There is a famous example of the fear, pain and joy concept told by Howard Schubiner, M.D., a leading pain researcher, of a construction worker who stepped on a nail that went through the sole of his boot and came out the top of the boot. Upon seeing the nail emerge through the top of his boot, the man began to scream in pain. He was taken to the emergency room, where he was given strong pain medication before they were able to get the boot off his foot. When they got the boot off his foot they discovered that the nail had gone between his toes and left no mark on his foot at all. So why did he experience pain? Because his brain was expecting it based on what he saw. That is the power of the brain – to create the sensation to protect the body from perceived danger. 

This is an example of the power of the brain to create pain based on fear and expectation. It neuro-circuits in the brain causing the pain responding to danger signals. Because the sensation of pain is one of the brain’s responses to danger signals, any experience that increases the potential of danger signals can increase the possibility of pain signals.

Fear is one of those things that can increase the danger signal. For example, if a person has had an injury in their foot that resulted in pain while weight bearing, then they may, very understandably, fear bearing weight in the future. That fear will then turn on the danger signal in the brain and increase the likelihood of pain being experienced. It can become a vicious cycle.

Everyone experiences anxiety from time to time. Some people experience it more frequently, in a way that interferes with functioning. Whether it is an occasional inconvenience or a daily struggle, learning tools to manage anxiety can be very helpful. Understanding how anxiety works in the body can help harness the power of the tools.

Anxiety is the body’s reaction to a perceived threat. It is a normal and good reaction when there really is a threat. Anxiety gives the body the energy to respond quickly to the threat. It is part of the sympathetic nervous system, otherwise known as the “fight or flight” system.

All mammals have a sympathetic nervous system that helps them survive when being chased by a predator or facing a disaster. Humans, like all animals, need this response when real danger happens. But humans are a bit different.

Trauma is more prevalent that most people realize. According to the U.S Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration’s website, two-thirds of people have experienced at least one traumatic event by age 16. In 2015, for every 1,000 children, 9.2 experienced some sort of child abuse or neglect. Their research suggests that 54 percent of U.S. families have been affected by some type of disaster. Many people have multiple or repeated trauma. The more intense and frequent a trauma is, the more likely it is to have an impact on people.    

Trauma has both short-term and long-term effects. In children this might be fear of being separated from a caregiver, excessive crying or screaming, weight loss and nightmares. In older children it could be poor concentration, feelings of guilt or shame, anxiety, depression, difficulty sleeping, eating disorders, self-harming behavior, sexual acting out or use of drugs or alcohol, among other things.

Olympic athletes train to be the best in the world at their respective sports. They are determined, talented, capable, and display a level of grit and determination qualifying them for the highest stage of competition. They spend years working toward a few simple ultimate goals: giving their best performance, honoring their country and leaving the court, mat, field or track with a medal in their hand.

When gymnast Simone Biles recently withdrew from the Olympic Games, it came to many as a surprise. What may have come as even more of a surprise to some is the reason she withdrew: her mental health.

This latest example of the courage of an athlete to stand up and let the world know that mental health is health has brought incredible awareness to the importance of mental health in all people, even Olympians.

If you’re an athlete, or if you have kids who play sports, you might be worried and wondering what you can do to address potential mental health struggles related to sports. Consider these suggestions when it comes to sports and mental health:

• Talk, talk, talk. If you find yourself experiencing stress, anxiety or depression related to a sport, consider finding a qualified counselor/therapist to discuss these issues. If you’ve got a child who plays sports, keep an open dialogue with them. Have regular, open and honest conversations about how they’re feeling, both mentally and physically.
• Watch for warning signs. This is especially important if you have a child or adolescent in sports. Keep an eye out for things like mood, sleep, or behavior changes that seem concerning.
• Find balance. It’s okay to admit that you need help or that you need to take a break from practicing or competing. If you feel overwhelmed consider meditation, trying new things or giving your body a rest.
• Ask for help. There is no shame in seeking out help, whether it be with a therapist, psychiatrist or other medical health professional. Treating a mental illness is just as important as treating a physical one.

Protecting and prioritizing your overall health is essential for all levels of athletes. It’s not rare to have an athlete pull out of a race, game or event due to a physical injury. Seeing an athlete withdraw for mental health reasons is much less common, however, its recognition is just as important. The hope going forward is that we assist athletes in all aspects of performance and recognize that mental health is health.

Thomas Bills, M.D., is a psychiatrist with a special interest in sports psychiatry. Dr. Bills is welcoming athletes to his office in the Towsley Building, located on the campus of MidMichigan Medical Center – Midland. Those who would like to make an appointment may call the office at (989) 839-3385.

The history of mental health treatment is a long story. The first private hospitals, known as almshouses, for those with severe symptoms of mental illnesses and the infirmed elderly, were created in the early 18th century. In the early 19th century, a new idea about care for the mentally ill called “moral treatment” emerged, which focused on the belief that kindness and quietness in treatment would help with recovery.

In the 1840’s, Thomas Kirkbride developed the “Kirkbride Plan” for moral treatment that included sunshine, fresh air, privacy and comfort. Throughout the 1850s and ’60s Dorothea Dix traveled throughout the country promoting this approach. By the 1870s virtually all states had such asylums. By the 1890s, private almhouses were sending people to the asylums. This influx overwhelmed both space and resources of the asylums and threatened their attempts at humane treatment. 

Planning on getting some work done outdoors? Keep these tips from Occupational Therapist Sam Penkala, O.T.R.L. in mind.

1. Examine your body mechanics of the shoulder when your arms are elevated.

• Above the shoulder internal rotation can cause irritation in the shoulder called shoulder impingement
• Try to avoid internal rotation of the shoulder, essentially making a thumbs down motion
• Keep your arm activity below the shoulder, if possible
• Take breaks, especially if above the shoulder activity is necessary, to give your muscles a chance to rebound, and analyze the effect your task is having on your body

Having trouble seeing things clearly? Is it difficult to watch TV, scroll on your phone, look at your computer, read a book or complete close-up tasks such as cross-stitching? Does it make you dizzy when you try to do any of these things? Have you been told you have a lazy eye? Does it seem like your glasses aren’t working well? Has your eye doctor told you there’s nothing wrong with your current glasses prescription?

If you’ve answered yes to any of these questions, you may have a problem with your visual or vestibular system, such as a condition of convergence insufficiency or unilateral or bilateral vestibular hypofunction.

The visual sensory system consists of the receptors in our eyes that detect light and the colors of objects, and the ability to have fine discrimination and visual acuity through the pupil. In other words, it helps us see things clearly.

The oculomotor system is a motor component of the eye function. It helps bring targets onto the fovea, found in the pupil, and keeps the targets on the fovea. This system uses six muscles that we have in each eye to move the eye in all positions. The eye movements perform two functions. First, it holds the image on the retina, and second, it allows the gaze or focus to be shifted.

One of the two functions of the eye movements is that it holds the images in the retina. There are three ways that oculomotor control works with eye movements to hold images onto the retina.

• Visual Fixation: Where the retina holds the image of a stationary object on the fovea while your head is stationary, for example, reading a posted sign while standing to look at it.
• Vestibular Ocular Reflex: Where images of the seen world are held steady on the retina during brief head rotations, for example, following a flying insect or animal.
• Optokinetic Reflex: Where images of what we see in the world are held steady on the retina during sustained low frequency head rotation, such as driving and looking out the window at passing objects or reading.

The second function of the eye movement allows your gaze to be shifted. There are three types of gaze shifting.

• Smooth pursuit: Holds the image of a moving target on our eyes
• Saccades: Where there is rapid movements of the eyes, for example, when we’re watching a tennis match
• Vergence: Moving the eyes in opposite directions to provide depth perception such as when reading a book or looking at your computer or phone.

Vestibular hypofunction occurs when the vestibular nerve is not responding to movement at an accurate rate. The person experiencing this can feel “off,” dizzy, unbalanced and may have trouble focusing. Vestibular therapy and exercises can help with these conditions.

Occupational Therapist Dawn Wylie, O.T.R.L., is a vestibular and balance specialist and part of MidMichigan Health’s Rehabilitation Services team. She sees patients in Alma.

May is Mental Health Awareness Month. Many people in modern society seem to have a perception that the world is divided into two categories when it comes to mental health conditions; those who have them and those who don’t. This mentality leads to all sorts of problems, including stigma.

 According to the American Psychiatric Association a stigma is a pervasive negative perception of people with mental health conditions. They identify three types of stigma:

• Public stigma – the negative attitudes others have concerning mental health disorders
• Self-stigma – the negative attitude one has about their own mental health, which can show up as internalized shame
• Institutional stigma – includes government or organizational policies that limit opportunities for those with mental health conditions, either intentionally or unintentionally

Humans have a tendency to divide the world into ‘us’ and ‘them,’ no matter what the topic is. People will put down ‘them’ in some way, to perceive ‘them’ as not as good as ‘us.’ This is true for mental health conditions as well as many other characteristics. Mental health issues have additional complexities involved with the perception.

Often people are uncomfortable with mental illness because they don’t understand it. Mental health conditions can result in behaviors that look bizarre or seem strange to some people. This is especially true for psychotic disorders. But people are often uncomfortable even with symptoms related to depression or anxiety, which are very common disorders. This may be because when people put all mental health conditions into one category and that category is associated with bizarre behavior they are likely to want to avoid it.

When people divide the world into two categories and perceive the ‘other,’ those with a mental illness, as somehow strange, they are not only perpetuating stigma and setting themselves up to treat others poorly, but they are also putting themselves at risk to feel shame when they, themselves, may struggle with a mental health condition, which they are likely to experience at some point; according to the World Health Organization, 46 percent of people will experience a mental health condition at some point in their life.

When people feel ashamed of their mental health status or repeatedly hear messages that they should feel shame, it’s less likely they’ll seek the care they need. According to the Centers for Disease Control and Prevention, embarrassment is one of the many barriers that stop people from seeking treatment. In fact, only about 20 percent of adults with a mental health condition actually seek treatment. 

There are many things people can do to reduce stigma. It begins with each person looking at how they think about mental health conditions. Instead of compartmentalizing the world, it is useful to recognize that every person is human and all humans have struggles at times. Sometimes these struggles interfere with functioning. When this disruption of functioning is great enough it may be diagnosed and may benefit from treatment.

People can also talk about it. Being open and honest about your own mental health can help others feel comfortable opening up about what they might be going through. People need to be careful with words. Using real mental health conditions as negative adjectives sends a message that those diagnoses aren’t taken seriously and aren’t worthy of seeking treatment for.

People should educate themselves. Learning more about mental health conditions and available treatments can help people to be better prepared to help friends and family by recognizing symptoms of mental health conditions, and recognizing and accepting in themselves.

There is no shame in seeking help for a mental health issue. In fact, seeking treatment is a commitment to yourself and for everyone you love. Recognizing that there is no shame in mental health struggles will result in reduced stigma and increased compassion for yourself and others.

All humans have struggles; it’s part of the human condition. Recognizing this can help people to be honest and accept others, and themselves, without shame.    

For those who are struggling, MidMichigan Health provides a Psychiatric Partial Hospitalization Program at MidMichigan Medical Center – Gratiot. Those interested in more information about the PHP program may call (989) 466-3253. Those interested in more information on MidMichigan’s comprehensive behavioral health programs may visit www.midmichigan.org/mentalhealth.