Tuesday, June 30, 2015

Racism, Discrimination, and Microaggressions: Effects on Mental Health

We know from extensive research that racism can cause significant harmful effects to the victim’s physical and mental health. In 2006, the American Psychiatric Association (APA) established a formal position against racism and discrimination, which partly states that the APA “recognizes that racism and racial discrimination adversely affect mental health by diminishing the victim’s self-image, confidence and optimal mental functioning…. APA believes that attempts should be made to eliminate racism and racial discrimination by fostering a respectful appreciation of multiculturalism and diversity.”

However, racism—prejudice or discrimination directed against someone of a different race based on a belief that one’s own race is superior—is not a mental disorder (it is not included in APA’s diagnostic manual*).
Racism may not appear in the form of clear and obvious acts, it may be in the form of less obvious, “every day” racism.  These acts, termed “microaggressions,” by psychiatrist Chester Pierce, M.D. in 1970, are subtle, often automatic, and nonverbal exchanges with negative overtones. Originally the concept referred to put-downs of blacks by whites in the post-Civil Rights era, but it has since evolved to include people with many differences.  
These subtle and even unintentional acts, can none-the-less be harmful. The effects of this on children are especially pronounced. Victims of racism often display signs of physical and emotional stress. Some victims even start behaving in self-destructive ways that conform to the negative stereotypes they are facing.
Even perceived discrimination can affect health and mental health in several ways, according to an analysis of more than 130 medical studies.** For example, the stress of ongoing perceived discrimination can lead to an increase in unhealthy behaviors, such as smoking or drinking, and decrease in healthy behaviors, such as exercising and healthy eating. If a person has a sense of hopelessness, and low self-esteem, they may be more likely to engage in risky behaviors.  
So how can people protect themselves?  Research suggests several ways to help protect yourself, including having a supportive network of friends and family you can talk to about problems; taking action to address a situation of discrimination, rather than ignoring or avoiding it; and having strong ties to the group(s) with which you identify.
We can all be more mindful of the existence and impact of even subtle and unintentional racism and racial discrimination in the lives of patients and their families and in their everyday practice.
Read more on the Microaggressions Project blog which provides many examples of everyday microaggressions from people across the country.

By Ranna Parekh, M.D.
Director, Division of Diversity and Health Equity\
American Psychiatric Association
*American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.) 2013. Washington, DC:  Author.
**Pascoe EA, Richman LS. (2009). Perceived Discrimination and Health:  A Meta-Analytic Review. Pscyhol Bull; 135(4):531-554.

Friday, June 12, 2015

Nutrition and Mental Health: Dr. Ramsey’s 5 Rules for Eating for Happiness

Dr. Drew Ramsey
A growing body of research is confirming the relationship between a good, quality diet and better mental health outcomes. Poor diet (generally defined as greater consumption of saturated fats and refined and processed foods and lower consumption of fruits, vegetables, fish and nutrient-dense foods) has been associated with depression, anxiety and ADHD. A recent review of studies focused on children and adolescents found a consistent trend in the relationship between a healthy diet and better mental health.(1)

So how do you go about improving your diet and your mental health without overly complicated or restrictive regimes? Drew Ramsey, M.D., psychiatrist, assistant clinical professor of psychiatry at Columbia University, and author, has identified a simple set of 5 rules to eat for happiness—advice he gives to patients and others who want to simplify meal choices and maximize brain health.

1. Skip the processed foods. Processed foods are filled with empty calories; whole grains, lentils, nuts, leafy greens, and seafood contain brain-healthy nutrients.

2. Don’t fear fats. “Good fats,” omega-3 fats DHA and EPA found in whole foods like fish, , dairy products and pasture-raised eggs, are great for your brain. Trans fats, however, are among the unhealthiest substances and are still found in many packaged baked goods.

3. Mind your meat. While a plant-based diet is important, the right meat is an important source of protein, zinc and vitamin B12. “Grass-fed” or “pasture-raised” beef and chicken and “farm fresh” eggs are more nutritionally beneficial.

4. Go organic. Organic choices, increasingly available at most supermarkets, avoid the potential risks of insecticides and pesticides. And summer is great time to check out your local farmers’ market.

5. Make friends with farmers. Shopping at your local farmers’ market can give you added motivation to stay away from a pre-packaged processed-food diet. Getting to know the people who grow your food also offers you the opportunity to gain a better understanding of what you’re eating.

As Dr. Ramsey notes: “The goal is not to become a food snob, but to make that vital connection between your fork and your feelings and choose foods that support your emotional well-being and enhance your sense of vitality.”

Follow Dr. Ramsey @DrewRamseyMD.

By Deborah Cohen, senior writer, American Psychiatric Association

(1) O’Neil A, Quirk S, Housden S, et al. 2014. Relationship between Diet and Mental Health in Children and Adolescents: A Systematic Review. American Journal of Public Health, 104:10, e31-41. www.ncbi.nlm.nih.gov/pmc/articles/PMC4167107/

Friday, June 5, 2015

From Secrets and Shame to an Authentic Self: How Caitlyn Jenner Could Reduce Stigma for Transgender People

When Caitlyn (formerly Bruce) Jenner revealed her new identity as a transgender woman this week, it sparked many news articles and conversations about what it means to be transgender.

“For many people, it is difficult to understand how you can feel like a different person in your own body,” said Marshall Forstein, M.D., chair of the American Psychiatric Association’s LGBT Caucus, Associate Professor of Psychiatry at Harvard Medical School and Director of Adult Psychiatry Residency Training at the Cambridge Health Alliance. 

As celebrities like Jenner and Laverne Cox share their personal stories, they help reduce the stigma around being transgender, Forstein said. “The more that people get to know people who are living their authentic lives, the easier it is to understand.”

“I think any time there’s a sudden revelation of secrets there are different ways people metabolize that information,” said Forstein said. “Some people will say: ‘Wow, how brave.’ Others will doubt that someone could know they are transgender from such an early age.” Although research on transgender is limited, evidence shows that changes in the brain may occur even before people are born—leading to a disconnect between their outward appearance and how they feel.

Despite the limited research on transgender individuals, Forstein said: “One of the things we know is that, by and large, people who do transition begin to feel happier about this consistency of the internal and external experience.”

While many people who are transgender experience anxiety and depression, Forstein said that this is usually a result of keeping their authentic identity hidden: “It’s the pressure of stigma and shame from being other than what society wants you to be.” As defined by the DSM-5, gender dysphoria ends once an individual has transitioned to their authentic gender. “Put yourself in a situation where you’re not allowed to be you—like when left-handed children were forced to write with their right hands—what would that do to your mental health?”

As Jenner shared with more than a million Twitter followers on Monday: “I'm so happy after such a long struggle to be living my true self. Welcome to the world Caitlyn. Can’t wait for you to get to know her/me.”

By Amanda Davis, Deputy Director of Corporate Communications and Public Affairs, APA

Wednesday, June 3, 2015

Reducing the Stigma of Addiction

Nora Volkow, MD, Director, NIDA
Addiction is common – an estimated 1 in 11 people in the United States experiences a substance use disorder in a given year. Despite significant advances in understanding and treatment, stigma still prevents many people from seeking help.
Nora Volkow, M.D., director of the National Institute on Drug Abuse, speaking recently at the APA’s Annual Meeting in Toronto, talked about some of the recent advances in the understanding of addiction and called on psychiatrists to help reduce the stigma of addiction and “help to eliminate the shame and suffering that accompany the addict who experiences relapse after relapse after relapse.”
Volkow opened her speech with a moving and emotional story of how she learned of her grandfather’s alcoholism and suicide. He had died when she was a girl of 6 in Mexico, but Volkow’s mother did not reveal the truth of her grandfather’s addiction and death until many years later, when her mother was dying and after Volkow had already achieved distinction as an addiction expert.
It was a dramatic illustration of the despair experienced by people who have an addiction and continue to engage in a behavior that they may know is destroying them. She described how it was once believed that addiction was a disorder of hyperactive reward centers in the brain—that people with addiction s sought out drugs or alcohol because they were especially sensitive to the pleasure-inducing effects of dopamine.
But Volkow explained that in recent years research has revealed just the opposite: that those with addiction are actually less sensitive to the effects of dopamine. They seek out drugs because of the very potency with which they can increase dopamine in the brain, often at the expense of other pleasurable natural stimulants that do not increase dopamine so dramatically
Moreover, she emphasized that addiction to drugs disrupts multiple systems in the brain that govern the ability to plan, anticipate, and change behavior in response to changing circumstances. Volkow said it is this phenomenon that accounts for the “craving” experienced by addicts and alcoholics in response to environmental triggers—often leading to what she characterized in the account of her grandfather’s death as that “one last moment of self-hatred.”

Adapted from Psychiatric News