how much sicker they are, too: By 2030, there will be 70 million people over the age of 65, of which an estimated 14 million will have Alzheimer’s and more than 50 million will have at least two chronic health conditions.

But just as the need for nurses is increasing, so too is the price for devoting one’s life to the direct care of strangers. Nearly a quarter of hospital and nursing home nurses aren’t satisfied with their jobs, according to one study, and more than a third feel burned out. “Burnout is an occupational hazard in nursing,” says Jeanne Geiger-Brown, dean at Stevenson University’s School of Nursing and Health Professions. “It is hard to generate a lot of caring about other people, because you are so depleted yourself.”

Burnout, of course, is caused by overwork, but what causes overwork is more complicated and reveals how the cost-cutting priorities of hospitals force their nurses to pay an emotional tax.

“What’s causing the overwork is the increased acuity of patients,” says Susan Letvak, a professor at the University of North Carolina at Greensboro School of Nursing. “You are only in a hospital if you are so acutely sick that you can barely move. The minute you can move, you are kicked out the door.”

“The push is to get everybody out of the hospital as fast as we can,” echoes Bernadette Melnyk, dean of the College of Nursing at the Ohio State University and the university’s Chief Wellness Officer. Melnyk and her colleagues recently published a paper that shows depression among nurses is associated with both burnout and medical errors.

Getting people out of the hospital “quicker and sicker,” as a few Harvard health policy researchers explain, is a response, in part, to Medicare’s prospective payment system, which pays a fixed amount for a diagnosis no matter the length of stay, and the need for open hospital beds. If that formula seems designed to create higher rates of readmission, well…yeah. Even so, there’s also a financial incentive to avoid having people readmitted.

How does the quicker and sicker approach add up for nurses? Physically, it means the shifts themselves are much harder, especially since shifts are often twelve hours to begin with, which itself is a risk factor for burnout and mistakes in a place where patient alarms are constantly sounding. “It’s not healthy for the nurses, it’s not safe for the patients,” Melnyk says.

Emotionally, the quicker and sicker model means the long hours are engineered to be less fulfilling. “It’s not very satisfying to just put bandaids on people who are really quite ill,” Geiger-Brown says.

When the hospital is successful at turfing patients to home or anywhere else, you might expect nurses to benefit somewhat: Fewer patients on a given day could mean a slower shift and a chance for a break. But that’s not how it often plays out.

“Minimum is maximum staffing,” Letvak says. “We don’t have any easy days anymore. If the [patient load] is low, which happens all the time, they send the nurses home, instead of them having a light afternoon. How few do we need? That’s all that you’re getting. Every time you are at work, it is a bad day. There really isn’t a chance of having a lighter day anymore.”

Yet nurses should have the lightest days possible—like air traffic controllers, they do a job in which we accept no room for mistakes. Suppose you know that the ideal number of patients for a nurse is four—would you want to be number five?

While it may seem like a water is wet revelation to say nurses should care for fewer patients rather than get sent home, take a look at the work of Linda Aiken and her colleagues at the University of Pennsylvania. They have shown just how many lives are on the line when nurses are overworked. Give a nurse just one patient beyond four and the chances of that patient dying shoot up 7 percent and the chances of that nurse getting burned out climbs an astonishing 23 percent.

Overworking nurses extinguishes their lifesaving impact. Aiken and her team have shown elsewhere that every ten percent increase in the proportion of nurses with bachelor’s degrees lowers the risk of death for patients by five percent. A study by a different group found that a 10 percent increase in registered nursing staff saves five lives for every 1,000 people discharged. (If five saved lives doesn’t sound like a lot, try replacing “five” with five names of your loved ones.)

And while nurses care for a sicker and older population in an environment that is a burnout and depression generator, they may avoid mental health care for themselves, fearing that a hospital concerned first-and-foremost with the bottom line will use a mental health diagnosis against them.

“Think about the legalities,” says Letvak, who teaches on law and policy. “If a nurse made an error and something were to come out that they had depression, and then you can see the research that links depression and errors, that nurse just exposed herself to potential liability.”

Reposted from: https://tonic.vice.com/en_us/article/43nkjd/nurses-overworked-stressed-burnout?utm_source=vicefbus

The Real Causes Of Depression Have Been Discovered, And They’re Not What You Think.

By: Johann Hari

Across the Western world today, if you are depressed or anxious and you go to your doctor because you just can’t take it any more, you will likely be told a story. It happened to me when I was a teenager in the 1990s. You feel this way, my doctor said, because your brain isn’t working right. It isn’t producing the necessary chemicals. You need to take drugs, and they will fix your broken brain.

I tried this strategy with all my heart for more than a decade. I longed for relief. The drugs would give me a brief boost whenever I jacked up my dose, but then, soon after, the pain would always start to bleed back through. In the end, I was taking the maximum dose for more than a decade. I thought there was something wrong with me because I was taking these drugs but still feeling deep pain.

In the end, my need for answers was so great that I spent three years using my training in the social sciences at Cambridge University to research what really causes depression and anxiety, and how to really solve them. I was startled by many things I learned. The first was that my reaction to the drugs wasn’t freakish ― it was quite normal.

Many leading scientists believe the whole idea that depression is caused by a “chemically imbalanced” brain is wrong.

Depression is often measured by scientists using something called the Hamilton Scale. It runs from 0 (where you are dancing in ecstasy) to 59 (where you are suicidal). Improving your sleep patterns gives you a movement on the Hamilton Scale of around 6 points. Chemical antidepressants give you an improvement, on average, of 1.8 points, according to research by professor Irving Kirsch of Harvard University. It’s a real effect – but it’s modest. Of course, the fact it’s an average means some people get a bigger boost. But for huge numbers of people, like me, it’s not enough to lift us out of depression – so I began to see we need to expand the menu of options for depressed and anxious people. I needed to know how.

But more than that – I was startled to discover that many leading scientists believe the whole idea that depression is caused by a “chemically imbalanced” brain is wrong. I learned that there are in fact nine major causes of depression and anxiety that are unfolding all around us. Two are biological, and seven are out in here in the world, rather than sealed away inside our skulls in the way my doctor told me. The causes are all quite different, and they play out to different degrees in the lives of depressed and anxious people. I was even more startled to discover this isn’t some fringe position – the World Health Organization has been warning for years that we need to start dealing with the deeper causes of depression in this way.

I want to write here about the hardest of those causes for me, personally, to investigate. The nine causes are all different – but this is one that I left, lingering, trying not to look at, for most of my three years of research. I was finally taught about it in San Diego, California, when I met a remarkable scientist named Dr. Vincent Felitti. I have to tell you right at the start though – I found it really painful to investigate this cause. It forced me to reckon with something I had been running from for most of my life. One of the reasons I clung to the theory that my depression was just the result of something going wrong with my brain was, I see now, so I would not have to think about this.

**

The story of Dr. Felitti’s breakthrough stretches back to the mid-1980s, when it happened almost by accident. At first, it’ll sound like this isn’t a story about depression. But it’s worth following his journey – because it can teach us a lot.

When the patients first came into Felitti’s office, some of them found it hard to fit through the door. They were in the most severe stages of obesity, and they were assigned here, to his clinic, as their last chance. Felitti had been commissioned by the medical provider Kaiser Permanente to figure out how to genuinely solve the company’s exploding obesity costs. Start from scratch, they said. Try anything.

One day, Felitti had a maddening simple idea. He asked: What if these severely overweight people simply stopped eating, and lived off the fat stores they’d built up in their bodies – with monitored nutrition supplements – until they were down to a normal weight? What would happen? Cautiously, they tried it, with a lot of medical supervision – and, startlingly, it worked. The patients were shedding weight, and returning to healthy bodies.

Once the numbers were added up, they seemed unbelievable.

But then something strange happened. In the program, there were some stars ― people who shed incredible amounts of weight, and the medical team ― and all their friends ― expected these people to react with joy, but the people who did best were often thrown into a brutal depression, or panic, or rage. Some of them became suicidal. Without their bulk, they felt unbelievably vulnerable. They often fled the program, gorged on fast food, and put their weight back on very fast.

Felitti was baffled ― until he talked with one 28-year-old woman. In 51 weeks, Felitti had taken her down from 408 pounds to 132 pounds. Then ― quite suddenly, for no reason anyone could see ― she put on 37 pounds in the space of a few weeks. Before long, she was back above 400 pounds. So Felitti asked her gently what had changed when she started to lose weight. It seemed mysterious to both of them. They talked for a long time. There was, she said eventually, one thing. When she was obese, men never hit on her ― but when she got down to a healthy weight, for the first time in a long time, she was propositioned by a man. She fled, and right away began to eat compulsively, and she couldn’t stop.

This was when Felitti thought to ask a question he hadn’t asked before. When did you start to put on weight? She thought about the question. When she was 11 years old, she said. So he asked: Was there anything else that happened in your life when you were 11? Well, she replied ― that was when my grandfather began to rape me.

As Felitti spoke to the 183 people in the program, he found 55 percent had been sexually abused. One woman said she put on weight after she was raped because “overweight is overlooked, and that’s the way I need to be.” It turned out many of these women had been making themselves obese for an unconscious reason: to protect themselves from the attention of men, who they believed would hurt them. Felitti suddenly realized: “What we had perceived as the problem ― major obesity ― was in fact, very frequently, the solution to problems that the rest of us knew nothing about.”

This insight led Felitti to launch a massive program of research, funded by the Centers For Disease Control and Prevention. He wanted to discover how all kinds of childhood trauma affect us as adults. He administered a simple questionnaire to 17,000 ordinary patients in San Diego, who were were coming just for general health care – anything from a headache to a broken leg. It asked if any of 10 bad things had happened to you as a kid, like being neglected, or emotionally abused. Then it asked if you had any of 10 psychological problems, like obesity or depression or addiction. He wanted to see what the matchup was.

Once the numbers were added up, they seemed unbelievable. Childhood trauma caused the risk of adult depression to explode. If you had seven categories of traumatic event as a child, you were 3,100 percent more likely to attempt to commit suicide as an adult, and more than 4,000 percent more likely to be an injecting drug user.

**

After I had one of my long, probing conversations with Dr. Felitti about this, I walked to the beach in San Diego shaking, and spat into the ocean. He was forcing me to think about a dimension of my depression I did not want to confront. When I was a kid, my mother was ill and my dad was in another country, and in this chaos, I experienced some extreme acts of violence from an adult: I was strangled with an electrical cord, among other acts. I had tried to seal these memories away, to shutter them in my mind. I had refused to contemplate that they were playing out in my adult life.

Why do so many people who experience violence in childhood feel the same way? Why does it lead many of them to self-destructive behavior, like obesity, or hard-core addiction, or suicide? I have spent a lot of time thinking about this. I have a theory – though I want to stress that this next part is going beyond the scientific evidence discovered by Felitti and the CDC, and I can’t say for sure that it’s true.

If it’s your fault, it’s — at some strange level — under your control.

When you’re a child, you have very little power to change your environment. You can’t move away, or force somebody to stop hurting you. So, you have two choices. You can admit to yourself that you are powerless ― that at any moment, you could be badly hurt, and there’s simply nothing you can do about it. Or you can tell yourself it’s your fault. If you do that, you actually gain some power ― at least in your own mind. If it’s your fault, then there’s something you can do that might make it different. You aren’t a pinball being smacked around a pinball machine. You’re the person controlling the machine. You have your hands on the dangerous levers. In this way, just like obesity protected those women from the men they feared would rape them, blaming yourself for your childhood traumas protects you from seeing how vulnerable you were and are. You can become the powerful one. If it’s your fault, it’s ― at some strange level ― under your control.

But that comes at a cost. If you were responsible for being hurt, then at some level, you have to think you deserved it. A person who thinks they deserved to be injured as a child isn’t going to think they deserve much as an adult, either. This is no way to live. But it’s a misfiring of the thing that made it possible for you to survive at an earlier point in your life.

**

But it was what Dr. Felitti discovered next that most helped me. When ordinary patients, responding to his questionnaire, noted that they had experienced childhood trauma, he got their doctors to do something when the patients next came in for care. He got them to say something like, “I see you went through this bad experience as a child. I am sorry this happened to you. Would you like to talk about it?”

Felitti wanted to see if being able to discuss this trauma with a trusted authority figure, and being told it was not your fault, would help to release people’s shame. What happened next was startling. Just being able to discuss the trauma led to a huge fall in future illnesses ― there was a 35-percent reduction in their need for medical care over the following year. For the people who were referred to more extensive help, there was a fall of more than 50 percent. One elderly woman ― who had described being raped as a child ― wrote a letter later, saying: “Thank you for asking … I feared I would die, and no one would ever know what had happened.”

The act of releasing your shame is – in itself – healing. So I went back to people I trusted, and I began to talk about what had happened to me when I was younger. Far from shaming me, far from thinking it showed I was broken, they showed love, and helped me to grieve for what I had gone through.

If you find your work meaningless and you feel you have no control over it, you are far more likely to become depressed.

As I listened back over the tapes of my long conversations with Felitti, it struck me that if he had just told people what my doctor told me – that their brains were broken, this was why they were so distressed, and the only solution was to be drugged – they may never have been able to understand the deeper causes of their problem, and they would never have been released from them.

The more I investigated depression and anxiety, the more I found that, far from being caused by a spontaneously malfunctioning brain, depression and anxiety are mostly being caused by events in our lives. If you find your work meaningless and you feel you have no control over it, you are far more likely to become depressed. If you are lonely and feel that you can’t rely on the people around you to support you, you are far more likely to become depressed. If you think life is all about buying things and climbing up the ladder, you are far more likely to become depressed. If you think your future will be insecure, you are far more likely to become depressed. I started to find a whole blast of scientific evidence that depression and anxiety are not caused in our skulls, but by the way many of us are being made to live. There are real biological factors, like your genes, that can make you significantly more sensitive to these causes, but they are not the primary drivers.

And that led me to the scientific evidence that we have to try to solve our depression and anxiety crises in a very different way (alongside chemical anti-depressants, which should of course remain on the table).

To do that, we need to stop seeing depression and anxiety as an irrational pathology, or a weird misfiring of brain chemicals. They are terribly painful – but they make sense. Your pain is not an irrational spasm. It is a response to what is happening to you. To deal with depression, you need to deal with its underlying causes. On my long journey, I learned about seven different kinds of anti-depressants – ones that are about stripping out the causes, rather than blunting the symptoms. Releasing your shame is only the start.

**

One day, one of Dr. Felitti’s colleagues, Dr. Robert Anda, told me something I have been thinking about ever since.

When people are behaving in apparently self-destructive ways, “it’s time to stop asking what’s wrong with them,” he said, “and time to start asking what happened to them.”

How to be merry even though it’s Christmas.

IT’S THE MERRY CHRISTMAS season, a holy time, joy-to-the-world days, happy Chanukah, the heartiest and most beautiful holiday of the year — except that it often doesn’t work out that way. And the only way to deal with this paradox is to understand how and why it works.

The truth is, few people get through these gala days without feeling decidedly annoyed by the season. With some, it’s only a flinching reaction to the insistent jollity. Others, particularly those suspended in the middle years between taskless childhood and self-indulgent old age, are harassed by shopping, wrapping, mailing, cooking and debts — and the notion that what started out to be a gentle religious festival has been hoked out of shape by the vendors.

Quite a number of people have an old grudge against Christmas: it is a regular reminder of disappointment, suffering or isolation in some less-than-perfect Christmas past. A proportion of these have what amounts to an annual breakdown at Christmas, one that is now being investigated by psychiatrists who call it either the Holiday Syndrome or Christmas Neurosis. Their main symptoms are depression and deep anger, though they may conceal them gallantly under the requisite degree of ho-ho heartiness.

These individuals are gloomy because of the idealized warmth and sweetness of the season, not in spite of it. Since they cannot, for various reasons, experience all the elation that seems to abound, their private desolation is the mark of failure, and a bitter one.

Most people can bask in Christmas as children do, frankly relishing the food and drink treats, the conspiracy of gift hiding, the expectancy of wish-fulfillment, the tumult of parties and gaudy decorations, the simplicity and sentiment of a baby Saviour. It’s a mass regression to untroubled pre-adolescence, and the pleasure seeking can be atoned for neatly by New Year’s resolutions.

But there are flickers of doubt. Carol singing can grow tedious, week after week, outdoor decorations are competitive and oath provoking, gift-shopping is exhaustion and frustration in a pure form. The relatives gather, not always a happy sight. A lot of people accordingly plan trips to remove themselves from Christmas, only to find themselves sourly marking the oddity of Christmas lights in a palm tree or the cheeriness of strangers in a ski lodge.

“Not being joyous during the Christmas season is much more common than most of us realize,” observed a report by four psychiatrists at the University of Utah, who recently completed a study of psychological complaints at yuletime.

Dismay, in a mild degree, is universal. Sociologists have been noting that ordinary conversations during the pre-Christmas rush are rarely luminous with goodwill. Women complain of weariness, anxiety while shopping, the greediness of their get; men are uneasy over expenses and drinking too much. “There are few spontaneous exclamations about how wonderful it all is,” comments a noted Canadian psychiatrist, Montreal’s Dr. Alastair MacLeod. “There seems to be a great deal of hostility and anger over being impelled into something.”

The tender concepts of the season, in the Christian religion of the Nativity and in Judaism the candlelight memorial to freedom, are hard to confront under the smothering of carnival commercialism. There is a resultant loss of tranquillity felt by everyone.

One of the world’s most distinguished psychoanalysts, Ernest Jones, once wrote that Christmas represents psychologically “the ideal of resolving all family discord in happy reunion.” It’s an excruciatingly vulnerable ideal, since distance, divorce and death can shatter it, while old grievances within the family can make success chancy.

There is a sharp rap of despair when the family can’t be together, or when it can and the gathering tends to stir up old irritations rather than erase them. The disappointment can be so acute that rage breaks out readily — murders are not uncommon at Christmas, or accidents involving a violent mood and family dissension on a monumental scale. In some countries,o notably Germany, the suicide rate climbs at this season.

Scientists became intrigued some twenty years ago with the special depression that Christmas creates, with glancing attention to the lesser blues that sometimes attend vacations in the summer or even Sunday afternoons. Comparing notes, doctors discovered that many of their psychiatric patients suffered severe setbacks during the Christmas season. Succeeding studies of normal people revealed a vast, subsurface ocean of unrest, a distress that seems so ill-timed that its victims usually hide it under a pseudo-enthusiastic and tiring kind of gaiety.

The United States psychoanalyst J. P. Cattell describes the Holiday Syndrome as extending for more than a month before Christmas to a few days after New Year’s Day. It is characterized, he reported in 1954 to the American Psychoanalytic Association, by the “presence of diffuse anxiety, numerous regressive phenomena including marked feelings of helplessness, possessiveness and increased irritability, nostalgic or bitter rumination about holiday experiences of youth, depressive effect and a wish for magical resolution of problems.”

That’s a wordy nutshell. Many people bear with year-long humiliations and misery but cannot avoid the futile hope that Christmas morning will cure it all. The season brings forth an inner child, a loitering Peter Pan who wants coddling and gets instead a hatful of bills. The knowledge that Christmas is an expensive cheat, with only a flash or two of lovely lustre, creates a general jangling of nerves that silver bells cannot quite cover.

Some people have a clear idea why they are unhappy at Christmas. One famous Canadian writer, for instance, was deserted by his wife on Christmas Eve and another buried his only daughter shortly after she had helped decorate the Christmas tree. A young mother of three whose critical in-laws visited her for six weeks before every Christmas, bulging the facilities of a small apartment, eventually detested the entire season. A Montreal engineer felt a chill every Christmas until he was nearly forty, a residue of his mother’s insistence that he open all his gifts alone in his room. A man who was raised in an orphanage doesn’t feel comfortable watching his children receive their presents — they’re never grateful enough.

Some experts feel that the North American accent on gift exchanging is causing a good deal of Christmas blues. To a child’s mind — and many an adult’s as well — the quantity and quality of gifts received is tangible evidence of his valuableness in the world. Friends who receive more and better gifts are assumed to be better loved, a brother or sister getting more lavish presents is a catastrophe. For this reason even mature people feel a droop in spirits as the last gift is unwrapped, while children are inclined to protest violently.

The emotional involvement in gift-giving is such that people who are unable to love their families, or who feel inadequate in some way, tend to give luxurious presents, beyond their means, as a conscience calmer.

Christmas, accordingly, can be an economic disaster and many heads are filled at this season with a dance of debts. The financial demands of gifts, decorations, tips and entertainment is a strain that creates panic, making tempers snappish.

Dr. MacLeod, the Montreal psychiatrist, is reminded at this time of the year of the potlatch customs of some British Columbia Indian tribes, who destroy their enemies by loading them with gifts and food. The guests of honor are expected to give an even more sumptuous feast and gifts in return, wrecking their resources if they comply and disgracing themselves if they don’t. Christmas gift-giving can also be persecution: there is a mutually ruinous trend on this continent to give back a slightly better gift than was received.

But worry over debt is only one of the many factors which disturb people at Christmas. Some scientists, notably Ernest Jones, suspect that a primitive identification with the sun affects mankind, so that the waning of the winter sun rekindles a primitive fear in everyone that human powers are weakening as well.

Some of the responsibility for Christmas depression would then lie with the early Christians who somewhat arbitrarily chose December 25 as Christ’s birthday, usurping the date of the most widely celebrated of pagan festivals. Ardent sunworshippers believed that the winter solstice, the shortest day of the year, was the date on which the old sun died and a new one was born. They celebrated giddily: plentiful food and drink, their best attire, fires lit to support the burgeoning young sun. The Romans ornamented their homes with wreaths and exchanged gifts and visits. The Druids gathered mistletoe and the Saxons holly and ivy.

More than three hundred years after the death of Christ, many of the new church’s followers were distressed that the teachings of the forgiving, love-honoring Son were being overshadowed by the harsher tenets of the Father. To elevate the importance of the Son, they decided to establish His birthday as a festival. Since the actual date was debatable (many modern scholars place it in the spring), the symbolism of the pagan feast to the newborn sun made it the most apt choice of several that were tried.

Bawdy beginnings of holy days

It was a technique of the time to smooth the way for conversion by supplanting pagan ceremonies with Christian likenesses. The Feast of the Epiphany, for instance, takes place on the day that Egyptians marked the virgin birth of their god Aeon. The festival of the goddess Diana was replaced with the Assumption of the Virgin and the Celtic Feast of the Dead became All Souls Day.

(Occasionally Christians grow fretful at the bawdy beginnings of some of their holiest days: An act of English parliament in 1644 abolished Christmas as a “heathen festival”; it was reinstated promptly when the Merry Monarch, Charles II, took the throne. )

Similarly, the Jewish ceremonial lighting of candles during Chanukah bears the imprint of pagan sunworshipping. The eight days of Chanukah have some points of resemblance to the Roman Saturnalia, also a festival of goodwill and rejoicing which was observed originally on December 19 and later extended for seven days. Chanukah, the happiest of all Jewish ceremonial days, celebrates the victory of a Jewish tribe, the Maccabees, in history’s first war of conscience.

The selection of deep. dark, cold winter for determined merrymaking sets up an inevitable conflict that many experts blame for some of the despondency of the season. Days of brief sunshine produce their own melancholy. And so does the imminence of the year’s end — the dying of time, years running out, life running out.

In addition to this, for many North American Jews Chanukah has become a period of painful yielding. Their holiday pales beside the more widely and conspicuously celebrated Christmas, a comparison which causes Jewish children to feel bereft. To offset this, some Jewish parents decorate a Christmas tree — calling it a Chanukah bush — and put presents beneath it. These concessions shame the devout. both those who practise them and those who observe their fellow Jews practising them, and thus contribute to holiday depression.

But the deepest and most serious depressions at this time, bordering on a temporary mental illness, are believed to be a legacy of jealousy in childhood. Some doctors have reported in scientific journals that some adults under psychoanalysis even demonstrate an unconscious and corrosive envy of the Infant who receives so much love and attention at Christmas and cannot be competed against.

Other experts are examining a theory that problems arise at Christmas because reality is suspended by the childish pursuit of pleasure. Dr. Cattell observed that most people are healthy enough to manage the intoxication of tinsel, spruce and incense without losing sight of maturity, but others regress firmly into childhood and find a chamber of horrors awaiting them.

The Christmas-Chanukah observances. however, cannot in themselves create an untypical mood. They only exaggerate feelings which during the rest of the year are simmering but kept repressed by the thumb of conscience. At holiday time the conscience relaxes and releases whatever malice and envy it has been hiding.

Sandor Ferenczi, a brilliant Hungarian psychoanalyst, believed that the loosening of external and internal restrictions, which accompanies a holiday-inspired release from routine, is frightening to some people, causing them to grow alarmed, despondent, restive and ill. Among the side-effects of festive easing of the conscience are an aroused sexual appetite and an interest in aberration.

The period surrounding Chanukah, Christmas and New Year’s Day is not only the most chaotic of the year but the most permissive of exuberant behavior. As a consequence it can exert a most disastrous effect on people who are confident only when they are under the control of a routine-filled life. Dr. Jules Eisenbud, a New York psychoanalyst, observed in a paper, Negative Reactions to Christmas, that this season permits “social sanction to forms of enjoyment which at other times must be held to a judicious minimum.” Another psychoanalyst, Dr. L. Bruce Boyer, added, “It is to be expected that the degree of neurotic response to such an intense holiday release would be frequent and severe.”

Psychiatrists arc collecting an interesting dossier of Holiday Syndrome case histories. One of them describes a woman engineer who was exhibitionistic, aggressive and convinced she was unwanted. At Christmas she always felt especially forlorn. “I used to feel that if I didn’t find something wonderful that Christmas, I’d find it another,” she told her doctor. The “something wonderful” was proof that her parents loved her, a gift that was perpetually withheld.

Another woman expressed hatred of her preferred brother only when Christmas approached, a malevolence that always surprised and terrified her. A psychiatrist drew out the underlying cause. As a child, the woman had always felt that her parents favored her brother. This feeling became particularly poignant at Christmas, and in later years, although she had long since forgotten the supposed favoritism, the coming of Christmas revived the hurt.

A department store buyer who also grew up with a much-favored brother became savage in her business relationships with men during the Christmas season and twice was fired because of it. Her doctor discovered she had once asked Santa Claus to change her into a boy so her parents would like her better. The collapse of this confidently expected miracle left her with an annual vendetta against the masculine sex.

A salesman who loathed Christmas traced it to an event when he was nine years old. He discovered a new bicycle hidden behind his house and assumed it was intended for his Christmas gift. When it went instead to his younger, handsomer and more clever brother, he formed a distrust for Christmas that thirty years of living hadn’t healed.

A strongly religious woman went to a psychiatrist when she realized she hated Christ every year at Christmas. She was blaming the Baby, it turned out, for her own emotionally barren childhood. A beautiful young girl began to quarrel viciously with her boy friend at Christmas, becoming demanding and petulant. Her father had deserted her mother, an absence the girl felt most acutely at Christmas and which ever after prodded her apprehension that all men eventually desert their wives.

The Utah psychiatrists studied the case of a man who was so wretched in his home town at Christmas time that he fled to a nudist camp. One father, otherwise a responsible citizen, passed bad cheques every Christmas. Another, who delighted his family with his choice of birthday and anniversary gifts, always refused to do any Christmas shopping at all. A divorcee who felt sentimental about Christmas couldn’t endure being alone then — she cried and broke out in hives.

“Some of the ordinary unhappiness at Christmas is related to the turbulence in the family,” explains Dr. MacLeod. “Quite a few people are sensitive to the strain of household upheaval and are upset by it. The home becomes unfamiliar, which disturbs and worries everyone. You’ll notice that children react by contracting some kind of ailment. We now know there is a definite connection between emotions and the body’s ability to defend itself against some of tile causes of illness.”

Whatever causes it — lack of sunshine, childhood jealousy, confusion, old wounds or apprehension because the lid is off — the Holiday Syndrome is now drawing considerable medical attention. The chief benefit so far is that those who endure the strange malady of loneliness in the midst of gladness, ire instead of awe, know at least that they are not oddities, but members of a substantial group.

They have some practical solutions to ponder. Some families have stopped sending Christmas cards and others exchange few gifts or none at all, investing the resultant saving in CARE packages or local givings. Some individuals have overcome their aversion to Christmas by rooting out their prized collection of old injustices. There is an evident trend toward quieter, sweeter family celebrations, a tendency to savor that has been accelerated by current portents of doom. With the hustle out, it’s astonishing what remains — a sense of holiness, for one, and peace, and even joy.

Repost from: http://www.macleans.ca/archives/how-to-be-merry-even-though-its-christmas/

What Not To Say To Those Struggling With Mental Illness.

For those who are grieving, the holidays are hardly “the most wonderful time of the year.” Not only are they navigating their pain, they’re doing it during a time that’s supposed to be joyous.

Loved ones often try to alleviate some of the grief a person may be feeling by offering helpful phrases or advice, but what may seem like a supportive statement could actually be exacerbating a person’s sadness, Dan Reidenberg, chair of the American Psychotherapy Association, told The Huffington Post.“Certain statements don’t take into account what the grieving person is feeling,” Reidenberg said. “They end up really focused on the person who isn’t grieving.”

Take a look at advice from Reidenberg and a couple of additional experts and avoid these common pitfalls:

1. “Smile, it’s the holidays.”

While this is a good intentioned way of trying to cheer someone up, it may come across as invalidating.

“Statements like these end up sending a message to the grieving person ‘hide your sadness’ or “’it’s not okay to be sad,’” Reidenberg said. “This hurts them, makes them feel more alone and that their grief might somehow be wrong.”

2. “Next year will be better.”

Grief often makes the future look foggy.

“The holidays are filled with memories of good times, happy times, when loved ones and friends shared experiences and made memories together,” Reidenberg said. “Those are now in the past for the person grieving and that is very hard on them.”
Include the individual in your holiday preparations and just spend quality time with them when they need it, Reidenberg suggested. A supportive presence goes further than you think.

3. Any questions about the details of the death.

Curiosity should be stifled in this case, according to Nancy Marshall, a licensed professional counselor and author of Getting Through It: A Workbook for Suicide Survivors.

“Don’t force anyone to tell the story over and re-expose the trauma,” Marshall told HuffPost. “Your right to the ‘news’ does not trump their need for well-being.”

4. “Let’s try not to think about them right now.”

“People have a hard time being around someone who is sad and grieving, so they often try to take their mind off it or somehow make it better and the reality is that sometimes it just can’t be better,” Reidenberg said.

Acknowledging a person’s loss is crucial. Instead, try asking the grieving individual about any traditions they used to love to do with the person who passed, Reidenberg advised. Allow the person to guide you on how much or little they want to discuss.

5. “They’re in a better place.”

It’s easy to default on cliches, but they often come across as impersonal. Phrases like “everything happens for a reason” and “they’re in a better place now,” can often make a person grieving feel even more isolated if they aren’t at a place where they can accept what happened yet, Reidenberg said.

Try saying something like “I can’t imagine how you must be feeling” or “Is there anything I can do for you?” instead. And never underestimate the power of saying that you’re sorry this happened to them.
Ultimately, grief will subside but your support through the process is vital for the person who is in pain.
“It certainly will never be ‘okay’ that this happened, but time will pass and the sharpest pain will recede from consciousness,” Marshall said. “Always be compassionate with yourself as an observer and with your friend who experienced a horrible loss.”

 

Reposted from: http://www.huffingtonpost.com/entry/what-not-to-say-to-people-who-are-grieving-at-the-holidays_us_585be878e4b0de3a08f448e1

Michael Phelps on Life After Swimming and His Battle With Depression.

The most decorated Olympian of all time wants you to know he has bad days — some very bad days — just like so many people. “I’m not a superhuman,” Michael Phelps tells LIVESTRONG.COM. “I’m a human being who was very fortunate to find something that I love and find something that I’m good at and really never give up. But, really, that’s it.”

While he made success in the pool look easy, a shadow hung over the star athlete for years as he battled depression. Now Phelps is sharing more about his mental health issues. “These are things that have been a part of me for so long,” he says. “I just decided it was time to open up and talk about some of the struggles I’ve had in my life. Just being able to get out and talk about it and communicate about it — almost become vulnerable — I think is something that will help a lot of people,” Phelps, who will appear in a new documentary titled “Angst” to talk about his depression and being bullied, tells LIVESTRONG.COM.

Since retiring from swimming with 23 gold medals after the Rio Olympics in 2016, Phelps has had to readjust his routine and figure out what’s next for him. “For a long time, swimming was that thing that got me out of bed every morning early to go and jump in a freezing-cold pool. But now, kind of starting the next chapter for me, I’ve been asking myself where I want to be and what I want to do.”

Those next steps include working on a cause close to his heart: water conservation. “I obviously grew up in water and in around water for a very long time,” Phelps, a global ambassador for Colgate’s Save Water campaign, says about the world’s most vital resource. “I think it’s little small things that we can do together — no-brainers like not leaving the faucet running when you brush your teeth [and taking] shorter showers.”

His life at home with his wife, Nicole Johnson, is also becoming more of a focus, as their son, Boomer, is now 17 months old and they are about to become parents for a second time. But Phelps says he would never force his kids into the athlete life. “For me, I had an awesome mom growing up who was just so supportive of everything that we did,” Phelps says. “If I wanted to quit swimming, she was fine with it because she wanted us to follow our hearts. The only thing I’m adamant about is that [Boomer] has to learn to swim. Other than that, he can play another sport, whatever makes him happy.”

Reposted from: https://www.livestrong.com/article/13590348-michael-phelps-on-life-after-swimming-and-his-battle-with-depression/?utm_source=facebook.com&utm_medium=referral&utm_campaign=Keywee&kwp_0=599482&kwp_4=2116520&kwp_1=884107

Almost half of Ontario youth miss school because of anxiety, study suggests.

At five years old, Shannon Nagy told her mother she wanted to die. In Grade 6, she missed almost the entire school year because more often than not, she couldn’t get out of bed.

Nagy, now 20, was diagnosed with anxiety, depression, attention deficit hyperactivity disorder and borderline personality disorder and was never able to finish high school. She spent most of her childhood immersed in a mental health care system that she said “did more harm than good.”

Her struggle to get help and the impact that struggle had on her education is a trend captured in a new survey commissioned by Children’s Mental Health Ontario, released Tuesday.

It found of the 18- to 34-year-olds surveyed across the province:

  • 46 per cent had missed school due to issues related to anxiety.
  • 40 per cent had sought mental health help.
  • Of those, 50 per cent found the experience of getting help challenging.
  • 42 per cent did not get the help they needed or are still waiting.

Parents are also impacted when their child has to wait as long as 18 months for mental health care, said Kimberly Moran, CEO of CMHO, the association that represents Ontario’s publicly funded Mental Health Centres and advocates for government policies and programs.

“Parents miss work and certainly myself as a parent, I have to take time to look after my daughter,” Moran said.

The Ministry of Health and Long-Term Care and Ministry of Children and Youth Services did not respond to requests from the Star for comment, with Monday being a holiday.

The study, conducted by research firm Ipsos, surveyed 806 people in October and suggests that a quarter of parents have had to miss work to care for their child due to issues related to anxiety.

When her 11-year-old daughter tried to die by suicide while on a year-long wait list for mental health care, Moran took a four-month leave of absence and then worked part-time. Six years later, she still takes about 10 per cent of the year off to help her daughter.

Half of the parents surveyed found getting their child mental health help was challenging because wait times are long, they don’t know where to go, or service providers don’t offer what their child needs, don’t exist in their community, are too far away or aren’t available at convenient times.

Anxiety is one of the “big front-runners” when it comes to mental illness in youth, said Lydia Sai-Chew, CEO of Skylark Children, Youth and Families, which offers free counselling and mental health services in Toronto. Wait times at Skylark for in-patient programs can be up to six months.

“The difficulty with wait times is that the youth gets more stressed, but so does the family,” Sai-Chew said. “Anxieties build up. They don’t have the strategies and it just gets worse.”

For 13 years, Michele Sparling of Oakville has juggled owning a business and taking care of her son who was diagnosed with anxiety and depression when he was 10 years old.

“If your child is home from school, you’re not leaving them alone,” Sparling said. “You’re worried when you have to step out for a moment. When a fire truck goes through your neighbourhood, you think ‘not my kid, not my kid.’

“That worry is constant.”

She said her family struggled to get her son the help he needed. In between driving him to and from appointments in Toronto, she got used to telling clients she might have to end a meeting at a moment’s notice if a crisis occurred. She watched as her son had to miss school, and continues to care for him now as he struggles with mental illness in university.

“This is not just about this one person, it’s about the bigger picture, the lost potential,” Sparling said. “I think we’re doing young people such a disservice.”

CMHO is asking the province to invest $125 million in community-based mental health centres, staffing and services for children and youth.

Reposted from: https://www.thestar.com/news/gta/2017/11/14/almost-half-of-ontario-youth-miss-school-because-of-anxiety-study-suggests.html

I’m Depressed And Employed: How I Make It Work.

Since I was 15, I’ve been dealing with depression. I’m not talking about the blues, sadness, or simply the Mondays, but suffocating, full-blown depression—the kind that leaves you empty and hurting all at the same time.

Throughout early adulthood, I had to constantly force myself to go to high school, college, and eventually, a full-time job. But then at 19, I was diagnosed with bipolar and things got even more complicated, adding mania, anxiety, and rapid cycling to the mix of symptoms. It seemed impossible to be productive, and there have been countless days, weeks, and even months when I worried I would lose my job to the all-consuming force of my depression.

In 2013, MacMillan published Perfect Chaos, a memoir co-written by me and my mother, detailing my struggles with depression and her efforts to be there for me. Over the years, I’ve become an expert in my own symptoms and the hows and whys of leading a productive life under these conditions. And while the conversation is being brought further and further out of the dark with each person that decides to speak up, I’d like to offer up some practical advice that’s served me well, because here’s the thing, dear reader: In my many moments of debilitating depression, I have not once lost my job, nor even been reprimanded. Here’s how I make sure to take care of myself within the context of getting out of bed to go to work every day, even when it seems impossible:

1.     I create the quickest morning routine possible, one painful, brilliant step at a time. The night before, I take a shower and choose an outfit. One that makes me feel comfortable, smart, and capable—that just says, “Yes, that’s me, a total badass. I got this.” The next morning, I dress, apply mascara and a bright punch of lipstick, and then I leave. No time to climb back into my closet trying to find body acceptance in a state of morning confusion. Out the door in fifteen minutes flat. No excuses.

2.     Once I arrive at work,  it’s time to make a daily task list. Tasks in general feel utterly impossible when you are depressed. The word “task” makes you want to cry on your desk. But this is important: I ask myself what needs to get done and what I can get done. I break each overwhelming, essential task down to the smallest possible steps and write an in-depth to-do list. Then I only focus on that task. I don’t allow myself to look further down the list. Once I manage that first task, I force myself to do two things: proudly revel in my success and—this is crucial—take a five-minute break.

3.   Next—and this is the hard one—I decide if I need to inform my supervisor. Because depression is constantly recurring in my life, it’s important to let my supervisor know I have a chronic illness. On those days when I do call in, he knows it’s valid. This is also something that you can discuss with your HR manager. Your supervisor doesn’t need to know the gritty details of your struggles; they simply need to know that you are experiencing a health struggle and that you are doing your best to work to your highest ability. You may need to present a doctor’s note to HR, but management may surprise you and support you beyond your expectations.

4.     Lastly, at the end of that exhausting day, I do my best to prepare for the next day and attempt some exercise (those endorphins do help!). Most importantly, I celebrate my victory. When you are depressed, the most powerful thing you can do for yourself is celebrate each accomplishment. You got out of bed; I’m so proud of you! You ate food; you are killing it! You stayed at work for a whole eight hours; you are a superstar! Never stop praising these steps, and slowly but surely you will find your way back out of that hole into the productive light of day.

Reposted from: https://www.girlboss.com/girlboss/2017/3/22/ive-had-depression-since-i-was-15-heres-how-i-handle-it-when-it-comes-to-my-career

Strategies to calm the anxious brain.

This is part of a series looking at micro skills – changes that employees can make to improve their health and life at work and at home, and employers can make to improve the workplace. The Globe and Mail and Morneau Shepell have created the Employee Recommended Workplace Award to honour companies that put the health and well-being of their employees first. Read about the 2017 winners of the award at tgam.ca/workplaceaward.

Does your mind sometimes create thoughts – ones that make you anxious or worried – that you’d rather not have?

When our unconscious brain provides a random thought like this – if we’re not aware – we can become overly focused on these thoughts that can negatively impact our mental health.

This micro skill introduces a concept called cognitive defusion – a strategy we can use when we need to become untangled from our thoughts.

By learning how to defuse unwanted thoughts we can remove their power over us. Those thoughts can be as simple as our mind telling us there’s a difference between what we have and what we want. The thought is nothing more than a warning light. What we do with this thought defines our thinking and emotions.

Awareness

When an automatic, unwanted, negative thought comes to the top of your mind, doesn’t feel good, and is distracting, the first step is not to fight it or hide from it. Acknowledge it as being present and a source of information. By “thanking our mind” for this thought without fighting it or judging we position ourselves to defuse its intensity, allowing us to use the information for some healthy action.

Accountability

Dr. William Glasser, author of choice theory, suggested that we may not have 100 per cent control over our thinking, but we have 100 per cent control over our actions. Where our body goes, our mind follows. By changing our focus from troublesome thoughts to an action we enjoy, or by giving our mind an opportunity to engage in something we find interesting, we can leave the negative thought at the curb and take control of our thinking. This is not hiding from the negative thought; it’s moving past it. There may be nothing to do now, and there’s no value in focusing on negativity that’s distracting.

Action

Persistent, negative thoughts that refocused attention doesn’t curb may require more action. Negative thoughts can be like weeds; they can multiply and take over our mind.

Cognitive defusing is about helping gain perspective so that we don’t give negative thoughts power to grow. “See thoughts as what they are, not what they say they are,” advises Steven Hayes, a professor at the Department of Psychology at the University of Nevada. Meaning a thought is just a thought – nothing more less.

Accept thoughts by name without any judgment – If negative thoughts are hanging around after you’ve engaged in an activity to re-direct them, this is fine. Stop for a moment and acknowledge the thought by name, like you would when meeting a new person. For example, “So it seems there’s anxiety, because I’m having thoughts that are due to my concerns about money and work.”

Redirect your mind – Take charge of your mind. Unhelpful thoughts are projections of some past or future concern that aren’t happening right now, so re-direct your mind in a non-judgmental way to something more positive. For example, “I get that this thought is providing me information and isn’t as helpful as it could be. Thanks for the anxiety, but I think I’d rather be calm.”

Focus on the now – We live in the now, not the future. Take a deep breath, focus on the now, and recognize that the unhealthy thought has no connection with what’s happening in the present; it’s just a thought. Practice focusing on the now, accept the thought and redirect your focus “since this isn’t happening now and there’s no danger, I’ll focus on getting my planned work done, then get to the gym for a good workout.”

By practicing cognitive defusion you can learn to look at negative thoughts as not being bad, just words and images in your mind that you can shape, process and release. The benefit is that this micro skill can teach you how to accept negative thoughts as information only; they don’t need to dictate your actions or feelings.

Bill Howatt is the chief research and development officer of work force productivity with Morneau Shepell in Toronto and creator of an online Pathway to Coping course offered through the University of New Brunswick.

This series supports The Globe and Mail and Morneau Shepell’s Employee Recommended Workplace Award.

This award recognizes employers who have the healthiest, most engaged and most productive employees. It promotes a two-way accountability model where an employer can support employees to have a positive workplace experience.

You can find all the stories in this series at this link:tgam.ca/workplaceaward

New clinic to support mental health in kids.

The numbers aren’t pretty, but the future may be brighter for families with children experiencing learning or mental-health issues, thanks to a new initiative led by Western Education.

According to Children’s Mental Health Ontario, as many as 1-in-5 children and youth in the province will experience some form of mental-health problem, with 5-in-6 of those not receiving the treatment they need.

The Child and Youth Development Clinic hopes to fill that gap by welcoming children who are currently without access to the types of services the clinic offers. This week, Western opened the clinic’s doors in the former Bank of Montreal Building, 1163 Richmond St., just outside the Western Gates.

“Every family has a child who, at one time or another, is at risk of learning or mental-health issues,” said Vicki Schwean, Education Dean and the clinic’s founder. “Ensuring the mental health and wellbeing of our next generation is immensely important and we’re thrilled to open the doors to the community at our new clinic.”

The clinic offers services for kids 3-18 years of age with educational, psychological, behavioural and speech and language difficulties – without a doctor’s referral.

Parents, guardians and service providers, such as school officials, mental-health providers and doctors, may refer children and youths to the clinic.

Families may call 519-661-4257 to make an appointment. They will be emailed a package asking them to fill out the child’s or youth’s developmental, medical, social or academic history. This information, along with any reports from previous evaluations and/or school information, will help the clinic plan the most appropriate assessment(s).

Cost is based on a sliding scale based on a parent’s income. No health card is required.

Western graduate students – under the supervision of experts in their field – will provide assessment and treatment options for children with educational, psychological, behavioural and speech and language difficulties either individually or in groups.

The clinic has eight Psychology graduate students and eight Speech and Language students.

As a school and clinical child psychologist, Education professor Colin King has learned a lot working in a variety of hospital, community and private settings with children having various learning, social-emotional and behavioural challenges.

“An interdisciplinary assessment provides families with the most complete profile for their child,” said King, who serves as the clinic’s director.

“It takes a village to raise a child. Once we fully understand a child’s developmental, medical and academic history, we can provide the most informed evidence-based psychological assessment, intervention and treatment.”

Repost from: http://news.westernu.ca/2017/10/new-clinic-tackle-mental-health-challenges-kids/

Human antidepressants building up in brains of fish in Niagara River.

Researchers studying fish from the Niagara River have found that human antidepressants and remnants of these drugs are building up in the fishes’ brains.

The concentration of human drugs was discovered by scientists from University at Buffalo, Buffalo State and two Thai universities, Ramkhamhaeng University and Khon Kaen University.

Active ingredients and metabolized remnants of Zoloft, Celexa, Prozac and Sarafem — drugs that have seen a sharp spike in prescriptions in North America — were found in 10 fish species.

Diana Aga, professor of chemistry at University at Buffalo, says these drugs are found in human urine and are not stripped out by wastewater treatment.

Could affect fish behaviour

“It is a threat to biodiversity, and we should be very concerned,” Aga said in a release from the university.

Niagara Falls Park Bridges

Fish in the Niagara River show concentrations of antidepressants in their brains higher than levels in the river itself. (David Duprey/The Associated Press)

“These drugs could affect fish behaviour. We didn’t look at behaviour in our study, but other research teams have shown that antidepressants can affect the feeding behaviour of fish or their survival instincts. Some fish won’t acknowledge the presence of predators as much.”

The Niagara River, which carries water from Lake Erie to Lake Ontario, is already under stress, with reports this summer of untreated wastewater released into the river.

‘Fish are receiving this cocktail of drugs 24 hours a day, and we are now finding these drugs in their brains’– Diana Aga, study author

The research, published in the journal Environmental Science & Technology, found levels of antidepressants in fish brains that were several times higher than levels in the river itself, indicating that the chemicals are accumulating over time.

The study set out to look for a variety of pharmaceutical and personal care product chemicals in the organs and muscles of 10 fish species: smallmouth bass, largemouth bass, rudd, rock bass, white bass, white perch, walleye, bowfin, steelhead and yellow perch.

Antidepressants stood out as the major problem.

Rock bass had high concentrations

The rock bass had the highest concentrations of antidepressants, but several fish had a medley of drugs in their bodies.

Aga said she did not believe the chemicals were a threat to humans, as people do not usually eat fish brains. However, she was concerned about the health of fish species who are continually subjected to an influx of chemicals, as well as the delicate balance among species.

Aga said wastewater treatment plants have not kept up with the times in attempting to remove drugs from their effluent.

Between 1999-2002 and 2011-14, the number of U.S. residents using antidepressants rose by 65 per cent,  according to the National Center for Health Statistics.

Wastewater treatment focuses on killing disease-causing bacteria and on extracting solid matter but not on removing chemicals that might be found in human urine, Aga said.

“These plants are focused on removing nitrogen, phosphorus, and dissolved organic carbon but there are so many other chemicals that are not prioritized that impact our environment,” she said. “As a result, wildlife is exposed to all of these chemicals. Fish are receiving this cocktail of drugs 24 hours a day, and we are now finding these drugs in their brains.”