NAMI Mercer County

Families Meeting the Challenge of Mental Illness

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Post Traumatic Stress Disorder (PTSD) after surgery?

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by Sharon Joag, MSW, LSW

What is the first image you have when you think about Post Traumatic Stress Disorder? If you are like me, the first thing that pops into my head is a war veteran; and someone who has been through something that induces major trauma, sometimes lasting for a lifetime.

But what about those who have undergone major surgery? Although much less talked about, trauma from surgery has now become a global public health crisis. Globally, 310 million major surgeries are performed every year, and of those, 40-50 million surgeries are performed in the US (Dobson, 2020). From the moment a patient is given a diagnosis the black cloud of imminent surgery looms ahead. First, the anxiety sets in, and the rumination on the actual surgery, what it entails, what exactly will happen in the operating room. Questions in the minds of patients. “Will I feel anything while undergoing surgery? Will anesthesia work? What is going to happen after surgery?” 

Doctors typically do not and cannot always talk to a patient about every single minute detail of a surgery. Surgeons can only provide an overview of a surgery, but the details are vague and sometimes unknown, even to the surgeon, until the surgery is actually underway. This uncertainty creates a milieu of confusion, and unhealthy rumination on all that could potentially go wrong, culminating in a deep anxiety and post-surgical depression that can last for months or years after the surgery, inevitably aiding in extending the recovery time of a patient who has undergone a major surgical procedure.

These ruminating thoughts can be overwhelming to an individual. Having regular therapy appointments to monitor an individual’s thought processes, and talk through some of these traumatic future events, especially a planned surgery is important in helping patients find tools that they can use to decrease stress levels, understand their thoughts, and find ways to manifest optimal mental health.

Many people suffer tremendously pre, peri and post surgically with anxiety and depression. Major surgeries such as surgery to remove cancer (breast, a portion of the esophagus, stomach or colon). The physical changes that a person has to endure post-surgery takes a toll on the psyche. The brain has to catch up with its new body image, food and diet changes, and sometimes chronic pain which has become a part of the new life. Often times, a person faces depression, fear and PTSD which causes sleep disturbances, and further delays mental healing.

Coming to terms with and accepting the new person post-surgery is an enormous and daunting hurdle. Having someone to speak with confidentially who can help to guide a patient through this process is essential. In addition, the caregivers in the equation cannot be neglected. They too have to come to terms with their new partner or spouse or loved one who is forever changed. Helping the caregiver to grapple with these changes is also much needed, as caregivers are many times the primary support system for an individual who has undergone major surgery.

Making a plan, setting long term goals, and then short-term goals that are achievable are important in achieving success with positive mental health. Speaking to a health care professional and understanding the importance of a support system including friends, family, and community are the pillars of a successful and positive mental health post-surgery, and recovery from PTSD due to major surgery.

References:
Dobson, G.P., Trauma of major surgery: A global problem that is not going away. International Journal of Surgery, 2020. 81(47-54).

Stanzel, A., Sierau, S. Pediatric Medical Traumatic Stress (PMTS) following Surgery in Childhood and Adolescence: a Systematic Review. Journ Child Adol Trauma 15, 795–809 (2022). https://doi.org/10.1007/s40653-021-00391-9

How Social Media Affects Body Image

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By Julia Roman, NAMI Mercer Fall 2023 Intern

With 4.89 billion users worldwide, social media is extremely prevalent. The increasingly widespread use of social media use in our society has led to extensive research that has consistently proven the strong correlation with negative body image ideals.

Social media provides constant exposure to unrealistic beauty standards for users. This is particularly harmful for younger audiences, as they are more impressionable. For example, young girls using social media platforms such as Instagram or TikTok are more likely to see an increase in body dissatisfaction. These platforms often glorify and normalize negative behaviors, such as extreme dieting, excessive exercise, or eating less than is necessary.

Exposure to these detrimental behaviors can lead to a skewed image of one’s body, which can ultimately lead to decreased self-esteem and an increase in disordered eating behaviors. For instance, when people see videos or images on social media of influencers, celebrities, or even their friends, they will inherently compare themselves to their physical appearance. This is intensified when the individual posts something that promotes changing one’s body, such as “What I Eat In A Day” videos, workout videos, “before and after” images, or “try-on hauls” in which the poster is engaging in body checking.

Since these behaviors are so normalized in our society, people posting this content on social media may not realize the harm. However, we must educate ourselves about how engaging in these practices can be detrimental to our mental health, as well as the mental health of our friends, family, and people we may not know.

While social media is inundated with harmful messages, many users attempt to counteract this with positive content. For example, the body-positive movement on social media has gained popularity, with millions of users tagging #bopo, #bodypositive, and #bodypositivity. This movement has been proven to help people appreciate their bodies more, as it encourages people to focus on the positive aspects, rather than elements they are unhappy with. Research has shown that viewing body-positive content can improve body satisfaction and increase positive mood.

While many of the statistics surrounding body image and social media are negative, we must also recognize that platforms such as Instagram and TikTok can also create positive environments for those struggling with body image issues. It is important to be mindful of the creators that we follow, as they can inadvertently have a large impact on a person’s perception of their appearance.

Comparison is the thief of joy, so it is necessary to remember that everyone is unique. Also, thin ≠ healthy: we must not assume that the way a person looks has anything to do with their health. We are only given one body, we should appreciate it for all that it does for us, rather than what it looks like.

If you are struggling with your body image and are trying to find ways to improve, try the following:

  • Follow body-positive creators on social media (I have listed some below)
  • Practice positive affirmations (examples below)
  • Practice gratitude for your body (examples below)
  • Don’t ruminate on body changes: this is a natural part of the human experience!
  • Remember that beauty is in the eye of the beholder

Body-Positive Creators:

Positive Affirmations

  • “I am worthy of love and respect, no matter what my body looks like.”
  • “I love and accept myself and my body unconditionally.”
  • “I am comfortable and confident in my skin.”
  • “My body is unique, and that is something to be celebrated.”
  • “I do not need to change my appearance to be beautiful.”

Gratitude for your Body

  • “I am grateful for the strength and health my body provides.”
  • “I appreciate that my body can breathe and move.”
  • “I am grateful that my body allows me to experience life fully.”
  • “I am thankful that I can participate in daily activities without a second thought”
  • “I am appreciative of my body’s healthy functioning which allows me to thrive”

Sources

  • Abdou, A. Follow These 8 Body Positivity TikTokers For An Instant Boost Of Self-Love. Gimme. https://gim.me/how-to/body-positivity-tiktokers-to-follow/.
  • Cohen R, Fardouly J, Newton-John T, et al. (2019) #BoPo on Instagram: An experimental investigation of the effects of viewing body positive content on young women’s mood and body image. New Media & Society 21: 1546–1564.
  • Cohen, R., Newton-John, T., & Slater, A. (2021). The case for body positivity on social media: Perspectives on current advances and future directions. Journal of Health Psychology, 26(13), 2365-2373.
  • “How Many People Use Social Media?” (2023). Oberlo. https://www.oberlo.com/statistics/how-many-people-use-social-media#:~:text=The%20latest%20figures%20show%20that,jump%20in%20just%20five%20years.
  • Jiotsa, B., Naccache, B., Duval, M., Rocher, B., & Grall-Bronnec, M. (2021). Social media use and body image disorders: Association between frequency of comparing one’s own physical appearance to that of people being followed on social media and body dissatisfaction and drive for thinness. International journal of environmental research and public health, 18(6), 2880.

Living with PTSD

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Post-traumatic stress disorder (PTSD) is developed as a result of experiencing or witnessing a traumatic event, and it actually changes the structure of your brain; complex PTSD (C-PTSD) develops as a result of experiencing repeated traumatic events and is more likely to occur if the trauma was experienced at a young age. Common symptoms associated with PTSD include nightmares, flashbacks, stress and anxiety, and hypervigilance. Linked below are a few personal stories from people living with PTSD, and while it’s commonly associated with veterans, these stories show that PTSD doesn’t solely emerge from experiencing combat situations, but that there are multiple situations that may result in its development.

Daniel’s story details how he developed PTSD after undergoing an emergency heart procedure and then experiencing a subsequent anxiety attack that he thought was another heart issue. He explains that he felt chest pain which brought him back to the traumatic night of his procedure, and immediately went to the emergency room because he thought it was happening again, only to be told he was having an anxiety attack. After seeking therapy, he was diagnosed with an anxiety disorder and PTSD. He was able to get on medication and found a variety of techniques to help manage his symptoms.

Rita’s story describes how for her, PTSD manifested in repeated panic attacks that wouldn’t stop no matter how many anxiety-related therapies she tried. Eventually she found a therapist who was able to put a name to her feelings of panic and identify that her PTSD stemmed from childhood. When she started doing EMDR (eye movement desensitization and reprocessing) therapy with this therapist, she finally started feeling some relief after a few weeks’ time.

Denise’s story details how she developed PTSD after a student threatened her and the other students in her classroom with a knife. She blamed herself for the incident and became emotionally volatile, experiencing violent mood swings and suicidal thoughts. She ended up going to her doctor, who gave her a tentative PTSD diagnosis, before going to a psychologist who affirmed it. She was then able to get on medication to help manage her symptoms, and ended up moving to get away from her environmental triggers.

If you or a loved one are experiencing symptoms of PTSD, don’t be afraid to seek out therapy using sites like Psychology Today, or other informational resources online like the APA, the Anxiety and Depression Association of America (ADAA), the National Center for PTSD through the VA, or NAMI’s own website.

Coming Out to Love & Support

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In recognition of June being designated as pride month, as a NAMI Mercer intern I would like to highlight some of the mental health struggles the LGBTQ+ community faces.

The coming out process can be a difficult and emotional experience for members of the LGBTQ+ community due both to difficulties with self-acceptance and uncertainty about the reactions of family and friends. Coming out is a lifelong process and if someone experiences rejection early on, it can prevent them from acknowledging their identity for a long time, leading to increased anguish and unhappiness, resulting in mental health issues. Rejection and/or a lack of understanding/support from loved ones can strain relationships and make the person trying to come out feel unloved.

Members of the LGB community are twice as likely as their straight counterparts to experience mental health issues and feelings of hopelessness; transgender individuals are nearly four times as likely as their cisgender counterparts to experience these issues. LGBTQ+ youth are also four times as likely as their straight counterparts to attempt suicide. Among the major risk factors associated with these mental health issues is receiving negative reactions upon coming out, as cited by The Trevor Project, a well-known suicide prevention organization for LGBTQ+ youth.

The most important thing loved ones can do to mitigate the risk of depression and suicide among members of the LGBTQ+ community is to be supportive during the coming out process, even if they have mixed feelings about this news. Parents can demonstrate support by actively listening to what their child is trying to tell them –without interruption, without finishing their thoughts for them. There’s a high likelihood that someone coming out has been thinking about their identity for years, and in this moment, they need to feel heard. They’ll be happy to answer any questions, provided they are asked in a respectful manner.

A psychiatrist at the Child Mind Institute notes, “when people feel loved and supported, they are more capable; they have greater resilience.” You can support a person coming out by treating them the way you did prior to their coming out, staying calm, getting to know their romantic partners, and educating yourself about this community. Helping someone feel loved is the most important thing you can ever do.

There are various resources online, available both to family members and LGBTQ+ individuals, to help them navigate the coming out process. Strong Family Alliance provides information and resources to LGBTQ+ people and their families. Their website details stages of coming out, how different parental actions can help or hurt an LGBTQ+ child, and the challenges parents and children may face after coming out. The Trevor Project is another valuable resource, as is a local LGBTQ+ center. Each person’s coming out experience is different but the need for love and support is common to everyone. Let’s make it a point to extend that love and support to anyone who needs it, this month and every month.

By NAMI Mercer Summer 2022 Intern Alexis

Hope After 40 Years with Depression

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A NAMI Mercer community member shared their story of living with depression, and finding hope after 40 years.

TW: mention of suicide attempt, discussion of depression symptoms

I was born broken. No, not a hole in my heart or some organ disease, but in the head. I believe this. You can come to your own conclusions.

I don’t remember much about my childhood. I know I was awful to my brother and sister. I was sullen and non-communicative and just generally unhappy. I was bullied pretty badly, but a lot of people were as kids and I don’t put much stock in it. I do know that I felt very different and alienated. I was taken for psychological testing when I was 14, and I still have the 5-page report of the doctors’ findings. It isn’t pretty.

When I was 15, my family had enough of my nonsense and sent me to boarding school in upstate NY. I had pretty much failed out of public high school, and was asked not to return after my freshman year. Boarding school brought me out of my shell a little, but I also learned to self-medicate with drugs and alcohol. College was a lot of fun, but again – too much drinking and drugs, and in the back of my head, I knew something wasn’t right. Of the first 9 classes I took in college, I failed 6. I was given a one year academic suspension and returned the following year, doing well enough to graduate in 5 years but it is not an academic record to be proud of. I majored in psychology because it sounded interesting, but I had no real plan – I drifted through college. I realize now that I was refusing to think about career paths because I was terrified of graduating, of joining the adult world, of growing up.

After a brief post-graduation trip around Europe with my brother, I returned to my father’s house in September of 1994. This is really where the story begins. I had to get a job, to begin my real, actual life, and I had no idea what or how to do it. I was terrified. I put a bare-bones resume together and sent out one or two job applications a day as the pressure and the terror continued to escalate. My father would yell at me seemingly every night about the fact that I was drifting, and I knew I was. I knew the feelings I was having weren’t normal, but I didn’t know what to do. On October 28, 1994, I finally snapped. I left my childhood and walked to my mother’s house – my parents had by then been divorced for 6 years but lived about a mile apart, and I cried to my mother and step-father for 2 hours, blubbering about anything and everything. The next day I was taken for evaluation, and I was given medication for the first time, and diagnosed with a word with which I was familiar but didn’t fully understand: depression.

There was no weight lifted from my shoulders – I settled into a morass of self-pity and spent the next 3 months in bed, trying to wrap my head around this new reality. I lay in bed and cried for three months while the TV played in the background. My mother and father both thought I should get out of the house, so I spent a few hours a day at my father’s office in Manhattan, inputting data into spreadsheets and taking frequent breaks to cry in front of my computer. It must have been somewhat embarrassing for him to have a 24-year old sitting in front of a computer in his office, crying while typing in data, and I still feel bad about that. I started working at my fathers office, and if I showed up three days out of five, it was a good week. 1994 through 1998 were filled with doctor’s visits, sleeping, isolating and generally still trying to wrap my head around the fact that I had a disease – that it was me, not someone else, but me that had one. In 1998, my father finally threw me out of his office after my mood swings became too much for him to tolerate. I got a part time job answering phones and fixing computers at a small private school in New York City, which lasted 9 months before the stress and anxiety got to me and I quit abruptly.

I’m going to fast-forward a little. The 2000’s were better, although I still suffered deep depressive episodes. In May of 2003, I woke up one morning with a new friend: anxiety. It started abruptly, and it made all previous anxiety seem like child’s play. It was persistent and all-consuming, and psychiatry was still very much in the dark ages at that point. They raised my Xanax to ridiculous levels, switched to Ativan, then Clonazepam, than back to Xanax. It didn’t do anything. I married my wife in 2005, we had my son in 2006 and another son in 2008. We moved to New Jersey in 2008. These events made me happy, but things still weren’t right. By this point I was on a combination of 7 or 8 different anti-depressants, and none of them really helped. I saw doctors and therapists, and none of them made a bit of difference. I am glossing over a lot of tough times in the 2000’s, but suffice to say I was a spectator in my own life, participating little and enjoying even less.

Then things got really bad.

In 2009, I lost my job in the housing crash, and I couldn’t look for another job. In 2010, I was hired as an IT Coordinator, and the stress and anxiety and depression went up another notch. By 2012, I was unable to function, and I took a three month hiatus from work and checked myself into another psychiatric facility. I was in two different hospitals in the summer of 2012, and I underwent 20 sessions of electro-convulsive therapy (ECT), of which I did most outpatient. It was horrible and traumatic. I remember my wife driving me home from one of the sessions as my breakfast sat forgotten in my lap. My head was leaning against the passenger-side window as drool ran down my chin. It didn’t help; I merely lost a lot of memory. I returned to work later that summer, and I tried my best to function. By 2013, I would step out of my office every morning, drive to a nearby parking lot and sob in my car. Sometimes I would call my wife or my mother and tell them that I just couldn’t take it anymore. Usually I just cried alone. By the end of 2013, this was happening two or even three times a day. In February 2014, I left at lunchtime and drove home. I never went back.

In 2014 I was hospitalized five times for depression, in New Jersey, then in Maryland, then in Connecticut. On September 20th of 2014, I attempted to end my life. On the next day, I tried again.

I won’t go into a blow by blow, but my family was by and large very angry. I did another two weeks inside a locked facility, and then it was decided that I wouldn’t return to my family, but rather live in my mother’s basement, which I did for the remainder of 2014 and most of 2015. I attended a day program in New York and changed medications, had individual and group therapy, and visited my family on the weekends. I eventually moved back into my house. A suicide attempt on your permanent record is a big black mark. My wife wouldn’t touch me. I was as miserable as ever.

I don’t remember much between 2016 and 2018, but I went through the motions. I saw a psychiatrist and a psychologist. Nothing worth remembering happened. I stopped reading and listening to music, I cut myself off from friends – I cut myself off from life. My psychiatrist gave up on me – we had tried every medication and every possible combination of medications available, and she was out of options. I switched doctors with no real change. At some point in there I tried experimental Ketamine infusions, which had shown so promise in patients with severe, clinical depression. It didn’t work.

On December 4th of 2018, my psychiatrist tried a new medication, probably out of desperation. Within 2 hours I felt noticeably better. I have burned by “feeling better” by medications before; the placebo effect usually lasts for three days and then the symptoms revert, so after 25 years of medications, I kept waiting for the other shoe to drop. And it never did.

We played around with the dosage, but there was no question that I felt better. Now I had a mess to clean up. 2019 was spent fixing up my head, dealing with brand new sleeping problems, and still waiting for the other shoe to drop. I don’t remember much about 2019 either, but I must have done some hard work internally. The depression was cut way down, although the anxiety was still there. When the pandemic arrived, I buried myself in music and continued to heal. My BDI (Beck’s Depression Inventory) self-assessment scores continued to drop from their baseline of 54, which is pretty bad. I made new friends online and got rid of old ones that I no longer needed. And some clarity returned to my thinking, for the first time since I was a pre-teen.

At some point during the very beginning of 2021, I realized that the anxiety was gone. I realized that there was a new sensation in my heart – love. It was a strange feeling; not one to which I was accustomed. 2020 was the best year of my life.

I am no longer symptomatic; I have my bad days like everyone, but I still wake up excited and ready for the next day. I see life now as a gift to be savored. I want to live forever. I appreciate the big things and the little things. I am a little sad about the years I lost, but my focus is on the future. I catch myself smiling at random times during the day. I feel confident, positive, and sharp. I went through almost 40 years of hell, but I am out the other side.