Dr. Henry Paul, MD

Psychiatrist, Author and Educator

SEXUAL ASSAULT ON COLLEGE CAMPUSES

November 29th, 2014

To make our college campuses safer, change still needs to come from many quarters: schools must adopt better policies and practices to prevent these crimes and to more effectively respond when they happen, and federal agencies must ensure that schools are living up to their obligations. To accomplish these and other goals, the President today is establishing a White House Task Force to Protect Students from Sexual Assault. The Task Force will:

Provide educational institutions with best practices for preventing and responding to rape and sexual assault.
Build on the federal government’s enforcement efforts to ensure that educational institutions comply fully with their legal obligations.
Improve transparency of the government’s enforcement activities.
Increase the public’s awareness of an institution’s track record in addressing rape and sexual assault.
Enhance coordination among federal agencies to hold schools accountable if they do not confront sexual violence on their campuses. Credit White House Task Force 2014 Click to read the report.

If you are the parent of a teenage boy, particularly if you are the father of one, it is important to talk to your son about date rape. Tell him the importance of respecting a woman, and that if a girl says stop or no, he must listen! Period, no questions asked. Make sure he understands that if he doesn’t stop he could be arrested. It is as simple as that! Make sure he knows that date rape is rape and rape is wrong. Above all, you need to reinforce the notion that being a man does not mean being indiscriminately or insensitively dominant.

Make sure to talk with your son about his feelings and urgings. As a man you need to help him to understand that his attraction to a girl and urges to have sex are perfectly normal. Encourage him to come to you with his questions and any confusion he has reading the signals that girls might be sending. Open a dialog with your son. He needs your guidance more than you might think.

If you have a daughter, make sure she knows that rape is a violent crime and that she has a right to stop a sexual encounter at any point. Impress upon her the dangers of alcohol or the use of other drugs, especially at social gatherings. She must understand that often “date rape” drugs are slipped into a potential victim’s drink, so she should be vigilant and not take a drink offered to her by a stranger or someone who she doesn’t trust. She should also never leave her drink unattended at a party.

Make sure if your daughter has been raped that she knows that it is not her fault in any way. Get her a mental health consultation to rule out any residual serious psychiatric effect. Sometimes short-term follow-up counseling can prevent far greater psychic harm in the future. Be there for her. Listen and be patient.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

THE DATE RAPE DRUGS

November 28th, 2014

“Campus Sexual Assault: A Particular Problem. As noted, 1 in 5 women has been sexually assaulted while in college. The dynamics of college life appear to fuel the problem, as many victims are abused while they’re drunk, under the influence of drugs, passed out, or otherwise incapacitated. Most college victims are assaulted by someone they know – and parties are often the site of these crimes. Notably, campus assailants are often serial offenders: one study found that of the men who admitted to committing rape or attempted rape, some 63% said they committed an average of six rapes each. College sexual assault survivors suffer from high levels of mental health problems (like depression and PTSD) and drug and alcohol abuse. Reporting rates are also particularly low.” White House Council on Women & Girls, January 2014

Certain drugs have been used in date rape, and your daughter must know about them. Rohypnol and GHB, are the two used most often and they both render a victim unable to move.

Rohypnol, the most commonly used date rape drug, is a tranquilizer that is sold illegally in the United States. The white tablets are easily dissolvable in drinks and are undetectable. Rohypnol is used to commit sexual assaults because it renders the victim incapable of resisting. The drug creates a high in combination with alcohol, impairs judgment and motor skills, and makes it impossible to prevent a sexual attack. Also called the “the forget pill” or “the mind eraser,” it causes a blackout so that nothing is remembered. It starts to work within thirty minutes, and peaks at two hours. Many victims have trouble speaking or moving. Their eyes may be wide open and they are able to observe events, but they are unable to move. Other effects of the drug include dizziness, disorientation, and often nausea. Afterwards the victim’s memories are cloudy and they can’t recall much of what happened.

Another date rape drug is GHB, gamma hydroxybutrate, which is also called liquid ecstasy or scoop. According to the Monitoring the Future; National Results on Adolescent Drug Use, GHB is available as an odorless, colorless drug that may be combined with alcohol and given to unsuspecting victims prior to sexual assaults. It may have a soapy or salty taste. Use for sexual assault has resulted in GHB being known as a “date rape” drug. Victims become incapacitated due to the sedative effects of GHB, and they are unable to resist sexual assault. GHB may also induce amnesia in its victim. Common user groups include high school and college students and rave party attendees who use GHB for its intoxicating effects. Overdosing on this drug can be fatal.¹

Women have reported being raped after being given these drugs involuntarily, usually slipped into one of their drinks. Common sense should prevail. Girls should be told never to accept drinks from anyone they do not know. Also, they should not leave their drinks unattended. They and their group of friends should know the effects of these drugs so that they can recognize if it is given to one of their friends while they are together at a party or other social gathering.

1 Monitoring the Future. National Results on Adolescent Drug Use. Overview of Key Findings 2010. http://monitoringthefuture.org/pubs/monographs/mtf-overview2010.pdf Accessed December 17, 2011

DATE RAPE – THE DANGERS

November 25th, 2014

“It is up to all of us to ensure victims of sexual violence are not left to face these trials alone. Too often, survivors suffer in silence, fearing retribution, lack of support, or that the criminal justice system will fail to bring the perpetrator to justice. We must do more to raise awareness about the realities of sexual assault; confront and change insensitive attitudes wherever they persist; enhance training and education in the criminal justice system; and expand access to critical health, legal, and protection services for survivors.” President Barack Obama, April 2012

Sexual assault on our college campuses is a growing epidemic. According to a White House report earlier this year, about one in five women are sexually assaulted while they are college students. Rape occurs when a woman is subjected to sexual intercourse, oral or anal sex, or any other sexual act against her will through the use of threat of force. “Date rape”, also called acquaintance rape or hidden rape, is when a woman is raped by an acquaintance.

Although it is impossible to know the exact frequency of date rape, in some surveys up to 20 or 30 percent of young women have stated that they been date raped or been victims of attempted date rape. Most of them knew their attacker and most of this sexual coercion occurred on dates. About five to ten percent of young males have stated they have attempted date rape. Date rape is rarely reported to the police. As a result, victims rarely get help, despite the fact that they have been seriously traumatized.

The typical scenario for date rape involves a young women who, at a club, bar, party or other recreational gathering, feels social and sexual pressure to meet a boy. Drinking is often involved and sometimes sexual provocations are made by both girl and boy. Eventually, the two end up alone in a car, in an isolated area, or in one of their homes. It is at that point that the male often overpowers, threatens and forces the rape victim to give in and have sexual intercourse.

Increased risk factors for getting date raped include “traditional” assumptions among some young women that they should be passive or submissive, and the boy is “supposed” to be dominant. The rapist often picks out victims who he feels, based on their personalities, will not turn him in. The young men who commit date rape are often influenced by a powerful version of “machismo” – an assumption that it is the male’s prerogative to be dominant and take what he wants sexually. Sexual aggression in this context is not only acceptable but idealized. The use of drugs or alcohol by the aggressor is very common.

After date rape, the victim often tries to rationalize what happened. She blames herself. Despite these attempts at rationalization, she often suffers some degree of post-traumatic stress symptomatology and depression, and may even contemplate or attempt suicide. A very small number of date rapes are reported to the police, because of her guilt (her sense that somehow she may have caused it), her acquaintance with her attacker, and sometimes even the dismissive way she may be treated by family. Sometimes, sadly, the victim’s family members or friends look for reasons to accuse her, such as claiming she drank too much, dressed too provocatively, or in some other way “brought it on herself.” Other effects of having been date raped include promiscuity, social withdrawal, chronic anxiety, and persistent mistrust.

DREAMS OF THE DEPARTED MAY BE A WINDOW TO WHAT IS DEEP INSIDE YOU

November 21st, 2014

“Dad looked fine, except perhaps for a less-than-flattering white sweater he didn’t, in reality, own. In my dream — that’s what this was — I didn’t know that he had died.” Paula Span, NY Times blog, “Dreaming of the Departed” The New Old Age; Caring & Coping.

Last week Paula Span’s New York Times blog, “Dreaming of the Departed” raised the question of how often family members dream of the dearly departed and what the dreams might mean. In her blog, she focuses on her experience of dreaming about meeting her dad in a deli two years after he passed.

“Seeing Dad left me wondering how often deceased family members enter their survivors’ dreams and what we know about what — if anything — that means. So I called Alessandra Strada, a clinical psychologist and director of integrative medicine and bereavement services at MJHS Hospice and Palliative Care in New York. She has listened to patients talk about their dreams for 20 years.” said Span.

Dr. Strada responded to Span saying, “Dreams are quite a prevalent component of the bereavement process.”

In the blog, Span referenced some interesting statistics from the recently published study in The American Journal of Hospice and Palliative Care that surveyed 278 caregivers (mean age: 63), nearly 60 percent of whom reported dreaming of relatives who had recently died in hospice care.

Over the years, many of my patients have told me that after experiencing a loss that they often think of the departed. Sometimes they feel as if they heard the voice or had seen an image of the dead person. They very often dream about them.

As a medical professional, I can tell you that dreams have always been a center of interest in a psychiatric practice as they are the most sensitive markers of what is going on deep in our personalities. Sigmund Freud considered the dream the “royal road” to the unconscious. Karen Horney said that early in a therapy the dream was sometimes the best indicator of what the patient is struggling with deep down.

Most patients feel good about having a “visit” from the departed. Others feel different, especially if the relationship with the departed was conflicted. These dreams, when gone into in detail, often reveal a lot about a person’s past and present relationships. Having such dreams is not pathological and should be accepted as a natural and revealing process. Of course, if the patient is suffering from a serious mental illness and such dreams cause great anxiety and instability then they should be seen as signposts to areas that need to be explored as part of the treatment being offered.

Note: Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

SHOULD I TALK ABOUT MY DEPRESSION AT WORK?

November 21st, 2014

Many people with depression or another mental disorder are overwhelmed enough just dealing with their diagnosis and their focus on getting better, so it is no wonder that they do not want the added stress of having to tell family, friends, co-workers and bosses about their mental health.

Last Friday, a New York Times article, Deciding Whether to Disclose Mental Disorders to the Boss analyzed the decision that Patrick Ross, a deputy director of communications for the U.S. Patent and Trademark Office, made when he decided to tell his boss he had bi-polar disorder.

There is no right or wrong answer about telling your boss or others that you have a mental disorder, but if suddenly you are unreliable, your work drops off, and you no longer are the team player you used to be, then your boss will notice.

At work, you have two options: tell your boss and hope s/he will understand or do not saying anything and hope it goes unnoticed (if it isn’t too severe).

In the NY Times article, Sarah von Schrader, a senior research associate at Cornell University’s Employment and Disability Institute, said, “In one recent study of 600 people with disabilities, roughly half involving mental health, about a quarter of the respondents said they received negative responses to revealing their problems — such as not being promoted, being treated differently or being bullied.”

For Ross, who recently published a book on the subject, “Committed: A Memoir of the Artist’s Road,” he said that telling his boss was more difficult than he had expected. Since he told his boss, Ross says the support from his boss has been positive and even helpful. Ross still wonders how telling might affect his overall career, though, since his job is a political appointment. Only time will tell.

The World Health Organization predicts that by 2020, mental illness will be the second leading cause of disability worldwide, after heart disease. Right now major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a new study funded by the National Institute of Mental Health, and the direct cost of depression to the United States in terms of lost time at work is estimated at 172 million days yearly.

I want to see a national dialog about mental health that helps employers to understand the importance of having an employee who is both physically and mentally well. Sadly, it is still a reality in America in 2014 that people with mental illness are somehow labeled or looked upon differently. I am proud to say that we are making strides in this country to change stereotypes like these. I only wish it could happen faster. Putting mental-health problems on an equal footing with physical illnesses will only help more people make the disclosure. In the end, all will benefit. An employee at the top of his/her game is much more productive!

WHAT IS THIS THING CALLED DEPRESSION ANYWAY?

November 18th, 2014

Depression is a scary word to hear, especially from a doctor who is diagnosing you! It is important to remember, when you are diagnosed with depression that you are not alone. Depression affects about 25 million Americans each year. That is about 5-8 percent of adults in the United States. What is startling is that only a fraction of these people receive any treatment.

Depression is a mental disorder. But depressive symptoms present themselves within other mental disorders such as: bipolar disorder, posttraumatic stress disorder PTSD, panic/anxiety disorder, obsessive compulsive disorder (OCD), schizophrenia and borderline personality disorder.

Depression can happen a few times in a lifetime, present with several episodes over a year or have ongoing symptoms that get better and worse. When someone comes in and receives a diagnosis of major depression, it is unknown whether this depression (not associated with mania or hypomania) is a plain unipolar depression or one that is part of bipolar disorder. Bipolar disorder is characterized by episodes of depression and mania/hypomania (like mania but less severe). This is very important because the depression that is part of bipolar disorder, called bipolar depression, is treated differently than simple unipolar depression.

When you first visit your psychiatrist make sure that you can provide a complete history of your mental health. This includes the drugs and treatments you have had over the years, as well as all your symptoms.

Depression symptoms, as listed by the National Alliance on Mental Illness NAMI, include:

Changes in sleep. Some people experience difficulty in falling asleep, waking up during the night or awakening earlier than desired. Other people sleep excessively or much longer than they used to.
Changes in appetite. Weight gain or weight loss demonstrates changes in eating habits and appetite during episodes of depression.
Poor concentration. The inability to concentrate and/or make decisions is a serious aspect of depression. During severe depression, some people find following the thread of a simple newspaper article to be extremely difficult, or making major decisions often impossible.
Loss of energy. The loss of energy and fatigue often affects people living with depression. Mental speed and activity are usually reduced, as is the ability to perform normal daily routines.
Lack of interest. During depression, people feel sad and lose interest in usual activities.
Low self-esteem. During periods of depression, people dwell on memories of losses or failures and feel excessive guilt and helplessness.
Hopelessness or guilt. The symptoms of depression often produce a strong feeling of hopelessness, or a belief that nothing will ever improve. These feelings can lead to thoughts of suicide.
Movement changes. People may literally look “slowed down” or overly activated and agitated.

Your doctor will ask you if you have mania/hypomania to determine if your depression is only depression or if it is bipolar disorder. NAMI also has a good fact sheet with the symptoms of mania. Symptoms of mania/hypomania can include:

Feeling overly happy for an extended period of time.
An abnormally increased level of irritability.
Overconfidence or an extremely inflated self-esteem.
Increased talkativeness.
Decreased amount of sleep.
Engaging in risky behavior, such as spending sprees and impulsive sex.
Racing thoughts, jumping quickly from one idea to another.
Easily distracted.
Feeling agitated or “jumpy.”

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

AUTISM – WHAT IS REALLY BEHIND THE RISING NUMBERS?

November 7th, 2014

“The dramatic increase in the number of children diagnosed with an autism spectrum disorder is largely the result of changes in how the condition is reported,” Danish researchers contend in a study out this week, and I agree!

The Danish study says that the increase in numbers is due largely to the changes in diagnosing and reporting.

“As our study shows, much of the increase can be attributed to the redefinition of what autism is and which diagnoses are reported,” said lead researcher Stefan Hansen, from the section for biostatistics in the department of public health at Aarhus University in an interview with CBS News. “The increase in the observed autism prevalence is not due alone to environmental factors that we have not yet discovered.”

In the United States, the U.S. Centers for Disease Control and Prevention estimates that one in 68 children have an autism spectrum disorder. The reported prevalence of the condition has increased over the past 30 years, according to the new study.

In the same CBS News interview, Amy Daniels, the assistant director for public health research at Autism Speaks, a New York City-based advocacy group, agreed that a significant part of the increase in autism has resulted from changes in diagnosis and reporting.

“The findings from this study are consistent with past research documenting the role of non-causal factors, such as increase in autism awareness, changes to diagnostic criteria and the increase in autism prevalence over time,” she said.

Scientists aren’t certain about what causes autism, but it’s likely that a combination of genetics and environmental factors play a role, according to the U.S. National Institute of Neurological Disorders and Stroke.

I believe that autism is a neurological disorder and not an environmental one. There are plenty of new studies and research about Autism. I just posted a blog in September about a research study that indicates that children’s brains with autism fail to trim the synapses as they develop, and that if safe therapies can be developed to clear these synapses, there might be new hope for treating autism.

Now, the most important thing about autism is that people are talking about it. The medical community is stepping up its research, and medical professionals and schools are looking at treatment and accommodations to help those diagnosed with the disorder. We have a lot of work to do to understand and to treat autism, and that work has begun! Stay tuned.

For more on the Danish study visit CBS News “What’s Behind the Dramatic Rise in Autism Cases?” For more on autism visit my recent blogs:

Children with Autism Have Oversupply of Synapses, Says New Study
Shock Em’ Out of Autism
CDC Says 11 in 68 Children is on the Autism Spectrum – So What Does That Really Mean?

DISCLAIMER