Monday, November 6, 2023

By Don Sapatkin

Good Monday morning! In today’s Daily: Doulas ease stress and reduce pregnancy complications, especially for Black moms-to-be. Many reasons, none of them good – led to the failure to prevent last month’s mass shooting in Maine.

Plus: Meet the therapy dogs that help nervous witnesses in a Chicago courtroom. Blame the Denisovans – not the Neanderthals – for some gene-linked mental health problems. A guide to opening a trans-generational dialog on mental health with Mandarin-speaking parents. And mentally ill people are still held in chains in Ghana, a Human Rights Watch report finds.

‘Doulas bring humanity back and put clients center’

Jacquesta Michel used a birthing doula during the final weeks of her pregnancy with Ezra (Photo courtesy Jacquesta Michel)

Jacquesta Michel’s baby shower was supposed to be themed around her favorite Disney movie, The Lion King. Then her blood pressure spiked. Instead of dancing and eating Simba cake, Michel found herself in the hospital nearly three months before her due date, sleeping fitfully and worrying that she and her baby wouldn’t survive. 

Her lifeline was Sabine Renois, a birth doula. Doulas are non-clinical health care workers trained to tend to the physical and emotional needs of women during pregnancy, childbirth and beyond. They’ve been around for centuries and in the U.S., are becoming more widely used, helping address longstanding inequities that lead to high rates of pregnancy complications and maternal deaths among mothers of color. Read the full story here.

The Maine shooter left lots of danger signs. Agencies shared what they knew. Yet no one stopped him.

Robert Card displayed a textbook set of warning signs: He was hearing voices. He told people that he was planning violence. And his behavior had markedly changed in the months leading up to the mass shooting he carried out [on Oct. 25]. His family, his superiors in the military and the local police knew all of this. Yet no one stopped him.

So begins a New York Times examination of what led up to an Army reservist murdering 18 people in a bowling alley and a bar in Lewiston, Maine. While every mass shooting is unique, the missed opportunities in this case are unusually clear.

A lot of people knew that Card, 40, was a high-risk danger to himself and others, multiple agencies had records about his behavior, and they shared lots of details about it. Card’s ex-wife and teenage son reported to law enforcement in May that he had become paranoid and angry, and picked up 10 to 15 guns from his brother’s house. The sheriff’s office investigated. He spent 14 days in a psychiatric hospital in July, the military designated him as “non-deployable” and directed that he not have access to weapons. That determination applied only while he was on duty, which reservists like him rarely are, and reserve medical personnel made multiple attempts to contact him. The military and sheriff’s office shared information as well.

The Times concluded that “shortcomings in the mental health system, weak gun laws and a reluctance to limit personal liberties can derail even concerted attempts to reduce gun violence in America.” The complex interplay of factors unique to every mass killing – some but not all involving mental illness – make such horrors all but impossible to prevent as long as unfettered gun access is considered a right more precious than the public’s health.

Studies have generally found that greater availability of firearms is linked to more homicides, suicides and accidental deaths. Polls from the Pew Research Center conducted in June continue to show high levels of support for making gun laws stricter (58%), preventing people with a history of mental illness from buying guns (88%), and banning assault weapons (64%). Despite clear majorities favoring these changes, the divided and dysfunctional nature of the U.S. political system continues to make such changes all but impossible to achieve.

In Chicago, Birdie and Junebug calm the anxious

Via Facebook

When U.S. District Judge Virginia Kendall presides over major criminal trials in her Chicago courtroom, she has a couple of allies, hidden from view, helping to ease the stress of witnesses. Two Bernese mountain dogs, Birdie and Junebug, sit hidden on the dais. They are not allowed near the witness stand because that could soften jurors’ perceptions of the person testifying. But these trained therapy dogs offer great comfort behind the scenes to witnesses who may be nervous about testifying, particularly victims, Kendall told the Chicago Sun-Times. And to stressed-out lawyers, jurors and even defendants during breaks.

When the high-stakes corruption trial of former Chicago Alderman Edward M. Burke begins today, Birdie and Junebug will likely be present. Lots of tension, suspense and drama are anticipated. Kendall, who was nominated to the bench by President George W. Bush, introduced the dogs to the crowd of defense attorneys and prosecutors during a status hearing in the Burke corruption case. They petted and cooed over Birdie; Junebug was at the vet.

“Your jury will have the benefit of calm court dogs,” the judge told them. “And the lawyers usually need them, too.” A federal court in San Diego upheld the use of a therapy dog in a sex-crimes case. The dog sat at the feet of the victim, invisible behind the stand, while she testified.

These ancestors you’ve never heard of may have harmed your mental health

Photo illustration: Shutterstock

The ancestors of modern humans began migrating out of Africa around 60,000 years ago, gradually moving westward through the Middle East and Europe and spreading across Asia. They encountered and interbred with the now-extinct Neanderthals, who had simultaneously evolved there, and then with the lesser-known Denisovans, who originated in Southeast Asia and are believed to have disappeared some 15,000 to 30,000 years ago. Many of us contain small amounts of DNA from both – although Africans have almost none from Neanderthals and Asians have more from the Denisovans.

Scientists interested in evolutionary changes that helped humans adapt to different environments have been studying DNA from two dozen populations around the world to determine why natural selection favored a particular genetic variant that originally came from Denisovan DNA. The gene, known as SLC30A9, plays a role in distributing and regulating zinc. The variant tweaks regulation of the mineral, which is important for healthy growth and the proper functioning of our immune and neurological systems. It’s also involved with processes that may protect against cold.

A team of Spanish researchers has now concluded that the chillier climate where humans who left Africa settled likely drove natural selection to favor the variant (ZnT9 50Val). It happens to also be associated with greater risk of depression and several other mental illnesses, but the evolutionary advantage of better survival in colder latitudes apparently outweighed any disadvantage related to mental health.

Given that the variant is “associated with greater susceptibility to several neuropsychiatric traits, we propose that adaptation to cold may have driven this selection event, while also impacting predisposition to neuropsychiatric disorders in modern humans,” the authors wrote in their research article, published in PLOS Genetics. The technical language was translated into readable English by ScienceAlert, a media outlet that covers scientific issues and discoveries.

In Ghana, mentally ill people are still often kept in shackles

“Shackled in Ghana for Mental Health Conditions” View Human Rights Watch video here.

In a country with a dire lack of mental health services, many Ghanian people with mental illness end up in “spiritual healing centers,” better known as prayer camps, where people may be treated not only with prayers but with shackles, according to Human Rights Watch. An investigator for the rights group last month found nine Ghanaians in one camp restrained in ankle chains extending less than two feet who were “forced to urinate and defecate in a shared small bucket.” Residents of another spoke of “constant, gnawing hunger” from inadequate food, and some appeared emaciated. Human Rights Watch said it witnessed denial of adequate food and freedom of movement, unsanitary conditions and lack of hygiene and lack of access to health care.

Ghana’s 2012 Mental Health Act pledged that people with psychosocial disabilities “shall not be subjected to torture, cruelty, forced labour and any other inhuman treatment,” including shackling. Under pressure from United Nations reviewers, the government promised in 2017 to enforce the law. But little has changed. Families  frequently bring relatives with real or perceived mental health conditions to faith-based or traditional healers because of widely held beliefs that witchcraft or a curse triggered the problem – and because their communities have few if any mental health services.

During a visit to Ghana last November, Elizabeth Kamundia, deputy director of Human Rights Watch’s Disability Rights Division, met a woman in a prayer camp who had been locked up in what looked like a prison cell for more than a year. When she returned last month, Kamundia wrote, everything looked the same: “I asked where she slept. ‘On the floor,’ a staff member said. ‘When you give her a mattress, she destroys it.’” Kamundia ended her account with a series of actions the country’s leaders need to take. First on the list: for “the Ghanaian government to recognize [the] inherent worth” of people with mental illness.

In other news…

Mental health in Mandarin Chinese: a starter kit for dialogue,” is the headline of a Los Angeles Times story co-written by a 2022-23 Times fellow named Helen Li who recalled her difficulty communicating with her immigrant mother about mental health concepts. She found that no words in Mandarin described concepts like “depression” and “fat-shaming” that could enable her mother to understand that she was unintentionally harming Li’s sister with her language. For the story, Li and her colleagues hosted listening sessions with Mandarin-speaking mental health professionals and community members to discuss words that often lead to cross-cultural misunderstandings as well as language that could open up dialogue. The result is an impressive guide to starting conversations, complete with Chinese-centric themes and key words within them analyzed in text and pronounced in audio files: saving face (miànzi 面子),grief (bēishāng 悲傷), pity (yíhàn 遺憾).

A new sports and performance counseling concentration at Arizona State University is training students to support communities like athletes, first responders, performing artists and military personnel whose jobs may make them prone to anxiety, depression, substance abuse and other mental health issues.

Harvard University is creating a program to study psychedelics in society and culture, Politico Pulse newsletter reported. The interdisciplinary effort, launched with a $16 million gift from Antonio Gracias, spans the law, divinity and arts and sciences schools with a goal of transforming the psychedelics research landscape through scholarship and convening for discussion groups of students, faculty  and experts with a range of humanistic and scientific viewpoints.

YouTube will limit repeated recommendations for videos that promote ideal standards of beauty or other attributes for teens that may be harmless when seen once but become problematic if viewed multiple times, Fierce Healthcare reported. Examples are content that compares physical features or idealizes specific fitness levels or body weights. Across the pond, leading broadband providers in the U.K. told the BBC that they would block access to a website promoting suicide. A BBC investigation linked the forum to more than 50 suicide deaths in the United Kingdom.

The switch from in-person care to telehealth didn’t worsen mental health care on some measures fora cohort of 120,000 Medicare beneficiaries with serious mental illness, according to a study in JAMA Health Forum. The study also found that the patients, who were diagnosed with schizophrenia and bipolar disorder, had 13% more mental health visits when their providers switched almost exclusively to tele-mental health services compared with those that remained predominantly in-person. Politico Pulse reported the study.  

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...