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Sh*t fit

21 Jul

While waiting for a client in Club Monaco last month, I wandered into the women’s clothing section to kill some time. There was a cute little suit jacket on the rack that, upon further inspection, I deemed too large for me.

“Manity sizing” strokes a fella’s ego by “decreasing” his pant size by name only, which may in fact increase the risk of health problems.

I looked at the tag for the size.

0. Zero. Size Zero.

Were it 1960, I would be considered a size 14, but at Club Monaco in 2011, I would fit a negative size – a minus 1 or minus 2.

A minus size, a minus size; a size of no sum or consequence. How can I be a negative size?

This terrifies me in a way because  I see a negative size as a non-size and as a human, I feel erased; fitting a negative clothing size makes me feel like a non-person. What is this new sizing system and what else are they messing with?

This is a post to explain why your clothes don’t fit you.

Erratic sizing

To keep things efficient, manufacturers use “average” sizes of a cross-section of people to create patterns for different sizes (small, medium, large, etc.), classified by their height and weight. The measurements (neck measurement for men, chest, waist, hip measurement for women, etc.) are added together and divided by the number of people measured, giving “average” measurements.

But there are lots of interpretations of average and so few of us are actually average-sized, that this is just one of the factors working against us when we walk into a clothing store:

  • There is no industry standard for sizing – I have size extra small, small, medium, and an extra-large piece from Chinatown in my closet but my measurements remain static, unchanged;
  • Every designer cuts a little or a lot larger or smaller than the next designer, so each line will fit differently (e.g. Tiger of Sweden is a trim cut but Mark’s Work Warehouse has offerings for more robust fellows);
  • Some but not all manufacturers buy into “vanity sizes”, whereby a piece of clothing that may truly fit you is called something smaller (you could have an actual 34″ waist measurement but you might wear a 32″ or 33″ vanity-sized pant);
  • Each style of garment is going to fit differently on each body – e.g. the rise of the pant will give a larger waist size because it sits at a wider point on the hips.

This causes a great deal of confusion for people who have to wade through an ocean of arbitrary sizing that may or may not hold their own weight. Pun intended.

In the age of political correctness where we’re more sensitive to other’s feelings, business owners and manufacturers have to keep in mind that a compliment in the form of a “smaller (vanity) size” can be a wolf in sheep’s clothing.

Vanity

I’ve been told by women that wearing a “smaller” size makes them feel better about themselves. I understand what it’s like to be heavy and not feel one’s best (I was pushing 150 lbs at age 22 – about 30 lbs more than I weigh now), so I can see why a size 8 would feel better than a size 12.

It shouldn’t be a surprise that the vanity sizing practice began in women’s clothing, but it has seeped into menswear, adopting the name “manity sizing”. This rather dishonest sizing system has become totally out of hand, so I looked at some online research to figure out what this silly sizing system is all about. This is what I found:

“Vanity sizing is the practice of using smaller numbered sizes on bigger clothing patterns… to make customers feel better about themselves and become more inclined to buy,” says one blogger who runs a PR and marketing company.  Her opinion has a ring of supply and demand to it.

“It is important for manufacturers to have an idea of what sells because retail sales still have not fully recovered since the recession hit in 2008.”

However, on vanitysizing.com, this suggestion is (rather cuttingly) downplayed. The author of the article has an economics background and suggests that sizing is based on demographics.

“If you sell to lower-income people, your average size is going to be larger than the average size sold to rich people. Boutiques sell pricier clothes that are sized on average, smaller than product in mass merchant stores.”

A very good Esquire style blog describes the confusion with the vanity sizing for men. First, the writer calling the practice

From the Esquire style blog – vanity sizing for men’s pants.

“flattery”, but as we know, flattery can only take you so far. He says he’s got a Russell Crowe build and though he’s enjoyed his manity-sized pants, he’s still perturbed.

“This isn’t the subjective business of mediums, larges and extra-larges — nor is it the murky business of women’s sizes, what with its black-hole size zero. This is science, damnit. Numbers!”

But the numbers don’t add up and because sizing is basically a free-for-all without a standard measurement guide. The illustration below from Esquire shows to what extent we’re being lied to – to the tune of up to 5″.

Erratic sizes

The waist is the most misunderstood part of a man’s body, I think. When I’m taking my client’s measurements, I explain the waist measurement concept/confusion.

I tell them that if I were a doctor and we were doing an annual physical, I would measure his waist just above his hipbone/through the navel. Most people don’t wear their trousers that high anymore (men did in the 40s) and that means that the point at which his waistband sits is not necessarily where we’ve taken the measurement of the waist – different styles of pants with different rise lengths (the distance from the crotch to the top of the waist) will give different waist measurements at different points on the torso.

An article from The Telegraph reports findings of a study they conducted on men’s waist sizes and found that “[o]verall, 28 out of 50 garments checked were found to be larger than on the label.”

“Shoppers quite reasonably expect 32 inches to mean just that,” said Richard Cope, chief trend analyst at Mintel, a London-based market research company. “They are becoming increasingly frustrated to discover their sizes vary from fashion brand to fashion brand and from item to item.”

Confused yet? You should be.

Health problems

If clothing manufacturers began vanity sizing to make larger people feel better about themselves as some people maintain, that’s one thing, but I’m seeing this sizing practice as a dangerous denial and health threat.

Vanity sizing is delusional, offering solace in a lie and erasing any guilt from consuming another baker’s dozen, putting people at greater risk of the health problems associated with obesity.  As the Esquire blog asks, “why should pants make us feel better about badness at health?”

Obesity is an enormous social and economic problem. Pun intended. Men with larger waists face different and more serious health problems than slim guys – a Stats Can study identified type 2 diabetes, cardiovascular disease, high blood pressure, osteoarthritis, some cancers, and gallbladder disease associated with obesity, as well as “psychological problems, functional limitations and disabilities.”

Have a look at these astounding rates from Statistics Canada‘s study of adult obesity in Canada:

In 2004, nearly one-quarter (23.1%) of adult Canadians, 5.5 million people aged 18 or older, were obese. An additional 36.1% (8.6 million) were overweight.

The 2004 obesity figure was up substantially from 1978/79, when Canada’s obesity rate had been 13.8%.

As body mass index (BMI) increases, so does an individual’s likelihood of reporting high blood pressure, diabetes, and heart disease. (Check your own BMI here.)

Canada’s adult obesity rate is significantly lower than that in the United States: 23.1 % compared with 29.7%. The percentage of Canadians who are overweight or obese has risen dramatically in recent years, mirroring a worldwide phenomenon.

I have to wonder if vanity/ manity/ insanity sizing is really making things better by way of our self-esteem, or if it's plunging us deeper into clothing chaos and confusion and denial about our bodies. To my mind, this sizing practice is a psychological experiment that may give extra space for denial; the man with the 41" waist who's wearing a 36" pant from Old Navy may feel a little dietary freedom because he thinks he's got room n0w: Hey, I can fit into a size 36 for the time being, so I've got room for another coupla Krispy Creme KFC Double Downs - bring it on! 

Like a temporary sugar rush before the crash, I think that as a society, we're just asking for trouble lying to people about their sizes. Sometimes I ignore sizes altogether and rely on a tape measure where the numbers are hard and they don't tell me any fibs. The point is to be comfortable in clothing that fits us, regardless of what size the marketing department gives.

Nice guys finish last… or do they?

17 Sep

nice guys finish lastNice guys finish last. There is some debate over how this quote came to be, but there is no doubt that it came from a cranky New York Dodgers manager, Leo “The Lip” Durocher (Durocher was famous for arguing with umpires). During the summer of 1946, Durocher`s response to sports reporter, Red Barber`s question, Why don`t you be a nice guy for a change? prompted an answer that would coin the famous line:

“Nice guys! Look over there. Do you know a nicer guy than Mel Ott [NY Giants coach] ? Or any of the other Giants? Why, they’re the nicest guys in the world! And where are they? In seventh place! Nice guys! I’m not a nice guy – and I’m in first place.” 

That fall in the Baseball Digest, Durocher’s quote about nice guys in seventh place was boiled down to last place, and the phrase was born.

So it’s that idea of Durocher’s that nice guys perhaps aren’t tough enough to win pennants or to be in first place that has captured our imaginations and damned nice guys to be unworthy, spineless, second-rate wimps. But is it really true, or have nice guys just given up and accepted the assumption that they’re unworthy, spineless, second-rate wimps?

Nice guys: It’s all about perception

I had the opportunity to speak with First Gentleman, Zacchary Falconer-Barfield, at The Perfect Gentleman in London recently and I asked him if gentlemen, the considerate, polite, chivalric types, have more luck with women. He said that the idea of women being attracted to bad boys is short-term and the appeal of the bad boy disappears quickly. These gentlemen, these nice guys, have a lingering effect and are the ones women want to marry or have long-term relationships with.

Psychology Today article speaks to this. In Do Nice Guys Really Finish Last? Theresa DiDonato says that “until a woman is interested in establishing a steady partnership, she may sacrifice niceness for other desirable attributes”. She goes on to suggest that for short-term partners, women may choose attractiveness over kindness, but for long-term relationships, kindness and warmth will have more importance.

“Men confuse “nice” with “weak” and this is the problem,” Falconer-Barfield says, “Being nice is being polite and respectful; someone willing to compromise. Being weak is lacking in self-confidence, but this is a temporary state of being, and it’s all in your head.”

I’m always thinking about the social prejudices that men live with and from what I can tell, the idea of masculine weakness is associated with the feminine and to be thought of as feminine is a cardinal sin in the world of men (though I’ve never been able to understand why). That pressure to be strong, to be the man’s man, to be the best, to seize the booty is the patriarchal expectation of males and it’s that kind of pressure that seems to sort out the men from the boys, or if you like, the jerks from the nice guys. But this expectation only exists if you say it does; if you don’t, you’re free to be who you want to be.

Who really finishes last?
boring guys finish last

While looking for graphics for this post, I found a meme that really spoke to me: Nice guys don’t finish last, boring guys do.

Nice is always better than nasty, and nice doesn’t have to mean boring. One can be nice and bold, or nice and adventurous, or nice with a sense of humour. Nice guys can have some edge to them, just like bad boys, but they’re probably more present and attentive. Interesting individual characteristics blend well with “nice”, so don’t be afraid to be yourself.

If I created another meme for this post, it would be Nice guys don’t finish last, guys that try too hard do. There are nice guys out there who have the best intentions but cater too much to other people and invariably cast their own needs aside in order to please others. (Here there is a hint of co-dependency here, but that is another topic.) Then there are the nice guys who don`t know how to say no and can easily be taken advantage of by those looking out for their own gain. Nice guys like this run the risk of turning into doormats, and honestly, people don`t respect doormats; they wipe their feet on them.

Scientific experiments discussed in this short video about nice guys finishing first explains that “[f]rom an evolutionary perspective, animals which contain genes that promote nice behaviour are likely to have more offspring. It’s the basic underlying code for altruistic behaviour – you help me and I’ll help you. And ultimately, we’ll all do better! So while some mean, cut-throat, or envious people may temporarily exploit and gain from others, in the long run, not only nice guys, but nice people, really do finish first.”

————

Stress and the man

19 Feb

From the archives… The differences between the sexes and how they deal with the physical, emotional, and mental effects of stress.

In the Key of He

stressWe all experience stress in our lives, but we don’t talk about it enough – men especially – but there is growing interest in the topic – upon this writing, “men and stress” catches 239,000,000 Google results.

I spoke to a couple of stress experts through the Distress Centres Ontario (DCO),  a provincial organization that provides support services to lonely, depressed, and suicidal people, often via a 24-hour crisis line.

DCO presented “The Good, The Bad and the Ugly of Stress”, focusing on how to shift from a stress reaction to a support response in our body.

Asha Croggan and Arianne Richeson co-presented the learning event – Asha provides support to crisis lines and suicide networks across Canada and is the Provincial Programs Manager for Suicide and Mental Health Networks, and Arianne Richeson is the Manager of Educational Service at Distress Centre of Ottawa and Region. Below are some…

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Spread ’em. Actually, don’t

8 Jan

you balls are not that bigInspired by New York’s Metropolitan Transportation Authority, the move to ban “man-spreading”–men who sit on public transit with their knees spread so far apart that they actually take up seats next to them–has reached Toronto and the Toronto Transit Commission, and it’s caused some interesting gender chatter.

Globe and Mail article on the topic mentions the Canadian Association for Equality (CAE) who started a petition to stop the ban on man-spreading. The group says, “This sets a very bad precedent as men opening their legs is something we have to do due to our biology. It’s physically painful for men to close their legs and we cannot be expected to do so, and it’s also a biological necessity for us to do so.”

According to the petition, a ban on spreading one’s legs would “be a big blow to men’s rights.” Men’s rights to do what? Take up unnecessary space on public transit? To be discourteous to others?

Mike Wood, a volunteer advocacy officer with CAE argues that men should be able to take up as much space as women who board buses with strollers, but he fails to understand that when women bring strollers onto a bus, there is another person in the stroller, and the baby in the stroller needs space, just like any other person.

I wouldn’t agree that testicles have any independent rights and need their own seat on the subway.

 In Heroes, Rogues, and Lovers: Testosterone and Behaviour, James Dabbs describes “panache” as a manner that seeks to get the attention and respect of others. “A person with panache,” he writes, “scores points by looking dominant. Bluffing often works just as well as fighting when it comes to getting attention and respect. Male animals bristle, puff, strut, preen, spread their tail feathers, control space, intimidate their opponents, and show off to get their way and impress the opposite sex.”

Is this not what man-spreading is? Puffing up to take up more space and display some form of power and superiority? Why else would a man would choose to sit in on public transit in a way that exposes his most vulnerable body parts, open to potential contact with knees and parcels at the sudden jolt of an unexpected brake. If I were a man, I would protect my fragile spheres, not make them targets.

Ball room

Subway behaviour has its own etiquette and etiquette is about respecting other people and making them comfortable. Man-spreading is the opposite of this. Mr. Wood mentions men’s biology a couple of times being the reason that men need to spread. Some men will need a little extra space for their tackle than others, yes, but how much space could comfort possibly require? Are your testicles so big that you need an extra foot to accommodate them? Perhaps it’s time to change your style of underwear instead of hogging transit seating.

The image used for this post is from a hilarious site about man-spreading. YOUR BALLS ARE NOT THAT BIG seeks to out man-spreaders on the New York subway by posting pictures of the culprits (world-wide submissions are welcome). The blogger makes it clear that man-spreading is about men concerned only with display and their own comfort, not the comfort of others.

Display includes body language, the expression of our self-confidence. Individual self-confidence and self-esteem speaks through the way we move and position ourselves in space, including the way we sit. A man who sits with crossed legs looks comfortable, a man sitting with knees 6″ apart also looks comfortable, but when men sit with knees wide apart, i.e. over 12″, he’s telling the world that a) he’s desperate for attention, b) he’s painfully insecure, and c) he wants to appear virile and by spreading his knees apart so far apart, he can show off those “big balls” of his. Testosterone likes to put on a good show, as Dabbs says.

Funny thing about virility: it’s often not what it seems. Like male animals, much of the virility is false but the display can be stunning.  I had a boyfriend with a huge set of testicles that hung heavily under his pinkie-sized penis which only ejaculated prematurely, so I wouldn’t say that large testicles necessarily indicate virility. The whole puffed-up, I-have-bigger-balls-than-you-and-that-makes-me-more-masculine mentality of man-spreaders is a delusion; mere posturing.

In the animal world as Dabbs mentions, panache works to look dominant and impress the opposite sex. I cannot imagine any woman being attracted to a man who tries so hard to show he’s masculine by exposing what he thinks are mammoth testicles to prove his manhood, while simultaneously imposing himself into other people’s space.

I’m not even sure that men are aware of how much space they take up because they haven’t been challenged on it until recently. Once men are called on it however, many will acknowledge their puffed-up, space-taking wrongdoing and change their position (at least this is what happens in polite Toronto). Several times I’ve been on public transit and saw the only seat available beside a wide-kneed man,  but instead of being intimidated, I said, excuse me, and lowered my bottom into the seat (while he scowled because I’ve messed up his space). If a man’s leg is in my space, I ask him to please give me some more leg room and I’ve never had an argument. Politeness and a kind smile can do wonders for personal comfort, so I recommend it.

Now that the New York subway system’s anti-spreading campaign is on and the messages are travelling to other large cities, it’s time for men (and women who take up more space than they need to) to pay attention and be more aware of the necessity to share space in our ever-increasingly populated cities. As subway posters in Philadelphia say, “Dude It’s Rude… Two Seats — Really?”

PS – Have a look at this site that features Japanese subway posters from the 1970s and 80s that even back then, tried to make people aware of how man-spreading negatively affects people.

 

Terry Crews: What Makes A Man 2014

27 Nov

I was lucky enough to attend the What Makes A Man (#wmam2014) conference in Toronto this week. Thewhat makes a man 2014 two-day conference was stuffed with speakers and presentations discussing the state of masculinity, road maps to manhood, and ending violence against women. There were some excellent discussions and ideas presented by writers such as Rachel Giese and Junior Burchell, a panel on mental health and masculinity, and fantastic closing session with TV actor (Brooklyn Nine-Nine, Everybody Hates Chris, Who Wants To Be A Millionare?) , former NFL player, and the Old Spice guy, Terry Crews.

Journalist and TV personality, Nam Kiwanuka, discussed manhood with Crews who spoke very freely about his childhood when he witnessed his father’s violence toward his mother, his anger, his terrible behaviour to his wife and family, and his porn addiction. Now Terry Crews is a man redeemed; he has seen the toxic  masculine code turn him and many other men into a stoic, angry, and aggressive men,and he recognizes how destructive this attitude was to his family. Mr. Crews made no move to hide his tears when he described the pain and the shame of mentally and emotionally abusing his daughter, and the relief that never came the day he beat his father out of revenge for the abuse given to his mother.

As I sat in the third row with tears in my eyes, what I saw before me was not a big, powerful football player or an American TV star. I saw a human being. Terry Crews is a real and grounded man who expresses himself naturally and believes that when men show their true feelings, they display strength, not weakness.

I want you to watch a few minutes of Terry Crews speaking to the Huffington Post. Here, he gives his views on anger, the NFL, Ray Rice, and domestic violence; the toxic mindset of hypermasculinity that teaches men that they are of more worth than women, and his strong belief in gender equality. I’d like to thank Terry for his courage and his inspiration, and bringing gender and masculine violence into the light.

PTSD and gendered mental health

30 Oct

Throughout this post-traumatic stress disorder series, we have seen massive misunderstandings about the illness and mental health in general, lack of funding yin yangfor proper support and care for those suffering, and alternative methods of treatment. But no matter what angle I look at PTSD and the way it affects men, it seems to boil down to a concept that is, as far as I’m concerned, the root of many social problems: disregard of the feminine and the reluctance of men to ask for help when they need it.

When I interviewed Kent Laidlaw, 25-year police force veteran, we had a fascinating discussion about PTSD, and he came out with a bomb. He said that while he was on the force during the 1990s, the popular and accepted view of PTSD was understood to be a “man’s” disorder, while women suffered from depression.

This is of course as ridiculous as it is untrue. Anyone can have PTSD and anyone can suffer from depression. I’m not sure if there is such a thing as a gender-related mental illness, but there are certainly gender-related beliefs around mental health.

“We assign a gender to human traits like emotional intelligence, and then “feminize” the act of asking for help, stigmatizing men who express they are hurting and need support,” says Jeff Perera, Community Engagement Manager for White Ribbon Campaign.

With associations like this, is it any wonder that men are terrified to show anything remotely suggesting that they are anything less than what is expected?

Socialized masculine stereotypes dictate that men are expected to know, to be in control of any situation, and to be self-reliant. With all of that real or imagined expectation, there is little room for their true selves. Constructed gender beliefs rob men of their authenticity and their naturalness, and this is alarming to me. I think it’s clear that men aren’t women, so it seems very strange to me that men insist on fighting tooth and nail to prove to the world that they aren’t women, even if it means sacrificing their quality of life and their health.

Bullsh*t gender expectations

Logic says that when we experience physical trouble, we seek medical help. Researchers now see PTSD as brain damage and this should warrant medical attention. Between the heart and the brain, the human body cannot function, so why wouldn’t someone seek medical help for a damaged brain, and how is it different from say, a broken leg or a malignant tumour?

In Why Men Won’t Ask For Help, Peter Griffiths says that “men can fall too easily into the “willpower” trap, and ignore available help at their peril. The wards and hospitals are full of men who refuse to go to the doctor when they have physical symptoms and who seem to prefer to pay the price rather than go for help.” How many of you can come up with an example of a man putting himself at risk because of this masculine code? I know a man who waited until he peed blood before going to a doctor after an excruciatingly painful sports injury.

As a society, we’re not going to get very far if we frown upon men going for help when they need it. It’s ridiculous and I believe, abusive towards men.

Masculine emotion and why men have trouble asking for help

Socially, we look through masculine eyes and make masculine judgements about the world around us. This distorted view not only disregards the feminine but promotes anxiety and violence in men who constantly try to prove themselves as men, and not women. Humans have dual nature and the feminine, like the masculine, exists within us all, but many men insist on fighting the impossible fight against this part of themselves.

While girls are socialized to be emotional and nurturing, it’s fine when they ask for help when it’s needed. However, boys are taught that emotions aren’t becoming to their gender to the degree that they may not even be able to recognize their feelings and thus, they cannot identify or understand them, let alone express them in a healthy manner. But whether or not the emotions are understood, they still exist, and attempting to deny them and take on the world can be devastating to a man and other people in his life.

“In many men’s minds,” Griffiths says, “if a man can’t handle everything, then he must be a failure. And if that’s the case, he feels embarrassed and afraid about others, especially other men, finding out he is “not a man”.”

The “grave” admittance of vulnerability and of relinquishing control is, for some men, an uncomfortable, if not, terrifying idea. Take the innocuous act of  asking for directions, for example. In Nick Collins’ Telegraph article, Men refuse to ask for directions out of “blind panic”,  he says that “while women are more happy to use all available resources to help them reach a goal, men will rigidly stick to their original “system”… even though it has clearly led them astray.”

He says that when confronting the idea that their system doesn’t work, it makes men flustered and causes them to do sometimes reckless things to avoid the reality of the situation/failure. Griffiths agrees, and says that men don’t like to admit or even recognize when they feel helpless, and can feel lessened at the thought of going to someone else who is better equipped to help solve their problem.

The social negativity around PTSD and mental illness in general keeps men away from getting help, an this is can be painful, devastating, and extremely damaging. Emma Watson, during her United Nations address this fall, drew attention to this idea as she summarized social problems that stem from society’s treatment of men: “We don’t often talk about men and gender stereotypes… but I’ve seen young men suffering from mental illness, unable to ask for help for fear it would make them less of a man. In fact, in the UK, suicide is the biggest killer of men between the ages of 20 and 49… I’ve seen men made fragile and insecure by a distorted sense of what constitutes male success.”

Permission to be vulnerable

Why has the gender that gave us the Sistine Chapel brought us to the edge of cosmocide? Why have the best and the brightest exercised their intelligence, imagination, and energy and managed only to create a world where starvation and warfare are more common than they were in Neolithic times? Why has the history of what we dare to call “progress” been marked by an increase in human suffering?

-Sam Keene, Fire In the Belly

Emma Watson says “When [men are] are free, things will change for women out of natural consequence. If men don’t have to be aggressive in order to be accepted, women won’t feel compelled to be submissive. Both men and women should feel free to be sensitive…[and] strong.

“It is time when we all perceive gender as a spectrum, instead of two sets of opposing ideals. If we stop defining ourselves by what we are not, and start defining ourselves by who we are, we can all be freer… Men should have permission to be vulnerable and human, to reclaim those parts of themselves they’ve abandoned, and in doing so, be a more true and complete version of themselves.”

We must do a collective about-face around our beliefs of men and allow them to ask for help when they need it, receive it, and heal. Women are not outside of social conditioning and are just as much a part of this equation as men are. Women have to give men the space and the respect to reach out for help, support men as they strive to be better people, and allow them to be vulnerable. I for one, feel a great privilege when a man cries in front of me because this is the man at his most honest.

When we stop propagating a violent and angry culture and let go of  masculine expectations, when we stop expecting men to be something they are naturally not, when we get over the idea of believing that anything feminine is weak, then change will occur. If we change our perspective about asking for help and consider it a strength and a strategy to utilize everything at our disposal to reach our goal, change will occur. We do this every day in business, so why not for ourselves?

To be concerned with what other people think is one thing, but to sacrifice our health for someone else’s sake is quite another. The traditional masculine stereotype exists simply because we let it, but the stereotype doesn’t serve anyone; it is an idea that we allow to exist in our minds, perhaps because we are afraid of change, or that we don’t have the imagination to think outside of the traditional box.

To make things different around mental illness and general life, all we have to do is simply change our minds.

Alternative PTSD treatments, self-healing, and self-empowerment

16 Oct

self-empowermentMore than a mental health issue, more than a first responder issue, post-traumatic stress disorder is a human issue. Post-traumatic stress disorder is a serious anxiety disorder often associated with the military, first responders, and sexual assault victims, but anyone who experiences trauma can be affected by it. As a one-time or accumulative anxiety disorder, PTSD can be a terribly haunting, unrelenting reality for many people.

People who are most prone to the illness are first responders because they see more trauma more often. Though there is effort on the part of first responder organizations to deal with trauma-stricken employees with early psychological support, peer support, medical attention, and hot lines, first responders continue to take their own lives. It seems that every week, we hear of another first responder suicide. Why is this happening? PTSD is a disorder in which therapies fall into a political game of what is acceptable and what is taboo, complicated by a negative social regard for mental illness, and a society that expects traumatized men to “suck it up” and get on with the job ( this topic to be further discussed in the next and final installment of this PTSD series).

PTSD is as complex as it is terrible.

Treatment of PTSD should be thought of as an investment. Until quite recently, the outlook for PTSD sufferers didn’t look so good unless years of therapy and pill-popping seemed appealing. New alternative therapies have emerged for PTSD, and the options give promise of better things to come, provided that we’re open to acknowledging that we have a problem that affects our normal function, and that we’re willing to reach out and ask for help.

The physical origins of PTSDbrain neurons

University of Toronto psychology PhD candidate, Lauren Drvaric, says “good mental health means good physical health and well-being. Poor mental health influences physical health, and we should be investing in the entire self, mind and body.”

Many professionals in psychiatric fields keep the mind and the body separate; their focus is on the mind, behaviour, and cognitive operations, with no attention paid to the body. This is curious, since the brain commands the body and the body responds to the brain; they cannot be separated.

Toronto psychotherapist, Matt Cahill, says when his clients do not verbally discuss their trauma, he picks up on the non-verbal cues. “Tears, blushing, or tremors, to name just a few,” he explains. “Sometimes a client will comment on how a part of their body feels numb or, alternately, feels constricted during a session where we are covering traumatic experience, rather than openly discuss their feelings. The body tells its own story, so I try to pay attention to everything.”

Dr. Bessel van der Kolk, has been involved with PTSD research for over 30 years and believes that trauma lies in our bodies; PTSD has a physical-basis that prompts “a cascade of physiological catastrophes that affects almost every major system in the body”.

Van der Kolk believes that trauma victims are alienated from their bodies by a response from a brain structure called the amygdala, the brain’s emotional processing and feeling centre. The amygdala responds to threats and traumas with a flood of hormones that set off the “fight-or-flight” response. The physical response subsides when the threat does, but when it doesn’t, as is the case with people with PTSD, the traumatic memories play out in the patient’s mind, and the amygdala continues to produce stress hormones that sustains a heightened state of anxiety.

Dr. Frank Ochberg, MD, psychiatrist, and founder of trauma science, believes that there are possibly two types of PTSD. One type makes PTSD-affected people more prone to flashbacks, and the other causes a numb, dream-like state that cushions people from feeling the anxiety associated with PTSD. Some people experience both types. Ochberg notes a measurable change in the electrical discharge of brain cells in the grey matter of the right temporal lobe in PTSD patients, and believes that this part of the brain is responsible for traumatic flashbacks.

Traumatic brain damage causes other problems in the brain. Dr. Ochberg notes a reduction in the number of pathway cells between the limbic system (of which the amygdala is a part of) and the grey matter (the thinking part of the brain). The hippocampus, another part of the limbic system, is part of the mid-brain that looks like a long wishbone; it organizes and saves memories and associates them with feelings and actions. Studies on combat soldiers exposed to trauma show a correlation between a smaller their hippocampal volume and the tendency to develop PTSD.

Trauma is literally “all in our mind” and also of our brain; it manifests physically as damage to our brains, and brain damage, as Dr. Ochberg sees PTSD, should be considered an injury, an injury that can be healed.

PTSD therapy: the body and mind connectionyoga

In her article, A Revolutionary Approach to Treating PTSD, Jeneen Interlandi says “If there’s one thing van der Kolk is certain about, it’s that standard treatments are not working. Patients are still suffering, and so are their families. We need to do better.”

Van der Kolk says psychological trauma should be treated through the body, not the mind. He says trauma has nothing to do with cognition, but the body interpreting the world as a dangerous place. In many cases, the PTSD patient’s body was violated, and they need to find a sense of security in their own bodies. “Unfortunately,” van der Kolk says, “most psychiatrists pay no attention whatsoever to sensate experiences. They simply do not agree that it matters.”

There are no cures in the world of psychiatry; there are no physical tests for mental health disorders, and there are no drugs that can cure brain injuries. However, it turns out that there are a number of promising, albeit unconventional therapies that eclipse traditional psychotherapy, and questionable, side effect-laden psychomeds for treatment of PTSD. Some of these therapies will sound odd, even outrageous, but there are no side effects, no secret ingredients, and best of all, many of them are free that people can do themselves.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR, or Eye Movement Desensitization and Reprocessing looks bizarre but it has an excellent track record for relieving mental and emotional anguish. During the treatment, the patient holds their trauma in their mind while their eyes follow the therapist’s fingers that move back and forth before them. It sounds crazy, but according to EMDR.com, the therapy works “for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level.”

Over 10,000 therapists worldwide use EMDR therapy and millions of people have been successfully treated since its inception in 1989. In fact, EMDR is now recognized as an effective treatment for trauma by the American Psychiatric Association, the World Health Organization, and the U.S. Department of Defence. This unusual therapy may still have its controversies, but van der Kolk, who uses this technique himself, knows what he sees in his own patients and places his faith in the treatment. EMDR is especially useful to people with acute PTSD from isolated traumatic memories like single episode assaults and car accidents.

Yoga and massage

Yoga and massage are complimentary therapies for people with PTSD. A U.S. yoga group specifically for PTSD-affected combat veterans, Yoga Warriors,  says that yoga helps veterans “retrain” their fight-or-flight response.

“When vets confront a situation that triggers their memories,” the Yoga Warriors site says, “instead of resorting to aggression or drowning in fear, they have other options: deep breathing, for example, as a means to self-calm.”

Yoga, like dance, focuses on breath and movement and helps with body and emotional awareness, relaxation, and mental clarity. Yoga Warriors says it “allows one to safely express stored emotions such as guilt, shame, anger, sadness and grief so those feelings can be understood and integrated.”

Massage, the laying on of the hands, can help people with PTSD relax and feel safe in their bodies; massage can release toxins, and reduce scar tissue and muscle pain. According to the Canadian College of Massage, the practice may make the PTSD-affected feel more mentally balanced, and can “help to reduce mental anguish, anxiety and trauma by regulating stress hormones. Regular massage therapy reduces cortisol [the stress hormone produced by the amygdala] and stimulates the release of endorphins like serotonin and dopamine”, the hormones that make us feel good.

Acupuncture

Acupuncture, the ancient Chinese treatment, is finally being taken seriously. Through the use of small needles, heat, or pressure on points of the body’s energy meridians, pathways that carry blood, body fluids, and Qi, or life force energy, this very effective therapy provides relief of many physical ailments, improves sleep, relieves stress, and balances the emotions. The theory is that when the body’s flow of energy is disrupted due to an injury, trauma, or an emotional disturbance, acupuncture can help to free the energy blockage and release the patient back into health. There is evidence that acupuncture can regulate brain function and modify the activity in the limbic system, where PTSD is thought to originate.

Energy psychology and Emotional Freedom Techniqueenergy

The energy meridians acupuncture is based on is the root of energy psychology, or energy medicine for the emotions, a method that helps change the way the brain processes thoughts, feelings, and behaviours. Clinical psychologist and pioneer in energy medicine, David Feinstein, says tapping on accupressure points changes the neuropathways to bring about changes in the energies that underlie psychological problems, including PTSD.

Multidisciplinary doctor and healer, Dr. Adonis Makris, says that modern medicine focuses on chemistry, but energy healing has to do with the body’s electricity. Energy work is based on the body’s undeniable electrical nature. Most of us don’t often consider the body electric, but if you’ve ever been to a hospital for tests, you may have experience with the EEG, or electroencephalograph, the system that monitors your brain’s electrical activity, or the EKG, or electrocardiograph that reads the heart’s electricity.

Both energy psychology and Emotional Freedom Technique (EFT) use the energy meridian system to initiate healing. Carol Look, EFT master, explains energy work affecting the entire body: “Our feelings, states, moods, and levels of stress are formed by emotional responses and subsequent chemical reactions to specific events in our lives. These events and chemical reactions are stored in our cellular, physical, and emotional memories.” Her explanation explains how memories, thoughts, sights, smells, and sounds can trigger a PTSD-related flashback or sustain the anxiety related to it.

By tapping on various energy points on the skin and focusing the mind on specific problems (i.e. trauma), the brain’s electrochemistry can be shifted and the body’s energy system brought into balance, which allows the mind and body to resume their natural healing abilities. Studies show that accupoint stimulation (tapping) can reduce production of cortisol, the stress hormone, normalize brain wave patterns, and like massage, increases hormones associated with pleasure.

Gary Craig, EFT founder, says that trauma is a result of a disruption in the body’s energy system, and tapping works to neutralize the emotional charge. “I have helped hundreds of people with traumatic memories,” he says. “After using EFT, not one person – ever – has shown any interest in exploring the issue further or “getting to the bottom of it”. For them, it is completely resolved and they are gratefully relieved of its burden. People’s attitudes about the memory change almost instantly. They talk about it differently. Their words shift from fear to understanding. Their demeanour and posture evidence a dramatic shift.”

“It’s difficult for us to compute EFT because it’s so foreign to us, so unconventional,” Craig explains, “but at the same time, we’ve been conditioned to believe that medicine is the answer and doctors should not be questioned, but second opinions are always a good option.”

This energy work sounds so simple, so amazing, but this seems too easy, I hear you say. Even the pioneers of the treatment and experts in Traumatology agree.

Dr. Charles Figley is a psychologist and expert in Traumatology at the Tulane University in Florida. He says that sometimes the simplest things bring on the strongest results: taking deep breaths can calm anyone down, getting into a warm bath to relieve stress seems to be “a miracle” he says, and EFT is just as miraculous. “We don’t understand it, and it doesn’t make sense, but it works.”

Dr. Figley believes in EFT and the tapping method for trauma. He sees tapping as an alternative to the hierarchy of fear method that many PTSD treatments employ — therapies that begin at the lower level and build up to the terror, like exposure therapy which forces the client to relive their trauma over and over again in an effort to desensitize the patient. “These simple treatments reverse 50 years of psychological research and are turning the scientific community on its head in many ways.”

Gary Craig explains that there is no long, drawn out, tell-me-your-life-story feature to EFT. “There are no pills. There is no painful reliving of past traumatic events. It takes a fraction of the time typically required in conventional psychotherapy, it is often done in minutes. People simply get beyond their emotional luggage, usually permanently, and go about their lives more effectively.”

Compared to EFT, Craig says, “in general, conventional psychotherapy is among the slowest, most ineffective sciences on Earth.”

Positive Psychotherapy

When we think of psychotherapy, we may envision people who languish on couches, discussing nighttime dreams with cold, our-of-touch Freudians  who write prescriptions for mostly useless drugs for years on end. But a new and progressive psychotherapy that you’ve probably not heard of is making headway.

Positive Psychotherapy, born in the late 1960s, focuses on a client’s perception to realize the positive influences in their life instead of focusing on the negative – an all-too-common modern psychological state. This type of therapy directs a client’s attention to such things as positive character strengths, optimistic emotions, and their happiness in the present moment. Positive psychotherapy is much happier and more dynamic than conventional psychotherapies and the treatment typically lasts for weeks, not years.

Tayyab Rashid, licensed psychologist at the University of Toronto and a practitioner of Positive Psychotherapy, explains that the treatment acknowledges the client’s negative emotions, but instead of picking them apart and dwelling on them, the therapy “aims to validate these experiences, whilst gently encouraging clients to explore their effects and seek out potential positives from their difficult and traumatic experiences.”

Positive Psychotherapy has made significant gains in trauma prevention, to the point that it has made its way into a U.S. army program, Comprehensive Solider Fitness. The therapy is used in resilience training to “build mental toughness and identify signature strengths, meaning, purpose, and positive relationships, in addition to preventing pathology.”

Alternative drug therapy: MDMApills

“There’s not a single pharmacological treatment out there that has been developed specifically for PTSD,” says Dr. Alexander Neumeister, MD and psychiatrist at the New York University. “There’s a consensus among clinicians that existing pharmaceutical treatments such as an antidepressant simply do not work.”

Long-term medication places a band-aid on the wound at the core of the problem: trauma; its emotions, its energy, and its connection to mind and body. An alternative to pharmaceuticals is psychedelics. These drugs are pure and powerful, and administered under controlled conditions. MDMA, methylenedioxymethamphetamine, also known as ecstasy, is one of these drugs and it has long-term potential for PTSD.

MDMA increases feelings of trust, affection, and compassion for others, could make an excellent combination with psychotherapy for PTSD. Unlike most mental illness medications that are taken daily for years, pure MDMA only needs to be used a few times or less, and there is no threat of addiction to the drug.

Early studies are promising. Dr. Michael Mithoefer is the investigator in MDMA studies through MAPS, the Multidisciplinary Association of Psychedelic Studies. Dr. Mithoefer has seen 90 percent of rape victim’s symptoms vanish after just one intense 8-hour session with MDMA. In another study, combat veterans, fire fighters, and police officers took MDMA and 14 out of 19 patients reported dramatic improvements to PTSD-related issues.

MAPS is the only organization in the world that funds clinical trials for MDMA-based psychotherapy, according to its website. The goal is to make MDMA into an FDA-approved prescription medicine by 2021.

Medical marijuanamarijuana

The drugs that they were giving them … they couldn’t get up in the mornings,” said Army first sergeant Gregory Westbrook. “Most of the guys weren’t the type of soldiers who had issues before Iraq or even in Iraq, but they bring them back and put them on these drugs, and they’re falling asleep in the chair. There was no way they could function, especially in a civilian job. So maybe marijuana is an alternative. (Source)

THC, tetrohydrocannibanol, the active chemical in marijuana, binds with cannabinoid receptors in the brain that affect appetite, memory, and pain. Marijuana is associated with forgetting and this is the link to PTSD that researchers are most interested in. “Forgetting well is almost as important as remembering,” says Michael Pollen, American author, journalist, activist, and professor of journalism, and author of Botany of Desire, an investigation of the nature of plants. “Forgetting is about editing, it’s about taking the flood of sense information coming at you, and forgetting everything but what is important.”

Pollen says that life is not about accumulating memory because memory can cripple us, and uses combat experiences in his argument. “Soldiers return from war zones traumatized by experiences that they can’t unlearn. So if you could help them unlearn that, essentially a productive kind of forgetting, with a drug or another kind of regime, it would be incredibly useful.”

Marijuana calms the mind, relieves anxiety, and promotes new thought patterns and behavioural responses. A recent Globe and Mail article reports that marijuana users may be more likely to survive a serious head injury. For people affected by PTSD, cannabis brings users into the present instead of watching the reel of never-ending traumatic scenes that keep them in their mental prison.

Medical marijuana for PTSD looks promising, but unfortunately, marijuana carries a stigma with it, even though it is legal for medical use. Sadly, the social stigma around cannabis is associated with the suicide of another first responder’s life. Just last week, RCMP Corporal Ron Francis, a PTSD sufferer and medical marijuana user, committed suicide.

Cpl. Francis was videotaped smoking pot while wearing his formal red serge, to protest the RCMP’s PTSD policy last year. “I’m trying to draw attention to the fact that the RCMP fails to have a program in place for proper [PTSD] screening for their members and proper information for their families,” he said. The National Post reported Justice Minister Peter MacKay’s condemnation of the stunt, saying it “sets a poor example for Canadians.” Francis was forced to hand over his RCMP uniform, and a year later, was dead.

If we as a society are serious in our support of people who suffer from PTSD, we must let go of old rules and laws that keep relief from those who need it most. Drug stigma is politically based and we have been conditioned to believe that illegal drugs – natural and synthetic substances associated with counter-culture — are harmful and should not be a therapy alternative. What is legal are dodgy, psychotropic medications with sometimes horrendous side-effects that may not do much to help people in dire need of effective therapies.

Through brain scan technologies, early neurological markers have emerged for PTSD. This is exciting because now that PTSD can be “seen”, it gives validation; a visual change in the brain makes it more factual, and this will move us toward a social acceptance of mental illness as something real.

Relief for PTSD sufferers may lie in unconventional therapies that don’t line the pockets of the pharmaceutical companies and are rooted in self-empowerment. We are more powerful than we think. As Dr. Makris says, “We have an incredible capacity to heal themselves in so many ways.”  

PTSD and first responders

2 Oct

“I think I’m too broken to ever be fixed.”
Text from Ken Barker, retired RCMP officer to his sister during a traumatic flashback

Barker was one of the first responders to arrive at the scene of the ambulancehorrific Manitoba Greyhound bus beheading in 2008. This summer, he ended his life. Since April 2014, Barker was one of an unprecedented number of first responders in Canada whose suicides have been linked to PTSD.

Post-traumatic stress disorder, considered an treatable anxiety disorder is a mental illness that can result from a traumatic one-time experience or accumulative trauma and stress on a personal or large scale. PTSD can bring the horrors of past traumas to life and wreak havoc in the minds and the lives of all it touches. PTSD can happen to anyone; the most vulnerable  people are rape victims.

PTSD has its roots and associations in modern warfare, and its incidence rate is highest among people who experience trauma every day – military and emergency services personnel. Symptoms include flashbacks to the traumatic event, nightmares, sleep disorders, and uncontrollable thoughts; anger, fear, distrust, personality changes, and extreme anxiety. PTSD can manifest physically as chronic pain and hypertension, and can induce self-destructive behaviour like drug and alcohol abuse, long-term addiction, and suicide. The collateral damage of PTSD is its effect on relationships, families, finances, and work and social status. It can be devastating on many levels.

PTSD in emergency services

The men and women of Canada’s public safety, military and correctional organizations witness human suffering up close and it sometimes becomes very difficult to cope with the aftermath. There is light at the end of that dark tunnel. There is help available, and we want to make sure these men and women – and their families — know where to find it.
Heroes Are Human

Vince Savoia is the founder of Heroes Are Human and a former paramedic. His organization focuses on PTSD research, education, and training, and acts as a peer and psychological support resource for Canada’s public safety organizations personnel.

Savoia says 16 – 24 percent of emergency personnel suffer from PTSD, but he believes this is a modest number. Paramedics are faced with more trauma more often, and run a risk of PTSD two to three times higher than in any other emergency service. Kim McKinnon, Superintendent at Toronto Emergency Medical Services (EMS), says PTSD predictors for paramedics include their “involvement in a critical incident like a mass casualty event, or an organizational or environmental event such as the death of a service member in the line of duty.”

EMS personnel tend to victims of horrific scenes large and small, they resuscitate the sick, and witness death. At the same time, they form a bond with sick and injured people as they spend time talking and giving hands-on treatment. This one of the reasons why Mr. Savoia believes paramedics are the hardest hit of any emergency service.

PTSD does not discriminate. While it affects paramedics more often, PTSD afflicts 10 – 12 percent of police officers and 6 – 8 percent of fire fighters. According to a recent StatsCan report quoted in the Globe & Mail, PTSD rates among members of the Canadian Forces have nearly doubled since 2002; 1 in 6 Canadian soldiers have mental health problems after ten years in Afghanistan. And the numbers keep growing.

First responder organizations must create programs and supports for their employees, but this takes funding and resources that may or may not be available. Some emergency services have excellent support systems in place for their employees like Toronto EMS’ comprehensive suite of services for employees to proactively manage their health. With a focus on prevention, their resources include early psychological support with a staff psychologist, a peer support team, employee assistance plans, and other community resources.

Canada’s RCMP has nation-wide systems in place that utilize peer support, RCMP doctors, and chaplains. A Regina RCMP sergeant explained that the RCMP wants to make sure it’s there to listen to their officers who respond to major incidents like car crashes, deaths of children, multiple fatality incidents, shootings, and violence.

We’re fortunate that we’re finally acknowledging PTSD as a real illness with real consequences, but despite the good intentions of emergency services to their employees, the question is, are the support systems being utilized, and if not, why not?

Stigma, discrimination, penalization, and the John Wayne Syndromesuffering in silence

In the emergency services culture, there is stigma and perhaps a shame attached to being affected by trauma and asking for help. It is considered a “weakness” and it is the largest problem that first responders face because it is a deterrent to getting help.

Though more women are joining military and emergency services, men still form the majority of employees, and because they’re men, they are expected to adhere to the traditional masculine code that demands they use the “suck it up” method of dealing with harrowing trauma and stress.

Vince Savoia says that first reponders work with respect for the public who needs them, but the same respect is not offered to colleagues. “First responders who look for support are bullied by their peers and colleagues,” he says, “they are ridiculed and harassed. Mental health is viewed as a weakness, not an illness, and the expectation is that we should be able to stop it and move on.”

The mental illness stigma exists in all branches of emergency services and the armed forces. David Whitley, a paramedic who suffered his own PTSD from a terrible ambulance accident, now volunteers for a local emergency services support group that checks in with first responders who experience potentially traumatic events like shootings, suicides, crashes, and situations that involve children.

“We give [members of the group] an opportunity to talk because there is a stigma,” he told the Toronto Star. “First responders need to lower the trauma mask, and that’s scary because there are feelings of vulnerability and anxiety. But if you don’t do that it’s a precursor to mental illness, including PTSD.”

Kent Laidlaw, a retired police veteran in Burlington, Ontario, and principal of Canuckcare, a consulting service for people who deal with workplace stress and trauma, says that the systemic corruption that exists in police ranks ensures that officers who ask for help are considered “less than” and therefore a weak link in the chain. They are penalized rather than punished, a subtle difference that speaks just as loud.

New York State police veteran and police trauma and suicide researcher, Dr. John Violanti, observed in the Ontario Ombudsman’s 2012 report that the nature of the policing environment often goes against the goal of improving health: “The police culture doesn’t look favorably on people who have problems… Not only are you supposed to be superhuman if you’re an officer, but you fear asking for help… you may not be considered for promotions and you may be shamed by your peers and superiors. In some cases, your gun can be taken away, so there is a real fear of going for help.”

 ***

Emergency service workers are very well trained but cannot be prepared for every possible situation, so perhaps masking the emotional response to what they experience is the way to cope, but unfortunately, first responders are human, and part of being human is to be emotional. To expect that anyone could not be affected by horrific and traumatic events is ridiculous, and then to believe that there is no emotional aftermath is absurd, even abusive.

The code of masculinity that demands men to be stoic, brave, and in control, subscribing to what Vince Savoia calls the “John Wayne Syndrome”: the tall, rugged, macho cowboy who can deal with any situation and stand up for justice. Savoia believes that first responders have to be this way in order to do their job, but what happens after the mission is accomplished and reality sets in?

On his very first call, a house fire, Vince Savoia lost his first patient, a two-year old child. He wanted to talk to his paramedic crew about it, but when he tried to, “the crew was very stoic –just walls.” If this code prevents men from being able to get support from the experiences of trauma in their jobs, what purpose does it serve? A culture of hyper masculinity is a hindrance more than a help; it creates broken men who can’t do the job as well as healthy men.

Saskatchewan counsellor, Peter Griffith, says that men don’t like to admit, or even recognize when they need help, to the degree that they will ignore their own health problems sometimes until it’s too late. Hospital wards, he says, “are full of men who refuse to go to the doctor when they have physical symptoms and who seem to prefer to pay the price rather than to go for help.”

Anna Baranowsky, a clinical psychologist who works with police officers in private practice, explained to the Toronto Star in 2012 that “people can recover[from PTSD], but if we see ourselves as being strong and we won’t tolerate any kind of weakness, then what we might end up doing is pushing (ourselves) until we are past the point of recovery, and that is really dangerous.”

Experts say that the stigma attached to mental health needs to change for us to get anywhere. It could be as simple as changing our perception of what it is to ask for help and equate it with responsible prevention, with the power to keep oneself healthy, capable, and strong. Putting a positive spin on the consequences of responding to a traumatic situation is much more agreeable than demeaning someone who can’t control their mental health response.

The PTSD misunderstandingshattered glass

There is a very interesting argument happening right now around PTSD. Some, like Vince Savoia, believe that PTSD is responsible for taking the lives of more than 20 first responders since the spring, but some mental health professionals like psychologist, Dr. Paulette Laidlaw, believes that PTSD has become something of a blanket diagnosis for many other problems.

While it’s true that in some cases, PTSD symptoms can worsen after an emergency service employee retires, Dr. Laidlaw wonders why is it when we hear “police suicide”, we make the automatic assumption that it is related to PTSD.

Dr. Paulette and Kent Laidlaw do not believe that first responder suicides are exclusively job-related, but are more likely a combination of many stresses including work, finances, and relationships. They say the individual’s long-term mental health should be examined and more questions asked about a first responder’s life before we slap the PTSD label on them, just because that individual happened to work in the armed forces or emergency services.

Dr. Laidlaw explains that PTSD is not as commonplace as we are led to believe. “PTSD affects only 8 percent of the population,” she says, “whereas depression affects 30 percent and anxiety touches 20 percent. We’re in murky water trying to distinguish PTSD from burnout, acute stress, trauma, grief, or clinical depression”.

We see PTSD in the news a lot and it has become something of a “trendy” disorder. Media reminders of the illness can cause people to self-diagnose via the Internet, and all hell can break loose. Dr. Laidlaw suggests that PTSD is the “sexy” disorder of the day, and with any popular disorder, like we saw with childhood ADHD, suddenly there are specialized medications and “PTSD therapists” come out of the woodwork. PTSD can only be diagnosed by registered psychologists and medical doctors.

How will change happen?fireman

“I wish I had cancer because then people would understand.”
-Veteran paramedic Ken Barker communicated to his sister shortly before taking his life

Mental illness is not something tangible, something that hurts, something that can be fixed with a cast or a bandage. It affects the brain and though it may not show on the outside, it can torment the mind from the inside.

Regard for mental health is changing, albeit slowly, but Vince Savoia believes that cultural change in PTSD acknowledgement has to come from the top down, and says that “we must respect mental wellness as an issue and stop the harassment and bullying from the bottom up. It has to be a grass-roots movement to encourage people to take responsibility about how they treat themselves and their colleagues.”

Dr. Violanti agrees:  “If I tell you that the first time you see a dead body or an abused child that it is normal to have feelings of stress, you will be better able to deal with them; exposure to this type of training inoculates you so that when it does happen, you will be better prepared. At the same time, middle and upper management in police departments need to be trained in how to accept officers who ask for help and how to make sure that officers are not afraid to ask for that help.”

This means changing the culture from one that ridicules people who need support to one that supports and embraces human vulnerability.

Dr. Jeff Morley, former RCMP officer and psychologist for Canadian Forces and Veterans Affairs says “Canada needs a national mental health strategy for first responders, but the political will does not exist right now.”  He says that to change the system, we need a high-profile person to promote the cause, like Romeo Dallaire who played a big role in the beginning but retired from senate this year.

“That, or if the government clues in that the high financial cost of not doing anything (i.e. disability costs, sick time, leaves of medical absence) exceeds the cost of early intervention, education, and prevention.” He says that the RCMP spends tens of millions of dollars per year on PTSD disability claims, but asks how much they’re willing to come up with to prevent it.

The Globe & Mail reports that global estimates for antiviral drugs have run close to $10-billion since the SARS outbreak of 2002.  The authors of the original report in the British Medical Journal acknowledged that the “important benefits have been overestimated and harms under-reported”. Imagine if the Canadian government spent the same amount on long-term mental health as it spends on stockpiling useless drugs for unlikely flu epidemics. Imagine if people shrugged off the toxic masculine codes that keep men from flourishing and actually paid attention to what they need. And can you imagine the tremendous benefits of supporting the mental health of the people we depend on to take care of us?

 

The evolution of PTSD

18 Sep

Some psychiatric casualties have always been associated with war, but it was only in the twentieth century that our physical and capability to sustain combat outstripped our psychological capacity to endure it. – Lt. Col. David GrossmanPTSD

The media frenzy around post-traumatic stress disorder (PTSD) may make us think that it is a new disorder, but PTSD reaches back to the early part of the last century where it began to manifest during the first major European war of the 20th century.

PTSD reared its ugly head during World War 1 when it was known as “shell shock”, a disorder of psychological origin. Soldiers on both sides of this conflict suffered immeasurably from new types of weapons in trench warfare: tanks, heavy machine guns, mortars, and poison gas including mustard, nerve, and chlorine gasses which caused horrific damage to the human body. Casualties were immense but for those who survived, a curious condition began to emerge. Shell shock was the first mental health disorder associated with war and the military wasn’t sure what to make of it.

BBC’s excellent documentary on shell shock explains the confusion around the sometimes bizarre behaviour found in military troops at the time: “Soldier’s unconscious minds, so distressed by war, crippled their bodies and took them out of fighting. The military found it hard to accept such a radical theory; it undermined the theory that men could and should control their fears and emotions.”

Soldiers stricken by war trauma displayed strange behaviours never seen before. Men in the ranks suffered from body tremors, paralysis, temporary blindness or loss of speech, and the inability to walk. As a misunderstood condition, shell shock was considered contagious and the men who suffered from it were thought to threaten to their platoons. Six months into the war, 15 percent of the British army suffered from the condition. Dr. Charles Myers, a consulting neurologist to the army with an interest in the growing condition, coined the term “shell shock” in 1915, and decided that the roots of the problem were psychological. By 1916, the British War Office officially recognized shell shock as a genuine war wound.

When officers began to display their own shell shock symptoms — stammering, irritability, and loss of memory — the military realized that this psychological response to warfare was taking an enormous toll. Something had to be done.

Military hospitals were set up and experiments with various treatments began; from Freudian dream analysis to hypnotism to electric shock, some shell shock therapies were successful, others not. The biggest obstacle to dealing with shell shock was the stigma attached to it; men affected by the condition were thought of as “incurable lunatics” or cowards, and a shame was carried with the condition, a shame divided up like a class system.

The condition did not discriminate, but the military did. Men in the ranks were shell-shocked but for an affected officer, to have shell shock in his medical records was an embarrassment so instead, officers suffered from “neurasthemia”, prolonged and exhaustive exposure to war. Officers, you see, were not meant to break down; they were strong, masculine leaders who could, or were expected to control their emotions and behaviour.

Shell shock was an uncontrollable external event that affected the military men internally, but it wasn’t interpreted that way. Sadly, many men who suffered from shell shock or neurasthemia were court martialed, shot, or committed suicide.

Battle exhaustion of World War IIWW2 military man

When World War II began, the military did not learn any lessons from the First World War, and shell shock took on a new identity: “battle exhaustion” or “battle fatigue”. Soldiers in this war suffered paralysis, amnesia, trembling, sleep disorders, memory loss, fear, isolation, and hopelessness. For a sense of the vastness of psychiatric casualties during this war, 20 percent of U.S. war casualties were neuropsychiatric-based, and 25 percent of all British D-Day casualties were psychiatric.

With numbers this high, the military was forced to look for more effective treatments, and young doctors wanted more dynamic cures for their battle fatigued patients. A number of new therapies emerged: talking therapy, individual and group psychoanalysis, electric shock therapy, hypnosis, sports therapy, and art therapy.

Battle exhaustion was considered a temporary condition and military psychiatrists believed that if the soldiers simply rested, they could recover and carry on fighting. An unconventional “sleeping therapy” or “narco-analysis” consisted of psychologically affected soldiers given sodium amytal (also known as “truth serum”), a sedative that induced sleep for weeks at a time to settle anxiety and exhaustion. Drugs administered during the sleep brought soldiers around so they could briefly recall and describe their battle experiences; this was considered a “cleansing” experience without any anxiety upon waking and completing the therapy.

Psychiatrists acknowledged by 1945 that every man had his breaking point and that shock and breakdowns were inevitable, yet the stigma of psychological damage from war remained. Battle fatigue was still considered contagious and men touched by the condition were treated like criminals at army hospitals. Being afraid and showing it was something of a military suicide because the consequence was the humiliation of being labelled “LMF” — lacking in moral fibre, or otherwise cowardly, and having your rank stripped from you. The only saving grace to battle fatigue this time around was that a frightened and battle exhausted man would not be shot.

It should come as no surprise that military men were psychologically impaired because of their wartime experiences. As one World War II solider put it, “I can’t stand seeing people killed.”

 Modern warmodern soldier

Technologies and the methods of modern war have changed enormously since wars after World War II, but the psychological effects of war have not. What was once known as shell shock, battle exhaustion, and post-Vietnam syndrome has become post-traumatic stress disorder, and it is just as devastating as it has always been.

PTSD seems to be an accepted part of military life in the modern era; the tragedy of the loss of human life and the psychological effects of death and destruction is part and parcel of serving one’s country. Indeed, one in three American service people suffer or will suffer from PTSD according to an Al Jazeera report, The War Within. The news agency describes PTSD as “a ticking time bomb with a decades-long fuse — a problem whose true magnitude is difficult to determine.”

Press TV documentary, Invisible Wounds-Break Down, investigates the effects of PTSD on Afghan war vets and reports that more than 30 percent of U.S. Afghanistan veterans are psychologically damaged.  Suicide is one of PTSD’s effects and according the U.S. Department of Veteran Affairs, about 18 veterans take their own lives every day.

The true tragedy of modern war is that the response for service people who reach out for help is ridicule, bullying, humiliation, and hazing; affected personnel are expected to “suck up” their psychological trauma. It’s some kind of unwritten code of valour and it reaps a heavy toll. Cynthia Thomas, a U.S. army wife interviewed by Al Jazeera said that her husband was punished for asking for help and in the end, did not receive any. His suffering continues.

“Unless these officers are held accountable,” she says, “nothing is going to change.”

Conclusion

War as an industry, an industry we’ve been conditioned to accept as a part of our modern life. But war isn’t natural. In fact, according to U.S. military psychologist, Lt. Col. David Grossman, humans very much go against the grain of nature when they kill their own, affirming the idea that war is an act of political will.

In a TVO interview about his book, On Killing, Grossman explains that the first time someone kills another person, it at first feels exhilarating because the target has been hit and the job done, but most people will feel empathy and profound remorse and nausea when they realize what they’ve done; killing is repulsive to us.

There is a lifelong process of rationalization and acceptance [to killing], and if an individual fails at this process, the result is post-traumatic stress disorder, or some type of trauma that will stay with them for the rest of their lives.

Grossman says that through conditioning and desensitization, we now associate violence with pleasure and by doing this we are overcoming a powerful resistance to killing in our minds and in society. He says that combat is more about posturing more than it is about killing, and maintains that combat troops during WWII actually fired their weapons at their enemy only 15 percent of the time (he says that the vast majority of death during that war came from the fighter planes that dropped bombs), to 55 percent in Korea, to a stunning 95 percent in Vietnam. Aiming a weapon at another human being and pulling the trigger became a conditioned reaction.

By now, war, violence, and killing as seen through TV, film, and video games, takes away the horror of human suffering and turns it into entertainment. This completely counter-intuitive perception has enormous implications, and people don’t really know what is at stake.

History has seen leaders use political means to carry out their aggressive and violent motives, leaving the agents of their intentions dead, maimed, or psychologically injured. Assuming a false presumption that men, at least according to the patriarchal construct of men, could ignore their natural emotional state and freely kill other human beings without psychological consequence has proven throughout modern history to be profoundly flawed and deeply tragic. Men are emotional human beings no matter what our patriarchal-based society imposes and expects. One cannot just walk away from taking the life of another human being and remain unaffected. It isn’t natural.

PTSD is an enormous and multi-faceted topic that I will continue to discuss in posts to follow. Thank you for reading.

Thinking outside of the masculine box

17 Apr

Media dictates gender roles.Last fall, I attended SkyWorks’ Real Change Boys Filmmaking Project to watch short documentaries about gender and identity by young men between the ages of 14 and 21. The films depicted issues around masculine identity, stereotypes, expectations, and the images of boys and men in media and popular culture.

One film spoke louder than the rest to me. In his film, Boxed In, Brandyn Pereira describes his realization that media portrays men and boys as one of a few narrow stereotypes. Brandyn was only 14 when he questioned gender portrayal and made his film. This outstanding young mind recognized the unnaturalness of gender stereotypes in media and started a conversation about it. I’m writing to continue that conversation.

Boxed In

Brandyn had a moment of recognition while watching television one day and noticed the stereotypical gender roles presented on TV.

“Almost every guy on these TV shows liked beer and sports, or they were the family man or the hero of the situation. Boys always liked video games, sports, and they rarely showed any emotion with their friends,” he says, “I’m wondering why the media depicts young men or boys like that.”

Media is enormously influential to us whether we like it or not; it tells us what to wear, how to smell, what music to listen to, what lifestyle to lead, and it doubles as an inadvertent guidebook to life. People—especially young people—look to television and the media to try to understand who they’re supposed to be. I remember looking to the TV for cues on how to be when I was a kid and sometimes I took on fabricated affectations because I wasn’t sure what else to do, and hey, if they did it on TV there must be some kind of truth to it, right?

Wrong.

Jeff Perera, Community Engagement Manager at the White Ribbon Campaign says in the film, “To be human is to be yourself; society is about trying to put you in a box.” It’s that gender box that Jeff is referring to and what Brandyn’s film is about.

When I met with Brandyn recently, we talked about the limitations of living in a gender-stereotyped box. “TV shows show only a few specific types of men: a) genius/smart guy, b) dim-witted, c) strong, or d) a wimp,” Brandyn says, “I noticed how the stereotypes don’t allow men and boys to be anything else.”

The men and boys in Brandyn’s film discuss the unreal masculine ideal presented in media, where males are always slim, fit, emotionless, macho, in control, and tough; good-looking, sports-obsessed, beer-drinking, video game-playing slices of the masculine ideal, out of touch with reality and their natural emotions.

These media stereotypes have the power to take us hostage and hold the dagger of social expectation to our throats. For some people like Brandyn, the media-generated masculine stereotype is not only confusing, “it is depressing for young people when they recognize they don’t fit the role and image of what is presented in the media.”

Contradiction, shame, insult

As a young person, Brandyn is quick to call out the media’s mixed messages. “I don’t know how I should act,” he says, “the message aimed at young people is to be yourself, but the next second we’re being told to conform. It’s confusing.”

Not only confusing but potentially damaging. We’ve had gender ideals pushed on us since birth, and some people believe so strongly in prescribed gender roles that they will cause trouble for people who fail to embody these expectations.

Calling someone “gay” as the go-to insult of childhood is sadly still holding its ground and it’s been around for a very long time. Brandyn told me about a time when one of his friends (a girl who has her own suite of gender expectations to deal with) accused him of being gay because he didn’t like all of the stereotypical masculine pastimes she learned about via media.

I’m quite sure that a child calling someone “gay” doesn’t understand what “gay” really means, though they do pick up on the term as an insult. Accusing someone of being “gay” really means that there is something “wrong” with that person because he doesn’t conform to the (white, str8, patriarchal) media-generated and socially sustained gender stereotype.

Brandyn says products “make kids cool” and explained that a few grades ago, he and his friends picked up on and adopted the gender stereotypes and products associated with it out of fear of not fitting in and the shame attached to that. Fear plays a strong role in motivation and retailers and marketers work this to their advantage.

Gender-differentiated products means more profit for retailers. Gendered colour is manufactured and nothing more than manipulation by the retail industry to get you to spend more money. Gender-specific products and marketing drive profits, and sexism in media sustains gendered ideals that are best left in the dark ages.

Deep down we know that no matter how much we shop and try to adopt these perfect lifestyles presented by the media, we never will truly become what we see and so we must settle on being ourselves. Jeff Perera believes that we need examples of diversity in media, to see men from different racial backgrounds, different sizes, shapes, tastes, and talents, to offer people more options to relate to.

Instead of ridiculous and unnatural gender codes, let’s celebrate and appreciate men and boys as wonderful unique creatures who can enjoy sports and video games if they want to, but may also like to sing, cook, and write short stories.

Guys like Brandyn.

 

Man boobs

23 May

Gynecomastia, enlarged male mammaries, also known as” man boobs” or “moobs”, can be a tricky conditionman boobs both physically and psychologically. If you “carrying extra baggage on the top floor”, as Seinfeld’s Kramer would say, read on.

This condition is complex and its origins are difficult to pin down; man boobs happen for many different reasons and different stages of a male’s life.

TIME attributes the condition to aging and also to hormones in adolescent boys, stating, “Nearly half of all men will experience it at some point in their lives, and not necessarily at the end. In fact, it’s most common during adolescence; 65% of boys have it at the age of 13 or 14.”

There are three stages in a male’s life when breasts can develop: infancy, when breast tissue is stimulated by high levels of estradiol and progesterone produced by the mother during pregnancy; in puberty, where hormones are completely out of whack as estrogen levels increase and jockey for position with testosterone; and as men’s testosterone levels decline and body fat increases as he ages, men over 60 experience increased estrogen which may be a factor in developing gynecomastia.

Endotext, a resource for endocrinology (hormone) professionals, explains that a “significant percentage of gynecomastia is caused by medications or exogenous chemicals that result in increased estrogen effect.” This includes some psychoactive drugs (e.g. Diazepam), cardiac and anti-hypertensive medications, drugs for infectious diseases (e.g.  Indinavir, for HIV/AIDS antiretroviral therapy), and illicit drugs like heroin.

No matter what the cause, enlarged mammaries can be psychologically difficult for men and boys to deal with. For some, man boobs can be nothing short of mortifying. I just tried searching “man boobs emotional/social support”, and I get pages of “how to get rid of man boobs” instead of how to reconcile them.

Am I surprised? Not at all. Am I saddened by the lack of support for boobed men? Absolutely.

Moob solutions

Plastic surgery is a drastic option for minimizing man boobs. The procedure removes tissue, scars, and causes pain. It should be the last resort.

According to Muscle & Fitness, part of the moob solution is in diet – easing up on estrogen-producing foods like wheat and grains and instead consuming foods high in monounsaturated fats like avocados, nuts, and olive oil to produce testosterone.  Zinc supplements are also recommended. Talk to a dietitian or a doctor about it.

I asked lifelong athlete and certified personal trainer, Patrick Marano, for exercises men can do to banish the moobs. Patrick suggests three main exercises that focus on building the pectorals, and recommends starting your training with lower weights and higher repetitions, increasing the weight as you get stronger:

1. Bench press: Lie on your back on a weight bench and a lift bar bell up and down slowly. As you move into heavier weights, always have someone “spot” you so there are no accidents!

2. Pectoral fly: Or the “Pec Deck” as Patrick calls it. The act of squeezing the pectorals helps strengthen them. This exercise is done on a weight machine.

3. Classic push up: Be sure you’re in proper form with a straight line from your head through your back to your heels, hands under shoulders. Patrick says to do “as many as you can”  and repeat for 3 – 5 sets. Lower slowly and push up slowly. If this is too challenging, push up from your knees instead of your feet.

Dressing the man boob

Obesity is also a major factor in gynecomastia, but not all heavy men have man boobs. A couple of differently shaped clients of mine have man boobs: one is heavy, rotund, and very confident, and the other is medium-sized, active, and very aware of his moobs (that are smaller in real life than they are in his head).

My job as an image consultant is to help my guys feel and look good in their clothes, so instead of resorting to the outright lie of compression garments to flatten your chest, try these dressing tips:

  • Avoid clingy fabrics that outline and accentuate your bumps and lumps;
  • Avoid heavy cotton sweaters – these tend to “fold” around man boobs when you’re sitting;
  • Wear patterned shirts that move the eye around,  but avoid horizontal stripes if you’re a larger man;
  • Jackets, cardigans, and vests do well to cover your chest excess;
  • Wear clothes that are your correct size – wearing too-big shirts to hide behind won’t do you any favours;
  • Wear a well-fit sleeveless undershirt alone in hot weather or under your shirt to smooth you out and hold you in (yes, men with boobs could use some support too without resorting to “The Bro” or the “Man-sseir”).