Psychotherapy & counselling treatments for depression.

Mental Health Stigmatization Spread by Mass Media.

In the aftermath of an unconscionable act of random violence, many people are inclined to label the perpetrator “crazy.” Although the criminal may have mental illness, automatically assigning the label “crazy” does a great disservice to people who live with mental illness every day.

In reality, somebody with mental illness is much more likely to be a victim—rather than a perpetrator—of violence. Calling a violent offender “crazy” spreads a dangerous stereotype and belies the complex relationship between criminality and mental illness.

The media teaches us about people with whom we do not routinely interact. This constant flow of data gives us incessant social cues about the nature of other groups of people—including which groups of people should be praised or scorned.

Media portrayals of those with mental illness often skew toward either stigmatization or trivialization. Consequently, all forms of media—including television, film, magazines, newspapers, and social media—have been roundly criticized for disseminating negative stereotypes and inaccurate descriptions of those with mental illness.

What Is Stigmatization?

Stigma happens when some person is viewed as an “other.” This other is denied full social acceptance.

Here is how stigma is defined by Ahmedani in a 2011 article titled “Mental Health Stigma: Society, Individuals, and the Profession”:

The most established definition regarding stigma is written by Erving Goffman (1963) in his seminal work: Stigma: Notes on the Management of Spoiled Identity. Goffman (1963) states that stigma is “an attribute that is deeply discrediting” that reduces someone “from a whole and usual person to a tainted, discounted one” (p. 3). The stigmatized, thus, are perceived as having a “spoiled identity” (Goffman, 1963, p. 3). In the social work literature, Dudley (2000), working from Goffman’s initial conceptualization, defined stigma as stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviors are viewed as different from or inferior to societal norms.

Of note, stigmatization is so entwined with the media that researchers have used newspaper articles as a proxy metric for stigma in society.

Stigmatization in the Media

Let’s consider some stigmatizations of mental illness disseminated by the media as hypothesized by Myrick and Pavelko in a 2017 article published in the Journal of Health Communication.

First, mental illnesses such as schizophrenia are seen as so disruptive to society that those with such conditions must be isolated from society altogether.

Second, media accounts focus on the individual with mental illness rather than framing mental illness as a societal issue. Consequently, media consumers are more likely to blame the individual for the illness.

Third, people with mental illness suffer from overgeneralization in media portrayals; everybody with a specific condition is expected to portray the same characteristics of the disease. For instance, depictions that all people with depression are suicidal, and all people with schizophrenia hallucinate. (In reality, only between 60 and 80 percent of people with schizophrenia experience auditory hallucinations, and a smaller number experience visual hallucinations.)

Fourth, media portrayals discount the fact that many people with mental illness don’t need to disclose this condition to everyone around them. Instead—whether by intention or not—mental illness often goes unrecognized. Portrayals in the media, however, present situations where everyone knows about a character’s mental illness, and this mental illness is no longer concealed.

Fifth, the media portrays mental illness as being untreatable or unrecoverable.

Trivialization

“Trivialization suggests the opposite in the case of mediated representations of mental illness: a downplaying of the notability or negativity of these conditions,” write Myrick and Pavelko.

Here are some possible ways that trivialization can rear its head in the media.

First, the media promotes mental illness as either not being severe or being less severe than it really is. For instance, many people with anorexia feel like their condition is made out to be less severe than it really is—in part, because people with the condition who are portrayed in the media minimize its serious and hide severe consequences.

In reality the death rate of anorexia is the highest death rate of any eating disorder. In an oft-cited meta-analysis published in JAMA Psychiatry in 2011, Arcelus and colleagues analyzed 36 studies representing 17,272 individual patients with eating disorders and found that 755 died.

Second, mental illness is oversimplified in the media. For instance, people with OCD are depicted as being overly concerned with cleanliness and perfectionism. However, the obsessive thoughts that drive these compulsions are overlooked.

Third, the symptoms of mental illness are portrayed in the media as beneficial. For example, in the television series Monk, the protagonist is a detective who has OCD and pays close attention to detail, which helps him solve crime and advance his career.

Alternatively, there’s the “super-cripple” misrepresentation. According to Myrick and Pavelko: “Akin to a mental ailment being perceived as an advantage, individuals with physical ailments have also been associated with the ‘super cripple’ label, a stereotype that attributes magical, superhuman traits to people with disabilities.”

Fourth, using media channels, people without disabilities mock people with disabilities by appropriating mental-illness terminology. For instance, the hashtag OCD (#OCD) is commonly used on Twitter to describe attention to cleanliness or organization.

Schizophrenia in Film

Probably the most disparaging stigmatizations of mental illness in media lie in the film portrayals of antagonists with mental illness. In particular, characters with schizophrenia are presented as “homicidal maniacs” in “slasher” or “psycho killer” movies. Such portrayals disseminate misinformation about the symptoms, causes, and treatment of people with schizophrenia and other forms of severe mental illness. Of note, popular movies have been shown to exert potent influences on attitude formation.

In a 2012 article titled the “Portrayals of Schizophrenia by Entertainment Media: A Content Analysis of Contemporary Movies,” Owen analyzed 41 movies released between 1990 and 2010 for depictions of schizophrenia and found the following:

Most characters displayed positive symptoms of schizophrenia. Delusions were featured most frequently, followed by auditory and visual hallucinations. A majority of characters displayed violent behavior toward themselves or others, and nearly one-third of violent characters engaged in homicidal behavior. About one-fourth of characters committed suicide. Causation of schizophrenia was infrequently noted, although about one-fourth of movies implied that a traumatic life event was significant in causation. Of movies alluding to or showing treatment, psychotropic medications were most commonly portrayed.

These portrayals were wrong and damaging for several reasons, including the following:

1. Portrayals of schizophrenia in recent movies often focused on the positive symptoms of the disease, such as visual hallucinations, bizarre delusions, and disorganized speech. These symptoms were presented as commonplace when, in fact, negative symptoms, such as poverty of speech, decreased motivation, and flat affect, are more common.
2. Several movies spread the false stereotype that people with schizophrenia are prone to violence and unpredictable behavior. Moreover, some movies presented people with schizophrenia as being “possessed.” These violent stereotypes poison viewers and engender harsh negative attitudes toward mental illness.
3. In these movies, 24 percent of the characters with schizophrenia committed suicide, which is misleading because in reality only between 10 percent and 16 percent of people with schizophrenia commit suicide during the course of a lifetime.
4. Characters with schizophrenia were usually depicted as white males. In reality, schizophrenia disproportionately affects African Americans. Furthermore, schizophrenia affects men and women almost equally.
5. In a few movies, schizophrenia is depicted as secondary to traumatic life events or curable by love, which are both misrepresentations of the disease.

On the bright side, Owen found that not all the information presented about schizophrenia in modern film was stigmatizing. For example, in more than half of the movies analyzed, use of psychiatric medications was depicted or alluded to. Furthermore, nearly half the characters with schizophrenia were depicted as poor, which jells with the epidemiological data that suggest people of higher socioeconomic means are less likely to experience schizophrenia.

Ultimately, negative portrayals—especially violent negative portrayals—of people with schizophrenia and other severe types of mental illness in the media contribute to stigmatization, stereotyping, discrimination, and social rejection.

What Can Be Done

In their 2017 study, Myrick and Pavelko found that television, movies, and social media are the most frequent sources of portrayals of mental illness that stigmatize and trivialize. However, as noted by the authors: “Given the power of media to quickly and widely spread inaccurate portrayals, a deeper understanding of their similarities, differences, and interactive effects is called for.”

We still need to better understand how these messages are disseminated by the media before we can act to rectify them. Currently, there is limited research examining how the media promotes mental-illness stereotypes, stigmatization, and trivialization. Nevertheless, certain suggestions regarding how to improve the depiction of those with mental illness in the media have been made.

1. Analyze mass-media production procedures to better understand the current practices, needs, values, and economic realities of screenwriters, producers, and journalists. For instance, understanding the balance between being newsworthy or emotionally arousing and verifiable.
2. Present mental illness only when relevant to the story.
3. Prefer non-individualized descriptions of mental illness and instead focus on the societal aspects.
4. Include expert input from psychiatrists during production.
5. Implement a mental health short course when training journalists.
6. Use mental-health terminology with precision, fairness, and expertise.

As individuals who consume copious amounts of mass media and engage on social media routinely, the best thing that we can do is to stop using words like “crazy” and “deranged” in a derogatory or flippant fashion. Moreover, it’s best not to make psychiatric diagnoses outside of a clinical setting. Only a specialist can make a diagnosis of OCD, depression, bipolar disorder, schizophrenia, and so forth. By labeling without proof, we hurt those who really live with mental illness on a daily basis.

Supporting a family member with serious mental illness.

Learn how to help a loved one through diagnosis and beyond

Mental illnesses are disorders that affect a person’s mood, thoughts or behaviors. Serious mental illnesses include a variety of diseases including schizophrenia, bipolar disorder, panic disorder, obsessive-compulsive disorder and major depressive disorder. Although they can be scary, it is important to remember that these disorders are treatable. Individuals diagnosed with these diseases can live full, rewarding lives, especially if they seek treatment as needed.

Being diagnosed with a serious mental illness can be a shock — both for the person diagnosed and for his or her family and friends. On the other hand, finally obtaining a diagnosis and treatment plan can sometimes help relieve stress in the family and start moving recovery forward. Family members can be an invaluable resource for individuals dealing with serious mental illnesses. By learning more about the illness, you can support your loved one through diagnosis and beyond.

Encouraging a loved one to seek help

While symptoms of serious mental illnesses vary, the following signs are among the more common:

• Social withdrawal.
• Difficulty functioning at school or work.
• Problems with memory and thinking.
• Feeling disconnected from reality.
• Changes in sleeping, eating and hygiene habits.
• Alcohol or drug abuse.
• Extreme mood changes.
• Thoughts of suicide.

If you’re concerned a friend or family member is exhibiting these signs, try to stay calm. It’s easy to imagine the worst-case scenario, but signs of mental illness often overlap with other problems. Consider whether there are other circumstances that might be affecting the person’s mood or behavior. Did the person recently experience a shock, such as the death of a loved one? Have they recently lost a job or started a new school?

Regardless of your answers to those questions, don’t let your fear of a diagnosis prevent you from encouraging your loved one to seek help. Start by talking to him or her. Express your concerns without using alarmist language or placing blame. You might say, “I’ve noticed that you seem more stressed than usual,” or “I’ve noticed you don’t seem like yourself lately.” Then back up those statements with facts, pointing out changes in hygiene or daily activities, for example.

Encourage your loved one to talk to a trusted health care provider. If he or she is hesitant to see a mental health specialist such as a psychologist, suggest a visit to a general physician. Offer to accompany them to the appointment if they’d like.

If your family member doesn’t take you up on your offer, consider alerting his or her physician’s office with your concerns. Though the physician may not be able to share information with you due to privacy laws, it will give the doctor a head’s up to be on the lookout for signs of mental health problems.

If you feel your loved one is in danger of harming himself or herself, or harming someone else, that’s an emergency. Don’t hesitate to call 911. If possible, ask for an officer trained in crisis intervention — many communities have officers on staff who are trained to diffuse a mental health crisis in the best possible way.

A flurry of emotions

It’s entirely normal to experience a flurry of emotions when a loved one is diagnosed with a serious mental illness. Guilt, shame, disbelief, fear, anger and grief are all common reactions. Acceptance can take time, both for the diagnosed individual, for you and for other family members and friends. That acceptance happens at a different pace for everyone. Be patient with yourself and others.

One of the most important things you can do to support a family member with serious mental illness is to educate yourself. The more you learn about what to expect, the easier it will be to provide the right kind of support and assistance.

Familiarize yourself with the symptoms of the disease so that you are able to recognize when your family member might be showing signs that his or her illness is not well controlled. Remember, too, that there’s a lot of information on the Internet. Some of it is accurate. Some is wildly incorrect. Find trusted sources of information, and don’t believe every horror story.

Balanced support

Medications can be helpful for controlling symptoms of many serious mental illnesses. But they might take a while to become effective, and medication alone is often not enough to keep these diseases in check. Encourage your loved one to take advantage of other resources, such as peer support groups and individual and/or group psychotherapy such as cognitive behavioral therapy or social-skills training.

When a loved one is living with serious mental illness, it’s easy to want to take charge. That’s often especially true when the person is your own child or partner. But taking on complete responsibility for him or her isn’t healthy for either of you. Individuals with serious mental illnesses are more likely to thrive when they are allowed to take appropriate responsibility for their own lives. Instead of driving your loved one to every appointment or errand, for instance, help him or her get a bus pass and learn the routes. Rather than preparing every meal for your loved one, teach him or her how to cook some simple, healthy meals.

Individuals with mental illnesses still have an identity, and they still have a voice. Engage your loved one in open and honest conversations. Ask what they’re feeling, what they’re struggling with and what they’d like from you. Work together to set realistic expectations and plan the steps for meeting those expectations. Recognize and praise your loved one’s strengths and progress. Research shows that compared to offering positive support, repeatedly prompting or nagging people with serious mental illnesses to make behavior changes actually results in worse outcomes.

Unfortunately, people living with serious mental illness still experience stigma and misconceptions. While that can be a difficult reality, the fact is that people diagnosed today can expect better outcomes than ever before. Medications have improved, and new evidence-based psychotherapeutic interventions can have powerful and positive effects. So try to stay positive. One of the most important things you can do to support a loved one with serious mental illness is to have hope.

Ways to Reduce Stress and Anxiety

Let’s face it; stress and anxiety aren’t going anywhere. As long as we’re living, we’re going to experience these emotions in one form or another and we all have different levels of anxiety and stress in our daily lives. But, there are some very simple ways in which you can reduce these feelings and create a more relaxed state of mind even in the midst of difficult times.

10 Ways to Be Focused and Sharp, Naturally

There are many natural ways to stay focused and sharp. From alternative therapies to herbal remedies, these natural approaches can help boost your productivity, protect your brain health as you age, and improve your overall wellbeing.

Nutrition to Stay Focused

Getting your fill of certain types of foods may help you stay focused and sharp. These foods include:

6 Things You Need To Know Today

1. There’s no such thing as a universal symbol in a dream.

If you dream about a dog, it doesn’t necessarily mean you’re lonely. If you dream about school, it doesn’t necessarily mean you’re stressed. Everything is context dependent, according to data from website uDreamed, which allows users “to record, analyze, match, and share their unconscious experiences and consult professionals to gain unique insights.” A test-anxiety dream is likely to signify a fear of judgment, but the meanings must always be passed through the lens of the individual experience. (The Cut)

Environmental Causes of Depression

Environmental causes of depression are concerned with factors that are outside of ourselves. They are not directly related to brain function, inherited traits from parents, medical illnesses, or anything else that may take place within us. Instead, environmental events are those things that happen in the course of our everyday lives. These may include situations such as prolonged stress at home or work, coping with the loss of a loved one, or traumatic events. Sometimes researchers refer to these as sociological or psychosocial factors since they bring together events that happen out in society with the inner workings of a person’s mind.

Are You In Control of Your Destiny?

Locus of control refers to the extent to which people feel that they have control over the events that influence their lives. When you are dealing with a challenge in your life, do you feel that you have control over the outcome?  Or do you believe that you are simply at the hands of outside forces?

If you believe that you have control over what happens, then you have what psychologists refer to as an internal locus of control.

A Neuropsychotherapy View of Depression

This short piece is intended to be a primer on the neurobiological underpinnings of depression and to give a neuropsychotherapeutic perspective on the disorder. Later on in this series we will go into more depth and detail on each of these brain regions, but for now here is a brief overview.There are four main brain areas that have been studies in relationship to depressive disorders and we will look at each of these and what part they play in depression.

 

1. PFC – The prefrontal cortex
2. ACC – The anterior cingulate cortex
3. The hippocampus
4. The amygdala

The Role of the Prefrontal Cortex in Depression

The prefrontal cortex (PFC) plays a vital role in the planning and pursuit of long-term goals and can maintain a focus and volition toward goals despite transient and/or short-term stimuli that may compete with such long-term goals. If we have a damaged PFC we may not have the ability to orient our behavior toward valued goals and can be left a victim of automatically responding to whatever is the current stimuli. Damasio (2000) describes Phineas Gage, who suffered major traumatic damage to his PFC at the age of 25, as one who not only had a major personality change, but as one who was unable to pursue goals or behave according to his own wishes.

The two halves of the PFC play different roles in guiding our behaviour based on our goals and values. The left PFC (lPFC) tends to operate along the lines of positive goals and emotions, whereas the right PFC (rPFC) has a bias toward negative emotions and avoidance goals (for a detailed study of the lateralization of the hemispheres, see McGilchrist, 2012). Some people have a tendency to be more lPFC activated and others more rPFC activated, thus manifesting a personality difference in pursuit of positive goals and generating positive emotions. Generally people will respond to stimuli and their circumstances with a bias to the right or left hemisphere depending on the context of the situation. A stable personality will be horizontally well integrated between the two hemispheres when dealing with life and pursuing goals.

In the case of a depressed individual the lPFC is underactive in an overall sense and in comparison to the rPFC. This lateral asymmetry is well documented (see Grawe, 2007, p.130) and accounts for the negative feelings and low volition for positive goal attainment in the depressed individual. Responsiveness to rewards, as opposed to punishment, is a function of the left medial region of the PFC, and with the lPFC underactive, there is less motivation for rewards. There have been studies showing depressed individuals responding to punishment but not to rewards (Henriques & Davidson, 2000), thus demonstrating the ineffectiveness of trying to establish positive goal attainment with the depressed client.

It has also been found that rPFC hyperactivity is linked to avoidance behaviors and negative emotions, and that this hyperactivity can be a global right-sided activation often associated with increased anxiety.

The depressed individual with an under activated PFC can have a reduced volume of PFC gray matter, likely due to underuse of the area. Both neurons and glia have been found to be less dense in the depressed PFC and suggest a lack of PFC structural requirements to perform the rational, motivating, positive goal pursuing tasks attributed to a healthy PFC (see Grawe, 2007. P.131 for statistics of PFC volume reduction). It would be unfair to expect a client to feel joy, and motivate themselves, if the neural underpinnings for such activity is severely degraded. There is something more fundamental that needs to be addressed, and restored in the capacity of the lPFC, before the depressed client can be expected to embrace positive motivations.

The Role of the Anterior Cingulate Cortex in Depression

The Anterior Cingulate Cortex (ACC) is consistently implicated in depressive disorders. The ACC can broadly be divided into two functional regions: 1) the rostral and ventral division involved with affect and autonomic function and connected with the hippocampus, amygdala, orbital prefrontal cortex, anterior insula, and nucleus accumbens; 2) a caudal division involved with cognitive processing and connected with the dorsal regions of the PFC, secondary motor cortex, and posterior cingulate cortex (Kandel, et al., 2012, p.1406).

The ACC is vital in monitoring inconsistency and conflict and mobilizes resources to attend to the conflict (like the executive functions of working memory and volitional effort). When a situation is encountered that is contrary to one’s wishes (including pain) then the ACC will recruit brain areas such as the PFC to resolve the situation and maintain desired goals.

In the case of depression the ACC is under-activated and the mobilization of volitional effort, for example, to change a situation from an undesirable direction is dampened. There is a typical resignation to circumstances and a passiveness and inability to cope with the demands of life.

Davidson et al. (2002b) proposes two subtypes of depression based on what we have discussed so far about the PFC and ACC:

1) ACC Subtype of Depression: Individuals with an underactive ACC and have resigned and lost the will to change.
2) PFC Subtype of Depression: Individuals who do experience a discrepancy between their state and the demands of the environment, but are unable to activate positive goal-oriented behaviour to effect change.

The Role of the Hippocampus in Depression

The hippocampus is part of the limbic system and is critical in consolidating short-term memory to long-term memory, contextualization, special memory and navigation. It contains a large number of glucocorticoid receptors, making it more vulnerable to long-term stress (chronically increased level of cortisol) than other brain regions.

The majorly depressed individual can have a volume reduction (between 8%-19%, see Campbell, et al., 2004; Davidson, et al., 2002a; Bidebech & Ravnkilde, 2004) of neurons and glia in the hippocampus. This hippocampal atrophy hinders the individual to place current events in context based on prior experience and thus impairs the cognitive ability to cope effectively with current challenges. The tendency to remember negative events and to interpret neutral or positive information as negative may be linked to hippocampal atrophy (see Gradin & Pomi, 2008, for an interesting neural network model).

The Role of the Amygdala in Depression

We know the amygdala as a primary center for anxiety as it performs it’s role of monitoring all incoming stimuli and evaluating that stimuli in terms of importance for the individuals motivational goals. If the stimuli are of high emotional/motivational value, then the amygdala ensures a higher level of cortical arousal and environmental monitoring.

With depressed individuals there is often increased activation of the amygdala as well as an increase in amygdala volume. It has been found that the degree of amygdala activation correlates with the severity of depression and that the amygdala may play an important role in the onset of depression. The heightened anxiety-readiness of the amygdala, particularly attuned to negative events, plays an important role in a bias toward storing negative memories and the tendency to ruminate and be preoccupied with negative thoughts.

As you can appreciate from the very brief outline above, mental disorders like depression have some serious neurobiological underpinnings that need to be addressed before the individual has the capacity to engage positive neural networks and resulting behaviour and emotions

Motivation Myths That Keep You From Reaching Your Goals

 

Are you falling prey to motivation myths that might be sabotaging your chances of achieving your goals? We all like to think that we have a pretty solid understanding of what makes us tick. The reality is that we are often surprisingly blind to psychological factors that contribute to our success and failure. Research has shown that not only are people sometimes quite poor at knowing what will make them happy, they also underestimate what it really takes to achieve their goals.