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Mental Health

Aside from helping with disorders, does cognitive behavioural therapy (CBT) help improve creativity?

I am not aware if CBT has been used in that context. I would just keep reading, going to school, listening to creative people and learning. I don't think you need psychotherapy to be creative.

On the other hand, if a problem interferes with your creativity because you are too busy worrying, there might be a benefit. For example, one of the problems with depression is that people ruminate too much. This takes up a lot of mental energy. With cognitive behavioural therapy you help people move away from rumination and focus on things that are more satisfying.

-Joseph Rochford, PhD, Mini-Psych School 2006

What inspired you to study mental illness?

The reason why I got into psychology was because I wanted to become a writer and I figured that, if I was going to write about significant things (i.e., people and their relationships), I needed to know something about the way people relate. As I was studying, I realized that there were other areas, other branches of psychology that were a little bit more scientific, or at least in which the rules made more sense to me. I started following those areas and found I had an affinity for them; then I gradually got into biology and started looking at the relationship between brain activity and behavioural activity and that’s how I got to where I am.

-Joseph Rochford, PhD, Mini-Psych School 2009

How many neurotransmitters have been identified to date and have we covered them all?

Simply put, neurotrasmitters are chemicals in the brain that send signals between brain cells. Too much or too little of certain neurotransmitters has been hypothesized to be responsible, at least in part, for certain mental illnesses. In the case of these illnesses, the brain has a problem with the reuptake of these neurotransmitters. For example, dopamine is a neurotransmitter whose levels are said to be too high in schizophrenic patients, whereas serotonin is said to be low in depressed patients.

It is difficult to state whether they have all been discovered. In 1936, a very famous neuroscientist by the name of Henry Dale published a paper saying that, in his view, we only needed two neurotransmitters: one to turn the brain on and one to turn the brain off. We’re up to 35 now, which shows that it’s a little bit more complicated than that. And one of those 35, it turns out, is not a liquid, but it’s a gas. So we have gas in our brain.
-Ridha Joober, MD, PhD, Mini-Psych School 2009

My daughter was just involuntarily admitted to a mental hospital. How can I cope with feelings that I may have betrayed her?

It’s hard to comment on case history because I don’t know all of the information. I would suggest trying and getting as much information as you can about the illness to understand why a particular episode might have been precipitated by a particular event or series of events or why it came about. But sometime the answers are just not there.

Find people who are in the same boat as you are and you will find that the feelings of guilt, worthlessness, and insecurity that you are having are not specific to you. By sharing them, you can deal with them as a group.

-Joseph Rochford, PhD, Mini-Psych School 2009

As a mental health specialist, do you believe that more people are developing mental illnesses?

I think that some illnesses rise and fall. For instance, depression goes down during wartime because people are too busy worrying about what is happening around them. But after the war is over, the rates go up again. So I think that depression and suicide rates can vary. I believe that suicide rates have actually increased in certain parts of the world—most likely because society in changing. I think that there are specific mental illnesses like schizophrenia, bipolar disorder, and major depression whose rates have stayed about the same.

What is neurophenotyping?

Neurophenotyping simply means trying to identify how genes influence behaviour. A genotype is all of the genes that you have; a phenotype is which of those genes get expressed. I think of the genotype as being a blueprint to build something. The phenotype is the actual building that comes out. What we do, once that building gets produced, is we test it behaviourally. We ask how it behaves. Neurophenotyping is really about identifying the behavioural consequences of changes in genes and to see how different drugs might influence that relationship.

-Joseph Rochford, PhD, Mini-Psych School 2009

Do people who show up late want to be noticed?

Do they do it because they want to be noticed? Or because they're disorganized? Or because they believe their time is so important, they don't mind making everybody else wait? Is this really a problem? If it is done to the extreme and affects a broad area of their lives, it is a disorder. Otherwise, it is just unacceptable behaviour. We all do things that irritate other people? That's why I've said that everyone is going to recognize themselves in all of the descriptions of disorders. But problem behaviours are only disorders when they are pervasive and serious, and have been that way for a long time.

Would the success of certain famous people with mental illness (Jim Morrison or Robin Williams) have been possible without their illness?

An undergraduate student was doing a research study on creativity in people suffering from OCD. The hypothesis was that, because people who have obsessive-compulsive disorder are so ordered and focused, and sort of compelled to do what they feel they have to do, their degree of creativity is going to be reduced relative to the normal population. It is really a question of channelling your talents or abilities into your prospective career. This is what counsellors do. They take your abilities and try to channel them into the most appropriate productive career. Why don’t we do the same thing for people who have mental illness? Because we do not think we can; but we can – we just have to know how to do it.

-Joseph Rochford, PhD, Mini Psych School 2009

What can you say about the importance of spirituality in the recovery from mental illness and health in general?

If you had asked me this question 25 years ago, I would have given you a completely different answer. I see spirituality as being an alternative form of support, comfort, and solace; and, if a person feels it helps them, then they should of course continue doing it.

-Joseph Rochford, PhD, Mini-Psych School 2009

What is being done for the homeless who are mentally ill?

Not enough! I would like to be able to tell you that we have big projects. However, we do not. There are challenges in helping certain homeless people. Some of them represent a category of mentally ill people who don't like institutions. They prefer the freedom of the streets. I'm not saying this in a sarcastic way. They do not want boundaries. We need to develop ways of helping them without putting them in institutions and locking them up. A lot of them have substance abuse problems that they're not ready to give up. They want to have the freedom to go out for a drink and come back. It's a challenge for us to find better ways of reaching out to these people, because they do suffer and they might be helped. However, we have to go to them. We cannot expect them to come to us.
-Mimi Israel, Mini-Psych School 2006

Is there a certain time during foetal development that can be associated with dopamine inbalance?

Many researchers at the Douglas are working on this topic. Brain insults very early on and during development affect the dopamine system. We know, for example, if we stress pregnant rats, the pups born from the stressed mothers will have higher levels of dopamine when they grow into adults. There is evidence that the dopamine system is very sensitive to brain stress during development.
-Ridha Joober, MD, PhD, Mini-Psych School 2006

Is it beneficial or destructive for mentally ill patients to be surrounded by others with the same or other mental disorders?

Because these are common disorders in adults, there is no reason why two people can't suffer from the same or different problems. First and foremost, if you truly love someone, that feeling is very special. You don't want to leave the person just because he is ill. Having said that, every interaction, every combination, can be a problem depending on how you view it. Generally, an anxious person will be more worried about their loved one than someone who is not as anxious.

Sometimes, when the anxiety is relatively mild, he can help the other person to visit doctors when necessary, or to treat certain fluctuations when things are getting worse. At the same time, you don't want to live with someone who constantly pushes you to deal with every little thing that happens. When people ask about anxiety and what should be done for their spouses or parents, I usually tell them that the best response lies somewhere between two extremes. The ultimate solution is to encourage people to face their fears and to reassure them. You do not want to overprotect them on one hand or push them too hard to confront their fears on the other. If you understand anxiety, you will know that this is the best way to approach the problem. Try to ensure that each member in the relationship knows each other's problems and what does and does not help.

The question also mentions schizophrenia. It is a very important problem in mental health, although not nearly as common as the problems we have discussed today. There are more misconceptions about schizophrenia than anything else. The first thing you notice when you work with people suffering from schizophrenia is that they are normal human beings with an illness. What that means is that they all have a mix of personality characteristics, just like other people, and they can have interesting stories to tell. Sometimes they don't want to be spoken to or may not be as sociable as someone else. However, when you get to know them, they can trust and form relationships just like others can. It just takes a bit longer. The important thing to remember is to treat them just like anybody else. They will learn to trust you and when you see things are not going well, you can suggest they go to the Hospital. They will listen to you because they have learned to trust you.

Forming relationships with people suffering from schizophrenia or other mental illnesses is essential. I say this because it is easy to just ignore people when we are not so comfortable around them. But if we form a bond, they are more likely to confide in us or in family members. They will be more likely to listen to us when we encourage them to comply with medication or to seek help if things get worse. By having a close relationship, we can also better be able to detect any changes in their mental states.

-Camillo Zacchia, PhD, Mini-Psych School 2006

Is it beneficial or traumatic to send young children to day care away from their parents?

It depends on the location, the type of day care and the type of employees, which are all different variables involved in stability. Ideally, children should be with the same person as much as possible and get the attention they need. Some day cares are very good, while others are not so good, just like schools. Parents need to be vigilant and get the best quality day care they can. The important thing is to have a good “fit.”
- Johanne Renaud, MD, Mini-Psych School 2010

How do you make young children aware that they are hurting someone else?

The role of parents is to explain to their children how to understand things. We always have to warn children about dangerous behaviour: not to run with knives, not to touch mom or dad's medications, etc. Of course, some things are easier to learn than others, and when it comes to hurting others, the only thing you can do is to repeat the same message, i.e., "How would you feel if someone said that about you?" At the same time, you don't want to push them, because children can feel very guilty. Some people are extremely sensitive, while others are not. You therefore have to try to find a balance and encourage children to understand what others are thinking without making them feel too guilty.
-Camillo Zacchia, PhD, Mini-Psych School 2010

Are there physical differences in patients suffering from Parkinson's disease?

Yes. In Parkinson's disease, an area in the brain called the basal ganglia degenerates. This area is also responsible for motor output, which explains the shaking at the beginning and then the progressive inability to move, to the point where the patient becomes paralyzed. Many years ago, we considered Parkinson's disease to be exclusively a disease of motor dysfunction. Today, researchers are asking patients with Parkinson's disease, “Do you have memory deficits and, if so, what are they?” We're finding that they do have profound memory deficits, particularly as the disease progresses.

-Joseph Rochford, PhD, Mini-Psych School 2006

How do you approach a teen who refuses to get help and denies having symptoms?

This question is always very relevant, as the first discussion with teens is the most difficult. As a therapist, I meet teens who come to my office and refuse to speak, while others shout or refuse to come in. However, there are some who don't want to leave once they arrive. Each case is different. I talk to them a lot, and I think this is the best way to regulate the conversation, to truly connect with them and to get them to express themselves. Direct contact is also helpful, especially for boys on the waiting list who do not want to come for treatment. In this case, I pick up the phone and call. You need to "shake things up" a bit to form a bond with them. Unfortunately, this is not always possible, and you have to wait until things are really going badly until you can help them.
-Johanne Renaud, MD, Mini-Psych School 2010

How does divorce impact small children?

Earlier divorce is actually easier for children than later divorce. Your reaction is really what will determine how your kids react. If you are mature and respect each other, the children will be fine. If you constantly scream at each other and put each other down in their presence, the children may have difficulties. This situation is more challenging for parents than for kids unfortunately.
- Johanne Renaud, MD, Mini-Psych School 2010

Are mental illnesses less frequent in "primitive societies"?

In primitive societies, the prevalence of schizophrenia and bipolar disorders is believed to have been the same as it is today. However, in some primitive societies people with severe mental disorders are better integrated into the community; they often remain in their homes. Suicide varies greatly from country to country. I would say that it is less prevalent in underdeveloped countries than in westernized countries. Anorexia is found all over the world, but some countries and ethnic groups are spared. For example, there's a lower incidence among black people. We don't know why. It's not just a question of cultural influence. True anorexia seems to have a fixed incidence in populations and but is not found in certain parts of the world, like in Inuit communities and in some Middle Eastern countries.
- Mimi Israël, MD, FRCPC, Mini-Psych School 2006

Is being transgender/homosexual a mental illness?

When it comes to sexual aspects, psychiatry has not had a brilliant history. Homosexuality was considered a disease up to the 1970’s, and it even used to be a classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM).Despite this awful history, there are people who nevertheless have sexual delusions, and that’s why it’s very important to get an opinion from psychiatrists and sexologists to determine whether the person has a delusion or whether this is actually part of their identity. Schizophrenia can affect a person’s basic identity, so we can say that sexuality has some impact if it affects identity. Delusion can also manifest as sexual ideas, so it’s very important to be careful when it comes to sexual identity and how it relates to delusions.
- Ridha Joober, MD, PhD, Mini-Psych School 2012

What is your definition of total recovery?

I would say that I have recovered well enough to stand before you and talk to you today. Total recovery would be someone who is 100 percent happy; however, total recovery is hard to achieve. I think recovery includes getting to a point where you are able to enjoy life, enjoy your day, look forward to new challenges, have a strong sense of yourself and a feeling of empowerment, feel like you are able to do things and not be defeated by the negativity around you, be able to take control of your life, and accomplish what you want to accomplish no matter where you’ve been in your past, even if you’ve experienced a great amount of marginalization. If you get beyond that and have a sense of empowerment, I would say you are well on your way to recovery.
-Janina Komaroff, Research Assistant, Douglas Institute, Mini-Psych School 2012

How can I help my sister who has true psychological and personal problems, but refuses to get help?

There are really only two options. In Quebec, and in many countries, you cannot force someone to be evaluated or treated against her will unless there is an imminent threat to her life or to someone else’s. If this is the case, the first thing to do is go to the courthouse and ask for a psychiatric evaluation. They will help you with the necessary forms and procedures.

Sometimes the person threatens a neighbour or the police. In such cases he or she is taken to emergency for an evaluation without the family having to get involved.

Needless to say, this is not what anyone wants. A far simpler solution (second option) would be to maintain lines of communication with your sister. At some point she might acknowledge that things aren’t going well. This is when you can offer to bring her to the hospital or a community organisation. If she goes on her own accord she is far more likely to comply with treatment.

-Camillo Zacchia, Ph.D., in response to a comment on his blog Psychospeak with Dr. Z, 2013

Is it true that a genetic disease isn’t automatically hereditary?

Absolutely. It could be that your father and mother transmitted genes that are normal, but something happened during the early stages of development that causes a chromosome to mutate or become damaged. However, in most cases, the genetic mutation is transmitted from the parents. Spontaneous genetic events are extremely rare.
- Ridha Joober, MD, PhD, Mini-Psych School 2012

Where do adults or teachers turn when a student shows signs of fairly significant psychological problems?

This is a difficult situation. Youth protection gets so many calls that if they see that somebody is there for the person, they won’t always keep a record of the report. In this case, we need to be creative and work with the community network. We need to involve social services at the CLSC or CSSS, and we need to have good relationships with our partners in this sector, such as social workers at the school and the CSSS.

There is also a difference between protection and help. Sometimes people are protected by others around them; they just refuse to get help, which is true for both young people and adults. If negotiating or encouraging the person does not work, you may have to get a court order, especially if the person is in a psychotic state. Another option is to bring the person to the emergency room, although emergency room staff won’t necessarily see the person accompanying the teenager. In any case, you need to continue to look for other solutions and keep trying to help the youth.
-Johanne Renaud, MD, Mini-Psych School 2012

How do parents talk openly about their teenager who has a mental illness?

It depends on who they would be speaking to and why. For example, if they are speaking to other people to gain knowledge about their children or find support, they could say, “My son or daughter has a mental health issue and it is manifesting in this way.” They could couch what they say in terms of recovery and ask others, “What have you done to recover? What is your experience and knowledge of recovery?”

The parents should focus on how they can take action instead of focusing on negative reactions such as “That’s terrible.” They should see the condition in practical terms, in the same way as a physical health problem. What do you do if you break your arm? You go to the doctor and get the best advice on how to carry on with your normal activities.
-Janina Komaroff, Research Assistant, Douglas Institute, Mini-Psych School 2012

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