When I visited my daughter, who is in her 40’s, in New Hampshire last summer, she had a book on the coffee table called “The Day I Ate Whatever I Wanted: And Other Small Acts of Liberation” by Elizabeth Berg. The title surely caught my attention not only because I am a writer but also because it’s such a universal desire for so many of us who are becoming more and more health conscious. . .at every age. We have learned that with each passing year, we have to cut back on more and more of the savory delights we could eat with NO CONSEQUENCES just a few years back.

With the holiday season right around the corner, plans for large meals and family feasts are underway. Most of us cringe a little at the thought of the struggle of the next few weeks. But our angst is really minor, even prone to humor, as evidenced by the book, when we think about those who suffer from eating disorders. For them, the pressure to be thin and fit into unreasonable standards of beauty causes intense anxiety, unfortunately sending individuals down the path to serious, even life threatening illnesses.

Eating disorders are serious health conditions that are destructive both physically and emotionally. Typically seen in youth, eating disorders impact approximately eight million people in the United States, according to the National Association of Mental Health. While stereotypically found in females, more than one million males struggle with eating disorders as well. Although the exact cause has not been determined, eating disorders are often attributed to a combination of genetic, mental health and social factors. Eating disorders are not just unhealthy -- they are serious and can be life-threatening.

Anorexia, bulimia and binge-eating disorder are the most common eating disorders. Characterized by extremely low body weight, recurring binging and purging and lack of control over food consumption, all three disorders are dangerous. Symptoms of eating disorders vary depending on the type of disorder. Common warning signs include a preoccupation with body or weight, an obsession with calories, food or nutrition, constant dieting regardless of weight, rapid unexplained weight loss/gain and avoiding social situations involving food. Individuals suffering from eating disorders also often make excuses for not eating, exercise compulsively, take diet pills or laxatives and eat alone, at night or in secret.

The good news is that eating disorders are treatable;--60 percent fully recover. The sooner an individual accepts treatment, the less intensive their treatment may be. Treatment varies depending on the level of severity, but can include individual or group therapy, nutritional counseling, support groups and residential treatment. Hospitalization is typically not needed unless an individual is dangerously malnourished, severely depressed or suicidal, suffering from medical complications or getting worse despite treatment. Treatments can be tailored to fit an individual’s needs in order to enhance their recovery. For treatment information in Oakland County call the Resource and Crisis Helpline 1-800-231-1127

If you know someone who needs help for an eating disorder, offer your assistance. This may be just the additional nudge they need to get motivated for recovery. Your support can make a difficult process more manageable. And this holiday season, shift your family’s focus from food to togetherness; it will bring extra meaning to the season, while also alleviating stress and challenges that food brings for many Americans.

Jacqueline Castine is the community education specialist at the Oakland County Community Mental Health Authority . Her fall class schedule is posted at www.jacquelinecastine.com. She is the author of I Wish I Could Fix It, But. . . She can be reached at castinej@occmha.org and 248-975-9684.

November was another busy month for the Community Network Services Anti-Stigma Program. November began with two presentations for MIAPSRS (Michigan Association of Psychosocial Rehabilitation Services) at their annual conference in Frankenmuth, Michigan. This year’s theme was “Money, Meaning, Moving Forward: Making Work, Work for You”. A one hour presentation of the same name was presented as the keynote address during breakfast and the popular “Recovery, It’s a Journey and Not a Destination” was presented in the workshop that followed.

The Auburn Hills Library requested a staff in-service on mental health issues to help them better respond to customers who may come into the library displaying symptoms of a mental health challenge.
OLHSA (Oakland Livingston Human Service Agency) invited the team back to participate in another conference. Two sessions were given to Head Start Staff to give them insight into mental health challenges and the stigmas associated with them. A number of resources were distributed as well to provide information on available resources in Oakland County for help with mental health issues.

The CNS Anti-Stigma Program also partnered with the Oakland County Community Mental Health Authority, the Oakland County Suicide Prevention Coalition and Christ the Redeemer Church to provide a program on general mental health information, suicide and stigma that’s been proven to be a deterrent to people getting the help they need. This topic was especially pertinent to the Lake Orion Community who unfortunately experienced the loss of a 15 year old young man to suicide earlier that same week. Many leaders expressed a desire to see the “Stomp Out Stigma” program presented to high schools in the area to help educate and better prepare young people on how to deal with any mental health issues that they may encounter.

Another successful program was done for the St. Joseph Mercy-Oakland Behavioral Health Day Program located at the Harold E. Fox Center in Pontiac. Because of the positive response to the program staff has requested monthly “Stomp Out Stigma” sessions for Day Program participants to the end of 2010.
Senior Citizens and their unique mental health challenges was the topic of the presentation given at the Kelly Morang Senior Center located inside the Charity Lutheran Church in Detroit, MI. The interaction between team members and Center Members was lively. Many had insight into mental health challenges that was gained through personal experience with mental health challenges, often through their loved ones. The center director was so impressed that she asked the team to come back next year to do another program for their seniors and the staff as well.

A recent Grey’s Anatomy episode tweaked my “Stigma In Action” button the other day. This episode, entitled “I Always Feel Like Somebody’s Watching Me”, featured two characters affected by Schizophrenia. One character was a young man named Tom who had been diagnosed with paranoid schizophrenia. The other character was his mother and caregiver. Within moments of meeting these two characters, Tom’s mother informs the doctors that her son “is a paranoid schizophrenic”. As the episode progresses, Tom displays extreme distress at the prospect of the doctors treating his mother or him, attacks a doctor, and then runs away. When this happens, one of the doctors on the show is heard talking about how stressful things are, partly because there’s “a paranoid schizophrenic on the loose!” Aside from these depictions of a person with a mental illness, Tom’s mom and her care giving role were also touched on. This character had neglected her own needs and health for a long time in order to care for her son. She said that her marriage ended because of it, and she had been sick for a long time but “could not seek treatment” because she had a sick son.

Unfortunately, these stigmatized words, images, and ideas are nothing new. We talk about similar depictions of mental illness monthly in this column. Regardless of how often I see and hear such things, It is always disturbing to me when a show as widely-watched and respected as Grey’s Anatomy gets it wrong. Yes, there are people in the world with paranoid schizophrenia. And yes, there are family members who have devoted their lives to caring for their loved one. In this, the show is correct. However, the way these characters were depicted did not illicit a “wow, that is so interesting, I never knew that about mental illness” from the audience. Instead, it generated a “that woman is crazy for spending her whole life on her son, and he’s a nut too!” type of response.

This episode could have been used as a teaching opportunity. The show talks about various medical issues each week, and the creators have said in interviews how careful they are to make sure that their medical facts are correct and the scenarios they present are possible. It does not seem as though they did this in this episode. They could have contacted any number of national advocacy bodies to ensure that they had their bases covered. They have stated that they are so careful to get their medical facts straight, I can’t help but wonder if it is stigma and lack of awareness that kept them from ensuring this certainty extended to the mental health realm.

I am sure that there was no harm meant by this episode. I don’t think that there were evil intentions behind the subject matter. I truly believe that it was a lack of education that kept the writers from handling this subject matter in a better fashion. As we continue to educate and spread awareness, it is important that our messages reaches far and wide, because as people surf the channels, we want the waves of information to be accurate and empowering!

Last month we celebrated Veteran’s Day. It is a day where we honor and remember those who have fought for our country, and are still fighting at this hour. However, it is our hope that we continue to honor and remember them even past Veteran’s Day; for they serve our country, our families, and protect our freedom.

On the eleventh hour of the eleventh day of the eleventh month, 1918, the guns fell silent on the Western Front in France as the Germans and their allies formally signed the Armistice ending the carnage of World War I. Subsequently, November 11 has become an honored day in the United States and for other countries around the world. An Act (52 Stat. 351; 5 U.S. Code, Sec. 87a) approved May 13, 1938, made the 11th of November in each year a legal holiday; "a day to be dedicated to the cause of world peace and to be thereafter celebrated and known as 'Armistice Day'."

As Armistice Day later became known as Veteran’s Day, we admirably take the time to honor those who have served in the Armed Forces. As we are embroiled in conflicts around the world, particularly in Afghanistan (Operation Enduring Freedom, OEF) and Iraq (Operation Iraqi Freedom, OIF), it is important to remember that there are thousands of men and women who are away from their families deployed to these distant lands. And, although we honor those who serve with a special day, more importantly, we must honor them when they return by providing their care.

After WWI, men returning from France began suffering from unexplained health problems. Intense anger, insomnia, memory loss, uncontrollable “shakes”, nightmares, hypervigilance and panic attacks. Shell Shock became the term known for this particular problem and was first used during the World War I to describe the psychological trauma suffered by men serving on the war's key battlefronts. Many of those suffering from shell shock were unfortunately simply sent home as cowards or institutionalized. Most of them simply suffered alone.
As more became known about the problem, shell shock was later redefined in World War II, Korea, and Vietnam as “Battle Fatigue.” Today, we know it as Post Traumatic Stress Disorder or PTSD. PTSD is defined as an emotional illness that usually develops as a result of an experience, or experiences, that produce fear, terror, and helplessness. PTSD sufferers experience symptoms in three main areas: re-experiencing the traumatic event or events through nightmares or flashbacks, avoidance of people, places or situations that might remind them of the event, and through increased arousal and sensitivity in daily living. PTSD has only been recognized as a formal diagnosis since 1980.

The Vietnam War veterans brought the issue of PTSD to our awareness. The condition was the rule rather than the exception among veterans seeking help. Substance abuse, divorce, and homelessness were rampant among Vietnam veterans. Looking for care for these issues, they began to overwhelm the Department of Veteran’s Affairs. As Vietnam veterans organized and became politically active, they demanded better care and treatment. Eventually, they started to get it.

However, we are again faced with overwhelming numbers of returning veterans who need help. According to Department of the Army research statistics, one in five returning soldiers from OEF/OIF will suffer from some form of PTSD. There are currently more than 300,000 soldiers who are currently diagnosed with PTSD and are undergoing treatment. There are believed to be at least 500,000 more suffering from PTSD. Currently there are 320,000 diagnosed with Traumatic Brain Injuries. As well, it is believed that these numbers are currently severely underreported.

The State of Michigan has provided a large contingent of National Guard and Reserves to OEF and OIF. According to Department of Defense statistics, more than 500,000 National Guard troops from around the country have served in OEF/OIF, one third of them more than once. As well, 15% of all troops serving are female, and women are 2 times more likely to suffer from PTSD.

As of this date, our military involvement in OEF and OIF has lasted longer than our military involvement in Vietnam.

As a nation, it is important that we remain involved and active in the pursuit of helping and advocating for care for our veterans. Although the wars are not always on the front page of the newspaper or on the first story on the news, our soldiers, sailors, airmen, Marines and members of the Coast Guard must be in the forefront of our thoughts and in our hearts. As a country, it is imperative that we educate ourselves on the struggles and challenges our veterans face, and demand that our political leaders and government ensure the best possible services.

November 11 is truly a special day for Americans. It is the day that we honor our veterans. For veterans, it is the day to remember that in 1918 “The War to End All Wars” ended. November 11 is the day the guns fell silent.