What I’ve learned from my “psych patients”

Learning is not just for school, but for life

Having worked as a mental health nurse for many years, it would be easy to assume that I’m usually the one doing the teaching and my clients are usually doing most of the learning.  That assumption would be completely wrong.  Yes, I’ve learned a lot in school and through continuing education, plus I’ve learned a lot from my own experience of mental illness, but I have also learned so, so much from my clients.  (Note: my use of “psych patients” in the title is only because it’s conveniently concise.)

One of my regular clients for several years was a transgendered woman with bipolar disorder.  She was the first trans person that I worked closely with, and I had the privilege of being able to support her through sex reassignment surgery and the various pitfalls she faced along her journey with transitioning and managing bipolar.  In Canada, public health insurance covers genital surgery but not procedures that are assumed to be “cosmetic” such as facial feminization and tracheal shaves.  I have vivid memories of making calls on speakerphone with her in my office about various issues.  The person we were on the line with would refer to her as “sir”.  My client would say “no, actually it’s ma’am, not sir”.  A minute later, it was “sir” again.  And then again.  My client’s eyes, posture, and voice all reflected her frustration and defeat, and I grew increasingly outraged at the casual, everyday stigma reflected in this call centre agent’s use of pronouns.  Every time I’ve worked with a trans client since then I can’t help but remember those phone calls as a microcosm of the stigma against transgendered people, and how much this parallels the stigma against mental illness.  But my client bravely soldiered through, and her capacity to cope despite the challenges of her mental illness was astonishing.

I have had some very interesting relationships with clients over the years, and one in particular will always stand out.  She was an older women with schizophrenia who I rather fondly thought of as crusty and cantankerous.  She was chronically psychotic, and frequently called the police because she thought poison was being placed her room.  It drove the building staff crazy, and I would regularly get calls from them asking me to come by and check on her.  The client had a fun, quirky sense of humour, and this produced some amusing insults directed my way; she wasn’t too fond of me because a) I didn’t believe her about the poison, and b) I came to stick a needle in her every couple weeks.  In time she ended up being diagnosed with terminal cancer, and moved into hospice care.  The change in her was the most remarkable thing I’ve ever seen.  After years of being continuously actively psychotic, her delusions abated, and she was the most relaxed and content I’d ever seen her  She enjoyed my visits, and while she still had the energy I would take her out for coffee.  She found greater peace as she neared death than she had experienced for many, many years.  Sometimes the world works in mysterious ways.

My own experience with mental illness has made me a strong advocate for client autonomy, although I’ll freely admit that at times I’ve seen involuntary treatment work wonders.  I had one client who came to me after a long stay in hospital.  He’d originally been admitted because he was making threatening gestures with a weapon, triggered by an uncommon symptom known as Capgras delusions, which involves the belief that familiar people have been replaced by imposters.  The client was released on a community treatment order, which mandated ongoing involuntary treatment in the community, and he was on an injectable antipsychotic every 2 weeks.  He was cooperative with the conditions, but was never uncomfortable with the idea of having these restrictions hovering over him, and he didn’t want to take the medication by injection.  The psychiatrist was concerned because the client didn’t have insight into his psychotic illness.  However, the client did believe he had depression, and I was able to work with him around that and he agreed that continuing to take the medication in oral form would be a good thing.  So I supported him in pushing the psychiatrist for a switch to oral meds and eventually the discontinuation of the community treatment order.  And it worked.  The client thrived.  I like to trot out that story when I’m advocating for other clients, because it’s such a great example of how empowering someone high risk can turn out really well.

Sometimes people get written off as lost causes, but there’s really no such thing.  I had one client who had fetal alcohol syndrome, was psychotic, was a heavy crack cocaine user, and regularly prostituted herself to feed her drug addiction.  She was behaviourally erratic and would blindly wander into traffic.  Staff at the ultra-low-barrier residence where she lived were terrified for her safety.  She had been started on an injectable antipsychotic, but it was hard to track her down to actually get a shot into her.  Luckily, my office was only a couple of blocks from where she lived, and I became a bit of a stalker.  My persistence paid off, along with a few cigarettes as bribes; once she was getting her shot regularly, her behaviour settled down.  She realized that the shot “helps my schizophrenia”, and she would approach me spontaneously with a smile if she saw me on the street.  I will happily take those small victories.

I have also had other clients teach me never to lose hope.  I had gotten a call from a local homeless shelter about a man who was extremely paranoid and ranting loudly about his various delusions.  He was tough to track down because as soon as he found out I was from the mental health team he avoided me (can’t say I blame him).  Getting him to hospital was quite dramatic, involving chasing him down the street, miscommunication with the police, and handcuffs.  But we worked with him, got him stabilized on meds, changed his meds when he had side effects, got him good housing…  and now he’s doing great and running a fantastic peer engagement project.   Success stories like this give me hope, both for myself and others.

Those are some of the clients that I think of often because of what they have taught me.  There is always reason for hope.

 

Image credit: Geralt on Pixabay

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The magic of animals in mental illness

guinea pigs

I am the proud mama of 4 guinea pigs, each one full of personality.  They mean the world to me, and sometimes they’re my reason to get through the day.  When my depression has left me feeling like I’m too tired to go out of bed, I can count on them to be very vocal about reminding me I need to get my butt up and give them their veggies.  When I have felt suicidal, they have given me a reason to carry on.

I’m a mental health nurse, and I’ll often take some of the piglets to work.  They are always a hit, and I find that the clients who are the most ill tend to be the ones who are the most drawn to my little furballs.  Sometimes I’ll feel like the most effective therapeutic therapeutic intervention I provided during a shift was my animals.  They can help people who are paranoid, anxious, or depressed.  Sometimes I’m able to give an agitated client a guinea pig to hold rather than giving them extra medication, and it can be just as effective.  Clients who have been quite disconnected from the world because of their psychosis will sit for hours holding a guinea pig.  Cookie (in the bottom picture) has watery eyes, and one client believed that her tears were because she knew what he was feeling.  He expressed a sense of appreciation that finally he felt understood.

guinea pig

So how are they able to work their magic?  I think it’s something along the lines of what psychologist Carl Rogers termed “unconditional positive regard”.  We may be broken and battered by our illness, feel like a failure, and be ready to give up, but none of that matters to our animals.  They will never judge us, and they will always accept us.

guinea pigI truly believe that our pets can tell how we’re doing.  Of course my little ones’ brains are far too small to have any grasp of human emotions, but they always seem to know when something’s not right.  My little Cookie (in the picture to the left) is crazy in love with me.  She likes to make sustained eye contact, and it feels like she’s looking straight into my soul.  Oreo (that’s her above with the white hair on her head) likes to give kisses, especially when I need them the most.

My guinea pigs, like many pets, love routine.  They know what they want and when they want it, and get pretty thrown off by changes.  That forces me to stick to a routine even when I’m feeling really low and amotivated.  With them around I’m never really home alone, which is particularly valuable when I’m isolating due to illness.  I also find them to be a helpful focal point during mindfulness meditation, as watching and listening to them do their thing really grounds me in the moment.

There’s a lot of literature on the internet about animal-assisted therapy and emotional support animals.  While dogs may be the most recognized support animals, there are many animals (including guinea pigs!) that can engage with humans in meaningful ways.  If you are thinking of getting a pet, please consider a shelter animal – they can’t wait to shower you with love!

 

Update (Nov 19/17): I have just added a 5th member to my guinea pig family.  I may be well on my way to becoming the guinea pig version of the crazy cat lady, but my mood has improved, and I’m feeling less isolated.  Magic.

 

 

Coming to meditation: From skeptic to believer

girl in seated meditation poseI was initially reluctant to try meditation.  My thinking went something along the lines of… I’m so f***ing sick of being inside my own head, so why on earth would I want to spend more time up in there?  But my depressive illness was kicking my butt despite being on a hefty load of meds, and I was willing to try just about anything that might help even a little bit.  Meditation seemed like a good fit with the holistic approach I was trying to put together, so I downloaded a couple of meditation apps (I’ve made some suggestions on my mental health apps resource page) and decided I was going to meditate for at least 5 minutes first thing every morning.

I remained unconvinced in my early days of meditating.  Most of the beginner meditations I was listening to focused on the breath, and the cynical part of me thought that seemed like a big waste of time.  I still had no real desire to focus inward any more than I already was.  I was horribly sick of myself and couldn’t avoid myself even if I wanted to, so the idea of sitting back and watching my thoughts go by didn’t seem much different from the average moment in my day.

Once I began to realize what wasn’t working, I started looking for something different.  Then I stumbled upon Cory Muscara’s 31-day fresh start podcast on Simple Habit, and something clicked.  This was the well guided mix of inward and outward focus that I hadn’t realized I was looking for, and I was hooked (along with a bit of a virtual crush, I must say).  Around the same time I also started doing restorative yoga, which incorporates a lot of meditation.  I could listen peacefully for hours to my teacher Tianne, whose voice is almost as soothing as Bob Ross from the Joy of Painting.

omMy meditation practice has since expanded to at least 15 minutes every morning and 5 minutes every night at bedtime.  I’m proud of the 140+ day meditation streak I’ve got going on my favourite meditation app.  I’m starting to understand the meaning of the quote often attributed to Victor Frankl: “Between stimulus and response there is a space.  In that space is our power to choose our response.  In our response lies our growth and freedom”.  Meditation can help to expand that space, and since I tend to be quite an emotional reactor (more like nuclear reactor what I’m not well), I’ll take any space I can get.

Some simple tricks I’ve learned are using a finger to trace an outline of the other hand, breathing onto the back of the hand, and effortless hearing (being a wide-open receiver to all the sounds around you).  I’ve found some breathwork to be really helpful, such as extending the exhalation or thinking of breath as an anchor, while other strategies are less helpful (alternate nostril breathing leaves me feeling like I’m gasping for air).  Like anything else in life, you take what works and leave the rest.

Mindfulness has become a bit of a buzzword lately, but this is not a new concept – mindfulness meditation is something that has worked for people for a very long time.  I started off a skeptic and am now a believer, but I still find I’m very particular about what resonates with me and what doesn’t.  Plus I’d probably be useless at trying to meditate without guidance.  There’s a lot of options out there to explore, and  I think that for anybody with mental health issues it’s worth doing some digging into meditation – some of it might work, some of it might not, but being able to widen that space between stimulus and response can be golden.

 

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Taking a holistic approach to mental illness and wellness

elements of wellness: yoga, sleep, nutrition, activity, physical health

In school, we study a lot of different subjects in order to get a well-rounded education that helps us to understand the world around us from different perspectives.  Yet when it comes to our mental health, it’s easy to to narrow our focus and come at the issue from one very specific direction.  Treatment providers can certainly contribute to this by emphasizing one particular approach over all others.  Working in the field of psychiatry, I’ve certainly encountered people who see meds as the be all and end all, but this sort of tunnel vision is by no means unique to the medical system.  There is also the opposite approach that is fervently against standard medical approaches, which can be equally problematic.

What if instead we took a holistic approach to mental health, coming at it from as many different angles as we could?  There are many treatment modalities that do not have to be mutually exclusive.  Certainly medications and certain types of psychotherapy have a strong scientific evidence base, but there are many alternative strategies that can be incorporated into a holistic approach that not only targets illness but aims for wellness.  I will elaborate more on these other strategies in future posts, but for now I’ll just say that the more tools we can add to our toolbox the better off we are.

connecting puzzle piecesKnowing whether a particular treatment is likely to work in a given population is useful on a broader level, but the science isn’t quite there yet to know what specific treatment will work for a specific individual.  We can’t know what will or won’t work for us until we try it.  For example, I’ve found that, despite being a huge proponent of psychotherapies such as CBT in my professional practice, in my personal experience it just hasn’t felt like a good fit for me.  Does that mean there’s something wrong with CBT? Absolutely not; it’s just not a piece in my puzzle at this point in time.
My current wellness plan includes:

Medications play an important role in managing the way that my depressive illness manifests, and I am lucky to have found a med cocktail that makes me feel more like myself and doesn’t cause a lot of side effects.  Still, targeting the symptoms of my mental illness with medication is not enough; I need to do more to work towards mental wellness.  The holistic plan I’ve arrived at makes me feel like I’m targeting mind, body, and soul and working as hard as I can at getting better.

What are the ingredients in your wellness recipe?  What pieces of the puzzle might be missing for you?

 

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What is wellness?

bicep_silhouette

Wellness can mean a lot of things to a lot of different people.  It is much more than simply the presence or absence of illness.  And what does wellness look like in the context of mental health?

I believe the foundation for mental wellness is strength.  I have major depressive disorder, and for me an important part of recovery is rebuilding my strength.  Regardless of whether or not I’m still having symptoms, I don’t consider myself to be well unless I feel strong – strong enough and resilient enough to handle the challenges that inevitably arise in life.

Rebuilding internal strength is a process, a journey, and is just as important as specifically targeting symptoms of illness.  The journey towards wellness is very individual, and may not have a lot to do with the nature of the illness itself.  It is a process of reflection, self-discovery, and trial and error.  It is often a search for meaning and purpose, for things that we can be passionate about.  Sometimes this can get lost if we focus too much on the manifestations of our illness, but if that happens we are doing ourselves a disservice.

We all deserve wellness – wellness on our own terms that gives us a reason to get up every morning.

 

Photo credit: Chance Agrella on Freerange