Today, the World Health Organization celebrates World Health Day 2017, a day aimed at stimulating discussion and action for worldwide health epidemics. This year’s World Health Day focus is depression — the largest cause of disability worldwide. Between 2005 and 2015, the number of people living with depression around the world increased by 18 percent. Depression and other mental health problems are no foreign issue to Oklahomans. In fact, despite improvements in recent years, Oklahoma still has the third-highest rate of mental illness among the 50 states.
As the anniversary of the Oklahoma City bombing approaches, many Oklahomans still deal with the lingering mental and emotional effects. As a long-time Oklahoma City resident and renowned leader in the mental health profession, INTEGRIS psychiatrist Murali Krishna, M.D. offers a unique perspective on the events of 22 years ago, based on his personal experience. Dr. Krishna was working in a downtown hospital at the time of the April 19, 1995 attack and treated hundreds of patients, acutely, and even more patients longer-term, for mental health conditions related to the bombing and its aftermath.
In honor of World Health Day and remembering a tragedy that affected Oklahomans far and wide, Dr. Krishna is sharing noteworthy information to help shed light on issues including depression, anxiety disorders and post-traumatic stress disorder (PTSD).
How are anxiety, depression and PTSD Related?
Anxiety is a normal physiological reaction to stress. You become tense; you have a fear of the unknown, a vague discomfort, nervousness or even tremors. “When it becomes excessive and pervasive, when there’s a stress indicator activated in the body that doesn’t shut off, that’s when an anxiety disorder may be diagnosed,” Dr. Krishna says. PTSD is a type of anxiety disorder caused by a traumatic experience and is characterized by intense anxiety, reoccurring dreams and reliving the event, among other symptoms.
Just as anxiety is a normal bodily reaction, sadness is a normal emotion, like happiness or anger. When sadness becomes persistent over a long period of time, depression may be diagnosed. “No two cases of depression are alike. Just like diabetes, it’s an illness, and no sex or age group is immune — in fact, depression is not uncommon in children,” Dr. Krishna says. “In depression, there’s usually no acute anxiety, although depression and anxiety can co-exist.”
Traumatic events can be at the root of both depression and anxiety disorders. “No two people experience a traumatic event in the same way,” Dr. Krishna says. “Some can develop PTSD; others have depression, and others may not experience any mental illness at all.” According to Krishna, your experience depends on your genetic predisposition, among other factors.
Interesting factors associated with PTSD
Repetitive exposure, as is common with national events that garner frequent media coverage, is not helpful for individuals suffering from PTSD. “The videos we watch and sounds we hear can be triggers for symptoms of PTSD. Even fireworks can be a trigger for certain people,” says Dr. Krishna.
The onset of PTSD can be delayed, especially in healing professionals and children.
- Healing professionals, like first responders, nurses and physicians must tend to the needs of others for a long period of time before recognizing and dealing with their own emotions. “The body is very resilient in the moment, but later on, those emotions will surface – often in six months to one year,” says Dr. Krishna.
- Children, whose brain evolution hasn’t yet completed, may not fully grasp the trauma until later in life. According to Dr. Krishna, “Their mind, maturity, personality and education are still developing, so the emotions surrounding a trauma may be submerged in their subconscious until maturation is complete and the effects aren’t seen until later on.”
Traumatic events can affect mental development. The Adverse Childhood Experiences research project, conducted by the CDC and Kaiser, found that medical professionals can make accurate predictions of future physical ailments and sicknesses based on the level of traumatic life events a person sustained as a child. “It’s amazing what they’ve found through this study about the long-term effects of childhood trauma. They can even predict a cancer diagnosis in certain patients who experienced major trauma earlier in life,” Dr. Krishna says.
Why is mental health so often placed on the back burner?
“People don’t realize that the most important part of health is the brain. It’s what controls everything else, and it’s the only major thing we can control and learn to change. We can’t control our hearts or our livers, and no new brain cells will ever form, but we can make new brain connections and change the way our brain works and thinks,” Dr. Krishna says.
“People aren’t aware of the connection between mental health and physical health, or really between mental health and everything else in our lives – that’s why it’s so easy to put mental health on the back burner.” Dr. Krishna explains. “For example, the reason there’s an obesity problem in this country is not for lack of exercise, although that contributes to the issue. The problem is that we’re not eating out of hunger; we’re eating for some other purpose. To meet some other need. That’s a mental health problem.”
How do we cope with mental health issues?
Treatment for mental health issues obviously varies based on the individual and his or her particular diagnosis. No two cases of mental illness are the same, but speaking generally, Dr. Krishna talks about coping within three distinct levels.
- Meet the Basic Human Needs. “First, we have to meet the basic human needs for survival: safety, shelter, comfort, food,” Dr. Krishna explains. “That’s the first response. Then, it’s about teaching anxiety disorder and depression sufferers how to tone down their physiological responses and help them keep from exhausting their reserves.”
- Develop skills of the mind. “One way we can do this is through breathing techniques. Breathing is a reflection of the state of the brain. So when we practice slowing down our breath to very few breaths per minute, we’re keeping our brain from exhausting those stress reserves,” he says. Another coping mechanism is meditation and mindfulness, or the act of being fully aware in the present moment. “Mindfulness has actually been proven to slow down aging at the cellular level. It’s truly amazing what it can do, and it’s a skill that anyone can learn. Like any skill, wellness skills must be practiced, but the effects can be remarkable,” Dr. Krishna says.
- Engage in therapy. Once basic human needs have been met and techniques such as controlled breathing and mindfulness are learned, therapy helps to continue skill development and identify triggers. “Therapy helps patients to learn to process life differently and respond differently to situations,” Dr. Krishna says.
Why is mental health so important for Oklahomans?
Mental health has been a major concern for Oklahomans for decades. Genetic predisposition is part of the issue, as are lifestyle factors and rates of other diseases. Twenty-two years ago, Oklahoma suffered a tragedy of a magnitude previously unseen, and the aftermath of that tragedy still affects countless individuals throughout the state. Dr. Krishna witnessed the attacks of April 19, 1995 from only a few blocks away and treated numerous patients, many with whom he still has a connection. The disturbing effects related to that trauma are not lost on him, but he hopes that Oklahomans can continue to make strides in recognizing and treating issues like depression, anxiety disorders and PTSD.
“We need to prioritize taking care of the brains of Oklahomans. Our health, our economy, our jobs, even our culture – it’s all at risk if we don’t take care of mental illness. The capacity of our workforce, the quality of our jobs and our education – it all depends on brain health. Our state’s leaders can only do so much with the budgets they have – mental health has to be made a priority – not just at the government level, but at the individual level and within families,” Dr. Krishna says.
INTEGRIS offers numerous mental health resources for the community. If you’re curious whether a professional mental health consultation might be worth looking into for you or a loved one, take our free, anonymous screening.