Career/Job Advice

Job Searching and Mental Health

If you are so very fortunate that your personal experiences of looking for work have been short-lived until you landed your job, you probably won’t be able to identify with the frustration people feel when in a prolonged job search. “What’s the big deal? Just keep trying and get working!”

Oh if only it were that simple. There are two basic realities of a job search for anyone; the things you can control and the things you can’t. The real key to understanding why some feel job searching is easy and others find it so intensely stressful still ultimately comes down to the above two realities, but the things one can and cannot control vary from person to person. This variance between people is often at the crux of extending or withholding sympathy and empathy for those in long drawn-out searches.

Such things one can’t control are the number of jobs employers need filled, the application process, and the length of the application process. So let’s say we agreed on those three things to start with. We can’t make employers hire more people, whether an employer has us apply in-person, on-line etc. nor their choice to conduct one or a series of interviews prior to making a hiring decision. Fair enough.

Beyond this, are there other things we cannot control in a job search? For some the answer is yes and for others it’s no. And this variance, this difference of opinion, is where some experience anxiety, frustration and immense pressure while others do not. Consequently those who feel a person should be able to have control over every thing else will have little patience dealing with people who claim to have little control over other factors.

We all handle challenges differently do we not? Take for example being rejected for a job one really wanted. We all might feel let down, disappointed and frustrated. Why is though that this period of time is brief for some and extremely long for others? If some of us can snap out of it, roll up our sleeves and look for other positions to apply to, surely we all have that capacity don’t we? So isn’t it just a question of willpower and attitude? Perhaps and perhaps not. Are there some other factors beyond attitude and willpower (things we can control) which we are not acknowledging?

What about say, mental illness? Surely mental illness is not something one can control as for example ones attitude. Mental illness is not something that is readily identifiable by those we meet nor in fact sometimes by those actually experiencing it. Suppose you awoke one morning with a rash on your arm. You could look at it and say, “Gee I appear to have a rash on my arm. I best get that looked at.” Others you met would say, “I see you have a rash on your arm, here let me help you. Have you had that looked at?”

Now suppose however you awoke one morning feeling down, lethargic and had a prevailing feeling of sadness for reasons that were not immediately clear. Would you look in the mirror and say, “Gee it appears I’ve got abnormal anxiety and depression this morning, I should book an appointment with a Mental Health Counsellor.” And when you met others would they say, “Ah, I see you’re depressed and having some crippling mental health issues beyond your ability to cope with. Have you had that looked at?” Doubtful.

The one thing that is true of two people who are looking for work; one of which has a mental health issue and the other who does not, is that both are coping to control what they can, but with different degrees of success based on what we can observe. So while both may get the email indicating they’ve been rejected in favour of someone else, the one can within a day bounce back and re-focus. The other may appear to wallow in sadness, miss appointments for job search help, even perhaps look to have given in and given up altogether.

It is you see something they have lost the ability to cope with for a period of time the way they once might have done. What was once abnormal has become their new normal. If you are close to this person, you might be profoundly affected by their change. Monitoring the change in someone’s mental health isn’t like keeping an eye on that rash. Where we are qualified to put on some ointment, bathe and cleanse a rash, we are not qualified or even know where to begin to help someone deal with their adversely changing mental health.

And in dealing with person who has a mental health challenge, it might be easier for us to ask them to just snap out of it, tough it out, deal with it, get over it – get back in other words to being the person they were before when we were comfortable with them and knew how to help them. It’s how we deal with our own fears in wanting to help and not knowing how.

A little empathy, kindness, patience and understanding is what is needed. Get a medical check up if you’re out of work and pay attention to changes you might be experiencing. Living with someone you suspect is experiencing some mental health changes? See your own doctor and get helpful suggestions and community referrals.

by Kelly Mitchell

*Re-posted with permission from: https://myjobadvice.wordpress.com/2015/01/12/job-searching-and-mental-health/

Aging/Gerontology, Book Review, Social Work/Helping Profession/Mental Health

Recovering from Genocidal Trauma: Book Review and Author Interview

Recovering from Genocidal Trauma: 

An Information and Practice Guide for Working with Holocaust Survivors

Myra Giberovitch, MSW, PSW

Book Review and Interview

While the book focuses primarily on Holocaust Survivors, it can be used and associated with other individuals who experienced genocide or mass atrocity crimes. Mass atrocity crimes include genocide, crimes against humanity, and war crimes. Acts include: murder, extermination, enslavement, deportation or forcible transfer, imprisonment, torture, rape, prostitution, or persecution based on gender, religion, race or culture. If we fast forward to modern times, examples of this would be Rwanda, Darfur, and the current situation in Syria and Iraq.

Holocaust Survivors lived through what many term as one of the ‘darkest times in history.’  They have much to share with and teach current, and future generations. Although many suffer from post traumatic symptoms such as anxiety, depression, sleep disturbances, recurring traumatic memories, and a variety of health conditions; these co-exist with their strengths, adaptive coping abilities, and perseverance to rebuild their lives after the war. They settled in new countries, learned new languages, trades and professions, started new families, and built new Jewish communities.

Holocaust survivors have much in common with current survivors of mass atrocity crimes. They were not greeted well or received with ‘open arms’ when they immigrated to new countries and communities after the war. Instead they were greeted with denial, non-acceptance, ignorance, indifference, avoidance, silence, and suspicion about their experiences. Most people did not want to listen to their stories and experiences or did not believe what they heard.

And yet, in spite of this rejection, survivors turned to each other for support and action. They created a host of new organizations and contributed to the cultural, educational, religious, and institutional development of the Jewish community. They institutionalized Holocaust education and remembrance and committed themselves to fight racism and social injustice.

Today, many survivor families consist of four generations – older adults, adult children, grandchildren, and great-grandchildren. The author points out that recovery is a lifelong process. Intrusive memories, guilt, sadness, and longing for family and friends who were killed prevail, at the same time that  holidays, life events, and accomplishments are celebrated.

This book is an informative and much-needed resource and guide for practitioners, medical professionals, spiritual leaders, community leaders, and students. The author documents her strengths-based approach that stresses listening to and learning from Holocaust survivors. She draws upon current research and practice literature from social work, sociology, medicine, neuroscience, and gerontology that have helped her to develop innovative service models and programs, and apply practical techniques, and individual and group interventions to empower survivors as they recover from tragedy and adversity.

The author writes about her own family history which provides a foundation for this book. Both of her parents are Holocaust Survivors and she was born after the war in a displaced persons camp in Germany. The offspring of Holocaust survivors experience first-hand their parents’ traumatic memories through their upbringing. While some parents shared their war experiences, others did not.

Such a horrible event in history should never happen again and yet genocide and mass atrocity crimes are still committed today. Has the world not learned? Remembrance is important along with leaving a legacy for future generations through books, video testimonies, movies, documentaries, poetry, art, and discussions, and interactions with youth. In so doing, the world and future generations will learn about events that happened more than 70 years ago.

What inspired you to write this book?

I was encouraged by requests from colleagues, students, and survivors to document my professional, volunteer, and personal experiences with Holocaust survivors and their families. They helped me realize that many service providers lack knowledge about survivors’ history and diversity, their psychosocial functioning, the impact of aging on traumatic memory, and specialized survivor-assistance resources. In my research, I found books and articles about the Holocaust, the theory and pathology of severe trauma, the psychosocial effects of such experiences, and clinical treatment of associated symptoms; but not much information about survivors’ adaptation and resilience, or programs focused on recovery.

I wanted to fill this information gap by writing a practice guide for communities, health care providers, survivors, academics, and students. I also wanted to broaden the perception of survivors that moves beyond pathology by discussing their adaptive coping abilities and achievements that co-exist with their physical and psychological vulnerabilities.

How can a book written about Holocaust Survivors be applicable to other individuals or groups of people who have lived through war, mass atrocity crimes, and other traumatic experiences?

This book is intended to reach a diverse audience from a variety of backgrounds using the experience of Holocaust survivors as an example. The practice philosophy, service models, and the programs and interventions can be replicated and adapted to survivors of other mass atrocities. Topics include:

  • A partial listing of mass atrocities committed during the past hundred years.
  • Part V summarizes major milestones that Holocaust survivors accomplished on their journey towards recovery that are applicable to other survivor populations. I also share my thoughts about creating a national resource to assist survivors of mass atrocities.
  • The discussion in this book follows a strengths-based framework when interacting with survivors and describes in detail, along with case examples, the specific skills and programs required to put this framework into action. This approach focuses on listening and learning from survivors, discovering their needs, recognizing their strengths, involving them in program creation, and encouraging them to participate in providing services and helping each other.
  • The impact of prolonged victimization and interventions such as empathic listening to modulate intense feelings and enhance well-being.
  • Environmental factors that reduce the impact of trauma.
  • A detailed description of specialized community-based services such as individual and group services that include a long-term group trauma recovery model.
  • Clinical interventions and therapeutic responses to survivors who encounter common issues, triggers, and emotional reactions.
  • Eclectic therapeutic modalities, including interventions ranging from complementary and alternative medicine (CAM) to techniques to help survivors achieve peace of mind.
  • Activities that bring meaning and purpose such as intergenerational programming.

Unfortunately, genocide and war did not end with the Holocaust. Mass murders continue to take place around the world. Those of us who work with Holocaust survivors have learned how to respond to individuals traumatized and displaced by war. This book transfers a legacy of knowledge and experience we’ve learned in working with Holocaust survivors to survivors of other mass atrocities. To these communities I want to put forth a message of hope – that recovery is possible.

Which chapter(s) in the book provide(s) a good foundation of information for an individual who has lived through/survived a traumatic event(s)?

I receive excellent feedback from survivors. Some tell me that reading this book has helped them to better understand themselves, especially the psychological impact of their traumatic experiences (chapter 5), the association between aging and traumatic memory (chapter 7), situations that may trigger memories of their persecution (chapter 14) and common issues unique to survivors such as impact of the past, bereavement and loss, significance of family, and religious faith (chapter 7).

Survivors tell me that this book makes them feel validated and understood. Some are buying copies for their children in the hopes of being better understood by them. One survivor thanked me for “understanding the soul of the survivor.”

Who is this book written for?

The intended audience for this book is: health-care and social service providers, survivors of mass atrocity, including their families, and communities, the academic community, including students, government agencies and policy makers, and others who want to understand this population and their special needs.

Parts I and II are intended for all readers and create a background and context for understanding the survivor population. Parts III and IV can be used by practitioners as a stand alone manual or guide for service delivery so that they can easily access this information and apply the interventions or replicate the programs. Part III discusses different services and programs for survivor populations along with suggestions on how to create them. Part IV identifies interventions used by professionals to respond to specific situations.

This book responds to both practitioner and student requests for a field guide written by an experienced practitioner who is also knowledgeable about the theory of social work practice. Frequently, students tell me that their studies over-emphasize theoretical research and lack practical applications such the development of service models, examples of clinical practice, specific interventions that focus on the helping relationship, and self-care techniques. I believe this book is well suited to university students who are training to become practitioners in the field and want to relate their academic studies to the practical world. For academic objectives, the book includes references to the literature for further study.

I want to thank Myra for agreeing to a book review and for answering the interview questions. Too soon, future generations will have to rely on books, video testimonies, documentaries, and movies to learn about the Holocaust. The chance or opportunity to speak to and learn from a Holocaust survivor lessens each day as they continue to age and become frailer. Older survivors are in their late 80’s and early 90’s. Child survivors are in their 70’s and early 80’s. This book is all encompassing and provides a solid foundation for practitioners, students, and anyone interested in learning about the Holocaust while at the same time providing information, techniques, and resources that can be used to assist others who have been subjected to or witnessed violence, trauma, war, and genocide.

By Victoria Brewster, MSW

*First posted on: http://www.socialjusticesolutions.org/2014/10/03/recovering-genocidal-trauma-book-review-author-interview/

 

Social Work/Helping Profession/Mental Health, Youth

Bullying and Mental Health

Teen bullying: why does it sometimes feel as if nothing is being done? Why are there so many teens being teased by their peers? Have things changed so much since I was in high school that the youth of today is under so much more stress, anxiety, and emotional pain? The youth of today is experiencing life much differently than a generation ago. Technology, social media, economics, family dynamics (more divorced, separated or blended families) and the educational demands (standardized testing, academic achievements) of schools today seem to place a huge load on kids. At the same time, this fast paced life of technology is occurring, kids and teenagers have access to an online world where individuals post every detail about their lives. Facebook, cell phones/texting have taken over the typical face to face interactions. Much easier to tease, make fun of, and bully an individual online than in person. More needs to be done both by parents/families, communities and schools re:  appropriate online postings for Facebook along with more support offered to deal with the fallout of bullying and potential mental health symptoms.

The Globe and Mail had an article on Mental Health and Bullying. It focuses on a school district in Eastern Ontario-Upper Canada School District- implementing a solution: Peer Mentoring which links grade 12 students who are trained to mentor every incoming grade 9 student. Besides mentoring, the initiative is an anti-bullying program called Link Crew founded by the U.S. Boomerang Project.

“The Boomerang Project is a company dedicated to both educators and students; our goal is to help create schools that not only teach students, but reach them as well. Whether it be through high school or middle school orientation and transition programs, student to student mentoring programs, an incredible teacher training, a powerful in-service, a dynamic speaker, or providing useful resources. Link Crew is a high school orientation and transition program that increases freshman success and Link Crew schools report having greater student connection, increased extracurricular participation, fewer discipline issues and improved academic performance.”

Peer to peer mentoring makes sense. Who does a 9th grader want to talk to about potential bullying and emotional upsets: an adult or a fellow student who may have gone through something similar? This does not take away the importance of a student speaking to the appropriate adult or professional if the needs go beyond what a peer can assist with.

Social and emotional needs must be addressed. Considering that students spend 5 days a week in the educational environment for at least 6 hours a day-it makes sense that these needs are addressed at school and can even become part of the curriculum.

I hope to see more school districts implement anti-bullying and peer-to-peer mentoring programs. What are you thoughts?

By: Victoria Brewster, MSW

*First posted at: http://www.socialjusticesolutions.org/2013/06/14/mental-health-and-bullying/

News, Social Work/Helping Profession/Mental Health

DSM-5 Changes: A Continuation

I continue to come across articles and information regarding the soon to be released DSM-5. Reading this link will provide quite a bit of information on the upcoming changes to the DSM. I have to wonder if our society is becoming too focused on a diagnosis and pharmacare.

“After the American Psychiatric Association (APA) approved the latest version of its diagnostic bible, the DSM-5, psychiatrist Allen Frances, the former chair of the DSM-IV task force and current professor emeritus at Duke, announced, “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry.”

That statement alone says it all especially coming from a psychiatrist.

Get ready to hear about a new mental illness diagnosis for kids: ‘disruptive mood dysregulation disorder‘ (DMDD)… Frances concludes DMDD “will turn temper tantrums into a mental disorder.”…

“What constitutes binge eating disorder? Frances reports, “Excessive eating 12 times in three months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM-5 has instead turned it into a psychiatric illness called binge eating disorder.”

The DSM-5 also brings us “minor neurocognitive disorder” — the everyday forgetting characteristic of old age. Francis states, ”Since there is no effective treatment for this ‘condition’ (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia.”

“First time substance abusers will be lumped in definitionally with hard core addicts despite their very different treatment needs and prognosis and the stigma this will cause.” DSM-5 also introduces us to the concept of “behavioral addictions,” which Frances points out “eventually can spread to make a mental disorder of everything we like to do a lot.”  And Frances adds that “DSM-5 obscures the already fuzzy boundary between generalized anxiety disorder and the worries of everyday.”

What about grief and bereavement which are also re-categorized in the upcoming DSM? Normal human grief, which I covered in another write-up here on SJS becomes yet another diagnosis: “In removing the ‘bereavement exclusion’, the DSM-5 encourages clinicians to diagnose major depression in persons with normal symptoms of bereavement after only 2 weeks of mild depressive symptoms.” Grief usually runs its course within 2-6 months and typically does not require treatment with medications. In addition:

The proposal by the DSM-5 Neurodevelopmental Work Group recommends a new category called autism spectrum disorder which would incorporate several previously separate diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified. The proposal asserts that symptoms of these four disorders represent a continuum from mild to severe, rather than a simple yes or no diagnosis to a specific disorder. The proposed diagnostic criteria for autism spectrum disorder specify a range of severity as well as describe the individual’s overall developmental status–in social communication and other relevant cognitive and motor behaviors.

Much of what I have read from parents and professionals is concern that the new definition of autism in the DSM-5 will exclude many people from both a diagnosis and state/provincial services that depend on a diagnosis.

The DSM has been looked at over the years, changes made by dropping diagnoses and creating new ones, but to what benefit? Studies that have been done over the years have caused some embarrassment regarding the DSM. For example, Read further about the 1973 study. In the study Eight pseudopatients were sent to 12 hospitals, all pretending to have this complaint of hearing empty and hollow voices with no clear content. All were able to fool staff and get hospitalized.

The 1980 DSM-III was dramatically changed to include concrete behavioral checklists and formal rules to solve the diagnostic reliability problem, hmmm…did it work?

I have the DSM-IV at a cost of $95 in 1995, and used it in graduate school and then professionally for 1 1/2 years with children. I had to choose a diagnosis for the insurance companies to pay for the therapy and treatment that was being provided and it had to be a diagnosis that the insurance company agreed with. I am not a fan of labeling people, especially children, as the diagnosis follows them around for many years if not their entire life. A label does not define a person, but unfortunately many become their label.

Should we focus more on treating the symptoms and less on the diagnosis? Are there alternatives to pharmacare? What changes can be made in the classroom or work setting to assist the person best? Have many of these diagnoses been created for insurance reimbursement purposes, especially when considering the new ones? Are everyday life choices and events being turned into a diagnosis?

The suggested price for the new DSM-5 is $199.00 U.S.! That is one expensive book.

Written by Victoria Brewster, MSW

*First published at: http://www.socialjusticesolutions.org/2013/02/17/dsm-5-changes-a-continuation/

Social Work/Helping Profession/Mental Health

System Malfunction: Mental Health Issues

Mental Health is an area that certainly needs improvements along with properly trained professionals. These professionals whether nurses, social workers, physicians or administrative staff  need regular skill upgrades provided by their employer, of their own choice/initiative or as required through the state, province or the profession itself.

Below is an example of what should not happen when an individual who has a history of depression goes off their medications of their own doing, exhibits behavior that causes one to pause and asks for help to make changes to this downward spiral.

A patient goes to his physician and shares that he has stopped taking his lithium and Paxil, admits to having returned to the habit of drinking one or two six-packs daily and more on weekends, stopped going to work and was fired. This man has no energy or ambition, is not sleeping well and recently had gotten angry with a neighbor and tried choking him. When asked him if he had other times when he considered doing things that might harm others, he said he had been driving around with his loaded gun, feeling very angry and wondering if he would feel better if he shot somebody, and whether it would be better to shoot somebody he knew or a stranger. Are these not warning signs that something serious is going on here! That little red flag should be in each of our minds with this information.

The man and the physician talk briefly about the fact that the medicines might have stopped working because of the alcohol, but that he was now dangerously depressed, and that the options were to go directly to the crisis unit for admission or, if he refused, I would call the police. He readily agreed to admission. “That’s why I’m here doc. I need help before it’s too late.”

His wife drove him straight to Crisis in the hospital across town, where he was evaluated. They called and told me the decision had been made to admit him.

Now, without relaying more information-what are your thoughts? What do you think will happen once he is at the hospital? Will he be admitted, sent way with a prescription or kept for observation until the morning? Which professional will make this decision and what is the reaction  of the physician who convinced the patient to go to the hospital?

Below are excerpts

He had been seen and evaluated by the nurse practitioner on call, was felt to be seriously depressed and “at major risk for harming himself or others.” It was late in the day, there was no bed available on the psych floor, and the psychiatrist had left for the day. The man was kept overnight in the emergency room for admission in the morning. During that time, he underwent the standard and metabolic screening and physical exam by the emergency room physician whose note confirmed the patient’s description of events.

Early Saturday morning he was visited in the ER by an intake worker. She reviewed the chart and spoke to someone on the psych floor, after explaining he did not need inpatient care. The man was discharged home with (written) instructions to see his primary physician to restart his medications. He was also told to call for an outpatient counseling appointment.

The phone call was made and he was told that the counseling sessions were booking into the fall and he would be put on a waiting list. If services were needed sooner, he should contact his primary physician or return to the Crisis Unit in the ER.

This is the unfortunate reality today. Not enough Mental Health workers to provide needed services, untrained staff, wait lists, budget cuts and it is the individuals suffering from mental health issues that are left to their own devices and every country has been witness to the types of tragedies that occur because of the above.

It took another 5 days before this man was admitted to the psychiatry floor of a local hospital, friends and family stepping in to provide assistance and a caring physician. What about those without friends or family? Those without a family or primary physician?  What about those individuals who do not seek help and do not recognize that their life is taking a downward spiral?

No country can afford to continue along its current path of reducing services or having untrained professionals. Mental Health issues are increasing not decreasing!  Has the world not learned from all the recent shootings?

Any individual who tells a professional or goes to a hospital or clinic seeking help because there is admitted risk of hurting/harming self or someone else, needs to be admitted for observation and placed in a safe environment. No bed in psychiatry? Place them in another bed, keep them in the ER, contact the physician who helped with the original admittance. DO NOT send the person home.

Written by Victoria Brewster, MSW

*First posted at: http://www.socialjusticesolutions.org/2013/02/15/mistakes-that-are-occurring-for-those-with-mental-health-issues-by-the-system/#comments

Social Work/Helping Profession/Mental Health

Seeing Past the Mask

In our professional and personal lives it is important to see past the ‘mask’ of another. The outside of a person can be a veneer in a sense that requires one to look further to see the individual within.

As you chip away at the ice,
You begin to see the object that is hidden within.

The beauty is hidden inside,
And as the ice melts,
The dazzling lights shine through.

Orange, green, yellow and blue.
The colors blind your eyes,
For their lights are intense.

As the ice melts further,
Even more beauty emerges.

As the cold increases,
The beauty within the ice is shut off.
For lights emerge only when the heat is there,
But the coldness creeps in more often than not
and the beauty is hidden once more.

This poem which I wrote many years ago describes the process of getting to know someone, whether friend, colleague, client or acquaintance. The journey of developing a relationship requires one to look beneath the outer skin or ‘mask’ of an individual. It requires people skills. It requires patience, a dance in a sense of asking questions, answering questions, being compassionate and empathic humans. One cannot take everything at face value. The ability to recognize and reflect is important as well, especially body language and non-verbal cues.

Written by Victoria Brewster, MSW

*First posted at: http://www.socialjusticesolutions.org/2013/02/12/seeing-past-the-mask/

Grief/Grieving/Bereavement, News, Social Work/Helping Profession/Mental Health

DSM-5: Bereavement and Depression

by Victoria Brewster, MSW

Thanks to LinkedIn, I came across an article on Grief/Bereavement and Depression in the NY Times. As a professional with an MSW, this article causes me to pause and to express concern. Grief/Bereavement is normal after the death of a loved one. As one who works with older adults, I have experienced the reality for many older adults, after a certain age it is more likely, that one is faced with death on a regular basis.

Depression has been underdiagnosed in older adults. When one’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? The DSM-IV clearly distinguishes between normal and expected grief after loss from the more persistent and severe symptoms of clinical depression.

Grief usually runs its course within 2-6 months and typically does not require treatment with medications. Those suffering from grief report symptoms that are also symptoms of major depression; sadness, tearfulness, insomnia and decreased appetite. But, researchers have noted, grief rarely produces the symptoms of depression, such as low self-esteem or feelings of worthlessness.

“Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.” – Eric Widera, Geriatrician

The 5th edition of the DSM , which is due out this year, would characterize bereavement as a depressive disorder.

In removing the ‘bereavement exclusion’, the DSM-5 encourages clinicians to diagnose major depression in persons with normal symptoms of bereavement after only 2 weeks of mild depressive symptoms.

This gives me the feeling that depression may become overdiagnosed and anti-depressants overprescribed for what should be ‘normal’ grief. What are your thoughts on this?

*First posted at: http://www.socialjusticesolutions.org/2013/01/25/dsm-v-bereavement-and-depression/