OPUS Vol. XI Issue I

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The Online Publication of Undergraduate Studies was initiated in 2010 by undergraduate students in the Department of Applied Psychology, NYU Steinhardt. The ideas and opinions contained in this publication solely reflect those of the authors and not New York University. All work is licensed under the Creative Commons Attribution Noncommercial No Derivative Works License.

To view a copy of this license, visit http://creativecommons.org

OPUS

Online Publication of Undergraduate Studies Volume XI Issue I | Spring 2020 Editors-in-Chief Oana Groza Andrew Han

Editors-in-Training Olivia Pagliaro Maya Metser Katie Mundt

Layout & Design Directors Chloe Carlson Sydney Liang Grace Park

Contributing Writers Maggie Zhang Sarah Khullar Kasane Tonegawa Olivia Matthes Theriault

Communications Director Freya Chen

Staff Writer Will Olesiewicz

Special Thanks Erica Rodriguez Dr. Gigliana Melzi Department of Applied Psychology NYU Steinhardt

Faculty Mentor Dr. Adina R. Schick

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Contents 05

Letter from the Editors

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Literature Reviews 07 Maggie Zhang Bilingualism and Inhibitory Control in Relation to Emotional Regulation 12 Sarah Khullar Openness to Seek Mental Health Services among Muslims in the Middle East Influence of Religious and Familial Cultural values on Muslims’ Openness to Seek Mental Health Services in the Middle East 16 Kasane Tonegawa Alternative Forms of Treatment for Treatment Resistant Deprsession 21 Olivia Matthes Theriault Resistant and Seclusion Use in Psychiatric Inpatient Settings

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Interview 28 Oana Groza and Andrew Han An Interview with Dr. Karthik Gunnia: A Glimpse into the Intersection of Music and Mental Health

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Album Reviews 33 Will Olesiewicz Frank Ocean’s Endless: Exploring Love in Early and Emerging Adulthood 38 Andrew Han ‘Wild and Fluorescent’: Emerging Adulthood in Lorde’s Melodrama

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Discography Review 51

Oana Groza Showcasing Vulnerability as Strength: A Brief Examination of Kehlani’s Discography

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Biographies

Letter From the Editors New York University’s Applied Psychology Online Publication of Undergraduate Studies, also known as OPUS, was established in 2009. OPUS provides Applied Psychology undergraduate students with a forum for sharing their independent work. This publication is entirely written, edited, and designed by Applied Psychology undergraduates, and is one of the only undergraduate psychology journals in the United States.

We are thrilled to present our Spring 2020 issue this year. The themes of this issue reflect the diverse clinical and research interests of our contributing writers and demonstrate an overarching desire to understand the nuances of psychologica l phenomena in a wide range of communities, thus embodying the ethos of Applied Psychology. For the first time ever, OPUS has published album reviews—reflecting the unique creative interests of our department and our drive to push the boundaries of previous OPUS issues.

To our readers: we hope this issue provides a brief escape from the current situation and demonstrates the excellence of our writing staff, all of whom made this release possible. Our issue this semester contains distinct explorations of psychological theories with real-world applications. Utilizing the Bilingual Inhibitory Control Advantage (BICA) hypothesis, Maggie Zhang explores how early childhood bilingualism enriches the relation between two crucial cognitive processes, inhibitory control and emotional regulation development. Sarah Khullar also examines how cultural values among Muslims living in the Middle East influence openness to seek professional mental health services.

Kasane Tonegawa tackles a fascinating, novel avenue of research, considering how alternative forms of treatment, such as professionally administered low doses of ketamine, can be used for treatment resistant depression. Lastly, Olivia Matthes Theriault investigates the effectiveness of restraint and seclusion practices in aiding patient recovery in psychiatric inpatient hospitals. To close her piece, she interviewed a Project Coordinator at Bellevue Hospital Child and Adolescent Acute Inpatient Psychiatric Unit about a groundbreaking framework, known as Trauma Informed Care (TIC), a promising approach to replace the use of restraint and seclusion practices in clinical settings.

In their album reviews, Will Olesiewicz and Andrew Han dive into Frank Ocean’s Endless and Lorde’s Melodrama, respectively, exploring prevalent themes seen during the transition from adolescence to young adulthood. Similarly, Oana Groza reviewed all of Kehlani’s projects to date, examining Kehlani’s narrative as she goes through emerging adulthood and motherhood. Oana and Andrew also conducted an interview with Dr. Karthik Gunnia, a Visiting Assistant Professor in the Applied Psychology department, who will be teaching a new course, entitled “Mental Health in Contemporary Music,” which will focus on how music can serve as a tool to support destigmatize and promote mental health. We hope to see future writers and Editor-in-Chiefs with new ideas that continue to explore the intersection of their creative and psychological interests.

Thank you so much to our enthusiastic and talented writers for your contributions. This semester presented unprecedented additional challenges with the COVID-19 pandemic. Our team worked tirelessly not only to release the issue, but also make it incredible! We would also like to thank our talented Layout & Design team—Chloe, Grace, and Sydney—for their hard work and commitment to bringing the journal to life. Special shoutout to Kylie McManus and Olivia Bowen for their beautiful artwork.

We are grateful to Dr. Gigliana Melzi, the Director of Undergraduate Studies in Applied Psychology, and Erica Rodriguez, the OPUS advisor for their continuous support of OPUS. Finally, we would like to thank Dr. Adina Schick, our faculty mentor, for her guidance, wit, and dedication to OPUS, without which this issue would not be possible.

Best, Oana Groza and Andrew Han

Oana Groza

Andrew Han

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Literature Reviews

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The Impact of Early Bilingualism on Inhibitory Control and Emotional Regulation Maggie Zhang

Inhibitory control and emotional regulation have long term implications for academic achievement and social functioning starting in early childhood (Anzman-Frasca, Francis, & Birch, 2015; Blandon, Calkins, & Keane, 2010; Carlson & Wang, 2007; Fan, Liberman, Keysar, & Kinzler, 2015; King, Lengua, & Monahan, 2013; Oades-Sese et al., 2011; Rhoades, Greenberg, & Domitrovich, 2009). Both emotional regulation and inhibitory control have underpinnings in the prefrontal cortex of the brain, suggesting that there may be a link between these two processes (Blair, 2002; Martin & Ochsner, 2016; Ochsner & Gross, 2005).

Inhibitory control is a cognitive skill that refers to the ability to control one’s thoughts and actions and facilitates children’s emotional regulation, which allows an individual to respond appropriately in social situations (Carlson & Wang, 2007; Hudson & Jacques, 2014; Šimleša, Cepanec, & Marta Ljubešić, 2017). Past research has highlighted the potential advantages of early exposure to or fluency in more than one language for inhibitory control, suggesting that early childhood bilinguals exhibit greater inhibitory control than monolinguals (Bialystok, 2017; Bialystok, Martin, & Viswanathan, 2005). Thus, it seems plausible that early childhood bilingualism might strengthen the relation between inhibitory control and emotional regulation. Therefore, the current review explores the following research question: Does inhibitory control enriched by early childhood bilingualism promote positive emotional regulation development? This paper focuses on research conducted with bilingual participants, in English and another language, who were exposed to both languages at home, at school, or with family members at least 10-25% of the time every day since birth (Byers-Heinlein & Lew-Williams, 2013).

Emotional Regulation and Inhibitory Control The development of inhibitory control and emotional regulation begins in early childhood (Anzman-Frasca et al., 2015; Carlson & Wang, 2007; Rhoades et al., 2009). Researchers exploring the relation between inhibitory control and emotional regulation typically create a scenario where the child receives a disappointing gift at the end of participating in a research study and have found that children who had higher levels of inhibitory control were significantly better at regulating their emotions and masking their disappointment by still reacting positively when receiving the gift (Carlson & Wang, 2007; Hudson & Jacques, 2014). By contrast, children with lower levels of inhibitory control had difficulty hiding their negative emotionality and looked or acted visibly upset over the gift (Carlson & Wang, 2007; Hudson & Jacques, 2014).

Emotional regulation is essential for child development

and has implications for academic achievement and social functioning (Birch & Ladd, 1997; Eisenberg et al., 1995; English et al., 2012; Graziano, Reavis, Keane, & Calkins, 2007; Gumora & Arsenio, 2002; Rydell, Thorell, & Bohlin, 2007; Trentacosta & Shaw, 2009; Valiente et al., 2010). Beginning in early childhood, emotional regulation predicts preschoolers’ academic achievement; students who display more emotional regulation have stronger relationships with their teachers, which, in turn, contributes to higher rates of early academic success and productivity (Birch & Ladd, 1997; Graziano et al., 2007; Gumora & Arsenio, 2002; Valiente et al., 2010). Emotional regulation also impacts social behaviors starting in preschool, with teachers and peers viewing students who have a greater ability to self-regulate and positive social relationships, more favorably (Birch & Ladd, 1997; Blair, Denham et al., 2004; Eisenberg et al., 1996; Graziano et al., 2007; McDowell, Kim, O’Neil, & Parke, 2002). Thus, inquiry into the mechanisms that enrich the associations between inhibitory control and emotional regulation is of particular importance. Once such mechanism might be childhood bilingualism.

Early Childhood Bilingualism Enriches Inhibitory Control The Bilingual Inhibitory Control Advantage (BICA) argument speculates that bilinguals perform better than monolinguals on tasks that require inhibitory control (Green, 1998). This argument is supported by research that has found that bilinguals demonstrate more instances of inhibitory control than monolinguals (Bialystok et al., 2005; Bialystok, 2017). One possible explanation for this advantage is that bilinguals simultaneously use one language while inhibiting interferences from the other language (Esposito, Baker-Ward, & Mueller, 2013; Hannaway, Opitz, & Sauseng, 2019). The active suppression of the second language, while using the intended one, demonstrates inhibitory control.

The most common method for measuring the relation between bilingualism and inhibitory control is through tasks such as the Stroop and Simon Tasks (see Figure 1 and Figure 2). Both tasks require participants to focus on one aspect of the task while ignoring irrelevant information, a core element of inhibitory control (Stevens & Bavelier, 2012). Supporting the BICA hypothesis, bilinguals were found to have higher instances of inhibitory control compared to monolinguals on both tasks, such that bilinguals were better able to suppress contradictory stimuli (e.g., the color of the word) and reacted faster than monolinguals (Bialystok et al., 2005; Bialystok, 2017; Blumenfeld & Marian, 2011; Esposito et al., 2013; Hartanto & Yang, 2019).

Literature Reviews | 7

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Given that bilinguals outperform monolinguals on tasks such as the Simon and Stoop Tasks, it is important to explore how early childhood bilingualism could be a factor that enhances inhibitory control and emotional regulation in children raised in bilingual households (Fan et al., 2015; Oades-Sese et al., 2011). In fact, greater inhibitory control is associated with greater social skills and academic achievement in bilingual children, due to their ability to control or adjust their behaviors in response to challenging situations and thereby more easily self-regulate (Carlson & Wang, 2007; Hartanto & Yang, 2019; Hilchey & Klein, 2011; Liu et al., 2019; Lukasik et al., 2018; Rhoades et al., 2009). Since early childhood bilingualism enriches inhibitory control and inhibitory control is linked with emotional regulation, growing up in a bilingual household could promote emotional regulation and effective communication (Fan et al., 2015; Oades-Sese et al., 2011). In fact, bilingual children as young as four-years-old have a greater ability to inhibit negative emotions in social settings and show more flexibility when responding to social situations, such as reacting calmly and positively to a disagreement (Carlson & Wang, 2007; Denham et al., 2003; Fan et al., 2015; Oades-Sese et al., 2011). Both emotional regulation and inhibitory control are necessary for bilinguals to restrain their own thoughts and actions in frustrating moments, enabling them to appear more emotionally regulated and deemed as likeable by their peers (Fan et al., 2015). Early childhood bilingualism thus appears to serve as a moderator for the relation between inhibitory control and emotional regulation, although more research on this topic is needed.

Conclusion Past findings support the BICA hypothesis, with bilinguals exhibiting greater inhibitory control and emotional regulation compared to monolinguals (Bialystok et al., 2005; Bialystok, 2017; Blumenfeld & Marian, 2011; Esposito et al., 2013; an et al., 2015; Hartanto & Yang, 2019; Oades-Sese et al., 2011). These advantages in inhibitory control and emotional regulation are noteworthy, because early childhood bilingualism could potentially offer an explanation for the greater academic achievement and social functioning in bilinguals compared to their monolingual peers (Fan et al., 2015; Oades-Sese et al., 2011).

Although a robust amount of literature has examined early childhood bilingualism, future research should examine how the development of inhibitory control differs for people bilingual in English and another written language, such as Spanish, compared to people bilingual in character based languages (e.g., Chinese). Additionally, to see the long term effects of early childhood bilinguals, more longitudinal studies should be conducted in order to see how early childhood bilingualism impacts the development of inhibitory control throughout their life, rather than conducting comparison studies for one age group at a time. These findings can have implications in practice and policy by emphasizing the importance of offering different 8 | Literature Reviews

language exposure in schools. Given the growing amount of bilingual children in the United States, research should support the importance of bilingual schooling, especially in communities with large immigrant populations.

Bilingualism, Inhibition and Emotion References Anzman-Frasca, S., Francis, L. A., & Birch, L. L. (2015).

Inhibitory control is associated with psychosocial, cognitive, and weight outcomes in a longitudinal sample of girls. Translational Issues in Psychological Science, 1(3), 203-216.

Bialystok, E. (2017). The bilingual adaptation: How minds accommodate experience. Psychological Bulletin, 143(3), 233-262.

Bialystok, E., Martin, M. M., & Viswanathan, M. (2005).

Bilingualism across the lifespan: The rise and fall of inhibitory control. International Journal of Bilingualism, 9(1), 103–119.

Birch, S. H., & Ladd, G. W. (1997). The teacher-child relationship and children’s early school adjustment. Journal of School Psychology, 35(1), 61-79.

Blair, K. A., Denham, S. A., Kochanoff, A., & Whipple, B. (2004).

Playing it cool: Temperament, emotion regulation, and social behavior in preschoolers. Journal of School Psychology, 42(6), 419-443.

Blair, C. (2002). School readiness. American Psychologist, 57(2), 111-127.

Blandon, A. Y., Calkins, S. D., & Keane, S. P. (2010). Predicting emotional and social competence during early childhood from toddler risk and maternal behavior. Development and Psychopathology, 22(1), 119-132.

Blumenfeld, H. K., & Marian, V. (2011). Bilingualism influences inhibitory control in auditory comprehension. Cognition, 118(2), 245-257.

Byers-Heinlein, K., & Lew-Williams, C. (2013). Bilingualism in the early years: What the science says. LEARNing Landscapes, 7(1), 95-112.

Carlson, S. M., & Wang, T. S. (2007). Inhibitory control and emotion regulation in preschool children. Cognitive Development, 22(4), 489-510.

Denham, S. A., Blair, K. A., DeMulder, E., Levitas, J., Sawyer, K., Auerbach-Major, S., & Queenan, P. (2003). Preschool emotional competence: Pathway to social competence?

Child Development, 74(1), 238-256.

Eisenberg, N., Fabes, R. A., Murphy, B., Karbon, M., Smith, M., & Maszk, P. (1996). The relations of children’s dispositional empathy-related responding to their emotionality, regulation, and social functioning.

Developmental Psychology, 32(2), 195-209.

Eisenberg, N., Fabes, R. A., Murphy, B., Maszk, P., Smith, M., & Karbon, M. (1995). The role of emotionality and regulation in children’s social functioning: A longitudinal study. Child Development, 66(5), 13-60.

English, T., John, O. P., Srivastava, S., & Gross, J. J. (2012).

Emotion regulation and peer-rated social functioning: A four-year longitudinal study. Journal of Research in Personality, 46(6), 780-784.

Esposito, A. G., Baker-Ward, L., & Mueller, S. T. (2013).

Interference suppression vs. response inhibition: An explanation for the absence of a bilingual advantage in preschoolers’ stroop task performance. Cognitive Development, 28(4), 354-363.

Fan, S. P., Liberman, Z., Keysar, B., & Kinzler, K. D. (2015).

The exposure advantage. Psychological Science, 26(7), 1090-1097.

Graziano, P. A., Reavis, R. D., Keane, S. P., & Calkins, S. D. (2007). The role of emotion regulation in children’s early academic success. Journal of School Psychology, 45(1), 3-19.

Green, D. W. (1998). Mental control of the bilingual lexicosemantic system. Bilingualism: Language and Cognition, 1(2), 67-81.

Gumora, G., & Arsenio, W. F. (2002). Emotionality, emotion regulation, and school performance in middle school children. Journal of School Psychology, 40(5), 395-413.

Hannaway, N., Opitz, B., & Sauseng, P. (2019). Exploring the bilingual advantage: Manipulations of similarity and second language immersion in a stroop task. Cognitive Neuroscience, 10(1), 1-12.

Hartanto, A., & Yang, H. (2019). Does early active bilingualism enhance inhibitory control and monitoring? A propensitymatching analysis. Journal of Experimental Psychology.

Learning, Memory, and Cognition, 45(2), 360-378.

Hilchey, M., & Klein, R. (2011). Are there bilingual advantages on nonlinguistic interference tasks? Implications for the plasticity of executive control processes. Psychonomic Bulletin & Review, 18(4), 625-658.

Hudson, A., & Jacques, S. (2014). Put on a happy face! Inhibitory control and socioemotional knowledge predict emotion regulation in 5- to 7-year-olds. Journal of Experimental Child Psychology, 123, 36-52.

King, K., Lengua, L., & Monahan, K. (2013). Individual differences in the development of self-regulation during pre-adolescence: Connections to context and adjustment.

Journal of Abnormal Child Psychology, 41(1), 57-69.

Liu, C., Yang, C., Jiao, L., Schwieter, J. W., Sun, X., & Wang, R. (2019). Training in language switching facilitates bilinguals’ monitoring and inhibitory control. Frontiers in Psychology, 10, 18-39.

Lukasik, K. M., Lehtonen, M., Soveri, A., Waris, O., Jylkkä, J., & Laine, M. (2018). Bilingualism and working memory performance: Evidence from a large-scale online study.

PLoS One, 13(11), 1-16.

Martin, R. E., & Ochsner, K. N. (2016). The neuroscience of emotion regulation development: Implications for education. Current Opinion in Behavioral Sciences, 10, 142148.

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McDowell, D. J., Kim, M., O’Neil, R., & Parke, R. D. (2002).

Children’s emotional regulation and social competence in middle childhood. Marriage & Family Review, 34(3-4), 345-364.

Oades-Sese, G. V., Esquivel, G. B., Kaliski, P. K., & Maniatis, L. (2011). A longitudinal study of the social and academic competence of economically disadvantaged bilingual preschool children. Developmental Psychology, 47(3), 747764.

Ochsner, K. N., & Gross, J. J. (2005). The cognitive control of emotion. Trends in Cognitive Sciences, 9(5), 242-249.

Rhoades, B. L., Greenberg, M. T., & Domitrovich, C. E. (2009).

The contribution of inhibitory control to preschoolers’ social–emotional competence. Journal of Applied Developmental Psychology, 30(3), 310-320.

Rydell, A., Thorell, L. B., & Bohlin, G. (2007). Emotion regulation in relation to social functioning: An investigation of child self-reports. European Journal of Developmental Psychology, 4(3), 293-313. Šimleša, S., Cepanec, M., & Ljubešić, M. (2017). The role of executive functions in language comprehension in preschool children. Psychology, 8(2), 227-245.

Stevens, C., & Bavelier, D. (2012). The role of selective attention on academic foundations: A cognitive neuroscience perspective. Developmental Cognitive Neuroscience, 2(1), S48.

Trentacosta, C. J., & Shaw, D. S. (2009). Emotional self-regulation peer rejection, and antisocial behavior: Developmental associations from early childhood to early adolescence.

Journal of Applied Developmental Psychology, 30(3), 356365.

Valiente, C., Lemery-Chalfant, K., & Swanson, J. (2010).

Prediction of kindergartners’ academic achievement from their effortful control and emotionality. Journal of Educational Psychology, 102(3), 550-560.

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Bilingualism, Inhibition and Emotion

Figure 1. The Stroop Task presents the word of the color associated with a different color. For example, the word presented is “red� but the color of the ink is in green. Participants are then asked to say the color of the ink instead of the word.

Figure 2. The Simon Task has participants press the left key if the blue circle appears and the right key if the red circle appears.

Literature Reviews | 11

Openness to Seek Mental Health Services among Muslims in the Middle East Sarah Khullar

Although rates of mental illness are the same around the world, the number of people treated for mental health conditions differ greatly across countries (Kayrouz et al., 2018).

In the Middle East, specifically, treatment rates of severe mental health disorders, such as non-affective psychosis, bipolar disorder, and depression, are significantly lower than the global prevalence of treatment for the same disorders (Kayrouz et al., 2018; WHO, 2017). Furthermore, stigma towards individuals with mental illness is more common in the Middle East in comparison to other regions, which might impact individuals’ choice of treatment (Sewilam et al., 2015). Of particular relevance are the beliefs and attitudes about mental illness that shape the perception of mental health services. Given the integral role of religion in everyday life, some individuals in the Middle East seek alternative options to cope with their mental health (Al-Krenawi, Graham, Dean, & Eltaiba, 2004; Ciftci, Jones, & Corrigan, 2013; Connors & Halligan, 2015; Corrigan & Penn, 1999; Zolezzi et al., 2018). Broader contextual factors, such as cultural values related to the family unit, also heavily impact one’s decision to seek out professional mental health services, especially considering the value placed on strong family units (Al-Krenawi et al., 2004; Gearing et al., 2012, 2015; Savaya, 1998). Thus, this review explores the following research question: how do the religious and familial values of Muslims in the Middle Eastern influence beliefs about mental illness and openness towards seeking mental health services?

Beliefs and Attitudes about Mental Illness from an Islamic Perspective Islamic teachings on health stem from the Quran, the Holy Book, consisiting of revelations from God to the Prophet Muhammad, Hadiths (sayings of Prophet Muhammad), and Sira (Prophet Muhammad’s recorded actions and behaviors which are meant to serve as a guide for Muslims in certain situations; Bagasra & Mackinem, 2014; Haque, 2004). Those who adhere to the Islamic faith believe that God is all-knowing, and ascribe to the Quran’s assertion that faith provides security when faced with challenging life circumstances, as only God knows what is best for an individual (Haque, 2004). Muslims, thus, are taught to cope with mental health issues by seeking help from the Quran, asking God for help, praying, patience, faith, and hope (Haque, 2004).

Moreover, faith in Islam is seen as fostering positive mental health; having a strong relationship with God leads to a sense of empowerment. This premise leads some Muslims to believe that mental illness is a result of lack of faith (Mehraki & Gholami, 2017 Haque, 2014). In fact, Muslims in the Middle East often 12 | Literature Reviews

attribute spiritual reasons to causes of mental illness, believing that it is a punishment from God, or that one has been possessed by jinn, or evil spirits (Al-Krenawi et al., 2004; Ciftci et al., 2013; Sewilam et al., 2015). Others, however, attribute environmental and biological factors, such as chemical imbalances, stress, or genetics, as causes of mental illness (Al-Krenawi et al., 2009; Bagasra & Mackinem, 2014; Savaya, 1998).

Yet, many with this viewpoint also believe that the risk factors themselves serve as a test from God, or that they result from not following religious teachings on how to prevent mental illness through positive qualities (i.e., faith, patience and repentance; Bagasra & Mackinem, 2014; Mehraki & Gholami, 2017; Haque, 2004). When one breaks God’s rules, it can lead to feelings of psychological turmoil, or a sense of guilt (Haque, 2004). To alleviate these feelings, the Quran advises that Muslims engage in repentance as God loves to forgive, so long as one does not repeat the sin that they have asked forgiveness for (Haque, 2004). Consequently, some believe that strengthening one’s faith and repenting for one’s sins is a sufficient solution for problems that may arise in regards to mental health. Because patience is described in the Quran as a positive quality, which can cure all sorts of illness, there is a belief that one must be patient to see the results from these practices (Haque, 2004). Thus, some might avoid or delay professional help-seeking, given the importance that Islam stresses on patience and the promise of greater rewards as a result of suffering (Merhej, 2019). Overall, then, as a result of their religious values and beliefs, many Muslims will approach an Imam or a religious figure as one of the first steps in treating mental illness perhaps making individuals to be less open to seeking psychological or psychiatric treatment (Dardas & Simmons, 2015; Merhej, 2019; Savaya, 1998; Zolezzi et al., 2018).

Cultural Values and the Family Unit Overall, Islam stresses the importance of taking care of one’s health by seeking professional treatment when needed, approaching illness with patience and prayer, and rejecting the stigmatization of others (Byrne et al., 2017; Haque, 2004). Thus, beliefs about mental illness stem largely from cultural values— and not from religious teachings (Dardas & Simmons, 2015; Kayrouz et al., 2018; Sewilam et al., 2015; Youssef & Deane, 2006; Zolezzi et al., 2018). Turning to religious leaders can often help mild symptoms of poor mental health through providing Sira and offering advice rooted in religion and religious values (Dardas & Simmons, 2015). However, turning to the family unit to alleviate mental health symptoms often precedes turning to religious leaders due to the important role that family plays in

Openness Toward Mental Health Services

Muslim communities (Ahsan & Ahsan, 2004; Savaya, 1998).

Family and marriage provide emotional security and a stable environment to raise children, allowing parents to pass on Islamic teachings and the right morals and values to the next generation (Ahsan & Ahsan, 2004). From a cultural standpoint, an individual’s actions reflect upon the entire family unit; thus, the maintenance of family reputation and privacy heavily influences one’s behaviors (Abdel-Salam et al., 2019). Some may avoid seeking professional mental health services and might instead prefer to consult with those within the family and community religious leaders, often making individuals less open to seeking professional mental health treatment (AlDarmaki, 2003; Al-Krenawi et al., 2009; Gearing et al., 2012, 2015; Hassouneh & Kulwicki, 2009; Savaya, 1998).

Marriage also has cultural importance among Muslim families in the Middle Eastern region, often informing the social roles associated with women (Al-Krenawi et al., 2009; Ciftci et al., 2013; Gearing et al., 2015; Gearing et al., 2012). Culturally speaking, a man typically chooses a woman to marry (although women have every right to refuse or reject the offer); as a result, more focus might be placed on women’s reputations in an effort to avoid presenting as undesirable to prospective husbands (Dwairy, 2006). Additionally, due to the strong spiritual beliefs about the predictors of mental illness (e.g, being possessed by evil spirits called jinn), some people might believe the presence of a mental health disorder can prevent women from fulfilling their roles in the family unit, such as serving as the “child carer” of the family (Ahsan & Ahsan, 2004; Al-Krenawi et al., 2009; Ciftci et al., 2013; Gearing et al., 2012, 2015; Scull et al., 2014). In fact, those with mental health disorders can be seen as less intelligent, unable to look after themselves, and unable to handle responsibilities, all of which potentially limit marital prospects, as men might view these as negative qualities in a partner (Al-Krenawi et al., 2004; Bener & Ghuloum, 2010; Zolezzi et al., 2018). The potential negative impact on marriage prospects might consequently contribute to one’s willingness to seek professional mental health services, especially given that maintaining the family unit is a strong cultural value among Muslims living in the Middle East (Abdel-Salam et al., 2019; AlKrenawi et al., 2009, 2004; Kayrouz et al., 2018).

The shame associated with a severe psychiatric diagnosis or a family member’s behavior might also bring shame to the entire family, resulting in “associative stigma” (El-Islam 1994; Zolezzi et al., 2018). The Arabic word alwasm attributes shame by labelling individuals exhibiting socially and culturally unacceptable behaviors as unfit members of society (Dardas & Simmons, 2015). Furthermore, haram (religiously forbidden) is tied to religious doctrine and is used in circumstances when an individual acts in a manner alternative to religious requirements (Ajrouch, 2004). These terms label an individual’s behavior; however, they may also attribute blame to the family by implying that the individual’s family condoned or failed to teach an individual why that particular behavior is deemed haram or aib (Ahsan & Ahsan, 2004; Ajrouch, 2004). Beliefs that those

Muslim communities (Ahsan & Ahsan, 2004; Savaya, 1998). with a mental illness should not get married, have children, and are unable to sustain friendships are often attributed to the shame and embarrassment others feel when associated with someone who has a mental illness (Zolezzi et al., 2018). Thus, an individual’s decision to seek treatment is often influenced by their attempt to avoid bringing associative stigma to their family, as family interests are often prioritized over individual interests (Abdel-Salam et al. 2019; Zolezzi et al., 2018).

Additionally, some women might experience even higher levels of shame due to a cultural belief that Muslim women represent a family’s sharaf, or honor (Abdel-Salam et al., 2019; Bener & Ghuloum, 2010). Consequently, some married women might be less likely to share mental health concerns with others or seek treatment, out of fear of harming their own reputation, as well as their family’s (Al-Krenawi et al., 2004). Given that many believe that the family unit serves as a source of emotional support and socialization, sharing personal issues outside the family might lead to negative attitudes towards the family (Ahsan & Ahsan, 2004). In fact, female Muslims express feeling hyper-aware of familial and societal expectations, particularly due to maintaining family honor and reputation - behaving in ways deemed socially appropriate - and acting in accordance with cultural gender roles (Abdel-Salam et al., 2019). Because maintaining family honor is an important cultural value in Muslim culture in the Middle East, the fear of shame can reduce a family member’s openness to seeking psychological or psychiatric care (Al-Krenawi et al., 2004). This, in turn, results in delaying seeking professional services until an individual displays severe symptoms, others have noticed the symptoms, or treatments through an Imam have been exhausted (Bener & Ghuloum; Dardas & Simmons, 2015).

Conclusion Overall, Muslim religious and family cultural values influence the beliefs and attitudes associated with mental illness, informing how mental health is approached and addressed. In some communities, having a severe psychological disorder has implications for the family unit and marital prospects, perhaps reflecting a family’s inability to effectively teach Muslim religious and cultural values. Given the expectation of placing family interests before one’s own, individuals in the Middle East might not seek out professional mental health services. Yet existing literature rarely discusses the potential differences in openness to mental health services across generations, primarily due to the lack of research on specific age groups. Future studies might address this limitation, as there are generational differences in following Islamic values (Haque, 2004). Perceptions of mental illness also vary by level of education and exposure to Western or modern mental health services (Zolezzi et al., 2018). Culturally relevant models have crucial implications for the successful design and implementation of mental health interventions, as religion is a key contextual factor that influences the accessibility of treatment. Thus, psychological and psychiatric services Literature Reviews | 13

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should provide access to resources to increase knowledge on the causes, symptoms and treatment of mental illness, while also considering the potentially critical role of faith-based services in this population.

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Openness Toward Mental Health Services References Ahmad, S. A., El-Jabali, A., & Salam, Y. (2016). Mental health health and the Muslim world. Journal of Community Medicine & Health Education, 6(445) 285-295.

Ahsan, N., & Ahsan, H. (2004). Foundation of a family: Importance, obstacles and possiblesolutions. Policy Perspectives, 1(1), 95-107.

Al-Darmaki, F. R. (2003). Attitudes towards seeking professional psychological help: What really counts for United Arab Emirates university students? Social Behavior and Personality, 31(5), 497-508.

Al-Krenawi, A., Graham, J. R., Al-Bedah, E. A., Kadri, H. M., & Sehwail, M. A. (2009). Cross-national comparison of Middle Eastern university students: Help-seeking behaviors, attitudes toward helping professionals, and cultural beliefs about mental health problems. Community and Mental Health Journal, 45(1), 26-36.

Al-Krenawi, A., Graham, J. R., Dean, Y. Z., & Eltaiba, N. (2004).

Cross-national study of attitudes towards seeking professional help: Jordan, United Arab Emirates (UAE) and Arabs in Israel. International Journal of Social Psychiatry, 50(2), 102-114.

Bener, A., & Shuloum, S. (2010). Gender differences in the knowledge, attitude and practice towards mental health illness in a rapidly developing Arab society. International Journal of Social Psychiatry, 57(5), 480-486.

Byrne, A., Mustafa, S., & Miah, Q. (2017). Working together to break the ‘circles of fear’ between Muslim communities and mental health services. Psychoanalytic Psychotherapy, 31(4), 393-400.

Cifti, A., Jones, N., & Corrigan, P.W. (2013). Mental health stigma in the Muslim community. Journal of Muslim Mental Health, 7(1), 17-32.

Connors, M. H., & Halligan, P. W. (2015). A cognitive account of belief: A tentative roadmap. Frontiers in Psychology, 5(1588), 1-14.

Corrigan, P. W., & Penn, D. L. (1999). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54(9), 765-776.

Dardas, L. A., & Simmons, L. A. (2015). The stigma of mental illness in Arab families: A concept analysis. Journal of Psychiatric and Mental Health Nursing, 22(9), 668-679.

Dwairy, M. (2006). Counseling and psychotherapy with Arabs and Muslims: A culturally sensitive approach. New York, NY: Teachers College Press.

El-Islam, M. (1994). Cultural aspects of morbid fears in Qatari women. Social Psychiatry and Psychiatric Epidemiology, 29(2), 137-140.

Gearing, R. E., MacKenzie, M. J., Ibrahim, R. W., Brewer, K. B., Batayneh, J. S., & Schwalbe, C. S. J. (2015). Stigma and mental health treatment of adolescents with depression in Jordan. Community Mental Health Journal, 51(1), 111-117.

Gearing, R. E., Schwalbe, C. S., MacKenzie, M. J., Brewer, K. B., Ibrahim, R.W., Olimat, H. S., … Al-Krenawi, A. (2012).

Adaptation and translation of mental health interventions in Middle Eastern Arab countries: A systematic review of barriers to and strategies for effective treatment implementation. International Journal of Social Psychiatry, 59(7), 671-681.

Haque, A. (2004). Religion and mental health: The case of American Muslims. Journal of Religion and Health, 43(1), 45-58.

Hassouneh, D., & Kulwicki, A. (2009). Family privacy as protection: A qualitative pilot study of mental illness in Arab-American Muslim women. Research in the Social Scientific Study of Religion, 20, 195-216.

Kayrouz, R., Dear, B. F., Karin, E., Fogliati, V. J., Gandy, M., Keyrouz, L., Nehme, E., Terides, M. D., & Titov, N. (2018).

Acceptability of mental health services for anxiety and depression in an Arab sample. Community Mental Health Journal, 54(6), 875-883.

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Literature Reviews | 15

Alternative Forms of Treatment for Treatment Resistant Depression Kasane V. Tonegawa

It is estimated that around 300 million people worldwide have been diagnosed with depression (World Health Organization, 2018). Depression is a mental illness that involves feelings of worthlessness, a lack of interest in previously enjoyable activities, thoughts of guilt, and changes in sleeping and eating patterns (National Alliance on Mental Illness, 2017).

Depression can sometimes result in suicidal ideations (i.e., thoughts or plans to kill oneself; NAMI, 2017), which often act as a precursor to suicide, a leading cause of death in the United States (Murphy, Xu, Kochanek, Curtin, & Arias, 2017). Around one-third of those with depression have treatment-resistant depression (TRD); in other words, there is no reduction in depressive symptoms or the symptoms relapse, despite the use of common forms of treatment, such as antidepressant medication or psychotherapy (Rajkumar, Fam, Yeo, & Dawe, 2015; Warden, Rush, Trivedi, Fava, & Wisniewski, 2006). It is imperative that alternative forms of treatment are explored for the 100 million individuals around the world with TRD (WHO, 2018). Recently, commonly used recreational hallucinogens, such as Lysergic acid diethylamide (LSD) and psilocybin mushrooms, have been examined for their benefits for depression, obsessivecompulsive disorder, and post-traumatic stress disorder (Roseman, Nutt & Carhart-Harris, 2018). In 2019, the Food and Drug Administration approved of ketamine, an anesthetic typically used for pain relief and sedation, as a possible form of treatment for TRD (Berman et al., 2000; Niciu et al., 2018; Price, Nock, Charney, & Mathews, 2009). As such, this review aims to describe current and alternative treatment options for TRD, including a promising new avenue of research involving the use of low doses of ketamine.

Prevalent Treatment Options for TRD Depression is typically treated with pharmacological drugs, psychotherapy, or a combination of the two (McConnell, Carter, & Patterson, 2019). Most antidepressant drugs increase the levels of neurotransmitters negatively correlated with depression, such as serotonin, dopamine, and norepinephrine (Epstein, Szpindel, & Katzman, 2014). The symptoms typically improve after two weeks of treatment, with a reduction in almost all symptoms in two months (McConnell et al., 2019). However, the symptoms might return or might not be alleviated at all, warranting a need for different treatment approaches that involve an increase in dosage, change of the drug type, or a combination of drugs (Epstein et al., 2014; McConnell et al., 2019; Shelton, Osuntokun, Heinloth, & Corya, 2010). Furthermore, physical side effects, such as weight gain or fatigue, and cognitive side effects, such as apathy and anhedonia, are also possible with pharmacological 16 | Literature Reviews

antidepressant treatments (Epstein et al., 2014; McConnell et al., 2019).

In order to increase the likelihood of efficacy, pharmacological treatment for depression is typically combined with a form of psychotherapy, in which the individual collaborates with a therapist to achieve relief of symptoms (Shelton et al., 2010). The most common form of psychotherapy used to treat depression is cognitive-behavioral therapy (CBT).

CBT is an approach that is based on the assumption that the negative thought patterns and beliefs are what contribute to depressive symptoms (Dorasamy, 2019). In this form of treatment, a therapist and the client practice role playing and restructure thought patterns to stop or change habitual negative beliefs (Dorasamy, 2019). Although the combined treatment of CBT and antidepressants is typically more effective, relapses or failure to alleviate symptoms might occur (Dorsamy, 2019).

When changes in dosage, drug types, and combinations of psychotherapy do not work, alternative forms of treatment— either pharmacological or non-pharmacological—can be used to treat TRD (Shelton et al., 2010).

Common non-pharmacological treatments include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS; Kayser et al., 2011; Shelton et al., 2010).

These forms of therapy are reserved as a last-resort or for urgent cases, such as risk of suicidality due to the negative cognitive side effects, including memory loss and confusion (Kayser et al., 2011; Kellner et al., 2012). ECT consists of inducing a brief seizure in the brain to increase levels of neurotransmitters dopamine and norepinephrine (Shelton et al., 2010). While ECT works faster and has a higher response rate than pharmacological treatments, it has a high rate of relapses, meaning the depressive symptoms may return (Kayser et al., 2011; Shelton et al., 2010).

Alternatively, TMS works by regulating the neural activity in brain regions associated with depression (O’Reardon et al., 2007). Although TMS has fewer side effects compared to ECT, results from TMS typically appear only after two weeks and might even require several weeks for significant alleviation of symptoms (O’Reardon et al., 2007; Shelton et al., 2010).

Therefore, although ECT and TMS are both effective forms of treatment, there are still cognitive side effects, high relapse rates, and long periods of time until alleviation is seen, thus meriting the need to examine unorthodox forms of treatment that are faster and more effective.

Alternative Treatments for TRD Hallucinogens, or drugs that cause hallucinations when consumed, have recently become considered as a possible form

Alternative Treatments for TRD

of treatment for TRD (Roseman et al., 2018). Some forms of therapy involving naturally-occurring hallucinogen—such as psilocybin mushrooms—are known as psychedelic therapy, in which small dosages of the drugs are administered in the presence and under the guidance of a therapist (Roseman et al., 2018). As with other forms of depression treatments, the exact mechanisms underlying the efficacy of the treatment are unclear. However, improvement in symptoms is related to the conscious “mystical” experience of the drug’s effects, rather than the targeting of specific neurotransmitters (Cahart-Harris et al., 2012; Roseman et al., 2018). In other words, the effects of the drugs are related to reported feelings of unity and awe that are experienced while on the drug (Cahart-Harris et al., 2012). This type of therapy is being examined for its unique approach to treating depression, as well as the quick alleviation of symptoms, which can be experienced in as little as an hour with two dosing sessions (Cahart-Harris et al., 2012). While the mechanisms underlying the efficacy of most antidepressant drugs occur on a neurochemical basis, the benefits of psychedelic therapy derive from the philosophical experiences that are induced by the hallucinogenic properties of the drugs (Cahart-Harris et al., 2012).

Another hallucinogenic drug is ketamine, an anesthetic that has historically been used to treat agitation and pain via sedation and numbing from low doses (Nichols & Paciullo, 2019). At a dissociative or high dose, the drug is known to have psychedelic effects, such as experiences of hallucinations and dissociation (Wolfson, 2014). Ketamine has the distinct benefit of alleviating suicidality in those with TRD and is, therefore, being examined more rigorously as a treatment option (Price et al., 2009, 2014). Nevertheless, because the mechanisms underlying the benefits are still unclear when treating TRD, ketamine and other hallucinogens are reserved as a last resort and require further research in order to better understand its effects (Ionescu & Papakostas, 2016).

How Ketamine Functions as an Antidepressant Typical antidepressant drugs target neurotransmitters serotonin and norepinephrine, but this mechanism does not always permanently alleviate depressive symptoms in individuals with TRD (Rajkumar et al., 2015). As a result, alternative treatments, such as ketamine, might be a solution given that it targets a different neurotransmitter called glutamate (Gould, Zarate, & Thompson, 2019; Trullas & Skolnick, 1990). Glutamate is a neurotransmitter that has been linked to depression and suicidality when at abnormally low levels (Deutschenbauer et al., 2016) The receptors that glutamate latches onto are so active in those with depression that it decreases the amount of glutamate in the synapses, or the gaps between neurons (Deutschenbaur et al., 2016; Krystal, Sanacora, & Duman, 2013; Reinstatler & Youssef, 2015). Ketamine is an N-Methyl-D-Aspartate (NMDA) receptor antagonist, meaning it inhibits the activity of the glutamate receptors, which results in higher levels of glutamate between neurons (Deutschenbaur et al., 2016; Luckenbaugh et

al., 2014). Because ketamine works to increase glutamate levels, it is hypothesized that its inhibitory effects on the receptors is one of the key factors in the drug’s antidepressant effects since it increases the neurotransmitter associated with elevated mood (Gould et al., 2019). Because ketamine targets a different neurotransmitter than typical antidepressant drugs, it is being explored as a promising alternative treatment to TRD. Ketamine’s potential use as a treatment option is especially unique given its rapid-acting effects that specifically reduce suicidal ideations (Ballard et al., 2014; DiazGranados et al., 2010; Price et al., 2009, 2014; Murrough et al., 2015). In fact, a reduction in suicidal ideations was observed in as little as 40 minutes, suggesting that ketamine might be especially suited for immediate reductions in depressive symptoms, possibly due to the drug’s hallucinogenic and dissociative properties (Ballard et al., 2014; DiazGranados et al., 2010; Price et al., 2009, 2014). However, the reduction of suicidal ideations via ketamine treatment has not been fully examined, because research on the drug’s antidepressant use is still in its beginning stages (Rajkumar et al., 2015). Even so, there might be a relation between reduction in brain regions affected by ketamine’s dissociative properties and the drug’s role as an NMDA receptor antagonist, perhaps contributing to its antidepressant effects in individuals with TRD (Erhardt et al., 2013; Luckenbaugh et al., 2014; Sowa-Kucma et al., 2013).

Examining the brains of individuals who have attempted suicide has elucidated that the level of quinolonic acid (QUIN) is uniquely related to suicidal ideations (Erhardt et al., 2013; Rajkumar et al., 2015; Sowa-Kucma et al., 2013). QUIN is an NMDA receptor agonist that has opposite effects of ketamine, such that it activates, rather than inhibits, the glutamate receptors, resulting in lower levels of glutamate (Erhardt et al., 2013; Gould et al., 2019). Increased levels of QUIN, which decreases glutamate, was found in suicide attempters, indicating that glutamate is strongly related to suicidal ideations (Erhardt et al., 2013; Sowa-Kucma et al., 2013). Accordingly, if reduced levels of glutamate resulting from QUIN are connected to suicidal ideations, then the consequential increased levels of glutamate resulting from ketamine might be key to its antidepressant effects.

While ketamine is not the only NMDA receptor antagonist, other NMDA-antagonist drugs, such as phencyclidine and methadone, have not had the same rapid-acting reductions in suicidal ideations that ketamine has (Niciu et al., 2018). In particular, unlike other NMDA receptor antagonists that do not result in such a robust decrease in suicidal ideations, ketamine can lead to dissociation, or a sense of a detachment from oneself and one’s surroundings (Luckenbaugh et al., 2014; Niciu et al., 2018; Sos et al., 2013). In fact, the dissociative side effects have been positively correlated with the antidepressant response and elevated mood (Niciu et al., 2018; Sos et al., 2013). Additionally, brain regions related to depression and suicidal ideations—the hippocampus and prefrontal cortex—are particularly affected by the occurrence of dissociation induced by ketamine (Erhardt Literature Reviews | 17

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et al., 2013; Rajkumar et al., 2015; Sowa-Kucma et al., 2013).

In particular, the brains of suicide attempters have reduced hippocampal volume and show signs of dysfunction in the prefrontal cortex (Erhardt et al., 2013; Sowa-Kucma et al., 2013). The regions of the brain where abnormalities are related to suicidality are also related to dissociation, which is prompted by ketamine’s increase in glutamate levels. It is possible, then, that the drug’s effects on suicidality are linked, at least in part, to its dissociative effects in these brain areas (Rajkumar et al., 2015). Given that it is rapid, effective, and specifically targets suicidality, ketamine may be a promising treatment for those with TRD. Conclusion For the one-third of individuals with TRD, alternative treatments that provide faster alleviation and higher efficacy are being explored. These treatments include ECT, TMS, and psychedelic therapy. While ECT and TMS are faster than pharmacological treatment, there are still cognitive side effects to consider (Kayser et al., 2011; Shelton et al., 2010). With psychedelic therapies, such as psilocybin mushrooms, the unique experience-based characteristic may be key in its efficacy for TRD treatment (Cahart-Harris et al., 2012). One of f the most promising psychedelic treatments is ketamine, which works to reduce suicidality in TRD by specifically targeting the NMDA glutamate receptors in the hippocampus and prefrontal cortex to increase levels of glutamate, the neurotransmitter responsible for suicidal ideations (Erhardt et al., 2013; Luckenbaugh et al., 2014; Rajkumar et al., 2015). Much of the research on ketamine’s effects on TRD began with a focus on its general antidepressant use, but the drug may have unique benefits in terms of reducing suicidality given its dissociative properties (Rajkumar et al., 2015). Given the relatively recent discovery of ketamine’s possible medical use along with other psychedelic therapies, many studies have not yet been placebo-controlled, randomized, double-blinded, or used a large sample, thus making conclusion of causality difficult (Ballard et al., 2015; DiazGranados et al., 2010; Murrough et al., 2015, Rajkumar et al., 2015). The current literature review was explored from a theoretical perspective given the dearth of clinical trials with the drugs. Therefore, it is necessary to not only conduct studies with larger samples but to also measure suicidality with scales specifically targeting changes in suicidal ideation over short periods of time. Another consideration for future studies is examining the long-term effects of repeated administration of ketamine and other psychedelic drugs, such as potential dependency and tolerance.

However, given the urgency required in treating suicidal TRD patients, it is likely that the potential benefits are greater than the costs (Rajkumar et al., 2015).

18 | Literature Reviews

Alternative Treatments for TRD References Ballard, E. D., Ionescu, D. F., Vande Voort, J. L., Niciu, M. J., Richards, E. M., Luckenbaugh, D. A., . . . Zarate, C. A. (2014). Improvement in suicidal ideation after ketamine infusion: Relationship to reductions in depression and anxiety. Journal of Psychiatric Research, 58, 161-166.

Berman, R. M., Cappiello, A., Anand, A., Oren, D. A., Heninger, G. R., Charney, D. S., & Krystal, J. H. (2000).

Antidepressant effects of ketamine in depressed patients. Society of Biological Psychiatry 47(4), 351354.

Carhart-Harris, R. L., Bolstridge, M., Rucker, J., Day, C. M., Erritzoe, D., Kaelen, M., ... & Taylor, D. (2016).

Psilocybin with psychological support for treatmentresistant depression: an open-label feasibility study.

The Lancet Psychiatry, 3(7), 619-627.

Deutschenbaur, L., Beck, J., Kiyhankhadiv, A., MĂźhlhauser, M., Borgwardt, S., Walter, M., ... & Lang, U. E. (2016). Role of calcium, glutamate and NMDA in major depression and therapeutic application. Progress in NeuroPsychopharmacology and Biological Psychiatry, 64, 325-333.

DiazGranados, N., Ibrahim, L. A., Brutsche, N. E., Ameli, R., Henter, I. D., Luckenbaugh, D. A., . . . Zarate, Carlos A., Jr. (2010). Rapid resolution of suicidal ideation after a single infusion of an N-methyl-D-aspartate antagonist in patients with treatment-resistant major depressive disorder. The Journal of Clinical Psychiatry, 71(12), 1605-1611.

Dorsamy, J. (2019). Psychological treatment for major depressive disorder: Effectiveness of cognitive behavioural therapy. Indian Journal of Public Health Research & Development, 10(9), 883-887.

Epstein, I., Szpindel, I., & Katzman, M. A. (2014).

Pharmacological approaches to manage persistent symptoms of major depressive disorder: Rationale and therapeutic strategies. Psychiatry Research, 220, S15-S33.

Erhardt, S., Lim, C. K., Linderholm, K. R., Janelidze, S., Lindqvist, D., Samuelsson, M., . . . Brundin, L. (2012).

Connecting inflammation with glutamate agonism in suicidality. Neuropsychopharmacology, 38, 743-752.

Gould, T. D., Zarate, C. A., & Thompson, S. M. (2019). Molecular pharmacology and neurobiology of rapid-acting antidepressants. Annual Review of Pharmacology and Toxicology, 59(1), 213-236.

Ionescu, D. F., & Papakostas, G. I. (2016). Current trends in identifying rapidly acting treatments for depression.

Current Behavioral Neuroscience Reports, 3(2), 185191.

Kayser, S., Bewernick, B. H., Grubert, C., Hadrysiewicz, B. L., Axmacher, N., & Schlaepfer, T. E. (2011). Antidepressant effects, of magnetic seizure therapy and electroconvulsive therapy, in treatment-resistant depression. Journal of Psychiatric Research, 45(5), 569576.

Kellner, C. H., Greenberg, R. M., Murrough, J. W., Bryson, E. O., Briggs, M. C., & Pasculli, R. M. (2012). ECT in treatment-resistant depression. American Journal of Psychiatry, 169(12), 1238-1244.

Krystal, J. H., Sanacora, G., & Duman, R. S. (2013). Rapidacting glutamatergic antidepressants: The path to ketamine and beyond. Biological Psychiatry, 73(12), 1133-1141.

Luckenbaugh, D. A., Niciu, M. J., Ionescu, D. F., Nolan, N. M., Richards, E. M., Brutsche, N. E., ... & Zarate, C. A. (2014). Do the dissociative side effects of ketamine mediate its antidepressant effects?. Journal of affective disorders, 159, 56-61.

McConnell, V. L., Carter, S. L., & Patterson, K. (2019). Major depressive disorder: Treatment-resistant depression and augmentation of other medication classes.

MEDSURG Nursing Journal, 28(4), 251-256.

Murphy, S. L., Xu, J., Kochanek, K. D., Curtin, S. C., & Arias, E. (2017). Deaths: Final data for 2015. National Center for Health Statistics, 66(6), 1-75.

Murrough, J. W., Soleimani, L., DeWilde, K. E., Collins, K. A., Lapidus, K. A., Iacoviello, B. M., . . . Charney, D. S. (2015). Ketamine for rapid reduction of suicidal ideation: A randomized controlled trial. Psychological Medicine, 45(16), 3571-3580.

National Alliance on Mental Health. (2017). Depression [Fact sheet]. Retrieved from https://www.nami.org/LearnMore/Mental-Health-Conditions/Depression Nichols, K. A., & Paciullo, C. A. (2019). Subdissociative ketamine use in the emergency department. Advanced Emergency Nursing Journal, 41(1), 15-22.

Niciu, M. J., Shovestul, B. J., Jaso, B. A., Farmer, C., Luckenbaugh, D. A., Brutsche, N. E., . . . Zarate, C. A. (2018). Features of dissociation differentially predict antidepressant response to ketamine in treatment-resistant depression.

Journal of Affective Disorders, 232, 310-315.

O’Reardon, J. P., Solvason, H. B., Janicak, P. G., Sampson, S., Isenberg, K. E., Nahas, Z., ... & Demitrack, M. A. (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: A multisite randomized controlled trial. Biological Psychiatry, 62(11), 1208-1216.

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Price, R. B., Nock, M. K., Charney, D. S., & Mathew, S. J. (2009).

Effects of intravenous ketamine on explicit and implicit measures of suicidality in treatment-resistant depression.

Biological Psychiatry, 66(5), 522-526.

Price, R. B., Iosifescu, D. V., Murrough, J. W., Chang, L. C., Al Jurdi, R. K., Iqbal, S. Z., . . . Mathew, S. J. (2014).

Effects of ketamine on explicit and implicit suicidal cognition: A randomized controlled trial in treatment‐ resistant depression. Depression and Anxiety, 31(4), 335-343.

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Ketamine and suicidal ideation in depression: Jumping the gun? Pharmacological Research, 99, 23-35.

Reinstatler, L., & Youssef, N. A. (2015). Ketamine as a potential treatment for suicidal ideation: a systematic review of the literature. Drugs in R&d, 15(1), 37-43.

Roseman, L., Nutt, D. J., & Carhart-Harris, R. L. (2018). Quality of acute psychedelic experience predicts therapeutic efficacy of psilocybin for treatment-resistant depression. Frontiers in Pharmacology, 8, 974.

Shelton, R. C., Osuntokun, O., Heinloth, A. N., & Corya, S. A. (2010). Therapeutic options for treatment-resistant depression. CNS Drugs, 24(2), 131-161.

Sos, P., Klirova, M., Novak, T., Kohutova, B., Horacek, J., & Palenicek, T. (2013). Relationship of ketamine’s antidepressant and psychotomimetic effects in unipolar depression. Neuroendocrinol Lett, 34(4), 287-293.

Sowa-Kućma, M., Szewczyk, B., Sadlik, K., Piekoszewski, W., Trela, F., Opoka, W., ... & Nowak, G. (2013). Zinc, magnesium and NMDA receptor alterations in the hippocampus of suicide victims. Journal of Affective Disorders, 151(3), 924-931.

Trullas, R., & Skolnick, P. (1990). Functional antagonists at the NMDA receptor complex exhibit antidepressant actions. European Journal of Pharmacology, 185(1), 1-10.

Warden, D., Rush, A. J., Trivedi, M. H., Fava, M., & Wisniewski, S. R. (2007). The STAR*D project results: A comprehensive review of findings. Current Psychiatry Reports, 9(6), 449-459.

Wolfson, P. E. (2014). Ketamine—Its history, uses, pharmacology, therapeutic practice, and an exploration of its potential as a novel treatment for depression. International Journal of Transpersonal Studies, 33(2), 33-39.

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20 | Literature Reviews

Restraint and Seclusion Use in Psychiatric Inpatient Settings Olivia Matthes Theriault

Those struggling with mental illness are placed in inpatient psychiatric care when they are at-risk to themselves or others (Torio, Encinosa, Berdahl, McCormick, & Simpson, 2015).

Psychiatric inpatient units are not designed to provide longterm care; the objective is patient recovery, which occurs when treatment sufficiently alleviates a patient’s acute symptoms for safe return to their community (Torio et al., 2015). In psychiatric inpatient units, psychiatrists utilize a variety of techniques to improve patient symptoms and aid recovery, including medication, safety planning, and talk therapy (Torio et al., 2015). However, when a patient is at risk of harming themselves or others, and previous deescalation attempts are unsuccessful, staff and psychiatrists frequently rely on restraint and seclusion practices (Azeem, Reddy, Wudarsky, Carbabetta, Gregory & Sarofin, 2015; Azeem, Aujla, Rammerth, Binsfeld, & Jones, 2017; Braun, Adams, O’Grady, Miller, & Bystrynski, 2020; De Hert, Dirix, Demunter, & Correll, 2011). Restraints come in either physical or chemical forms and are used to limit a bodily movement (Azeem et al., 2015, 2017). Physical forms of restraints include weighted vests, straight jackets or belts that forcibly keep the patient confined to a bed or chair, while chemical restraints include drugs, such antihistamines and antipsychotics, used to sedate patients (Day, 2002). Additionally, seclusion is the act of locking a patient in their room away from the rest of the group (Azeem et al., 2015, 2017). This practice is used when patients are being disruptive to group care or potentially aggressive (Azeem et al., 2015, 2017).

In recent years, there has been significant controversy over the use of these tactics, as research has indicated that the use of restraints and seclusion is physically and psychologically harmful for patients and for those who witness these methods (Butler et al., 2011; Hammer et al., 2011). Yet, some psychiatric caregivers argue that the use of restraint and seclusion tactics are necessary for controlling aggressive patients and teaching patients how to verbalize their emotions and exhibit self-control (Day, 2002; De Hert et al., 2011). Thus, this literature review sought to explore the following question: How effective are restraint and seclusion tactics in aiding patient recovery?

Restraints

Restraining patients is seen as a necessary tool for controlling those who might be at risk of harming themselves, others, or property (Day, 2002). Theoretically, restraints are only used when other deescalation tactics to return a patient to an unagitated state, such asconsulting a patient’s safety plan, voluntarily moving a patient to a quieter room, or avoiding known patient stressors in the first place, have failed (Azeem

et al., 2015, 2017). More than half of all patients are restrained within five weeks of treatment, and 20% are restrained within their first week of treatment (Braun et al., 2020). The practice came under scrutiny when patients and staff cited the experience as traumatizing, and moral concerns about the use of restraint and seclusion arose (Butler et al., 2011; Hammer et al., 2011).

In fact, the repeated use of restraints to prevent harm actually results in increased staff and patient injuries due to patients resisting restraint (Azeem et al., 2015, 2017; Day, 2002; De Hert et al., 2011; Greenwald et al., 2011; Lebel et al., 2010; Nelstrop et al., 2006).

However, in practice, restraints are frequently viewed as the only available method for controlling a patient who is perceived as aggressive (Moghadam, Khoshknab, & Pazargadi, 2014). Staff often cite aggressive patient behavior and potential for self-harm as antecedents for restraining patients (Braun et al., 2020). While staff administer restraints in the hope of reducing harm to patients, there have been several high profile cases of restraint usage resulting in patient asphyxiation, ultimately leading to their death (Lebel, Huckshorn, & Caldwell 2010).

Reports on deaths in psychiatric facilities due to restraints sparked public concern and reformed training requirements for staff administering restraints (Altimari & Weiss, 1998; Lebel et al., 2010). Similarly, research has indicated that reducing the frequency of their use in psychiatric hospitals has led to fewer staff and patient injuries as well as lower rates of staff turnover (Azeem et al., 2015, 2017; Day, 2002; De Hert et al., 2011; Greenwald et al., 2011; Lebel et al., 2010; Nelstrop et al., 2006). The physical harm coupled with patient distrust fails the ultimate goal of hospitalization in aiding patient recovery (De Hert et al., 2011; Lebel et al., 2010).

Nevertheless, restraints remain the predominant method for tending to a patient who is perceived by staff to be aggressive (Day, 2002; De Hert et al., 2011; Lebel et al., 2010; Moghadam et al., 2014; Nelstrop et al., 2006; Prinsen & van Delden, 2009).

Studies of restraint usage in psychiatric hospitals have not linked the number of restraints per patient to less aggressive patient behavior, yet this practice continues to be used (Day 2002; De Hert et al. 2011; Nelstrop et al., 2006; Prinsen & van Delden, 2009). Furthermore, restraint use is not related to improved therapeutic outcomes, such as functional impairment—a measure of the impact of a patient’s illness on their day-today functioning (Brown et al. 2013; Greenwald et al., 2011).

The therapeutic efficacy (i.e., or the impact on successful treatment of a patient as measured by behavior and self-reports) of restraints is not known, as the practices are not evidencebased, but rather based on theory and everyday practice (Day, Literature Reviews | 21

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2002; De Hert et al., 2011; Lebel et al., 2010; Moghadam et al., 2014; Nelstrop et al., 2006; Prinsen & van Delden, 2009). When restraint usage declines, a patient’s length of stay and levels of functional impairment also reduces, indicating that the use of restraint and seclusion does not positively contribute to improving patient recovery (Brown et al., 2013; Greenwald et al., 2011). Yet restraint use remains widely practiced, in part due to its historical use in standard practice (Day, 2002).

Restraints also undermine a patient’s progress, as patients cite their time in restraints as traumatizing, resulting in feelings of powerlessness and fear (Butler et al., 2011; Hammer et al., 2011; Fryer et al., 2004). In particular, patients with trauma histories of sexual and physical abuse are reminded of their experiences of abuse when forced into restraint, or even when watching another patient forced into restraints (Butler et al., 2011, Hammer et al., 2011). Patients with trauma backgrounds are more likely to be put in restraints than patients without those histories, as aggression is often a behavioral symptom of trauma histories (Braun et al., 2020; Hammer 2011; Fryer et al., 2004).

This method can cause retraumatization for the patients which can subsequently disrupt the therapeutic process and hinder progress towards their recovery (Butler et al., 2011; De Hert et al., 2011; Fryer et al., 2004; Hammer et al., 2011). The effect of restraints usage in patients with trauma histories often extends patient length of stay and removes patients from their support network, indicating that patients are not receiving the highest level of care available to them (Butler et al., 2011; Hammer et al., 2011; Muskett, 2013). Ultimately, restraint use is traumatizing for all patients, posing a particular threat to patients with trauma histories (Butler et al., 2011; Fryer et al., 2004; Hammer et al., 2011). Despite the theoretical basis behind the practice and its widespread use, this tactic has well documented harms of their use and impedes a patient’s ability to recover (Braun, 2020).

Seclusion Similarly, the use of seclusion remains popular in psychiatric hospitals, without substantial supportive evidence on the behavioral benefits needed for patient recovery. Seclusion is designed to limit a patient’s ability to cause harm and to teach patients how to control their behaviors by placing patients in a different room away from the group (Day, 2002; De Hert et al., 2011). The theoretical basis of seclusion is rooted in behavioral psychology, with the idea that patients’ inappropriate behavior will stop after being removed from the group they wish to be a part of (Day, 2002). However, what constitutes inappropriate behavior is largely at the discretion of staff members and lack concrete guidelines—which might lead to seclusion being overused or used unjustifiably (Day, 2002: De Hert et al., 2011).

The application of seclusion varies, and is largely dependent on hospital resources and practices (Day, 2002). Some hospitals have a designated seclusion room, which typically has limited to no furniture, but may have a bed equipped with physical restraints (Day, 2002). The absence of furniture creates a space that lacks comfort and aims to reduce inappropriate patient behavior with 22 | Literature Reviews

the idea that patients will not want to be uncomfortable again (Day, 2002). The key difference between a seclusion room and a standard patient room is that patients do not stay overnight, and it is established as a place of punishment in response to a behavior staff want to decrease (Butler et al., 2011; Day, 2002; Fryer et al., 2004; Hammer et al., 2011). Hospitals that do not have designated seclusion rooms will involuntarily confine the patient away from the group by locking the patient in their room alone, whereas other deescalation techniques ask patients to leave the group to calm down and return when ready (Azeem 2015; 2017; Day 2002; De Hert et al., 2011). Seclusion, however, removes the patient’s agency and choice by controlling their ability to return to the group (Azeem et al., 2015, 2017; Day 2002; De Hert et al., 2011). Similar to restraint use, the loss of control stemming from seclusion is cited as a traumatizing experience while hospitalized (Butler et al., 2011; Fryer et al., 2004; Hammer et al., 2011). However, seclusion continues to be used as a deescalation technique because, unlike restraints, it does not result in physical harm (Azeem et al., 2015, 2017; Lebel et al., 2010).

Although patients have reported fewer negative experiences in seclusion than restraints, seclusion continues to be a potentially traumatizing experience for patients (Bergk, Einsiedler, Flammer & Steinert, 2011). Seclusion allows staff to remove a potentially aggressive patient from areas where they could cause harm (Bergk et al., 2011; Huf, Coutinho & Adams, 2012). On average, 9.5% of adult patients and 47% of youth patients in psychiatric facilities are secluded during their stay (Crenshaw & Francis 1995; De Hert et., al, 2011.) However, seclusion is not found to reduce the use of subsequent seclusions for patients as their treatment progressed, which, theoretically, is the purpose of the tactic (Hickerson & Garrison, 1991). In particular, seclusion does not reduce the inciting behaviors that deem patients at risk to themselves or others, thus ineffectively aiding patients’ recovery (Hickerson & Garrison, 1991). Patients often report seclusion as traumatizing and express feelings of disempowerment, anger, and fear, hindering their treatment progress (Butler et al., 2011; Hammer et al., 2011; Fryer et al., 2004; Meehan, Vermeer, & Windsor, 2000). Debriefing conversations with patients after experiencing seclusion further reveal the traumatic effect of seclusions, with reports that nearly half of patients who experience seclusion have “probable PTSD” stemming from the event (El-Badri & Mellsop, 2008; Meehan et al., 2000; Whitecross, Seeary & Lee, 2013). Overall, much like restraints, the use of seclusion is based in theory and not evidence (Day, 2002).

Exploring Alternatives The use of restraint and seclusion in psychiatric inpatient hospitals offers no clear therapeutic gain, while causing harm to patients who experience either tactic (Azeem et al., 2015, 2017; Braun et al., 2020; Day 2002; De Hert et al., 2011; Meehan et al., 2000). Restraints put patients as well as hospital staff in harm’s way (Azeem et al., 2015; 2017). Reducing the use of restraints

Restraint and Seclusion Use in Psychiatric Care

has resulted in fewer staff and patient injuries and lower rates of staff turnover (Azeem et al., 2015, 2017). The main argument for continuing to use these methods is fear that patients will harm themselves, other patients and staff, or hospital property, despite research that indicates that staff and patient injuries decrease when restraint and seclusion use is decreased (Azeem et al., 2015, 2017; Brown et al., 2013). Although restraint and seclusion may temporarily limit a patient’s ability to cause harm, the psychological repercussions of restraint and seclusion for patients are serious (Azeem et al., 2015, 2017; Brown et al., 2013; Butler et al., 2011; Hammer et al., 2011; Fryer et al., 2004; Meehan et al., 2000; Whitecross et al., 2013).

Acknowledging that it is necessary to prepare for instances when a patient may become aggressive, several alternative measures are recommended. One suggestion is the use of Trauma Informed Care (TIC), a collection of best practices for service providers that emphasizes the importance of understanding a patient’s trauma history and cultivating safe and trusting environments for patients (Berliner & Kolko, 2016; Butler, Critelli & Rinfrette, 2011; Fallot & Harris 2009).

To further explore TIC in inpatient psychiatric hospitals and how it can be used as a potential alternative to restraint and seclusion use in these settings, an interview was conducted with Kate Vooreheis, a Project Coordinator at the Bellevue Hospital Child and Adolescent Acute Inpatient Psychiatric Unit.

Bellevue is the oldest public hospital in America and a pioneer in medical research, and their child and adolescent psychiatric unit was the first in the country and is committed to providing high quality mental health care to children in New York City.

Ms. Vooreheis has been at Bellevue for three years, managing research projects regarding the role of trauma backgrounds in child and adolescent psychiatric inpatient admissions, on a unit committed to TIC principles.

OMT: What is your professional background? How long have you been working with TIC? KV: I began working at Bellevue after graduating from NYU, [for] about three years. I was excited to work at Bellevue because they were examining the role of trauma in psychiatric admissions, which is often overlooked. I have spent the past three years collecting data about the role of trauma in child and adolescent psychiatric inpatient admissions and working alongside a team that is very committed to understanding the trauma backgrounds of the patients at Bellevue.

OMT: How would you define TIC? KV: I am a big proponent of TIC. TIC to me means not discounting a patient’s history [and] always keeping the whole patient in mind when developing a treatment plan. It is important to keep trauma histories in mind because it does significantly affect a patient’s presentation and recovery. TIC was not something I had heard of before coming to Bellevue.

TIC allows clinicians to treat patients effectively, and I think a lot of other hospitals and treatment centers could be using this

care model to more effectively treat their patients.

OMT: How long has Bellevue been practicing TIC? KV: I cannot give an exact date, but Bellevue began doing more work and generating awareness around TIC in 2009 with the development of the Bellevue Innovation Lab. OMT: Is Bellevue currently doing any studies to demonstrate the strengths of TIC? KV: No current studies, however, we do collect data examining the role of trauma in treatment, presentation and length of stay among other factors.

OMT: What makes Bellevue’s Psychiatric Unit unique? How does Bellevue define trauma and does it differ from other settings?

KV: I think the idea of early intervention makes these units unique. We understand the role of trauma in presentation and are able to address patients’ trauma backgrounds at a young age.

OMT: Does Bellevue use a specific model of TIC? KV: Bellevue does not use a specific model of TIC. The former chief of service was very committed to TIC and understanding patients’ trauma histories, so there is an expectation of the department to enact general TIC principles. We also screen patients upon admission and discharge for trauma histories to ensure that clinicians know a patients full background and take that into account when developing a treatment plan.

OMT: How do you think Bellevue’s use of TIC and their use of restraint and seclusion complement or oppose each other?

KV: The majority of clinicians at Bellevue are practicing a TIC module, so it is my impression that they really aren’t using restraints or seclusions, or those “extreme measures” unless they absolutely have to. There’s an argument that restraint and seclusion can be more traumatizing and further traumatize a kid, and even that a hospitalization itself is a trauma. I think it is necessary in some cases, but the staff does not want to be restraining a child. Restraints are only used if the child is at risk to themselves or others. When treatment is effective and clinicians are really getting to the root cause, then “extreme measures” like [seclusion and restraint] are not really necessary.

OMT: Do you see different emphasis from clinicians and nursing staff when it comes to TIC? KV: I think clinicians place a higher priority on TIC than nursing staff. The staff at Bellevue works together in an efficient way that I have not really seen elsewhere. But I know nursing staff and techs are on the ground with patients all the time and so I wonder if TIC practices and responses are not always implemented in the hectic hospital environment. But I do feel that Bellevue’s department creates a strong community feel and staff works together to do what is best for the patient.

OMT: Is TIC enough of an alternative to the use of restraint and Literature Reviews | 23

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seclusion? Or will psychiatric care always have to use these tactics?

KV: I think restraint and seclusion will always be there as an option. However, I think that as more clinicians are educated about TIC and the role that trauma plays in psychiatric care, restraint and seclusion use will decrease. Restraint and seclusion will always be there for patients who do not have trauma histories. It may be something that patients have to experience before significant progress is made in their treatment. We see a lot of very traumatized kids and if aggressive behavior is accompanying that, it might take some time for that kid to have a “breakthrough” or to “let you in,” but as treatment progresses it should be used less and less.

OMT: Do you think TIC should be encouraged as a replacement for the use of restraints and seclusion? If so how can we disseminate information about TIC and promote this practice over restraint and seclusion?

KV: I think restraint and seclusion should be the last resort.

I think with time, as the role of trauma in treatment is better understood and we are able to address the root of the behavior, one would likely see fewer aggressive outbursts that warrant the use of restraint and seclusion.

OMT: What are your personal thoughts on restraint and seclusion?

KV: As I mentioned before, I think that restraint and seclusion should be a last resort. I think especially in children and adolescents there is a risk of further traumatizing the child.

[Thus] restraint and seclusion should be avoided unless absolutely necessary in keeping patients and staff safe.

OMT: What are some limitations to TIC? KV: I think the lack of knowledge of the general psychiatric community. TIC is still pretty up and coming. I am not sure I see a drawback to TIC, but there is a lack of education and understanding of the role of trauma in psychiatric presentations.

I do not think it’s standardized in clinician training and education.

OMT: What are the strengths of TIC and why do they outweigh the limitations?

KV: I think safety is the biggest strength of TIC. Keeping staff and patients safe should be a priority in inpatient settings.

OMT: How can we ensure that not only clinicians are aware of TIC but also the staff?

KV: I think trainings on the role of trauma in psychiatric diagnoses and how trauma may present itself in patients would be beneficial for staff. These trainings are lacking in many settings and are not standardized.

OMT: Where do you see TIC going in the future? How can we make it a standardized practice in clinical settings?

KV: I think raising awareness of TIC and the role of trauma in psychiatric presentation is important. Ensuring that staff and 24 | Literature Reviews

psychiatric presentation is important. Ensuring that staff and clinicians understand the role of trauma and how it may present is important for children getting the best care. Programs such as Think Trauma are great examples of education for staff and clinicians and I think more programs like it are needed.

Analysis and Conclusion Given the high risk of retraumatizing patients while in restraints or seclusion, it is important to account for patient’s histories when considering how to regulate patients who may be perceived as aggressive. Interviewee Kate Vooreheis and others hope there will be a shift away from the overreliance of restraint and seclusion and promote TIC instead. Trauma Informed Care (TIC) is a newer model of care that has been suggested as a method for limiting, or replacing, the use of restraints and seclusion (Azeem et al., 2015; 2017; Brown et al., 2013; Greenwald, Siradas, Schmitt, Reslan, Fierle & Sande 2012). TIC is a collection of best practices for service providers that emphasizes the importance of understanding a patient’s trauma history and cultivating safe and trusting environments between service providers and patients (Berliner & Kolko, 2016; Butler, Critelli & Rinfrette, 2011; Fallot & Harris 2009).

Implementing TIC models in inpatient psychiatric hospitals has resulted in decreases in the use of restraint and seclusion tactics, staff and patient injuries, staff turnover and patient length of stay (Azeem et al., 2015; 2017; Brown et al., 2013; Greenwald et al., 2012). While there will always be a multitude of approaches available for clinicians and staff to use when treating patients, it is important to carefully examine which ones best aid patient recovery and minimize additional trauma during a patient’s stay.

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Hartford Courant. Retrieved May 17, 2020, from https://www.courant.com/news/connecticut/hc-xpm 1998-10-17-9810170180-story.html Azeem, M., Aujla, A., Rammerth, M., Binsfeld, G., & Jones, R. B.

(2017). Effectiveness of six core strategies based on

trauma informed care in reducing seclusions and

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30(4), 170–174.

Azeem, M. W., Reddy, B., Wudarsky, M., Carabetta, L., Gregory,

F., & Sarofin, M. (2015). Restraint reduction at a

pediatric psychiatric hospital: A ten‐year journey.

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Berliner, L., & Kolko, D. J. (2016). Trauma informed care: A

commentary and critique. Child Maltreatment, 21(2), 168–172.

Bergk, J., Einsiedler, B., Flammer, E., & Steinert, T. (2011). A

randomized controlled comparison of seclusion and

mechanical restraint in inpatient settings. Psychiatric

Services, 62(11), 1310–1317.

Braun, M. T., Adams, N. B., O’Grady, C. E., Miller, D. L., &

Bystrinski, J. (2020). An exploration of youth physically

restrained in mental health residential treatment centers. Children and Youth Services Review. 110(1), 1-8.

Brown, A. D., McCauley, K., Navalta, C. P., & Saxe, G. N. (2013).

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environment of traumatized children and youth in

congregate care. Journal of Family Violence, 28(7), 693–703.

Butler, L., Critelli, F., & Rinfrette, E. (2011). Trauma-informed

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Crenshaw, W., & Francis, P. (1995). A national survey on

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Day, D. (2002). Examining the therapeutic utility of restraints

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De Hert, M., Dirix, N., Demunter, H., & Correll, C. U. (2011).

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use in children and adolescents: A systematic review.

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El-Badri, S., & Mellsop, G. (2008). Patient and staff perspectives

on the use of seclusion. Australian Psychiatry, 16(4), 248–252.

Fallot, R., & Harris, M. (2009). Creating cultures of trauma informed care (CCTIC): A self-assessment and

planning protocol. Retrieved from children.wi.gov website: https://children.wi.gov/Documents/CCTICSelf-Assess mentandPlanningProtocol0709.pdf Fryer, M. A., Beech, M., & Byrne, G. J. (2004). Seclusion use with

children and adolescents: An Australian experience.

Australian and New Zealand Journal of Psychiatry, 38(1), 26-33.

Greenwald, R., Siradas, L., Schmitt, T. A. Reslan, S., Fierle, J.,

& Sande, B. (2012). Implementing trauma-informed

treatment for youth in a residential facility: First-year outcomes. Residential Treatment for Children & Youth, 29(2), 141-153.

Hammer, J. H., Springer, J., Beck, N. C., Menditto, A., &

Coleman, J. (2011). The relationship between seclusion

and restraint use and childhood abuse among

psychiatric inpatients. Journal of Interpersonal

Violence, 26(3), 567–579.

Huf, G., Coutinho, E. S. F., & Adams, C. E. (2012). Physical

restraints versus seclusion room for management

of people with acute aggression or agitation due to

psychotic illness: A randomized trial. Psychological

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Lebel, J., Huckshorn, K. A., & Caldwell, B. (2010). Restraint use

in residential programs: Why are best practices ignored? Child Welfare, 89(2). 169-187 Meehan, T., Vermeer, C., & Windsor, C. (2000). Patient’s

perceptions of seclusion: A qualitative investigation.

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Psychiatric nurses perceptions about physical restraint:

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Muskett, C. (2013). Trauma-informed care in inpatient mental

health settings: A review of the literature. International

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F., Cronin-Davis, J., ….Tsuchiya, A. (2011). A

systematic review of the safety and effectiveness of

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26 | Literature Reviews

OPUS (2019) 10:2

Interview

27 ||Literature 16 LiteratureReviews Reviews

An Interview with Dr. Karthik Gunnia: A Glimpse into the Intersection of Music and Mental Health Oana Groza and Andrew Han

Music is a near-universal medium that has the ability to form individual identities, create social ties within a community, and even help individuals transition from one life stage to another (Hense & McFerran, 2017). Overall, music serves an array of functions that can support one’s psychological, social and cultural development, whether that be from variations of music therapy or casual listening in everyday contexts (e.g., exercising, completing work, daily routines). Notably, in music therapy, therapists use music as a tool to promote well-being through a variety of strategies, which include music listening and games, song discussion, vocal and instrument performance, songwriting, instrumental improvisation, and other unique approaches (Bruscia, 2014). These techniques encourage a patient’s relaxation, which—in turn—facilitates discussion about their own feelings and thoughts evoked by the music.

Of particular relevance is music listening and song discussion as many people dedicate a large portion of their time listening to music on a daily basis (Fitch, 2006, Ligia, 2019), yet there is limited research on the implications of music in nonclinical settings. Music plays an especially distinct role in the lives of young people, who spend two hours a day listening to music; in fact, music is the second most used mood regulation method—after exercise—among youth (Thayer, Newman, & McClain, 1994). For young people, music can be used in many contexts, including pleasure, reduction of stress, formation of bonds with peers, and identification with a cultural group (Lonsdale & North, 2011). Music is also associated with the expression of one’s cultural identity and serves as one of the most salient features of social and cultural groups, especially among minority communities (Boer & Fischer, 2012; Frith, 1996). Given the meaningful implications of music in contemporary society, further research is needed to examine the accessible everyday applications of music in young people’s lives, particularly in promoting positive mental health and well-being.

Dr. Karthik Gunnia studied cognitive science and developmental psychology at UCLA. During his undergraduate career, he felt driven towards application-based research. He then worked at a group home with adolescents, leading him to pursue a Psy.D. at George Washington University. He then taught as an adjunct faculty member at NYU, Columbia University, Pace University, and the New School for Social Research. He also started his own clinical practice, focusing primarily in child and adolescent mental health. In 2019, he joined the NYU Applied Psychology Department as a full-time professor, where he currently teaches both undergraduates and graduate students in the counseling program. Upon discovering that Dr. Gunnia is teaching a new undergraduate elective, Mind Playing Tricks on

Me: Mental Health in Contemporary Music, the Editors-in-Chief (and self-proclaimed music reviewers) became interested in his perspective on the intersection of music and psychology. We thus spoke to Dr. Gunnia about his personal passion for music, his upcoming new course, and how music can serve as a tool to support and destigmatize mental health issues, particularly amongst young people.

What sparked your interest in music?

Music has always played a central role in my life. I played the saxophone growing up and jazz saxophone in high school, and I was part of the radio station at UCLA, where I had my own radio show. I also beatboxed in acapella groups in college and grad school. I’ve always been interested in music but it has always been more of a hobby for me.

What led you to create the new course Mental Health in Contemporary Music?

Among my favorite musical acts are hip-hop artists and rappers who discuss mental health in their music. In some of my classes, I’ll play some songs that help people get a stronger sense of the experiential aspects of mental health, because it’s difficult to fully understand the experience of complex mental illnesses like depression. You can read psychoeducation materials about depression, but hearing someone else discuss their own experience of mental health and emote about it in songs is different… Some artists wear their hearts on their sleeves, and you can hear the struggle in their songs, which allows the listener to bridge their own experiences with that of others.

Why is it important to examine how music relates to psychology?

One of my main passions—both clinically and as a professor—is destigmatizing mental health issues. Mental health, anxiety, depression, and more serious psychosocial health issues are much more common than most realize. However, I think as a society we do a really poor job of discussing and normalizing mental health issues, which acts as a barrier to accessing treatment. Not only are people suffering from mental health issues, but there is this added pressure of “I can’t ask for help” or “I don’t want to talk about it.” So I think it’s really important to educate students and the public, as a whole, about how prevalent mental health issues are and to get help when you need it; music is a really effective way to do that. Especially with young people, mental health issues often start during the teenage years and young adulthood. The research consistently shows that the earlier you get help for mental health difficulties the better the outcomes. So if we can get kids and young adults to feel Interview | 29

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comfortable sharing what they’re going through and asking for help when they need it, that’ll make a huge difference in society.

Can music serve as a tool for those with mental health illnesses?

Most definitely— I think some artists are excellent at expressing themselves in very specific and unique ways. So for someone suffering with mental illness, hearing a musician talk about something similar to what they’re going through will hopefully make them feel less alone and have some of that psychological burden relieved. [We] also have musicians outside of the songs talking about what they go through and their own struggles. In general, having public figures who are more willing to share are about [their] own journey… allows everyone to see that experiencing mental health issues is relatively common and nothing to be ashamed of.

How can one’s cultural background play a role in their connection to music?

From my understanding, hip-hop in black communities can be such a powerful tool, and rappers have a lot of power with the messages that they send—including how they depict substance use and mental health symptoms. For example, Kendrick Lamar is a much different rapper compared to more mainstream artists because he talks about mental health. Kendrick does not drink at all, and he has a song called ‘Swimming Pools,’ which talks about alcohol addiction. But it’s very different from other artists in the 2000s, in which the depiction of alcohol was mostly fun without consequences, rather than alcohol as an escape or coping mechanism. I think all of Kendrick’s albums are some of the best albums that have ever been made. He is an amazing role model in his discipline and the way that he writes music and connects his own personal experiences.

Lizzo is in that same underground hip hop scene and has been around for almost a decade, even though she just blew up last year. Her music is unique in the way that she combines pop with body image and positivity. Ariana Grande’s Thank U, Next is also another pop album, but she sneaks in lyrics that’s authentic and communicates her past struggles in detail. I think this is important because people want to hear about the individuals behind the songs, and both of these artists have had a significant influence on female empowerment. People are much more transparent now and willing to share their own challenges related to mental health.

What are some of your personal favorite albums?

When I wanted to create this course, the two artists that came to mind were Julien Baker and Aesop Rock. Julien Baker is a singer-songwriter who talks a lot about depression.

In her last album, Turn Out all the Lights, she has a song called “Claws in Her Back” that really delves into thoughts of suicide and explains depression in a way that academics and clinicians could never do. That whole album is an arc on her mental health and you can tell she writes songs because music plays a role in 30 | Interview

supporting her mental health. Aesop Rock has also been rapping about mental health issues for a while now, and he uses his music as an outlet for expression. In his last album, he has a song about going to a psychiatrist and what that experience is like.

For a lot of artists, their music is their therapy; they write it out on the page and that’s how they both cope with their hardships.

In recent months I have also been listening to a lot of Run the Jewels, Doomtree, Isaiah Rashad, and Fiona Apple.

What do you hope students will learn in your new course?

Music is a great way to reach young people. If you have a musician who is openly sharing thoughts of anxiety and depression and putting it out there, then it makes a difference as more young people are willing to talk about what they’re going through. With more open conversations, we normalize mental health [and] take away some of the shame associated with it— which I think would be really valuable. I’m hoping that this class will help the students destigmatize it for themselves and they, in turn, can share that with other people.

Analysis and Conclusion

The interview with Dr. Gunia highlighted several key takeaways regarding the power of music, a near-universal language that can be used to support youth and diverse populations today. First and foremost, musical artists often write about their own mental health issues, such as depression, suicidal ideations, post-traumatic stress, and psychosis, establishing a connection with listeners who might also be experiencing the same hardships. In doing so, music allows individuals to identify with an artist’s vulnerability showcased in a song, making listeners feel less alone and reducing the stigma attached to mental illness and access to treatment. Considering that the transition to adulthood is a particularly difficult period, young people are at an increased risk to face mental health issues (Arnett, 1995). Music and lyrical content often reflect the challenges facing youth today, including identity formation, decreasing dependence on caregiver support, peer and romantic relationships, and perceptions of self (e.g., self esteem; Arnett, 1995; North, Hargreaves, & O’Neill, 2000), thus providing young people with ability to validate their internalized emotions, such as sadness, grief, anger, and anxiety, especially during times of crisis (Papinczak et al., 2015). In addition to the shared connections established between artists and listeners, music acts as an alternative therapy by encouraging positive emotion by providing a temporary escape from the discomforts and challenges of life (Sloboda, 2005; Tarrant, North, & Hargreaves, 2000).

Music also has the ability to become the voice of cultural groups (Forman, 2012). In fact, hip hop, which arose in the Bronx during the 1970s, quickly became the musical language of African American and Puerto Rican populations (Chang, 2005). Hip hop culture, which spans from rap music to breakdancing and graffiti art, plays a particular role in addressing the often-neglected experiences of disenfranchised

An Interview with Dr. Karthik Gunnia

groups (Winfrey, 2009). As mentioned in the interview, hip-hop proves to be a particularly powerful tool in empowering black youth in the United States. In addition to influencing cultural expression,including fashion and communication (Abdul-Adil, 2014), music is a promising and accessible form of psychotherapy, addressing the unique experiences and hardships of black people (Decarlo & Hockman, 2004; Travis & Deepak, 2011).

Despite the widespread applicability of music in the daily lives of young people, research on how music, particularly hip hop, can improve mental health outcomes has been sorely lacking. In order to better understand how contemporary music can help support mental health and facilitate awareness, Dr. Gunnia’s perspective highlights how future efforts need to address health outcomes with music, or hip hop, interventions.

In particular, minorities bear the burden of mental health issues, demonstrating the need for culturally competent interventions that address mental health (American Psychiatric Association, 2017; Ng, Zhang, Scholle, & Guerino, 2017).

Research has confirmed that culturally competent interventions intended for a target population are more effective in comparison to standard treatments (Chowdhary et al., 2014). One way has been through the integration of hip hop and rap into new and existing evidence-based treatments. For example, Tyson’s (2002) study had group therapy sessions where participants listened to songs about unity and self-identity and subsequently discussed their thoughts, feelings, and reactions to it. Results from the study indicated that participants who listened to hip hop music had improved peer relations compared to the standard group (Tyson, 2002). Expanding upon Dr. Gunnia’s insights, hip hop and rap resonate strongly with listeners and can be used as a persuasive communication tool for expression of one’s thoughts and feelings, and can also dismantle the stigma surrounding mental health by fostering awareness and meaningful conversations on the topic.

Starting in the Summer of 2020, Dr. Karthik Gunnia will be teaching a new Applied Psychology elective entitled Mind Playing Tricks on Me: Mental Health in Contemporary Musicat the Steinhardt School of Culture, Education, and Human Development. In our interview, he informed us that the course is designed to help students destigmatize and reflect the experiences of mental health in a unique way. Each week will focus on a different mental health topic and symptoms that many people experience (e.g., suicidal ideation, psychosis, panic attacks). Throughout weekly topics, students will analyze songs that address these themes and discuss their own thoughts and reactions in relation to literature on symptoms of mental illness.

He hopes to bring in guest lecturers from the music industry and psychology field to talk about their take on the intersection of music and mental health. If only we weren’t graduating, because we would love to take this course!

Interview | 31

OPUS (2020) 11:1 References Abdul-Adil, J. K. (2014). Modern Rap Music: Mining the

Melodies for Mental Health Resources. Journal of

Youth Development, 9(2), 149-152.

American Psychiatric Association (2017). Mental health

disparities: Diverse populations. https://www.psychiatry.org/psychiatrists/cultural competency/education/mental-health-facts Arnett, J. J. (1995). Adolescents’ uses of the media for self socialization. Journal of Youth and Adolescence, 24(5), 519–533.

Bruscia, K. E. (2014). Defining music therapy (3rd ed.).

University Park, IL: Barcelona Publishers.

Boer, D., & Fischer, R. (2012). Towards a holistic model of

functions of music listening across cultures: A

culturally decentred qualitative approach. Psychology

of Music, 40(2), 179–200.

Chowdhary, N., Jotheeswaran, A. T., Nadkarni, A., Hollon, S. D.,

King, M., Jordans, M. J., … Patel, V. (2014). The

methods and outcomes of cultural adaptations of

psychological treatments for depressive disorders: a

systematic review. Psychological medicine, 44(6), 1131–1146.

Chang, J. (2005). Can’t stop won’t stop: A history of the hip-hop generation. New York: Picador.

Decarlo, A., & Hockman, E. (2004). RAP Therapy: A Group

Work Intervention Method for Urban Adolescents.

Social Work With Groups, 26(3), 45-59.

Forman, M. (2012). That’s the joint!: The hip-hop studies reader.

New York: Routledge.

Frith, S. (1996). Performing rites: On the value of popular music.

Cambridge: Harvard University Press.

Hense, C., & McFerran, K. S. (2017). Promoting young people’s

musical identities to facilitate recovery from mental illness. Journal of Youth Studies, 20(8), 997–1012.

Lonsdale, A. J., & North, A. C. (2011). Why do we listen to

music? A uses and gratifications analysis. British

Journal of Psychology, 102(1), 108-134.

Ng, J., Zhang, Q., Scholle, S. H., & Guerino, P. (2017). Racial

and ethnic disparities in mental health among diverse

groups of medicare advantage beneficiaries. Center

for Medicare & Medicaid Services Office of

Minority Health. https://www.cms.gov/About-CMS/Agency Information/OMH/Downloads/Data-Highlight Vol11-Dec-2017.pdf North, A. C., Hargreaves, D. J., & O’Neill, S. A. (2000).

The importance of music to adolescents. British Journal

of Educational Psychology, 70(2), 255-272.

Papinczak, Z. E., Dingle, G. A., Stoyanov, S. R., Hides, L., &

Zelenko, O. (2015). Young people’s uses of music for well-being. Journal of Youth Studies, 18(9), 1119-1134.

32 | Interview

Silverman, M. J. (2019). Music therapy and therapeutic alliance

in adult mental health: A qualitative investigation.

Journal of Music Therapy, 56(1), 2019, 90–116.

Sloboda, J.A. (2005). Exploring the musical mind: Cognition,

emotion, ability, function. Oxford: Oxford University Press.

Tarrant, M., North, A.C., & Hargreaves, D.J. (2000). English and

American adolescents’ reasons for listening to music.

Psychology of Music, 28(2), 166–73.

Thayer, R. E., Newman, J. R., & Mcclain, T. M. (1994). Self regulation of mood: Strategies for changing a

bad mood, raising energy, and reducing tension.

Journal of Personality and Social Psychology, 67(5), 910-925.

Travis, R., & Deepak, A. (2011). Empowerment in context:

Lessons from hip-hop culture for social work practice.

Journal of Ethnic And Cultural Diversity in Social

Work, 20(3), 203-222.

Tyson, E. H. (2002). Hip hop therapy: An exploratory study of a

rap music intervention with at-risk and delinquent youth. Journal of Poetry Therapy, 15(3), 131–44.

Winfrey, A. M. (2009). Healing young people thru empowerment

(H.Y.P.E.): A hip-hop therapy program for black

teenage boys. Chicago: African American Images.

OPUS (2019) 10:2

Album Reviews

16 | Literature Reviews

Frank Ocean’s Endless: Exploring Love in Early and Emerging Adulthood Will Olesiewicz

Four years after his debut album, Channel Orange, Frank Ocean released a 45 minute album titled Endless. Since its release, Endless has grown to be a cult-classic amongst fans who often praise the album for its unpolished tone and experimental qualities. The album defies standard music conventions, such as the song-writing structure of verse–bridge–chorus repetition, and incorporates a stream of conscious writing style, allowing Ocean to showcase his inner thoughts instead of standard lyrical narratives.

The subject matter of Endless is largely derived from Ocean’s early to mid-twenties, a stage that developmental psychologist Erik Erikson called early adulthood. In this stage, Erikson (1968) found an overarching presence of desire for intimacy and fear of isolation. Endless involves much deliberation on the idea of finding a life partner and settling down to start a family. Ocean often holds this idea in contrast to the freedom of sexual promiscuity and indulgence that his newfound wealth has given to him. In more recent years, developmental psychologists have started to call this life-stage emerging adulthood, a period that focuses on the transition from adolescence to adulthood (Arnett, 2000). In this stage, the individual person typically learns to depart from their home life, upbringing, and immediate family learning to become an independent and self-sustaining adult (Arnett, 2000). Previous research has linked this transition period, usually between the ages of 18 to 25, to significant growth in identity formation and one’s world view (Davis, 2007; Lee, 2019). Further, people in this stage often explore careers, finalize identity formation, and form long-term romantic interests (Arnett, 2000). Ocean explores the theme of transitions by discussing his own experience of this age-range, writing about moving from poverty to wealth, the formation and dissolution of romantic relationships, as well as the acceptance of his own sexuality. Thus, this album review explores how Endless grapples with this psychological stage through showcasing Ocean’s changing attitudes towards love interests; specifically the exchange of sexual freedom for longterm relationships, as well as the identity formation found in accordance with the themes of emerging adulthood.

Early Adulthood and Relationships Erikson’s Early Adulthood stage describes people ages 2129 through the crisis of need for intimacy and fear of isolation (Erikson, 1968). As opposed to adolescence, relationships in the early adulthood stage often focus on interdependence and commitment, and last longer on average (Chen, 2006; Collins & Laursen, 2012). People in early adulthood also put more personal investment into complex relationships, involving

higher commitment to a significant other, as well as longer-term connection to a partner (Erikson, 1968; Yablonska 2013).

Frank Ocean, in his four album discography, incorporates writing about positive and negative romantic relationships.

A large part of Endless is devoted to the idea of settling down with a partner and forgoing the open relationships he enjoyed for early-on in his life. The listener can find this distinction by comparing an early song on the album Comme des Garcons with later tracks. In Comme des Garcons, French for “as the boys [do],” Ocean talks about starting a romantic relationship with someone, while both were cheating on their respective partners.

Ocean writes, “Kept it faded on the side We were seeing someone We was dating on the side He was seeing double” (Ocean, 2016, track 6).

The sexual promiscuity found in this song is more reminiscent of romantic relationships in late adolescents than in early adulthood through its focus on sexuality over romanticism.

Research has shown that many in the early adulthood stage often exchange sexual freedom of adolescence with multiple partners towards a more monogamous long term-relationship (Boislard, van de Bongardt, & Blais, 2016; Collins & Laursen, 2012; Yablonska, 2013).

Later in the album on the track Wither, Ocean sings about his desire to start a family with a long-term partner. Ocean states, “And tonight I’ll hold you close, close enough to bruise Hope a garden grows where we dance this afternoon Hope our children walk by spring when flowers bloom Hope they’ll get to see my color Know that I’ve enjoyed sunshine Pray they’ll get to see me, me wither” (Ocean, 2016, track 9).

Here, Ocean describes what many in early adulthood are searching for – the ability to find a person with whom they can raise children and make a life beyond their own. Research has shown that people in the early adulthood stage often hold their relationships to high standards, going so far as to judge them based on their ability to form into a lifelong marriage (Mitchell, 2002). People in this stage have been shown to desire partners that care as much about the relationship as they do (Collins & Laursen, 2012; Mitchell, 2002).

Ocean integrates this idea in his song Slide On Me, which is emblematic of the modern obsession for the perfect relationship.

In this track, Ocean sings “I’m still working while you dream pop …

This is for when you change your mind and slide back this way This is for that night when setbacks won’t let that much fade

Album Reviews | 35

OPUS (2020) 11:1

Guess you can’t blame the ones you choose” (Ocean, 2016, track 12).

Slide On Me shows Ocean describing a relationship that is not equal in terms of effort given. Ocean finds too much conflict in his relationship as he is with a partner who does not put as much effort into the relationship as he does. The conflict found here is reminiscent of the early adulthood theme of mutual investment in a relationship, where partners expect each other to foot an equal amount of the burden (Collins & Laursen, 2012). Likewise, Sulman (2017) describes how people in this stage focus on keeping the other in the relationship appeased, and hoping that they hold the same intentions. In these songs, Ocean describes the early adulthood concept of deliberating through all of the criteria to find the right person to start a life with.

Emerging Adulthood Since Erikson’s theory was first published, the recent rise of college attendance has led psychologists to examine new stages of the developmental trajectory (Archibald, Feldman, & McHenry, 2015). With young adults having more time to devote to identity and career formation than previously before, psychologists have attempted to understand the mentality of people of this age range – thus resulting in the creation of the psychological stage emerging adulthood (Arnett, 2000). Emerging adulthood can also be understood as a stage of “delayed responsibility,” as college attendance gives young adults more time than their previous generational counterparts to decide on a career and start a family (Arnett & Jensen, 2015; Davis, 2007). This notion of delayed responsibility gives people in this stage a few years to define one’s self in terms of career choices, friendships, and interests. The identity formation of emerging adulthood largely focuses on the development of one’s career and “purpose” in society (Arnett & Jensen, 2015; Zorotovich & Johnson, 2019).

Ocean first incorporates emerging adulthood in his song U-NI-T-Y, a rap-song about his early financial and career success in the music industry, stating

and

“My head fatiguing off the opus Kept it underground to focus I feel afterlife, six under oath, don’t want no hocus pocus,” “You still are no match, you get no rematch Boy, you missed your moment Perusing the MoMA, I’m all on my lonely, burst in tears” (Ocean, 2016, track 3).

Here, Ocean focuses on figuring out his career trajectory before he dies: by searching for self-purpose and meaning in his music.

Ocean hopes to avoid a passive and monotonous life-style, what he describes as idly viewing an art gallery, in pursuit of something greater. Ocean portrays himself as feeling that he will have missed his moment if he stands still, slowly watching life go by. Young adults in emerging adulthood often echo Ocean’s sentiment here as they can often be found switching jobs or careers in search for more fulfillment (Arnett, 2000; Arnett & Jensen, 2015). Further, adults in this stage will often look for employment that gives the worker a purpose and provides a 36 | Album Reviews

benefit to society (Arnett & Jensen, 2015; Lee, 2019).

These themes of Emerging Adulthood are also found in the song Sideways, a spoken-word poetry piece about Ocean’s obsession over his career. Ocean states, “I was in all them hours in it 10K, tokin’ mid strokes ... All this hotel living, Might as well pay the mortgage what I’m spending …

When I’m down they gon’ celebrate Sittin’ sideways, too sideways Nah, it’s not too late” (Ocean, 2016, track 13).

Ocean describes the obsession he has for working on his musical grandeur, so much so that he is willing to spend 10,000 hours— the approximate amount of time needed to become an expert at something, as coined by author Malcolm Gladwell (2008)— working on something he believes can socially and financially benefit him. Ocean elaborates on this idea as he describes his need to settle down and take on more financially mature decisions, such as obtaining a mortgage (Ocean, 2016, track 13).

These concepts are indicative of the young adult’s pressure to participate in the job market and establish a career trajectory.

Although the experience of college often gives young adults the ability to explore their passions, it can also create a sense of urgency to find fulfilling work as the financial burden of college starts to emerge (Zorotovich & Johnson, 2019). This need becomes more urgent as emerging adults look for work which stems from something that is rewarding to one’s personal goals and achievements (Arnett & Jensen, 2015). Sideways further showcases the contradicting nature between having the freedom to explore and the feeling of urgency to move forward, that is often found in emerging adulthood.

Class Critique of Emerging Adulthood Although prevalent in psychological literature, emerging adulthood has also seen criticism from researchers. Specifically, the theory has been scrutinized for its lack of applicability to poor and working-class young adults (Cherney et al., 2019; Cote 2014). The theory fails to provide insight into those who must enter the workforce immediately after high school, due to personal or financial reasons (Cherney et al., 2019).

Understanding this psychological stage in terms of class and wealth leads many to wonder if it is fair to group all young adults into the emerging adulthood category (Cote, 2014). Ocean’s Endless provides insight into this dilemma as he uses the album to reflect on his escape from poverty. Perhaps Ocean’s early financial success in the music industry gave him the opportunity to participate in emerging adulthood. Research shows that the ability to go to college and still have free time to explore one’s passions and career interests is largely unavailable to those who must work or support themselves through college (Cherney et al., 2019; Vosylis & Klimstra, 2020). Ocean did not have the financial freedom to explore himself and his passions until he eventually succeeded in the music industry and could now financially support himself.

Ocean explores his impoverished childhood in the song Alabama, which recollects scenes from his youth. Ocean states,

Early & Emerging Adulthood: Frank Ocean

“My barber fresh out the penitentiary That alcohol was stingin’ me My four cousins stayed with me, stayed with us One was in the shower My aunt in law come over to fuss and fight So she get out in cutoffs and a wifebeater” (Ocean, 2016, track 2).

Comparing this excerpt with a line on a later track titled ‘Hubbolts,’ where Ocean sings “Suburbia got a yard/ All this estate for my mind to run”, reveals that the shift from poverty to wealth allowed Ocean space for himself to explore his thoughts and passions in greater depth—similar to those in emerging adulthood (Ocean, 2016, track 10). Many in this stage are able to rely on parental or supplemental income to explore different careers and live in different cities. Ocean, however, relies on his own income to support his period of exploration and growth, allowing him to understand the privilege associated with being an emerging adult. Ocean touches upon this idea on the song U-N-I-T-Y, with the lines

themes of early and emerging adulthood. Listeners may be able to explore the psychological themes of adolescence found in Blonde by using a similar framework to this review.

At its very essence, Endless reveals itself to be a vignette of Ocean’s early to mid twenties, showcasing his desire to find a partner, establish a career and explore a life worth living.

Through his sonic and lyrical mastery, Frank Ocean is able to capture the audience’s attention, transporting them into his own psyche and showing them an unfiltered and genuine part of his life-experience.

“Iberville 1995/ You’d think that was airstrikes on outside I put refugees in my villa, play kids the Fu-Gee-La All this space Atlanta, place order McMansions and two apple pies” (Ocean, 2016, track 3).

In this excerpt, Ocean name-drops the projects where he grew up (i.e., Iberville, New Orleans), while comparing the living situation to that of a war-zone. He develops this metaphor with the wish that he could take in the refugees from the projects (i.e., the people living in his former neighborhood), and let them experience the wealth he has been able to gain since escaping.

While the listener can only speculate, it can be surmised that Ocean is able to experience the freedom of emerging adulthood, and the subsequent formation of his life-trajectory, through his newfound wealth through the music industry.

The psychological themes of early and emerging adulthood allow for novel insight into Ocean’s artwork. Their addition showcases Ocean’s deliberations on love, career exploration, and existential questions of his future. Further, the theories of early and emerging adulthood provide the listener with a point of reference to understand the psychological and chronological contexts surrounding the album.

Conclusion Ocean’s Endless gives the listener an artistic insight into the early to mid twenties, a time period that has been extensively portrayed in music over the recent years. A dissection of this album through the lens of psychological literature allows the audience to fully grasp the development of Ocean’s persona throughout the early and emerging Adulthood stages. The benefit of understanding this psychological stage through the medium of music provides the listener to feel shared human-connection by discussing widespread themes of deliberations and life crises in this stage. However, there are limitations to this review, as Ocean does not give many public interviews and rarely confirms the veracity of his songs—blurring the lines between reality and story-telling. Despite his isolation from media, Ocean furthers these topics on his next album Blonde, which also integrates Album Reviews | 37

OPUS (2020) 11:1 References Archibald, R. B., Feldman, D. H., & McHenry, P. (2015). A quality-preserving increase in four-year college attendance.

Journal of Human Capital, 9(3), 265-297.

Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469-480.

Arnett, J. J. (2015). Emerging adulthood: The winding road from the late teens through the twenties. New York, NY: Oxford University Press.

Collins, A. W., & Laursen, B. P. (2012). Relationship pathways: From adolescence to young Adulthood. Los Angeles, CA: SAGE Publications.

Cherney, K., Rothwell, D., Serido, J., & Shim, S. (2019). Subjective financial well-being during emerging adulthood: The role of student debt. Emerging Adulthood, 1(1), 216-227.

Cote, J. E. (2014). The dangerous myth of emerging adulthood: An evidence-based critique of a flawed developmental theory. Applied Developmental Science, 18(4), 177-188.

Davis, S. N. (2006). Gender ideology construction from adolescence to young adulthood. Social Science Research, 36(1), 1021-1041.

Erikson, E. H. (1968). Identity: Youth and crisis. New York: W. W. Norton Company.

Gladwell, M. (2008). Outliers: Why some people succeed and some don’t. New York: Little Brown & Co. Lee, Y. (2019). Transitions in adulthood and women’s attitudes toward the gender division of labor in South Korea. Journal of Child and Family Studies, 28(2), 1815-1825.

Mitchell, Stephen A. (2002). Can love last?: The fate of romance over time. New York: W.W. Norton.

Shulman, S. (2017). The emerging adulthood years: Finding one’s way in career and intimate love relationships. The Psychoanalytic Study of the Child, 70(1), 40-62.

Ocean, F. (2016). Endless [CD]. Los Angeles, CA: Def Jam Recordings.

Vosylis, R., & Klimstra, T. (2020). How does financial life shape emerging adulthood? Short-term longitudinal associations between perceived features of emerging adulthood, financial behaviors, and financial well-being. Emerging Adulthood, 1(1), 1-19.

Yablonska, T. (2013). Family factors of a person’s identity development during adolescence and early adulthood.

Social Welfare Interdisciplinary Approach, 3(2), 31-40.

Zorotovich, J., & Johnson, E. I. (2019). Five dimensions of emerging adulthood: A comparison between college students, nonstudents, and graduates. College Student Journal, 22(1) 376-384.

38 | Album Reviews

“Wild and Fluorescent”: Emerging Adulthood in Lorde’s Melodrama Andrew Han

Nearly four years after shifting the paradigm of the pop industry with her debut album, Lorde told her fans in a social media post that “Writing Pure Heroine was my way of enshrining our teenage glory, putting it up in lights forever so that part of me never dies, and Melodrama—well, this one is about what comes next” (Yelich O’Connor, 2016). Departing from the minimalist production and candid portrayal of suburban teenage anxieties in her first album, Melodrama explores Lorde’s colorful transition from adolescence to young adulthood—a psychological stage known as emerging adulthood (Arnett, 2000; Weiner, 2017). During this period, which occurs between the late teens and early-to-mid twenties, a person learns to stand alone, retiring from the luxury of their familial dependence and upbringing in pursuit of the autonomous nature of adulthood (Arnett, 2015).

In particular, this self-focused era is characterized by intense identity exploration while navigating frequent changes in one’s love and social life, educational and vocational pursuits (e.g., college, entering the workforce), and living arrangements (Jensen, 2011). For Lorde, this meant returning to New Zealand and removing herself from the grandeur of being a pop star, which many rising artists choose to revel in. This approach allowed Lorde to undergo the challenging, yet universal, process of becoming an adult in a way that was similar to many of her young listeners—including leaving her family home in New Zealand and reformulating her identity amidst unstable circumstances, particularly after having her heart broken by her first love (Donnellan, Trzesniewski, & Robins, 2011; Field, 2011). In Melodrama, Lorde articulates her coming-of-age story, inspired by heartbreak, in a concept album about a party, where recreational alcohol and drug use among youth is common. This recurring theme serves as the guiding pillar of an album that reflects the subject matters in popular music and literature on emerging adulthood (Arnett, 2005).

Chronicling drunken and drug-induced nights, Lorde narrates how her thrilling experiences interplay with her thoughts, feelings, and actions, particularly after a breakup.

Given that the transition from adolescence to adulthood is a relatively unstable time of young people’s lives (Laiho, 2004), a romantic breakup can heavily impact an individual’s self-concept and self-esteem during a critical period of identity development, a core feature of emerging adulthood (Luciano & North, 2017).

In fact, most people withstand at least one emotionally earthshaking romantic dissolution by the end of their adult years, sometimes triggering the onset of severe mental health issues, such as depression, anxiety, obsessive thoughts, and higher risk for suicide (Field, 2011). What distinguishes Lorde from her 40 | Album Reviews

musical generation is her sheer authenticity and vulnerability— her willingness to openly describe personal tales of rejection and depression that many 21st century young adults face.

Much of popular music is typically dominated by “poptimism,” a term coined by music journalists to refer to media that promotes unrelentingly uplifting and positive portrayals of the process of overcoming life’s obstacles, particularly breakups (Weisbard, 2012). Lorde, however, doesn’t pretend she can easily shake off the newfound hardships of adulthood. Using prevailing themes featured in both pop music and emerging adulthood— ranging from the inelegancies of party culture, the apocalyptic feelings of heartbreak, and learning to be independent without the comforting context of youth—Melodrama paints a picture of emerging adulthood as blue, emotional, and dramatic as its album artwork and title suggests, testifying to one of the most discussed topics in music: a breakup. Rather than resisting the archetypes—falling in and out of love, the near-utopian flashbacks, crying at a party, the foolish debauchery of a night out—Lorde revitalizes and collapses the timeline of a heartbreak, using the transformative journey to unmask the liberating selfpower of dancing alone. This review explores how Lorde’s unique lyricism and production in her sophomore album evokes the dramatic shifts in emotional states often seen in young people, accurately portraying the challenges facing emerging adults today in their transitions from adolescence.

Lorde’s ability to authentically express her experiences as a reflection of her worldview and age is her one of signature qualities. When she, a 16 year old middle class teenager living in the suburbs, called out the music industry about the unrealistic, nearly unattainable depiction of alcohol, drugs, and partying amongst obscenely wealthy musicians on her hit, Royals, audiences identified with her. But how does an artist recalibrate her identity as a “normal” teenager when she has become a renowned pop star herself? Lorde chose to turn inward, going back home to New Zealand and moving out of her family home after turning 18 years old. During this time, she also braved the dismantling of a three-year relationship with her first love.

Feeling rejected and betrayed, Lorde sings of jealousy in the beginning lines of Green Light. Grief-stricken at the possibility that her ex might have moved on, Lorde compares the chatter of rumors to teeth, “Well those great whites they have big teeth Hope they bite you Thought you said you would always be in love But you’re not in love, no more” (Yelich-O’Connor, 2017, track 1).

Lorde then immediately annotates herself, as the song switches from a minor to a major key: “But I hear sounds in my

Emerging Adulthood In Lorde’s Melodrama

mind/ Brand new sounds in mind” (Yelich-O’Connor, track 1, 2017). This shift represents how young people frequently vacillate between mood states (Larson, Moneta, Richards, & Wilson, 2002), and as Lorde drops the facade of bitterness in identification of her broken heart, she looks forward to her burgeoning independence. But she still can’t let go of the emotional turmoil and sharp memories of her ex. In anthemic fashion, Lorde chants “‘Cause honey I’ll come get my things, but I can’t let go/ I’m waiting for it, that green light, I want it/ Oh I wish I could get my things and just let go,” using a traffic light as a metaphor to grant her the license to let go of her past and move on to the future (Yelich-O’Connor, 2017, track 1). Almost all young adults report experiencing the disintegration of a romantic relationship (Connolly & McIsaac, 2009), and many individuals associate the period after with severe distress and loss—an aching that Lorde wishes to erase (Davila, Steinberg, Kachadourian, Cobb, & Fincham, 2004).

In addition to its refusal to rhyme and its downbeat prechorus, which contrasts the structure of most pop music, Green Light’s mercurial musical production matches its lyrical content, as the song quickly transitions from jarring, “angry” piano chords to a euphoric, dance-pop chorus, underscoring how youth are likely to experience extreme changes in affect—both positive and negative (Larson et al., 2002; Silvers et al., 2012).

Lorde’s first song marks the beginning of a night-long adventure in personal rediscovery and renewal as Lorde catches sight of a new sense of strength, resilience and optimism, even if she’s the drunk girl at a party bawling about her ex. Lorde reasserts, “That tonight and tomorrow [that girl] starts to rebuild” (Phillips, 2017). Capturing the desire for emancipation from pain while a past breakup is weighing her down, Green Light sets the stage for an entire album dedicated to the wide range of emotions an emerging adult can feel over the course of a single night.

Lorde’s inner turmoil, activated by rumination over her ex, lingers in Sober, the second song in her journey, as she plunges into a night replete with alcohol and drugs—perhaps using the near-blinding occasion of partying as an excuse to forgo dealing with the emotions, responsibilities and realities of adulthood.

Because drug and alcohol use are particularly extensive in adolescents and young adults (Arnett, 2005), heartbroken youth might engage in recreational substance use as alternatives to “get over an ex” (McKiernan, Ryan, McMahon, Bradley, & Butler, 2018). Overall, partying serves as a common opportunity for people to spend time together and often involves substances that might encourage them to behave in out-of-the-ordinary ways—likely as a means to escape from the grim realities of contemporary adulthood and breakups (Arnett, 2005; Demant & Østergaard, 2007). Instead of characterizing a glamorous and consequence-free party scene typically portrayed in pop music, Lorde expresses how alcohol and drug use can be a source of anxiety—how she wishes to be elsewhere, but continues to stay due to the toxicity of millennial paranoia and the fear of missing out: “Oh God, I’m out of clean air in my lungs

It’s all gone Played it so nonchalant It’s time we danced with the truth Move alone with the truth” (Yelich-O’Connor, 2017, track 2).

Dancing in an inebriated state, Lorde cannot help but think of her ex, even if she puts on a veneer of indifference in front of the public, peers, and her potential hookups. Although many young people phase out of problematic substance use behaviors (e.g., binge drinking) after their early 20s, risky drinking and drug use as well as casual sexual relationships (e.g., friends with benefits) can have destructive personal and social consequences, especially when these alternatives are viewed as accessible coping mechanisms to shield anxiety (Cooper, 1994; Hingson, Heeren, Zakocs, Kopstein, & Wechsler, 2002). For Lorde, partying and engaging in these behaviors might be a strategy to free herself from the feelings of loneliness and grief after her last relationship, noting that “I’m acting like I don’t see/ Every ribbon you used to tie yourself to me” (Yelich-O’Connor, 2017, track 2). As she dances with another person, she now fears love gone bad. She even questions: “But what will we do when we’re sober?” echoing the uneasiness and uncertainty young people encounter when forced to confront and reconcile with their actions once released from the spell of intoxication (YelichO’Connor, 2017, track 2).

In Homemade Dynamite, a percussive, hip-hop driven party track, and one of the album’s few optimistic offerings, Lorde further expands upon these themes by romanticizing sensation-seeking, the increase in risky behaviors (e.g., drunk driving) seen in adolescence and young adulthood (Arnett, 1992; 2005). Here, Lorde equates the close-knit, grandiose dynamic among her friends to an explosive grenade, and she, as always, illustrates a scene doused in hedonism and an amusing eye-roll: “Blowing sh*t up with homemade d-d-d-dyna— Might get your friend to drive, but he can hardly see We’ll end up painted on the road, red and chrome All the broken glass sparkling I guess we’re partying” (Yelich-O’Connor, 2017, track 3).

Lorde recognizes that there might be underlying consequences to her reckless behavior, even if a part of her also embraces and revels in indulgence. At its surface, the song portrays partying and alcohol use as a form of “togetherness” that collectively unites young people to break free from their normal routines and, in Lorde words, “behave abnormally” (Demant & Østergaard, 2007; Douglas, 2003; Ham, Bonin, & Hope, 2007; Yelich-O’Connor, 2017, track 3). Many emerging adults justify risky behaviors believing they will lose those opportunities later in life—exemplifying the carefree and brash disposition of youth, which many people are not willing to give up just yet (Ravert, 2009). Thus, sensation-seeking, as seen in Melodrama, can be viewed as a unique characteristic of emerging adulthood, in which recklessness represents broader exploration among young adults who are in pursuit of new and meaningful experiences (Arnett, 2005).

Another key facet in the lives of emerging adults is the Album Reviews | 41

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pursuit of romantic relationships, from committed, longstanding partnerships to more casual, short-term connections (Arnett, 2015; Bersamin et al., 2013). In The Louvre, Lorde elaborates on the album’s references to drugs, opening with the strumming of a guitar that mimics one’s fluttering heartbeat while being in love. She whispers in admiration, “Well, summer slipped us underneath her tongue/ Our days and nights are perfumed with obsession” (Yelich-O’Connor, 2017, track 4), comparing the “warm” feelings of euphoria associated with “summer,” a slang-term for the party-drug ecstasy (Cohen, 1995; Kiyatkin & Ren, 2014), to a magnetic relationship—generally intense and elating, but short lived. Drugs represent the naiveté of young love as Lorde basks in “a rush at the beginning,” but is self-aware: “I get caught up just for a minute” (Yelich-O’Connor, 2017, track 4). Romantic relationships can be a source of positive affect and well-being (Dush & Amato, 2005), and Lorde likens her “supernatural” affection to artwork showcased in the famous museum in Paris, France, even if it is “Down the back, but who cares, still the Louvre” (Yelich-O’Connor, 2017, track 4). Against a backdrop of glistening synths and buoyant harmonies, Lorde tells her audience to listen to her beaming heartbeat and dance to it, evoking the blissful nature of being in love, an empirical feeling that researchers can identify and measure (Mashek, Aron, & Fisher, 2000). A compelling aspect of Melodrama is the high number of songs that have long outros of instrumentation without any lyrics, a bold artistic choice not generally seen in pop music. Young people have described love as “You could spend every second [together] and never get bored” (Williams & Hickle, 2010), and The Louvre ends with a finale as enchanting as its subjects: a grandiose guitar-driven outro, emblematic of a sun-soaked image or the climactic moment of a soapy romantic comedy.

Yet there is innocence in The Louvre, which is indicative of how youth are sometimes unaware of how romantic relationships can have devastating personal consequences, and, in certain cases, be deceitful (Field, 2011; Martin, 2015). Many emerging adults have to face what happens after the shared frequency of reciprocated love and effects of “summer” has faded. While The Louvre offers a picture of love at its most dreamy state, Liability spotlights a heartbroken young woman at her most vulnerable, both lyrically and sonically. A stark contrast to the previous track, Liability is a somber, stripped down piano ballad, another switch-up symbolic of the shifting frequency and intensity of thoughts and emotions among young people (Laiho, 2004).

High-quality intimate relationships are often a cornerstone of adult well-being, making them a long-term goal for emerging adults, who are transitioning from the primary relationships of childhood (e.g., caregivers) to long-term friendships and committed romantic relationships (Montgomery, 2005).

Breakups can be a severely distressing event for an emerging adult, provoking widespread interferences with one’s mental health, including sleep disturbances, bereavement, intrusive thoughts, and “broken heart” syndrome, which is described as a physical pain in the chest—heartache that mimics the symptoms 42 | Album Reviews

of a real heart attack (Connolly & McIsaac, 2009; Field, 2011; Wittstein et al., 2005).

Inspired by a crying session during a late-night taxi ride in New York City, where much of the record was written and produced, Lorde mourns, “He don’t wanna know me/ Says he made the big mistake of dancing in my storm” (YelichO’Connor, 2017, track 5), referring to the trademark “storm and stress” young people inhabit (Arnett, 2008). She bleeds further: “They say, ‘You’re a little much for me You’re a liability You’re a little much for me’ So they pull back, make other plans I understand, I’m a liability Get you wild, make you leave I’m a little much for… everyone” (Yelich-O’Connor, 2017, track 5).

The loss of a romantic relationship might be the loss of the closest adult relationship a person has, which can have dramatic impacts on their self-concept and self-esteem, both of which are integral to positive identity development (Luciano & Orth, 2017; Slotter et al, 2010). Liability grasps the fear that loved ones will leave at some point. In the song, Lorde views herself from the lens of others who may have left her; occupying a space where she feels that she isn’t enough, but too much—all at the same time. Grappling with the emotional maelstrom in young people’s lives, where the manic ferocity of adolescence clashes with the looming expectations of adulthood, Lorde introspectively explains how lost friendships and relationships can crack our already fragile selves, even though inevitable changes in one’s social life are bound to occur during emerging adulthood (Jensen, 2011).

Detailing the self-blame, loneliness, preoccupation, and insecurity after rejection from someone she loved, Liability snapshots how devastating heartbreak can be at an early age (Davis, Shaver, & Vernon, 2003). Partly about the consequences of fame, Lorde presumes that she is too “wild” for others and that her presence might be overbearing for those who are not accustomed to her lifestyle. Lorde has internalized the rejection from her ex, dispersing the fatal blow to other aspects of her psychosocial well-being. Following a long-term relationship, people can experience dramatic reductions in self-esteem and changes to their positive views of self (Luciano & Orth, 2017; Slotter et al., 2010). Believing that she is a faded artist, ex-lover, and friend, she laments, “The truth is I am a toy that people enjoy/ ‘Til all of the tricks don’t work anymore/ And then they are bored of me” (Yellich-O’Connor, 2017, track 5), amidst piano chords with a deliberately missing note, personifying the loss after losing love that previously ignited sparks, pictured in The Louvre. However, Lorde’s greatest gift is how she renders a still, desolate sonic landscape to match the song’s lyrical content, which wallows in waves of juxtaposing emotions within the same song. Ultimately, Lorde details a young woman alone—but healing: “So I guess I’ll go home into the arms of the girl that I love The only love I haven’t screwed up She’s so hard to please but she’s a forest fire I do my best to meet her demands

Emerging Adulthood In Lorde’s Melodrama

Play at romance, we slow dance in the living room But all that a stranger would see Is one girl swaying alone stroking her cheek” (Yellich-O’Connor, 2017, track 5).

The most blue and crestfallen song on Melodrama is also the first track about self-care during the process of rebuilding one’s self after the conclusion of a long-term relationship. Although Lorde has been disappointed by others, she realizes that she has never let herself down and will continue to enjoy her own company. Lorde is alone, but free to be who she is—without the weight of her first love. Romantic breakups can serve as a lesson for young adults, who learn to regulate their emotions, endure stress, and eventually pursue other goals, interests, and people that match their needs and desires (Norona & Welsh, 2017).

Liability epitomizes heartbreak for emerging adults who are more susceptible to extreme moods (Fisher, 2006), re-instilling the thematic spirit of Melodrama, in which emotions can feel potent, even soul-crushing, in the moment, but—at the end of the day—fleeting and not permanent. Despite hitting rock bottom, Lorde knows that she is “Better on my own” (YelichO’Connor, 2017, track 5).

Instead of hiding behind the curtain of partying, substance use, and sensation-seeking, Lorde bares all in Liability, telling a story about coming to terms with how her heightened emotions may be a central element of her personal and musical identity, which she, at times, believes to be too “wild”. Lorde reasserts herself as a liberated young woman and artist—finding comfort in her identity, vulnerability and full range of emotions—a key stepping stone of identity development in emerging adults who learn to live independently and self-govern without the context of their upbringing (Arnett, 2000). She ultimately attains healthier approaches to overcome heartache, using her hours alone with music as a form of therapy (Papinczak, Dingle, Stoyanov, Hides, & Zelenko, 2015). At the end of the song, she leaves listeners with a haunting, but earnest, final image, where she has her happy ending, but on her own: “You’re all gonna watch me disappear into the sun” (Yellich-O’Connor, 2017, track 5).

Autonomy after the residue of a breakup continues in Lorde’s two-part track, Hard Feelings / Loveless, the longest track of the album, and one of its most ambitious. In the first part, Lorde archives the details of her past relationship, eulogizing all the mundane memories of young love, moments she now acknowledges as meaningful. The first part of the song acts as a last mourning, in which she comes to terms with the closure of the relationship, admitting that these memories will leave indelible marks: “Please could you be tender and I will sit close to you Let’s give it a minute before we admit that we’re through…

I’m at Jungle City, it’s late and this song is for you ‘Cause I remember the rush, when forever was us Before all of the winds of regret and mistrust Now we sit in your car and our love is a ghost Well, I guess I should go” (Yelich-O’Connor, 2017, track 6).

Rather than concealing this history, Lorde forges ahead, coming alive and making music in New York City, while honoring that emerging adulthood is a steady cycle of mistakes and

that emerging adulthood is a steady cycle of mistakes and lessons learned, one of them being her first love. Hard Feelings references the mixed feelings after a breakup, in which a person concedes that a past relationship has no longstanding purpose.

The intense emotions of heartache are largely influenced by a young person’s maturing impulse control (Fisher, 2006), and emerging adults adjust from familial dependence to selfdirection (Tanner, 2006), finding ways to conquer distress by themselves. Lorde informs, “I light all the candles/ Got flowers for all my rooms/ I care for myself the way I used to care about you” (Yelich-O’Connor, 2017, track 6), practicing self-care for herself, the only one who will always be there after the party.

Nonetheless, Lorde knows that the memories will flood back in on occasion, and the album’s most affecting moments are the lost apparitions of first love that Lorde will always remember fondly. After a cacophony of unwieldy, industrial-based sounds, Lorde peels back the layers of maximalist production and embraces a sentimental moment: “Three years, loved you every single day, made me weak It was real for me, yup, real for me Now I’ll fake it every single day ‘til I don’t need fantasy, ‘til I feel you leave But I still remember everything, how we’d drift buying groceries How you’d dance for me I’ll start letting go of little things ‘til I’m so far away from you” (YelichO’Connor, 2017, track 6).

As melodramatic as the album title denotes, Lorde deviates from the somber textures of the first bit of the track, smugly chanting in the next: “Bet you wanna rip my heart out Bet you wanna skip my calls now Well, guess what? I like that ‘Cause I’m gonna mess your life up Gonna wanna tape my mouth shut Look out, lovers We’re L-O-V-E-L-E-S-S Generation” (Yelich-O’Connor, 2017, track 6).

Seesawing in a sea of anger, resentment, and cynicism against a club-driven beat, Lorde mercifully chants about the “storm and stress” young people incarnate in the second part of the track (Arnett, 2008). Lorde toys with and mocks the belief that contemporary youth is a “loveless” generation as a result of society that has moved away from the traditional family values of past eras, who often associate women with more avoidant emotional expression styles (Labouvie-Vief, Hakim-Larson, & Hobart, 1987). In Loveless, Lorde entertains and attunes herself to the feelings of apathy, rage, and the entire spectrum of emotions one can experience as a young adult, in addition to the heartrending burdens expressed in Hard Feelings.

Lorde begins to acknowledge that her fluctuating mental states are a broader contextual feature of emerging adulthood in Sober II (Melodrama), the title track in which Lorde becomes more lucid from a hangover or the dazed inebriation of the night’s carnage (Arnett, 2008). Amidst an orchestra of violins, a fitting score akin to a Shakespearean play, which the album is a direct nod to, Lorde elaborates on her loneliness and selfdestructive cycles: “Lights are on and they’ve gone home Album Reviews | 43

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But who am I? Oh, how fast the evening passes Cleaning up the champagne glasses” (Yelich-O’Connor, 2017, track 7).

Discussing the range of emotions heard in Melodrama, Lorde has shared that the album title mirrors her still-growing maturity, “I felt more aware of my age, than I have ever, making [this] record… In these moments, I just was gripped by an emotion.” But she corrects herself, saying “Oh, I’m feeling this because I’m twenty and everything’s f*cked up in my brain. I’m actually rewiring to become an adult” (Oliver, 2017). In some ways, Melodrama is a humorous jab at how young adults feel, which she likens to a Greek “melodrama,” a piece of theater with overwrought characters and histrionic story arcs in Lorde’s conceptual night out.

“All the glamour, and the trauma And the f*cking melodrama (whoa, whoa-oh) All the gunfights, and the limelights And the holy sick divine nights (whoa)” (Yelich-O’Connor, track 7).

Existing as an emerging adult in today’s world can be exhilarating and numbing, all at once. Lorde also speaks to a younger audience (i.e., aged 18 to 35), the largest age group experiencing depression and anxiety (Casey, 2013). In the empty quiet of the morning after, Lorde realizes that her emotions are temporary “lightning flashes” and that life might not be as polished as previously thought: “We told you this was melodrama/ You wanted something that we offer” (Oliver, 2017; Yelich-O’Connor, 2017, track 7). But what else could we expect of a sardonic generation that laughs off the pain we feel with memes and humor—a cure to relieve us of the red-hot nature of the world, divided by political and social unrest?

Another piano ballad, Writer in the Dark, uses the pop music trope of a scorned lover, with Lorde illuminating a flare of self-growth during a nearly-desperate, exposed moment.

A hopeless romantic at heart, she achingly howls, invoking a falsetto inspired by another unconventional artist, 80s art pop singer-songwriter Kate Bush: “Now she’s gonna play and sing and lock you in her heart Bet you rue the day you kissed a writer in the dark I am my mother’s child, I’ll love you ‘til my breathing stops I’ll love you ‘til you call the cops on me But in our darkest hours, I stumbled on a secret power I’ll find a way to be without you, babe” (Yelich-O’Connor, 2017, track 8).

Pledging that she’ll rise to great lengths for everlasting love, Lorde also prides herself in full identification of her artistry and songwriting—one of the pivotal strides of emerging adulthood, in which one discovers their passions, vocational interests, and “niche” in society (Arnett, 2000; Erikson, 1968, p. 156). Using music as a portal to advance from her past and create meaningful art that reflects those personal experiences, Lorde reclaims her identity as a female musician, who will always write about her emotions, and pays loving tribute to her mother, who is a writer as well. She notes that getting over an ex will never be a straight line: “I still feel you, now and then Slow like pseudoephedrine When you see me, will you say I’ve changed?

I ride the subway, read the signs 44 | Album Reviews

I ride the subway, read the signs I let the seasons change my mind I love it here since I’ve stopped needing you” (Yelich-O’Connor, 2017, track 8).

Even in fanatical, extreme, and so-called melodramatic moments of heartache, Lorde gradually recognizes that she will always look back on this time every now and then, whether that be in the lens of growth or loss. Yet, she unearths the “secret” elements of adulthood, no longer requiring the comfort of another individual, knowing she can find comfort in herself, self-love, and the music she creates. Lorde is aware that she’ll always remember her first relationship, learning to cope and fill the void with songwriting, a metamorphic craft she can use to protect herself and promote her own well-being (Papinczak et al. 2015). Speaking about the song, Lorde reaffirms her selfconcept, self-esteem, and identity, “It’s what I’ve always been. It’s what I was when you met me. It’s what I will continue to be after you leave. That’s exactly what was going to happen when you kissed a writer in the dark” (Oliver, 2017). The light at the end of a tunnel filled with emotional wreckage and debris, Writer in the Dark ends with a haunting melody, played by an intimate string orchestra, the last time the melancholic, theatrical sound of the wooden instrument is heard.

In Supercut, which refers to a compilation of video clips assembled for the “best” moments, Lorde dignifies one of the greatest pop archetypes—crying on-the-dance floor—fully embracing a record filled with a montage of the vivid emotions stirring in young people’s minds. Lorde opens the song, tenderly remembering what she shared with her first love: “In my head, I play a supercut of us All the magic we gave off All the love we had and lost And in my head The visions never stop These ribbons wrap me up But when I reach for you There’s just a supercut” (Yelich-O’Connor, 2017, track 9).

With wistful and nostalgic lyrics in contrast to the euphoric striking of the piano, Supercut envisions Lorde reliving a flipbook of memories from her first relationship while also accepting that her memory is betraying her. Lorde catches herself dreaming in the whimsical nature of love, admitting her recollection is a hologram, a mere illusion: “But it’s just a supercut of us” (Yelich-O’Connor, 2017, track 9). Though supercuts can conjure a unifying theme, they can be deceptive, obsessively isolating a single element or the pinnacles of an entire relationship and ignoring all the reasons why it doesn’t exist. Supercut also mirrors young people’s widespread social media use, in which electronic surveillance of past relationships, a common post-breakup behavior today, can be a major source of distress (Lukacs & Quan-Haase, 2015). Social media can be a misleading distillation of a person, oftentimes staging moments people want to disclose with others whilst burying the sorrows that everyone encounters. Supercut represents a generation in which the “perfect” relationship and life is captured through a filtered social media feed.

Emerging Adulthood In Lorde’s Melodrama

Driven by 80s disco-inspired electropop and a danceready beat, the song’s bright and blazing production evokes how blissful love can be, in which Lorde and her former partner, like many youth, believed “anything is possible” (Arnett & Schwab, 2012). Lorde describes her past experiences as “wild and fluorescent” (Yelich-O’Connor, 2017, track 9), a bittersweet encapsulation of the seemingly endless “possibilities and optimism” of emerging adulthood, when each moment feels like a milestone that can “dramatically turn the direction of one’s life” (Murray & Arnett, 2019, p. 21). Confused and heartbroken, combined with the dizzying turbulence of her young self, Lorde wonders what she did wrong, looking for an answer in the sonic mosaic of memories with her past lover. Yet, notably, Lorde no longer associates “wild” with emotional wroughtness, gathering that things that are “wild”, like herself, can also be as beautiful as the love in her past relationship, even if it doesn’t exist anymore.

Noting its status as the “eleventh hour” showstopper and the only song on the album where she is directly speaking to someone (Oliver, 2017), Lorde has called Supercut the denouement of Melodrama: a soliloquy about faded first love during her Shakespearean-like play of a young woman’s night out. Before the song’s climax, Lorde’s bare vocals encloses the maximalist production—almost as if she is alone in an empty room. She builds to a primal scream: “Cause in my head (in my head, I do everything right) (When you call I’ll forgive and not fight) (All the moments I play in the dark) (Wild and fluorescent, come home to my heart)” (Yelich-O’Connor, 2017, track 9).

The chorus amplifies to a club-inspired downbeat against a dreamy wave of synths and harmonies, as Lorde whips through a final montage of filtered memories that invoke a serene, buzzing feeling of reciprocated chemistry that has now faded. At an abrupt end, she solemnly confides, “In my head I do everything right,” encompassing what it’s like to have your heart broken after giving it your all (Yelich-O’Connor, 2017, track 9). Paying homage to defiant pop icon Robyn, one of the main inspirations for the album, Lorde learns to be okay with “dancing on [her] own” at the end of the night (Robyn, 2010).

Supercut concludes with a lyricless minute-long outro, allowing listeners to relive the feelings and memories invoked by the song, even if painful. As an emerging adult, Lorde asks her audience to trust the process of adulthood and to find selfacceptance and care, even during moments of intense, gripping emotions. The journey of adulthood and overcoming a breakup is often a non-linear path—individuals can feel heartache at any given point, even when “doing well.” While romantic relationships serve as important developmental milestones for young people (Norona & Welsh, 2017), not all relationships are meant to last forever. Sometimes, a person’s past relationship might not match their goals and needs, fostering reconciliation and acceptance of the breakup, as well as personal growth (Gala & Kapadia, 2013; Norona, Olmstead, & Welsh, 2016). As the clarity of the musical production quietly muddles, resembling a warped sound underwater, Lorde “lets go” of the past, rendering

the gradual fading memories as time and new experiences push forward. Heartbreak will always be poignant, and Lorde’s retelling pinpoints the gravity of lost love and nostalgia, and the actual physical pain of heartbreak and grief linked in the brain (Flaskerud, 2011)—the burden of missing someone who now only exists as a memory. Abandoning the innocence and protective bubble of adolescence, Lorde is ready to settle in her flashbacks and grief, self-restore, and acknowledge that all-consuming emotions exist but should never restrain her identity. Supercut is pop at its pure essence: a perfect economy of words that describes the simultaneous and complex intersection of loss and growth in a young woman coming to her own. In its intimate conclusion of a muted vocal and clouds of ambient synths, Lorde loves her own company, even when playing a highlight reel of the past. Whether it’s crying on the dance floor or ruminating alone in her bed, as depicted in the album cover, Lorde shines. Perhaps she is doing everything right.

Lorde’s introspection evolves in Liability (Reprise), as she reexamines her headspace of self-doubt and solitude, deepening her understanding of her relationships and how they define her narrative. She echoes “I’m a liability/ Much for me/ You’re a little much for me,” but she soon detracks, “no no no no…”

(Yelich-O’Connor, 2017, track 10). With the newfound optics of adulthood, Lorde learns that she’ll move on from and accept these crushing experiences as reflections of the necessary instability in love, education, work, and place of residence after adolescence, all of which cultivate Lorde’s growth and ability to take back control (Murray & Arnett, 2019): “Maybe all this is the party Maybe the tears and the highs we breathe Maybe all this is the party Maybe we just do it violently” (Yelich-O’Connor, 2017, track 10).

A symbolic narrative for the departure from adolescence, the party acts as a comprehensive commentary on one’s “twentysomethings,” an emotionally vivid time that is “exceptionally full and intense, but also exceptionally unstable” (Murray & Arnett, 2019, p. 17). Older adults often cite this period as the most valuable stage of their lives, with enduring ramifications on personal development (Martin & Smyer, 1990).

Dethroning her self-image in the first iteration of the song, Lorde stands up, “But you’re not what you thought you were” (Yelich-O’Connor, 2017, track 10), finally believing she isn’t a “liability” or the “wild” force that makes others leave. Lorde withdraws from the innocence of youth, which she tried so desperately to hold onto, and welcomes the realities and deeprooted fear of growing up, accepting the personal tragedies that prevail in modern life and love. Entering the gates of adulthood whilst saying farewell to a relationship can be a whirlwind, albeit necessary, crusade, in which one learns to develop a clear selfconcept and more stable self-esteem and emotional state that is less contingent on others’ evaluations (Lodi-Smith & Roberts, 2010; Meier, Orth, Denissen, & Kühnel, 2011). Even after being left by someone she loves, Lorde gradually embraces herself and the mortality of human emotion—the “ribbons” that tied her down. She decides to not kill the pain that she feels, because, Album Reviews | 45

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in doing so, she would also deny herself of all the feelings, and joy, that is being young: a time when we surrender control from our heads to our hearts. Appreciating that her life will never be as innocent or new again, Lorde whispers bittersweetly, “Leave,” one of the final indications that she is far removed enough from her past, and youth, to march on (Yelich-O’Connor, 2017, track 10).

Melodrama is not a breakup album. In her own words, Lorde has firmly declared that it’s “a record about being alone,” featuring the ups and downs of solitude and heartbreak at the crossroads of the chaotic, high-stakes reality of adulthood (Weiner, 2017). The album ends in anthemic fashion with Perfect Places, recounting the vacillating triumphs and woes of young people during a night out: “Every night, I live and die Feel the party to my bones…

I hate the headlines and the weather I’m nineteen and I’m on fire But when we’re dancing I’m alright It’s just another graceless night” (Yelich-O’Connor, 2017, track 10).

Referencing the circus that emerging adults live in—the parties, the drinking, the casual hookups, the social events—as well as the weighty expectations of looming adulthood (Claxton & Dulmen, 2013; Murray & Arnett, 2019), Lorde maintains partying as a metaphor for youth in a divided world, as she participates and indulges, yet again. She integrates these experiences as a part of her daily life, validating partying as a social means of networking among young adults who can’t let go of the irresponsibilities of youth (Demant & Østergaard, 2007).

However, Lorde is increasingly self-aware in the personal heaven and hell that is the party—the overarching thematic concept the album is built on—as emerging adults desire accessible means to cope with their turbulent world (Arnett, 2005). Lorde exhilaratingly doubts, “This is how we get notorious/ ‘Cause I don’t know/ If they keep tellin’ me where to go/ I’ll blow my brains out to the radio.” With a rally from a choir in the thick of blaring synths, she then leads: “All of the things we’re taking ‘Cause we are young and we’re ashamed Send us to perfect places All of our heroes fading Now I can’t stand to be alone Let’s go to perfect places” (Yelich-O’Connor, 2017, track 11).

Honoring passed musical icons Prince and David Bowie, the latter of whom called the pop artist the future of music (Weiner, 2017), Lorde delivers on high expectations with a sophomore album that speaks to the dynamic lives of young people: constantly making mistakes, learning from them, and gaining the courage to accept the messes we are left alone in bed with. In the theater of the night, Lorde wonders if party culture leads to revelation, or submerges self-expression in the name of feeling free and mindless enough to be oneself. Presenting a philosophical question at the final lines, which also end with the piano, the “brand new sounds” of adulthood that began the album in Green Light, Lorde contemplates with her listeners: “All the nights spent off our faces

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Trying to find these perfect places What the f*ck are perfect places anyway?” (Yelich-O’Connor, 2017, track 11).

Now a jaded, yet mature woman, Lorde concludes that pure happiness isn’t obtainable. As people continually yearn for catharsis, Perfect Places casts doubt on the purpose of partying, questioning if it discloses or stifles her inner truths. But Lorde recognizes that she is not perfect, and that she doesn’t have to be, scraping away the zeitgeist of today’s generation who strive for perfection during a time of frequent mistakes and imperfections (Nehmy & Wade, 2015). Like many others in their twenties, Lorde resolves that she isn’t the person she expected to be, and that’s okay. No longer shouldering the burden incurred by a breakup, Lorde links her emotional intensity with her identity as a musical artist and the broader landscape of a modern young adulthood, discarding society’s pursuit for the “perfect” journey and ending as nonexistent. Melodrama finds Lorde at a time of heightened self-pity but, most importantly, self-reflection.

Reestablishing her focus on personal welfare over past relationships as well as the stormy nature of emerging adulthood, Melodrama is much less an album and more of a statement on the emotional renaissance of a young woman in 2017. The album avoided the “sophomore slump” seen in rising musical artists and was frequently cited as the top ten best albums of the 2010s (NME, 2019; Rolling Stone, 2020), further confirming its prominence as a cultural gem and defining record for gen-z and millennials alike. But there are several limitations that warrant mentioning. First, this review is an analysis of the album according to literature on emerging adulthood; it is not a direct examination of the artist’s development, or that of other age groups. Second, it is critical to evaluate music along the perspectives of specific cultural groups, who might hold certain albums with elevated reverence. In fact, Melodrama has spawned a cult following among the LGBTQIA+ community, who often undergo a “second adolescence” (Pollard, 2020). Many queer individuals’ normative experiences of first love and consequent breakups, which typically come later in life compared to their cis-gendered, heterosexual peers, can feel even more profound— especially given the repressed expressions of love in childhood and adolescence, a psychosocial environment in which queer relationships might be controversial (Pollard, 2020). Rather than complying with the guidelines of popular music, which is overshadowed by records with loosely-related, “playlist” driven songs, Lorde sets her 40-minute coming-of-age feature over the course of a party, a sprawling, cinematic metaphor for the swinging emotional spirit of young people’s heartbreak, which can reprioritize a person’s future identity, values, and relationships (McKiernan et al, 2018). Commemorating her early years, Lorde has conveyed, “Even when I was little, I knew that teenagers sparkled… I knew they knew something children didn’t know, and adults ended up forgetting” (Yelich-O’Connor, 2016). Melodrama archives the richly-textured memories of exodus from adolescence with fine-grained sonic architectures that match the poignant swirls in the minds of youth: the upbeat,

Emerging Adulthood In Lorde’s Melodrama

party songs have hints of poison, while others wallow in selfpity, despite tides of enlightenment. Lorde continues to affirm her status as a generational voice during a “wild and fluorescent” era of existing at odds with oneself and the universe, a time of incessant relapse and renewal. Since its release, fans are in desperate need of another album that might recount the dread of one’s twentysomethings in a world on fire, amidst an isolating pandemic and socio-political overture.

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Discography Review

Showcasing Vulnerability as a Strength: A Brief Examination of Kehlani’s Discography Oana Groza

Amid the era of isolation and social distancing, R&B neo soul songstress Kehlani released her sophomore album It Was Good Until It Wasn’t, a refreshing project providing listeners with an escape from the uncertain realities. Her breakthrough as a finalist on America’s Got Talent with high school teen band Poplyfe put a spotlight on the Oakland born-and-raised artist.

Shortly after the show, Kehlani went solo, and, by the age of 19, she released her first mixtape, Cloud 19. Less than a year later she followed up with her second mixtape, You Should Be Here (YSBH), which secured a Grammy nomination, making her the first ever female artist nominated for a mixtape. At an age when most of us were struggling to articulate our own thoughts, Kehlani had a tight grasp on it, translating her experiences into her art. She has always been blunt and transparent about her life - both the good and the bad - while exhibiting continued growth with each new project. Her debut album SweetSexySavage came out of the precipice of her own battles with mental health, showcasing her strength and resilience. And while pregnant, she created another mixtape, While We Wait, dedicated to her daughter.

Kehlani’s songs play like conversations between herself, people in her life (both present and absent), and her listeners.

Embedded in her music are recurring themes that propel the message she sends to her listeners. Her grace, growth, and ingenuity has long been admired by her fans and lauded by critics.

This review examines how Kehlani’s discography demonstrates growth and renewed understanding as she grapples with both new and old life experiences, such as feelings of love and loss.

Emerging Adulthood and the Rise of Kehlani Kehlani’s first work was released at the age of 19 and her most recent at 25, a period conceptualized by developmental psychologist Arnett as “emerging adulthood,” which is marked by changes and identity formation (Arnett, 2004). Once seen as a transition, emerging adulthood is now considered a period in psychosocial development where young adults are not yet shifting and settling into their long-term roles, but rather venturing into different experiences (Arnett, 2007). What makes emerging adulthood unique is the prominence of five distinct features: (1) identity, (2) instability, (3) self-focus, (4) feeling inbetween, (5) and possibilities/optimism (Arnett, 2004). Through Kehlani’s entire discography we see how she explores feelings of love and relationships, and with each new work, we see a progression, a new understanding guided by old experiences.

Her first mixtape, Cloud 19, put the Oakland native on the map and revitalized the R&B genre. The eight track mixtape primarily focuses on relationships as Kehlani asserts her worth

through the exploration of romance and identity. The first track off the mixtape, FWU, narrates the modern-day love story as the rising artist declares her loyalty, singing, “So if you ride then I’m riding too By your side kinda stuck on you” (Parrish, 2014, track 1)

Moreover, in the second verse she describes their ambition and commitment to each other in the hopes of building a meaningful future stating, And

“You love when I handle shit I already get it”

“Papi’s a hustler chasing mucho dinero” (Parrish, 2014, track 1)

One of the hallmarks of emerging adulthood is the seemingly endless possibilities. Without the full taste of real life, emerging adults hold high expectations about the future, envisioning a loving and lifelong partnership and a rewarding job (Arnett, 2004). For individuals who grew up in difficult conditions (e.g., poverty), emerging adulthood presents the chance to leave their old environment and create a new network of support, providing young people with optimism about these new possibilities of change (Arnett, 2004). As she envisions her future with her partner —“years down the road when up on out the projects”—she highlights the supportive and hardworking dynamic between them as they chase their dreams (Parrish, 2014, track 1).

Following FWU, in the track As I Am, Kehlani expands upon her expectations in relationships and opens up about her feelings, asking, “If I gave you the chance to hold my soul would you just feel me, see the real me?” (Parrish, 2014, track 2)

Love should not only be reciprocated, but proclaimed loudly and proudly. She will not shy away from admitting her feelings and being her true self and hopes to see the same from others.

Cloud 19 as a whole is upbeat, fun, and catchy. Its youthfulness is relatable and emphasizes the playfulness and expectations that are inherent in young love. But this narrative shifts in her second mixtape, You Should Be Here (YSBH), as she dives deeper into the intricacies of relationships. Although the dynamics and expectations of a relationship may vary, the message of her second mixtape is unmistakable; it’s in the title. Her transparency and directness is immediate, beginning in the Intro, where she gives listeners a glimpse into her life:

“They say God gives his toughest battles to his strongest soldiers and what doesn’t kill you makes you stronger. And as much as anyone can say how invincible I seem or how fearless I am or how brave I must be, I’m still human. And I’ve seen things and I’ve felt more pain than some will in their entire lives, all before the age of even being able to buy a f*cking drink at a bar.” (Parrish, 2015, track 1) Album Reviews | 53

OPUS (2020) 11:1

While identity formation begins in adolescence, it is much more apparent in emerging adulthood and focuses primarily on exploring love, work, and worldviews. Emerging adults navigate this by engaging in various experiences before slowly making a lasting decision in these areas (Arnett, 2000). During this period, romantic and physical relationships are explored with more focus on intimacy than in adolescence and are more focused on implicitly answering the question: “given the kind of person I am, what kind of person do I wish to have as a partner through life?”

(Arnett, 2000, p. 473). Given the identity explorations, emerging adults often experience constant changes and disruptions, which leads to a new intensity and instability in this life stage (Arnett, 2004). With these changes - as a result of their explorations emerging adults progress, providing clarification for the future they seek with these two features going hand-in-hand (Arnett, 2004). In her YSBH mixtape, Kehlani continues to explore her identity and confronts the instability.

As she draws on personal experiences throughout this project, she navigates relationships with eloquence and straightforwardness. In the raw title track of YSBH, we already see a change in her expectations from her romantic partner, no longer focusing just on loyalty, opening with: “So far gone and you think I can’t tell Can’t tell that you are disconnected You pulled away and I miss your presence” (Parrish, 2015, track 2)

We can feel the pain Kehlani feels as she dissects the dissolution of the failing relationship. The chorus articulates her expectations, “you should be here, right here.” Little else matters without presence, which is further illuminated in the emotional and highly visual track, The Letter, where Kehlani confronts the heartbreak and abandonment she felt growing up, sorrowfully singing, “There’s an emptiness that only few ever feel And I somehow missed the meaning of love that is real” (Parrish, 2015, track 9)

While not explicitly stated, the track circles back to the message, as Kehlani wishes her biological mother was there with her when she was growing up. Shortly after her birth, Kehlani’s mother was, as the artist stated, in and out of her life. The pain of her biological mother’s intermittent presence has left scars unhealed, and she attempts to reconcile with this relationship in the melancholic track. She further questions her biological mother’s love for her in the second verse when she pleads for an answer, “And if you weren’t gonna guide me Why bring me into the light?” (Parrish, 2015, track 9)

The abandonment drives Kehlani to wonder if she ever felt and was taught what love is. She tries to grapple with this, but can only reach the quivering conclusion, “maybe I didn’t deserve you.” In congruence with her theme, Kehlani wants this pain to serve as a reminder to others: you should be here. Even though she is no longer a child, in a period of instability and feelings of in-betweenness, she is processing all the relationships - past and present - in her life.

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The confident and unfettered Californian native continues to unravel the complexities of relationships after the release of her debut album SweetSexySavage (SSS), while embracing the woman she became. SSS has swagger, vulnerability, and cognizance as she explores her understanding and expectations of love and relationships. In the second track of SSS, Distraction, she details a fun love, one that is not serious and noncommittal, “This life can can make you so jaded So we can stay shaded just to us and try to get it right” (Parrish, 2017, track 3)

During emerging adulthood, there are typically few obligations that require daily commitments to others. The absence of these commitments coupled with newfound independence, suggest that now-emerging adults must make their own decisions (Arnett, 2004). Thus, emerging adults are self-focused and are able to gain the foundation and necessary skills to become selfsufficient before long-term commitments to love, work, and life in general (Arnett, 2004). It is a time for exploration, and Kehlani is doing exactly that. In SSS, Kehlani demonstrates the complexity of love; sometimes you want a casual, fun relationship without the work of a real one, whereas a “real” relationship can be hard to detach yourself from it, even knowing that it isn’t what’s best for you. In fact, she later elaborates on the pitfalls of love in the track In My Feelings, where she’s not afraid to admit she’s been wounded as she reflects on what it means to be in a relationship long after the love has faded and turned sour.

“Why after all these times, you still play all these games?

Why after all these nights, I still give you all my days?” (Parrish, 2017, track 15)

As she learns from each experience, whether casual or serious, she comes to realizations that allow her to understand what she is looking for. The autobiographical track Not Used To It stories the singer’s life growing up and how that has made it difficult for her to let her guard down and trust the partners in her relationships. She admits that her reluctance to open up is not necessarily a unique experience - “I don’t mean for it to sound so damn common” - but regardless, she is still adjusting to this process. She cites that the traditional idea of love, marriage, and family was not been present in her life growing up, “And I still never been to a wedding And I just see my family stressing Over the sons who grow up with no daddies in every generation” (Parrish, 2017, track 8)

The absence of her father (who as stated earlier in the track, has passed away when she was young), coupled with the single mothers in her family, has put a strain on her ability to form a trusting relationship with men. Through her inner turmoil laid bare on the track, we see how she struggles to overcome this when she reveals, “But when I say it’s hard to open up to you It’s hard to get close to you I want it with everything in me To one day just say I’m in love with you” (Parrish, 2017, track 8)

Emerging adults are no longer adolescents, but have ambiguous feelings about being considered adults, generating an in-between

Kehlani: A Brief Examination

sentiment (Arnett, 2004). Generally, emerging adults view their ability to accept responsibility, make independent decisions, and become financially independent as criteria to evaluate whether they consider themselves an adult (Arnett, 2004).

Slowly, emerging adults build up confidence in these areas, but at the same time experience a feeling of in-between, which is demonstrated by the juxtaposition of her hesitations in the lyrics and the punchy and upbeat nature of this song. However, the song retains a sense of optimism and hope as Kehlani aspires to become more confident in her future relationships, which is further echoed by the sentiment in the post chorus. She strives to “one day” reach a point where she can be vulnerable and push past the uncertain feelings (Parrish, 2017, track 8).

Ultimately, emerging adulthood emphasizes a broad range of experiences in love and relationships which make for an intense period in life, and we see this reflected through Kehlani’s early projects. They are not always enjoyable; these explorations can still result in feelings of rejection, disappointment, and loss (Arnett, 2000). Nevertheless, they provide vital clarity that shapes the future we seek in adulthood.

Reflections of Motherhood in her Music Kehalni’s third mixtape - While We Wait (WWW) - was written and recorded during her pregnancy with her first child and released just over a month before she gave birth. The title of the mixtape has a double meaning, as Kehlani awaits the imminent birth of her daughter and the release of her second album. The role of motherhood has a notable impact on Kehlani’s outlook, which is subsequently reflected in her music.

Developmental psychologist, Erik Erikson, argued that identity may be renegotiated to some extent when adopting a new role, such as motherhood (Erikson, 1968). In particular, pregnancy for first-time mothers often instigates this negotiation as they create space for their child (Laney, Carruthers, Hall, & Anderson, 2014; Smith, 1994). Research has shown that motherhood causes women to assess their autonomy, appearance, and sexuality, and also has a profound impact on their identity, as their experiences and personalities become intensified (Laney, Hall, Anderson, & Willingham, 2015; Nicolson, 1999; Smith, 1994).

Women’s identities are modified and redefined as they reflect on who they are and their relationships with others (Laney et al., 2015; Nicolson, 1999). Now, the needs of their child are much more immediate and salient in comparison to their own needs (Laney et al., 2014; Smith, 1994). Ultimately, mothers have cited the experience of motherhood as personally expansive, as their compassion and empathy increases and deepens their understanding of others (Laney et al., 2014).

Although always incredibly attuned to herself and surroundings, Kehlani’s emotional intelligence and empathy grow further as she transitions into her new role as a mother.

WWW is a distilled project that demonstrates the shift in her work as Kehlani becomes a mother. The artist shows us that there are challenges to relationships, and that it is important to acknowledge these feelings. She circles back to this idea in

the first track, Footsteps, as she once more reminisces a lost relationship, but with a new perspective, opening with, “Patience could’ve done us well ‘Cause I could tell that all we lack was presence” (Parrish, 2019, track 1)

The track sets the tone of mixtape, one of pain and uncertainty, while also expanding upon ideas in her old works. Albeit a dysfunctional relationship, her refreshing honesty allows us to pinpoint the problems, like their inability to meet each other emotionally or communicate their expectations, singing, “But still, cheers to being honest Neither of us knew what we wanted But all we knew is that we cared Still all we painted was a moment” (Parrish, 2019, track 1)

In her resolve, there is a profound eloquence as she melancholically explains how the relationship, borne out of subdued love instead of nurture, has led to its decay as she sings in the second verse, “And I really wanna work this out ‘cause I’m tired of fightin’ And I really hope you still want me the way I want you And it really feels like this sh*t been on autopilot And it’s habitual to be the b*tch I am, but not the chick you want Residual damage left in place of what was beautiful Excuses only work when what we’ve done is still excusable You let the truth unfold” (Parrish, 2019, track 1)

Although Kehlani was committed to her relationship, only the embers of their love remain. This track in particular demonstrates her evolution from her first mixtape to now; failed relationships are a common theme in her work, but she becomes more articulate in illuminating the pitfalls of romance in WWW as the process of becoming a mother has helped her re-evaluate her personal relationships.

Evolving from Distraction, Kehlani reassesses the intricacies of a casual relationship on her second track, Too Deep.

Almost as if in conversation with herself, Kehlani ruminates over her situationship - realizing that feelings are one-sided and her partner is looking for more than she can give. A once “candy crushing” fling, meant to be fun, has turned confusing as she questions why the boundaries are being pushed, “I don’t know why you pass for it Wasting energy texting me Text messages, threat messages” (Parrish, 2019, track 2)

And as the song progresses, the confusion and back-and-forth escalates ultimately ending with both hurt as she narrates the unexpected whirlwind in the bridge, culminating with, “You just wanna talk, I don’t wanna listen Now I wanna talk, you don’t wanna listen I don’t ever wanna lose you again You don’t ever wanna see me again Say that I’m done, leave you alone Mark you, then call you again” (Parrish, 2019, track 2)

Perfectly encapsulated in a simple sentiment, Kehlani showcases the messy realities of undefined relationships. However, WWW is not all about lost hope and unlucky love. The second to last track, Butterfly, explores the metamorphosis of a new relationship and the process of opening up to one another.

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OPUS (2020) 11:1

While she patiently understands and navigates the barriers in the relationship, she longs for her partner to open up - like a butterfly emerging from its cocoon - so that she can learn more about who they are. She encourages him to share with her, softly rapping in the outro, “I see you duck and dodge at every bend Afraid to play your card, be forced to show your hand I hope you take from this that it’ll make you no less of a man To break your walls and simply grab my hand Love shouldn’t be contraband It shouldn’t trample on your confidence Shouldn’t be seen as less than compliments” (Parrish, 2019, track 8)

Committed and willing, she continues to share what she sees from her partner and empathetically and enthusiastically encourages them to shed their walls. Through the confusion, uncertainty, and pain, Kehlani learns new lessons from each relationship. In a period of transition, she does not veer away from nor dilute previously established themes. Instead, as she becomes a mother, she grows, refines, and clarifies her understanding.

These ideas are further strengthened, retaining a similar vibrancy and versatility as her previous works in her sophomore album It Was Good Until It Wasn’t (IWGUIW), currently one of her most cohesive projects to date. Released just over a year after the birth of her daughter, Kehlani still refuses to hold back, as demonstrated by the precision and directness in her tracks on the album. Her past has made her who she is and she embraces exactly that, refusing to hold back. She does not shy away from the apocalyptic nature - further exemplified by the album cover - of relationships and loss in the album. And while the album’s undercurrents are much more somber than her previous rawbut-wistful projects, Kehlani once again reclaims the experiences and showcases her vulnerability as her greatest asset. WWW was just a glimpse into how motherhood transformed her; IWGIUW demonstrates how she translates her maternal wisdom into a new sense of clarity and outlook as she liberates herself from the uncertainties, burying the pain and loss.

In the first track of the album, Kehlani re-explores an unhealthy relationship, aptly naming the track Toxic.

Immediately she admits that they are both at fault in the slow trap song, singing, “Damn right, we take turns bein’ grown I get real accountable when I’m alone” (Parrish, 2020, track 1)

But if motherhood has shown her anything, it’s that she has no time to entertain these roller coaster relationships. The bridge culminates with Kehlani crystalizing one of the fundamental issues: she wants stability and the relationship doesn’t give her that, “Somehow, I’m always caught in your dramatics All in your acrobatics You know I want the static” (Parrish, 2020, track 1)

Kahalani doesn’t have time for “dramatics.” She has a daughter and family to look after now. This idea is furthered in the pleading track Bad News, which draws on the relationship between her parents as she implores her partner to change their dangerous 56 | Album Reviews

lifestyle. With worry and concern in her voice she sings,

“Don’t wanna get no call with no bad news I know all the stories from your tattoos” (Parrish, 2020, track 3)

Kehlani’s previous projects have established her commitment to her relationships, sometimes even past the point where it can be saved. However, recognizing that she needs to create space for her child, she departs from this mentality in the track Grieving. She somberly documents the extent to which she’s over-committed herself to the relationship in the opening verse: “Askin’ for space, I’d give my leg for it I’ve reached a point, it’s like I beg for it I give my sweat and tears, damn, I bled for it No one would bet that you would lose me like that No one would guess I had the strength to fall back” (Parrish, 2020, track 13)

Although she is devoted and cares deeply, Kehlani cannot put herself in that position anymore. Her time and focus has pivoted to her daughter, who supersedes anyone else. Circling back to earlier messages, motherhood provided her with a growth in unexpected ways; she garnered the strength to pull herself away while also recognizing the time and attention she gave, proclaiming “It’s a merry-go-round from sun-up to sundown You want me to stay here, mother all your sons now This sh*t ain’t no fun now Name a b*tch patient like that Name a b*tch to cater like that” (Parrish, 2020, track 13)

The second verse solidifies the dismemberment of the relationship: she gave more than most and the tumultuous nature of the relationship has reached her limit. While her last track is not her own and instead features Jealous collaborator Lexii Alijai, Lexii’s Outro is dedicated to the late-rapper to honor her legacy. In the track Lexii raps,

“I told her, “This is life, you just gotta wake up and grasp the sh*t,” huh Ain’t got no time to make no accidents ‘cause you gotta be passionate” (Parrish, 2020)

The tribute is reminiscent of the theme of YSBH: value the time and presence you have with people, you never know when it can be taken away. Similarly, while IWGUIW mostly mourns love lost, Kehlani retains hopefulness as she - in collaboration with Jhene Aiko - envision healthier relationships filled with support and success in the fourth track Change Your Life where she raps, “I’m here to excel with you Here to break bread with you, Here to travel the world and sleep in different beds with you Here to make revenue Know it’s impressin’ you.” (Parrish, 2020, track 6)

She is ambitious and driven and expects the same from a partner, a sentiment that is similar to FWU. Although the tone of the album starkly contrasts earlier works, the parallels continue, now with a new perspective, aided by her identity as a mother. Kehlani has not forgotten the life lessons she has learned before motherhood, but she has grown and gained an even deeper understanding of them. Through this album, the R&B singer undergoes a healing. The album is a cleansing,

Kehlani: A Brief Examination

leaving the toxicity and turbulence in the past,reminding us that a new beginning is on the horizon.

Conclusion Kehlani’s work showcases how life informs and shapes our understanding of relationships. By grounding it in psychological theory, the listener can better how Kehlani’s development translates in her art. While the artist has been very transparent about her life and experiences, it is important to note that the conclusions generated in this review are limited, as they are not necessarily confirmed by the singer herself. Emerging adulthood is a confusing and exciting time and the artist helps listeners navigate this period through her intensely personal songs. Through the years, Kehlani has continued to grapple with her experiences utilizing her work as a vessel to accomplish this.

Motherhood provided a new perspective and clarity reflected in her songs with an even deeper empathy and emotional intelligence than before. And while her priorities change, she does not forget the lessons she has learned. Her past shaped the person she is today, and she is unapologetic about it. Let’s see where her storytelling takes us next.

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OPUS (2020) 11:1 References Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480.

Arnett, J. J. (2004). Emerging adulthood: The winding road from the late teens through the twenties. New York: Oxford University Press.

Arnett, J. J. (2007). Emerging adulthood: What is it, and what is it good for? Child Development Perspectives, 1(2), 68-73.

Erikson, E. H. (1968). Identity: Youth and crisis. New York, NY: Norton.

Laney, E. K., Carruthers, L., Hall, M. E. L., & Anderson, T.L. (2014). Expanding the self: Motherhood and identity development in faculty women. Journal of Family Issues, 35(9), 1227–1251.

Laney, E. K., Hall, M. E. L., Anderson, T L., & Willingham, M. M. (2015). Becoming a mother: The influence of motherhood on women’s identity. Identity, 15(2), 126-145.

Nicolson, P. (1999). Loss, happiness, and postpartum depression: The ultimate paradox. Canadian Psychology, 40(2), 162178.

Parish, K. (2014). Cloud 19 [CD]. Self-released.

Parish, K. (2020). It Was Good Until It Wasn’t [CD]. Los Angeles, CA: Atlantic.

Parish, K. (2017). SweetSexySavage [CD]. Los Angeles, CA: Atlantic & TSNMI. Parish, K. (2019). While We Wait [CD]. Los Angeles, CA: Atlantic & TSNMI. Parish, K. (2015). You Should Be Here [CD]. Los Angeles, CA: TSNMI. Smith, J. A. (1994). Reconstructing selves: An analysis of discrepancies between women’s contemporaneous and retrospective accounts of the transition to motherhood.

British Journal of Psychiatry, 85(3), 371-392.

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OPUS (2019) 10:2

Discography Biographies

26 | Literature 16 Research Article Reviews

Oana Groza

Andrew Han

Editor-in-Chief oana.groza@nyu.edu

Editor-in-Cheif han.andrew@nyu.edu

Oana Groza is a senior majoring in Applied Psychology and Global Public Health. With a vested interest in public health, she has taken on several roles during her undergraduate career to further her interest in the field. During her sophomore year, she joined the Public Health Policy team in the College of Global Public Health. As a research assistant she assisted on projects that identify and investigate nutritionrelated campaigns and advertisements to provide policymakers and organizations with empirically supported guidance to improve public health.

She is also a part of HealthCorps—a nonprofit aimed to provide school-based health education and outreach to children and adolescents— as a Monitoring & Evaluation intern, where she assists with developing and implementing various wellness initiatives. Oana is interested in improving children’s well-being and health outcomes on a global level, by implementing sustainable programs and interventions to support parents and communities. In the near future, she plans to get her Masters in Public Health, but in the meantime she will be working for the USDA National Hunger Clearinghouse as a Communications Coordinator.

Andrew Han is a senior majoring in Applied Psychology and Global Public Health with a minor in Sociology. Throughout his undergraduate career, Andrew has engaged in several research experiences, including the RISE (Researching Inequity in Society) Team and beELL Lab. Currently, he is a research assistant for the Play and Language Lab, where he codes and analyzes naturalistic video data on how culture, children’s social partners, and features of families’ home environments impact infant learning and development.

Under the mentorship of Dr. Catherine TamisLeMonda, Andrew conducted an honors thesis examining the influence of sounds in the home environment on Latine motherinfant language outcomes. In addition, he is an Editorial Assistant for the Journal of Social Work Practice in the Addictions in the Silver School of Social Work. Andrew hopes to join a career path that achieves social change by supporting children and their families and incorporates the intersection of education, research and policy.

He intends to pursue a PhD in Counseling, School or Educational Psychology. His research interests include strengths-based exploration of culturally-competent practices and education among youth in urban environments.

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Olivia Pagliaro Editor-in-Training op496@nyu.edu

Olivia is a junior in the Applied Psychology program, double majoring in Gender & Sexuality Studies. She is passionate about bridging psychology and gender & sexuality, evident by her research interests and experience. She previously worked on the Transgender Identity Formation Study research team her sophomore year, and now works on Dr. Yoshikawa’s research team with the Gender and Sexuality Alliance (Gay-Straight Alliance) Study. Olivia will be interning at Girls Inc. Summer 2020, and will also be an Inside Scoop Mentor during her upcoming senior year. She plans to pursue a Master’s in Mental Health and Counseling upon graduation.

Maya Metser

Editor-in-Training maya.metser@nyu.edu Maya is a junior in the Applied Psychology program. She is currently working as a research assistant at the ISLAND Lab, where she explores the impact of early environments on infant neurodevelopment. In the past, she was an advocate for the ROSES research team, where she completed two interventions with adolescent girls. She was also a research assistant at the SCAN Lab, a fetal neuroimaging lab, where she pursued a personal project on the effects of prenatal maternal stress on fetal brain development. Moving forward, she hopes to bridge her passion for neuroscience, education reform, and juvenile justice reform to make early environments better support positive development.

Katie Mundt Editor-in-Training kvm256@nyu.edu

Katie is a junior in the Global Public Health/Applied Psychology program. She is interested in improving community health through a psychological lens, applying the skills and theories from psychology to health research and policy reform. She worked at NYU Langone on the Smoke-Free Housing Project, evaluating the effectiveness of a smoke-free policy in NYC public housing developments. Currently, she works as a research assistant for RISE, and has helped develop a research proposal for the Social Perception Action & Motivation (SPAM) lab, which will be carried out Fall 2020. After graduation, she hopes to continue working in public health research, eventually seeking a Masters in Public Health.

Biographies | 61

Chloe Carlson

Layout and Design Director cec747@nyu.edu Chloe is a freshman in Applied Psychology with a strong interest in the effects of media on the mind. She hopes to minor in Media, Culture, Communication and continue generating more psychology related media in order to further raise mental health awareness and educate others.

Sydney Liang

Layout and Design Director syl569@nyu.edu Sydney is a sophomore in the Applied Psychology program with a minor in Media, Culture, and Communication. She spent this past semester as a Human Resources intern at the ShangriLa while studying abroad in Australia, and has previously volunteered in various organizations pertaining to children’s development and social justice. Sydney plans on exploring the field of research while also seeking further opportunities related to industrial-organizational psychology.

Grace Park

Layout and Design Director hjp332@nyu.edu Grace is a sophomore in Applied Psychology minoring in Nutrition. She is interested in raising awareness of mental health in the Asian American community and hopes to one day help individuals in minority populations by providing culturally competent care. Grace hopes to complete her masters at NYU for Counseling for Mental Health and Wellness.

Freya Chen

Communications Director yc3244@nyu.edu Freya is a sophomore in Applied Psychology and double majoring in Economics. She’s been highly involved with local charity organizations in helping children in poverty in underdeveloped areas in China. She also volunteered in supporting education in rural areas. She has high enthusiasm in speaking for the underreported groups and caring for their mental health. She’s currently looking for research in areas related to women’s mental health.

62 | Biographies

Maggie Zhang Contributing Writer mz1491@nyu.edu

Maggie is a senior studying Applied Psychology. Since her sophomore year, she has been a research assistant at the ISLAND Lab, an infant neurocognitive lab interested in how social and language environments impact early infant development.

She has enjoyed the process of collecting data and building relationships with participants, including parents and infants.

Maggie is interested in studying the bi-directionality of parentchild interactions both behaviorally and physiologically, which she has explored in her honors thesis.In the future, Maggie aspires to pursue a Ph.D. in Clinical Psychology and hopes to bridge together clinical practice and research.

Sarah Khullar Contributing Writer sk6470@nyu.edu

Sarah is a senior majoring in Applied Psychology, with a minor in Middle Eastern Studies. In the past, Sarah has worked for Dr. Javadani’s lab as an advocate for ROSES, completing three advocacy interventions with at-risk youth. Her cultural background as Indian-Palestinian has led her to explore beliefs and attitudes towards mental health in the Middle Eastern region, in addition to research on refugee populations. She is also interested in prison reform, juvenile justice in the United States, and how gender and race affect incarceration. Sarah hopes to continue working with refugee and incarcerated populations, hopefully continuing her education in social policy and intervention.

Kasane Tonegawa Contributing Writer kvt219@nyu.edu

Kasane is a graduating senior in Applied Psychology with minors in Italian Studies and Sociology. She is passionate about activism and social justice, especially in the areas of mental health stigma and access to mental health coverage. Kasane has been using her experience working as a Resident Assistant at Carlyle Court and as a Research Assistant at the Suzuki Lab in order to better understand how to work with people and how to re-conceptualize mental illnesses to reduce stigma. Kasane hopes to work in public policy and strives to use her passion for social justice to influence her work.

Biographies | 63

Olivia Matthes Theriault Contributing Writer omt228@nyu.edu

Olivia is a graduating senior in the Applied Psychology department on the Pre-health track. She has spent the past three years on ROSES, a strengths-based advocacy program for girls with system involvement in NYC. During her time on the team, she has served as an advocate, peer supervisor, and research assistant. Olivia is also a research assistant in the Department of Child and Adolescent Psychiatry at Bellevue Hospital. Olivia hopes to continue to explore her interest in research postgrad, and to eventually attend medical school.

Will Olesiewicz Staff Writer wjo229@nyu.edu

Will is a senior in their final semester in the Applied Psychology program, with a minor in French. Previously, Will has worked as a teaching assistant at various schools in the NYC area, such as the Brooklyn Free School and GO Project. Among many interests, they are passionate about alternative education programs, adolescent mental-health, and advocating for the removal of socio-economic barriers to quality education.

Further, Will is an amateur musician who spends their freetime composing music and posting it on the internet. After graduation, Will plans to take a gap-year working at a no-kill animal shelter before pursuing grad school.

64 | Biographies

Biographies | XX