Throughout this pandemic, many people have exchanged humorous anecdotes about finding some relief for their anxiety through snacking. “The Covid-19” is a lighthearted (though often not untrue) reference to the weight people have gained while in isolation, deprived of many of their usual activities. Francophones call it “Le Quarantaine,” a play on words for a term meaning both the act of being in quarantine, and the French word for “Forty,” the number of pounds one gains while sitting at home seeking comfort within the contents of their pantry.
However, while indulgence is one manifestation of the pandemic, denial is another, potentially leading to much more serious, or even tragic consequences.
In an interview conducted by Iman Kassam for CTV News Montreal, Dr. Nicholas Chadi, a pediatrician who specializes in adolescent and addictive medicine, says younger people may, when in isolation, redirect their energy inward. That can lead to unhealthy fixations.
“Teens might have lost their social support, their sports, their activities, their way to kind of be themselves, and may turn towards fixation on body image, eating, exercising, and that can lead to anorexia.”
Photo: Danielle Helm, To Eat or Not To Eat?
Ann Kerr is a Psychotherapist and an Occupational Therapist at the Clinic on Dupont. She is also an Assistant Professor in the Department of Psychiatry at the University of Toronto. She says that an initial sign that a person’s relationship with food may be unhealthy is the amount of time they spend obsessing about how food is affecting their self-image.
“Probably everyone has some experience of feeling that they could be better if they were only a little lighter, or a little more fit, or had more muscle definition. Part of that is dose. The amount of time and effort spent controlling and aspiring to a certain level of fitness, or a certain look, is what is more the hallmark of when something is becoming disordered.”
This behaviour, she explains, can begin even in elementary school students, due to a society that increasingly values a certain type of aesthetic.
“It used to be something that was really seen around puberty. As a young person changes, their body composition changes as they start to menstruate. Young girls put on more body fat, and that was a trigger point. But that is no longer the case; it is much younger now...it is (at) 10 years old. That is probably more of the social context, the dieting, the whole concept of size being very important.”
Kerr explains that boys also fall victim to eating disorders, which can be triggered by bullying, or as a consequence of mental illness, such as depression or obsessive compulsive disorder. Treatment for these children is often medical in nature and can involve hospitalization followed by FBT, or Family-Based Therapy, which gives parents tools to ensure their children eat properly, and put weight back on. However, in some instances, Kerr says, parents can be the triggers.
“They are a reflection of the bigger culture. So if you have parents who are highly invested in (the) shaming of people who are larger, and they're obsessed with their exercise and their diet, that for sure creates a petri dish for an eating disorder (in their children).”
Photo: Christy Mckenna, Grab
While extreme examples of eating disorders can be fatal, there is a large segment of the population that, while not self-obsessing at a clinic level, are still too hypervigilant about their appearance and nutritional habits. Kerr spoke about the general undercurrent of body dissatisfaction which is prevalent in today’s society. What is healthy monitoring? And what role can food play during times of stress, such as the onset of winter during a global pandemic? Kerr says the key is ensuring you keep your diet varied, and, most importantly, listening to the physical cues your body is giving you.
“You can have the cake, and then the next meal you probably don't have the cake; you have a piece of fruit. The feeling that you don't have to undo any eating. Because if you eat too much cake you'll feel pretty ill. So pay attention to that. Your body will say, ‘Enough of the cake, I've had enough.’ But, the real practice is, you have what you like, and trust that your body will give you a cue to what you should have next...That is how to be more normalized about it.”
She also stresses the importance of healthy routines.
“Especially with Covid-19, there is a pervasive feeling of anxiety right now...People are normally clock-bound because we're supposed to get up and go to work. But now we don't go anywhere.So the idea is to still keep meals at very regular times, that helps. Sleep should still be at a regular time, and add exercise. And that all helps with stress. Meals are three times a day, always. Don't skip meals. And then there are snacks, like tea breaks, or an evening snack if you are up late, or a morning snack if you get hungry. So being very scheduled helps with stress. Exercise helps with stress. Regular sleep helps with stress.”
One of the biggest battles may still be the stigma attached to expressing behaviours or feelings which may be disordered. People resist making a phone call, or visiting a clinic, or talking to a friend, for fear of being dismissed. They are often patronized, and told, “We are all going through the same thing.” During Covid-19, we are all experiencing the same pandemic, but the stress manifests itself very differently in each of us. Our reactions are the result of our genetics, our social environment, and our learned behaviour. Changes to one’s body may be a normal part of a changing routine. However, emotional distress, despondency, or obsession are - and should be treated as - red flags of a more serious problem.
In Canada, The National Eating Disorder Information Centre Helpline can be reached at 1-866-NEDIC-20, or via email through their website. In the United States, National Eating Disorders can also be reached through their site, or by calling 1-800-931-2237. They also have 24/7 crisis support. Simply text “NEDA” to 741741.
Few life experiences introduce feelings of euphoria and despair more quickly, consecutively and frequently than becoming a first-time parent. The elation of holding your first child can be as acute as the melancholy of postpartum depression. But what if the latter were not only more manageable, but also foreseeable?
Dawn Kingston, a registered nurse, and PhD is Canada’s only endowed research chair in perinatal mental health. Before specializing in the causes and prevention of postpartum depression, she was a neonatal nurse focused on preventing preterm birth. Her research led her to examine the effects of stress on premature births, and low birth weights. The data began to lead her to the cause-and-effect relationship between a mother’s perinatal anxiety and depression, and the development of more acute conditions post-delivery. In other words, as with maternal instinct after birth, women often feel something is wrong before they even become pregnant. This can then manifest itself into postpartum depression.
“One of the biggest predictors of whether women get postpartum depression and anxiety is if they had something not only during pregnancy, but before pregnancy as well. For women who struggle with prenatal depression and anxiety, as many as fifty to eighty percent continue to have symptoms postpartum. So we’re used to thinking of postpartum depression as this globular thing that happens after women have a baby, but (if you have) those symptoms prenatally, those symptoms very often continue, which is another reason to make sure you get help in pregnancy.” Dr. Kingston said, when we spoke recently.
By radarxlove
As is so often the case when attempting to overcome mental health issues, stigma is the tallest hurdle. Women who are, or who are attempting to become pregnant, will pay closer attention to their work schedules, their diet, and their exercise routine - generally with the blessing of their partner, family and friends. But expressing concern about stress or worry is still discouraged or dismissed. I asked Dr. Kingston why women were reluctant to broach the subject.
“I think part of it is the media propelling the myth that the only mental health issue in the perinatal period is postpartum depression - I think that’s a big part of it. I think that the other part of this is that women who are pregnant are stigmatized and silent. Without even understanding there is even such a thing as prenatal anxiety and depression, women are afraid to ask their physicians about it. It’s interesting, when we’ve interviewed women, and asked what are their barriers to raising a conversation about mental health and pregnancy, some of them have given answers like, 'We want to be a good patient. We don’t want to talk about things that might not be an issue during our seven-minute prenatal visit.'”
Like many of us, they don’t want to seem a bother to their physician.
Upon hearing that a mother is anxious or worried about her pregnancy, it is natural for a friend’s or partner’s calming instinct to take over. After all, parenting is a tremendous responsibility that a mother and father are committed to for a lifetime. “Don’t worry, it’ll be fine,” seems a responsible form of encouragement. Unfortunately, this sort of support can be one of the biggest barriers to a mother-to-be who is considering mental health treatment, or who feels despair.
“Three-quarters of women told us, ‘If my partner, or my mother, or my sister normalized or told me I was okay, I would likely not have raised it with my doctor.’ So it becomes a barrier. I tell women, trust your gut. At this stage in our healthcare system you must raise it with your doctor. They are not going to ask, so you’ve got to trust your gut that something is wrong. What is wrong with asking? There is no cost to asking the question whether this is normal or not.”
Barefoot and Pregnant - Ryan
A woman’s personal support system may not even be the biggest obstacle. Dr. Kingston explained that, shockingly, the Canadian Medical Association guidelines don’t support depression screening in primary care. Why? There is a fear that the screening itself will make the condition worse. There is a sense that talking about depression will be a catalyst to triggering the condition. However, Dr. Kingston says, the exact opposite is true,
“There’s no evidence. And we found in our work that women actually feel validated. You want women to be able to say, ‘That’s me; that’s exactly me.’ Then the next step is, where so we go from here?”
This triggers mental illnesses most nebulous questions, “What is normal?” and, “When is it time to ask for help?”
“A normal life anxiety or a bit of worry over the baby, or the baby’s health, or (the baby) not eating the right thing...are not going to be long-lasting in general. You won’t have those for weeks on end; maybe minutes, maybe hours, but certainly not much beyond that. The diagnostic marker is always two weeks or more; for anxiety it’s more. I think, in general, it’s the longer you have something the more you should be concerned that it’s something above normal.”
Dr. Kingston goes on to describes acute situations,
“You’re worrying about things you might not have worried about before, and your worry is relentless; you wake up with it in the morning and you go to bed with it. There is this uncontrollable, agitating, restless worry where you just can’t stop it. Your mind is spinning. All the things that you do to control your normal anxiety and worry don’t work anymore. So it becomes this relentless kind of gut-wrenching tension, irritability, (a) sense of not having control.”
Trust in your instincts is invaluable. Raise your hand, step forward, ask questions. There is never shame in self-care. Approximately 9 months after conception, a parent becomes a psychologist, a relationship and grief counselor, a teacher and a doctor to their child for the rest of their lives. Time put aside for yourself becomes inversely proportional with your dedication to your child. Talking about your anxious feelings, and your worry about becoming a mother, is more easily said than done. But going into pregnancy with joy and confidence can lead to two lifetimes of benefit. It will allow you better manage the occasional despair of parenting, also to revel in its frequent euphoria.
From the July edition of Alive Magazine, this article - entitled "As You Go Along" - asks : When you are a parent of a child, and also a child of a parent afflicted with dementia, how do you plan for what’s coming? And then asserts that sometimes, you just don't.
I'd like to thank two people who were not only instrumental in contributing to this article, but also as much in guiding me through a challenging year: Sabrina Dion and Caroline Meynard. These two women, thankfully, have as much experience with dementia as they do patience.
Throughout the various stages of parenthood, people have always referred to “the woods.” As infants, once our children slept through the night we were (supposedly) “out of the woods.” However, the forest was far more expansive than those early parenting metaphors suggested. Toilet training? Woods. Feeding themselves? Woods. Walking? Woods.Tropical, temperate, boreal. Woods, woods, woods.
Recently, when my eldest child turned 13 years-old, I benefited from the wisdom of friends whose sons and daughters have passed through the fires of adolescence. I realized I was not out of any woods. I am now, rather, strolling the pastures between them. Drivers licenses and drinking ages were crouched like bandits in the forest beyond the next bluff.
But, as with many of my sandwich generation peers, the next thicket bloomed even sooner than predicted; my mother was diagnosed with Alzheimer’s disease and Lewy Body dementia. I have reflected on the trials, fears, and compromises necessary to see to it that she is being well cared for, as well as to accept what I cannot change. Through that article, and conversations since, I realized what a comfort it was for me to talk with not only other children of parents afflicted with dementia willing to share their struggle, but also to have access to the reassurance and expertise of those who support and treat victims of cognitive illnesses.
Though these diseases can manifest themselves through myriads of different symptoms, the caregivers’ challenges (and stresses, and fears) are remarkably similar. While families are often thrown into a state of panic by the realization of what steps must be taken to protect their parent, medical staff who specialize in caring for patients and their families rarely encounter a scenario they are not familiar with.
Sabrina Dion is a registered nurse at a private residence which specializes in caring for men and women at various stages of loss of autonomy.
She sympathises with those living with the emotional weight of moving a parent into a home for the first time. While altruism is an able motivator, the burden can detract from - and begin to deteriorate - the caregiver’s relationship with their spouse, their children, and their career. Dion says this can have devastating emotional costs:
Families are very upset, families feel a lot of guilt, families are going through a crisis. Parents are no longer in their home, their safety’s at risk. So it’s a rush to get them into a safe environment. It’s a struggle between, “How I am going to handle my home life?” and, “How am I going to make sure my mom or my dad, or either, or both is ok?” And then I remind them, “What you’re doing is looking out for your mother’s or father’s best interests. You know they’re in an unsafe environment, and you know you can give them a better quality of life given you can’t change the outcome of dementia or Alzheimer’s.” This is where it becomes a mish-mash, this is where it becomes really challenging. You have to have a career, you have to get to work, you have to take care of your children. The you have to make sure that your parents - if they’re compromised with the loss of autonomy or of cognitive deficits - are taken care of as well. It’s a lot. Caregiver burnout, that’s the big thing that I look for...that’s my red flag. Because you taking mom or dad to your home, and not being able to be there and not being able to understand, and burning out, is not going to help them in the long run.
Dominic Smith - Elder and Rehabilitation Care
Caroline Ménard is a psychologist, and coordinator of the Behavioural and Psychological Symptoms of Dementia team at the University of Montreal Geriatric Institute. She says it is often easiest to think of this time as a time to mourn*:
It is no longer the mother or the person you knew. It is like mourning for the person you used to know; mourning for them before their passing. It is mourning for what was their daily life, which has now become the loss of a driver’s license or the person leaving their apartment. There is also the loss of the person they used to be; they may have been very reserved and now they act out. Those changes can be very, very emotionally difficult.
Once the elderly parent is removed from the dangers of autonomy, the child and lifelong friends of the patient become spectators of the slow, long-term ravages of cognitive decline. The patient’s personality changes, their physical abilities diminish, and their memory becomes confused and diffused. Dion spoke to me about those feelings of helplessness:
You can visit your parent, and the parent doesn’t recognize you. That’s a really difficult one for children to deal with. That’s when a lot of the children come to my office and it’s like, “Wow, I can’t believe that just happened, that person is my mother.” So it’s to remind them that if they call you your brother or your husband or tell you, “I know you but I don’t know your name,” just keep going with the conversation. Because there is no point in trying to pull things out of a person. It will get them frustrated, it will get them upset, it will get you upset.
Ménard points out that while specific memories may no longer be viable, emotional memories may last until the very end, and should not be ignored:
The person may not recognize a person as being their son or daughter, but they will still feel happiness when they see that person because of the history they shared. I have seen people nearly unresponsive in their beds, but upon hearing their spouse’s voice, their eyes open and they smile. That is their affective memory.
Photo: Mariano Cuajao
Victims of Alzheimer’s may also become physically abusive to those they formerly cared for. This impulsive behaviour is the disease, not its host. It is an uncontrollable impulsive reaction. Although it may seem a very personal, hurtful act, the recipient must remind themselves they have done nothing wrong. They are caring for someone losing their filter.
Ménard iterates that each person digests the realities of Alzheimer’s in their own way. Some may react with urgency, while other need time, and distance. Reactions of families and friends can be as varied as the effects of the disease itself:
For some children, accepting what’s coming creates too much anxiety, it’s too difficult. Sometimes it’s better to just deal with this moment. But, eventually, you have to express your emotions. Support groups can be extremely helpful navigating a person through the changes which lie ahead.
She also stresses the importance of asking for help before burnout takes a physical and emotional toll:
There are many more resources than there used to be. There’s the Alzheimer's Society of Canada, for instance. It is important for the child to understand the illness. Since you yourself are a child, and you may also have young children in your life, you have to be able to express what you’re living through, and the emotions which are being triggered; that can be very helpful. You have to ask for help.
Guilt. That emotion that often forbids one from finding their way out of the woods. It is all-powerful, and ironically had its profile created throughout our upbringing with our parents. And no one can trigger a more pointed guilt reflex in a child than their mother or father. There is often so much unresolved, so much unspoken. And, now, as a result of cognitive decline, that relationship may be beyond redemption.
Dion reassures families that that time has passed, and children can feel pride in refocusing their energies:
I think a good reminder and takeaway is for children who have parents who have Alzheimer's or any type of vascular dementia or Lewy Body, is to remember that, whatever choice you’re making, if it’s for your parent’s best interests, it’s always the right decision. And you have to understand that you have permission to live your life and raise your own children. It’s the natural cycle of life.
Being lost in the woods is also part of life's natural cycle. With dementia, that journey can take years to complete. Perhaps the challenge is not seeking a path out of the forest, but to try to find the right tools for long-term survival, as well as company for the journey ahead.
Wayne S. Grazio - Lost (in one's thoughts)
* Interview with Caroline Ménard conducted in French. I provided the English translation.
It was her makeup application that first made me think something was not right. Foundation that was a few millimeters short of her hairline, and a few more from her jaw. Odd, I thought. In hindsight, I recognize the irony—misapplied camouflage attempting to conceal a slow deterioration. A failed cover-up. What gradually followed for my mother were lost words and mild disorientation. Then, crisis.
As with addiction, when reaching out to someone with dementia one can only prod, and suggest, and hope. Often, however, there must be a bottoming out—a physical or psychological cellar, a darkness through which the ill cannot see without guidance and advocacy. My mother fell into that cellar this past April.
The woman who had, after her own mother’s passing, assumed the role of family matriarch, was being crippled by the mysterious demons of dementia and delirium. The transition was gradual: at first forgetfulness and disorientation, a solemn diagnosis of Alzheimer’s, and ultimately a terrifying psychosis triggered by the unforgiving combination of a urinary tract infection and slow cognitive decline.
Two weeks earlier she was misplacing keys and struggling to comprehend Visa statements. Now, her apartment betrayed a scene of violence: a chair strewn in the hall, food and Corningware on the floor, and stories of strangers creeping up the back stairs where no stairs existed. To her uninitiated children, it was a psychological supernova; a terrifying introduction to the enigmatic and sometimes violent world of delirium.
Seven months later, the urgency is struggling to be replaced with acceptance, balanced with fatigue; the responsibility of a child towards their parent is wrestling with the responsibility of a father towards his children, and that of a grown adult granting himself the gift of self-care.
****
Jose Carlos - Alzheimer
ACCEPTING THE LOSS OF THE PERSON WHO WAS
In my experience, most adults have complicated histories with their parents, which inevitably colour any present day interactions. There are incidents which are both unforgiven and unforgotten. Our parents try to compensate for their own regrets by regularly offering course corrections on our own parenting voyage. Nearly every adult child / parent relationship is a full plate drizzled with appreciation and overbearance; with affection and exasperation.
Dementia unplugs the pool of personal history. All that was is drained away, one day at a time, and is replaced by a new iteration of a being who is not quite whole. Reconciling one’s self with that, means learning to find an escape route through which you can permit yourself to be free of that history. It becomes a frank exercise in acceptance and objectivity: those arguments unresolved, and those wounds unhealed, can no longer be allowed to demand your energy, or your time, or your impatience. Your parent, in almost every definable fashion, has become your child.
It suddenly became necessary for me to re-centre my thought process. I found it often useful to imagine my mother a stranger. How would I care for the elderly mother of a close friend? Which version of myself would I want to present to a septuagenarian in crisis on a street corner? Those answers were simple: patience, kindness, and advocacy. A relationship with acceptance, and absolutely no sense of a shared history.
Those touchstones of my relationship with my mother forty-five years in the making—my parents’ divorce and its consequences; personalities in conflict; disapproval and debate–must be buried in a grave alongside what used to be the healthy psychological profile of my aging parent.
Alzheimer’s and dementia: the ultimate arbitrators of any relationship.
Susan Sermoneta - L9999251
DAD, WHAT’S HAPPENING TO BUBBY?
As a child, I have become responsible for my mother’s well-being. As a parent, I am constantly standing on a teeter totter’s fulcrum, trying to credit my children’s intelligence by keeping them informed, while balancing that against the preservation of their memory of their grandmother who used to be well enough to host them for sleepovers and lead them on subway trips to see the Nutcracker.
Protectionism was my first instinct: euphemize recent stories of screaming, physical restraints, and terrifying hallucinations by replacing them with, “Bubby’s okay, and she sends her love.”
Much of that language trots alongside the timeline of the disease. During the first weeks, diagnoses are uncertain, and prognoses are hopeful. Time, though, slowly absorbs equivocation. Now, in early December, it is likely my mother is as improved as she will be. Throughout these months of treatment, bevies of conversations with physicians, nurses, mental health professionals, with my sister, my wife, and my mother’s lifelong friends, have helped me become comfortable with my own understanding of this disease. The result is my being more able, and more comfortable, being truthful and straightforward with my children.
They are old enough to understand that if I am not bringing them to visit their bubby, it is probably best they are not exposed to what lies on the far side of that hospital door. My answers to their questions have finally become frank. We speak of depression, and dementia, and Alzheimer’s. At a psychologist’s request, we send videos of the grandchildren. I explain to my children that bubby becomes agitated and sad, and seeing them, even though a tablet’s screen, brings her great comfort. It is one of the cruelest dimensions of this type of psychological disintegration: there is just enough residual intelligence and understanding for my mother to recognize the grandchildren, and to ask after them, and to be comforted by their image. However, enough logic and dimension has been stripped away that every day brings with it bursts of fear and anger, and outbursts of tears and confusion.
“How is Bubby?” She’s not well. She gets very sad. But she misses you. She loves hearing stories about you, and seeing pictures of you. And she probably won’t get better.
Susan Sermoneta - L9999251
GUILT VS SELF-CARE
Summers, for me, are a period of lighter workloads and more flexible hours. If there was good fortune to be found in what was transpiring with my mother, it is that the crisis was born in late April. This resulted in my sister (a school teacher with similar flexibility during the summer months) and I were in a temporal position of being able to become full-time advocates during an emergent situation. Each of us was on-call either daily or every second day at the hospital, asking questions of the medical staff or being bedside attempting to digest a prognosis. We were able to be present during her UTI diagnosis and treatment, and then throughout the decision-making and healing process of a double craniotomy. We were there to provide recognition and comfort when she was moved for a short period into a residence, and then researched on her behalf and advocated for her readmittance to the hospital when her cognitive and behavioral condition became once again unstable.
Summer’s end brought with it the fall of our flexibility, and the onset of not only real life (school for my sister and my children, and my more demanding workload), but also with it the complicated logistics of my mother no longer being at a residence down the block from me, but rather in a hospital which would demand extra hours of weekly commuting were I to attempt to maintain my previous visitation schedule.
I was also beginning to understand the toll of caregivers’ fatigue. I was short-tempered with my family, not sleeping properly and was slinking back to fast food and potato chips as dopamine delivery systems while I was stuck in rush hour traffic. (It became a ritual that I meet my sister outside her house prior to hospital visits with a McFlurry for each of us. What she never knew is that, when I was alone, I upsized my small to a medium. Here lies the confession, sis.)
Therapy helped. Although guilt is the world’s most sensitive hair-trigger. Every call from the hospital elicits a churning of regret. My ability to overcome and assuage my guilt is directly related to the nature of the conversation.
The calls I have learned to most easily recover from are those from the nursing staff informing me my mother has fallen, but is unharmed (a several times weekly occurrence), or the necessity of hiring someone to care for her toenails, or the connection or disconnection of the television.
Conversely, guilt perverts itself into shame and sorrow when my mother calls asking if I have any room in my house, even for just a day or so, so she can live with her family while she obtains a new credit card and shops for a condo. The pleas are tear-filled. I can hear my mother fighting to sound as rational as possible, as though she were aware that her psychological health was tenuous, and under constant evaluation. (Even in relaying these details, my guilt coerces me into justifying that, during those same conversations, she will confide in me that there are men chasing her, that she had been out for a drive earlier that day, and that she has been caring for her cat. All this while not realizing she has not left the hospital for months.)
Many people who visit a counselor for their marriage or other relationships are told: you cannot love others unless you learn to love yourself. That seemed to me the mantra of ethereal hipsterism until a few months ago. Now, I accept it as a truism.
My mother is in a place where she is being cared for. We are fortunate that, despite the nurse’s salary she earned throughout her career, she was a careful and steadfast financial planner and we are thankfully able to provide companions for her. I am learning to give myself permission to be my own first priority. Who do I want to be? How do I want to feel? What kind of energy do I want to reserve for my own family? Finding the answers to these questions is far easier that implementing their solutions. My mother’s friends and more distant relatives, who are satellites to her predicament, grasp for news and explanations and understanding. Helplessness can be excruciating. I have learned to answer only when it is convenient for me, and only truthfully. I have accepted that, if my mother’s condition has worsened, or improved, or stabilized, it is not because of what I have not done. It is because this is the nature of this disease. No amount of my attention can scrape away plaques and tangles, or frighten away hallucinations, or defeat depression. Her bedside will welcome me when I am available, and will wait silently during my absence. All the while, dementia will creep in through the cracks, whether I am posted guard or not.
****
The gifts of a long-term illness such as Alzheimer’s are as few as the memories the disease leaves in its wake. However, its lessons can be ironically abundant and fruitful. Discovering those lessons, and drawing meaning from them, is the slog. I relentlessly try to remind myself that each day offers rewards in some form. A hug from my children, my wife’s humor showing up in a text, driving in the middle lane while absorbing an hour of my favourite podcast. Forever in the shadow of those moments lurks the awareness of the life my mother is “living,” a grey room in a geriatric hospital. Sadness. Fear. Loneliness. Confusion. The cruelty of a disease which strips away not only mental souvenirs, but with them wedges of personality and understanding. Since beginning to speak aloud (and write) of these circumstances, I have met many peers and friends who have been affected by dementia in those people dear to them. Many who suffer from Alzheimer’s are left docile and accepting, even from within their cognitive blindness. Others, like my mother, are treated more cruelly. The remaining aspects of their personality are darker embers, sediments not deglazed. Why? What determines one’s experience with dementia? Genetics? Personality profiles? Environment?
The only certainty seems to be all the things which will forever be uncertain. And acceptance seems to be the only state which allows us, the satellites to the disease, to continue to function from a place of patience, and gratitude for ourselves and for our own families. It is a mental exercise of daily personal challenge and learning. Should I ever become afflicted by Alzheimer’s intellectual invasion, I hope that—at the very least—I can remember a life lived without regret.
Discussions about women's biological clocks are fairly routine. Interestingly, studies have begun to pop up showing that men, too, experience decreasing fertility sooner than we first thought. When asked, men also admitted to feeling deep regret about choosing career over parenthood. This was the topic of my most recent visit to Breakfast Television:
I often quote the late Roger Ebert's mantra, "It's not what a movie is about, it is how it is about it." As a writer, after years of wondering whether I should address any given topic, I finally have come to enough terms with one subject in particular that it was time to ask, "Why am I not writing about this one?" Why am I not writing about my mental health?
S-T-I-G-M-A: noun, "A mark of shame, or discredit." (Merriam-Webster)
Depression - by Ryan Melaugh
That's why. I have been seeing a psychologist for nearly eight months. At first weekly, then bi-weekly, and now every third week. I would prefer to go no more often, but mental health care is not inexpensive.
Why, just a couple of weeks before Christmas 2016, did I decide things had gotten so bad that I needed psychological therapy? The answer to that question is at the very epicentre of what ails our understanding of mental health: Things had not gotten so bad, and I wanted them never to deteriorate to that point. I wasn't depressed; but I was occasionally sad. I wasn't suffering from anxiety; but I was anxious. I wasn't right. I wasn't looking forward to most of what a week would bring. I knew others who did suffer from serious anxiety, depression, and schizophrenia. What business did I have thinking I needed therapy? It was one friend who asked me one question that convinced me to call a psychologist: "Wouldn't life be better if you did look forward to things?" I didn't really think that was possible. But, what if it was?
What if it was?
I had spent years thinking my feelings weren't worthy of being addressed. But don't those who are further down the spectrum of mental illness begin at the beginning? Didn't they, one day, tip from being fine to being not-so-fine? Didn't they slowly teeter from unhappy to depressed? Ultimately, for many who suffer, "not fine" went unaddressed and ignored, and became "unwell." This, in turn matured into "ill." Mentally ill.
A therapist was recommended to me by a close friend. She explained, "The psychologist begins with a half-hour phone consultation during which she will decide whether she thinks she can help you." The therapist's website extolled meaningfulness, lasting relationships and self-healing. As men, we are taught to belittle what is perceived as daytime talk show language. We don't watch Oprah, though we may want to. We don't emote, though we should. We don't seek help, even when we must.
Ironically, my physiological reactions as I dialed the psychologist's number mimicked my behaviour under stress: dry mouth, palpitations, perspiration, tightness in my throat and rapid speech. This, I would learn weeks later, is my body engaging its fight-or-flight reflex. It determined--while I was calling a therapist to ask for her help--that I was under attack. That is how men have been conditioned to react to weakness: fight it, or run away. Don't succumb; don't seek solutions; don't share. Fight, or run.
Tension - by Matt Harris
"How can I help you?" She asked. I explained how I didn't look forward to things. I could fake it, but, in almost all situations, I would look forward to just being home. And I craved alone time, always. It was not a question of whether this was 'normal', it was a matter of this psychological need being unhealthy for myself and my family. I am a husband, and a father of two, and a son, and a brother, and a friend, and an employee, and a school volunteer, I want to be eager for the days ahead. I envy those who are excited about parties and barbecues and having a drink with friends.
Slowly, therapy is teaching me how to summon the strength to ask for what I need: an afternoon away, or half-an-hour of reading on the couch in the evening instead of watching TV with the kids. I have gotten over the prejudice I held towards meditation. I can lie on the floor of my bedroom listening to my meditation apps (Buddhify and Meditation Studio), and feel more rested and peaceful after only twenty minutes. I am also learning that I can allow myself to enjoy things within my own framework. If I don't want to socialize at a party, I can sit and listen. I have to change people's expectations of what I bring to a room. I am more of an introvert than an extrovert, and I have to give myself permission to behave accordingly.
There are rough patches as I work on myself. I am changing the person my loved ones and peers have come to know over decades. This is an adjustment for them as well. And that's okay. It is okay for there to be moments of strife and disagreement. This does not mean I am failing, or losing, or neglecting. It means I am human and am demonstrating qualities that many others have already mastered: self-assurance and independence from expectation.
I have written before about depression, especially in men, and how those affected by a family member's suicide have tried unique approaches to reach those who are reluctant to reach out. The resources are in place. What is not established is a systematic change to the perception that psychological hardship should not be addressed in the same fashion as physical discomfort. When your joints are sore, how long before you pop acetaminophen and mention it to your family practitioner? Do you hesitate to mention to friends an appointment with a physiotherapist to strengthen your back?
Contemplating suicide is not the only gateway to picking up a phone. And S-T-I-G-M-A should not be allowed to shame you into keeping quiet. Worry about the perception of seeking talk therapy is valid, and it may not release its grip. Asking for help concerning your mental health is difficult, and uncomfortable, and is often dismissed by family and peers. But, wouldn't it feel good to feel good? Wouldn't it be healing to speak with a professional who brings with them none of your history, or knowledge of your habits, or judgment about your behaviour?
I spent years wondering whether I was a worthy candidate for therapy. Wondering wasn't helping. Thinking wasn't healing. Hiding was hurting. So I talked. And now you know.
Increase your folic acid intake. Eliminate tobacco and alcohol. Reduce caffeine in your diet. Maintain proper nutrition and regular exercise.
Congratulations, you're pregnant!
There have been many debates surrounding the type of lifestyle changes which need to be implemented and/or maintained during pregnancy. "What harm can it do?" and, "My babies were fine, and I didn't really scrutinize my lifestyle," are common refrains when justifying being more lax with one's pre-natal health than is suggested by physicians.
However, a new study suggests that, despite giving birth to an apparently healthy baby, the conditions in utero may have lasting effects which can influence a child's health into adolescence and adulthood.
A team from Quebec-based Research Unit on Children’s Psychosocial Maladjustment had the results of their study published in Human Brain Mapping. Their subjects were pairs of identical twins, which they followed from birth, through to their teenage years. They found that, despite having identical genetic profiles, one twin presented with different birthweight from the partner in the uterus. The twin with the higher birthweight also showed more advanced brain development as the children grew older.
By the time our participants had reached teenagehood, differences in brain volume were present in the cortex, which is where much of our regulation of emotions and cognitive processes takes place. Interestingly, twins with large differences in birth weight and cortical structure also had epigenetic differences. This means that what happens in utero may affect a person’s brain development by the time they reach their teen years, and that epigenetic processes may play a role in this relationship.
Photo: Allan Foster, "The Second Reason"
The article describes epigenetics as changes in the activity of how a gene is expressed through environmental experiences, rather than alteration of the genetic code itself. This means that there could be factors affecting one fetus more than the other, which may be extrapolated and manifested as differences in the children more than a decade later. Dr. Booij explains to Concordia University:
Since the twins in our study are genetically identical, this difference in birth weight must be due to specific factors acting in utero. For instance, one fetus might have a better placement in the womb or better access to nutrition.
The study focused on in utero conditions affecting one fetus, positively or negatively, more than the other. However, as any parent with more than one child can attest to, no two, or three, or four siblings are alike. Wouldn't the parenting style and external factors after delivery also affect a child's emotional and physical health? For example: parents are often more nervous and strict with a first child versus their younger siblings. Children from one family also may have drastically different nutritional and/or lifestyle habits--i.e. be more inclined towards a healthy diet or athletics--than the other sibling. Wouldn't these factors also explain the differences in sibling brain profiles through the teenage years? I posed that question to Dr. Booij:
In general since the twins were raised in the same family and all still lived with their parents, many measures are similar (e.g. Eating habits). We have measures on parenting (in which the parent fills in a questionnaire for each child how e.g. Strict they are with each child). We noted that these measures were very similar.
Nevertheless, we can expect that factors after birth play a role, and that the differences within twin pairs may become larger once the twins are more apart. In fact, we continue to follow the twins and hopefully can repeat the epigenetic and brain measures in a new data collection when they are older.
What does this mean for a woman and her pregnancy? It may be further evidence that all that advice and caution one receives prior to, and during pregnancy, may not only mean a healthier baby at birth. It may also be the gateway to a healthier adolescent and, therefore, a happier and healthier adult.
This week, the NFL and the CFL have announced they will introduce a new sideline concussion test this season. The NFL was founded 1922. The CFL had its genesis as the Canadian Rugby Football Union in 1884. These sports have been around for more than a century. Finally, with a not-so-delicate push by documentaries such as League of Denial and lawsuits brought by former players suffering from chronic traumatic encephalopathy, or C.T.E., professional sports organizations are beginning to admit what they don't know about concussions.
Now, children should hope there is a trickle-down effect to coaches, and especially parents.
I suffered a concussion at the age of 12. I regained cognitive function while standing in my living room, unable to explain the scrapes down the right side of my body. I had apparently been in a bicycle accident. After spending 24 hours in a hospital observation room—being awoken every hour—I returned home, and resumed my regular sporting activities a short while later. That course of treatment could have killed me. It would not really have been anybody's fault. Little was understood about concussions in 1984, or 1994, or even 2004. But, in 2015, there are fewer and fewer excuses for coaches, doctors, trainers, and parents to rely on when they send an athlete back onto the field after they've suffered a head injury, as minor as it may seem at the time. Knowing that, there will still be young hockey, rugby, and football players (three of the most violent sports as far as concussions are concerned) who will be told to "Man up!" or to "Get back out there!" because "Everybody gets hit; it's part of the game."
John Boulay is a certified athletic therapist, a part-time professor at Concordia University's Department of Exercise Science and Athletic Therapy, and teaches Advanced Emergency Care in Sports. He is also part of an provincial body studying concussions. His first suggestion, even before I began the interview, was to post this great YouTube concussion primer, put together by Doctor Mike Evans:
Mr. Boulay emphasizes how difficult it is to diagnose a concussion, especially for parents. The real problem is, if you aren't careful, you could be ignoring a dangerous situation.
As hard as it may be, it cannot be left up to (parents) to decide when our children are free to return to the field. Why? Because a concussion hides a potential life-threatening entity.
Somebody hits their head, and they have all these concussion signs. Is it a concussion? We’re not sure, we’ll tell you in one week if it was. If you survive the next 20 or 30 minutes, you’re okay. The next timeline is the next 3 to 4 hours; you’re okay. The next 24 hours? You’re okay. This continues for up to 4 to 5 to 6 days.
These guidelines, he mentions, are in place for anyone, over the age of 25. For anyone younger than that, the wait period extends to two weeks because the frontal area of the brain only matures between the ages of 20 and 30. It is imperative that parents and coaches are able to identify the signs and symptoms of a concussion in children. There are 22 of them:
- Headache - Nausea - Balance Problems - Dizziness - Fatigue - Sleep more than usual - Drowsiness - Sensitivity to Light - Sensitivity to Noise - Irritability - Sadness - Nervousness - Feeling more Emotional - Feeling slowed down - Feeling "foggy" - Difficulty Concentrating - Difficulty Remembering - Visual Problems - Getting confused - Clumsy - Answering questions more slowly.
Of course, John Boulay explains, it's important to understand how these symptoms compare to your child's baseline behavior. If your son or daughter normally gets headaches in a moving car, or has a habit of being a little clumsy, you would look for these signs to be worse than usual. So, you child gets tackled heavily, or is the recipient of some other form of head trauma on the field, and they exhibits any of these signs or symptoms for only a day or two, Boulay warns against shrugging it off and saying "Oh, they're fine. They can play again on Sunday."
Your job as a parent is to recognize these signs and symptoms of a concussion. If they abide within 15 minutes, don’t worry about it (they don't need to go to a hospital). But they’re still off for two weeks. Even if he’s fine after 15 minutes. We don’t know if it’s an evolving catastrophe or not. And we don’t know if those symptoms are going to pile onto each other. The new protocol is to have an asymptomatic week, and it is now "Return to Learn" before "Return to Play". "Return to Learn" is a return to cognitive function. (After one week) you have to be able to read, you have to be able to focus, you have to able to do homework assignments, and exams (symptom free). There’s another phenomenon, which is outside the concussion realm, it’s called “Second Impact Syndrome.” It’s not a bleed, because bleeds are what we usually die of. You don’t die from a concussion, except for this rare phenomenon. What happens is, when a child hits their head a second time while they still have symptoms, there is a great amount of swelling to the point where it’s pushing so hard it’s herniating the brain and causing extreme congestion….intracranial pressure. The second impact only happens if you play with symptoms.
IGNORING THE SYMPTOMS, OR HIDING THEM FROM PARENTS OR COACHES CAN BE FATAL
I’ve been a therapist at judo camp for 22 years. In my 22 years we’ve had 2 deaths—a 14-year-old and a 16-year-old—exactly for the reason I’m talking about. Not a second impact, but rather going back and not being monitored. The 16-year-old in Manitoba hit his head, told his parents, but never told the coach. He went back, hit his head again two days later and died. An epidural bleed. The second one, in Alma, Quebec in 1997, hit his head, told his parents, but never told the coach. He went back. He didn’t hit his head again, he just started jogging to warm up for judo, and the clot dislodged and he died. In those two cases, if they had been withheld, they would have been alive. So that’s why we only know after a week. It used to be, since 2001, a six to seven day layoff. As of last year, more literature is coming, it’s changing all the time. It’s now two weeks for anyone under 25-years-old. One week "Return to Learn" before "Return to Play."
If the symptoms continue to worsen within the first fifteen minutes, or the child vomits three times within the first twenty-four hours, he or she should be taken to the hospital. Otherwise, they can be kept at home, and monitored. But, even how parents should monitor their child has evolved. No more waking them up every hour or two overnight.
At the time of injury, you take the signs and symptoms. If they’re okay 2 or 3 hours later, they’re probably okay to go to bed. Two hours later you go and see that they’re okay, that they’re not seizing, that they don’t have one eye open. Or, if they’re awake, you’ll know why they don’t feel well the next day; because they didn’t sleep well all night. For now, you leave them be, you go and check on them in two hours, and then you go and check on them in four hours. Then 24, 48, and 72 hours. It takes six or seven days to find the evolution. What you want is to see the symptoms (improving). If they’re not doing well, then you have to get yourself to a concussion clinic.
BUT WHAT ABOUT PARENTS WHO SAY, "BUT LOOK AT HIM, HE'S FINE!"
There’s two things. If he has active symptoms, he could dislodge a clot; he could recommence a bleed. So you can have an acute evolving catastrophe. Or you’re adding more sub-concussive hits to an already accumulating problem. After they’ve had two or three in a row, it doesn’t take much; the threshold decreases. The next hit they have, instead of having a little concussion, they’re going to have a big one, and this can throw a kid’s life out of whack for weeks, for months, for years.
DO HELMETS PREVENT CONCUSSIONS?
Helmets can help reduce the impact, but there is no helmet that will help reduce the incidents of a concussions. You can still get skull fractures, too. If you're skiing at 30 km/h and hit a tree (with a helmet), you’re going to get a concussion. Maybe it helps with a reduction, but is won’t prevent it 100%. With the mechanisms of injury, you don’t have to hit your helmet; you can hit your chin, you can fall on your buttocks. It’s the brain hitting against the inside of its cell.
John mentions a frightening statistic: two out of three concussions are not properly diagnosed and treated. Which means those children are returning to play before their brains have healed. It's one thing to be your child's cheerleader, it's another to push them past the point of what is safe and logical.
Listen, concussions happen. We’re not going to put the kids in a padded room. Play rugby, and football, and all that. But, play by the rules. And the rules are: you cross the line, you’re out. You have concussion signs? You’re out for two weeks. It’s only 2 weeks! It’s only a game. Especially elite athletes. Why are they going to school? You want to leave with a degree, right? You want to leave with more intelligence than you came in with. It is not worth it. I’ve worked at the professional and the Olympic level. I will pull my kid out. It’s an Olympic Games? I don’t care. People will look at me, “You can’t. This is so important.” I’m the advocate for the kid, I should protect the kid; I should be sued if I don’t do that. Parents should be even more careful than I am.
During the first part of my conversation with Dr. Sally Spencer-Thomas, psychologist and CEO & co-founder of the Carson J. Spencer Foundation (CarsonJSpencer.org), we discussed the support systems fail men who are at risk of taking their own lives. One of the many reasons these victims of often undiagnosed mental illness continue to suffer is because they fail to feel a connection with available resources. They are worried that if they call a 1-800 number provided to them through work (if they're lucky enough to have an employer who provides one) they will be met with the same skepticism they encounter when they discuss their feelings of frustration, fatigue, and anger with their social circle.
Dr. Spencer-Thomas and her organisation have taken the unusual step of surveying members of high-risk categories (working-age males in high-stress jobs who suffer from an undiagnosed mental illness) about what they feel is lacking from conventional treatment options.
We asked a number of men that we considered double jeopardy men - men with a number of risk factors who were not going to seek care on their own - what would work for them; what would reach them? What they told us they wanted was humor. There was certainly evidence from some other campaigns that used humor to touch some of the social barriers around difficult topics. A number of men had told us that dark humor is the way we get around a lot of difficult things. We tried to strike a balance of how to make it fun, but not offending.
The foundation needed a vehicle which would be taken seriously. But they also needed a portal which was welcoming; one which users could share with friends who would understand the appeal of seeking help from this interface in the first place. Naturally, the challenge was to create a resource which could integrate humor into therapy offered for such distressing conditions as bi-polar disorder and depression. The Carson J. Spencer Foundation teamed up with the Colorado Department of Health & Environment and Cactus - an ad agency in Denver - to create ManTherapy.org
They created a character called Dr. Rich Mahogany. He is a man who talks about mental health in a way that our double-jeopardy men can relate to, and they pass it on to each other. It really takes the things that we know about mental health and translates them to a tone and a language and a format that can reach these men who can be very challenging to find and to benefit.
At ManTherapy.org's homepage, the actor portraying Dr. Mahogany brings an immediate grin to the face of any web-surfer. He is a robust character; that next-door-neighbor type who never misses a chance to yell "Good Morning!" to you in his boxer shorts as you hurriedly scramble to your car in the morning, while also being the kind of guy you could pass hours with sitting on your front porch. What is also notable on the homepage are the buttons which let you instantly - and anonymously - access the National Suicide Prevention Lifeline (1-800-273-8255) as well as the Veteran's Crisis Line. Rich will also guide you to information on "Gentlemental Health" and Man FAQ's about Depression, Anxiety, Anger & Rage, and Substance Abuse.
But Dr. Mahogany's real goal is to encourage men to dig a little deeper.
When you get to ManTherapy.org, Dr. Mahogany welcomes you in, and you can fill out an 18-point header section, which is based on actual standardized tools for screening depression, anger, and anxiety which quickly evaluates for the person taking it - how bad is it? Most of the people who access the online tool are people who need help in that moment but a lot of the time it’s the people surrounding them who are worried about them, and we also encourage them to take this training tool.
Even the questionnaire is created with humor. The header above the first question "Tell Me About Your Sleep Habits" reads: "Did you know koalas sleep eighteen hours a day? Lazy Bastards." Who wouldn't want to move on the next question?
Once the eighteen multiple-choice questions have been answered (it took me less than ten minutes), Dr. Mahogany gives you a quick oral evaluation - speaking to you directly. The screen then reveals an official piece of paper (I know it is one, because it says "Official Piece of Paper" at the top) which can be printed. This contains a written evaluation as well as a percentage score in several key categories. It also immediately provides links for support (there is also a free search function to access a therapist near you). The idea is, Dr. Spencer-Thomas explained, that people will print this report and use it as a tool if they decide to seek help from an outside source. The site has been a tremendous success, but it has also highlighted how great the need is for support of this type.
We’ve had almost 500,000 people visit the website. The average time spent on the site is 6 minutes, which is an eternity. Our organization has been doing quite a bit of work with the first responder community and fire fighters and law enforcement. Obviously they’re not all men, but the vast majority are men. They have been asking “Can we have a fire service version of this, or a police version of this?” Also, with the veterans' community, they’re looking for more of a warrior angle, because soldiers have specific needs. So we are looking for additional funding which will target those specific populations. When we did our evaluations after the first 18 months, we asked people "What would you change? What is your favorite thing?" They said “We want more. Can you make one for gay men? Can you make one for women?” And we answer them by saying "Sure! Can you help us find some funding?"
Where healthcare is concerned, financing is always a challenge. However, specifically when talking about the challenges of dealing with mental health, stigma may still be the greatest obstacle. Too often people who suffer from depression or bi-polar disorder are left to wrestle their own demons and turn to self-medication through drugs or alcohol. Dr. Rich Mahogany is a welcome resource with a patient ear and an encouraging voice. One can only hope he can become an example for the individuals, families and friends of those who feel they have nowhere to turn.
