Blog

Top 10 Research Developments in September

October 8, 2021October 21, 2021

After Labor Day weekend, I consider it Fall. September was the shot of energy I needed; the desire to engage with research returned to me. The star of September’s show was the leak of internal Facebook documents, initially published by the Wall Street Journal, showing years of incriminating data obtained by the platform. Facebook’s studies repeatedly showed causal connections between Instagram use and mental health problems, such as eating disorders, among adolescent girls. The data has galvanized legislators and researchers to dig in so expect to keep seeing related content in future recaps. For now, enjoy and welcome to autumn!

Apple is reportedly working on using iPhones to detect and flag signs of anxiety and depression. Data collected on the phone regarding metrics like mobility, sleep and typing style may hold the key to early detection.

Penn University released a study on the damaging effects of gun violence on children. Researchers found kids located blocks away from a shooting are more likely to visit the ER for a mental health emergency.

Mental health problems can be spread at work, just like the common cold. A study shows new hires can affect co-workers with their mental health problems.

The most critical quality for effective leadership is EMPATHY a study shows. Empathetic leaders drive retention, innovation and more.

Getting a first dose of the COVID vaccine boosts your mental health says this study.

The Lancet is peer reviewing a study showing that over half of young people globally say climate change anxiety is affecting their daily life.

Muslims in America face a 50% higher risk of suicide than others says this study. And it’s mental health, not martyrdom driving the numbers.

An excess of free time is harmful to your mental health.

Studies of COVID’s harm to our mental health continue being released. The latest snapshot here.

Research shows a connection between air pollution and severe mental illness.

community

We Need a Moratorium on #NYTough

September 23, 2021October 21, 2021

New York City has a bad a** reputation.

Those of us who came of age in the 90s have been known to substitute “Crooklyn” for Brooklyn while wearing a “New York F**king City” shirt. We hold Cardi B in the highest regard for identifying as a “Bronx B**tch”.

Grit is all of New York’s shared experience–the social glue that transcends class, ethnicity, and borough of origin.

But I, for one, am growing tired of this image. Alienated and exhausted from 20+ years of tough guy adjectives, I’ve reached the end of my rope. Yes, New Yorkers are #strong and New Yorkers are #tough.

But New Yorkers are human beings and that means we are other things too.

I spent 48 hours this week working from the Financial District–a dramatically different place after COVID. I was often alone on my midday walks and this led me to question the emotional utility of proclaiming #NYTough qualities again and again and again.

Why? Partly because of the law of diminishing returns: overuse has led to a weakening of its power.

But more importantly, I’m troubled by the substance. Toughness may be the armor we don but pain is the path we tread. One cannot separate the two and come up with a slogan for the ages. And so, #NYTough feels empty because it fails to recognize the foundational source of our strength: #NYPain.

Taking in a largely deserted Financial District for the first time, something I’ve never seen in my 20 years in New York, I was struck by the radically different quality radiating from Wall Street’s buildings and sidewalks.

#Fragile best describes it. Achingly fragile, in fact.

This time when I walked down Wall Street, instead of thinking of the New York Stock Exchange, I thought of actual New Yorkers; you and me, still sheepish after the compounded pain of multiple tragedies.

In the evenings, I gazed down from the elevated terrace of my hotel at the wound inflicted on 9/11. What’s been built in the space left from the World Trade Center’s destruction is beautiful because it tells the whole story. The Memorial is a poignant symbol of gaping loss and the Freedom Tower embodies human resilience.

I thought about how our collective understanding of pain and trauma has advanced in the years since 9/11. Awareness of grievous harm done to women, Black people and marginalized communities in general has told us not to approach pain with a fatherly slap on the back. In the language of trauma, an admonition to “stay STRONG!” is problematic; it fails to confer comfort and risks further suffering with the implication that sadness, depression and anxiety are human experiences best crushed by blunt force.

Hopefully movements like #MeToo and #BlackLivesMatter have taught us some humility with the knowledge that meaningful comfort involves stepping into another’s loss, bearing witness to their grief and providing companionship in such space.

Words like “weak”, “soft”, and their counterparts “strong” and “tough” do not belong here. They negate, oversimplify, and dismiss when our job is to hear, affirm and accept.

I believe New York possesses all the strength it needs to rise back up: it’s always been there and always will be.

I also know where it comes from. That pain is long overdue for some air time.

Recent

Top Ten Research Developments in July

August 16, 2021August 16, 2021

I resume this series with JOY because newly published research has been providing major insights into behavioral health topics these days. July has given us updated numbers on COVID’s impact on our mental health, drawing distinctions based on age, gender and economic circumstances. Last month’s findings also touch on critical components of wellness like sleep, alcohol consumption, and sexual identity.

For the highlights, see my personally curated list below:

1 ONE night of decreased sleep is all it takes to negatively impact our psychological and physical health.

2 The Rand Corporation measured the magnitude of America’s mental health crisis, tapping artist Giorgia Lupi to create a visual representation of the complex array of factors involved.

3 Despite the strains associated with urban living, researchers from the University of Chicago found residents of cities less depressed than other Americans.

4 The increase in alcohol abuse stemming from COVID is not being adequately addressed by the medical profession says data elaborated upon in a piece published in The NY Times.

5 In the West, wildfires are increasing and victims will face serious mental health consequences say researchers from UCLA. The study emphasizes an urgent need for services to support survivors.

6 New parents need social support beyond the baby phase to effectively combat an increased risk for anxiety and depression says this study.

7 A Denmark study found links between schizophrenia and elevated levels of marijuana abuse.

8 A new drug for postpartum depression is poised to transform treatment, according to data cited by Time Magazine.

9 LGBTQ+ youth experience more severe mental health challenges than their straight peers; a study from Utah looks at the potential causes.

10 Writing is a proven method of healing trauma! Data that confers scientific legitimacy on something I already know is a beautiful thing!

We’ll end on that note. You’ll being seeing the August round up soon.

community

TikTok Becomes a Mental Health Hub by Elsie Ramsey

August 3, 2021October 1, 2021

I was recently made aware that therapists are blowing up on the video sharing platform, TikTok. I easily located a top 10 list of the most influential clinician’s accounts in Cosmopolitan’s July 2020 issue and urge you to take a look for yourself. Sure, the players have likely shifted in the last year but the rankings are not the point. Instead, in the pages of Cosmo, you can observe the phenomenon in action, within its proper context.

Consider the transformative potential a globally successful platform presents to the anti-stigma movement’s momentum. If you work in the mental health space and remain uncomfortable with the field’s embrace of virtual treatment and other innovations, I have this to say: you did not beat them so now you must join them.

If you are new to this platform, here is why these therapists popularity is something we must stop and take notice of. TikTok is often the germinating ground for viral content, a social media taste maker for young people of every stripe. Recently the app has become a vessel for healthy activity like reading books. In 2021, The New York Times reported that viral TikTok videos by young people relating the emotional impact of books on them, tagged with the label “BookTok”, significantly drove sales of literature.

And then there are the therapists.

As I joyously poured over #mentalhealthtiktoks, one account pulled at me with special force: @theshaniproject has over 238k followers and a bio that begins with “Dope AF Therapist”. As a clinician of color, Shani is an especially important member of the top 10 field. We know there is a sizable treatment gap in minority communities, partly because there are not nearly enough culturally competent therapists in the marketplace. Highly visible black therapists, dope AF or not, are something we need to see much, much more of.

The role these therapeutic influencers play is, of course, no substitute for treatment, and that fact is made abundantly clear in each account’s featured content. While exploring, you will see highly watchable snippets of advice about taking care of your mental health and what therapy is all about. Such a playful, light touch is the perfect mode of seduction for the average person with no experience or familiarity with treatment or the practice of psychological self care. Scrapping the hard sell approach invites engagement and broadens the tent, which is the ultimate goal for a mental health advocate like me.

Of course the combination of TikTok and clinical advice is not free from controversy or disapproval from some corners. I can understand those feelings without sharing them. TikTok’s embrace requires a particularly challenging paradigm shift to the dynamic between patient and provider.

If you have been a participant in the practice of psychotherapy at any point in the last 30 years, as either a provider or client, the idea of a working relationship that places both parties on a level playing field is extremely bizarre. More than just bizarre when viewed as a disruption to the traditional therapeutic alliance. Characterized by boundaries and roles, the clinical dynamic has been a key pillar of psychiatric medical doctrine from its beginnings in the Mid-19th Century.

Now is when we should look to the important lesson COVID taught: the truism that “when one door closes, a window opens”, applied to many of our most fundamental human habits.

Plunging into tele-therapy for over a year went surprisingly well. Some say better than well. Entering each other’s homes and intimate spaces shattered the formalities originally thought essential for effective psychotherapeutic treatment. It turns out they were not that essential after all. I made more progress with my therapist during COVID via FaceTime than I did during 7 years of office visits. There are a number of reasons for that sped up progress but I believe the increased intimacy and informality was significant.

Whether you agree with me or not about the value of pursuing exciting new ways to expand treatment and diminish stigma, it is happening. The era of TikTok therapists and virtual treatment has arrived. There will be no going back because progress changes us from the inside out.

I would like to take this moment to welcome the newcomers into living the “examined life” as psychoanalyst Stephen Grosz calls one which includes therapy.

It is within that thoughtful space that meaning is found and claimed.

holidays

Loneliness is a Mark of Distinction

July 3, 2021July 3, 2021

On holiday weekends like the fourth, I’m inspired to share a truth that we often forget: loneliness is NORMAL.

Yet, whether in a crowd or alone, the lonely see themselves as an error in creation, unfit for life; destined to watch scenes of intimacy through windows.

To prove the flaw in this logic, I’ve gathered some of my favorite reflections on loneliness written by literary legends whose names you will recognize.

If you are feeling pangs this holiday weekend, I hope you experience some comfort in knowing what stellar company you’re in.

“God, but life is loneliness, despite all the opiates, despite the shrill tinsel gaiety of “parties” with no purpose, despite the false grinning faces we all wear. And when at last you find someone to whom you feel you can pour out your soul, you stop in shock at the words you utter – they are so rusty, so ugly, so meaningless and feeble from being kept in the small cramped dark inside you so long”. -Sylvia Plath

“Why do people have to be this lonely? What’s the point of it all? Millions of people in this world, all of them yearning, looking to others to satisfy them, yet isolating themselves. Why? Was the earth put here just to nourish human loneliness?”. -Haruki Murakami

“Remember: the time you feel lonely is the time you most need to be by yourself. Life’s cruelest irony”. -Douglas Coupland

“Maybe ever’body in the whole damn world is scared of each other”. -John Steinbeck

“Loneliness is the human condition. Cultivate it. The way it tunnels into you allows your soul room to grow. Never expect to outgrow loneliness. Never hope to find people who will understand you, someone to fill that space. An intelligent, sensitive person is the exception, the very great exception. If you expect to find people who will understand you, you will grow murderous with disappointment. The best you’ll ever do is to understand yourself, know what it is that you want, and not let the cattle stand in your way”. -Janet Fitch

“There is a loneliness in this world so great that you can see it in the slow movement of the hands of a clock”. -Charles Bukowski

“Where are the people?” resumed the little prince at last. “It’s a little lonely in the desert…” “It is lonely when you’re among people, too,” said the snake”. -Antoine de Saint-Exupéry

“We must become so alone, so utterly alone, that we withdraw into our innermost self. It is a way of bitter suffering. But then our solitude is overcome, we are no longer alone, for we find that our innermost self is the spirit, that it is God, the indivisible. And suddenly we find ourselves in the midst of the world, yet undisturbed by its multiplicity, for our innermost soul we know ourselves to be one with all being”. -Hermann Hesse

“I felt a haunting loneliness sometimes, and felt it in others–young clerks in the dusk, wasting the most poignant moments of night and life”. -F. Scott Fitzgerald

“Perhaps only people who are capable of real togetherness have that look of being alone in the universe. The others have a certain stickiness, they stick to the mass”. -D. H. Lawrence

Policy

Talk to Me! I Talk Back! By Khadeeja Morse

June 29, 2021June 30, 2021

In a psychotic episode, my son, Mikese, drove a car into a family who was bicycling outside their home on June 24, 2018. Pedro Aguerreberry, a 42-year old father of two sons, aged three and eight, was tragically killed as a result.

The state of Florida has determined that Mikese is not guilty by reason of insanity. On April 19, a judge will finalize this decision and determine where Mikese needs to be placed.

This horrible tragedy might never have happened if Mikese had received the treatment he needed—the treatment his brain illness deserved, and the treatment my son pleaded for when he took himself to our local police station and confessed he might hurt someone.

We will never stop reading about horrible events like my family’s until more people understand the obstacles to treatment our loved ones face, and until unjust laws are changed. That’s why I talk back.

Our fight continues to free Mikese from the criminal justice system and allow him to be treated in a psychiatric hospital.

We seek to have him removed from the criminal justice system completely, with no oversight. Mikese’s civil and legal rights were violated from the very beginning. Mikese was not in his sound mind to even be able to accept his Miranda rights based on all of the evidence at the time of the arrest. This was well documented in all of the records from the day of the arrest.

Why should Mikese be removed from the criminal justice system? There are a number of reasons.

Beyond the Mental Illness Stigma Is a Brain Disorder

Most people don’t realize schizophrenia and bipolar disorder are actually serious brain disorders (SBD). The American Psychiatric Association describes both schizophrenia and bipolar disorder as brain disorders.

Being diagnosed with one of these disorders is bad enough. Having a combination, which is what Mikese has, is worse. To further complicate things, Mikese also suffered from anosognosia, which is when a person lacks awareness of their illness. Anosognosia is a common symptom of schizophrenia and bipolar disorder.

Mikese had the wicked trifecta of schizophrenia, bipolar disorder and anosognosia. The hard, cold truth is that many people suffering from these illnesses end up homeless or incarcerated.

The IMD Exclusion and How It Contributes to Tragedy

The IMD exclusion prevents federal Medicaid funds from being used to care for individuals aged 21 to 64 in institutions for mental disease with more than sixteen beds. It basically discriminates because an illness is classified as “mental” instead of medical.

Since there’s no funding for mental illness, even if there are hospital beds available, a person with an illness classified as a mental illness can’t fill the bed. He simply gets released to his own accord, like Mikese was.

An excellent article by the National Shattering Silence Coalition explains why and how policies like the IMD exclusion discriminate against people with SBD, which is typically referred to as serious mental illness (SMI).

Why Classification Matters

I can’t give you a better example of why classification matters than another heartbreaking news story that happened on the same day as our tragedy. A distraught mother describes losing consciousness due to a medical emergency while bathing her infant daughter. Her baby drowned, and sheriffs classified this as an accidental drowning. You’ll hear her say she had no idea what happened. Click here to watch.

This video is especially hard for me to watch because when the police were at our house interrogating Mikese, I recall him saying the same thing as this mother. He said he felt something take over his body, and he didn’t know what happened.

The mother has a medical illness. Mikese also has a medical illness, but his is classified as a “mental” illness. Both conditions led to actions that resulted in loss of life. Yet each situation was handled very differently by the medical and legal systems.

Now can you better understand the ridiculousness of the IMD exclusion?

HIPAA Laws Further Complicate Things

In an additional unfortunate and related twist, HIPAA privacy laws often prevent families from finding out any information about their loved ones before, during, and after hospitalizations.

What’s worse is that loved ones are often released to the streets, alone, with no support or guidance. They are left to fend for themselves while managing a medical condition that significantly impairs how they think. How does that make sense?

Can you imagine just releasing to the streets someone suffering from a stroke or heart attack before they were fully recovered, without any notification to a family member or loved one about the condition, care, or treatment?

Deadly Duo

The deadly duo of the IMD exclusion and family-unfriendly HIPAA laws often creates an insurmountable barrier for families. I call it a deadly duo because this combination is what led to the tragedy.

When Mikese took himself to the police, they “Baker-acted” him and he was admitted to Gracepoint, a psychiatric hospital in Florida for people deemed a threat to themselves or others.

The Baker Act is the authorization to involuntarily confine someone for up to seventy-two hours. It is important to note that while the Baker Act involves involuntary confinement, Mikese requested help by initiating contact with the police. The fact that he sought help is part of why he should be freed from the criminal justice system and allowed to get the help he was seeking before the tragedy.

Mikese was still psychotic at the hospital, so much so that we had to take over his medical decisions because he wouldn’t take medicine and attacked a public defender who came to see him.

He was kept in the hospital for about seven days and released because he was supposedly stable. We know he was far from stable. Despite needing longer treatment to stabilize, he was prematurely released from the hospital because there was no funding for “mental” illness. The IMD Exclusion negatively impacted him.

Also, there was no aftercare to support him when he was discharged. Since he’s an adult, Mikese was released to the streets, alone, with a messy stack of hard-to-read paperwork, a bus pass and a “good luck.” Within days of his release, the tragedy happened.

Proof Is in the News

When we realized the police were not going to be truthful about what happened with Mikese, we knew we needed to speak up.

This was our first formal interview with a local news station. Listen all the way to the end when the reporter speaks to a local expert about the lack of available funding and space to support patients with mental illness.

As I have often said, this crisis of lacking mental health care is the worst kept secret in the country, getting very little media attention or funding.

Who Else Will Be Held Accountable?

This is why, after another local news story about Mikese’s sentencing, I wrote an open letter on Facebook to State’s Attorney Andrew Warren, asking who else he would hold accountable for Pedro Aguerryberry’s unfortunate and unnecessary death. On air, Warren states, “This case shows the consequences of Florida’s broken mental health system, and the victim’s wife and kids are left holding the pieces.”

His statement shows the great hypocrisy of the system, acknowledging only one side of the equation. It is true that the Aguerryberry family experienced a horrific loss that never should have happened. However, they aren’t the only ones who are left holding the pieces.

Far too often, families like ours, who have been desperately trying to support our severely mentally ill loved ones with very few external resources, are left holding the sharpest pieces of the broken mental health system. We are marginalized and vilified because of the undesirable behavior of our loved ones. We get words and platitudes of understanding and support, especially after a tragedy or around election time, but not real, sustainable or meaningful proactive support.

Why I Talk Back

Click here for all images from my TikTok video. As you look at them, please keep in mind the whole story.

I talk back because my son couldn’t speak for himself. I talk back because it was very clear to us very early on that the police weren’t going to be honest about his brain illness. They had already begun to vilify and dehumanize Mikese during their press conference. They left out vital information about his illness and even the fact that they were the last ones to hospitalize him.

I talk back because there are thousands of people suffering from untreated SBDs. I talk back because those thousands of people have thousands of loved ones who are doing the best they can for their seriously ill loved ones. They too suffer profound pain and trauma as they watch their loved one slip away and are helpless to do anything about it.

I talk back because we need to be seen, heard and acknowledged. I talk back because we need help and not just lip service around election time or after a tragedy.

I talk back because we ask for help but what we usually get are bloodied fingers from the sharp, broken fragments of a failed mental health system we’re forced to piece together with our bare hands.

How You Can Help

I am a proud member of the National Shattering Silence Coalition and very much support their programs and platforms. The Calls to Action section of their website offers some great ways you can help support our cause.

Please also continue to keep our family and the Aguerryberry family in your thoughts and prayers.

Namaste.

Recent

Overturning State Licensing Laws is a Life or Death…

June 18, 2021June 22, 2021

When COVID started demolishing pillars of communal life, many Americans found themselves hovering close to an emotional edge. The demand for mental health treatment spiked sharply, reflecting an increased need from current patients and a new call for services from first time sufferers. In January 2021, 41% of adults reported symptoms of anxiety and/or depressive disorder, a number that has been stable since spring 2020. Early 2020 data showed that drug overdose deaths were particularly pronounced from March to May 2020, coinciding with the start of pandemic-related lockdowns. Access to treatment was, and continues to be, a life or death issue. At the same time, something else was happening: with no magic bullet in sight, Americans started weighing the relative merits of the old versus new. Change had come overnight and in some areas of life, it felt like an improvement.

Residents of states observing federal and state restrictions expressed satisfaction with less hours spent working from the office. The Economist cites data showing pre-pandemic Americans spent only 5% of their working time at home. By spring 2020 the figure was 60% and the transition was going more smoothly than expected.

No profession was more impacted by this shift than psychotherapy. The standard practice has always been for treatment to take place in an office setting, doctor and patient seated across from one another in close proximity, Covid’s restrictions forced therapy out of the office and into the virtual sphere, thrusting the whole field into uncharted territory.

State of emergency laws were passed to accommodate new challenges. One particularly welcome overhaul was the suspension of confusing, restrictive state licensing laws that prevented clinicians from treating patients in different states. Psychiatrists had been treated like lawyers under the former legislation, permitted to practice only in states where they had passed a regional exam. The regulation makes sense for lawyers, given the variance of state laws, but not for doctors, who treat the same psychiatric symptoms regardless of geography. Clinical depression looks no different in California than it does in New York. With restrictions lifted, access to treatment grew exponentially. Residents of rural areas, historically underserved because of clinician shortages, got care. People sheltering in place out of state did not experience any harmful interruptions to their therapeutic work. Without the increased flexibility, millions of people would have been left to navigate the distress of isolation, economic uncertainty, and grief, all alone.

As a new resident of Pennsylvania, I benefited personally from these adjustments. My treatment was in flux—while looking for a local doctor, I continued working with my longtime psychiatrist, licensed to practice in New York State. The policy overhaul kept me and countless other vulnerable patients from reaching a crisis stage.

With ample time to observe the effects of virtual treatment, the merits of teletherapy, an already vastly successful modality from the perspectives of app enthusiasts, gained mainstream acceptance from clinicians and patients alike. A branch of medicine slow to move towards telehealth flourished and grew. Anyone observing or participating in the phenomenon witnessed a beautiful thing; not only did many more people get treated, studies collecting feedback from patients and doctors showed absolutely no compromise in the quality of care. Patients reported feelings of deeper intimacy towards therapists and additional comforts unique to the modality, like the presence of pets during sessions and an increased openness connected to sharing from relaxed spaces.

With respect to the life saving impact remote care has had on Americans who struggled before and during COVID, along with the sizable projections for emerging needs from formerly untreated groups, the temporarily relaxed laws need to be made permanent. Legislative action from both federal and state authorities will prevent widespread tragedy. We should all be asking our lawmakers, “if not now, when?”.

The American Psychiatric Association put forth an informed and well organized list of policy suggestions. If implemented, the modifications will eliminate crippling barriers to care going forward. Each proposal concerns one of the four problematic areas of former legislation: reimbursement, HIPPA/privacy standards, licensing, and prescribing power. The continued improvements in treatment outcomes and access to care rely on their passage.

1) Extend the telehealth waiver authority under COVID-19 beyond the emergency deceleration to study its impact

2) Remove geographic restrictions for mental health and allowing the patients to be seen in the home

3) The Drug Enforcement Agency should finalize regulations for Ryan Haight Act to allow for the prescribing of controlled substances via telehealth without a prior in-person exam

4) Continue to pay telehealth services on par with in person visits

5) Allow for the use of telephone (audio) only communications for evaluation and management and behavioral health services to patients with mental health and substance use disorders when it is in the patient’s best interest, and should be paid at no less than an in person visit

6) Maintain coverage and increased payment for the telephone evaluation and management services

7) Remove frequency limitations for existing telehealth services in inpatient settings and nursing facilities

8) Include all services on the expanded Medicare-approved telehealth list including group psychotherapy

9) Allow teaching physicians to provide direct supervision of medical residents remotely through telehealth

There is no middle ground when it comes to reimagining the framework denying the necessity of easily accessible care for a traumatized country. Failure to act will leave us all vulnerable.

healthcare

Top Ten Research Developments in May

June 1, 2021June 6, 2021

May was full of important breakthroughs, covering a range of mental health areas of research: Yale University released the results of a study that identified the over 100 gene variants connected with major depressive disorder. The University of California San Francisco released the results of the first comprehensive MDMA phase 3 clinical trial. A study showing correlation between past depression and/or depressive episodes during gestation, even if resolved by the time of birth, with poorer quality mother/infant relationships.

This is a curated list of what I consider the additional highlights from last month’s publications:

1 We all know poor sleep is connected with poor mental health, worsening existing symptoms and sometimes leading to first time symptoms of emotional distress. Unfortunately, sleep issues have been understudied: this piece gathers the work that has been done and what we know today.

2 Boston Children’s Hospital published a study showing connections between improved mental health and transgender surgery.

3 Apparently there’s a connection between our heart health and higher levels of mental illness, according to this study.

4 The effects race have on our mental health and how to address the concerns as we return to communal life is shared here.

5 A new digital behavioral health platform comes to market for employers concerned with supporting the mental health of employees.

6 Sens. Amy Klobuchar and Tina Smith announced May 18th that the Minnesota Department of Human Services has received a $2 million grant from the U.S. Department of Health and Human Services (HHS) to support mental health care.

7 Screen time may not play a meaningful role in our mental health after all.

8 The damage done to communities of color by unjust police killings is described and outlined here.

9 A look at one of the primary reasons mental health apps work for so many users.

10 Psychedelic medicine is about to rock the psychiatric profession, ushering in a new era in its practice.

Stay tuned for June’s highlights: this roundup will be a regular monthly piece from here on out! Happy reading, everyone.

depression

The Bottom by Elsie Ramsey

May 16, 2021July 31, 2021

If you’ve been given the diagnosis of Major Depressive Disorder, it’s likely there exists a moment in time (often more than one), that was singularly horrible for you. A year, a summer, a weekend—the duration isn’t significant because in the moments when life becomes unbearable, time ceases to exist. We don’t ever forget these interludes and that’s not always a bad thing.

What bothers me is how society likes to have the final word on whether your personal crisis was really a crisis. Put differently, did it meet the criteria for “bottom” or “rock bottom” status, if the interlude hit a level of depravity inappropriate for polite conversation. Through an absurdly reductionist metric, serious breakdowns are ones that resulted in hospitalization and/or death. If we’re being lenient, at least the inability to leave bed, eat and sleep in simultaneous connection.

By those standards, the most excruciating periods of my life just weren’t that serious. I say that’s blatantly false and if you’d been there to witness them, I’m confident you’d agree.

There should be NO qualifying criteria applied to breakdowns. Engaging in such judgements delegitimizes the pain many of us battled while showering, going to the office, and trying with all our strength to render invisible.

And while we’re on the subject of universally experienced dismissals issued to depressed people, who remembers that time someone accused you of choosing to be unhappy? How was it for you? Did you die a little inside after the shock subsided? I did.

The hostile pronouncements that by taking some nice long walks and relinquishing that indulgent embrace of victimhood, (plus, don’t forget the yoga and meditation!), the whole breakdown would have blown over. Or never happened in the first place.

The perennial fresh air cure! Its proponents are everlasting and undeterred. The fact that walks are still so frequently recommended to depressed people as curative is simply tragic. I love walks and nature time; both are essential components of the routine I’ve developed to feel well, but without the full compliment of psychotherapy, medication, spiritual practice and human connection, walks would do exactly nothing.

What I’d like others to know is that by understanding my deepest episodes of emotional pain as no different, qualitatively or quantitatively, from anyone else’s, I’ve cultivated a feeling of pride in my strength and will to live.

Pride in asking for support as soon as I feel my depression starting to pick up steam.

Pride in the relationships I’ve forged with therapists who’ve walked next to me through many dark, scary places.

Put simply, I’m proud I made it. And if you’re reading this, you should be too. Anyone who has experienced a bottom, and you know who you are, deserves to know their pain is legitimate. With or without hospitals.

Shared Stories

Prison Reality Shows, Freud and Mental Health Month 2021

May 3, 2021July 31, 2021

Here we are in May of the year 2021, on the cusp of a monumental mental health pandemic. COVID’s long shadow will surely fall over the whole world, as universal as the night sky, or a traffic jam, or a child taking their mother’s hand. Never before have we had such sophisticated and accessible means for treating emotional pain. The coming years will test their limits.

There is comfort to be found in knowing we stand on the shoulders of giants as this challenge draws near. The man some call the founder of individual psychotherapy, Alfred Adler, died 84 years ago this month. The Austrian neurologist Sigmund Freud left the planet 82 years ago, though his presence is often felt in our professional trainings, therapy sessions and armchair musings on ego. And far earlier than these titans made their contributions to humanity, a Philadelphia physician and signer of the Declaration of Independence, performed an impromptu therapy session in the basement of the Pennsylvania Hospital. Dr. Benjamin Rush entered the facility in the late 18th century and found mentally ill people chained to the walls on the hospital’s subterranean floor, filthy and neglected by staff. Even more stunning, he sees visitors, who for a modest admission fee are permitted to observe the patients for a little excitement. In a radically subversive move, Dr. Rush began talking to them and the metaphysical healing power of connection worked its miracle—patients began to reanimate.

There have been so many transformative strides in the last century; we must honor and celebrate them all. These victories are triumphs over an elemental human weakness—the condemnation of what we cannot understand.

Does that mean we should consider the door of an incredibly dark chapter closed because locking people up and throwing away the key is unimaginable today? And that voyeuristic gawking for purposes of entertainment is even more unimaginable now that we understand mental illness? Anyone who says yes is either uninformed or blatantly dishonest.

Do you know where the majority of mentally ill Americans live in the year 2021? Let’s make this a multiple choice question:

home

residential treatment

prison

Yes, it’s the last one.

And often, when sickest and most in need, sitting in solitary confinement—I credit my hometown New York for being one of the first states to make that illegal.

A follow up question: do prisons possess robust mental health treatment arms, complete with social workers, psychiatrists, and spaces for therapy?

We all know the answer.

While today’s entertainment choices fall far short of the inhumane practice of paying to see people shackled in basements, many of us have a taste for voyueristic viewing of the very real human suffering of others on screen. Reality rehab is a genre that’s exploded in recent years; I’ve probably watched every episode of every season of the addiction docu-series “Intervention”. Many of us also indulge in the deliciously guilty pleasure of reality prison shows; a genre dating back to the early 90s, when Cops possessed enough cultural capital to turn the male “undershirt” into the “wife beater”. MSNBC’s “Lockup Raw”, A&E’s “60 Days In”, and Netflix’s “The World’s Toughest Prisons” are some of the recent hits but in a genre constantly releasing new content, it’s difficult to keep up. Prisons have no shortage when it comes to film crews.

Is it fair to suggest we consider the possibility that our embrace of addiction and mental illness media has its roots in the darker rituals of freak shows?

There are five seasons of Netflix’s “The World’s Toughest Prisons” available for streaming on the platform right now. Here’s how the premise is described by the show’s producers: “Investigative journalists become voluntary inmates in the world’s most volatile prisons, where intimidation and brutality rule”.

“Lockup Raw” was recently cancelled after fifteen wildly popular seasons on MSNBC’s weekend lineup to make room for new documentary content, but the show that started it all’s CEO says his company, 44 Blue Productions, “may continue to produce prison-themed unscripted programming in the future”. I don’t doubt it.

I suspect that as we become a society more aware of the prevalence and exquisite suffering caused by serious mental illness, our entertainment tastes will change.

And rather than continuing to wallow in the dysfunction, I’d like to focus on the power we have to upend this perverse paradigm. No solution will succeed though without an exhaustive taxonomy of the problem and its origins. And then we must tear it down in order to build something new.

Hope and action will replace despair and impotence this year as COVID absolutely forces us to face this issue. I feel like Freud, Jung, Adler, and all the other greats are watching us from their otherworldly places and hoping we do the right thing. I, for one, don’t want to let them down.