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Think Stigma Isn’t Real? Think Again.

You may or may not know about the court case involving the actor Johnny Depp and his ex-wife Amber Heard. In 2018, Heard wrote in the Washington Post about being physically abused. Now, “Depp is suing for $50 million in damages and denies ever being physically violent with Heard. Heard is countersuing for $100 million and claims she was only ever violent with Depp in self-defense or defense of her younger sister.” Alone, this topic does not warrant a post on this blog, but the case took a turn when Shannon Curry, PsyD, MSCP, a psychologist for the prosecution, claimed that Heard had borderline personality disorder (BPD) and histrionic personality disorder (HPD). Historically, people with BPD are seen as challenging, a label which turned into aggressive and uncontrollable, and finally violent. An overwhelming quantity of studies investigating possible links between BPD and violence contribute to the stigma from a scientific standpoint, and Hollywood representations of the disorder affect the popular culture representation. Moreover, diagnoses are rather vague: to have BPD and HPD, you only need to demonstrate five of the nine traits listed, and even then, whether or not a person exhibits a certain trait is largely left up to the judgement of the clinician. As soon as BPD enters the discussion, regardless of the person in question, so too do the unreasonable and exaggerated stereotypes. The author of the article, Emma Flint, who has BPD, argues writes that “In my own relationships, I’ll admit, I have a terrible temper. I personally suffer with awful mood swings, often accompanied by rage and hysteria. Does that sound extreme? Yes. Does that make me a bad person? No. I may go to dark places, but the most harm done is always to myself, not to someone else.” BPD is terribly misunderstood by the general populace.

Twitter exploded after the diagnosis, vilifying and canceling Heard. Here is one of the posts (trigger warning – some of the things that people say here are upsetting). As Flint says, regardless of whether or not Heard has BPD and whether or not she is guilty, using mental illness as some sort of infallible silver bullet in a court case is unacceptable and only serves to promote rigid stereotypes and stigma. In my opinion, another problem that arises is the conflation of the factionalization of celebrity culture with mental health. What I mean is social media has fractured into camps supporting either Depp or Heard, with strong opinions on both sides. Opponents of Heard took this diagnosis and ran with it, possibly demonstrating confirmation bias. It’s fine to hate Amber Heard, but that hate should not extend to BPD or other mental health diagnoses. Nor should one person’s hateful perception of BPD “prove” Heard’s guilt.

Moreover, the dichotomization of Heard’s supporters and detractors – you either love her or hate her – only enforces the single, extreme representation of BPD in popular culture: either you’re some sort of narcissistic sociopath, or you’re not. The very terminology of a court case – someone vs. someone, winner, loser, innocent, guilty – also reinforces the idea that in every case, someone is wrong and the other is right. While I won’t deny that that is the case in some trials, the decisions and judgements that contribute to an “either/or” verdict are much more complex than the outcome suggests. Adding mental health into the fray suggests that it, too, is binary. 

However, mental health is a potentially important facet of a court case. If confirmed by multiple sources, a diagnosis can and should be considered in the face of charges if it is relevant. The problem here, however, is how this information is delivered to the public. Amidst existing stigma against BPD, the coverage and wording of Heard’s diagnosis only reinforced the negative perception. When interpretation is left completely up to the public, of course the prevailing mindset (i.e. stigma and misunderstanding) will prevail. It is the implicit social responsibility of people such as Curry to make sure that evidence in court cases cannot be misconstrued and misunderstood, indirectly harming other people. When that is not possible, that responsibility falls to ordinary citizens, to challenge problematic ideas and offer balanced insight.

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The Legal Battlefield

The Few. The Proud. The Marines are an elite branch of the U.S. Armed Forces, tasked with protecting their country’s interest internationally. However, when at home, their battles are very much different, especially for those with mental illness, reports The War Horse in an article posted this month. When Lance Corporal Kameron Duval, inebriated, wandering in the river, and planning to take his own life, accidentally injured a fellow marine, he was interrogated without an attorney and charged with a felony, without even being given a fresh change of clothes. He was locked up for 240 days and denied treatment. Ever since he was arrested, professionals for both the prosecution and defense agreed that Duval had severe PTSD, but the Marines did not drop the charges, claiming that Duval was simply making trouble and faking mental illness to get out of trouble. The Marines even tried to have a doctor testify against him, an act which would have violated the Health Insurance Portability and Accountability Act (HIPAA), which protected medical information. The Marines, however, maintained that “Evidentiary rules are separate and distinct from HIPAA.” Duval had sought psychiatric help before, but therapy sessions were not helpful, and it felt like the military did not actually care about his mental health, since he was scheduled to be discharged soon. 

An investigation found that Duval’s commander was fostering a hostile work environment: verbally abusing, harassing, and unjustly relieving her subordinates and forcing them to punish Marines, as well as lying in official statements. During a training exercise in a blizzard, she prevented a Maintenance Battalion from delivering supplies to starving Marines, claiming that they were not sufficiently trained for the weather. However, the Maintenance Battalion had had training, and the commander was just looking for an excuse not to be held responsible for any potential incidents. Marines could not dispute her authority, and she was never punished for her actions. Out of the hundreds of Marines interviewed, the only people who had anything good to say about her were the most senior officers, whose performance reviews were signed by none other than the commander herself. The investigation suggested that the commander be fired and punished, but she was only given a slap on the wrist and kept her job.

Duval is not alone: many other Marines were brutally treated, unjustly punished, and their careers ended by a system designed to deny them help and recourse. Major Anna Rubio-Fleischer had experienced multiple traumas in her career as a marine: being thrown over a desk by an officer and told that she should “watch the tone of her voice,” being sexually assaulted, and being abandoned by the administration. When Rubio-Fleischer tried to kill herself, the Marines tried to have her interrogated, but thankfully were denied by the hospital staff. Rubio-Fleischer was not mentally capable of answering inquiries; the leadership was just trying to find a reason to get rid of her. Despite doctors’ orders, Rubio-Fleischer’s superiors required her to resume full duties, and a few days later she made a second suicide attempt after having been denied vacation. After being released from the hospital, she was transferred to a Wounded Warrior Battalion, which she was fine with, since being a marine was a negative experience. However, she was given an adverse performance review which called her “derelict in her duties as a leader,” even though her few absences from work were excused absences to take her special needs child to medical appointments. This performance review could negatively affect her future employment opportunities and demonstrates that the Marines were just looking for ways to hurt Rubio-Fleischer, since they couldn’t charge her with anything.

Veteran Corporal Thae Ohu was recently threatened with a gag order because she spoke up about the failed investigation of her sexual abuse allegations and the legal controversy surrounding her mental illness. Like Duval and Rubio-Fleischer, Ohu sought help multiple times, having been admitted to the hospital several times, diagnosed with multiple mental illnesses, and recommended for medical retirement. In a psychotic episode, Ohu attacked her boyfriend and was charged with attempted murder. Her officer was offered multiple choices (the decision was not left up to the court) for how her case should be handled – medical retirement, administrative separation, or punitive discharge. Of course, her officer chose the latter, denying her the all the benefits of veterans, including mental health care. Ohu was imprisoned in an “anti-suicide cell”, where she was denied a Bible and sufficient menstrual pads, clothing, and bedding. The toilet was literally a small hole in the ground, and she had to push her feces through the holes – with her bare fingers. She wasn’t given enough toilet paper and wasn’t allowed to wash her hands before eating food for which she was also denied utensils. The “anti-suicide cell” only served to promote suicidal ideation, and over and over she tried to saw off her legs using the threads of her nylon tunic. Even after leaving confinement, Ohu was denied mental health treatment. Not only did Ohu’s punishment permanently affect career, but it also left an indelible psychological scar.

If this article does not effectively demonstrate the extent to which the military judicial system has failed, nothing will. Mental health treatment doesn’t exist in the military, even if it’s serious: if you have mental illness in the Marines, you are doomed from the very start. Duval, Rubio-Fleischer, and Ohu all visibly needed help, but none was given. In Rubio-Fleischer’s case, the Marines followed none of the doctors’ orders after she had tried to kill herself, and even took away her vacation – almost as if they were trying to cause another incident. And, when an incident ocurred, as it inevitably would, the Marines did everything in their power to destroy her, even going so far as, in Duval’s case, to toe the line of the HIPAA or claim something as ridiculous as faking mental illness. Marines with mental illness are seen as nothing more than liabilities. In fact, it seems to me that some of the punishments meted out to these three former Marines were motivated not so much by a misguided sense of legal duty or even lazy expedience, but rather by a deep hatred and disgust. When given the role of judge, jury, and executioner, Ohu’s officer delivered the harshest possible sentence, sending her to the accursed “anti-suicide cell”. The brusque interrogation and treatment of Duval was unnecessary. The Marines even did their best to ruin Rubio-Fleischer’s life with a bad performance review, even though at that point she was already out of their hair. I can’t say with absolute certainty that some of these injustices were motivated by stigma, but it definitely played a role.

This problem is not limited to mental health – the faults within the military judicial system go far deeper. The case of Duval’s autocratic commander and the physical, verbal, and sexual abuse of Rubio-Fleischer and Ohu are just some examples among many. The Marines’ ability to skirt federal law and Ohu’s commander’s ability to override judicial rulings are yet more issues with this system. To be blunt, the military is an institution where prejudices can run wild. What the Marines needs is accountability: accountability of its officers, accountability of its administrators, and accountability of its judical system. Accountability not just to the law, but to the moral standards of the public, in order to make it harder for civil rights violations to triumph and to prevent stigma towards mental illness from creating such a hostile environment. We also need to stop thinking of the military as a separate bubble. It’s a large institution, one that is most definitely not exempt from scrutiny. The irony is, the military might require more mental health services than any other government institution, due to its strenuous requirements and environment. Maintaining discipline and order within the military is a difficult task, but it should not come at the cost of careful, objective consideration of the facts with a particular emphasis on mental health.

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The Mental Health of Cancel Culture

Therapy is aided self-reflection and self-improvement. However, as psychologist Maggie Mulqueen opines, cancel cultureis increasingly harmful towards mental health, and even encroaching upon the haven of the therapist’s couch. Social media’s mob mentality and hostility towards even the slightest indication of an unpopular opinion often create anxiety and conflict within a person. For example, the mother of a transgender child socially withdrew out of fear that people would negatively interpret her actions. A professor who held an unpopular viewpoint at his university started to lose sleep and fear losing his job, driving him to seek therapy. Even during therapy sessions, however, he made sure prevent potential misunderstanding about his beliefs. Only when he was able to speak openly did the healing process begin. Self-expression is important to connect to others and be happy, yet cancel culture prevents people from doing so. Moreover, therapists may themselves be vulnerable to repercussions if they aren’t careful about what they talk about, such as guns. Barriers to therapy are not just institutional – perceived difference between the therapist and patient, in identity (such as sexuality) or beliefs (such as vaccination status) often cause the patient to alienate themself out of a belief that the therapist will not understand them.

            This post is sort of a follow-up to my previous post about the mental health of politics. What is happening with cancel culture is, if you think about it, terrifying. The universality of social media and the loss of privacy invoke images of a dystopian future where the government spies on its citizens and immediately kidnaps anyone who shows a sign of subversion. Obviously, nothing as extreme as that is going on. Rather than the government, the orchestrators behind cancel culture are the forces of society itself. The way I see it, a clash between therapy and cancel culture is inevitable: more people than ever are seeking therapy in an increasingly polarized political climate. Beliefs are inextricably tied to the highly personal discussions of therapy, so controversial discussions are inevitable. However, as Mulqueen asserts, these conversations are very important, so something must be done. Don’t get me wrong – I’m not necessarily canceling cancel culture. I think it is a good thing that so many people are passionate about speaking up about difficult subjects. The issue is the way that a trend that was once benign and intellectual has been corrupted and turned into a vehicle for thoughtless mob action. Like how a neutrophil at the site of an infection may start to harm tissue cells if left unregulated, cancel culture has started attacking people indiscriminately, sometimes doing more harm than good. Thus, in trying to regulate cancel culture, we must be careful to avoid the overcompensation that dysregulated cancel culture in the first place. The key lies in the name: the goal is not to cancel, but rather to educate and inform. Thus, instead of canceling cancel culture, we should share more stories about just how much it is spiraling out of control. Maybe then, only then, can we restore the sanctity of the therapy room.

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Is Mental Illness Related to Gun Violence?

No, explains Butte County Behavioral Health Director Scott Kennelly. Only 3-5% of mass shooters have a mental illness. Yet, when politics fails us, people often turn to the wielder of the gun rather than the gun itself. It is easy to categorize mass shooters as mentally ill, as if they have a disease that makes them intrinsically different from any of us. However, this heuristic model skirts the real issue, which Kennelly calls “adverse childhood experiences.” This may sound flippant and clichéd, but those who resort to gun violence have had hard childhoods. The traumas of their early years motivate them to do what they do. These traumas are in turn created by the many problems of society: poverty, prejudice, privilege, etc. It’s a story we’ve all heard before, but that does not mean it is not true, nor does it take away any of its importance.

Reframing the narrative on gun violence and mental illness -

            Gun violence may not be generally related to mental illness, but the two are not entirely unconnected. It is a sad truth that society’s disregard and stigma can lead people with mental illness to do things that they would otherwise not do. This begs the question of how we treat those 3-5% of cases where there is a clear connection between the shooter and mental illness. For example, a Texas man was recently acquitted of murder, due to a mental illness. This case raises several issues: where do we draw the line when mental illness is concerned? Some people may be concerned that mental illness may become an excuse to get away with crimes. Doing so would only cause more misunderstanding of mental illness. However, it is imperative that we not forget the importance of understanding people holistically. Thinking through the lens of mental illness is valuable in many ways. In other words, then, as with all topics which are posted on this blog, my answer to this problem is complicated. One solution is to treat every gun violence case with the most attention to detail and nuance as possible, gathering as much information as possible to make the most informed decision possible. Meanwhile, we must enact sociopolitical reform to reduce both the connection between mental illness and gun violence and reduce gun violence in general. The fundamental goal, however, is always the same: educate and inform about mental illness.

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The Letter

Angela Bryant, diagnosed with Bipolar I and PTSD in January of 2020, was an associate professor of sociology at Ohio State University, until she found out that she had submitted an angry letter of resignation during a manic episode in November of the same year. Horrified, when she tried to rescind her resignation, Ohio State refused to let her back, even though she had recovered through therapy and medication, and had the backing of many of her colleagues and her therapist to go back to work. Turning to the law did not help either: the Ohio Civil Rights Commission ruled that Bryant’s case was not discrimination, as she had not submitted formal documentation of her disability to the university. The reality, however, was that the aggressive letter to the chair of the sociology department, with whom Bryant was on good terms, was clearly out of character and an indication that something was wrong. This case has caused criticism from within the university, but the institution’s sole response is that the decision should be left to the professionals. At the same time, school officials hold that Ohio State is an equitable space for its faculty and students.

It is quite easy to see that Ohio State is vainly trying to deflect. Moreover, the court ruling relies almost completely on semantics. It’s hard to decide which is more pathetic – the school’s lack of mental health policy, or their efforts to pretend that they’re not at fault. To the school’s credit, it is possible that there are extenuating circumstances to which the public is not privy, but it would be naïve to just leave it at that. It is very hard to believe that the university wholeheartedly believed that Bryant was in her right mind when she sent her resignation letter, if it was indeed as uncharacteristic as the article asserts. Perhaps the school was looking for a reason to get rid of her, as she had been excused from her teaching since her diagnosis in order to receive treatment. Whatever the exact reasons, the university took advantage of the lack of legal infrastructure concerning mental health, and that is unacceptable. Almost as unacceptable as the judicial lapse which cemented Bryant’s unjust fate.

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The Psychology of Anti-Vaxxers

To avoid potential controversy, I’m going to preface this post with this: get vaccinated. Vaccines save lives. That statement should seem obvious, and yet the past years have seen the rise of the antivaxx movement. Why? Part of the answer is a conspiracy mentality: believing in a sinister, clandestine elite that tricks the masses with elaborate hoaxes in order to further their own agendas is a shockingly good predictor of antivaxx beliefs, data shows. Trump was one of these people, and he was not quiet about it. As a result, vaccines have been inextricably tied with politics, a very dangerous situation indeed. Personal beliefs should have no bearing on matters of public safety. In terms of partisan correlations, there is no simple explanation. Antivaxx beliefs are not limited to the far right or the far left and are more united by conspiracist mindsets. Peoples’ beliefs are a product of their own personalities, cultural and social identities, and ideologies. I think the diagram provided in this article sums up this idea succinctly:

However, people have a right to believe what they want. After all, it is not like antivaxxers came out of their mothers’ womb believing that vaccines would give them autism. What is problematic is how information is spread to people, a topic I discussed in my previous post. Certain people are more susceptible to misinformation, either because of a lack of contrasting evidence or the environment in which they live. If we’re not careful, misinformation can spread as easily as COVID did pre-vaccine. This post is not partisan or even trying to convince people to vaccinate. It is a cautionary tale of the repercussions of ignoring how the human mind processes information when developing policy.

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Battle of the Brains

War is bad[citation needed]. There are obvious physical repercussions for civilians caught in the crossfire, as is documented in the daily news coverage in Ukraine – the endless bombings, brutality, and deaths are a tragic reality for Ukrainians. However, there are also substantial risks to the mental health of civilians, especially for children, who are most vulnerable to the drastic changes in routine and protracted trauma of war. In past wars, children who lived through conflict were likelier to develop anxiety and depression, and though not all will become traumatized, most react to trauma. For example, some will become more agitated and restless, while others withdraw and internalize, which is mistakenly interpreted as a “good” reaction to trauma. The mental health of adults is no less important. The care and support that parents provide to their children play a significant role in how children are affected by war, and if those parents are despondent or traumatized themselves, they cannot provide that support. Babies, while they may not understand the full scope of the situation, are also susceptible to the negative impacts of impaired parental interaction. Experts recommend providing some sort of structure to children – such as school or time to spend with families or play. Ukrainians certainly have it the worst, but ordinary people around the globe are also mentally affected by the war. Anyone who has felt depressed or anxious after watching the news knows what I mean. In addition, unfiltered footage of disturbing scenes of death, destruction, and tragedy are disseminated directly to the populace through social media platforms such as the immensely popular TikTok or Instagram. It is not that the interconnectedness and information accessibility of social media is a bad thing – social media can be used to foster positive awareness and solidarity. However, the flip side is true: depending on how it is used, it can have repercussions on mental health. Studies have indicated links between watching too much news coverage of 9/11 and the Boston Marathon bombing with greater acute stress, and even symptoms of PTSD. Social media is also a breeding ground for fake news and misinformation, a digital pandemic that has infected the world far longer than COVID has. Lack of certainty about whether a source can be trusted can blur the line between reality and fiction and cause psychological distress. The rampant social media coverage of the war is a continuation of a pattern that has existed as long as social media, but which escalated around the 2016 presidential elections. The same urge that causes you to waste an hour watching cat videos also encourages you to feverishly scroll through psychologically damaging images and videos. That is not to say, however, that one should ignore the war. It is important to be informed and aware, but how you do it is up to you, and depending on the choice you make, your mental health could suffer.

Mental Health and war | Cartoon Movement

As always, this particular issue speaks to a larger defect of the system – the usage of social media. This isn’t my first post about social media. TikTok is a multiple offender, back when kids were mistakenly self-diagnosing with mental illnesses. The technologies of the age are becoming more and more metaphysical (think Metaverse and NFTs) and information-based. In my opinion, the world is experiencing a paradigm shift towards a more introspective, independent, and psychological mindset. So far (so far!), the primary human function that machinery has not replaced is the brain, and the job market is increasingly becoming reliant on expertise (shoutout to all the minimum-wage immigrant manual laborers). Indeed, the “information age” is aptly named. The human psyche now finds itself at the center of civilization, putting it under great pressure. However, the system has not adapted to this shift, and as a result lacks support for mental health. Think about it this way – if we gave coal energy to humans without climate controls, they would pollute the atmosphere with greenhouse gases (wait, where have we heard this before?). Policy has historically been rather slow, but that by no means excuses its failure to address the evolving needs of humanity. Technological progress is accelerating, and at some time in the future, we will reach a tipping point. On the other hand, by focusing on the mental health of non-combatants, I don’t mean to belittle the struggles of Ukrainians, which have the most priority and significance. But as for the war, I have little to say. Why is there even war in this day and age? War is unacceptable in more ways than one and is a disease many times more ancient than COVID and social media misuse. We should have found a vaccine for war a long time ago, but I suppose there will always be anti-vaxxers (*cough cough* Putin). Anti-vaxxers? That’s a great idea. Maybe I’ll make it my next blog post.

Support Ukraine!

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The Mental Health Climate

It’s obvious just how much the pandemic is affecting our mental health – but it is not the only thing. A recent United Nations climate report puts mental health at the forefront of the many climate-related issues our world is facing. Not only are younger populations indirectly affected by climate anxiety, but those who live through hurricanes and floods are also susceptible to mental disorders – in fact, 20-30% of them develop PTSD or depression. Wildfires induce anxiety, substance abuse, and sleeping issues. Interestingly, hotter weather by itself causes mental health problems, demonstrated by a study of almost two million Americans. Displacement, unemployment, and food insecurity brought on by climate change are also behind many of the stresses people around the globe face. Walking through wildfire smoke and city smog all day isn’t exactly enjoyable, either. It is even possible for people to experience psychological distress from seeing the destruction of landscapes which are important to them. Especially negatively impacted are first responders, youth, women, indigenous peoples, and outdoor workers. For example, the Inuit, who live in the Arctic and who must hunt and fish for sustenance, are facing increasingly dangerous and unpredictable environments. However, part of the problem is how we think about climate change: most of the time, climate change conversation is centered on pessimistic fatalism, and we often ignore the fact that taking steps to counteract climate change, such as using cars less and walking instead, can have positive effects on our mental health. 

Climate change in the context of mental health - The Concordian

In my opinion, this climate change report is not a game-changer: it is simply one more reason to prioritize climate change, if there weren’t enough reasons already. It is also yet another indication of the nation’s nonexistent mental health support system. Of course, that is not to say we should just ignore the problem. In my opinion, the value of this report is not in its actual content, but rather what it shows us about how to think about mental health. The more the professional lens is focused on mental health, the more it becomes just how important it is to look the world in that way. Starting with the pandemic, studies have been finding previously overlooked yet critical ways that our society interacts with mental health. It turns out that politics and TikTok can take a toll on mental health, for example. Moreover, we must ask ourselves how people of different ages, socioeconomic statuses, ethnicities, occupations, and genders are affected differently. How can we outfit the response to mental health crises in a way that befits the specific situation? If I were any more pretentious, I would call this my model for mental health policy. Climate change is just one example of where this could and should be applied. What about the war in Ukraine? That’s a great idea. Maybe I’ll make it my next blog post.

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Fighting on Two Fronts

*Note: since this entry is so long, I have split it up into multiple paragraphs. Only the last one is my opinion on the matter.

            While pointless war and unspeakable violence rage in Ukraine, we are waging our own war at home, argues a recent Slate article. Like soldiers on the front line, healthcare workers must battle a crafty, intricate, dangerous foe, and experience suffering and stress in the process. This enemy is COVID-19, and though we may now think of the pandemic as the status quo, our nation’s soldiers are bearing the brunt of the attack. In recent years, there has been an exodus of health care workers, with almost 1 in 5 quitting their job. The commonly offered explanation is burnout: before the pandemic, burnout rates were as high as 54%, and COVID-19 exacerbated the situation. However, the authors of the article seek to highlight other, subtler stress mechanisms at work behind the scenes, by comparing the battle against COVID-19 to actual war. For example, the decreased individual attention that patients receive due to limited availability of resources and personnel can cause health care workers to experience moral injury, or the feeling that one has failed due to the disparity between their idealized and actual jobs. In addition, the inconsistency of care standards and conditions across hospitals can make workers feel insecure, and the constant transitioning between the front lines of the pandemic and the home environment is disorienting and can cause people to cope by fixating on only one reality. Finally, health workers have had to fill the role of providing mental health care as well, adding even more emotional stress. 

            These stressors combine to produce a form of trauma. The type of disorder that is often associated with trauma is Post-Traumatic Stress Disorder (PTSD), in which a single extremely traumatizing event produces psychological aftereffects, but the trauma experienced by health care workers is closer to complex trauma, a type of trauma characterized by chronic exposure to stressful, unpredictable environments. The latter type has a PTSD equivalent, or c(complex)-PTSD, whose symptoms include dissociation, relationship issues, destructive behaviors, emotional dysregulation, and feelings of shame and guilt. No doubt health care workers are experiencing these symptoms as they struggle through the stressful environments of the front line. Granted, due to the lack of research on the mental struggles of health care workers during the pandemic, the exact nature of this trauma is unknown. However, understanding these challenges as trauma is important, and using this framework, we can copy the way the military deals with trauma. As a result of World War II, the military evolved to integrate mental health care into the fabric of its system. Ironically, though, the health care system stigmatizes mental health, as professionals are expected to stoically endure hardships. What’s worse, the stressors that health care workers experience during the pandemic are subtle and harder to notice than sudden traumas, such as the death of a patient.

            To address these needs, the authors suggest a government-run professional mental health taskforce, carefully and equitably coordinated, with “a trauma-informed approach; an emphasis on interpersonal, family-based care; standardized criteria for recognizing those at risk; and more universal mental health screening.” In addition, the authors encourage continued research into the nature of health care-related trauma, not just in the pandemic environment, but in general as well.

            Health care workers are hailed as heroes, yet they do not receive the support that heroes generally receive. To me, the system has failed to recognize the universality and intersectionality of mental health. Veterans suffering from PTSD (or “Shell Shock,” as they called it then) after World War I were very visibly afflicted, leading to the incorporation of mental health services into the military after the next World War. Apparently though, society has not deemed the daily grind as warranting sufficient attention. The ghastly statistic of 54% burnout even before the pandemic demonstrates just how little attention mental health had been receiving. Just as the world is experiencing the physical conflict between Ukraine and Russia and the subtler battle waged against COVID-19, so too in the United States are our health care workers and general populace fighting against the physical symptoms of the virus and the mental symptoms of the pandemic. The pandemic has stripped bare our country’s mental health care system and exposed the pitiful paucity of support. In my opinion, sending in health care workers without mental support is tantamount to sending soldiers to the front lines as suicide bombers. Of course, the pandemic front lines are not as dramatic as military front lines, but the essence is the same – sacrificing valuable workers by failing to invest in their long-term usefulness (i.e., providing mental support so that workers don’t quit). Health care workers care for us, but who cares for them? The answer is “nobody,” and that needs to change.

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COVID-19’s Effects on the Brain

In the largest study of COVID-19 and mental health to date, researchers from the Veterans Administration and Washington University in St. Louis found that COVID-19 survivors had a 35% higher risk of developing anxiety, 39% for depression, 41% for sleep disorders, and 80% for neurocognitive decline, or “brain fog,” in layman’s terms. Antidepressant use increased proportionally, as well as the likelihood of opioid usage (a 76% increase in risk!) and thus substance abuse. Even when compared to the typical negative mental effects of ordinary sickness or hospitalization, COVID-19 had a significantly greater impact, suggesting that the study’s results were unique to COVID. This side effect of the virus is hypothesized to be a direct result of the virus’s influence on the brain. The study examined 153,848 COVID-19 patients from March 1, 2020, to January 15, 2021, and compared the data with more than 5.6 million COVID-free people. The sample size was relatively diverse, containing a sizable number of women, African Americans, and people of different ages. Granted, this study was conducted before the large-scale introduction of the vaccine and the Delta and Omicron waves.

            Even so, this study demonstrates, with little room for doubt, just how dire this country’s situation is. The previous posts have mainly focused on the stress caused by the effects of the pandemic, but the virus itself has an incredible impact on mental health, and this discovery was made only very recently. Obviously, one way to circumvent this issue is to help prevent infections – by wearing masks and getting vaccinated. Of course, these measures cannot possibly prevent all infections, even if everyone follows them, so we must be prepared to deal with the inevitable mental health fallout from COVID-19 cases. As I have said time and time again, the mental health pandemic is possibly one of the greatest threats this country has faced, and yet it continues to worsen and languish in relative obscurity. The day that this issue is brought into the limelight will hopefully be the day that we start to fight back against the enemy right under our noses.