With the growing diversity of the U.S. population, it is imperative that we, as mental health treatment providers, are culturally aware and competent in providing the best possible evidence-based healthcare.

This post is Part 2 of 2 in which Dr. Chapman discusses healthcare’s responsibility to our changing community. Part 1 can be found at: What are Mental Health Disparities?

I am pleased to welcome back Clinical Psychologist, Dr. L. Kevin Chapman, who serves as Associate Professor, and Director of the Center for Mental Health Disparities at the University of Louisville. Dr. Chapman is an expert in evidence-based psychotherapy practice and focuses his academic endeavors on efforts to eliminate mental health disparities.

With the growing diversity of the U.S. population, it is imperative that we, as mental health treatment providers, are culturally aware and competent in providing the best possible evidence-based healthcare.

I am pleased to welcome Clinical Psychologist, Dr. L. Kevin Chapman, who serves as Associate Professor, and Director of the Center for Mental Health Disparities at the University of Louisville. Dr. Chapman is an expert in evidence-based psychotherapy practice and focuses his academic endeavors on efforts to eliminate mental health disparities.

This post is Part 1 of 2 in which Dr. Chapman discusses healthcare’s responsibility to our changing community.

80% of Americans on the East Coast identify money as a significant source of stress in their lives, according to the 2011 American Psychological Association, Stress in America Survey.

And, while the economy, housing market, and job markets remain significant concerns for many, personal finances remain the most common concern for Americans.To a large extent, our lives revolve around money; it determines our housing, our schools, our clothing, our meals, our self-care, anour entertainment. It is closely connected to our education, our employment, and, to some extent, our identity. It is no wonder so many Americans report financial concerns.Financial stress is often overlooked and dismissed as an insignificant, common experience; however, worries about money can have very significant effects on our lives, including our daily functioning, interpersonal relationships, physical health, and emotional well-being.

Sara pulls the woven, green hat from her head to show her nearly bald scalp, with only a few tufts of long, thin hair surrounding her crown. Sara has trichotillomania. She pulls her own hair out.

This is not the first time I met with Sara. In fact, we’d been working together for months, but this is the first time she felt comfortable enough to show me what she’s done to herself.“This is where I pull from, Dr. Deibler,” she explains. I nod and say nothing, not because it’s unimportant, but because it’s important to react as if this discussion is like any other discussion, even though she has never before revealed her trichotillomania to anyone.It hadn’t always been this way for Sara.

She began pulling her eyelashes and eyebrows at age 7. Now, at age 14, she’s pulled nearly all of the hair from her head and wears a cap so that no one can see. It’s not that she’s never sought help. She’d been to therapist after therapist, each one helping her cope with her parents’ divorce and family problems, but none of whom knew how to help Sara with her hair.

I had never seen anyone quite like “Max.”  The plunge from what appeared to be a normal 8 year-old boy to a scared, paranoid, fragile child who was grasping to hold on to reality was striking.  Max knew what many of his doctors had yet to discover, he had a raging strep infection. And, this infection, like many times in the past, would run rampant  in his body, largely undetected, causing him to experience a host of symptoms of serious mental illness.

In 1998, Dr. Susan Swedo, a researcher at the National Institute of Mental Health (NIMH), first described in the scientific literature a subtype of OCD in which children demonstrated an abrupt onset of neuropsychiatric  symptoms (OCD, tics, ADHD-like symptoms, anxiety) preceded by streptococcal infection. This syndrome was termed PANDAS, Pediatric  Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.  In PANDAS, the body’s immune system is over-reactive to  strep bacteria, leading to psychiatric and neurological symptoms.

The greatest challenge for Max was the professional community’s debate over the very existence of PANDAS/PANS.

In 1998, Dr. Susan Swedo, a researcher at NIMH, first described in the scientific literature a subtype of OCD in which children demonstrated an abrupt onset of neuropsychiatric symptoms (OCD, tics, ADHD-like symptoms, anxiety) with a “saw-toothed” course, preceded by streptococcal infection.  This syndrome was termed PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.  In PANDAS, the body’s immune system is over-reactive to strep bacteria, leading to psychiatric and neurological symptoms.  Dr. Swedo continued to study this subgroup and investigated potential therapies, including intravenous immunoglobulin (IVIG), plasmapheresis, and antibiotic prophylaxis to prevent symptom exacerbations. PANDAS remained a little known and debated diagnosis.

Dr. Swedo, and more recently, other researchers as well, have dedicated themselves to understanding this phenomenon.

Let’s face it; people are drawn to television programming that evokes emotion.  Whether it’s a love story, action film, comedy, or a heart-wrenching drama, we are drawn to watching the emotional experiences of others. Sometimes, watching these illustrations of life serve as a means of fantasizing, sometimes escape and wonder, sometimes amusement; and always an experience of emotion in response to what we see.  We naturally attempt to relate or empathize with the characters on the screen.  So, how do we react when relating to the character is something we are not able to do? What if we cannot understand their emotional experiences, their thoughts, or their choices?

Television has been flooded in recent years with “reality” shows about psychological disorders. From trichotillomania and OCD to compulsive hoarding sufferers, documentary-style programs have attempted to capture the experiences of these individuals in their daily lives and in snapshots of evidence-based treatment for public display. Public reaction seems to be generally positive, as evidenced by the continued growth of this television genre; however, there is also a consistent undertone of questioning whether there is an exploitative nature of such programming. Is it helpful to the public, or, is it simply voyeuristic, like a train wreck we cannot help but watch?