Bipolar 2 From Inside and Out

Men and Mental Health: Two Stories

06 07 26

There are so many Awareness Months these days that it’s hard to keep track of them all. June alone has Pride Month, Caribbean American Heritage Month, National Immigrant Heritage Month, Men’s Mental Health Month (which is also recognized in November), and National PTSD Awareness Month, as well as celebratory or awareness weeks and days.

The Verbate site, which keeps track of these awareness days and months, has this to say about Men’s Mental Health Month: “Men’s Mental Health Month raises awareness of the unique mental health challenges men face and the social stigma that often prevents them from seeking support. Research shows men are less likely to seek mental health care, despite experiencing higher rates of suicide and untreated mental health conditions. Cultural expectations around masculinity and self-reliance can deepen isolation. This observance encourages open conversation, early intervention, and inclusive definitions of well-being.”

They also offer suggestions on ways to celebrate the awareness month inclusively:

• Share mental health resources and benefits.

• Normalize help-seeking behaviors through leadership modeling.

• Highlight intersectional perspectives on masculinity.

• Encourage open, stigma-free conversations.

The statistics regarding men’s mental health are fairly well-known and easy enough to find, though they differ from source to source. Men’s rates of suicide, especially compared to women’s, are often mentioned. So too is the lower number of men seeking help for their mental health compared to women.

But statistics provide an arm’s-length look at the problems. While that’s valuable, so are men’s stories regarding the need for better care with mental health problems.

Owen’s Story

Owen worked for years in a highly responsible, high-stress job at a facility that required him to supervise a large number of men. The long hours contributed to his increasing inability to cope. His home life deteriorated, and he stopped pursuing his former interests and activities. His friendships fell by the wayside until he had only one close male friend.

Then Owen was fired from his job. He drove home, then sat in his car, unable to move. Before long, an ambulance pulled up. Owen’s coworkers had seen how distraught he was and called for a wellness check. The EMT squad took him to the emergency room for screening. Owen found it fairly easy to respond to the questions in ways that would not raise alarm bells and was sent home.

Over the following months, Owen realized that he needed emotional and mental help, rather than just a new job. He went to a therapist, who prescribed SSRIs and a course of talk therapy. Eventually, Owen was able to voice his feelings and move on to a lower-stress job that didn’t require him to supervise anyone. His mental health improved.

Franklin’s Story

Franklin was married with three young boys, and he had a temper. His wife, Leslie, had a progressively debilitating and ultimately fatal disorder, which meant that Franklin was increasingly responsible for the children. He shared his interest in trains with them and got them a pet tarantula. But the kids knew that when Daddy got mad, he blew up. Leslie joked with them that Franklin was like the Incredible Hulk; when he was angry, he turned into another person.

After Leslie died, there was no buffer between Franklin and his boys. As the kids grew up, they became more and more estranged from their father. Franklin had trouble keeping a job and, for a time, had to sleep in his car. Eventually, Franklin moved in with his aging mother and tried to care for her. But he reverted to his old habit of yelling at her when he was irritable or became angry. His physical health declined as he aged, too, and he never sought treatment for either his various ailments or his anger issues.

Seeking Help—Or Not

Owen’s and Franklin’s mental health suffered at various times over the years. Owen had less extreme bouts of depression besides the one when he lost his job. He lived off his retirement savings for a year. That relief from the pressures of the job, and the medication and therapy he received, turned his life around. He still experienced reactive depressive episodes, but not out of line with the extent of the everyday problems he encountered.

Franklin became an increasingly angry man. Family members wondered if he was treating his mother abusively, but never broached the subject with her because she had made it known that she was unwilling to accept any other living arrangement, such as assisted living.

Both Owen and Franklin would have benefited from a social structure that was more supportive of men receiving help with their mental health. Owen might have sought help before the long build-up to the end of his job and learned healthy ways to cope with the pressure. Franklin could have dealt with the death of his wife and caring for his aging mother while taming his temper and explosive interactions. Both would have been better off.

In this Men’s Mental Health Month, let’s try to reach out to friends, family members, and coworkers like Owen and Franklin before their situations become desperate. Help them get the help they need. They aren’t immune to psychological difficulties just because they’re men.

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“Deprescribing” Psych Meds

05 31 26

I saw my psychiatrist this week for a med check and asked him about RFK, Jr.’s crusade against antidepressants. He said a good number of his clients had asked him about it. He reassured them that he was not going to cut them off.

Then Dr. G. said, “They’ll pull up to your house in a black Suburban, with face masks on, and ring your doorbell.” (He was joking.) I replied, “I have a gun.” (I wasn’t.)

Still, the fear is real. I’m not sure if Kennedy has an actual plan to curb what he considers an overprescribing of antidepressants. But those of us who need them are genuinely afraid that he will find some way to take them away from us. Maybe he’ll try to cut down the supply coming from the drug companies. Maybe he’ll invent some system by which doctors will be penalized for writing “too many” prescriptions. Or maybe he’ll put in place his threatened “wellness farms,” where people with mental illness will supposedly be cured by fresh air, organic food, no medication, and hard outdoor labor, much as he has recommended for “reparenting” children on ADHD meds.

The psychiatric community is as alarmed as their clients. At this year’s meeting of the American Psychiatric Association, doctors expressed fears that if Kennedy’s recommendations are put in force—and maybe even if they’re not—people who currently take antidepressants or other meds may decide to quit cold turkey or taper off without their physician’s advice and supervision, both of which are dangerous. Physicians also fear that patients will refuse necessary medications and relapse without them.

Kennedy has particularly targeted SSRIs (Selective Serotonin Reuptake Inhibitors) such as Zoloft (sertraline), Prozac (fluoxetine), Lexapro (escitalopram), and Paxil (paroxetine). Other targeted medications include antipsychotic medications, mood stabilizers, stimulants, weight-loss drugs, ADHD medications like Adderall, and combinations of these drugs. All these, Kennedy says, add up to a “dependency crisis driven by overmedicalization.” He has described the people who take these medications as “addicts.”

Kennedy compared coming off SSRIs to his experiences with trying to curb his heroin addiction: “You just have to steel yourself for 72 bad hours.” (He said that he had tried to quit and gone through withdrawal “a hundred times.”) He has also said, without evidence, that SSRIs are partly responsible for the rise in school shootings and other mass shootings.

The New York Times reported that at the Mental Health and Overmedicalization Summit organized by the MAHA (Make America Healthy Again) Institute, speakers were discussing “a variety of steps to address the overprescription of psychiatric medications, such as phasing out school-based mental health screenings, requiring written informed consent before starting medications, and featuring prominent, cigarette-style warnings on packaging.” It’s also been proposed that clinicians be paid through government programs to “deprescribe” patients. Too, there were discussions about changes in insurance billing and an “expert panel” with the mission to “develop clinical guidelines for deprescribing.” “This summer,” the Department of Health and Human Services says, “The Substance Abuse and Mental Health Services Administration, or SAMHSA, will release training modules focusing on the risks of psychiatric medications and on tapering and deprescribing.”

The risks of coming off psychotropic meds went largely unaddressed. People who have tried to do so without proper medical supervision have reported “brain fog,” as well as “emotional blunting, loss of motivation, suicidal ideation, and difficulty in withdrawing.” Some have also reported “shocklike sensations, flu-like symptoms, insomnia, nausea, and restlessness.”

It’s true that many medications, including some psychiatric medications, have been overprescribed. But they’ve been judged safe enough to be prescribed by primary care physicians as well as psychiatrists. Targeting and demonizing SSRIs and ADHD medications will leave patients with few ways to get the treatment they need. NPR reports that Dr. Theresa Miskimen Rivera, president of the American Psychiatric Association, has said, “It really is an oversimplification. And it really ignores the larger reality, which is that too many patients really cannot access timely, comprehensive care that is much needed for our nation.”

Personally, I have been taking various combinations of these medications, including SSRIs, for decades. My psychiatrists have never recommended stopping them, and I have never wanted to. The medications and the dosages have changed over the years, as needed. Psychotropic medications have literally saved my life as well as my sanity, and allowed me to function well in my relationships, my career, and my other activities. I don’t consider them cure-alls; I still have occasional symptoms of depression and hypomania. But being told by a government agency to quit them, or even to taper off them, scares me. I hope Kennedy’s ideas are never instituted, but given all the other recommendations he has proposed, I’m far from sure that they won’t be.

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The Importance of Apologies

05 24 26

When my mother was a young woman, she had the chore of cleaning up her parents’ bedroom and emptying the trash. She came across a condom and asked her mother what it was. Grandma gave my mother an innocuous but wrong answer, claiming it was where Grandpa spit when he was chewing tobacco.

Later, of course, my mother learned about condoms and what they were really for. She told me this story much later in life and expressed disappointment and hurt that her mother hadn’t told her the truth.

When I was a tween, I asked my mother a question about my body and asked her not to tell anyone what I had asked. Minutes later, I heard her telling my sister, “She thought she was developing, but she’s not.” I was disappointed and hurt.

Neither my mother nor I said anything about these incidents at the time. My mother only told me her story when I was an adult. I don’t think I’ve told mine until just now, in this post. I’m sure both of us would have felt better if our mothers had apologized to us.

Neither of these incidents was earth-shattering. They were just that—lone incidents, not part of a pattern of untrustworthy behavior. We didn’t feel we had to break off all contact with our mothers. We still loved them. I know it just goes to show that they were human and therefore imperfect. But I know I was a bit let down, and suspect my mother was too.

The Guardian recently printed an article about Lindsay C. Gibson’s book Adult Children of Emotionally Immature Parents. The author of the article, Emline Saner, chose to highlight a story from that book in which a mother apologised to her child, then seven, for being too harsh while potty training her as a toddler. It let the child know that the child had done nothing wrong—that the mother was admitting that she had fallen short because of circumstances in her own life. In this instance, the daughter burst into relieved sobs.

I wouldn’t call my mother or my grandmother emotionally immature. Our parents were human. Both of them fell short in communicating about difficult subjects. Later on, we felt that we had deserved the respect of being told the truth and being listened to. We weren’t significantly harmed by their lapses. But they were something we remembered into adulthood.

Saner’s article says, “Gibson’s idea of emotional immaturity is not an official diagnosis. It has been criticised for being too broad, for shifting blame onto parents, and for tempting readers to pathologise fairly benign, if irritating, traits alongside more obviously abusive ones. But it has also clearly deeply resonated with people who recognise the deficiencies of their parents, the effect it had on them growing up, and the present struggles they are dealing with.”

No parent is perfect. They all do some things that upset their children, especially when the parent is stressed by circumstances outside of the child’s comprehension or control. But apologizing for those lapses takes a lot of self-knowledge, empathy—and yes, emotional maturity. It gives a child a role model, too. Children learn that parents aren’t perfect, that they can do things that upset the child without meaning to. They also learn that apologizing is the first step in making right something that was hurtful.

My husband (and many other former children) have had trouble apologizing because they’d been told, “Say you’re sorry,” when they didn’t feel sorry. Maybe having an adult who modeled apologizing to a child would have helped them feel more comfortable with making apologies when they were needed.

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Was My Family Dysfunctional?

05 17 26
Clockwise from left: my father, my sister, my mother, and me

Leo Tolstoy said, “All happy families are alike; each unhappy family is unhappy in its own way.” Nowadays, we don’t talk about happy and unhappy families. We talk about functional and dysfunctional ones.

If you ask, most people will say that all families are dysfunctional. They differ only in the degree of dysfunction and the ways that dysfunction presents.

But is that true? Is there really no such thing as a functional family?

First, we need to look at some definitions.

What Is a Dysfunctional Family?

According to certain stats, 70% to 80% of families are dysfunctional. But what does that mean?

Fortunately, the term “broken home” has been retired, and single-parent families are no longer considered automatically dysfunctional. In fact, a dysfunctional family can result in a separation or divorce that makes the remaining family structure much more functional.

In addition to dysfunctional families, we talk of “toxic” families, “traumatic” families, and “estranged” families. (There’s obviously considerable overlap.)

But are those the only kinds of dysfunctional families?

A 2024 article by Kaytee Gillis in Psychology Today says, “Having one or two unhealthy behaviors crop up occasionally is usually not cause for concern. Traumatic dysfunction involves patterns of behavior that are harmful and pervasive, such as emotional or physical abuse, neglect, or extreme manipulation that occurs over a long period of time. This type of dysfunction creates an environment of fear, instability, and ongoing emotional pain, leading to significant psychological scars and lasting trauma that likely impacts you today.”

In a 2023 article, also in Psychology Today, Gillis identified five different kinds of dysfunctional families.

• The family that believes they have no problems because they project them all onto other people.

• The family that worries about what others think of them and carefully controls appearances.

• The family with one “scapegoat” member who is blamed for any and all problems.

• The unpredictable family that changes based on traumas like mental illness, addiction, or abuse. (This is what most people think of when they consider dysfunctional families.)

• The family that faces challenges from extreme conditions such as generational poverty or violence.

Nidra Nittle, in VeryWellMind, lists three kinds of dysfunctional families:

• The emotionally unavailable family.

• The family of addicts and enablers.

• High-conflict and abusive families.

Soulaima Gourani, writing in Forbes, says “subtle issues such as the inability to give unconditional love, … and poor boundaries contribute to dysfunction. Regardless of what the cause is, the outcome is the same. An unhealthy emotional connection can lead to the breakdown of the family unit and residual shame.” She adds, “I believe strongly that the concept of family is up for discussion. We can define family for ourselves and break the cycle of dysfunction. How we do this depends on our resolve to make a different choice.” Many people these days are creating new family structures that they hope will be less dysfunctional than the ones they grew up in. “Chosen family” is edging out “blood kin” as a preferred family pattern.

Was My Family Dysfunctional?

I didn’t grow up in a ’50s television family, though my parents took the roles of breadwinner and homemaker. They never had loud arguments or violent behavior. We had an alcoholic uncle and a “bad girl” cousin, but neither of them lived with us, so we weren’t exposed to their behavior much. My parents weren’t very outgoing, but my father did have some friends in the neighborhood and at his work. He was part of the gun culture, but deeply law-abiding and a stickler for safety. My mother was quiet but creative, exchanging crochet patterns with friends around the world. She also had a strength that most people never noticed. And we had at least one “chosen” family member, a friend of mine whose parents were divorced and who became an acknowledged sister to me.

All of that says that we were pretty darned functional. I can’t identify us as any one of Gillis’s five types or Nittles’s three types of dysfunctional families. But there was mental illness in the family (mine, undiagnosed at the time), which no one had any idea how to cope with, and some devastating health problems that directly or indirectly affected us all (cancers and a heart attack). My sister and I are now estranged (by my choice), so that likely indicates some dysfunction somewhere. I’m not in touch with uncles, aunts, or cousins either, and have surrounded myself with people I have chosen to be close to.

Put all that together, and I’m probably the closest thing my family had to a dysfunctional member. The family structure seems to have been as functional as anyone’s ever is.

All in all, I’ll take it.

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Men’s Mental Health and the Manosphere

05 10 26

June, which is coming up faster than you think, is Men’s Mental Health Month. We can expect PSAs about depression and PTSD, messages that men are allowed to have feelings and seek help, and actors and sports stars admitting they have reached out to other men who were having problems.

Teens and young men in particular need to see and hear these messages. In addition to raging hormones and brains that aren’t fully developed in the impulse control regions, young men don’t often learn how to deal with troubled thoughts and feelings, and they can fall victim to addiction to violent video games or online gambling. These powerful forces influence them in ways that are detrimental to their mental and emotional health.

And on top of all that, they can be lured into unhealthy feelings and behaviors by the Manosphere.

What Is the Manosphere?

The manosphere is a section of the internet, including social media apps, Reddit, YouTube, blogs, podcasts, gaming forums, websites, and communities that give a voice to dissatisfied, lonely, frustrated, and frequently hostile men. Their needs are real, but the solutions offered for them are harmful. The manosphere likely originated from the men’s rights movement, which promoted the idea that men were treated poorly in custody decisions and other areas of life. Much of the blame was directed at feminists. One of the manosphere’s main complaints is that by encouraging men to get in touch with their softer sides and emotions, men are being feminized, and that’s a bad thing. They call giving in to feminist thinking “taking the red pill,” a reference to the movie The Matrix. Red pill content is pervasive on the internet and often referred to in real-life conversations.

The manosphere seeks to offer a different definition of masculinity that they say young people are not receiving. Unfortunately, what the manosphere presents as an alternative is toxic masculinity and a return to caveman-like behavior. Women who object to what they are promoting are viciously and often obscenely attacked online. Women in the #MeToo movement are met with stories of false accusations of rape, and women are routinely pictured as sex objects and/or adversaries. In addition, segments of the manosphere promote anti-LGBT+ views, racism, and other forms of hate speech. And the “incel” community (involuntary celibates), who blame women for not being sexually attracted to them, have been known to attack women physically in real life. They have a sense of entitlement when it comes to women’s bodies.

Why Is the Manosphere Harmful to Men’s Mental Health?

First, denizens of the manosphere preach extreme self-reliance. And they deny that psychological problems even exist. Men who ask for help are seen as weak. They’re supposed to handle all their difficulties themselves. They ignore or scorn messages that seeking help for mental health is legitimate. There’s tremendous stigma attached to seeking help for depression, anxiety, loneliness, and relationship problems. And the manosphere teaches maladaptive coping mechanisms, rage, and aggression disguised as bonding and shared hardship.

Then, too, the manosphere promotes messages they call “male empowerment” or self-improvement. Teens and young men are particularly vulnerable. It sounds so positive and harmless—or fun, as parts of the manosphere claim to turn boys and young men into “pick-up artists” who scoff at the idea of consent. Empowerment, as the manosphere defines it, appeals to youngsters who feel alienated and discontented. It also results in disrespectful harassment and even violent behavior towards women and trans people they see as pushy or threatening, including authority figures such as teachers, women who blog about video games, and their female classmates as well.

The masculine ideal in the manosphere relies heavily on the physical attributes of video game and action movie heroes or bodybuilders: toned and ripped, square-jawed, and athletic. Achieving this is called “looksmaxxing,” and teens and young men are particularly susceptible to it. Preteen and teen girls already get messages from the media that their looks are deficient and in need of sometimes extreme improvement; now, preteen and teen boys are getting similar messages. This process results in significantly lowered self-esteem, and the manosphere seems to offer a solution, such as ads for products, coaches, courses, and supplements, often dangerous ones, that will help youngsters achieve the “right” body type. (Teens have actually been advised to tap on their face with a small hammer to achieve the “chiseled jaw” look.)

What to Do About the Manosphere

Combatting the malign influence of the manosphere will not be easy. Manosphere influencers present messages that appeal to teens and young men, who don’t realize how harmful they are. Getting young males to listen to messages that men are allowed to have, and do have, mental health difficulties, and that seeking professional help is acceptable, isn’t a “sexy” message that plays on insecurity, misogyny, and blame-shifting. But it’s something that needs to be done before we lose a generation of young men to a vision of toxic masculinity.

Another avenue that needs to be considered is educating young men with critical thinking skills and information on how the internet works. They need to be able to examine manosphere content with an eye toward how reliable the information they receive is and what the poster has to gain. They need to understand that when they click on a link or watch a video, they will receive more content related to that interaction—more videos of Andrew Tate and other influencers, more links to other manosphere sites, more content that espouses misogynistic and patriarchal views, and more looksmaxxing promotion.

We need safe, male-friendly, and peer-to-peer spaces in families, schools, and counseling practices for young men to process what they hear versus what they feel. They need to know that talking to other young men and to mental health professionals about their problems, questions, and difficulties is a valid way to get the support they need. We need to offer alternatives to the manosphere, examples of nontoxic masculinity, and ideologies that don’t present women as the enemies of men. We need to present messages that there is no one way to look or to be if you’re male, and no one way that women view men or act toward them. In particular, those messages need to come from male role models in boys’ lives and in the media. And those messages need to be appealing and repeated. Of course, women have a lot to offer, too. But until the influence of the manosphere is tamed, women’s messages are likely to be discounted, ignored, or even violently rejected.

That’s a lot to ask of a PSA.

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When Journaling Doesn’t Work

05 03 26

If there’s one thing people tell you to do when you have a mental health issue, it’s to start a journal. They may not call it that. They may say it’s a place to write affirmations, or things you’re grateful for, or aspirations. But what they really mean is a journal, a written record of what’s going on inside you.

But sometimes that doesn’t work. You may not be in touch with your inner feelings yet enough to know what your dreams mean or whether you need to explore your inner child’s trauma. It may simply be too soon.

Writing isn’t a bad idea, though. It just may be a mistake to call it a journal or to try to make it a way to explore your inner life. But there are other things you can do while you’re waiting until journaling is right for you.

One avenue you can try is other forms of writing. Don’t even think about your difficulties and how to solve them. You can get to that later, probably with the help of a therapist. For now, just write poetry. About anything. Your cat. The tree outside your window. The guy you just met at a party. Literally anything. Don’t try to be deep. Don’t try to write something meaningful, something for the ages.

Just put words on paper. Lord knows, they don’t have to rhyme. And don’t show it to anyone. The idea isn’t to impress anyone with your innate poetic talent. It’s just to get used to the idea of putting words on paper. Sure, it will feel weird at first (especially if you do try to make it rhyme). You don’t have to set any kind of goal like writing a poem every day or even every week. Just every once in a while, sit down at your computer (or, if you must, sit with a legal pad under a lilac bush) and write a poem. Or revise one you wrote the week before.

If you feel so inclined, try setting your poem to music. Strum that old guitar you haven’t dug out in months, or noodle around on GarageBand. Don’t make it a chore. Try it, just for the heck of it. Or you can decide to scrap the poems and just play around with music. There’s nothing that says you have to write poetry. What you’re doing doesn’t have to involve words at all.

Or, if none of that appeals to you, pick up a pencil and doodle, the way you do when you’re on infinity hold on the phone. Start with boxes and squiggles. If one of them starts to look like a pirate chest, go for it. See if your doodle turns into that, or something else. Draw a cartoon face. Then draw a setting for it. Is this your pirate? Is it a bartender? Is it an astronaut? Or take an empty candy wrapper and tape it to a sheet of paper. What can you make of it? Is it the body of a bird? Does it remind you of a ballet dancer’s costume? Does it begin to look like the tree outside your window? Just keep doodling.

The point of all this is not to create Great Art or to spur Great Revelations about your inner life. The point is simply to let yourself play—with words, with sounds, with sketches. Or pottery. Or katas. Just get used to the idea of letting something inside you come out. It doesn’t have to be important and meaningful. If it’s meant to be, that will come later.

I tried to start a journal once. It was pathetic. I recorded my daily activities, which at the time consisted largely of deciding whether to get out of bed that day. I recorded what I felt (depressed). Each page, each day, was the same. It was boring and no help at all. I was a dud at journaling.

Instead, I started this blog. In it, I was free to write about myself, but also about what I saw and heard in the world around me—what other people thought about mental illness and whether I agreed with them. Things I’d heard in the news and how the stories made me feel—outraged or comforted or confused.

It wasn’t journaling. I learned a lot from it, though (primarily that journaling wasn’t for me). No affirmations. No dream analysis. Over the years, though, it’s given structure to my week and a place to say things that aren’t necessarily profound. To ask questions and grope for answers.

Go thou and do likewise. Or go thou and do something else. The medium doesn’t matter.

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A New Addiction

04 26 26

You see a lot in the news these days about gambling addiction, particularly since there are booming sites for online gambling, prediction markets, and sports betting platforms.

Digital gambling can rise to the level of an addiction. And addiction, as the DSM tells us, is a disorder. You can have a narcotics abuse disorder or an alcohol abuse disorder. In both of those disorders, you use something—alcohol or drugs.

But gambling addiction is different. You aren’t consuming any substance. You’re performing a behavior—risking money on an outcome. It shares all the characteristics of gambling, however: risk, reward, and uncertainty.

How Digital Gambling Addicts You

Gambling addiction, and especially digital gambling addiction, works by using some of the same strategies that other addictions do, and some that are specific to technology. Here’s how apps that appeal to kids turn into digital casinos:

Solitude: Most often, it’s just you and the machine. The social cues that tell you to stop aren’t operative. This is particularly true of children, who often play gambling games online, alone in their bedrooms. That encourages, if not addiction, at least problematic usage,

Continuousness: Gambling apps provide endless content that plays automatically. The slot wheels keep turning, and the card games keep going. Other online games trap you with continuing levels and new, open-ended content. The player wants more and more stimulation and continues playing.

Speed: The faster you play slots, the longer you gamble. It’s a lot like other social media. Scrolling through new content makes it difficult for you to stop. Infinite scrolling accelerates the presentation of more content in a feedback loop.

AI: When you play against an AI system, it feeds you what you’re interested in and teases you with promises of more and new content. However, they don’t give you exactly what you want. Instead, they tease you with something close to what you want, and you keep playing to reach the reward.

Brain chemistry: When you do win, even a small amount, your brain receives a hit of dopamine, and you feel good. The sensation of winning just makes you want to play more.

Money: Online sports gambling, in particular, offers the possibility of winning actual money on the outcome of games or even plays within those games. It’s the same as the promise held out by the stock market. If you’re really quick and clever, you can reap rewards. And literally anything can be bet on. Recently, a man with insider information won $400,000 by predicting when a world leader would be toppled.

These factors combine to create a state in which a user is metaphorically glued to their device. You lose track of place and time in a kind of dissociative state that is difficult to break free from, especially for children.

The Companies That Run the Games

Online gambling really took off during the COVID pandemic, when people were sheltering at home with limited choices of amusement other than their computers and smart phones. And it has snowballed from there.

What to do about this “public health crisis,” as gambling addiction has been called? “You regulate the distribution, the speed, the type, the access to the product, because the product is what’s dangerous,” Harry Levant, director of gambling policy at the Public Health Advocacy Institute (PHAI), has said, calling for gambling to be treated like alcohol or tobacco. “The problem is the product, not the people.”

There are consequences for the players, but now there are starting to be consequences for the purveyors of online gambling and addictive digital pastimes. Both Meta and Google were tried and found liable for endangering children via their addictive products. They’re appealing, of course.

But the cases have put parents on notice that their children may not be doing homework alone in their darkened rooms. In addition to harassing classmates and posting nude pictures, they may be playing addictive games, either with points or money as the reward. If it’s money that gets exchanged, parents need to keep their credit card information secure. There have been cases in which children have lost thousands of dollars of their parents’ money playing online games. And the game companies have been notoriously indifferent to pleas for restitution. They claim that players have to be a certain age, and that they know they are spending or risking money in order to play.

Some of their “clients” have started as early as middle school. “If I had a bad day I’d gamble. If I had a good day I’d gamble,” one said. “Gambling was my best friend.”

What can be done about online gambling addiction? “If they come into the office, we do what we do for any other addictive disorder,” Dr. Timothy W. Fong, clinical professor of Psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, has said. “We do psychotherapy, we have Gamblers Anonymous, we have medication, and strategies to get people to work hard on their recovery, where their addiction can be contained.”


 

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What Is Intimacy?

04 19 26

The first thing you probably think of when I say “intimacy” is “sex.” That’s natural. Most people do. Sex is a particular kind of intimacy, but it’s not the only one. Others can be just as intoxicating, fascinating, and compelling. They can be a great way to bond with another person and provide fulfillment.

You may think that treatment for mental illness will take intimacy away from you. I’m here to tell you that you can still have intimacy with another person. It may or may not be sexual intimacy, but it’s valuable all the same.

Intimacy is a bond between two people. While it can be caused by sexual attraction, we all know how quickly a sexual bond can fade or disintegrate. Sometimes, a couple can have another form of intimacy once sexual intimacy is no longer possible. And, of course, there are couples who can maintain sexual intimacy until quite late in life.

Another way you can bond in a kind of intimacy is through shared trauma. As the saying goes, shared pain is halved and shared joy is doubled. The trauma doesn’t have to be a natural disaster, though that can certainly bond people who show kindness to each other. Once, I was sitting next to a man at a concert when a song touched a deep nerve and made him dissolve in tears. I reached for him and held him until the song was over. That started a deep friendship that has lasted for decades.

I’ve also found that shared symptoms can lead to a kind of intimacy. If both of you find your legs twitch when you’re not paying strict attention to stopping them, if you’re taking the same medications or have the same adverse reactions to them, or if you’ve both been gaslighted, you can find yourself exclaiming, “Hey! You too!” It helps to know that you’re not alone in your pain.

Humor, especially dark humor, is another way of sharing intimacy. It’s that shared joy principle. One way that’s worked for me and others is to use quotations from funny movies or songs—Young Frankenstein, Monty Python and the Holy Grail, Buckaroo Banzai, and Weird Al Yankovic are among my go-tos. Puns. Bad jokes. A good, shared belly laugh is a powerful bonding experience. It can lead to endless conversations that reveal lots about another person.

Some couples who have explored these alternative kinds of intimacy find they can live without traditional sex or can find sexual fulfillment solo. Those are valid choices, too. Even people who have sex with a partner can use sex toys and other aids from time to time. They’re easily available on the internet, so you don’t even have to go to a potentially embarrassing sex shop.

Of course, you might point out that these kinds of intimacy require meeting people, and going out may be something that frightens you. Fortunately, technology provides answers. With telephones, computers, and the internet, you don’t have to be in the same room with another person to develop intimacy. You can even turn off your computer’s camera so your new friend won’t see you. I’ve corresponded with a kindred soul via old-fashioned snail mail. And it’s something you can work on with your therapist if non-sexual intimacy is your goal.

If sexual intimacy is what you want, however, you can start with these techniques and work up to the big event. Having a solid foundation for touch, foreplay, and sex will make the process go more smoothly. Leaping into a sexual relationship without exploring other kinds of intimacy can leave you open to disappointment, a mismatch of sexual styles, and a devastating ending. Taking your time and finding a partner who doesn’t pressure you for sex will help you achieve sexual fulfillment when you are truly ready for it.

Intimacy with sex? That’s another topic for another week.

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mental health

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Off My Meds, But Not by Choice

04 12 26

I’ve been off my meds for about a week now, and it’s really getting to me.

I didn’t go off them on purpose. It was an accident. I tried to get back on them as soon as I could. But I kept encountering roadblocks.

It happened like this. My husband and I flew down to Florida to pick up a car that his mother was giving us. We drove it home to Ohio, stopping at a nice hotel in northern Georgia. When we got home, I discovered that the bag I keep my pills in was gone.

Replacement Pills

Let me start by saying that yes, I am an idiot. I had simply taken the bag of pills and put it in our travel duffel. I know I should have one of those pill caddies so I could divide up my meds and take with me only as many as I need. But I didn’t, so when the bag disappeared, so did my entire supply for the month. I had to start replacing them.

My non-psychotropics were no problem. I simply went on my PCP’s patient portal, explained what happened, and requested new prescriptions. The doctor’s office sent them promptly to my pharmacy. I called the pharmacy to let them know what was going on. They sounded like it was no big deal. They did say that, as I was basically asking for a refill before it was time for one, my insurance company likely wouldn’t pick up the tab. That was fine. All my scripts were generics, and the pharmacy had a discount card that they applied to the costs, so it wasn’t a big financial hit. The next day, I had my physical medication needs restocked. No big hassle.

The psychotropics, not so much.

Hassles

We arrived home and discovered that the bag of prescriptions was missing late on Friday. I called the hotel we stayed at to ask whether the bag had been found. They said they would check with housekeeping the next morning. It actually took until Monday for them to determine that no, housekeeping denied all knowledge of the bag of pill bottles.

I called our pharmacy Saturday morning to find out what the process would be to refill them. I had a hunch it wouldn’t be as straightforward as the other prescriptions had been. I was right.

I would have to see my doctor to get new prescriptions ordered. They worked me in on Tuesday, the first day he was in the office. I was also told that I would need to make a police report. Two of my prescriptions were for controlled substances, an anti-anxiety med and a sleep aid. I naively thought those were the only two I’d have trouble refilling.

I tried to picture myself calling the police four states away, saying that I most likely left my medications in the hotel room, and could they please investigate. Maybe police departments are used to this kind of thing, but even if they do it all the time, I assumed that the wheels of justice would grind slowly, and they wouldn’t make it a priority. Not when it was likely a case of stupidity, not a crime.

I went to the doctor’s office on Tuesday. He listened to my story, agreed that I should have a pill caddy, and sent new prescriptions to the pharmacy over the computer. I saw him do it. I thought that would be the end of it.

Phone Tag

That was not the end of it. When I called the pharmacy to see when my meds would be ready, I was told that they couldn’t fill the prescriptions because it was too soon. I explained again about the missing bag of prescriptions and was told that I had to get new prescriptions and file a police report. I told them that I had seen the doctor just that morning and had watched him send the new prescriptions. And that the doctor had not told me I had to file a police report under these circumstances.

The pharmacy told me that the doctor had to verbally authorize filling the prescriptions early. Fine. I thought that the pharmacy would reach out to the doctor’s office, as they do when there are no refills on a prescription. But no. The doctor’s office would have to call them. By that time, the doctor’s office was closed, and Dr. G. wouldn’t be back in until Thursday.

Wednesday was spent alternately making calls to the pharmacy and the doctor’s office. The pharmacy said that speaking to the medical assistant would be good enough. But, of course, again, they didn’t mention that the office would have to call them. I spent the day trying to get the two entities to talk to each other. Each time I called the pharmacy, I spoke to a different person who had no notes on what had gone before and started all over about it being too early to refill and needing a police report. Each time I called the doctor’s office, I was told they had spoken to the pharmacy or had just left for the day.

Thursday, I had been unmedicated for a week. I wasn’t sleeping more than three hours a night, and my anxiety was working overtime. I was mentally dizzy from all the runarounds and explanations. I couldn’t remember whom I had talked to last or what I’d told them. I didn’t have enough executive function to write everything down, with a timeline and names. My voice as I spoke to the various parties was rising in pitch and lowering in coherence.

At last, I called late Thursday afternoon, and my prescriptions were ready. But only the controlled substances. The mood stabilizer and SSRI hadn’t been filled. It was too soon, I was told. Oh, they were new prescriptions? Had I filed a police report?

I’m going online right now and ordering a pill caddy.

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mental health

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Was My Ex a Narcissist? Maybe Not

04 05 26

I know I’ve said my ex was a narcissist. His pleasures and interests were the only ones that counted. If I said that I liked something, like a certain style of music or kind of food, he said, “Eat shit. Fifty million flies can’t be wrong.” He talked about how important his honor was. He invented something that I would collect, just so he could pre-select gifts for every occasion. To quote the song “My Baby Thinks He’s a Train,” “He dragged me ’round just like an old caboose.”

But was he a true narcissist or simply a self-centered asshole?

Well, he was never diagnosed as a narcissist. The only time he saw a therapist was when we went for couples counseling. He aligned himself with the therapist. He made it seem like I was the crazy one, and he was only there to help me because he loved me so much. (That was gaslighting, not narcissism.)

And that’s an important point. Only a psychiatrist can diagnose a true narcissist: someone who has narcissistic personality disorder.

What’s Narcissistic Personality Disorder?

The Diagnostic and Statistical Manual-V (DSM) has a list of criteria that add up to Narcissistic Personality Disorder. There may be changes in the DSM-VI, currently being written, but for now, in order to be diagnosed, a person has to exhibit:

A pervasive pattern of grandiosity, need for admiration, and lack of empathy, as well as five or more of the following behaviors or traits:

grandiose sense of accomplishment

My ex: Check. Always had to be the smartest person in the room, though he never completed his doctorate. Thought his middle name, Albert, was a reference to Einstein.

preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

My ex: Probably not. Content with a public service government job; bounced from relationship to relationship.

believes that he or she is “special” and unique and can only be understood by or should associate with other special or high-status people (or institutions)

My ex: Pretty much. Only associated with neighbors who could do something for him; felt others had lower status.

requires excessive admiration

My ex: Check. Wanted to be known as the smartest, funniest, most talented, skillful, and well-loved.

a sense of entitlement

My ex: Not sure. Regarding sex, intimacy, and attention, yes. In other ways, not so much.

interpersonally exploitative

My ex: Big check. Put people in “can’t-win” situations.

unwilling to recognize or identify with the feelings and needs of others

My ex: Check. See above.

envious of others or believes that others are envious of him

My ex: Not really, or didn’t say so.

arrogant, haughty behaviors and attitudes

My ex: Check. Corrected others’ pronunciation; got to define “quality” for others.

Explanations

By those criteria, my ex might qualify as being among the 1% or 2% of people who have a Narcissistic Personality Disorder—if diagnosed as such by a psychiatrist, not through the lens of only one person—me—who is not truly qualified to assess him. I can’t truly say that he had the Narcissistic Personality Disorder, only that he exhibited some narcissistic traits when I was with him.

There’s a possibility that we were simply incompatible, or that I exhibited unhealthy traits too, or that he was fine in relationships with others, or that he was simply a selfish asshole and nothing worse. If you were to believe social media, 30% to 40% of bad relationships were caused by a narcissistic partner.

There are different degrees of bad behavior. A person can be a gaslighter without being a clinical narcissist. They can be abusive. They can be cold and unforgiving. They can behave so badly that you think of them as abusive or narcissistic. None of those are good things. But calling someone a narcissist is giving them what is essentially a meaningless label, or at least one that says, “I suffered when I was with them.”

So, I did suffer. My ex treated me and others badly. But as for his being a real-life Narcissist, the jury remains out.

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mental health

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