The Grey Dog

I was once a moody child; I’m still a moody child… sorry, adult. Anyway, I’m also a bit sensitive about the topic. It’s as if being moody means being naughty, or maybe contrary. Not quite right in the head, or something -not well adjusted, at any rate. I take exception to that. I mean, just because I often have trouble mixing with people at parties who only want to make small talk -usually about other people- and then walk away shouldn’t disqualify me from church or anything… Okay, I don’t go to church, but you see what I’m driving at, I hope. Moods are kind of baroque frames around my happiness. They make even run-of-the-mill joy look like ecstasy.

I’m not advocating ignoring the more severe and persistent forms of mood -they may in fact herald something very important. I am saying that not all of us who are occasionally disgruntled, frustrated, or unhappy have some underlying pathology. And to label those occasions as bouts of depression is to dilute the word, mistake the condition, assume everything is the black dog.

I was therefore relieved to find someone who relates to that view:  https://theconversation.com/is-my-child-depressed-being-moody-isnt-a-mental-illness-92789

The author, Dr. Stanley Kutcher, Sun Life Financial Chair in Adolescent Mental Health, at Dalhousie University, Begins by noting that, ‘[…] if the media coverage is to be believed, we are drowning in a sea of mental illness that threatens to overwhelm post-secondary Institutions. […] The prevalence of mental illnesses (defined using clear diagnostic criteria) is not rising in this cohort.

‘Youth self-reports of negative emotions are increasing. But the self-report scales used in studies documenting this have not been calibrated for generational changes in language use. Nor have the results been validated using clear, clinically valid, diagnostic criteria applied by expert clinicians.

‘[…] The above noted self-reports do identify the ups and downs of everyday emotions, but these are not criteria for diagnosis of mental illness. So we can say that youth on campus may report feeling more negative emotions than previously, but this is not the same thing as saying that young people have more mental disorders than previously.’

He cites an interesting example of the lack of application of basic critical thinking and analysis: ‘In late 2017, the study “Mental ill-health among children of the new century: Trends across childhood with the focus on age 14” was published by the National Children’s Bureau in the United Kingdom.

‘This showed that self-reported negative emotions were present in about one quarter of this surveyed group, but this was interpreted as 25 percent of 14-year-old girls in the UK suffer from depression! The fact that parental reports identified about five per cent of this cohort as having significant mood problems was ignored by almost all commentators. This latter number is much more in keeping with known rates of depression in the population.’

I wonder if our expectations of normalcy are to blame. As Dr. Kutcher explains, ‘These concerns are not the result of substantial epidemic increases in the rates of mental illness. They arise, in some part, from poor mental health literacy and unrealistic expectations of the normal emotional states that life challenges elicit.’

He makes some interesting and important points, I think. ‘[…] First, the increased public perception that being well means only having positive feelings is taking over the social discourse on mental health. When the measure of health is simply feeling good, negative emotions become a marker of being unwell. […] Without addressing the life challenges and opportunities that negative emotions signal to us, we can’t develop resilience. Mental health is not a static concept wearing a big smile. There are good days and bad days, good weeks and bad weeks. We still have mental health even if we are having negative emotions.’

‘Second, the use of words originally developed to identify mental illnesses to describe normal negative emotional states has burgeoned. […] Further, the use of terms denoting illness, such as depression, to mean all negative emotions is even more confusing. Now, words like sadness, disappointment, disgruntlement, demoralization and unhappiness are all lumped together as depression.’

He feels that the continued and almost obsessive use of technologies like smart phones for communication-especially by the young- may limit their ability to express complex messages and ideas and hence increase the sense of isolation, of being misunderstood -or perhaps, of even being mislabelled. And since it is adults, by and large, in charge of the classifications, it’s almost a case of two solitudes, two Magisteria, staring at each other -neither the wiser. Neither the winner…

Interestingly, I think I caught a whiff of this while waiting for a bus the other day. Two quite young teenage girls were sitting on the only bench in the little shelter, both clutching their mobile phones like purses. Because the rest of the bench was filled with their back-packs and some school binders, I merely stood outside and leaned against the wooden frame.

“But what did he say, Kitty? Is he, like, mad at you or something?” This from a petite little girl with long, straight dark hair and a big red coat with only a pair of blue boots sticking out from the bottom.

Kitty shook her head and leaned back on the wall of advertising behind her. She also had dark hair, but short and messy. It fit rather well with a large, thick and ragged blue sweater, torn on at least one sleeve to show a thin arm underneath. Her jeans were also fashionably torn, but looking as new as her pink running shoes. “No… Not mad… Just, like, upset. He says I’m moody -and all because I don’t want to, like, talk with him and Mom at the dinner table. I mean, nobody, talks anyway.” She shrugged theatrically and leaned forward on the bench again.

Her friend sighed sympathetically. “Yeah, my mom keeps wanting me to… you know, like communicate with her, too. But I mean, ever since dad left, she’s always either on her phone, or has the TV on.”

Kitty, nodded. “Yeah well, like, my parents think I should see a counsellor at school… They think I’m depressed, eh?” Her friend’s expression tightened, but she stayed silent. “But my dad always has his phone on the table and, like, keeps glancing at the news on his apps or, like, he’s waiting for an important Email, or whatever. And my mom’s a realtor, remember, so she does the same.” Kitty glanced around the wall and saw a bus was coming. “That’s all they talk about, anyway, Jen.”

Jen was staring intently at the ground in front of her. “Well, I think my mom’s depressed, you know, but she won’t go see anybody about it.” She took a little stertorous breath. “She thinks she’s coping… But I think, like, she’s just escaping online and stuff…”

The bus pulled up, and Jen seemed on the verge of tears, so Kitty reached over and hugged her. “We have to be strong for them, you know, Jen…”

That’s all I heard before they quickly gathered their things and walked over to the bus, arm in arm. Kitty must have whispered something else to her, because they both started to giggle before they got on.

I don’t know if it’s the technology, but it did make me wonder whether we really have a handle on mental health yet.

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A Childless Motherhood

Well of course! Did we think there would be no consequences? Did we actually think we could get away with it? That there weren’t two sides to the story that we all needed to hear?

Sometimes I think we are so focused on our journey to right a wrong, that we wander off the path to those we hope to save. Things are too partitioned -a modern day rendition of the biblical Matthew 6:3 where the left hand does not know what the right hand is doing… Or, perhaps, is not doing.

If one side of a page seems to contain all the information I seek, I may miss what’s written on the back. I feel no need to turn it over. An article in the Conversation turned the page for me:

https://theconversation.com/losing-children-to-foster-care-endangers-mothers-lives-93618

The author, Elizabeth Wall-Wieler, a PhD student in Community Health Sciences at the University of Manitoba, writes that ‘Mothers whose children are placed in foster care are at much higher risk of dying young, particularly due to avoidable causes like suicide. When a child is placed in foster care, most of the resources are focused on the child, with little to no support for the mothers who are left behind.’

In retrospect, of  course, it seems obvious -the mother-child bond is not something easily missed, and whether or not we attribute it to physiological changes such as oxytocin levels in her blood, or less reductionist, atavistic mechanisms, it is a powerful thing, dismissed only at her -and our– peril.

The author was involved in two large studies, one of them published in the Canadian Journal of Psychiatry, which ‘[…] looked at suicide attempts and suicide completions among mothers whose children were placed in care.

‘In this study, we compared rates of suicide attempts and suicides between 1,872 mothers who had a child placed in care with sisters whose children were not placed in care. We found that the rate of suicide attempts was 2.82 times higher, and the rate of death by suicide was more than four times higher for mothers whose children were not in their custody. […] Mothers whose children are taken into care often have underlying health conditions, such as mental illness and substance use. In both studies, we took pre-existing health conditions into account, so that was not the reason for the higher mortality rates we found.’

And, the author feels, ‘Most legislation pertaining to child protection services indicates that families should be supported, but the guidelines around what is expected of the child welfare system when it comes to the biological mothers are not clear. The main role of social workers is to ensure that the child is doing well. Social workers are already so busy, so it is often hard for them to justify spending their limited time to help mothers resolve challenges and work with them to address their mental and physical health needs.’

Other studies have also addressed the issue of sending children to foster care: ‘A study in Sweden found that by age 18, more than 16 per cent of children who had been in foster care had lost at least one parent (compared to three per cent of children who had not been in foster care). By age 25, one in four former foster children had lost at least one parent (compared to one in 14 in the general population). This means that many children in foster care don’t get the chance to be reunited with their families.’

I thought that the whole idea of fostering a child was care and sustenance until a more permanent placement was achieved or, ideally, the birthparent was able to reassume custody. This is perhaps more likely if the child can be placed with members of the same family -grandmothers, aunts, etc.- but even then, if the mother does not receive adequate support and treatment for the condition that led to the apprehension of her child, the results are apt to be the same.

In Canada, it seems, the mothers most affected are those from the indigenous community -our First Nations. The Canadian Minister of Indigenous Services, Jane Philpott, addressed indigenous leaders about this issue at a two-day emergency meeting on Indigenous Child and Family Services in Ottawa in January, 2018. http://www.cbc.ca/radio/thecurrent/a-special-edition-of-the-current-for-january-25-2018-1.4503172/we-must-disrupt-the-foster-care-system-and-remove-perverse-incentives-says-minister-jane-philpott-1.4503253 ‘The care system is riddled with “perverse incentives”. Children are being apprehended for reasons ranging from poverty to the health and addiction issues faced by their parents. In some provinces, rules around housing mean that your children can be taken away if you don’t have enough windows. “Right now dollars flow into the child welfare system according to the number of kids that are apprehended.” […] If financial incentives were based on “how many children we were able to keep in homes, how well we were able to support families — then in fact there would be no financial reason why the numbers would escalate.”’

But it’s not too difficult to read something else into all of this, of course. Uncondoned behaviour -behaviour frequently associated with poverty or marginalization- is often penalized isn’t it? Sometimes it is as simple as avoiding the transgressing community, further marginalizing it, but increasingly it is intolerance. Refusal to address the underlying issues. Not even trying to understand.

I admit that it is a difficult journey, and the road that winds between the abused child and its troubled parent is fraught. To empathize with the mother when her conduct may have been so clearly unacceptable, is seen as anathema. And yet, an attempt to understand is not a plea for condonation, merely a search for a solution. Nobody should get away with family neglect -but nothing happens in a vacuum. And there are always unintended consequences, aren’t there? Even our best intentions miss something in retrospect -solve one problem, create another. Our focus is often far too narrow -helping one person misses the one standing beside her.

Perhaps it’s time for us to stand back. As Ms Wall-Wieler puts it, ‘Specific guidelines need to be put in place to make sure that mothers are supported when their child is taken into care. This would improve the chances of reunification. And, by virtue of being a human worthy of treatment with dignity, mothers deserve support, even if it does not directly relate to how she interacts with her child(ren).’

‘Of the good in you I can speak, but not of the evil.
For what is evil but good tortured by its own hunger and thirst?’
Kahlil Gibran

 

 

 

 

 

 

Whether ’tis Nobler in the Mind

I may have inadvertently stumbled upon something important. I may have found a boundary marker that potentially distinguishes New Age from Old Age. Of course, definitionally I could be way out of my league –New Age being construed as anything that happened after I left university- but considered as a panoply, I think it works, if only conceptually.

I happened upon an article in the CBC news app while scrolling through my phone, that struck me as interesting: http://www.cbc.ca/1.4302866 -perhaps because I had never thought about technology in those terms, and perhaps because I felt embarrassed that I had been caught doing just that.

The premise was that we seem to turn to various apps on our devices for problem solving of many sorts. Everything from comparing shopping prices to trends in fashion to the latest news. And, as we are increasingly discovering, these digital peregrinations revisit us in the form of directed advertisements hoping to cash in on our whimsical journeys. Nothing is thrown away in the digital world –even our whims are stored, categorized, and pragmatically redistributed. And if notions, then it seems a small step to include moods. Emotions –positive, or otherwise- should be equally trackable.

In fact, I learned that ‘Google announced it now offers mental-health screenings when users in the U.S. search for “depression” or “clinical depression” on their smartphones. Depending on what you type, the search engine will actually offer you a test. […] And Facebook is working on an artificial intelligence that could help detect people who are posting or talking about suicide or self-harm.’

Perhaps this is where I feel the shadow of a boundary issue. There seems little question that mood disorders transcend age and gender; what is more problematic, however, is whether there may be a generational divide in confiding those emotions digitally, or even believing that solace could lie therein. The problem is not so much in putting these issues in writing –diaries, and correspondence, after all, have long been a rich retrospective source for biographers. The difference, it seems to me though, is the intent of the disclosure –diaries have traditionally been personal, and usually, not meant as a way of communication, but rather a way of sorting out thoughts. Private thoughts. Letters, as well, were directed to particular individuals –often trusted confidants- and not meant for publication outside that circle. Have the older generation –Generation R, for example (Retirement, to attach a label)- been sufficiently swept up in the digital river, to feel comfortable in clinging to its flotsam like their children?

I’m certainly not gainsaying the efforts of the internet giants to expand into the mental health realm –it seems a natural progression, so perhaps this is a start… and yet it’s one thing to key in on various words like ‘depression’ and have the algorithm kick in with a screening test, but another to sift through the context to determine the appropriateness of offering the test. I suppose random screening like that may be helpful for some, but as Dr. John Torous, the co-director of the digital psychiatry program at Harvard Medical School and chair of the American Psychiatric Association’s workgroup on smartphone apps, observes, ‘”One of the trickiest things is that language is complex … and there’s a lot of different ways that people can phrase that they’re in distress or need help.”’ Amen to that.

Quite apart from translational difficulties and the more abstract and culturally-fraught issues with their changing metaphors and societal expectations, there are other language problems –even in the dominant language of whatever country: changing vocabularies, local argot, and misspellings, to name only a few.

To state that human culture is complex, is a trope, and to believe that artificial intelligence will be able to keep up with its multifaceted, ever-changing face, anytime soon is probably naïve. And, as the article points out, privacy –no matter the promises of the internet provider, or the app-producer- is another weak link in the chain. Quite apart from malicious hacking, or innocent and trusting confidence in the potential for help, ‘Our phones already collect a tremendous amount of personal data. They know where we are and who we’re speaking and texting with, as well as our voice, passwords, and internet browsing activities. “If on top of that, we’re using mental-health services through the phone, we may actually be giving up a lot more data than people realize,” Torous says. He also cautions that many of the mental-health services currently available in app stores aren’t protected under federal privacy laws [at least in the United States], so you’re not afforded the same privacy protections as when you talk to a doctor.’

In a very real –if mainly age-related- sense, I am relieved I did not grow up in the digital age. I am fortunate that Orwell’s prescient ‘1984’ was available, not as a quaint attempt at predicting the future, but as a warning about a creeping surveillance that seemed so malevolently unrealistic when it was written –it was first published in 1949, remember. And when I read it, the date was still sufficiently far in the future that it seemed more science fiction than predictive. Yet, as the years wore on, and society changed in unexpected ways, the horrors of the theme, for me at least, became more and more uncomfortable. More and more possible, despite the reassuring smoke blown in our eyes by those eager for progress, and mesmerized by the possibilities.

I mention this, not to suggest that I was unique in this discomfort –I was obviously not- nor to imply that what we are now experiencing is evil, or even threatening, but merely to explain the hesitation of many of those my age in accepting, unreservedly, the digitally-wrapped gifts so readily proffered. It is not a venue to which I would likely turn for health issues, or emotional sustenance.

For me, there is something more reassuring about an eye-to-eye encounter with another member of the same species, able to understand the vagaries of language, and compare the nuanced phrasing of my words with the expression on my face. Perhaps, I’ll change -perhaps I’ll have to- and yet… and yet I’d still feel better dealing with an entity –a person– able to experience the heart-ache and the thousand natural shocks that flesh is heir to. And yes, someone who has read and understood what Shakespeare meant.