Leaving on a Jet Plane

Hello friends! 
Summer school is over, and it's vacation time!  I am getting some much needed time with family this week.  I am looking forward to new experiences, and hoping for some insights to share with you.  I am getting to use my skills for dealing with anxiety since I'm flying to get to where I'm going!  I am hoping to get to work on relationships while I am away.  I am going to a new city, and can't wait to see it.  I hope to have a lot to share with you this week and after, but blog entries are second to my personal life.  
Everyone have a wonderful week.
Be well.

Medication: A Love/Hate Relationship

Yes, it's another entry about medication.  This stuff is really important though, and worth another discussion.  
I am going to start this post with a disclaimer: I am not a psychiatrist, nor am I any sort of doctor.  I can’t give medical advice other than to say that if you have any sort of issue with psych meds, speak to your psychiatrist, or medical practitioner.  If you are experiencing a psychiatric emergency, go to your nearest emergency room, or dial your local emergency number.  

Having both worked in mental health and being a mental health patient myself, I have a lot of experience with psychiatric medications.  Additionally, I take medication for my Cerebral Palsy.  I have had my fair share of patients tell me they were having trouble getting their mind around having to take a medication every day for the rest of their life.  I heard this sentiment more often from younger clients, but certainly from people of all different stages of adulthood.  My favorite one was during a group at my job at the state hospital.  I'd been facilitating this group for about six months, so the participants knew me, and each other, well.  They knew that I don't do pity parties, and that I am big on personal responsibility and accountability.  The group got into a fairly heated discussion about psychiatric medications.  A person released from the state hospital can, under certain circumstances, be returned to the hospital even after earning release if he or she stops taking their prescribed psychiatric medications.  This is a bone of contention for many of the patients, especially the ones who are back at the hospital for this very reason.  So, during this particular group, the new member attempted to play upon my sympathies by saying to me, “(my name), you have no idea what this feels like though.  I am going to have to take a pill every single day for the rest of my life just to function!”  I could hear the other guys in the group start snickering.  I cocked my head, looked at him, and stood up on my good leg, allowing my bad arm to dangle.  I almost never let my patients see me like that, but this instance called for it.

“Really?” I asked.  “Care to repeat that?”  The man stammered out an apology, and stopped talking.  

It’s a pretty big head trip to know I need medications just to get through my day.  People with both physical and psychiatric diagnoses have even more medications to manage.  I have Cerebral Palsy, Depression, and Anxiety.  Each is medicated a little differently.  I take medications which work together to give me better results.  It means carrying a lot of pills with me when I travel.  I go to the pharmacy multiple times in a given month because of course, they’re not all on the same refill cycle.  In a way it’s good though, because I’d never be able to afford all of them at once.  I tell you this not for pity nor sympathy.  I certainly don’t say it to be an inspiration!  I want someone else facing this to know that I get it, and you’re not alone.

When I had a patient come back into the hospital after having gone off of medications, I always sat down and talked with them as soon as they were stabilized to figure out why?  The answer was frequently this: The patient started feeling good.  This happens when the meds are right, and it’s a wonderful thing!  He or she started thinking, “What if I skip a day?  What’s the worst that could happen?”  Then they notice they don’t have the side effects anymore.  Some people who experience a lesser degree of Mania called Hypomania enjoy the slightly euphoric feeling, and the productivity that comes with it.  But then the symptoms start interfering with their ability to get things done.  They started skipping required meetings and appointments, which raised red flags.  Hopefully, their county worker caught up with them before any more damage was done, like say, a crime.  Hopefully.  The next thing they knew, they had a direct ticket back to inpatient treatment.  Do not pass go, do not collect 200 dollars.

What I hope to drive home is that this can be any of us.  I have written about side effects before, but it is worth repeating: If the side effects are unmanageable, talk to the prescribing doctor right away.  Pay attention to warning labels.  If you start to experience dangerous side effects, seek emergency treatment, please!  

I believe that feeling apathetic, indifferent, or just plain blah (technical term) about medications is a normal part of coming to terms with our need for them.  I used to ask my patients this: If you had Diabetes and needed insulin, would you take it?  If you had Cancer and needed chemotherapy, would you do it?  They would always answer, “Yes.”  

Mental health affects our well being as much as physical health.  To imply otherwise, or outright deny it, is cruel to the patient, and negates all the work that they do to deal with symptoms.  Medication is a large part of successful management of a mental illness, but it’s only a starting point.  It helps us to get our thinking back to where we can do everything else we need to do to feel our best.  If all I do is take my meds but don’t take care of everything else that makes me who I am, I am existing, but not living.  My hope for you is that you are able to get as much out of life as you can.  We don’t live our lives in spite of our diagnoses.  They are part of us.  It’s what we do with them and about them that defines us and our character.

Be well.

Stages of Morality: Don't You Know Better?

This entry is going to be an informational one.  I want to talk about the concept of morality, and how we learn it as human beings.  This is one of those topics that I really enjoyed when I was studying for my board exams.  

I plan to talk about different theories about stages of development on this blog.  They’re really important in understanding why people do what they do, whether it’s other people or ourselves.  I want to make something really clear here: When we talk about stages of development, it is completely unreasonable to expect a person to do things at a stage they have not yet achieved.  Also, in order to get to the next stage, the person has to complete the one before it.  A young child might be able to count from 1 to 10.  This doesn’t mean we sign them up for algebra next.  It doesn’t mean the kiddo will never do algebra, it’s just not the next logical step.  Stages of development cannot be skipped.  Each stage, no matter the model, builds upon the one before it.  If you get nothing else from this entry, STAGES OF DEVELOPMENT CANNOT BE SKIPPED.  It is my hope that by explaining various stages of development theories, we can keep expectations reasonable.   

So, without further ado, I’d like to introduce you to the stages of moral development!  (Everybody play nice, no matter what stage applies to you.)

The stages of moral development were developed (I know, groan) by Lawrence Kohlberg, a graduate student at University of Chicago in 1958.  Kohlberg’s theory explains how people make decisions involving morality.  

Kohlberg’s 6 stages are broken down into 3 levels: Pre-Conventional, Conventional, and Post-Conventional.

The Pre-Conventional level is comprised of the stages of 1) Obedience and Punishment Orientation, and 2) Self-Interest Orientation.  In the Obedience and Punishment Orientation stage, our morality is guided by the consequence of the action, rather than the action or the goodness or the action.  Another way to say this is that we’re avoiding punishment.  A child may think, “I got spanked last time I hit my sister, so I won’t hit her again.”  This has nothing to do with the fact that hitting is wrong, or that the subject cares about his or her sister and doesn’t want to harm her.  At this stage, the person is only trying to avoid punishment.  This may sound selfish, but this is where we all start.  Remember, children are self-absorbed, but they’re supposed to be.  They’re children!  Self-Interest Orientation comes next.  Think of this one as, “what’s in it for me?”  Again, the subject isn’t yet able to think about the effects of their decisions on others.  Remember when we talked about reinforcing desired behaviors?  Here’s where that starts working well. If I do X, I get Y.  When we ask a child in the Pre-Conventional level, “How would you like it if she did that to you?” they don’t have the skills yet to make that connection.  It doesn’t mean that they’re a bad kid.  In fact, they’re doing exactly what they’re supposed to be doing: Developing.

A person typically moves into the Conventional Level sometime during adolescence.  Stage three of moral development is Interpersonal Accord and Authority.  At this stage, a person is morally motivated by obedience to social norms, and being seen by others as good.  A person at this stage may not like a rule, but will not question the need for the rule.  Their focus is on following the rule in order to be accepted.  The second stage in the Conventional Level is  Authority and Social-Order Maintaining Orientation.  That’s a wordy way to say doing the right thing because it’s good for society.  I don’t speed down a city street and run red lights.  I don’t just not do it to avoid being arrested or because I’ll get a reward for driving well, like lower insurance rates.  I don’t even drive slower just because there’s a sign with the speed limit.  Now I do it because it’s part of my responsibility in maintaining social order.  I am contributing to the society in which I live.  Morality is still dictated by an outside force, but I am able to see why, and adhere to the rule.  Many of us never get past stage four, but it’s okay.  Developing to this stage is enough to keep us productive members of society who basically function well in relation to other people.

At the Post-Conventional Level, a person may enter the fifth stage, which is Social Contract Driven.  At this stage, the person sees the world as being comprised of different people with values, rights, and opinions.  At this stage, the person will think critically about societal laws and norms.  What’s right and what’s wrong will be seen through the lens of what promotes the greatest good for the greatest number of people?  This is a central theory of democracy.  The sixth and final stage is Universal Ethics and Principles Driven.  At this stage, altruism and universal principles of ethics drive behavior, even if they supersede the law.  Decisions are absolute.  For a person to reach this stage is rare.  Think Ghandi.  

Whenever I hear a parent shout at a child, “Don’t you know any better?”  I often think to myself, “Nope, not yet.”  We grow by being held accountable, and I’m not trying to say we shouldn’t be raising children, or expecting each other, to be good people who make good choices.  It is important though to have reasonable expectations that set people up for success.  It can also be really exciting to see someone coming into a new understanding as they grow.  Children are not miniature adults.  Everyone only gets one childhood.  Now that we know that a person can’t skip stages, we can work on helping them achieve each stage as successfully as possible.  Assisting a kid to be good at being a child is how we get them to be good at being adults.

Be well.

Sending My Regrets: How Mistakes Can Help Relationships

I’ve been thinking a lot about regret lately, and how good I am at being my own worst enemy.  My mother says she never really needed to punish me, since whatever I put myself through was always worse than anything she could have done.  Regret, and by extension shame, are two of the most difficult feelings to manage.  I know I have brought up shame before.  This is a big one though.  The problem is that once something is done or said, there’s no way to go back and fix it.  We can only move forward.  I want to share an experience I’ve had, what I got from the experience, and what I hope for as I go on.  

I have a family member I used to be very close to when I was little.  As I grew into adulthood and embarked on my own life, we grew distant.  I missed what we had, but felt that I didn’t know this person anymore, and therefore didn’t know how to fix it.  I started making assumptions about this person’s feelings about me and my lack of importance to her.  Big mistake.

When we did attempt to communicate, it usually dissolved into a a fight.  Again, this was based on assumptions we were making based on the lack of communication.  I know I said some things that I regret to this day.  Then one day, something changed.

This person did me a huge favor.  I was stunned.  If I were in a different position, I might have even refused it, just so that I wouldn’t feel beholden to her.  Talk about cutting off my nose to spite my face!  Now, remember, the problems between us had stemmed from lack of communication.  The day after the favor, I texted her to give her an update.  We ended up chatting a little.  It was nice, and the next day I texted her to say good morning, and tell her I hope she had a good day.  From there, we started talking about our plans for the day.  I started texting her every morning.  We started talking.  First it was little odds and ends about what we were up to, but then we started getting into the meat.  We each said how much we’d wanted this, but didn’t know how to achieve it.  Months later, we’re still at it.  Most days it’s just little tidbits about our day.  Sometimes we really need to talk something out though, but that’s what we do: we talk.  I know that I don’t feel so defensive when she brings up an issue, because our relationship is so much more now than a laundry list of hurts.  The tougher talks are balanced now with support, laughter, banality, concern, and love.  

Something I ask people who are in conflict is this: Is your priority the relationship, or being right?  While it’s not necessarily an either/or, it’s important to prioritize those two goals.  It is vital to healthy relationships that each person take responsibility for their part.  There are very few conflicts in which each party doesn’t have at least a part, no matter how small, in what is happening.  

We are all going to make mistakes.  It’s part of being human.  Unfortunately, many of these mistakes will involve doing some sort of harm to another person, usually a loved one.  Most of the time though, the mistake isn’t going to matter nearly as much as what we choose to do with it.  If nothing else, there is always something to be learned.  Always.  Shame can be debilitating, especially when it’s about our relationships.  The best tool I know to fix it is action.  Do something about it.  Even if it doesn’t fix the problem, it moves you from being a victim of your choices to a participant.  You have no control of how another person is going to respond to your efforts, and that part can be really hard.  But if you know you have done your part, then please stop losing sleep over it.  It’s one thing to forgive someone else, but forgiving yourself is a whole different thing.  Use mistakes and feeling of regret as motivation to learn and do better.  That is the control you have over those painful situations.  Now if you’ll excuse me, I have a text to respond to.  

Be well.

Shoulda Coulda Woulda...Victim blaming

My hope for this blog is that people can learn from it as well as find their own stories here.  I believe there are experiences which are shared by many of us, and we find comfort in knowing we are not alone.  I try to maintain a balance on my blog of information and experience, education and emotion.  I know that for myself, if i understand on an intellectual level what is happening to me, it helps me manage the feelings that come up.

Today I want to talk about an instance when we find ourselves wanting to achieve distance from one another and find differences: victim blaming.  This is when we put responsibility for a crime or abuse on the victim, and give at least partial absolution to the perpetrator.  

We do this in a lot of different ways.  Some of them are subtle like not not picking up the phone when a friend calls, whom we know is in an abusive relationship.  I want to differentiate here between not answering because we are not in a place to be receptive, and not answering because we, on some level, just want her to do it for himself or herself already!  We do it when we erase their experience by saying that men cannot be sexually assaulted.  

Next, there are the questions we ask: Why doesn’t she just leave?  Why were you walking there at night? You had how many drinks?  What did you think was going to happen? We also may make statements like, “I would never go to the ATM at night!”  “That’s why I am always careful.”  “You know, you should always use the buddy system!”  Of course there is a time and place to talk about prevention.  Right after the fact and directing these statements to the victim is not it.  

What is truly alarming to me is how these incidences are dealt with on a larger, systemic and societal level.  One example that comes to mind is the idea that a person in the commercial sex industry, or prostitute, cannot be raped.  Let’s be very clear that this is a sex positive blog, and I support the choices of consenting adults.  Someone who works in the commercial sex industry and is robbed or sexually assaulted will not be able to report the crime out of fear or being blamed for it.  His or her victimization will be seen as their own fault for being in the situation.  

So why do we do it?  First, I believe that when we do it, we believe we are helping.  We don’t want to see that person go through such an ordeal again, so we make suggestions as to how they could prevent it.  While we may believe this is the right thing to do, we may actually be making things worse for someone we love and care about.  The person has already been through something traumatic.  Then we are adding to the trauma by implying that they are responsible for it.  If you are not sure how to help someone, ask them.  If that doesn’t seem right given the situation, then ask if they’d like you to just be there.  If they don’t accept any assistance, it’s not personal.  It’s not about you in this time, it’s about them!  Also, even if it’s the person you are closest to in the world, they may not reach out to you.  Again, this is not about you.  Try to see where your loved one is doing what they feel they can to take care of themselves.  There will be ways to help.  Instead of seeing it as rejection, try to think of it as, “not right now.”  

The second reason we do it does have to do with ourselves: We want to feel that we are different enough that it wouldn’t happen to us.  We take comfort in this sense of security, even if it is false.  We need to tell ourselves that we somehow are at less risk for having the same thing happen to us.  We play Monday morning quarterback, saying what we would do differently.  This gives us comfort, and helps us differentiate from potential victimhood.  

We can do better though.  We can make different choices that support relationships with one another.  We go about doing this by acknowledging our own fears and limitations.  If I don’t know that something is a problem, I can’t fix it.  I may be afraid of having the same bad thing happen to me that has happened to my friend, but this doesn’t give me license to treat her badly.  I am responsible for my own reactions.  Her healing needs to be about her. 

As we go through life and survive different events, we have the potential to grow from these experiences.  When we share this strength with one another, it reinforces it within ourselves.  If we could each focus on strengthening and reinforcing the pack instead of picking off the weaklings, we’d each be quite a force to be reckoned with!  So that’s my challenge to each of us, including myself:  Take care of one another.  If you need to focus on the differences in order to feel safe, find an outlet that still keeps the victim’s needs as a priority.  Each of us will, at some point, require care from others in order to recover from something.  Your giving care and compassion to another helps them to heal and grow so that when the time comes, they will have all they need to return the favor.

In the mean time,

Be well.

A question to my readers

What would you like to see covered on IOI?  Is there a question you have about mental health, mental illness, or anything you've been curious about?  Let me know in the comment section, and I will do my best to write about it.  Thank you so much.
Be well!

The House Always Wins: Behaviorism, or Why We Do What We Do How We Do, Part 2

Welcome to day two of behaviorism!  Now that you’ve mastered the terminology, we get to discuss what works, and why.  

I’ll get right to the point: Reinforcement works to change behavior.  Punishment does not.  When a behavior is reinforced, it means that the subject has to do the correct behavior in order to earn the reward.  It doesn’t matter if the reward is to earn something good or take away something bad.  The desired behavior still happens.  Punishment, on the other hand, does not work.  The subject still changes their behavior, but they do it to avoid punishment.  They may still do the same behavior, but they’ll get better at not getting caught.  Since last time little Billy hit his sister and left a mark, next time, he’ll pull her hair.  

So now that we know that we should to reinforce behaviors that we want, let’s talk about how we go about doing it.  First, it has to be something the subject wants.  It doesn’t matter if we’re talking about adult humans or puppies, this is how behaviorism works.  If we know that little Bella loves magic markers but couldn’t care less about stickers, then magic markers are going to be the reward.  If we made the reward stickers, she’d have no reason to try to earn them.  Some people call this finding their currency.  Then we establish with the subject how to earn the reward.  Bella has to wash dishes four nights this week.  Keep it simple.  It has to be observable and measurable.  Star charts, or some sort of visual tool, are important.  The subject will see their stars begin to accumulate.  This is a great way to combat frustration in the instances she doesn’t earn her star.  Stay focused on the positive.  “You didn’t earn your star today, but you did it two nights in a row before this!  You’re half way there!”  At the end of the week, we continue to focus on the positive, whether she’s earned the reward or not.  “You did the dishes three nights this week!  Great job!  Just do that plus one more next week so you can get your markers!”  Keep the focus on what she has done, not what she missed.  

Once she’s got that down pat, we raise the bar.  Now she has to set the table and wash the dishes four nights a week.  The parent can decide what the new system will be.  Does she have to do both to earn a star, or is it one star per task?  How many for the new reward?  Bella’s room is going to be overflowing with markers pretty soon.  Bigger tasks earn bigger rewards, but may also take longer to earn.  Also, keep it appropriate to age and capability.  A teenager may be required to mow the lawn and do his own laundry to earn a ride to the mall or the movies, for example. 

Now let's talk about how often a reward is given. At first, it is every time.  Then over time, we space out the reward schedule.  But the most effective reward schedule is random.  The behavior is praised every time, but the reward may or may not be given.  It doesn't just work on dogs and children.  I bet you are drawn in by intermittent rewards. If you don't believe me, go plunk some quarters into a slot machine. You are not going to win every time.  In fact, you will lose more often than you win.  But every so often, you will get enough of a reward to keep you interested in playing. So you pull that lever again, and again, and then just one more time, really! Okay, one more...and three out of five match! You didn't even come close to the jackpot, but it's enough to make you think, "just one more."  It's the same thought process that gets people buying lottery tickets. Every time the jackpot gets high enough to be newsworthy, the next story will be about the lines out the door at the local convenience store.  The odds of any given ticket matching all six numbers in the Powerball game are one in 292 million.  We know this, yet just the opportunity for the intermittent reward is enough to keep us coming back every time. Intermittent reward also makes us believe unrelated events could be related.  According to research by Monica Wahdwa, Assistant Professor of Marketing at INSEAD, a person who matches five out of six numbers is more likely to play again than someone who only matches two out of six.  We attribute this to luck, when really, it's purely random.  The lottery officials know this. They know you are going to keep buying tickets. The casinos know this. They know you're going to keep pulling the lever. You're going to play just one more hand.  The house always wins.

There you have it: intermittent positive reinforcement at random intervals. It works on training dogs, children, and you!

Be well. 

The House Always Wins: Behaviorism, or Why We Do What We Do How We Do, Part 1

Okay, I had fun writing the title for this entry.  This entry is probably not going to change anyone’s life, but it should be fun.  I’m going to break down the concept of behaviorism.  Put the pillow away, this is actually interesting!  Behavior simply means how we act, particularly in regards to others. Behaviorism is one of those terms that gets tossed around with a remarkable level of inaccuracy.  Two specific terms that are used interchangeably are “reinforcement” and “punishment.”

Reinforcement means that the desired behavior is addressed, punishment means that the undesired behavior is addressed.  See? Easy!  Okay, there’s more to it than that.  

Here’s where it gets trickier: There’s a positive way and a negative way to reinforce or punish.  This sounds like the positive way is good, and the negative way is wrong, but this is not correct.  This is another way behaviorism terms get misused.  Positive means adding something, Negative means taking something away.  

What that leaves us with are four categories: Positive reinforcement, Negative reinforcement, Positive punishment, and Negative punishment.  

Here’s how each category works when we combine the definitions:

Positive reinforcement: Positive means adding something, reinforcement means addressing the desired behavior.  Put them together, and you get adding something to address the desired behavior.  I can rephrase that, and simplify it into one word: Reward.  Examples of positive reinforcement are sticker charts when the child does her chores, money for the child’s good grades, or an extra hour of TV time when the child does the dishes.  See?  Kid does something good, kid get’s something.  

Negative reinforcement: Negative means taking something away to address a desired behavior.  It’s rewarding someone by letting them not do something.  I had a teacher in the 6th grade who gave two spelling tests per week.  We had a pretest on Monday, and a posttest on Friday.  The pretest was to introduce the words for the week, and assess the knowledge base of the class.  If anyone got one hundred percent on the pretest, they would also receive an automatic one hundred percent on the posttest, and not have to take it on Friday.  Here’s the thing: the teacher would often say during a lesson, “this is a great word for next week!”  Guess what you could count on needing to learn to spell?  So the desired behavior was that we studied our spelling words.  This was negatively reinforced by not having to take a second test on the words if we got them right on the pretest.

Now for positive punishment.  This means adding something to address undesirable behavior.  The best example I know of is a spanking.  When the kid does something wrong, they receive physical pain.  Remember the first scene of the original Ghostbuster’s movie when Dr. Venkman administered a shock every time the guy gave the wrong answer?  In the movie, Venkman explained that he was testing the effects of negative reinforcement on psychic ability.  What he was actually using was positive punishment.  *sigh*  I forgive you, Dr. V.  It’s only fair after what happened with you girlfriend turning into a dog and all.  Getting back to the example: The wrong answer accounts for the “positive” part of the definition, doing a behavior, while the shock is the “punishment.”  

Last but not least is negative punishment.  I’ll give you a minute to figure out the definition, since I’m sure you’re a pro at this by now…If you said taking something away to address an undesired behavior, here’s a positive reinforcement!  I mean, good job!  High five!  Negative punishment is evident when two children are fighting over a toy, so the caregiver takes the toy away.  Fighting is undesirable behavior, so there’s the punishment aspect.  Taking away the toy is removing something, which is what makes it negative.  

Now you’ve got the terms down.  I’m proud of you!  This is something a lot of people, including mental health professionals, get wrong.  I’m going to do the entries on behaviorism in two parts.  Tune in tomorrow when we’ll talk about what works and why.  Since behavior is simply how we act, the next time someone asks you if you’re behaving, you can honestly answer, “Yes!”  Just hope they don’t ask how.

Be well

Inspiration Porn

Today I want to tell you about something that happened my first week in a new department when I was still working at a state hospital.  I was no longer working on the units because of my Cerebral Palsy, but had started working in a department with no direct patient contact.  At the time, I was using my walker, or even my wheelchair, as needed since I was recovering from a knee injury.  

Every month at the department-wide meeting, a different staff member was supposed to bring in something to promote diversity.  That’s a whole different blog entry, but back to this particular day…the staff meeting went fine, and then it was time for diversity.  The responsible staff member passed around copies of a photo of a man and a little girl, both amputees with new prosthetics (if I am using the wrong terminology, please let me know so I can fix it!). The caption read, “The only disability in life is a bad attitude. -Scott Hamilton”  The staff member beamed at me, and welcomed me to the team.  I half smiled and thanked him, but I was extremely uncomfortable.  I couldn’t put my contracted little bent finger on why though.  Since then, I have come across a term that describes that moment perfectly: INSPIRATION PORN.  Pornography, by the traditional definition, is media depicting erotic or lewd images to evoke sexual arousal by the consumer.  For the purpose of IOI, inspiration porn is depiction of people with disabilities doing things people without disabilities don’t think they should be able to, for the person viewing it to be inspired.  Often the caption will be something to the effect of, “What’s YOUR excuse?”

I find these memes and such problematic for a number of reasons.  The first is that it reduces the person with the disability down to a one-dimensional figure; a caricature.  This is something the media often does to people with disabilities.  We are either the comic relief, the misunderstood villain, or the tragic figure.  All three are shown to overcome their disability by the end of the story.  The person with a disability frequently has little to no backstory unrelated to their disability.  I know this has gotten better in recent years, but it still predominantly the way people with disabilities, both mental and physical will see themselves depicted.  

Second, it implies that because one person can do something it’s perceived they shouldn’t be able to do, anyone can do anything.  It creates unrealistic expectations.  If somebody sets their mind to do something and achieves that goal, then yes, they should be celebrated.  Shout it from the rooftops!  Goals are extremely important, as they keep us moving forward.  They can motivate us and help us focus.  But goals need to be individualized.  I have zero interest in running unless I am being chased by something hairy with big teeth, a spider, or some stranger telling me I inspire them.  So please don’t hold up a picture of someone with leg braces on running to show me what I’m capable of doing.  For certain disabilities, trying to run could seriously injure them.  

Third, it teaches people to see people with disabilities as inspirational.  People I don’t even know have come up to me on the street when I’m using my walker to tell me what a good job I’m doing.  I want to pat them on the head and say, “you are too!  Keep trying!”  Telling me I’m doing a “good job” just getting through my day-to-day life is incredibly condescending.  It reduces me to what they see in front of them: a disabled person using a walker.  It takes nothing else into account.  I default, in that person’s mind, I am the tragic figure they are so used to seeing on TV and in the movies.  No backstory.  I used to have a different coworker who, ever time she’d see me in the hall, would tell me I inspire her.  It had no meaning to me though.  I didn’t inspire her, her idea of me did.  My character did.  

I also have friends and family who tell me I inspire them.  This feels different.  They know me.  They know my strengths and my challenges.  I am a three dimensional being.  They’ve seen me at my best and my worst.  We’ve gone through things together.  We encourage each other, and can laugh our butts off at one another when we fall down, before offering a hand to pull each other back up.  

So instead of “you inspire me,” why not try “Hey! How’s it going?”  Get to know someone.  Pre judging someone for what you perceive to be a positive reason is still pre judging.

My favorite people in my life are the ones who see my disability for what it really is.  It’s a part of me that affects how I live my day to day life.  One of my favorites was when I told a coworker I was going to steal his coffee.  His response was, “Go for it, Gimp.  I can outrun you!”  It may sound awful, but it made my day.  We joked about coffee all the time, being the two most caffeine addicted staff on our ward.  For him to just pull my disability in as just another part of who I am made me feel completely accepted.   

So here’s a special shout out to those incredible people in my life who get it; the people who know all the different things that make me who I am, and love me from the top of my head to the tips of my toes; the ones who are there for all the spasms, laughter, and tears in between; the people who know who I am, and love me anyway.  Here’s my little secret: they inspire me too.

If you say you can't draw, then that's why you need to.

I want to write about something fun today.  The nuts and bolts posts are important, and I hope you are getting useful information from them.   Today I want to get creative.  More importantly, I want you to get creative!  If you are dealing with a mental health diagnosis, this can be a really important way to work with and work through symptoms as they arrive.  But even if you don’t have a diagnosis, this is something I guess I can share with you too.  You’re welcome.

As for me, I really enjoy writing, I always have.  As early as middle school, I wanted to be a writer “when I grow up!” I still want to be a writer when I grow up!  I also love to draw.  Whenever I share my art with someone, 95% of the time the response is the same: “I can’t draw!”  My response is, “when was the last time you tried?”  It’s not about being good at it, it’s about doing what makes you feel good.  I have never sat down with my sketch book, worked in it, and walked away feeling worse.  Drawing and writing are ways that I process.  For me, this means getting me past whatever thought is stuck on repeat in my head.  

Doing something creative allows us to access parts of ourselves we don’t encounter in our day to day lives.  Marc Chagall said that “Art picks up where nature ends.”  I’d like to take this a step further and say that art picks up where words end.  Art is its own language.  Even when we engage in writing as an art form, we are tapping into creativity.  When we access creativity in one aspect of our lives, we start extrapolating it into other areas.  I problem solve while I draw.  I problem solve by drawing.  In the past year, I starting doing art about Cerebral Palsy.  Doing so gave me a sense of control over my disability I’d never experienced.  I decided how it would be depicted on the page.  A monster? A torturer? Something comedic?  It was all up to me.  This made me feel less powerless when I had to do things like take a muscle relaxant.  I figured I’d gotten my digs in, we (the CP and I) could both use a break.

In the town where I grew up and went to college, there was a local folk singer I liked to go see when she performed.  One of her songs was just about having a bad day.  Here’s the first verse, reprinted with permission:

Well it’s a bad damn day 

I got another ticket today

And it’s my third one this week

Leave me alone

And if you see me on the street

Don’t talk to me 

Unless you really have to

Unless it’s an emergency

Like you caught your leg on fire

And can’t put it out yourself

Yeah, only if you really need my help

Cause if you call my name

And you ain’t in pain

I’m gonna be even more pissed off than I am right now.

Who can’t relate to this feeling?  Leave me alone!  My day sucked!  But what this woman chose to do with it was to use the creative method that works for her: writing and making music.  

So maybe it’s writing songs.  Maybe it’s drawing pictures.  It could be slapping some paint down because the colors look like how you feel.  You don’t need a fancy camera to take pictures, use your phone, or a little point and shoot pocket thingie (technical term!).  Writing this blog helps me organize whatever’s bouncing around my cranium that day, and reminds me of things I need to do for my own self care.

Find what works for you.  Make it yours.  Find what expresses what’s left when you’ve run out of words to say.  Make time for it.  You will learn more about yourself.  It’s not about being good at it, it’s about expressing what you need to say when the words leave off.  Figure out how to say what needs to be said.  Draw, sing, dance, take pictures, paint, do improv.  Or you could even…start a blog!

Be well.

Finding a Therapist: Because You're Worth It!

Earlier this week I wrote about what to expect when you’re put on an involuntary hold.  Today I want to write more about long-term help.  I hope that none of you ever get to the place where an emergency hold is necessary.  But if you do, taking the mystery out of the process may make it a little easier.  At least that was my goal.

So now let’s get into the subject of seeking more long-term help.  I wrote yesterday about my psychiatrist and my therapist.  Both of these professionals have been invaluable to my mental health and well being.  Finding the right professional for yourself can be a daunting process.  I strongly suggest to start this process when things are going well.  it makes dealing with any frustrations or setbacks that much easier.  Also, if you are already seeing a professional when things start to go wrong, you already have an established relationship.  When I am not doing well, it’s so much harder to describe my background, and what got me to where I am.  If you already have a therapist and/or psychiatrist, the foundation is there.

So, to go about finding one of these helpers, here are some starting points.  Your milage may vary:

If you are working, see if your employer has an Employee Assistance Program (EAP).  My former employer’s EAP pays 100 percent for three sessions with a therapist.  These three sessions are great for you and the therapist to get to know each other.  It gives you time to start digging into why you are there, and how they can help.  It also gives you some time to find out if that person takes your insurance, and how much they charge.

Your insurance carrier will be able to tell you therapists in your network.  This can be done over the phone, or on the carrier’s website.  This is great if you know you’re going to need for insurance to cover some of the cost.  Understand that some therapists have limits for how many people they will take with certain insurance plans.  Insurance companies also may not have up to date information.  Please try not to get discouraged.  Take a deep breath, and call the next one.

Your primary care doctor may be able to refer you to a therapist.  If they do and you like the person, make sure to let your primary care provider know.  Also let them know if it’s a bad match, if the therapist isn’t taking new patients, or if any other issues arise.  

There are several different websites to help you find a therapist.  If you have unique circumstances, like needing a therapist who speaks a different language, many of these websites will allow you to search by that criteria.  The websites often list specialties of the particular therapist.  These may be things like anxiety, trauma, or substance abuse.

Word of mouth can also be a great way to find a professional.  If you call a professional who is currently treating someone you know, they cannot disclose anything about you to the person who referred you, and vice versa.  In fact, don’t be surprised if they don’t seem to know who you’re talking about if you tell them who referred you.  If whomever referred you tells you how much they are paying, remember that every situation is different.  Some therapists who take insurance will allow you to pay the whole fee out of pocket.  Others have sliding scales.  It is not uncommon for a therapist’s fee to go up over time, but for them to allow existing patients to continue paying the same rate. 
If you find a professional through other means, let me know so I can add it to the list.  This can be a challenging process, but it’s so important to mental health.  Please don’t give up, and remember to stay safe in the mean time.

Be well.

Salutations, Medication!

A few days ago I shared that every 3 months I get shots for my Cerebral Palsy.  They make me feel pretty awful for the first 72 hours.  Recovering from the shots this time got me thinking about medication in general.  

Before I go any further, I am going to assert that I am pro-psychopharmacology.  I believe strongly in treating mental health issues with psych meds.  I know that there is a wide range of points of view on this topic.  That’s a good thing.  It means we’re talking about it, and engaging in an ongoing dialogue.  This is how we learn and keep growing.  Getting back to my own point of view, since it is my blog, I believe that meds play an important role in the treatment of mental illness.  

I began treatment with a psychiatrist after having had my psych meds prescribed by my general practice doctor for years. (I'd tried off and on for a few years to find a psychiatrist, but that's another entry.) After about 6 months of seeing this new doctor, it was clear that a medication I was taking had become problematic. I was really scared to talk to my psychiatrist about it. I really like this doctor, and was afraid of being judged. Instead, I was heard and understood. Being heard and understood is a human need. Shame is one of the most stifling emotions we can have, and the problem I had with the medication made me feel awful about myself. A great weight lifted from my shoulders when my doctor replied to my tearful explanation with, "Clearly this is the wrong med for you. There's nothing wrong with that!" 

If I'd kept my pain and anguish to myself and just tried to power through how the med was making me feel, I could have been in some very real trouble. All it took was speaking up. 

All medications have side effects. Some are so mild, the patient doesn't even notice them. Others are easily managed, and some are tolerated for the benefit of the drug. When a medication is causing side effects that feel as bad, or worse, than the symptom it's supposed to be treating, PLEASE say something!  

Now, here’s the thing about psych meds: they work by treating chemical imbalances in the brain.  For example, a person with Depression has a lower amount of certain neurotransmitters, like Serotonin.  Medication works to fix this.  For a person with Depression to see the best results, however, medication should be part of more comprehensive treatment.  

In addition to my psychiatrist, I also have a therapist.  My therapist and I work together to see patterns in my life that contribute to Depression, and patterns in Depression that affect my life.  We have worked together to help me identify when I am having a depressive episode before it becomes so severe it takes over my ability to function.  When I’m able to identify an episode early on, I can take steps to keep it from getting worse.  From there, my therapist and I look at what I need to do during a depressive episode to start feeling better.  If I don’t do anything at this stage, the symptoms will progress and make it much more difficult for me to reach out and access the help I need.  One of the first things I do is call my psychiatrist, and tell her that I’m having symptoms.  She can then work with me to see what can be done, medication wise, to help me work on feeling better.  My therapist and I work on breaking things down into manageable tasks so that life doesn’t feel so overwhelming.  My Depression tries hard to tell me terrible things about myself, but talking them out with someone keeps me from getting sucked into believing them, or worse, acting on them.

Medication alone will not fix a mental health issue.  Behavior alone will not fix a mental health issue.  Friends and family alone will not fix a mental health issue.  Therapy alone will not fix a mental health issue.  Here’s the big one though: You alone will not fix a mental health issue.  No matter how many times I go through it, I am always pleasantly surprised at how much easier it is once I get my support people involved.  This doesn’t mean it’s easy.  But every time I get through it, I prove that nagging voice in the back of my mind wrong.  

Please don’t be afraid of the meds.  You can’t drive a car without gas, but you still have to do other things to make the car move.  Mental health issues can be made manageable if you can take care of the different components so that they all work together.  One of my first feelings when I start experiencing symptoms is fear.  I am learning that this fear is just my Depression trying to take over before I can send it back from whence it came.  It takes work, but it’s worth it.  You matter.  

Be well.

Who’s driving the bus?

I had a professor in graduate school who used to use this analogy for when mental illness was taking charge of a person’s life.  It’s a good analogy.  The healthy self may still be on the bus and see what’s going on, but not able to get to the wheel, much less take control.

I want to expand on the metaphor in this blog entry.  I believe that each person is a sum of all of their experiences.  The 5-year-old you that got your first spanking with a belt?  She lives inside you.  The 12-year-old  who got teased in school because he was dyslexic and had trouble reading aloud in class?  Right there.  So is the valedictorian, and the man who will never forget how beautiful his wife looked walking down the aisle.  They’re all in there.  Every you that has ever been is on the bus.  Don’t worry, you get to use the carpool lane. Here’s the thing about the bus: Only one gets to drive at a time.

Most of the time, it’s our present day self.  He, she, or your pronoun of choice drives around through your life.  Sometimes other passengers may give input like, “It’s you from last year.  That restaurant gave us food poisoning.  Keep driving!” Or a much younger passenger may get really excited about getting to have the kind of ice cream that was our favorite when we were 7 years old.  For the most part though, we stay in the driver’s seat.  

But then something different happens.  We find ourselves in a neighborhood that looks and feels familiar, but not for a good reason.  We realize we’ve been here before.  This neighborhood smells the same as the aftershave our attacker was wearing.  The light is the same as it was the day of the car accident.  For whatever reason, I don’t like it here, and I certainly don’t like driving through this part of town.  What may happen then is that whichever passenger was driving here before will start trying to take the wheel.  The 4-year-old runs away and hides.  The 19-year-old reacts by getting into a physical fight.  The 30-year-old turns to alcohol.  It’s not an issue of character or strength.  We’re doing what we know how to do.  The thing is, we can boot those past selves out of the driver’s seat just as quickly as they grabbed the wheel from us.  There’s more to it than that though.  This can quickly escalate into a tug-of-war.  When the rope is replaced with a steering wheel, it’s pretty easy for this big, cumbersome vehicle to get into trouble fast.  We need to figure something else out.  I have to keep driving, but 4-year-old me can still watch what’s going on.  What’s really cool is that 4-year-old me can be helped by watching.  He or she can see that just because it feels the same doesn’t mean we’re going to be harmed.  

It doesn’t mean the other passengers never get to drive.  The 21-year-old who felt SO grown up and sophisticated having her first glass of champagne can also feel just as enthralled signing papers for her first mortgage.  Sometimes when we get together with friends and laugh until we cry, it feeds the 10-year-old who loves nothing more that a good case of the giggles at a slumber part after lights out.  The important part though is that our present day self can step right back in whenever he or she needs to.  Keeping our past selves safe is how we heal them.  Uncle may have hurt your 7 year old self, and it hurts and it’s scary to be around him now, even decades later.  But 7 year old self, I will never let him hurt you again.  I will protect you the way no one did when you needed it.  Now you can get on with the business of being 7.  

It’s past Present Day Me’s bedtime, so I’m going to park the bus for the night.  Drive safe, everyone.

Be well.

Time to panic, panic attack!

It's time for the panic attack to start panicking, because we're going to talk about how to get rid of it!
Last time on IOI, I gave a biology lesson and a history lesson, AND managed to put all 4 of my readers to sleep at the same time!  It was a proud day for me.  I started writing about panic attacks and what causes them.  Solving a problem works better if you know what's causing it.  I don't want a bandaid on my broken arm, I want a cast that's going to help the bone heal.  So now that I know what's happening to my brain and my body during a panic attack, I can use my parasympathetic nervous system to make choices to counter the effects. No dozing off over there...I'll try not to do that again.  Probably.

So, there's WAY too much adrenaline in the body thanks to this panic attack and if the body doesn't do anything with it, it's going to feel bad physically.  When it's your body this is happening to, move.  Do whatever you can to move.  If you're in a physically confined environment, like your seatbelt is buckled, your seat is upright, and your tray table is in the locked position, You can still wiggle your toes and fingers.  Roll your ankles, wrists, and neck.  Wiggling toes also works in situations like meetings where you really have to be stealthy.  If you are some place with more options, move more.  Stomp your feet, or at least tap them if stomping isn't safe for you, physically.  Stretch.  Stand up.  Walk around.  Run in place.  Run out of place...you get the idea.

Moving makes your blood circulate faster, so the adrenaline gets moved around, and eventually used up.  But it gets used up in smaller amounts so you're not being flooded anymore.  Also, by focusing your attention on your body, you're no longer solely focused on what was causing you to panic in the first place.  This means your brain can move on from what it had previously thought was a threat, and get back to the business of regulating itself and feeling better.  So now that you've dealt with the physical effects of the panic attack, you can start working on taking some control over your mind.  There are a lot of different ways to do this.  I am going to describe a technique that works really well for me.  If you already have one that you like, by all means, use it!  There are plenty out there, so find what works for you.  My preference is to be able to do this out loud.  But if that's not possible given the situation, it works fine to just think it:
Start with naming 5 things that you see, each prefaced with, "I see..."  Right here at my desk, I see a lamp, I see my computer, I see a glass, I see pencils, I see a notebook.
Next, 5 things that you hear, again, each prefaced with "I hear..." I hear birds, I hear the fan, I hear typing, I hear myself breathing, I hear birds.  Yes, I said birds twice.  It's fine to repeat.  Don't get caught up in what you're saying or how you're saying it.  
Third is 5 things you feel.  This means using your sense of touch, not your feelings.  I feel my glasses on my nose, I feel my back against the chair, I feel my feet on the floor, I feel my fingertips on the keyboard, I feel myself breathing.
Next, say 4 things you see, hear, and feel, using the same method.  Then 3, then 2, then 1.  
What I like about this technique is it gets me present. This way my brain stops paying attention to the threat that was probably never actually going to kill me anyway.  Not only that, but my focus changes to my immediate surroundings and my body.  As I go through each cycle of I See, I Hear, I feel, I become more aware of my body calming down, and going back to its usual functioning.  
Feel free to use this and share it.  I also like to use it at night when I can't shut my brain off and get to sleep.  When I use it for sleep, I almost never make it all the way through the third round.  
I'm so relaxed now, I need a nap.
Be well.

Fighting and flying: why panic attacks rock!

Today seems like a good day to write about anxiety.  It must be because I got 8 shots yesterday.  Talk about anxiety producing!  If you’ve never had an anxiety attack, or panic attack, I am truly happy for you.  They’re awful.  They’re terrifying.  

I have had panic attacks for as long as I can remember.  One thing I am truly grateful for in my professional training, however, is how much I have learned about them, and how to treat them.

First, let’s talk about what a panic attack actually is: an over-engagement of the sympathetic nervous system.  Yep!  Simple as that!  But to break it down further…a very long time ago when we lived in caves, drew on walls with rocks, and were trying to figure out the whole fire thing, life was pretty dangerous.  We got eaten by big animals a lot more frequently than we do now, despite what Shark Week may lead you to believe.  Were it not for fight or flight, we'd have been snack food for lots of different bigger animals, and that would be it for the species.  Human beings are also animals though, and our animal brains do wonderful things to protect us.  This includes our fight or flight mechanism.  We have 5 senses that are constantly taking in information.  The information goes to our brain, and the brain decides what to do with it.  Then the brain sends us into action.  Some of these messages get delegated to the parasympathetic nervous system, which I can override.  My leg itches? My brain tells my arm to move my hand, my hand to curl my fingers, and my fingers to scratch the itch.  If I don’t stop the process, the itch will get scratched.  I can, however, tell that part of my brain, “not now,”  If I happen to be in a situation where I can’t reach down and scratch. I can choose not to do it.  Then there are the things my brain tells my body to do that I don’t get to override.  Remember the sympathetic nervous system from earlier?  That’s where these end up.  Some of these are great!!  They tell my body to do things like breathe, and keep my heart beating.  But when the message is I’M BEING THREATENED AND AM ABOUT TO DIE, everything goes into overdrive.  My ability to feel pain goes down, my heart rate goes up, and I start breathing faster.  All of these are to enable my body to fight off the threat, or to run really really fast to get away from that saber-toothed cat.  What makes all of this possible is adrenaline.  My brain floods my body with the stuff to make everything happen.  So, there’s the mechanics.  Senses take in information, brain decides it’s bad, sends adrenaline to make my body do what it needs to in order to survive.  Somewhere is the last bajillion years, give or take, we stopped having to run away from big cats nearly as often in order to survive.  Our brains, however, have not gotten the message.  So information comes in, brain sends adrenaline, but there’s no need to run, nor fight to the death.  Enter panic attack!  The feeling of my heart racing, my thoughts going too fast, and panting for breath are all brought to me courtesy of my sympathetic nervous system.  My brain has sent enough adrenaline to carry me through the threat.  The thing is though, I don’t need to fight or fly so the adrenaline is all dressed up with nowhere to go, so it starts settling in.  This doesn’t feel good, and it’s why our bodies feel the way they do when we’re having a panic attack, and for a little while after.  

TL;DR: Panic attacks, and what happens during one, kept humans alive long enough for you to be here.

So why the anatomy lecture on a mental health blog?  Because now that we know what’s causing the way we feel, we can be more effective at doing something about it.  I’m going to pause here and break this up into two entries.  Stay tuned for our next episode when our hero (that’s YOU!) will send the panic attack into oblivion and reign victorious once again!  

Be well.

Fighting on multiple fronts

As I mentioned in my first post, in addition to Major Depression, I also have Cerebral Palsy. I am mostly mobile, but feel much safer using a walker.  Today seems like a good day to talk about when medical and psychological diagnoses decide to stake claims on the same person.  
Every three months or so, I get Botox injections for the CP. It works by fully relaxing the muscle, then mildly paralyzing it.  It starts to wear off after a few weeks, and then I get about a month or two of "normal" usage before it starts tightening up again, and it's time for more shots.  To give you an idea of the difference between cosmetic and therapeutic botox, my in-depth research, aka Google, tells me that for crow's feet, one injection averages 10 units of Botulinium Toxin Type A.  (I sound so smart!) For my CP, I get 300 units, divided among 8 injections, give or take.  The side effects are pretty brutal for about the first three days.  I got my shots this morning, so if you're going to throw things my way, throw soft things.  Thank you.
It is certainly not uncommon for a person with a physical disability to also have a mental health diagnosis.  It makes sense, actually.  We experience the world differently, and are exposed to a lot of things our non-disabled counterparts are not.  There's also an alarmingly high prevalence of abuse that happens to people with any sort of disability, but that's a whole different post.  
So this particular post deals with managing a mental health diagnosis and a physical diagnosis at the same time.  The challenges are the same as for a person dealing with one or the other, with more thrown in. To keep life interesting.  For example: I know that something that really helps me when my Depression is bad is to draw.  The Cerebral Palsy, however, may have other plans.  I may not be able to hold a pencil, may not feel like sitting up at my desk, or may be too tired from not having slept the two nights before because the CP felt like being nocturnal. This is why it's so important to have as many things at my disposal as possible that can help with how I feel.  Maybe drawing with a pencil isn't going to happen, but I can take out my tablet, and use a drawing app in whatever position feels most comfortable.  Maybe I can use my equipment to get myself outside.  My shower is accessible for me, and taking a shower is one of my favorite ways to help myself when I am having symptoms of Depression.  
It may not be the CP holding me back from managing the Depression.  They two seem to have a mutual understanding, and take turns.  Gee, how considerate. /sarcasm font.  So when the Depression is making it hard for me to do what I need for the CP, the activities may be different, but the strategy is not: do what I can.  Focus on what makes me feel better, not worse.  I may feel better physically after a walk outside, but the Depression zaps both my energy, and my drive.  The thought of putting on shoes, finding my keys, and going feels like I might as well try to scale the Empire State Building.  But I can still get myself to open the windows, and drink a big glass of water.  Is that going to solve everything? Of course not! I have Depression and CP! But it helps turn down the volume on that nagging voice inside me that tells me I can't. Can't fight, can't succeed, can't do just about anything.  
Keep It Simple, Stupid.  But this time, I'm not the stupid one.  My Depression especially loves to complicate things for me until I feel paralyzed.  Well maybe that's not the right word for a blogger with Cerebral Palsy, but you know what I mean right? So let's make the acronym for ourselves Keep It Simple, Sane.  Sane and simple.  Find what makes sense for you without overcomplicating it.  Find what you can do, and focus on it.  Make lists.  Keep them handy.  I'll write entries in the future about these, but for now, let's keep it simple and sane.  Remember that small successes are just as important as big successes, maybe even more so.  The small ones remind us that we're capable.  We're creative.  We're resourceful.  Take that, Depression.  Okay, time for crackers and ginger ale.  
Be well.

We got some 'splaining to do...

As someone who has worked in mental health, I have had patients describe this to me.   As a woman, a person with a disability, and a person with a mental illness, I have experienced it.  As a human being, I see it over and over.  It’s when person A tells person B what person B’s experience is.  This gets called different things: mansplaining, whitesplaining, straightsplaining…you get the idea.  What I have observed that I find particularly alarming is that the person doing the ‘splaining is the person who belongs to the majority group.  History is written by the winners, but so is the present in this case.  When I first got my diagnosis of Major Depression, I had people whom I know love and care about me, explain what I need to do next.  Apparently their cousin’s girlfriend’s nephew’s bestie has depression, and she started running 5 miles a day and eating more pineapple, and now she’s great!  Or ZOMG, Psych meds are poison!  You can’t take those!  You may feel better mentally, but there’s a .00000001% chance your liver WILL explode.  I like to believe this comes from a well-meaning place.  I think there’s also another motivating factor: No one wants to be powerless.  When we see someone suffering, especially a loved one, it’s awful.  We mean it when we say we’d trade places with them if we could.  So if there’s anything at all that a loved one believes can help, they’re going to cling to it.  When we reject it, they may take it personally.  That’s on them though, not you.  You’re not required to make someone feel better about your illness.  There are a number of ways you can respond to sanesplainers: “Oh! I hadn’t thought of that.  Thanks,” and then get on with your life.  “My doctor/therapist/treatment team/guru and I are making those decisions, but thank you for wanting to help.” Lather, rinse, repeat as needed.  “I had no idea you’d gotten your MD!  If I’d known I would have sent a gift!”  Okay, this one’s getting snarky.  It happens.  How ever you choose to respond, there may be some pushback.  Just remember that you are responsible for yourself, and do what you can to be safe.  After having someone push a Multi-Level Marketing juice as the miracle cure for my CP several times, I’d had it and told him, “you have to stop.  Now.  My friends support me in doing what needs to happen to be well, but they don’t make the decisions.”  We’re not friends anymore, and I am totally fine with that.  

I want to go back for a moment to something that I said earlier.  Our loved ones may be saying these things out of their own feelings of powerlessness.  My suggestion for how to deal with well-meaning sanesplainers goes like this: “I really appreciate how much you want to help.  If our positions were reversed, I’d do anything I could think of to help.  But what I need right now is…” Fill in the blank.  A sandwich? Someone to listen? A ride to your next appointment? A girl’s night or guy’s night out or in?  Again, you are not responsible for taking care of other people’s reactions to your illness.  But these are opportunities for relationship building that will last long after the episode is over.  Please remember to keep yourself safe.  This includes in relationships too.  I know I have a hard time not feeling like a burden to my loved ones when I am not doing well.  But when all is said and done, my time comes around to be there for someone else.  This is the nature of healthy relationships.  As we work through the challenges in times of crisis, we are also working on strengthening our relationships in times of wellness not just with friends and family, but also with ourselves.

HELP! Demystifying Involuntary Holds

So far, I’ve been focusing on things you can do for yourself and your own mental health.  But before I go any further, I want to start addressing the subject of getting help.  First and foremost, let’s talk about emergencies.  

*If you are experiencing a psychiatric emergency, Call your local emergency number, or proceed immediately to the nearest emergency room, provided you are able to do so safely.  Psychiatric emergencies include wanting to kill or harm yourself, wanting to kill or harm someone else, or having already taken steps to do any of the above.  

*When you make contact with someone, don’t worry about what you’re going to say, or how you’ll say it.  Do your best, and let them do their jobs.  The professional will know what to ask, and how to help you be safe. When I was hospitalized, it was because I sought out help.  I went to the local county’s emergency mental health center, and told the intake worker I was having a strong desire to hurt myself, and that I had a way to do it, and everything I needed to get the job done (Professionals call it “means and a plan”).  

*Know that once professionals are involved at the crisis or emergency level, your choices will be limited.  This is not to punish you.  This is what they’re there for.  It’s to keep you safe.  The night I was hospitalized for the first time, I was terrified.  I knew that my life was unraveling from the inside out, and that I couldn’t put it back together myself.  I remember clearly the worker coming back into the room after interviewing me.  He very calmly told me that I was being placed on a 72-hour hold.  He explained that this meant that I would not be allowed to leave, and that I would be transported to a 24-hour facility for assessment and treatment.  My initial reaction was relief.  It was some of the most intense gratitude I’d ever felt.  I was going to be cared for.  I was safe.  It was out of my hands.  I went back and forth between relief and fear many times while we waited for transportation.  

*The upside to emergencies is that they don’t last long.  Dealing with the emergency and its aftermath may last much longer, but the worst of it is over.  I experienced a flood of emotions over the days and weeks following that first night.  But not a single one of them felt worse than when I was trying to deal with it on my own.  It’s okay to be scared.  You’ve earned it!  An important realization for me that first night once I finally got to go to bed was that as scared as I was, nothing was happening to me that was even 1/10th as bad as what my own brain had been putting me through.  

*Whether you believe it or not, there’s someone who is eternally grateful you exist.  When we lose someone we love and care about, there’s a ripple effect that happens for the rest of our lives.  Maybe the losing someone in your life has been a significant part of your own challenge with mental health.  But something inside of you has decided not to set off that ripple effect for someone else.  But once the crisis passes, and it will, you get to see what strength you actually have.  You were just about convinced you couldn’t go on, but you did.  You’re still here, and you’re awesome.  You’re amazing.  You’re honestly a miracle.   

Burning

I’m spending time this weekend with family that live within a couple hours from my place. Where they live was hit hard by a devastating wild fire almost a year ago. I’ve been coming to this area for about a decade. I love it here. I have friends and family, and places that feel sacred to me. Significant life events have transpired here. Driving in today, the devastation was palpable. It emanates from the burnt skeletons of trees. Manzanita trees look wrought iron sculptures. There is nowhere to look without being stared down by harsh reality and grief. Someone I was talking to was lamenting how the fire has changed the community as a whole. She knows 40 people just from one class she takes, who lost their homes. Most have relocated out of the area. Two local destination resorts burned to the ground, displacing hundreds of workers who also lived on the respective sites. 
So here we are, almost a year later. There is new growth. Trees are beginning to repopulate. Homes are being built. People I know who were forced to relocate have discovered new opportunity, and some, profound joy. 
Fire is one of the ultimate equalizers in life. It doesn’t take anything into account except whether something is fuel. Race, ethnicity, gender, sex, sexuality, income, ability, we’re all fair game. Here’s the thing though, it has a purpose. Nature uses fire periodically to clean house. From the underbrush to the tallest tree, it all goes, and makes room for new life. 
I’m not advocating or even suggesting that we run out and become arsonists. In fact, please don’t! But what I’m saying is that sometimes, our biggest and most seemingly devastating changes turn out to bring forth new opportunity like nothing else could. 
My diagnosis of Major Depression came from personal devastation that lead to my first hospitalization. I thought my life was over, and couldn’t see a way out. But I had to get the debris cleared out to lay the foundation for what my life has become today. My choice today is to keep focusing on the burnt out remnants, or cultivate new growth. Fire is going to happen. We all experience our own versions of complete devastation. But as long as we’re not consumed, new growth and determination to survive, then to thrive, will have space to push through.

A New Spin on TMI

It’s been a tough week for a lot of people.  There were two officer-involved shootings that garnered national media attention, as well as a sniper shooting of law enforcement officers at a Black Lives Matter event.  Several people on my Facebook page have stated that they need a break from social media.  I was so happy for those people.  You can’t address a problem you aren’t acknowledging.  
Some people need to feel like they’re plugged in, and well informed.  Go for it!  Some people can handle limited amounts of information, and only at certain time.  Awesome sauce!  Others need time away from media and need to be in control of where, when, and how they get their news.  High five!  Each person has to make the best decision they can for themselves.  TMI indeed stands for “Too Much Information.” 
In this case though, we’re not talking about aunt Sally’s sex swing and feather boa collection.  TMI refers to knowing when you’ve had enough.  Maybe it’s because you’ve started having nightmares.  Perhaps you’re thinking, or even talking, about the event so much, it’s interfering with your ability to do your job, or get your homework done.  It could be that you’re starting to have survivor’s guilt.  Whatever the case may be, it’s okay to turn off CNN, walk away from your laptop, or suggest to your friend that she change the subject when it comes up.  
It doesn’t mean you’re avoiding the topic, as long as you’re doing enough to keep yourself informed to the point you are safe.  For example, if you can’t bring yourself to check traffic in a part of town that’s prone to freeway shutdowns (hi Bay Area!), you’re putting yourself at risk of being caught in a protest that may end up exacerbating underlying anxiety.  Be aware of your reactions and responses when you’re getting information.  Try to get to know yourself enough to keep yourself mentally safe.  Always, and probably most importantly, if you start getting into trouble, have a plan for how you’re going to get out of it.  Safety first, friends!  Remember to put your own oxygen mask on first. 

Planning Ahead

Having a self care plan will be an ongoing topic here at Inside Outside In.  For my own mental health, I have two.  The first, I use when things are starting to go wrong.  Some examples of when I’ve used it are to deal with a panic attack, when my Cerebral Palsy is making me feel bad physically, or when I know I haven’t had enough sleep.  My plan reminds me of safe things I can do to change the way I’m feeling.  I can go sit outside where I live, and I know that this is something that helps me.  Sometimes I feel better if I draw something.  At the very top of my plan are the words “WATER FOOD MEDS.”  This is to remind me that there may be a physiological reason for the way I feel.  It is a cue for me to think about how much water I’ve had that day, what and how much I’ve eaten, and whether I’ve taken all of my meds.  My plan also has a list of safe people I can call or text.  Depression thrives in isolation, and shrinks in company.  My safe people know about my diagnosis, and I can be honest with them about my symptoms.  Right now, there are about 12 things on my plan.  It’s important to make the plan when you are doing well.  It’s also good to revisit it from time to time, and make sure the things you have listed still apply.  If you have a friend listed as a support person and then the two of you have a falling out, when you’re feeling bad is probably not the best time to be reminded of it!

Here’s where it gets a little trickier, but just as important

Next up is the crisis plan.  This is what I use when things have really broken down, and I know I need more help than what I can do for myself.  My spouse knows where it is.  It clearly outlines how they will know that I need outside help.  Some of the these are, “I state that I’m suicidal.”  “I refuse more than 1 meal per day.”  “I skip two classes in a row.”  These are observable things with no ambiguity.  I either eat 2 meals per day, or I don’t.  I state that I’m suicidal, or I don’t  (I always say that I am, when I am.  If you don’t, then it’s not appropriate for your plan!).  Next up is what I want my spouse to do, and how to do it.  I have phone numbers listed, and what to tell that person.  Examples of useful numbers may be your physician, therapist, or psychiatrist.  Maybe you’re really close to your step-mom, and want her to know immediately if something is wrong.  It’s totally up to you.  Just as important are the people you don’t want called.  It doesn’t necessarily mean they can’t help in the future, it just means this is not a call to be made during the crisis.  The next item on my plan is where it’s okay to take me.  There is a hospital in my area I will not go to.  There are a couple of other facilities where I feel comfortable, and would want to be taken.  This is all spelled out in my plan.  I have a list of what I need to bring with me (sweat pants, t-shirts, underwear, my box of medications, my favorite book, etc).  Now, here’s a biggie: at the top of my crisis plan, I have written: “IF (my name) REFUSES TO FOLLOW THE CRISIS PLAN, I GIVE PERMISSION FOR EMERGENCY INTERVENTION.”  I’ve signed it at the bottom.  So, there it is.  It’s out of my hands, and my spouse’s.  It’s spelled out very clearly what to do when.  Yes, this is a modified version of published material.  I’m writing about what I’ve found helpful.  

TLDR: The three most important points are: 1)  Have a plan for when things start to go wrong, 2) Have a crisis plan, 3) Share the crisis plan with someone you trust.