From a Psych Hospital to Harvard Law: One Black Woman’s Journey With Bipolar Disorder

Krista L. R. Cezair

Ms. Magazine

Originally posted 22 Feb 24

Here is an excerpt:

In the spring of 2018, I was so sick that I simply couldn’t consider my future performance on the bar exam. I desperately needed help. I had very little insight into my condition and had to be involuntarily hospitalized twice. I also had to make the decision of which law school to attend between trips to the psych ward while ragingly manic. I relied on my mother and a former professor who essentially told me I would be attending Harvard. Knowing my reduced capacity for decision‐making while manic, I did not put up a fight and informed Harvard that I would be attending. The next question was: When? Everyone in my community supported me in my decision to defer law school for a year to give myself time to recover—but would Harvard do the same?

Luckily, the answer was yes, and that fall, the fall of 2018, as my admitted class began school, I was admitted to the hospital again, for bipolar depression this time.

While there, I roomed with a sweet young woman of color who was diagnosed with schizophrenia, bipolar disorder and PTSD and was pregnant with her second child. She was unhoused and had nowhere to go should she be discharged from the hospital, which the hospital threatened to do because she refused medication. She worried that the drugs would harm her unborn child. She was out of options, and the hospital was firm. She was released before me. I wondered where she would go. She had expressed to me multiple times that she had nowhere to go, not her parents’ house, not the child’s father’s house, nowhere.

It was then that I decided I had to fight—for her and for myself. I had access to resources she couldn’t dream of, least of all shelter and a support system. I had to use these resources to get better and embark on a career that would make life better for people like her, like us.

After getting out of the hospital, I started to improve, and I could tell the depression was lifting. Unfortunately, a rockier rock bottom lay ahead of me as I started to feel too good, and the depression lifted too high. Recovery is not linear, and it seemed I was manic again.

The info is here.

Here are some thoughts:

In this powerful piece, Krista L. R. Cezair candidly shares her journey navigating bipolar disorder while achieving remarkable academic and professional success. She begins by describing her history of depression and suicidal thoughts, highlighting the pivotal moment of diagnosis and the challenges within mental health care facilities, particularly for marginalized groups. Cezair eloquently connects her personal experience with broader issues of systemic bias and lack of understanding around mental health, especially within prestigious institutions like Harvard Law School. Her article advocates for destigmatizing mental health struggles and recognizing the resilience and contributions of those living with mental illness.

Unraveling the Mindset of Victimhood

Scott Barry Kaufman

Scientific American

Originally posted 29 June 2020

Here is an excerpt:

Constantly seeking recognition of one’s victimhood. Those who score high on this dimension have a perpetual need to have their suffering acknowledged. In general, this is a normal psychological response to trauma. Experiencing trauma tends to “shatter our assumptions” about the world as a just and moral place. Recognition of one’s victimhood is a normal response to trauma and can help reestablish a person’s confidence in their perception of the world as a fair and just place to live.

Also, it is normal for victims to want the perpetrators to take responsibility for their wrongdoing and to express feelings of guilt. Studies conducted on testimonies of patients and therapists have found that validation of the trauma is important for therapeutic recovery from trauma and victimization (see here and here).

A sense of moral elitism. Those who score high on this dimension perceive themselves as having an immaculate morality and view everyone else as being immoral. Moral elitism can be used to control others by accusing others of being immoral, unfair or selfish, while seeing oneself as supremely moral and ethical.

Moral elitism often develops as a defense mechanism against deeply painful emotions and as a way to maintain a positive self-image. As a result, those under distress tend to deny their own aggressiveness and destructive impulses and project them onto others. The “other” is perceived as threatening whereas the self is perceived as persecuted, vulnerable and morally superior.

The info is here.

Here is a summary:

Kaufman explores the concept of "interpersonal victimhood," a tendency to view oneself as the repeated target of unfair treatment by others. He identifies several key characteristics of this mindset, including:

• Belief in inherent unfairness: The conviction that the world is fundamentally unjust and that one is disproportionately likely to experience harm.
• Moral self-righteousness: The perception of oneself as more ethical and deserving of good treatment compared to others.
• Rumination on past injustices: Dwelling on and replaying negative experiences, often with feelings of anger and resentment.
• Difficulty taking responsibility: Attributing negative outcomes to external factors rather than acknowledging one's own role.

Kaufman argues that while acknowledging genuine injustices is important, clinging to a victimhood identity can be detrimental. It can hinder personal growth, strain relationships, and fuel negativity. He emphasizes the importance of developing a more balanced perspective, acknowledging both external challenges and personal agency. The article offers strategies for fostering resilience

What predicts suicidality among psychologists? An examination of risk and resilience

S. Zuckerman, O. R. Lightsey Jr. & J. White

Death Studies (2022)

DOI: 10.1080/07481187.2022.2042753

Abstract

Psychologists may have a uniquely high risk for suicide. We examined whether, among 172 psychologists, factors predicting suicide risk among the general population (e.g., gender and mental illness), occupational factors (e.g., burnout and secondary traumatic stress), and past trauma predicted suicidality. We also tested whether resilience and meaning in life were negatively related to suicidality and whether resilience buffered relationships between risk factors and suicidality. Family history of mental illness, number of traumas, and lifetime depression/anxiety predicted higher suicidality, whereas resilience predicted lower suicidality. At higher levels of resilience, the relationship between family history of suicide and suicidality was stronger.

From the Discussion section:

Contrary to hypotheses, however, resilience did not consistently buffer the relationship between vulnerability factors and suicidality. Indeed, resilience appeared to strengthen the relationships between having a family history of suicide and suicidality. It is plausible that psychologists may overestimate their resilience or believe that they “should” be resilient given their training or their helping role (paralleling burnout-related themes identified in the culture of medicine, “show no weakness” and “patients come first;” see Williams et al., 2020, p. 820). Similarly, persons who believe that they are generally resilient may be demoralized by their inability to prevent family history of suicide from negatively affecting them, and this demoralization may result in family history of suicide being a particularly strong predictor among these individuals. Alternatively, this result could stem from the BRS, which may not measure components of resilience that protect against suicidality, or it could be an artifact of small sample size and low power for detecting moderation (Frazier et al., 2004). Of course, interaction terms are symmetric, and the resilience x family history of suicide interaction can also be interpreted to mean that family history of suicide strengthens the relationship between resilience and suicidality: When there is a family history of suicide, resilience has a positive relationship with suicidality whereas, when there is no family history of suicide, resilience has a negative relationship with suicidality.

The research is here.

Promoting wellness and stress management in residents through emotional intelligence training

Ramzan Shahid, Jerold Stirling, William Adams
Advances in Medical Education and Practice ,Volume 9

Background: 

US physicians are experiencing burnout in alarming numbers. However, doctors with high levels of emotional intelligence (EI) may be immune to burnout, as they possess coping strategies which make them more resilient and better at managing stress. Educating physicians in EI may help prevent burnout and optimize their overall wellness. The purpose of our study was to determine if educational intervention increases the overall EI level of residents; specifically, their stress management and wellness scores.

Participant and methods: 

Residents from pediatrics and med-ped residency programs at a university-based training program volunteered to complete an online self-report EI survey (EQ-i 2.0) before and after an educational intervention. The four-hour educational workshop focused on developing four EI skills: self-awareness; self-management; social awareness; and social skills. We compared de-identified median score reports for the residents as a cohort before and after the intervention.

Results: 

Thirty-one residents (20 pediatric and 11 med-ped residents) completed the EI survey at both time intervals and were included in the analysis of results. We saw a significant increase in total EI median scores before and after educational intervention (110 vs 114, P=0.004). The stress management composite median score significantly increased (105 vs 111, P<0.001). The resident’s overall wellness score also improved significantly (104 vs 111, P=0.003).

Conclusions: 

As a group, our pediatric and med-peds residents had a significant increase in total EI and several other components of EI following an educational intervention. Teaching EI skills related to the areas of self-awareness, self-management, social awareness, and social skill may improve stress management skills, promote wellness, and prevent burnout in resident physicians.

The research is here.

Meet the Chatbots Providing Mental Health Care

Daniela Hernandez
Wall Street Journal
Originally published Aug. 9, 2018

Here is an excerpt:

Wysa Ltd., a London- and Bangalore-based startup, is testing a free chatbot to teach adolescents emotional resilience, said co-founder Ramakant Vempati.  In the app, a chubby penguin named Wysa helps users evaluate the sources of their stress and provides tips on how to stay positive, like thinking of a loved one or spending time outside.  The company said its 400,000 users, most of whom are under 35, have had more than 20 million conversations with the bot.

Wysa is a wellness app, not a medical intervention, Vempati said, but it relies on cognitive behavioral therapy, mindfulness techniques and meditations that are “known to work in a self-help context.”  If a user expresses thoughts of self-harm, Wysa reminds them that it’s just a bot and provides contact information for crisis hotlines.  Alternatively, for $30 a month, users can access unlimited chat sessions with a human “coach.”  Other therapy apps, such as Talkspace, offer similar low-cost services with licensed professionals.

Chatbots have potential, said Beth Jaworski, a mobile apps specialist at the National Center for PTSD in Menlo Park, Calif.  But definitive research on whether they can help patients with more serious conditions, like major depression, still hasn’t been done, in part because the technology is so new, she said.  Clinicians also worry about privacy.  Mental health information is sensitive data; turning it over to companies could have unforeseen consequences.

The article is here.

Preventing Med School Suicides

Roger Sergel
MegPage Today
Originally posted May 2, 2018

Here is an excerpt:

The medical education community needs to acknowledge the stress imposed on our medical learners as they progress from students to faculty. One of the biggest obstacles is changing the culture of medicine to not only understand the key burnout drivers and pain points but to invest resources into developing strategies which reduce stress. These strategies must include the medical learner taking ownership for the role they play in their lack of well-being. In addition, medical schools and healthcare organizations must reflect on their policies/processes which do not promote wellness. In both situations, there is pointing to the other group as the one who needs to change. Both are right.

We do need to change how we deliver a quality medical education AND we need our medical learners to reflect on their personal attitudes and openness to developing their resilience muscles to manage their stress. Equally important, we need to reduce the stigma of seeking help and break down the barriers which would allow our medical learners and physicians to seek help, when needed. We need to create support services which are convenient, accessible, and utilized.

What programs does your school have to support medical students' mental health?

The information is here.

What is moral injury, and how does it affect journalists covering bad stuff?

Thomas Ricks
Foreign Policy
Originally published September 5, 2017

Here is an excerpt:

They noted that moral injury is the damage done to a “person’s conscience or moral compass by perpetrating, witnessing, or failing to prevent acts that transgress personal moral and ethical values or codes of conduct.”

While not all journalists were affected the same way, the most common reactions were feelings of guilt at not having done enough personally to help refugees and shame at the behavior of others, such as local authorities, they wrote.

Journalists with children had more moral injury-related distress while those working alone said they were more likely to have acted in ways that violated their own moral code. Those who said they had not received enough support from their organization were more likely to admit seeing things they perceived as morally wrong. Less control over resources to report on the crisis also correlated significantly with moral injury. And moral injury scores correlated significantly with guilt. Greater guilt, in turn, was noted by journalists covering the story close to home and by those who had assisted refugees, the report added.

Feinstein and Storm wrote that moral injury can cause “considerable emotional upset.” They noted that journalists reported symptoms of intrusion. While they didn’t go into detail, intrusion can mean flashbacks, nightmares and unwanted memories. These can disrupt normal functioning. In my view, guilt and shame can also be debilitating.

The article is here.

Surgeon General Concerned About Physician Burnout

by Joyce Frieden
MedPage Today
Originally posted April 10, 2016

Here is an excerpt:

But in the months since he has taken office, a growing concern about emotional well-being emerged "from conversations I had with community members, and it is based on the science developed over the years that tells us emotional well-being is an important driver of health."

"People think that emotional well-being is something that happens to you -- things line up in your life, you have the right job, and your health is good, and [you are in] a happy family and in a good relationship and you're happy in your emotional life," he said. "But there's a growing body of science that tells us there are things we can do to develop our emotional well-being proactively, and that in turn can have a positive impact on our health."

Murthy noting that promoting well-being doesn't require reinventing the wheel as there are already programs focused on emotional well-being that have significant outcomes for health and education, but people just don't know about them.

The article is here.

Nurses Say Stress Interferes With Caring For Their Patients

By Alan Yu
NPR.org
Originally posted April 15, 2016

Here is an excerpt:

Almost 20 percent of newly registered nurses leave a hospital within the first year for the same job elsewhere, or a different job in a different organization, according to a 2014 study. Rushton says to her, that means health care organizations aren't investing enough in their nursing staff.

Nurse burnout also is linked to moral distress, Rushton says, from situations where nurses know what they should do for their patients but can't act on it. For example, nurses might have to give a patient at the end of life a treatment that causes suffering without any medical benefit. She just started a program called the Mindful Ethical Practice and Resilience Academy to try to help new nurses deal with moral distress.

It's a series of in-person workshops, some of which involve nurses using simulations to practice how to make their ethical concerns heard at work. One scenario includes a patient with a complex medical condition and a nurse has been caring for him and talking to him for days following the recommended treatment.

The article is here.

Note: There are several significant areas that apply to mental health professionals in terms of stress, moral distress, professional respect, and overwork.

Compassion fatigue resiliency training: the experience of facilitators

Potter P, Pion S, Gentry JE.
J Contin Educ Nurs. 2015 Feb;46(2):83-8.
doi: 10.3928/00220124-20151217-03

Abstract

This qualitative evaluation examined compassion fatigue facilitators' perceptions of the effects of a compassion fatigue resiliency training program in an urban medical center in the midwestern United States. Nine months after completing a compassion fatigue resiliency facilitator training program, 15 participants wrote short narratives describing how the program affected them. Participants described how the training program benefited them both personally and professionally. Two main themes were identified from the narrative analysis: self-improvement and application of resiliency. All of the participants described one or more self-improvements as a result of the program, particularly in regard to emotional health. All of the participants also described how they regularly applied one or more of the resiliency skills taught in the class to improve their ability to manage stress and prevent compassion fatigue. This program shows promise in ameliorating compassion fatigue and burnout in health care providers.

The entire article is here.

Gruesome case videos became too much for top psychiatrist

Chris Cobb, Postmedia News | Originally published 11/11/13

Dr. John Bradford’s mental breakdown hit without warning less than half an hour after he watched Canadian Air Force colonel Russell Williams sexually assaulting two young women whom he would later kill.

During his long and distinguished career as a doctor and teacher, the internationally renowned forensic psychiatrist had become skilled at emotionally detaching himself from all manner of horrendous images.

He was relatively comfortable sitting across a table from the likes of notorious sex killers Paul Bernardo, Robert (Willie) Pickton and Williams.

And like all professionals in his line of work, Dr. Bradford was trained to focus on the killer, not the crime. His job is to get inside a killer’s mind, not to pass judgment on the severity or brutality of the killer’s actions.

The entire article is here.

Thanks to Gary Schoener for this article.

Antidotes to Burnout: Fostering Physician Resiliency, Well-Being, and Holistic Development

By Herdley O. Paolini, Burt Bertram, & Ted Hamilton
Medscape News
Originally published April 19, 2013

Florida Hospital -- an Orlando-based 8-campus hospital with 2200 beds, a 2000-plus physician medical staff, and more inpatient admissions annually than any other hospital in the United States -- is home to Physician Support Services, a pioneering program created to address physician burnout.

The program provides whole-person care through specialized professional resources aimed at maximizing the personal and professional well-being of Florida Hospital physicians and their families. The direct financial benefit of the program to Florida Hospital is in excess of $5 million over the past 2 years, and the program has rescued the careers of more than 100 physicians in the past 10 years.

The service includes confidential psychotherapy and coaching, continuing medical education (CME) with credit that is focused on helping physicians integrate their personal and professional lives, dialogue programs about cultivating meaning in medical practice, physician leadership development, and marriage retreats.

The Florida Hospital program is based on an in-depth and compassionate understanding of the forces affecting physicians and the practice of medicine, as well as the belief that physician leadership is crucial in envisioning and operationalizing the changes that are needed in the practice of medicine. Rather than ignoring, stigmatizing, or penalizing distressed physicians, Physician Support Services pragmatically addresses the emotional, spiritual, family, and performance issues associated with physician burnout, while intentionally developing physician leadership.

The entire story is here.

Spiritual Care and Moral Injury in Service Members

By George F. Handzo
Caring Connections
Volume 10, Number 1
Winter 2013

Here are some excerpts:

It is important to note that moral injury has been widely discussed in several contexts, including sexual assault and the provision of health care—the latter being mainly in the nursing literature. While there are significant overlaps in cause, symptoms and spiritual interventions, moral injury in the military is focused on and arises from the particular context of the service member’s involvement in combat. In the military, moral injury is most often talked about as a subcategory of PTSD although, as I will discuss below, this can be a misleading characterization.

Definitions

Moral Injury:

The behavioral, cognitive, and emotional aftermath of unreconciled severe moral conflict, withdrawal, and self-condemnation. It closely mirrors re-experiencing, avoidance, and emotional numbing symptoms of PTSD.   Unlike life-threat trauma, moral injury may also include: self-harming behaviors, such as poor self-care, alcohol and drug abuse, severe recklessness, and parasuicidal behavior, self-handicapping behaviors, such as retreating in the face of success or good feelings, and demoralization, which may entail confusion, bewilderment, futility, hopelessness, and self-loathing. (Litz, B, et al, 2009)

Moral Distress:

The painful psychological disequilibrium that results from recognizing the ethically appropriate action, yet not taking it, because of such obstacles as lack of time, supervisory reluctance, an inhibiting power structure, institution policy, or chain of command considerations (Corley et al., 2001) (Thus, moral distress in this context is largely a symptom of moral injury).

PTSD:

The result of exposure to events so overwhelmingly stressful and extraordinary that anyone who experiences them would be distressed. In the experience of the ma, the person usually fears for his or her life or the lives of others. This triggering traumatic event overwhelms the person’s ability to respond or cope adequately. For normal diagnostic purposes, PTSD has four components – the stressor, re-experiencing, avoidance, and hyper-arousal.   All four components must be present for a diagnosis of PTSD.

The entire article is here.

Thanks to Gary Schoener for the article.

The Winter Issue of Caring Connections is entitled Light in the Darkness: Hope, Resilience and Moral Injury and has several articles related to moral injury.

Psychologist Suicide

By Tori DeAngelis
November 2011, Vol 42, No. 10
Print version: page 19

A colleague's death is hard to contemplate. But the suicides of two psychologists in 2008 — as well as those of noted psychologists Michael J. Mahoney, PhD, in 2006, and Lawrence Kohlberg, PhD, in 1987 — prompted an ad hoc APA committee to look closely at what is known about this hazard and what the profession can do about it.

The group – led by Phillip M. Kleespies, PhD, of the VA Boston Healthcare System and made up of members of APA's Advisory Committee on Colleague Assistance, the APA Practice Directorate and the APA Div. 12 (Clinical) Section on Clinical Emergencies and Crises — examined research in four critical areas: suicide rates, risk factors, impact on others and how colleagues support psychologists in distress. They also examined the current state of prevention and intervention, and suggested ways to enhance training in this vital area.

(cut to the final portion)

"Suicide by psychologists, individuals with special expertise in human behavior, seems to be particularly fraught with challenges and raises concerns specific to psychology such as doubt in the value of therapy," they write. "Identifying risks, reducing the stigma associated with acknowledging hopelessness or despair, and overcoming other barriers to intervention are critical to reducing the incidence of suicide."

The entire story can be read here.

Self-Care and Building Resilience

by John Gavazzi, PsyD ABPP

Ethics Chair

Psychologists aim for excellence in all of their professional roles. We often do not realize that average, everyday concerns, such as balancing professional stresses with personal life, reflect important aspirational ethical considerations. Within the domain of positive ethics, psychologists must be attuned to self-care and engage. Because, within the context of psychotherapy, we use ourselves as an instrument of our trade, self-care is essential to effective treatment.  Unless we take optimal care of ourselves, it is less likely that psychologists can provide the best possible services.

Ironically, while we encourage our clients to meet their own needs, psychologists often neglect their own self-care. There are a number of terms used to describe the occupational hazards of practicing psychotherapy, including “burnout” and “compassion fatigue.” Because working therapeutically with others involves empathy, this necessary and often rewarding emotional connection can also be the source of physical and emotional difficulties for the treating psychologist. We all know that whether a client is depressed, manic, traumatized, anxious, or cycling in chaos, the psychologist uses his or her cognitive and emotional resources as part of treatment. Combine the need to use extensive cognitive and emotional skills with long hours, managed care shenanigans, HIPAA requirements, and any other stressor of maintaining a practice, it is easy to see how working as a psychologist can be physically and emotionally exhausting.

Psychologists must remain aware of the requirements of our work and plan for stressors in order to function well. By engaging in healthy self-care activities, we are better able to take care of personal lives, and ourselves, which ultimately lead to better treatment for our clients.

APA recently published a document for psychologists to educate their patients on “Building Your Resilience.”  While APA geared the document for patients, psychologists may want to review the suggestions to help build their resilience.  Here are some of the suggestions:

Find positive ways to reduce stress and negative feelings

Following a stressful event, many people feel they need to turn away from the negative thoughts and feelings they are experiencing. Positive distractions such as exercising, going to a movie or reading a book can help renew you so you can re-focus on meeting challenges in your life. Avoid numbing your unpleasant feelings with alcohol or drugs.

Look for opportunities for self-discovery

People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation for life.

Nurture a positive view of yourself

Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.

Keep things in perspective

Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion. Strong emotional reactions to adversity are normal and typically lessen over time.

Maintain a hopeful outlook

An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.

Take care of yourself.

Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing and that contribute to good health, including regular exercise and healthy eating. Taking care of yourself helps keep your mind and body primed to deal with situations that require resilience.

We all could use these types of reminders from time to time.