On Friday, they announced a new initiative focusing on mental health treatment. The new effort will involve having academics train primary-care physicians to strengthen and better coordinate their mental health care.

It’s the right focus, because family doctors and general practitioners prescribe the majority of antidepressants in this country, and are often the first-line professional to see a patient who may have a mental health concern.

But then the director of Project ECHO, Sanjeev Arora, spoke.

According to Politico, this is what he said:

Primary-care providers “don’t have the expertise to make the right diagnoses” for mental disorders, said Sanjeev Arora, director of Project ECHO and professor at the UNM Health Sciences Center. “They see this enormous difficulty, but they don’t have access to any psychiatrists,¹ so they don’t know how to get that expertise.”

While it’s partially true that many physicians don’t have the “expertise” to make the right diagnosis, they actually do a pretty good job of at least recognizing mental health concerns. Throw in easy-to-use and -score screening measures, and physicians have a pretty good set of tools already. Some use them, but most don’t.

The first problem isn’t making even more tools and resources available to primary care physicians. The problem is getting them to use them regularly, and incorporate them into their ordinary practice.

The second problem is one of followup. If, by and large, physicians already are making the appropriate referrals to mental health professionals when they see their patient may benefit from specialized mental health treatment, who’s doing the followup?

Unfortunately, it’s usually not the physician’s office. Patients often don’t followup with mental health treatment referrals.² Unless that changes — someone is there to help a patient understand the benefits of getting care and treatment for their mental health concern and makes sure that they do — all the access to additional “expertise” isn’t going to help much.

So most physicians already have access to a multitude of quick screening tools that they can provide their patients. They also usually have access to a select list of trusted mental health professionals they refer to and trust, too.

What Project ECHO is essentially adding is a case conference — via videoconferencing — for physicians:

Primary-care doctors participating in the project will meet once a week with academic health specialists from UNM by video conference. The doctors will be able to discuss a range of issues that they’ve encountered from patients with complex mental health needs and draw from the academics’ expertise.

Which is a great idea, except for the use of academics instead of fellow clinicians.³ I assume they’re going to use academics who actually see real patients too, because otherwise this isn’t going to be very helpful in the long run. Researchers are really good at what they do — but usually dealing with the complexities and real world challenges of individuals isn’t among their expertise or usual skill-set.

I think it’s fantastic if a physician could have case conferences with mental health experts — which is something that, honestly, they should already be doing as a part of any modern, holistic, multi-disciplinary practice. The fact that many physicians (most?) don’t have a multi-disciplinary practice that incorporate and embrace mental health professionals is a shame — and where the real effort should be focused on expanding.

If Project ECHO can help physicians realize they should be doing this, then it’s a win-win for everyone.

Read more: New project addresses mental health care gap

Read more about Project ECHO: Project ECHO Launches National Institute to Spread Transformative Care Model; Embarks On Initiative With GE Foundation to Expand Mental Health Care Access

1. And last time I checked, a lot of different mental health professionals — not just psychiatrists — have expertise in diagnosing mental disorders. Psychologists, for instance, come to mind.
2. Ehrenreich MJ, Robinson CT, Glovinsky DB, Dixon LB, Medoff DR, Himelhoch SS. (2012). Medical inpatients’ adherence to outpatient psychiatric aftercare: a prospective study of patients evaluated by an inpatient consultation liaison psychiatry service. Int J Psychiatry Med., 44, 1-15.
3. Because most academics often don’t see patients — given that they’re, well, academics.

Oops.

10:50 a.m. Wrote a premature announcement on a website that I would not be blogging there anymore –which got me cut off from access to the blog.

Yikes!

12:00 p.m. Forgot my towel at the public pool. Had to air off using the hand and hair dryers.

Embarrassing.

5:30 p.m. Showed up at my daughter’s book group on time for once! The mom answers the door and tells me it’s next week.

Really?

That is an average beginning to most days.

I try not to keep track of all my mistakes, but they are like my kids’ shoes: impossible to miss. Just when I think I have entered a space safe of them (utility closet), there they are.

I wish I could say that twelve years of therapy have helped me to accept my errors, but, honestly, all those hours on the couch haven’t made a dent in the self-flagellation exercises that consume most afternoons after a good blooper.

The other day, after passing my quota of blunders, I reached for Alina Tugend’s book, “Better by Mistake,” to legitimize and justify and make sweet all my slipups. She says in her pages that despite the current cultural pressure to be an overachieving perfectionist, it’s good to mess up. Perfectionism isn’t all that, and sometimes you can learn more by focusing on your mistakes.

There’s this one study I love that found that those high in perfectionism did worse on a writing task than those lower in perfectionism when judged by college professors who were blind to the difference in participants.

Now mind you, there is a small chance that those college professors just sent their own “someone has died and I’m not telling you who” email to the campus and are trying to rationalize their own oopsies, but I doubt it.

James Joyce wrote, “Mistakes are the portals of discovery.”

Consider Oprah. She began her career about 40 miles from my home as an anchorwoman for the Baltimore news. She was demoted because she became too emotional when interviewing people. She would cry on camera. So the station gave Oprah her own talk show. To get rid of her.

Author Tara Gold rattles off more examples in her book, “Living Wabi Sabi” (a Japanese concept of imperfection):

Babe Ruth struck out twice as often as he hit home runs. Albert Einstein failed his college entrance exam; teachers described him as “mentally slow, and adrift in foolish dreams.” Agatha Christie couldn’t spell; she had to dictate her mysteries. A young Walt Disney was fired from his first media job for “lack of imagination.” Michael Jordon was cut from his high school basketball team.

Granted, sound bites like those always sound sweeter in retrospect. But who’s to say next week, I might be able to say to myself, “You know that towel that I forgot at the pool? Thank God it was left on my bedroom floor to soften a fall of my son as he launched his lacrosse ball at his sister.”

“The mass email? Turns out my co-worker and her family loved all the fruit baskets that were sent her way.”

Image by: www.semsamurai.com

Oops: Why Mistakes Aren’t Bad was originally published on Sanity Break at Everyday Health.

Specifically, Ruiz’s article was centered around the behavioral concept of resiliency. She provided medical research and testimony, as well as case study, that early formative experiences may produce structural adaptations to genes

Amazing, that early experiences can have such an impact on the developing physical brain. But what about later in life? Short of the eventual physical decline of aging in the brain structure, are there other experiences which significantly alter the actual organic brain?

Drink and drugs immediately come to mind… But these affect functioning ability, no?

Not much evidence existed until recently to support claims that receptors in the brain can be significantly physically altered from what they were at birth due to genetics.

But good evidence of late can be found by studying the methodology behind a treatment program for addicts — Suboxone prescription/maintenance.  Suboxone is a drug prescribed mainly to heroin addicts who have struggled to stay clean. It originated as a more viable alternative to methadone, which has worse side effects.

Suboxone, which combines buprenorphine with naloxone (Narcan), works in similar fashion to Antabuse (disulfiram) for alcoholism.  It is an “agonist” — once in the system, narcotics are rejected by the body and they are not even desired.

Why is this?  One of the best (and visually interesting) depictions of the normal vs. addicted brain is provided in accompanying literature to the drug Suboxone by Richard I. Gracer, M.D., whose clinic in California administers it:

Visualize a rectangular green meadow… mildly sloped with the left side being higher.  This represents the area of the brain in which narcotic receptors are found.  At left edge is a box the size of a hockey goal.  This is the endorphin factory from which a steady stream of low weight, slippery bowling balls (the endorphins) emerge. (Endorphins are natural compounds we all produce that act as the body’s own painkiller, and fill the same receptor sites that narcotics do.

There are bowling ball sized indentations in the meadow which are the sites of [the pain-killing] receptors.  We all need a significant percentage of these to be filled to be comfortable.  Since the balls are low in weight they do not cause their new indentations and because they are slippery they do not stay in place of the receptor holes for long before going off the right edge of the meadow.

There are sensors under the meadow, which measure the weight and number of balls and how many receptor holes are filled.  When there are a lot of balls the sensors slow down [ and vice versa].

Under normal circumstances of pain, there is an increase in endorphin production… If a narcotic is taken, a large quantity of much heavier balls are released which cover almost all of the receptor site holes.  Because they are so predominant and heavy, they stop endorphin production and the factory becomes dormant.  They also make new holes with their weight, which now have to be filled for the person to stay out of drug withdrawal.

If drug use persists, the factory is dismantled and can lose its ability to produce any natural endorphins.  It may take a very long time for it to regenerate and in some cases may never be able to function at its former level.

Addicts who end up taking suboxone are usually folks less likely to thrive in a 12-step support program.  Their will, their drive for self-help might be called into question.  But the research behind the effectiveness of suboxone treatment suggests otherwise.  The structural components of their brains, muted by long-term drug abuse, have been indelibly changed.

Our mental health is not a matter of simple nature vs. nurture — but instead nature and nurture, both, affecting our very brain chemistry.

Reference

Gracer, Richard I., M.D.  (2006). How Buprenorphine Works. San Ramon, Calif.: Gracer Medical Group.

But if we look a little more closely, we might see a flicker of self-doubt in the eyes of these fine folks. If we listen with a little extra care, we may sense a subtle lack of self-worth lurking beneath their surface. If we watch a little more attentively, we may see some effort behind their smiles and a waver in their confidence.

These are the people who are living their lives under the influence of powerful, invisible childhood emotional neglect (CEN).

The definition of childhood emotional neglect is simply this: A parent’s failure to respond enough to a child’s emotional needs. When a child grows up in a household where emotions are not validated, accepted, or responded to enough, he learns how to put his own emotions aside.

A child who grows up this way becomes an adult who doesn’t value, trust, or even know his own feelings. This child may grow into a fully functional, outwardly strong adult. But he will feel a deep sense inside of himself that something is missing; that something isn’t right.

He will feel that a most deeply personal, biological part of himself (his emotions) is invalid, or unacceptable, or missing. He will question his decisions. He will be confused by his own behavior and the behavior of others. He will struggle to feel connected to the people he loves the most, to fit in, to belong.

Yet, this emotionally neglected child, in adulthood, will be perplexed as to what is wrong with her, or why. Childhood emotional neglect is so subtle and unmemorable that she may have no awareness that anything was missing in her childhood.

So she will struggle in silence, put on a good face, and hide from herself and others that deep, painful feeling that something is just not right.

As a psychologist who has helped scores of people become aware of and conquer their CEN, I have tracked it through multiple generations within families. I see CEN as one of the most surreptitious, destructive influences upon the health and happiness of our society. Its invisibility not only increases its power, it also allows it to self-propagate stealthily from one generation to the next, to the next.

Emotionally neglected children grow up with a blind spot about emotions, their own as well as those of others. Through no fault of their own, when they become parents themselves, they’re not aware enough of the emotions of their own children, and they unwittingly raise their children to have the same blind spot. And so on and so on, through generation after generation.

So the world is full of people who always come through for others, who put their own needs aside. They paste those beaming smiles on their faces, put one foot in front of the other and soldier on, giving no hint of how they really feel.

My goal is to make people aware of this subtle but powerful force from their past. I want to make the term emotional neglect a household term. I want to help parents know how important it is to respond enough to their children’s emotional needs, and how to do so. I want to stop this insidious force from sapping people’s happiness and connection to others throughout their lives, and to stop the transfer of emotional neglect from one generation to another.

If you identify with the face of CEN, it is vital that you take it seriously. It is by dealing with our own legacy of childhood emotional neglect that we can not only heal ourselves, but also ensure that we do not pass it down to our own children.

To get more information about CEN and emotionally responsive parenting, visit www.emotionalneglect.com to take the Emotional Neglect Questionnaire and learn more about Dr. Webb’s book, Running on Empty: Overcome Your Childhood Emotional Neglect.

The article nicely brought a mental health issue with the potential to affect us all one step closer to the general public.  As well, though, it pointed toward something fascinating — that in terms of causalities of mental health and illness, there is “nature and nurture” and then there is something else.

“Nature” widely has been understood to be our genetics;  “nurture” our early life experiences.  Human behavior has been catchphrased as shaped by these two for centuries.

But then there is brain chemistry.  The genetics category, you say?  Not so fast. Apparently it can be altered by early formative experience.

Here’s the summary:

Scientists are just now beginning to understand how traumatic early-life experiences can alter how genes are expressed. A developing field of study,  known as epigenetics, examines how environmental factors like stress and parental attachment can turn genes regulating the brain’s stress response system on or off.

So writes Rebecca Ruiz, the author of this extensive article that offered much more than mere human interest element and peek into resiliency.  She is a NBC News contributor and reporter who was able to research her subjects (tragedy survivors and scientists both) and produce her findings with the support of a Rosalyn Carter Fellowship for Mental Health Journalism.

Ruiz states, “Emerging research on the biology of resilience” (that elusive ability to “bounce back” and move fluently through transition) “…suggests [that] a person’s ability to recover – or risk spiraling into depression” — depends not on the nature/nurture axis alone, but indeed “on an elusive combination of early life experiences, genetics and brain chemistry,” all.

This more than suggests brain chemistry is starting to be seen as a third spoke, mitigated by what our ancestors gave us but also what our early family life was like.  For example, the brain genetically predestined to be in a normal range of stress functioning might organically be newly molded, negatively, by the happenings under the roof of one’s family home.  Or vice-versa, a genetic proclivity toward mental illness within the actual brain structure might be structurally tempered by a nurturing home-life with adults who physically express love and model effective coping strategies toward stress.

The work of Dr. Tallie Z. Baram, a neurobiologist at University of California, Irvine, is presented in Ruiz’s article.

[Baram] has studied how resiliency or vulnerability is shaped in early life. She has found that consistent nurturing parental care in rodents silences a gene that activates a key part of the body’s stress response system. ‘If the gene is repressed, that lowers your gear or the rev, so you are less sensitive to stress and therefore less vulnerable to stress-related disorders,’ Baram said.

Ruiz’s reporting concludes, for now, that “[I]t’s not yet possible… to detect these changes in the brains of patients. Scientists at the National Institute of Mental Health are developing brain-imaging technologies to visualize the chemical markers that attach to genes, but there is not yet a practical biomarker or tool that could be used in a clinical setting.”  But research (and likely Ruiz’s continued scholarship and reportage) should provide hope for individuals looking for advancements in mental health.

Think early life experiences shaping brain chemistry is provocative?  Look for the second in this two-part series, dealing with brain chemistry as altered by later life experiences.

It also helps us confront hardships, and make beneficial changes in our lives. Self-compassion “allows us to engage our brain and body’s basic soothing system,” said Dennis Tirch, Ph.D, a psychologist and director of The Center for Mindfulness and Compassion Focused Therapy.

By supporting ourselves, we create “a secure base” to deal with challenges. “As a result, cultivating self-compassion can help us to have the motivation and the courage to engage in behavioral changes, leading us to live bigger lives, and move towards what matters to us.”

Unfortunately, many people — especially those with mental illness — can sometimes be particularly hard on themselves.

Tirch has found that clients who’ve had painful or critical relationships in their early lives have a tougher time supporting and being kind to themselves.

They also might “experience an inner voice that evokes shame or a sense of worthlessness.”

The stigma surrounding mental illness only feeds the inner critic. Individuals with mental illness often experience feelings of shame and inadequacy and believe their illness is somehow their fault, Marter said.

They may internalize the negative (and, unfortunately, common) myths about mental illness. As Marter said, “It’s hard to be self-compassionate when living in a culture that is not always informed or compassionate about mental illness.”

So how can you be kinder to yourself if it doesn’t exactly feel natural or automatic? You can learn.

“Fortunately, self-compassion can be trained and that process can be liberating,” said Tirch, also author The Compassionate-Mind Guide to Overcoming Anxiety. “Training the mind in compassion allows [people] to develop a supportive, helpful and empowering way of relating to themselves.”

Tirch helps his clients “use imagery, meditation, behavior change and thought exercises to cultivate their compassionate minds.” Here are several self-compassionate strategies to start you off.

1. Listen to kindness.

Tirch’s website offers excellent audio practices, which focus on meditation and imagery, to help people become more self-compassionate. Find the practices that resonate with you, and make them a habit.

Christopher Germer, Ph.D, a clinical psychologist who specializes in mindfulness- and acceptance-based treatment, has many free meditations on his website. You’ll also find meditations on Kristin Neff’s website. She’s the author of Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind and a self-compassion researcher.

(Neff shared her tips for self-compassion in this piece.)

2. Treat yourself like a loved one.

Marter suggested readers treat themselves like they would their child, best friend or someone else they love deeply (and unconditionally). In other words, “if you are saying things to yourself that you wouldn’t say to somebody else, you need to turn down the volume on your inner critic.”

3. See a therapist.

If you’re not already working with a therapist, seek professional help. Every mental illness is treatable. A mental health professional can help you cope effectively with your illness and learn to be more self-compassionate. Marter helps her clients zero in on their inner critic and quiet those self-destructive thoughts.

“Eventually, clients report hearing my voice throughout their day and then begin to internalize a more compassionate and positive inner dialogue.” She also helps them overcome their past, practice acceptance and stay in the present moment.

4. Get support from a 12-step program.

Marter works with many clients who are in recovery from substance or alcohol abuse. “They carry a tremendous amount of shame and self-blame around their addiction.” Twelve-step programs, she said, are helpful in “working towards acceptance, forgiveness and self-compassion.”

Learn more about Alcoholics Anonymous and Narcotics Anonymous.

5. Remember that mental illness is an illness.

If you have a mental illness, you might think it’s your fault, and you don’t deserve compassion. Or, if you’re struggling with depression, bipolar disorder, an eating disorder, ADHD or any other illness that sinks your sense of self (and supplies your inner critic), you might think you don’t deserve much of anything.

Marter regularly reminds her clients that mental illness has a “biomedical component.” It is not the result of poor choices, personality flaws or some weakness on your part. Thinking mental illness is your fault is like believing you’re to blame for having asthma, diabetes or cancer. The empowering part is that you can seek professional help and cultivate healthy habits. But your illness is not your fault.

If you have a low sense of self, it may be a symptom of your mental illness. This is another concern that therapy can help with.

6. Remember that everyone struggles.

Comparing yourself to others can fuel feelings of inadequacy, Marter said. But remember that everyone has challenges. Don’t compare your insides to another person’s outsides, she said.

“I believe we all have mental health issues at various points in our lives, whether it be anxiety, depression, self-esteem problems or difficulty managing stress. I believe this is a part of the human condition and that mental health issues are a normal response to a person’s nature and nurture.”

Self-compassion might not seem natural to you right now. Fortunately, it’s a skill you can practice. And with more and more practice, you can extend more and more kindness and support your way.

It seems so, according to a paper recently published in the journal Medical Hypotheses.

The paper is based on two major assumptions. One is that inward cognitive attention is the cause of all emotional suffering. And two is that emotional suffering can be overcome by simple acts of outward cognitive attention.

Evidence suggests that emotional distress — and all major psychiatric disorders — are associated with a state of excessive inward attention. And inward attention that is excessive in its intensity or duration could easily become pathological or troublesome.

In the context of this paper, the term “inward attention” is broadly defined as the state of cognitive attention where attention is directed toward internally generated information such as thoughts and emotions. Brooding, deep contemplation, and engaging in anxious thoughts all are examples of states of inward cognitive attention.

A state of inward attention makes the mind highly receptive to internally generated information and amplifies the subjective experience of thoughts and emotions. Thus, in a state of inward attention, anxious thoughts and emotions imprint deeply on the psyche and this leads to the reinforcement of the maladaptive neural processes in the brain. Hence, the tendency to excessively focus attention inward is the primary factor in the onset and maintenance of emotional distress and psychiatric disorders.

When we experience anxiety and worry, our mind engages in itself intensely. Our mind can also engage in itself when we are low in mood or simply idling away. During these moments of inward attention, our awareness of our surroundings is also reduced. What this means is that the more attentive we are to our thoughts and emotions, the less attentive we become to our surroundings.

Similarly, when we are more attentive to our surroundings, we become less attentive to our thoughts and emotions. What this means is that even a simple act of consciously looking at the surroundings is enough to make us less attentive to our thoughts and emotions. Starved of attention, our intrusive thoughts and emotions will recede and the underlying neural processes will slowly weaken over time.

Hence, emotional well-being can be achieved by training the mind to be less internally directed and more externally directed. A strategy of externally directed visual attention can be used to counteract the tendency of inward attention. Visual stimuli from the external world provide an easy and neutral reference frame to divert attention away from one’s internally generated information.

To implement this strategy, try to consciously “look at the external world” as often as possible. You do not have to go out of your house to do so. The words “external world” in this context simply refer to your field of view (in contrast to the inner world of your thoughts and emotions).

Simply look at anything — a computer screen or a face or anything else that is in your field of view and convenient to you. Doing this does not have to disrupt your other activities. For instance, in a situation where you are speaking to an audience, try to look at the external world consciously as you speak. You do not have to use any special effort or apply concentration while you consciously look at things. Merely looking at the outside world consciously is enough.

Repeat this practice as often as possible, especially during times of anxiety and emotional distress. Persistent practice will train your mind to be more attentive to your surroundings and less attentive to your thoughts and emotions.

Reference

Sebastian, R. (2013). “A novel technique of using externally directed visual attention to treat psychological illnesses.” Med Hypotheses, June:80(6):719-21 http://www.ncbi.nlm.nih.gov/pubmed/23490204

I envy those people who are certain of themselves. They have no doubts. “This is what I want. This is what I’m doing. This is what I believe. Don’t really care if you agree with me or not.”

Me. I have major doubts about all kinds of stuff. From whom to marry? (Knew I was making a mistake when I said “I do.” But I did.) To what to buy? (I spend way too much time returning stuff.)

When I finally do make a decision, does that end the turmoil?”

Mr. Indecisive continues:

“I wish it did. I’m forever second-guessing my decisions. Did I do the right thing? Maybe I should have done this instead of that. The incessant chatter in my head can drive me crazy. Well, not really crazy.

I’m not a nut job. But I guess you could say I’m neurotic. I read somewhere that the best definition of neurosis is that it’s a need that can never be satisfied. Like people who have a neurotic need for money. They can be billionaires, yet they never have enough. (Maybe that’s what’s wrong with the greedy one percent who won’t pay their fair share of taxes).

Well, I think I should stop jabbering away, Doc, and let you get a word in edgewise. Maybe you can help me become more decisive.”

Whew, I said. Let’s both take a few deep breaths before I say anything. Let’s just be here — you and me. Let me assure you that nothing you have described is horrendous. Yes, it’s irritating. Yes, it’s troublesome. Yes, it robs you of positive energy. But it’s not something horrible. And it’s not something that you can’t modify.

Now that you’ve taken a breather and stopped beating yourself up, let me tell you a few things that might lighten your load.

1. There are so many choices in the marketplace that we can feel tormented over whether we made the “right” or the “best” decision. From our travel decisions to our toothpaste decisions, we have choices. Lucky us. Sometimes we make a great choice. Other times, we don’t. But it’s rare — extremely rare (unless you’re on a self-destructive bender) — that any decision you make will have major negative consequences.
2. Looking for the “perfect” decision is a prescription for driving yourself crazy. Instead, look for a “good enough” decision vs. the absolute best one. But shouldn’t you always want the best? No, no no! Why not? Because if you always have the best, you’ll never appreciate it. Because if you demand the best, you’ll always second-guess yourself as to whether what you have is, indeed, the best. Because if you’re only satisfied with the best, you’ll spend way too much time and energy seeking that elusive goal.
3. Seek to make peace with the different parts of your brain. Your emotional part wants everything to be easy and enjoyable. Why not? You only live once – go for it! Then, the executive part of your brain (the part that’s concerned with long-term planning) chimes in and gums up the works. Let’s say you bought an expensive item and feel great about it. But then, you feel guilty that you spent so much money. Did you really need it? Was it worth it? Your brain is in a tug-of-war. Which part wins? Whichever wins, you’re going to feel uncomfortable with your decision unless both parts of your brain work cooperatively. So, strive to make your decisions acceptable to all of you, not just a part of you.
4. But aren’t there ever times that one should spend a lot of time pondering a decision, weighing what’s really best? Absolutely. But pick your battles. If it’s truly a significant decision, spend time reflecting on your choices. Get information. Speak to experts. Do your research. Just don’t confuse mundane decisions with meaningful decisions.

From the Newtown, Conn. tragedy in December 2012, to the Oscar-winning movie Silver Linings Playbook and all the way through the DSM-5 controversy this spring, mental illness has certainly been getting plenty of attention in the news.  

Spanning the horrific to the enlightening, from the uplifting to the nitty-gritty, these three cultural talking points alone have been reshaping America’s ongoing thinking about a frequently overlooked aspect of our general health.

Considered in itself (or in its partial absence, illness), mental health shapes the rest of our health. If one is off-balance emotionally — even temporarily — physical health can and usually does suffer.

A wise woman-friend once pointed out to me that disease stems from just that — “dis-ease,” essentially, in one’s way of being in the world. Thus impairment to behavioral ways of coping with stress or grief is intrinsically connected to bodily suffering.

That is why mental illness — and on the further end of the continuum, mental health and wellness — must be identified, understood together, and appropriately dealt with (not demonized).  Mental illness affects one-quarter of the population at any given time, according to statistics from the National Institute of Mental Health and multiple other sources.

Two decades ago, I worked as a vocational coordinator at a psychosocial rehab agency in Pittsburgh.  We served the needs of mental health consumers (as they were professionally referred to) — a good many of whom had recently been released from two psychiatric hospital  “catchman areas” (a fancy name for locational pinpoints).  Some with severe schizophrenia had come out of two nearby state hospitals as well, but many were simply individuals dealing with major depression or borderline personality disorder.

They were looking for community and assistance with housing, work and disability concerns.  Our agency provided all, in the form of a consumer baseball team, billiard table and other social gathering point essentials. It also provided particular help in transition housing, supported employment, disability applications and more.

I  was charged with finding what was termed “competitive employment,” meaningful work, for those who came through the agency and were capable of it. Mostly I engaged in advocacy. It lay at the root of the agency’s mission.

Before I could get someone from staffing at Carnegie Mellon University to hear me out on the talents of particular individuals, I had to be a master stigma fighter.  I learned fast and soon became passionate about it, for I saw myself and a larger society in the eyes of my consumers.

I was also fast learning (both on the job and off) that the absence of mental illness — that is, true mental health — must be striven for in order to achieve overall wellness and wholeness of body and life.  My hope, entwined with my great pleasure in writing for Psych Central, is that society catches on to these facts sooner than later.

There is one age group that often gets overlooked when it comes to depression and that’s the elderly.

In seniors especially, symptoms of depression are sometimes missed or confused with the effects of other illnesses or medication they may be using. Also, the typical symptoms of depression — such as fatigue, lack of appetite and loss of interest in previously loved activities — are often put down to the aging process and not depression. Studies on the number of elderly people experiencing depression varies, but it’s estimated 6.5 million of Americans over 65 are depressed.

Sadly, only about 10 percent of those people actually receive any help.

Seniors are especially vulnerable to other complications from depression. They are at higher risk of physical illnesses such as cardiac disease, which can lead to death from heart attack. It also makes it harder for them to recover from illness, which again puts an elderly person more at risk.

Suicide in the elderly also is a huge problem, especially for white men over 80; they are twice more likely to kill themselves than anyone else from a general population.

One of the main reasons depression isn’t always recognized in older people is because they tend to brush off, minimize, or deflect how they are feeling with comments such as “I’m OK, I’m just not sleeping too well. I’ll be fine after a good night’s sleep;” or “I’m not lonely, my dear. Don’t worry about me. How are the children?;” or “I’m fine, really. I’m just not very hungry at the moment. I think I’ve had a bug, but I’m OK now.”

These comments make it easy for friends, family, or doctors to miss what is really going on. I know this from personal experience, as my mother was a pro at this deception. She would have an appointment with her doctor, go in, put on her best face and leave as if nothing was wrong. When I’d ask her if she told her doctor about this issue or that symptom, she’d say, “Oh, no, I didn’t want to make a fuss.” Her thinking was that she had to look well for the doctor, and that was her learned behavior – never let anyone know you’re not doing well.

It’s hard to understand why somebody wouldn’t want to tell a doctor they’re suffering, but I remind myself that people in their 70s and 80s were born in the 1930s and 1940s — a time when people didn’t really talk about feelings. I think this is due to the devastation caused to families by the Great Depression and two world wars. It was easier to “just get on with it” than dwell on the emotional trauma of that time.

5 Ways You Can Help a Senior with Depression

From my experience, I know getting help for an elderly relative is difficult, but if you are concerned about someone and think their current behavior and mood is compromising their life, here are 5 things that might help.

1. Even though you’re concerned for them, it’s best not to let your anxiety manifest by getting angry at them or demanding that they seek help. Trying to force a person into seeing a doctor or therapist can have the opposite effect. You’re better off taking things slowly. Try engaging in calm conversation. Find out what they might be worried about or what might have changed in their life recently. Gather information which you can then use to highlight and clarify why it might be a good idea for them to get help.
2. When trying to talk to them about how they are feeling, try to avoid using words that might make them defensive. Words such as ‘depression,’ ‘struggling’ or ‘can’t cope’ can strike fear into their hearts. Barriers will most likely be raised and they’ll refuse to talk about it. You’re better off using words such as ‘sad,’ ‘blue,’ and ‘rough time.’ These words take the edge off what might be a scary subject.
3. Elderly people often will not want to make a fuss, so feelings of guilt and shame can be prevalent. Try to reassure them that you are not judging them for how they feel, and that you care about them. Help them understand that it’s their choice to get help and that you will do what you can to support them.
4. Supporting a depressed relative doesn’t mean that you take over and do everything for them. As much as you might want to help, doing too much can reinforce their thinking that they are now ‘useless and a burden.’ It is important to try to find a balance between helping them and having them help themselves. Together it can be useful to break down tasks into smaller activities. By doing smaller tasks, they are less likely to get tired and avoid doing what they need to. Doing less each day can mean doing more over the week.
5. Seeing a psychiatrist can be scary for anyone, let alone an elderly person who tries to avoid doctors. See if you can get their permission to be a part of the appointment process. This can be useful because often the scariness of the situation, and their limited cognitive functioning due to depression, can mean an elderly relative doesn’t say what has been going on for them. They could lack the ability to retain the information the psychiatrist is telling them.

It is safe to say the definition of honesty can mean a lot of different things for a lot of different people. Wikipedia defines honesty as “the human quality of communicating and acting truthfully and with fairness.” Merriam-Webster defines honesty as “a fairness and straightforwardness of conduct; adherence to the facts.” How do you define honesty and what does it mean to you?

I think it’s also safe to say that we all expect honesty from others. No one likes the feeling of being deceived or lied to. However, do we practice honesty in our day-to-day living?

There are definitely some benefits to being honest. For one, it keeps us out of trouble. When we are honest, we have nothing to hide, and with nothing to hide, there is nothing to be found.

Honesty also gives us credibility with others. If caught in a predicament, people are more likely to believe those of us who have been honest and forthcoming.

It also gives us a sense of freedom. If you’ve ever found yourself holding on to a lie, you know the feeling of freedom that comes when you are able to tell the truth. When we tell the truth we feel better mentally and physically. Our lies and secrets often can make us sick in many different ways. When we are honest, we have better and closer relationships with others. Our relationships become more meaningful because we have better communication and an overall better sense of trust.

If you find that you are not an honest person, or would like to strive to be more honest, have no fear. Being honest really is not that difficult.

First, we have to examine the things that keep us dishonest. These things often are negative feelings or emotions. Sometimes we avoid being honest due to fear of how others will respond. Other times it may be a result of embarrassment. Other times it may be a result of trying to avoid conflict with others or taking responsibility for an action. When we can examine why we are being dishonest, we can begin to deal with those feelings, process them, and move forward toward more honest living.

We also have to practice telling the truth without exaggeration. Sounds a little silly, but how many times have you heard someone with outstretched hands say, “I caught a fish this big,” when it was really a tiny brim? How many times have you or someone else exaggerated how many clients you saw, how bad traffic was, or how much you spent on an item? When we practice telling the truth without exaggeration, it not only forces us to become more honest. It also forces us to begin to examine why we would exaggerate such details to begin with.

Lastly, we should practice honesty in simple situations. For example, you are in the drive-thru at a local fast food restaurant. You pay for your food, but you get $2 extra in change. Two dollars is not a lot of money these days. Do you drive off or return the extra money?

Let’s say you’re at home and a visitor comes by unannounced. Do you pretend to be sick or not at home or do you state you just don’t feel like company?

If you said you’d return the money and be honest with your visitor, you’re thinking honestly. When it becomes easy for us to be dishonest in small situations, it becomes even easier to be dishonest in bigger ones. If we make it a daily habit to practice honesty in all that we do, we find it much easier to become honest people more often.

Aromatherapy can play a part in wellness, but its applications go way beyond the massage room at the spa. 

Some new takes on good smells — even some that you may recognize — follow below. And believe it or not, research backs up a lot of these findings.

For instance, dab a solid-gel flower scent (popularly sold by various makers) on your inner wrist. It can remind you of a behavioral habit you want to transform or bring you to a place of peace amid chaos of the coming day.

If you counsel or coach, bring scent into your office space with essential oil drops on the breeze of a blowing curtain. Lavender will help calm pets headed to the vet while showing guidance and a reassuring strength.

Essential oils (which are flowers, herbs and other organics) can be found at your local co-op, Whole Foods or from sites like auracacia.com. Read up on the details of the natural world’s variety, sensing the uniqueness of jasmine or basil, and how each might affect your emotional makeup.

Experiment, too, with bringing in not only cut flowers for vases, but floating blooms in bowls of water for a particular room.  Flowers given to others are known gifts; when bought or given to the self in myriad form, they can be even more valuable.

Rosemary is clarifying; it can awaken all your senses and be utilized for energy.  It would serve yoga and ritual work equally well. To invoke meditation, help breathing, and get centered, sandalwood and clove bud make a good pairing. The faintest bit in therapy should draw out communication.

To cheer (as well as detoxify), grapefruit is amazing. Nothing will open channels quite like the uplift of this scent. Motivation problems? Try not just any old orange, but tangerine.

Tangerine, peppermint and eucalyptus can help with the mental focus and discipline involved in attempting new behavioral strategy and employing new coping mechanisms. And apparently rose absolute and geranium in equal measures brings balance of spirit and feeling of harmony. Why forgo that?

Who knows just how the mind works? Brain studies on health and illness are just beginning to take off now with much-needed research. In addition to significant knowledge likely to be gained about brain matter, structure and genetics, scent may be found to play a role.

“Instead, it’s about elevating that conversation to a national level and bringing mental illness out of the shadows.”

Indeed. And while I’m preaching to the choir of voices who read this blog regularly, maybe through your social shares and Likes on Facebook, we can reach a few new people who might not know the secret of mental health — we all have it. And just like our physical health, it can sometimes go kablooey.

The day started out with a modest standing reception in the Entrance Hall of the White House. Over 150 people gathered together and mingled. Among many others, I met two great women from ReachOut.com, an innovative website targeted toward young adults and teens with mental health issues. Started in Australia back in 1998, Jack Heath took what worked in Australia over to the US in the mid-2000s. It’s a great website and resource for teens and young adults, and is worth checking out.

After coffee, juice and danish, we were ushered into the majestic East Room of the White House for Opening Remarks by President Obama (the transcript and video are here). It was an eloquent speech by the President, reaffirming the need to shine a spotlight on mental health on a nationwide scale.

It was followed by an interesting question-and-answer session moderated by Health and Human Services Secretary Kathleen Sebelius. It featured actress and founder of Bring Change 2 Mind, Glenn Close, head of the American Psychological Association, Norman Anderson, Active Minds’ speaker Janelle Montaño, former Senator and now head of the National Association of Broadcasters, Gordon Smith (who lost his son to suicide), and Barbara Van Dahlen, founder of Give an Hour.

We adjourned next door to the Eisenhower Executive Office Building’s South Court Auditorum (a stark contrast to the beauty of the East Room) for a few short talks (less than 10 minutes each, I’d say) from a handful of additional speakers, moderated by U.S. Secretary of Education, Arne Duncan. These speakers included David DeLuca with DoSomething.org, who was talked about a new service to be called Crisis Text Line, and Sara Critchfield, with Upworthy, a social media sharing site. There were others, too, but I don’t have space to note them all here.

We then broke out into networking sessions of about two dozen people per room. It appeared somewhat random who ended up with whom (I did have Patrick Kennedy in my group, a really great guy and excellent orator), but it was a chance to chat with other people more intimately about how we can work together more closely in the future. I met a few great folks from a number of organizations which we’ll be featuring in the weeks and months to come as we figure out how to best work together.

The day finished with a brief speech by Secretary of Veterans Affairs, Secretary Shinseki, another brief few words from actor Bradley Cooper (who recently played a character who had bipolar disorder in Silver Linings Playbook, and Vice President Biden, who spoke for nearly a half hour.

My Take-Away

As President Obama said, this is not the start of a conversation, but rather the continuation of a conversation on a heightened, national level. The Veterans Administration, for instance, has already hired 1,600 new mental health professionals since last August, to help meet the burgeoning demands of veterans’ mental health needs. And the President wants to hire another 5,000 mental health professionals hired to help young people better deal with their mental health needs in school.

These are very good starts.

But in the meantime, we still grapple with basic issues surrounding insurance and billing. The Affordable Care Act should make mental health care available to more Americans, but it remains to be seen whether it actually will or not because of discrepancies that still exist in parity.

I learned that sometimes it takes a President to get people from the same area — in this case, mental health — to sit down and talk to one another. As I remarked to Tracy Todd, Ph.D., Executive Director of the American Association for Marriage and Family Therapy, I find it astonishing that professionals — and their leaders — from different backgrounds — psychiatrists, psychologists, marriage and family therapists, social workers, psychiatric nurses, etc. — don’t have these conversations on their own. And of course, include patients, advocates, clients, survivors and more in those discussions as equal partners (as they always should be).

I’m glad President Obama demonstrated the courage and leadership to hold this conference — the first held at the White House in over 13 years. I suspect you’ll see a lot more collaborative projects and efforts arising from it in the months to come.

President Obama:  Thank you so much. Everybody please have a seat. Thank you so much. Welcome to the White House. Thank you Janelle for that introduction and sharing your story and making such a difference through your organization. We’re really proud to have you here. I want to thank Secretary Sebelius, Secretary Arnie Duncan, Secretary Eric Shinseki, for their leadership and helping organizing this event. I also want to acknowledge some outstanding members of congress who are here and who care deeply about this issue.

Finally, I want to thank all of you for participating in this National Conference on Mental Health. We wanted to bring together folks who suffered from mental illness, and families who supported them. We wanted to bring together advocates and educators, faith leaders, veterans, local officials.

All of you have shown an extraordinary commitment to what is a critical goal. That is, to make sure that people aren’t suffering in silence.

That we have the capacity to pull together all the resources and support and love that’s out there. To go after an extraordinary challenge in our society. The main goal of this conference is not to start a conversation. So many of you have spent decades waging long and lonely battles to be heard. Instead, it’s about elevating that conversation to a national level and bringing mental illness out of the shadows.

We want to let people living with mental health challenges know that they are not alone. We’ve got to be making sure that we’re committed to support those fellow Americans because struggling with a mental illness or caring for someone who does can be isolating. I think everybody here who has experienced the issue in one way or the other understands that. It begins to feel as if not only are you alone, but that you shouldn’t burden others with the challenge.

The darkness day in and day out‑‑ what some call a cloud that you just can’t seem to escape‑‑begins to close in. The truth is in any given year one in five adults experience mental illness. One in five. 45 million Americans suffer from things like depression or anxiety, schizophrenia or PTSD. Young people are affected at a similar rate. So we all know somebody, a family member, a friend, a neighbor, who has struggled or will struggle with mental health issues at some point in their lives.

Michelle and I have both known people who have battled severe depression over the years. People we love. Oftentimes those who seek treatment go on to lead happy, healthy, productive lives. We know that recovery is possible. We know help is available, and yet as a society we often think about mental health differently than other forms of health. You see commercials on TV about a whole array of physical health issues, some of them very personal.

[laughter]

And yet, we whisper about mental health issues and avoid asking too many questions. The brain’s a body part, too. We just know less about it. There should be no shame in discussing or seeking help for treatable illnesses that affect too many people that we love.

We’ve got to get rid of that embarrassment. We’ve got to get rid of that stigma. Too many Americans who struggle with mental health illnesses are still suffering in silence rather than seeking help. We need to see it that men and women who would never hesitate to go see a doctor if they had a broken arm or came down with the flu.

They have that same attitude when it comes to their mental health. We’ve seen veterans who come home from the battlefield with the invisible wounds of war. Who feel somehow that seeking treatment is a sign of weakness, when in fact, it’s a sign of strength. We see it in parents who would do anything for their kids, but they often fight their mental health battle alone, afraid that reaching out would somehow reflect badly on them.

We see it in the tragedies that we have the power to prevent. I want to be absolutely clear that the overwhelming majority of people who suffer from mental illnesses are not violent. They will never pose a threat to themselves or others and there are a lot of violent people with no diagnosable mental health issues. We also know that most of suicides each year involve someone with a mental health or substance abuse disorder.

In some cases when a condition goes untreated, it can lead to tragedy on a larger scale. We can do something about stories like these. In many cases treatment is available and effective. We can help people who suffer from a mental illness continue to be great colleagues, great friends, the people we love. We can take out some pain and give them a new sense of hope. But it requires all of us to act. There are a few ways we can do our part.

First, we’ve got to do a better job recognizing mental health issues in our children and make it easier for Americans of all ages to seek help. Today less than 40 percent of people with mental illness receive treatment. Less than 40 percent.

Even though three‑quarters of mental illnesses emerge by the age of 24. Only about half of children with mental health problems receive treatment. Now think about it, we wouldn’t accept it if only 40 percent of Americans with cancers got treatment. We wouldn’t accept it if only half of the young people with diabetes got help. Why should we accept it when it comes to mental health? It doesn’t make any sense.

The good news is there’s plenty of groups that are stepping up to change that. A former colleague of mine, Gordon Smith, former Republican Senator who lost his son to suicide 10 years ago. I remember him speaking so eloquently about it. Gordon is now the head of the National Association of Broadcasters and today, the National Association of Broadcasters is announcing a new campaign designed to change attitudes about mental illness through TV ads and social media. Because Gordon doesn’t want other parents to go through the agonizing loss that he’s endured. We thank you Gordon, for that great work.

[applause]

We’ve got secondary school principals who are holding assemblies on mental health. We’ve got organizations like the YMCA who are volunteering to train staff to recognize the signs of depression and other mental illnesses in our young people. We’ve got leaders from different faith communities who are getting their congregations involved. Dozens of other organizations have today made similar commitments.

We’re very thankful to all of you. There are other people who are leading by example. My great friend, Patrick Kennedy, when he was running for reelection back in 2006, he could have avoided talking about his struggles with bi‑polar disorder and addiction. Let’s face it, he’s a Kennedy.

[laughter]

His seat was pretty safe. Everybody loved him. And yet, Patrick used his experiences as a way to connect and to lift up these issues, not hide from them. One day a woman came up to Patrick at a senior center and told him she was afraid to tell her friends she was taking medication for a mental illness because she was worried they might treat her differently. She told Patrick, “You’re the only one who knows aside from my son.”

Patrick started realizing how much power there could be for people to speak out on these issues. Patrick carried these stories back with him to Washington where he worked with a bi‑partisan group of lawmakers including his dad to make sure the mental health services you get through your insurance plan at work are covered the same way that physical health services are. A huge victory.

[applause]

Because of Patrick’s efforts and those of colleagues who worked with him, it’s easier for millions of people to join him on the road to recovery. Which brings me to a second point. It’s not enough to help more Americans seek treatment, we also have to make sure the treatment is there when they’re ready to seek it. For years now our mental health system has struggled to serve people who depend on it. That’s why under the Affordable Care Act, we’re expanding mental health and substance abuse benefits for more than 60 million Americans. New health insurance.

[applause]

New health insurance plans are required to cover things like depression screenings for adults and behavioral assessments for children. Beginning next year insurance companies will no longer be able to deny anybody coverage because of a preexisting mental health condition.

[applause]

We’re also investing in science and basic research to make it easier to diagnose and treat disease early. Earlier this year, I announced an ambitious initiative to develop tools for mapping the human brain, which could help scientists and researchers unlock the answers to conditions that affect mental health. We’re also doing more to support our troops and our veterans who are suffering from things like traumatic brain injury or PTSD, Post Traumatic Stress Disorder.

Today. we lose 22 veterans a day to suicide. 22. We’ve got to do a better job than that of preventing these all too often silent tragedies. That’s why we’ve poured an enormous amount of resources into high quality care and better treatment for our troops. Today, under Eric Shinseki’s leadership the VA is going even further. They’re partnering with 24 communities in 9 states to help reduce wait times for veterans seeking mental health care.

They’ve met their goal of hiring 1,600 new mental health providers. Which means this summer, they’re going to hold more than 150 summits like this one in communities all across the country so that every one of our service members and veterans understand. Just like you take care of yourselves and each other on the battlefield, you have to do the same thing off the battlefield. That’s part of being strong. For many people who suffer from mental illness recovery can be challenging but what helps more than anything, what gives so many of our friends and loved ones strength, is the knowledge that you’re not alone.

You’re not alone. You’re surrounded by people who care about you and who will support you on the journey to get well. We’re here for you and that’s what this conference is about. That’s why these issues are so important. If there’s anybody out there who’s listening, if you’re struggling, seek help.

Man 1:  Thank you, Mr. President.

President Obama:  You’re welcome. [applause]

If you know somebody who is struggling, help them reach out. Remember the family members who shoulder their own burdens and needs our support as well. More than anything, let people who are suffering in silence know that recovery is possible. They are not alone. There is hope. There is possibility. That is what all of you represent with the extraordinary advocacy and work that you’ve already done.

Thank you all for being here. Let’s do everything we can to help our fellow Americans heal and thrive. Now I would like to turn it over to Secretary Sebelius, who will be leading our opening panel. Thank you very much everybody.

[applause]

Additional Information

White House blog entry on the conference

Vice President Biden, Veterans Affairs Secretary Eric Shinseki, and actor Bradley Cooper wrap up the end of the conference (Video, 38 mins)

Others are sympathetic at first, offering empathy and support. But it’s not long in our fast-paced society until people begin to lose patience with you. “Get over it already!” is their new message.

Not a bad idea, you think. But how do you do this? If you could get over it already, wouldn’t you have done it?

You’re right. Lots of people don’t know how to create closure after a hurtful blow. They don’t know how to move on. They don’t know how to let go. They don’t know how to bounce back from a psychic injury.

If this describes you, see if these guidelines might be helpful:

1. Wounds take time to heal. So, be gentle with yourself.If you find yourself being judgmental for what you did or didn’t do, take a deep breath. Let go of your judgments. Let yourself be.
2. You may want nothing more than to be left alone with your hurt and anger. Do that. But not for too long. Take a nap. But do not spend the day in bed.
3. Summon up the courage to start the day anew.Get out of bed. Let go of the anger. Be open to what a new day might bring.
4. Talk to someone who understands, not just what happened, but what the event means to you. If someone starts “Yes, Butting” your experience, that’s not the right person.
5. Life often is a harsh teacher. Be aware of what you’ve learnedfrom the hurtful experience — about yourself, about the other person, and about life itself.
6. If what you learned seems to be all negative (you can’t trust anyone, life stinks), think outside the box to find something positive. It may take time to realize what this might be.
7. Focus on what’s important to you now.What do you truly appreciate now? Despite the loss, despite the hurt, despite the disappointment, what’s still good about life?
8. Reflect on what you can do now. You can’t undo the past. But possibly, you can make this very next day a better day for you.

Creating closure doesn’t mean repressing your feelings. It doesn’t mean forgetting about what happened. It simply means that you put less emphasis on the past in order to create a future. You let today in. And tomorrow in. And next week in. And next year in. Then one day, you recognize that you have indeed “gotten over it.”