Mental Health, Naturally

The Family Guide to Holistic Care for a Healthy Mind and Body

By Kathi J. Kemper

American Academy of Pediatrics

Copyright © 2010 Kathi J. Kemper, MD, MPH, FAAP
All rights reserved.
ISBN: 978-1-58110-310-6

Contents

Also available from the American Academy of Pediatrics,
Title Page,
American Academy of Pediatrics Department of Marketing and Publications,
Copyright Page,
What People Are Saying,
Dedication,
Acknowledgments,
Part 1 – INTRODUCTION: CHALLENGES AND GOALS,
How to Use This Book,
1 – ARE MENTAL HEALTH PROBLEMS REALLY A PROBLEM?,
2 – WHAT IS MENTAL HEALTH?,
Part 2 – FUNDAMENTAL STRATEGIES,
3 – EXERCISE,
4 – RESTFUL SLEEP,
5 – NUTRITION,
DIETARY SUPPLEMENTS: OVERVIEW,
6 – DIETARY SUPPLEMENTS: VITAMINS,
7 – DIETARY SUPPLEMENTS: MINERALS,
8 – DIETARY SUPPLEMENTS: ESSENTIAL FATTY ACIDS,
9 – DIETARY SUPPLEMENTS: AMINO ACIDS,
10 – DIETARY SUPPLEMENTS: HORMONES,
11 – DIETARY SUPPLEMENTS: PROBIOTICS,
12 – POSITIVE ENVIRONMENTAL FACTORS,
13 – PROTECTING AGAINST NEGATIVE ENVIRONMENTAL ASPECTS,
MANAGING STRESS: OVERVIEW,
14 – MANAGING STRESS: EMOTIONAL PRACTICES,
15 – MANAGING STRESS: MENTAL PRACTICES,
16 – MANAGING STRESS: SPIRITUAL PRACTICES,
COMMUNICATION SKILLS AND COMMUNITY BUILDING TO PROMOTE MENTAL HEALTH: OVERVIEW,
17 – COMMUNICATION SKILLS: BEING A FRIEND TO YOURSELF,
18 – COMMUNICATING WITH OTHERS,
19 – BUILDING COMMUNITY, SUPPORT, AND FELLOWSHIP,
Part 3 – BEYOND FUNDAMENTALS: ADDITIONAL HELP,
20 – HERBS,
21 – HOMEOPATHY AND BACH FLOWER REMEDIES,
22 – MASSAGE,
23 – ACUPUNCTURE,
24 – CHIROPRACTIC AND OSTEOPATHY,
25 – MAGNETS AND ELECTRICAL STIMULATION,
Part 4 – PUTTING IT ALL TOGETHER,
26 – ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: IMPROVING FOCUS AND ATTENTION,
27 – ANXIETY: IMPROVING A SENSE OF SECURITY, SERENITY, CALM, CONFIDENCE, AND COURAGE,
28 – DEFEATING DEPRESSION: BUILDING HOPE,
29 – ADVOCACY TO PROMOTE MENTAL HEALTH,
RESOURCES,
ACTION PLANS,
REFERENCES,

CHAPTER 1

ARE MENTAL HEALTH PROBLEMS REALLY A PROBLEM?

* * *

Yes! Mental health problems are among the most common, serious, and deadly human health problems faced worldwide. Mental health problems rank up at the top along with heart disease, cancer, obesity, AIDS, and injuries as leading causes of suffering. In one way or another, mental health problems are associated with all of these killers. Mental health, on the other hand, is key to happiness, productivity, and global harmony.

If you or someone you love has a mental health challenge, you are not alone. You are right to be concerned; these problems are serious. And there are dozens of things you can do to promote mental health in you, your family, and your community.

Before we get started on specific options and plans, let’s review some of the scientific studies that address how common mental health challenges are.

You Are Not Alone

Mental health challenges are very common. The US National Institutes of Mental Health (NIMH) estimates that more than 25% of adults (55 million Americans) have a diagnosable mental disorder. About 40 million have an anxiety disorder, 21 million a mood disorder, 9 million an attention-deficit /hyperactivity disorder (ADHD), 6 million a panic disorder, and millions more another problem such as Alzheimer disease or schizophrenia. That doesn’t include the millions who are stressed out and struggling but don’t fit a specific psychiatric diagnosis. The American Academy of Pediatrics reports that more than 14 million children and adolescents in the United States (about 1 in 5 children) have a mental health problem that interferes with their ability to function on a day-to-day basis.

Mental disorders are the leading cause of disability in the United States and Canada for people in the prime of life. A major study conducted by the World Health Organization, the World Bank, and Harvard University concluded that mental illness accounts for a major portion of the burden of disease in the United States and other developed countries. Worldwide, mental illness causes a greater disease burden than cancer.

Silent Suffering

Much of the burden of mental illness has been silent or undetected. One of the reasons mental health problems are not detected is that they appear as fatigue, sleep problems, or chronic pain, so we focus on physical rather than mental or emotional stress. Another reason for this silent suffering is the stigma historically associated with mental health problems; they have been considered moral failures, character flaws, or a sign of a religious or spiritual deficit. Being cast in this light has made a lot of people reluctant to admit they have a problem, and has led to a lot of ineffective approaches to preventing and managing problems. Only by recognizing mental health as equally valid and important with positive parallels to physical well-being can we begin to address the unmet needs.

Unmet Needs

Although mental health challenges are common and cause significant suffering, needs for care are often unmet. Even in affluent countries, between one third and half of people with serious problems do not receive adequate care or follow-up. Effective care does not need to be expensive or high tech. Many interventions can be made within families and at a community level by peers, schools, businesses, or primary care clinicians and do not require expensive specialists. Some of the most helpful approaches to improving mental and physical health, such as exercise and sunshine, are free.

Onset, Youth: Effect, Lifelong

Most mental health problems appear for the first time in childhood or adolescence. Prevention and early recognition can improve lifelong educational achievements and career prospects; reduce the likelihood of violence, early pregnancy, and criminal behavior; optimize parenting for the next generation; and improve the likelihood of long-term physical health and well-being. Investing in early promotion of mental health has a very long and rich return on investment.

Risks: Family, Behavior, Environment

Mental health problems come from a combination of family (genetics), behaviors, and environment. For example, children whose parents are depressed have a high risk of developing behavioral and mental health problems, injuries, and other health problems requiring expensive medical care. However, even in people who have been dealt a bad hand genetically, attention to healthy habits (eg, activity, sleep, nutrition, stress management) and a healthy environment (physical factors and social relationships) can modify gene expression and support overall health, including mental health.

Chronic Conditions

Mental health challenges such as anxiety, depression, and excessive distractibility and impulsivity are chronic conditions. Symptoms may wax and wane, but the underlying problems often reoccur, particularly when people are stressed. Most conditions cannot be officially diagnosed until symptoms have been present and had a significant effect on life activities for several months. This means that treatments, strategies, interventions, and practices need to become part of an overall approach to a healthy lifestyle rather than expecting a one-time pill or 2-week course of therapy alone to “fix” the problem. The fact that mental health challenges are chronic and often undetected emphasize the need for everyone to adopt healthy lifestyles to prevent problems and promote mental and physical health.

Breaking Down the Numbers

Although serious problems such as autism, schizophrenia, and suicide have gotten the most press, other mental health problems such as anxiety, depression, and distractibility/impulsivity (ADHD) are actually more common. Figure 1-1 shows how common different mental health problems are in US children.

The “Youth Risk Behavior Survey — United States, 2007” reported an alarming percentage of problems among US high school students (ninth–12th grade):

• Sixty-nine percent sleep fewer than 8 hours on typical school nights.

• Twenty-eight percent reported feeling sad or hopeless for at least 2 weeks in the past year, so badly that their emotions interfered with daily activities; about half of these students had seriously considered suicide.

• Twenty-six percent reported binge drinking (5 or more alcoholic drinks on one occasion); 45% of students had consumed alcohol in the past 30 days.

• Seven percent reported having attempted suicide.

Unlike growing pains and pimples, most mental health problems are not outgrown. The burden of poor mental health among adults is truly staggering. In the United States, the lifetime prevalence of diagnosable anxiety disorders is approximately 29%, while 21% of adults have had serious depression. Throw in the 15% who report having had a substance abuse problem (not including tobacco), and the overall rate is about 46% (there is some overlap). The proportion of US adults with mental health challenges per year is shown inFigure 1-2.

Let’s look a little more closely at some of the biggest challenges — attention deficits, anxiety, depression, and stress. Many families who have one type of mental health challenge also have others, and those with physical health problems also tend to have more mental health challenges. Let’s look at them one at a time.

Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder is characterized by impulsivity and distractibility. Like Scott, whose story began on page 3, an increasing number of people are distractible or impulsive. About 10% of 10-year-old US boys have received prescriptions for medications to treat ADHD. More boys than girls are diagnosed with ADHD. In girls, inattention is more common than hyperactivity, so their problems may go unnoticed. Attention-deficit/hyperactivity disorder is a problem for adults, too; between 4% and 5% of adults meet formal diagnostic criteria for ADHD, and adults are the fastest growing market for ADHD medications. Self-medication with tobacco, alcohol, and illicit drugs is also common. Impulsively trying such substances to fit in is common among teenagers, but experimentation easily leads to addiction with terrible, even deadly consequences.

Prescription medications are popular medical treatments for ADHD. The use of prescription stimulant medications quadrupled between 1987 and 1996. Of the top 5 prescription drugs for children in the United States (based on spending), 3 are for ADHD, 1 is for asthma, and the other is for allergies. Medications help improve symptoms for about 65% of patients. The other 35% are not helped by medications but may well benefit from healthier habits; a supportive, structured family life; and less stressed, more supportive communities.

Unlike taking penicillin for strep throat, medications for ADHD don’t lead to a cure in 10 days; they only work when they are taken. Many people do not want to take medications every day for the rest of their lives, especially if the drugs have side effects. Side effects plague 30% to 50% of patients who take prescription drugs for ADHD. Some of these side effects are medically serious (ie, death, heart attacks, liver failure), and some turn kids into such zombies that parents would rather have them bouncing off the wall than zoned out. The US Food and Drug Administration (FDA) has recommended serious warnings on commonly used ADHD medications.

Fortunately, there are safe, natural strategies to help achieve better focus, internal discipline, patience, and attention.

Anxiety

Like Don, 18% (nearly 1 in 5) of adults are afflicted with a diagnosable anxiety disorder (Figure 1-3).

Between 4% and 7% have a general anxiety disorder, 4% have posttraumatic stress disorder (PTSD), 2% to 8% have specific phobias, 1% to 2% have obsessive-compulsive disorder, 1% to 2% have panic attacks, and 8% have mixed anxiety and depression. Anxiety is emotional and physical. It includes feelings of being threatened, restlessness, and irritability; sleep problems; tension; dry mouth; heart palpitations; and sweating. The rate of diagnosable anxiety disorder has risen in the past few decades.

One form of anxiety, PTSD, is often triggered by natural disasters, among other serious threats. With global climate change, the number of natural disasters is increasing; 157 million people were affected by natural disasters in 2005, reflecting a fourfold increase in the number of disasters since 1975. These experiences can trigger PTSD in children as well as adolescents and adults. According to the National Child Traumatic Stress Network, about 25% of youth undergo a traumatic event such as physical or sexual abuse, assault, trauma, a car crash, a painful medical procedure, disasters (eg, floods, hurricanes, wars, volcanoes, tornadoes, terrorist attacks, tidal waves, drought, famine), or witnessing violence at home or in the neighborhood.

About 4% to 10% of US children and adolescents have a diagnosable anxiety disorder. In early childhood, anxiety can occur as separation anxiety or school phobia; in older teens, it can take the form of social anxiety disorder (extreme, disabling shyness).

Untreated, the long-term consequences of anxiety include depression, chronic headaches, pain, and sleep problems, and it can interfere with school and job performance and impair social relationships. Anxiety can also affect those with ADHD or depression. Common but unskillful self-treatment for anxiety sometimes includes overeating, alcohol, tobacco, or drugs, leading to obesity or addiction. Medical therapies and psychotherapy are helpful for about 60% to 70% of patients with anxiety disorders. Difficulties with access, side effects, and stigmatization have limited their use. There are natural therapies and lifestyle choices that are safe and effective in preventing and managing anxiety. Healthy strategies can promote a sense of calm, secure confidence in you, your loved ones, and your community.

Depression

Depression is common, and rates have increased dramatically over the past 50 years. The US NIMH estimates that depression is now the leading cause of disability in the United States. The World Health Organization reports that depression is the second leading contributor to the global burden of disease for persons 15 to 44 years of age. Depression causes as much suffering and disability as heart disease or diabetes. Each year, nearly 10% of adults experience some kind of depression (see box below); by the time they are 40 years old, nearly 20% of Americans have experienced an episode of major depression (Figure 1-4). Fewer than 20% of these people receive what is considered adequate medical treatment for their suffering.

At any one time in a typical US high school of 4,000 kids, more than 200 are experiencing severe depression. This is not just the short-term heartache of not making the varsity team or breaking up with a boyfriend; this is serious, diagnosable depression, affecting grades, social activities, and long-term health. Depression is a major risk factor for suicide. The majority of depressed teens do not get professional mental health treatment. Because depression is a chronic, recurrent disorder, many of these teens grow up to be depressed adults, barely able to function at work or in the community. Failure to prevent, recognize, and treat depression represents a huge cost to society in terms of lost human resources.

In addition to those who have had diagnosable depression, many more experience subtle mood problems that can still sap energy and impair performance. Individual mood problems limit productivity in the workplace and the creative, problem-solving energy needed in our communities.

Many people with depression also have other chronic illnesses. About 1 in 5 people with a physical disease such as angina, arthritis, asthma, or diabetes also have depression. People with depression along with another illness have much worse overall health than those who struggle with just one problem. For example, patients who have asthma and either depression or anxiety tend to have a greater burden of asthma symptoms than those who have asthma alone. Part of the reason for this increased disease burden is that upset people tend to smoke more than others, and smoking makes many diseases, including asthma, much worse. It’s also because emotional distress affects immune function and muscle tension — and both contribute to asthma symptoms.

Causes

Depression is typically recurrent and often runs in families. This is partly because of genetics and partly because of the influence of being around others who are depressed. Healthy family members of patients with a mood disorder have significantly lower levels of high-density lipoprotein (good) cholesterol, higher levels of inflammation-causing fatty acids, and different levels of the hormone prolactin and the neurotransmitter serotonin than those in other families. This means that biochemical differences that run in families can predispose people to develop depressed mood. However, genetic dispositions are not death sentences; optimal habits and healthy habitats are especially important for those facing genetic challenges to maintaining positive moods.

Duration

Without treatment, bouts of serious depression typically last about 8 months. Medications can help reduce symptoms in adults and older teens with severe depression; however, most are not very effective for mild or moderate depression or for children. Because of FDA warnings about the increased risk of suicide, withdrawal symptoms, and other side effects with medications, many people are reluctant to use them. This has led millions of individuals and families to look for safe approaches to alleviating depression.

As with ADHD and anxiety, programs and therapies that promote healthy lifestyles and positive coping strategies have proven effective in preventing depression, even in those at very high risk for developing severe symptoms (eg, children of depressed parents).

Stress

There is no such thing as a stress-free life. If someone doesn’t experience stress, that person is probably in denial or dead! Stress can come from physical factors (eg, being hungry, too hot, too cold, too tired), emotional events (eg, a death in the family, loss of a serious relationship, threats of loss), or mental factors (eg, time pressure, changing routines, excessive workload). Stress is distracting and makes it difficult to concentrate, focus, and patiently pursue long-term goals. Stress triggers symptoms of anxiety and depression. Stress can cause headaches and butterflies in the stomach, trigger heart attacks, and impair the immune system, leaving us more vulnerable to infections and less able to fight cancer. In today’s world, everyone needs effective stress management skills.

(Continues…)Excerpted from Mental Health, Naturally by Kathi J. Kemper. Copyright © 2010 Kathi J. Kemper, MD, MPH, FAAP. Excerpted by permission of American Academy of Pediatrics.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.