Month: October 2015

The Reality of Mental Illness

The Reality of Mental Illness“The mentally ill frighten us and embarrass us.  And so we marginalize the people who most need our acceptance.  What mental health needs is more sunlight, more candor, more unashamed conversation.”  – Glenn Close

Mental illness carries a stigma.  The mentally ill carry it with them at all times, like a big, ugly, hairy mole on one’s face that people try to avoid looking at.  It’s sad and it’s frustrating.  Regardless of how far mental health has come with trying to eliminate such stigma, it’s still very much alive.  A majority of Americans continue to remain misinformed and even fearful of the mentally ill.  Just watch the news in the days following a mass shooting.  You will hear the question loud and clear:  Was the shooter mentally ill?

The truth is, there are an awfully lot of myths out there about mental illness that too many people still believe.  It’s important to debunk these myths.  By dispelling such myths, we take a powerful step toward eradicating the stigma and the public’s fears surrounding mental disorders.  Following, you will find 12 common myths about mental illness, as well as the facts, the reality, of mental health in the United States.

Myth #1:  I don’t know anybody with a mental illness.  Mental health problems don’t affect me.

Fact:  Mental health problems are actually very common, and it’s very likely that if they don’t affect you now, they will at some point during your lifetime.

  • According to the National Alliance on Mental Illness (NAMI), approximately 1 in 5 adults in the U.S. (43.7 million, or 18.6%) experience mental illness in a given year.
  • Approximately 1 in 25 adults (13.6 million, or 4.1%) experience a serious mental illness in a given year that substantially interferes within or limits one or more major life activities.
  • Approximately 1 in 5 youth aged 13 to 18 (21.4%) experience a severe mental disorder at some point during their life.  For children aged 8 to 15, the estimate is 13%.

Myth #2:  Mental disorders are not real illnesses like cancer and heart disease.  People with mental illness are “crazy” and could “snap out of it” if they really wanted to.

Fact:  Mental disorders are legitimate medical illnesses, just like cancer and heart disease.  Research has shown time and time again that there are genetic and biological causes for mental illness.

Myth #3:  People with mental illness are “weak” and “lazy.”

Fact:  Mental illness has nothing to do with being lazy or weak.  Mental illness is the result of changes in brain chemistry or brain function.

Myth #4:  Mental illness isn’t that big a deal.

Fact:  Here are some statistics that suggest otherwise:

  • According to NAMI, serious mental illness costs the U.S. $193.2 billion in lost earnings per year.
  • Individuals living with serious mental illness face an increased risk of having chronic medical conditions.  And adults in the U.S. living with serious mental illness die an average of 25 years earlier than others, largely due to treatable medical conditions.
  • Over one-third (37%) of students with a mental health condition aged 14 to 21 and older who are served by special education end up dropping out of school – the largest dropout rate of any disability group.

Myth #5:  People with mental health problems are violent and unpredictable.

Fact:  Only 3 to 5% of violent acts can be attributed to individuals living with a serious mental illness.  In fact, people with severe mental illnesses are actually 10 times more likely to be the victims of violent crime than the general population (

Myth #6:  Mental illness is just an excuse that people who commit crimes use in order to stay out of jail.

Fact:  Approximately 20% of state prisoners and 21% of local jail prisoners have a recent history of a mental health condition (NAMI).

Myth #7:  Kids who become involved with the juvenile justice system are “bad” kids and have problems because of “bad parenting.”

Fact:  First off, kids who become involved with the juvenile justice system aren’t necessarily “bad” kids; they are kids who have most likely made some very poor choices.  According to NAMI, 70% of youth in the juvenile justice system have at least one mental health condition and at least 20% suffer from serious mental illness.  Many factors can contribute to mental health problems (, including:

  • biological factors, such as genes, physical illness, injury, or brain chemistry
  • life experiences, such as trauma or history of abuse
  • family history of mental health problems

Myth #8:  But kids can’t get mental illness.  They can’t get things like depression and anxiety disorders.

Fact:  Kids can and do develop mental illness, depression and anxiety disorders included.  In fact, this can happen to anyone at any age.  Half of chronic mental illness begins by age 14.  Unfortunately, just over half (50.6%) of kids aged 8 to 15 are reported to receive mental health services.

Myth #9:  Depression is a normal part of the aging process.

Fact:  It is not normal for older adults to be depressed.

Myth #10:  Addiction is a lifestyle choice and shows lack of willpower.  People with substance abuse problems are “bad” people.

Fact:  Addiction is a disease that generally results from changes in brain chemistry.  Few, if any, choose to become addicted to substances.  Addiction has nothing to do with being a “bad” person.  Among the 20.7 million adults in the U.S. who experience a substance use disorder, 40.7% (8.4 million) had a co-occurring mental illness.

Myth #11:  People with mental health needs, even those who are managing their mental illness, cannot tolerate the stress of holding down a job.

Fact:  People with mental health problems are just as productive as other employees.  Employers who hire people with mental health problems report that their workers have good attendance and punctuality, motivation, good work, and job tenure to be on par or greater than other employees.

Myth #12:  Suicide will never affect me.

Fact:  These sad statistics unfortunately suggest otherwise:

  • Suicide is the 10th leading cause of death in the United States.
  • It is the 3rd leading cause of death for people aged 10 to 24.
  • It is the 2nd leading cause of death for people aged 15 to 24.
  • More than 90% of kids who die by suicide had a mental health condition.
  • The highest suicide rates in the U.S. are found in white men over age 85.


“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.”  – Bill Clinton



“Mental Disorders in America” (The Kim Foundation)

“Mental Health By the Numbers” (National Alliance on Mental Illness)

“Mental Health Myths and Facts” (

“Myths Vs. Facts on Walk in Our Shoes” (Walk in Our Shoes)

National Institute of Mental Health (NIMH)

“Misconceptions About Mental Illness – Pervasive and Damaging” NARSAD Research Newsletter, Volume 13, Issue 4, Winter 2001/2002, p. 28


Target of the Office Bully

Bully BossSeveral years ago I went through one of the most devastating experiences of my life.  I was the target of an office bully.  It started from day one and her treatment toward me spiraled downhill from there.  I was constantly berated and sabotaged at every turn.  She would close the door and have secret meetings with me to demean me and inform me that I must have a “cognitive disconnect” because there was no other explanation for how someone could possibly be so stupid.  She would assign me task after task after task until my to do list easily topped 100 items that I was responsible for.  She would one minute tell me I needed to take notes in meetings and then come to me afterward in private and tell me I wasn’t allowed to take notes.

When I finally got the courage to confront her about her behaviors toward me, she insisted that I must be mistaken because she liked me, that she would never treat me in such ways.  For a time, she had me believing that I must be crazy, that all my perceptions had to be wrong.  I woke up every day dreading going to work.  While at work, I would cower in my office and pray that she wouldn’t find me.  I couldn’t understand her behavior toward me.  I spent every day confused as to what I was doing wrong because even when I thought I was doing everything right, my boss was still able to find some detail I had supposedly missed.

As hard as I tried not to let my boss bother me, one day I broke and asked a co-worker what I was doing wrong.  It was then that I was informed that I was just her newest target, that she had a long, long history of bullying employees until they finally gave up and quit.  I wanted to give up and quit too, but I desperately needed the money.  My co-workers seemed to very supportive, that is until the day I finally quit my job.  Then they mysteriously disappeared as my support system, after telling me, of course, that they wouldn’t back me up about the behaviors they themselves had observed from my boss toward me; they told me they couldn’t afford to lose their jobs, after all.  Neither could I, but the day finally came where I just couldn’t take it anymore.  I took a deep breath and quit, then walked out the door to my car, where I cried and cried all the way home.

By the time I left my job, my self-worth was shattered.  It took months for me to finally be able to look back and realize that the job was destroying me the whole time.  It took even more months for me to look back and recognize that NO ONE should be treated the way I was treated, that I was worth so much more than my boss had ever given me credit for.  Looking back, quitting that job was one of the best decisions I ever made.  My health deteriorated while I was there, my stress levels were always high, and psychologically, I was depleted.  Removing myself from that incredibly unhealthy situation was the best option I could have chosen.

What is Workplace Bullying?

According to the Workplace Bullying Institute’s (WBI) 2014 National Survey, 27% of Americans have directly experienced or are currently experiencing abusive conduct at work, or workplace bullying.  72% of the American public are aware of bullying in the workplace.

Workplace bullying is defined by the WBI as “repeated, health-harming mistreatment… in one or more of the following forms:  verbal abuse, threatening, humiliating or offensive behavior/actions, work interference, sabotage which prevents work from getting done.”  What constitutes workplace bullying?  According to the definitions included in most anti-bullying bills, definitions of abusive conduct include:

  • repeated infliction of verbal abuse, such as the use of derogatory remarks and insults
  • verbal or physical conduct that a reasonable person would find threatening, intimidating or humiliating
  • gratuitous sabotage or undermining of an employee’s work performance
  • conduct that a reasonable person would find to be hostile, offensive and unrelated to the employer’s legitimate business interests

It should be noted that a single act of any of these things doesn’t constitute abusive conduct unless it’s especially severe.  In some anti-bullying bills, the definitions further include “conduct that results in material impairment of a victim’s physical or mental health,” as documented by a physician or otherwise supported by expert evidence at trial.

As was true in my own situation, “gas lighting” has also been documented to occur in the workplace.  This is where the bully (or bullies) try to convince the target that his or her perceptions are wrong.  An example would be an employer telling the target that a project was due on a certain date but the bully later denying this and insisting that they said it was due much earlier.

What Type of Person is Usually Targeted for Abusive Mistreatment in the Workplace?

The WBI (2014) found that 37% of targets are actually compassionate and kind people.  22% display agreeableness, and 19% portray cooperativeness.  This means that an overwhelming majority of those targeted possess positive attributes.

According to Laurissa Doonan’s article, “Do You Know a Bully Boss?”, “bully bosses bully because you threaten them in a way that makes them nervous.”  The target is generally one who can expose the bully’s weaknesses and shortcomings.  “You’re probably smarter than them, and unwittingly demonstrate that just by doing your job.”

Who are the Biggest Perpetrators of Workplace Bullying?

According to the WBI’s 2014 National Survey, an overwhelming majority (40.1%) of principal perpetrators are bosses.  Second in line at 19.0% are peers of the same rank as their targets.

Bullying Target

The Impact of Bullying in the Workplace

The impact that workplace bullying has, both physically and mentally, warrants that this is a very serious problem.  Being the target of a workplace bully causes severe distress.  Stress is the very real biological human response to stressors; bullies are the stressors in this case, as well as the coworkers and institutional helpers (Human Resources and senior management) who stand by and do nothing when a target expects and so desperately needs them to help.

Distress triggers the human stress response, automatically coordinating the release of glucocorticoids that flood the brain and body.  Prolonged exposure of brain tissue glucocorticoids results in atrophy of areas responsible for memory, emotional regulation, and the ability to sustain positive social relationships.

There are other stress-related and health complications from prolonged exposure to the stressors of bullying as well, including:

  • cardiovascular problems
  • neurotransmitter disruption
  • atrophy of the brain’s hippocampus and amygdala
  • gastrointestinal problems
  • immunological impairment
  • auto-immune disorders
  • fibromyalgia
  • Chronic Fatigue Syndrome
  • diabetes
  • skin disorders

Wow.  And sadly, the greater the exposure to such stressors increases the severity of psychological impact.  Not surprisingly, bullying also results in psychological-emotional injuries, including:

  • debilitating anxiety
  • panic attacks
  • depression
  • post-traumatic stress disorder (PTSD)
  • shame
  • guilt
  • an overwhelming sense of injustice

Additionally, the WBI 2012-D study found that 29% of bullied targets considered suicide; of these, 16% had a plan to carry it out.

Few Laws Protect Workers from Bullying

Unfortunately, as of this date, few laws protect workers from this sort of thing, primarily because it’s difficult to always classify certain actions as bullying.  While there is an effective method to determine bullying in the court system, the terms of that system are susceptible to the interpretation of the court.

In a court of law, the Intentional Infliction of Emotional Distress (IIED) claim provides the groundwork for one to prove that certain workplace bullying is intentional and can cause extreme emotional distress.  Four elements of IIED must be proven by the plaintiff in order to win such a case in court:

  1. Intentional or reckless conduct
  2. Extreme and outrageous conduct (which is the most difficult to prove because harassment and verbal abuse are generally not what the court defines as “outrageous”)
  3. The actions of the wrongdoer caused the plaintiff emotional distress.
  4. Emotional distress must be severe (so that the victim suffered a compensable injury).

The truth is, unless a worker is protected under federal and state statutes, such as Title VII, which prohibits discrimination based on race, religion, sex, or national origin, he or she has few protections legally against being bullied in the workplace.  Though some states have enacted or are in the process of enacting the Healthy Workplace Bill and a majority of people seem to support it, the system still has quite a way to go in protecting workers.

Until then, it’s important to heed some advice:

  • Don’t blame yourself.
  • Document everything.  Every incident.  And do so in a non-emotional way, stating just the facts.  Leave out explanations of how the bullying incidents make you feel.  Also be sure to document the presence of any witnesses.
  • Don’t allow meetings to take place in secret.  Sharilee Swaity advises to never allow any meeting to take place without having a paper trail of it.  Insist that you receive an email outlining everything that happened during the meeting.  If your boss refuses or neglects to do so, then send him or her an email outlining all that happened and ask them to confirm.
  • Don’t isolate yourself.  Take measures to ensure that you take care of yourself.



Do You Know a Bully Boss?

What Employers Should Do About Workplace Bullying

What NOT TO DO When Being Bullied at Work

Workplace Bullying and What It’s Like Working In a War Zone

Workplace Bullying Cases are Hard to Prove

Workplace Bullying Institute



My Favorite “Non-Therapeutic” Games… Find It

Find It GameI love using games in therapy, and kids love playing games in therapy!  Last week I posted about the use of the Jenga game as a therapeutic intervention during counseling sessions.  It’s an excellent resource for just about any topic or skill that you’re trying to teach to kids, adolescents, and adults alike.  I use a number of games in therapy sessions, both therapeutic and “non-therapeutic.”  The difference between the two is what their intent and purpose was when the game makers created them.  “Non-therapeutic” games are simply those that you can find at your local department store in the game aisle, like Candy Land, Jenga, and Operation, but in my experience, ANY game, regardless of its intent during creation, can be made therapeutic.  Today’s game can be found in both therapy resource catalogs AND the game aisle.

Find It as a Therapeutic Intervention

Find It, like Jenga, is another one of my favorite “non-therapeutic” games to use as a therapeutic intervention with children and adolescents.  Find It is a classic I Spy game that comes in a nice sturdy cylindrical container filled with miscellaneous small objects to find (e.g., a rubber band, an eraser, a feather, etc.) that are hidden in a colorful array of beads, pebbles, or dried rice (depending on which version of Find It that you choose).  I primarily use the game with children and teens that I’m treating for Attention-Deficit/Hyperactivity Disorder (ADHD) or who have other issues in which they have difficulty with focus and attention.  I use the game to help improve their concentration and focus, as well as to informally assess their distress tolerance.  The object of the game is simple:  Find as many objects from an included list as you can.  You can do this activity timed or take as long as you need.

The first time I give a child the Find It game during session, I collect baseline data by setting a time limit (for example, 10 or 15 minutes) and assess how many objects they can find within that given time frame.  The game itself includes a small notepad checklist, so we mark each item off as it is found.  I write down the time limit I give the child (whether it was 10 or 15 minutes) and the number of objects found, and then I put the information in the child’s file so I can access it in future sessions.

How Often to Use Find It in Session

We play the game intermittently; the next time we play the game is generally a few sessions after I’ve collected the initial baseline data.  The sessions in between are spent doing other focus improving activities in order to help the child develop his or her skills.  When we play the game again, I give the child the same time limit as before.  Again the child is asked to perform the same task:  Find as many objects as possible before time is up.  The objects are never in the same place as they were initially, as each movement of the container shakes and jumbles the objects around.  I record the data afterward, just as I did the first time the child played.  This time I’m looking to assess whether the child’s scores (number of objects found in a given time) have improved as a result of our working on their focus, concentration, and attention span.

Find It as a Tool to Improve Distress Tolerance

Find It also allows me to see how a child tolerates the distress and frustration that comes with sometimes having difficulty finding the small objects.  During game play, if a child is becoming noticeably distressed, I teach coping and self-regulation methods that they can use to slow down and bring their focus back to the game again.  Between sessions, we will work on improving the child’s distress tolerance and learning effective coping skills to help handle frustration.

How Long to Use the Find It Game

I generally give the child the Find It game and assess their focus once every few sessions until I see that their scores have significantly improved and/or their distress tolerance is handled appropriately on a consistent basis.  Once I see that the child has improved, we put the game away, though the child usually ends up getting it out at the beginning or end of future sessions as a transition activity.


My Favorite “Non-Therapeutic” Games… Jenga

Jenga photoGames are wonderful to use in therapy, especially with kids!  I utilize a number of games in therapy sessions, both therapeutic and “non-therapeutic,” the difference being what their intent and purpose was when the game makers created them.  “Non-therapeutic” games are those that you can find at your local department store and find in the game aisle, like Scrabble, Monopoly, and Battleship.  In my experience, ANY game, regardless of its intent during creation, can be therapeutic.  I’ve taken many, many “non-therapeutic” games and turned them into awesome therapeutic interventions in therapy.  The results are always amazing.  Kids love that they’re playing a game, and they don’t even mind that I may have changed it up a little.  My next few posts will be about some of my most favorite “non-therapeutic” games to play in therapy.

Therapeutic Jenga

Jenga is a gem!  I have used Jenga hundreds of times as a therapeutic intervention.  The game can be used in so many ways and with practically any topic you think of.  Additionally, I’ve found that I can use Jenga with any age group:  children, adolescents, and even adults!

When I first started using Jenga, I would write various tasks and questions based on the skill I was trying to teach on the individual wooden blocks.  This isn’t necessarily a bad idea, but it didn’t take long before I had spent a small fortune on Jenga games.  If you walk into my office, you’ll find several Jenga games, each covering different topics and for different age groups, all created before I eventually realized that it was significantly more cost effective to just purchase one Jenga game, color code the blocks with stickers or markers, and create prompt and task cards to use instead.  You can create your own Therapeutic Jenga any way you wish, but if you plan to use the game for several different skill teachings, I’d advise the latter method.

Therapeutic Jenga is played by following the game’s original game instructions, regardless of what topic or skill is being taught.  Simply color code your individual blocks with various colored stickers or by using different colored markers prior to play.  Have color coded task/prompt and/or question cards prepared as well.  During game play, a task card is drawn according to the color code on the block that is plucked from the tower.  The person who picks the block is the one who answers or completes the question/prompt.  Just for fun, I intentionally leave a few of the blocks blank (with no color code), which are used as free passes, meaning there’s no question/prompt to complete – the kids and teens especially love when they choose one of these!

What therapeutic skills can be taught using Therapeutic Jenga?

Among other topics, I’ve used Therapeutic Jenga for rapport building, reinforcing positive relationship skills, social skills, teaching emotion identification and expression, communication techniques, anxiety reduction, impulse control, and even to teach all ages how to dispute irrational self-talk.  I’m yet to witness even one person complain about not wanting to play Therapeutic Jenga.  It’s a game that is always met with an excited and receptive attitude!

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