Having lived sans cable for the past five years or so, when I’m in the mood for some network entertainment I usually turn to Netflix and usually delve head first into a series. Mad Men, the hit AMC series about advertising men in the 60s, is my latest vice, and I’ve been going gang-busters through the first few seasons recently. I never knew I would be so fascinated by the lifestyles of the 1960s, but I can’t get enough! While keeping in mind the fact that everything is amplified for television, I’m riveted by the complicated gendered relationships between men and women, the parenting styles, the political climate, and, of course, the portrayal of mental health. Oh, and the hairstyles. I love those.

What’s so fascinating about Mad Men is that it offers a glimpse into how far we’ve come – and haven’t come – in our social development. Mental health is no exception. When Betty Draper notices numbness in her hands and discovers that this could be psychosomatic, she urges her husband Don to allow her to attend therapy. Don is at first incredulous about the idea of his wife confiding in a stranger to solve her seemingly physical ailment, but when the problems continue he relents. What we soon discover, however, is that Don is keeping close tabs on his wife’s sessions, getting a full report from her psychiatrist after each meeting.

My jaw literally dropped when I saw this exchange transpire, but then I reminded myself just how long fifty years is in the world of mental health. It was only in 1996 that former President Clinton enacted the Health Information Portability and Accountability Act – HIPPA – that provided protection for individuals’ health information being communicated. Just to be clear, in today’s world, one would need to give explicit permission for a partner to receive information about one’s treatment. And detailed information about one’s sessions would virtually never be revealed.

In fact, a lot has changed in the world of mental health since the days of Betty and Don Draper. To put in context, here are some of the developments in the past fifty years:

1966 – Alcohol abuse and dependence were finally recognized as a major public health issue, and federally-funded organizations were developed to research these illnesses. We’re still trying to establish the the exact causes of alcoholism, and genetic research is helping us understand it’s biological roots.

1970 – The FDA approved the use of lithium to treat mania. This revolutionary drug drastically reduced the number of days spent in inpatient hospital. It’s also credited with sharply reducing the number of suicides in areas where it was prescribed.

1976 – The number of people in psychiatric hospitals was dropping dramatically as an emphasis on treating individuals in their own communities developed. While giving individuals tools for community-living was important, many patients were pushed out on to the streets still ill-equipped to manage their illness. Some became victims of trauma – individual and institutionalized.

1978 – Many people still claimed that autism was caused by refrigerator mothers, parents that offered a “genuine lack of maternal warmth.” While we still aren’t clear on the causes of autism today, we’re generally agree cold moms are not to blame.

1986 – Homosexuality was removed from the Diagnostic and Statistical Manual (the Bible for mental health practitioners) as a diagnosis. It took this long despite compelling research in the 1940 and 1950s by the likes of Alfred Kinsey, Evelyn Hooker, and others. No one ever claimed that the American Psychiatric Association was speedy on these things.

1989 – Former President Bush signed a proclamation establishing the 1990s as the Decade of the Brain. The 90s saw an enormous boon in research on genetics and the brain. By 2000, genetic researchers had finished mapping human genes. The goal is to help identify specific genes and how they are associated with various illnesses. [Are eating disorders brain disorders?]

2002 – New Mexico allows psychologists (not, psychiatrists – click here if you’re not sure of the difference), to prescribe psychotropic medication. Hotly debated, but the future may hold more prescription privileges for appropriately trained psychologists.

2008 – The Mental Health Parity and Addiction Equity Act was passed. This landmark legislation required  insurance companies that offer mental health benefits to provide coverage on-par with medical coverage. Unfortunately there are still many insurance companies that are trying to sneak around this, and eating disorders are often not covered.

2010 – Nourishing the Soul was born! (Sorry, had to add that in there!)

As you can see, while advances in mental health may seem to progress at a snail’s pace in real time, in the context of our history we’ve made great strides in this field. And what has universally propelled this forward movement has been the willingness of invested parties to speak up. Whether as a clinician speaking up on behalf of your patients, as a concerned family member advocating for your loved one, or as a consumer of mental health services sharing your struggle, putting these issues at the forefront has meant everything.

So on World Mental Health Day 2011, I urge you to use your voice to keep the momentum going. This week, write a blog post about the role of mental health services in your life, share your story with a friend who might need to hear it, or even lobby in Washington. Whatever you do, remember that mental health is health, and it takes our voices make sure it gets the respect and recognition that it deserves.

For more World Mental Health Day posts, head over to PsychCentral. How are you recognizing the importance of mental health in your life today?

{Natalie Dee Comics}

A few weeks ago I had the pleasure of attending a two-day training in Palo Alto (um, who can beat the location? really…) on Family-Based Treatment (FBT) for eating disorders, sometimes called the Maudsley Approach. The experience was incredibly rich and this will hopefully be only the first of many posts based on what I took away from it.

When I left California, I took with me a deeper understanding of how parents and caregivers can be helpful, or rather, vital, in the process of recovery.

You may be thinking, “Wow, that’s not rocket science. You don’t have to do an intensive training to figure that out.” But in fact for many of us, clinicians included, this is a new concept.

This is not to say that in my own practice I don’t incorporate family support and even do family therapy. But do I rely on the parents of the individual with the eating disorder to do the therapy? In a word, no.

Proponents of FBT would suggest that parents are, in fact, the best possible people to do the intense work of treatment. In short, this means that FBT teaches caregivers the skills they need to implement re-nourishment at home. Parents initially take control of restoring the individual’s weight, gradually turning over appropriate control to their child after a period of time.

If this seems foreign to you, you are not alone. The radical-ness of this idea is radical in part because our society has readily adopted the notion that parents are the root of all of our problems and thus cannot be the source of our solutions.

Putting aside the question of whether that’s a valid argument for a moment, here’s another question: How did we start blaming parents for, well, everything?

Looking back at nearly every public tragedy in history, we find questions about the parentage of the individual responsible. We want to know the background of Adolf Hitler, and from where his brutality might have stemmed. We wonder, who exactly did raise Bernie Madoff? An article in the Philadelphia Daily News recently asked about the shootings in Arizona, “At the risk of sounding harsh, how could the parents of accused shooter Jared Lee Loughner have missed so many signs that their son was a major safety threat?”

And when it comes to individuals with severe mental health or developmental issues, the history of parent blame is perhaps even more striking. And, as Dr. James Lock, one of the major investigators and proponents of FBT said in our recent training, “And let’s be honest, when we say ‘parent blame,’ what we really mean is ‘mom blame’.”

Indeed, the term “refrigerator mother” has plagued the moms of mentally ill and developmental delayed individuals since the mid-20th century. The idea was that the mothers of children with schizophrenia and autism were emotionally cold and distant. In the first paper to describe autism, Leo Kanner described a cause being “genuine lack of maternal warmth,” and parents of these children as “just happening to defrost enough to produce a child.”

Ouch.

Similarly, parents have historically been blamed for eating disorders as well. In the ground-breaking 1978 book, Golden Cage, psychiatrist Hilde Bruch suggested that narcissistic and unloving parents, or hypercritical and over-involved parents, actually caused these illnesses. Now most experts agree that parents do not cause anorexia or other eating disorders. When experts talk about parental contributions today, they are more often talking about the genes that they pass down. Scientists suggest that over 50% of a person’s risk for developing an eating disorder is attributed to genetics.

Does this mean that parents don’t contribute to the development of an eating disorder? I would say no. Parents comments, personalities, own mental health issues, and modeling can in fact influence the development of a disorder. And yes, in many cases those struggling need to better understand the development of their beliefs around food, shape, and weight and, at times, to even redefine what family means.

When things “go wrong” our instinct is to look to the parents; we believe that some answer lies in their egregious errors. Why do we do this? Perhaps it makes us feel safe. We need to know that the man with schizophrenia screaming at the wall couldn’t be our son – we wouldn’t let it get to that. Or that the girl starving herself to an emaciated death – we’re better parents than that. If the cause is genetic or, worse, unknown, then we’re all at risk.

But what we lose in blaming parents is the opportunity to enlist an incredible ally – people who (at least usually) truly know and love the individuals suffering. These are the people who at the end are making the hard sacrifices and praying to whatever entity they believe in for that individual’s safety and protection. When we riddle parents with blame, blame that they often all too easily take upon themselves, we’re might be colluding with the illness.

What role do you think parents might play or not play in mental health issues?

{Image Credit :: Gabi + Jeremy Photography}

“Your legs are getting big,” my co-worker said as she eyed my stocking-clad gams. I was wearing a skirt as opposed to expandable-waist pants, and, at 8 months pregnant, was large and soft in unexpected places. Like my legs.

Those movies where the protagonist dons a modest prosthetic bump and declares herself knocked up? Not accurate, as it turns out. No, there are countless body parts that swell and stretch and slump during pregnancy.

And countless people to comment on the expansion of such parts. If you’ve never been pregnant, you may fail to appreciate the extent to which women in this “condition” are subject to scrutiny and judgment and evaluation. From the size and shape of their bellies, to the decision to wear high heels, drink an occasional glass of wine, eat chocolate cake (which contains caffeine, as a well-meaning but nosey colleague reminded me), or even partake in exercise, pregnant women receive more advice than they know what to do with.

People seem to assume two things about the condition of pregnancy: 1. It renders women stupid and unable to think for themselves, and 2. It makes them interested in what you think. Particularly in your thoughts about whether their weight gain is sufficient or, conversely, exorbitant.

I’ve written before about my history with Anorexia, that mind- and soul-consuming state in which the sufferer believes that weight and food are twin forces of evil–forces that can only be defeated by the virtues of discipline, self-sufficiency and unyielding control. Luckily, my eating disorder occurred many years before my first pregnancy (nearly 15 years, in fact), so I had ample time to make peace with food and weight. I had come to enjoy eating and inhabiting my body in a way I could not previously have imagined.

Yet even with that much recovery under my belt (or the elasticized panel on my skirt), I was unprepared for pregnancy and its effects. The weight gain was mostly tolerable, but at times I felt panic, due to the unpredictability of growth; I couldn’t say whether my body would increase by 15 pounds or 50. And this scared me. More than a little.

But it was a diagnosis of gestational diabetes that really tested my recovery. Not just the lancets and blood, which had me all kinds of anxious, but the requirement that I monitor—closely—what I put in my body: the carbs, fat and protein. I had to immerse myself in a world I’d long ago deserted through self-imposed exile. I had to revisit charts and lists that contained information I’d necessarily wiped from my mind, because it served as the scaffolding of my eating disorder, the architectural plans of Anorexia.

I had long divorced myself from the idea that foods are “good” or “bad,” and instead adopted the attitude that everything is appropriate in moderation. And yet here was the diabetes educator, telling me that pasta and bagels were indeed bad, even dangerous.

Thoughts about restriction and weight danced in my head. Some were based in the present, in the desire to ensure my own well-being and that of my unborn child. And some were ghosts from the past, seductively lingering and making false promises. My job was to differentiate them, to decipher friend from foe.

In the end, I was able to do this, not just for the sake of my baby, but because I didn’t want to go back to that degrading, lonely and terrified existence. There was too much at stake, and I knew that carbs weren’t the real enemy (at least after I had given birth and learned that the diabetes was resolved). Through luck, intention, and lots of pushing, I was able to deliver a healthy baby and then return to my customary mix of varied foods and unplanned eating–some of this and that, in the morning or darkest hour of night.

And I was able to return to chocolate chip cookies. My mother delivered some to the hospital, and I ate them in bed while holding my sweet, sleepy child. A delicious delivery, indeed.

Dr. Dana Udall-Weiner is a clinical psychologist, mother of two, and Nourishing Body Image Award nominee. She blogs at The Body and the Brood, offering action-oriented advice and musings on food, family, culture. You can also find her on twitter. You can learn more about eating disorders and pregnancy here, or by contacting the National Association of Eating Disorders.

How was your body image affected by pregnancy?  Did you get lots of comments from friends or strangers? And if you’ve ever had an eating disorder, did you find it difficult to deal with changes in your weight and your shape?

{Image Credit :: Wilson Fotografie}

In a world where wedding planning involves weeks of heart-wrenching debate over how to appropriately signify mom’s longtime boyfriend (or dad’s) on the invitation, and having a half-sibling or step-daughter is more the rule than the exception, one would imagine that we as a society are becoming more open to the idea of non-traditional families.

But what if our relationship with our family is not mired by the complex reconfigurations of re-marriage and adoption, but rather by the painful reality that our family just isn’t very good for us?

We’ve been taught to believe that our family, and particularly our parents, are to be our advocates and our protectors. They are our coaches and our cheerleaders, our safe-keepers and the creators of our joy, our shoulders to lean on and our sleeves to wipe away our tears. That is, except when they are not.

For some of us, our parents and families are not our beacons of safety, but rather perpetrators of hurtful attacks. They can abuse us physically, verbally, and emotionally, leaving scars that may run as deep as the ocean but never show on the surface of the peaceful lakes we have created. Families can tear us down, weaken our connection to ourselves, and make us question what can be trusted in this sometimes chaotic world.

Of course, this isn’t true for all families, or even most. Fortunately for many of us, our families are our sources of strength and comfort, empowering and emboldening us to live the lives we were meant to live. But when they’re not, and they don’t, what do we do?

Then, in the midst of what we have lost, we rebuild. We create our own families.

Recently a woman I know, Jenny, told me about a very special relationship she had developed with with a neighbor that lived down the block. My friend was much younger than this woman, Susan, who was in her early sixties by the time that the pair met. Jenny told me that when she encountered Susan, she felt a connection with her instantly. Sure they were separated by at least a generation, maybe more. But they bonded over a love of green tea, science fiction books, and the Rolling Stones.

Over the years, their relationship became a mixture of friendship and mentorship. Jenny shared with Susan about her strained relationship with her own mother, who lived several states away, and about the hole that this had left in her heart. She shared that she often ached for the love of her family, particularly around holidays, and how she had used many things – food, alcohol, even reading fiction – as a way to escape the pain she felt. Susan, like all good mentors and friends, validated Jenny’s struggle and did little else but be with her. For Jenny, this was enough. The comfort of feeling accepted unconditionally was what was missing for her, and she found this in the quiet moments spent in Susan’s garden or at her kitchen table.

Jenny told me that several years later, Susan unexpectedly died of a stroke. Jenny was devastated initially, feeling that the universe had taken away her greatest advocate. But later she recognized that she was able to move through the pain because Susan had taught her to do so – by allowing her to feel the pain without judgment. Jenny told me with a mixture of sadness and joy in her eyes, “My mother gave me birth, but Susan gave me life.”

That phrase has stuck with me. I began to reflect on all of the individuals who had given me life and taught me to be more of who I am. Some of them have been family in the traditional sense. And some have been the family that I have created for myself. Whether connected by blood, proximity, or good books, the people that we choose to make our family should be the ones that give us the gift of life – our own.

How do you define family?