From the Jackson Hole News & Guide Column Sound Mind

Trauma has been a much talked about issue in the field of mental health over the past several years. Trauma has become an important part of understanding the impact of events on our development and daily functioning. While June is recognized as Post Traumatic Stress Disorder Awareness Month, this is a topic that most of us can relate to on some level, especially over the last year.

The relationship between psychological trauma and how it affects mental health, PTSD, or what it does to the brain and child development have been the focus of much research. National Institute of Health research shows that more than 70% of the general population has experienced at least one incident of trauma during their lifetime. Since then we have also dealt with a global pandemic; I am guessing that number may now be closer to 100%.

What exactly is psychological or emotional trauma? While there are varying definitions, simply put, psychological trauma can be described as damage to the psyche due to experiencing a traumatic event, a series of events or ongoing relentless stress. Not everyone will react to an event in the same way or at the same level. Some may carry long-term symptoms and others will not. Psychological or emotional trauma can elicit a variety of reactions, both physical and emotional.

Physical symptoms may include trouble sleeping or nightmares, fatigue, difficulties concentrating, being easily startled, agitation or anxiety, muscle tension, aches and pains, or a racing heartbeat.

Symptoms can be experienced for a few days to several months and can fade as the incident is processed. However, certain events or situations that remind you of the event may trigger a reaction even as time passes.

Research into brain function shows that trauma can affect your brain in several areas of functioning. This may cause ongoing dysregulation and the emotional and physical symptoms listed above. One level of functioning is survival instinct, or “flight, fight or freeze,” which releases cortisol into the system to prepare for danger.

On the recovery side would be the brain’s signal to relax, sleep and repair or return to a baseline. Our normal response is for the mind and body to communicate and regulate between these two. A traumatic situation can release chemicals to respond to a crisis but stress hormones (cortisol) may not return to normal after a traumatic event and decrease the effectiveness with other neurotransmitters to send messages.

This may create dysregulation between a message from your brain to your body in crisis response and returning to repair or relaxed state. When one area of the brain is under- or over-functioning it can affect the way you process information, think, sleep or wake and even your behavior. When you are operating in crisis mode there is less ability to learn, regulate or use logic or reasoning.

So now that we know a bit about what is going on, what do we do about it? To move on from psychological and emotional trauma you may have to experience feelings and memories that have been avoided. Trauma treatment may involve processing memories and emotions related to the trauma, regulating “fight, flight, freeze” energy, learning to regulate strong emotions, and building interpersonal skills and connections with others.

There are several common therapeutic approaches that may be helpful in treating emotional and psychological trauma. One such approach is Cognitive Behavioral Therapy. This is a common type of therapy that helps you become aware of your thoughts and feelings surrounding events and how they may be directing your behavior.

Another approach is Eye Movement Desensitization and Reprocessing, called EMDR, which incorporates elements of CBT with eye movements or other forms of bilateral stimulation (left/right brain) that help with reprocessing traumatic events.

Somatic Experiencing can be used to focus on the body and sensations rather than the thoughts, emotions or memories associated with trauma. This is used on the premise that the focus on the body will release the pent-up related energy.

Healing takes time, and each person moves through the process at her own pace. If you find that you are having trouble with daily functioning, experience severe or ongoing anxiety or fear, are having nightmares or flashbacks, feel disconnected or find yourself coping with drugs or alcohol, it may be time to seek help.

From the Jackson Hole News & Guide Column Sound Mind

Suicide is a difficult topic to talk about, but the fact remains that the numbers have been increasing nationwide over the past decade. Add to that this past year’s pandemic challenges — isolation, loneliness and issues with politics and social media — and we are seeing many people struggling at higher levels.

Suicides, usually fueled by underlying mental illness, are especially worrisome for the groups that are seeing the largest increases: adolescents and college students, veterans and older adults, as well as those in the highest-risk populations. Before the pandemic, more than 40,000 Americans died by suicide every year, making it the 10th leading cause of death in the nation.

Wyoming and other Western states tend to have numbers even higher than the national average. Suicide is the second leading cause of death in Wyoming for people ages 10 to 34, the Centers for Disease Control and Prevention says. The suicide rate in Wyoming tends to be one of the highest in the U.S., usually within the top three, along with Montana and Alaska. The statistics are heartbreaking for those lives lost, but also for all the people left behind. Teton County has seen fewer than other Wyoming counties for the past decade or so.

What can you do? There are several options for free training to help members of the community recognize and respond to someone who is struggling. The Jackson Hole Community Counseling Center’s Mental Health First Aid program is one. This eight-hour training covers a variety of mental health issues. Specific to suicide prevention are safeTalk and Question, Persuade and Refer, or QPR. These trainings give people the skills to recognize the warning signs of suicide, ask questions and provide resources for intervention. They are free to the public and can be set up for organizations or interested community members.

Small towns present more difficulties with talking about suicide. Many times people first reach out to loved ones, clergy, teachers or friends, who may worry about saying the wrong thing. How can we go about discussing the issue respectfully and responsibly?

First: Be direct when talking about suicide.

Do not be afraid to ask the question “Are you having thoughts of suicide?” One of the biggest misconceptions regarding suicide is that if you ask the question you may plant the idea. Actually, asking the question shows support and concern.

If someone is showing suicidal ideation, don’t dismiss or minimize the person’s comments (i.e., “It’s really not that bad”). Instead, face it head-on:

• Talk to the person about your concern. Ask if he or she has been thinking about attempting suicide or has a plan for how to do it. Having a plan indicates a higher risk of action.
• Seek help. Contact the individual’s doctor, mental health provider or other health care professional. Let other family members or close friends know what’s going on.
• Call a suicide or crisis hotline. 
• Make sure the person is safe. If possible, eliminate access to anything that could be used to attempt suicide. For example, remove or lock up firearms, other weapons and medications.
• Call 911 if the person is in danger of self-harm or suicide. Make sure someone stays with that person.

Education plays a crucial role for communities in preventing suicide and eliminating the stigma surrounding mental illnesses. Articles about suicide can educate readers about risk factors, warning signs and local resources for intervention.

In addition, there is much more to understand about why people choose suicide as an option.

Many families or loved ones blame themselves or feel judged by others. Education may provide interventions and understanding to not only minimize risk but also be respectful to the people affected by suicide. Those talking about suicide should be sensitive to tone, content and language. Responsible discussion should avoid judgment — intentional or implied — when reporting the full story and should also include education about suicide prevention.

Without a doubt, discussions about suicide should be happening throughout our community. At the same time there should be a focused approach to overall community-based mental health care to address the underlying mental illness issues and increase hope.

Several organizations and individuals are working as part of the Teton County Suicide Prevention Coalition on initiatives to provide information, support, counseling, training and prevention programs.

Call the Jackson Hole Community Counseling Center at 733-2046 or the Teton County Prevention Management Organization at 264-1536 for details or to get involved. Services are available and made affordable for our community either through Counseling Center and the Mental Health JH program.

From the Jackson Hole News & Guide Column Sound Mind

As the reality of COVID-19 hits us locally as well as spreads across the nation, many individuals are understandably experiencing increased anxiety and stress. Those who are already struggling with mental health issues may be triggered even more so.

The Centers for Disease Control and Prevention has put together “community mitigation strategies” to limit the spread of COVID-19, the disease caused by the coronavirus. They include suggestions for what we, as a community should be doing to slow the spread of the virus in order to avoid overwhelming the health care system.

This is called “social distancing,” a term that epidemiologists are using to describe a conscious effort to reduce close contact between people to slow exposure. It really should be viewed as physical distancing, as the goal is to keep at least 6 feet between you and other people.

One of the strategies is to cancel or limit large venues where crowds or groups people gather or even move to a higher-level “stay at home” order. Those are especially important for people who have a heightened risk of being more severely impacted by the virus.

These seem like extreme measures and can increase the feeling of anxiety and even lead some to panic. Keep in mind that for most people the virus is not life-threatening. Considering the preparedness efforts, it is important to keep things in perspective. Research shows that the most effective way to handle a pandemic is to take an aggressive approach and incorporate those distancing measures.

One thing that we do know, our daily lives are going to be deeply disrupted, for a while. No one knows for how long or entirely what to expect, leading to an increased general feeling of loss of control. It is important to manage stress and panic and move toward preparation and regulation.

So, what can we do to manage this increased stress and anxiety? Here are some ways:

Stay connected. That may sound difficult when we are trying to distance ourselves, but there are some creative ways to do it while continuing to be responsible. Use technology, phone contact and FaceTime to check in with friends and family. Pay special attention to those who are the most at risk and vulnerable, as they are likely to feel the most isolated and may not have many resources. Try to check in with someone else at least once a day.

Take care of you. Maintain your physical health by using precautions like washing your hands frequently, wearing a mask when out in public, wiping down surfaces, getting enough sleep, eating healthy, exercising, and monitoring any symptoms. Distancing does allow for walks outside, hikes and other activities that limit social interaction to one or two people with allowed distancing. Plan for any medication needs. Many insurance agencies are relaxing the requirements around timing and are allowing for 90-day supplies.

Keep informed, especially about what is going on locally. The St. John’s Health COVID-19 webpage, StJohns.health/coronavirus-info, and the JHCOVID.com site are updated frequently. They have information on where to go if you are experiencing symptoms, and resources for finding food, financial aid, and help for mental health stress. Ready.gov is also a great resource for all sorts of disaster preparedness guidelines.

Acknowledge your anxiety. Some anxiety is normal, but take notice if it is rising too high. In such a case you might consider taking a media break and doing something else for a while. Start a journal, or try doing a meditation, taking a walk or engaging in an activity. Practice mindfulness. MyStrength.com is a free, confidential and mobile-friendly resource for education and activities related to anxiety and other issues. It has a module specific to reducing stress and anxiety related to the coronavirus.

Stay home as much as possible, and limit close contact to those in your household. That said, get outside every day if you are able. You can still enjoy the spring weather. Just do it in a way that is safe and appropriate.

Give yourself a break. With everything that is going on — working remotely, dealing with kids at home, feeling anxiety about a new routine and the unknown — there is a lot to deal with. It is OK to let some things go and just do your best to make it through the day. Take that advice to the outside world as well, and try not to judge people on what is going on. You never know the struggles or stories of others.

Remember: We are all in this together and can get through it as a community. One of the things I love about Jackson Hole is the way we come together to help our neighbors. On that note, don’t forget to howl at 8 p.m. nightly to show appreciation for those front-line workers. Thank you to everyone who is coming together and working tirelessly to keep our community whole.

From the Jackson Hole News & Guide Column Sound Mind

Mental illness is a term that is frequently used in all types of conversations. It is being discussed as it relates to politics, funding and service area gaps, employment and homelessness, and it spans socioeconomics and all populations, youth to seniors. Yet there may be confusion about what it is everyone is talking about.

Webster’s Dictionary defines mental illness as “medical conditions (such as major depression, schizophrenia, obsessive compulsive disorder, or panic disorder) that are marked primarily by sufficient disorganization of personality, mind, or emotions to impair normal psychological functioning and cause marked distress or disability and that are typically associated with a disruption in normal thinking, feeling, mood, behavior, interpersonal interactions, or daily functioning.”

The reality is that mental illness is a broad continuum of diagnosis and severity. Awareness is increasing and perceptions are changing along one side of the spectrum. There appears to be more acceptance of depression, anxiety and trauma-related issues. However, judgment and misinformation tend to increase along the continuum regarding more serious problems such as bipolar disorder or schizophrenia and psychosis.

Some of the attention to the issue is being driven by mass shootings in the news, causing policymakers and the public to pair “mental illness” with violence and assign blame. Implying that the risk of violence comes from individuals with serious mental illness is not supported by evidence. Research indicates that people with a serious mental illness account for only 4% of violent events, according to the National Institute of Mental Health. National statistics also show that people with serious mental illnesses are over 10 times more likely to be the victim of a violent crime than the general population.

There is a difference between serious mental illness and severe emotional distress. Using the broad term can have a great impact on those who are dealing with a diagnosed mental illness such as depression or anxiety. It perpetuates an incorrect assumption that individuals with mental illness are dangerous. That can create a dynamic in which those who need treatment the most avoid it.

It is hard to imagine that a mentally healthy person might intentionally kill multiple strangers. It is true that mental illness may play a limited role in mass violence. The National Council on Behavioral Health notes in a report from August 2019 that there is evidence of a serious mental illness in roughly 60% of individuals who perpetrate mass violence.

It is also true that the common characteristics and environmental factors of perpetrators should be considered. Those that occur most often are male, history of childhood abuse, feelings of isolation and hopelessness, substance use and possibly the harboring of grievances related to work or school. They may also be having trouble with finances and interpersonal relationships, be involved in domestic violence, have a sense of being victimized and feel indifferent to life. They often die by suicide. However, correlation is not causation, and any one of these factors alone is not to blame.

Again, mental illness is a broad spectrum, and when fingers are pointed at an entire population, the attached shame becomes a barrier to seeking treatment and further marginalizes individuals who are already struggling.

Also, keep in mind that mental illness is common. One in 5 individuals struggles with some sort of mental health problem, and 4.5% of adults in the U.S. experience a more severe mental illness. But the more mental illness is paired with being dangerous or violent, the less likely individuals are to seek treatment.

Early intervention for many of the characteristics I’ve talked about here can be effective in preventing violence. In addition to increasing access to treatment for mental illness, we should be focusing on identifying factors that contribute to the common characteristics listed here.

Solutions could include increasing social connection for those at risk, along with promoting resources and community education related to mental illness. In addition, there should be continued discussions of red flag laws to reduce easy access to firearms for those at risk for violence.

The bottom line is that the issue is more complicated than just one factor. That means that an effective solution will need to be multifaceted.

From the Jackson Hole News & Guide Column Sound Mind

Mental health awareness month, May, recognizes that 1 in 5 adults will experience a mental illness this year.

Roughly 60% will not seek treatment due to barriers.

June is recognized as Men’s Health Awareness Month.

Men make up almost 80% of suicide victims in the United States. Men living in small towns, rural areas and other places with fewer resources have particularly high rates of suicide. In fact, Wyoming has the third-highest rates of suicide in the country.

In general, men tend to seek treatment for mental health problems less than women, yet they experience mental illness in the same or greater numbers than women. There are several theories about why that happens.

Mental illness carries a good amount of stigma in general, but there may be stronger barriers for men due to the perceived norms of masculinity.

Many boys learn that expressing vulnerability is a weakness. Many are taught to suppress emotional responses other than anger and happiness. If they are not taught how to express and process a variety of emotions, then as adults they may be limited to anger when dealing with depression or life stresses.

“Traditional masculinity is psychologically harmful,” the American Psychological Association states. “Socializing boys to suppress their emotions causes damage that echoes both inwardly and outwardly.”

New guidelines on traditional masculinity suggest “socialization for conforming to traditional masculinity ideology has been shown to limit males’ psychological development, constrain their behavior, result in gender role strain and gender role conflict, and negatively influence mental health and physical health.”

A man with more “traditional views of masculinity” may think himself weak or judged if he is unable to “tough it out” on his own or admit to struggling.

Seeking support may conflict with the view that a man must be stoic, independent and aggressive and have emotional control. That leaves some men feeling isolated and angry.

How can we go about changing this?

The National Institute of Mental Health has a new campaign, called “Real Men. Real Depression,” that aims to normalize help-seeking.

There are other supports, like ManTherapy.org, that attempt to use discussions with all sorts of men — including famous athletes — about struggles with depression and anxiety to model and normalize the issue with humor. It’s been shown that men are more likely to seek treatment for problems they feel other men are dealing with as well.

In addition to changing perceptions about seeking support there are also some attempts to change the way society views masculinity. In addition to the campaigns mentioned earlier there are several targeted suicide prevention efforts, like Making Connections for Mental Health and Wellbeing Among Men and Boys, a program provided through a partnership of the Movember Foundation, Prevention Institute and a team from the University of South Florida.

In addition, several educational films, such as “Tough Guise” and “The Mask You Live In,” are sparking discussions about how boys are raised.

Changing attitudes about admitting vulnerability and seeking help is also something that we can all participate in. Being aware of our own language and approach to culture and norms could also go a long way toward reducing the stigma not just for men but for everyone who needs support.