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Please welcome Elaine J. Alpert, MD, MPH as today's guest writer. Dr. Alpert is an internationally-respected family violence, sexual assault, and human trafficking education, advocacy, and policy expert. She is an independent curriculum design and policy consultant in all forms of violence prevention, teaches at the University of British Columbia School of Medicine, and provides expertise in Human Trafficking as Senior Global Health Fellow at Massachusetts General Hospital’s Division of Global Health and Human Rights. She also serves as a Trustee of the all-volunteer Steve Glidden Foundation, which provides summer camp scholarships for children who are homeless, refugees, abused, or affected by family or community violence. She can be reached at ealpert@rcn.com. 

I’ve been watching news coverage about Ray Rice’s domestic violence (DV) assault for the past two days now and I have to say that, on balance, I am disappointed.

As a veteran physician, educator and scholar in the fields of domestic violence, sexual assault and, more recently, human trafficking, I’ve been paying attention over the years both to events (often tragic) as they happen, and to trends in both media expertise and public perception. Here are some observations along with a few words on how I think the media can do better:

Media attention ideally should:

  • Tell the viewing, listening, reading, or clicking audience what happened (report the news);
  • Raise questions that people might not otherwise have considered;
  • Educate, inform and raise awareness among the general public; and
  • Motivate people to action (for example, by providing ready resources for those at risk, and by showing those who want to help how to do so).

How good a job do our media really do (in general) when reporting about DV? Typically, for a few days after a high profile DV assault or murder, we see coverage about whatever “event” transpired, along with passionate and generally well-meaning attention paid to DV as a whole. Overall, (and not specific to the Rice case), we tend to see variations of:

  • Shock or disbelief that such a nice guy could have done such a terrible, unanticipated thing, often supported by “evidence” of niceness – he was a pillar of the community, he walked his dog every morning, he brought the paper to the elderly neighbor’s door, he belonged to the neighborhood watch, etc.  Often these “nice guy” testimonials come from neighbors or passers-by;
  • Proclamations that this was either a one-off act of insanity or passion, or at least could not have been predicted  – he must suddenly have lost control, perhaps something happened (provoked him) to make him “lose it,” no one saw this coming, etc. These “no-one-saw-this-coming” testimonials are usually from acquaintances, co-workers, or local officials, often accompanied by assurances that the neighborhood itself is “nice,” “quiet,” or “tranquil,”  or at least full of hard-working, honest and earnest people. Accompanying footage often shows tree-lined streets and picket fences whenever possible;
  • A general wringing of hands about difficulty the “victims” (or their children) may encounter moving forward (sometimes accompanied by additional angst about extended family members, pets, or traumatized neighbors). A few even engage in hand-wringing about the future well-being of the perpetrators (think Steubenville). All commentators can participate freely in the wringing-of-hands exercise, including reporters themselves; and
  • Assurances that whatever tragic event just transpired was the tipping point and things will be better (this will not happen again, police responses will be improved, weapons will be better regulated, social service referrals will be handled more promptly, etc.). Such assurances usually come from local or statewide officials.

And then, almost like clockwork, once the arraignment (or funeral) has passed, and the world turns its attention to the next short-cycle news event, coverage moves to the next ratings-boosting headline.

Although still early, this pattern is already being replicated in the Ray Rice assault. The current pundits – at least on the news clips I am watching – are predominantly:

1. NFL or other sports experts/journalists talking about how it's important to figure out who in the league knew what, and when they knew it, while proclaiming how shocked they were when these allegations first arose last winter because Rice was – guess what – a pillar in his community;

2. Journalists and authors who are either psychologists or other counselors, or who have had personal experiences with DV and have written (and are, at times, quite obviously plugging) books about what "battered women" are “like” or what they “go through,” earnestly trying to explain Janay Rice’s various (and some would argue, stage-managed) "stand by your man" statements;

3. Legislators who proclaim (sometimes with passion) that DV is bad and VAWA is good; or

4. Lawyers who wonder why Rice was allowed to enter a "diversionary" program and was not jailed for aggravated assault.

Some of this commentary can add value to the societal discussion that needs to take place. Clearly, it is necessary, but it is not sufficient.

What I do NOT see - and what I think really needs to be featured prominently – is reporting that provides:

1. Commentary from DV experts, including community-based or national experts from DV advocacy organizations, recognized scholars, and those whose expertise is in primary prevention – changing conditions to prevent DV from occurring in the first place. Baltimore (and the DC Metro area) has all of that to offer - and then some.

2. Resource information for the viewer (or reader) on how to get help or how to get involved to help. This can easily be offered as a “crawler” with the vital information scrolling past at the bottom of the screen on TV or as a sidebar in print or on the internet.

At least as far as I have seen, very few "pundits" have talked about how to reach out to, and empower, survivors.  No one (at least on broadcasts I’ve seen) has told viewers who may be in danger that there are vital community-based services in most localities and how to contact them to get help. Not one has talked about the restorative power of support groups (though lots of pundits have talked about how important it is for the Rices to get one or another kind of therapy for things that may or may not have happened in their own childhoods). Not one has talked about how to engage men and other bystanders as active allies to challenge and change entrenched social norms that tolerate and promote violence. And not one has displayed the National DV hotline phone number (1-800-799-7233) or website (http://www.thehotline.org/).

Many years ago, when print media reigned supreme, the Boston Globe included an inset box with every article about DV. The box included a stylized image of a telephone, words identical or similar to “To Get Help,” and a DV hotline number. This boxed information was normally inserted in the final layout process. During a layout makeover several years ago, this vital information got dropped and, to my knowledge, has not been restored.

Including “To Get Help” info about DV in print, on TV news, and on web-based news sources is such a no-brainer. Why not include it automatically in news reporting?

None of this is rocket science – whenever you read about a disaster of any other kind – from Katrina to Sandy to tornadoes – there is ALMOST ALWAYS commentary from experts in the field, accompanied by a box or informational inset that provides information for people who need help or who want to volunteer, contribute or help in some other way.  Why is there a different set of rules for DV?

So we have come a long way I guess, but the media has still not got it quite right – at least not yet.

Janay – if you read this, your local DV organization is ready to reach out to you without judgment, and with compassion, patience, information, empowerment, and support.  If only the TV would tell you the phone number…
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Today's guest post comes from Julie Maier. Julie has a master’s degree in social work and is currently a PhD student in the Kinesiology Department at the University of Maryland (Physical Cultural Studies focus).  Her research interests focus on the intersection of mental health, gender, sexuality, and the body. If you'd like to get in touch, she can be reached at jmaier@umd.edu

Olympic season brings with it a plethora of news stories focused on some of the best athletes in the world.  In addition to factual accounts of Olympians’ performances, human-interest stories and sensationalized gossip pervade the print and online media.  Indeed, one would have to bury his or her head in the snow to avoid hearing about athletes during this time of year.  While many Olympic-centered articles are seemingly trivial, some stand out as having the potential to create a more socially just world.  For example, an Olympian came out describing his struggles with something that remains relegated to doctors’ offices or psychology classrooms: mental illness.  Though athletes’ discussion of mental health can be seen as a way to de-stigmatize this issue, the overall impact is dependent upon informed reporting that does not perpetuate misconceptions about various forms of distress.

  Upon winning the gold medal in the 1,000 meter men’s speed skating event in Sochi, the news reports that followed not only detailed the Dutch athlete Stefan Groothuis’ Olympic win, but his disclosure of his battle with depression.  According to Reuters, Groothuis had struggled with depression for years, which hindered not only his training, but his overall ability to enjoy life.  Casert, in an article by the Associated Press, noted that Groothius’ depression brought him to the point of contemplating suicide.  By opening up about mental illness, Groothius joins a handful of professional athletes who, through the years, have come out as living with particular forms of distress such as depression, borderline personality disorder, bipolar disorder, and obsessive compulsive disorder.

The significance of such attention to mental health issues cannot be overstated.  Though progress undoubtedly is being made to reduce the stigmatization of those who live with mental illness, there is still a long way to go.  For instance, in a 2014 article published in Psychiatry Services, Dr. Jennifer Stuber and colleagues found that negative attitudes towards people with mental illness were prevalent amongst the lay public, as well as some mental health providers.  Participants indicated being particularly afraid of individuals with schizophrenia due to the misperception that such people are inherently dangerous.  Additionally, over two-thirds of the general public and almost one half of mental health practitioners in the study reported not wanting somebody with schizophrenia to marry into their family.  Such stereotypes contribute to an environment in which those suffering from mental health conditions are subject to discrimination, marginalization, and various forms of abuse.  Greater openness about mental health may help to educate the general public about a topic that frequently arises only in light of sensationalized tragedies such as mass shootings, and then quickly disappears, sending the message that those with mental illness are a threat to public safety, and mental health is only appropriate to discuss when lives have been taken.

The fact that professional athletes are stepping out and talking about their experiences with distress is of particular importance.  In the realm of sport, a traditionally (and still!) masculine domain, mental illness is too often equated with weakness.  In fact, historian Dr. Roberta Park (2012) noted that sport was used as a way to toughen up men returning from war who were suffering from what we might now consider a form of post-traumatic stress disorder (PTSD). The idea that mental illness is a form of weakness or an excuse can be seen in many of the responses to NBA player Royce White’s coming out as having obsessive compulsive disorder and generalized anxiety disorder (GAD) in 2012, which included death threats.  Such negative reactions, however, only reaffirm the importance of celebrated athletes speaking up about mental health.

Although self-disclosure is of course not enough in and of itself to drastically change the lives of those living with depression, schizophrenia, or the like, it can have a positive impact on the discourse surrounding mental health.  This is dependent upon the way journalists and others craft and frame the athletes’, and other public figures’, stories.  For example, one headline pertaining to Groothius announced that “Groothuis gold ends years of misery, depression,” while another boasted that “Stefan Groothuis overcomes depression and wins Olympic gold.”  Such framing may perpetuate the misconception that most mental illnesses can be overcome, never to return, as opposed to an ongoing condition whose severity may ebb and flow throughout one’s life--something that can be managed, though never fully cured.  This is not to discount Groothuis’ experience; perhaps he has indeed ‘overcome’ depression. However, for many suffering from depression—particularly, major depressive disorder—they may never be fortunate enough to be totally free from depression (see psychiatrist Peter Kramer’s widely cited book, Against Depression, for more on this).  With that said, the aforementioned headlines may make people with depression who have struggled for years to recover feel further marginalized, while perhaps sending the message that mental illness is temporary.

Additional conversation surrounding mental health is desperately needed, and stories such as Groothius’ help to chip away at the deep-seated misunderstanding and stereotyping pertaining to mental illness.  Hopefully one day athletes coming out with their stories of depression will be a non-issue, but until then, such disclosures are vital for the health of all.
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Hello to all my Pop Health readers!  I apologize for the lack of new blog posts since January.  I was planning to go on maternity leave in late March, but my little guy decided to surprise me 8 weeks early on January 29th instead!  He is doing great (thanks to everyone who has reached out).
Since I will be writing less frequently while on maternity leave, I will be integrating some wonderful guest posts on the blog.

Thank you to everyone who has volunteered their time to contribute to Pop Health over the next few months!