No Stigma, No Shame, More Happiness

I saw this on Facebook and wanted to share it. As someone who both wears glasses and takes medication to keep my brain from trying to kill me, I feel it is an excellent analogy:

FB_IMG_1496322585743

The text reads:

“I wear glasses. Can I manage without glasses? Well, yes, probably. I could squint a lot, constantly move up close to anything I want to see, take the bus or a taxi if I want to go anywhere. I could just accept that I’ll never be able to see eagles flying in the sky or whales jumping out of the ocean.

But why? Why try so hard to manage life when I could just put on a pair of glasses? No one would ever suggest a near-sighted person should just work harder. No one would say ‘Maybe that’s just your normal’ to someone who needs glasses. They would say ‘Let’s go to the eye doctor and get you a prescription so you’re able to see again.’ You shouldn’t have to try so hard.”

– My doctor (paraphrased), when I expressed doubts about going back on an anti-depressant. (via webreakthenwebuild)

(via squidilydink)

This is such a good analogy because nobody thinks about it like this. If you wear glasses, you literally need constant use of a medical aid to experience the world like most people do. If it were anything besides glasses, that would be considered a disability. But needing glasses is an extremely common, visible, and accepted form of disability to the point that we don’t even consider it one, we just accept that some people need glasses and that’s perfectly normal and there’s nothing wrong with needing to rely on them.

That is how all disabilities and illnesses should be seen, and how we should look at treatment for them. You have a problem, and you need help dealing with it, and there’s nothing wrong with either of those things. That’s perfectly normal and that’s okay.

(via ninjarobotclone)

And there are a couple more lines but forgive me I don’t feel like typing them out. The important parts are quoted above.

Putting aside the issues of for-profit pharmaceutical companies, our limited understanding of how certain drugs affect the brain, abuses in the mental illness management system, and that our society is so fucked up at least a quarter of us meet the criteria for mental health diagnoses while the rest are just plain miserable …

While we work on fixing that stuff: some of us need medication (and/or therapy) to function, just like some of us need glasses to see, and that’s okay. There should be no stigma associated with it, no shame in engaging in treatment, etc. When I finally get around to acquiring my next pair of glasses, I look forward to picking out frames I like and feel confident wearing. Similarly, it feels really good to own the work I’m doing in therapy and the medications I take: to be honest and unapologetic about what I need to not only live but (dare I say it?) thrive. It’s part of who I am, similar to how my glasses are part of my style (or look, hehe).

Of course I’m fortunate in that I have access to the care I need and communities where talking about one’s therapist, medication, and/or mental health is … if not normal, at least accepted. It’s understood that we’re all people and we all have our issues, we all struggle sometimes and we all need support. That shouldn’t be a matter of me being fortunate, though, it should be normal – like how acceptance of people wearing glasses is normal now, where once wearing glasses was stigmatized.

Learn more about being stigma free, and take the pledge.

Solidarity.

The Power of Music and Metaphor

I had one of my most intense and effective sessions ever with Wakana last week. She supported me by alternating between A Major and A minor chords on the piano, adjusting her style & chords to complement the emotions I was expressing. I sang, nonverbal melodies at first and words as they came to me – statements and images and raw expressions of anger, grief, triumph… She sang too, reflecting and supporting and occasionally making suggestions. It was very intense; we peeled back most of my defenses as I became more and more relaxed.

It’s one thing to know, cognitively, that one’s self-judgment is the result of early, most likely pre-verbal, experiences of being judged and found lacking. Of not having one’s emotional needs meet sufficiently, and so on. It’s relatively easy (now, after studying psychology for over a decade) for me to connect my current emotional difficulties and insecurities to past experiences. (And yet I’m still surprised how often certain ones come up in therapy.) I’ve built this narrative about my life that organizes the chaos, giving it purpose and meaning; I can reflect on it and pat myself on the back for all the things I’ve overcome.

Yet, time and time again, Wakana tells me the same thing: “You’re too hard on yourself.” She asks what it is I dislike so much about myself. And other than this nonverbal sense of being Wrong, I can’t really answer her. Not in straightforward prose, anyway.

It’s another thing entirely to go through the process of seeking the cause of my self-judgment as it exists deep within my psyche, much as one might search a room for an item one has lost. Several years ago I moved into the other apartment in my mom’s 2-family house; she had been using its closet and cabinets for storage but was happy to have me move back in with her. As Banji helped me clean and re-organize, we identified items that were not mine. Then we moved the items to a space where Mom could sort through them without entering my apartment. We called the items “someone else’s problem,” which made it easier to remove them from my space.

I felt like I was doing that again as I searched for what could possibly be so “wrong” about me. What did I find? The Single Thing I most want to change about myself is this feeling like there’s something inherently wrong with me, which makes me depressed and anxious and keeps me from fully living my life. It keeps me from loving myself. I judge myself for judging myself for judging myself.

… Or so I thought during the session last week. The judgment is definitely what I want and need to change, but I’m still judging something about myself… Perhaps something that doesn’t need to change after all. As I wrote and re-read the above, I realized that I judge myself for having intense emotions – especially when they come up at inconvenient times. The sadness, grief, anger, fear, anxiety, etc. take over my body all too often, usually at times when my “rational side” considers them to be utterly inappropriate.

Today I tried to acknowledge and accept how I was feeling without judging or fighting it. I felt anxious while getting ready to leave the house and considered taking the medication my nurse practitioner prescribed, but decided instead to accept that I felt anxious and continue getting ready. I felt tears welling up in my eyes during conversations and let them flow, inwardly acknowledging why they were there while continuing to share my ideas and experiences.

The problem isn’t my emotions. The problem is that it is risky to allow one’s emotions to show in most social situations. It’s that I have been judged and punished from a young age whenever I expressed strong emotions – especially if my doing so inconvenienced the adults in my life. It’s that, until recently, I haven’t had the support and tools I need to express and manage my emotions in healthy ways, instead of suppressing them.

My emotions are inextricable parts of me that serve vital functions, even if they’re often not what I want or (think I) need at the time. The judgment isn’t mine. It belongs to cultural norms that should be obsolete and caregivers who internalized those norms. As humans we both create and adapt to our environment (society)… and we have an uncanny knack for creating unhealthy environments for ourselves and our children. Self-judgement and internalized stigma are two related ways in which we adapt to some of the most toxic elements in our environment.

(I feel the need to include that not everything in Western society is toxic; some aspects are actually quite awesome. Also, just as we create our environment, we can change it for the better.)

The thing is, it’s one thing to know that cognitively, to think it and talk about it with other people. It’s something else entirely to, as in the movie Inception, delve deep into one’s own mind and find something that was placed there by someone else. Wakana helped me do that last week; now I’m looking for the “someone else’s problem” box.

Awareness Wednesday

May is Mental Health Awareness Month (for another week and a half), so here are some links to sites and articles about mental health:

Mental Health America.net has resources and involvement opportunities

May 7th was Children’s Mental Health Awareness Day

Make the Connection has support and resources for veterans and their families

The Young Minds Advocacy Project works for legal and social change to help low-income youth access mental health resources

Minority Mental Health Awareness Month includes links to information and resources for people of color

Speak Out! a powerful statement by a Latina feminist mental health activist

Mental Health Awareness and the LGBT Community

Bisexual Mental Health

Transgender Mental Health

National Mental Health Awareness Month and the Importance of Language

Every month is Mental Health Awareness Month here at a day with depression, and I’m glad to have the support of President Barack Obama’s proclamation for one month each year.

Among the topics he discusses – care for veterans, reduction of stigma, that “taking action to help yourself is a sign of strength,” etc. – I personally am most grateful for the Affordable Care Act. As a result of this legislation, Fox and I have health insurance that enables us to receive the medication and marriage counseling we need. Around this time last year I felt like our marriage was falling apart. Now we’re working together and supporting each other. Fox has held down a job for 6 months (and counting!). I am less than a week away from completing the last two classes I need for my Master’s degree; after nailing my piano final last night(!) I feel like I’m ready for internship and will be an awesome music therapist.

I have a bone to pick with President Obama, though. His proclamation begins:

This year, approximately one in five American adults — our friends, colleagues, and loved ones — will experience a diagnosable mental health condition […] and many others will be troubled by significant emotional and psychological distress, especially in times of difficulty.  For most of these people, treatment can be effective and recovery is possible.

(emphasis mine)

I wish he would use more inclusive language; that would be a great way to reduce the stigma around mental health issues. The language in this proclamation suggests that mental health issues affect other people, even if “they” are the people “we” interact with every day. It seems like the President is trying to distance himself from the people who live and struggle and sometimes even thrive with these issues. He’s practically saying: “this thing exists and we need to be aware of it – and just to be clear it doesn’t affect me, and I don’t think it affects you.” IMHO, that contributes to the stigma.

I imagine that we’re all in a room, and Mr. Obama is on the stage giving a speech, and I’m in the front row because hey, I’m the one imagining it. He’s talking to me… about me, as though I’m not sitting right in front of him and can’t hear him. I’m probably one of the people who are the happiest to be there listening to him, and yet he’s not really talking to me. I think maybe he’s talking to the person sitting next to me.

However, more than 20% of the people in this room are the population he’s talking about (as though we’re not there listening to him – probably filling the front-and-center seats). The person sitting next to me might feel the same way I do; they probably think I am a member of the President’s intended audience. But neither of us will admit it, because then we’d be marking ourselves as “other” – as not really belonging in that room where “normal” people go to become more aware of us. (How ironic is that?) Instead of connecting with each other, we each go home feeling more isolated than ever. (And the “normal” people go home unaware that we were literally sitting right in front of them.)

What about us? I wish someone would say: “This year, approximately one in five of us will experience a diagnosable mental health condition and many more of us will experience significant emotional and psychological distress, especially in times of difficulty. For most of us, treatment can be effective and recovery is possible.”

That wording makes it sound like mental health issues affect everyone, and needing help with them is normal. If I attended a speech and the speaker said that, I would feel like I belonged in that room. Isn’t that what reducing stigma is all about?

You don’t have to be one of the “one in five” – or the “many more” – to use this language. You just have to be willing to admit – to yourself and everyone else – that you could be. If you’re brave enough to do that, you can help us feel safe admitting that we are. That’s how you let us know we’re “not alone.”

Disability

I finally did something I should have done at least 2 years ago: I contacted the disability resource center on campus regarding accommodations for my mood disorder. It feels like signing my own death sentence, or at the very least admitting defeat. I would never have done it, but I need an extension to complete my degree (I “should” be graduating this semester) and my academic adviser suggested this as my first step.

disability form

part of the registration form requesting information about the type of disability, problems it causes in an academic setting, previous and currently-requested accommodations

I’ve been putting the whole thing off because of internalized stigma around mental illness, and possibly also some ableism. Saying I have a disability – rather than “I’m going through a rough time” – marks me as different, deficient, other. Possibly for life.

My hope for the future has relied heavily upon the belief that the difficulties I’ve been facing (my whole life) are temporary – “a minor setback” – and soon I will “recover” and have a “normal” life. Ironically, I was able to take this step because I’ve been feeling better: with more hope, positive self-esteem, determination, energy… but the obstacles to functioning in society are still real. I keep saying I just need things to settle down a bit so I can get my feet under me, but experience says they never will. (And to be honest, I’m not sure I’d want them to. For things to settle down as much as it seems I need, life would be boring.)

Life is chaotic. Our society isn’t built for people like me. (It actively and persistently oppresses us.) I can learn, grow, adapt, take meds, reach out for support, request accommodations… I recently learned about MTHFR mutations and suspect they may be a contributing factor; I plan to talk to the APN about genetic testing and supplements that might be helpful, in hopes we can get my insurance to cover them. But even with that: much if not most of the food that is available to me has been “fortified” with folic acid, the very substance that may be interfering with my body’s functioning.

My point is, social, institutional, economic, and other norms need to change before marginalized groups and individuals will be able to live “normal” lives.

If that’s what we even want. “Normal” as defined by whom? I don’t want to “be productive” and “contribute to the economy.” I want to thrive. I want to express myself creatively, share joy with others, feel safe and whole and loved…

One of the things that makes requesting disability accommodations at school so painful is that academic excellence used to be a major strength – possibly the major strength – I relied on to survive. I wasn’t being challenged on my level in elementary and middle school, so all I really had were my grades. They were my proof that I was worthy of existing. They provided some stability in a chaotic home. Even as I began to be challenged in high school and undergrad and developed a love of learning, my grades were a primary source of self-confidence and pride. Academic excellence was – and to some extent still is – an important part of my identity. Too bad it doesn’t actually mean all that much in the real world.

A woman smiles broadly while holding up a letter.

Maria was very happy to receive an A for the term!

Now my classes aren’t really about learning information and answering questions on a test or writing papers. I can do those things – when I manage to concentrate, which is becoming quite difficult. They’re about practical skills, social skills, being and doing and interacting – often on a deeply personal level. They’ve been churning up the painful realities of my life – that’s what forced me into therapy. I can’t just put my blinders on and memorize facts anymore, I have to look in the mirror, internalize things, face my worst fears, and guide others through them.

I have to juggle academic responsibilities with everyday life, which has become a lot more complex since I graduated college. There’s always something. Getting Fox to and from work every day. Remembering to take antibiotics that are making me sick following periodontal surgery. A problem with our plumbing that’s got Mom stressed out. Everyday chores… I never got the hang of them. And for some crazy reason I’ve decided that now is a good time to adopt new pet rats…

from reelmomevents.com

from reelmomevents.com

The worst part is, I have to prove that there’s something wrong with me. The head of the disability resource center replied to my email: she won’t even schedule an appointment to talk to me until she receives documentation of my difficulties. The guidelines for said documentation are quite intimidating:

  • a complete DSM-IV diagnosis (which Wakana actively avoids and psychiatric professionals have disagreed on)
  • description of my specific symptoms (I could write that)
  • my current treatment
  • “identification of the substantial limitation on a major life activity presented by the disability” and how that applies to academics
  • recommendation of specific accommodations that are supported by the diagnostic information
  • all this information has to be on official letterhead that includes the mental health professional’s credentials and contact information

I think Wakana and I could come up with something useful for most of those items, but we’ve drawn a blank when trying to come up with specific accommodations relevant to an academic setting that would actually help me. (I doubt “not having to demonstrate the skills I’m supposed to have been developing over the course of the semester” is an option.) That’s part of why I wanted to talk to the head of the disability resource center: to explain my situation and learn what requests might be considered relevant and reasonable. (e.g. What accommodations might reduce the social anxiety I experience around having to demonstrate my skills?) There’s information on the website, but it’s not really relevant to my situation.

It also irks me that throughout the site, “it is the student’s responsibility to” fight tooth and nail for these accommodations. I’m thinking perhaps the people who came up with these policies do not have disabilities – psychiatric or otherwise. At the time(s) when I would have benefited the most from having a documented disability and certified requests for accommodations, I was in no condition to be acquiring such documentation and meeting with indifferent strangers. (One might argue I was in no condition to be taking classes, but that perspective might exclude me from higher education indefinitely. Isn’t that what the disabilities resource center is supposed to help avoid?)

Reaching out for help with psychiatric issues isn’t easy. People say “go get help” like it’s the easiest, most obvious thing in the world. It’s not. It’s counter-cultural. It’s acknowledging a reality most people don’t want to accept: that we’re vulnerable and have fears and doubts and feel pain … That dedication and hard work (and good grades) don’t provide happiness, wellness, or financial stability. People don’t want to consider the possibility that maybe the dominant Western cultural expectations aren’t realistic and may even be harmful. They don’t want to believe that we’re honestly having a problem; they tell us we’re being lazy.

In a way applying for disability accommodations is admitting defeat, it’s saying: “I find your game too difficult, so I need you to change the rules for me, specifically, because I’m less capable than everyone else.”

Except that clearly it’s not everyone else.

And when we do reach out for help, the response is far from welcoming and supportive. We’re put on waiting lists, required to fill out mountains of paperwork, interrogated, told we can schedule an appointment after providing documentation, etc. It fuels the cognitive distortions that are common in depression, especially “I don’t matter.” and “No one cares about me.” It makes following through on the initial request for help very difficult.

Almost as though the very people who are supposed to be helping us don’t want to.

Blog for Mental Health 2015 – aka the elephant in the room

a smiling elephant walking toward the right side of the image and spraying water from its trunk: over its back and onto the words "2015 blog for mental health"

Blog For Mental Health 2015 badge by Piper Macenzie

This is my third year taking the pledge:

“I pledge my commitment to the Blog for Mental Health 2015 Project. I will blog about mental health topics not only for myself, but for others. By displaying this badge, I show my pride, dedication, and acceptance for mental health. I use this to promote mental health education in the struggle to erase stigma.”

I absolutely love that the primary image in this year’s badge is an (adorable) elephant! It just so happens to fit perfectly with where I am on my mental health journey:

I’ve spent the past 2+ years learning to accept that my “mental illness” is an inextricable part of me, while also working to unlearn the distorted beliefs and once-adaptive behaviors that keep me from fully expressing my true Self. One of these beliefs is perfectionism, particularly when it comes to playing guitar and piano in class: I believed I had to conform perfectly to academic, musical, and social expectations in order to be accepted by my peers. I have also spent my whole life trying to hide the fact that I (like anyone else, though perhaps sometimes to a greater degree) have times when I feel insecure, frustrated, angry, guilty, vulnerable, sad, anxious, confused, etc.; that there are times when I don’t know what to do and times when I make mistakes. I did this throughout my childhood and adolescence to provide some stability to a family that often felt determined to tear itself apart. But it became overwhelming as an adult.

Eventually I just couldn’t do it anymore, and I didn’t know how to function in society without doing it. So, I withdrew. At times I withdrew a bit too far, disappearing into video games. But, for the most part, I think the withdrawal was both healthy and necessary. It enabled me to prioritize my mental health above other concerns for the first time in my life. It required me to be honest with myself and those closest to me, in ways I’d never dared before.

Blogging for mental health has contributed immensely to this process. This blog gives me a safe place to share my thoughts on topics I might otherwise consider taboo. Writing helps me get a better sense of what I’m thinking and feeling, to better understand what’s really happening beneath the sudden flashes of anger or crushing guilt or hurricane of conflicting emotions. (It probably has something to do with a distorted belief.) Sometimes I receive comments from other bloggers who offer support, congratulations, advice, encouragement, and the knowledge that someone can relate to my experiences. I can see that people are reading the blog (even if they don’t respond directly); my voice is being heard. And I have the opportunity to read about the experiences of other bloggers, to connect with them through comments, to feel a sense of community.

(Sounds good, right? Join the Blog for Mental Health Project!)

So, elephants. I’ve come a long way on my mental health journey; I’m replacing my distorted beliefs (e.g. “I have to be perfect to be accepted.”) with more realistic ones (e.g. “It’s okay to let my imperfections show.”). I’m even trying out new behaviors, like telling my small group I’m not sure what to do or admitting to a classmate that I’m (also) terrified to play in front of our piano class. So far they seem not only to accept, but maybe even to like me.

I think the next step is to be honest about my mood disorder in my everyday life, with people who know my legal name. I won’t be as candid as I am on this blog, but it’s important to talk about mental health issues. I especially need to be able to do it in my music therapy classes, conferences, and (someday) my work environment. I want to help create communities of mutual support, where talking about mental health issues is the norm and it is safe to be genuine.

Not only does talking about mental health issues give others permission to do the same – which could save a life – but it has been and still is a safety issue for me. I need to be able to say things like “that was triggering for me,” “I’m not role-playing anymore; this is how I actually feel,” or even “I need a break from this, can someone come out to the hallway with me?” When I speak up and receive support from someone else, my emotions and destructive thoughts can’t overwhelm me. I feel better about, well, everything.

Blog for Mental Health FAQ | Take the Pledge! | 2015 Official Blogroll

Reframing

many picture frames of different shapes and sizes, painted a variety of colors, standing up and leaning against each other. from magpieweekend.com

many picture frames of different shapes and sizes, painted a variety of colors, standing up and leaning against each other.
image credit: Becca at magpieweekend.com

Lately I’ve found myself reframing stressful experiences by highlighting the positive aspects, seeing them as learning experiences, or considering the new opportunities they provide. A prime example of this occurred while I was walking to class last Wednesday, feeling absolutely horrible about myself for being late. I thought about how I felt (almost suicidal), what had triggered it (fear that I would never belong in a group), how I would have responded in the past (stayed home, possibly hurt myself), and how I was behaving at the time (going to class!).

I wasn’t exactly in the best frame of mind to think positive thoughts about myself, but I imagined the instructor saying, “Wow, you were feeling that insecure and you still came to class? That shows a lot of dedication! This must be very important to you.” In other words, I imagined someone else saying something positive about me – the thoughts were my own and they contained positive self-talk, even though I couldn’t express and experience it directly as such. That’s… actually quite healthy.

Since then I’ve taken some time to put the whole incident in perspective. There were a lot of factors that made doing my schoolwork and showing up on time for class on Wednesday very difficult for me. I’d spent most of the weekend decluttering, a task that – while necessary and healing – I found very stressful. Fox had offered to join me in continuing that task on Monday, but instead we ended up shoveling snow. I stayed up all night in preparation for a daytime sleep study on Tuesday… during which I did not sleep. Lack of sleep alone probably would have been enough to undermine my ability to function on Wednesday, and I was already painfully aware of the 17th anniversary of my father‘s death on Thursday. I believe it may have predisposed me to cognitive distortions like only viewing the negative aspects of things, generalizing, and catastrophizing.

As much as I’d like to be functional at this time of year, it seems most adaptive to accept that I will need to take “mental health” days on and around February 5th – and to plan accordingly. At the very least, I need to do my best to avoid making extra appointments around this time, especially since I never know how the weather might impact my plans. It’s not a weakness, it’s making an informed decision and engaging in self-care.

Considering everything that was going on, I handled myself quite well on Wednesday. I actually got up, got dressed, and tried to go to class. I traveled all the way to the classroom door before my anxiety got the best of me. The class has a strict attendance policy, so I’d be lying if I said I wasn’t concerned about the consequences. But all I did was miss one class. That’s a very minor mess up in the grander scheme of things.

More importantly, when I got home I wrote a blog post about my thoughts and feelings. I expressed what was going on instead of allowing it to consume me; this kept me safe until Fox came home, hugged, and comforted me. Even though I couldn’t reach out to anyone directly, the public post let Banji know what was going on. She reached out to me and we had an awesome, healing conversation. The written record has also made it easier for me to talk about and reflect upon what happened. This blog is an awesome resource that I’ve created for myself and that you, my readers, have helped maintain as a safe space. Thank you.

The imagined conversation in my most recent post is a reframing of my Wednesday class as an opportunity for growth and healing. This is a big deal for me. Yalom (the author of our primary textbook) recommends understanding mental illnesses in terms of how they affect our relationships – both with other individuals and our ability to function within groups. He instructs (group) therapists to treat these difficulties, for they are the true pathologies clients face. In this class, not only do I have to function in a group where the expectation is that we’re all “normal” (to be honest, I have a hunch that at least 20% of us have mental illnesses – probably more considering we’re all studying to be therapists)… but I’m also studying myself as the “other” as I read and listen to class discussions about people with mental illnesses, “their” problems, and how to treat “them.” It’s all about what I need and often feel I can’t have, what I simultaneously strive for and run away from.

This class is the embodiment of my psychopathology, including (especially!) the internalized stigma. I’ve already had to drop it once; on Wednesday I thought that history would repeat itself. But in reality I have a choice, and that choice is mine alone. I can decide I’m not ready to face it so directly; far from “another failure,” this option opens all sorts of opportunities to me. I could focus more on activism, composing, write a book, find a job, volunteer, hang out at Fox’s workplace all day, read every book in the library … there are too many possibilities. I spend my life playing Skyrim because I’m overwhelmed by all the possibilities. But they’re there! And each one comes with its own challenges. Each one will probably cause me similar problems, all linked back to some aspect of my psychopathology. Each one holds some potential for personal growth.

Or I can keep going to class on Wednesdays and be in that group, whatever that means. I’m increasingly convinced that it needs to include coming out as having mental illness, even if the conditions are not ideal. I could be so vague as to say “I have a mood disorder” or explain that “I live with depression, anxiety, and occasional hypomanic symptoms.” I’m leaning toward the latter because it paints a more interesting, complex, and accurate picture.

I really hope that whatever I say will encourage the other students in that class who have mental health issues to speak up, because there’s no way I’m the only one. One of the readings for this week (by Yalom) was all about how the therapist needs the courage and confidence to be human in the therapy group – fallible, affected by group members, and in the process of learning about zirself through zir experiences in the group. Part of being human is having mental health issues – by Yalom’s definition, difficulty relating with others and functioning in groups, and even doing things that aren’t necessarily healthy in an attempt to be accepted by a group. Group therapy is therapeutic because it provides a safe place to stop doing those unhealthy things and try out new ways of being with individuals and groups – a space that is created and maintained first and foremost by the therapist. How can we create such a space for our clients, if we can’t do it for ourselves?

Before I can do it for my (future) clients, I need to do it for myself. I’m already a member of a group of student therapists who are learning to do group therapy and (probably) feel just as uncomfortable as I do. As much as I want to claim that I’m coming out to help and/or teach the other students in my class, what it ultimately comes down to is that I can’t struggle to pass as “sane” anymore. It hurts too much and requires too much energy. I need to be in the world and I need to be fully myself, including my mad self. Why not here and now?

Links:

Everyday Health: Cognitive Restructuring

Mind Tools: Cognitive Restructuring – with free downloadable worksheet

Feim Zii Grom! (Become Ethereal)

trigger warning: pressure from medical professionals to lose weight, a potentially suicidal thought
content notes: From this point on, assume I’m being sarcastic, unless otherwise indicated.

I’m so grateful to my APN for forcing me to schedule a sleep study at the particular center she chose! I met the most wonderful doctor ever at my consultation. He had the miraculous ability to diagnose me with obstructive sleep apnea before conducting an actual sleep study, based on my answers to a few questions – and my weight!

Did you know that losing weight will solve all of my problems, including but not limited to sleep apnea! Clearly my lifelong history of depression, irritability, and anxiety are the result of my recent weight gain (which caused the sleep apnea) and not a lifetime of difficult family dynamics, codependency, emotional & physical abuse, and painful losses I never fully mourned. If I just lose weight, the sleep apnea will go away and I’ll be a happy, healthy, energetic, fully-functional adult! I’m so excited I want to go bake some cookies – but I won’t eat them!

[not sarcastic: Okay, I need to take a breather. *takes deep breath* My ability to put on this false, overly-cheerful tone is scaring me.]

I thought I was going to learn more about what the sleep study will entail: what kinds of tests they’ll run, what I’ll be expected to do, what treatment options might be proposed. Maybe a boring discussion about “practical” things like what my insurance is likely to cover and how I can access whatever I’ll need to get a better night’s sleep… why would I ever want that?

I’m so glad that instead, I got a lovely lecture on how weight loss could help me. You know, there really is an unfortunate shortage of information about dieting and what ideal bodies look like in this culture. I could almost cry to think of how fortunate I’ll be to have the opportunity to consult with a nutritionist and learn things about healthy eating that aren’t plastered all over the internet and every physical object that stands still long enough!

Even more exciting is the idea of having an exercise regimen! Ooh! The word “regimen” inspires so much joyful anticipation in me! I wonder how many crunches I’ll have to do each day, and how frequently the number will increase. Most of all, I look forward to seeing the expressions of disappointment and hearing the additional lectures about how important weight loss is every time the number on the scale isn’t what they’ve determined it should be. I just revel to think of it!

[not sarcastic: Actually, if they require me to adhere to an exercise regimen and be held accountable to someone else for weight loss – especially if treatment for my very real and serious mood disorder is contingent upon my successful compliance – I will … be dangerously tempted to kill myself.

also not sarcastic: By the way, there is one area in which I’m fairly confident taking Lamictal/lamotrigine was helping me: it reduced my suicidal ideation a great deal. I went from having suicidal thoughts almost every day and urges more frequently than I’d like to admit, to only occasionally having suicidal thoughts and rarely having suicidal urges. Even with all the stressful stuff I’ve been writing about, the temptation to harm myself has been a lot less severe than it was before I started taking this medication.]

Think you’re excited now? Just wait until you learn what happens next! When I – like practically everyone else – fail miserably at my attempts to intentionally lose weight, I can try bariatric surgery! (or, as Chrome’s spell checker wants to call it, “barbaric” surgery!) I can’t wait to trade in treatable conditions like sleep apnea for new long-term complications like low blood sugar, malnutrition, ulcers, and death (rare)! Equally exciting is the opportunity to struggle (for the rest of my life) with the same dieting I failed at when trying to lose weight without surgical interventions…

By far, the best part of today’s consultation was the rapport I developed with this amazing doctor. I was worried that he might listen to me when I told him about how my past efforts to intentionally lose weight have resulted in long-term weight gain. It would have been so terrible if he had respected my silly assertion that I “don’t” want to have bariatric surgery.

Ah, what a relief it is to have a doctor who dismisses my clearly-stated preference to receive treatment for the condition that brought me to his office in the first place. I’m so glad he spent most of our time together advertising for a surgeon he knows. Now I have the name and number of a doctor I may never be able to afford, and who most certainly doesn’t take my health insurance! I have never been more blessed.

I can’t wait to go to the surgeon’s free seminar and plead with him to take mercy on my poor obese soul by mutilating my body for a reduced cost. Perhaps he will take pity on me by referring me to a butcher whose fees are within my meager budget. I shall commence saving for it immediately. I know! Let’s use the money we foolishly used to spend on groceries! That should kill two birds with one stone.

[not sarcastic: I wish I’d read Ragen Chastain’s recent post, When You Have to Confront Weight Stigma before going to the consultation this morning. I could have brought her cards from What to Say at the Doctor’s Office with me. Maybe they would have helped me keep the focus of the sleep study consultation on my need for help getting a better night’s sleep! At least I know of these resources for next time, and now you do, too!]

Good to See You… but I Wish You Weren’t Here

I just got back from my fourth visit to the APN. I told her the Lamictal seemed to be helping; I’ve been less depressed, my lows haven’t been as low, and my mood is more stable – even with the stress of adjusting to Fox’s new job and wedding planning crunch time and health issues, etc. She decided to increase my dose to 50mg daily and encouraged me to find things to do that would give my day structure and social opportunities.

Someone else was coming in for an appointment as I was making future appointments to see the APN once a month; after a short time I noticed that person was waving to me. It took a few moments for me to recognize her: a former classmate! She started asking how I was and when I was done making my appointments she came over to give me a hug. I was glad to see her but concerned: she seemed stressed and anxious and was clearly going through a rough time – otherwise why would she be at a community mental health center? I wanted to ask questions to show interest in her well-being, but I didn’t want to ask anything that might make her feel uncomfortable. And then she had to go in for her appointment.

On the one hand it was kind of encouraging to know I’m not the only one from my school / program needing to take some time for self-care. It’s kind of normalizing? And I’m glad she’s able to access at least some of the help she needs. I like my APN and I’m pretty sure that’s who she was there to see; I feel fairly confident that she’s in good hands.

On the other hand, I’m kind of shaken. I wasn’t expecting to be in a peer social situation with someone from school. We’d had some opportunities to bond as classmates but I see her more as a “friendly professional acquaintance” than a friend. I’m used to doing everything in my power to hide my mental health issues from friendly professional acquaintances; now one has seen me at a community mental health clinic! I don’t think she’d tell anyone – just like I’m disinclined to tell anyone who might know her – but it’s still awkward!

And my first response is to try and figure out what I can do to help her. What would be appropriate to say to help her feel more comfortable? How can I reach out to her to try and offer some support? I need to be careful how I proceed so I don’t risk outing her. Maybe I shouldn’t even be writing about this!

I guess it’s good that I’m so compassionate. But I need to think about how I feel and what I need. I kind of needed to be in and out of my appointment without unexpected socialization. I also need to socialize with peers other than Fox and the all-too-occasional rendezvous with other friends. I kinda want to reach out to her – “Maybe we can meet at a cafe or diner that’s convenient for both of us? Are you free during the week?” And I kinda want to hide in my shell, try to pretend this didn’t happen.

Mental Illness Awareness Week

In honor of the work NAMI does, the first full week of October (10/5-11) is “Mental Illness Awareness Week.” People are encouraged to wear green, there’s apparently a solid green ribbon, and depending on your location there may be various events to raise awareness. People are also encouraged to “Tell your story and help inspire others!” – just be aware that the submission guidelines give NAMI permission to add or delete information as they see fit.

The phrases "It's time," "Mental illness affects everyone," and "Go green for Mental Illness Awareness Week" on a green background. There is a solid green ribbon in the center of the image.

Image from http://www.nami.org; Visitors are encouraged to post this as their Facebook profile picture and another image from the site as the banner on their timeline.

I have to admit, I’m not feeling particularly “inspired.” I’m pretty sure my “story” would be rejected because I don’t want to try to spin it (or allow it to be spun) to be a “message of hope” for other people. Frankly, I don’t think we need to spread “hope,” we need people to understand the harsh realities we and our loved ones face: the stigma, the uncertainty, the pain of thinking we’re getting better just to have another horrible day, the difficulty accessing mental healthcare, the ways in which our illnesses impact our relationships, etc. – basically, the stuff mental health bloggers post about year-round! If people really want to raise awareness, they should link to us. (Note: NAMI prohibits links to personal blogs or websites in their “You Are Not Alone” submission guidelines … but there’s nothing to keep someone from posting whatever links they want on their own social media pages, etc.)

Some places to get started (besides this blog): A Canvas of the Minds, Blog for Mental Health, The Mental Health Writers’ Guild, and Broken Light: A Photography Collective. I’ve selected these sites to link to here because they in turn link to individual bloggers who write about a wide range of mental health related topics. I welcome additional suggestions in comments!

Understanding our experiences is a good start, but it isn’t enough. We need to work together to change them – which means changing social, cultural, and especially institutional norms to be healthier for people (especially children) so we don’t get mental illnesses in the first place. I think most if not all of the “stigma” around mental illness exists because talking about it ultimately requires us to question and challenge norms that form the cultural and more importantly financial foundations for our societies, including: valuing people for their economic success, unattainable standards of beauty, pressure to conform to gender roles from birth (particularly masculinity), various intersecting systems of privilege and oppression, etc. etc. etc.

When I told Fox I was uncomfortable sharing my story – because it’s not the after-the-fact, good depressive “success” story they want to hear – he said it’s the story people need to hear. The here-I-am-right-in-the-middle-of-the-storm story. The I-don’t-know-how-long-I-can-hold-on reality. The “actually, I’m the one who could use some hope, because a big part of my problem right now is that I don’t have any.”

I’ve had mental illnesses on the “mood disorder” and “anxiety” spectra for most of my life, and I’ve been consistently living with diagnosable symptoms for over 4 years. I don’t even know what my diagnosis is, and frankly, I’m inclined to think that’s for the better. It’s frustrating to be unsure what to even say I have, but it means I and the people trying to help me can focus on my individual needs and what I’ve found to be helpful (or unhelpful). It means we can move past labels to the underlying psychological structures and processes that may have been adaptive at one point in my life, but came at a cost I can’t afford to keep paying.

In a word, it means I can focus on my own personal growth.

I think it’s great that in addition to Mental Health Awareness Month in May, there is a week in October dedicated to, well, basically the same thing. I kind of wish they didn’t call it Mental Illness Awareness Week though – because an illness is something outside of or other than oneself that affects one (hopefully temporarily) and needs to be treated, if possible, cured. It’s very easy for people to say “Well, I don’t have this illness, so this issue isn’t relevant to me;” if someone they care about has one or more mental illnesses, they may not even be aware of it (unlike with a less-stigmatized condition, which people would probably talk about).

Additionally, I haven’t found it helpful to think of my previously-adaptive, now increasingly problematic patterns of thought and behavior as an “illness” that is separate from and/or imposed upon my self. If anything, I’ve found it to be harmful; it means there’s something “wrong” with me that needs to be “fixed” in order for me to “function” in society, and until that happens I’m worth less than “healthy” individuals.

These patterns of thought and behavior, whether I like them or not, are part of me. I created them to protect me. They’ve helped me meet the demands placed on me by parents, other family members, teachers, employers, etc. They’re part of how I learned skills I still find useful, that are necessary if I ever want to have a career and other things that people associate with “functioning” and having a “normal” and/or “meaningful” life. Getting rid of them wholesale as part of “curing” my “mental illness” would be a disaster.

What I need, as mentioned earlier, is to grow. Part of that is letting go of the things that are hurting me or aren’t helping me any more. A lot of it is changing things that are adaptive in some ways, harmful in others. For example, my perfectionism: I place a very high value on creating the very best product I possibly can – such as well-written, relatable, informative blog posts. I put a lot of effort into accomplishing this, and gain a lot of satisfaction from doing so. Great. When I apply it to academic papers, the result is usually a grade of A. Fantastic. But I need to stop allowing my desire to produce the best quality product to keep me from starting the process, or to cause me to neglect my other needs and responsibilities during the process. I need to stop basing my self-esteem on how others respond (or don’t respond) to my work. I need to develop an inherent sense of self-worth, a concept I frankly don’t understand because it’s never been an intrinsic part of how I understand myself or the world; it’s not part of how I was raised or the society I was raised in. We value and celebrate people based on what they do, and deny people access to basic needs – never mind “rights” – because we don’t see them doing enough to “earn” it. The closest I can come to understanding inherent self-worth is to try to apply my belief that other people deserve to have their basic needs met no matter what to myself.

If there’s anything to be aware of during Mental Illness Awareness Week, I think it’s actually the message from NAMI that yes, it affects everyone. Everyone has to develop some unhealthy patterns of thought and behavior to survive in a society that was built by the privileged and wealthy to continue benefiting themselves at the expense of everyone else. These patterns influence how we treat each other and raise our kids and perceive ourselves. Some of us just show it more; we become the mirror no one wants to look at because they when they do, they see what they don’t want to know about themselves. I wish I could say something like “It’s not that scary,” but to be honest I still find it very difficult. I guess all I can ask is for people to pick up the mirror and pass it around, so we all have the opportunity to look. Wear green and post a selfie. Send out the message that this is important.