Post-traumatic Stress Disorder

Post-traumatic stress disorder, or PTSD, is characterized by negative symptoms and behaviors surrounding a traumatic event or events. Not all traumatic experiences lead to PTSD, and not all PTSD is chronic. The lifetime prevalence rate is about 8.7%, with 3.5% of Americans dealing with PTSD per year. Exposure to trauma can be direct or indirect, like sexual assault or the death of a loved one. Afterward, a number of symptoms occur: one or more symptoms of intrusion, where the trauma is re-experienced. One or more symptoms of avoidance, where anything related to the trauma is avoided. Two or more symptoms of negative alterations in mood or cognition, where beliefs surrounding the event or self are skewed. Finally, two or more alterations in arousal and reactivity, where the body reacts to stimuli in a different way than before the trauma. These symptoms must last for at least one month, cause clinically significant distress, and are not attributable to any other condition. Treatment consists of medication and psychotherapy. Medication is usually an antidepressant, though there is a medication used for treating sleep problems and nightmares. Cognitive behavioral therapy works to restructure thoughts surrounding the trauma, creating healthier responses to the event and reminders, and dealing with guilt or shame surrounding the event. Unlike some other mental illnesses, it is possible to recover from PTSD completely.

 

PTSD can be overwhelming. For a college student, this can mean a variety of things. Concentration is inhibited, making it difficult to complete assignments or study for exams. Depending on the trauma, certain normal college situations may be triggering to the individual. Students with PTSD can be self-destructive in a number of ways, including not going to class and alcohol or drug abuse. Many people with PTSD also have other mental illnesses, like depression, anxiety, or eating disorders. These problems simply compound the issue. Students with PTSD may need accommodations specific to reducing stress and anxiety, like more time for assignments or exams. Treatment is also essential to this process. Students with PTSD can and do succeed in college, they just need the right support in order to cope with their trauma and reduce its effects on their ability to function.

Resources:

https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/dxc-20308550

https://www.psychologytoday.com/blog/somatic-psychology/201208/students-ptsd

https://www.mirecc.va.gov/visn19/docs/presentations/Overview_PTSD_College_Setting.pdf

Racism’s Emotional Toll on Student Minds

Our screens and feeds are filled with news and images of black Americans dying or being brutalized. A brief and yet still-too-long list: Trayvon MartinTamir RiceWalter ScottEric GarnerRenisha McBride. The image of a white police officer straddling a black teenager on a lawn in McKinney, Tex., had barely faded before we were forced to grapple with the racially motivated shooting in Charleston, S.C.

I’ve had numerous conversations with friends and colleagues who are stressed out by the recent string of events; our anxiety and fear is palpable. A few days ago, a friend sent a text message that read, “I’m honestly terrified this will happen to us or someone we know.” Twitter and Facebook are teeming with anguish, and within my own social network (which admittedly consists largely of writers, academics and activists), I’ve seen several ad hoc databases of clinics and counselors crop up to help those struggling to cope. Instagram and Twitter have become a means to circulate information about yoga, meditation and holistic treatment services for African-Americans worn down by the barrage of reports about black deaths and police brutality, and I’ve been invited to several small gatherings dedicated to discussing these events. A handful of friends recently took off for Morocco for a few months with the explicit goal of escaping the psychic weight of life in America.

It was against this backdrop that I first encountered the research of Monnica Williams, a psychologist, professor and the director of the University of Louisville’s Center for Mental Health Disparities. Several years ago, Williams treated a “high-functioning patient, with two master’s degrees and a job at a company that anyone would recognize.” The woman, who was African-American, had been devastated by racial harassment by a director within her company. Williams recalls being stunned by how drastically her patient’s condition deteriorated as a result of the treatment. “She completely withdrew and was suffering from extreme emotional anxiety,” she told me. “And that’s what made me say, ‘Wow, we have to focus on this.’ ”

In a 2013 Psychology Today article, Williams wrote that “much research has been conducted on the social, economic and political effects of racism, but little research recognizes the psychological effects of racism on people of color.” Williams now studies the link between racism and post-traumatic stress disorder, which is known as race-based traumatic stress injury, or the emotional distress a person may feel after encountering racial harassment or hostility. Although much of Williams’s work focuses on individuals who have been directly targeted by racial discrimination or aggression, she says race-based stress reactions can be triggered by events that are experienced vicariously, or externally, through a third party — like social media or national news events. She argues that racism should be included as a cause of PTSD in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (D.S.M.).

Williams is in the process of opening a clinical program that will exclusively treat race-based stress and trauma, in a predominantly black neighborhood in Louisville. Shortly after the Charleston shooting, I called Williams to discuss her work; what follows is a lightly edited and condensed transcript of our conversation.

What is race-based stress and trauma?

It’s a natural byproduct of the types of experiences that minorities have to deal with on a regular basis. I would argue that it is pathological, which means it is a disorder that we can assess and treat. To me, that means these are symptoms that are a diagnosable disorder that require a clinical intervention. It goes largely unrecognized in most people, and that’s based on my experience as a clinician.

What are the symptoms?

Depression, intrusion (the inability to get the thoughts about what happened out of one’s mind), vigilance (an inability to sleep, out of fear of danger), anger, loss of appetite, apathy and avoidance symptoms and emotional numbing. My training and study has been on post-traumatic stress disorder for a long time, and the two look very much alike.

Over the weekend, I received several distressing emails and texts from friends who were suffering from feelings of anxiety and depression. Do you think we should all be in treatment?

I think everyone could benefit from psychotherapy, but I think just talking to someone and processing the feelings can be very effective. It doesn’t have to be with a therapist; it could be with a pastor, family, friends and people who understand it and aren’t going to make it worse by telling you to stop complaining.

What do you think about the #selfcare hashtags on social media and the role of “Black Twitter” as resources for people who may not have the resources they need to help process this? Are online interactions like that more meaningful than they initially might seem?

Online communities such as VitalStudentMinds.com — can be a great source of support, of course — with the caveat that even just one hater can be stressful for everyone, and that’s the danger of it. But if you don’t have a friend or a family member, just find someone who is sensitive and understanding and can deal with racial issues.

In our initial email about the ripple effects of the murders in Charleston, you used the phrase “vicarious trauma.” What does that mean?

Because the African-American community has such a long history of pervasive discrimination, something that impacts someone many miles away can sometimes impact all of us. That’s what I mean by vicarious traumatization.

Is racial trauma widely recognized as a legitimate disorder?

The trauma of events like this is not formally recognized in the D.S.M. It talks about different types of trauma and stress-related ailments, but it doesn’t say that race trauma can be a factor or a trigger for these problems. Psychiatrists, unless they’ve had some training or personal experience with this, are not going to know to look for it and aren’t going to understand it when they see it. In order for it to be recognized, we have to get a good body of scientific research, a lot of publications in reputable peer-reviewed journals. Right now, there’s only been a few. And we need to produce more.

On your blog, you chronicled the experience of a woman who encounters a therapist who dismisses her fears about racism. Is one barrier to treatment getting the medical community to acknowledge that racism exists?

Yes. A lot of people in the medical community live very privileged lives, so racism isn’t a reality to them. When someone comes in and talks to them, it might sound like a fairy tale, rather than a real daily struggle that people are dealing with. Research shows that African-Americans, for example, are optimistic when they start therapy, but within a few sessions feel less optimistic and have high early dropout rates. It could be that clinicians don’t know how to address their problems, or they may even be saying things that are subtly racist that may drive their clients away. If the patient feels misunderstood or even insulted by the therapist and they don’t go back and get help, they end up suffering for years or even the rest of their lives for something that is very treatable.

Is there a recommended model for treatment?

We have great treatments that are empirically supported for trauma, but the racial piece hasn’t really been studied very well. That’s no easy task, because when we write these articles, they go to journals, where an editor looks at it and decides if it’s worthy and applicable to go in the journal. And then it goes to reviewers who decide if it’s a worthy and applicable topic.

Why has it taken so long to get momentum?

If you think about it, they weren’t even letting black people get Ph.D.s 30 years ago in a lot of places. Ethnic minority researchers are the ones who are carrying the torch, by and large. We’re only to the place now where we have enough researchers to do the work. And there’s so much work that needs to be done.

Checkout our handout for more information on coping with trauma. 

Persuasive Speech & Insight: Stigma of MI

As most of us know firsthand the difficulties of life with mental illness, its detrimental that we  represent the mental health community in our communities.

Here is a well laid out example to get the ball rolling.

 


“The Stigma of Mental Illness”

“You don’t look like you have leukemia. I think you’re making it up to get attention.” “Well, call me when you decide to stop having arthritis.” “The cure for your epilepsy is to try harder not to have seizures. Just pull yourself together.” We wouldn’t say these things to someone with a physical illness, but people with mental illness hear such statements all the time. According to the CDC, in any given year, 1 in 4 adults in this country has a mental disorder. With numbers like these, it’s majorly important that we as a society change the way we view mental illness and treat those who live with it. The facts are clear: the stigma of mental illness is undeniable. Let’s first discuss what mental illness stigma is, then some reasons why it is harmful, and lastly what you can do to fight it.

So what exactly is stigma? Stigma shows up in different forms. The President’s New Freedom Commission on Mental Health defines stigma as “a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses.” So, stigma begins in our minds. It happens when we believe myths and popular media portrayals of mental illness, such as, “All people with mental illness are violent,” and we start to put those with mental illness in a box. We assign labels and see them as different from us. And the moment we start to see someone or something as “different”, it sets the stage for wrongful treatment to occur. Think of racism or sexism. Stigma is no different, although we don’t consider it a blatant social taboo in that sense. And like those forms of prejudice, stigma manifests itself outwardly—in both subtle and overt discrimination. Let’s talk about the harm this causes—both for the person with mental illness and for society at large.

First, stigma harms the individual with mental illness. The CDC reports that only 20% of adults with a mental disorder saw a mental health provider in the past year, and the shame and embarrassment associated with getting help is a major barrier. We have created a society where people don’t want others to find out about their “issues”, and for this reason alone, many avoid seeking treatment. Instead, they may turn to dangerous coping methods such as smoking, binge eating or drinking, which raises their risk for chronic disease and early death. According to the National Alliance on Mental Illness, those living with serious mental illness die an average of 25 years earlier than the general public—largely due to treatable conditions. On a broader level, stigma harms society. Discrimination against people with mental illness leads to unequal access to housing, health care, employment, education, and community support, and this leads to unemployment, homelessness, and poverty. Serious mental illness costs America over $190 billion in lost earnings per year. At the highest level, stigma influences policymaking. For example, stigma shaped the creation of the Medicaid law, limiting the funds used for treating mental illness but not physical illness. Such things make it difficult to access services for those who do seek help. The June 25, 2014 issue of USA Today tells the story of Laura Pogliano, whose 22-year-old son has schizophrenia. She lost her home after she chose to pay her son’s $250,000 hospital bills instead of her mortgage because his care was not covered by insurance. With all these barriers, is it any wonder that on average, people with mental illness wait nearly a decade after their symptoms first appear to receive treatment?

So, what can you do about this problem? A lot. You see, stigma is something we create, which means it is also something we can reverse. First, you can educate yourself about mental illness. It’s as simple as doing a Google search. Learn the truth about these diseases so you can recognize myths and misconceptions when you hear them and point out, “Hey, that’s not true.” Education also gives you the awareness necessary to change the way you speak. Don’t toss around terms like “crazy”, “lunatic”, or “the mentally ill”. Also, don’t say things like, “He’s bipolar,” or “She’s an anorexic.” A person is not their illness. Instead, say, “She has anorexia,” or “a person with bipolar disorder”. The Substance Abuse and Mental Health Services Administration, or SAMHSA, calls this “people-first language”. I encourage you to take it a step further, and actually talk about mental illness. According to Patrick Corrigan, psychology professor at Illinois Institute of Technology, “Research shows that the most promising way to dispel stereotypes is to meet someone with mental illness face-to-face.” That’s why I tell my story.

My name is Mei. I’m twenty years old. I love reading, writing, art, psychology, and watching The Big Bang Theory. I dream of being a social worker, falling in love, and traveling the world. And— I live with depression, post-traumatic stress disorder, and an eating disorder. I found that I’d internalized the stigma of mental illness so much that I’d ask people, “Do you still want to be my friend?” I realized I was almost expecting people to judge me as being “mental” or “unstable” and consequently not want to have a relationship with me. And I thought, “What is so wrong with our society that I feel I have to ask this question? If I had, say, asthma, or chronic migraines, would I still feel I’d have to ask, “Now that you know I have this condition, do you still want to be my friend?”? That leads to my third point, which is simply, be a friend. SAMHSA emphasizes the importance of positive relationships and social connections for mental illness recovery. The handout I’ve given you today lists some things you can do to help someone with a mental illness. Because mental illness is so widespread, I guarantee you that right now, you have someone in your life who needs this.

Today we talked about three aspects of mental illness stigma—what it is, why it hurts everyone, and what we can do about it. Friends, do you realize that you have the ability to create a world where someone like me, who lives with mental illness, can expect the same level of support and care as someone who has a physical illness? Maybe you can’t change the attitudes of everyone in the country, but you can choose how YOU act. You can be that caring and nonjudgmental friend someone needs. You can speak up and say, “We shouldn’t be ashamed to talk about this.” I’m doing it. Will you do the same?

Just think:

  • What common myth/stereotype irks/infuriates you? (For me, the popular “default” image of someone with mental illness as a filthy, disheveled man or woman with violent tendencies, rambling incoherently as they wander the streets. Yes, some people with mental illness do fit this stereotype, but most of us appear “normal”, people at whom you wouldn’t glance twice.)
  • What aspect of mental health would you like to see addressed more publicly? (For me, I’d like to see more people talking about PTSD as a result of traumas other than combat. For instance, did you know that children in foster care suffer higher rates of PTSD than veterans?)

By Meiyi Kiyoko Angel Wong Founder of, fighting for mei. Used with permission. All Rights Reserved.

College Mental Health Crisis

STAFF REPORT—

When I look back at college, I can say with utter certainty that “these were among the best days of my life.”

I was “independent” and “free” (both words I enjoyed using) and I considered myself unfettered by parental monitoring.

I forged new relationships.

I stayed out late.

I had meaningful and existentially provocative conversations with classmates.

I fell in love.

What’s not to like?

Ironically, it turns out that these very features of college – the unfettered independence and developmental exploration that I relished – can make college great for some young people, and at the same time can make college absolutely miserable for others.

When I was in college, there wasn’t much room for the miserable part.  Universities acted like the emotional hardships of being away from home were unusual and rare and administrations largely ignored these issues.

Today, things have definitely changed.

Colleges acknowledge that students experience profound emotional struggles, but colleges have remained largely ill-equipped to help these students.

Let’s look at the good, the bad and the ugly of the college mental health universe.

The Good

There are more opportunities for developmental growth than ever before. Colleges actively recognize the immense variety of ways that young people come of age. There are academic and extra-curricular offerings for people to explore who they are and what values they hold dear. This is especially the case for special programs designed to support women and minorities, programs that we never dreamed would occur as recently as 20 years ago.

The Bad

We’re also seeing increasing drop-out rates, more powerful distractions from the online world, and greater academic and social expectations for students.  Add to this the ever-growing financial challenges for students and parents and the decreased certainty of finding a job, and we have the cliché of the “perfect storm” for the emotional stress of higher education.

The Ugly

As we said above, despite great strides, colleges remain largely ill equipped to negotiate these complex psychosocial waters.

As students in the United States head back to college for the winter term, we’d like to address some of the greatest psychological challenges facing universities and their students. This week we’re going to tackle the most disturbing and unsettling issue in college mental health – the possibility of deliberate self-harm and even suicide among university students.

We don’t want to be too alarmist.  Although suicide attempts on college campuses do appear to be increasing, it is not the case that simply being in college means that someone will more likely consider suicide.  However, because many psychiatric illnesses have their natural onset among college-aged individuals, students are at higher risks when these illnesses coincide with the college-related stressors we’ve outlined above.

Consider these statistics:

  • There are more than 1,000 suicides on college campuses each year – That’s 2-3 deaths by suicide every day
  • Suicide is the second leading cause of death among college-age students
  • More than half of college students have had suicidal thoughts, and 1 in 10 students seriously consider attempting suicide
  • Most importantly: 80-90% of college students who die by suicide were not receiving help from college counseling centers

These are of course alarming statistics. Some have even called this a crisis.  The most important question to ask, therefore, is this:

What can we do to improve the situation?

To answer this question, let’s start by looking at what we know about college suicide.

Attempts at suicide and death by suicide are most common in college students who:

  • Are depressed
  • Are either under the influence of substances, or have a substance use problem
  • Have made a previous attempt
  • Have a family history of a mood disorder such as depression or bipolar disorder
  • Are struggling with a history of trauma

We also know that students often tell others when they’re emotionally struggling, and that teachers, peers and resident assistants are more adept at recognizing emotional distress among struggling students.

Nevertheless, suicidal students often feel helpless, hopeless, and trapped. Some of these students resist seeking help because they’re ashamed.  They might fear a “black mark” on their record or being judged by others.  Even if they don’t have these concerns, they often don’t know what services are available.

Obviously, this is a complex and multi-faceted issue.  We won’t be able to rectify this trend overnight.  But there are steps we can take to ameliorate the risks.  These include:

1.  Establish new educational platforms about depression and suicide.  Key to prevention and early intervention is education about mood disorders and suicide risk.  Some educational initiatives include live and online modules that can be used in a wide range of forums on campus – from dorms to the classroom to campus-wide events. These modules are not just for students; parents and faculty benefit as well.  We also need to be more creative in our educational approaches. For example, a film series on depression and suicide followed by discussion groups could be an incredibly powerful way to educate the community.  There are a number of very informative online sites that can serve as adjuncts to these educational efforts.  Chief among these are Griffin Ambitions, the American Foundation for the Prevention of Suicide and the Jed Foundation.  Another important component includes making students aware of what they can and should do if they are worried about a friend or fellow student. In fact, everyone on campus needs to know where to go and what to do when there are safety concerns.  Each college campus should have a user-friendly website or app that features a clear description of the risk factors for suicide and self harm and explicit advice about how to approach a student about whom there are question

2.  Increase access to mental health services.  Every member of the university community as well as parents and family should know how to seek help on and off campus.  A college website can house all the needed information about these services, including information about clinicians and the nature and coverage provided by insurance.  This information should also include clear directions about how to access the best emergency departments either on campus or in local hospitals if serious concerns are warranted

3.  Support community forums.  Most students struggling with a mental illness or emotional crisis feel alone and frightened.  Study after study tells us that we feel better and safer with social supports.  Providing community forums on a regular basis, and throughout the campus, sends a key message: You are not alone, and something can be done about your suffering.

4.  Foster peer counseling.  Depressed and suicidal students are often more likely to talk with friends than parents, teachers or advisors.  We have seen this demonstrated in the success of the programs like AA for substance use disorders and in support groups for all sorts of emotional and behavioral difficulties.  Organizations such Active Minds, tailored to college students, have been highly effective in the mission of peer counseling.

5.  Decrease the stigma of mental illness.  Perhaps the greatest barrier to seeking help is the fear of being judged or ridiculed. Many individuals still do not believe that depression and mood disorders are illnesses and feel that suicide is a sign of deep personal weakness.  Colleges need to take the lead in dispelling these false beliefs. Treatments for depression are effective, and the entire college community needs to be aware of this fact.

6.  Promote means for increasing student wellbeing.  Depression is often prevented by a number of activities – regular exercise, good sleep habits, substance use awareness programs, group discussions, cognitive behavioral techniques, expressive arts, and discussion groups have all proven helpful. These activities should be encouraged and fostered on college campuses.

Because each college is unique, colleges must tailor these initiatives to their own circumstances, but the benefits of taking action cannot be underestimated.  Colleges can literally save lives. They just have to act.

This blog was originally posted on The Clay Center for Young Healthy Minds at Massachusetts General Hospital and includes a podcast reviewing the college mental health crisis.

For additional information please see:

From the Clay Center

When Kids Leave Home: Part 1

When Kids Leave Home: Part 2

Examples of college webpages:

Counseling & Psychological Services – University of Pennsylvania

Mental Health and Well-Being – Cornell University

Dear Teachers & Professors,

An open letter to those in education

Dear teacher(s)  professor(s),

TO WHOM IT MAY CONCERN:

I am a person living with mental illness. Odds are, I’m not the only person in your life who faces this — whether you know it or not. Your knowledge about mental illness may be limited to what the media says, or what society says. With the alarming amount of college students with mental illness these days, I would hope you’ve educated yourself on this topic.

I am a person living with mental illness. I’m also a good student. Yes, I may have missed class, not participated in a discussion or turned something in late, but if that’s all you see then you’re not seeing the whole picture. I’m not asking for excuses or looking for a way to get out of assignments or rules. I would love to be able to adhere to everything without a problem. But I can’t. I have a disability, and even the department that provides accommodations for disabilities doesn’t help much. Aside from the scars on my body and physical symptoms of panic attacks, my illnesses are invisible.

When I don’t come to class, you may see a student who is lazy or didn’t feel like coming. But what you don’t see is the restless night I had tossing and turning with my insomnia. You don’t see the black mass encompassing my entire being some days. You don’t see the fight in my mind between staying alive or giving up. I’m not just lazy. It’s not because I didn’t finish the homework. I wasn’t in class because I couldn’t get out of bed today. I could not face the light of day because my depression had chained me to the darkness of my room.

I had a teacher tell me once it wouldn’t be fair to the people who always made it to class if my absences didn’t affect my grade. At the time, I understood. But looking back now, I realize that makes no sense. Accommodations exist for people with disabilities for a reason. By “understanding” but still penalizing me for something caused by my mental illness, you are keeping me at a disadvantage. It’s not fair to expect I be on par with other students who don’t have the added obstacle of an illness. I promise I’m giving it my all. I’m balancing my recovery and my education at the same time, and I shouldn’t feel like I have to choose. I shouldn’t feel like I can’t do both.

I’m not asking you to never expect me in class or constantly give me extensions. I’m not saying to just let it slide. I’m asking you to be empathetic, understand that I’m a student facing an illness and help me succeed. I’m asking you to not give me a low grade solely because my mental illness prevented me from having a perfect attendance. I’m asking that you look at me as a whole person. I’m asking that you care, and if you can, that you advocate for students like me. I’m a person living with mental illness, and there are so many of us who need your understanding.

-JACOB M. GRIFFIN
BALL STATE UNIVERSITY
FOUNDER OF GRIFFIN AMBITIONS LIMITED, A HOOSIER BASED 501c/3 NON-PROFIT
FOUNDER OF ACTIVE MINDS AT BALL STATE UNIVERSITY