Mental health series, part 3


Mental health

David’s story

By Andrew Miki

Andrew MikiEarlier in the school year, CPCO and Starling Minds’ founder and CEO Dr. Andrew Miki launched an online mental health initiative supporting our Practising Associates. Starling is an online program available to all CPCO members. The program includes an example of an administrator called David to explain mental health concepts and how to increase resiliency to stress. To learn more about Starling Minds, please read our earlier blog posts.

The Starling program was developed by Dr. Andrew Miki. Andrew is a registered psychologist with over 10 years of experience working with patients to treat depression, anxiety and other mental health issues using Cognitive Behavioural Therapy (CBT).

This is the third of several posts Andrew is contributing to our blog.

Treating educators, who are off work due to anxiety and/or depression, is a large part of my practice. In my previous blogs, I described my early experiences with David, a 58-year-old Principal. His daughter’s recent diagnosis of OCD had taken a toll on him. Watching his own child suffer with so much emotional pain was simply unbearable for him. Until David had visited my office, he had not spoken to anyone about what he was going through.

David’s daughter, Sarah, was in Grade 11 but had already missed a considerable amount of school that year. This was unusual for her as Sarah was an active honours student who was involved in several teams and clubs. About six months earlier, she became increasingly afraid of contracting various infectious diseases because her best friend at school had a severe case of chicken pox. As she researched more about contagious diseases, her OCD symptoms intensified. Sarah began to sanitize her hands more often and she avoided touching anything in public. If her skin did come into direct contact with anything outside of her bedroom at home, Sarah would immediately find a washroom and spend 5-10 minutes washing to make sure it was clean. On several occasions when Sarah couldn’t wash her hands, she experienced a panic attack.

Sarah was very self-conscious about her OCD tendencies. She tried her best to hide it but her classmates began to notice how long she spent washing her hands and how much school she was missing. Her confidence was eroding and she was becoming more socially anxious. When her anxiety spiked, Sarah found it so overwhelming, that it was a relief for her to stay home to avoid facing everyone at school in order to maintain the façade that everything was “normal.”

One issue that made everything worse was David’s mother-in-law, Kathy. She was very opinionated on his parenting style and thought that it was “too lenient and coddling.” Kathy felt that Sarah needed more boundaries and “tough love to snap her out of it.” Kathy’s presence and input caused a rift between David and his wife, Angela. David wanted Angela to distance their family from Kathy to protect Sarah. Angela found her mother’s disapproval to be unbearable, so she blamed David for consistently making the situation worse. Their conflicting opinions on how to manage Sarah’s condition created the most tension they had experienced in their 30+ years of marriage. Their relationship had become increasingly cold and upsetting.

David was always thinking about Sarah: how she was doing, how he could fix the situation, and how everything had seemed to deteriorate so quickly. When it wasn’t about Sarah, he worried whether he and Angela would argue that day. But no matter how much he tried to problem-solve, he couldn’t find any new answers. He tried to keep himself busy and distracted with his work, but the domestic situation was always in the back of his mind.

When I first met David, there was no doubt in his mind that he was struggling; however, he was very sensitive about whether he met the criteria for depression. When I explained the mental health continuum, he initially thought that he was in the Low Average to Borderline range (see Continuum of Mental Health in Module 4 of the Starling Minds program). Like many people, David had a dual standard when it came to mental health. He was extremely empathetic towards his daughter, students and staff with their mental health issues. On the other hand, it was completely different in regards to himself. David felt that he should always be in control of how he feels and what he thinks, because in the past he had never experienced any problems. Although he didn’t say it explicitly, David’s inability to manage psychologically was, to him, a sign of weakness and failure.

David was surprised when I told him that he met criteria for moderate generalized anxiety and mild depression. As I described his tendency to “think a lot” and his inability to “shut his brain off,” he acknowledged how often he thought about his daughter. I reframed this tendency to think as him worrying about real problems and issues in his life (see Misconceptions About Worry in Module 8). Whenever his mind had the opportunity to wander, he would worry about how she was doing at that moment, how she felt about her OCD, how it would affect her relationships, and whether it would limit her future. His worry also extended to his mother-in-law’s opinions and his relationship with Angela. I described how his worry was excessive (see Excessive Worry in Module 8) and how the high level of physical anxiety he experienced (i.e. muscle tension, headaches, heart palpitations; see Anxiety and Worry in Module 8) contributed to his irritability, fatigue and sleep problems.

Once David realized how often he felt anxious and worried, he agreed that it was more prevalent than him feeling occasionally sad about his family’s recent struggles (see The Depression and GAD Relationship in Module 4). We had to reframe his conceptualization that someone is depressed when “they can’t get out of bed” or have thoughts about hurting themselves. After explaining the continuum of depression (see Clinical Depression in Module 4), he could see that his previous conceptualization was a much more severe presentation. Instead, he realized that his mood was consistently lower compared with how he usually felt and that his depression was in the mild range.

I told David that he had “functional anxiety and depression” similar to how someone may be a “functional alcoholic.” He was able to keep up for the most part at home and work, despite how he felt. Once David agreed with our new conceptualization, he quickly asked, “Now, what can I do about this?”

David’s first training exercise was to use the Mood Tracker in the Starling program. I asked him to create three mood entries that tracked what he was doing and how he felt throughout the day. The goal was to increase his awareness of when he felt more worried, anxious and sad. By reviewing his Mood History graphs, we looked at data that showed patterns of what triggered his moods to change. This would set the foundation for additional skills that he could learn to break those patterns.

At least 20 per cent of all Canadians will have an experience like David’s. Have you or any of your family members had a similar story? Mental health issues do not happen in isolation. They also affect those who are close to the person experiencing them. I will cover how they affect the family unit in my next blog post in September.

* Please note: the case study of David was created to illustrate a wide range of issues that are faced by Principals’ and Vice-Principals. David’s name and all of his personal details have been changed to protect his confidentiality/privacy.

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