OCD Patients

Obsessive-Compulsive Disorder Patients

Soon after obsessive worries begin, OCD patients typically do something to diminish the worry, a compulsive act. If they feel they have been contaminated by germs, they wash themselves; when that doesn't make the worry go away, they wash all their clothing, the floors, and then the walls. If a woman fears she will kill her baby, she wraps the butcher knife in cloth, packs it in a box, locks it in the basement, then locks the door to the basement. The UCLA psychiatrist Jeffrey M. Schwartz describes a man who feared being contaminated by the battery acid spilled in car accidents. Each night he lay in bed listening for sirens that would signal an accident nearby. When he heard them, he would get up, no matter what the hour, put on special running shoes, and drive until he found the site. After the police left, he would scrub the asphalt with a brush for hours, then skulk home and throw out the shoes he had worn.

Obsessive doubters often develop “checking compulsions.” If they doubt they've turned off the stove or locked the door, they go back to check and recheck often a hundred or more times. Because the doubt never goes away, it might take them hours to leave the house.

People who fear that a thud they heard while driving might mean they ran someone over will drive around the block just to make sure there is no corpse in the road. If their obsessional fear is of a dread disease, they will scan and rescan their body for symptoms or make dozens of visits to the doctor. After a while these checking compulsions are ritualized. If they feel they have been dirtied, they must clean themselves in a precise order, putting on gloves to turn on the tap and scrubbing their bodies in a particular sequences ; if they have blasphemous or sexual thoughts, they may invent a ritual was of praying a certain number of times. These rituals are probably related to the magical and superstitious beliefs most obsessionals have. If they have managed to avoid disaster, it is only because they checked themselves in a certain way, and their only hope is to keep checking in the same way each time.

Obsessive-compulsives, so often filled with doubt, may become terrified of making a mistake and start compulsively correcting themselves and others. One woman took hundreds of hours to write brief letters because she felt so unable to find words that didn't feel “mistaken”. Many a Ph.D. Dissertation stalls – not because the author is a perfectionist, but because the doubting writer with OCD can't find words that don't “feel” totally wrong.

When a person tries to resist a compulsion, his tension mounts to a fever pitch. If he acts on it, he gets temporary relief, but this makes it more likely that the obsessive thought and compulsive urge will only be worse when it strikes again.

OCD is very difficult to treat. Medication and behavior therapy are only partially helpful for many people. 

Even some forms of obsessive jealousy, substance abuse, compulsive sexual behaviors, and excessive concern about what others think about us, self-image, the body, and self-esteem can be helped.

(Brain Lock Unlocked. The Brain That Changes Itself by Norman Doidge, M.D., excerpt).

Schizophrenia

Schizophrenia

Read this text to learn more about causes of schizophrenia, signs to watch for, treatment available.

What is schizophrenia? 

Schizophrenia is a mental illness that affects about 1 in every 100 persons.

People with schizophrenia sometimes do not know the difference between what is real and what is not real.

For example, they may hear “voices” of people who are not real. This may leave them mixed-up, upset and afraid. They sometimes say and do things that appear unusual or do not make sense to other people.

Severe types of this illness can cause problems at home, school, work or in a person’s social life.

What causes schizophrenia?

There is no one reason why someone develops schizophrenia, but researchers are studying its causes.

• Scientists believe that abnormal brain chemistry is responsible.
• It may be a partly inherited illness.
• Stress can play a role in making the symptoms worse.
• Signs and symptoms:

Not everyone with schizophrenia has the same symptoms. Symptoms are usually first seen in teens and young adults.

Delusions:

Delusions are false personal beliefs that can be quite strange to others and are very hard to change.

For example, some people with schizophrenia may believe that others are trying to hurt them, or that he or she is famous or has special powers.

Hallucinations:

Hallucinations are experiences that are not really true.  Hallucinations can be experienced as images, sounds, feelings, tastes or smells.

Hearing voices is the most common hallucination in schizophrenia. These “voices” may talk to each other, warn of dangers, or even tell the person to do something.

Thinking, speaking or behaving in a disorganized way:

Schizophrenia can make things difficult. People with schizophrenia may not be able to concentrate on one thought for very long and may be unable to focus their attention. The way they speak or may appear strange or disorganized as well.

Negative symptoms

A person with schizophrenia may not show a lot of emotion. The person may not want to be around others, may have very little to say or may not be interested in doing things. These symptoms are often the hardest part of the illness for families and friends to understand. Sometimes people misunderstand these symptoms as laziness, but they are really one of the most difficult parts of the illness to treat.

What are the treatments?

Medication: Currently, medications are available which often reduce or eliminate the symptoms of schizophrenia. But the symptoms very usually keep coming back without medication and ongoing treatment is needed.

Sometimes the doctor may need to change the treatment plan to manage the illness effectively. For example, the doctor may change the type or dose of medication. Sometimes people can get depressed or even suicidal because of their symptoms.

Other supports that can be helpful:

• Family, friends and self-help groups;
• Close follow-up with a professional;
• Coping and problem-solving skills education;
• Job training.

 Dr. Bell, I presume, has already told you that Ruy has lost the ability to read and write. Ordinarily that's indicative of advanced dementia praecox, isn't it? However, I think Mr. Jacques' case presents a more complicated picture, and my own guess is schizophrenia rather than dementia. The dominant and most  frequently observed psyche is a megalomanic phase, during which he tends to harangue his listeners on various odd subjects.

We've picked up some of these speeches on a hidden recorder and made a Aipg analysis of the word-frequencies. 

A Zipf count is pretty mechanical. But scientific, undeniable scientific.... Back in the forties, Zipf of Harvard proved that in a representative sample of English, the interval separating the repetition of the same word was inversely proportional to its frequency. He provided a mathematical formula for something previously known only qualitatively: that a too-soon repetition of the same or similar sound id distracting and grating to the cultured mind. If we must say the same thing in the next paragraph, we avoid repetition with an appropriate synonym. But not the schizophrenic. His disease disrupts his higher centers of association, and certain discriminating neural networks are no longer available for his writing and speech. He has no compunction against immediate and continuous tonal repetition.

Just listen: “Behold, Willie, through yonder window the symbol of your mistress's defeat: The Rose! The rose, my dear Willie, grows not in murky air. The smoky metropolis of yester-year drove it to the country. But now, with the unsullied skyline of your atomic age, the red rose returns. How mysterious, Willie, that the rose continues to offer herself to us dull, plodding humans. We see nothing in her but a pretty flower. Her regretful thorns forever declare our inept clumsiness, and her lack of honey chides our gross sensuality. Ah, Willie, let us become as birds! For only the winged can eat the fruit of the rose and spread her pollen...

Did you keep count? The author used the word “rose” no less than five times, when once or twice was sufficient. He certainly had no lack of mellifluous synonyms at his disposal, such as “red flower”, “thorned plant”, and so on. And instead of saying “the red rose returns” he should have said something like “it comes back.”

(And lose the triple alliteration. We can re-examine that diagnosis very critically. Everyone who talks like a poet isn't necessarily insane.)

(The Rose. Charles L. Harness)

Severe types of this illness can cause problems at home, school, work or in a person’s social life. Illustration: © Megan Jorgensen.

Antidepressant Medication

Antidepressant Medication

Antidepressant medications are used to treat many psychiatric illnesses such as depression, anxiety disorder, obsessive compulsory disorder.

These medications help treat and prevent symptoms from returning. A patient and his or her doctor will choose the best antidepressant medication for the patient.

What are antidepressant medications used for?

These medications are used to treat many symptoms, including feeling sad, low energy, nervousness, repeated and unsetting thoughts and actions, thoughts of suicide.

How long will this medication take to work?

It can take four to six weeks before you start to feel better. Do not change the dose or stop taking the medication without talking to your doctor. Antidepressants take time to work.

How long do I need to take this medication?

The length of time you take an antidepressant will depend on what illness you have. You should talk to your doctor about how long you will need to take this medication.

What are the possible side effects?

Not everyone has side effects. If you do have side effects they usually are not serious. Most of the time side effects will get better with time.

Common side effects include:

• Constipation (difficulty going to the bathroom)
• Diarrhea
• Dry mouth
• Feeling less interested in sex or difficulty having sex
• Feeling nervous
• Feeling tired
• Headache
• Trouble sleeping
• Upset stomach

(This not a complete list of side effects. If you are worried about these of other side effects talk to your doctor or pharmacist).

Some side effects can be serious such as:

• Flu-like symptoms
• Difficulty breathing
• Skin rash or itching
• Change in mood to unusually happy or excited
• Feeling very nervous, confused or upset
• Thoughts of suicide
• Thoughts of hurting yourself or others.

If you have any of these side effects, you should tell your doctor right away.

Interactions with other medications

Antidepressant medications can change how other medications work. Antidepressants may not work properly when taken with other medications. Always check with your doctor or pharmacist before taking other medications, vitamins or herbal medicines.

Things to consider:

• Do not stop or change the dose of your medication without talking with your doctor
• Tell your doctor about any changes in the way you are feeling or acting
• If you feel sleepy, do not drive a car or do other things where you need to be awake
• Do not drink alcohol while taking an antidepressant.

Do not change the dose or stop taking the medication without talking to your doctor. Antidepressants take time to work. Illustration: Megan Jorgensen.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD)

What is OCD? Obsessive-compulsive disorder is an anxiety disorder. People with OCD have repeated, upsetting thoughts or images that may make them do things over and over. The obsessive thoughts or images are called “obsessions”. The actions that are done over and over again to make the thoughts go away are called “compulsions”. These actions give only brief relief from anxiety. Many people with OCD know that their actions are not normal but they cannot stop or control them. OCD can be so severe that it stops people from having a normal life.

What causes OCD?: There is no one reason why someone develops OCD. Family history, brain chemistry and stress play a big role in producing the illness.

OCD occurs in people of all ages but symptoms are usually first seen in teens and young adults.

Signs and symptoms

Examples of obsessions include:

• Keeping things neat or in special order
• Fear of germs
• Fear of being hurt
• Fear of hurting others
• Upsetting thoughts about sex
• Upsetting thoughts about religion

Examples of compulsion include doing one of these things over and over:

• Washing hands
• Cleaning
• Arranging things
• Counting
• Repeating words silently
• Praying
• Checking things (such as whether the stove if off or the door is locked).

What are the treatments?: OCD generally responds well to treatment, such as medication and psychotherapy.

Medication will help reduce anxiety, unwanted thoughts and repeated actions.

A type of psychotherapy called Cognitive Behaviour Therapy (CBT) teaches how to deal with anxiety and how to stop doing unwanted things.

Support from family, friends and self-help groups can also be very helpful.

Cognitive Behaviour Therapy (CBT) teaches how to deal with anxiety and how to stop doing unwanted things. Image: © Megan Jorgensen.

Electroconvulsive Therapy

Electroconvulsive Therapy (ECT)

What is ECT? Electroconvulsive Therapy or ECT is a medical procedure used to treat symptoms of some mental illnesses such as severe depression, Bipolar Disorder and psychosis. ECT can also help people who have thoughts of hurting themselves or others. Your doctor may ask you to try ECT if other treatments have not worked in the past. During ECT, a small controlled electric current is passed through the brain.

How does ECT work? It is believed that ECT helps the part of the brain that controls emotions and thoughts to return to a more stable condition.

• ECT treatments are usually done twice a week.
• ECT may be used with other types of treatments, such as medications and psychotherapy.
• After you feel better ECT may be continued to help keep you feeling better.

How do you prepare for ECT?

• Your doctor will explain the procedure and answer your questions. You will need to agree in writing to have ECT.
• You will have blood tests and a cardiogram (a test of your heartbeats) to make sure you do not have any physical problems that prevent ECT.
• The day before treatment your doctor may make changes to your medication. You will need to stop eating and drinking after midnight.
• In the morning, your nurse will help you get ready and will accompany you to the treatment room.
• When you arrive in the treatment room, a nurse will put an intravenous line (TV) into your arm. Medication will be given to you to help relax your muscles and put you to sleep for the treatment.

What happens during the treatment?

• Your heartbeat, blood pressure, oxygen levels and your brain waves will be monitored.
• A blood pressure cuff is placed on one of your arms to measure your blood pressure. A small monitor is put on one of your fingers to measure the oxygen level in your blood.
• When you are asleep, one or two electrodes (small metal discs) are placed on the side of your head. These electrodes carry the electrical current through your brain. The current lasts from 1 to 4 seconds. You will have a short seizure (your muscles contract and then relax). This lasts 20 to 60 seconds.
• You will not feel pain.
• You will not remember this part of the treatment because you are asleep.

What can you expect after treatment?

• Your nurse will continue to check you’re your blood pressure, oxygen level, heartbeat and breathing.
• After resting, you may eat and return to your regular activities.

What are the side effects of the treatment?

• You may feel muscle aches, headache or jaw pain. The pain goes away after a few hours.
• You may feel confused and forget what happened just before and after the treatment. Your memory usually returns after a few hours.

What are the risks?

Electroconvulsive Therapy is a safe treatment with the same type of risks as any other treatment that uses general anesthesia. Your doctor will discuss possible risks with you.

Do you have other question about ECT?

If you have any question, it is very important to discuss them your doctor or nurse before you have ECT.

ECT. Illustration by Elena.

Bipolar Disorder

Bipolar Disorder

Bipolar disorder is a mood disorder. A person with Bipolar Disorder has extreme “high” and “lows” in mood. It is different from the normal “ups” and “downs” that everybody goes through. Severe types of this illness can cause problems at home, work, school and social life… it may even result in suicide.

What causes Bipolar Disorder? – There is no one reason why someone develops Bipolar Disorder. Family history and brain chemistry play a big role in producing the illness. One`s personality and stress can bring on the illness.

Signs and Symptoms – A person with bipolar disorder has extreme changes in mood, such as overly “high” (Mania) and overly “low” (Depression). Some people have periods of normal mood in between. Periods of Mania may last several days to mouths. Periods of Depression may last several weeks to months.  These symptoms are a change from a person`s normal behaviour.

Symptoms of Mania may include:

• Very good mood
• Increased energy and restlessness
• Too many ideas too fast
• Talking more than usual or very quickly
• Less need for sleep without being tired
• Poor judgement and acting without thinking. For example, spending a lot of money, careless driving, increased use of alcohol or drugs, getting into fights, foolish financial decisions
• Unable to focus
• Exaggerated believes in one's abilities.  For example, believing he or she id God or has special powers (such as being able to fly), thinking he or she is smarter than others, etc.
• Feeling “on top of the world”.

Symptoms of Depression may include:

• Feeling sad, crying for no obvious reason
• Feeling hopeless and empty
• Feelings of guilty or worthless
• Loss of interest or pleasure in activities once enjoyed
• Low energy or feeling tired
• Difficulty thinking or remembering things
• Sleeping too much or too little
• Eating less or more than usual
• Thoughts of suicide

What are the treatments?: Bipolar disorder responds well to treatment once the illness has been diagnosed. Since the symptoms of Bipolar Disorder will keep coming back, ongoing treatment is needed. A combination of medication and psychosocial treatment (such as stress management) is best for managing the illness over time.

Sometimes changes to the treatment plan may be needed to manage the illness effectively. For example, the psychiatrist may change the type of dose of medication. Support from family, friends and self-help groups can also be very helpful.

A person with Bipolar Disorder has extreme “high” and “lows” in mood. It is different from the normal “ups” and “downs” that everybody goes through. Illustration: © Megan Jorgensen.

Down Syndrome and Mental Retardation

Down Syndrome & Mental Retardation

*The following account is not meant to cover ALL cases of children with special needs, but only one special case which I found to be quite contrary to what the health care system intends to accomplish with help and support programs.

Boy: I love you!

Girl: But you tried to kill me many times!

Boy: I love you!

Girl: But you destroyed my life and make me miserable!

Boy: I love you!

Girl: But nothing you do shows me love, and everything you do shows me hate!

Boy: Well, I got mental retardation and you have to forgive all my mistakes and accept my twisted, horribly dangerous and deleterious to you definition of love. Otherwise you're selfish and mean and I'll get my therapists to tell you the same thing! (and I'll also stalk you to death… and they'll help me, because I'm a child with special needs, which means I have all the privileges and none of the responsibilities, even though I stopped being a child many decades ago…)

The Diagnostic and Statistical manual (DSM, several versions) published by The American Psychiatric Association (APA) outlines disorders involving mental retardation. Mental retardation is usually defined as IQ (Intelligence Quotient) below 50 points.

In today's blog entry, I would like to address the treatment of children with special needs in our society. However, I am focusing on the reverse side of the medal, on the (probably few) cases, when the special needs child (now well in his 50s) starts to abuse the system…

Hope exists always. Illustration by Elena.

First of all, I have a degree in psychology and some (sparse) clinical experience. As most people who have at some point in their lives been unemployed know, looking for a job involves browsing through job offerings and finding the one that best fits your qualifications. For example, if I see an employer advertising a position for which a Master's degree in engineering is required, alongside 10 years of experience in aeronautics, I will pass on the job offering. I will not expect the interviewer to completely overlook my lack of qualifications based on the fact, that, say, he or she likes me and wants to be my friend…

But what does that have to do with today's article? Simple. Too many people have been (falsely!) misled by society to believe that they can achieve anything, if only they try hard enough, want it enough or are loved enough. But, it's simply not true. You cannot be an engineer with unfinished high school and no experience. A 60-year-old paraplegic cannot be the new star player of the National Hockey League, and a 80-year-old, heavily overweight, short woman cannot be America's next supermodel. Not because people are bad, but because life is hard/harsh and life is what it is: Not a fairytale.

Something I dislike about Canada versus the United States is the greater importance we seem to accord to people with difficulties. For instance, in America, elementary schools getting the best grades are allocated more funds than less achievement prone schools. The reverse is true for Canada. In the same way, I remember a particular story which left me perplexed the one time I was assigned as a psychotherapy counselor to a kindergarten facility.

At the facility, one child was diagnosed with Down Syndrome. He had severe mental retardation, and even the simplest everyday tasks were a real challenge to him. Of course, many people felt sorry for him and pitied him as a result, but the perverted effect was that he evolved into this self-entitled, mean, little brat who knew no boundaries. Sometimes, by trying to accommodate someone with a mental illness, we unwillingly teach them that any and all their behavior is ok, even if it hurts others, that they are somehow above making efforts, because they are 'special'…

I know many of you will hate me for telling the truth, but it gets worse. The child constantly picked on a little girl there. He stole her toys, pushed her to the ground, punched her in the face several times and was bullying her to such an extent that the little girl stopped attending preschool altogether, out of fear. Nobody did anything because he was a child with special needs and she was a healthy girl. But in the real world, once we get past governmental subsidies and additional funds and resources with those facing extra challenges, the healthy little girl is likely to be more productive and more likely to generate something of value for the economy, than the little boy who cannot even tie his shoes without the constant special help of two babysitters and one extra nanny (paid for by the government!). In my personal opinion, the situation was exacerbated by the fact that the little boy was Canadian, while the little girl while likewise Canadian, was of Hungarian origin. Funny how if anyone else did the dangerous, abusive (and illegal between adults!) things he did, they would be arrested and perhaps even imprisoned. But hey, he's got problems, so let's make her suffer, and focus on making it easier for him to feel good about the abusive, uncaught criminal he is growing up to be. So why did the fact that he had Down Syndrome and severe mental retardation suddenly obliterated the fact that she bled, that she was also human, that she was hungry (because he continuously stole her food)? Many people get very uncomfortable looking at things from this perspective, but the fact that he was a special needs child did not automatically mean that her life was worthless and that none of her needs mattered at all, but at least in that particular case, it seemed it did…

Mental Retardation. Photo by Elena.

Abnormal-Psychology (thesis)

Abnormal Psychology

Introduction

The Diagnostic and Statistical Manual of Mental Disorders is used by psychiatrists, as well as psychologists, although since they are not doctors, psychologists cannot diagnose a patient or prescribe medication. Psychology professionals’ treatment usually consists of cognitive behavioral (“talk” and restructuring) therapy.

The DSM-IV-TR is divided into five axes. Axis I states any mental disease, Axis II is for personality disorders and mental retardation, axis III is for general health, axis IV refers to psychosocial and environmental factors, and Axis V is for functioning (on a scale). Since its inception in 1952, the manual has changed many times and now includes substance abuse and eating disorders. All disorders have as a condition that they must cause significant distress to the patient and/or impair his or her functioning in some significant way.

Also, the disorder should not correspond to the expectations of the individual’s culture (e.g. if a person is part of a tribe that ritualistically believes going into trances and seeing mountains dance, a person from that tribe cannot be considered delusional if he or she complies with the norm; this may be a little exaggerated but hopefully it gets the point across). The following information is IN NO WAY SUFFICIENT to allow a diagnosis.

AXIS I

Schizophrenia Schizophrenia literally means a splitting of the mind, which is a fairly accurate description since the clinical disorder is a sort of split from reality. There are several types of Schizophrenia: Paranoid, Catatonic, Residual, Disorganized (Hebephrenic) and Undifferentiated. Symptoms can be positive - aspects that are there but that should not be, and negative - aspects that should be present but are not.

The main positive symptoms include delusions (irrational persistent beliefs in spite of evidence to the contrary) and hallucinations (perception in the absence of stimuli). Negative symptoms include flat affect (inability to express emotions), lack of personal hygiene, social and occupational dysfunction. There currently is no cure for Schizophrenia but antipsychotics and other drugs can help control the problems.

Depression & Bipolar Disorder

In Major Depressive Disorder (MDD) some of the recurrent signs are low and sad mood that lasts for over two weeks, loss of concentration, feelings of despair or helplessness, changes in weight and/or appetite, social withdrawal, loss of interest in activities previously enjoyed, lack of energy, and dark thoughts. The causes of MDD are often biological and even genetic (people who are homozygous - have two copies - of the short allele of gene 5-HTT are more vulnerable to develop the sickness even given the same stressors as heterozygotes).

The biological explanations stem from the findings that individuals with MDD have a lower production of the neurotransmitter serotonin (feelings of well-being regulator). Consequently, serotonin reuptake inhibitors such as Prozac have been successful, however antidepressants have also backfired in several, sometimes tragic, ways. Depression is almost twice as common in women than in men. Individuals suffering from manic depression (Bipolar Disorder) alternate between days of mania and months of depression. During manic episodes, individuals tend to become promiscuous, reckless, very talkative, elated and prone to overspending. The mood stabilizer lithium is often used to treat this condition.

Phobias may vary. Illustration by Elena.

Phobias OCD, GAD, AD(H)D

A writer with Obsessive-Compulsive Disorder (OCD) was portrayed by Jack Nicholson in the motion picture As Good as it Gets. The disorder is characterized by intrusive thoughts, repetitive rituals and unusual behavioral patterns. Phobias are irrational fears that endure despite the patient knowing that they are irrational. Examples include fear of spiders, Arachnophobia, and of public places, Agoraphobia. Agoraphobia can manifest with or without panic attacks. People with Generalized Anxiety Disorder (GAD) tend to worry exceedingly about potential difficulties, in addition to, everyday matters. The primary distinction between fear and anxiety, is that fear is of something confirmed while anxiety is not. GAD is often treated with anxiolitics as well as antidepressants. ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) are mainly found in children and adolescents.

The drug Ritalin has usually been prescribed, and has also been abused by students wishing to increase their intellectual performance, a dubious and dangerous practice. A lot of discussion was generated as to whether the disorder is or not over diagnosed.

AXIS II

Personality Disorders One of the reasons that personality disorders get their own axis is that there is no cure and that they are not diseases as the previous cases. They are considered to be, in a way, the extremes of the bell curve of personalities in the general population. The fact does not make them any easier for the incumbent or those around him or her. The most vicious is Antisocial Personality Disorder, also called psychopathy. The rest are Paranoid, Histrionic, Borderline, Obsessive-Compulsive, Anxious (Avoidant), Dependent, Passive-Aggressive, Schizoid, Narcissistic, Mixed and Unspecified Personality Disorders (PDs). Persons with Borderline PD tend to hurt themselves, psychopaths others. Narcissistic and Histrionic PDs are characterized by self-centeredness for the former and excessive need to be the center of attention for the latter; Schizoid PDs comprise the attributes of solitude and emotional withdrawal (to an excess).

Mental Retardation

Mental retardation is usually diagnosed before the age of 18, by severe learning disabilities and an IQ score below 70 points on a standardized test. The condition has many genetic, biological, traumatic and environmental causes. Autism and other developmental disorders would also be coded on Axis II, even in children of normal or high intelligence.

Conclusion

In an attempt to remain concise, the above list is incomplete. Categories such as NOS (Not Otherwise Specified), and descriptive parameters (comorbidity, prevalence, incidence, demographics) were omitted. Likewise, some disorders, such as Schizoaffective, Dysthymic, Conduct and Learning Disorders, have been left out. Moreover, an alternate diagnostic tool, the ICD-10 (International Classification of Diseases, tenth version, published in 1990; in use until eleventh edition is endorsed in 2014) is beyond the scope of the present discussion.

Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitude (Thomas Jefferson). Illustration : Megan Jorgensen.

Adrenaline and Cortisol

Adrenaline & Cortisol

The words adrenaline and epinephrine, as well as noradrenaline and norepinephrine are used interchangeably. Adrenaline reportedly has effects of giving people superhuman strength, speed and other abilities that allow them to react adequately under traumatic conditions. Underneath it all, it is adrenergic receptor activity that is sought after by adepts of extreme sports, bungee jumping and free styling.

Seifert et al. (2009) confirmed their hypothesis on cerebral metabolism, that at the brain level sugar is processed quicker due to adrenaline but not noradrenaline. Mitchell et al. (2009) examine noradrenaline spillover in the brain, and in their experiment trimethaphan injection acts as a lowering mechanism.

Cortisol is a neurohormone produced by the endocrine system. The exact fields that investigate such cases are neuropsychopharmacology and neuropsychoendocrinology. Cortisol and the HPA axis (hypothalamic-pituitary-adrenal; also known as HTPA or LHPA where L - limbic) are related to stress. Cortisol has been studied in rats; rat pups were said to grow up with different abilities for cortisol secretion depending on the way they were reared (low licking and grooming versus high licking and grooming). The finding had epigenetic implications (Lord, 2009). Epigenetics refers to the possibility that the genetic code can be altered due to environmental pressures. In the popular media cortisol and stress have been blamed for weight gain. Cortisol acts by blocking an appetite-suppressing signaller, thus leading to higher calorie consumption and fat accumulation. Stress has been cited as responsible for many ills; it is plausible that worries predispose one to overeating. In contradistinction, oxytocin is a neuropeptidede that in humans and voles is partly responsible for socialization and couple formation, and occasionally lowers cortisol released during partners’ disputes (Ditzen, 2009).

Epinephrine is sometimes confused with ephedrine or ephedra (herb). Ephedrine is a component of some gym performance enhancers, commonly called ‘fat burners’. The substance had some trouble with the FDA (Food and Drug Administration) due to suspected safety concerns, leading to regulations. But that is not the topic here. Epinephrine and norepinephrine are neurotransmitters in the human central nervous system (CNS). Both are catecholamines synthesised from the amino acid tyrosine, acting both as neurotransmitters and stress hormones.

Septic shock, a condition characterized by generalized infection and the organism’s reactions to it, is regularly treated with administration of dopamine or norepinephrine rather than epinephrine. However there is no evidence that epinephrine alone rather than norepinephrine and dobutamine does the deed any differently (Agrawal, 2010). Vasopressin is also sometimes administered in such cases, but Russell et al. (2008) consider it largely ineffective as compared to norepinephrine. The all-or-none potential of neural cells or the body’s reactions to epinephrine (adrenaline), norepinephrine (noradrenaline), cortisol, oxytocin, vasopressin, progesterone, estrogen, testosterone, dobutamine (synthetic drug), dopamine, serotonin and GABA represent typical topics of neuroscientific inquiry.

The adrenaline of a live performance is unlike anything in film or theater. I can see why it's so addictive. Gwyneth Paltrow. Photo : © Megan Jorgensen.

Delusions

Delusions

Delusions are persistent irrational beliefs, immune to contrary evidence and causing great distress and/or social, professional, academic, and personal dysfunction.

While hallucinations and delusions are most commonly associated with schizophrenia, psychotic features can be present in Bipolar Disorder, severe Depression, Delusional Disorder, Dementia, Substance-Induced Psychosis and other psychiatric conditions.

Further, a person may present with schizotypy without having schizophrenia, such as in Schizoaffective Disorder or Schizoid Personality Disorder. According to Peters et al. (1999), psychotic symptoms could be viewed as the maladaptive extremes of a continuum of traits present in the general population and quantified in order to prevent breakdowns and improve treatment.

The diathesis-stress model can be defined as such: An individual has a, presumably inherited, predisposition towards an illness, but the problems will only manifest themselves if the organism experiences a significant stressor. The main themes delusions center on are grandeur, persecution (paranoid thinking), disintegration and contrition, as defined by the Delusions-Symptoms-States-Inventory (DSSI, Foulds & Bedford; 1975).

The authors found that the majority (93.3%) of their sample (480 clinical patients in psychiatry) had symptoms in agreement with the scale. The Present State Examination (Wing et al., 1974) adds three other categories, while the DSM-IV-TR (American Psychiatric Association) expands to include erotomanic, jealous, somatic and mixed subtypes in addition to the initial four. Bowins & Shugar (1998) found that a person’s self-esteem and self-regard greatly influenced the content of his or her delusional ideation, and led to “delusions [being] experienced as comfortable (or uncomfortable) and enhancing (or diminishing)” (154).

Delusions are persistent irrational beliefs. Illustration by Elena.

The following list represents the delusions’ subdivisions found in their study, in order of frequency:

I. delusions of reference

II. delusions of persecution

III. grandiose delusions

IV. delusions of control

V. thought insertion

VI. thought broadcasting (feeling that others can hear one’s thoughts)

VII. somatic delusions (hypochondriac)

VIII. delusions of guilt

IX. thought withdrawal

X. thought reading

XI. religious delusions

XII. delusions of jealousy

XIII. delusions of catastrophe

XIV. delusions of thought control

XV. sexual delusions

The scientific literature is divided on the function that delusions serve in relation to self-esteem, if any, but these experimenters were able to demonstrate that among current active psychosis inpatients, self-esteem and self regard were positively correlated with delusional substance.

Thus, subjects with better global self-images had delusions that reflected that notion more than their lower self-appraised counterparts. Bowins & Shugar (1998) also noticed that the higher self-esteem patients rated their deluded experiences more enhancing and comforting. However, the subsets of the personality variable reflecting professional, academic, physical and social dimensions failed to be translated into delusional content.

Perhaps the above information helps to understand why patients with delusions cling to their unsupported worldviews so strongly, despite the impairment it causes in their lives, especially in cases where the irrational thoughts are enacted. Even if the inner consistency rationale elucidates the disturbances, it lacks the ability to make it any easier for those afflicted as well as for their close ones. Hopefully, scientific breakthroughs will alleviate those burdens in the near foreseeable future.

“It is amazing how complete is the delusion that beauty is goodness.” (Leo Tolstoy, The Kreutzer Sonata). Image: Megan Jorgensen.

Demonology

Now, some people are not religious, agnostic or even atheist - and I believe that's ok. I believe in God, but I also believe in democracy and freedom of choice. But lately… I'm starting to understand that there are also demons! They look just like humans, but they are real demons underneath. You can usually tell, by the way their treat their own mothers, for example…

Demonology is a pseudoscience akin to astrology. Remember astrophysics and astronomy? We'll, it's nothing like that! Luckily, there are also angels, and archangels; and they fight fire with fire. Everyday. For man(and woman)kind ;)

References:

• Bowins, B. & Shugar, G. (1998). Delusions and self-esteem. Canadian Journal of Psychiatry, 43 (March): 154-8.
• Foulds, G. A. & Bedford, A. (1975). A hierarchy of classes of personal illness. Psychological Medicine, 5 (2): 181-92.
• Peters, E., Joseph, S. A. & Garety, P. A. (1999). Measurement of delusional ideation in the normal population: Introducing the PDI (Peters et al. Delusions Inventory). Schizophrenia Bulletin, 25 (3): 553-76.
• Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). Measurement and classification of psychiatric symptoms. Cambridge, England: Cambridge University Press.

Serotonin

Serotonin

Serotonin (5-hydroxytryptamine) is a neurotransmitter that is primarily involved in mood regulation. The neuromodulator is best known for its involvement in depression, although its malfunction has also been implicated in other psychiatric conditions, such as Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Attention-Deficit Hyperactivity Disorder, Borderline Personality Disorder, Post-Partum Blues, Autism, eating disorders, panic attacks, phobias and even Schizophrenia (an affliction also involving dopamine overabundance).

Patients with Major Depressive Disorder produce less serotonin as measured by neuroimaging techniques, and this finding is the basis for the common medications used to treat depression, selective serotonin reuptake inhibitors (SSRI). Perhaps the most famous SSRI is fluoxetine, brand name Prozac. The production of serotonin may depend on whether the individual is homozygous (two copies) or heterozygous (one copy) of the 5-HT short allele, homozygotes are more likely to succumb to depression even if under the same stressful circumstances than heterozygotes or those who have not inherited that allele at all (Caspi et al., 2003). Individuals with two copies of the long 5-HT allele are the least prone to developing the illness. Notwithstanding, in their meta-analysis across studies, Risch et al. (2009) found little evidence supporting this result.

According to Nugent et al. (2008), severe tryptophan depletion leads to a relapse of depressive symptoms. Tryptophan is an essential amino acid found in aliments such as pasta and turkey and a precursor to serotonin synthesis. In the experiment, subjects returned to normal as soon as tryptophan was reincorporated into their diet.

In their review of findings, Russo et al. (2009) cite several authors that have attested to serotonin mediating sleep, aggression, anxiety, thermoregulation, satiety and stress, Curiously, neurogenesis also seems to depend on serotonin. The reviewers also explain the brain reaction to low tryptophan blood plasma levels and “speculate about the possible survival value of this mechanism” (259).

Neurogenesis is the appearance of new brain cells (neurons) and Banasr et al. (2004) found that adult neurogenesis is enhanced by serotonin agonists (agonists stimulate, antagonists inhibit). Several receptor subtypes are implicated in the process, and the scientists came to the conclusion that serotonin was beneficial to adult cell proliferation, especially in the following brain regions: subgranular layer (SGL), subventricular zone (SVZ), dentate gyrus (DG) and olfactory bulb. A small reminder that gyrus (plural form gyri) refers to convex parts of the brain surface gray matter, while sulci (singular form sulcus) denote concave parts.

Dayan et al. (2008) suggest that serotonin deficiency mitigates impulse control by lowering inhibition, thus making the action with potentially adverse consequences more likely. The authors also discuss serotonergic pathways’ implication in thought processes related to aversive thought processes. Recalling that in encountering a new stimulus, an organism is often faced with an internal aversion versus approach conflict, the decision resting on whether the object in question poses a threat or promises a reward, respectively.

“Most people are about as happy as their self confidence will allow them to be.” (Shannon L. Alder). Illustration : Megan Jorgensen.

References:

• Banasr, M., Hery, M., Printemps, R. & Daszuta, A. (2004). Neuropsychopharmacology, 29 (3): 450-60.
• Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, HL., McClay, J., Mill, J., Martin, J., Braithwaite, A. & Poulton, R. (2003). Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301 (5631): 386-9.
• Dayan, P.  & Huys, Q. J. M. (2008). Serotonin, inhibition and negative mood. PLoS Computational Biology, 4 (2): 0001-11.
• Nugent, A. C, Neumeister, A., Goldman, D., Herscovitch, P., Charney, D. S. & Drevets, W. C. (2008). Serotonin transporter genotype and depressive phenotype determination by discriminant analysis of glucose metabolism under acute tryptophan depletion. Neuroimage, 43(4): 764–774
• Risch, N., Herrell, R., Lehner, T., Liang, K. -Y., Eaves, L., Hoh, J., Griem, A., Kovacs, M., Ott, J. & Merikangas, K. R. (2009). Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events and risk of depression: A meta-analysis. JAMA, 301(23): 2462–2471.
• Russo, S., Kema, I. P., Bosker, F., Haavik, J. & Korf, J. (2009). Tryptophan as an evolutionary conserved signal to brain serotonin: Molecular evidence and psychiatric implications. The World Journal of Biological Psychiatry, 10: 258-68.

Dopamine

Dopamine

Dopamine is one of the major excitatory neurotransmitters in the brain. The neurochemical of the catecholamine group has been associated with reward mechanisms, novelty seeking, addiction and other behavioral and biological phenomena.

Too much dopamine has been linked to schizophrenia, too little to Parkinson’s disease (which is why patients taking antipsychotics would usually not be prescribed dopamine agonists, while patients with Parkinson’s disease are given L-Dopa, a dopamine precursor).

The present paper will attempt to highlight some of the repercussions dopamine has on the human experience. The involvement of dopamine in reward anticipation has largely been established. Ikemoto (2007) reviews scientific literature to arrive at a better understanding of the dopamine reward circuitry. For example, laboratory rats and mice learn to self-administer drugs of abuse unless they were given dopamine blockers (for a list of works see Ikemoto, 2007).

There are several types of dopamine receptors (D1, D2, D3, D4 and D5), persons with pathological overeating features have been found to have abnormally low quantities of D2 type receptors. Wang et al., (2001) used PET (positron emission tomography) scans to measure D2 receptors distribution in obese subjects compared to controls.

Too much dopamine has been linked to schizophrenia, too little to Parkinson’s disease. Photo by Elena.

The number of receptors correlated negatively with BMI (i.e. as recorded BMI increased, listed D2 numbers decreased; body mass index, underweight below 18.5, obese above 30). The authors hypothesized that since dopamine is responsible for motivation and reward feelings, individuals lacking dopamine may be overindulging to fill the chemical messenger void. Thus, by enhancing dopamine activity in persons with the condition, it may be possible to stop overeating in such cases.

Conversely, the opposite is true in patients with schizophrenia, they have an abnormally high D2 activity, which is predicted by the classic hypothesis that schizophrenia is related to dopamine hyperactivity leading to the logical consequence that all antipsychotics act as dopamine antagonists. Interestingly, in their article, Seeman & Kapur (2000) expose the contradiction that surrounds D2 receptors and the mental illness.

Some previous studies in vivo have found abnormalities, some failed to do so. Further, the authors caution that since most studies that have found increased D2 population in the striata of patients with schizophrenia postmortem were done following antipsychotic use, the drugs may have influenced the outcomes. In reviewing a vast array of literature, Huey et al. (2006) came to the conclusion that patients with frontotemporal dementia (FTD) exhibited a dopaminergic deficiency.

Other neurotransmitter circuits they covered in their meta-analysis were serotonin, also deficient, and acetylcholine, appearing undamaged in FTD. However, they warn that the studies surveyed were challenged in sample size and lacked control groups, a potential limitation of the comparison. Loss of dopamine producing neurons is a distinctive feature of Parkinson’s disease (Lotharius & Brundin, 2002). As expected, the personality trait of novelty seeking, prompted by dopamine, is diminished in patients with the illness (Menza et al., 1993). Still it is unclear whether such conservatism is due to dopamine deficiency or reclusiveness brought on by the confines caused by the disease.

Benjamin et al. (1996) found that having two copies of the long allele of the D4DR gene led to higher scores on the NEO-PI-R personality questionnaire in areas coding for novelty seeking, and its components: exploratory excitability, extravagance and disorderliness. The conscientiousness (lower) and extraversion (higher) dimension were also correlated with the genotype. However, the experimenters remark that the polymorphism accounts for only part of the story since other genes are similarly involved in producing the phenotypes.

The five types of dopamine receptors are D1, D2, D3, D4 and D5. The neurotransmitter is associated interalia, with reward. Image: Elena.

References:

• Benjamin, J., Li, L., Patterson, C., Greenberg, B.D., Murphy, D.L. & Hamer, D.H. (1996). Population and familial association between the D4 dopamine receptor gene and measures of Novelty Seeking. Nature Genetics, 12  (January): 81-4.
• Huey, E.D., Putnam, K.T. & Grafman, J. (2006). A systematic review of neurotransmitter deficits and treatments in frontotemporal dementia. Neurology, 66 (1): 17-22.
• Ikemoto, S. (2007). Dopamine reward circuitry: Two projection systems form the ventral midbrain to the nucleus accumbens-olfactory tubercle complex. Brain Research Reviews, 56 (1): 27-78.
• Lotharuis, J. & Brundin, P. (2002). Pathogenesis of Parkinson’s disease: Dopamine, Vesicles and -synuclein. Nature Reviews Neuroscience, 3 (12): 932-42.
• Menza, M.A., Golbe, L.I., Cody, R.A. & Forman, N.E. (1993). Dopamine-related personality traits in Parkinson’s disease. Neurology, 43 (3): 505-508.
• Seeman, P. & Kapur, S. (2000). Schizophrenia: More dopamine, more D2 receptors. Proceedings of the National Academy of Sciences of the United States of America, 97 (14): 7673-75.
• Wang, G. -J., Volkow, N.D., Logan, J., Pappas, N.R., Wong, C.T., Zhu, W., Netusil, N. & Fowler, J.S. (2001). Brain dopamine and obesity. The Lancet, 357 (9253): 354-57.

About Ecotherapy

About Ecotherapy

Ecotherapy, earth-centered therapy or green therapy refers to healing and growth nurtured by interaction with the earth.

There is a difference between ecotherapy which includes work with the body and ecopsychology, the study of the psychological relations with nature providing a solid theoretical, cultural, and critical foundation for ecotherapeutic practice. Experts regard ecotherapy as applied ecopsychology. As such, Ecotherapy employs different methods and practices in systematic attempts to reconnect the psyche and the body with the terrestrial sources of all healing.

Ecotherapy is also different from psychotherapy in its focus on transforming our relationship to the natural world. Psychotherapy aims to help individuals understand and create meaning from emotional and psychological difficulties they are experiencing. Ecotherapy, utilising psychotherapeutic principles, forms a relationship to the natural world in order to enable us to make sense of our inner emotions and life experiences. We may feel depressed, anxious, lost and alone, overwhelmed by our thoughts and feelings and unable to draw upon previous ways of coping. In short, psychotherapy in combination with the natural environment allows us to develop new ways of understanding ourselves and feel integrated in our lives.

Ecotherapists believe that nonhuman forms of life have a right to exist for their own needs and purposes, and that this includes leaving plant and animal ecocommunities intact and protecting the needs, health, and sense of agency of our animal companions.

Ecotherapists regard our work as part of an ongoing collective effort to build just and sustainable communities in which all forms of life can delight and mature.

Ecotherapy. Photo by Elena.

As a term defining nature-based methods of psychological and physical healing, ecotherapy points to the need to reinvent psychotherapy and psychiatry as sciences related to the human-nature relationship. Ecotherapy takes into account both the traditional indigenous wisdom and the modern scientific understandings of the universe. This approach defends the point of view that people are connected with, embedded in, inseparable from the rest of nature. Grasping this fact shifts our understanding of how to heal the human psyche and the dysfunctional human-nature relationship. In fact it has become clear that what happens to nature for good or ill impacts people and vice versa. And the process leads to the development of new methods of individual and community psychotherapeutic diagnosis and treatment.

Relationships of healing with nature and Earth require us to acknowledge our participation in industrial, governmental, or organizational actions that harm the environment and to seek alternative actions whenever possible. This relationship holds cultural, ecological, epistemological, spiritual diversity to be a precious source of enrichment, value, and, ultimately, survival. The more diverse the ecosystem, the greater its resiliency, creativity, and resourcefulness.

According to Howard Clinebell, who introduced the term Ecotherapy in 1996, an ecotherapist should  take guidance from an Ecological Circle of three mutually interacting operations or dynamics:

• Inreach: receiving and being nurtured by the healing presence of nature, place, Earth.
• Upreach: the actual experience of this more-than-human vitality as we relocate our place within the natural world.
• Outreach: activities with other people that care for the planet.

Here are some examples of ecotherapy research findings, quoted in different sources – “Connection to Nature Vital to Our Mental and Physical Health”, “Equine Therapy Helps Withdrawn Vets Reconnect, “immersion in Nature Makes us Nicer”, “71% Report Depression Decrease After Green Walk”, “How the City Hurts Your Brain…and What You Can Do About It”, “Drug Addiction: Environmental Conditions Play Major Role In Effective Treatment And Preventing Relapses, Animal Study Shows”.

Note that a certificate in ecotherapy is not a license to do psychotherapy, but ecotherapy techniques are being taught to practicing psychotherapists, whose concentration on mending relationships and inner conflicts benefits from placement in the wider ecological context in which all human activity unfolds.

Keep also in mind that although ecotherapy interventions tend to be much less invasive than drugs or psychotherapy, ecotherapist should always put the well-being of clients first and carefully monitor potential safety and health concerns.

Understanding one’s existence as such is always an understanding of the world (Martin Heidegger). Photo : © Megan Jorgensen.

Preventing Suicide

Preventing Suicide

It is a very difficult topic to bring up. However, when someone talks about suicide or brings up concern for a loved one, it is important to take action and seek help quickly.

What is suicide: suicide means that someone ends their life on purpose. However, people who die by suicide or attempt suicide may not really want to end their life. Suicide may seem like the only way to deal with difficult feelings or situations.

Who does suicide affect: About 4000 Canadians die by suicide every year. Suicide is the second-most common cause of death among young people, but men in their forties and fifties have the highest rate of suicide.

While women are three to four times more likely to attempt suicide than men, men are three times more likely to die by suicide than women.

Suicide is a complicated issue. People who die by suicide or attempt suicide usually feel overwhelmed, hopeless, helpless, desperate, and alone. In some rare cases, people who experience psychosis (losing touch with reality) may hear voices that tell them to end their life.

Many different situations and experiences can lead someone to consider suicide. Known risk factors for suicide include:

• A previous suicide attempt;
• Family history of suicidal behaviour;
• A serious physical or mental illness;
• Problems with drugs or alcohol; a major loss, such as the death of a loved one, unemployment, or divorce;
• Social isolation or lack of a support network;
• Family violence;
• Access to the means of suicide.

While we often think of suicide in relation to depression, anxiety, and substance use problems, any mental illness may increase the risk of suicide. It’s also important to remember that suicide may not be related to any mental illness.

Warning Signs. Illustration by Elena.

What are the warning signs

Major warning signs of suicide spell IS PATH WARM:

I – Ideation: Thinking about suicide.

S – Substance use: Problems with drugs or alcohol.

P – Purposelessness: Feeling like there is no purpose in life or reason for living.

A – Anxiety: Feeling intense anxiety or feeling overwhelmed and unable to cope.

T – Trapped: Feeling trapped or feeling like there is no way out of a situation.

H – Hopelessness or Helplessness: Feeling no hope for the future, feeling like things will never get better.

W – Withdrawal: Avoiding family, friends, or activities.

A – Anger: feeling unreasonable anger.

R - Recklessness: Engaging in risky or harmful activities normally avoided.

M – Mood change: A significant and brusque change in mood.

How can I reduce the risk of suicide?

Though not all suicides con be prevented, some strategies can help reduce the risk. All of these factors are linked to well-being.

These strategies include:

• Seeking treatment, care and support for mental health concerns – and building a good relationship with a doctor or other health professionals.
• Building social support networks, such as family, friends, a peer support or support group, or connections with a cultural or faith community.
• Learning good coping skills to deal with problems, and trusting in coping abilities.
• When a person receives treatment for a mental illness, it can still take time for thoughts of suicide to become manageable and stop. Good treatment is very important, but it may not immediately eliminate the risk of suicide. It is important to stay connected with a care team, monitor for thoughts of suicide and seek extra help if it is needed. Community-based programs that help people manage stress or other daily challenges can also be very helpful.

What can I do if I experience thoughts of suicide?

Thoughts of suicide are distressing. It is important to talk about your experiences with your doctor, mental health care team, or any other person you trust. They can help you learn skills to cope and connect you to useful groups or resources. Some people find it helpful to schedule frequent appointments with care providers or request phone support. Other things that you can do include:

• Calling a crises telephone support line;
• Connecting with family, friends or a support group. It can be helpful to talk with others who have experienced thoughts of suicide to learn about their coping strategies.
• If you are in crisis and aren’t sure what to do, you can always call 911 or go to tour local emergency room.

Some people find a safety plan useful. A safety plan is a list of personal strategies to use if you thing you are at risk or hurting yourself or ending your life. You can create a plan on your own, with a loved ones, ot with your mental health care team. Your plan may include:

• Activities that calm you or take your mind off your thoughts;
• Your own reasons for living;
• Key people to call if you’re worried about your safety;
• Phone numbers for local crises or suicide prevention helplines;
• A list of safe places to go if you don’t feel safe at home.

How can I help a loved one?

If you are concerned about someone else, talk with them. Ask them directly if they are thinking about suicide. Talking about suicide won’t give them the idea. If someone is seriously considering suicide, they may be relieved that they can talk about it.

If someone you love says that they are thinking about ending their life, it is important to ask them if they have a plan. If they have a plan and intend to end their life soon, connect with crisis services or supports right away. Many areas have a crisis, distress, or suicide helpline, but you can always call 911 if you don’t know who to call. Stay with your loved one while you make the call, and don’t leave until the crisis line or emergency responders say that you can leave.

The two most important things you can do are listen and help the connect with mental health services.

Listening

Here are tips of talking with a loved one:

• Find a private place or let your loved one take as much time as they need.
• Take your loved one seriously and listen without judgement – their feelings are very real.
• Keep your word – don’t make promise you can’t keep or don’t intend to keep.
• Tell your loved one that they are important and that you care about them.

Supports

If your loved one already sees a doctor or other mental health service provider, it is important that they tell their service provider about any thoughts of suicide they may have been having. Depending on your relationship, you can offer to help – by helping your loved one schedule appointments or by taking them to their appointments, for example.

If your loved one doesn’t see a mental health service provider, you can give them the phone number for a local crisis line and encourage them to see their doctor. Your loved one may also be able to access services through their school, workplace, cultural, or faith community.

Supporting a loved one can be a difficult experience for anyone, so it’s important to take care of your own mental health during this time and seek support if you need it.

If you need more help

Contact a community organization like the Canadian Mental Health Association to learn more about support and resources in your area.

Founded in 1918, the Canadian Mental Health Association (CMHA) is a national charity that helps maintain and improve mental health for all Canadians. As the nation-wide leader and champion for mental health, CMHA helps people access the community resources they need to build resilience and support recovery from mental illness.

Visit the CMHA website at cmha.ca. Mental Health For All!

Thoughts of suicide are distressing. It is important to talk about your experiences with your doctor, mental health care team, or any other person you trust. Illustration: © Megan Jorgensen.