Heads Up: Changing Minds on Mental Health

Melanie Siebert is a youth and family counsellor working in Victoria, British Columbia. In her daily work, she listens to young people who are struggling to find that sense of peace, belonging, and a meaningful life. Heads Up: Changing Minds on Mental Health, another title in “Orca Issues” series, contains true stories from Siebert’s professional experience, retold with the permission of clients whose names have been changed in order to protect their privacy. Each chapter contains at least one of those stories which offers a specific and personal focus to the issue explored in each of the book’s six chapters.

Heads Up begins with an overview of "Mental Health: the science, theories and mysteries.” Good mental health is defined as “the ability to enjoy the good things in life and cope with the difficult things. It’s the ability to adapt and change. . . .[it] doesn’t mean the absence of struggles; it means being able to take care of yourself and your relationships.” So, what is mental illness or mental disorder? Those who suffer from mental illnesses - anxiety, depression, schizophrenia or post-traumatic stress disorder - experience serious changes in thoughts, perceptions, emotions, and behaviours, . . . serious enough that the person has difficulty taking care of themselves or relating to others. (pp.10-11) Bio-medical perspectives on the treatment of mental illness focus on the brain, although Siebert is quick to point out that psycho-social, trauma-informed and Indigenous perspectives offer alternative treatment approaches.

This first chapter, one of the longer chapters of the book, provides a clear understanding of the circuits and chemicals which work together to enable learning, emotions, and behaviour. Human brains are complex: the emotional brain helps us to survive through reaction, and the thinking brain, the neocortex, enables us to plan, decide, decode language, remember, and create meaning. The neocortex regulates emotional response, and our emotional responses typically precede our logical responses. As well, our bodies manifest our emotional responses (through tears or fear), and humans, in order to function within the community, learn to “read” those physical cues. However, intense emotion can highjack an individual so that he or she looks for means to numb those emotions, or, in the case of traumatic incidents, the victim “freezes” and later may have no memory of the event.

Trauma and its impact on the emotional brain are discussed extensively. Regardless of its source, sensory cues such as “a scent, texture, sound, place, or any other reminder” (p. 24) can trigger a stress response to a deep-seated memory of a traumatic event. Those who survive trauma live with an overwhelmed nervous system; some are always on edge, and others zone out. Trauma is often the outcome for those who experience adverse childhood experiences (ACE): neglect (physical or emotional), abuse (physical, emotional, or sexual), or extreme family difficulties. Physical illness is more likely for those with multiple ACEs, as are learning difficulties, unhealthy coping mechanisms, and social dysfunction.

Emotional well-being can also be affected by social problems. Those who are marginalized because of poverty, race, sexuality, or any other form of societal discrimination have a difficult time feeling safe, secure and accepted in the world. Siebert also discusses the role of intergenerational trauma resulting from the physical, emotional, and sexual abuse experienced by those Indigenous people or whose family attended residential schools. Nevertheless, there are Indigenous communities who have returned to traditional approaches to healing, and, in the case of mental health, the focus is on seeking a sense of balance amongst “the mind, body, emotions and spirit” . . . “within oneself and in all one’s relations.” (p. 40)

The history of attempts to heal mental illness is the focus of the second chapter, “Sinners, Beasts, or Fools?” Those who have been labeled as insane have often been treated in ways that we would now describe as inhumane. In many ancient societies, those who exhibited many of the behaviours of mental illness, such as hallucination or bizarre behaviour, were thought to be possessed, either by good or evil spirits. Those possessed of evil spirits were treated by some type of “ritual, in which a person with spiritual authority calls on a higher power to evict the evil spirit.” (p. 45) Later, the famous Greek physician, Hippocrates, posited that the brain, just like any other organ in the body, could experience disease, a concept which was supported by Islamic physicians During the eighth century CE, Islamic societies built bimaristans>, hospitals with special wards for those suffering mental illness, and the treatment dispensed was remarkably humane and advanced. However, mental health treatment in the western world often amounted to little more than imprisonment, with patients in asylums being kept in solitary confinement and subjected to treatments such as induced vomiting, purging, and bloodletting. Opened in 1247, the Bethlehem Royal Hospital was one of the first asylums, and, by the 17th century, it was a medical facility for the insane. “Bedlam”, as it was then known, became a synonym for a state of chaos and uproar, indicative of the life of its patients.

Throughout the 19th and 20th centuries, enormous progress was made. Sigmund Freud developed psychoanalysis, a “talk therapy”, in which patients were encouraged talk and bring to consciousness their dreams, memories, or ideas which might be causing them emotional pain. In the 20th century, a variety of physical therapies, some of which were invasive and downright dangerous (i.e. lobotomy) were tried. The greatest promise came through the development of psychiatric medications, and, although many patients are afforded great relief from a variety of distressing symptoms, the exact mechanism by which the drugs worked remains a mystery. Drugs don’t always work for all patients and all forms of mental illness, but, when they do, people can find relief and a way back to wellness.

In 1952, the American Psychiatric Association published a landmark work, The Diagnostic and Statistical Manual of Mental Disorders (known as the DSM), which categorizes disorders by providing the diagnostic criteria for them. Searching for the biological causes of mental illness has led to research into its genetic determinants, and, while psychiatric disorders often appear to run in families, exactly how genetic predisposition leads to mental illness remains unclear. Siebert poses some interesting questions about psychiatry. “Has psychiatry led to compassionate, effective treatments or has it labeled and stigmatized suffering? (p. 67) Some patients have experienced poor treatment, and some believe that they and their families have been dismissed or denied services that they believe would be helpful. Cultural assumptions can lead to bias against patients of certain ethnicities or races, and lack of cultural awareness can make the doctor-patient relationship less than productive.

The middle of the twentieth century saw another major reform in mental health: deinstitutionalization moved patients out of hospitals and into the greater community. Intended to lessen the number of admissions to hospital and to make hospital stays as short as possible, government funding for community services has rarely been adequate, often leaving families to pick up the role of care-giver and care-taker. Those who have no family to provide supports often find themselves homeless, and, in some cases, their behaviour leads to police intervention. Increasingly, police take on very difficult work with the mentally ill: looking for a missing person, forcing entry into a person’s home, or taking them to hospital against their will. It’s frightening for the individual in mental distress and profoundly burdensome for police officers, many of whom have no specialized training to deal with these crises.

Siebert states that “when youth come to see [her] for counseling, they just want to know ‘what’s wrong’ with them.” (p. 85) Receiving a diagnosis can be helpful to some, assuring them that they’re not alone and that they have a treatable illness. In other cases, a diagnosis is disempowering or masks the real source of the apparent problem. Nevertheless, the chapter entitled “Tell me what’s wrong” provides clear and concise descriptions of some of the more common diagnoses of mental disorders: anxiety, depression, bipolar disorder, psychosis, PTSD (post-traumatic stress disorder), eating disorders, OCD (obsessive-compulsive disorder), borderline personality disorder, substance abuse, self-injury (cutting, burning or otherwise causing oneself physical injury), and most seriously, suicidal thoughts. The discussion of suicide is particularly valuable, not only for its description of the nature and manifestation of its warning signs, but also for providing ways in which to provide support to a friend or family member exhibiting suicidal ideation.

Once receiving a diagnosis of “what’s wrong”, working towards wellness can take many forms, not all of which involve medication or talk therapy. The chapter on “The Road to Wellness” focuses on recovery, a personal journey in which “a person gets to decide for themselves what a meaningful, dignified life looks like.” (p. 125) Recovery involves developing resilience, moving beyond feelings of shame, forgiving oneself, reaching out to others, and recognizing when connecting with a professional – a family doctor, psychiatrist, psychologist, counselor, or therapist – is necessary to help make that “good, safe connection with another human being” (p. 134) that can help one to heal. Siebert provides very concrete suggestions, “good hits” of self-care that anyone can use to get through life’s lows, including exercise, getting enough sleep, and doing good for others.

The final chapter, “Candid and Courageous”, begins with stories of celebrities who have been candid and courageous in confronting and admitting to their own struggles with mental health: pop star Selena Gomez, Olympian Michael Phelps, Lady Gaga, Prince Harry. Having it all doesn’t “insulate a person from mental health struggles.” (p. 146) It can be difficult to overcome the stigma that is sometimes attached to mental health challenges, but attitudes are slowly changing, and there is a new openness to talking about mental health and admitting to the need for help. The rest of the chapter offers a series of stories of people, organizations, and programs engaged in offering that help. It ends with Siebert’s telling of receiving a cry for help, a text from a teen saying, “I’m crying right now. It’s all too much.” (p. 167) Painful though it was to receive that text, Siebert goes on to speak of her admiration for that teen who had the courage to ask for help and get to a place of safety. It is her hope that society will better understand mental health and mental illness and respond to it with caring and compassion.

Siebert packs a great deal into Heads Up, offering history, factual information, and individual stories, as well as honest and compassionate reflections on her professional experiences and her own dark moments. Following the text of the book is a “Resources” section which provides listings of web-based crisis resources, integrated youth services, general mental health information, and topic-specific resources (i.e. focusing on specific mental disorders). A Glossary defines bold-faced words and terms used throughout the book, and an Index concludes the book. Heads Up is well-illustrated with black and white photographs, line drawings, and reproductions of art works. Sidebars provide in-depth definitions of terms such as “hysteria” as well as profiles of people, past or present, who have made significant contributions to the field of mental health.

Heads Up: Changing Minds on Mental Health is a concise but thorough examination of the complexities of mental health and its contents are highly accessible to high school students in grades 9-12. As Siebert points out, “many mental health problems start in childhood and adolescence”, (p. 149) and early awareness of the problem aids in successful treatment and recovery. It’s also valuable reading for parents, teachers, or counsellors, offering perspectives that just might change long-held attitudes or ways in which to support a student or family member struggling with mental illness. Heads Up: Changing Minds on Mental Health is a must-have acquisition for school library nonfiction collections, and it’s worth stocking extra copies for the bookshelves of school counselling staff.