RELIGION, CULTURE & MENTAL HEALTH
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.
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."
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.”
After more than a decade of hugely successful mental health awareness campaigning, 2020 is the time to focus our efforts on more complex problems such as schizophrenia and borderline personality disorder (BPD).
In my role as CEO of a mental healthcare charity, I work closely with patients who live with these incredibly complex mental health problems. Their experiences can be both debilitating and life changing. For many, ongoing care and rehabilitation is a necessity. But hope is also important – it’s the difference between surviving and living. That’s why we need to open up conversations around mental health, in particular a discussion of our response to patients who are struggling with these conditions.
Thanks to the success of mental health awareness campaigns – including those run by Mind and Rethink Mental Illness – we have made great leaps in dismissing unhelpful prejudices surrounding conditions such as anxiety and depression. In fact we are in a completely different place today, compared to where we were in 2007, when such campaigns began.
But I think as a society we need to understand what it’s like living with more complex conditions such as psychosis, schizophrenia and borderline personality disorder.
To find out how big the variance in stigma is, we conducted a public survey – the results of which are significant. It found that despite increased understanding of common mental health problems, complex conditions are still hugely misunderstood. For example, three in five people still believe the adage that schizophrenia means having a split personality, while one in 10 confused schizophrenia with someone who has psychopathic traits.
This misunderstanding of schizophrenia has undoubtedly led to fear and stigma. One in four people admitted they would be nervous if someone they knew was diagnosed with schizophrenia, compared to just one in 20 when asked the same question about depression. Imagine the impact that has on the person living with the illness, particularly if they’re living in the community.
One patient, who was recently in our care, couldn’t have described it better; she explained that schizophrenia is not a choice, just like someone wouldn’t choose to have cancer. She said people’s judgements often come through a lack of knowledge and understanding, rather than anything malicious.
It’s unsurprising that we, as a society, have such views. With a lack of voices emerging about complex mental health conditions, we often rely on Hollywood films to fill the void. But depictions in films can often be unhelpful and tend to perpetuate the notion that mental deterioration leads to violence, which is quite simply misleading, especially when you consider someone living with schizophrenia is more likely to be the victim of violence, than be the perpetrator of it.
You could also argue that depression and anxiety require greater awareness because they are more prevalent in society, but the statistics suggest otherwise. According to Mind, three in every 100 people will experience depression, compared to two in 100 people for BPD or one in 100 for psychosis.
The results from our survey show we should aim to focus the conversation on severe and enduring mental health problems. Educating people and addressing these issues will make it easier for people to live the lives they want to lead in the community, without fear of being judged.
But changing public perception is not something that one charity or one campaign can tackle alone. If we all consistently, and responsibly, challenge myths around complex mental illness and have more open conversations, together we can break the stigma.
Soaps such as Hollyoaks and Coronation Street have gone someway in tackling this already and should be praised for their responsible explorations of experiences such as psychosis. I’d love to see more stories like this being told through characters we know and love, as well as more real-life case studies being featured in the media.
People living with schizophrenia or BPD can often feel ashamed and isolated. Add that to the impact of their clinical symptoms and life can become quite despairing.
It’s time we saw the person first, and the illness for what it is. Yes, complex conditions can be distressing, but with the right care and support many people go on to live happy and purposeful lives. Let’s open up the conversation and stop being afraid of talking about complex mental health problems.
Katie Fisher is CEO at mental health charity St Andrew’s Healthcare
According to this year’s “Stress in America” survey, Americans report various issues in the news as significant sources of stress, including health care, climate change, mass shootings and the upcoming presidential election.
“There is a lot of uncertainty in our world right now — from mass shootings to climate change. This year’s survey shows us that more Americans are saying these issues are causing them stress,” said Arthur C. Evans Jr., Ph.D., the American Psychological Association’s (APA) chief executive officer.
“Research shows us that over time, prolonged feelings of anxiety and stress can affect our overall physical and mental health. Psychologists can help people develop the tools that they need to better manage their stress.”
The APA’s Stress in America survey was conducted between August 1 and September 3, 2019, by The Harris Poll among 3,617 adults living in the U.S.
According to the findings, around 7 in 10 adults (69%) say that health care is a significant source of stress — nearly equal to the 71% who say mass shootings are a significant source of stress.
Among adults who experience stress about health care at least sometimes (47%), the cost of health care is the most commonly cited source of that stress (64%).
Adults with private insurance (71%) are more likely than those with public insurance (53%) to say the cost of health care causes them stress. More than half of adults overall (55%) worry that they will not be able to pay for health care services they may need in the future.
Mass shootings are the most common source of stress cited by U.S. adults in 2019, with more than 7 in 10 adults (71%) saying mass shootings are a significant source of stress in their lives. This is an increase from 2018, when more than 6 in 10 adults (62%) said mass shootings were a significant source of stress.
By demographic, Hispanic adults are most likely to say mass shootings are a significant source of stress (84%), followed by black (79%), Asian (77%), Native American (71%) and white (66%) adults.
More than half of U.S. adults (56%) identify the 2020 presidential election as a significant stressor, an increase from the 52% of adults who reported the presidential election as a significant source of stress when asked in the months leading up to the 2016 contest.
Stress related to climate change/global warming has increased significantly since last year (56% in 2019 vs. 51% in 2018). And more adults are reporting that widespread sexual harassment causes them stress today than said the same in 2018 (45% in 2019 vs. 39% in 2018).
Immigration is cited as a stressor by nearly half of adults (48%), with Hispanic adults most likely to identify it as a stressor (66%), followed by Asian (52%), Native American (48%), black (46%) and white (43%) adults.
Discrimination is another stressor that has become more prevalent in recent years (25% vs. 24% in 2018, 21% in 2017, 20% in 2016 and 20% in 2015).). In 2019, the majority of people of color (63%) say that discrimination has hindered them from having a full and productive life, with a similar proportion of LGBT adults (64%) expressing the same sentiment.
When looking at the responses of people of color, this year’s results represent a significant increase from 2015, the last time this set of questions was asked, when less than half (49%) said that discrimination prevented them from having a full and productive life.
“This year’s survey shows us that current events affect Americans differently, with people of color more likely to say they feel stressed about health care, immigration and discrimination,” said Evans.
“While these are important societal issues that need to be addressed, the results also reinforce the need to have more open conversations about the impact of stress and stress management, especially with groups that are experiencing high levels of stress.”
Regarding the nation’s future, fewer than 2 in 5 adults (38%) feel the country is on the path to being stronger than ever, but nearly three-quarters (73%) feel hopeful about their future.
While average reported stress levels remain constant compared with last year (4.9 in 2019 and 4.9 in 2018 on a scale of 1 to 10, where 1 is “little or no stress” and 10 is “a great deal of stress”), there continues to be a generational difference, with Gen Z adults reporting the highest average stress level (5.8), followed by Gen Xers (5.5), millennials (5.4), boomers (4.2) and older adults (3.0).
Among the stressors that the survey tracks each year, work (64%) and money (60%) continue to be the most commonly mentioned personal stressors. However, the economy is cited as a significant source of stress less frequently in 2019 than it was at its height in 2008 (46% in 2019 vs. 69% in 2008).
Source: American Psychological Association
Annastasya Watts has a busy life.
Along with studying psychology at university, the 19-year-old from Western Australia is also a manager at a fast-food outlet and a volunteer with a number of community organisations.
Annastasya was also diagnosed with depression and generalised anxiety disorder at the age of 15.
Her symptoms were further affected after she was sexually assaulted when she was 16.
"Even just talking about it with my friends now, it's kind of insane to me how many people go through this," she told SBS News.
Annastasya said the assault resulted in post-traumatic stress disorder.
“I denied it for a long time. It took me a long time to come to grips that this happened. For people who are going through that, I want them to reach out. If you can't talk to your friends and family about it, talk to a professional."
One in four reporting mental health challenges
A study of more than 28,000 Australians between the ages of 15 and 19 has found they are more likely to report feelings of psychological distress than they were seven years ago.
The report, released on Wednesday by homelessness charity Mission Australia and mental health research not for profit The Black Dog Institute, also shows young females are twice as likely to report mental health challenges than young males.
The 'Can we talk?' report is a summary of reports spanning seven years between 2012 and 2018, looking at levels of mental distress in people aged 15-19.
It found almost one in four young people in 2018 say they are experiencing mental health challenges, with a rise from 18.7 per cent in 2012 to 24.2 per cent 2018 in the number of people experiencing psychological distress.
A higher proportion of Aboriginal and Torres Strait Islander young people also met the criteria for psychological distress than their non-Indigenous peers, with reporting current rates of 31.9 per cent.
CEO of Mission Australia James Toomey said there may be a number of reasons behind the increase.
"There is a greater confidence and understanding of what actually constitutes psychological distress for young people,” he said.
Mr Toomey said those surveyed also reported feeling like there were more expectations on them, triggering more feelings of distress.
The director of the Black Dog Institute Professor Helen Christensen said it was difficult to pinpoint the exact reasons behind the increase.
"What we can say is the kids have not really changed in terms of their psychological and biological makeup. So we have to look for external influences,” she said.
“We really can't say what it is, but we can say that it is reliably increasing."
Girls more likely to report
Girls and young women are twice as likely to say they are experiencing mental health challenges than males in the same age group, the report found.
Mr Toomey said one of the reasons may be because of a greater understanding of what might constitute psychological distress in young women as well as more pronounced concerns about body image.
Annastasya said in her experience there was more pressure on young men to hide their emotions.
"It's that whole stigma of for men of 'you have to be strong, you have to act tough, you have to be the man', while for girls, we're more prone to sharing our feelings and opening up.”
As to where people go to for help, respondents said friends, parents, and the internet were their top three sources of help, but in remote Indigenous communities where internet access was patchy, that avenue wasn’t always available.
There are also concerns the children of migrant and refugee background are also less likely to seek help with mental health issues.
Swathi Shanmukhasundaram is a youth advisor and a Shout Out speaker at the Centre for Multicultural Youth, and speaks on mental health issues.
She said shame can be a factor in young people from some communities coming forward.
"There's a huge burden of feeling like you have to save face and carry the family honour and recognising or even speaking about that you have a mental illness or that you're dealing with that in your family," she said.
She said some people worry speaking out "can taint that public image and dishonour your family".
Annastasya, who was born in Indonesia to an Indonesian mother and an Australian father, says her Indonesian family favour a spiritual approach to mental health.
"It was a really big worry for me at the start because I was brought up in a western society, but my background is not completely western. Indonesia is a very religious country so it was very different," she said.
Policy recommendations in the report include more funding to find out why females report high rates of distress, improved social media literacy, and more input from young people in the design of services.
Annastasya says she decided to speak out about her experience in the hope of helping others as well as herself.
She does this as a youth spokesperson for the Black Dog Institute, sharing her experience with high school students.
Therapy, she says, has helped her better identify symptoms of stress.
"If I start feeling like everything I do is a chore and that I am not succeeding in anything, and that life kind of feels a bit hopeless, that's when I know I really need to start looking out for my mental health.”
Suicide attempts are rising among black teens in the U.S. even as they fall among youth from other racial and ethnic groups, a study suggests.
Researchers examined nationwide survey data from nearly 200,000 high school students collected between 1991 and 2017. While the overall proportion of teens reporting suicidal thoughts or plans declined for all racial and ethnic groups during the study period, the proportion of black teens attempting suicide surged by 73%.
“Whatever is happening to result in a downward trend among teens in the general population is missing black teens,” said Michael Lindsey, lead author of the study and executive director of the McSilver Institute for Poverty Policy and Research at New York University.
Overall, 7.9% of teens attempted suicide during the study, and 2.5% sustained injuries as a result. Almost one in five teens reported suicidal thoughts and 14.7% planned a suicide, researchers report in Pediatrics.
Self-reported suicide attempts rose in black teenagers, even as they fell or followed no significant pattern in white, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native teenagers, the study found.
While suicide attempts decreased among teen girls overall, they increased among black teen girls.
There was also a surge in injuries from suicide attempts among black teen boys.
More research is needed to determine why traditional precursors to suicide attempts like thinking about or planning a suicide are decreasing while actual attempts are going up, Lindsey said by email.
The current study can’t explain why suicide attempts and injuries are rising among only certain groups of youth.
“We believe that it’s important for parents, mental health service providers and school personnel to learn the signs of depression in black youth,” Lindsey said. “We know that suicidality can stem from untreated depression and, in addition to the classic signs of depression, such as becoming withdrawn or having a depressed mood, black teens may present with physical complaints, such as persistent headaches or stomach aches or with interpersonal challenges, such as angry outbursts, which may be construed as behavioral problems rather than cries for help.”
A separate study in Pediatrics looked at suicide rates for cisgender teens - youth whose gender identity matches their sex assigned at birth - and for transgender teens - whose gender identity does not match their sex assigned at birth.
This study examined online survey data from 2,020 teens ages 14 to 18, including 1,134 who identified as transgender.
Compared to their cisgender counterparts, trans teens were more than twice as likely to report having a death wish or suicidal thoughts. Trans youth were also 82% more likely to plan a suicide and 65% more likely to attempt suicide.
“Trans teens are under much greater potential societal pressure, such as parental disapproval, bullying, and difficulty in finding romantic and other friends,” said Dr. Benjamin Shain of NorthShore University HealthSystem in Deerfield, Illinois and the University of Chicago Pritzker School of Medicine.
Teens are increasingly in danger for suicide and from related mental health problems such as depression, Shain, author of an editorial accompanying the studies in Pediatrics, said by email.
Parents should keep an eye out for evidence of depression, severe mood changes, substance misuse or suicidal thoughts or behaviors, Shain advised.
Other warning signs may involve changes in how teens behave in school or in relationships with friends and peers, Shain said.
In particular, parents should get help for teens when they see a “change in functioning such as lower grades, less interest in activities, isolating from friends and/or family, or dangerous or impulsive behaviors,” Shain added.
SOOTHING EMOTIONS WILL GUIDE YOU WITH RESEARCH, ARTICLES, AND INTERACTIVE TOOLS TO HELP YOU ON THE JOURNEY OF NAVIGATING YOUR MENTAL HEALTH.
© COPYRIGHT 2015. "Soothing Emotions" is a registered trademark of SoothingEmotions.com ALL RIGHTS RESERVED
DISCLOSURE: THE CONTENT PROVIDED ON THIS WEBSITE IS FOR EDUCATIONAL AND INFORMATIONAL PURPOSES ONLY, AND IS NOT MEDICAL ADVICE, MENTAL HEALTH ADVICE, OR THERAPY. IF YOU ARE HAVING A MEDICAL OR MENTAL HEALTH PROBLEM, PLEASE SEEK APPROPRIATE HELP FROM AN APPROPRIATE PROFESSIONAL. IF YOU ARE HAVING A MEDICAL OR MENTAL HEALTH EMERGENCY, PLEASE CALL 911, YOUR LOCAL EMERGENCY NUMBER, OR GO TO YOUR NEAREST EMERGENCY ROOM.