Author Archives: Janet Coburn

Autism and Mental Illness

 

One of the big debates in the neurodivergent world is how autism and mental illness should be classified. Are they unrelated to each other? Do they – or should they – come under the same heading? Is autism a mental illness or not?

Cara Nissman of Autism After 16 hits the nail on the head when she says, “Part of the reason it is so hard to separate out mental illnesses from autism is that autism is still not fully understood and looks different in each person.”

David Rettew, M.D., writing in Psychology Today, expands on this idea:

This debate has surfaced many times before and in many venues.  It is a difficult one to resolve because there really is no scientific basis on which to separate a psychiatric disorder from a neurological or developmental one.

Certainly there are some things that feel different when considering autism, especially in its more severe forms, relative to things like depression or anxiety.

But what is it that feels different? The DSM-V, the comprehensive reference manual for psychiatrists, lists Autism Spectrum Disorder among its diagnoses. But that does not automatically mean that autism is a mental illness. After all, at one time homosexuality was listed in the DSM as one.

According to the NIMH, “Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior.” That implies that autism is a matter of neurodivergence – that the autistic brain is “wired” differently from those of neurotypical people.

But isn’t that true of various mental illnesses as well? My bipolar brain is wired differently too and I consider myself neurodivergent. Schizophrenia is clearly related to brain wiring. And all of these conditions can be affected, it is currently thought, by genetic and/or environmental components – including both mental illnesses and ASD.

The website itsnotmental.blogspot.com begs to differ. That site, in promoting the idea that autism is not a mental illness, argues that:

the term “mental illness” is not a diagnosis. It is jargon – a term society uses to refer to some, usually severe and persistent biologically-based, disorders of the brain such as schizophrenia or bipolar disorder which are in the psychiatric manual of symptoms and labels for sets of symptoms arising from some malfunction of the brain, regardless of cause.

So far so good. But It’s Not Mental contradicts itself by espousing the idea that true mental illnesses are based on psychological and emotional components. That’s a point of view I cannot wholly accept, given what we know of biochemistry, neurotransmitters, the brain, and disorders such as bipolar.

Besides, might there not be psychological and emotional factors associated with autism spectrum disorders? Even if the causes (still largely unknown) are developmental or neurodivergent in nature, the effects of ASD can certainly include psychological and emotional problems. Fear, anxiety, and depression can all occur in children or adults who feel they are “different” or are seen as such.

There is also the problem of co-morbidity, or both conditions occurring within the same individual. Nissman sees it as “a growing challenge in the autism community”:

A number of people with autism also have some form of mental illness and the illness can go inadvertently untreated if believed to be just another characteristic of autism.

Indeed, studies within the past 15 years have shown about 70 percent of people with autism spectrum disorders may meet criteria for what are known as comorbid mental health disorders described in psychiatry’s diagnostic manual.

What’s the answer? Right now, it’s a big “We don’t know.” If we’re talking brain wiring and neurodivergence, autism and mental illness have a number of commonalities. If we’re talking about developmental disorders, they’re probably not related to each other.

But we certainly shouldn’t ignore the possibility of the two occurring together. While psychological therapy and medication may not be the first line of treatment for ASD, it seems clear that at least some persons with autism might benefit from them as an addition.

And that, to me, is the bottom line – not how we define the conditions, but how we care for the people who have them.

 

References

http://autismafter16.com/article/09-24-2012/when-autism-and-mental-health-issues-collide

https://www.psychologytoday.com/us/blog/abcs-child-psychiatry/201510/is-autism-mental-illness

https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml

http://itsnotmental.blogspot.com/2007/12/autism-is-not-mental-illness.html

Talking to Ourselves

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Recently on Facebook I asked how many of my friends knew the meaning of the semicolon – other than as a mark of punctuation. About two-thirds of those who responded did. The rest either didn’t or had some vague idea but no real knowledge. But I’m pretty vocal about mental health issues and a fair number of my friends have similar problems and difficulties, so that two-thirds figure is likely not representative of the population at large.

Yet I see increasing numbers of t-shirts, bracelets, and other paraphernalia adorned with semicolons and sometimes colorful butterflies or the word “warriors.” But nowhere does it say what the semicolon stands for. For those of you who don’t know, the semicolon marks that place in a sentence where a writer could have stopped, but chose to go on. As such, it has become a symbol for suicide prevention and mental health awareness.

I have a semicolon tattoo myself. I don’t regret getting it. It reminds me, as the saying goes, that my story isn’t over. But when I got it, I also hoped it would be a tool for education – that I could explain to those who saw it and asked what the symbol meant.

Unfortunately, no one has asked.

I’d hate to think that the semicolon has become like a secret handshake that identifies members of our tribe to one another, but leaves out the rest of the world. As stigma-fighting symbols go, it doesn’t seem terribly effective.

The political conversation has become so fraught that no one talks to anyone who doesn’t believe in the same things. And I’m afraid that, like them, we’re largely talking to ourselves.

Self-talk is important – definitely something we should pay attention to and work on improving. But if we really want to fight stigma, we need to talk to other people about it.

I see a fair number of stigma-fighting memes and discussions, but unfortunately, most of them take place in mental health support groups, where the message is not as much needed as in the larger world outside our band of the mentally ill.

Of course, there are organizations such as NAMI, Bipolar Awareness – Stop the Stigma, and Stigma Fighters that dedicate effort to reducing stigma. And they are doing a good, necessary thing.

But what about the rest of us? What can we do to break out of our shells and involve the rest of the world in our cause?

One thing is to question other people’s assumptions when we see or hear them. When you read a post that calls the weather bipolar, answer it. Explain why that’s not a good comparison – that it trivializes a very real problem that millions of people face every day. And when someone assumes that a mass shooter or other terrorist must be mentally ill (or “off his meds”), remind them that those with mental illness are more often the victims of violence that they are the perpetrators of it.

Will people get the message, or will they just dismiss you as “politically correct” or a “social justice warrior”? Personally, I can think of worse names to be called, and many of us have been called them. But just as “retarded” and “gay” are no longer acceptable as synonyms for “weird” or “stupid,” we should try our best to make “crazy” and “mental” and “psycho” and that annoying little twirl of the finger by the temple no longer acceptable as shorthand for behavior that one doesn’t understand. (I still haven’t figured out how “dumb” and “lame,” both ableist language, have managed to skate by.)

What I’m saying is that to fight stigma we need to engage with the world outside. We need to explain why certain uses of language are hurtful and what the truth is about the many people who are affected by mental illness.

I’ve had to smack a few friends on the nose with a rolled-up newspaper when they get it wrong and I try to put my two cents into other discussions that are portraying the mentally ill insensitively. I think about what I’m going to say and even practice it before I speak or press send. (Sounding well-informed and reasonable is the way I want to express my message.) I post my blog entries to “public” as well as to friends and support groups. Sometimes I even talk to my family about stigma.

As a group, we need to do a whole lot better at not hiding from stigma but confronting it wherever we see it. We can live with stigma or we can fight it.

Forgiving and Forgetting

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Forgive and forget. That’s the saying.

To err is human; to forgive, divine. That’s another saying.

But what about when you can’t forget and can’t forgive? When you’re human, not divine?

Forgiveness is a tough subject for me, because there are things I can’t forget, despite the fact that either my bipolar disorder or my meds have made my memory spotty at best. But there are things I remember too well. And some of those I can’t forgive.

I can’t forgive the person who called my mother a murderer because she had her sick, ancient little dog euthanized. And then kept rubbing her face in it by saying she did not support my mother’s actions. This person caused my mother unnecessary pain when what she needed were understanding and comfort. By those criteria, I am a murderer too. A person that toxic is someone I don’t need in my life.

And maybe that’s wrong of me, but it was my decision.

Another person I can’t forget or forgive is my gaslighter, Rex, about whom I’ve written before (see https://wp.me/p4e9Hv-pm, https://wp.me/p4e9Hv-dR, https://wp.me/p4e9Hv-4t). In one of those posts I said, of forgiving and forgetting:

I can’t do either. The memories have faded over time and seldom give me flashbacks anymore. (The dreams still come.) As for forgiving? He’s never asked for it and never would. I’m sure he doesn’t think he did anything that needed forgiving….

That emotional abuse happened, and I can’t forget it. It was my first serious relationship and I left chunks of my soul and most of my barely existent self-esteem in that house on the hilltop. I had failed – at the relationship, at meeting my parents’ expectations, at so many things. I felt I was the one who needed forgiveness and spent much of the following years repeating incessantly, “I’m sorry.”

I once encountered a Christian who said that the essence of forgiveness was to “fore-give,” to give someone something before they ask for it, as in Jesus, fore-giving his life for His followers. Or giving a homeless person your coat before they ask for it.

I’ve since been told that that’s an inaccurate reading of the word “forgive.” But at the time it stuck with me and influenced my thinking. If that was forgiveness, I didn’t understand it and couldn’t accomplish it. Something to do with that “to forgive, divine” thing.

I couldn’t fore-give my mother’s pain. I surely wouldn’t have given it to her myself and I couldn’t fore-give that other person the right or the opportunity to do so.

I couldn’t fore-give Rex my pain. I gave him enough of my life – over a year – as well as some of my hopes and dreams and aspirations. And yes, at the time, my love.

I’ve thought about writing him a letter, the kind that therapists often suggest you write as an exercise in exploring your feelings, explaining what went on from my point of view. But I haven’t – not even the kind that you don’t mail.

It would be futile. I’ve written about the person and the pain here in these posts and it hasn’t done a thing toward making me forget or forgive. Far from forgetting, I sometimes need to remind myself of the pain – to affirm to myself that yes, it really was that awful and to warn myself never to get caught in a situation like that again.

I don’t go through my life holding grudges against everyone who has ever wronged me (or my mother). Everyday hurts – unless they come every day – are possible to let go of. I’ve mostly forgotten the kids who bullied me in school. And I’ve forgiven them. They were kids and didn’t know any better. I’ve forgiven friends who have cut me out of their lives because they couldn’t handle my bipolar symptoms. Sometimes I can’t handle the symptoms either. If I get fed up with my disorder, it’s easy to see how someone else could too.

I’m not going to give you any advice on forgiveness and whether you should forgive or not. The topic is too complex and I don’t know how or why you’ve been wronged.

All I’m going to say is to be a little easy on yourself if you find you can’t forgive what you can’t forget. Those sayings about forgiveness are guidelines, not laws, and your situation may not fit into those guidelines. Just know that I do understand.

Realistic Self-Care

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I hate articles about self-care for mental illness such as the one I saw recently that said:

…[W]ays I practice self-care include swimming and Pilates, getting regular massages, spending time with friends and family, since staying connected is an essential part of emotional health at every age, watching TV, and seeing movies. I also love going for walks, especially near Santa Monica beach, and reading or listening to books.

If I could do all those things, I wouldn’t need self-care! When I’m depressed or anxious, I cannot make myself swim or exercise, or even get out of bed and shower at times, which lets out going to the movies and spending time with friends, too. I can maybe read a book or listen to a podcast if I’m not too twitchy and if my attention span and concentration will cooperate. And I can sit on the sofa and watch TV, but that feels like uselessness, not self-care.

Plus, guess what? A lot of those activities cost money.  Massages, movies, exercise classes (for which you need exercise clothes), and swimming (for which you need a swimsuit) would all require “shopping therapy,” which I loathe IRL and can’t afford online.

I personally would love a massage, but that’s not self-care for everyone. As Emily Roberts points out in “Self-Care for Mental Health: Find Ways That Work for You”:

The myth of a massage as an essential self-care activity – or anything that makes you more anxious – isn’t helpful for your mental health. I didn’t listen to my body the first time I booked a massage and guess what? It was so triggering to my body I couldn’t even finish it….I started to cry and couldn’t compose myself 10 minutes into the appointment. I was embarrassed and confused. I thought, “This stuff works for all the people in the magazines. What is wrong with me?”

I decided that booking an extra appointment with my therapist and having a date with my best friend was more helpful as self-care for my mental health than pushing myself to practice self-care in the way the media was telling me to.

One person’s mani-pedi can be another’s nightmare. I much prefer small ideas for self-care rather than big expeditions or splurges. For me, comfort food is one form of self-care. It has to be something I can make easily, though, like frozen mashed potatoes, mac-n-cheese, or French bread pizzas. (The microwave is my friend.)

Of course, these comforts require a little planning when I’m not overwhelmed to the point that I need self-care to restore me. I must think ahead, during those times when I’m able to go to the store, to bring home the foods that are easy to make yet soothing.

Another self-care technique I came across is definitely more my speed. Caiti Gearsbeck, in “Make Your Own Mental Health Self Care Kit” offers a simple, DIY alternative. She recommends filling a shoebox or other box with soothing things that appeal to all five senses, plus a few activities. Here are a few of her examples:

Sight: photos, cards, and letters

Smell: essential oils or candles

Taste: chocolate or tea

Sound: meditation CD or an mp3 player with a playlist

Touch: soft cloth or stuffed animal, stress ball or fidget cube

Activities: coloring books and pencils, a journal, a favorite movie

She adds: Whatever works for you!

For me, that box would contain photos, Irish Spring soap, oolong tea, an mp3 player, a stuffed animal (I have lots to choose from), and a CD of The Mikado. I’d need a cat in the box, too. But given the nature of cats, there would probably be one in there anyway, whether I wanted it or not. All of that is stuff I have around the house, unless I’m out of Irish Spring or oolong. Add a quiet room like the bedroom or my study and I’m all set. At least until I can afford a massage.

 

References

https://blogs.psychcentral.com/millennial/2017/10/make-your-own-mental-health-self-care-kit/

https://www.jwi.org/articles/mental-health-and-self-care

https://www.healthyplace.com/blogs/buildingselfesteem/2018/5/self-care-for-mental-health-find-ways-that-work-for-you

The Compliant Patient

My mother was not a compliant patient. She would have side effects from medication and just stop taking them: The meds gave her sores in her mouth or nauseated her.  And that’s valid. We’ve all had medications that we couldn’t tolerate because of the side effects. But Mom stopped taking them without telling her doctor. Once she went to the emergency room, where they had a list of the meds she was supposedly still on and I had to tell intake, “No, she stopped taking that one. And that one too, I think.” (She was not mentally ill, but that’s where I’m going with this.)

There is only one psychotropic medication I know of (though there may be others by now that I haven’t heard about), where the potential side effects are so horrible – potentially lethal – that patients are advised to stop taking them immediately and get medical help right away.  The side effect is called Stevens-Johnson Syndrome and it is a potentially fatal rash.  I wrote about it a few years ago, (https://wp.me/p4e9Hv-1g)

Other than that one instance, psychotropic medications should never be discontinued unless you have consulted your physician. You never know what withdrawal symptoms lie in wait for you, but they’re bound to be unpleasant, even if they don’t cause you to relapse, which could easily happen. Withdrawal from any drug is not fun; it’s to be avoided.

Nonetheless, I read posts in support groups all the time which say that people have decided by themselves to stop taking a medication, or even all their medications on their own. I have friends who have taken their treatment into their own hands this way.

There are several reasons they sometimes give for giving up medications. One is that the meds aren’t working. What they really mean is that the meds aren’t working yet. Many psychotropics don’t show positive effects until they have built up in your bloodstream, which can easily take four to six weeks. Expecting results in a day or two is unreasonable.

Others stop taking their meds because they “feel better” and think they no longer need the pills. This is just ridiculous. The meds are the reason that you feel better. Your psychiatric condition does not just go away, like the flu, when you feel better. Your disorder may soon come roaring back (or creeping back). And the thing is, when you restart a medication, it sometimes no longer works as effectively. Then you have to start all over with a new prescription and have another four to six weeks of symptoms while you wait to find out if it works or doesn’t.

Still other people simply don’t like taking medications.  This I don’t understand.  People take meds for flu and infections and such conditions and never seem to resent them. Maybe it’s the idea that you could well be – will likely be – on psychotropics for the rest of your life. But lots of people have meds they need for life – insulin, cholesterol meds, anti-inflammatories, asthma meds, thyroid meds, and others. People don’t quit taking those just because they don’t like to take pills or injections.

I think the real reason people don’t like to take their psychiatric meds is that they’re psychiatric meds. There is still massive stigma around the subject of mental illness. Taking medication for a mental illness means admitting you have one, which some people are reluctant to do.

Or they may be giving in to “pill-shaming.” There are plenty of people, perhaps in your own family – and certainly across the Internet – who will tell you that all you need is self-love or affirmations or sunshine or exercise or vitamins or meditation or willpower to banish your mental illness. Funny how they never tell people that sunshine will cure their broken leg or that exercise will cure their breast cancer.

I hesitate to say that I love my psychotropics, but in a way I do. They have brought me out of states of mind that were harmful to me. They have made it possible for me to function and create and communicate. They probably have saved my life.

Occasionally I let my psychiatrist know that I may need a change in dosage or that one of meds is no longer working. I’ve even reviewed with him whether there are any meds I could quit taking (there aren’t at the moment). But I keep taking them faithfully, every day, morning and night.

I need the psychotropics. So I am a compliant patient.

Reaching Out and Reaching In

A lot has been said in recent days about reaching out when you’re in trouble psychologically. And that’s always a good idea. Reach out to your friends, your family, your therapist, your psychiatrist, your church or synagogue or temple.

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Unfortunately, not everyone has those resources. And sometimes when you reach out to them, they do not reach back to you or even respond in hurtful ways.

Sometimes – many times – you’re just not able to reach out. That’s true of me, anyway. When major depression hits me like a truck, I get immobilized. Uncommunicative. Isolated. I usually have the wherewithal to get to my therapist, if my husband drives me, but not much more.

My family and friends can tell when I’m in trouble. And they do reach out, even when I don’t reach back.

My mother always knew when I hit a particularly bad spot because she could recognize it in my voice – it lacked animation, even if I was talking about something I loved. Not that I talked much or felt much. Depression can damp down all your feelings sometimes. You don’t cry, you don’t feel sad. You feel nothing. And it shows to someone who knows how to look and listen.

This is called “flat affect” by psychiatrists. The person’s face, voice, mannerisms do not reflect emotions, sometimes not even anxiety or despair. And sometimes people adopt a flat affect so as not to betray their inner turmoil. (It can still leak out around the eyes, even to relative strangers. And I don’t mean crying.)

My husband knows I’m depressed when I turn monosyllabic. Ordinarily, I enjoy talking to my husband about anything and nothing – things we’ve read or heard, what’s happening at work (his, mostly), funny things the cats did, and so forth. But when I stop responding and communicating, or respond only with “yeah,” “nah,” and “meh” sorts of answers, or don’t laugh or at least groan at his jokes, he knows I’m headed downward.

I stop communicating other ways, too. I don’t post on Facebook or only pass along the occasional pass-along. I skip commenting on posts regarding things I usually care about. I spend hours alone reading, if my sometimes-dubious powers of concentration let me. Or I sleep, and nap, then sleep some more. I certainly don’t leave the house or even make plans to go out. I don’t call friends. I isolate. I don’t reach out, like the memes say I’m supposed to.

I am fortunate to have friends that do reach out to me. John would lend me books, talk about them with me, and listen if I needed to vent. Peggy would call and invite me to visit, even when she knew I wasn’t leaving the house. Pete sometimes IM’s every day just to check in and JB assures me that when he IM’s and I don’t feel like chatting that’s still okay. Robbin calls me and tells me all about her life even when I can’t talk about mine, then says, “Let me know when you surface.” If she doesn’t hear from me for awhile, she calls again and reminds me that I can call her too. (She can also “read” my voice and knows when there’s some topic I’m avoiding.) My husband offers a hug or kisses me on the head. My mother prayed for me. I am fortunate indeed to have had people like these around me when I really need them.

Reaching out to others is good. So is reaching in to the suffering. Best is a combination of both. But that takes work and not everyone is able to do it.

If you can reach out, reach out.

If you can reach in, reach in.

If you’re lucky, you’ll meet in the middle, where hope lives.

 

Where Churches and Mental Illness Meet

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Lately, I’ve been thinking – and writing – about the place where faith and mental illness intersect. (See Mental Illness, Faith and Sin – https://wp.me/p4e9Hv-DB; Prayer and Bipolar Disorder – https://wp.me/p4e9Hv-B6.) I’m still thinking about it, so I’m still writing.

Churches, among other groups, have outreach ministries to the homeless mentally ill, providing sandwiches, socks, and hope of salvation. And the stereotype of the soup kitchen is that patrons “pay” by listening to a hymn or a sermon.

But what about the rest of the mentally ill community – those like me who have homes and families and a certain degree of function? What are churches doing about us?

The answer is: They struggle, but at least some of them are doing something.

Of course, some of them are doing the wrong thing. Andrea Jongbloed reported in Relevant magazine:

I sat in the chair in my pastor’s office, listening to him list off strange things I had done recently. My pastor informed me, “the church leadership is not convinced you are mentally stable enough to continue leading your bible study.”

It wasn’t supposed to happen this way. I had come here to talk about the book I was writing, on mental health and spirituality. Instead, I felt bombarded with accusations…. I left feeling judged and misunderstood.

An article in Christianity Today notes, “In many ways, the church, the supposed haven for sufferers, is not a safe place for those who struggle with mental illness.” The author adds:

The more Christians struggle with how to deal with mental illness, the more we fail to create a safe and healthy environment in which to discuss and deal with these issues. As a result, many of our Christian churches, homes, and institutions promulgate an aura of mistrust, guilt, and shame.

Amy Simpson, writing at qideas.org, outlines what is wrong with churches’ relationship with the mentally ill:

In general, the church tends to handle mental illness in one of three ways: ignore it, treat it exclusively as a spiritual problem, or refer people to professionals and wash our hands of their trouble.

Like it or not, the church is the first place many turn in crisis. And fair or not, the church’s silence or rejection feels like rejection from God. We cannot keep turning away from the most vulnerable among us.

According to Lifeway Research, however, 66% of pastors speak to the church about mental illness in sermons or large group messages “once a year, rarely, or never.” And 74% of pastors say that they are “reluctant to get involved with those with acute mental illness because it takes too much time and resources.”

But some churches are taking on the challenges, or at least trying to.

In a PBS interview, Deborah Potter, a correspondent from Religion and Ethics Newsweekly, explores how Holy Comforter Episcopal Church in Atlanta and St. Catherine-St. Lucy Roman Catholic Church in suburban Chicago are providing not just outreach, but community to the mentally ill.

According to Potter,

Holy Comforter responded … when a group home opened nearby and the priest at the time invited the residents to church. Today, almost two-thirds of the congregation is made up of people with mental illness—including bipolar disorder, clinical depression, and schizophrenia—who worship together and pray together.

The video also features Connie Rakitan, who founded the program at St. Catherine-St. Lucy, “helping to design worship that’s welcoming to all.”

Rakitan explains:

Walking into a church with a long service and a long sermon and lots of music and lots of people could just be so overwhelming that it’s just not doable….We would never, ever use a healing passage, because we would not want to set somebody up for an unrealistic disappointment, because the fact is not everybody gets cured.

Rakitan also points out that the church community offers something that the mentally ill may not find elsewhere: “Their families might be alienated from them or estranged or whatever. They might not have work communities. What do they have left but their faith in God?”

Lorrie Lattimore, of the Baptist Press, tells about a weekly “combined Sunday school and worship time” at First Baptist Church, Tuscaloosa, Ala.

It’s not an ordinary class. Some get up and pace during the Bible lesson. Some rock steady in their chairs. Some mumble to themselves. But all love God and know God loves them in spite of being consumers [sic] of a mental illness, those who have schizophrenia, for example, or depression or bi-polar disorder. Jimmy Tilley, the leader of the class, who also suffers from depression, chronic anxiety and obsessive-compulsive disorder, wouldn’t want the group to act any other way.

She adds:

Few Baptist churches offer some kind of outreach for mental illness consumers. Jim Hightower, minister of pastoral care at First Baptist Church…. noted more churches should have education programs and even ministries because “every church has members who have a mental illness.”

The best advice for churches? Amy Jongbloed sums it up nicely:

Be open to learning about mental illness. Have potentially awkward conversations with newcomers who struggle with their mental health. You won’t regret stepping outside your comfort zone. You will be blessed with stories of struggle, resilience and redemption. If you’re lucky, maybe you’ll even become part of someone’s story of recovery and reconciliation with the Church.

References

http://www.pbs.org/wnet/religionandethics/2012/06/22/june-22-2012-churches-and-the-mentally-ill/11386/

http://qideas.org/articles/mental-illness-what-is-the-churchs-role/

http://www.villagelife.org/church/archives/baptist_mentalhealth.html

https://www.christianitytoday.com/edstetzer/2016/may/christian-struggle-with-mental-illness.html

https://relevantmagazine.com/god/church/4-misconceptions-about-mental-illness-and-faith

How Writing Can Be Therapeutic

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I write because I have to. It’s what I do. It’s also how I make my living (along with editing and proofreading and now, transcribing). But I also feel that writing is therapeutic for me.

Maybe it can be for you too. Let’s look at some different kinds of writing and how they might help.

Journaling

Journaling is what I actually set out to do when I started this blog. I meant it to be a day-to-day journal of my feelings, my accomplishments, and my difficulties. At the time, however, I was rather depressed and could see only difficulties, not accomplishments.

Journaling works for a lot of people because they can have a record of their mood swings, as well as a place to work out problems and say things they can’t say to anyone else. If they wish, they can share the journal record of moods with a therapist. Journaling is kind of like keeping a diary, but more purposeful.

Blogging

I turned my journaling into a blog. What had started, to be honest, as a lot of whining became a space where I could share stories about what happened to me and others, where I could examine news stories and media statements about bipolar and mental illness, and post opinions about coping and stigma and relationships and medication and all the other fun stuff that goes with mental illness.

Blogging is one way to reach out to others. And there are other people out there who want and need to hear what you say. I have blogging friends who share unique insights that alter how I see my disorder and how I cope with it. Think of blogging as a journal you publish, at least in a limited way.

Unsent Letters

This is a technique that therapists use to help you surface your feelings toward another person and have a safe space to explore those feelings. The fact that you never send the letter means that you can focus on your own feelings and not worry about what the other person might think or say about it.

I’ve used unsent letters to unpack my confusion about IMs from another person. Instant messages are not really the place to hash out the nuances of a relationship or what deeper meaning a particular comment may have had.

Usually, by the time you’ve finished, the letter no longer even needs to be sent, though I advise keeping it around to contemplate later.

Poetry

Poetry is often thought of as a way to express emotions. But really, poetry can be about anything the poet wants to say. Here’s a sonnet I wrote about depression and healing:

The air is still and blankets all my sense.
I’m muffled, muzzled in the sheltering dark
But dare not pray for fire, with bright, intense,
loud flames that rend the silence with a spark.

I breathe, or not? It’s sometimes hard to tell
When swathed in clinging, stifling musty scent
That fills my nostrils and my brain as well
Which cannot will the veil be shredded, rent

to save from suffocation. How shall I
Withstand this cycle till the day appears
And breezes blow the dust away from my
Stopped ears and eyes and lungs, plugged full with fears?

Pull off the cover and let free the soul.
Take broken breath and heal it into whole.

Poetry doesn’t require that much form and structure to be effective or therapeutic. Free verse, or unrhymed, unmetered poetry, is often the place people start. That doesn’t mean it’s easy, though. You have to dig deep to get at what you want to say and how you want to say it, if you’re writing for anyone other than yourself.

Publishing

Speaking of writing for someone other than yourself, there are always fiction and nonfiction (in addition to blogging). If your stories or articles or poems or books are good enough, they could even be published.

You can write either fiction or nonfiction for publication. It’s rare to see fiction on mental health topics, but Sylvia Plath’s semi-autobiographical The Bell Jar and Abigail Padgett’s Bo Bradley mystery series are places to look for inspiration.

Short nonfiction is easier to place, with TheMighty.com being a great site to submit factual personal accounts of invisible illnesses, including mental disorders. You can also share on Medium, where you can tag posts with appropriate descriptors like Mental Health or Psychology.

Getting paid for your published writing is another matter entirely, but it can be done. Writing for publication, however, is fraught with potential pitfalls. It is easy enough to trigger anxiety or imposter syndrome regarding submitting, not to mention waiting for a reply. And the inevitable rejections (everyone gets some) may play hell with your self-esteem.

My advice? Write. And keep writing. Whether you decide to try for publication or write strictly for yourself, it will be a good thing. Why miss another chance to explore your feelings, express your thoughts, and possibly share with others?

 

Would You Try Electroshock?

Photo by Mike T

In the course of dealing with my bipolar disorder, I had a near brush with electroshock. I managed to avoid it, but I did give it serious thought.

Now 60 Minutes has come out with a piece called “Is Shock Therapy Making a Comeback?” You can see the segment here: 60 Minutes.

ECT(electroconvulsive therapy, the modern name for the procedure), which is often done on an outpatient basis, works by inducing a brief seizure in a patient. The seizure, which lasts about a minute, releases multiple neurotransmitters in the brain, all at once. The patient is required to have someone to transport them to and from the appointment. Treatments are typically applied one or two times per week for 6-8 weeks.

In a brief article excerpted from the news show segment, Dr. Charlie Welch, of McLean Psychiatric Hospital, explains how ECT differs from how it was performed in the past: “What’s different first of all is that it’s done under general anesthesia with a muscle relaxant. So when the treatment is done, the patient is sound asleep and completely relaxed.” Call it a kinder, gentler shock treatment.

That was the procedure that my psychiatrist offered me after he had spent a number of years trying me on various medications that either didn’t work, or helped only partially.

My immediate reaction was negative. I recall thinking, “Fuck, NO! Keep away from my brain, you Nazi sadist!” After I calmed down a bit, I did some research.

ECT, my sources said, was a long way from the cruel, stigmatizing procedure portrayed in One Flew Over the Cuckoo’s Nest. The Internet was little help, though. The opinions and experiences of people who had undergone electroshock ranged from “It was hideous” to “It was a miracle.”

Truthfully, I was appalled by the notion of electrical jolts surging through my brain. My precious brain, which had both sustained me and betrayed me throughout my life.

Then I thought some more. So ECT sometimes causes memory loss. I already had that, thanks to some of my meds. I would be altering my brain with electricity. But hadn’t I been altering it for years with chemicals – medications that no one seemed to know how they worked?

So I went back to my doctor and said I would at least talk to the doctor who would perform the procedure. And I lined up a journalist friend to write about my experiences if her editor approved. (Note: In the 60 Minutes piece, former Massachusetts First Lady Kitty Dukakis gave permission to have her treatment filmed and broadcast.)

My psychiatrist, however, had one more medication that he wanted me to try before we took that next step. And it worked. So much for electroshock.

Now as to that side effect of memory loss – Dr. Sarah Lisanby of the National Institute of Mental Health in Maryland has developed a new treatment that seems to avoid that particular consequence.

The procedure is called Magnetic Seizure Therapy (MST) and it uses magnets (duh!) to stimulate more precisely focused seizures than ECT does. These focused seizures seem to avoid the parts of the brain associated with memories. As Dr. Lisanby told the 60 Minutes reporters, “For some people, ECT may still be needed. But if Magnetic Seizure Therapy could be effective without the memory loss who wouldn’t want to try that first?”

Would I try MST if I relapsed into treatment-resistant depression? I would certainly consider it, if it were out of the testing stage by then. And I’d do that before I signed up for ECT. While I have memories I’d prefer to forget, with my luck, those would be the ones left unaffected.

The cynical side of me says that these seizure-causing therapies are becoming more popular because insurance companies like the notion of a short course of 6-8 weeks of treatment instead of years of talk-and-medication. (Although Kitty Dukakis said that she has done ECT for years now and expects to continue into the foreseeable future.)

But I could be wrong. It is possible that some kind of treatment could be short in length but longer-lasting in effectiveness. I’m not ruling it out. At this point I’m not ruling out anything that could aid in my progress and my healing.

 

Bad Thoughts and Tattoos

Sometimes I have bad thoughts. We all do. I find that mine fall into three groups.

The first kind of bad thoughts are when I want to snap or snipe or snark at my husband, despite the fact that he is indispensable to me. He takes care of me, understands me, helps me, hugs me, feeds me in ways I can’t begin to describe.

When those bad thoughts arise, I have a brief internal chat with myself. (It looks like I’m thinking what to say because that’s exactly what I’m doing.) Then I choose not to say the nasty thing or I think of a less-nasty way of saying it. (I’ve written about the phenomenon before in “Managing My Anger” https://wp.me/p4e9Hv-kw.)

The skills involved are impulse control, the use of “I statements,” and the ability to rephrase. I try to say something that will get my point across without hurting or making things worse. These are techniques I have learned over the years, which makes me think they are things that can be developed with a little practice.

Learning to restrain myself has prevented many a fight. Some people find this style of communication inauthentic or wishy-washy – that I am tiptoeing around my husband instead of saying what I really think. All I can say to that is that it works for me and for our marriage.

The next kind of bad thought is the kind that comes with depression: I’m useless. I’m pathetic. I can’t do anything right. I’m worthless. Jenny Lawson (aka The Bloggess) talks about these thoughts in her book Furiously Happy, and she has one thing to say about them: Depression lies. These are the thoughts of a biochemically influenced brain that makes you miserable and sometimes wants to kill you, or at least kill your possibility of happiness.

Fortunately, my husband has read Jenny Lawson too. When I express these bad self-thoughts – and it’s best if you have a safe person to tell them to – he reminds me. He doesn’t try to deny the thoughts (You know you’re not worthless. You do lots of things right). He tells me, “That’s depression lying to you.” I used to get stuck in these cycles a lot before I was properly medicated and before I had his help and that of my therapist.

Then there are the really bad thoughts, those of self-harm or worse. Most of the time I don’t have these anymore, but when I do, there is one thing I can do. (Actually, there are more things I can do, but this is one that works for me.) I look at my tattoos.

The one on the right wrist is a symbol for bipolar disorder made up of punctuation : ) :  in the form of a smiley face/frowny face. This reminds me that my brain isn’t working right and is sometimes out to get me.

The other is on my left wrist, near my scars from self-harm. It is a semicolon. You may have heard about the Semicolon Project or seen the semicolon symbol on t-shirts or jewelry.

The semicolon is my favorite punctuation mark. It comes at the place in a sentence where a writer could choose to put a period and stop; instead, she continues the sentence. The semicolon says, “My story isn’t over,” something you’ll also see on t-shirts and such. (I’m thinking of making that sentence my third tattoo.)

Recently I had a bout of those really bad thoughts. But I looked at my tattoos and told myself, “My story isn’t over yet. I still have things I need to do.” One of them is to tell my story, in this blog and in a book I’m trying to write.

My tattoos helped me get over the bad thoughts. They have paid for themselves many times over. I never regret getting them. They may have saved my life.