Category Archives: Education

“I Have a Mental Illness” Project

Please come visit my new posting site (and podcasting site) ihaveamentalillness.com. I am a cofounder, though not the initial founder, that honor goes to another.

We are trying to educate the community. Please visit, and leave comments so that we can be a better bastion as time goes on.

unconstructed

Tagged , , , , , , , ,

What Not To Say To Someone With Mental Illness

If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather. Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.
– Stephen Fry
Many people don’t know how to approach a friend or a family member who has depression. Many feel uncomfortable by this thought. Our society is partly in denial of suffering and does not accept that a person can suffer despite his best efforts. This discomfort and confusion may lead those around the person—despite their best intentions—to be “walking on eggshells”. This is very noticeable to the suffering persons and alienates them further.

I compiled a list of top 5 worst things and 1 best thing to say to a person with depression, with explanations.

What Not To Say:

1. “I know just how you feel.”

Possibly the most harmful characteristic of clinical depression is its inaccessibility to those who have not suffered from it. The feeling of isolation that the person with clinical depression feels is compounded by others’ inability to relate and sometimes even to merely accept that they have an illness. Unless you have tried to kill yourself or have actually been formally diagnosed with major depressive disorder, you don’t, and this will only minimize the person’s pain.

2. “Why are you depressed?”

Can be interpreted as a challenge (“are you really depressed?”). The person is depressed because he has clinical depression. And feeling depressed is only one out of dozens devastating symptoms of clinical depression. Just by asking this question you are demonstrating your ignorance of the very nature of clinical depression. The cause of depression is a mystery even in the medical field. Besides, why does it matter? Would you ask a cancer patient, why did you get cancer (bad mattress)? it’s a stupid question. Unless you care about the etiology of depression, this question will be perceived as a challenge. Only a clinically depressed person know what it’s like to be clinically depressed.

3. “You are more fortunate than some people.”

If you could just see the good in your life you wouldn’t be so miserable. The person with depression cannot control how he or she feels, just like a cancer patient cannot heal his cancer simply by thinking. Depression is the result of complex interaction of biopsychosocial factors continuously in flux. The person has no say in when or how it will lift. Saying this will make the person with depression feel guilty about his inability to feel pleasure despite having more food, money, and a better shelter than many others. Physical possessions do not determine happiness. Besides, the inability to feel pleasure is a hallmark symptom of depression. Not only does it invalidate their feelings, but also chides them for feeling this way, not to mention serving as a reminder of their inability to feel even a drop of pleasure. It’s like asking a quadriplegic person to pick up a rock. Saying, “others’ problems are worse than yours”, will only make the person feel even more guilty about feeling bad.

4. “snap out of it” / “it’s just a phase, you’ll get over it”

Try saying this to a person in a diabetic coma or with terminal cancer (the Burden of Disease for severe depression is the same as for terminal cancer). A person with depression, like with cancer, does not have control over his infliction. It’s like the person is in prison: it wouldn’t be helpful to say, “don’t worry, you’ll be free someday.” The fact is that it hurts and he needs your support and understanding.  It’s dismissive and can be interpreted as, “just accept that it sucks and don’t whine”, which leads me to number five.

5. “Stop whining about life.”

May be combined with “everybody has problems, but you don’t see them whining about them”, or “you’re being selfish”. Depression is not about whining.

Bonus: “How are you?”

Bad to ask especially when you don’t really want to know. Asking “how are you” may be done to appear caring, as if asking about your depression, but without the risk of breaching a boundary by asking about it directly. Actually responding by talking about your depression in detail would put the person off in such a casual setting, leaving you no other choice but to respond with the perfunctory “fine”. This may make the person with depression feel stigmatized and an outsider. So, only ask this question of somebody who knows you know about his or her depression or if you really want to know. Otherwise avoid it.

What To Say:

“It must be really bad for you to feel like this, please tell me more. Even though I can’t imagine what you are going through, I am here to support you.”

If you don’t know if something you say is appropriate, just say, “I don’t know what’s to say not to offend you, but I really want you to feel better. I’m sorry if anything I say hurts you. Let me know if it does so I can correct myself. Just know that I only mean the best.”

Tardive Dyskinesia

Some of you probably know what this is.

I may be developing/have developed this.

For those who aren’t familiar, tardive is a potentially permanent side effect of antipsychotics. Presents as minor mouth tics, muscle tension and generally feeling physically uncomfortable. It’s on wikipedia, you can look it up if you’re interested.

Anyway, I’m apathetic now. I just am so used to shit hitting the fan I don’t care that it’s raining shit.

I hope any of you reading this will never run into this condition. It’s a nasty bit. And any of you who have switched antipsychotics know that the process can be very, very harsh.

Good luck,

unconstructed

Tagged , , , , ,

The Square Circle: Consciousness, Mental Illness, and Local Understanding

In Dr. Sacks book “The Man Who Mistook His Wife For A Hat“, in precisely the case of the man who mistook his wife for a hat, we see consciousness.

Or at least, insofar as I can perceive consciousness.

And this is precisely the problem. We cannot conceive consciousness for, if we did, it would be akin to conceiving a square circle.

There is a mathematical analogy here, and I beg my non-mathematician readers to allow me this as I do not know how to otherwise describe it without referring to persons, but as soon as I have done that I have forgotten the possibility of a square circle, indeed I may very well be, in some sense, actively supressing the square circle.

There exists, within the mathemato-cosm, an idea known as a “smooth manifold”. These are, essentially, surfaces on which we can create a calculus, in the same sense as we “create” a calculus in 3 dimensional space. Or, for those to whom calculus does not help understanding, imagine that we could generalize speed and acceleration and distance on this body.

“Locally”, in a mathematical sense, a 3 dimensional manifold looks like our common understanding of three dimensional space. We must be careful here in explanation because “Locally” and “Globally” are vastly different and often hard to understand.

Imagine that you were walking on a road and all of the sudden your understanding of speed and distance suddenly failed you, to such a degree that you could not even tell if you were moving. But once you reacclimated yourself to this spot, everything came back into view.

This is my current understanding of consciousness. Globally we are systems, locally we are individual persons. This would seem contradictory and backwards if interpreted incorrectly, so let me explain…

When I say locally here I do not mean one in a crowd or a persons feature. I mean the entire person. By global I mean, in effect, a surveillence under which personhood cannot be understood. Like the manifold it is not real 3 dimensional space, but rather only recognizable at local understanding. Similarly, from a personal view, that is a view that assumes ones own personhood, others are visible as persons. But insofar as we cannot understand our own personhood we cannot understand or comprehend personhood in the other either.

This allows for an interesting understanding of mental illness. If we saw “ourselves” as something that does not admit a legitimate understanding of “ourselves” mental illness would be self-understood to be an abberation in nature. That is we would perceive, rather than a distorted worldview, a distorted brain chemistry which affected this being that we cannot legitimately call “myself”.

The experience of mental illness is the experience of our understanding of self fighting for legitimacy as a being in a complete sense rather than an “Ikea Disaster” (if there really is such a thing as an “Ikea Success”).

Given this understanding the necessity of psychotherapy of some sort in addition to psychiatric care is readily apparent. Should we recover from the brain chemistry error, we must also recover from the self-conception error, an error developed in defense of personhood during a time of self-crisis.

Tagged , , ,

Psychiatric Medication: A Primer In Medical Frustration

Imagine you have something like leukemia.

In order to know you have that the doctor has to in effect prove that you have it. Which can be done (though I know nothing of the complexity involved in diagnostic).

Now think if the doctor had to diagnose leukemia without modern instrumentation, so he’d have to just watch you and see what happens.

Look up the signs and symptoms of Leukemia and take out all those that require physiological testing outside of visual analysis.

http://en.wikipedia.org/wiki/Leukemia#Signs_and_symptoms

“All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.”

So if you don’t have medical tests, you have nothing to go on.

Now think about the brain. How do we know what part of the brain does what? Two ways that I know of are analyzing case studies of people who had brain damage at a specific location and look for deficits or stimulate that part of the brain and analyze what the person says he or she is experiencing.

And that’s just the low level analysis.

Consider than how difficult it is to diagnose something like bipolar, which is diagnosed via the DSM IV (or V if it’s out yet).

 

  • The presence of a hypomanic or major depressive episode.
  • If currently in major depressive episode, history of a hypomanic episode. If currently in a hypomanic episode, history of a major depressive episode. No history of a manic episode.
  • Significant stress or impairment in social, occupational, or other important areas of functioning.[13]\

 

How many of those do you think can be explained via medical testing? The answer is, at present, none. The other problem is that it’s not at all clear that bipolar II has the same cause in all cases.

So we now approach medication.

In our leukemia example, there are treatments that attempt to control it to the point of remission. Granted, this is very very hard to do and leukemia is a terrible disease, however…

How does a psychiatrist pick a drug for bipolar II?

He can’t. Or at least, he can’t obviously pick one. Except possibly in the case where only one medication exists for the specific noted behaviors. In bipolar II this is not the case. Further consider that a few of the major drugs for bipolar were originally used for epileptic patients to keep their seizures controlled or at least lower the occurrence.

This is not to say that psychiatric intervention doesn’t work. I myself am currently on a medical cocktail that seems to work (although lately I’ve been experiencing a level of depression that I haven’t felt in a while…).

But I’m on Pristiq, Wellbutrin, Lamictal, Provigil, Adderall, Cogentin and Abilify.

That’s a lot of meds.

Now what do I do when something goes bad like it has recently?

All of those drugs are working to keep my bipolar in check.

So how do you figure out which one is failing to help? Or how do you switch out one med for another?

It’s not easy. On the patient or the psychiatrist.

This becomes extremely frustrating.

And this is all without mentioning the fact that many of these medications have extreme side effects. In many cases the patient has to decide what they’re willing to live with. Do you accept the possibility of Tardive Dyskensia? Or do you accept psychosis? Do you accept the possibility that one of your drugs will stop working, because at the moment it works pretty well?

These are all hard questions.

And I don’t know the answers.

 

unconstructed

Tagged , , , , , ,

Starting an FAQ page

am developing a frequently asked questions page for this blog. The goal is to give answers to parents and associates of the mentally ill and give answers to the mentally ill themselves. I remember when I was diagnosed. I didn’t want to be. I thought it meant I was crazy. I literally screamed at the nurse that I wasn’t crazy before going to the fetal position and crying as I rocked back and forth. I repeated to myself “I’m not crazy. I’m not crazy.” So perhaps my leading question is:

Am I crazy? As asked by the newly diagnosed patient.

No, you are not crazy. Crazy is not really an appropriate term in this context, in that it is non-diagnostic and nebulous. What does crazy mean? Does crazy mean you may have a problem related to brain function that is causing visible issues that are directly and strongly affecting your life? Then I suppose I’m crazy. Hopefully that means “Oh, I’m in good company” rather than “Holy crap! How can I be in the same category as him??” But people often have this image of crazy that implies a person
A) doesn’t know they are crazy
B) acts without any rationale.
The first one is silly. When you are diagnosed and accept that diagnosis, you no longer fit that criterion even under the most lenient forms of “crazy”. The second is simply false. With very very few exceptions people act according to their present, sometimes evanescent, rationality. If you are manic for example, you may feel that you do not need to sleep. In this case it is perfectly rational at the time not to sleep. Is it deterimental? Often yes. But it is not irrational relative to the person making the decision. Perhaps we all need to realize this, even those of us who are mentally ill. We are still responsible for our actions in most cases, but we are not acting without reason. As an associate of a mentally ill individual one should not react as though their actions are random. They aren’t (except in some strange cases of schizophrenia and even that’s doubtful). We must understand that to that individual at that time what they are doing makes sense.

For example, there is a condition known as body dysmorphic disorder or BDD. This is a continuing and pathological state of believing oneself to be ugly and unattractive bodily. This is not the standard idea we associate here. This is much in the same vein as paranoia, at the time you don’t understand that this is wrong. You don’t even understand that there’s a possibility that this isn’t true. Rather than seeing attractiveness as being in the eyes of the beholder, you see it as, at least in your own case, factual and inescapable. Your friends, with good intentions, may try and convince you that you are good looking. In BDD this WILL NOT WORK.

So, I guess the take away is:

you’re not crazy. crazy can’t be mitigated. you are not crazy and therapy and if necessary medication are your best bet for stability.

If anyone has any questions they think should be on the page, leave your question in the  comments section and I will do my best to answer them.

Tagged , , , , , , ,

It’s just in your head

Mental illness is a condition. We must remember that. A recent comment on a post led me to make this a post, since it was getting a bit long for a comment and contained issues that I wanted to express to the general public readers.

Some people have “pulled themselves out” of depression. But what does that mean?

If you pull yourself out of mental illness and get back to normal functioning… I don’t know, I’d be hard pressed to call that mental illness. Sure, you might be able to get to some form of function, but completely recovering by yourself to the same place you were before in my opinion is not mental illness.

Clinical Depression is mental illness.

Mental illness is by definition highly debilitating.

“In addition, for a diagnosis of major depression to be made, the symptoms must not be better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.”

http://psychcentral.com/disorders/sx22.htm

One of the problems with depression is that people treat it differently than bipolar or schizophrenia, because for one reason or another only bipolars and schizophrenics are “crazy”.

For many people I would argue that they cannot get out of it themselves. I mean, think of a broken leg. Ya you can let it heal, but you’ll often be debilitated for life because of very badly healed bone.

People often do not treat mental illness and “physical” illness the same way. For some reason antidepressants are a “crutch” that isn’t necessary, while a physical crutch is at least temporarily necessary if you want to be able to deal with anything more than laying down. Antidepressants are more like a wheel chair in many cases. A paralyzed person can work without a wheelchair, but it’s damn near impossible. I don’t see why people assume depression or bipolar or schizophrenia is necessarily different.

There are cases of temporary mental illness, that is, mental illness that seems to be healed after a certain amount of time. And I do believe that can be real depression. Just like pneumonia is a temporary illness if you get it dealt with, in some cases depression can be temporary.

We must be careful though. Depression is not just the feeling or the apathy. If it is truly a brain chemistry issue, fixing your own physical brain is extremely difficult or possibly impossible. Depression can entail a lot of things that are very hard to deal with. In my case (with bipolar) I had psychosomatic aphasia and paralysis. I also have Tourette’s and OCD. Those two are often comorbid.

Attempting to deal with it completely by yourself is what people usually do before they get help. No one wants to think of themselves as mentally ill. You have to get to the point where you can’t get out of it yourself and are willing to admit that you’re ill. Or to the point where you’re a danger to yourself or others.

I really am not trying to single the commenting person. First, the position given was vague and I don’t want to impute intent or meaning when I’m not completely sure. Also it’s a common position and should be addressed to everyone. I’m not mad about what the person wrote. Honestly it gave me the inspiration to write this post. And I certainly do not impute all these beliefs to that person, I’m relatively sure that person didn’t mean everything that I wrote down. It just reminded me and I wanted to write out the possibilities thoroughly.

Tagged , , , , , ,

On Therapy And Therapists: Why Not Just Drugs?

Think about what happens when someone does serious injury to their back. Sometimes surgery is required. Sometimes pain meds are required.

And sometimes physical therapy is required.

Why is this?

Physical therapy is required to help get the person back to normal movement or at least improve abilities to move. If you didn’t have one, any bad habits picked up to eliminate or minimize pain wouldn’t easily be fixed.

Compare this to therapy for the mentally ill. Consider OCD. OCD (Obsessive Compulsive Disorder) is marked by compulsions to do one thing or another. But what happens when you do something many many times? It becomes habit. A psychiatric medication may be able to make the obsessions escapable, but removing the habit will take more than that.

I had the potential to ruminate if I wasn’t thinking about enough things. Rumination would just bring back negative thoughts. So I multitasked to an extreme degree to keep the thoughts back. Some drugs I take help me to avoid the really deep depression where the negative thoughts emanate but they can’t remove the habit of overtasking, that is multitasking taken to a level such that nothing actually gets done. It was a defense mechanism against the horrible thoughts. I’m working on this at the moment, and I’m seeking a Cognitive Behavioral Therapist/Dialectic Behavioral Therapist to help me with that.

Medications can do a lot of things. I like to think of it as someone throwing you a rope when you’re in a very deep hole that you can’t get out of. You say ‘Well, I would get out of this hole, but what will I do then? I’m always in this hole. I’ve planned days, months even years relative to being in this hole. I can’t just leave!” Therapy is a method of getting the individual to grab the rope.

It’s not just the rope. It means you have a way of getting out. Therapy helps remove the habits revolving around being in the hole.

Tagged , , ,

On Therapy and Therapists: Introduction

I will be writing up some posts on therapists in the near future, but I really want to recommend this link

 

http://counselorssoapbox.com/2012/01/19/how-does-therapy-help-people/

 

The author gives very clear descriptions of different sorts of therapy and I think it helps to help people understand what’s involved and not believe simplifications some people give to devalue the practice.

Tagged , , ,

Mental Illnesses: Perspectives From The Mentally Ill

I’m working on putting together a new page on the site. This is for people with mental illnesses to describe their understanding and their experience of mental illness. I want to cover at least:

Depression, Bipolar (I and II), Borderline Personality Disorder, Adult ADHD, and Fibromyalgia.

A person on ProBlogger thought of this. A page to describe mental illness in a personal way, rather than a behavioral diagnostic of webMD. Not to disparage webMD by the way. They provide a good service. But they don’t have a personal description. They don’t have implications the illness has on everyday life.

We need that. The world needs that. The mentally ill and those who are not need that.

Message me at

archangel.associate@gmail.com

with a story. I won’t necessarily post them, but if I do I will not edit them. By that I mean the person will tell their own story as they see it. Editing the work would make it partially mine, and not fully theirs.

Tagged , , , , , ,