0 Boston Marathon Runner & Psychiatrist Shares Personal Story of Patriots' Day 2013

Special guest post by psychiatrist Brent Forester, M.D.

"People here need to talk about what they have been through,” says Dr. Forester. “I spoke with my medical students after the race, and they all wanted to do something to help. I told them that the injured, their families, and first responders all need a lot of emotional support.”

Monday, April 15, 2013 began as a sunny, chilly early spring day...a perfect respite to our long, dark, cold winter that brought challenges to the months of training required to run a marathon. My wife, Kim, was giving me a hard time for the training schedule I was keeping, perhaps secretly knowing what I did not yet realize: I was destined to run Boston in 2013.

What began as a challenge from Kim to run a half marathon in 1999 had morphed into a full blown passion and time consuming avocation: running long distance races to fundraise for the Alzheimer’s Association and this year, a mentoring program for future geriatric psychiatry clinicians. But after a personal best in the Chicago Marathon in October 2012, I had decided to spend 2013 focusing on a more “normal” distance of 13.1 miles, setting a goal of running 50 half marathons by my 50^th birthday (35 down with three years to go!).

Perhaps by fate, one of my running buddies was felled by a foot injury and offered me his number for Boston in late February, with only six weeks to go until race day. Luckily, I had been training with this most incredible group of friends, all neighbors and fellow runners, meeting five days a week at 5:40 a.m. (or earlier!) at the corner of Ledge and Mossman in Sudbury. Sadly, a year of brainstorming had yet to generate a team name.

On Saturday before the marathon, our families and friends gathered for a festive night of pasta to celebrate all the hours and miles of running, lack of sleep, painful legs, and cross-training efforts that included early morning TRX and spin classes and a Tuesday night yoga group for runners (minus the see-through Lululemon wear). Anticipation and excitement for Monday, Patriots’ Day, was at a peak.

The Boston Marathon is known for Heartbreak Hill, the cheering Wellesley women, the rowdy and inebriated Boston College students, the biker bar patrons on the Hopkinton/Ashland line yelling in their black leather outfits drinking beers on a Monday Morning. Where else does this happen? The Boston Marathon is all about the crowds. They are loud, deep, diverse, and hysterically funny with signs and outrageous costumes. The same fans cheering on the world’s elite, yell even louder for the “normal” charity and barely qualified runners, distributing beer, oranges, pretzels, and even Vaseline on a stick to reduce the inevitable burning and blistering skin.

Monday, April 15^th was a tough run for me. It was warmer in the sun than expected, and a pacing problem during the first half of the race left me weary climbing Heartbreak Hill. But a running buddy neighbor of mine ran a mile with me through the Newton Hills, and then I took off, determined to complete this race in less than four hours. It would be very close. The Red Sox crowd had just spilled into Kenmore Square when I arrived, and they were loud…but I stayed focused, down and up Commonwealth Ave. crossing beneath Massachusetts Ave., then a right on Hereford, a surprisingly tough hill up to Boylston, and a left hand turn down the long, endless 800 meters to the finish line near Dartmouth.

3:58:46. I did it! Exhausted. About to break out into tears reflecting my emotional sense of accomplishment and relief, when I heard behind me a massive explosion. I ducked. We shook. And then I looked behind me at a cloud of smoke and debris. “Oh my God,” I thought immediately of the many lives that had instantaneously ended or changed forever. But it was all very confusing: Where were my wife and daughter? I’ve got to get out of here. Where were the water and the silver warming cape? Was that a terrible accident or… And then the second bomb, panic; we were under attack.

Where was the next bomb going to strike? I borrowed a cell phone, “Kim, there was a bomb at the finish line; I am fine. Where are you?” She was driving on Huntington and Dartmouth, a block away…oh no. “Stay away from the Westin, do not park; drive to the corner of Boylston and the Commons.” How come everyone was so calm? The volunteers handed out our water, the silver cape, food, and the precious finisher’s medal, and then I left on Berkeley to the buses for my yellow bag and the port-o-potties, but were they even safe?

I do not recall well the four block walk to that meeting spot; it seemed endless, and there was no Kim when I arrived. And no cell phone service. Then, three of our psychiatry residents came walking across the street, calmly and not sure of what was happening. They are a godsend of emotional support with cell phones. I am shivering. I have not eaten or even sipped any water. An hour passes; finally Kim and my daughter arrive, unscathed. We were safe.

And then the “what ifs” race through your mind: What if I had taken my usual port-o-potty break or not pushed through those last few miles to break the four hour mark? I cannot really think about these realities.

Will the marathon, Patriots’ Day, Boston, Fenway Park, and all the stadiums hosting our beloved local sports teams ever be the same again?

The timing of the bombs was such that the charity runners were crossing the finish line, the four hour gang, not the elites or the sub-three hour athletes, but the everyday guy and gal who train though ice and snow for this moment, to cross the finish line in Boston cheered on by hundreds of thousands of loud supporters, strangers who seem to care about you and want to see you reach your goals whatever they may be. They were the targets of the Boston bombers.

Boston strong, the theme that has risen from the ashes of this tragedy, carries us forward and brings us closer together as a community of runners, spectators, first responders, healthcare professionals, firefighters, and police. We are all together now as one, culminating in the heroic 24 hour siege and Boston area lockdown, another surreal event capturing the intensity, exhaustion, and ultimately relief of a region.

Finally, at 8:42 p.m. on April 19^th, it is over. In a boat on Franklin Street, five blocks from my old Watertown apartment. The local hero is a regular guy who spies the blood and then the suspect.

It’s now time to go to sleep. I'll be up in five hours to meet my running crew for a slow six miles around our neighborhood, running for the first time since Hopkinton and sharing our stories, our grief, our anger, and our triumphs. This is the way we process our emotions and move forward. We still need a name for our crew; Sudbury Strong may work.

The American Psychiatric Association's website has resources for coping with traumatic events and how to help children.

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0 Tips for Talking to Children about the Connecticut School Shooting

By David Fassler, M.D.

Parents and teachers are faced with the challenge of discussing the recent tragic school shooting in Newtown, Connecticut with young children. Although these may be difficult conversations, they are also important.

There are no "right" or "wrong" ways to talk with children about such traumatic events. However, here are some suggestions that may be helpful:

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  Create an open and supportive environment where children know they can ask questions. At the same time, it's best not to force children to talk about things unless and until they're ready.

  
  
  
  


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  Give children honest answers and information. Children will usually know, or eventually find out, if you're “making things up.” It may affect their ability to trust you or your reassurances in the future.

  
  
  
  


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  Use words and concepts children can understand. Gear your explanations to the child's age, language, and developmental level.

  
  
  
  


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  Be prepared to repeat information and explanations several times. Some information may be hard for them to accept or understand. Asking the same question over and over may also be a way for a child to ask for reassurance.

  
  
  
  


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  Acknowledge and validate the child's thoughts, feelings, and reactions. Let them know that you think their questions and concerns are important and appropriate.

  
  
  
  


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  Remember that children tend to personalize situations. For example, they may worry about their own safety or the safety of friends or siblings when going to school.

  
  
  
  


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  Let children know that lots of people are helping the families affected by the recent shooting.

  
  
  
  


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  Don't let children watch too much news coverage with frightening images. The repetition of such scenes can be disturbing and confusing.  

  
  

  
  
  
  

Children learn from watching their parents. They are very interested in how you respond to local and national events. They also learn from listening to your conversations with other adults.

Children who have experienced trauma or losses in the past are particularly vulnerable to prolonged or intense reactions to news or images of violent incidents. These children may need extra support and attention.

Children who are preoccupied with ongoing questions or concerns about safety should be evaluated by a trained and qualified mental health professional. Other signs that a child may need additional help include sleep disturbances, intrusive thoughts or worries, or recurring fears about death, leaving parents or going to school. If these behaviors persist, ask your child's pediatrician, family physician, or school counselor to help arrange an appropriate referral.

Although parents may follow the news with close scrutiny, most children just want to be children. They may not want to think about or discuss violent events. They'd rather play ball, climb trees, or ride bikes.

Senseless, violent crime is not easy for anyone to comprehend or accept. Understandably, some young children may feel frightened or confused. As parents, teachers and caring adults, we can best help by listening and responding in an honest, consistent, and supportive manner.

Fortunately, most children -- even those exposed to trauma -- are quite resilient. However, by creating an open environment where they feel free to ask questions, we can help them cope with stressful events and experiences, and reduce the risk of lasting emotional difficulties.

David Fassler, M.D., is a child and adolescent psychiatrist practicing in Burlington, Vermont. He is also a clinical professor in the Department of Psychiatry at the University of Vermont, College of Medicine.

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0 Tips for Talking to Children about Aurora Shooting

By David Fassler, M.D.

Parents and caretakers are faced with the challenge of discussing the recent tragic shooting in Aurora, Colorado with children. Although these may be difficult conversations, they are also important. There are no “right” or “wrong” ways to talk with children about such traumatic events. However, here are some suggestions that may be helpful:

• Create an open and supportive environment where children know they can ask questions. At the same time, it's best not to force children to talk about things unless and until they're ready. 

• Give children honest answers and information. Children will usually know, or eventually find out, if you're “making things up.” It may affect their ability to trust you or your reassurances in the future.

• Use words and concepts children can understand. Gear your explanations to the child's age, language, and developmental level.

• Be prepared to repeat information and explanations several times. Some information may be hard for them to accept or understand. Asking the same question over and over may also be a way for a child to ask for reassurance.

• Acknowledge and validate the child's thoughts, feelings, and reactions. Let them know that you think their questions and concerns are important and appropriate. 

• Remember that children tend to personalize situations. For example, they may worry about their own safety or the safety of friends when going to the movies or other public areas.

• Let children know that lots of people are helping the families affected by the recent shooting. 

• Children learn from watching their parents. They are very interested in how you respond to local and national events. They also learn from listening to your conversations with other adults.

• Don't let children watch too much television / news coverage with frightening images. The repetition of such scenes can be disturbing and confusing. 

• Children who have experienced trauma or losses in the past are particularly vulnerable to prolonged or intense reactions to news or images of violent incidents. These children may need extra support and attention.

• Children who are preoccupied with questions or concerns about safety should be evaluated by a trained and qualified mental health professional. Other signs that a child may need additional help include ongoing sleep disturbances; intrusive thoughts or worries; recurring fears about death, leaving parents, or going out to public areas. If these behaviors persist, ask your child's pediatrician, family physician, or school counselor to help arrange an appropriate referral.

• Although parents may follow the news with close scrutiny, most children just want to be children. They may not want to think about or discuss violent events.  They'd rather play ball, climb trees, or ride bikes.

A senseless, violent crime is not easy for anyone to comprehend or accept. Understandably, some young children may feel frightened or confused. As parents and caring adults, we can best help by listening and responding in an honest, consistent, and supportive manner.

Fortunately, most children -- even those exposed to trauma -- are quite resilient. However, by creating an open environment where they feel free to ask questions, we can help them cope with stressful events and experiences and reduce the risk of lasting emotional difficulties.

David Fassler, M.D., is a child and adolescent psychiatrist practicing in Burlington, Vermont.  He is also a clinical professor in the Department of Psychiatry at the University of Vermont College of Medicine.

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0 Suicide Prevention for Seniors and African Americans

By Gina N. Duncan, M.D.

Don Cornelius’s death shocked many of us. The report that his death was a suicide has made it all the more tragic. Best known as the founder of Soul Train, Don was an icon in American music history. Unfortunately, as noted by others commenting on his death, the “Love, Peace, and Soul” he promoted as a public figure may have eluded Don in his personal life, particularly in his later years.

Now we are further shocked by the untimely death of Whitney Houston. Her battle with drug abuse was well known, though the cause of her death has not yet been determined. In our sensational, media-driven culture, the very personal details of celebrities’ mental, emotional, and family struggles are often on display for public entertainment, sympathy, judgment, and criticism. In recent years, with the tragic losses of Michael Jackson, Amy Winehouse, Heath Ledger, and others, the dangers of illegal and prescription drug abuse have been given an increasing spotlight in the media.

 

Don Cornelius’s death, however, highlights two mental health issues that are significantly under-discussed in the public: suicide in African Americans and in seniors.

Depression is under-diagnosed in older adults. It often co-occurs with medical illnesses such as heart disease, diabetes, stroke, and cancer, and can be associated with the social difficulties and financial strain many older adults experience. Because of this, we tend to accept depression as a natural consequence of aging, but this is not so. When depression is present, it not only diminishes a person’s quality of life but also increases his / her risk of death by delaying or worsening recovery from the medical illness or by suicide. Depression is also under-recognized and under-treated among African Americans and other minorities. 

I recently spoke at a National Alliance on Mental Illness (NAMI) program called "Sharing Hope: Understanding Mental Health" in Augusta, GA. “Sharing Hope” is an educational program designed to raise awareness of mental health issues in African American church congregations. One woman there told us that her brother had died from suicide not long ago. She explained that he had been troubled for some time and had made threats before but not acted on them. She asked: Were there signs she and her family missed? Was there some way they could have prevented it? She expressed feelings of guilt and shared that she and her family blamed themselves for not having done more, yet at the same time, they didn’t know what more they could have done. 

My heart goes out to her and to anyone who has been affected by the suicide of a loved one. Feelings of guilt, self-blame, and shame are common. Perhaps some consolation can be found in the recognition that it’s impossible to fully control the decisions and actions of another adult. There are support groups for survivors of suicide that provide a place to express these complex emotions. Seek support from your faith if that is relevant to you, and tune out those who would make negative remarks about your loved one's fate after death, as none of us have the final say in that matter. 

The best suicide prevention is early recognition and treatment of depression. Depression may be masked by factors such as medical illness, dementia, personality style, and other mental illnesses, so understand the symptoms. 

If you are concerned about a loved one, please follow these suggestions:

1)  Do not be afraid to ask if they are considering suicide--you will not plant the thought in their mind by asking.

2)   Stage an intervention if necessary, where you can express your concerns and encourage them to get treatment.

3)  Take any and all threats or gestures seriously--seek help from their doctor immediately or call 911.

We should celebrate the achievements of Whitney Houston, Don Cornelius, and the other amazing talents we’ve recently lost; our lives are richer for their contributions. I hope that by raising awareness of these critical mental health issues, their untimely deaths will cause others to seek help and to heal. 

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0 Helping Others Helps Your Mental Health: Why Volunteering Makes Us Happier

By Roberto Blanco, M.D.





I had just sat down for Dr. Norden’s Neuroanatomy class when one of my classmates, who had just walked into lecture late, announced he heard on the radio that a plane had crashed into one of the World Trade Center Towers.  As was her way, Dr. Norden showed immediate concern, and before I knew it, we were watching another plane fly into the second tower live on CNN in the front of the lecture hall.  It was a surreal scene in Light Hall on Vanderbilt’s Medical campus; one that I did not expect to experience.  The rest of the day was a blur of events and emotions – people in a state of shock, tears shed, classmates comforting each other, and Dr. Norden attempting to put things in perspective.  Class was dismissed for the day, and the rush to call loved ones in New York City and Washington, D.C. began.  My thoughts immediately turned to family members who lived in New York and worry when I was unable to reach them.



10 years ago, the world of every American changed.  In response, the country and the world came together in support of the victims of the terrible tragedy.  People from far and wide drove, some for thousands of miles, to reach New York City and care for complete strangers.  People sacrificed their time, sweat, and a good portion of their lives and livelihoods to help those in need.  Donations flooded in to support the victims’ families.  A rush of prayers, love, and aid from across the globe also streamed in for those affected.  It seemed that the world was one in giving to those who had lost.



I recently wrote a blog post here on happiness, human fulfillment, and flourishing.  In that posting, I discuss human fulfillment and flourishing as the real definition of happiness and the final aim of all of what we do.  A great way to help yourself and your own mental health is to help others.  Feeling useful and needed is a wonderful way to work towards human fulfillment and recognize all you have for which to be grateful.  Serving others is a sign of individual and community emotional health.  Volunteering your time and talents also leads you to finding the love within yourself that you didn’t know you had.  When faced with those who have lost and are truly in need, just like on September 11th, the true beauty of mankind comes out.  



For Sunday's 10th Anniversary of September 11th, President Obama is calling for a national day of giving in memory of those who passed during the attacks.  His goal is to have over 1 million Americans engaged in volunteer work on September 11th.  The American Psychiatric Association has joined "Give an Hour" in aid of military members, veterans of Iraq and Afghanistan, and their families as part of the “I will” campaign to encourage that same spirit of service that was felt in the days following the attacks.  So, think about joining us in giving by helping build a house for a needy family through an organization like Habitat for Humanity.  Volunteer to distribute food or give to your local food bank.  Help a friend move.  Donate time or resources to a homeless shelter, spend time with the elderly, or serve at a local hospital.  This September 11th, let’s honor those who died by helping a member of your community in need.

In photo: Dr. Blanco and another volunteer work together to build a home through Habitat for Humanity

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0 Coping During Disasters

By Gabriela Cora, M.D., M.B.A.





The earthquake in Haiti hit the most impoverished nation in the Western hemisphere. A land already struck by hurricanes, the loss of life in the thousands magnifies the catastrophe exponentially. What to do onsite and what to in the States when family members worry about loved ones?

Aside from the physical devastation caused by natural disasters, the psychological short and long-term impact may be even more damaging. Keeping up to date with the latest news while not overdoing this all day long will help you cope with the situation. 





Additionally, taking control of simple habits, accepting help, eating, drinking clear water and having some sleep will help through the difficult aftermath. One particularly challenging area is keeping children safe both physically as well as psychologically. As an adult in charge of your own children or caring for other children during a disaster, it’s most important to provide for physical safety, keep them busy helping out others, if they can, and allow them to share their fears and worries. 

Visit Switchboard Miami for additional hotline assistance, available in Creole.

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