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The Role of MDMA (Ecstasy) in Coping with Negative Life Situations Among Urban Young Adults

Try out PMC Labs and tell us what you think. Learn More. This article examines the role of Ecstasy MDMA or 3, 4-methylenedioxymethamphetamine as a drug used for self-medication and coping with both short- and long-term negative life situations. We show that urban youth who do not have a specific diagnosed mental illness are more likely than those who have been diagnosed and have received treatment to use Ecstasy to cope with both situational stress and lifetime trauma. Diagnosed and treated youth sometimes self-medicate with other drugs, but do not choose Ecstasy for mediation of their psychological stress. We discuss the implications of self-medication with Ecstasy for mental health services to urban youth experiencing mental health disparities, and for the continued testing and prescription of MDMA for therapeutic use in controlled clinical settings. Exposure to stress and trauma in low-income urban communities is exacerbated by limited availability of mental healthcare services to address the specific needs of impoverished communities Brown et al. Even with better access to mental health services, the existing delivery system is not organized to address the broader structural factors that cause stress, depression, anxiety and trauma in the lives of these young people. Thus, many urban youth are left to address the consequences of trauma on their own. In communities where alcohol and illegal or illegally diverted prescription drugs are readily available, young people coping with trauma and other forms of hardship may find substance use to be an effective temporary or more permanent solution to mediate or dull psychological pain and unresolved emotions and conflict resulting from past or persistent experiences. An extensive literature review suggests that individuals with both diagnosed and undiagnosed mental health problems may use alcohol and other drugs as a means of dulling or numbing psycho-emotional pain Bizzarri et al. We compare the influence of past and current treatment histories on the use of Ecstasy for self-medication in both diagnosed and treated and undiagnosed individuals in our analysis. The implications for improving access and quality of mental health services for urban youth experiencing mental health disparities and the potential of MDMA for use in controlled therapeutic settings to address emotional traumas, relational problems and enduring intrapsychic conflict among young adults are discussed. It was later rediscovered by the psychedelic therapy community in the s when psychiatrists and therapists began utilizing it as an adjunct to psychotherapy Cohen ; Saunders Patients receiving treatments with MDMA also reported an increased ability to negotiate certain thoughts and emotions, moving toward or away from thoughts and memories ordinarily experienced as disturbing or unpleasant Doblin An overwhelming majority of subjects reported an overall positive effect from the drug, as well as problem resolution in many cases Sessa Scheduling prohibited the manufacture and distribution of Ecstasy and severely limited its use in research and medicine Peroutka However, supporters of the drug claimed that the healing potential of Ecstasy should not be lost to the therapeutic community Cohen From to recorded use of Ecstasy among high school students slowed precipitously in response to national campaigns designed to increase perceptions of the dangers associated with use. Recent reports suggest that Ecstasy use is once again rising Johnston Singer and colleagues found that urban young adults who used MDMA reported experiencing more psychological distress in conjunction with social, familial, and childhood trauma as well as more peer-related problems than a similar group of nonusers. Further, individuals with a history of childhood and adolescent mental health disorders show an increased tendency to use Ecstasy Huizink et al. Jansen found dependency to be linked with self-medication for post-traumatic stress disorder PTSD in a sample of Ecstasy users. Data derived from our study of Ecstasy use and sexual risk provide the basis for improving the understanding of the circumstances under which Ecstasy is used as a means of self-medication to cope with trauma and life stresses and the implications for expanding the therapeutic use of Ecstasy to facilitate counseling therapy in clinical settings. The study was conducted in Hartford, Connecticut—an impoverished city and the state capital of Connecticut, one of the wealthier states in the U. The city has a lively night life with larger clubs concentrated in the downtown area that attract young people from the southern and central parts of the city and many surrounding towns, as well as smaller bars and restaurants throughout the city that tend to serve local youth and families. Despite various efforts to improve public schools in Hartford, both the quality of primary education and access to higher education remain relatively low, making it difficult for many youth to compete in the primary sources of employment in the city, which are in the finance, business, insurance and health care sectors. Opportunities for pursuing positive social and recreational activities are likewise limited by a few public gathering places attractive to youth e. In addition to these structural constraints, many young people, especially African-American and Latino youth, experience perceived and actual discrimination especially in downtown clubs and are exposed to intermittent violence in their neighborhoods. With limited incomes and economic opportunities, many young adults do not have private insurance and thus have difficulty accessing both primary care and behavioral health resources. Youth find it difficult to relieve the stresses associated with urban life either through an active social life or through professional counseling services, both of which are limited in the greater Hartford environment. During an month period from June to December , they recruited the study target of approximately Ecstasy-using sexually active youth who met the eligibility criteria for participation in the study. Participants were eligible for inclusion if they were aged 18 to 35, had used Ecstasy within the last four months and resided in Hartford or the towns immediately surrounding the city. To recruit the study sample, the research team used face-to-face methods including direct street recruitment at bus stops and other locations where youth collected, in addition to focus groups and presentations in colleges and other community settings. They also placed well-designed recruitment fliers in locations that were popular among young people of diverse backgrounds, including clubs, bars, parks, malls, shopping centers and small shops on main streets of the city. Some participants also were recruited through chain referral. Interested participants called the field team to schedule an appointment and were screened for eligibility on the phone. Participants who met the eligibility criteria were scheduled for an interview and were screened again prior to the interview. If confirmed as eligible, they signed a consent form and participated in a two-part A and B interview conducted over the course of one to two weeks. A semistructured interview schedule was developed for both parts of the interview. One hundred eighteen participants completed the Part A interview including demographic and historical information, gender roles and relationship dynamics, drug use career, history and current use of Ecstasy, beliefs about the effects of use and reasons for use, beliefs about sexuality and condoms, and peer and partner drug use and sex. Interviews were transcribed verbatim by a transcription service and replayed and checked for accuracy. Coding in Atlas ti 5. Part A interviews provided the data for the current article. During our coding we noted that though all respondents used Ecstasy on one or more occasion to enhance their sexual experience, some described other reasons for using the drug related to psychological stress or emotional pain. This led us to question whether and how Ecstasy might be used to self-medicate. After reviewing all of the interviews, we found that 45 participants had experienced and coped with one or more serious negative life situation in their lifetime. Thirty-six of them had used Ecstasy for coping purposes. Nine participants used Ecstasy for pleasure but not for coping. The interviews with these 45 participants are the basis for the current analysis. The other 73 participants did not report experiencing serious trauma, psychological stress or depression negative life situations during their lives and were using Ecstasy for noncoping reasons fun, better sex, relaxing with friends, going to clubs. Abuse: reported past or current maltreatment by another individual, including sexual abuse rape, sexual assault, sexual molestation ; physical abuse injury, physical suffering, bodily harm ; and emotional abuse threats, fear, intimidation. One-Time Loss: Loss of a family member, friend or partner due to death or institutional intervention. Lifestyle Stressors: Problems related to everyday socioeconomic concerns, including household finances, childcare, family and employment issues. First we examined all interviews for instances and types of negative life situations and compared them across treated versus untreated participants, and diagnosed versus undiagnosed cases. Then we extracted those cases where respondents specifically reported Ecstasy use as a coping strategy and compared them to cases where respondents reported other coping strategies, including several instances in which they reported using other drugs, but not Ecstasy. Seventeen self-identified as Hispanic or Puerto Rican The majority of these participants More than half Among those who reported experiencing negative life events, we identified two main groups. Of these 36 participants, 29 had never sought or received a specific mental health diagnosis. Seven reported that they had received a mental health diagnosis in the past, for which they had received no treatment or unsatisfactory treatment, and they were not in treatment at the time of the interview. The majority of Group A members 31 were using Ecstasy rather than other drugs to cope with their negative life situation; of these, 26 used only Ecstasy and five used Ecstasy plus other drugs to cope. On the other hand, none of the members of Group B were using illicit drugs to cope with their negative life situation although all of them used Ecstasy for pleasure. In terms of amount of use, there was no significant difference between the two primary groups except for a small number of daily users in Group A and none in Group B. Most participants in Group A had negative feelings about their Ecstasy use; in contrast, half had positive or neutral feelings about their use in Group B. Only four participants in the entire group of 45 —all members of Group A—expressed a desire to quit use of Ecstasy altogether. All of the 45 participants in our sample reported at least one and many reported two or three negative life situations at the time of the interview. Twenty-five reported coping with only one situation five with abuse, ten with relationship problems, three with loss and seven with a current lifestyle situation. The remainder of the participants, with one exception 2 , were coping with the intersection of two negative life situations. Below, we describe in greater detail the negative life situations experienced by those untreated or ineffectively treated in the past, along with their reasons for using illicit drugs and Ecstasy in particular to cope with those situations 3. An examination of reasons for initiation to Ecstasy use shows that for the most part, youth did not start their use of Ecstasy because of their desire to reduce emotional stresses, or to numb pain. They began to use MDMA because they were with friends or partners who were using it or introduced them to it. However a small number of participants four began their use of Ecstasy specifically to cope with depression, sad feelings or stress. The remainder, the vast majority of coping users, reported that they themselves discovered the self-medicating effects of Ecstasy over time as they continued to use it for other purposes. A total of seven participants reported coping with either physical, sexual, emotional or a combination of two or three forms of abuse in the past by using illicit drugs including Ecstasy. Abusive situations involved hitting, beating, threatening, false accusations, and forced sex or rape, sometimes continuing over a long period of time. For each, the first instance of abuse happened either during childhood or in the early adolescent years, but two participants reported additional instances of rape that occurred in later adolescence. The quotes below reflect different forms of abuse including sexual abuse. P: No, there were a lot of things. Lot of family issues. Just like emotional abuse like. These and other accounts of abuse remain vivid in the memories of participants. Even when they occurred in the past, many experiences of abuse were described as if they were ongoing, suggesting that they produced enduring trauma. Most respondents report being abused by family members or family friends, and thus found it difficult not only to escape from abusive environments but also to report or to talk about their experiences with other family members, like parents or siblings. Many respondents recounted living in constant fear of abuse because of their inability to avoid continuing interaction with the abusive household member, and the inability of others in the household to protect them from it. Participants reported that Ecstasy was effective in alleviating fear and anxiety, as well as helping them to temporarily forget instances of abuse. Eighteen participants reported using drugs to cope with negative relationships with their primary romantic partners or their family members. Of these, 16 used Ecstasy for this purpose; the other two used marijuana. Here we focus on the 16 participants who were using Ecstasy to cope with serious relational problems with partners, former partners, parents of their young children, or parents or other family members. Problems involved recent arguments and conflicts with partners, separations due to infidelity, conflicts over parenting responsibilities and disagreements with parents. More than half of this group reported coping with another current problem related to loss or lifestyle. Seven participants reported using Ecstasy to deal with the continuing pain and distress associated with past relationships. Others mentioned that ongoing relationship problems resulted in day-to-day stresses that Ecstasy helped to alleviate. For example, one participant described how she felt when her much older husband refused to allow her to leave the house. She described how this caused her to feel depressed and to turn to Ecstasy to relieve her depression. InD year-old Puerto Rican female. Fights with partners or family members were also described as events that triggered use. One respondent reported that:. My ex. I caught him cheating on me. I was on E. I was numb. What did just happen? Oh, yeah, this happened. InD year-old Hispanic female. Two participants mentioned using Ecstasy as a way to improve their negative partner relationships. One mentioned, for example, that it helped her to communicate better with her partner:. And like a couple of times, we worked out our problems. We were having big problems, and we worked it out on it \\\\\\\\\[Ecstasy\\\\\\\\\]. It was kind of weird. My girl has a lot of issues, like depression issues, just the way her life … I wish I could snap my fingers and change things for her because she wants to be so outgoing and so positive, in the situation that we live in she is forced not be. She kind of like the backbone of the family, when you meet her you will be like … she is tiny and small, but she is like the head of the household, everybody comes to her house with problems, everybody comes to her to ask for things; so many people depend on her without us having anything. But she will pop a pill and she will be like this total bright side to it; like she is happy. So sometimes I see her all pissed and I will give her a pill. InD year-old Hispanic male. This participant gauged the mood of his partner as a way to know when it is appropriate to give her a pill. He stated that Ecstasy brought out a positive dimension to his partner that was often hidden because of the past and present difficulties she faced in her life. In our sample, loss of a loved family member or friend was not uncommon. Three were coping with the loss of a child two with death and one with lost custody ; two with the loss of a parent; one with the loss of a grandparent; one with the loss of a close friend; and one because her mother went to jail. These losses were both long-term and recent, and resulted in both the initiation and increase in the use of Ecstasy. One participant stated:. When my mother died was when I first started using … She died of breast cancer. My father got married again and she died of leukemia, which is crazy … Actually it is a year and six months that she passed … So I numbed myself by taking E. Another participant said she started to use Ecstasy more regularly after her father died some years ago:. Well, because after my dad died I used it a lot, you know, pretty much for depression, when I get depressed just to get my … clear my head and stuff. Although the loss may trigger Ecstasy use, individuals often continue to use Ecstasy long after the loss of the loved one and to attribute their use to the pain of their loss. One participant who experienced multiple negative life events, when asked why she used Ecstasy responded by saying:. Things you go through. Things that repeat in your head … Things you went through life. My beatings. My losing kids. This participant was using Ecstasy to cope with not only past abuse, but also with the death of her children. Participants described using Ecstasy to reduce anxiety and to escape from stress. One participant said:. To, uh, have all your worries put aside. InD year-old Caucasian female. I feel like I can just lay back and say you know this is life, hug my kids, my husband and be happy. One participant described it in this way:. Nearly half of these participants said that unresolved past troubles and painful experiences continued to interact with their current situations, making it difficult to focus on effective approaches to dealing with day-to-day struggles of child rearing and household management. These individuals experienced Ecstasy as a helpful release, reducing tension and anxiety, helping them to forget about their problems, enhance relationships and find ways to relax. As everyday pressures mounted, Ecstasy helped to reduce stress, mediate communication and help to cope with the many ongoing challenges of survival in a resource-limited environment. Nine participants in the sample were diagnosed formally with a mental health problem and had either undergone treatment or were in treatment. At the time of the interview they were not using illicit drugs to cope with a negative life situation. Almost all of these respondents eight reported that they were dealing with the consequences of past abuse; and four mentioned other problems of which two were relational and the other two had to do with the loss of a loved one. The ninth participant was also facing a relational problem. All three participants who reported relationship problems were dealing with very difficult family situations. One participant recounted his experience of abuse:. InD year-old White male. This participant was diagnosed with manic depressive disorder and PTSD. He described seeing a psychiatrist while he was on military base. At the time of his interview for the study, he was trying to identify a psychiatrist and seek treatment. Another participant described her experience with loss and how she dealt with it through professional help:. P: So he \\\\\\\\\[her father\\\\\\\\\] ended up with lung cancer. So that, he was real sick and I was the one who always took care of him … That was hard. And then when he died, I was the only one taking care of him … It affected me a lot. It was hard for me. Very, very hard for me. The same participant continued to describe her mental health diagnoses, which emerged after the loss of her father. At the time of the interview this participant was currently taking medication for her disorders and was working. Seven of the nine participants mentioned taking medication at some point after their diagnosis. Two were still taking medication at the time of the interview and reported that the medication was beneficial. Others reported receiving effective mental health treatment. Of the nine diagnosed participants, six had received professional help from either a counselor or a physiatrist, two participants received drug treatment and one was admitted to an institute for anxiety and depression. Avenues for diagnosis varied and included diagnosis in the military, diagnosis in prison, hospital admittance for psychological symptoms or attempted suicide or referral to the juvenile justice or child welfare services. Unlike those in the untreated or poorly-treated group, these respondents were currently using prescribed medication or considered themselves recovered, and none was using Ecstasy or any other drug to cope with their past or present negative life situations. A number of researchers write about MDMA use in urban areas. A majority of their research focuses on sexual and drug risk behaviors on the one hand, or the search for enjoyment and pleasure on the other. Cultural studies on the other hand favor understanding drug use in the context of the quest of postmodern youth for identity and pleasure to relieve boredom and the limitations of a working or middle class lifestyle Hunt Neither approach, however, reflects the challenges youth face in their efforts to achieve adulthood. Nowhere is this truer than with respect to urban working class and marginalized young people who suffer unduly from personal losses, prolonged exposure to violence, lack of economic resources, and stigma and discrimination associated with class, race and ethnicity in resource-poor urban environments. These chronic and acute stresses have the potential for contributing to clinical or subclinical depression, anxiety, and PTSD-like symptoms. In our analysis we first isolated respondents who listed as their most salient reason for using Ecstasy their efforts to cope with a current or continuing emotional problem. We compared them to those who reported using Ecstasy for other reasons fun, sharing with friends, going out, dancing or sex and found that the latter group had not experienced similar negative life situations either in the past or at the time of the interview. These youth described using Ecstasy to cope with adverse emotional states associated with negative life situations primarily by blocking them out or forgetting about them. We then reviewed more deeply the life histories of Ecstasy users who described coping with negative life situations in their Part A interviews. In the process we noted that some of them mentioned having been diagnosed with a mental health problem in the past. This led us to question the relationship of diagnosis and treatment to Ecstasy use, and to hypothesize that those diagnosed and undergoing treatment would be less likely to use Ecstasy to address their mental health problem. A comparative analysis showed that Ecstasy was used to cope with emotional problems, abuse and loss only by those who had not been diagnosed and treated, or who were diagnosed and treated but considered their treatment to be unsatisfactory. Most mentioned specifically that they used Ecstasy to cope with emotional stressors. Among the few who use other drugs as well, Ecstasy was their drug of choice. Further Ecstasy was the drug most preferred for coping purposes. These data suggest that both diagnosis and effective treatment were critical factors in avoiding self medication with Ecstasy. The primary means of obtaining a mental health diagnosis and treatment were parental intervention or through institutional intervention. Institutional interventions included removal from the family and placement in a foster home or institution, hospitalization, or imprisonment or detention due to illegal activity Bhui et al. Only a few individuals sought treatment on their own. Our research on Ecstasy suggests that it serves an important function in the lives of urban youth facing stressful life situations including past and present trauma. These individuals exert agency in drug decision making, carefully considering how, why, when and under what circumstances they use Ecstasy. Most of the time respondents using MDMA to cope with emotional stress report that the drug is producing the desired effect and their drug experiences and perceptions of MDMA are generally positive. They report that Ecstasy dulls their pain, reduces tension, improves communication, and helps them to avoid undesired arguments with people important to them. Further, they report that Ecstasy dims the memory of past trauma, helps youth experiencing PTSD-like symptoms to sleep at night, and enables them to get on with their daily lives. These explanations, which address relational problems, differ from those given for the use of other drugs. Research has shown that Ecstasy has been associated with cognitive impairment, attention deficits, long lasting neurotoxicity as well as a range of mental disorders Lieb et al. Because of its status as a Schedule I drug, there is currently no control over the quality or content of MDMA purchased illegally and used for self-medication or recreational purposes. The content of these pills is unknown and they may be adulterated with dangerous ingredients or fillers. Despite the many precautions youth report in trying to obtain safe pills, most youth in this study could report at least one negative instance of Ecstasy use, often in association with other drugs including alcohol. If the primary purpose of use is pain alleviation, youth are taking unnecessary risks, with potential negative consequences. Our study and others Abram et al. Low rates of treatment-seeking found among our participants are consistent with studies showing that minority youth in particular are less likely to seek professional help for mental health problems Cauce et al. With appropriate treatment including counseling and the discretionary inclusion of appropriate anti-anxiety or antidepressant medication, we believe that young people could and would make a decision to shift away from self-medication with Ecstasy in favor of more effective controlled medication and counseling. There is a pressing need for publicly-funded, developmentally and culturally appropriate mental health care for young people, in order to reduce stigma associated with diagnosis and treatment and to address the systemic factors leading to the observed need for self-medication among urban, minority and low-income youth. Individuals using Ecstasy to self-medicate in these contexts do so with no professional guidance or knowledge of how to progress through personal problems in ways that will lead to long-term resilience. Their continued use of Ecstasy and expressed desire to continue taking the drug with no proximate plans for cessation are further evidence that self-medication without supervision may not effectively capitalize on the potential therapeutic properties of Ecstasy when used in more controlled settings. Research to date e. Doblin and other proponents of MDMA use in therapy suggest, and are attempting to show, that controlled doses can help to reduce incapacitating symptoms of trauma such as avoidance and hyperactivation e. Researchers concerned about the therapeutic value of Ecstasy have obtained permission to test it in clinical settings for treatment of PTSD and cancer-related pain Morris ; Doblin A number of clinical trials funded by the Multidisciplinary Association for Psychedelic Studies MAPS are currently underway to test the utility of MDMA as a therapeutic tool to assist psychotherapy for the treatment of PTSD and other trauma-related illnesses, including those stemming from sexual assault, war, violent crimes and other traumas. The results of these studies have been sufficiently successful for researchers to receive permission from the FDA to train psychotherapists to deliver counseling in association with MDMA prescription to patients MAPS Careful screening measures can help to identify individuals most likely to benefit from therapeutic use of Ecstasy, along with contextual factors most likely to facilitate treatment. In sum, urban youth in our study lack access to mental health services and counseling that would alleviate their psychological pain, relieve their stress, and improve their quality of life, health and relationships. Thus they turn to coping strategies such as the use of Ecstasy and other drugs that are illegal, or diverted from their prescribed purpose, in order to reduce emotional distress and pain resulting from stressful life situations and past or current abuse, to improve their mood, and to enable them to function more effectively in daily interaction with friends and loved ones. Further research is needed to demonstrate that improving access to appropriate mental health treatment and medication reduces the use of Ecstasy or other drugs for self medication. Finally, research is needed to explore the potential of Ecstasy administered under controlled conditions to reduce pain stemming from exposure to violence and abuse in childhood or early adolescence, and enhance capacity for building rewarding sustainable relationships even in difficult life circumstances. The study has some limitations. The sample used for it was drawn from a study which focused on elucidating the relationship between Ecstasy and sexual risk. Hence, not all participants were asked specific details pertinent to the subject matter of this study such as if they had ever used Ecstasy for coping or if they had a history of mental health diagnosis. Additionally, given the subject matter of this article, some participants may not have been comfortable discussing past traumatic events which may have been the impetus for their Ecstasy use or a history of mental health diagnosis or problems. Further, the study was localized to the Hartford and greater Hartford area, thus participants may not be representative of the general population of urban Ecstasy users. Lastly, the inclusion criteria, of individuals who had used Ecstasy within the past four months, did not allow us to fully explore the possibility of finding individuals who were once using Ecstasy to cope and were no longer using the drug or individuals who stopped using Ecstasy due to either adverse effects or problem resolution. The authors would like to express gratitude to several people for their assistance in the development of this study. We would like to thank Ivica Pavisic for his involvement in the early stages of the development of this study. Lastly, thank you to the participants for sharing their stories. National Center for Biotechnology Information , U. J Psychoactive Drugs. Author manuscript; available in PMC Jul 1. Lwendo S. Moonzwe , M. Schensul , Ph. Kostick , Ph. Jean J. Kristin M. Author information Copyright and License information Disclaimer. Please address correspondence and reprint requests to Lwendo S. Moonzwe at moc. Schensul at gro. Copyright notice. See other articles in PMC that cite the published article. Abstract This article examines the role of Ecstasy MDMA or 3, 4-methylenedioxymethamphetamine as a drug used for self-medication and coping with both short- and long-term negative life situations. Abuse A total of seven participants reported coping with either physical, sexual, emotional or a combination of two or three forms of abuse in the past by using illicit drugs including Ecstasy. E: Was it just physical, was it physical violence? Were there other forms of violence? E: Do you think drugs helped you deal with that? P: Yeah, yeah. InD year-old Caucasian female These and other accounts of abuse remain vivid in the memories of participants. Negative Relationships Eighteen participants reported using drugs to cope with negative relationships with their primary romantic partners or their family members. E: How do feel about not being able to leave the house? P: It gets me stressed and depressed. E: What are some of the things that happen when you get like that? P: I take an e-pill \\\\\\\\\[Ecstasy\\\\\\\\\]. InD year-old Hispanic female Two participants mentioned using Ecstasy as a way to improve their negative partner relationships. InD year-old Hispanic male This participant gauged the mood of his partner as a way to know when it is appropriate to give her a pill. Loss In our sample, loss of a loved family member or friend was not uncommon. One participant who experienced multiple negative life events, when asked why she used Ecstasy responded by saying: … Pain. My burying six children in Bloomfield Cemetery InD year-old Hispanic female This participant was using Ecstasy to cope with not only past abuse, but also with the death of her children. One participant described it in this way: P: I wanted to feel happy, like, I wanted to feel love with everybody and happy. E: Yeah, and did \\\\\\\\\[Ecstasy\\\\\\\\\] do that for you? P: Yeah. Yeah, it did that. InD year-old Hispanic male Nearly half of these participants said that unresolved past troubles and painful experiences continued to interact with their current situations, making it difficult to focus on effective approaches to dealing with day-to-day struggles of child rearing and household management. Diagnosed and Treated Nine participants in the sample were diagnosed formally with a mental health problem and had either undergone treatment or were in treatment. 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