The term “smiling depression” – appearing happy to others while internally suffering depressive symptoms – has become increasingly popular. Articles on the topic have crept up in the popular literature, and the number of Google searches for the condition has increased dramatically this year. Some may question, however, whether this is actually a real, pathological condition.

While smiling depression is not a technical term that psychologists use, it is certainly possible to be depressed and manage to successfully mask the symptoms. The closest technical term for this condition is “atypical depression”. In fact, a significant proportion of people who experience a low mood and a loss of pleasure in activities manage to hide their condition in this way. And these people might be particularly vulnerable to suicide.

It can be very hard to spot people suffering from smiling depression. They may seem like they don’t have a reason to be sad – they have a job, an apartment and maybe even children or a partner. They smile when you greet them and can carry pleasant conversations. In short, they put on a mask to the outside world while leading seemingly normal and active lives.

Inside, however, they feel hopeless and down, sometimes even having thoughts about ending it all. The strength that they have to go on with their daily lives can make them especially vulnerable to carrying out suicide plans. This is in contrast to other forms of depression, in which people might have suicide ideation but not enough energy to act on their intentions.

Although people with smiling depression put on a “happy face” to the outside world, they can experience a genuine lift in their mood as a result of positive occurrences in their lives. For example, getting a text message from someone they’ve been craving to hear from or being praised at work can make them feel better for a few moments before going back to feeling low.

Other symptoms of this condition include overeating, feeling a sense of heaviness in the arms and legs and being easily hurt by criticism or rejection. People with smiling depression are also more likely to feel depressed in the evening and feel the need to sleep longer than usual. With other forms of depression, however, your mood might be worse in the morning and you might feel the need for less sleep than you’re normally used to.

Smiling depression seems to be more common in people with certain temperaments. In particular, it is linked to being more prone to anticipate failure, having a hard time getting over embarrassing or humiliating situations and tending to ruminate or excessively think about negative situations that have taken place.

Women’s Health magazine captured the essence of smiling depression – the façade – when it asked women to share pictures from their social media and then to recaption them on Instagram with how they really felt in the moment they were taking the picture. Here are some of their posts .

Burden and treatment

It is difficult to determine exactly what causes smiling depression, but low mood can stem from a number of things, such as work problems, relationship breakdown and feeling as if your life doesn’t have purpose and meaning.

It is very common. About one in ten people are depressed, and between 15% and 40% of these people suffer from the atypical form that resembles smiling depression. Such depression often starts early in life and can last a long time.

If you suffer from smiling depression it is therefore particularly important to get help. Sadly, though, people suffering from this condition usually don’t, because they might not think that they have a problem in the first place – this is particularly the case if they appear to be carrying on with their tasks and daily routines as before. They may also feel guilty and rationalise that they don’t have anything to be sad about. So they don’t tell anybody about their problems and end up feeling ashamed of their feelings.

So how can you break this cycle? A starting point is knowing that this condition actually exists and that it’s serious. Only when we stop rationalising away our problems because we think they’re not serious enough can we start making an actual difference. For some, this insight may be enough to turn things around, because it puts them on a path to seeking help and breaking free from the shackles of depression that have been holding them back.

Meditation and physical activity have also been shown to have tremendous mental health benefits. In fact, a study done by Rutgers University in the US showed that people who had done meditation and physical activity twice a week experienced a drop of almost 40% in their depression levels only eight weeks into the study. Cognitive behavioural therapy, learning to change your thinking patterns and behaviour, is another option for those affected by this condition.

And finding meaning in life is of utmost importance. The Austrian neurologist Viktor Frankl wrote that the cornerstone of good mental health is having purpose in life. He said that we shouldn’t aim to be in a “tensionless state”, free of responsibility and challenges, but rather we should be striving for something in life. We can find purpose by taking the attention away from ourselves and placing it onto something else. So find a worthwhile goal and try to make regular progress on it, even if it’s for a small amount each day, because this can really have a positive impact.

We can also find purpose by caring for someone else. When we take the spotlight off of us and start to think about someone else’s needs and wants, we begin to feel that our lives matter. This can be achieved by volunteering, or taking care of a family member or even an animal.

Feeling that our lives matter is ultimately what gives us purpose and meaning – and this can make a significant difference for our mental health and well-being.

The piece by Olivia Remes was originally published on ‘The Conversation‘ February 19 2019.

I hear it often: A friend swears that her running practice staves off bouts of low spirits. Another says going to the gym before work keeps him mentally steady.

Perhaps you’ve heard similar stories; perhaps you believe it for yourself.

Those anecdotes prompt some questions. Is there evidence to support the idea that exercise can have an effect on depression? And if so, how much exercise? A number of research studies have been done to answer those questions and others.

One study assigned participants, 202 depressed adults at least 40 years old, to one of four groups. One group attended supervised group exercise sessions three times per week, where they monitored their heart rate as they walked or jogged on a treadmill for 30 minutes. A second group received similar instructions but were left to work out on their own at home. Groups three and four took pills: either the antidepressant medication sertraline or a placebo.

After 16 weeks, researchers rescreened participants for depression and found 45 percent of the people in the supervised exercise group no longer met the criteria for major depression. In the other groups, 40 percent of home exercisers, 47 percent of medicine takers and 31 percent of placebo pill takers were no longer depressed.

That’s right, the supervised exercisers did as well as the people who took an antidepressant. As promising as these results were, however, it was a small study.

James Blumenthal, a psychologist at Duke University who co-wrote the paper, says there are a number of studies that, like his, support the idea that exercise might be helpful in treating depression. Like his, most of the studies are small. “There are no large, multicenter clinical trials,” he says, which are typical for drug studies funded by pharmaceutical companies.

There are also issues with the design of experiments, says Chad Rethorst, a researcher at the University of Texas Southwestern Medical Center. “What is the comparison control condition?” A placebo pill prevents people from knowing if they’re getting medicine or not; it’s hard to come up with a placebo situation for exercise.

Still, a number of scientists have combined results from the many small studies to see if an overall effect can be described. These review papers generally find a small to moderate effect of exercise in the research studies. How does that evidence translate to the real world?

“Any treatment for depression works for some people, but not for everybody,” Blumenthal says. That’s true for medication, talk therapy and exercise alike.

Depressed patients, by the nature of their condition, are not motivated, Rethorst says, so engaging in a new and challenging activity can be tricky.

Mental health practitioners probably will mention exercise, along with other healthy behaviors such as sleep, to their patients, even as they prescribe talk therapy or medication as the main treatments. But it’s not clear how many psychologists or psychiatrists actually prescribe exercise as a treatment.

Some practitioners do advocate exercise.

Antonia Baum, a psychiatrist in private practice in Bethesda, says, “I always take an exercise history with my patients.” As for starting and sticking with an exercise program, she’ll talk through the basics and help people find an activity that they’ll enjoy.

“You need to find a way that’s sustainable,” she says.

A 2015 survey suggested that a majority of depressed patients would be interested to try “an exercise program designed to improve mood.”

Rethorst reviewed the studies to come up with guidance for providers on how to prescribe exercise, including what kinds of exercise, frequency, intensity, duration, and how to help people stick to a program.

How much exercise? The research studies suggest that at least 150 minutes of aerobic activity — walking, jogging or biking — per week is good. Conveniently, that’s in line with public health guidelines from the Centers for Disease Control and Prevention.

A few studies have found positive effects with resistance training or weight-based exercise, but there’s more evidence for aerobic activity.

For people who may want to try exercise as a treatment for low mood or depression, Rethorst says it’s still wise to seek a practitioner’s help.

“The optimal clinical practice will include regular monitoring of symptoms, as with the initiation of any treatment plan,” he says. Worsening of symptoms might prompt different or additional treatments.

In other words, don’t undertake exercise-as-treatment on your own. If you’re really depressed, you need treatment and oversight. For instance, exercise doesn’t always work. You may put yourself at risk of not having other treatments at the ready if you’re not seeing a provider of some kind.

Also, maintaining an exercise program is not easy — it’s time-consuming and it’s common to lose motivation at some point. Getting social support by joining a group or class of some kind can help. Baum says she sees her patients regularly enough, often weekly, that she can check in and encourage people to stick with it.

Blumenthal says he sees good adherence to exercise by the participants in his studies. But, he adds, “We do lots of monitoring. The accountability aspect may be critical.”

You may need patience. “The benefits occur within six to eight weeks — not right away,” Blumenthal says. “Meds work a little more quickly.”

And, of course, exercise is good for many other aspects of your health. “I believe in exercise personally and in my practice,” Baum says. “I endorse its beneficial efforts.”

This piece by Jill U. Adams was originally published on ‘The Washington Post‘ March 17 2019.

When the Swiss Machine was on a break we made little houses for dandelion seed heads, which my sister had adorably named “tree stars”.

Though we grew up and inevitably retired the Swiss Machine and our plant pets, my instinct to use imagination as respite from the real world hasn’t faded.

I’m a daydreamer. I actively and passively experience mind-wandering, whether it’s an allotted pre-bedtime daydream about a crush, or glazing over in the garden imagining future experiences and revisiting memories. I find it a calming, sometimes joyful experience.

But, while studies have shown that imaginative play in childhood can be linked to creativity in adulthood, much of the research on daydreaming has typically focused on its negative impacts: from hampering productivity at work to overwhelming mind-wandering episodes that inhibit daily life, known as maladaptive daydreaming.

However, research is beginning to show positive links between daydreaming and a healthy mind.

In January, researchers at the Georgia Institute of Technology published new research into the first person experience of daydreaming in the workplace.

Although participants expressed guilt about daydreaming or “mind-wandering”, they also expressed positive impacts on mental health and productivity following a daydreaming episode.

“This study complements existing research to show that, in some situations, daydreaming can be helpful,” researcher Kelsey Merlo said.

“People can use daydreams as ‘mini-breaks’ throughout their workday, allowing them to return to their work feeling more refreshed, energised, and productive.”

Given that mindfulness and being present in the moment are very much in vogue, it is no surprise that daydreaming – arguably the antithesis of being present – doesn’t instantly spring to mind when we are considering how to improve our mental health.

“Daydreaming has traditionally been associated with negative connotations, and this may hark back to our days at school when it was essential to pay attention to encode and learn a significant amount of information,” Muireann Irish, associate professor of psychology at the University of Sydney, said.

In 2017, University of Cambridge researchers established a relationship between the default mode network (the brain network associated with daydreaming) and accurately performing tasks on autopilot, and many experts now agree that there can be significant mental health benefits to daydreaming.

There has been research to show mind-wandering indicates higher intellect and creativity, as well as studies that have shown, in simple terms, problem solving can be improved by allowing the mind time to wander.

It is no surprise that daydreaming doesn’t instantly spring to mind when we are considering how to improve our mental health.

“Allowing our minds to wander, free from work demands and constant streams of information, may be just as important as engaging in mindfulness techniques to promote wellbeing,” Associate Professor Irish said.

“Many famous writers and artists report having their ‘eureka’ moments during periods of quiet contemplation. It seems the key to flexible and creative insights is taking time away from the problem at hand and allowing ourselves to daydream.”

Susan Krauss Whitbourne, professor emerita of psychological and brain sciences at the University of Massachusetts Amherst, explained that, while there can be negative effects from daydreaming, as long as daydreaming is used to allow your creative mind to wander free, it can only benefit your mental health.

“Imagining your ‘hoped-for’ goals in life and using daydreaming to motivate you to achieve those would have a positive effect on your mental health,” she said.

For me, there are few pleasures greater than spending time indulging in daydreams about my own personal “hoped-for” goal of winning the lotto. In my reveries I assign myself the role of a (non-criminal) Great Expectations style secret benefactor, bestowing properties and all-expenses paid trips abroad upon my family and friends. This positivity and agency could be the key to reaping the rewards of mind-wandering.

“Studies of clinical populations reveal that the content of one’s thoughts may be the crucial factor in determining whether daydreaming is adaptive or maladaptive,” Associate Professor Irish explained.

Merlo acknowledged uncontrolled daydreams, such as obsessive worry or rumination, are bad for mental health, but also said that her study showed that the emotions in a daydream, both positive and negative, can influence how you feel after the daydream has ended.

Though mind-wandering and mindfulness appear polar opposites, Merlo explained that they may not be quite as different as they initially appear.

“How we manage where our mind goes, whether through the strategic use of positive daydreaming or mindfulness, could be what helps us live our happiest lives,” Merlo said.

Like my early adventures in the imaginary Swiss Machine, choosing where we go and who we become in our daydreams – if it’s positive – may just lead healthier minds, and could allow us to feel relaxed and be more creative in our everyday existence. Who doesn’t (day)dream of that?

This piece by Jenny Haward was originally published on ‘The Sydney Morning Herald‘ 15 March 2019.

It’s touted to relieve pain, lower stress and anxiety, and bolster cognitive performance, but does the practice of mindfulness physically change the brain — and if so, how do we know?

Key points:

• Meditation practices that use mindfulness have been around for millennia
• Only recently have neuroscientists been able see exactly how the brain changes after mindfulness programs
• There are still plenty of questions to answer about the neuroscience of mindful meditation, including its long-term effects

First, it’s important to know that mindfulness programs can take many forms, from free mobile apps to highly structured, weeks-long guided sessions. So all these different habits are likely to produce different effects.

In neuroscience research circles, there are two major mindfulness regimens: mindfulness-based stress reduction and mindfulness-based cognitive therapy.

People undertaking the mindfulness-based stress reduction course receive eight weeks of intensive mindfulness training, which takes elements from practices such as meditation and yoga.

It’s been around since the 1970s and, as its name suggests, it was created to alleviate anxiety and stress.

Mindfulness-based cognitive therapy, on the other hand, was primarily designed for those with depression. It weaves aspects of mindfulness — like meditation — together with a type of psychotherapy.

In the past decade, high-resolution brain imaging has let us look beneath the skull and find out what effects these mindfulness programs have on the way the brain works.

How mindfulness shapes the brain

It’s still a burgeoning field, but a few different studies have suggested mindfulness interventions increase the volume of brain regions that help regulate emotion and attention.

One area that seems to get chunkier is called the anterior cingulate cortex, according to Neil Bailey, a neuroscientist at Monash University.G

“The function of this region seems to be related to choosing between competing brain processes,” he said.

“So if you’ve got a part of your brain that’s saying ‘eat the doughnut’ and another part of your brain that’s saying ‘no, do your homework’, the anterior cingulate cortex is the part that decides which to focus on.”

If the anterior cingulate cortex focuses attention, it’s the prefrontal cortex — responsible for complex cognition — that sustains that focus. It also seems to thicken up with a bit of mindfulness training.

The hippocampus and amygdala, which are primarily responsible for memory and emotional processing respectively, change as well — in the strength of their connections.

When the amygdala is activated, it can trigger the “fight or flight” response, the reflex that gets your heart pumping and your body ready to react to a threat.

It’s thought that some people with anxiety disorders have a hyper-responsive amygdala, eliciting fight or flight even when there’s no life-threatening danger.

After a bout of mindfulness training, the amygdala might still kick in, but messages feeding into it from the prefrontal cortex and hippocampus that give context to the situation — that it’s not a life or death scenario — may be stronger.

“What research has shown is that there’s less amygdala activity after a mindfulness intervention and that it’s related to the downregulation by the other brain areas,” Dr Bailey said.

Measurements aren’t perfect, but are improving

Dr Bailey uses a technique called an electroencephalogram, or EEG, to look at how mindfulness changes the brain’s function.

It’s a cap of electrodes that can pick up electrical activity in the brain’s outer layers.

The system has been used for many years and is very reliable, but relatively indirect.

To get right inside the brain and find out if its shape and size are changing, the best technique we have is magnetic resonance imaging or MRI.

These scans are the closest we can get to cracking open a person’s skull and taking a ruler to their grey matter. It’s the technique used in the studies, mentioned above, examining the cortex after mindfulness training.

An MRI machine records virtual slices through the brain (or any other squishy part of the body).

It was developed in the 1970s, but in recent years, MRI resolution has improved vastly thanks to more powerful electromagnets.

“The stronger the magnet, the better the image,” said Rebecca Koncz, a neuropsychiatrist at the University of Sydney who is also completing a PhD in brain imaging at the University of New South Wales.

MRI these days commonly operates with a 1.5- or 3-tesla magnet — around the strength of the electromagnets that hoist cars in scrapyards.

Newer, more expensive MRI models use a 7-tesla magnet or higher.

As well as more precise size-and-shape measurements, these superpowered magnets are proving useful for taking snapshots of the brain in action: a sort of whole-brain activity map called functional MRI.

This “fMRI” tracks oxygen in the brain’s blood supply, to see which parts are working harder. The idea here is that more activity needs more oxygen.

It’s the type of evidence which revealed, for example, that mindfulness training can dampen the activity of the amygdala.

Still, even top-shelf MRI machines have their limitations.

They divvy up images into 3-D pixels called “voxels”. Depending on the thickness of the slice, one voxel is usually around 1 cubic millimetre.

A morsel of brain tissue that size can contain tens of thousands of cells, so slight density or volume changes might go unnoticed.

And the difficult, indirect analysis required to quantify brain activity from fMRI data has led to criticisms about whether the results are meaningful.

There’s plenty left to discover

The neuroscience of mindfulness has drawn on all of these techniques — but is still in its infancy.

There are plenty of questions left to be answered, such as: Does the quality of mindfulness practice matter? Is there a dose-dependent effect (i.e. more mindfulness, more change)? And are there long-term effects on the brain?

Some evidence shows that compared to the wider population, long-time meditators have more brain volume in, for instance, the prefrontal cortex.

But there are no longitudinal studies as yet that have followed novice mindfulness practitioners to see if they maintained their newly gained brain bulk.

Even though the benefits of mindfulness can sometimes be overstated, there is likely to be a good reason it’s been around for so long, Dr Koncz said.

“Mindfulness and meditation have been practised for thousands of years. Perhaps science is just taking a bit of time to catch up.”

This piece by Belinda Smith was originally published on ‘ABC News‘ 19 February 2019.

When Jenny Green watched her daughter, Jacalyn Williams, pole dancing, she never imagined it would one day be her up on stage.

But, all that changed less than two years ago, when Jacalyn took her own life.

Ms Green, 50 then took on her daughter’s passion for the pole and making it her own.

“I sort of hit rock bottom and I was depressed,” Ms Green said.

“I was angry, one, that she left us. I was heartbroken, and I thought, you know, I’ll try pole to see why my daughter loved it so much.”

Fast forward to today, and Ms Green has transformed her shed in to a memorial for her daughter.

Two silver poles are bolted in to the ground in the middle of what Ms Green has dubbed her “woman cave”.

She said it is a place she can visit, practice and still feel connected to her daughter.

“I feel like she’s there,” Ms Green said.

“She would train seven days a week it drove me insane … I was a bit envious of her and her pole because it took our mother daughter time away.”

She said she now understands her daughter’s obsession with pole dancing.

“I can see why she did love it so much,” Ms Green said.

“You meet a lovely array of people; the pole industry is very caring it’s like one big family.

“And they come from all walks of life and you could be having a bad day and I’ve gone in to the studio crying and by the end of it I come out with half a smile and the tears have diminished.”

Remembering Jacalyn

Ms Green described her daughter as someone who wore her heart on her sleeve.

“If someone had fallen down on the street she’d be the first one there picking them up,” she said.

“She could go into a room and if people were upset she’d be the loudest one there and five minutes into it everyone would be laughing and be high-fiving.

“She knew how to light up a room.”

But Ms Green said her daughter kept her mental illness secret.

“She had a lot to live for … the world was practically at her fingertips, but it just wasn’t good enough and she thought that was her only way out.”

Ms Green visited Jacalyn a few days before she died.

“I’d gone down three days before she took her own life,” she said.

“I knew she was upset, and she promised me, ‘Mum I promise you I won’t do anything stupid. You know I’m stronger than that. You’ve made me stronger than that’.”

Ms Green spoke to her daughter Jacalyn just hours before her death.

“It was 7:30pm. I hadn’t quite finished work yet and rang her back on the way home,” she said.

“She said, ‘Mum I’m okay, I’m all good. I promise, you know, I’ll come up next weekend or the week after’ … that never happened.”

How pole dancing saved Ms Green’s life

Ms Green said pole dancing gave her a reason to wake up every morning, after the death of her daughter.

“Depression and suicide turned my life and my family’s life upside down and into chaos,” she said.

“I fight with it on a daily basis, from the time I go to sleep until the time I wake up.

“I sometimes even fight with it in my sleep. It’s a fighting battle everyday but you just take one step at a time, 10 minutes at a time.

“If it wasn’t for pole and I don’t really like to say this, I don’t think I’d be here.

“I think the pole dancing was a major part to get myself up off the couch, stop feeling sorry for myself because I was going downhill into depression.”

She said she had met lots of people in the pole industry with similar stories to hers.

“We find a lot of people in the pole industry, they’ve suffered depression and pole dance has been their way out,” she said.

When asked where she gets her strength from, Ms Green said she did not know.

“Some days are really difficult,” she said.

“I’d really like to delete Facebook, but I can’t. I have a ritual every morning, that I go through the memories and see what memories come up for the day. It might be a memory from Jaclyn because she’s being silly, or she’s made a comment or posted a photo.”

“Those memories are sort of what keeps me going.”

Ms Green suspected her daughter would laugh at the thought of her mother fiercely training on the pole.

“My daughter she’d probably say, ‘Mum you’re a nut’. She would be proud, I hope she’d be proud,” Ms Green said.

‘The system has failed’

Ms Green lamented that the mental health system failed her daughter.

“When Jaclyn went in to hospital that night … the doctors reported, the ED department states she has suicidal tendencies,” she said.

“They knew she had suicidal tendencies, but they let her go home.

“I will give that report to my solicitor later, because I want something done about it.”

She said the entire system needed an overhaul.

“The system has failed, and it does fail people,” Ms Green said.

“It fails them every day … I can’t blame the doctors, they’re trying their best, but they want to push you out as quick as possible because they don’t have the beds.

“[Jacalyn] was on the waiting list to be seen by a psychiatrist.

“She’d taken her life in September, she was due on the fourth of October to see the psychiatrist but obviously couldn’t last that long.”

Ms Green’s experience prompted her to create the Rockit Foundation, a grassroots organisation that aimed to provide financial and emotional support to people suffering from mental illness.

“When a family member goes through this and you’ve got to sit down with police and give statements, you know even two months after the fact and the case isn’t still closed, the coroner hasn’t signed off, [you’re] toing and froing from police to coroners … I said, ‘how long does a loved one have to wait to have closure?'” she said.

Ms Green said she hoped to help family members and friends who too have lost a loved one to suicide.

“You’re never going to have closure,” Ms Green said.

“I can’t say not one person was nice, but they’ll send you away with a pamphlet saying, ‘Support after Suicide’.

“If you’re anything like me, you put it on the ‘to do later’ pile because you’re still trying to get through today, you’re still trying to get through yesterday.”

Ms Green hoped the foundation could pay for and expedite professional help for those that really need it and to save someone from dying by suicide.

“Even one life, I’ll be happy,” she said.

This piece by Will Kendrew and Mahalia Dobson was originally published on ‘ABC News‘ 11 March 2019.

A new awareness of the impacts of ‘pill shaming’, which can prevent people from purchasing medication to help treat their mental illness, has emerged in online forums.

The movement has been shared across various social media and blogging sites, with individuals using #PillShaming to open up about their own experiences, or to encourage others to drop the stigma around mental illness and taking medication.

The campaign has been discussed internationally, with one blogging site’s video attracting around 15 million views.

In 2017, The National Rural Health Alliance (NRHA) identified that around 20 per cent of people Australia-wide experience mental illness.

However, rates of suicide and self-harm increased for people living more remotely.

Royal Australian and New Zealand College of Psychiatrists (RANZCP) president Kym Jenkins said that anecdotally the amount of medication being prescribed to regional Australians to help treat or manage an individual’s mental illness had increased.

Despite this, some professionals working in the mental health space have said a negative stigma in regional Australia had caused people to feel embarrassed about accessing medication.

Dr Jenkins said continued efforts to reduce negative perceptions of mental illness must be made and if more locals were to share their personal stories, the stigma could be reduced.

“We don’t have much in the way of role models or stories coming out from people who are living rurally and remotely,” she said.

“[People opening up and] saying, ‘I’ve had this mental illness, I got it treated, I feel better now and feel that I’m a contributing member of society again’ [would be positive].

“We don’t have many … people modelling how to get treatment for mental illness and how effective that treatment can be.”

Fear of knowing chemist staff

South Australian psychiatrist Ken Fielke, who specialises in rural patient care, said a significant number of people were not taking the medication that had been recommended, as patients felt uncomfortable about purchasing medication from their local pharmacy.

“I go to a range of different towns across the state — they are fish bowls — and people are really concerned about their privacy and confidentiality,” Dr Fielke said.

“In some respects, it’s great to be in a rural community where you’ve got networks and people that support you, but in [others], you also want confidentiality and privacy and with mental health issues that is often the case.

“[This is something] we wouldn’t think about with some other conditions that you go the pharmacy and get your script filled for.”

Dr Kym Jenkins said anecdotal evidence suggested that this issue was not limited to just regional SA and was an experience noted in many other regional areas nationwide.

Taking medication ‘somehow’ viewed as a weakness

Melbourne woman and ‘A Path To Follow’ founder, Kirstie Edwards, has lived with mental illness for most of her life, starting treatment about 15 years ago.

Ms Edwards grew up in a country community in Victoria and moved to the city in her late teenage years.

The mother of three said it was unsurprising that people felt embarrassed or uncomfortable about accessing medication, as the negative stigma still surrounded mental illness in rural areas.

“More people may be taking medication than what they previously were, but they are not open about it,” she said.

“There is still this overriding sense — more so in the country — that society tells us we should be able to cope with this on our own, and if we’re not then somehow that’s a weakness.

“My family in the country knew I was sick, but they certainly didn’t know the details.

“I am still much more open about my mental health journey with my family and community in Melbourne than I am with those people from the country.”

Rural GP shortage a barrier

According to Dr Fielke and the NRHA, a key to successfully supporting a person’s mental illness treatment is a strong connection with their general practitioner.

Dr Fielke said this was difficult for people living in regional areas that did not have ongoing GP services or communities that had a high turnover of GPs working in the community.

He said this caused people to be less trusting of diagnosis and treatment, including medication.

“General practice is changing and a GP that [would have treated you from] cradle to grave … is becoming less and less common,” he said.

“If you can’t see a regular GP, or you’re seeing a locum, then you’re seeing someone who doesn’t know you so well and that does make it more difficult to get the mental health care that you might require.”

NRHA chief executive Mark Diamond said the impact of rural GP shortages on patient care was a major concern.

“The research that we have done in relation to access to health care indicates that around 20 per cent of a person’s health outcome is impacted by a timely, appropriate and affordable access to care,” he said.

“The health outcomes that country people experience are poorer than their metropolitan counterparts and most of that is attributable to this issue of access to timely, appropriate and affordable care.”

Can pill frustration and pill shame be beaten?

Treating mental illness with medication is not the first preference for many and is often an emotionally and physically draining journey.

Ms Edwards, who had strong support from her family during treatment, said she had to persevere and continue to follow up with medical professionals and encouraged others to do the same.

“I can see why people give up on medication because it can be a really hard journey to have to go back and say, ‘This isn’t working’, or ‘I actually feel worse’,” she said.

“Even in the city we had to work really hard to try and find somebody who I could connect with on an ongoing basis.

“After a period I got better, but that was after quite a lot of experimentation to get the right medication and then the right level.”

This piece by Laura Collins was originally published on ‘ABC News‘ 4 February 2019.

When Melbourne veterinarian Dr Nicola* told her boss she was struggling in the face of an unrelenting caseload, she said her concerns weren’t taken seriously.

Dr Nicola said overtime was frequent and expected.

The constant pressure to bill clients resulted in rushed consults and every shift became a race against the clock.

Going to work quickly became associated with feelings of dread.

“I think deep down, in the back of my mind, I knew that this workplace wasn’t working for me,” Dr Nicola said.

“It was knowing that I would be stepping into chaos.”

“That I would be stepping into an overwhelming situation. It was a feeling of defeat.”

“The working style was wearing me down…we did have a few meetings but essentially they weren’t going to be able to meet too many of my needs.”

A psychologist suggested she was experiencing burnout. And it was impacting all other aspects of her life.

“I couldn’t find joy in the things that normally [I] would have. I spend a lot of time dancing. I didn’t want to dance anymore. I am owned by two cats. I couldn’t bring myself to care for them,” she explained.

“It was an overwhelming feeling of lack of control, but absolutely at the same time this feeling of numbness.”

What is burnout?

Sufferers of burnout describe feelings of continual fatigue, reduced empathy and disconnection from activities that would otherwise bring them meaning or purpose.

It’s different to experiencing bouts of stress, according to psychiatrist Professor Gordon Parker AO, founder of the Black Dog Institute.

“Stress is when you’re in that fight or flight mode,” Professor Parker said.

“Your adrenaline is pouring out and you’re fired up and you’re doing things and you’re on the go.

“Burnout is when that fire is no longer present… your eyes are looking a bit blank and your mind is a little bit blank and you’re not performing as well as you should be.”

“The true state of burnout would be where the individual is exhausted week in week out…it’s unrelenting and unremitting.”

Whilst the phenomenon is thought to be on the rise in modern workplaces, it was first documented by disaffected fourth-century Christian monks who described being stifled by feelings of ‘grey’.

They called the experience, ‘acedia’, which translates to ‘not-caring’ in Greek.

“You do feel exhausted across the day, across the week…those blue skies don’t seem to press your buttons like they used to,” Professor Parker said.

“People with burnout are more just feeling a state of drifting along and not experiencing any great pleasure and that’s a very disquieting state.”

Isn’t this depression?

Although burnout shares traits with depression, such as social withdrawal and decreased performance, how the conditions are related is not well understood.

Recognising the signs of burnout

• Emotional exhaustion—harder to bounce back from challenges, trouble sleeping
• Not taking much pleasure in life
• Lacking empathy or disconnection from others
• Reduced concentration span—skimming articles, flicking through channels
• Diminished work performance
  
  Source: Professor Gordon Parker from The Black Dog Institute

But self-esteem could be critical in determining the difference.

“What is central in my view to defining depression is a drop in one’s self-esteem and self-worth,” Professor Parker said.

“For people with burnout, many will describe that their self-esteem is impacted to some degree, but it’s not central to the construct.

“There, I think, lies the difference, that is self-esteem drop is central to depression but it’s not central to burnout.”

Professor Parker is leading an Australian-first study into burnout, with hopes of developing a diagnostic tool to measure and treat the condition.

Demanding workplaces and perfectionism create a toxic recipe

Beware workplaces where stress is worn as a badge of honour.

Burnout can be triggered by continual exposure to stress and a high-pressure work environment, along with other factors such as lack of resources and support, Professor Parker explained.

This combination, along with a perfectionist personality style, can create a toxic situation for burnout to emerge.

“Most people in our research that experience burnout are reliable, conscientious, perfectionistic people…where work is extremely important to their self-identity and who they are as human beings,” Professor Parker said.

“For many that reaches the level of workaholism — they take pride in their work.”

“I suspect that people who have a personality style where they just say no ‘worries mate, she’ll be right’…I don’t think they experience burnout.”

Is taking a holiday the antidote to burnout?

Unfortunately, the cure for burnout is not as simple as taking a holiday, explained Professor Parker.

“If you’re really burnt out you won’t be able to lie on a beach with ease….you’ll be thinking about what’s going on at work,” he said.

“I suspect it’s a bit of horses for courses scenario where for some people doing something like exercise distraction is going to be the most helpful [treatment] and for other people it’s going to be the relaxation strategies of mindfulness, meditation yoga and so on.”

“And then in some workplaces there may be activities that can be introduced that the working hours can be changed.”

Veterinarian Dr Nicola was prepared to walk away from her profession until she found a workplace that would accommodate her new workplace boundaries, such as reduced hours and longer client consults.

“I was open with my new boss about where I was at burnout wise,” she said.

“I was lucky to come across someone who had an appreciation for taking care of one’s mental health.”

*Name has been changed

This piece by Karla Arnall was originally published on ‘ABC News‘, 7 March 2019.

Everyone has bad days at work, but there are signs that employees need to watch out for before a bad week at the office turns into never-ending, debilitating work stress that is ruining your health.  

Too many Americans are trapped in toxic jobs, a problem employers and employees need to take more seriously. Jeffrey Pfeffer, an organizational behavior professor at Stanford who wrote the book Dying for a Paycheck, found through his research that poor management in U.S. companies accounted for up to 8 percent of annual health costs and was associated with 120,000 excess deaths every year.

Your body may know before you fully do that your job is to blame for your stress symptoms, sending you red alerts that you are not okay. 

You can’t sleep

“A lot of times the first thing we’ll hear about is sleepless nights,” said Maryland-based clinical psychologist Monique Reynolds of the Center for Anxiety and Behavior Change. “People report either not being able to sleep because their mind is racing or not being able to stay asleep. They wake up in the middle of the night thinking about their to-do list.”

A few restless nights is not a huge deal, but if it becomes a pattern, that may be a sign your job stress has become toxic.

“If it’s consistently related to work, that is a sign that something is off-balance,” Reynolds said. 

You get headaches 

Your muscles tense up to guard your body from injury. When you see the workplace as a danger zone, it keeps your muscles wound tight, according to the American Psychological Association. Chronic tension in the neck, shoulders and head can be associated with migraines and tension headaches.

“Stress creates physiological symptoms, and that manifests as pain,” said Reynolds.

Your muscles in general ache  

When your job is toxic, it can feel like you’re fighting off a wild tiger at your desk. Under a perceived threat, your brains flood your system with adrenaline and other stress hormones.

“Our nervous systems in toxic jobs are constantly on edge,” Reynolds said. “We are constantly anticipating, ready to react to an unpleasant boss or co-worker.”  

If you are always typing “just following up” emails with your shoulders hunched and your jaw clenched, this could be a sign that your job is impacting your health. 

Your mental health gets worse 

Reynolds noted that increased stress can exacerbate existing mental health issues. “Someone who might be a worrier in a really toxic work environment; that worry will often exacerbate to cross the clinical threshold,” she said.

If you feel like your boss is always out to get you, your mental health pays a price. One 2012 analysis of 279 studies linked perceptions of organizational unfairness with employee health complaints such as overeating and depression.

E. Kevin Kelloway, the Canada Research Chair in Occupational Health Psychology at St. Mary’s University, said that unfair treatment at work can cause us outsized stress.

“Injustice is a particularly toxic stressor because it strikes at the core of who we are,” he said. “When you treat me unfairly you attack my dignity as a person —essentially saying that I don’t deserve fair treatment or to be treated the same as others.”

You get sick more often

If you are catching colds constantly, consider how you are feeling about your job. A large body of research shows that chronic stress can compromise the immune system, making you more susceptible to illness.  

You lose interest in sex

How you spend your time reflects what you value. When you bring your work home with you, your relationships can suffer. The American Psychological Association notes that when women have to juggle professional stress on top of their ongoing personal and financial obligations, it can reduce sexual desire. For men, this chronic stress can result in lower testosterone production, which in turn leads to lower libido. 

“There has to be a certain amount of relaxation in order to allow the arousal feeling to arise,” Reynolds said. “Then there’s the time factor. People report not having enough time to have sex.”

You are tired all the time

This is fatigue, a bone-deep weariness that no nap or weekend lie-in seems to cure.

Kelloway noted that “there is no set way that individuals react to a toxic workplace,” but he said that fatigue is in the range of physical symptoms employees may feel. 

Toxic jobs can create a cycle that drains us, said Pfeffer. “You’re feeling overwhelmed, because you’re working too long, and you’re working too long because you’re feeling overwhelmed,” he said. 

Your stomach is acting up  

Indigestion, constipation, bloating can all be associated with stress, because stress impacts what the gut digests and can also change our gut bacteria, which in turn impacts our mood. 

It’s why you may get stomach pangs when you are upset, said Kelloway, who experienced this himself in one toxic job.

“About six months in I started to notice that every Sunday afternoon I developed a pain in my stomach. It was not the symptom but the timing (just as I was starting to think about what I had to do on Monday morning) that alerted me to the connection to the job,” he said. “All symptoms went away when I quit the job and moved on to something else.” 

Your appetite changes

Your appetite is closely linked to your brain. Under acute stress, your fight-or-flight response releases adrenaline, telling your body to suppress digestion to focus on saving us from a perceived danger, according to the Harvard Health Letter. Under long-term stress, though, your body’s adrenal glands release and build up cortisol, a hormone which can increase hunger. When your job is causing long-term emotional distress, you may turn to food for comfort.  

Harvard also reports that eating sugary foods may blunt stress-related responses and emotions, which is why they’re often seen as comfort foods ― but that’s an unhealthy habit you should avoid. 

What you can do to combat this 

Take breaks. After your body goes on high alert to defend you from unreasonable demands and bad bosses, you need to give it time off. 
“When we don’t give our nervous system an opportunity to relax and reset itself, it starts to cause long-term damage,” Reynolds explained. She said that companionship outside of the workplace, meditation and exercise can help to offset the stress symptoms.  

Reframe your negative thinking. One of the principles of cognitive behavioral therapy is that how you think can change how you feel. “It’s not possible for everyone to switch jobs, but we can focus on the situation that we can control,” Reynolds said. We can use mindfulness to manage our unhelpful rumination about how the presentation went or what our colleagues are thinking about us. 

Leave. See this as the warning that you need to get a new job or else. Pfeffer said that long hours, absence of autonomy, uncertain scheduling and economic insecurity at jobs are all factors that contribute to a toxic workplace environment that employees need to leave behind, not just cope with. “You need to fix the underlying problem, not deal with the symptoms,” he said.

This piece by Monica Torres was originally published on ‘HuffPost‘, 21 January 2019.

Sitting in a hospital waiting room for hours on end can be emotional and draining, but a Queensland woman has found a unique way to make the most of her time during her husband’s cancer treatment.

Ann Sharp knits colourful teddies to donate to her local doctor’s surgery.

She said the process of knitting the bears worked as mental therapy, easing her anxiety about her husband’s treatment, and was also a way to give back to the community.

“It makes me a lot calmer, if I’ve had a bit of a stressful day you just sit and knit away,” she said.

“Your mind isn’t on whatever’s happening around you.”

Over the past year, Ms Sharp has knitted more bears than she can count and donated them as part of the Mount Morgan Family Practice’s “Care and Share Bear Project”.

“If it makes somebody happy that’s the best part,” she said.

The Care and Share Bear Project

The project’s coordinator, local nurse Rebecca Rendall, said patients were offered the bears as support during their appointment and were free to take them home.

The project was initially launched as way to take away the anxiety and stress that sometimes came during a visit to the doctor.

“We wanted to do something that would make [patients] feel welcome,” she said.

“Teddy bears for most people is something they can associate with and often they see that as a comfort thing.

“The children would be passing through and they don’t know us.

“But they come in and, when we start talking to them with a bear, suddenly the ice is broken and the child comes to life.”

Knitting treatment for addiction, arthritis and mental illness

Ms Rendall said the project expanded to help adults with addiction, mental illness, and people with a disability.

She said patients were now offered the option of knitting as part of their treatment.

“People with smoking habits or people that have food addictions, if we could get them to knit a bear or crotchet a bear … that was like a diversional therapy,” she said.

“We have a family that has gone through quite a traumatic experience in the past.

“[Knitting] helped them become less anxious and probably more open to talking about their experiences.”

Psychologists have commended the Care and Share Bear initiative and say activities such as knitting can have profound benefits for people’s mental and physical health.

Associate Professor Talitha Best said, in this sense, knitting offered people in the community an opportunity to give back, while also promoting their own health and wellbeing.

“Using our hands generally activates a whole lot of different processes both from our emotional wellbeing and the actual function of our brain,” she said.

“It engages our brain in a focussed activity which by default helps us become a little bit more rested.

“That has a flow-on effect to reducing some of our stress and promoting stimulation in the brain related to that fine motor movement.”

This piece by Rachel McGhee and Jacquie Mackay was originally published on ‘ABC News‘, 6 March 2019.

Some of the biggest stars of the game, including Sydney’s Lance Franklin, premiership Bulldog Tom Boyd and most recently St Kilda’s Jack Steven are among those to have stepped away from the game to deal with mental health issues.

The group, known as the Industry Governance Committee, was set up by the players association as part of the $2.1 million the AFLPA spend on player development each year.

Brisbane Lions football boss David Noble, North Melbourne player Jamie MacMillan and leading player agent Tom Petroro, were part of the specially formed group that collected data from all 18 clubs to get a sense of how players viewed the treatment of mental health.

The independent review will see the AFL and clubs pour more money into player development and concentrate on the access that players have to individual support.

One of the other major outcomes from the review will see the league hire a head of mental health, who will oversee the programs of all 18 clubs and answer to football boss Steve Hocking.

But with the space still relatively new in the game, not all 18 clubs have full-time registered psychologists, which has seen several players go through the players’ association to seek professional help.

While the systems inside clubland will ultimately improve over time, AFLPA boss Paul Marsh maintained it was important that players had options. “Some players will want to access club support, some players may want to access support outside of the club network and it’s important we have an independent system,” Marsh told The Age at the AFLPA season launch.

“We are trying to address the environment around our footballers surrounding mental health.

“Time away from footy has been a real focus, players having meaningful time at the club and making sure they have balance away from footy, that’s utopia for us, that we are progressing those areas.

“It’s a proactive approach to mental health management.”

Steven, who remains interstate as he takes some time away from football, is still yet to be ruled out of the Saints’ opening round game against Gold Coast. He could return home as early as this week and is said to be doing well.

This piece by Sam McClure was originally published on ‘The Age‘, 5 March 2019.