Written by: Anet Khechoumian , Licensed Marriage and Family Therapist 

Being in the 21st century, many people may believe that genocides are old and archaic acts that no longer occur, though unfortunately, it is an act that leaves residual effects for decades following, and continues to take course in today’s generation.

Past and Present Trauma

The definition of Genocide is stated to be, “a crime against humanity, characterized by the intent to annihilate a group defined by presumed group characteristics, such as ethnicity, religion or class. It is a crime both against a group, defined on the basis of group identity, and against its individual members.”^[i] A genocide is known to leave behind sizeable consequences onto the children of genocide survivors and contributes substantially to the formation of transgenerational trauma. Transgenerational trauma occurs when symptoms and behaviors of trauma survivors (evident by anxiety, agitation, dissociation, blunted affect, sadness, or numbness of emotions), are passed along to the subsequent generation. These negative symptoms contribute vastly to how the current generation can understand, heal, and cope with present traumas and stressors.

Stages and Characteristics

The Armenian Genocide, that involved the heinous killing of Armenians by Turkey between 1915-1917, has been known to have left a lasting impact on the health and wellbeing of survivors and their children. The impact of such acts can be seen in pre-genocide, genocide and post-genocide characteristics. Pre-genocide, Armenia was formulated by ethnic religious groups (Christian), mainly rural, and identified strongly by its racial ideology. Genocide characteristics included being perpetrated by outside groups, being forced to deport their home, separation of families, forced relocation by form of death march, being subjected to systemic mass extermination, destruction of mass communities, systemic rape of women, and 1.5 million victims. Post-genocide (which has since been recognized as a genocide by 29 countries), has faced the refusal of Turkish acknowledgment of deaths, no reparations, increased organization of groups within, and migration of the diaspora (mainly in the US and France).^[ii]

The most utilized quality assessment tool is currently known as the Genocide Studies Quality Assessment Tool, GeSuQ, developed by a group of epidemiologists, psychiatrists, public health experts, anthropologists, sociologists, and statisticians. Though ample studies have not yet taken place on survivors of genocide, it is known that subsequent life events, stressors, and situations may influence the health of children of survivors. Though genocide undoubtedly leads to disruption of family bounds, survivors of the Armenian genocide and the Holocaust were less likely to experience rejection or betrayal of their own parents or other family members/friends. After having endured a genocide, families may be known to be less likely to undermine basic trust in close relatives, due to the learned need for survival buoyed by the community and familial bond.^[iii]

In their DNA

Family violence was associated with more psychopathologies in the offspring of survivors, emphasizing the important role that current life events play in the development of such pathologies, among those whose earlier life renders them either vulnerable or resilient.^[iv] Resilience is best understood as the process of overcoming the effects of adverse experiences rather than succumbing to them. Resilience is also undoubtedly developed through traumatic adversities endured by individuals, families, and communities. One theory also speaks of a selection bias associated with the genocide, with those who had (mental) health problems before a genocide, may have had a smaller chance of survival. Therefore, survivors may have been protected against mental health conditions through a variety of factors such as genes, personality traits, and social and chance factors- some of which may be influenced and transmitted to the next generation via either nature or nurture.^[v] This theory is in the early stages of studying how cortisol responses and epigenetic changes reflect differently in the biology of survivors.

Though the fallouts and consequences of a genocide are catastrophic and horrific, they are also seen to be a strong contributing factor to why Armenian survivors of the 21^st century carry such pride, unity, resiliency in their culture, belief in their faith, their people, and their homeland. Though some may believe that the attempt of annihilation of a race may have weakened them, the Armenian people show the contrary, and continue to be even more resilient and unified. The very characteristics that were developed as a necessity to survive a genocide, remain present as the characteristics that allow the people and culture to thrive.

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^[i] United Nations. Convention on the Prevention and Punishment of the Crime of Genocide. New York, NY: United Nations Organization 1948.

^[ii] Lindert J, Knobler H,  Kawachi I, Bain P,  Abramowitz M, McKee C, Reinharz S,  McKee M.  International Journal of Epidemiology, Volume 46, Issue 1, February 2017, Pages 246–257. 2016 Oxford University Press.

^[iii] Sagi-Schwartz A, Van IMH, Grossmann KEet al. . Attachment and traumatic stress in female holocaust child survivors and their daughters. Am J Psychiatry 2003;160:1086–92.

^[iv] Roth M, Neuner F, Elbert T. Transgenerational consequences of PTSD: risk factors for the mental health of children whose mothers have been exposed to the Rwandan genocide. Int J Ment Health Syst 2014;8:1–12.

^[v] Sagi-Schwartz A, Bakermans-Kranenburg MJ, Linn S, van Ijzendoorn MH. Against all odds: genocidal trauma is associated with longer life-expectancy of the survivors. PLoS One2013;8:e69179.

{Connect} Web: AnetTherapy.com -IG:@AnetTherapy- Email : AnetTherapy@gmail.com

Written by: Anet Khechoumian, Licensed Marriage and Family Therapist

Most of the world has seen and heard a lot from Kanye West in the recent weeks, either by twitter, or his political campaign rally. The speech given at his political rally drew curiosity and began questioning the unruliness of his behavior. Mr. West has been open about his diagnosis of Bipolar Disorder, as the cover art for one of his recent music albums, “Ye ” had the text, “I hate being Bi-Polar, its awesome” written on it, which is emblematic of his diagnosis all together. Throughout the years, Mr. West has discussed that he has not always maintained a stable medication regimen, which draws the unknown factor, of when he may be on public display while on or off of his psychotropic medication, since his behaviors look different from the times when he has actively said to be taking his medication. 

What is Bipolar Disorder?  

Clinically we characterize Bipolar Disorder by extreme mood swings (that can range from mania to clinical depression), lasting at least one week, and present nearly everyday, for most of the day. Other distinctive characteristics may include grandiosity or inflated self esteem, pressured speech, decreased need for sleep, flight of ideas or racing thoughts, distractibility, increase in goal directed tasks, harm to self or others, and excessive involvement in activities that can have unwanted consequences (ie: large shopping sprees). The mood disturbance is significantly severe and causes marked impairments in social or occupational functioning.

Grandiosity can afford a person the ability of having high accolades and expressing how they are often singled out enough to be excellent in their craft, or be the world’s best at what they do. Within this belief system, being in that 1 % range, increases the chances of having the thought pattern prevalent outside of the manic state, which may give way to creative and successful outcomes, when actively carried out. Synesthesia is a known neurological condition, where information meant to stimulate one of your senses (such as sight) stimulates several of your other senses (such as sound). Synesthesia is incorporated with such thought patterns, which are described as seeing color when hearing music, or visa versa, which is generally when we see how the heightened state of thinking or mania can display high levels of creativity. Those with bipolar disorder, will often share that they see and hear sensations in assorted ways. Fusing things together by having an elevated thinking state during mania, allows for more creativity and more of an opportunity of being “out of the box.” 

All the Hype about HypoMania 

Before mania, we commonly see what is called hypo mania (which is a more mild form of mania, though it can still cause some lifestyle disturbance and show higher than normal levels of energy). One aspect of Mania to remember is that you can have psychosis within a manic episode, which is likely to include hallucinations and/or delusions. A Manic episode requires meeting a minimum of three criteria , such as showing distractibility, indiscretion (doing things that you normally would not be doing), and hypersexuality (which is not limited to excessive desire for sex). These characteristics are even more apparent when our executive functioning is not intact. Oftentimes, what you are thinking can come out impulsively, as seen in pressured speech. Pressured speech is best defined not by speed, but rather impatience and difficulty to stop talking. This can be seen when someone is speaking at a pace that is intense and can quickly digress, with a shifting stream of thoughts. There can be a variation of how similar traits are displayed, versus meeting the strict criteria of a diagnosis. Although, the rule out should be exhaustive, and should ideally take several months to monitor a pattern of when the onset of symptoms arise. Bipolar is often diagnosed between a person’s teen-years to mid 20’s (early adulthood).  

Normal or Not 

The word normal is defined in the Webster dictionary as, “conforming to a type, standard, or regular pattern,” which can be said to be a subjective and nebulous term. 

Being outside the realm of “normal” is significant, when even within that realm, the behavior is still seen to be unusual. Thoughts in the mind can become so intense, that to your own accord, you feel the emotional catharsis to scream, cry or yell. The emotional lability that a person can have when in a depressive or mixed episode state is not so much relevant to the event, but can rather be a small prompt to evoke a strong emotional response (evident by clear display of anger, confusion or hurt). We look at a significant influx of energy, which can reflect numerous activities that can individually be seen as normal, although seeing them all being done concurrently is significant. Additionally, these such activities are carried out for multiple weeks at a time, with little needed sleep or rest. Thought distortions are common while being very productive during a hypomanic phase (as there is less desire to come back down), and can be difficult to recognize.  Family and support can recognize that more so than individuals experiencing the mood changes. Familial containment helps the person acknowledge that they need help and be less inclined to resistance. Before Bipolar Disorder is diagnosed, there are other factors that need to be ruled out, which is what the clinical term refers to as a differential diagnosis. If providers are not making accurate assessments, a misdiagnosis can occur more frequently, and cause continued distress and agitation. 

Misdiagnosing Minorities 

Within the minority populations (particularly African  Americans), patients may present with symptoms of mania, although if providers are not culturally competent, they may not consider the symptomology related to mental illness. If you are emotionally labile, volatile or displaying an alarming thinking process, providers can often times see that to be either a cause of any form of substances use, or have a higher probability of misdiagnosing a more severe disorder (such as Schizophrenia or Schizoaffective Disorder). Minorities have the same prevalence as others, to have bipolar disorder, but are more often undiagnosed or misdiagnosed.  The cultural competency presents with challenges, as psychosis or bipolar induced psychosis need to be better deciphered.   

Treatment 

Bipolar disorder is known to show a depressive presentation, which often directs physicians to more likely prescribe popular antidepressants (such as an SSRI like Zoloft, Sertraline or Paxel). These medications can cause what is called a “flip,” which is seen when targeted symptoms are not adequately reduced, and the presenting problems are still prevalent. Other conditions that are commonly known to also cause emotional lability, (such as being hypoglycemic, or having hypothyroidism), need to be ruled out before psychiatric medication is taken. Though genetics do play a role, environmental stressors are a strong contributor as well. Genetic vulnerability decreases resiliency and can make it easier to be affected by environmental stressors or triggers.   You can be selective with choosing your providers, and inquire about practice patterns to help feel comfortable and establish a reciprocated dialogue.  

Treatment can be difficult because the adherence to medication is challenging, as continuity of treatment and consistency of engagement are key factors to sustainable health.  We often see that after clients near the one year mark, they show stability and progress, as that is a time when medication may begin to taper off, and clients feel that the medication is no longer necessary. When inevitable stressors occur and triggers are present, patients are then reluctant to tell people they are struggling, and have reservations about returning back to treatment. Find a provider you can relate to. The stigma remains because when improvements are made, people do not usually want to talk about them later, and they are not visibly apparent. Mental illness is recommended to conjoin with talk therapy to help manage the triggers, decrease irritability, and better manage emotional responses.

It may be confusing for others to witness the behaviors of Mr. West, as his mood impairments are seen on a large public scale, which is why we strive to educate others and encourage more empathy and understanding.  The mental health community is undoubtedly grateful for the vulnerability that Mr. West and his family share, as their efforts contribute to decreasing the negative stigma of mental illness. By understanding how mental illness is presented, it discourages judgment and shame, and allows more room for support and care.

Anet Khechoumian, MS, MBA, LMFT

{Connect} Web: AnetTherapy.com -IG:@AnetTherapy- Email : AnetTherapy@gmail.com

Written by : Anet Khechoumian, Licensed Marriage and Family Therapist

Most people may be asking themselves, “was I always this anxious, or is this new?” 

Generalized Anxiety Disorder is known to be one of the most commonly diagnosed disorders in America, and now we have a global pandemic to exacerbate these worries even more.  For most of us, hindsight can be a helpful way to understand stressors or highlight our best abilities, as past patterns can be a great way to reflect on how we function. Research has been a helpful tool in providing data for what strengths and challenges have been present from past similar circumstances (the SARS outbreak in 2002 or the Ebola outbreak in 2014).  We see how a health pandemic poses both a physical and mental threat, as the two are often intertwined with one another.

WHAT IS GOING ON IN MY HEAD? 

The disruption of our daily schedule can feel unmanageable when disorganized. Some common emotional responses may include anger, anxiety, boredom, loneliness, high urgency, depressive mood or panic. We may not always be cognizant of what we are feeling when these emotions are combined in nontraditional methods. 

Such disruptions may include escalated anxiety, sleep disturbance and hypervigilance. These symptoms also mirror the early warning signs of psychosis, which include isolation, strong (or lack of) emotions, decline in self-care, difficulty concentrating and decline in performance. As we are unfamiliar with what is taking place in our emotional and/or mental state, it is easy to think that we are experiencing a psychotic episode, but it is important to acknowledge and understand that we are simply unfamiliar with what is taking place in our emotional and/or mental state. Historically speaking, after the impact of a significant stressor, we see higher rates of relapse, and setbacks towards recovery begin to arise. As commonly utilized coping skills decrease and fewer distractions are available, the situation provides a vulnerable state especially for those in recovery. We also see higher rates of burn out, as increased time is dedicated towards technology for many uses (work, entertainment, shopping, etc.), and financial stress becomes more prevalent. 

IS MY BRAIN STRESSED OUT?

The amygdala is the part of our brain that is responsible for survival, memory and emotions. This is a significant area that is heightened and stimulated during a time of distress, such as a pandemic. This distress is not limited to only the fear of becoming ill, but also the many other factors effected, such as jobs, resources, schools, or events.  The amygdala is also responsible for the release of adrenaline and cortisol, which are the stress hormones that significantly contribute to the physiological presentation of anxiety. Some of the most common ways in which anxiety can physically present itself include difficulty breathing, dizziness, excessive sweating, stomach cramps, headaches, muscle tightness, restlessness, lack of focus/clarity, trembling, etc. Interestingly enough, anxiety can also serve as a useful form of comfort, if we are more familiar with functioning in chaos. 

HOW DO I STAY RESILIANT?

As human beings who have endured many stages of personal or circumstantial stressors, where we see time and time again how capable and adaptable, we are. Remember to try and incorporate some form of balance between work and personal life (even if that structure is not exactly the same as before). Receiving information is essential, although having a reliable source, that is time bound and consistent, can decrease the overflow of worry and information surplus. We are in an unusual time, where we may experience ongoing alarming thoughts, mistrust, confusion, and restlessness, yet we maintain hopeful and resilient for ourselves as well as others. Numerous reports reflect that people can feel the discomfort is shared amongst a larger group, and though we may all be isolated from one another, we simultaneously feel connected and relatable, on an exceptionally higher scale. So, call your loved ones and talk to them. Even if it’s to express your fears and anxieties. It still helps to verbalize your thoughts so that your loved ones can try and comfort you or even just distract you for a couple of minutes. Most importantly, stay safe and be well !

Anet Khechoumian, MS, MBA, LMFT  

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