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

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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

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?

 

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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

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?

 

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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

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

Book review: After Suicide

AfterSuicide

In After Suicide, author Charlotte Underwood describes her journey following her father’s suicide.  The book also serves as a how to guide to picking up the pieces after the suicide of a loved one, both practically and emotionally.  She shares the lessons she learned along the way, and speaks openly about some of the destructive coping strategies she turned to.  There were significant negative consequences in her own life as a result of her father’s suicide, and this serves as a good reminder that suicide never just affects the person who dies.

This book is very moving and has quite an intimate feel to it.  In the conclusion, Charlotte writes that the book is her way of reaching out a hand to support her readers, and this is very much what it felt like.  This short ebook is available as a free download and is well worth a read for anyone whose life has been touched by suicide in some way.

 

You can find Charlotte on her blog Charlotte Underwood.

 

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

Image credit: Smashwords Books

Suicide and barriers to help-seeking

brick castle walls

There’s lots of information out there about crisis resources for people thinking about suicide, but resources accomplish very little if we don’t reach out to access them.  There are many reasons people don’t seek help, and I wanted to talk about a few of them here based on my own experience with major depressive disorder and suicide attempts.

Fear of being a burden

No matter how much anyone might say “you’re not a burden”, I wouldn’t believe them.  The suicidal thoughts were such a heavy burden for me to carry, so why would I want to place some of that burden on anyone else?  And it doesn’t feel like it is with pack animals where I can shift my rocks to someone else’s donkey and make it lighter for my donkey.  It feels more like extra rocks would be getting dumped on both donkeys, so I’ve got extra weight weight that I have to carry as well.

Fear of others’ responses

There’s a lot of stigma out there in the world, about mental illness in general and suicide in particular.  When the word “selfish” gets tossed around in relation to suicide, that’s certainly not going to make it more likely that people will speak up.  Being judged is the last thing someone needs when they’re feeling desperate.

For those of us who have been open with others about our illness, even if we’re not necessarily worried about stigma there’s still uncertainty about how others might respond.  People say well-meaning but just plain stupid things about depression all the time, so what kind of supportive idiocy is likely to come out of their mouths when faced with the topic of suicide?  That I should be grateful for what I have, even though none of it matters?  Or maybe something along the lines of oh, you should go out for a walk in nature?  #SickNotWeak #FuckTheWalk

Hopelessness

My illness makes me feel like there is no hope for the future, and it’s when that hopelessness gets particularly intense that I want to end my life.  I’m not thinking oh, if only I could get help things would be so much better.  At that point, I have given up and don’t want anyone trying and failing to help and in the end just making things more difficult.

Over the entire course of my illness it has proven to be very hard to treat.  In the past I was able to achieve full remission eventually, but now it seems like that may be a thing of the past.  Because of my professional background I know what my options are, and I know there aren’t a lot of them, which tends to really reinforce those feelings of hopelessness.

Worthlessness

When mental illness steals away your whole sense of worth as a human being, it can start to feel like people would barely notice, much less care, if you weren’t around any more.

Crisis lines/services

The only time I’ve ever used a crisis line myself was in the first few weeks after my first hospitalization.  I had discharged myself against medical advice after they decided not to renew my involuntary committal.  I’d been in hospital for 2 months, and out I went, with no discharge plan in place.  I was cutting as a strategy to cope with suicidal thoughts, and mostly when I called the crisis line I talked about the cutting rather than what was underlying it.  I guess it was nice to have someone to talk to, but I remember feeling like their responses were kind of formulaic, as if they’d been told these are the things you should say in these situations.

A lot of crisis lines have volunteers providing support.  I’m sure they’re great, they care, they want to listen, but they don’t have the level of expertise of mental health professionals.  Part of that is that they don’t have training in assessing mental status, which makes me inclined to think they have a lower threshold of concern to call the police.  I may be overestimating the risk of this, but if I’m thinking about ending my life the last thing I want is the police banging on my door.

In some ways it works against me that I’m a mental health professional, because it means I know a lot of people working in local emergency and non-emergency mental health services.  I have no desire to call the emergency mental health service or go into the hospital emergency department and have to deal with some asshole that I’ve worked with before and know is useless at their job.

Fear of hospitalization

This is the single biggest reason I keep my mouth shut when I’m thinking about suicide.  I’ve been hospitalized four times, and these experiences were extremely difficult.  When I’m at my lowest, given the choice between death and hospitalization, realistically death is going to win out.  This reflects fundamental flaws in a system that disempowers and traumatizes patients, but there’s also a sense of personal failure that I connect with hospitalization.  This isn’t a judgment I pass on others, but probably part of why I apply it to myself is that three out of four of my hospitalizations were involuntary, so it’s kind of a failure to maintain the ability to make choices for myself.  This fear of hospitalization is deeply ingrained in me, and over the years it has made me tell lies and keep secrets.  I realize that this is something that puts me at risk, but I don’t see that just spontaneously changing.

 

I know that reaching out for help dealing with thoughts of suicide is the right thing to do, and it’s certainly what I would urge to anyone reading.  But realistically it’s just not alwawys that simple, and I think it deserves some thought when we’re not in the midst of our deepest lows.

What has been your experience of accessing help in crisis?

Click here for info on crisis support resources.

 

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Crisis resources for suicide prevention

cartoon face shushing surrounded by the word suicide

Sadly, we hear all too often of people who have lost their lives to suicide.  Many among us in the mental health blogging community have either attempted suicide or had thoughts of doing so.  There are resources available to support us; it’s just a matter of knowing what they are and being willing to reach out (I must admit that’s something I’ve been reluctant to do in the past, and I’ll talk more about this in tomorrow’s post).  Here are some of the many resources that are out there.

International:

  • The International Association for Suicide Prevention has listings of crisis centres organized by continent and other resources worldwide.
  • Unsuicide has listings of IM, chat, and text services in Australia, Canada, the USA, and the UK
  • Wikipedia has a list of suicide crisis lines for 48 different countries
  • Suicide.org has a list of local crisis lines for multiple different countries

 

Australia

 

Canada

 

India

 

UK:

  • Samaritans crisis line 116 123
  • CALM webchat for men
  • Papyrus HopeLineUK for adults under 35, call 0800 068 41 41 or text 07786209697

 

USA:

 

Safety planning apps

 

 

 

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Book review: Should I Have Told You That?

book cover: Should I have told you that

In Should I have Told You That?: A Memoir, Liz Lea doesn’t pull any punches; she sets the tone for this early on, writing that her grandmother hated her, and it was mutual.  The book is written in a chatty tone, kind of like you might expect if you sat down with someone and they were regaling you with tales of their adventures (not to mention misadventures).  The short chapters help make it easy to read.

The author shares her struggles with multiple health issues, in particular bipolar disorder and chronic severe migraines (and throw in some hypothyroidism for good measure).  These had a significant impact on her level of functioning, and led to major changes in her life compared to the escapades of her early 20’s.  She shares about her multiple hospitalizations for bipolar disorder, as well as the long and difficult road, involving countless ER visits, to find safe and effective treatment for her debilitating migraines.  Despite it all, though, in this book she demonstrates that she has been able to move forward with recovery.

Much like how someone might tell their life story verbally, the book jumps around temporally; as a reader, I found this made it a little hard to follow at times.  Overall, however, the book feels like it gives the reader a genuine look into Liz’s life, with nothing being held back or prettified for publication.  This is real life.

 

You can find Liz on her blog The Liz Lea.

 

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

Image credit: Amazon.com

What’s in a name? Labelling and mental illness

dictionary excerpt

I’ve written about this a few times before, but the language people use when it comes to mental health  is so important that I could probably talk about it ad nauseam.  There are a lot of words that get tossed around to describe who we are and what we experience, and in this post I’ll consider a few of them and whether they are helpful or harmful.

We all have multiple different role identities; this is a sociological concept that refers to identities that are defined around a certain role. Some of my role identities are daughter, sister, nurse, and person with depression.  The weighting placed on the importance of these role identities varies greatly, both by individual and by context.  Mental illness awareness campaigns will often say that we shouldn’t refer to people by an illness identity, e.g. he is a schizophrenic, because it doesn’t define who they are.  I believe we all have the right to have control over our identities and those aspects of our identities by which we wish to be known and understood.  I know bloggers who describe themselves as being bipolar, for example, and that is completely okay, but I don’t think that others should try to impose an illness identity upon us.

Then there is the question of what terminology to use to refer to those of us living with mental illness and our relationship with mental health services.  Consumer, psychiatric survivor, patient, client, person with lived experience…  There are lots of terms floating around out there, and everyone seems to have a different preference.  I don’t like consumer, because to me it sounds like an economic term, and one that is based on service use rather than personal experience (I dislike service user for a similar reason).  While we are certainly survivors, the term psychiatric survivor seems to suggest a very antagonistic relationship with the mental health care system, and while that’s certainly the case sometimes, it doesn’t seem like a particularly productive way of defining ourselves.  I actually like the term patient in certain contexts. I know it’s fallen out of favour for the most part, but for me it comes back to the idea of role identities.  I play the role of patient at certain times and in certain contexts, although it doesn’t define me as a person overall.  As a nurse I talk about my patients because I’m interacting with them as they are engaging in that role, not because I see patient as their defining identity.  I often refer to myself online as a person living with mental illness.  I know some people use the term “suffering” and others quite dislike it; I don’t have strong feelings either way.

I’ve always been a bit puzzled when I see “mental health” used as a synonym for “mental illness” (e.g. “I have mental health” used as a substitute for “I have a mental illlness”).  I know it’s reasonably common, but to me it seems like a misnomer.  Perhaps it’s sometimes used as a euphemism (somewhat like mental health “issues” or “problems”), but my personal preference is for a bit more specificity.

The problem with nonspecific term is that vagueness can leave a lot of room for misunderstanding.  One of my pet peeves is “nervous breakdown”.  It’s not a term that has any psychiatric meaning; it’s just something that’s thrown around haphazardly to describe a random assortment of experiences.  The vast majority of people out there in the world are clueless enough about mental illness without muddying the water with amorphous terminology.

There are a lot of derogatory terms that relate to mental illness, including crazy, nutty/nutbar/nutjob, psycho, bonkers, insane, looney tunes, etc.  I admit that I use these terms, but not to criticize people with mental illness.  If a “normal” person was doing something bizarre (I could insert a Donald Trump reference here but I’ll restrain myself), I might say that person is “batshit fucking crazy”.  Or sometimes I might use the word “crazy” as a good thing; for example, I really like helping patients who are highly psychotic, so I might express my preference as “the crazier the better”.  I sometimes describe myself as crazy, and I recently saw another blogger write about being a fruit loop in a positive sense.  I guess what I’m trying to say is a lot of it comes to down to intent and context.  Words like crazy aren’t going anywhere, but I think we can take away some of the power they have to harm, perhaps in the way that members of the LGBTQ community have taken ownership of words that were once used against them.

We also have “normal” people co-opting mental illness diagnostic labels to refer either to themselves or others.  OMG, I can be so OCD sometimes.  She is, like, so bipolar!  The guy I like didn’t respond to my text and now I’m totally depressed!  I tend to consider this use of language to be more harmful than the casual use of derogatory terms, because it significantly minimizes and invalidates the experiences of those who actually have those illnesses.  I’m not sure what we can do to change this aside from calling it out when we see it.

That brings me to diagnostic labels applied by the medical profession to people who have mental illness.  For some people, a diagnostic label can feel like an attempt to cram them into a small box that doesn’t have room for individuality, while others might find diagnosis liberating, as it helps them understand what they’re going through and what treatment options are available.  For me it’s been more the latter.  A diagnosis is not who anyone is; it’s a framework that describes certain elements of experience that tend to be shared among people with the same diagnosis.  Getting a diagnosis doesn’t change who a person is or what their personal experience is, although unfortunately there are some people who are going to judge us based on that label.

What are your language preferences or pet peeves when it comes to mental illness?

 

Image credit: PDPics on Pixabay

My relationship with death

mourning candle

Content warning: This post talks about suicide, but not in the present tense.


I’ve always thought my reaction to death was a bit weird, in that I’ve never had a strong reaction to death.  Part of it is that I view death less as a loss and more as a natural transition, and part of it is probably how I think about people who are aren’t physically present.  I’ve always tended to have an out of sight out of mind sort of view of people I don’t have regular physical contact with.  This has popped up in various ways, and is probably a big part of why I’ve never been good at maintaining long-distance friendships.  In a way death feels like the same thing taken to an extreme, a twisted form of object impermanence.

My dispassionate view of death has become even more firmly entrenched since my first episode of depression.  Sometimes when my depression has really bad I’ve had thoughts of suicide.  I’ve attempted suicide four times outside of hospital plus several times in hospital.  It seems unrealistic to me that I would live until a natural death (which, given my genes, probably would happen until well over 90).  I just can’t imagine living another 50+ years, and I’m ok with the idea that my life might end prematurely due to suicide.  It’s not necessarily an outcome I actively desire, but it seems the most likely.  While I do reach out for help with my depression, I don’t disclose to health care providers when I have active thoughts of suicide.  It’s not an issue right now, but most likely it will come into play at some nebulous point in the future.

As my depressive illness has progressed, the future seems very indistinct.  I have a hard time imagining what my life might be like at 50, 60, or beyond.  I’ve got no partner, no kids, a small family, and only one friend.  Life is something I just keep doing out of momentum, not because there’s anything to look forward to.  I sort of feel like that should disturb me, but I’m pretty indifferent.

My grandma, who I’ve always been very close to, is 101 years old, so clearly she doesn’t have long to live.  And I wonder sometimes how I’ll react when she dies.  Will I grieve?  Or will I just shrug and move on, all the while hating myself for feeling that way?  I don’t know, but I’m inclined to think the latter.

Death and I have a weird relationship.  Please don’t worry about me; I’m fine, this is just something I think about sometimes.

What is your relationship with death like?

 

Image credit: geralt on Pixabay

Maybe stupidity is contagious?

Quora logo

I’ve done a couple posts before about the wild and wacky questions and answers on Quora, a free-for-all of stupidity interspersed with a few brave souls trying inject a little bit of accurate information into the mix.  Here are some of the gems I’ve seen recently:

 

Question: Are mental illnesses like depression contagious?

Answer (from someone who claims to be a “fully qualified psychotherapist):

Depression is a man made illness. Yes, it can be contagious due to the fact we are empathetic (for the most part discounting psychopaths etc).
Depression does not work as a medical disease i.e. it can not be caught by breathing the air, but it can be caught by emapthising [sic] with others blight [sic].

Depressed people also generally will not express anger correctly and as such turn it inward on themselves rather than having a conflict which will promote change. If a group of people feel this powerlessness then that depression will spread quickly.

Another answer: Depression has a physical cause. Mostly depression is caused by the high amount of sugar people eat, as well as the “other” forms of sugar like high fructose corn syrup, and fast absorbing carbs like white bread. People who eat well and exercise, can deal with most issues, and the little stress that a person may encounter when having to listen to someone’s problems, is easy to deal with.


Question: When a person who’s schizophrenic looks in a mirror can they sometimes see the other other personalities?  How different do they actually look?


Question: Do psychiatric drugs cause chemical castration?


Question: Is shoplifting tied to Abilify or schizophrenia?


Question: Would mental health checks once every 5 years for gun owners help prevent the mass shootings epidemic?


Question: Should we not allow those with mental health histories to drive, since they may run over someone?

AnswerI couldn’t resist giving my own snarky answer to this one:  Maybe we shouldn’t allow anyone who’s human to drive, since they may run over someone.


Question: Why are schizophrenics so reluctant to take their medicine when doing so would make them “normal”?


Question: Are schizophrenia and schizoaffective disorder a side effect of demonic possessions?


Question: How do people with serious depression die?

Answer: I won’t repeat the exact answer, but some jackass decided to graphically describe all the various people he knows of and exactly how the committed suicide.  And why do they do this, pray tell?  Well, here’s this dumbass’s brilliant answer:

Depressed people have immune system issues. Their immune system is up and down continually and thus many people have almost constant flu, fevers, infections, bowel issues, skin diseases, etc, for which “medical science” seems to have no cure. Despondent, these people find their own cure, usually with a pill overdose washed down with alcohol. We must forgive and pity them.

 

So given the rampant stupidity out there in the world, I’m thinking that maybe one strategy for fighting stigma might developing some kind of IQ booster that can be aerosolized and sprayed over the world at large.  Is that too much to ask?

My mental illness is a member of the family

family of elephants

It’s easy for me to focus on how my mental illness has affected me, but it has also profoundly affected my family, and that’s something that perhaps I should give a bit more thought to.

When I first became ill in 2007, I didn’t say anything to my parents or brother, although my mom thought something seemed off.  I’m told that I called my parents after I’d been in hospital several days since my 2nd suicide attempt, but I told them that I didn’t want them to come to visit me.  My mom ended up taking a couple months off work and stayed in my condo while I was in hospital (they live 4 hours away).  She didn’t approve when I became romantically involved with another patient, and as a result I stopped talking to my parents for several months.

When I got sick again in 2011 I realized that I needed to go into hospital, but I wanted to do it in the city where my parents live rather than the city where I live and work as a nurse.  Apparently my dad drove down and picked me up, and then took me to the hospital, where I would spend the next 2 months.  My parents really noticed the memory loss I had from the ECT, as I would ask them the same questions over and over.

The next summer I completely fell apart just before leaving on a trip to Russia.  I called my parents from my hostel in Moscow sobbing uncontrollably.  I can only imagine what that must have felt like for them.  Several months later I decided to return to hospital in the city where my parents lived.  I was really unhappy with how I was treated during that hospitalization and fought the treatment team every step of the way.  I was discharged still very unwell, and my parents were extremely concerned.

A couple of months later I attempted suicide and ended up back in hospital.  I called my brother to let him know.  He came over to my place to take care of my guinea pigs, and while he was here he cleaned up the mess I’d made when I urinated on the floor.  When he came to visit me in hospital, I asked him to get rid of my suicide note so our parents wouldn’t see it (I didn’t realize at that point that the police had already taken it).  That was the only time I’ve ever seen him cry.

When I got sick in 2016, I broke off all contact with my family for over a year, thinking that they would judge me and I couldn’t deal with that.  I resumed contact last fall, but it’s been tough.  I still don’t feel comfortable sharing much with them.  My parents are judgmental; not in a malicious way, but more that they think things should be done in a particular way and doing them differently is just plain wrong.  It’s how they are and how they’ve always been, but what I used to roll my eyes over and joke about with my brother and grandma is now something I’m very wary of.  I also find that with my family I have a very hard time putting on the superficial act of normalcy that I would use with strangers.  So I have nothing superficial and casual to say, and I don’t feel comfortable sharing anything deeper about myself, which makes for pretty scanty conversation.

I don’t think my grandma every really did understand much about my illness, but now she has started dementing and doesn’t even remember that I have a mental illness.  She occasionally makes stigmatizing jokes about crazy people, and I know I need to just let that go.

This mental illness journey is never one we truly walk alone, no matter how alone it may make us feel.  It’s the kind of illness that leaves its mark not only on us but on those that love us, and I almost feel like I owe my family an apology, even though the depression isn’t my fault.  I feel very far away from my family, and I don’t know when/how/if that’s going to change.  But right now the only way to bring about any kind of change is by continuing to work on myself.  The future will be what it is.

How has your family been affected by your own illness journey?

 

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Evidence-based treatment of bipolar disorder: The CANMAT/ISBD guidelines

path forks into 3 possible decisions

In 2013 the International Society for Bipolar Disorders and the Canadian Network for Mood and Anxiety Treatments combed through the scientific literature and put together these guidelines for the pharmacological treatment of bipolar disorder.  Treatments are classified as 1st, 2nd, or 3rd line based on the strength of existing evidence to support their effectiveness.  Also included are treatments that are sometimes used in bipolar disorder but for whatever reason don’t necessarily have a research base to back them up.

No treatment guideline in the world is going to be able to say what treatment is going to work in a specific individual.  However, they can provide a good idea of what has the best chance of working, and I think it’s always valuable to know what your options are.

Here are the recommendations for acute mania, acute depression, and maintenance treatment.

Acute mania

1st line:

  • lithium
  • divalproex
  • atypical antipsychotic: risperidone, paliperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, asenapine

2nd line:

  • carbamazepine
  • haloperidol

Not supported by evidence:

  • gabapentin
  • lamotrigine
  • topiramate

 

Acute bipolar depression

1st line:

  • lithium
  • lamotrigine
  • quetiapine
  • lithium/divalproex + selective serotonin reuptake inhibitor (SSRI)/bupropion
  • olanzapine + SSRI
  • lithium + divalproex

2nd line:

  • divalproex
  • lurasidone
  • quetiapine + SSRI
  • modafinil
  • lithium/divalproex + lamotrigine or lurasidone

3rd line:

  • carbamazepine
  • olanzapine as monotherapy (i.e. the only treatment)
  • electroconvulsive therapy (ECT)
  • lithium combined with carbamazepine, pramipexole, or an MAOI
  • lithium/divalproex + venlafaxine or tricyclic antidepressant
  • lithium/divalproex/carbamazepine + SSRI + lamotrigine
  • quetiapine + lamotrigine

Not supported by evidence:

  • gabapentin
  • aripiprazole
  • ziprasidone

Acute bipolar II depression

1st line: quetiapine

2nd line:

  • lithium
  • lamotrigine
  • divalproex
  • lithium/divalproex + antidepressant
  • lithium + divalproex
  • atypical antipsychotic + antidepressant

3rd line:

  • antidepressant monotherapy
  • quetiapine + lamotrigine
  • ECT
  • N -acetyl cysteine
  • T3 form of thyroid hormone

Maintenance therapy

1st line:

  • lithium
  • lamotrigine
  • divalproex
  • atypical antipsychotics: olanzapine, quetiapine, risperidone, aripiprazole
  • lithium/divalproex + quetiapine/risperidone/aripiprazole/ziprasidone

2nd line:

  • carbamazepine
  • paliperidone
  • lithium + divalproex/carbamazepine
  • lithium/divalproex + olanzapine
  • lithium + risperidone or lamotrigine
  • olanzapine + fluoxetine

3rd line:

  • asenapine
  • phenytoin
  • clozapine
  • ECT
  • topiramate
  • omega-3 fatty acids
  • oxcarbazepine, gabapentin

Not supported by evidence:

  • gabapentin, topiramate, or antidepressants when used alone as monotherapy
  • flupenthixol as an adjunctive treatment

 

The role of antidepressants:

Antidepressants don’t always work well in bipolar disorder, and they can potentially do more harm than good.  In case you’re interested, the International Society for Bipolar Disorder has a task force report on the use of antidepressants in bipolar disorder.

 

And there you have it, folks.  Was there anything in the guidelines that surprised you?  And for those with bipolar disorder, how does your treatment regimen compare to what’s in the guidelines?

 

Full reference:

Yatham, L.N., Kennedy, S.H., Parikh, S.V., Schaffer, A., Beaulieu, S., Alda, M., O’Donovan, C., MacQueen, G., McIntyre, R.S., Sharma, V., Ravindran, A., Young, L.T., Milev, R., Bond, D.J., Frey, B.N., Goldstein, B.I., Lafer, B., Birmaher, B., Ha, K., Nolen, W.A., & Berk, M. (2013). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAD guidelines for the management of patients with bipolar disorder: Update 2013. Bipolar Disorders, 15, 1-44.

 

Image credit: 3dman_eu on Pixabay

Book review: If I Could Tell You How It Feels

Book cover: If I could tell you how it feels by Alexis Rose

If I Could Tell You How It Feels: My Life Journey With PTSD captures Alexis Rose’s journey toward healing from PTSD.  The book consists of narratives interspersed with poetry, along with beautiful art by Janet Rosauer.  The chapters are short, which I always appreciate since it makes it easier for readers with concentration problems, and they flow nicely.  Alexis doesn’t go into details of her trauma, minimizing the chance of triggering her readers.

Over the years Alexis has experienced severe symptoms of PTSD.  She has flashbacks which are easily triggered, and she describes the considerable effort she’s had to put in on an ongoing basis toward managing her triggers.  As she worked with her therapist she learned tools to manage her ongoing symptoms.  However, she has come to understand that for her there will be no cure and she will have long-lasting effects that will require ongoing work to manage.

Alexis describes the multitude of interpersonal challenges that go along with PTSD, from the doctor who asked why she couldn’t just get over it, having to navigate friendships, losing the people that backed out of her life and managing the walls that she put up for self-protection.  Her family has been profoundly impacted by her illness, and she describes how roles within the family have had to shift over time, requiring adaptability from all of them.

Self-stigma has been an issue, and she writes “I wrestle with feeling like I’m lazy because I haven’t cured myself of this illness”; this is something that will probably sound familiar to many of us in the mental illness community.  She describes self-doubt as an unwanted houseguest, but one that no one else can see.  When things get really hard, she has to actively remind herself that she is in the process of healing.

Alexis shares some of the valuable lessons she has learned along her journey.  She has come to understand that while PTSD impacts her it doesn’t define her, and while she was a victim she is definitely a survivor.  This resonated strongly with me, as I grappled with the term victim with respect to my own experience of workplace bullying.  Alexis talks about her struggle to establish an illness-free identity despite her ongoing symptoms; again, this is something I suspect will resonate strongly with many readers.  She has learned to set boundaries, remove toxic people from her life, and reach out and ask for help when needed.

Alexis identifies a number of strategies that have been helpful on her non-linear road toward healing.  Writing has been helpful for processing memories, and naming what had happened to her made it easier to see the bigger picture.  Radical acceptance has allowed her to find greater peace, own her past, and acknowledge the hard work she has put in.

While this book talks about the challenges of PTSD, the focus is very much on healing and learning to live your best life even with ongoing symptoms of illness, and as such readers with various other mental illnesses are likely to feel a sense of connection.  The title is very apt, and Alexis does an excellent job of capturing what her healing journey feels like and has felt like at various points along the way.  This is an inspirational book that I would highly recommend.

 

You can find Alexis Rose on her blog Untangled

 

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

Image credit: Amazon.com

We have a message – how do we spread it?

megaphone

May is mental health awareness month, and I’ve seen a lot of great blog posts related to this.  But I wonder sometimes if we’re doing a lot of preaching to the choir and not necessarily creating a lot of change in stigma on a broader scale.  I know that researchers like Patrick Corrigan have found that exposing people to individuals with mental illness is one of the most effective ways to counteract stigma.  So sharing our stories is a good thing, but how do we make sure we’re reaching people?

When it comes to challenging stigma online, it’s my belief that we have to pick our battles, at least to some extent.  Besides the trolls who are just plain nasty, there seems to be a subset of people who actively choose ignorance and aren’t interested in being exposed to new ideas (or reality for that matter).  I always feel bad for people who get sucked in trying to educate this group of folks and end up frustrated by these folks’ intransigence.  I think our best chance of success is with people who are ignorant due to lack of exposure rather than due to head-up-ass syndrome.  So, how to find those people and how to reach them?

There are a lot of organizations out there working to fight stigma.  This is useful, but there are also limits.  These types of organizations often focus on specific events or awareness-raising campaigns.  Initiatives like Mental Health Month in the United States, Mental Health Awareness Week in Canada and the United States, and Bell Let’s Talk Day in Canada can reach large target audiences, but whether that audience is actually engaging beyond a token retweet or two is debatable.  This is a dialogue that needs to happen year-round, and I think that’s where we as individuals come in.

We’re the ones that really bring a human face to mental illness.  We’re the ones who show that it can happen to your parent, friend, or partner.  I really don’t know what the best way is, but probably the more different ways we communicate our message the better.  Blogging, social media, doing interviews for podcasts, speaking in-person at awareness events…  There are a lot of options to choose from, and it’s exciting to read on people’s blogs all the different ways that they’re getting their message out there.  And the more of us that are speaking up the better.  There are a heck of a lot of us out there with mental illness, and it seems hard to believe that there’s not somehow a way for us together to create huge change.

If 1 in 4 of us will experience mental illness, and we can each convince 1 person that mental illness is real, it’s serious, and it’s ok, then that’s half the world.  The ignoramuses of the world will always be there, but by ignoring them we will have more energy to focus on getting the word out to the people that have the brains to listen.  So let’s keep talking.

 

p.s.: If you haven’t already added your blog to Stoner on a Rollercoaster’s campaign for mental health awareness, you can do so here: https://stoneronarollercoaster.wordpress.com/2018/04/27/mental-health-awareness/

 

p.p.s. You can find details on My Loud Bipolar Whispers’ mental health awareness campaign There’s Glory in Sharing Your Story here: https://myloudbipolarwhispers.com/2018/05/02/a-revised-guide-how-to-write-and-share-your-story-for-theres-glory-in-sharing-your-story/

 

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What I’ve gained from my mental illness

woman holding out a white rose

I’ve read before that mental illness should be viewed as a gift, and while that struck me is a big fat load of BS, it did prompt me to give some thought to things that I have gained from my illness:

  • greater empathy and compassion
  • greater understanding of mental illness
  • makes me a better nurse
  • has helped me to be less judgmental
  • has made me more open-minded and accepting
  • has given me a greater appreciation of wellness, happiness, and hope
  • it inspired my masters thesis and several published academic papers
  • it has put me in a better position to challenge stigma
  • it has allowed me to access a sense of community and belonging among mental health bloggers
  • it has pushed me to take a closer look at my thoughts and emotions
  • it has made me take a more holistic view of managing health problems in general

What have you gained from your mental/physical health challenges?

 

Image credit: Photo by Annie Spratt on Unsplash

Mental illness and the dreaded job interview

woman preparing for a job interview

Job interviews are unpleasant at the best of times, and to me have always felt very fake.  But throw mental illness into the mix, and they can be a huge obstacle.  There are a number of aspects of job interviews that particularly worry me.

Answering unexpected questions

My cognitive symptoms of depression aren’t as bad now as they have been, but my brain is still pretty slow to react to anything unexpected.  Even in low-pressure situations I may be asked a question and I just can’t generate an answer.  I may make light of it and brush it off as oh, brain fart, I lost my train of thought.  In a high-pressure interview, my mind would go blank, and that would make me anxious, which would further ensure that my mind would stay blank, and I would be left staring stupidly at the interviewer.

Having to identify positive examples

I can identify some positive things in my past and present, but put me on the spot and the only things that my mind can find are negatives.  Throw in that my memory is not that great, and I would be waiting/begging for the ground to open up and swallow me.

Having to sell myself

I’ve always thought it felt rather fake trying to convince interviewers that you’re amazing and wonderful and all that crap, because it always seems like there’s things you’re expected to say and not say.  It’s tough even when I believe that I actually am pretty wonderful.  Now?  Well, I know that I have my strengths, but the idea of trying to self myself to someone makes me want to barf.  I have to work hard at trying to shift focus to genuine positives, and trying to portray a prettily wrapped fake package of trite expected positives sounds pretty close to impossible.

Questions about interpersonal things like dealing with conflict

I hate people.  I like my fellow bloggers, and I like my patients, but otherwise I pretty much hate people in general these days.  That hasn’t always been the case, but the combination of depression and having experienced workplace bullying have pretty much soured me on humanity.  So there’s that.  Then there’s avoidance, the coping mechanism I’ve had to rely on far too often to extricate myself from situations I don’t have the resources available to cope with.  So when faced with the inevitable interview question about how I handle conflict, I can hardly say I run as far away as I can as fast as I can to hide out in my cave away from people, who, by the way, I hate.  Can’t talk about being bullied, either, because that’s not considered acceptable.  Obviously I would need to lie.  Depression makes me very good at lies like “I’m fine” or “I’m okay”, but makes me very bad at crafting (and remembering) more elaborate lies.

Having to answer questions about gaps in my resumé

I quit a job because I was bullied.  I was unemployed for 9 months due to lasting effects of the bullying.  One of my current jobs, the one in mental health, I think I’m going to leave off my resumé entirely.  So there’s holes, and in my experience interviewers tend to be nosy buggers, so they want those holes filled in or the application goes straight in the recycle bin.  Except neither bullying nor mental illness are “acceptable” excuses for resumé holes.  So what, more lies that I’d have to pull out of my ass that is getting sorer by the minute?

Managing anxiety

Interviews are anxiety-provoking for anyone.  Anxiety isn’t a huge part of my depression,  but not surprisingly it gets amplified in high-stress situations, and my brain runs in circles but doesn’t move forward.  So then it’s a matter of figuring out a pre-medicating strategy; enough Ativan and/or Seroquel to tone it down without turning me into a drooling zombie.

Managing triggers without either crying or completely shutting down

There was one interview I did while I was depressed, and I don’t remember if it was something the interviews said or the way they said it that triggered me, and I started crying.  I couldn’t stop, so I just got up and walked out.  Not surprisingly I never heard from them again.

 

Mental illness is hard enough without having to concoct BS stories to appease potential employers who are bursting at the seams with stigma.  Even employers who are more progressive are likely to have an easy time coming up with excuses not to hire someone who has a hard time explaining away the effects of their illness on their work history.

Has your illness impacted your search for work?

 

Image credit: FotografieLink on Pixabay

What scares me

eyes showing fear

I came up with this list as part of my bullet journal.  I feel like there should be a lot more things on it, but this is what has jumped into my head thus far.

  • never getting well
  • not being able to get another nursing job
  • being forced to move for financial or other reasons
  • not having enough income to get by
  • losing my extended health insurance
  • having another failed suicide attempt
  • losing my independence
  • rejection
  • invalidation
  • not having anyone I feel safe with
  • being completely alone
  • and on a lighter note, various creepy crawlies that I’m not interested in naming

 

What scares you?

 

Image credit: ghwtog on Pixabay