★ “Informative, diverse, and highly engaging; a much-needed addition to the realm of mental health.”—Kirkus Reviews, starred review
Featuring real-life stories of people who have found hope and meaning in the midst of life’s struggles, Heads Up: Changing Minds on Mental Health is the go-to guide for teenagers who want to know about mental health, mental illness, trauma and recovery. For too long, mental health problems have been kept in the shadows, leaving people to suffer in silence, or worse, to be feared, bullied or pushed to the margins of society where survival is difficult.
This book shines a light on the troubled history of thinking about and treating mental illness and tells the stories of courageous pioneers in the field of psychiatry who fought for more compassionate, respectful and effective treatments. It provides a helpful guide to the major mental health diagnoses along with ideas and resources to support those who are suffering. But it also moves beyond a biomedical focus and considers the latest science that shows how trauma and social inequality impact mental health. The book explores how mental health is more than just “in our heads” and includes the voices of Indigenous people who share a more holistic way of thinking about wellness, balancing mind, body, heart and spirit. Highlighting innovative approaches such as trauma-informed activities like yoga and hip-hop, police mental health teams, and peer support for youth, Heads Up shares the stories of people who are sparking change.
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Text copyright © Melanie Siebert 2020
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system now known or to be invented, without permission in writing from the publisher.
Library and Archives Canada Cataloguing in Publication
Title: Heads up: changing minds on mental health / Melanie Siebert ;
illustrations by Belle Wuthrich.
Names: Siebert, Melanie, author. | Wuthrich, Belle, 1989- illustrator.
Series: Orca issues.
Description: Series statement: Orca issues | Includes bibliographical references and index.
Identifiers: Canadiana (print) 20190226226 | Canadiana (ebook) 20190226269 | isbn 9781459819115 (softcover) | isbn 9781459819122 (pdf) | isbn 9781459819139 (epub)
Subjects: lcsh: Mental health—Juvenile literature. | lcsh: Teenagers—Mental health—Juvenile literature. | lcsh: Well-being—Juvenile literature. | lcsh: Adolescent psychology—Juvenile literature.
Classification: lcc rj503 .s54 2020 | ddc j616.8900835—dc23
Library of Congress Control Number: 2019954271
Simultaneously published in Canada and the United States in 2020
Summary: This nonfiction book for teen readers is a guide to understanding and coping with mental health, mental illness, trauma and recovery. It features real-life stories of resilient teens and highlights innovative approaches to mental health challenges.
Orca Book Publishers is committed to reducing the consumption of nonrenewable resources in the making of our books. We make every effort to use materials that support a sustainable future.
Orca Book Publishers gratefully acknowledges the support for its publishing programs provided by the following agencies: the Government of Canada, the Canada Council for the Arts and the Province of British Columbia through the BC Arts Council and the Book Publishing Tax Credit.
The author and publisher have made every effort to ensure that the information in this book was correct at the time of publication. The author and publisher do not assume any liability for any loss, damage or disruption caused by errors or omissions. Every effort has been made to trace copyright holders and to obtain their permission for the use of copyrighted material. The publisher apologizes for any errors or omissions and would be grateful if notified of any corrections that should be incorporated in future reprints or editions of this book.
Edited by Sarah N. Harvey
Design by Belle Wuthrich
Cover and interior illustrations by Belle Wuthrich
Ebook by Bright Wing Books (brightwing.ca)
orca book publishers
Printed and bound in China.
23 22 21 20 • 4 3 2 1
The Science, Theories and Mysteries
Sinners, Beasts or Fools?
The Awful History of “Treating” Mental Illness and the Efforts for Reform
Psychotherapy, Psychiatry And Community Treatment
Tell Me What’s Wrong
The Road to Wellness
On Surviving and Thriving
Candid and Courageous
It’s Time to Talk
Table of Contents
I want to tell you a story. I hadn’t heard from Tina in a while, so when she called and asked me to meet her at McDonald’s, I jumped at the chance. It was late at night. I wanted to buy her something to eat, but she wouldn’t let me. Tina was wearing a tutu and layers of sweaters and hoodies topped with a hockey jersey. She waved her arms and rattled a stream of disconnected thoughts on the fbi, diamond jewelry and salvation, then ordered an extra-large coffee. The server was polite and smiling, and I was relieved that she treated Tina kindly.
Tina’s stare was intense and darting. She sussed out the tables warily, then picked one. She was edgy about cameras recording us. She kept telling me to keep my voice down. She should be paid $1,000 an hour to model, she said. People were breaking into her apartment. A famous singer was in love with her and his new hit song was written for her. When I questioned something, she flared into anger, pointed her finger at me. “I know!” she said. “I have the mind of God.” I was tense. I didn’t know what to say. I knew she wasn’t eating. She wasn’t sleeping. She wasn’t working. She kept thinking people were out to hurt her. She was suffering, and it broke my heart.
Tina is someone I love who has been diagnosed with a mental illness. She is also one of the most generous, thoughtful, intelligent and kind people I know. When she’s feeling better, she strikes up lively, warm conversations with strangers. She attracts a mob of kids wherever she goes and loves to blow bubbles or do magic tricks. She surprises people with delightful, zany gifts. But sometimes her thoughts don’t match reality. Sometimes her feelings come out in intense waves. I’m pretty sure the famous singer isn’t in love with her and no one is breaking into her apartment. And yet her feelings of elation and fear are absolutely real.
When Tina first started struggling, it was very confusing for me. Her thoughts seemed disconnected from reality. I didn’t understand. And I didn’t know how to help her.
I was also having my own troubles. I’d find myself biking to university day after day, crying while I rode but not knowing why. Soon nothing was fun anymore. I just wanted to lie in bed and never get up. Concentrating and getting my work done was a struggle. On the outside, I could often fake it, but on the inside, it felt like I was shriveling up. I didn’t know where to get help, and I certainly didn’t want to tell anyone what I was going through because I felt like such a failure. I didn’t know how to help myself either.
Eventually I talked to a counselor. And slowly I started opening up to people in my life. Turns out I wasn’t the only one feeling strange and alone. The more I talked about what I was going through, the more I found that other people had similar experiences and understood my confusion and pain.
We all go through tough times. This is human. Distress sometimes even helps us to change and grow. But just as we all need to learn to take care of our physical health, we also need to learn to take care of our mental health in order to cope with troubles and enjoy life. Things get trickier when distress gets so intense that it’s difficult to function in daily life, or when it goes on so long that it seems never-ending. We often call this a mental illness or mental disorder. Between health and illness there is a wide range of experiences, and most often people don’t fit neatly into any box or diagnosis. That’s why I want to tell you a bunch of stories that illustrate how each person’s struggle and journey to wellness is unique and personal.
Some people’s troubles are expressed outwardly, in words and actions that might seem odd or big and emotional. Other people keep things more hidden and suffer in silence. Either way, it can be very difficult and confusing—both for the person who is struggling and for their loved ones. And yet I believe there is hope for all of us to find peace, belonging and a meaningful life.
I work now as a youth and family counselor. Each day, young people sit with me and talk about what’s up. They tell me about what sucks in their lives, sometimes ranting, sometimes barely able to get a word out. It’s all okay. My office is a place where I hope people can just be themselves. To do that, they have to feel safe. So that’s my job—to be present, calm and accepting, so that each person can freely speak from their heart.
“Just as we all need to learn to take care of our physical health, we also need to learn to take care of our mental health.”
I wish I could tell you some of these stories, because the youth I see inspire me every single day with their strength, honesty and courage. But I’ve made a serious promise to each of them that I’ll keep their stories private. So in this book I only tell stories I’ve lived and stories from my friends, family and people I’ve interviewed who gave me permission to tell their stories, sometimes after I’ve promised to change their name to protect their privacy.
Science can tell us a lot about how our brains work and why we feel and think the way we do. For each one of us, our sense of well-being is affected by the body we were born with, the good and bad things that have happened to us and the choices we make. To feel happy and well, we all need healthy food, a safe place to live and a sense of belonging. When people are bullied or discriminated against or made to feel like they don’t matter, it hurts their mental health.
“Mental” might make it sound like it’s all in our heads. I think it’s more than that. When we’re in distress, our bodies, our emotions, our thoughts and our spirits are involved. In fact, the word psyche—which is part of the words psychology and psychiatry—comes from a Greek word that means “the breath of life.” Psyche refers to that most mysterious thing that makes each person a one-of-a-kind living being. That’s what we’re talking about here—what happens when our living being gets injured. It’s not just in your head. This is core stuff! It’s not simple or easy. And there is still a lot we don’t know about why people suffer from emotional pain and distress. So hang on as we explore both what we know and what we don’t know, the theories and the mysteries. The stories in this book will show you there’s hope for anyone who’s struggling.
Suffering has always been a part of being human. Philosophers, shamans, priests, artists, scientists, doctors and therapists have all tried to understand it. Throughout history, people have tried to figure out how to get through it. How to make it better. No life is pain-free. Everybody hurts.
While some pain is clearly physical—like the pain from a twisted ankle—pain is often thought of as being emotional, psychological and even spiritual. It hurts when someone says something mean. It hurts when no one understands. It hurts when you’ve let yourself or someone else down. Sometimes suffering comes in the form of sadness, worry or anger. Sometimes it’s self-hatred or shame. Sometimes it’s racing thoughts or an ache in your chest or a dead feeling inside. Sometimes it’s pain there just isn’t words for.
It’s scary to think that it’s possible to lose control of your thoughts and emotions, to lose all sense of what’s real and what’s not. Or to be so anguished that you no longer feel like yourself. Or to be in such immense pain that it seems almost impossible to go on living. This is serious stuff.
Good mental health is the ability to enjoy the good things in life and cope with the difficult things. It’s the ability to adapt and change. And to balance stress and relaxation. Good mental health doesn’t mean the absence of struggles; it means being able to deal with things and still take care of yourself and your relationships.
Everybody has ups and downs. Everybody has thoughts and feelings that sometimes are overwhelming or distressing. So what is mental illness? When does regular old sadness tip into depression? When does a burst of energy and creativity become manic? When do worries morph into an anxiety disorder? When do odd beliefs become delusional or psychotic?
Mental illness and mental disorder are terms often used to describe when a person’s thoughts and feelings are messed up to the point that it is difficult for them to function in regular life. A mental illness or disorder—like anxiety, depression, schizophrenia or post-traumatic stress disorder (ptsd)—is a label that’s attached to a cluster of symptoms that cause a person great distress. The symptoms can include major changes in a person’s thoughts, perceptions, emotions, and behaviors. To qualify as an illness or disorder, these symptoms are usually serious enough that the person has difficulty taking care of themselves or relating to others.
The World Health Organization names mental disorders as one of the top causes of poor health and disability. Keep in mind, though, that many mental health issues are temporary and resolve with time and good self-care.
The terms mental health, mental illness and mental disorder all come from a medical perspective that tends to focus on the brain as the source of the problem. This brings up some questions: Is what we’re talking about really mental? I mean, is it all in our heads? And is what we’re talking about truly illness? Is it a disease or defect in the brain? Is it something wrong inside an individual person? Or is it more complicated than that?
As you’ll see in this book, people have different takes on this. Cultures have different takes on this. And through time, understandings have shifted.
We’re going to look at some of the different ways of making sense of mental health. Biomedical explanations focus on genetics and the brain’s circuitry and chemicals. This approach relies on science to provide insight into what is out of whack in our brains, so that we can develop treatments, as we have for other illnesses. We’ll also look at psychosocial explanations, which focus more on how people’s wellness is affected by inequality, discrimination, violence, poverty and other social problems. This approach emphasizes the need for society to change in order for people to be healthy and happy. We’ll look at Indigenous perspectives that offer a more holistic approach, where wellness is about balancing mind, body, heart and spirit. In this view, a person’s wellbeing is interconnected with their family, community, culture and land. We’ll also consider a trauma-informed approach, one that emphasizes how trauma—really scary, overwhelming experiences—can affect our whole body and sense of self.
Each of these approaches to understanding mental health can open up different possibilities for sparking change in ourselves and in our world.
Pop-U-lar! Pop-U-lar! Shawn Glynn Pendenque rode high on a Toronto Pride Parade float pumping out his hit single, “Popular.” The crowd pulsed to the electro-dance groove he lay down. “They know who you are because you’re popular!” he sang.
Back then, Shawn looked the part of a magnetic Black pop star. His music career was ramping up. He had an education and a day job as a youth counselor. He owned a house and a car. But underneath all that success, Shawn says, “I was totally messed up.”
Shawn Glynn Pendenque
Shawn had worked with youth for over a decade. At some point the number of Black youths he saw going to jail started to really bother him. The bruises and wounds he saw on their bodies made his stomach knot. Anger started to boil. “I felt I had to be a savior for these kids,” Shawn says.
Looking back, Shawn sees that he slowly started becoming delusional. He started to think he was an angel sent to save these kids. He heard voices from heaven. He believed he was Jesus. For weeks, he didn’t sleep. Sometimes he’d roam the streets, muttering, raging. Night after night, he worked frantically on a twenty-seven-page manifesto declaring that court judges were all going to burn in hell.
Shortly after Shawn sent his manifesto to the judges, cops raided his house and arrested him for uttering death threats. Shawn was characterized as a religious extremist and imprisoned. No one realized he was having a mental health crisis and needed help. In prison the symptoms of psychosis got worse and worse until he lost all touch with reality. Eventually he was diagnosed with schizoaffective disorder, a condition that includes major mood symptoms along with hallucinations and delusions.
“I lost absolutely everything,” Shawn says, “my home, my car, my record label, my professional identity.” When he was released from prison, he had nowhere to go. He turned to Loft, a nonprofit organization in Toronto that supports people with mental health and addictions challenges. Given a stable home, Shawn started to work on his recovery.
We’ll pick up Shawn’s story again later, but first let’s take a closer look at the brain, so we can begin to understand what goes on inside our heads.
The brain is such a delicate, Jell-O-y glob. On YouTube, I watch a neurobiologist hold a shiny pink brain in her latex-gloved hands, caressing its plump worm-like texture. It’s eerie and marvelous to think that this fragile thing once floated in someone’s skull, processing sights, sounds, thoughts, feelings—a whole world of experience.
Science has focused on the brain as the center of operations, the key to understanding our emotions and behavior. And yet, as scientist Emerson M. Pugh once said, “If the brain were so simple that we could understand it, we would be so simple that we couldn’t.”
“If the brain were so simple that we could understand it, we would be so simple that we couldn’t.”
Emerson M. Pugh
The brain is an incredible mass of about 100 billion nerve cells called neurons. Every action or emotion creates a pathway in your brain, a trail laid down by one brain cell releasing a chemical and the next cell absorbing it and sending it on down the line. These chemical messengers are called neurotransmitters. Each skateboard trick or math problem lights up a precise path in the brain. And every time you repeat an action or a thought, that pathway is strengthened. If you have learned to play a guitar riff or sink a basketball, you know how it starts off feeling awkward and clumsy, but as you keep practicing, eventually you can do it without thinking—well, obviously you’re still thinking, but it’s effort-less. Here’s what happens: “neurons that fire together, wire together.”
Scientists used to think that the majority of the brain’s development happened in early childhood and that, after that, things got pretty static. Now we know that the human brain is incredibly plastic. Plasticity refers to the ability of something to be easily shaped or molded. In this case, neuroplasticity means that the brain has the ability to change and grow throughout a person’s life. This is good news—it means we can work to heal our brains. If you light up the pathways that make you feel good and calm, those pathways get strengthened.
The science of neurotransmitters has helped us understand that mental illnesses are linked to chemical imbalances. Over 100 neurotransmitters have been identified. The psychiatric medications we now use to treat things like depression or schizophrenia work by blocking, stimulating or mimicking these chemicals. In Canada, psychiatric medications are the most prescribed drugs other than cardiovascular (heart) medications.
Even though medications don’t work for everyone, they can provide relief from the symptoms of mental illness. For Shawn, medications helped him calm his emotions and get on with living.
Each person has a unique factory for producing the chemicals of consciousness. This factory may have production glitches related to the biology you’re born with. But mental illness isn’t necessarily just a chemical imbalance. Life causes chemical imbalances. Everything from grief to violence to hunger to bullying can mess with our chemical balance. Positive experiences like a comforting hug, a sunset or a hard run can produce happy chemicals. Factory settings might be skewed, but that’s usually not the whole story. Sometimes we’ve got to work on fixing life in order to get the good chemicals flowing.
The emotional brain sends signals of danger or safety to the body. The thinking brain can help us understand and respond to these signals. But big emotions can overwhelm our ability to think clearly.
The main job of a brain is to ensure survival. The emotional part of the brain is built to react to danger in order to keep us safe. Recently, machines have been invented that can watch the brain in action. pet scans and fmris allow scientists to track what happens in the brain when a person meditates or is given a mouthful of sugar or is reminded of a violent attack they once experienced.
The most basic part of the brain, the part that first develops in the womb, is the brain stem. Sometimes it’s called the reptilian brain because it is as ancient and simple as a snake’s brain. The brain stem controls the vital functions of breathing, body temperature and heart rate.
The limbic brain records memories and whether they were pleasant or unpleasant. It’s called the mammalian brain because it’s something that all social mammals have. This is where emotions are sparked. The limbic brain judges what is dangerous or safe, pleasurable or painful.
Together, the reptilian brain and the mammalian brain can be thought of as the emotional brain. The emotional brain is in charge of survival. It’s fast and instinctive. It lights up for sugar. It freaks at danger. Even a memory of something bad can get the emotional brain revving with fear.
The neocortex—often called the thinking brain—is in charge of logic, imagination, planning and control. It figures out how things work, weighs pros and cons and makes decisions. Other mammals also have a neocortex, but in humans it’s thicker and more developed. The neocortex is the command center where we decode language, store information and generate meaning.
When we feel calm and safe, we are better at making good decisions and connecting with others.
It’s the thinking brain that allows us to regulate our emotions and hold off on impulses so we can consider our options and predict consequences. It helps us to take a second and not say or do something hurtful. It helps us resist a piece of cake or punch a pillow instead of a person.
It’s also the part of the brain that lets us tune in to another person and understand their experience. In other words, it helps us to be compassionate and socially connected. The thinking brain helps us to act wisely and develop caring relationships.
Since the emotional brain reacts with lightning-fast reflexes, the thinking brain is pretty much always playing catch-up. If you round a corner and encounter a stranger in a dark alley, your body will react before you have time to think about who they are or why you’re scared. The emotional brain can trigger the whole body into fight, flight or freeze (see more on p. 22) before you can even think. It takes time for the thinking brain to catch up and make sense of the experience.
Paul D. MacLean
Neuroscientist Paul D. MacLean
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