Editor’s note: This article contains mentions of suicide. Details have been altered to protect client privacy.

Bill promised not to kill himself, as long as he could continue to see me. Despite his severe depression, this 67-year-old Vietnam veteran showed up at my office each week at 1 p.m. on Tuesday wearing the same stained beige t-shirt, torn jeans, and a faded baseball cap with the words United States Air Force embroidered boldly across it. His sour body odor choked the room as I listened to the horror of his nightmares and gauged the degree to which he wanted to kill himself that day. The hour before he arrived, I spent readying myself for his whirlpool of despair and avoiding the obvious fact that this person wasn’t getting better. In my 20 years as a psychotherapist, I had never encountered someone in therapy who worried me as much as Bill.

I was his third therapist. Before he reached me, Bill had already spent years in weekly therapy at our facility. His previous therapist ended treatment because he believed Bill was “not interested in getting better.” Still, I was optimistic that I could help this stubborn, but fragile, man. Bill reinforced my aspirations at first by leaving our sessions lighter. His depression soon reappeared, however, like a disturbed old friend who comes for a visit, somehow moves in, and requires a police escort to leave. But no matter how depressed Bill felt, he would always make it a point to end our sessions with, “I really appreciate our work together, and thank you for your time.” This gave me hope.

[fat_widget_right]Bill was angry, bitter, and resentful about many things. At the top of his list was his sister, Kate. What likely started as sibling rivalry in childhood simmered into a putrid sludge of jealousy, betrayal, and abandonment so thick that Bill’s irritable bowel syndrome flared up whenever his sister’s number flashed across his cell phone. Unfortunately, Kate was the only other consistent person in Bill’s life.

The only way I seemed to get through Bill’s anger was to connect with him as a person, not as a therapist. Whenever I strayed from my clinical persona and mentioned that I enjoyed a certain book or movie, he came alive. Bill would recommend certain books or DVDs and loan them to me like a devoted uncle. These exchanges touched my heart and showed me the thoughtful and caring man below his embittered exterior.

Over the first four years of our work, I came to recognize that Bill might be getting worse. There were ups and downs, but the downs came more quickly and stayed longer. His melancholy started to weigh me down, too. I began to feel burdened by our sessions and had trouble tolerating his misery. I knew it was my professional responsibility to work through my resistance, but I struggled. At times, his pain was almost too much to bear.

Somewhere around the middle of his fifth year of treatment, Bill blurted out that he found a “foolproof” suicide method on the Internet. His eyes twinkled as he shared that the suicide would mimic some other form of death.

Somewhere around the middle of his fifth year of treatment, Bill blurted out that he found a “foolproof” suicide method on the Internet. His eyes twinkled as he shared that the suicide would mimic some other form of death. “No one would ever know,” he mouthed his excitement. His demeanor frightened me so much I changed the subject. Later, once we had both calmed down, I asked him to tell me more about this method, but he had moved on. “I don’t want to talk about it,” he insisted. So, I assessed him once again for suicide risk. No, he reminded me, he wouldn’t kill himself as long as he could continue to see me.

After that, I started to question whether I’d be able to keep Bill alive. The gravity of my increasingly impossible duty sat on top of me in session, as I drove home, and at night while in bed. I felt so powerless. The truth was, I couldn’t secure Bill’s safety unless he verbalized intent to kill himself—only then could I hospitalize him. Bill knew this. He knew exactly what words would have him locked up in the psych ward, and he carefully avoided them. He had been hospitalized once before, a number of years ago, and wished never to return.

A few months later, Bill came to session particularly upset. He was being evicted from his flat where he’d lived for the past 30 years. His landlords had sold the property. Bill decided he was going to fight it. His determination seemed to embolden both of us for a few weeks. Bill secured a lawyer and showed up to session bathed and wearing clean clothes. I began to believe that if we could win this fight we might finally lift his depression. As it became clearer that Bill would be forced to leave, I changed course. Not Bill, though.

Bill started missing sessions. At first, I was secretly relieved that I didn’t have to spend the hour arguing with him about finding a new place to live. These disputes wore me out. But I was also worried about him, so after a couple of cancelled appointments I insisted he come back in. Things were not going well at all. Eviction was imminent. As a last resort, Bill had called his sister to ask if he could “crash” for a couple of weeks. Kate refused.

Bill sobbed in my office. I felt crushed, too, as I assessed for suicide and he promised, as always, not to hurt himself. His mood improved as we talked over his situation, and he felt supported. Toward the end of session, he promised to see a doctor about his IBS and attend a stress management group before our next meeting.

When I arrived at work the following Tuesday, I had a voicemail waiting for me from the site manager of our clinic. Bill’s sister, Kate, had contacted him. She hadn’t heard from Bill on her 40^th anniversary and found this strange. Nor was he answering his phone. Kate decided to call the police to check Bill’s apartment, where they found him found him on the bathroom floor, dead. The message ended by informing me Bill’s body would be sent for an autopsy to rule out suicide.

I cherished Bill and felt honored by his trust. Then I remembered the words he had used about a year ago—“foolproof suicide.” My grief turned to panic as I began to question whether he killed himself or not, and if so, could I have prevented it?

I locked the door to my office, put my head on my desk, and wept. I was devastated. I cherished Bill and felt honored by his trust. Then I remembered the words he had used about a year ago—“foolproof suicide.” My grief turned to panic as I began to question whether he killed himself or not, and if so, could I have prevented it? Why hadn’t I pressed him more for details? My thoughts jumped down that dark black hole, until I remembered I could only take Bill at his word. He had promised not to kill himself that day, as well as the gazillion other days I had asked him.

The coroner’s report came back a month later. It determined the cause of death to be a myocardial infarction—heart attack. I was relieved. Bill’s death was due to natural causes. But to this day, I still wonder if he may have used the “foolproof suicide” plan. He had come to the end of his road: he was elderly, physically impaired, soon to be homeless, and completely alone. His last remaining pleasure might have been to make sure he would ruin his sister’s anniversary each year by dying on the same day. Yet I can’t be fully certain. If he had taken any actions to bring about his death, they left no trace.

Bill’s death had me asking some very painful questions. Was there more I could have done? Was the therapy unsuccessful? And, most damning—was I to blame for his demise? Thankfully, the uncertainty around his death left many of these questions unanswerable and spared me from the agony I would have felt had I known for certain that he committed suicide under my care. In the end, after I tried so hard to protect Bill, he in his death may have, in fact, protected me. I will never know for sure, and I’m pretty certain that Bill intended it that way.

Susan Oren is a clinical psychologist who has been treating clients and training psychology pre-doctoral interns for over 25 years. Her writing has appeared in professional journals and books as well as in the Huffington Post and three anthologies.

Having a mental health issue can be very isolating. You may feel like no one understands the pain and despair you experience. Because of this, you might keep your condition to yourself, confiding in no one. This is not uncommon.

The stigma surrounding mental health doesn’t help. Many people are hesitant to open up about their struggles out of concern for being judged and thus go to great lengths to hide their conditions from coworkers, friends, even family members.

People with depression and anxiety, among other issues, often isolate because of lack of energy or because they are unsure how to get support. Being open about a mental health condition constitutes taking a risk, which can feel scary. Not everyone may be supportive, some people don’t know how to help, and some people in your life may choose to remain ignorant.

A mental health condition has nothing to do with what kind of person you are. It doesn’t mean you overreact to things, that you’re “just” feeling down, that you’re incompetent, that you’re weak, or that you’re “crazy.” Just as people who struggle with a physical health issue need and deserve support, people with a mental health issue need and deserve the same.

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Contacting a therapist is a great step in the right direction, of course, as a professional is best positioned to help you understand the factors contributing to what you’re feeling and can point you toward helpful resources. He or she can’t replicate the compassion and empathy of close friends or family members, however.

So how can you find the support you need? Here are five considerations to help you get what you need when you need it most.

1. Learn as much as you can about your condition so you can explain to others what you experience. Many people’s only source of information about mental health is what is portrayed in the media, which more often than not is inaccurate or even demeaning. But if you can describe what it’s like to live with bipolar, for example, you can inform others and help them understand how they can best support you. By educating yourself, you can educate others.
2. Identify someone you think might be a support to you. Whether a friend or family member, this should be a person you trust, who has displayed compassionate tendencies in the past. Again, not everyone will understand, want to understand, or be able to help.
3. Think about what you hope to get out of the conversation you will have with this person. Are you looking for someone to vent to (“Work was so rough today that I spent 30 minutes in the bathroom crying”), or would you like help solving a problem (“I’m so anxious that I need help getting to the grocery store”)? Be specific about what you need and why you need it: “I’m feeling really stressed right now and could really use someone to talk to,” or, “My depression is making it hard for me to get out of bed each day and take care of my house and family. Do you have any suggestions?” Practice asking for what you need.
4. Recognize that some people may be better at supporting you than others. The first person you confide in may not understand. Keep sharing until you’ve found the person or people who can support you. If someone you asked for help cannot follow through, understand that it’s not something you’re doing wrong. They may be dealing with their own struggles and simply not have enough energy or wisdom to help you with yours.
5. Don’t rely on just one person. Try to build a support network, one person at a time. This way, if one friend or your partner can’t talk right away, there are others you can reach out to.

It should not go unacknowledged that, for some people, finding support is exceedingly difficult. People whose pool of family and trusted friends is limited or nonexistent may feel like they have no one to turn to. However, there is always someone who not only will listen but wants to listen—whether it’s a therapist, a pastor or church member, or someone who volunteers for a crisis line. There is always support. The key is summoning the strength to ask for it, something everyone must do at one time or another.

Mental health conditions are very common, so keep sharing; chances are, sooner or later someone you confide in will have dealt with their own struggles. You shouldn’t have to go it alone. Each time you are open about your condition, you decrease the stigma and ignorance surrounding mental health issues. Little by little, we can change the world.

In the face of our depressed moods, friends, loved ones, and even our therapists may say things like, “Stop doing that to yourself!” or “Get over it!” We may even say to ourselves, “Why can’t I just get over it?” These forms of “psychotherapy” usually come from a loving place but often turn out to be ineffective. But why? Why is it that we can stop ourselves from doing certain things (touching a hot stove, for instance), but when it comes to the low energy, hopelessness, helplessness, and self-attacking thoughts of depression, we can’t “just get over it”?

When ‘Get Over It’ Does Work

Believe it or not, as a therapist I spend a fair chunk of my day using a form of “Stop It!” therapy, often with success. When a person is (1) in conscious control of a behavior, (2) no longer wants to do it, and (3) wants my help to stop, challenge (Abbass, 2015) or response-prevention interventions can be quite effective.

“Get over it!” is a form of challenge or response prevention—it says, “Stop doing the thing that hurts you!” When you look at it that way, you can see the loving core of the comment. When someone asks me for help with a pattern they know is self-defeating, such as stubbornness or detachment, but they intentionally continue to do it, challenging them with a “don’t” intervention is one of the most compassionate, helpful things I can do.

When ‘Get Over It’ Doesn’t Work

When someone has conscious control over a behavior, “get over it”-type interventions can help, but my clinical work looks much different when the self-defeating pattern is unintended or unconscious, habitual, or automatic. Decades of clinical research in intensive short-term dynamic psychotherapy (e.g., Abbass, 2015) have shown that a portion of those experiencing depression have symptoms driven by an unconscious emotional process—a process that, at least at the start of therapy, occurs automatically and is entirely beyond their control.

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In ISTDP, we call this process “repression” or “instant repression”—the process by which mixed emotions toward another person are instantaneously and unintentionally shunted back against the self, either in the form of depression or somatic symptoms (this is a slightly different definition of repression than in psychoanalysis).

Often, people who experience repression-driven problems never recognize they were mad at someone else; instead, they are instantly overcome by a process of self-blame and self-torture that leaves them feeling fatigued and hopeless. At no point did they decide to do this. Before therapy, this is just how their brains are wired; they automatically say, “When I feel anger toward someone I love, I protect them by pointing it back at myself.” Considering the people we love most are the most likely to irritate us, this is a potentially dangerous state of affairs.

Saying ‘Get Over It’ to Someone with Repression

So what happens when we say “get over it” to someone with depression that is driven by unconscious repression? Here, the “get over it” confronts the depressed mind with an impossible task: (1) gain conscious control of an unconscious process that is currently operating out of your awareness, or (2) do a thing you simply can’t do (yet).

When people, especially people we love, challenge us to do something that is impossible, it triggers anger, and in the depressed mind where instant repression is still active, that anger will deflect right back onto the self. Instead of lovingly reducing the person’s symptom burden, then, the “get over it” would actually make symptoms worse by activating anger that will be sucked back in via repression.

When people, especially people we love, challenge us to do something that is impossible, it triggers anger, and in the depressed mind where instant repression is still active, that anger will deflect right back onto the self.

‘Get Over It’ and Psychotherapies for Depression

Some therapies encourage us to challenge, question, or detach from our depressive thoughts and moods. Other therapies encourage us to get up and do something even when we have no energy. Sometimes, for some people, these approaches produce positive benefits.

My concern, however, is that for folks who have depression caused by unconscious repression processes, questioning their thoughts implies, “Don’t think that,” and encouraging different behaviors implies, “Don’t be like that.” These both sound a lot like saying “get over it” to someone who is not in conscious, intentional control of the symptom; asking them to do something different when they literally cannot. This could trigger anger toward the therapist that will get shunted into repression and lead to worsened therapy outcomes. No one wants that.

How ISTDP Can Be Useful

ISTDP is an ideal therapy for building the capacity to become consciously aware and tolerant of the mixed emotions that usually get deflected back on the self in repression-driven depression and somatization. When working with people with depression in ISTDP, the therapist is in a largely supportive mode, helping people self-reflect on and feel the feelings that were previously getting automatically and unintentionally converted into depression or somatic symptoms. This builds affect tolerance—the ability to feel feelings while still being able to think clearly and channel them in a satisfying way.

This process helps people with repression because, rather than telling them what not to do or what they should do, it gives them another option—it helps them become more comfortable with their emotional reactions so they can then decide how to channel their emotions. In ISTDP, what people wind up “getting over” is the destructive way their mind would unconsciously bury mixed emotions. Once they can think clearly while being in touch with their emotions, rather than being unconsciously overwhelmed by those emotions, they can then make wise, authentic decisions about what to do.

Reference:

Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press.

You are not alone—not everybody loves the holidays, and plenty of people hate them. Thanksgiving is only round one. Not long after, you get socked with a real haymaker, the endgame (literally, December)—Christmas or Kwanzaa or Hanukkah or whatever version of party-on you choose … or that’s been chosen for you, I suppose.

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Not to mention it gets really dark really early now and, depending where you live, perhaps freezing cold and snowy. The celebrations you don’t feel part of, plus the longer nights, the light deprivation, and the crappy weather, can cause emotional and physiological reactions that make you feel even worse.

A lot of people struggle with the commercialization of the season as well; many stores set up holiday displays and started piping in seasonal music before summer was out! For many people, the significance of the holidays, or what they’re supposed to stand for, is lost in the hustle and bustle.

No, you are not a terrible person for feeling down this time of year. A great many people feel depressed and stressed and lonely and grief-stricken and resentful this time of year. It may seem like everybody else is celebrating with special loved ones and you’re not, and you may feel all alone and, worse, obligated to join celebrations you don’t feel are for you. But remember, not everyone has family, not everyone has family they want to spend time with, and not all families have learned to put aside the family drama and just let everybody have a good time together.

There’s a store near where I live. Every year about this time, they put a sign in their window: “Sharpen your knives for the holidays.” It’s a hardware store, so I read it literally—bring in your knives and we’ll sharpen them right up. But for what? I always wonder. Are those knives for slicing up turkey and ham or for self-defense? Do we kind of feel like turkeys and hams, sitting around the big table with all those relatives we have nothing to say to and who don’t like us much either?

No, you are not a terrible person for feeling down this time of year. A great many people feel depressed and stressed and lonely and grief-stricken and resentful this time of year.

Do you have to see your family? Spending time with friends instead can be enjoyable. Would you feel guilty if you did that?

Put aside for a moment family obligations. What would YOU like to do? What would make YOU happy? Some reflection on why, specifically, the holidays are so rough for you may help guide you as you search for ways to get through them. Any form of self-care might do. You deserve to feel taken care of, even if it’s you doing the caretaking.

Forget, for a moment, everyone else’s expectations of you—which are probably based on the expectations others have of them, anyway. What are YOUR expectations, both of yourself and of others? The weight of feeling like you have to meet someone else’s expectations can add to heaviness of the holidays. Know what matters to you and strive for that, first and foremost.

On the other hand, how long do the holidays last? Two dinners together can’t last longer than, say, twelve hours all together? Six hours each, maybe? Of course, in some families, even that much time can feel like an eternity. It may be that you have to set boundaries in order to ensure that your needs are met. This could mean limiting your exposure to family gatherings or festivities in whatever way makes them manageable or palatable. Two hours per event? Three? A $10 limit per gift? No gifts? Whatever you decide, no guilt necessary; you’re simply doing what you need to do.

Is there somebody you can talk to? There is always somebody, even if that person is a therapist, support group, help line, or faith or church community. I can assure you that you are not alone, and that many other people out there would likely find comfort in knowing you feel the same way they do. If you can’t bear the thought of family time, let like-minded people be your tribe this season—a season that will mercifully pass.

Sincerely,
Lynn

The expression, “If it bleeds, it leads,” has been used to characterize media coverage of lurid stories since the early days of newspapers, and today’s around-the-clock news cycle has made avoiding negative news nearly impossible.

The near-constant barrage of stories about disease outbreaks, war, and natural disasters are taking a toll on people who consume the news, said Dr. Mary McNaughton-Cassill, a psychologist who studies the connection between stress and the media.

“What I believe happens to most people is that it adds to a feeling of malaise—a feeling that the world is just not going well,” she said.

Psychologists have studied the connection between repeated exposure to negative news items and an increase in feelings of depression and anxiety among news consumers. Some people may experience compassion fatigue or secondary traumatic stress, becoming less sympathetic to the plight of others over time due to an overabundance of stories of violence and suffering in the media. Others may experience a reaction similar to those who have experienced trauma firsthand.

Connection Between Media Exposure and Acute Stress

A 2013 study looked at the effect of continuous media coverage of the Boston Marathon bombings on a group of respondents from New York City, Boston, and the rest of the United States. A total of 4,675 adults took an Internet-based survey within a two to four-week period after the bombings on April 25, 2013; of that sample, about 10% were directly exposed to the bombing and 9% experienced the lockdown in Boston while police were looking for the suspects. Other respondents without direct exposure to the bombing reported six or more hours of daily media exposure to bombing coverage.

[fat_widget_right]The results indicated those respondents viewing news coverage for six or more hours were nine times more likely to report high acute stress levels than those with minimal media time. Those who had direct exposure had continuous acute stress symptoms but were less likely to exhibit high acute stress, perhaps, as researchers suggest, because emergency responders were on the scene to provide support. Researchers say repeated exposure to traumatic imagery through the media can activate fear circuitry in the brain and cause flashbacks—two precursors to developing posttraumatic stress (PTSD).

E. Alison Holman, PhD, lead author of the study, recognizes the results are correlational and the relationship between media and trauma is complicated.

“There are so many factors one needs to consider—prior life history (trauma, stress, health, social, family circumstances), ongoing post-Boston Marathon Bombing stressors, coping skills, and emotion regulation skills,” Holman said. “It is possible that this could happen, although I would caution that many people have acute stress symptoms that dissipate over time. We are currently looking into the question of quantity (hours) versus content (images, sounds) that might predispose someone to developing lasting posttraumatic stress and other mental health issues. At this point, all I can say is that it seems that both really matter.”

In a 2007 study, 179 college undergraduates were shown a 15-minute news broadcast, followed by a 15-minute relaxation exercise or a 15-minute lecture. The negative feelings induced by the newscast returned to a baseline level only in the group exposed to the relaxation exercise, suggesting that simply diverting attention was not enough to buffer negative feelings.

Coping With Negative News

The ways in which people cope with grim subject matter in the media can be categorized in three ways, McNaughton-Cassill said. The first group—hypervigilant and prone to anxiety—are the most self-selecting of what news they view and will generally tune into a message they agree with.

“If they’re not plugged in, they feel they’re missing something,” she said.

“If your work requires that you engage with frequent media stories—especially if they are of graphic violence—build stress-relieving activities into your routine so that you can counteract the negative effects.” —E. Alison Holman, PhD

The second group may tune out entirely and be unaware of what is going on the world, McNaughton-Cassill said, while the third group—the middle-ground category that most people fall into—is viewing news in a random manner and not consciously thinking about media exposure.

McNaughton-Cassill admits neither extreme is ideal but suggests people should be willing to set limits in terms of how often they check news and what items they choose to pay attention to.

Those who work in journalism may need to take extra precautions to neutralize potentially negative outcomes. Holman cautions people to avoid watching a 24-hour news cycle filled with negative news, as it is often sensationalized for shock value.

“There are studies showing that reporters who are frequently exposed to images of graphic violence report experiencing more mental health-related symptoms, and women may be more vulnerable to having a stronger physiologic stress response than men after subsequent stress when primed with reading negative news articles versus neutral news articles,” Holman said. “If your work requires that you engage with frequent media stories—especially if they are of graphic violence—build stress-relieving activities into your routine so that you can counteract the negative effects.”

Because media outlets are now under immense pressure to produce a continuous stream of news content, it is becoming increasingly difficult to filter out what information represents a legitimate threat and what is more benign.

“The way our memory works, we’re wired to pay attention to negative, scary things,” McNaughton-Cassill said. “The truth is, on objective measures, we’re much better than in the past.”

McNaughton-Cassill sees a silver lining to negative news if it propels people to action and toward contributing a solution to the problem. She suggests a solutions-based approach to counteract the negative aspects of news.

“I think the tagline that is missing in the media is ‘What can we do?’ What is the solution?” she said. “They need to show more people who are trying to solve problems.”

References:

1. Holman, E. A., Garfin, D. R., and Silver, R. C. (2013). Media’s role in broadcasting acute stress following the Boston Marathon bombings. Proceedings of the National Academy of Sciences of the United States of America, Vol 111 (1), 93-98. doi:10.1073/pnas.1316265110
2. Moeller, S. D. (1999). Compassion Fatigue: How the Media Sell Disease, Famine, War and Death. New York, NY: Routledge.
3. Schwarzer, R. (1997). Psychosocial Notebook. Retrieved from http://www.macses.ucsf.edu/research/psychosocial/anxiety.php
4. Szabo, A. and Hopkinson, K.L. (2007). Negative psychological effects of watching the news in the television: Relaxation or another intervention may be needed to buffer them! International Journal of Behavioral Medicine, Vol 14 (2), 57-62. doi:10.1007/BF03004169

Two new studies suggest online therapy may be effective for treating mental health issues. Online therapy is increasingly popular, particularly among people who live in rural areas and cannot easily get to a therapist’s office or who are concerned about the costs of in-person therapy. New technology may pose some concerns, and the security of online therapy continues to be an issue, but research suggests the benefits may be significant.

The Benefits of Online Cognitive Behavioral Therapy

The first study, published in the Canadian Medical Association Journal, reviewed studies of online cognitive behavioral therapy (CBT) conducted between 2000 and 2012. CBT is a widely used and well-researched form of therapy, with most studies saying in-person forms of this treatment are highly effective. CBT focuses on reducing negative thoughts, thereby changing behavior and alleviating symptoms.

Most of the studies tracked participants for a relatively short period of time after undergoing therapy—ranging from eight weeks to about two years. Researchers found online CBT could effectively reduce symptoms of depression and other mental health issues. In some cases, online CBT was even more effective than traditional in-person therapy.

[fat_widget_right]Most online CBT sessions focused on short-term goals and symptom relief. Because the studies did not track participants for an extended period of time, the researchers do not know if the symptoms were permanently alleviated. The team that conducted the analysis cautions that some human connection is lost with online therapy, but they also say the evidence supporting online therapy’s effectiveness is significant.

Reducing Suicidal Feelings in Doctors

Another study, published in JAMA Psychiatry, looked at how online therapy affects the well-being of new doctors. Young doctors often work long hours, including nights and weekends, and the stress of those long shifts can lead to mental health issues such as depression and suicidal thoughts. One previous study found that suicidal thoughts increase four-fold during a medical residency.

Researchers looked at 200 first-year medical residents working 80-hour weeks and overnight shifts. Compared to doctors who received no online therapy, doctors who received four 30-minute online sessions before beginning their residency had fewer suicidal thoughts. Because the sessions were delivered online, researchers say it might be possible to provide such treatment to other doctors while still keeping costs low.

References:

1. Mozes, A. (2015, November 3). Online therapy may help some with emotional problems. Retrieved from http://health.usnews.com/health-news/articles/2015/11/03/online-psychotherapy-may-help-some-with-emotional-problems
2. Online cognitive behavioral therapy benefits people with depression, anxiety. (2015, November 2). Retrieved from http://www.sciencedaily.com/releases/2015/11/151102125440.htm
3. Study: Online therapy eases new doctors’ suicidal thoughts. (2015, November 4). Retrieved from http://news.wabe.org/post/study-online-therapy-eases-new-doctors-suicidal-thoughts

As the human lifespan grows, many people are now living well into their eighties and nineties. That’s wonderful news, but it comes with new challenges. One of them is the challenge of addressing mental health issues in our aging parents.

Depression is frequent among older adults. The rate of depression in persons over age 65 varies depending on the person’s overall health and living situation, but it can be as high as about 27% (Cswe.org, 2015).

What Causes Aging-Related Depression?

Several factors can contribute to depression in older adults, including:

• Preexisting depression: If you have a parent who has struggled with depression at different points in his or her life, it is more likely to recur as he or she ages. People with untreated depression in the past might have poor life coping skills and a tendency toward negative thinking. As they face the challenges of aging, it may be more difficult to maintain a positive outlook.
• Preexisting anxiety: Individuals with a history of anxiety often become more fearful as they age. (Many individuals become fearful as they age, but this tends to be more pronounced in those with a history of anxiety and worry.) As a result, they often isolate. They don’t go out often and rarely make new friends or participate in social activities. This can lead to depression.
• Difficulty with life review: One of the tasks of healthy aging is to review one’s life, feel proud of the positive contributions, forgive oneself for mistakes, and let go of resentments toward others. Some people have difficulty reviewing their lives. They may get stuck on one or more aspects and dwell. For example, someone may feel he or she did not accomplish enough or continue to hold anger and resentment toward a sibling. All that unfinished business becomes emotionally toxic and may block the person’s ability to feel joyful and at peace.
• Friends and family dying: There was a two-year period in the life of my in-laws (who are in their late eighties) where every time I spoke to them on the phone, they had a death to talk about. This is a unique reality of aging: your friends start to die, one by one. There isn’t always time to properly grieve, and it can lead to feelings that the world is not a happy place anymore. In addition, the death of a spouse or partner is often a huge emotional shock that can lead to overwhelming sadness and confusion. Many older adults wonder what will happen to them without their spouse or partner. The fear and sadness can amplify each other.
• Declining abilities: It’s both frustrating and frightening to realize that you are no longer able to do the things you once did. It’s also a reminder that the end of life is nearer. Many people react to that by clinging to independence rather than by asking for or accepting help. In some cases, declining abilities can lead to isolation, a sense of being useless, and feelings of depression.

For many aging adults, the world can seem like an increasingly confusing place. There are always new technologies and new ways of doing things. Feeling unsure of themselves, older adults may become stubborn and cling to the things they know and are more comfortable with. Keep in mind that for many in this generation, psychotherapy and mental health treatment may not be seen in a positive light, having been stigmatized throughout their lives. Thus, suggesting therapy may seem extreme or even insulting to an aging person, even if he or she would clearly benefit.

How to Support a Depressed Parent

1. Respect his or her need for independence, and don’t try to take control.
2. Offer love and support; just letting him or her know you care and are available is enough. For many people (young and older), admitting that they are depressed is difficult.
3. Delicately suggest one or two visits with a therapist who is experienced in geriatric issues, then leave it up to your parent whether to continue.
4. Talk about a friend or someone you know who experienced a time of depression and then recovered. Gently suggest that perhaps it is similarly possible for your parent to improve his or her mood and sense of happiness.
5. Learn active listening and empathy skills and become a good listener, without judgment or advice.

Is Medication a Good Option?

Sometimes, medication can be a good option for older persons, and sometimes it can make things worse by affecting cognitive function. It’s important to get a thorough evaluation by a qualified mental health professional who is trained in a variety of treatment approaches.

Watching an aging parent give up and not take good care of himself or herself can be heartbreaking and frustrating. It’s natural to want to insist that your parent get help, but being overly pushy can make things worse. A gentle approach that respects your parent as a competent adult is often the best bet.

Reference:

Gellis, Z. D., & McCracken, S. G. (2015). Mental Health and Older Adults – Chapter 3: Depressive Disorders in Older Adults. Council on Social Work Education. Retrieved from http://www.cswe.org/File.aspx?id=23509

Earlier this year, a Michigan judge incarcerated three children after they refused to see their father. The children say their father is abusive, but the father claims the mother has initiated a campaign to alienate him from his children. After swift public outcry, the judge released the children, ordering instead that they participate in parental reunification therapy.

Divorced parents often engage in acrimonious custody fights, and some parents may launch extended campaigns to destroy their children’s relationship with the other parent. Parental alienation syndrome, originally coined in the 1980s, remains a controversial diagnosis and is not listed in the DSM-5.

A broken relationship with one parent can be destructive to children, but so can spending time with an abusive parent the child fears. Parental reunification therapy requires children to spend extended periods of time with the alienated parent, often without contact from the other parent. The theory is that this is the only way to break the cycle of parental alienation, but controversy swirls around the practice. Critics say the therapy could be used to force contact with abusive parents, and the treatment may amount to “deprogramming” that can be traumatizing.

Alzheimer’s Disease Consists of 3 Distinct Subtypes, According to UCLA Study

A UCLA study has identified three potential subtypes of Alzheimer’s. Though more research will be necessary, the subtypes could shed light on Alzheimer’s causes as well as potential treatment. Inflammatory Alzheimer’s is characterized by an increase in C-reactive proteins, as well as an increase in serum albumin and globulin levels. Non-inflammatory Alzheimer’s does not produce the same increases, but does lead to other metabolic abnormalities. Cortical Alzheimer’s—which often affects relatively young individuals—affects language first and produces effects that are more widely distributed across the brain.

The Sinister Science of Addiction

Research has long suggested that addiction is a disease rather than a personal failing, and measurable differences in brain chemistry account for much of the behavior associated with addiction. A new video in the Reaction series—a group of videos produced by the American Chemical Society—shows how addiction functions in the brain.

Criminals Acquire Guns Through Social Connections

[fat_widget_right]Popular myths suggest most guns used in crimes are stolen, but new research suggests that friends and family are a more likely option for acquiring guns. Research on the Cook County Jail in Chicago about how jail inmates obtained guns suggests that 60% of the guns were purchased or the product of a trade. Chicago gun laws prohibit selling guns to people with criminal records, so many former inmates are unable to acquire guns at gun stores or through other traditional avenues.

Trial Review Confirms Common Antidepressant is ‘Unsafe and Ineffective’ for Teens

Paroxetine—better known under its brand name of Paxil—has been prescribed to teens to treat depression since 2001, but new research argues the practice should end. Not only was the drug no better than a placebo; it was also potentially dangerous. In 2012, GlaxoSmithKline, the pharmaceutical company that markets the drug, was fined $3 billion for failing to report drug safety information to the Food and Drug Administration and for illegally marketing some of its drugs.

The Psychology of Why People Like Steve Rannazzisi Lie About Having Survived 9/11

A handful of people have been accused of lying about being present at the 9/11 terrorist attacks. This week, comedian Steve Rannazzisi came clean, admitting he had been lying about his presence at the World Trade Center that day. Experts are unsure why some people feel compelled to lie about a history of trauma. Theories include a need to feel involved, a craving for attention, serious mental health issues, and false memories.

More Time Outside Tied to Less Nearsightedness in Children

According to a study of Chinese schoolchildren, spending time outside could reduce the rate of nearsightedness. As many as 90% of Chinese high school graduates are nearsighted. But the study, which followed almost 2,000 schoolchildren for three years, suggests that as little as 45 minutes outside each day could reduce the country’s rate of nearsightedness.

Eating a Lot of Fish May Help Curb Depression Risk—at Least in Europe

A number of studies have tied Omega-3 fatty acids—present in high quantities of fish—to a potential treatment for depression. A pooled analysis of 26 studies involving 150,278 participants suggests that Europeans who consume fish can reduce their depression risk by as much as 17%. This correlation was found only in European studies. The reduction in depression risk as a result of high fish consumption was higher among men, who saw a 20% reduction. Women’s risk of depression dropped by about 16%.

More than a quarter of Americans experience mental health issues each year, and the World Health Organization reports that depression is the leading cause of disability worldwide. However, many Americans think mental health care is both expensive and difficult to access, according to a study jointly sponsored by the National Action Alliance for Suicide Prevention, the Anxiety and Depression Association of America, and the American Foundation for Suicide Prevention.

In a survey of 2,000 adults, most (almost 90%) said they equally valued physical and mental health. One third reported that mental health care is hard to access, and 40% said high costs are a barrier to treatment. Forty-seven percent thought they had experienced a mental health issue, but only 38% of them had received treatment.

[fat_widget_right]Among those who sought treatment, therapy was the most popular option, with 82% pursuing psychotherapy and 78% taking medication. Eighty-six percent said that they knew mental health conditions such as depression increase the risk for suicide, but only 47% knew that anxiety-related conditions could also increase one’s suicide risk.

Though federal laws mandate equal coverage for mental and physical health, a number of recent reports suggest that many insurers continue to deny mental health claims.

64% of Psychology Experiments Fail Replication Test

In May, GoodTherapy.org reported on research suggesting that the majority of psychology studies could not be reproduced by subsequent researchers. Reproducibility is a hallmark of sound science. When a study’s results cannot be recreated, this suggests that the study could have been flawed, biased, or a fluke. Now, the results of that research have been published in Science, sparking debates about a so-called crisis in psychology. The research argues that the results of only a quarter of social psychology experiments and half of cognitive psychology experiments could subsequently be reproduced.

Living Small: The Psychology of Tiny Houses

Tiny houses are trending all over social media. For young people facing an expensive housing market, more economically sized homes can be enticing. These houses encourage people to reduce their carbon footprint by living simply, offer greater mobility because they can easily be moved by a trailer, and are much more affordable than standard-size homes. Moving into a tiny home may require significant downsizing of clothing, furniture, and belongings, but the advantages may include increased control over one’s housing experience, a private alternative to keeping costs down, and the ability to personalize design to fit one’s mood.

Health Buzz: Alcohol Education Should Begin at Age 9

Parents often delay talking to their kids about alcohol until the adolescent years, but a new survey published in the American Academy of Pediatrics suggests that these conversations should begin much earlier. The survey found that two thirds of teens had consumed alcohol by their high school graduation and that a quarter have had more than just a few sips before eighth grade. Researchers also found that children and teens drink more heavily than adults, raising concerns about alcohol poisoning and addiction. To give kids accurate and relevant information, the report recommends parents begin the alcohol conversation by the time their children are 9 years old.

Religion Rarely Part of ICU Conversation

Though three quarters of people charged with making health care decisions in an intensive care unit report that religion and spirituality are “fairly” or “very” important in their lives, less than 20% of family health care meetings involve discussion of religion or spirituality with doctors and other caregivers. Particularly when discussing end-of-life decisions, religion can be important, but it is usually the caregiver, not the doctor, who broaches the subject.

Japan’s Worst Day for Teen Suicides

September is National Suicide Prevention Month. For many Japanese parents, it may also be a time of increased concern about suicide among their teens. In Japan, more school students commit suicide on September 1 each year than on any other day. Though experts have posited various explanations—such as worries regarding bullying at school after a summer break free of emotional and physical attacks from peers—suicide remains common. Japan has one of the world’s highest suicide rates, and suicide is the leading cause of death among people aged 15 to 39. Figures from the Japanese government show that more than 18,000 adolescents under the age of 18 committed suicide between 1972 and 2013.

Oliver Sacks, Renowned Neurologist Who Wrote About His Cancer, Dies at 82

Famed author and neurologist Oliver Sacks died of cancer at his home on Sunday, August 30. Sacks wrote about unusual neurological conditions, often naming books after symptoms he saw in his clinical practice, such as The Man Who Mistook His Wife for a Hat. He was the inspiration for the doctor played by Robin Williams in the 1990 movie Awakenings, which is based on Sacks’ 1973 book of the same name.

Lack of Sleep Puts You at Higher Risk for Colds, First Experimental Study Finds

According to a study of 164 healthy people, inadequate sleep could increase the risk of developing a cold. Scientists monitored participants’ sleep patterns for a week, then quarantined them in a hotel for five days and exposed them to a cold virus. Researchers also checked the participants’ blood for an antibody that fights the common cold, then removed participants who had the antibody to make sure those participants would not bias the infection rates of the group.

At the end of the quarantine period, 45.2% of those who slept less than five hours a night exhibited at least one sign of illness—revolving around mucus production—and one other immune response. Of those who slept five to six hours, the cold rate was 30%, compared to 22.7% for those who slept six to seven hours. The rate was only 17.2% for those who got more than seven hours of sleep. At the end of the study, researchers determined that people who slept less than five hours per night were 4.5 times more likely to get sick than those who slept seven hours or more.

If her heart is broken, maybe it’s because her father broke it first. Her inability to accept herself is probably because he told her that she would never be good enough for anyone or anything.

I am a young lady that grew up without a father. I would watch enviously as friends celebrated father’s day, wishing I could do the same. I remember spending hours imagining my father coming back and telling me how he has missed me in his life. I imagined conversations and holidays that I knew would never happen. I could not fathom why I was never good enough for him to call daughter. If I am not good enough for my father, how will I be good enough for anyone else?

[fat_widget_right]This began my journey to self-loathing. As an eight-year-old, I would spend hours drawing circles around the areas I wanted to change. As more and more people around me commented about my weight and unattractive features, I began to obsess about my image. I moved from dreaming about plastic surgery to experimenting with ways to lose weight. People around me were too busy to realize that I had begun experimenting with diet pills, binging and purging, and starving myself for days on end. All I could think about was being skinny. Maybe if I was smaller, I would be sexier. Maybe if I was skinnier, more people would love me. Maybe if I was skinnier, my father would come back…

My strong desire to be loved strained my relationship with food, and began to take a toll on my mind. I would find myself crying for hours on end, not even sure what I was crying about. I began hiding from the world, thinking of ways to give myself an early exit. At that moment I did not realize that I was suffering from depression. In all honesty, I thought that’s how life worked: some people deserved happiness, and some didn’t. I was one of those that didn’t deserve it. I was not popular, and I didn’t fit in with anyone in my family. I was a constant outcast, and this pushed me into further isolation.

My isolation made me desperate. I wanted someone, anyone to love me. I wanted to feel like I belonged somewhere. So I clung on to the first sign of love that presented itself to me. It always came in the form of an abusive relationship, but that didn’t matter to me. I allowed people to cheat, because at least they would come back to me. I justified the physical abuse, blaming myself for saying or doing the wrong thing. I endured the emotional and psychological torture, because at least I was not alone. Any attention I received was better than nothing at all. I would run away from any “good guy” because someone like me didn’t deserve anything good.

Today, I’m a work in progress. I still have food issues that make me border on an eating disorder. After six different combinations, I have found antidepressants that are helping to pull me out of the dark shadows of my mind. I still find myself afraid of relationships, scared that I might end up in more abusive relationships. I try to keep my mind occupied with small happy thoughts, which will one day lead me to some form of happiness.

I was first diagnosed with depression in my last year of university. From that day on, my life changed. I have tried over four combinations of medication over the last two years. I try to focus on the positive: my love for God, writing, and yoga. I am lucky to have family and friends that support me even when they don’t understand my struggle.  

Ros keeps a blog at memoirsofavirginprostitute.blogspot.com.

These days, it seems like depression is all over the news. It usually gets publicity when a high-profile tragedy occurs. You don’t hear people talking about how great they feel now that their depression is being effectively treated. A lot of inaccuracies and half-truths get thrown around, and it can be tough to dig through them and find the facts.

Here are 10 particularly troubling myths and misconceptions about depression. I’d love to hear what you would add to the list!

1. It’s Something You Should Be Ashamed Of

The shame people often experience with depression (or any other mental health issue) is real, but this doesn’t mean embarrassment is warranted. In the United States and its territories, as many as 9% of the population currently meets the criteria for depression. Hundreds of celebrities, athletes, and political figures are known to have struggled with depression. You have nothing to be embarrassed or ashamed about. Depression doesn’t mean you’re lazy or pouting or ungrateful.

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2. If You Have Depression, You Will Always Feel Depressed

Depression comes in all shapes and sizes. For many people, their depression changes throughout their lives. Medication, life events, hormonal changes such as pregnancy or menopause, illness, or stresses can change depression. Some people find that psychotherapy relieves their symptoms, others seek out medication or homeopathies, and some make behavioral changes, such as exercise.

3. Depression Is Always Hereditary

Studies have shown that between 40% and 50% of depression is rooted in genetics. So if your parent or sibling has depression, it’s not a guarantee that you will develop it. There are also things you can do that might minimize your risk of developing depression. These include maintaining a strong support network, staying active, having a healthy diet, and learning positive coping skills such as meditation and deep breathing.

4. If Something Horrible Didn’t Happen, You Should Not Be Depressed

This is simply not true. Many people have a trigger in their lives, a trauma they can pinpoint as a starting point for their depression, such as the loss of a loved one or the loss of a job. Sometimes a passing challenge, such as failing a test or moving, can bring on a major depressive episode. Or the depression can appear with no known trigger at all.

5. Depression Is Simply a Feeling

Depression is not having “the blues” or feeling sad. The DSM-5 (a handbook used by mental health professionals to determine what constitutes a diagnosable issue) includes a list of symptoms. People who are clinically depressed have a cluster of these symptoms, such as thoughts of suicide or death, insomnia or hypersomnia, significant weight loss, and depressed mood most of the day nearly every day.

6. Medication Is a Sure Cure for Depression

Unfortunately, there is no magic pill that can obliterate depression. Depression is a complicated beast that can be incredibly hard to treat. Medication can be helpful at managing depression for some people. Others find that medication doesn’t help or, due to side effects, can even make things worse. It can take trying several different medications or combinations of treatments until you feel better.

7. Therapy Is a Sure Cure for Depression

Psychotherapy certainly can help people who struggle with depression. It’s been shown to decrease many symptoms and help people manage their moods. Like medication, though, therapy is not a cure in and of itself. Many people respond to therapy, but some don’t. A combination of therapy and medication tends to yield the best results, and many people incorporate both in their healing.

People with depression aren’t always depressed. Like everyone else, they have their good days and bad days.

8. If You’re Depressed, You Can’t Be Happy

People with depression aren’t always depressed. Like everyone else, they have their good days and bad days. When their depression is being effectively treated, the good days outnumber the bad. You cannot look at people’s Facebook pages with pictures of them laughing and enjoying life and conclude they’re not depressed. Many people are good at hiding their feelings and present to the world a persona that is much different from what they are experiencing.

9. Depression Shouldn’t Be Talked About

Millions of people throughout the world will experience depression sometime in their lives. You’re far from alone, and it doesn’t have to be something you keep secret. I’ve worked with people in therapy who, upon sharing their experience with friends and family, expressed surprise at how many of them also have struggled with depression.

10. If You Have Depression, You Will Never Have a Fulfilled, Productive Life

Depression is not a life sentence to misery. Depression is a treatable condition, and people who are diagnosed with it can go on to have wonderful, happy lives. The key is getting the correct treatment. If something you try isn’t working, keep searching. Find a psychiatrist or doctor who will patiently work with you to find the best medication, if you go that route. Find a skilled therapist who specializes in depression and whom you trust and feel a connection with.

Depression does not have to hold you hostage. The more people are honest about their struggles, the more accepting and understanding society will be—and the better off we all will be.

References:

1. Centers for Disease Control and Prevention. (2010). Current Depression Among Adults – United States, 2006 and 2008. MMWR 2010, Vol. 59 No. 38.
2. Levinston, Douglas F., & Nichols, Walter E. (2015). Major Depression and Genetics. Stanford School of Medicine, Genetics of Brain Function. Retrieved from http://depressiongenetics.stanford.edu/mddandgenes.html

Although recent developments in the investigation into the crash of Germanwings Flight 9525 reveal that copilot Andreas Lubitz had recently researched suicide methods and the security of cockpit doors, making it appear as though he deliberately crashed the plane in a suicide attempt, many unanswered questions remain regarding his motivations for bringing down a plane full of passengers. The media have latched onto Lubitz’s history of depression and mental health treatment, painting a grim portrayal of hidden mental health challenges. Some headlines appear to suggest that depression alone can lead a person to behave violently toward others, though this is rarely the case. In the aftermath of a violent tragedy like this one, news headlines frequently point to a perpetrator’s mental health issues, leading the public to believe that conditions like depression and the people who experience them should be feared, when in fact, issues like depression, anxiety, and anger are common, everyday concerns that affect many millions of people around the world and are infrequently associated with extreme violence.

Can Depression Make a Person Homicidal?

Though depression is a leading factor in suicide, affecting about 90% of people who kill themselves, it’s certainly not the only reason people harm themselves. Challenging life circumstances, social rejection, a breakup, poverty, terminal or chronic illness, and a host of other factors can contribute to a person considering or attempting suicide.

Ruth Wyatt, a licensed therapist in New York, told GoodTherapy.org that suicide is a complicated issue. “I think it is important to remember that the vast majority of people being treated with counseling and/or medication for depression or other emotional issues are not suicidal,” she said.

Suicide, though, is not the same as homicide. There is no evidence suggesting that people with depression are more likely than people who do not have depression to harm others. Thus moves to prohibit pilots who have depression from flying or to implement workplace mental health screenings may do nothing to prevent a future catastrophe. Research has consistently shown that people labeled as “mentally ill” are significantly more likely to be victims of violence than they are to be perpetrators. A 2014 study found that a third of people with mental health issues are victimized in any given six-month period.

Mental Health and the Workplace

Lubitz is not the only person to have ever concealed a mental health issue from an employer. Indeed, for many people who struggle with depression, anxiety, and other mental health concerns, sharing the diagnosis with an employer could feel inappropriate.

One recent study found that nearly 40% of people would not tell their employers about a mental health condition. Half of that group worried that disclosing a mental health condition might negatively impact their careers. These concerns are not necessarily misplaced, either. Sixty percent of respondents said they’d be concerned if a colleague had a mental health issue, with 40% saying they’d be worried that mental health issues could impact workplace safety.

Workers with mental health concerns may face ostracism at work, and in some cases, could even lose their jobs. News of the Germanwings crash has prompted some workplace safety advocates to push for pilots with mental health issues to be ousted from their jobs. Given that about one in four adults experiences a mental health issue each year, making a job contingent upon a mental health screening could leave millions out of work.

Stigma and Treatment

At first glance, mandating mental health screenings for those whose jobs can be used to harm others might seem like a practical measure. After all, mental health services are notoriously difficult to access, and some people with mental health issues are reticent to seek assessment or treatment. Some, like Lubitz, actively conceal their diagnoses, even when they may not be well enough to work.

However, forced screenings and treatment also have the power to raise needless alarm bells about mental health. When a job requires people to undergo mental health screenings, the subtle message may be that those with mental health issues are unqualified. This can increase mental health stigma, and the Centers for Disease Control and Prevention say that stigma is the leading barrier to mental health treatment.

[fat_widget_left]A 2014 study of 90,000 people found that 75% of people with mental health issues do not seek treatment. Researchers found that stigma was the most commonly cited reason for not pursuing treatment. Other reasons included shame and embarrassment—two emotions that may be heightened by sensationalized coverage of mental health issues.

Andrew Archer, a licensed clinical social worker in Madison, Wisconsin, worries that excessive reliance on mental health screenings could eventually label everyone as “mentally ill.”

“The ubiquity of screenings, awareness, and treatment for mental health issues will ultimately conclude that we all have a ‘mental illness,’ ” Archer said. “Major life stressors such as the ending of a relationship or role transitions have the potential to push us all over the edge. The impact is moderated by our safety nets—supportive, loving relationships—who won’t let us fall. Suicide is the shrapnel that rips through entire communities. The truth is that mental health providers have become incredibly skillful at predicting when someone will not commit suicide, but are less effective at predicting when someone will.”

Treatment can and does work for many people experiencing mental health conditions, even for people struggling with obstacles that seem insurmountable. If you are experiencing a mental health condition or emotional crisis, consider finding a trained mental health professional who can assist you in your recovery. Additionally, if you are or someone you love is experiencing suicidal thoughts, contact the 988 Suicide & Crisis Lifeline at 988 or your local law enforcement agency immediately.

References:

1. Adolescents Cope with Mental Illness Stigmas, Report CWRU Researchers. (2010, May 25). Retrieved from http://blog.case.edu/case-news/2010/05/25/mentalillnessstudy
2. Brown, Pamela, Smith-Sparker, Laura, and Pleitgen, Frederik. (2015, April 2). Germanwings Crash: Co-pilot researched suicide methods, cockpit doors. Retrieved from http://www.cnn.com/2015/04/02/europe/france-germanwings-plane-crash-main/
3. Greenberg, Gary. (2015, April 2). No, psychiatry could not have prevented the Germanwings Disaster. Retrieved from http://www.newyorker.com/news/news-desk/no-psychiatry-could-not-have-prevented-the-germanwings-disaster
4. Frequently asked questions. (n.d.). Retrieved from https://www.afsp.org/understanding-suicide/frequently-asked-questions
5. Mental illness facts and numbers. (n.d.). Retrieved from http://www2.nami.org/factsheets/mentalillness_factsheet.pdf
6. Shipman, M. (2014, February 25). Study shows mentally ill more likely to be victims, not perpetrators, of violence. Retrieved from https://news.ncsu.edu/2014/02/wms-desmarais-violence2014/
7. Stigma of mental illness. (2013, October 04). Retrieved from http://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm
8. Stigma of mental illness remains barrier to treatment. (2014, February 26). Retrieved from http://consumer.healthday.com/mental-health-information-25/anxiety-news-33/the-stigma-associated-with-mental-illness-remains-a-key-barrier-to-health-care-685196.html
9. Violence and mental illness: The facts. (n.d.). Retrieved from http://promoteacceptance.samhsa.gov/publications/facts.aspx?printid=