Monday, April 10, 2023

By Don Sapatkin

Good Monday morning, readers. Today, an upbeat Daily: A home-like program in Oakland supports Cambodian refugees who survived the Khmer Rouge. Two colleges want to incorporate student mental health in all they do. A psychedelics pioneer asks his cancer – while on acid – about his impending death. And dementia caregivers weigh truthfulness and consequences.

An essay on whether to lie to dementia patients brings up a familiar dilemma

It’s a decision that I face all the time. When my 101-year-old stepmother asks whether she is paying for her round-the-clock health aides, do I tell her the truth (yes, a lot) and upset her (a lot)? Or should I lie and allow her to remain calm and enjoy the memories that we find together? I’m uncomfortable with both. In an essay for the New York Times, however, cardiologist and author Sandeep Jauhar has (just about) convinced me that it’s best for her to remain peacefully ignorant. My own conscience isn’t relevant.

Jauhar illuminates his own, similar dilemma with considerable reporting. Lying to dementia patients was consistently discouraged in the 1980s and ’90s. Then an English homemaker named Penny Garner noticed that allowing her mother to have her perspective, no matter how absurd, kept her calm and happy. Garner spoke up about it, to the great dismay of experts. The concept became known as validation therapy, which morphed into therapeutic deception. Garner’s idea is now used on many dementia units here and overseas, some of which Jauhar visited.

One large dementia village in the Netherlands uses a small army of caregivers who present themselves – and act as – gardeners, hairdressers or supermarket workers. They also practice the white lie. “If a patient is asking for her daughter, and you know the daughter isn’t coming, you say, ‘She will come in a couple of hours,’” says a guide who showed Jauhar around one such facility in the Netherlands. “It is dealing with dementia the way it is.” Still, Jauhar does not like to lie and avoids it whenever possible. I’ve found that gently changing the subject usually does the trick. (“What was it like raising your daughter?”) Especially since my stepmother may ask the same fraught question in 30 minutes, and again in a couple hours.

“A place of shade” helps Khmer Rouge survivors heal

CERI seems more like a temple – or a home – than a clinic. For two decades, the nonprofit Center for Empowering Refugees and Immigrants in East Oakland has served as an oasis. It’s “a place of shade,” as one client put it, “a place to heal,” says another – for immigrants traumatized by the brutal Khmer Rouge regime that ruled Cambodia in the late 1970s.

The success of CERI’s program comes from its focus on transplanting Cambodian culture to an old Victorian in East Oakland and the atmosphere, which participants say is like a second home. Soreath Hok, the child of Cambodian refugees and a reporter for Central California’s KVPR public radio, explored the program in a podcast for sister station KQED.

The center hosts cooking classes and has a room with mats but no chairs, where elders sit and talk for hours, like they did back home. Hok, who reported on CERI last year for KVPR, says in the podcast that she was looking for efforts that really worked to help people from her community, who suffer from high rates of PTSD and depression. She found it in this place that makes people feel welcome and allows them to open up about their mental health.

Colleges put mental health at center of student life

Teenagers are entering college with exceptionally high rates of sadness. So institutions of higher education “must put student wellness at the forefront of the college experience.” That’s the gist of an opinion piece in The Philadelphia Inquirer by two new college presidents – Robyn Hannigan of Ursinus College and Stacey Robertson of Widener University.

Ursinus in October became the first liberal arts college to sign the Okanagan Charter, an international pledge with two calls to action:
1) to embed health into all aspects of campus culture, including administration, operations, and academic programs
2) to promote action and collaboration on health, both locally and globally.

It also founded a new division of health and wellness that unites athletics, clinical services (including medical care, counseling, and sports medicine), and health promotion (both prevention and advocacy) under one administrative roof.

Widener is aiming for similar goals through a four-year partnership with the Jed Foundation to develop a strategic plan that will guide the university in implementing tools, strategies, and techniques designed to improve student mental health and wellness and increase a sense of belonging and connection.

How incarceration destroys your mental health

Photo: Shutterstock

There’s little question that jails, prisons and detention facilities for juveniles and immigrants are bad for mental health. Rates of PTSD are five times higher among inmates than the general population. That’s partly because more people enter these institutions traumatized or with mental illness or addiction. The Insider looked at the other part:

Incarceration often includes excessive heat or cold, frequent violence, unsafe working environments, and punishments like solitary confinement. All those are stressful, and stress contributes to all sorts of mental health problems.

Loss of control — when to wake up, what to wear, how to spend your day — can cause your brain to lose the flexibility needed to make choices and practice self-control. Isolation from friends and family can lead to depression. Becoming emotionally numb – expressed visually as a “prison mask” – can, over the long term, trigger anger, violence and suicidal thoughts. And sleep deprivation, says neurologist Audrey Nath, “may result in cognitive deficits similar to being drunk.”

In other news…

Starting an overdose patient on buprenorphine in the ER does not trigger withdrawal symptoms from fentanyl, Politico’s Pulse newsletter reported. The finding, published in JAMA Network Open, is important because few patients are likely to follow doctors’ advice to seek out treatment with the highly effective medication once they leave the emergency department — especially since they will quickly go into withdrawal and buy drugs on the street to avoid it.

The FDA will require opioid manufacturers to include mail-back envelopes so patients can dispose of unused pills. The effort will likely start next year, Politico’s Prescription Pulse newsletter reports. Here’s FDA head Robert Califf:

Anger is more common in adults who suffered childhood trauma, Medscape reported. Emotional neglect during childhood is associated with a 40% increased likelihood of subsequent anger. Psychological abuse was linked to 30% higher odds. Childhood trauma also manifests differently by sex in adulthood, according to a presentation at the European Congress of Psychiatry. The findings are significant because psychiatric treatments for past trauma may differ from treatments for depression.

Dr. Roland Griffiths, a pioneer in studying psychedelics, discussed his approaching death from colon cancer in a relaxed interview with New York Times columnist David Marchese. And yes, he did an LSD session and asked the cancer: “‘This process, is it going to kill me?’ The answer was, ‘Yes, you will die, but everything is absolutely perfect; there’s meaning and purpose to this that goes beyond your understanding, but how you’re managing that is exactly how you should manage it.’”

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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Type of work:

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...