This is a wonderful post from a favorite blogger who has experience working through issues daily with little ones. As the Sandy Hook children and our nation works past the recent issues It is good to have several ideas on how to relate to our young ones and find ways for them to relate to us. Often we forget to listen. It is more important to listen than to speak sometimes and that is forgotten in the mix. Please find comfort in this Bloggers post through my link. She is amazing!
Handle with Care
The change of seasons can be an enjoyable time for most. It gives a lovely spray of change for a while. Colors palates change, the weather gives a nice diversity for the senses, food choices often switch to more seasonally acceptable acquisitions and we enjoy – if only for a while – the difference. Some individuals however struggle with the changes into the colder seasons. Below is information from the Mayo Clinic on Seasonal Affective Disorder. The website is wonderfully helpful as is Webmd in giving information to help individuals become proactive in managing their health. As always I am available through the messengers, phone, private Facebook messages – always put the topic up front (Example: re: question mental health topic) as I delete the ones that are not obvious questions or outreach. Wishing you better ..Jean
Definition of: Seasonal affective disorder (also called SAD) is a type of depression that occurs at the same time every year. If you’re like most people with seasonal affective disorder, your symptoms start in the fall and may continue into the winter months, sapping your energy and making you feel moody. Less often, seasonal affective disorder causes depression in the spring or early summer.
Treatment for seasonal affective disorder includes light therapy (phototherapy), psychotherapy and medications. Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.
In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. However, some people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.
Fall and winter seasonal affective disorder (winter depression)
Winter-onset seasonal affective disorder symptoms include:
- Loss of energy
- Heavy, “leaden” feeling in the arms or legs
- Social withdrawal
- Loss of interest in activities you once enjoyed
- Appetite changes, especially a craving for foods high in carbohydrates
- Weight gain
- Difficulty concentrating
Spring and summer seasonal affective disorder (summer depression)
Summer-onset seasonal affective disorder symptoms include:
- Trouble sleeping (insomnia)
- Weight loss
- Poor appetite
- Increased sex drive
Seasonal changes in bipolar disorder
In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania). This is known as reverse seasonal affective disorder. Signs and symptoms of reverse seasonal affective disorder include:
- Persistently elevated mood
- Unbridled enthusiasm out of proportion to the situation
- Rapid thoughts and speech
When to see a doctor
It is normal to have some days when you feel down. But if you feel down for days at a time and you can’t seem to get motivated to do activities you normally enjoy, see your doctor. This is particularly important if you notice that your sleep patterns and appetite have changed or if you feel hopeless, think about suicide, or find yourself turning to alcohol for comfort or relaxation.
The specific cause of seasonal affective disorder remains unknown. It’s likely, as with many mental health conditions, that genetics, age and, perhaps most importantly, your body’s natural chemical makeup all play a role in developing the condition. A few specific factors that may come into play include:
- Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may disrupt your body’s internal clock, which lets you know when you should sleep or be awake. This disruption of your circadian rhythm may lead to feelings of depression.
- Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in seasonal affective disorder. Reduced sunlight can cause a drop in serotonin that may trigger depression.
- Melatonin levels. The change in season can disrupt the balance of the natural hormone melatonin, which plays a role in sleep patterns and mood.
Factors that may increase your risk of seasonal affective disorder include:
- Being female. Seasonal affective disorder is diagnosed more often in women than in men, but men may have symptoms that are more severe.
- Living far from the equator. Seasonal affective disorder appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter, and longer days during the summer months.
- Family history. As with other types of depression, those with seasonal affective disorder may be more likely to have blood relatives with the condition.
- Having clinical depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.
Take signs and symptoms of seasonal affective disorder seriously. As with other types of depression, seasonal affective disorder can get worse and lead to problems if it’s not treated. These can include:
- Suicidal thoughts or behavior
- Social withdrawal
- School or work problems
- Substance abuse
Treatment can help prevent complications, especially if seasonal affective disorder is diagnosed and treated before symptoms get bad.
Preparing for your appointment
You’re likely to start by seeing your family doctor or primary care provider. Or, you may start by seeing a mental health provider such as a psychiatrist or psychologist.
Because appointments can be brief and there’s often a lot of ground to cover, it’s a good idea to be well prepared for your appointment. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do:
- Record your symptoms so that you can tell your doctor or mental health provider exactly what they are (feeling down or having a lack of energy, for example).
- Write down information about your depression patterns, such as when your depression starts and what seems to make it better or worse.
- Make a note of any other mental or physical health problems you have. Both can affect mood.
- Write down any major stressors or life changes you’ve had recently.
- Make a list of all medications you’re taking, including vitamins or supplements.
- Write down questions to ask your doctor.
****Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For seasonal affective disorder, some basic questions to ask include:
- Are my symptoms most likely caused by seasonal affective disorder, or could they be due to something else?
- What else could be causing or worsening my symptoms of depression?
- What are the best treatment options?
- Are there any restrictions that I need to follow or steps I should take to help improve my mood?
- Should I see a psychiatrist, psychologist or other mental health provider? What will that cost, and will my insurance cover seeing a specialist?
- Is there a generic alternative to the medicine you’re prescribing me?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions at any time during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- What are your symptoms?
- When did you first begin having symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Do you have any other physical or mental health conditions?
- Are you taking any medications, supplements or herbal remedies?
- Do you use alcohol or drugs?
- Do any of your blood relatives have seasonal affective disorder or another mental health condition?
Your doctor may also ask other questions depending on your individual situation.
Tests and diagnosis
To help diagnose seasonal affective disorder, your doctor or mental health provider will do a thorough evaluation, which generally includes:
- Detailed questions. Your doctor or mental health provider will ask about your mood and seasonal changes in your thoughts and behavior. He or she may also ask questions about your sleeping and eating patterns, relationships, job, or other questions about your life. You may be asked to answer questions on a psychological questionnaire.
- Physical exam. Your doctor or mental health provider may do a physical examination to check for any underlying physical issues that could be linked to your depression.
- Medical tests. There’s no medical test for seasonal affective disorder, but if your doctor suspects a physical condition may be causing or worsening your depression, you may need blood tests or other tests to rule out an underlying problem.
Seasonal affective disorder is considered a subtype of depression or bipolar disorder. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health provider to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms.
To be diagnosed with seasonal affective disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.
The following criteria must be met for a diagnosis of seasonal affective disorder:
- You’ve experienced depression and other symptoms for at least two consecutive years, during the same season every year.
- The periods of depression have been followed by periods without depression.
- There are no other explanations for the changes in your mood or behavior.
Treatments and drugs
Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, your doctor will be careful when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.
In light therapy, also called phototherapy, you sit a few feet from a specialized light therapy box so that you’re exposed to bright light. Light therapy mimics outdoor light and appears to cause a change in brain chemicals linked to mood.
Light therapy is one of the first line treatments for seasonal affective disorder. It generally starts working in two to four days and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving seasonal affective disorder symptoms.
Before you purchase a light therapy box or consider light therapy, talk to your doctor or mental health provider to make sure it’s a good idea and to make sure you’re getting a high-quality light therapy box.
Some people with seasonal affective disorder benefit from antidepressant treatment, especially if symptoms are severe.
Antidepressants commonly used to treat seasonal affective disorder include paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac, Sarafem) and venlafaxine (Effexor).
An extended-release version of the antidepressant bupropion (Wellbutrin XL) may help prevent depressive episodes in people with a history of seasonal affective disorder.
Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take antidepressant medication beyond the time your symptoms normally go away.
Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects.
Psychotherapy is another option to treat seasonal affective disorder. Although seasonal affective disorder is thought to be related to brain chemistry, your mood and behavior also can add to symptoms. Psychotherapy can help you identify and change negative thoughts and behaviors that may be making you feel worse. You can also learn healthy ways to cope with seasonal affective disorder and manage stress.
Lifestyle and home remedies Tests and diagnosis
If your seasonal depression symptoms are severe, you may need medications, light therapy or other treatments to manage seasonal affective disorder. However, there are some measures you can take on your own that may help. Try the following:
- Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office.
- Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.
- Exercise regularly. Physical exercise helps relieve stress and anxiety, both of which can increase seasonal affective disorder symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.
Several herbal remedies, supplements and mind-body techniques are commonly used to relieve depression symptoms. It’s not clear how effective these treatments are for seasonal affective disorder, but there are several that may help. Keep in mind, alternative treatments alone may not be enough to relieve your symptoms. Some alternative treatments may not be safe if you have other health conditions or take certain medications.
Supplements used to treat depression include:
- St. John’s wort. This herb has traditionally been used to treat a variety of problems, including depression. It may be helpful if you have mild or moderate depression.
- SAMe. This is a synthetic form of a chemical that occurs naturally in the body. SAMe hasn’t been approved by the Food and Drug Administration to treat depression in the United States. However, it’s used in Europe as a prescription drug to treat depression.
- Melatonin. This natural hormone helps regulate mood. A change in the season may change the level of melatonin in your body.
- Omega-3 fatty acids. Omega-3 fatty acid supplements may help relieve depression symptoms and have other health benefits. Sources of omega-3s include fish such as salmon, mackerel and herring. Omega-3s are also found in certain nuts and grains and in other vegetarian sources, but it isn’t clear whether they have the same effect as fish oil.
SAMe and St. John’s wort can interact with medications for other conditions, especially antidepressants. Talk to your doctor before trying either of these remedies to make sure they’re safe for you.
Mind-body therapies that may help relieve depression symptoms include:
- Guided imagery
- Massage therapy
Coping and support Lifestyle and home remedies
Following these steps can help you manage seasonal affective disorder:
- Stick to your treatment plan.Take medications as directed and attend therapy appointments as scheduled.
- Take care of yourself. Get enough rest and take time to relax. Participate in a regular exercise program. Eat regular, healthy meals. Don’t turn to alcohol or illegal drugs for relief.
- Practice stress management. Learn techniques to manage your stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
- Socialize. When you’re feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around. They can offer support, a shoulder to cry on or a joke to give you a little boost.
- Take a trip. If possible, take winter vacations in sunny, warm locations if you have winter seasonal affective disorder or to cooler locations if you have summer seasonal affective disorder.
Magi Jean McBride
Mayo Clinic Staff, (Aug. 10, 2012) Mayo Foundation for Medical Education and Research; http://www.mayoclinic.com/health/seasonal-affective-disorder/DS00195
Schizophrenia: A View Within
January 20, 2010
Maladaptive behavior comes from various biological, psychological, and environmental occurrences. The theories involved help students acquire an understanding of the deep-seated behavioral needs of prospective future clients. Mental health services, in the young deaf community, have many issues pertaining to providing adequate care. Living in profound silence, 43% of deaf youth struggle to prevail in life with mental illness. Counselors and psychiatrist are sacrificing to meet their unique needs. Prospective treatments and theory of behavioral modification can only help if one understands the causes and issues related to the illnesses. This is a look at the deaf culture, their mental health dilemma, and the sacrifice developing to accommodate the silent world.
Schizophrenia: A View Within
The human organism is susceptible from conception to death for varied alterations, which effect behavior and thought. Mal-adaptation is often a replacement behavior that occurs as a result of the alteration in thought pattern. Schizophrenia is considered to be a maladaptive behavior brought on by various causes still undergoing investigation. (NIMH, 2009)
Biological factors would include such issues as genetics, disease, alcohol use of parents or self, other substance abuse, and chemical poisoning, as well as structural brain abnormalities or injuries that effect behavioral outcomes. (Sarason, 2005) Genetic defects can include a predisposition to varied brain disturbances. (Comer, 2004) These can be passed from generation to generation and may become determinable at conception or even before. (Comer, 2004) Genetic testing for various probabilities has a long way to go. (NIMH, 2009) Present information states there is a “genome scan” for determining some of the variations of genetic predispositions for schizophrenia, but it is not completely accurate. (NIMH, 2009) The concept that it can be found is one issue and the determination of the best way to fix the occurrence is far in the future, if even in our lifetime. Genetic engineering is full of alternate ramifications and ethical considerations that will no doubt be the manifestation of a super acquisition of legal and scientific laws such as is beyond our present imagination.
Disease in infancy, childhood, or adulthood, can cause damage to the brain in various ways. Encephalitis causes inflammation to the brain usually after a viral infection or preceding a vaccination for proposed serious illness. (NINDS, 2007) Ischemic Stroke causes brain damage when the blood vessels in the brain become clotted, blocked, or plugged. The perpetual stress on blocked veins builds as the blood continuously pumps. The vessel gives way becoming a hemorrhagic stroke, which bleeds into the brain causing damage. Transient ischemic attacks (TIAs) happen, when blood supply is interrupted in brief increments. The ramifications of stroke can cause somatic conditions, yet the unseen and often less noticed effects are alterations of mood, thought, behavior, and even change in personality, thus causing mental conditions or disorders. (Satcher, 2007)
Traumatic brain injury (TBI) happens when forceful impact to the head causes damage to the brain. TBI can leave many lasting mental effects, including such behavioral/mental health challenges as depression, anxiety, personality changes, aggression, acting out, and social inappropriateness. TBI’s are on the rise with the war as are maladaptive abnormal behavioral issues, whether from the tragedy of war and survival or the injuries incurred. A soldier’s symptoms may also overlap with Posttraumatic Stress Disorder, making it more difficult for doctors to treat. (NAMI, 2009)
One considering the alcohol and substance abuse or use must consider the affect on infants and children first as the mold is made or broken in childhood, even infancy. Guided more so internally by the genetic grid, an embryo is formed. If the parent drinks while pregnant, there is an effect. The genetic makeup carries what has been the past as well as the future is embolden in every cell. Was the Grandfather predisposed to a mental illness such as schizophrenia or maybe depression? Thinking about this aspect of the human experience when considering brain function as well as the varied genetic issues of other possible configurations that make an individual what they inevitably are is amazing to say the very least.
Psychological theories include Freud’s theory of psychodynamic motivators for maladaptive abnormal behavior. This is the mental law that random thought is guided and connected by underlying motives, conscious, or unconscious that causes the behavior to be validated or rewarded. (Westen, 1998) The theory of instinctual drives such as: sex, physical urges, and aggression, manifest to mold maladaptive behavior that forms into anxiety or personality abnormalities. (Westen, 1998) The conflict between the id, the ego, and the superego, continually cause emotional friction in an already at risk individual, thus wearing down the normal ability to adjust in some circumstances and causing abnormal adjusting in some situations. (Westen, 1998)
Another factor, which should be considered, is environmental. The environment that one is constantly in affects the mental state of the individual. Chronic violence, poverty, excessive worry can cause anxiety or personality abnormalities. (NIMH, 2009) Posttraumatic Stress Disorder is a stress related illness from extreme trauma such as war, rape, or extreme violence. It is interesting that those reared and continuing life in normal, quiet, peaceful, situations have lower instances of mental illnesses. (NIMH, 2010) Racial and cultural divisions that are stressful can bring about personality and other possible sensitive counseling needs. The environmental impact of variables on mental health can be many with divided impact. The goal should be to aid the client in overcoming and integrating, thus becoming empowered in their own positive traits building the self-confidence they need to continue. (NIMH, 2010)
Struggling with Schizophrenia (295.30), PTSD (309.81), Manic Depression (296.33), as well as other numerous mental and physical challenges that at times are very crushing have taught this author about survival and the creative nature of the human spirit. The desire to do better despite the issues, to create a life from the ashes at 42, to reach out and find a way to overcome maladaptive behaviors that alienate and cause division between clients, their families and society is ever present. The blessing of therapist and psychiatrist, who have walked the roads of mental illness and social stigma, is priceless. This author has taken a 28-year span of successes and failures in a life with mental/physical illness and taken charge with the use of self-help books, research, medication, therapy, good doctors, and constant awareness of new and better medical management to find a better life. The days are scheduled like everyone’s. They are often exhausting, sometimes overwhelming. Unusual family issues and extreme stress with the muscle disease that is prevalent often overwhelms this author. Medication for pain and anxiety is limited to non-narcotic by choice, being able to think clearly is most important. The support structure present that is the best and most supportive is the doctors and therapist rather than family. This course has been very helpful in the journey to become a psychologist and better understand the behaviors of those so affected by the same issues that molded the views this author has carried for years. There are others though who struggle silently, in a world of quiet repose, where therapist and doctors have a language barrier. The deaf face amazing challenges in the mental health system.
Voices in the Silence: the Interview
“The voices tell me to cut myself. It makes me feel… feel as if I have control over just one thing in my life.” Suzan replied in sign language, when I signed to her about her schizophrenia and cutting ritual. She is 17 years young. A prominent student in high school, she also was in several extra-curricular activities. The schedule in front of me was staggering. “When I take my medication I have better days. I like to stay busy; it helps me to deal with the inner problems,” Suzan continued. “I am lucky; we have a counselor at school, which referred me for services, so many people receive no help at all.” She is not alone fighting a severe mental illness. Her plight echoes throughout the young deaf community.
Mental illness issues affect 43% of the deaf youth in America. (Eldik, 2004) The illnesses range the full gamut, from depression to schizophrenia; all of which are very hard to treat in the hearing community, under the best of circumstances. Medications and therapy treatment assigned for the group must be changed and altered to get the right balance. Communication is imperative to this process. (Carlson, 2008) Chemical consistency in the individual is remarkably different from one person to another; balance in the brain enzymes and medication application can incur many trial and error efforts to discover what works best, with the least side effects. This author’s treatment and observations through the last 28 years of mental illness still takes time and proper communication with the professionals to achieve and maintain a feasible balance. Trying and accommodating the various medications in different dosages over time to find a combination that stabilizes the illness takes patience, trust, and communication. Continuing close relationships with psychiatrist and therapist help as medications build a tolerance in the brain and must be changed to have continuing good results. This is an intricate dance between the patient and the professionals.
Communication is Vital
The young deaf community are susceptible to challenges the hearing world seem to be unable to conceive. This is manifest in the communication situation. Communication interferences in the postlingually deaf subjects determine a predisposition to mental distress. The subject observes the loss as more of a disability than prelingually deaf individuals do. De Graff (2002) found correlations in the prelingually deaf population as having a better self-image and quality of life than their postlingual counterparts. (DeGraff, 2002) Accordingly, DeGraff surmised the postlingual group felt socially isolated, less accepted by there hearing peers and more likely to have additional medical and social problems. Sign Language and speech reading in addition to written language are used to assess the deaf for mental difficulties. Various mental issues, in the hearing-impaired community, have no relative association with the level of imparity in the hearing. (Wallis, 2004) Internal and external manifestations studied in the subjects to determine the viability of treatment may gain the psychiatric personnel insight into the depth of illness. Truly, communication is imperative to the well being of the patient.
Progress serving this dynamic group of deaf marches forward as psychiatrist, counselors, therapist, and social workers are reaching out to gather and treat this vast array of people. The loving dedication of counselors and therapist learning to use American Sign Language with their deaf patients is cause for great pride. Providing translators for deaf clients is a hard job. Fifty-six percent of the deaf in one important study were unable to find accessible mental health care for lack of translators. (Steinberg, 1998) Casework and management plans effectively in place help benefit the deaf so they are able to make a fulfilling life. Positive reinforcement and patience is a virtue. Linguistic barriers often disadvantage the deaf who are able to read and write. The use of the English language for the deaf is very different from what a hearing person uses. The lack of use of conjunctions, prepositions, time continuums, and phrases cause many problems also in diagnosing adequately the specific symptoms of some forms of mental illness. Deaf think in pictorials and sign language, how does one ask, “Do you hear voices?” (a sign of schizophrenia) (Shapira, 1999) A few moments of fast signing by a patient can be seen as a manic state rather than a change in emotion. Expressions of emotions by the deaf are also a conveyance of their language; they rely on the facial expressions and body actions to understand or express the situation. This also is at times miss-read by a well-meaning clinician. The language of sign does not have adequate words for a variety of emotions; this can pose so many issues. This is why emotional behavior and facial expressions are imperative to the deaf so they gain insight. The deeper study of kinesics in the culture would help professionals diagnose illness more effectively. The ability to test by using genome will render an amazing aid for more accurate diagnosis in cases where communication is stifled. (NIMH, 2009)
The Hope for Development
Schools and mental health agencies are encouraging the deaf to become professionals in the mental health fields. The hope for the future of the deaf culture is healthy productive individuals that direct the members of their society to prosper and strive to build a well-educated peer base. The development project in place is to increase the number of signing members in the mental health and counseling community. Adapting test for mental evaluations will also help. Time and patience are encouraged by all involved. The protocol now is to have a double evaluation before commitment, this second opinion procedure is in place to secure the diagnoses and stop miss-understandings that cause wrongful commitment.
It is a personal hope that someday the mental health services for the deaf will be as easy to acquire as it is for the hearing world. I have 28 years of experience with the mental health system and 30 years working with the deaf. I intend on having many more years ahead to continue my work. Anthropology is the study of humanity and the contemporary human diversity. I am so profoundly touched by the deaf culture as a whole. The voices in the silence are many. Deaf old and young have issues. There are answers. The best of care takes time. Time takes the voices away.
Abnormal Psychology, Fifth Edition, Ronald J. Comer, (2004) Worth Publishers and W.H. Freeman and Company, New York, NY
American Annals of the Deaf 148:5, Eldik, V. (2004). . In Volume 148, (Spring Ed.), (pp.390-395 ). : .
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National Institute of Mental Health: Post Traumatic Stress Disorder http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
National Institute of Mental Illness: Schizophrenia http://www.nimh.nih.gov/health/publications/schizophrenia/complete-index.shtml – pub6
Foundations of Physiological Psychology, Neil R. Carlson (2008) New York, NY: Pearson Education INC
Sarason, I.G., Sarason, B.R. (2005) Abnormal Psychology – The Problem of Maladaptive Behavior. Upper-Saddle River, NJ: Pearson Education, INC
Shapira, N. A. MD, PhD (1999) Evaluation of bipolar in inpatients with prelingual deafness. The American Journal of Psychiatry, 156(8), 1267-1269
Steinberg, A.G. MD, Eckhart, E.A.CSW (1998, July) Cultural and Linguistic Barriers to Mental Health Services From the Deaf Consumers Prospective. The American Journal of Psychiatry, 155(7), 982-984
Traumatic Brain Injury: Veterans Resource Center NAMI: http://www.nami.org/Template.cfm?Section=Traumatic_Brain_Injury&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=85&ContentID=52915
The Scientific Legacy of Sigmund Freud: Toward a Psychodynamically Informed Psychological Science, Drew Weston, (1998) Harvard Medical School and Cambridge Hospital/Cambridge Health Alliance. The American Psychological Association, Copyright, 1998
Wallis, (2004) Journal of Deaf Studies and Deaf Education 2004. . In (Ed.), (9: pp2-14 ). : . http://jdsde.oxfordjournals.org/cgi/content/abstract/9/1/2