Divorce by 10,000 cuts

April 12, 2022

Good morning MindSite News readers. Today, we bring you an essay about the little things that can poison a marriage, and the need for marital compromise as an act of love. We also share two articles about efforts to boost mental health in Africa – one by building a humane hospital and training humane therapists and the other by training peers to provide support to their neighbors. Plus: Looking at the gender imbalance in dementia and seeking knowledge from spiny mice about the mood swings and pain of menstruation.

Divorce by 10,000 cuts

It’s less the Major Marriage Crimes – sexual affairs or physical, emotional, or financial abuse – that end marriages, and much more the tiny actions (or inactions) that seem innocuous in the day-to-day. For relationship expert Matthew Fray, it was his repeated refusal to put a dish in the dishwasher at his ex-wife’s request, because he thought her insistence was silly. But what he thought to be “petty and meaningless” read to her much differently. 

Adapting an essay from his new book, This Is How Your Marriage Ends, for The Atlantic, Fray wrote, “My wife didn’t flip shit over a dish by the sink because she’s some insufferable nag who had to have her way all the time. My wife communicated pain and frustration over the frequent reminders she encountered that told her over and over and over again just how little she was considered when I made decisions.” Offering advice that’s largely applicable to all intimate relationships, Fray explained the importance of doing some things not because you want to, or even because you understand the origin of your partner’s request. Rather, do them “because you love and respect your partners,” and to them, it really matters.

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Building a mental health care system from scratch in Sierra Leone

What was once the setting for hundreds of years of psychological horror is now the site of new hope in mental health: The former Kissy Lunatic Asylum has become the Sierra Leone Psychiatric Teaching Hospital today in Freetown. Patients were previously chained to the walls of the facility, “untreated by medication or therapy,” and even lacking appropriate hygienic care, according to the New York Times. In 2014, Partners In Health, the Boston-based health care charity that works in some of the world’s poorest countries, began collaborating with Sierra Leone’s health ministry to transform the hospital. “And on the 18th of August, 2018, we unchained the patients,” Anneiruh Braimah, the head of nursing, told the Times. “It was epic.” Today, the building and culture has been overhauled to offer thoughtful and humane mental health care to adults and children alike. And the hospital is at the center of a national effort to create a mental health system – essentially, from scratch.

Their efforts are purposeful, sincere, and necessary—three consulting psychiatrists, the only ones in Sierra Leone, currently oversee six residents who will soon become the first psychiatrists ever trained in the country. The small number is reflective of a country  “with only three physicians for every 100,000 people,” where “mental health care is often seen as an impossible luxury.” These days, thanks to Sierra Leone’s government directing financial support from Partners in Health, the World Bank, and other donors to transform its health system, things in Kissy are changing. 

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Addressing trauma without professional therapists

Maji Hailemariam Debena grew up in Ethiopia during the Ethiopia-Eritrea War, so she knows first-hand about both war trauma and the dearth of psychological support in the region. Today, she’s a mental health epidemiologist based at Michigan State University, writing about the challenges of healing from post-war trauma, especially when access to mental health support isn’t widely available. In an op-ed published in NPR, she writes about the privilege she has to access private therapy in Michigan, in contrast to the situation back home. With just one psychiatric hospital and 100 licensed psychiatrists confined to the most urban areas in the nation of 115 million, Debena suggests the use of non-traditional programs to aid Ethiopian citizens in search of mental health support. 

Specifically, she made note of peer support programs, including the grandmothers of the Friendship Bench program in Zimbabwe. In lieu of professionals, Friendship Bench recruits and trains grandmothers to offer talk therapy in unconventional settings, such as outdoor parks, to help women in their communities with depression. Other developing countries also make use of peer support programs where participants are trained and develop skills in reducing interpersonal conflict, building social support and encouraging active listening.

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In other news…

With the number of people with dementia expected to rise from 6 million today to 13 million by 2050, Yale Medicine published an article on its public blog to address a few questions: Can we predict who will develop Alzheimer’s disease (AD) and other dementias? Can we identify biomarkers to predict disease development early? How can AD and dementia be treated? And how do sex and gender affect risk factors, symptom onset, and disease progression? Two-thirds of adults with AD are female, but scientists are unclear if biology or environment underlie those numbers – or the fact that women tend to live longer. Some studies suggest that certain heart conditions link more strongly to cognitive decline in women, even though men are generally at greater risk for heart disease by mid-life with conditions such as high blood pressure and diabetes.

Can spiny mice offer hope to menstruating humans? Science is trying to figure that out. Menstruation is uncommon throughout the animal kingdom, and cultures around the globe have been dismissive of women’s pain, stress and mood swings. But after centuries of not prioritizing women’s health – “there’s a national institute for every organ system except for the female reproductive tract,” this article from The Guardian notes, and no new treatments for menstrual pain and heavy bleeding for more than 30 years  – legislators in the U.S. and the U.K. are doing a bit more to study women’s reproductive health issues. One focus for researchers: the spiny mouse, one of the few animals that exhibits a menstrual cycle similar to humans. Scientists are stepping up studies that use these rodents in the hope of developing new therapies for conditions like endometriosis, adenomyosis, heavy bleeding, and PMS.

In the Strawberry Hill neighborhood of Kansas City, Kansas, residents have taken a different approach to the possibility of new mental health facilities opening in their community. Rather than view such facilities as a liability because of who they serve, they’re thought of as ways to anchor a network of agencies that support overall health. “We want to be a one-stop shop for health, not just mental health,” Stacie Stoltz told Next City. She’s a clinical manager at the new Strawberry Hill mental health center within the University of Kansas Health System. Her message: “We’re walking distance from the library and the grocery store, so…come to the library, come to our building for mental health, and, hopefully, someday, perhaps some physical health as well.” 

We all know by now that mental health among college students has worsened during the pandemic. But a study recently published in the Journal of Affective Disorders finds that students of color are both more vulnerable to mental health problems and less likely to seek help. Inside Higher Education reported on the study, which analyzed survey data from 2013 to 2021 from more than 350,000 students at 373 colleges. While the overall number of students seeking help increased over time, the number of Asian, Black and Latinx students seeking treatment “was consistently below the lowest rate for white students.”

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If you or anyone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. And if you’re a veteran, press 1.

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