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Except from ‘Dyslexia and Mental Health: An Academic Perspective’
This chapter is based on Alexander-Passe (2010), from on a study of N=29 dyslexic adults, N=22 who presently or have in the past suffered from a depressive disorder.
The study compared depressive to non-depressive dyslexics, gender and degree to non-degree educated dyslexics. Whilst qualitative in basis, it used IPA (Interpretive Phenomenology Analysis) to find common themes to understand this sample better.
With this large sample, childhood to adulthood was investigated, specifically emotional coping strategies – both positive and negative. Self-harm was also investigated (food, alcohol, drugs, cutting and other), thinking about suicide and attempted suicide was investigated and will be the focus of this chapter.
Not surprisingly self-harm was greater in the depressive to non-depressive sample; however, the type of self-harm was different in each group. Males and non-depressives tended to predominantly self-harm with alcohol, followed by food and then rarely with bodily harm, whereas females tended to predominantly self-harm with food, then bodily harm and lastly alcohol. Depressives self-harmed predominantly with food and then equally between alcohol and bodily-harm. Each had their own profile and suggests that self-harm is a complex issue, with self-harm activities happening both as children and adults. In this study, children self-harmed as young as 5-10 years old in reaction to primary school work pressures, as well as feeling different to their peers.
Half the sample thought about suicide and less than half went on to actually attempt suicide. These thoughts, along with the high frequency of helplessness in the sample, suggest that suicide was viewed by many as a logical option to end their helplessness. Cases of suicide attempts as children were common, as many felt there was no option open to them to cope with the pressures from schoolwork and they perceived their parents did not understand what they were going through. What this suggests is that parents and schools need to look out for children at risk and put policies in place to manage the school workload of children. Drug overdoses, cutting wrists and alcohol poisoning (on purpose) were found in this study in both depressive and non-depressives - these were due to helplessness and are important to highlight, as dyslexia should not just be seen as a problem affecting a persons ability to read and write. The long-term emotional effects of feeling alienated by your peers and frustrated by your difficulties, even for simple basic tasks, should not be underestimated.
The following quote from Alexander-Passe (2010) details the real emotional journey of dyslexics.
Do you think dyslexia and depression are linked? Absolutely. Do you know many dyslexics who are depressed? No, but there are a few, a couple that are, a couple that hide it well. Do you know why depression and dyslexia could be linked? Yeh. I get many frustrations with it [dyslexia], the effort taken to do the simplest task and the reward is less than other peoples who put half the effort in to achieve the same or better grades, we put twice the effort in. Do you think that some dyslexics don’t get depressed? I think they all get symptoms of it, but it seems to hit [depression] the ones that try and do academically more or ones that…I thought about different types of dyslexia for a while. You seem to get dyslexics who want to do well and want to do more than they are capable of to prove to themselves that’s it's not a big problem; the dyslexics that are happy with what they are doing, feel happy with what they are doing and are happy with their lot, maybe it’s a feeling that you should be doing something better, with the effort they put in. Do you think that some dyslexics deal with the problems/effects differently? Anger? Yes anger, some, when I was first statemented (at school), the psychologist said ‘a lot get angry and a lot get violent and they get more attention and statemented quicker’, because it’s more visible, so maybe it’s a moral aspect of knowing the difference or not having the restraint. Do you think that dyslexics will either get depressed or angry? Yes it’s possible. The ones that don’t get depressed lash out. Then maybe it’s more a social thing about how they are brought up. (Ronnie).
The aim of the study was to pose a semi-structured interview script to a range of UK adult dyslexics to investigate how they cope, their reactions to success/failure and a review of their childhoods to identify where any emotional damage originated. Adult dyslexics were chosen as they would have the ability to review their childhood for the origins of their coping strategies and could give a data rich explanation of any suffering. Four groups were sought: dyslexics with and without a clinical depression diagnosis, degree-educated and non-degree-educated dyslexics.
Participants were recruited via three medias. Firstly, an email was sent to large UK dyslexia newsgroups, secondly an advert on the beingdyslexic.com website and thirdly approaching several dyslexia associations for website inclusion. Although four groups were requested, the largest group replying were dyslexic adults with depression.
All participants were required to provide evidence of a formal diagnosis of dyslexia (commonly from an educational psychologist), however evidence of depression was not sought as this would be more difficult to attain from their physician or hospital, indications would be sought within the interviews. However most provided supporting evidence to their depressive disorder, ranging from GP/hospital letters to empty prescription anti-depressants (SSRIs) bottles. Whilst mild depression is common in society, only severe cases tend to be referred to a physician for clinical diagnosis. In all, N=29 (mean 40.56yrs, SD 12.67) dyslexic adults were recruited, N=22 (mean 42.32yrs, SD 13.0) had a depression diagnosis (rated as either a clinical depression diagnosis or at least one course of physician/GP prescribed anti-depressants) and N=7 (mean 35.14yrs, SD 10.89) with no depression diagnosis. With the depressed dyslexics, there were N=15 females (mean 38.8yrs, SD 11.71) and N=7 males (mean 49.86yrs, SD 11.42). With the non-depressed dyslexics, there were N=3 females (mean 18yrs, SD 1.63) and N=4 males (mean 43.5yrs, SD 6.54). The mean age of dyslexia diagnosis was 28.09yrs (SD 11.83) in the depressive sample and 22.28yrs (SD 14.77) for the non-depressive sample, indicating that the non-depressives tended to be diagnosed earlier, however in both groups they were mainly diagnosed post-school and after leaving university.
Depression was the main focus of Alexander-Passe (2010) and the vast majority of the sample felt dyslexia and depression were correlated, as they understood that the effects of dyslexia covered all interactions with society, not just in school, but learning, reading, and writing as well. It was also felt that traditional treatments offered by their physicians were unsuitable. This may be due to firstly their brains having unique neural wiring and SSRI (and other medications) may affect such frontal lobe areas in non-standardised ways, causing as (some participants found) a lack of control of daily basis tasks. Secondly, with investigations of CBT (Cognitive Behaviour Treatment) it was noted that CBT relied on modifying what the therapist believes to be irrational thought behaviours; however, to the dyslexic these fears were real, as dyslexia affects every interaction an individual has with society.
Fearing someone will laugh at you for being overly clumsy or forgetting things were perceived as real concerns and not something, you can easily undo with CBT. Thus if the CBT counsellor does not take dyslexia as a major variable, the patient will be in conflict with the whole course of treatment.
The main focus of this chapter was an investigation into self-harming as a reaction to difficulties and as a by-product of depression, based on the data from Alexander-Passe (2010). Overall self-harm in its many forms was used by the vast majority of the sample, with food and alcohol more commonly than bodily harm. Self-harm was used by individuals for several reasons and mainly it was to do with regaining control in their life - where they felt they had no or little control in other aspects (e.g. school, career, relationships etc). Food was an interesting form of self-harm; as it extended to binge eating as a comfort food, leading to obesity as another means to distance themselves from society (there is an illogical perception in society that fat people are abnormal and off-putting). One participant in the study also noted anorexia; not for attention seeking as she wore layers to bulk up, but as a form of control as she felt helpless in other areas of her life. Many self-harmers in the study mentioned feeling unworthy, to explain why they resorted to punishing their bodies for causing them emotional pain due to humiliation.
With bodily harm, it was interesting to note that for those who hit their heads in frustration – it was to hurt themselves to gain a chemical reaction or stimulus from feeling pain (a natural high), rather than for anger. As many in the study perceived dyslexia caused them to have a faulty brain, the idea of hitting something broken to get it to work cannot be discounted. In the case of cutting, again there was a chemical and psychological release from spilling blood in a way of regaining control in the perceived ‘crazy world they lived in’.
Not surprisingly self-harm was greater in the depressive to non-depressive sample; however, the type of self-harm was different for each group. Males and non-depressives tended to predominantly self-harm with alcohol, followed by food and then rarely with bodily harm, whereas females in general, tended to predominantly self-harm with food, then bodily harm and lastly alcohol. Overall depressives self-harmed predominantly with food and then equally between alcohol and bodily-harm. Each group had their own profile and suggests that self-harm is a complex issue, with self-harm activities happening both in child and adulthood. In this study, children self-harmed as young as 5-10 years old in reaction to primary school work pressures, as well as feeling different to their peers.
Half the sample thought about suicide and less than half went on to actually attempt suicide. These thoughts, along with the high frequency of helplessness in the sample, suggest that suicide was viewed by many as one option to end their helplessness. Cases of suicide attempts as children were common in this study, as many felt there was no other option open to them to deal with the pressures from schoolwork and they perceived their parents did not understand what they were going through. What this suggests is that parents and schools need to look out for children at risk and put policies in place to manage the workload of children. Drug overdoses, cutting wrists and alcohol poisoning (on purpose) were found in this study by both depressive and non-depressives, these were due to helplessness and are an important aspect to highlight, as dyslexia should not just be seen as a problem affecting a persons ability to read and write. The long-term emotional effects of feeling alienated by your peers and frustrated by your difficulties, even for simple basic tasks, should not be underestimated.
Such long-term effects as noted by self-harm and suicide come from long-term feelings of anger and resentment towards teachers from their childhood. The humiliation and alienation as experienced by dyslexic adults comes from their own school days, being made to feel abnormal as children.
From the sample the vast majority still resented their childhood teachers and a large percentage also felt anger towards these teachers, with many asking ‘what could I have been?’ and questioning lost opportunities in life. Resentment and anger was greatest amongst non-depressed females, followed by non-degree educated depressives. Both groups one could hypothesise had not attained as per their childhood dreams.
In summary, the study looked at how dyslexic adults are still affected by their difficulties and how they are still affected by their childhood experiences of school. The longevity of school trauma and its effect on adult happiness and career progression means that school is an important period in a dyslexic’s life and educators need to focus on preventing further generations from experiencing negative and emotionally damaging school experiences, which can trigger lifelong mental illness.
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