Mental Health and Gun Control

This is a controversial topic; I recognize that. I also will not pretend to be an expert on gun safety or public policy. However, I do know a lot about mental health, and I do consider myself an expert on promoting safety among those with mental health diagnoses. 

In mental health fields, when someone is at risk of hurting themselves or another, we assess for three primary things: Plan, Intent, and Means. Often, people have a plan for how they might commit a violent act, but they do not intend to do it. Other times, people have a plan and intent but lack the means. It is only when people have a plan, the intent to execute the plan, and the means to execute the plan that we are truly concerned about safety. Any missing ingredient of the Plan + Intent + Means equation is a barrier to harm. This is why it drives me insane when mental health gets blamed for mass shootings (or even violent crime) in this country.  

Yes, mental health concerns are part of the equation in many cases. However, even the most motivated person cannot commit a mass shooting without a gun. To promote public safety, we need to limit the plan, the intent, AND the means. If we are successful in just one of these areas, we could save a lot of lives. It is reckless not to address every component of the equation, and it irks me to no end that our policy makers cannot see this. 

Coping with Repeated Tragedy

The events of the last few months, beginning with Hurricane Harvey and culminating with the mass shooting in Las Vegas, have left me speechless and paralyzed. For over a month, I have struggled with a sense of helplessness and hopelessness in a world that has felt hostile as a result of both natural and human destruction. In situations where I am typically confident, persistent, and assertive, I have felt ineffective and often given up before even getting started. Only yesterday, while having a conversation with someone else who is struggling from general malaise related to a sense of being unable to control the negative climate in which Americans are currently living, did I realize that I had succumbed to learned helplessness and that I did, in fact, know the way out.

This personal journey led me to realize that there are likely many of you who are experiencing similar feelings. In fact, my immediate peer group, which is typically full of vocal promoters of social justice, has been largely silent about the events in Puerto Rico and Las Vegas. While many of my peers, and myself, published and promoted awareness of the needs of Hurricane Harvey’s victims, the silence grew larger and larger with each subsequent disaster: Hurricane Irma, Hurricane Maria, and now the man-made disaster in Las Vegas. Many of us likely are victims of learned helplessness.

Learned helplessness is a psychological concept first identified by Martin Seligman in 1967. In Seligman’s early experiments, dogs were divided into groups. All of the dogs were given electric shocks, but only one group of them had the ability to press a lever and end the shocks. Every dog then was moved into a different box in which they all had the ability to escape being shocked by jumping over a small barrier. Interestingly, the dogs who had previously been able to control being shocked learned to jump over the barrier quickly. In contrast, the dogs who had not been able to control the shocks in the past simply laid down and whined while being shocked. They had learned that they had no ability to end their suffering, so they stopped trying to do so. Like Seligman’s dogs, the series of events in the last few months has many of us laying down and “taking it” from the world around us. We fought hard at some point (whether it be against destruction from hurricanes earlier this year or against mass shootings for the last 30+ years), but we have learned that no matter what we do, nothing will change, and so we sit in our boxes whimpering when we are shocked. This is a quick path to depression.

So, what are we to do? First, let me start by saying that the reasoning abilities of humans is a great place to start. We can convince ourselves that doing something is better than doing nothing or that we have to continue to try to change the world no matter how long it takes. Second, let me say that behaviors can be unlearned. We have the ability to teach ourselves that we can, in fact, affect change as long as we start small, set attainable goals, and reach them. No, no one person reading this blog has the ability to make sure another person doesn’t open fire on a group of innocent civilians. However, each of us has a role to play in encouraging, fighting for, and ultimately causing change. During my conversation yesterday, the person with whom I was speaking pointed out that it took decades for equal voting rights legislation to be passed in the United States. I would argue that voting rights are still not exactly equal, but that is beside the point. Either way, it is true, monumental change took monumental effort and courage. However, change would never have occurred at all if no single person had fought for it. That is the important point here, no change can occur if no one stands up for it. So even though it may feel like whatever you have to contribute is insignificant, that is simply not the case. If you contribute your capabilities to a cause, the momentum of that cause grows by that amount, no matter how small.

With that I encourage you to begin fighting for whatever it is that you believe in with whatever effort you have. Only then can you facilitate change. Fortunately, you will also be fighting for your own mental health at the same time.

TRAUMA TREATMENT - The Who

This blog is the first of what will be a series of blogs about the who, what, where, when, and why of trauma-related treatment. As someone who specializes in treatment for trauma-related disorders, I get a lot of questions about these five elements, and I want to take a little time to provide some answers.

The answer to the question of "Who" seems like it would be straight-forward but often instead leads to more questions. The simple answer is that anyone who is experiencing negative impacts on their lives as a result of a traumatic event is a candidate. This response, however, leads to two questions: (1) How do you define "negative impact" and (2) What is a traumatic event. 

Let me answer the latter of these two questions first. According to the DSM-5, a traumatic event is a time in which a person is exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence through experience, witnessing the event, learning about the event happening to a family member or close friend, or indirect exposure to the event (usually as a result of being in a profession that often involves death or serious harm to individuals). In layman's terms, if you either experience or see someone experience physical harm, that counts. Also, if you learn about a family member or close friend experiencing physical harm, that counts. Finally, if you regularly are exposed to details of someone experiencing physical harm (say as a police officer, paramedic, detective, etc.), that counts. 

Now, let me answer the other question, "How do you define 'negative impact'?" This is a very difficult question to answer because there are so many ways in which a person may suffer as a result of a traumatic experience. I will start with what many people think of as the "official" diagnosis related to trauma, Post Traumatic Stress Disorder (PTSD). PTSD is a diagnosis characterized by a combination of re-experiencing symptoms, avoidance symptoms, and negative thoughts or feelings. Long story short, a person re-lives the traumatic event in some way; avoids things related to, or that may remind them of, the traumatic event; and experiences negative thoughts or feelings. The specifics of this diagnosis are available here.

However, PTSD is in no way the only outcome of having a traumatic experience. Often, people end up with one or two of the three categories of symptoms required for PTSD, in which case their presentation may look more like another anxiety disorder or depression. Sometimes, people only experience difficulties in one very specific area of their life but not in others (e.g., being unable to enjoy sex after a sexual assault but having no other difficulties). In still another way, the traumatic experience may interfere with closeness in relationships or lead to interpersonal difficulties. Some people become dependent on alcohol or drugs. The list goes on and on. Ultimately, the defining thing to ask yourself if you're thinking you may need trauma-related treatment is, "Is there something that is not going well in my life because of a traumatic event that I experienced at some point in my past?" If the answer to this is yes, then you likely would benefit from seeking treatment for PTSD.

More on the "What" of trauma treatment next time. In the mean time, if you believe you do need treatment for trauma-related difficulties, don't hesitate to contact me or another provider in your area. 

Gratitude

As those of you who follow this blog know, I typically do not disclose anything about my personal experiences in an attempt to not take away from whatever you may have happening in your life. However, my story this week was so impactful that I believe it is helpful to pass along some details. This week has been a particularly difficult week in my household. My 16-month-old was fighting a significant illness requiring close monitoring and frequent breathing treatments, which meant that his parents got very little sleep and carried a lot of anxiety. In this context, I found it difficult to remain positive and upbeat. Fortunately, I was able to tune in to the advice that I frequently give others as part of treatment for anxiety and depression - EXPRESS GRATITUDE.

Clinical research shows that one of the thought patterns that maintains anxiety and depression is "mental filtering." This essentially means that your brain is like a sieve - negative experiences get trapped, and positive experiences run through and down the drain, ceasing to exist. You can imagine how this might lead to ongoing negative emotions like anger, anxiety, and sadness. Gratitude is one way to fight back against this filter. By paying attention to, and being grateful for, good things that happen or are embedded in a bad situation, you have the power to alleviate negative feelings. For me this week, that was about remembering how fortunate I was to have access to quality healthcare, to have the flexibility in my family for us to miss a combination of four workdays, and for the fact that we never did have to make that drive to the hospital despite the packed bags and fraying nerves.

What can you find to be grateful for in your daily experiences? Remember this question during difficult times, and you may find yourself managing challenges with a more stable state of mind. In order to practice this skill so that you can easily use it when times get tough, I recommend that you do the following exercise every day:

Each day, first thing when you wake up in the morning, name 3 things that you are grateful for. They can be anything, big or small. Some examples include having your family, the sun shining, your health, waking up another day, being in a comfortable bed, having somewhere to go to work, or being able to move your body. Sometimes it takes a little searching, but we all have at least 3 things that we can be grateful for each day. This exercise will help build your mental muscle for gratitude so you become stronger in the face of adversity. So give it a try. 

I am grateful to you for reading this, and I hope this skill is helpful. As a reminder, if you find yourself struggling with mental health difficulties that become difficult to manage on your own, I am here. 

Behavioral Activation

One of the leading evidence-based interventions for depression is Behavioral Activation - a strategy designed to get people with depression doing something that provides some type of emotional "reward" (e.g., sense of accomplishment, pleasure, gratitude).

Traditionally, this involves having people assign 30 minutes per day as a "pleasant activity time" during which they choose from a menu of things that they either know they enjoy or used to enjoy. A great one can be found here. Simple right? For some people, yes, but not for others.

Some people are able to maintain motivation and energy despite their depression. However, many others are not. This lack of energy and motivation is often a symptom of depression, so depression inherently makes getting out and doing pleasant activities difficult.

I find that it can be extremely helpful to liken depression to a parasite or monster. By doing this, the person with depression (maybe you) can more easily imagine the fight you are having. Depression wants you to stay home, sleep, or avoid people. Meanwhile, you have to fight back by getting out and doing the things that depression does not want you to do. Only then will depression start to fall away.

You might find that this analogy gives you the extra push to get out the door. But what if it doesn't? Then, you're going to need more structure and support to engage in pleasant activities. Ask a friend or partner to come get you and take you to do something, make a commitment to a volunteer agency, post sticky notes around the house, set reminders on your phone - do whatever it takes to get out and do something that might insert a little more positive experience and emotion back into your day. With that, you hopefully will start to heal and win the fight against depression.