"Call Me Crazy": Lifetime's New Movie That Champions Hope and Resilience Around Mental Illness

*Warning: it was difficult to write this post without including a few small spoilers, but I hope you'll watch the whole film anyway.

On Saturday April 20th, Lifetime debuted "Call Me Crazy: A Five Film".  The film (which boasts a star-studded cast and director list) includes five short stories that examine the impact of mental illness from various perspectives.  Each story is named after the main character: "Lucy", "Grace", "Allison", "Eddie", and "Maggie".

In the first story, we are introduced to Lucy (played by Brittany Snow).  Lucy, a law student, has recently been admitted to a psychiatric institution after experiencing a schizophrenic episode.  She is struggling to see how she can live a "normal" life that includes relationships and a career.  Her clinician encourages her to finish law school because she has insight into something very few people understand (mental illness)- so who knows how many people she could help?

In "Grace", we meet a daughter who has been living with a bipolar mother for her entire life.  Grace is played beautifully by Sarah Hyland from "Modern Family"- I loved seeing her in a dramatic role.  We see the "highs" and "lows" of her mother's condition.  We also see the devastating impact that it has on Grace's life when it is not treated.  Grace often plays the role of caretaker- making sure her mother is safe.  We see her struggle to have her own life aside from her mother's illness.

"Allison" offers the viewers a twist.  She plays Lucy's younger sister.  So we step back from Lucy's view and we see how mental illness has affected her entire family.  Allison's childhood, her sense of safety, her relationship with her parents- were all changed as a result of her sister's illness.  She has bottled up a lot of anger and finds it difficult to support her sister through her recovery.

"Eddie" introduces the only male main character.  He is suffering from severe depression.  He has withdrawn from his wife and his friends.  He has stopped receiving help from his therapist.  We watch his wife intervene after discovering that he may be thinking about suicide.

Finally, "Maggie" introduces topics that (unfortunately) are all too common these days- post traumatic stress disorder (PTSD) and military sexual trauma among our returning veterans.  Maggie (played by Jennifer Hudson) was victimized during her time in the Army and its lasting impacts are threatening her ability to have a healthy relationship with her family.  Here we get another update on Lucy- she is now a lawyer and is representing Maggie in court.

While each story stands on its own, Lucy's story is woven throughout "Allison" and "Maggie" as well.  I really liked this strategy.  Not only because I became invested in her character during the first story...but also because seeing her evolve over time helped to demonstrate some key themes from this film- hope and resilience.

As Lucy says to Maggie: "I am living proof". [Of what?] "That there is hope".  In court, Lucy reminds Maggie's judge that having mental illness does not mean that you are a bad person or a bad mother.  She also reminds him about the importance of social support, "it is nearly impossible to get well alone".  Even though we see all of these characters at their lowest point- there is still hope that they can feel better, have strong relationships, and contribute positively to the world.

It seems fitting that Brittany Snow's character delivers these messages about hope and resilience, as she is a strong advocate for them in real life.  Together with the Jed Foundation and MTV, she founded Love is Louder.  Love is Louder is an inclusive movement that amplifies messages of love and support to combat negative messages resulting from bullying, loneliness, and stigma.  She has also publicly shared her own battles with anorexia, depression, and self harm.

As a health educator, I highly recommend this film as a resource for discussing mental illness, suicide, stigma, social support, and help-seeking.  Since each story is approximately 20 minutes, they can be broken down into segments or watched all together.  This film is a great example of Entertainment Education, which is an area of public health that acknowledges the strong impact that television and movies play in educating the public about health issues.

If you or someone you know is struggling with a mental illness, please reach out:
National Suicide Prevention Lifeline (1-800-273-8255)

"Girls" Tackles OCD: What I Hope IS NOT Happening In Our Emergency Departments

This afternoon I had the pleasure of having some downtime- so I used it to catch up on the three recent "Girls" episodes sitting on my DVR.  Having avoided spoilers, I was surprised and saddened to see Hannah (Lena Dunham) being consumed by Obsessive Compulsive Disorder (OCD).  We learn that she had a serious bout with the condition once before- in high school.  It was so serious that she sought professional help and medication at that time.  Flash forward to her post-college life and we see her plagued again...perhaps triggered by the stress of a recent break-up and a looming book deadline.

While there are several disturbing issues in the most recent episode "On All Fours" (you can see the comments in Alan Sepinwall's review for those details), I want to focus specifically on Hannah's trip to the local emergency department (ED).

I was very upset watching this scene and I'll tell you why:

We know that emergency room providers are key gatekeepers for those who are suicidal and/or suffering from mental illness.  Research tells us that 1 in 10 suicides are by people seen in an emergency department within 2 months of dying.  Acknowledging the importance of this gatekeeper role, leadership organizations in suicide prevention have created a variety of toolkits and resources to educate and train emergency department personnel to identify patient warning signs and assess their risk.

In "On All Fours", Hannah visits the ED after obsessively sticking a Q-tip in her ear, getting it stuck, and experiencing pain.  After lying to her parents by saying she has "12-15 good friends" to accompany her to the ED, she goes alone.  The scene opens with the doctor telling her, "Well, you must be feeling pretty silly."

As the doctor examines her injured ear, Hannah says:

"I've just been having a little trouble with my mental state."
"I have a lot of anxiety and I didn't think stress was affecting me but it actually is."
"I'm not saying this was an accident, but I was just trying to clean myself out."

At no point does the doctor respond to any of these statements.  He is all business, telling her to follow-up with a specialist if she is still experiencing pain in a few days.  As Hannah lays down so he can put antibiotic drops in her ear, she pleads with him to look at her other ear.  He snaps at her "there is nothing wrong with the other one."  Hannah cries on the bed because it (the drops? her situation?) hurts so bad.

He discharges her and she walks home alone.  In just a t-shirt and no pants.

Now I'm not saying that Hannah was acutely suicidal or verbalized such a threat in the ED.  However, I am saying that she made several clear statements about her mental health that should have been treated with concern and respect by a competent medical provider.  Her demeanor and her appearance deserved a kind ear, a social worker's visit, someone to ask if she was all right.

These recent episodes have been applauded for their accurate portrayal of OCD.  I hope that a future episode will show a portrayal of a caring and skilled provider using the public health prevention and education tools that are available to assist someone in desperate need of help.

For any readers that may need help:

• The National Suicide Prevention Lifeline:  1800-273-TALK
• Substance Abuse & Mental Health Services Administration: (SAMHSA) Mental Health Treatment Finder

Tumblr Contemplates A New Policy Against Self-Harm Blogs: Let's All Weigh In

Tumblr is a popular microblogging platform.  It lets you share anything from text to pictures to video.  According to their website, the average Tumblr user creates 14 original posts each month, and reblogs 3. The "reblog" button on all Tumblr posts allows a meme to spread rapidly across thousands of blogs with just one click.

As with other social media platforms, tumblr has an enormous reach (18,878,347,183 total posts as of the time of this blog).  Therefore, it has great potential to help and hurt the public's health as it facilitates communication among millions of people.

A few weeks ago, Tumblr presented to its users a challenge (and possible solution) regarding blogs that promote self-harm.  Their users are being asked to weigh in on the policy.  I think that is a smart move.

Here is an excerpt from the Tumblr staff blog: 

Our Content Policy has not, until now, prohibited blogs that actively promote self-harm. These typically take the form of blogs that glorify or promote anorexia, bulimia, and other eating disorders; self-mutilation; or suicide. These are messages and points of view that we strongly oppose, and don’t want to be hosting. The question for us has been whether it’s better to (a) prohibit them, as a statement against the very ideas of self-harm that they are advancing, or (b) permit them to stay up, accompanied by a public service warning that directs readers to helplines run by organizations like the National Eating Disorders Association.

We are planning to post a new, revised Content Policy in the very near future, and we’d like to ask for input from the Tumblr community on this issue.

The blog goes on to say that they currently think the right answer is to implement a policy against pro self-harm blogs.  They aim to focus only on blogs that actively glorify or promote these behaviors. They also intend to start showing public service announcements (PSAs) on specific search terms like "anorexic" or "thinsperation".  It is unclear from their post how this policy will actually be implemented.  It would take enormous staff resources to comprehensively review their site and remove concerning materials. 

Other online and social media platforms have struggled with similar issues regarding how to respond to users that may be searching for or posting worrisome content.  Here are a few examples of other challenges and solutions:

• When someone uses Google or Yahoo to search for the term "suicide", the link to the National Suicide Prevention Lifeline is provided as the first result.
• In December 2011, Facebook began a new service that allows "Friends" to report concerning posts.  Facebook then sends an email to the person who posted the suicidal comment encouraging them to call the hotline or click on a link to begin a confidential chat. Note that Facebook does not troll the site itself, but instead waits for reports to come in.  
• Pop Health has previously posted about the debate regarding Twitter's duty to restrict hate speech vs. its duty to promote free speech among its users.

From these examples, you can see that there have been a variety of approaches to address potentially unhealthy or unsafe posts on social media platforms.  Sites can decide to be inclusive of all posts, they can let users police each other and report concerns, they can post resources in response to keywords, they can actively prohibit certain content...or they can use some combination of these strategies.

• What strategy or combination of strategies is best for the public's health?  
• If users are prohibited from posting, does that make them more isolated and less likely to connect to services?
• Should the overall health of the user group outweigh the health of that individual?

Tumblr is encouraging users to weigh in on their plan...so I ask you to both comment here and contact them at policy@tumblr.com. 

Media Must Cover Suicides Cautiously- In Today's Philadelphia Inquirer

An editorial that I co-authored ran in today's Philadelphia Inquirer. The piece is in response to media coverage of the suicide of a Philadelphia Firefighter. In a previous blog post following a celebrity suicide, I discussed the public health implications of the media coverage that follows. It can either encourage negative behavior in the audience by including unsafe and unnecessary details like detailing suicide methods...or it can encourage positive help-seeking behavior by including resources like the National Suicide Prevention Lifeline. I encourage all bloggers, communication professionals, and journalists to review the expert recommendations on how to safely report on suicides.

I look forward to hearing your comments!

Google Continues to Use its Power for Public Health Good

Yesterday, Google announced its new surveillance system for Dengue Fever. Dengue Fever is a disease caused by four related viruses spread by a particular species of mosquito. It can cause high fever, rash, muscle and joint pain, and in severe cases- bleeding, a sudden drop in blood pressure (shock) and death. Millions of cases of Dengue infection occur worldwide each year. Most often, dengue fever occurs in urban areas of tropical and subtropical regions.

The system is similar to that which was previously released as their Google Flu Trends program. These systems use search queries within Google (for example those that enter the disease's name and/or symptoms) to identify trends. The Dengue system also takes advantage of a new feature called Google Correlate, which shows previously unknown correlations between search terms. These correlations allow researchers to model real world behaviors by examining internet search trends. For those who may be skeptical of this model, you should check out a publication (co-authored by Google and the Centers for Disease Control and Prevention-CDC) in the 2009 Nature Journal . The article reports that "because relative frequencies of certain queries were highly correlated with the percentage of physician visits in which a patient presents with influenza-like symptoms, we can accurately estimate the current level of weekly influenza activity in each region of the United States, with a reporting lag of about one day."

This is a pretty exciting addition to public health surveillance (where the goal is systematic, ongoing, data collection that is used to monitor trends, identify priorities, direct resources, identify emerging hazards, and evaluate interventions).

This is not the first time that Google has jumped into the public health field with an impressive contribution. In 2010, Google searches related to suicide started appearing with a message guiding users to the toll-free number for the National Suicide Prevention Lifeline. The number is 1-800-273-8255. Triggered by searches such as "I want to die" or "ways to commit suicide," the number is listed next to an icon of a red telephone, at the top of the search results.

The addition of the Lifeline number came shortly after (at the suggestion of a Google user), the company started displaying the hotline for the American Association of Poison Control Centers after searches for "poison emergency."

These cases of Google's work in public health are great examples of effective health communication and public health principles:

• Identifying the primary channels through which your audience searches for health information (more and more are utilizing the internet) and delivering accurate and effective information and/or interventions via those channels.

• Maximizing data driven surveillance systems- using existing data (e.g., internet searches) to identify public health trends.

• Building strong partnerships (as evidenced by the publication by Google and CDC) CDC has partnered with a company with specific expertise and resources in an area that can be invaluable to their work.
  

Hollywood's "Dilemma": Should "Gay" Jokes Be Censored?

Recently I went to see "The Social Network". We watched several movie trailer previews, including the Ron Howard directed film "The Dilemma". The preview included a scene with Vince Vaughn exclaiming to a conference room full of colleagues, "Ladies and gentlemen...electric cars are gay". He goes on to clarify that he does not say "gay" to mean happy, instead he compares its level of "coolness" to your parents chaperoning a school dance. I leaned over to my husband and whispered, "I thought they were taking this scene out of the trailer?". I guess it had not yet been pulled (and was instead being seen by millions, as The Social Network was #1 at the box office that week).

The controversy regarding this quote began several weeks ago. CNN's Anderson Cooper was one of the first to draw attention to the preview when he appeared on the Ellen DeGeneres Show. His argument (especially in light of the recently publicized suicides involving gay children/teenagers) was that we must "make those words unacceptable cause those words are hurting kids". In addition, the Gay & Lesbian Alliance Against Defamation (GLAAD) put out a statement on the situation:

"When 'gay' is used as a pejorative, it frequently sends a message- particularly to youth and their bullies- that being gay is wrong and something to laugh at. We invite Vince Vaughn to work with us and help insure that gay youth and those perceived to be gay aren't put in harm's way by such jokes".

Last week, Vince Vaughn addressed the above concerns with his own statement that highlighted his feelings that the "gay joke" should be kept in the trailer and in the movie:

"Let me add my voice of support to the people outraged by the bullying and persecution of people for their differences, whatever those differences may be. Comedy and joking about our differences breaks tension and brings us together. Drawing dividing lines over what we can and cannot joke about does exactly that; it divides us. Most importantly- where does it stop?"

ABC's The View also discussed this during its "Hot Topics" show yesterday. I was actually pretty surprised that there seemed to be consensus and support for Vince Vaughn's statement. How can you censor a "character"? This was not about Vince making homophobic statements...but it was the statements of his character. What if the character is a jerk? Then he/she will sound like a jerk. Whoopi Goldberg spoke about recently watching "Roots" on TV and how much of the message was lost due to the censoring of the racist language.

I can see both sides of the argument on this one. Of course, people of all ages look to celebrities and movies to be role models and to confirm (or break) social norms. Therefore, statements using "gay" as a pejorative can absolutely influence the beliefs of an audience. However, I also understand the slippery slope of censorship and the concern that stories can no longer be told with the same honesty and depth of characters. It is also unclear how this censorship would be overseen and enforced. Can we always tell the difference between a statement of someone's beliefs and their attempt at a joke? And just because something is intended as a joke, does that really mean there are no consequences? If your boss "jokes" about how your clothes fit...it is still sexual harassment.

With tomorrow being "Spirit Day" to combat anti-LGBT bullying, it seemed very timely to toss this "dilemma" out to my readers for comment. I look forward to your thoughts.

Bullying: Is Technology Helping Us or Hurting Us?

Like many of you, my heart broke when I heard about the suicide of Tyler Clementi last week. Unsure of exactly how I wanted to focus my blog on this topic, I took a little time and read the comments coming through on Facebook and Twitter. I talked to colleagues and friends. And something that really struck me was that many people expressed that technology was the problem. All this new technology can only lead to bad things. Right? I agree that new technology has played a large part in our discussions around bullying the past few years. There seems to be an assumption on the part of the bullies that they can be protected by technology- that their identity can be kept "anonymous" in the cyber-world. Perhaps more kids bully online because it is easier to insult or hurt someone at that distance- versus right to their face. Of course, these hurtful comments or videos now have a much broader reach. They can be disseminated through the school, city, state, or even country in just minutes. And you can't take them back. I also think that technology is evolving so quickly that we don't always understand the new boundaries for privacy.

But even with all the new challenges and channels to bullying that technology brings, I still do not believe that it is the root cause. As a friend of mine tweeted this week (yes- Beth G you get a shout out here) "Thinking on the Tyler Clementi case. Tired of hearing that technology is to blame. I'm pretty sure Dharun Ravi and Molly Wei are, actually". Let's not forget the role of personal responsibility- I believe that gets lost when the blame falls squarely on technology.

So with all of that as a backdrop for this discussion, I decided that I wanted to focus my blog on how technology can also help us to combat bullying and help those at risk for suicide. Risk for suicide can increase among those who feel isolated and disconnected from resources. They can also suffer when surrounded by social norms that do not support help seeking for the resources that they need.

So I wanted to present these resources that have gone viral in just the past few days. I can't help but think about all the isolated kids/teens they may reach:

1. MTV launched an Iphone application to combat bullying called "Over the Line". Users can post a bullying scenario that they've experienced and other users can vote if it was "over the line". This has the potential to help promote positive norms/limits regarding how we treat each other. The peer support online may also encourage users to ask for help.

2. MTV was also involved in the launch of "Love is Louder". This "movement" has begun primarily in response to anti-gay bullying and suicides among LGBT youth. Viewers (and celebrities) can upload videos of support for these youth. It has been described as a way to channel the sadness and anger we all feel following these events. Again- this has the potential to build peer support among individuals that may be at risk. It also introduces celebrities or role models to support positive social norms.

3. Columnist Dan Savage has organized the "It Gets Better" campaign. The goal is to reach out to lesbian, gay, transgender and bisexual youth who may be the victims of bullying and remind/assure them that things will get better. This campaign has also attracted many celebrity supporters telling their stories (e.g., Tim Gunn from Project Runway was featured on many of my friends' Facebook pages today).

4. Four days ago, Ellen DeGeneres posted "An Important Message" on YouTube regarding the recent suicides of LGBT youth. As of tonight, there had been 235,627 views of that video. She pledged her support and encouraged all of us to have zero tolerance regarding bullying and the loss of these kids/teens.

So that's the complicated story. Technology brings new prevention challenges to bullying. But it can also build peer networks and deliver resources to those in isolation. It can bring the voice of celebrities or other role models into the discussion, which can be a strong influence on kids/teens. I urge us not to write off all technology in light of recent events.

For example, if anyone reading this blog needs help- please call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255). Their technology even allows for Veterans to chat with an online counselor. Amazing!

Technology: Building Social Connections or Breaking Them Down?

Last week, a friend at work told me that she had given up watching TV for Lent. She said "every time I give up TV, my quality of life goes up". I thought of her immediately today as I read this new article in TIME, "Logged on, checked out...of relationships?" The article discusses a study (published in the March issue of the journal Archives of Pediatrics & Adolescent Medicine) which studied adolescents during two periods of time (1988 and 2004). The adolescents who spent more time watching TV or playing video games were more likely to report lower quality relationships compared with those who logged less screen time.
I find this fascinating because I have followed the debate among colleagues and friends regarding the increase in the use of technology and its impact on social connections. For example, kids that may be "outcasts" at school may find friends online. They may have hundreds of Facebook "friends". They may find lots of kids with similar interests by joining "groups" online. However, one has to ask, are Facebook friends "real"? I personally have 355 friends on Facebook, but would only consider about 10 of those people close friends in my day to day life. Is it worth it to focus your time and attention to online activities (as noted above) to the detriment of your "real life" relationships with friends and family?
In looking at how social connectedness can be a protective factor for things like suicide, the question has also come up: "Is it the quantity or quality of relationships that really count?" In research on college students, studies like Healthy Minds are beginning to indicate that it is the quality that counts. However, unlike my previous posts where it has been easy for me to take one side or the other...I'm torn about this issue. The authors of the above study were as well...they note that there is an obvious correlation between online activities and relationship quality, but the causal link is not clear.
Therefore, I believe it is probably some happy balance that is best. Facebook friends and groups are not all superficial and time wasters. People can connect (or in many cases, "reconnect") with friends and colleagues with shared histories or interests. I've seen Friends post a concerning or unsafe status and 20 people jump in with words of encouragement or offers of help...which is wonderful. On the flip side, it helps to turn the computer or TV off and enjoy the world around us...strengthen those connections with those we live with, eat dinner away from the TV, etc. And of course on that note, I'll log off. LOST starts at 9pm ;)