365 Days of gratitude

gratitude word graphic with woman holding arms open toward the sky

I have been keep a daily gratitude log in my bullet journal, and so far I’ve only missed one day this year (because I was working nights and confused about what day it was).  I try to come up with something new each day, although I’m not always feeling creative enough for that, and some things I’m so grateful for that a single mention just isn’t enough.  Here are some of the things I’m grateful for that have made it into my journal so far:

  • the sun
  • the blue of the ocean
  • my amazing Grandma
  • lots of guinea pig behaviours: the way they beg for food, the noises they make, their funny sleeping positions, the games they play with each other, and of course their cuddliness
  • going for massages regularly
  • treats from Starbucks
  • my comfy cozy home
  • aromatherapy
  • blogging and the WordPress community
  • that I have a doctor I feel comfortable with
  • nights that I get lots of sleep
  • for the natural beauty I see right outside my window, including the birds nesting on my balcony in the spring
  • my friend who supports me even when I’m upset
  • a somewhat odd assortment of food, including pancakes, chocolate pudding, apple pie, baguette with brie cheese, and Raisin Bran
  • cozy socks and slippers to keep my feet warm
  • occasions when I’ve been able to help others

 

What are some of the things you’re grateful for?

 

Image credit: johnhain on Pixabay

Advertisements

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I worked 6 night shifts at one of my jobs.  One of the shifts was a last-minute overtime shift which meant I couldn’t stick to my normal medication and sleep schedule.  I was reminded that I can’t sleep if I don’t take medication, no matter how exhausted I am.  It’s hard to say how much of that is the effects of depression and how much is because my brain is used to having drugs.  Regardless my brain on no sleep is not a pretty place, and I’ve been pretty low-functioning for the second half of the week.  Overtime makes for damn good money, though.
  • At that same job, I saw on the schedule that in a couple of weeks a new hire is going to be orientating to night shift, and rather than schedule this person to orientate with me, they’ve booked the person to orientate on a different unit with another casual nurse who’s only 3 months out of nursing school.  Now I don’t have any desire whatsoever to orientate new staff, but I’m sensing an underlying not-so-subtle message here; this isn’t the first time they’ve made it clear that they don’t want new staff orientating with me.  Fuck that place is obnoxious.
  • I’m fairly certain my other job is going to cease to exist.  HR has set up a teleconference for all staff in my program on Monday, so I should find out then what’s up with the suspicious hints lately.
  • I saw my doctor for the first time in a few months.  I didn’t really feel like I had anything to say.  I told him I was doing fairly ok most of the time.  He wasn’t totally convinced, but he said I looked good so he would let it go.  Normally I’m not a fan of the “you look good” routine, but he’s consistently observed that when I’m struggling I don’t even try to put on a mask with him so it’s quite visible, so in this particular situation it didn’t bother me.
  • I had dinner with my brother, and while it wasn’t quite as painful as the last time I saw him, it was still uncomfortable.  He was telling me about some of our parents plans that came as news to me, and it bothered me that I was hearing this stuff via my brother rather than directly from my parents.  Pretty much all my parents ever tell me is where they’ve gone out to eat or what they’re watching on Netflix.  I’ve been feeling alienated enough from them all ready, and now I feel that even more so.
  • I decided to go ahead and book a flight to Italy for October.  I’ve been contemplating it for a while now, and I finally came to the conclusion that I was never going to feel fully comfortable making a decision, so I might as well just go for it.  And I’m flying on points, so if I end up cancelling the flight it’s not the end of the world.

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… judgementality?

psychology word graphic in the shape of a brain

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: judgementality

Shortly after I scheduled this post in my queue, I saw a post on the same topic on Scarlett’s BPD Corner.  I figure a topic must be a pretty good one if it’s on multiple people’s minds at the same time.  [As a quick spelling geek comment, judgementality is spelled with an e after the g, while judgmental is more commonly spelled without an e.  I also had to look up what the noun version of the adjective judgmental would be, because I really didn’t know.]

According to Psychology Today, being judgmental involves getting satisfaction out of making negative moral assessments of other people.  This serves to increase the judgmental person’s sense of self-worth by establishing that they are better than others who fail.  The judgmental person may quickly leap to conclusions, and move from an assessment that another person’s actions are wrong to a view that the person as a whole is flawed.  Humanistic psychologist Carl Rogers recognized the negative impact of judgementality, which was why he believed therapists should demonstrate unconditional positive regard.

We all consider the world through an evaluative lens, and Psychology Today suggests several factors come into play in determining whether this is being done in a constructive or destructive way:

  • the use of empathy to understand where the other person is coming from
  • the values-frame dynamic: whose values are being used to frame the judgment and why?
  • the power dynamic: how much influence do your judgments potentially carry?
  • the person vs situation dynamic: is this a selfish person or a person being selfish in this particular situation?
  • the person vs act dynamic: distinguishing between the person and their actions
  • the open vs closed dynamic: are we open to changing our evaluation if new information arises?
  • the shallow vs expert knowledge dynamic: a strong evaluation shouldn’t be based on limited knowledge

Another Psychology Today article points out the distinction between making an observation such as “he talks very slowly” and adding a judgmental conclusion to the observation “he talks very slowly, therefore he must be stupid.”

Being judgmental isn’t something that’s generally seen as desirable, but we all do it to a greater or lesser extent.  I think mental illness makes us particularly likely to pass judgment on ourselves, but perhaps it makes us less likely to be judgmental about the challenges that others are facing.  I see a difference between judgment that is kept internal and judgment that is acted on externally.  A lot of the judgments I make remain with the inside-my-head voice and don’t spill over into my interactions with people.  I also try separate general observations of broad groups from specific individuals (e.g. in the case of racial stereotypes about bad driving).  If I think someone is batshit-crazy for their religious or political beliefs, I try to keep in mind that is only part of who they are and don’t extrapolate to them being batshit-crazy full stop.

I struggle with passing judgment on others’ intelligence (or more specifically, lack thereof).  I’m a fairly intelligent person, and there are a lot of stupid people out there in the world.  I sometimes feel kind of guilty about this, since it seems so snobbish, and I’m not always sure where the line lies between making an observation and being critical.

In my work I think I probably struggle the most with being judgmental regarding antisocial types.  My clinical approach is to give a very controlled, matter-of-fact non-reaction when they talk about their criminal and other assorted nasty behaviour, but on the inside I’m thinking damn this dude is a scumbag.  So much for empathy.

I think it’s not a bad idea for all of us to give some thought to our own particular flavour of judgementality and whether it’s helping or hindering us.  What are some of the contexts in which you find yourself passing judgment on others?

 

Sources:

https://www.psychologytoday.com/us/blog/bringing-sex-focus/201204/whos-judmental-five-key-symptoms

https://www.psychologytoday.com/ca/blog/theory-knowledge/201305/making-judgments-and-being-judgmental

https://www.psychologytoday.com/us/blog/think-well/201801/are-you-good-judge-or-just-judgmental

Image credit: GDJ on Pixabay

The best things in life are free

shaggy yak

The world is pretty darn expensive these days, especially when income is limited related to our mental illnesses.  But there are some pretty cool things that can be done for free, and here’s a few that I’ve come up with:

  • You may wonder why I’ve chosen a shaggy yak picture to go along with this post – well, it’s because the internet allows you to find free photos of anything you could possibly want (and I mean who wouldn’t want a shaggy yak)
  • Speaking of the wonders of the internet, it allows you to learn about just about anything at no cost
  • Snuggling with animals
  • Reading (the local library is my go-to for books, and I love that my library has ebooks that can be checked out)
  • Writing
  • Watching nature
  • Thinking about the mysteries of the universe
  • Listening to things like raindrops falling, the wind blowing through the trees
  • People-watching
  • Walks in the sunshine
  • Daydreaming
  • Singing along to your favourite songs
  • Love (cue J.Lo song My Love Don’t Cost a Thing, but don’t cue the video because I find it annoying)

What are your favourite free things to do?

 

Image credit: hbieser on Pixabay

Book review: Furiously Happy

book cover: Furiously Happy by Jenny Lawson

In Furiously Happy: A Funny Book About Horrible Things, Jenny Lawson uses “furiously happy” as a weapon to counter mental illness, and intends to “destroy the goddamn universe with my irrational joy and I will spew forth pictures of clumsy kittens and baby puppies adopted by raccoons and MOTHERFUCKING NEWBORN LLAMAS DIPPED IN GLITTER AND THE BLOOD OF SEXY VAMPIRES.”  This is my kind of gal, someone who doesn’t let depression stop her from embracing her quirkiness and finding humour in the world around her.

Some chapters talk specifically about mental illness, but the majority are funny anecdotes.  The book is jam-packed with all kinds of critters ranging from living to taxidermied to costumes, including Rory the scary as hell taxidermied raccoon on the front cover.  There are also random observational rants, e.g. about female clothes not having pockets, and a pocketbook being neither pocket nor book.  She talked about being bewildered by a Japanese computerized toilet, leaving me wanting to shout me too soul-sister!

She challenges some of the stigma around mental illness and its treatment.  She sarcastically observed that if someone’s cancer returned, “it’s probably just a reaction to too much gluten or not praying correctly.  Right?”  And then there was the gem about dealing with medication side effects “which can include ‘feeling excessively stabby’ when coupled with some asshole telling you that ‘your medication not working is just proof you don’t really need medication at all.'”

You know those silent moments that crop up every so often when you’re seeing your therapist?  Jenny knows how to fills those awkward silences with panache, with such observations as: “Is it normal to regret not making a sex tape when you were younger and your boobs still pointed vaguely at the ceiling when you were on your back?  Because I feel like no one ever talks about that.”

She points out that seemingly having it all doesn’t mean not being depressed of anxious.  She admitted that “I only have a few days a month where I actually feel like I was good at life…  The other days I feel like I’m barely accomplishing the minimum or that I’m a loser.”

I don’t usually rely quite so heavily on quotes when writing reviews, but Jenny’s words are far funnier than mine, and I wanted to share some of my favourites.  This book is laugh out loud hilarious, and a delightfully sneaky way of attacking stigma without being  primarily about mental health.  You will read more about taxidermy than you could ever imagined, and you might even be tempted to get your very own taxidermied armadillo purse (yup, that’s a real thing, Google it).

 

You can find Jenny on her blog The Bloggess.

 

You can find my other book reviews on my blog index.

Image credit: Amazon

The way the media talks about suicide matters

cartoon face shushing surrounded by the word suicide

The way the media reports on suicides can affect the likelihood of the suicide contagion (or “copycat”) phenomenon.  There are a number of organizations that have put together media guidelines for reporting on suicides, and this is a summary of some of their recommendations.

Do’s:

  • include local crisis line information and other community resources
  • include warning signs and information about what to do
  • report on suicide as a public health issue
  • get information from suicide prevention experts
  • use the terms “died by suicide”, “completed suicide” or “killed him/herself”
  • look for links to broader social issues
  • if possible provider education the links between suicide and other issues such as mental illness and substance misuse
  • avoid the use of language that normalizes suicide or presents it as a solution to problems
  • word headlines carefully, and avoid using the word “suicide”
  • be particularly careful when reporting celebrity suicides
  • avoid printing a photo of the person who completed suicide, and if one is used it should not be displayed prominently

 

Don’ts:

  • don’t use sensationalist headlines
  • don’t use prominent placement (e.g. front page) or undue repetition
  • don’t use photos of the location/method of death, grieving friends/family
  • don’t describe a suicide as inexplicable or without warning
  • don’t quote/interview first responders about cause of suicide
  • don’t describe suicide as “successful” or “unsuccessful”/”failed”
  • don’t report specific details of the method
  • don’t offer over-simplified reasons for the suicide
  • don’t romanticize the suicide
  • don’t present a melodramatic depiction of suicide or its after-effects on others
  • don’t label certain locations as “hot spots” for suicide
  • don’t use hyperbolic descriptions like “suicide epidemic”
  • don’t publish suicide notes

 

Sources:

reportingonsuicide.org

Canadian Association for Suicide Prevention

Samaritans

World Health Organization

 

Image credit: geralt on Pixabay

Where to go for insider knowledge on psychiatry

"knowledge is power" written on a chalkboard

Health professionals are required to continually update their knowledge related to their field of practice.  One of the nice things about the digital age is that it’s easy to access continuing education activities online, and many of them are available at no cost.  I freely admit that I’m a geek and I love learning new things, so I thought I would share some of the sites that I use to keep up to date.  Since they’re geared toward health professionals rather than the general public some of the more in-depth info might be a little hard to follow, but I think it could still be informative.

I hope you find something that’s of interest to you 🙂

 

Image credit: geralt on Pixabay

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I worked five night shifts, but I stuck firm to my sleep schedule so it’s been ok.
  • There have been indicators that make me suspect that for one of my jobs the particular program I’m working in is going to get shut down, which would mean bye-bye job.  I’m just trying not to think about it.
  • I’ve done very little writing this week.  I just haven’t really been focused enough for it, plus working full-time hours gets in the way of both reading and writing.
  • I finally started looking at the Italy guidebook I bought several weeks ago.  It takes me one step closer to actually making a decision to do a trip in the fall.
  • I’m not usually prone to migraines, but I had a nasty one on Thursday that involved pulling over to throw up on the side of the road.
  • My guinea pig Oreo is quite the resilient munchkin.  She wasn’t feeling well at the beginning of the week and I was quite worried about her, but now she’s back to her happy self.  I wish I could bounce back that easily!
  • It seems to be getting easier to make small talk when it’s expected.  I guess appearing to be more polite is probably a good thing.
  • I’ve let meditation fall by the wayside.  When I think about it I sort of feel like I should try to pick it up again, but at the same time I’m having a hard time caring enough.  I have been trying to be more mindful of the sounds of nature.  Last night it rained quite hard and the sound of it was so soothing.
  • I didn’t make it to yoga this week, but I had a massage and got out for a walk most days.
  • Some goings-on on my balcony: From my 2nd round of attempting to plant a  balcony garden, I’ve got a little itty bitty basil sprout, which counts as success in my books.  And the woodpeckers that were hanging out on my balcony in the spring had disappeared for a few months but are back now

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… Self-esteem

psychology word graphic in the shape of a brain

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: self-esteem

Wikipedia defines self-esteem as “reflects an individual’s overall subjective emotional evaluation of his or her own worth”.  It reflects a person’s beliefs about the self and emotional states.  Self-esteem is seen as a predictor of outcomes such as academic achievement, happiness, and interpersonal relationships.  While there may be short-term variations, self-esteem is thought to be an enduring trait.  Self-esteem is heavily influenced by life experience, particularly childhood experiences.

People with high self-esteem firmly stick to their values/principles, trust their own judgment and problem-solving abilities, and are sensitive to the needs and feelings of others.  People with low self-esteem tend to be self-critical and hypersensitive to criticism from others, are indecisive and fear making mistakes, tend to be perfectionistic, tend to feel guilty, and have a negative general outlook.

The last time I was in hospital, one of my doctors was a quacky psychoanalytic type.  He was telling me I needed to do this psychodynamic therapy-based group after discharge, and the part of the group he thought I needed most was the module on improving self-esteem.  I told him that when I’m well my self-esteem is actually quite good, and he condescendingly explained that no, it was not, because if I had good self-esteem I wouldn’t have attempted suicide.  I would’ve slapped him upside the head except that’s generally not the best approach with someone who has the final say in your discharge.

It’s true, though.  When I’m well I have good self-esteem.  I know myself well, am comfortable in my own skin, know what I’m good at and not good at, and I’m fiercely independent, which makes it easier not to spend much time worrying about what other people think of me.  I suspect a lot of that comes from a very well-adjusted childhood.  Affection was never lacking.  School was easy for me and I did well at it, and this was very positively reinforced by my parents.  By the time high school rolled around I felt pretty far removed from the world of the “in crowd”, but I was comfortable in my little niche.  From a young age I wanted to do things my own way, whatever that might be, and again, this was something that was encouraged by my parents.

Being stuck in a prolonged depressive episode, my self-esteem has suffered.  I don’t know this depressed self as well because she’s an unpredictable, fluctuating self.  The things I used to know I was good at are now so much harder and are not predictably reliable.  Some of the things that used to make me me feel hidden away somewhere.  I’m not always self-critical, but I’ve become ultra-sensitive to criticism from others.  Strangely, though, while I’m sensitive to the criticism that is wielded outwardly as a weapon, I don’t care that much about what people might think about me.  As long as it stays inside their heads, I don’t place a lot of value on what others think, in large part because in general I hate people (thanks to the depression).  It doesn’t make a lot of sense, but that’s the best explanation I can come up with.

Has your self-esteem been influenced by your illness?

 

Source: https://en.wikipedia.org/wiki/Self-esteem

Image credit: GDJ on Pixabay

How not to be supportive

hand statue supporting tree branch

I think most of us probably have a few of them in our lives: the people that want to be supportive, but they’re just way off the mark.

The fixer:  This is the person who wants to figure out how to solve your problems because then you’ll no longer have anything to be mentally ill about, right?

Have you tried… ?  My aunt’s neighbour’s dog’s best friend said that going out for a walk every day made them feel much better.  You should try it!

Other people are worse off:  This is the “children are starving in Africa” argument.  As if by reminding you how bad some people have it they’ll magically convince you that you’re not actually mentally ill after all.

It’s not so bad…  Oh, you’ve been bullied, that’s really sad, but look on the bright side, you didn’t get physically assaulted.  Cheer up!

It’s normal to feel that way:  Anyone would feel badly if they had to deal with [shitty situation x], it’s normal!  No need to worry about it!

Are you taking your medication?  I get this a lot from my family, because they don’t seem to understand that I can be unwell and still be taking my meds as prescribed.

You look really good:  This is the good old assumption that if you look good, then you can’t be sick.  Maybe if you’re reminded of this often enough you’ll realize that you were just confused and you must not be sick after all.

Try to focus more on the positive:  Thank you.  Perhaps I will need to remove my pink unicorn horn from where it is shoved up my ass and use it to stab you in the eye – now that would be positive.

 

In many ways I find it easier to ignore the people who are saying stupid things out of stigma, because I can write them off as being dumb-asses.  I’m less sure how to handle the people who are well-intentioned but clueless.  It’s not exactly polite to ask people who hit them with a stupid stick.  Sometimes I think it’s easiest to just let things slide and try to focus on the good intentions rather than the crap that comes out of the mouth.

What are some of the well-meaning but ignorant comments you’ve gotten?

 

Photo by Neil Thomas on Unsplash

Evidence-based treatment of anxiety

path forks into 3 possible decisions

In this post I’ll take a look at some of the available treatment guidelines for anxiety disorders.  While psychotherapies are extremely important in the management of anxiety disorders, this post will focus only on anti-anxiety medications.  The treatment guidelines I refer to come from the British Association for Psychopharmacology and the World Federation of Societies of Biological Psychiatry.

Benzodiazepines, while effective, are generally only recommended for short term use or where other treatments have failed, and there should be a careful consideration of the risks vs benefits for the specific individual.

Generalized Anxiety Disorder

It may take up to 12 weeks to achieve full response to antidepressant medication, but if there is no response at all after 4 weeks it is unlikely that particular medication will start to work with a longer duration of treatment.

1st line: SSRI (selective serotonin reuptake inhibitor): citalopram, escitalopram, paroxetine, sertraline

Alternatives to SSRI: SNRI (serotonin and norepinephrine reuptake inhibitor: venlafaxine, duloxetine), pregabalin (high dose may be more effective); quetiapine may be effective as monotherapy at doses of 50-300mg/day

2nd line: agomelatine, quetiapine, some benzodiazepines (alprazolam, diazepam, lorazepam), imipramine (a tricyclic antidepressant or TCA), buspirone, hydroxyzine (a sedating antihistamine), trazodone

 

Panic disorder

It may take up to 12 weeks for medication to fully take effect.  When discontinuing medication after long-term treatment a lengthy gradual taper is recommended (over at least a 3 month period).

1st line: SSRI

Alternatives: some TCAs (clomipramine, desipramine, imipramine, lofepramine) venlafaxine, reboxetine, some benzodiazepines (alprazolam, clonazepam, diazepam, lorazepam), some anticonvulsants (gabapentin, sodium valproate)

Avoid: propranolol, buspirone and bupropion

 

Social Anxiety Disorder

It may take up to 12 weeks for medication to fully take effect.

1st line: SSRIs

Alternatives: venlafaxine, phenelzine, moclobemide, some benzodiazepines (bromazepam, clonazepam) and anticonvulsants (gabapentin, pregabalin), and olanzapine

Avoid: atenolol or buspirone in generalized social anxiety disorder; beta blockers can be effective for performance anxiety but not social anxiety disorder in general

 

Obsessive Compulsive Disorder

1st line: SSRI (may need a high dose)

Alternative: clomipramine

Add-on treatment: atypical antipsychotic, haloperidol, mirtazapine (may speed up response to citalopram)

 

What has your experience been like with anti-anxiety medication?

 

Image credit: 3dman_eu on Pixabay

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I worked 4 night shifts this week and only had one client for my other job, and it all went smoothly.  I wonder, though, about people who leave a mess for their coworkers to clean up.  Did they grow up in a barn or do they just not give a shit?
  • Someone did something that upset me, but I was able to make a conscious choice to keep my reaction contained (as opposed to a shove it under the rug and ignore it choice).  That felt like progress.  Of course I later ended up ruminating about it for a few days, so there’s definitely still work to be done.
  • I’ve been craving sugar, and giving in to those cravings more than I probably should.  Ever since I had a big dip in my mood a few weeks ago I just haven’t cared enough to try to throw healthy food into my body.  I just want gummy bears.
  • I was reading through my WordPress reader and came across an article about the same topic I’d written a couple of weeks ago.  I started reading, and realized that most of the words were mine.  Entire paragraphs of words were mine, verbatim.  Now I’m totally cool with people reblogging my work or using an idea of mine to create their own post, but this was full on plagiarism.  And when I called the person out on it, they denied it.  The whole thing left a rather yucky taste, particularly because not only were they passing off my words as their own but also my thoughts, feelings, and experiences.
  • Went to yoga once and out for a few walks.
  • My weekend wrap-up posts come from my weekly summaries in my bullet journal. I had been including sections for goals and self-care, but I haven’t been keeping that up over the last few weeks.  It’s time for that to change, and today I wrote out my goals for next week.

 

That’s about it; it’s been a pretty quiet week for me.  How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… the Myers-Briggs Type?

psychology word graphic in the shape of a brain

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: Myers-Briggs Type

The Myers-Briggs Type Indicator (MBTI) was created by mother-daughter team Katharine Cook Briggs and Isabel Briggs Myers, neither of whom had formal training in psychology or psychometric testing.  The test was partially based on Jungian personality theory.  It’s not considered to have strong psychometric properties due to poor validity and reliability.  For each of the 93 questions posed, the test-taker is given a choice of two possible responses.

There are 16 types based on a combination of 4 letters:

  • Introversion / Extroversion: expending vs drawing energy from outward action
  • iNtuition / Sensing: relying on hunches vs concrete/tangible information
  • Feeling / Thinking: decision-making from an empathetic or logical perspective
  • Perception / Judging: reflects preference for using sensing/intuition or thinking/feeling function when relating to the outside world

The actual MBTI is copyrighted and isn’t available for free, but there are a number of adaptations that are free: 16Personalities, PsychCentral, Truity, and Humanmetrics.  Three of these told me I’m an INFJ, while one told me I’m an INTJ.  They all showed I lean heavily toward introversion and judging, while I had relatively more balance between intuition/sensing and feeling/thinking.

In general, I’m not all that keen on these sorts of typologies.  Yes, they can give us a clearer picture of how we tend to interact with the world, but I’m not convinced that all people can be divided up among 16 neat little boxes.  We all have natural tendencies, but it seems overly simplistic to think that we are unlikely or unable to venture beyond that.

What are your thoughts on the Myers-Briggs Type Indicator?

 

Image credit: GDJ on Pixabay

Should mental illness be used to explain bad behaviour?

illustration of an angry germ

When people see and hear statements or actions by others that seem to make no sense or are morally abhorrent, all too often mental illness is tossed around as a possible explanation.  Take mass shootings, for example.  For someone to do something like that, they must have something wrong in their heads, they must be disconnected from reality, they must have mental illness, right?  Yeah not so much.  Yet far too many people don’t understand this.  I even remember speaking to a fellow mental health nurse several years ago who thought mass killers must be psychotic to do something so unimaginable.  If even someone that works in mental health is that misinformed, is it any surprise that the average idiot out there in the world doesn’t get it?  I’ll warn you right now, this post is perhaps not the most cohesive; instead it touches on a variety of unpalatable subsets of the population that have crossed my mind recently.

It seems as though there are a lot of angry white men making themselves visible these days.  They come in a variety of flavours, including neo-Nazis, but it was only after a recent mass killing in Toronto that I became aware of the term “incel”, or involuntary celibate. This particular breed of asshole blames women who won’t sleep with them for all of the problems in their lives.  Men who have expressed such sentiments have engaged in mass killings in the past, but the incel term was new to me.  Apparently in November 2017 Reddit banned an incel subreddit due to violent content.  Some of this lot believes that women who are having sex but aren’t willing to have sex with them (Stacys) should be punished, and deserve to be raped.  Men (Chads) who are getting laid are another target of their violent ideation.  The incel mindset is repulsive and abhorrent, but that doesn’t mean that there needs to be a “thinking too much with your penis” mental illness whipped up to describe these characters.

Pyschopathy isn’t a diagnosis in the DSM, although its closest equivalent would be antisocial personality disorder.  Much of our understanding of psychopathy comes from Dr. Robert Hare, who developed the Hare Psychopathy Checklist (more info here).  A psychopath knows exactly what they’re doing.  They know that things they do are considered “wrong” by society, but they just don’t care; it’s not their problem.  While many psychopaths are criminals and end up in prison, there are also psychopaths leading apparently successful lives.  In my nursing career I’ve only encountered one patient who was quite clearly a psychopath.  He was a master puppeteer, and it was chilling to see how he smoothly manipulated the world around him, using violence whenever it suited his needs.  There is some debate as to whether psychopathy is a form of mental illness, but unlike mental illnesses which tend to impair one’s control, psychopaths have the control of a finely tuned orchestra.  The psychopath is very much in touch with (and in control of) reality.

Pedophilic disorder is listed in the DSM, and my personal prejudice is to call BS on that. To me it’s along the lines of homophilia, which was previously included in and then removed from the DSM.  Haven’t we established that sexual preference is not a mental illness?  People can fantasize about whatever they want in their heads, but I strongly believe that the monsters who act on pedophiliac fantasies do not deserve the excuse of getting a mental illness diagnosis.

There’s lots of talk on the internet about narcissists and narcissistic abuse.  This has always concerned me a bit.  First, let me say that my issue is not with those who talk about being victims of narcissistic abuse; I don’t in any way doubt that these people have experienced serious psychological and emotional abuse.  What I question is whether it’s useful or appropriate to attribute the abuser’s behaviour to a personality disorder, particularly when it would seem that in many cases a diagnosis of narcissistic personality disorder is not something that’s been made by someone qualified to do so.  I feel like it’s a slippery slope that seems to take responsibility for one’s actions away from the abusive individual’s conscious intentionality.  I’m guessing that it’s a way for those who have been victimized to understand and contextualize their experience, but I would worry that focusing on the abuser’s mental health (or lack thereof) shifts focus away from the abuse victim’s own mental and emotional wellbeing and the attention it deserves.

Unfortunately the world we live in includes some pretty despicable human beings.  When mental illness is implicated in their horrible acts, this is likely to only further promotes stigma.  Sometimes an awful person is just an awful person, end of story; no need to drag mental illness into it.

 

Image credit: OpenClipart-Vectors on Pixabay

Book review: Daring Greatly

Daring Greatly by Brene Brown

In Daring Greatly, Brene Brown borrows the words of Theodore Roosevelt to encourage us to find the courage to be vulnerable.  Vulnerability, which she says encompasses uncertainty, risk, and emotional exposure, “sounds like truth and feel like courage”.  The book takes a very common sense, practical approach.  Findings from the author’s extensive research are presented, and this is done in a way that is engaging and didn’t feel like reading about research.

The author challenges several myths about vulnerability, including the idea that it is a weakness.  She points out that daring greatly requires challenging shame and the gremlins it fills our heads with.  She has come up with term “gremlin ninja warrior training” to describe how to build shame resilience; this includes recognizing shame, talking about how you feel, and reaching out for help.

She identifies varies strategies (e.g. perfectionism and numbing) that we use to shield ourselves from vulnerability, and ways that we can break down those shields that are holding us back.  She believes that disengagement underlies many social problems, and this is influenced by the gap between our the values we practice and the values we aspire to.  She offers “minding the gap” as a daring greatly strategy to combat this.

The section on rehumanizing education and work resonated particularly strongly with me, as I have experienced workplace bullying.  A culture of shame in the workplace may be demonstrated through behaviours such as blaming, gossiping, favouritism, name-calling, and harassment.  It can be even more overt when shame is used as a management tool through the use of “bullying, criticism in front of colleagues, public reprimands, or reward systems that intentionally belittle people.”  This kind of shaming “crushes our tolerance for vulnerability, thereby killing engagement, innovation, creativity, productivity, and trust.”

There is also a chapter devoted to parenting.  Parenting has been shown to be a key predictor in how susceptible children are to shame, and children need to experience compassion, connection, worthiness, and belonging, not fear, blame, shame, and judgment.  None of the recommendations she makes are new and earthshattering, but they are all powerful and remind us to be aware of the messages we are conveying and behaviours we are modelling.

Society often tells us that being vulnerable is a sign of weakness.  This book does an excellent job of challenging that and demonstrating how courageous and powerful being vulnerable really is.  Mental illness in particular tends to make us fearful of being vulnerable, and this book offers some very good food for thought.

If you’re interested in finding out more about Brene Brown’s ideas on vulnerability, you can find her TED Talks here.

 

You can find my other book reviews in my blog index.

Image credit: Amazon.com

What the STAR*D study means for depression treatment

brain shining like a star

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial studied 2876 people with major depressive disorder to evaluate their response to depression treatment in a real-world setting.  Unlike the randomized controlled trials that are often used to evaluate a drug’s efficacy, there were few exclusion criteria, the patient and their physician knew which drug they were taking, and patient choice was incorporated.  Four sequential levels of treatment were established, and if a patient failed to achieve remission after 12-14 weeks, they would be moved to the next level.  The target was full remission, unlike many other studies which measure response (i.e. a ≥50% reduction in symptom rating scale scores).  Remission rates can be substantially lower than response rates, but are useful because there are better long-term outcomes for people who do achieve full remission.

Level 1 treatment consisted of citalopram, and 28% of patients achieved remission based on the Hamilton Rating Scale for Depression (HAM-D).  Certain factors were identified, such as other comorbid mental illnesses, that were associated with lower or higher remission rates.

In level 2, patients were offered cognitive psychotherapy, a switch to another antidepressant (randomly selected), or the addition of another medication to augment the treatment.  Among level 2 patients who switched to another medication, remission rates were 21.3% for bupropion, 17.6% for sertraline, 24.8% for venlafaxine.  Rates were similar among those patients who switched to cognitive psychotherapy.  Among the patients who received augmentation treatment, the remission rates were approximately 30% for both bupropion and buspirone.  Augmentation with medication produced more rapid remission than augmentation with cognitive psychotherapy.

In level 3, patients who switched medication were randomly assigned to mirtazapine or nortriptyline, and patients who received an medication for augmentation were randomly assigned to lithium or the T3 form of thyroid hormone (liothyronine).  Remission rates were 12.3% for mirtazapine, 19.8% for nortriptyline, 15.9% for lithium, and 24.7% for thyroid hormone.

In level 4, patients were randomly assigned to switch to either tranylcypromine (an MAOI antidepressant) or venlafaxine plus mirtazapine.  Remission rates were 6.9% for tranylcypromine and 13.7% for venlafaxine plus mirtazapine.

Altogether, 67% of patients were able to achieve remission.  The study found that people may still remit by 12 weeks even if there’s only a modest symptom reduction at 6 weeks.  However, the more treatment steps that are required, the lower the chance of a patient achieving remission and the higher the chance of intolerable side effects and relapse.

Personally I found the take-home message from this study rather discouraging.  During my last hospitalization I argued that my suicide attempt was supported by the STAR*D’s not so subtle hint that I was shit outta luck.  I think it’s crucial that we find new kinds of treatment that will help that 33% of people who just aren’t achieving remission with many currently available antidepressant medications.  This study doesn’t consider all potential treatments; for example, atypical antipsychotics, ketamine, and ECT aren’ included, and psychotherapy plays a limited part.  Still, we deserve better.  A lot better.

 

For more info on the research terminology I’ve used in this post, see my post on research literacy.

Image credit: geralt on Pixabay

Quotes from bloggers

red rose sitting atop a book

I have a section in my journal where I write down some of the lines other bloggers write that grab my attention.  Here’s a selection:

“First I need to get to know you more before you start to finger me” – My Inner MishMash

“Nothing better than killing two pterodactyls with one boulder” – Bella’s Babbles

“They feel like you’ve overstayed your welcome at the pity party” – Ease the Ride

“Just because your ass is numb and you feel fine doesn’t mean that sitting on the tack is good for you” – Laina Eartharcher

“I wonder if the folks who say [happiness is a choice] know that I also think them not choosing to undergo emergency cranial rectal extraction – when they so obviously need it – is a choice I blame them for” – Lavender and Levity

“I tend to judge people on their personal merits, so if you’re an asshole, you’re an international asshole” – Ultra Regret

“Don’t have a bucket list, fuck it list is huge” – Liz at Therapy Bits

“In living with mental illness, the mind, like a castle, has many defences.  We are the opposing army laying siege…  But as we make progress we become stronger and the walls become weaker.” – Blue Sky Days 365

 

Image credit: Katzenfee50 on Pixabay

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I worked 5 night shifts this week, but stuck very closely to my med/sleep schedule that works best and it was manageable.
  • Only saw 1 patient this week at my other job.  I was doing a hormone injection for him as part of his prostate cancer treatment, and unfortunately he is losing his battle with the cancer.  I’ve had more of my patients die in the last year and a half at this job compared to my whole career prior to that.
  • I was perhaps not as observant as I should have been when piping up in support of a friend, and got some mud hurled at me as a result.  Fun times.
  • My gut has not been happy with me this week, and I’ve been bloated and crampy.  I’m sure my lousy diet lately hasn’t been helping, but neither has the heat.
  • Speaking of which, the weather’s been pretty hot here this week, and my lithium seems to make me particularly prone to wonky hydration and electrolytes when I’m hot and sweating.  I’ve been drinking coconut water, since it’s packed with electrolytes, and that seems to help.
  • My springtime attempt to grow a balcony garden failed, so I’ve planted some more seeds and hoping at least one or two will sprout.

I’m used to getting spam comments/likes from automated bots on my blog.  I’ve gotten a few odd messages before through my blog contact form from random non-Wordpress people, but this week for the first time I got a message that was directly targeted with what I suspect were malicious intentions.  This person started off praising my blog and saying he also had depression, etc, etc.  The tone was what you’d expect from a regular person and not a spammer.  Then he mentioned that in one post I had talked about getting a large sum of money from my grandma, and he encouraged me to be cautious about putting something like that out there because people might try to take advantage of me.  But that post was from back in December, and a dig through my stats showed that post hadn’t been viewed any time recently, so somehow this person managed to look at it without leaving a digital footprint.  There were a few other subtle red flags that something fishy was going on, and  I came to the conclusion that this person had looked at my blog and decided to deliberately try to connect with me by making himself appear to be vulnerable and then try to scam me.  That really gave me the heebie-jeebies.  Now it’s possible that I’m being overly suspicion and have chosen not to ignore some poor innocent person, but my spidey-senses tell me otherwise.

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… Resilience

psychology word graphic in the shape of a brain

In this series, I will dig a little deeper into the meaning of psychological terms.

This week’s term: Resilience

I used to be at least moderately resilient, but when depression is doing it’s thing I feel like I have no resilience at all, and the slightest little hiccup will knock me on my ass.

Wikipedia defines resilience as an individual’s ability to “successfully cope with adversity” and “bounce back from a negative experience with ‘competent functioning'”.  It is considered a learnable ability that can vary over time rather than a static personality trait.

There are various biological factors that can impact resilience  The sympathetic nervous system is involved in stress reactions including fight/flight/freeze, and the hypothalamic-pituitary-adrenal (HPA) axis is involved in the release of the stress hormone cortisol.  There is growing evidence that these systems are impacted by factors in the brain including neuropeptide Y.

One study found six major predictors of resilience: positive and proactive personality, experience and learning, sense of control, flexibility and adaptability, balance and perspective, and perceived social support.  Other studies have identified other factors that contribute to resilience: supportive and loving relationship, the ability to make realistic plans, self-esteem, strong communication skills, and the capacity to manage strong feelings and impulses.

The American Psychological Association recommends 10 strategies to improve resilience:

  1. maintain good relationships with others
  2. don’t view stressful events as being unbearable problems
  3. accept that some circumstances can’t be changed
  4. set realistic goals
  5. take decisive actions in stressful situations
  6. engage in self-reflection and self-discovery following losses
  7. build self-confidence
  8. take a long-term perspective
  9. maintain a hopeful outlook and visualize positive outcomes
  10. engage in self-care of both mind and body

Looking at this information, what jumps out at me is my lack of interpersonal relationships.  Yet while it’s the most obvious factor that I’m missing, I’m not quite sure how to address it.  My inability to trust others was not learned over night, nor will it be unlearned overnight.  But perhaps recognizing the connection between relationships and resilience will help motivate me to work harder at this.

Is resilience something that you have challenges with?

 

Source: https://en.wikipedia.org/wiki/Psychological_resilience

Image credit: GDJ on Pixabay

Our complicated relationships with medications

capsules filled with sparkles

I can’t think of any other type of health condition that has as polarized a relationship with medication as mental illness.  In some ways, to medicate or not to medicate has become a moral issue, with various involved parties taking a stance based on principle.  Often this stance is very broad, making sweeping generalizations.  I recently read and reviewed the book Lost Connections, which argues that all depression is situational and medications should not be used.  Some people connect psychiatric medication use to violence, such as the incoming director of the National Rifle Association (NRA) who has suggested a link between school shootings and Ritalin (methylphenidate).  I’ve seen Twitter comments blasting people who wrote about the positive effects they experienced from medication.  We would never hear any of this kind of thing if we were talking about blood pressure medication, so why are there so many eager to shout from the rooftops when it comes to psychiatric meds?

My own view is certainly shaped by my professional training; I used to be a pharmacist, and now I’ve been practicing as a nurse for 13 years in mental health settings.  I understand how medications produce the effects (both positive and negative) that they do, and have the research literacy to separate the BS from legitimate information.  I look at medication as a tool, and any given medication may or may not work for any given individual, and may or may not be tolerated by that individual.  I have seen medication be life-saving for people, and it certainly has made a huge difference in my own illness.

In general it seems like people tend to speak up, both online and in person, more often about things that go badly for them than things that go well.  The same appears to be true with medication.  I’m a bit fuzzy remembering the details, but not too long ago someone had written a post about antidepressant withdrawal, and someone else commented about how venlafaxine is a garbage drug that no one should take because of the withdrawal effects.  I’m sure that individual’s experience was very negative, but it’s easy to see remarks like this about side effects and overgeneralize, making the assumption that they occur for all/most people taking the drug.  Unfortunately we don’t yet have a way of predicting who will respond to or tolerate particular drugs (although I’m sure the science will get there as the role of pharmacogenomics expands), but to allow treatment decisions to be based on people’s negative comments online doesn’t seem particularly helpful.

I suspect that some of the time meds are demonized because of poor clinical practice by prescribers.  If physicians aren’t responsive to the side effects people are having, ordering any necessary bloodwork, or prescribing drugs that are actually appropriate and effective for the condition being treated, those things don’t mean the drug itself is inherently bad.  Instead, it means that the prescriber is being irresponsible.  I can’t help but think of a blogger with bipolar disorder who was treated for many years with high-dose clonazepam, and then had it discontinued abruptly.  In my mind that is shocking malpractice and a gross misuse of a medication that is not even indicated for treatment of bipolar disorder (but can be very useful when used carefully and appropriately).

It’s also problematic when doctors prescribe a medication and make it out to be a sort of panacea that will fix everything.  We all know there’s a lot of different things involved in getting well, whether we’re on medication or not.  Psychosocial stressors and underlying trauma aren’t going to disappear with a wave of the SSRI wand, and that’s fine, but doctors should be open with their patients about what medications will and will not do.  If patients are coming in misinformed and expecting to pop a happy pill, the health professional has a responsibility to educate them about the nature of mental illness and its treatment.

As Shakespeare’s Hamlet might say:

To medicate, or not to medicate: that is the question:
Whether ‘tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles,
And by opposing end them?

Where do you stand when it comes to medications?

 

Image credit: rawpixel on Pixabay

Book Review: My Age of Anxiety

Book cover: My Age of Anxiety

My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind is written by Scott Stossel, who lives with generalized anxiety disorder (GAD) as well as several phobias.  The book looks at his own experience but also contains extensive research on theoretical perspectives on anxiety and how these have evolved over time, the evolution of diagnostic categories, and the history behind various treatment approaches including the development and marketing of anxiolytic drugs.  While it offers wide-ranging information, at times it struck me as a bit excessive.

Something I struggled with in this book, and I feel bad saying this, was that it felt kind of like when I’m reading a novel and I just don’t like the character you’re supposed to like.  Sometimes this just happens, but I also think I need to question whether there’s there’s an underlying bias in play as well.  The author is a man who seems to have high levels of neurosis as a stable trait.  He wrote: “Writing this book has required me to wallow in my shame, anxiety, and weakness so that I can properly capture and convey them – an experience that has only reinforced how deep and long-standing my anxiety and vulnerability are.”  I’m usually a pretty compassionate, empathetic, and not overly judgmental person.  Perhaps it’s the wallowing bit that gets to me, or perhaps it’s that the anxiety and shame seems so fused with who he is and who he always has been.  Yet temperament isn’t something we choose, so why should that make a difference in how I react to someone?  

Perhaps it’s to do with changeability, and that brought to mind a question: if you’re highly neurotic by nature, does anxiety treatment work or are you shit outta luck?  Stossel looked at the question of nature versus nurture, both of which play a role.  Temperament is thought to be innate, there is certainly evidence of a genetic element to anxiety disorders, and parenting styles are also believed to have an impact.  The development of phobias in childhood is a predisposing factor for the development of adult psychopathology.  For the author, who has a strong family history, the cause is likely a combination of a heaping helping of all of these.  He admits that judges himself for being anxious, and worries that “resorting to drugs to mitigate these problems both proves and intensifies my moral weakness.”  He has done many years of psychotherapy, including Freudian-style psychodynamic and cognitive behavioural, and tried various medications, “but none of these treatments have fundamentally reduced the underlying anxiety that seems woven into my soul and hardwired into my body and that at times makes my life a misery.”

It was clear from an early age that the author had an anxious temperament, beginning with frequent temper tantrums as a toddler.  He experienced significant separation anxiety, which intensified at age 6, coinciding with his mother starting night school.  He began experiencing emetophobia (fear of vomiting) around the same time, and this worsened in grade 7 after he overheard a teacher describing vomiting due to food poisoning.  Grade 7 was also when he had to attend a new school, which resulted in daily battles and social withdrawal, and at that time he was put on medications (chlorpromazine and imipramine).  

anxiety written in Scrabble tiles

Stossel’s mother was highly over-protective and over-involved, but he writes that she deliberately withheld affection in the hope that might prevent anxiety similar to what she herself had experienced as a child.  She physically dressed him until age 9 or 10, picked out his clothes every night until age 15, ran baths for him while he was in high school, and didn’t allow him to walk anywhere that streets might be too busy to cross or neighbourhoods might be dangerous.  As I read the chapter that covered this I freely admit I judged, thinking no wonder this kid had problems.

It has been shown that people with IBS (irritable bowel syndrome) and/or panic disorder are more physically reactive to stress and tend to convert emotional distress to physical symptoms.  The author describes significant physical symptoms with his anxiety, particularly gastrointestinal symptoms, which then feeds into his emetophobia.  As an adult, a therapist had attempted to do exposure therapy using ipecac to make him vomit.  The ipecac was ineffective, and the experience only contributed further to the emetophobia.

The book covers the history of various types of medications used for anxiety, including opium, barbiturates, and benzodiazepines.  When chlordiazepoxide became the first benzodiazepine on the market in the United States in the 1960’s, it quickly became the most prescribed drug in the country.  Medication use for anxiety increased even further with the introduction of the SSRIs (selective serotonin reuptake inhibitors).  The author observed that “the explosion of SSRI prescriptions has caused a drastic expansion in the definitions of depression and anxiety disorder (as well as more widespread acceptance of using depression and anxiety as excuses for skipping work), which in turn caused the number of people given these diagnoses to increase.”

The book covers an array of research studies that have been conducted on anxiety as well as a wide range of relevant theories, from Freud who thought anxiety was the basis of all mental illness to attachment theories to Klein’s false suffocation alarm theory of panic attacks.  Societal views on anxiety over time are also discussed, including American General George Patton’s belief in World War II that in order to prevent the contagion of “combat exhaustion” from spreading it should be punishable by death.

At 401 pages including footnotes, this book isn’t a quick light read.  It took me over three months in fits and starts to read it, in part because my concentration wasn’t always up to it.  It’s jam packed full of information, so it’s a lot more to absorb than just a first-person account of mental illness.  I think what I appreciated the most about it was how it forced me to reflect on and question my own ideas and judgments.  It’s well-researched, and I would say it’s a good choice for anyone who’s looking for a broader historical view to help contextualize their own experience as the author does in this book.

 

You can find my other book reviews in my blog index.

Image credits: Amazon.com, Wokandapix on Pixabay

To avoid or not to avoid, that is the question

woman sitting in dark room with light shining through blinds

Sometimes avoidance is adaptive.  If we see a mama bear and her cubs, we know we need to steer clear.  This is when our caveman brain is programmed to kick into fight or flight mode, and we probably never would have moved far beyond the caves without it.  But a lot of avoidance is maladaptive, and often it’s hard to see the difference.  Cognitive behavioural therapy talks about safety behaviours, which are behaviours that we deliberately engage in to try to keep ourselves safe from whatever causes us to feel fear or anxiety.  However, these behaviours actually serve to reinforce anxiety rather than keeping us safe from actual dangers.

I think avoidance can be a reasonably good thing if it is consistent with underlying values.  As an introvert, I know that large group social situations are very unpleasant and exhausting for me, and I would much rather spend time one-on-one with close friends.  It felt quite empowering when I decided to limit my exposure to unpleasant social gatherings and focus on the kind of socializing that I valued.  On the other hand, my depression makes me avoidant of people in any context, which really isn’t consistent with who I am as a person.

Some approaches to dealing with trauma, like cognitive processing therapy, suggest that avoidance serves to perpetuate incomplete processing of the trauma, and avoidance must be addressed and overcome in order to proceed with processing of the traumatic memories.  I have tried to push through this in creating my own trauma account, but I’ve taken a break from that process over the last couple of weeks because I haven’t been feeling very well.  It’s hard to tell if that’s just me giving in to avoidance, but right now I don’t feel like I’d  be able to create a psychological safe place to contain that.

Avoidance tends to be my fall-back coping mechanism when I don’t have the mental/emotional capacity to deal with a given situation at a given time.  I try to give myself permission to be ok with using avoidance in those contexts, but it’s also a signal that I need to work on building resilience, which I’m really not sure how to do.  Avoidance gets me out of a situation I can’t cope with, but if I’m not somehow building my capacity to cope, the pattern is just going to keep repeating.  I don’t know that it’s necessarily a matter of learning new skills, because I think I manage pretty well when I’m not depressed.  But when I’m not well it feels like I lose access to a lot of things that would normally be available when I’m well.

I really don’t have any answers right now.  Avoidance is probably going to continue being my fall-back for the near future, and I’ll just have to see how things evolve.

What role does avoidance play in managing your mental health/illness?

 

Photo by Xavier Sotomayor on Unsplash

What would recovery look like?

silhouette of a man standing atop of a hill

Recovery means different things for different people.  Here’s what my recovery from depression would look like:

  • confidence
  • the ability to feel joy/pleasure
  • resilience
  • hope
  • a sense of purpose and meaning
  • feeling strong
  • having a sense of control over my life
  • being able to smile and laugh, and mean it
  • looking forward to things
  • being able to generate emotional responses to events in a way that is consistent with my values
  • feeling open to new things
  • being able to look to the past or the future without being overwhelmed by pain

 

What are the essential elements of what recovery would look like for you?

 

Photo by Pablo Heimplatz on Unsplash

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I worked 4 night shifts in a row this week at my job at a concurrent disorders transitional program.  I stuck to the sleep and med schedule that I’ve figured out works best for me when I’m doing nights, so it was manageable.  I’m working a lot of nights over the next month and a half, and I’m hoping that it won’t have too much of an impact on my mental health.
  • One morning at work we were doing our last round of patient checks at 6am and found a patient lying on the floor in his room only partially responsive.  It was later determined he’d overdosed on fentanyl.  I’m normally very on the ball when it comes to crisis situations, but I’m not particularly normal these days.  I’ve been a nurse long enough that the taking care of the patient part of it still came naturally.  What I struggled with was communicating to others.  When I was on the phone with 911 requesting paramedics, I was having a hard time putting sentences together.  I think I forgot to say I was a nurse and I guess the 911 operator assumed I was dumb as a post, so he was talking to me like I was an idiot, which threw me off even more.  I was able to be somewhat more coherent with paramedics when they arrived, but still a far cry from my “normal”.  It’s hard to be reminded of just how impaired I am now compared to the way I am when I’m well.
  • The next night I was talking to my coworker, who also happens to be my only in-person friend, about how I was feeling.  His first response was that I’d done well and I was being too hard on myself.  That was sufficiently frustrating that I snapped at him “that is really not helpful!”  I felt kind of bad about getting irritated, but what I really needed at that point in time was validation, not rah rah let’s be positive.
  • I’m also feeling frustration with my other job.  Nothing major, just annoying stuff that tends to crop up every so often.
  • My concentration hasn’t been great.  I’ll come to the end of reading a blog post and think wait a minute, I have no idea what I just read.
  • I continue to eat absolute crap because I don’t care enough to put any effort into food preparation.  I think this coming week I really need to get that under control before sugar starts exploding out of my orifices.
  • I made it to yoga for the first time in 3 weeks, so that was good.  I also had a massage.

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

Online mental health workbooks

person writing in a notebook

There was a lot of interest in my previous post Mental health worksheets galore, so I thought I’d do a follow-up post with some more resources.

Cognitive behavioural therapy (CBT)

Dialectical Behaviour Therapy

Other

 

Image credit: Free-photos on Pixabay