Showing posts with label Health-Mental. Show all posts
Showing posts with label Health-Mental. Show all posts

January 2, 2020

Cornell Analysis Finds Discrimination Impacts The Health of LGBTQ

Eromin Center executive director Anthony Silvestre, left, and clinical director Mary Cochran are pictured in the center’s office in Philadelphia in 1981.

In a review of thousands of peer-reviewed studies, the What We Know Project, an initiative of Cornell’s Center for the Study of Inequality, has found a strong link between anti-LGBT discrimination and harms to the health and well-being of LGBT people.

The results of the analysis, the largest-known literature review on the topic, indicate that 286 out of 300 studies, or 95%, found a link between anti-LGBT discrimination and LGBT health harms.

“The research we reviewed makes it crystal clear that discrimination has far-ranging effects on LGBT health,” said Nathaniel Frank, director of the What We Know Project, an online research portal that aggregates existing peer-reviewed LGBT research. “And those consequences are compounded for especially vulnerable populations such as people of color, youth and adolescents, and transgender Americans.”

The research team screened more than 11,000 titles and read more than 1,300 peer-reviewed studies in order to identify those that addressed the question, “What does the scholarly research say about the effects of discrimination on the health of LGBT people?” Among the key findings identified by the report:

Anti-LGBT discrimination increases the risks of poor mental and physical health for LGBT people, including depression, anxiety, suicidality, PTSD, substance use and cardiovascular disease.
Discrimination is linked to health harms even for those who are not directly exposed to it because the presence of discrimination, stigma, and prejudice creates a hostile social climate that taxes individuals’ coping resources and contributes to minority stress.

Minority stress – including internalized stigma, low self-esteem, expectations of rejection and fear of discrimination – helps explain the health disparities seen in LGBT populations.

Discrimination on the basis of intersecting identities such as gender, race or socioeconomic status can exacerbate the harms of discrimination based on sexual orientation or gender identity.
Protective factors against the harms of discrimination include community and family support; access to affirming health care and social services; and the establishment of positive social climates, inclusive practices, and anti-discrimination policies.

The report is relevant to debates currently unfolding nationally about whether to ban discrimination or, alternatively, allow a “license to discriminate” through religious exemptions from discrimination law, Frank said. The data also offer guidance on what policies and practices can help mitigate the consequences of anti-LGBT discrimination, prejudice, and stigma, he said.

“Sometimes research really humanizes a policy debate, and this is one of those times,” said Kellan Baker of the Johns Hopkins Bloomberg School of Public Health, co-lead of the study. “Whatever you think of what the law should say about anti-LGBT discrimination, this research makes indisputable that it inflicts great harm on the LGBT population, and gives policymakers and individuals tools to reduce those harms.”

Focusing on public policy debates around inequality, the What We Know Project connects scholarship, public policy, and new media technology.

“The goal is to bring together in one place scholarly evidence that informs LGBT debates, so that policymakers, journalists, researchers, and the public can make truly informed decisions about what policies best serve the public interest,” Frank said. “We don’t call ‘balls and strikes’ in our analysis, but simply describe what conclusions the studies reach so visitors may evaluate the research themselves.”

The full research analysis and methodology can be viewed on the project website.

November 10, 2018

Half of UK Have Experienced Depression, 52% For Gays

More than half of LGBT people in the UK have experienced depression in the past year, according to a LGBT charity.
Stonewall says 52% of the 5,000 lesbian, gay, bi and transgender people it surveyed said they'd struggled with it.
That's higher than average - mental health charity Mind says that, in the general population, 25% suffer from a mental health issue each year.
"The results are alarming but sadly they're not surprising," says NHS clinical psychologist Chris Wilson.
"They do reflect what we see in clinical practice."

'I was always called names'

Girls playing footballImage copyrightGETTY IMAGES
Image captionBree says she was worried her love for playing football at school would make her a target
Bree, who's 19 and lives in London, says she's struggled with her mental health because of her experiences as a young gay teen.
"When I was at school, I was always the butt of the gay jokes and it made me feel ill," she tells Radio 1 Newsbeat. 
"I guess you'd say I'm your stereotypical lesbian. So at school I was always called names at every opportunity they had."
When she realised she was gay at 13, Bree says she was "terrified" her friends would find out because of their homophobia towards LGBT people.
"It's really depressing to realise that everyone around you thinks that you're disgusting and you can't actually do anything to change it."
Bree says she's now "comfortable" with herself and her sexuality, but even now says she suffers from anxiety when she is in public with her girlfriend.
"On the depression side of things, things are a lot better now, but you still do get that anxiety when you go out and you feel like you could be outed," she says.

'It was a tough place to be inside my head'

CounsellingImage copyright

Image captionCharlie, not pictured, struggled with alcohol addiction for 10 years
Charlie, not his real name, 29, says the mental health problems he experienced as a teen later led to alcohol problems.
He's only recently been able to deal with them.
"It was a tough place to be inside my head," the 29-year-old says. 
"There was no education on mental health and no education on LGBT issues - or even the existence of LGBT people in a normal, functioning role in society." 
Charlie says he began using alcohol in his late teens to feel more confident and "forget about all the stuff that was inside my head".
"From the age of eight to at least 16 or 17 I had to hide what I was feeling. 
"As those emotions got harder to deal with, it was harder to hide them and that caused a lot of strain on my brain, which led me to develop anxiety and depression throughout my teenage years."
Charlie is now in rehabilitation for alcohol addiction, but says he's sad to think of what he's "missed out on" during his life due to his mental health issues.
He urges young LGBT people to speak to someone they trust if they are experiencing mental health issues.

July 9, 2018

I'm Gay, Board and Lonesome But My Social Life is Good



Mintu was a looker with shapely legs and light olive skin. The first time our new sports teacher looked at him, we all knew that he fancied him like mad. This happened in class VIII around the mid-1990s. It was also the time when a Juhi Chawla movie was released and everyone in our class started calling him Juhi.
He was not talkative.
He would sit in the third row next to the window and quietly read film magazines hidden cleverly in his textbooks and would set his hair and occasionally look up to the teachers to prove his attentiveness. I felt he was lonely. He didn't have any friends. Sometimes he would take out his chap stick and apply on his lips and go back to his reading unperturbed by anything happening around him. Perhaps that's how lonely people are - in their own world.
Mintu was feminine, beautiful and guarded his reclusion in his make-believe world. I tried to talk to him many times and he would just reply in monosyllables and never added anything or asked anything to give friendship a start.
I stepped back after a few attempts. I saw him crying in the library once but could never ask because I feared he would not answer. He was not a raging Juhi Chawla fan and the students called him Juhi to mock him.
He had overheard that they actually named him Hiju or Hijra. If you flip the name Juhi, it could loosely be arranged as Hiju. That was the smartest way to refer to him and this is how the other students had their share of banter.
Mintu went home for summer vacations and never returned to school. Later, we heard he had jumped off the terrace and died. It was a suicide. He died of loneliness and rejection. We heard that his own father used to call him those names and his mother just cried incessantly without reacting. He had no protection and no support from family and obviously, no love. Loneliness and death at the age of 15. Unbelievable!
There were only two people from school who attended his funeral. One of them was me.
There were many queens in our school, mostly closeted like me. We often used to hang around in the old dilapidated basketball field applying Vaseline on our eyelids and that would add some shimmer to our eyes. We hoped that maybe this little act of freedom would add some shimmer to our lives, too.
That was our adda. Whenever we felt lonely, we would run there. The basketball court was ignored, too. No one played there so it would host us happily, I thought. Someone or the other was always found there. We had a few allies, mostly our seniors, who would join us sometimes for a small talk. We teased them and they did the same when they found one of us with them alone. Each gay guy in our school was lonely and ran to the court looking for a similar soul to talk to. We laughed, talked, ate stolen food from tuck-shop and ran back to our respective classes.
We spoke about Mintu for months and no one knew what happened to him. It was difficult. We had to pretend to be someone else while talking to our teachers, parents and to everyone. We couldn't be openly gay in front of them. We feared rejection, scolding and disapproval.
But everyone else knew. Our watchmen, school bus drivers who would often ask for blow job from each of us and they wouldn't give up if we refused. I constantly looked for a cockroach spray like Hit that would also repel humans. We battled it would. One thing you learn pretty early when you are gay is that you can't give in. The fights were endless. They would take advantage of our loneliness. Some of us were raunchy kids. To kill loneliness we would often indulge in sex with someone we liked.
We were just exploring our bodies because we didn't know what sex meant. Or we were abused. Isn't that child abuse? Now I realise when I was felt up in a crowded bus or one of those drunken uncles who would show up once a year during Diwali and would grab my cheek to kiss and forcibly move his lips to mine and I repulsed him like a force of a current. But I wouldn't report this. I knew it was bad. No one taught me these things but in my heart I knew those were bad things that were not to be told or discussed. Boy, I was wrong.
Then we all grew up with our loneliness and in bits, our togetherness. I picked up cigarettes to kill my boredom, read books after books, had multiple sex partners.
Is there a hairline difference between boredom and loneliness? Boredom is just for the moment, for that time around. It's short-lived but loneliness is for a long time. Maybe it can stretch till eternity. It's a disease. It doesn't go away. I try to be resilient by going to the parties, try drinking the heavier cocktails like long-island-tea or just down neat whiskey pegs and sleep until Monday morning and then begin the work week. I wear a smile to every party I go to. Parties are ephemeral. And then I return to my empty apartment in the city and I feel the familiar loneliness surround me again. My mom's death left a huge void in my life and I have been really lonely without her. Probably the pain cannot be described in words. But I miss her. Perhaps she knew. And I know she understood. I was her child. And that's all that mattered to her and me.
Then I met Raj whose depression cost him his job and his social life. He even broke up with his boyfriend. He hugged me and gave me the gloomiest smile I ever saw on someone's face. I felt like crying. I remember we kissed once. But that doesn't mean anything. He is seriously lonely and needs serious help. He told me he was speaking to some psychiatrist. He is anxious about his future. He has practically given up on life. It is an extreme loneliness because he was ousted from his family many years ago and now his lover has also forsaken him. So practically he is loveless and homeless.
"There won't be more than four people in my funeral," he told me wryly.
But I can see through his pain. Those dark circles around his eyes say a lot about him. He lives on Xanax and Vodka and those are his parachutes to temporary happiness.
On grounds of loneliness, I have not found much difference between my gay friends and straight friends. My straight friends comprise mostly single successful men and women in their thirties or forties. Some are in relationships but they are still lonely and constantly want to hang out without their partners on weekends while the rest succumb to mindless travels or find their anchorage in their respective careers, do hard drugs and tell too many lies.
And it all boils down to loneliness. Loneliness will lighten once they have a legit life partner but where is the partner, their knights in shining armours? I wish life partners could just be ordered on phone like food. It's such a grilling, excruciating exercise to select a life partner or a perfect companion. My friends have such high standards and they are highly successful and that becomes a hindrance in the selection process. No one wants to compromise on any grounds. The shortlisted candidate doesn't realise he has been shown his place already. He is out and she is lonely again but the search is on. And this is an endless cycle. And where do I or people like me find long lasting love?
I really want to thank the gay activists working to legalise homosexuality. The only hope is that this will bring some positive changes into some of our lives. It will change the quality of our life. We can walk on the road with our head held high. We will be free to live without any inhibition and that means a lot for us. The key reason behind a gay man's loneliness starts from a lack of acceptance.
I never had to struggle through my sexuality. I am lucky in a way that I came from a family that accepted what the world looked upon as "transgression". I live my life on my own terms but I don't know if I can deal with my loneliness. If I was accepted wholly by our society, things would have been much better for us. Loneliness is an untold pain that lingers until we die.
If you compare it to some serious illness it is just as brutally manageable like diabetes or HIV/AIDS but we are condemned to die with it without proper treatment.
Can't scientists invent a pill for loneliness? It's hard to discuss and even tougher to hear about. Just a bit of social interaction and a friendlier approach can bring huge changes in our lives. Politicians have no interest in us because we are not their vote bank.
We have to wage a battle every day to be who we are, to be able to embrace our identity that doesn't belong to the prescribed gender binary. And it is tiring. It wears us out.
I go to fabulous parties wearing the most risqué outfits that I have. I wear my make-up but do you see the "invisible scar" on my face? Make-up hides it but I see it.
I come back home alone and lie down in my cold bed but my body is even colder. There is no one to hold me through the night. I wake up the next morning and slowly sip my coffee at 1pm and think what to wear in the night for yet another party or consider calling someone over? Another day, another time. Things are always the same. The routine never ends. The battles never end. Only we fade out. Bit by bit. Like the cigarette that dangles from my lips. It burns out. We do, too.


Pupps RoyPUPPS ROY @puppsroy
The author believes he is an outlier. He loves to love and yet when he returns home after parties, he writes endless notes on identity and loneliness. He wears wigs and carries Hermes sometimes and alternates between different alter egos – tough and sexy and delicately so.

June 23, 2018

UN World Org No Longer Classifies Transgender as Mental Illness But Then There is a Crazy Name Donald

The World Health Organization (WHO) announced it no longer classifies being transgender as a mental illness.

The specialized agency is part of the United Nations and focuses on international public health. The WHO removed all trans-related categories from mental disorders in its International Classification of Diseases (ICD) this week. 

They've now been classified under other sexual health conditions, with the WHO explaining in a report that "the rationale being that while evidence is now clear that it is not a mental disorder, and indeed classifying it in this can cause enormous stigma for people who are transgender, there remain significant health care needs that can best be met if the condition is coded under the ICD."  

The change not only will decrease stigma worldwide by validating transgender identity, it will also guide medical professionals treating transgender individuals. legitimate. Lastly, the change will also guide medical professionals.
"The intention is to reduce barriers to care," Geoffrey Reed, a psychologist worked on the ICD, told The New York Times.

Over 100 civil rights groups have signed onto a letter warning to the Federal Bureau of Prisons of the dangers posed by the Trump administration’s rollback of Obama-era protections for transgender inmates.
The agency updated its Transgender Offender Manual last month, changing from a policy that had housed trans inmates on a case-by-case basis to one that relies solely on “biological sex.”
“The designation to a facility of the inmate’s identified gender would be appropriate only in rare cases,” the new version of the manual reads. It also states that transgender inmate safety is important, but that officials must also “consider whether placement would threaten the management and security of the institution and/or pose a risk to other inmates in the institution.” 
iStock / Getty Images Plus
“Transgender prisoners will unquestionably suffer serious harm if this policy is implemented as written,” the letter to Bureau of Prisons acting Director Hugh Hurwitz argues. “We ask that you reaffirm the BOP’s commitment to the safety of all of the people in its custody. We ask that you reaffirm the BOP’s congressionally-mandated obligation to adhere to each of the final National Standards to Prevent, Detect, and Respond to Prison Rape under the Prison Rape Elimination Act. We ask that you follow the requirements of PREA and the U.S. Constitution, not to mention basic human decency, and house transgender prisoners safely, based on their individual needs.” nThe changes to the manual came after a group of Christian women in a Texas prison sued in U.S. District Court, claiming violations of privacy and endangerment of physical and mental health.
Ian Thompson, a legislative representative for the American Civil Liberties Union, who signed the letter—alongside groups such as the American Psychological Association, AIDS United, and the NAACP—told HuffPost the new BOP policy “all but mandates that transgender people in prison are to be housed according to their assigned sex at birth, regardless of the person’s gender identity.”
Thompson added that the policy “sends a clear message of disrespect, discrimination, and disregard that we know will have serious implications for the safety of transgender people in federal prison,” and is based in “anti-trans bigotry that animates the actions of this Justice Department.”

April 26, 2018

In The Netherlands Mentally Ill Criminals Are Treated In a Very Unique Way

In the Netherlands, criminals with mental illness are treated completely differently in many other countries. Melissa Hogenboom visits a Dutch prison to find out how.
When I arrive at Zwolle prison in the Netherlands, it’s initially hard to imagine that the quiet building, situated next to a fast-food establishment and a garden center, houses 400 or so inmates – including those with some of the most severe psychiatric disorders among the prison population. Though the car park is full, there is nobody around outside the building. It’s not even immediately clear which door will open for me, but when enter I see that cameras were already recording my every move.
Although I first enter into the staff area – separate from the prisoners by several locked doors, I am still subject to strict security checks. My passport, work ID, and camera are checked, and my belongings scanned before I may enter. It’s clear from the moment I pass through the heavy metal doors, that I am entering a prison.
About 124 men and 36 women live here, separate from the general prison population. A third of the women are in the “crisis ward”: the place where their condition is stabilized before they enter the general psychiatric ward.
There are 421 female prisoners in the Netherlands (Credit: Melissa Hogenboom)
Globally, this is rare. In countries like the UK and US, prisoners with mental health conditions often end up in the general prison population. But in the Netherlands prisoners are streamlined into specific segments following a charge. The idea is that this way, they can receive the proper, and particular, care they need.
I’m visiting Zwolle prison to understand what effect this segmentation has – and to what extent it helps those who are mentally unwell. My main focus is on how it affects women, following my in-depth piece last week looking at women with mental health issues in prisons. (Read more: Locked up and vulnerable: When prison makes things worse.)
Five levels of justice
One of the unique things about the Dutch criminal justice system is that a person can be judged to be responsible for their crime on five levels. “Dutch law differs from English law in that it recognises a sliding scale from full responsibility through to total lack of responsibility, with three levels in between,” explains one report in the journal Criminal Behaviour and Mental Health. While the diminished responsibility clause in the UK is similar, there is no such sliding scale.
Consider a situation where an individual takes drugs that contribute to a psychotic episode. If they then go on to commit a violent crime, they can be held responsible on some level, as they made the decision to take the drugs. But if the psychotic episode wasn’t drug-induced, they might be seen as less responsible for their crime.
At the Zwolle PPC, half the females have committed acts of arson
This means that mental illness among criminals is tackled quite differently compared with many other countries. If found to have a mental health issue, a convict can be sent to one of several different places. “They filter them at the beginning before they are even inside,” says Maud Verbruggen, a psychologist at Zwolle Prison. When a person first enters prison, they are again quickly seen by a psychologist or psychiatrist. At Zwolle, I meet staff who work with these prisoners, psychologist Verbruggen and psychiatrist Menno van Koningsveld.
 They tend to get beaten, abused, or get medication taken from them 
Those who have the most severe cases or those who refuse treatment can be sent to what’s called a PPC – short for a penitentiary psychiatric center. PPCs are separate from the general prison population, as is the case here in Zwolle.
In less severe cases, they can go to a place called the EZG(extra care facility), which is set up to “offer a quiet and stimulating environment”, according to the Dutch Ministry of Justice. There are also several places in general mental health hospitals for those who agree to voluntary treatment.
There are many benefits to this early streamlining, the team tells me. If you place people, especially those who self-harm, on a regular floor, “it would be a disaster,” Verbruggen says. They need more structure and need to be better protected – and they are also less predictable, she explains.
Psychologist Maud Verbruggen and psychiatrist Menno van Koningsveld
For instance, in regular jails in the Netherlands, it is becoming increasingly more routine for inmates to get their own keys to their cell. Not so at the PPCs. There the prisoners have less responsibility because they are more vulnerable, the doctors say. 
 Women who find themselves here enter when their world is falling apart 
“They tend to get beaten, abused, or get medication taken from them,” says van Koningsveld, who has worked in prisons for several decades. The inmates also may engage in antisocial behavior such as shouting at night. And intentionally or unintentionally, they may harm themselves: van Koningsveld says some of them “literally eat their own socks”, or pick plugs apart and try to swallow any small metal fragments they get their hands on.
There are 12 beds in the female crisis ward for those experiencing acute mental health symptoms, some of whom refuse medication. (In that case, van Koningsveld can step in and overrule an inmate’s refusal).
Zwolle Prison
Additionally, there are women who are kept separate for their own safety, such as the small number who have committed infanticide, a crime that can attract abuse or harassment from the other prisoners. These women typically also tend to be on suicide watch.
Women who find themselves here enter when their “world is falling apart”, Verbruggen says. The help they get gives them structure and a daily routine, as well as food, shelter and medical care. Many of these women did not have adequate access to these basic needs in the past, especially those who lived on the streets.
On the day I visit, there are 12 free beds in the women’s ward, a rare occurrence – usually, there is a waiting list as demand remains high. Although the Netherlands has seen dramatically declining prison populations year on year, with 19 prisons recently closed, van Koningsveld explains that this is large because of electronic ankle bracelets and an increase in community sentencing.
Criminal Myths
A special series about the factors that shape crime
At a time when prison numbers are rising throughout the world, BBC Future is exploring several misconceptions about criminals and crime.
If some of our ideas about criminals are wrong, this has lasting implications, both during prison and when they re-enter society.
If you are enjoying this story, take a look at the other pieces in our Criminal Myths series, including: Locked up and vulnerable: When prison makes things worse.
For psychiatric patients, particularly women, prison populations are actually increasing. That is true both in the Netherlands as well as worldwide, research shows. It’s not immediately clear why. It might be due to a shift in society, van Koningsveld guesses. Social structures are not as closely-knit as they used to be, and he believes that people have become more individualistic. “When you start shouting [on the street] there’s rarely anybody who says – do you want something to eat. Instead they call the police.” Research backs this up. A 2017 study on 78 countries found that individualism has increased in “most of the societies” tested.
The prison population in the Netherlands is declining (Credit: Melissa Hogenboom)
As of April 2018, there were 421 women among the roughly 8,000 prisoners in the Netherlands, according to the Ministry of Justice. This is down from 547 in 2016. The director of the prison service, Angeline van Dijk, told the BBC On Assignment programme in 2016 that aside from the increase in the use of ankle bracelets, one reason for such a stark decline is that jail is largely used for dangerous and vulnerable individuals. But those who commit less severe crimes can be sentenced in the community. (Others blame cuts to the police force for the decline, instead).
The average stay for women entering the Zwolle PCC is about four months. It’s often a holding place before they get sentenced, or sometimes even released. If a judge lets them go free, it can leave little time for a mental health programme to be effective.
This is one of the reasons that repeat offenses – and psychiatric relapses – remain common. Verbruggen and van Koningsveld also explain something I did not expect: inside, prisoners are more likely to get psychiatric care than they are on the outside. This is attributed to a shortage of psychiatrists for the general population. Another point is that the inmates tend to be “problem patients”, who can be aggressive and often require immediate help, rather being placed on typically long waiting lists.
Violent crimes 
Those who commit the most serious violent offenses can be detained in a forensic institution called the TBS(terbeschikkingstelling), which means “at the disposal of the government”. They can be held there until they are no longer deemed a risk to the public – something that is reviewed every one or two years.
The sign here reads "entrance for inmates" (Credit: Melissa Hogenboom)
Vivienne de Vogel works as a forensic psychologist at one of these TBS hospitals in Utrecht, specializing in violent female offenders. She tells me that if the risk of reoffending is high, the inmate’s stay can be extended for several years beyond their original prison sentence (both a prison and TBS sentence can be given). The average stay is between six and seven years and the aim of TBS is twofold: to protect the public as well as rehabilitate those who are there.
 Risk-assessment tools have been developed for men and are tested on men 
In 2007, researchers noted that this system has “been a pragmatic and successful way of reducing reoffending of high-risk offenders in the Netherlands,” and that the UK could learn from the Dutch. The UK, in fact, did open a similar institution inspired by the TBS in 2001 but it was seen as ineffective “in managing those whom it was primarily targeting and may not have been cost-effective,” according to a 2010 report. It was “decommissioned” in 2011.  
Still, one weak point that the Dutch system shares with prisons elsewhere is that it was developed largely with men in mind. For instance, risk-assessment tools have been “developed for men and are tested on men,” de Vogel says. Yet she has found that women who commit violent crime show a patterned history of complex problems that are different from men.
This is especially the case for some of those who commit very serious crimes, such as one woman with a history of psychopathy who ordered the rape of another with whom her boyfriend had been unfaithful. Probing a little deeper, de Vogel quickly noticed that these women almost always had troubled backgrounds. Taking into account their full life history does not excuse their offenses. But she found that it does help to treat their mental illness and to rehabilitate them.
That’s why de Vogel has developed a gender-specific risk assessment tool, not yet widely used, which takes into account risk factors like a history of prostitution, difficulties raising children, teenage pregnancy and low self-esteem – the latter of which has been found to be a risk factor for female reoffending, but not for men.
Lighters, food, cigarettes are not allowed (Credit: Melissa Hogenboom)
De Vogel hopes that society at large will understand that these women can and should be “treated” as well as convicted – something that will help prevent reoffending in the future, she says. (The approach seems to work; few women who leave TBS reoffend).
 They also feel because they are in prison they can’t go any lower, and need to change 
When I looked at mental health in the prisons system, particularly in the UK, I found that individuals struggle to receive the help they need. It’s often left to charities to step in. In Zwolle, Verbruggen says that isn’t the case – at least not when they enter prison. As well as the resources that the Dutch system provides, there is the sense of having hit bottom. “They also feel because they are in prison they can’t go any lower and need to change,” she says of the inmates. As in the UK, though, psychiatric care outside prison also can be harder to access.
That’s not to say there is enough time to address a patient’s needs before they are released. It’s telling that the aim of PPCs is “stabilization”. Even the average stay of four months does not necessarily leave enough time to treat other underlying conditions or to begin to think about rehabilitation.
When they leave prison, people can find themselves in the same chaotic social structures that they were before – on the margins of society, meeting the same individuals that contributed to their trouble in the first place.
As I leave Zwolle prison through a metal detector that beeps as I pass, two large blue metal doors close behind me. I know I am unlikely to be back any time soon. Unfortunately, this may not always be true for the inmates who leave the same way once their sentence ends.
Written By Melissa Hogenboom
Criminal Myths is a new series curated and edited by Melissa Hogenboom. She is @melissasuzanneh on twitter. Are there other factors or questions you think we should explore? Let us know your opinions on the social links below, or share your thoughts with the hashtag #criminalmyths. 

April 5, 2018

I’m a Gay Psychiatrist and Here’s Why I Went on Grindr to Survey Men {What is Grind'r Doing to Our Gay Men?}


This story originated at VOX and it has the adamfoxie🦊blog taste

When I open the Grindr app on my smartphone, I see there’s a 26-year-old man with tanned abs just 200 feet away. He’s called “looking4now,” and his profile explains that he wants sex at his place as soon as possible.
Scrolling down, I find 100 similar profiles within a one-mile radius of my apartment in Boston. I can filter them by body type, sexual position (top, bottom, or versatile), and HIV status.
As a gay psychiatrist who studies gender and sexuality, I’m thrilled with the huge strides we’ve made over the past decade to bring gay relationships into the mainstream. The Supreme Court ruled that same-sex marriage is a constitutional right. Today in Boston, two men can walk down the street holding hands without consequence.
But I’m worried by the rise of the underground digital bathhouse. Apps like Grindr, with 3 million daily active users, and others like Scruff and Jack’d, are designed to help gay men solicit sex, often anonymously, online. I am all for sexual liberation, but I can’t stop wondering if these apps also have a negative effect on gay men’s mental health.
Since there’s little published research on the men using Grindr, I decided to conduct an informal survey and ask men why they’re on the app so much and how it’s affecting their relationships and mental health. I created a profile identifying myself as a medical writer looking to talk to men about their experiences. I received about 50 responses (including propositions). 
It’s a small sample size, but enough to give us some clues about how Grindr is affecting gay men. And it doesn’t look good.

Apps like Grindr are designed to make finding sex easy. And that can make them hard to stop using.

The most common reason users gave for going on the app is that sex feels great and Grindr makes it accessible, right at your fingertips. The screen full of half-naked men excites users. With a few clicks, there’s a possibility of meeting a sexual partner within the hour.
Neuroscientists have shown that orgasm causes activation of pleasure areas of the brain like the ventral tegmental area while deactivating areas involved with self-control. And these patterns of activation in men are strikingly similar to what researchers see in the brain of individuals using heroin or cocaine. So when a neutral action (clicking on Grindr) is paired with a pleasurable response in the brain (orgasm), humans learn to do that action over and over again.
This can be a normal pleasure response or it could be a setup for addiction, depending on the situation and individual.
Grindr, intentionally or not, also leverages a psychological concept called variable ratio reinforcement, in which rewards for clicking come at unpredictable intervals. You may find a hookup immediately, or you may be on your phone for hours before you find one.
Variable ratio reinforcement is one of the most effective ways to reinforce behavior, and it makes stopping that behavior extremely difficult. Slot machines are a classic example. Because gamblers never know when the next payout will come, they can’t stop pulling the handle. They hold out hope that the next pull will give them the pleasurable sound of coins clanking against a metal bin, and they end up pulling for hours.
Now imagine a slot machine that rewards you with an orgasm at unpredictable intervals. This is potentially a powerful recipe for addiction and may explain why one user I spoke with stays on Grindr for up to 10 hours at a time, hoping to find the perfect partner for casual sex.
The phrase “addiction” continues to be controversial when it comes to sex and technology, But as John Pachankis, an LGBTQ mental health expert at the Yale School of Public Health, described the impact of Grindr to me: “I don’t know if it’s an ‘addiction,’ but I know it causes a lot of distress.”
For now, it’s hard to know just how many Grindr users feel their use of the app is problematic. Early research on app use and health has focused only on sexually transmitted infections, for instance, rates of HIV among Grindr users, using Grindr to get people tested for STIs, etc. 
Just last week, Grindr announced that it will start sending users HIV testing reminders and the addresses of local testing sites (on an opt-in basis). In less pleasant news, BuzzFeed revealed on Monday that Grindr has also been sharing the HIV status of its users with third-party companies. (The company later said it would stop sharing the information.)
Though there is this new attention to sexual health, both Grindr and the research community have been silent on mental health. Yet since 2007, more gay men have died from suicidethan from HIV. 
This suggests it’s time we start thinking about Grindr’s health effects more broadly. Other dating apps, like Tinder, for example, are now the subject of early research looking at mental health implications. It’s time to do the same for gay hookup apps. 

Grindr may provide men with some relief from their anxiety and depression. But it’s temporary.

For some users I talked to, the allure of Grindr was not just the rush to feel good. It was to stop feeling bad. Users told me they log on when they feel sad, anxious, or lonely. Grindr can make those feelings go away. The attention and potential for sex distract from painful emotions.
A staggering number of gay men suffer from depression, with some estimates as high as 50 percent. Because gay men’s anxiety and depression often stem from childhood rejection for being gay, messages of affirmation from other gay men are particularly appealing. Unfortunately, these messages are typically only skin-deep: “Hey man, cute pic. Looking to ****?”
A recent survey of 200,000 iPhone users by Time Well Spent, a nonprofit focused on the digital attention crisis, showed that 77 percent of Grindr users felt regret after using the app.

 The users I interviewed told me that when they closed their phones and reflected on the shallow conversations and sexually explicit pictures they sent, they felt more depressed, more anxious, and even more isolated. Some experience overwhelming guilt following a sexual encounter in which no words are spoken. After the orgasm, the partner may walk out the door with little more than a “thanks.” 
And yet they keep coming back for that temporary emotional relief. One user told me that he feels so bad after a hookup that he jumps right back on the app, continuing the cycle until he is so tired he falls asleep. Every once in a while, he deletes the app, but he finds himself downloading it the next time he feels rejected or alone.
“We see patients like this almost every day,” Pachankis told me. “Apps like Grindr are often both a cause and a consequence of gay and bisexual men’s disproportionally poorer mental health. It’s a truly vicious cycle.”
Not all Grindr users are addicted and depressed, of course. Some users I interacted with seem to use Grindr in a healthy, positive way. One man I interviewed met his fiancé there; they are excitedly planning their wedding. Some I spoke with said they use the app for sex but haven’t suffered any negative consequences and have control over their use.

Using Grindr may keep men from finding lasting relationships

Why do so many of these men turn to Grindr to begin with? Perhaps Grindr’s popularity is a sign we haven’t made as much social progress as we think for same-sex relationships. The general population seems comfortable with the idea of gay marriage, but it’s still difficult for a gay man to find a partner.
One 23-year-old user told me that the only places he can find gay men are clubs and Grindr, and both are hypersexualized. The cultures of both intimidate him. According to Pachankis, gay culture is often “status-focused, competitive, hierarchical, and exclusionary.” He explains that these traits are common among men generally, but in the gay community, they become amplified in a group that “both socializes and sexualizes together.” 
The 23-year-old is afraid of rejection, and Grindr shields him from the pain of in-person turndowns. “My framework now is sex first. I don’t know how to date people in person.” 
His relationships, he says, start with casual sex on Grindr. They first meet at 2 am for a hookup. He’ll try to schedule the next sex date a little earlier, maybe 11 pm. Then the next step may be drinks.  
But this sex-first approach hasn’t led to lasting relationships for the men I interviewed and is affecting their self-worth and identity. “My self-esteem now is all about my sexual ability,” the 23-year-old said. “I don’t feel confident about myself as a partner in any other way.” 
Another user told me he downloaded the app hoping to find a husband. Now he says that when he and a boyfriend (he’s gone through several) fight, his natural response is to open Grindr to “find an alternative” instead of working through problems. He can’t maintain a monogamous relationship because he is constantly cheating.

There may be ways to treat men with problematic Grindr use

The mental health professionals I spoke to are seeing problematic Grindr use in their clinics. And there is little published guidance on how to help those who are struggling.
Doctors I spoke to say the best available tools for treating problematic Grindr use are the ones they use in general sex addiction treatment. Citalopram, a common antidepressant, was shown in one small study to be helpful with sex addiction in gay men. Naltrexone, a drug commonly used for other compulsive behaviors, may work as well. 
For more extreme cases, patients could request hormonal implants that turn off testosterone signaling, making sexual cravings less intense. However, even these treatments have modest empirical support at best, and none have been studied for hookup app use specifically.
Dr. Shane Kraus, the director of the behavioral addictions clinic at Bedford Veterans Hospital and an assistant professor of psychiatry at the University of Massachusetts Medical School, says the most promising treatment for problematic Grindr use is likely talk therapy techniques like cognitive behavioral therapy (CBT). CBT can teach patients to engage in other behaviors that are more productive (though often more difficult and time-consuming than Grindr) to help them feel loved or supported. 
Another psychotherapeutic technique known as acceptance and commitment therapy (ACT) can help teach patients how to better tolerate the feeling of being alone without logging on to Grindr.
The dynamics of Grindr, though, are complicated, and it can take time to work through all the angles. Are you self-soothing anxiety? Are you addicted to sex? Have you lost interest in your monogamous relationship? Do you think you can’t attain love, so you’re settling for hookups? Did your parents tell you being gay is wrong and you’re searching for acceptance? Ultimately, Kraus explains that therapy can help clarify these kinds of thoughts and feelings, and lead to insights that bring about a healthy change.
He also believes it’s only a matter of time before states and the federal government sponsor research exploring Grindr use and mental health. Grindr did not respond to our request for comment on this piece. But if future data supports what I suspect about the link between Grindr and mental health problems, even small interventions like advertising mental health resources on the app may help to address these users’ suffering.
As we continue to fight to bring gay relationships into the mainstream, we need to keep an eye on Grindr and how it both reflects and affects gay culture. The bathhouse is still around. It’s now open 24/7, accessible from your living room.
By Jack Turban a physician and medical writer at Harvard Medical School, where he researches gender and sexuality. His writing has appeared in the New York Times, Scientific American, and Psychology Today, among other publications. Find him on Twitter at @jack_turban.

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