RELIGION, CULTURE & MENTAL HEALTH
Faith, Hope, and ADHD
My spiritual beliefs help me cope with my adult ADHD, as well as my sons’ condition. I am a pharmacist, and I am frustrated with faithful people’s ignorance about ADHD. Many within the church consider the condition to be a spiritual problem. Most have no idea of the medical basis of the condition, so they rely on what their friends tell them. The church has to get educated about ADHD. Parishioners who have children with the condition are doing them a disservice by not having them treated. -Craig, Florida
I am spiritual, but don’t belong to any organized religion. Nothing in my life is organized. I talk to my inner self to help me focus. -An ADDitude Reader
I find a lot of peace in the notion that God loves and works through imperfect people. My medical practice is devoted exclusively to patients with ADHD. Here in the Bible Belt, there are many people who attend church but feel guilty because their minds wander during the service. They can’t remember the sermon, people’s names, or the meetings they promised to attend. -An ADDitude Reader
To deal with ADHD productively, you need a lot of patience. The disorder is one of those things we have to embrace as part of our lives, and we must be proactive in working around it. It’s a lot easier to do that when you have a sense that there is a higher purpose behind these challenges. -An ADDitude Reader
In trying times, it’s our faith that God has a plan for us that keeps things in perspective. Adults and children with ADHD have many gifts that can bless others. -Lesly, California
I can’t imagine getting through life without prayer and God. My go-to verse is Jeremiah 29:11. It tells me that God knows the plan for me and my children, even if I don’t. As a divorced working mom of three children, two of whom have inattentive ADHD, my life is crazy. I find myself wondering when they are going to “get it!” God reassures me that I’m doing the best I can, and, I hope, one day, my kids will realize it as well. -Angelyn, Georgia
We are all “gems of inestimable value.” When I mess up and things get chaotic, it helps to remember that. Meditation and prayer center me and increase my focus. And then there is that beautiful quote: “This too shall pass.” -Donna, Norway
When I accepted the fact that I have ADHD, I was able to help myself through prayer and meditation. I was angry at God at first because I lived half my life before being diagnosed. It was like finding the last few pieces of the puzzle that is me. Reading the Bible helps me get through the rough days. I enjoy Psalms and Proverbs. -Kat, Iowa
God’s word provides amazing support for our family. Stories of Bible characters, like David, Ruth, and Esther, have helped us remember to be brave even when others do not understand us. The 23rd Psalm has been special to us through the years, as well. Prayer helps me face each day with grace when I struggle with challenging times and failure. -An ADDitude Reader
My faith strengthens my ability to deal with everything, including my inattentive ADHD. I ask God several times a day to keep me focused and on track with my daily activities. When I sit down to read my Bible or listen to a sermon, my mind runs down little “bunny trails” that are opened up by what is being said or what I am reading. -Tamie, Missouri
Our faith sustained us when we had trouble with school administrators. We prayed for guidance on how to treat our child’s condition and to find tools to help him be successful. God answered our prayers and led us to all the help we needed. Our son is now a confident, happy, straight-A student with lots of friends. We always rely on God to guide us through life’s many challenges. -An ADDitude Reader
My faith keeps me from going insane when dealing with my ADHD child. I do not care if other people don’t believe that ADHD is real. If they have seen my child or me on and off our medication, they know that ADHD exists. -An ADDitude Reader
As a parent, I often pray in frustration: “God, give me the words!” Usually, I’m looking for the right thing to say to my kids to connect with them, get them to hear me, or help them understand something. Asking for the words always helps. I also teach my children to pray out of gratitude and when they are frustrated or upset. It calms and centers them. -Susan, Michigan
One of my daughter’s favorite thoughts about her ADHD is that God does not make mistakes. He has a very special plan for her in life. -An ADDitude Reader
I pray for patience and strength, and I give thanks for the challenges my son presents me with. It has made me a better person. -Sheila, Illinois
The Serenity Prayer keeps things in perspective in dealing with my ADHD. Recognizing that some things are beyond my control helps me calm down – and when I’m calmer, I manage my symptoms better. I also say to myself, “This too shall pass.” Things might suck today, but there is a chance that they will be better tomorrow. -An ADDitude Reader
I don’t get angry with God about the fact that my child has ADHD. I think ADHD is one of the ways God delights in the diversity of His children. -Beth, Delaware
I pray for my son, Noah, and the challenges he deals with. I also see that Noah has insight, talents, and compassion for others that come from his own trials. I try to forgive myself when I overreact. -Beth, Tennessee
I don’t allow my ADHD, which I was diagnosed with late in life, to get in the way of trusting and loving God, and thanking him for the blessings He gives. -Kathleen, California
My trust in and reliance on God strengthens my ability to deal with my son’s ADHD symptoms…and so does prayer. The bible verse that helps me tells me not to worry about anything…instead, pray about everything. I get upset with myself when I overreact toward my son. -Claire, Texas
My “church” has no walls. It is the woods near my home, where I hike. -An ADDitude Reader
ADHD has always set me apart from others, but my faith keeps me anchored in the knowledge that, even if no one else understands me, God does.” -Lesley, Tennessee
I am a deep believer and trust that God gave me my child because we belong together. Without that belief, I think I would have felt defeated long ago. My son was adopted, and how that came to pass is another reason I believe God chose him for me and me for him. -Cyndy, Florida
Although ADHD sometimes keeps me from staying on track according to my time line, I may be right on time on God’s time line. -Tiffany, Tennessee
When things get hard with our nine-year-old, I remind myself that everything happens for a reason and that God is in control, not me. It’s easier said than done, though. I pray a lot, and I know that, in time, God will do what’s right for our son to get him through the hard times! -Jamye, Colorado
Saying a prayer of forgiveness every week helps me. It clears the board for me on the weeks that I have not been the perfect parent. -Susan, Arizona
Subliminal messaging and nudge psychology lead us to believe that we can be influenced without us realising, but just how powerful is our unconscious mind?
Sometimes when I ask myself why I've made a certain choice, I realise I don't actually know. To what extent we are ruled by things we aren't conscious of? – Paul, 43, London
Why did you buy your car? Why did you fall in love with your partner? When we start to examine the basis of our life choices, whether they are important or fairly simple ones, we might come to the realisation that we don't have much of a clue. We might even wonder whether we really know our own mind, and what goes on in it outside of our conscious awareness.
Luckily, psychological science gives us important and perhaps surprising insights. One of the most important findings comes from psychologist Benjamin Libet in the 1980s. He devised an experiment which was deceptively simple, but has created an enormous amount of debate ever since.
Participants were asked to sit in a relaxed manner in front of an adapted clock. On the clock face was a small light revolving around it. All those taking part had to do was to flex their finger whenever they felt the urge, and remember the position of the light on the clock face when they experienced the initial urge to move their finger. At the same time as that was all happening, the participants had their brain activity recorded via an electroencephalogram (EEG), which detects levels of electrical activity in the brain.
What Libet was able to show was that timings really matter, and they provide an important clue as to whether or not the unconscious plays a significant role in what we do. He showed that that the electrical activity in the brain built up well before people consciously intended to flex their finger, and then went on to do it.
In other words, unconscious mechanisms, through the preparation of neural activity, set us up for any action we decide to take. But this all happens before we consciously experience intending to do something. Our unconscious appears to rule all actions we ever take.
But, as science progresses, we are able to revise and improve on what we know. We now know that there are several fundamental problems with the experimental set-up that suggest the claims that our unconscious fundamentally rules our behaviour are significantly exaggerated. For example, when correcting for biases in subjective estimates of conscious intention, the gap between conscious intentions and brain activity reduces. However, the original findings are still compelling even if they can't be used to claim our unconscious completely rules our behaviour.
Another way of approaching the idea of whether we are ultimately ruled by our unconscious is to look at instances where we might expect unconscious manipulation to occur. In fact, in my research I asked people what those were.
The most common example was marketing and advertising. This may not be a surprise given that we often come across terms such as "subliminal advertising", which implies that we are guided towards making consumer choices in ways that we don't have any control over consciously.
James Vicary, who was a marketer and psychologist in the 1950s, brought the concept to fame. He convinced a cinema owner to use his device to flash messages during a film screening. Messages such as "Drink Coca-Cola" flashed up for a 3,000th of a second. He claimed that sales of the drink shot up after the film ended. After the significant furore around the ethics of this finding, Vicary came clean and admitted the whole thing was a hoax – he had made up the data.
In fact, it is notoriously difficult to show in laboratory experiments that the flashing of words below the conscious threshold can prime us to even press buttons on a keyboard that are associated with those stimuli, let alone manipulate us into actually changing our choices in the real world.
The more interesting aspect around this controversy is that people still believe, as has been shown in recent studies, that methods such as subliminal advertising are in use, when in fact there is legislation protecting us from it.
But do we make decisions without consciously thinking? To find out, researchers have investigated three areas: the extent to which our choices are based on unconscious processes, whether those unconscious processes are fundamentally biased (for example, sexist or racist), and what, if anything, can be done to improve our biased, unconscious decision-making.
To the first point, a pivotal study examined whether the best choices made in consumer settings were based on active thinking or not. The startling findings were that people made better choices when not thinking at all, especially in complex consumer settings.
The researchers argued that this is because our unconscious processes are less constrained than conscious processes, which make huge demands on our cognitive system. Unconscious processes, such as intuition, function in ways that automatically and rapidly synthesise a range of complex information, and this gives an advantage over thinking deliberately.
As with the Libet study, this research motivated intense interest. Unfortunately, efforts to replicate such impressive findings were extremely difficult, not only in the original consumer contexts, but beyond into areas where unconscious processes are thought to be rife such as in unconscious lie detection, medical decision-making, and romantically motivated risky decision-making.
That said, there are of course things that can influence our decisions and steer our thinking that we don't always pay close attention to, such as emotions, moods, tiredness, hunger, stress and prior beliefs. But that doesn't mean we are ruled by our unconscious – it is possible to be conscious of these factors. We can sometimes even counteract them by putting the right systems in place, or accept that they contribute to our behaviour.
But what about bias in decision-making? A highly instructive study showed that, through the use of a now widely adopted technique called the implicit association test (IAT), people harbour unconscious, biased attitudes towards other people (such as racial or gender discrimination). It also suggested that these attitudes can actually motivate biased decisions in employment practices, and legal, medical and other important decisions that affect the lives of those on the receiving end.
However, the alarm can be muted when looking more closely at research on the topic, since it shows two critical problems with the IAT. First, if you look at an individual's test scores on the IAT at one time, and get them to do it again, the two don't match consistently – this is known as limited test-retest reliability. Also, it has been shown that IAT results are a poor predictor of actual decision-making behaviour, which means that the test has low validity.
There have also been efforts to try to improve the way we make decisions in our day-to-day lives (such as healthy eating or saving for retirement) where our unconscious biased processes might limit our ability to do so. Here the work by Nobel laureate Richard Thaler and Cass Sunstein has been revolutionary. The basic idea behind their work comes from cognitive scientist Daniel Kahneman, another Nobel prize winner, who argued that rash decisions which are primarily unconsciously motivated.
To help improve the way we make decisions, Thaler and Sunstein contend, we need to redirect unconsciously biased processes towards the better decision. The way to do this is through gently nudging people so that they can automatically detect which option is the better one to take. For example, you could make sweets less easily accessible in a supermarket than fruit. This research has been adopted globally by many public and private institutions.
Recent research by my own team shows that nudge techniques often dramatically fail. They also backfire, leading to worse outcomes than if they weren't used at all. There are several reasons for this, such as applying the wrong nudge or misunderstanding the context. It seems that more is needed to change behaviour than nudging.
That said, nudgers lead us to believe that we are more easily influenced than we think, and than we are. A fundamental aspect of our psychological experiences is the belief that we are the agents of change, be it personal circumstances (such as having a family) or external ones (such as anthropogenic climate change).
On the whole, we would rather accept that we have free choice in all manner of contexts, even when we perceive it is under threat from mechanisms unconsciously manipulating us. However, we still strategically believe we have less agency, control and responsibility in certain areas, based on how consequential they are. For example, we would rather claim conscious control and agency over our political voting than over what breakfast cereal we are purchasing.
So, we may argue that our poor breakfast choice was down to subliminal advertising. However, we are less inclined to accept being duped into voting a certain way by big tech social media forces.
Headline-grabbing scientific findings in psychology often don't help because they add to some of the extreme intuitions that we are fundamentally ruled by our unconscious. But the more robust scientific evidence indicates that we are more likely governed by conscious thinking than by unconscious thinking. We might get the sense that we aren't always fully aware of why we do what we do. This might be because we aren't always paying attention to our internal thoughts and motivations. But this isn't equivalent to our unconscious ruling our every decision.
While I don't think so, let's say that we are actually ruled by the unconscious. In this case, there is an advantage to entertaining the belief that we have more conscious control than not. In cases where things go wrong, believing that we can learn and change things for the better depends on us accepting a level of control and responsibility.
In cases where things go well, believing that we can repeat, or further improve on our successes, depends on accepting that we had a role to play in them. The alternative is to submit to the idea that either random, or unconscious forces dictate everything we do and in the long run that can be devastating mentally.
So why did you fall in love with your partner? Maybe they made you feel strong or secure, challenged you in some way, or smelt nice. Just like any other matter of importance, it is multifaceted, and there is no single answer. What I'd argue is that it's unlikely that your conscious self had nothing at all to do with it.
Newswise — The U.S. military veteran population is known to have abnormally high rates of suicide, so health officials have been concerned that the COVID-19 pandemic might elevate risk of psychiatric disorders, particularly among those suffering from post-traumatic stress and related disorders.
A recent national study of more than 3,000 veterans participating in the National Health and Resilience in Veterans Study did find that 12.8% reported post-traumatic stress disorder (PTSD) symptoms related to COVID-19 and 8% said they had contemplated suicide during the pandemic.
However, the same survey, published April 8 in JAMA Network Open, revealed another, startling finding. A full 43.3% of respondents -- more than three times the number of those reporting COVID-related PTSD symptoms and five times the number of those who had contemplated suicide -- said that they have experienced positive psychological benefits during the pandemic. These veterans reported greater appreciation of life, closer interpersonal relationships, and an increased sense of personal strength.
"Yes, there have certainly been many negative mental health consequences of the pandemic, but we are also seeing that a considerable proportion of people may experience positive psychological changes," said Robert Pietrzak, director of the Translational Psychiatric Epidemiology Laboratory of the U.S. Department of Veterans Affairs' National Center for PTSD, associate professor of psychiatry and public health at Yale, and lead author of the paper. "This suggests that the experience of stress and trauma related to the pandemic can lead to positive personal growth."
Over the past decade, Pietrzak and Steven Southwick, the Glenn H. Greenberg Professor Emeritus of Psychiatry at Yale and senior author of the new paper, have been studying veterans who experience what is known as "post-traumatic growth" following a traumatic experience. Scientists have long been fascinated with the concept of resilience -- how people who endure trauma find a way to bounce back. The concept of post-traumatic growth posits that while trauma can increase risk for mental disorders such as PTSD, it may also spur positive personal growth.
For the latest findings, Pietrzak and Southwick initially asked veterans about their psychological health between November of 2019 and March 2020. The advent of the pandemic motivated them to follow up that survey with another, of the same group, a year later. In this second survey, they asked questions about PTSD symptoms and possible positive psychological changes related to the pandemic.
Of the 3,078 veterans who responded to both surveys, 43.3% reported that the pandemic led to positive psychological changes in their lives. Among veterans who screened positive for COVID-related PTSD symptoms, more than 70% reported experiencing these changes.
"Post-traumatic growth is a process that often happens naturally and is stimulated by reflective processing about a traumatic event," Pietrzak said. "Sometimes you need to be sufficiently shaken by an experience and even experience symptoms of PTSD to begin to process it at a deeper level and ultimately be able to grow from it."
Greater post-traumatic growth -- particularly an increased appreciation of life and improved interpersonal relationships -- was also associated with a 40% lower likelihood of contemplating suicide during the pandemic. This finding suggests that psychological interventions to promote post-traumatic growth may be a helpful measure to prevent suicide among veterans.
While the scientific study of post-traumatic growth is relatively new, the concept is not. Ancient religious and spiritual traditions, philosophers, and scholars have long expressed the potentially transformative power of suffering.
"The saying 'Grow through what you go through' captures the essence of post-traumatic growth," Pietrzak said.
He and his colleagues plan to continue to follow their cohort of veterans over time to examine the longer-term course of post-traumatic growth and whether it may help promote resilience to subsequent traumatic events.
The National Health and Resilience in Veterans study is supported by the U.S. Department of Veterans Affairs National Center for PTSD.
Jack Tsai, an adjunct associate professor of psychiatry at Yale who also serves as campus dean and professor of public health at the University of Texas School of Public Health in San Antonio, co-authored the paper.
TORONTO -- Severe anxiety linked back to the COVID-19 pandemic now has a name: “coronaphobia.”
The term refers to a severe type of anxiety that specifically pertains to the pandemic. The condition has similar symptoms to general anxiety, however its symptoms are an extreme pandemic-related disorder.
Doctors who coined the term define it as “an excessive triggered response of fear of contracting the virus causing COVID-19 leading to accompanied excessive concern over physiological symptoms, significant stress about personal and occupational loss, increased reassurance and safety seeking behaviors, and avoidance of public places and situations, causing marked impairment in daily life functioning," according to a study published by the U.S. National Library of Medicine.
The report analyzed nearly 500 studies that outlined components and outcomes leading to anxiety and depression relating to the pandemic.
Vancouver-based psychiatrist Dr. Shimi Kang, an associate professor of medicine at the University of British Columbia, says that although the fear is real, people should be cautious when calling something a phobia.
By definition, a phobia is an irrational fear of something that leads to erratic behaviour. She says that much of the fear associated with COVID-19 is justified, especially because it is a potentially life-threatening disease.
“I think it’s very debateable whether the fear is irrational or not,” says Kang.
Kang says that any stress can turn into a phobia, and it isn’t surprising that people are demonstrating phobic-like behaviours during the pandemic. A phobia has to be a dysfunctional disorder that causes impairment in the person’s physical, mental and social health.
“On the other hand, I’ve seen patents who have an excessive fear and it is impacting their mental health. I have patients who won’t go outside,” she says.
Kang says it’s important to balance mental and physical health, but that some of her patients are suffering in fear of COVID-19.
“I tell my patients they have to go for a walk. I tell them to use the guidelines but stay on the other side of caution and try to go out -- avoidance makes phobias worse,” she says.
Although fear is a “common” outcome during pandemics, the evolving disease has unique risk factors.
She says people with underlying health conditions could be more vulnerable to exhibit an extreme fear surrounding the pandemic. It is important to acknowledge that it is perfectly normal for people to experience some level of stress or anxiety, and there are ways to manage those emotions, according to Kang.
“Routine regular sleep, regular cardiovascular exercise three times a week for 20 minutes, and routine positive socialization, are all ways to treat that stress,” says Kang.
She adds that there are also other natural ways that will help with easing stress and anxiety.
“One of our most powerful anti-depressants is actually contribution. When we feel like we are making a difference in a positive way, any act of helping others will release dopamine in the brain,” she says.
Whether that may be holding the door for a stranger or waving to long-term care residents, small things will not only help the individual doing the act, but it will also help someone else.
Nice vs. Kind
What is the difference between being nice and being kind? At first glance, it is hard to tell. We seem to use “nice” and “kind” interchangeably when describing people. A “nice person” holds the door for others, and so does a “kind person”; both behave in ways that demonstrate consideration for others. So are “nice” and “kind” just synonyms for each other?
Not exactly, according to dictionary.com. “Nice” is defined as “pleasing; agreeable; delightful”, while “kind” is defined as “having, showing, or proceeding from benevolence.” This difference seem to explain why we use “nice” but not “kind” to describe things besides people and the way they treat each other. For example, “nice shirt” is understood as a compliment (albeit a vague one), but “kind shirt” is a nonsensical phrase. It seems that while “nice” and “kind” carry positive connotations, only the latter indicates an ethical significance.
Does that mean that “kind” is merely a subset of “nice” that applies to ethical matters? Since “nice” describes moral things that are pleasing, as well as nonmoral things that are pleasing, perhaps “kind” simply refers to the first group of nice things. While this interpretation is appealing in its simplicity, it might be that things can be nice without being kind, and vice versa. The distinguishing factor seems to lie in the motivation of a person or act.
For example, consider again how holding the door for others can be described as either “nice” or “kind”. If the underlying motivation is to create a favorable impression for the purpose of asking for a favor later, then the action can be considered nice due to its pleasing effect, but not kind without a sense of benevolence. Conversely, if the motivation is to spare the other person from extra effort or inconvenience, then the action can be considered kind, as well as nice if it pleases the other person. After all, pleasing others and benevolence do not have to be mutually exclusive.
It seems that they do not have to be mutually inclusive, either. Perhaps not every action coming from a place of benevolence has a pleasing effect. For example, imagine that you have to break some bad news to a good friend of yours. While the news is almost guaranteed to displease your friend, you know that the information will help them in the long run. In such a situation, breaking the news to your friend can be considered a kind action, but not necessarily a nice one.
What do you think? What marks the difference being nice and being kind? Can the two overlap?
To better understand what you’re about to read, there’s something you should know right off the bat: The majority of AAPIs (Asian Americans and Pacific Islanders) don’t seek help for mental health issues. According to the National Latino and Asian American Study (NLAAS), AAPIs are three times less likely to seek mental health services than white people. A staggering 2016 study by the CDC showed that half of all the suicides were committed by AAPIs in the U.S. Part of it is a holdover; in Asian countries, talk therapy is rare. Psychotherapy isn’t covered by the Korean National Health Insurance, so the access to get help in South Korea is limited. In Japan, hospitals privately set their own costly psychotherapy prices at about $100 a session. And India’s first-come, first-serve method means that people travel and wait for hours in hopes of seeing a psychiatrist for a few minutes.
But as a U.S.-raised Korean-American born to immigrant parents, I didn’t need research to tell me that AAPIs don’t subscribe to psychotherapy. For many of us, talk therapy isn’t part of our vocabulary — we weren’t brought up to discuss our own emotions. Instead, we’ve been conditioned to think about how our actions could affect our greater community; that others’ feelings are more important than our own, and that there's shame in airing dirty laundry. We’re taught to buck up and overcome these issues in isolation, like our parents and theirs had done before them. In turn, seeking professional help is viewed as a weakness in character, or a flaw in your upbringing. In the West, tending to our mental health is seen as courageous. In the East, it’s seen as indulgent and selfish.
In lieu of therapy, some AAPIs cope by dissociating, compartmentalizing, or suppressing negative feelings — techniques that research assistants Led Camille Soriano and Tiffany Tran at The Menninger Clinic in Houston, TX, point out are classic examples of avoidance coping. Rather than seek external help, AAPIs tend to use coping sources within the family structure, which could be due to their strong culture of respect for elders and authority figures. “Research says that these kinds of coping can be adaptive in the short-term during times of intense trauma or stress,” wrote Tran in an email. “But long-term, avoidance is a dysfunctional coping style because you’re avoiding your emotions rather than facing them.”
While in quarantine mode, I’ve been rewatching The Sopranos and I can’t help but recognize how Tony Soprano’s emotional distress, stemming from running a mafia empire, are similar to how AAPIs’ deal with mental health concerns. Like Tony and his chronic anxiety attacks, Asians may look into treatments only when they've reached a breaking point that's caused a major disruption in their lives. In the first season, Tony is reluctant to talk to his therapist, Dr. Melfi: he can’t articulate the complicated relationship he has with his mother; he relies on a Prozac prescription as a quick solution; he outright rejects Melfi’s thoughtful and sound assessments that his unresolved emotional issues drive his anxieties. Tony is also embarrassed to admit to his wife that he’s seeking help.
The binary approach to mental health — talk therapy is correct; repression is wrong — isn’t helpful when presented so reductively, especially when you consider the many Asians who have been successfully avoidance coping for centuries. Research shows that techniques like expressive suppression can work. One 2014 study on Chinese individuals even stated that emotion regulation “might be as similarly effective as, or even more effective than, acceptance in regulating negative emotion in Chinese subjects.” And psychologists have found that repressing negative memories has proven to be an essential method in treating PTSD — and it’s gentler than forcing someone to confront their traumas head-on. In a New York Times Magazine story, psychiatrist Bessel van der Kolk raised concerns that the desensitization process of exposure therapy can be harmful, and that trauma “[is] not something you can talk yourself out of” when it comes to cognitive behavioral therapy.
But the reality is that the majority of AAPIs don’t talk at all. When we fixate on internal struggles in isolation, depression and anxiety become exacerbated — feeling stuck between two sides can oftentimes lead to a sort of paralysis, wherein you don’t seek help in any form. The numbers prove that Asians are severely depressed. So, is there a middle path for Asian-Americans who are struggling?
Thankfully, there are an increasing number of options available. “For some, it can feel strange or even inappropriate to be telling your family business to a stranger who isn’t Asian in any sense — like, if you're feeling pissed about your parents’ somewhat patriarchal attitudes, or how they express love in a way that you don’t understand," says NYC-based clinical psychologist Marcia Liu. “Those kinds of dynamics can be quickly minimized and labeled as ‘typical Asian parenting’ by the uninformed therapist, which then can feel incredibly othering and demoralizing. There’s also pressure to be loyal and speak honorably of your parents in spite of abusive or even destructive dynamics, no matter what. It's a conflict that many Asian-Americans must navigate."
Dr. Liu recommends those interested in therapy to look at organizations like Asian American Psychological Association (AAPA), which works to pair potential patients with medical professionals who are culturally aligned with patients’ Asian values and identities (Dr. Liu is also a member of AAPA). For example, you can request a doctor who is LGBTQIA-friendly, based in Wisconsin, and speaks Tagalog, and the org will do its best to find a close match. Dr. Liu stresses that patients should feel entitled to finding a doctor who is a strong fit.
The number of local clinics serving Asian-American communities is also growing, like the Charles B. Wang Community Health Center in Manhattan’s Chinatown and Queens’ Flushing. “Their doors are open to everybody, but they specifically offer culturally competent services for the Asian-American community in New York City in both primary care and mental health treatments,” says Dr. Liu. Charles B. Wang has implemented a unique approach; they treat physical ailments with behavioral ones together, not separately. This integrated process caters to AAPIs, who are more likely to experience mental illness in their physical bodies, manifesting as headaches, gastrointestinal issues, or even a loss of eyesight. Physicians can also administer a depression screening as a regular part of the yearly physical. If a patient screens positive, they can then be referred to the mental health department, all within the same building. “I think of therapy as an acculturation issue,” says Dr. Liu. “It's about blending what is not the norm in one culture with what is the norm in another culture, and finding something that works in between. The step to seeing a therapist is a very bicultural move.”
Even though U.S.-based Asian patients may be more readily accepting of a hybrid approach, broaching the topic with their traditionally minded family members still requires sensitivity. TV writer and performer Hye Yun Park has been in and out of therapy since she was 15 after her first suicide attempt as a teenager. While Park’s Korean parents were supportive of her receiving mental health services, they also wanted to keep it a family secret. “Every time my mom drove me [to the clinic], it was as though she was driving me to get an abortion,” the now 36-year-old Park recalls of the experience.
Last summer, Park checked herself into a psychiatric clinic when her suicidal tendencies became more extreme. “I'm done being passively suicidal. I want to actively live,” she says of her decision. Park’s current outpatient program includes group therapy sessions that utilize dialectical behavioral therapy (DBT), which is a skills-based program that includes core mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. In these sessions, patients learn tools like how to meditate and balance priorities within their close relationships that help them cope through moments of duress.
When Park last updated her mother on her mental health status, she did it gently, telling her mother that she’s been in rigorous therapy and back on medication, but she withheld the information that she’d been hospitalized. “I wanted to save [my mom] the anxiety of worrying about me,” Park says. “[There are] mechanics of how love can work between a parent and child [in an Asian culture], and how they can be so adamantly against certain things that are actually for the wellbeing of their children. But I don't blame her for not understanding. I have a lot more compassion towards her.”
When I ask Park about representation in her group therapy sessions, Park mentions that it’s predominantly white, although that hasn’t changed her overwhelmingly positive experience of therapy. “But yes, I do crave seeing more Asian bodies in those spaces,” Park says. “I had a hard time in my 20s talking about mental health to other Asian people because nobody was talking about it. So in my adult life, I’ve made it a mission to talk candidly about my mental health, and try to hold a safe space for others to talk about theirs.”
Two months into quarantine and a few seasons into The Sopranos, I'm seeing Tony’s relationship with Dr. Melfi at the seven-year point. The show is smart in taking Tony’s mental health journey slowly; he doesn’t even experience his first major breakthrough until the third season. It’s a reminder that therapy can be effective, but only when a patient puts in the work and time to get better.
“There are definitely risks to therapy, too,” says Dr. Liu. “It’s a cruel fact that a lot of times, you have to get a little worse to get better. You’re going to have to look at things that are causing you stress, including how you might be contributing to the pain yourself. It can be uncomfortable. For most, therapy takes time and commitment. It’s about developing a muscle that takes time to strengthen.” She also acknowledges that there are questions surrounding whether or not therapy is the best tool for people who are collectivistic, like many Asian-Americans. “I'm careful not to say that it's the only way for people to resolve whatever they're experiencing, but it is an available, structured, and formalized way to receive instrumental support,” she says. “It’s a wonderful opportunity to get to know yourself, cope with stress, and experience joy. People usually, as a result, understand themselves better regardless of whether they're collectivistic or individualistic.”
Although the number of AAPIs receiving mental health treatments is relatively small, I’m grateful to know that thoughtfully administered AAPI-aligned options are out there, and these services are likely to grow as more Asians opt for therapy. But in the meantime, something that I and fellow AAPIs can do in the immediate is talk more openly about mental health issues. We can all agree that this topic ought to be less taboo and more normalized. Oftentimes, it’s the silence of what AAPIs don’t talk about that can be the most deafening. But, with these innovative approaches to mental health becoming increasingly prevalent within the Asian-American community, it’s a positive sign that a larger cultural shift is on the horizon.
Cultural Masks Around the World
Masks have been used around the world for centuries for all kinds of religious and cultural celebrations. Some masks honor those who have died, some represent animals or spirits and some simply disguise a person's identity. Now, as we are all tasked with wearing masks for protection during the coronavirus pandemic, Newsweek is taking a look at the types of masks that were used long before they became a part of the world's daily wardrobe.
1. Hunting Festivals, Alaska
The Yup'ik and Inupiaq peoples wear masks during special ceremonies, the most important being the midwinter hunting festivals. Carved by—or under the supervision of—a shaman, these masks sometimes represent a shaman's spiritual helpers and can also be hung in homes to ward off harmful spirits.
2. Mardi Gras, New Orleans
The legalization of masks in New Orleans dates back to 1827. Though only legal on Mardi Gras wearing masks is a big part of traditional Cajun and Creole events and minimizes class differences.
3.Día de los Muertos, Mexico
The Day of the Dead commemorates family members who have passed away. During this end-of-October celebration, people will often paint their faces or wear masks of clay or papier-mâché that resemble skulls, as well as create altars, or ofrendas, to celebrate the departed.
4. Bailes, Guatemala
Since the colonial era, masks have been worn in various fully-scripted performances, known as bailes or danzas. These tell stories both historical and mythical. They are performed at indigenous festivals and Catholic feast and often depict animals, saints, conquistadors or Mayan warriors.
5. FESTIMA, Dédougou, Burkina Faso
The biennial Festival International des Masques et des Arts (FESTIMA) celebrates and exhibits traditional masks from various West African countries. Worn by dancers, these masks are made of leaves, straw and wood and symbolize the worship of ancestors and spirits and also honor traditional mask-wearing at rituals like weddings and funerals.
6. Carnevale, Venice
Dating back hundreds of years, Venetians would disguise themselves during the Carnevale di Venezia, an annual festival that draws thousands of tourists. During the French conquest and Austrian occupation, the wearing of masks was forbidden, though the tradition resurfaced in 1979.
7. Kandyan Dances, Sri Lanka
A variety of traditional dances ward off demons, provide entertainment and heal the sick. Most incorporate masks made during a lengthy process using wood from the local Kaduru tree. Each mask is linked to a particular piece of folklore or character.
8. Balinese Masks, Bali
With roots in animism—the belief that plants, inanimate objects and other natural phenomena have souls—these masks are seen as a way for spirits to visit the physical world. They are reserved for use only during sacred ceremonies, but tourists can purchase masks crafted specifically for decorative uses.
9. Noh Theater, Japan
The all-male Noh Theater, developed in the 14th century, is the oldest major theater art still regularly performed. The lead character, or shite, will wear a mask made of Japanese cypress that tells the audience what kind of character to expect.
Over the course of five consecutive days last month, Dr. Jamye Coffman saw seven children and infants who had been abused so severely that they required hospitalization at Cook Children’s Medical Center in Fort Worth, Texas. At the time, the city, along with the rest of Texas, had recently declared an emergency over the rapid spread of novel coronavirus. Typically, the hospital sees fewer than 10 cases of fatal child abuse in a year, but that week, two died from their injuries.
It is too early to link this single — and anecdotal — spike in severe child abuse to the COVID-19 pandemic and the stress it’s causing, said Coffman, who serves as medical director of the Cook Children’s Center for Prevention and Child Abuse and Neglect. In fact, it will take more than a year to get a clearer picture of what’s happening nationwide, due to the lag in collecting and sharing child welfare data.
But Coffman said she is concerned that a trend she has seen before will play out again as the nation reels from the profound effects of the virus and the stresses brought on by mass unemployment, food insecurity and illness. During the last financial recession, which rolled out much more slowly than the current crisis, the rate of physical abuse and child deaths linked to abuse both increased at her hospital, she said.
“It all just adds stress on top of stress,” she said. “Any time there’s increased stress increases the risk of abuse on children.”
So she said she alerted the Fort Worth community through the local news to raise awareness of a possible rise in child maltreatment and prevent more children from dying, if the trend bears out. “It is hard to know if the numbers have gone up in the last few days or if medical providers are looking carefully and reaching out,” she said. “It’s too soon to tell if what we’re doing is making a difference.”
But even when federal data is available for this period, it may not show the full extent of abuse because of the ways crises also inhibit reporting.
Why the pandemic could play a role
No one knows how long this pandemic will last, and that uncertainty can cause anxiety, tension and irritability for children and caregivers. The United Nations has already raised the alarm that reports of domestic violence have soared around the world, underscoring how unsafe homes can be during a pandemic.
In the extreme, child abuse may happen when a caregiver is “pushed over the edge” by circumstances often outside their control, said Dr. Robert Sege, who directs the new Center for Community-Engaged Medicine at Tufts University.
Child welfare experts are most concerned about three conditions happening right now.
Routines are being disrupted. With businesses, schools and daycares shuttered, parents and children are in each other’s constant company, sometimes in close quarters. That may be welcome time spent together, but it can also be incredibly stressful when coupled with the demands of work, bills and other anxieties. Children, too, may act out when they are under stress.
Jobs have evaporated. By March 28, 6.6 million Americans had filed first-time jobless claims in a single week. Before that, nearly a fifth of Americans said they’d lost wages or jobs due to COVID-19, in a PBS NewsHour/NPR/Marist poll conducted March 13-14. That means more households are straining under the weight of debt and economic insecurity.
Children are isolated from others who care. Before the COVID-19 pandemic, the act of going to school and being seen by teachers, staff and fellow students stretched a modest net to help catch children who might be mistreated. Before, someone outside the home might spot a bruise and ask how things were going. Amid social distancing, that oversight is gone.
“These are all conditions that set up what might lead to child abuse and neglect,” said Sege, who served on the American Academy of Pediatrics’ Committee on Child Abuse and Neglect.
Under normal circumstances, the highest risk period for a child to die after being abused or neglected is during the first year of life, he said. Given the stress summoned by a pandemic, Sege said that risk for the youngest children only rises.
“It’s that additional toll on vulnerable families that we’re worried about,” said Jessica Bartlett, who directs early childhood research for Child Trends, a nonpartisan organization that studies children’s well-being. “It can be the straw that broke the camel’s back.”
What the data says (and what it may miss)
For care professionals, a 15-month lag in data can hinder their ability to combat maltreatment. Bartlett said that the more real-time data they have about abuse, the better they can “respond appropriately.” But getting national data more quickly is tricky, said Sharon Vandivere, senior research scientist at Child Trends.
Twice a year, states and localities submit data that tracks child abuse and neglect to the federal government, she said, where it is then compiled, cleaned, analyzed and published. The most recent data available is from 2018. For years, child advocates and researchers have explored new ways to update child welfare data systems, but haven’t made substantial progress.
When life is disrupted by a natural disaster, research has shown that incidents of abuse have increased, and children in dangerous situations can fall through the cracks in the system. That may be happening now, since teachers, early childhood education providers and home health clinicians are obligated to file reports of suspected child maltreatment, Bartlett said, but the COVID-19 pandemic has interrupted or suspended those services.
When it comes to the Great Recession, the official government data do not reflect an increase of abuse. In 2007, at the outset of the financial crisis, 794,000 children in the U.S. were abused or neglected, according to the federal Administration for Children and Families. Amid the throes of the banking crisis in 2008, that estimate appeared to dip to 772,000 children and in 2009, official estimates said 702,000 children were maltreated. But a 2015 report by a children’s advocacy group found that hospital admissions for serious child abuse and traumatic brain injuries did increase during the time period, and found that these upticks were geographically aligned in areas with higher home foreclosure rates and unemployment rates.
There has been a push to explore ways social media or online searches can fill in gaps and offer more immediate insights about how and where children might be suffering, but questions must be weighed, about how reliable and accurate those data points might be, Vandivere said.
What to do when stress takes over
The daily stress of the current pandemic, and the isolating measures taken to combat it, make impulse control increasingly difficult, said Dr. Steven Berkowitz, a child psychiatrist at the University of Colorado School of Medicine.
To those who feel at risk of causing harm to their children, Sege suggests:
There is no shame in asking for help during times of unprecedented stress, Coffman said, adding that community members need to watch out for their friends and step in if they think someone needs help.
“Social distancing doesn’t have to be social isolation,” she said.
It is more important that people support families who may already have been struggling with child maltreatment, domestic violence, substance use or other issues to prevent trauma from happening in the first place, Bartlett said, rather than simply identifying families where a child has been hurt or overlooked.
For those who identify a family who may be struggling and want to help, Sege suggests calling, texting or video-conferencing with them to ask how they’re doing, or offering to pick up groceries, diapers or other essential supplies.
“Sooner or later, the viral infection will pass,” Sege said. “We want to make sure our children are physically and psychologically safe through all this.”
A new study investigating factors that contribute to psychological distress in adults has found that that risk of malnourishment is linked to psychological distress among Canadians aged 45 years and older.
"These findings are consistent with other research which has found links between poor quality diet, and depression, bipolar disorder, and psychological distress," says study lead Dr. Karen Davison, Health Science faculty member at Kwantlen Polytechnic University in Surrey, BC. "Collectively, they indicate that nutrition may be an important consideration in mental health care."
Adults who have insufficient appetite, face challenges in preparing food, or consume low-quality diets are identified to be at risk of malnourishment. Indicators of a poor diet found in the study that were associated with psychological distress included low fruit and vegetable intake and higher levels of chocolate consumption.
Given that lower grip strength is a measure of poor nutrition, the researchers also explored the relationship between grip strength and psychological health. Men with low grip strength had 57% higher odds of psychological distress.
"This finding is consistent with previous studies which suggests that psychological problems such as depression are associated with an increased risk of frailty" says co-author Shen (Lamson) Lin, a doctoral student at University of Toronto's Factor Inwentash Faculty of Social Work (FIFSW).
Other factors associated with psychological distress among older Canadians
In addition to nutrition indicators, other factors found to be associated with psychological distress include chronic pain, multiple physical health problems, poverty and immigrant status.
One in five older adults with three or more chronic health problems were in distress compared to one in 17 who did not have any chronic conditions. One-third of women and one-quarter of men in chronic pain were in distress.
"Distress is common among those experiencing uncontrollable and chronic pain. Furthermore, dealing with multiple physical health problems can be upsetting and can make day-to-day activities, work and socializing much more difficult." says senior author, Esme Fuller-Thomson, professor at FIFSW and director of the Institute for Life Course & Aging. Fuller-Thomson is also cross-appointed to the Department of Family and Community Medicine and the Faculty of Nursing.
The prevalence of distress was highest among the poorest respondents; One in three older adults who had a household income under $20,000 per year were in distress.
"It is not surprising that those in poverty were in such high levels of distress: Poverty is a chronic and debilitating stressor. It can often be challenging even to pay one's rent and put healthy food on the table. Poverty may also result in poorer housing and neighborhood quality, and greater residential turnover which are also stress-inducing," says co-author Yu Lung, a doctoral student at FIFSW.
The study also found that immigrant women living in Canada less than 20 years had a higher prevalence of distress than women who were Canadian-born residents (21% vs 14%).
"Unfortunately, this survey did not identify the reasons for the greater distress among immigrant women, but we hypothesize that it may be due to the difficulties of resettling in a new country, such as language barriers, financial strain, complications of having one's qualifications recognized, distance from family and other social support networks and perceived discrimination" says co-author Hongmei Tong, Assistant Professor of Social Work at MacEwan University in Edmonton.
"Although immigrant men also face many of these settlement problems, they were not at elevated risk of distress compared to their Canadian-born peers," says co-author Karen Kobayashi, Professor in the Department of Sociology and a Research Affiliate at the Institute on Aging & Lifelong Health at the University of Victoria. "One idea we hope to explore in future research is whether these gender differences could be due to the fact that the husbands initiated the immigration process and the wives may have had limited or no say in the decision to leave their homeland."
The study team analyzed data from the Canadian Longitudinal Study on Aging which included 25,834 men and women aged 45-85 years. The article was published this month in the Journal of Affective Disorders.
"The team's findings suggest that policies and health care practices should aim to reduce nutrition risk, improve diet quality, address chronic pain and health problems and poverty among those experiencing poor mental health," adds Dr. Davison. "Given that mental health conditions place a large burden of disability worldwide, such program and policy changes are becoming critically important."
‘IT JUST FEELS LIKE A BLACK HOLE’
When you’re struggling with depression, there are days when leaving the house can feel like a challenge.
Add on the demands of a job and life can feel overwhelming.
For Lisa, who asked Global News to change her name to protect her identity, depression has affected her ability to function at work. The 29-year-old has dealt with anxiety and depression since her teens, but when she lost her mother a few years ago, her mental health greatly suffered.
“I would find myself sitting at my desk having no idea what I was doing there,” she said. “I couldn’t focus, I would stare at my screen and let tears roll down my face without any emotion.”
What is depression?
Lisa is not alone. Around one in five Canadians will experience a mental health problem, like depression or anxiety, at some point in their lives. While depression has various markers, common symptoms include trouble concentrating and a loss of interest in work, which can directly affect how someone functions in the workplace.
Aside from work, people dealing with depression can also experience a lack of interest in friendships, hobbies and relationships. Symptoms of depression also include suicidal thoughts, irritability, trouble concentrating or making decisions, and crying easily.
There are often physical symptoms, too, including muscle aches and pain, psychomotor impairment (like slowed speech), changes in appetite and low energy levels.
While everyone experiences sadness, major or clinical depression is a mood disorder that affects the body and mind. One of the main differences between sadness and depression is a despairing mood that lasts more than two weeks, the Centre for Addiction and Mental Health (CAMH) points out.
Depression can be caused by various factors including genetics, personality, hormones, brain chemistry and major life stress, according to CAMH.
How does depression affect work?
For people with severe depression, getting out of bed to go to work may not always be possible, said Steve Joordens, a professor of psychology at the University of Toronto.
“Many of the people who are most severe are not going to work. They’re literally not leaving their bed, not leaving their bedroom, and that’s when it gets really dangerous,” he said.
People experience different levels of depression, he explained, meaning those with mild or moderate cases may still maintain professional commitments — even if it’s very challenging.
“A critical feature of depression is nothing seems to matter; there seems to be no point in doing anything,” he said.
At work, depression can make it harder for people to concentrate and be productive, said Nasreen Khatri, a registered clinical psychologist and clinician scientist with Baycrest’s Rotman Research Institute in Toronto. Depressed workers may also feel exhausted or overwhelmed.
Depression can also make employees more socially withdrawn, and all of this impacts workplace productivity.
“Mental illness costs the Canadian economy $51 billion a year, and 500,000 Canadians call in sick every week due to a mental health issue,” Khatri said.
“Most short- and long-term disability claims are made for a mental health issue.”
When 29-year-old Natasha was going through a hard mental health period, getting through the workday was often a challenge.
Natasha, who asked Global News to change her name for privacy reasons, works with children. While her therapist told she was experiencing depressive symptoms, those symptoms really affected her job.
“I was super distracted,” she said. “In my job, I literally have to be excited and upbeat, and it was just hard for me to do that.”
Getting help for depression
Depression is a health condition like any other, and it’s important people speak to their doctor if they’re experiencing symptoms or struggling with low mood, Khatri said. Treating depression is key to managing its symptoms.
A health professional will recommend the best treatment plan, which can include medication and therapy. Joordens says cognitive behaviour therapy (CBT) can be very helpful in treating depression as it helps change thinking patterns.
In addition to treatment, Khatri said doctors can also help patients figure out a professional plan that may include accommodations at work or a leave of absence.
“It’s important to focus on the basics when depression can make even the smallest task seem like an effort,” she said. “Doing your best to get adequate rest, sleep, eating well and reaching out to supportive friends and family is key.”
There’s unfortunately still a stigma around mental health issues, which can prevent employees from seeking help or asking for accommodations. But workplaces need to recognize depression as a serious health issue, and implement ways to support workers, Khatri said.
This can include crafting a “practical road map” of how to support workers dealing with mental health issues, she said, like making employees aware of assistance programs and creating a step-based approach that makes it easier for employees to approach bosses about their mental health concerns.
It’s also vital for workplaces to model positive mental health behaviour, she said.
“Cultivating a culture of psychological safety, so that everyone at work feels welcome, safe, comfortable, confident, and feel that they can share ideas and speak up when they want or need to is key.”
Natasha was close enough with her colleagues that when they learned she was struggling, they offered support.
“They would step up and take more of a lead … because I was just not myself,” she said.
Both Lisa and Natasha found therapy to be helpful for managing their conditions at work and in their personal lives. Through medication and therapy, Natasha says her mental health has greatly improved and she can now better cope with work.
Lisa says her partner is very supportive, and always listens to her when she’s struggling.
“Depression is something that I know I will always deal with [and] for me it’s important to have people I can talk to and won’t be judged by,” she said.
“My biggest fear for my mental health in the future is when I go through another trauma with loss. I truly hope I am able to see the light at the end of the tunnel but when you’re in it, it just feels like a black hole.”
SOOTHING EMOTIONS WILL GUIDE YOU WITH RESEARCH, ARTICLES, AND INTERACTIVE TOOLS TO HELP YOU ON THE JOURNEY OF NAVIGATING YOUR MENTAL HEALTH.
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