Mention a victim of domestic violence and who do most people immediately imagine? Perhaps a disheveled young woman with bruises on her chin and a black eye, looking sad, frightened and forlorn. This is certainly one of the faces of domestic violence, but far from the only one.

One in every four women will experience at least one form of domestic violence in her lifetime. Over 85 percent of domestic violence victims are women, but men are victims as well. According to the National Coalition Against Domestic Violence:

1. One in six women and one in 33 men have experienced an attempted or completed sexual assault.
2. Less than 25 percent of all physical assaults, 20 percent of all sexual assaults and 50 percent of all stalkings by domestic partners are reported to the police.
3. Domestic violence is one of the most chronically under-reported crimes despite the fact that “Violence against a partner or a child is a crime in all 50 states,” according to the Centers for Disease Control and Prevention.

Defining domestic violence

Although physical violence is the most obvious and well known kind of domestic violence, there are many more that are more subtle, insidious and often hidden. Even within assault and battery, the category includes blows that inflict internal damage or bruising in “places that don’t show.” Other types of violence include dominance, humiliation, isolation, threats, intimidation, denial and blame.

Abuses may be emotional, sexual, verbal, economic and social, as well as physical. The U.S. Office on Violence Against Women (OVW) defines domestic violence as a “pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner.”  The definition states that domestic violence “can happen to anyone regardless of race, age, sexual orientation, religion or gender.”

Cycle of abuse

Victims of domestic violence usually experience the “cycle of abuse,” which creates a confusing situation for the victim and leaves them open to further abuse. After the abuse occurs, the abuser may feel guilty, make excuses and resume “normal” behavior, often called the “honeymoon” phase. The abuser may then start building resentment against the victim, thinking of how to “get even,” after which the abuser may create another opportunity to justify abusing their victim, starting the cycle over again.

Adding mental illness and substance abuse to the mix

Domestic abuse is often accompanied by substance abuse and/or mental illness in the part of the abuser. Sometimes the victim turns to self-medicating to cope with the stress and the pain. Mental health professionals often find patients come for treatment for depression, anxiety or even suicidal ideations only to find that these patients are experiencing mental distress at least in part because of an abusive situation in their life.

It is imperative that clinical professionals, both medical and psychiatric, be aware of the danger signs and symptoms of domestic violence in order to help identify those dealing with it or at risk for it. They have an obligation to provide proper interventions.

However, everyone should be aware of signs of domestic abuse, and if you suspect that someone you know is being abused, speak up. If you’re hesitating—telling yourself that it’s none of your business, you might be wrong or the person might not want to talk about it—keep in mind that expressing your concern will let the person know that you care and may even save his or her life.

Silence hides violence. Speak up.

These days “friend me” has become an action, indicating someone wanting to establish contact on Facebook. What started as a purely social networking site has expanded into a medium for change, but nothing so important as the Facebook service designed last year to help prevent suicide.

When on Facebook, users can provide support and help to friends when they identify comments that appear to indicate thoughts of self-harm or suicide. If someone has concerns for a friend, they can use either the Report Suicidal Content link or other report links throughout the site.

The person who posted the suicidal comment will receive an email from Facebook encouraging them to call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Alternately, the person can click on a link to begin a confidential online “chat” with a crisis worker.

The Lifeline is a toll-free hotline that has 152 local crisis centers across the country and is funded by the Substance Abuse and Mental Health Services Administration. The hotline is answered 24/7 and has answered over 3 million calls since it started in 2005.

The Surgeon General of the United States, Regina Benjamin, MD, MBA, serves on the National Action Alliance for Suicide Prevention. On the Surgeon General’s website, she points out,

“Nearly 100 Americans die by suicide every day, which is 36,035 per year…. These deaths are even more tragic because they are preventable.”

“Identifying those at risk is the cornerstone to suicide prevention,” says Kelly Posner, director of the Center for Suicide Risk Assessment at Columbia University/New York State Psychiatric Institute.  “Facebook’s innovative services enable concerned users, or ‘friends,’ to intervene immediately and initiate this life-saving identification process. Reaching people through venues they use and providing them with referrals is an important and encouraging step in the right direction.”

The military is keenly aware of the problem of suicides. According to Veterans Affairs Secretary Eric K. Shinseki, a retired Army general, former Army Chief of Staff, and a combat-wounded Vietnam veteran, “Suicide is the second-highest cause of death for young people ages 25 to 34.”

It is a problem the military has seen acutely in the last 10 years, and the Veterans Administration has also focused this month on prevention of suicides. Since many armed services personnel keep in touch with family and friends by using Facebook, this service can help identify and refer active-duty military when a concern is raised, saving Americans even far away from home.

For those who want information on how to help identify someone at risk for suicide, I recommend the American Foundation for Suicide Prevention. The site offers clear guidelines about psychiatric disorders, warning signs of imminent danger and some concrete things to do to help.

Once a concern is raised, a referral to a crisis intervention hotline or other professional treatment is needed to prevent the senseless loss of life to suicide. What better act of friendship could there be?

May is Mental Health Awareness Month.

The Menninger Clinic family of staff and patients recently experienced one of life’s stressful events: moving.

Even though we all love our wonderful new facility, the process of preparing for the move, making the move and settling in have created stress that is challenging for us all. During Mental Health Awareness Month, one of the areas of focus for the month is stress and how it affects health.

When under pressure, we all experience similar feelings, such as fatigue, irritability and a decreased ability to cope. We may experience headaches, stomachaches or other physical manifestations of tension. However, there is a difference between common stress and abnormal stress. With common stress, the symptoms are temporary, and emotional and physical equilibrium are re-established once the stressful stimulus is over or has significantly lessened. When the symptoms of reaction to stress persist and compromise functioning, it can indicate mental illness.

Sometimes a simple change such as deep breathing, taking a walk, talking with a friend or having a cup of tea can help relieve some of the feelings generated as a reaction to stress. As clinicians, we need to appreciate that we may experience the effects of the strains of everyday life and that simple techniques may be adequate to help us get through periods of difficulty.

Yet our patients come to us with emotional challenges that make them more susceptible to the negative symptoms of the pressures they face, and their response to stressors may evoke maladaptive behaviors. It is our task to do more than provide support and care to help them get through short-term stresses like moving. We must teach coping skills that will help them not only survive stress but prevail over its often deleterious and pervasive effects on their lives and their health.

We have all known someone who is struggling with or has suffered from an eating disorder.

 Some are dealing primarily with anorexia, restricting their intake of food and fluids to the point that basic body functions are threatened, even life itself. Others find themselves driven to bulimia, bingeing on foods to excess only to purge them from their bodies by vomiting, taking laxatives, over-exercising or a combination of these. This puts their bodies at risk for dangerous fluid and electrolyte imbalances that can trigger conditions including heart attack, liver damage, kidney failure and death. Other people overeat without purging and gain unhealthy amounts of weight, increasing their risk for hyperlipidemia, cardiovascular disease, hypertension, liver disease and diabetes.

The National Eating Disorders Awareness (NEDAwareness) Week is an effort by healthcare providers and others committed to raising awareness of the dangers surrounding eating disorders and the need for early intervention and treatment. This year’s theme is “Everybody Knows Somebody” because awareness of eating disorders is crucial to recognizing the illness so that it can be treated as early as possible and treated properly.

Eating disorders contribute to altered mental states, which puts patients at increased risk for suicidality, depression, psychotic episodes, OCD and other kinds of self-harm such as cutting or burning themselves and substance abuse. The social stigma about body image compounds the stigma around mental illness.

There are so many misconceptions about eating disorders. Some people attribute these eating-disordered behaviors to vanity or social acceptance. Others think it is a personality problem in which the patient is trying to exhibit “control” over their lives or others through their illness. The real etiology usually lies in deeply felt damage from trauma at an early developmental stage, undermining the most basic of Maslow’s needs for sustenance and survival.

The good news is that increased awareness can help get those suffering from eating disorders into appropriate treatment, which to be successful requires a team approach of psychiatric, medical and nutritional care. Eating disorders are serious, life-threatening illnesses, and it is important to recognize the pressures, attitudes and behaviors that shape them.

'Tis the season

This time of year creates different reactions in people. Most of us are blessed to have family and friends with whom to share the holidays, and are able to celebrate all the things for which we are thankful. It is a joyful time: We travel to be with people we miss and share traditions of food, song, decorations, lights, games and warm interactions. To most of us, it is a festival for the senses and a time we look forward to every year.

Unfortunately, not all people will feel that way. Some are alone, depressed, fearful and in need. For them, the holidays bring thoughts of what their lives lack, which can make their emotional distress worse. Travel challenges can trigger panic disorders and destabilize bipolar disorders. Eating disorders can be triggered by holiday foods and the pressure to indulge in them. Alcohol is free-flowing in some settings, and those challenged with addiction have additional pressure with which to contend. People may feel forced to be with individuals they may avoid the rest of the year, and old issues can arise, increasing the stress. Expectations run high, and disillusionment fuels conflicts. Even under the best of circumstances, the holidays are stressful, and stress can precipitate underlying depression and anxiety.

Some surveys indicate that not only do many people suffer from depression during the holidays, some experience distress to the extent that they cannot partake in the season’s activities at all, increasing their sense of isolation and exacerbating existing mental illness. At worst, the depression is severe enough to generate feelings of hopelessness and thoughts of suicide.

The positive news is that support from loved ones and treatment by mental healthcare professionals can help individuals cope with depression, anxiety and other mental illnesses, both during the holidays and when the regular routine resumes.

As you count your blessings this holiday season, consider giving to non-profit organizations that support those with mental health issues in gratitude for the health your family enjoys or maybe the help these organizations provide for someone you care about. 

Have a safe, happy and blessed holiday season!

Editor’s note: Many wonderful non-profits treat individuals with mental illness, do research into the nature of mental illlness and help families cope with the effects of mental illness. These organizations work at the national, regional and local levels to alleviate suffering and offer hope. Many, including The Menninger Clinic and The Gathering Place, Menninger’s psychosocial clubhouse, send out year-end appeals. Others, including the National Alliance on Mental Illness and Mental Health America, urge their web visitors to support their work. To find other mental health non-profits in need of your support this holiday season, a quick Google search will lead you to them. 

To all who struggle with addiction or substance abuse:

As a psychiatric nurse, I deal every day with people who are trying to cope with anxiety, depression, OCD, PTSD, schizophrenia or other mental illnesses. Many of them have been trying to cope with the distress of their illnesses by self-medicating. Some abuse prescription medications such as anxiolytics or pain meds, while others use marijuana and tell themselves it’s “not really a drug.” Some drink excessive alcohol, and others take anything they can from LSD to mushrooms to crack cocaine to meth.

The one characteristic all these people have is that they come to treatment in pain. And just being in treatment doesn’t mean they are hopeful about being there. A large part of the staff’s job is to help the patients find that hope. Without it, nothing else progresses because the work in overcoming illness and addiction is hard.

If someone arrives still under the influence of drugs/alcohol, they have to go through detoxification. We use medications to try to ease them through that process, but it is still not an easy one. However, almost always after detoxing, the patient is much better able to consider other things on which to focus and to stay focused on those things that form the steps of recovery.

During treatment, other means of coping with stress need to be found for each patient, along with better habits of responding in new, less destructive ways. The lucky ones find the right person with whom to explore, process and resolve their underlying issues, particularly trauma. Without that process, relapse is all too common.

I admire anyone who makes that first step and starts some kind of treatment. I use the analogy that everyone has a little red wagon, and we pull it around, carrying our emotional baggage. In treatment, we try to help the patient unpack some of that baggage, put it in the right storage or maybe even discard some of it, making the wagon a little lighter to pull.

Treatment is available, but you may have to look for it. Some people are fortunate enough to be able to afford wonderful private facilities. Others have to hope they are lucky enough to find good care in a public system. Keep looking. Ask for guidance, but seek help if you are dealing with addiction or any mental illness. I have seen life-changing results from getting the right care.

Best wishes in your recovery.

Dee G. Henderson, MSN, RN-BC

Editor’s note: Dee wrote this blog post in honor of National Recovery Month.