Bipolar 2 From Inside and Out

Archive for the ‘Mental Health’ Category

Completing Therapy

In a sense, there’s no such thing as completing therapy, and in another sense, it’s necessary. Right now, I’m trying to balance between the two poles of that spectrum.

I know that, barring any unlikely miracle cures (which I don’t anticipate), my bipolar disorder is something I’ll be dealing with for the rest of my life. On the other hand, I have on occasion achieved periods of stability in which therapy was no longer a necessity.

Sometimes it’s been my therapist who has encouraged me to leave treatment because they didn’t feel that I had symptoms severe enough to require further therapy at that time. I was, if not cured, stable enough to function well without weekly or biweekly boosts of psychological or psychiatric tune-ups. (Once, when I left therapy this way, Dr. L. told me solemnly, “I hope you don’t think I’m rejecting you.” I didn’t, but I thought it was nice of him to bring up the subject.)

Once I quit therapy because it was supremely unhelpful. It was couples therapy, and it wasn’t achieving its goals. The therapist sided with my husband and shredded me. After a few sessions, I refused to go back.

Sometimes, my therapy has quit me. I had a very good relationship with Dr. R., my psychiatrist, who retired and moved across the country. I knew I still needed the services of a psychiatrist as well as a therapist, so I began the long search for another practitioner who could help me, had an opening, and would take my insurance. It’s a process much like interviewing candidates for a job. You need to find a good fit (i.e., one who won’t shred you). At the time I mostly needed someone who could supervise my meds, as I was seeing a therapist for my ongoing psychological issues.

I stayed with that therapist for years. It began to become clear that perhaps I should leave therapy when I needed therapy less often—once every other week instead of every week, then once every three weeks, and eventually every month. Even when we still had sessions, they ran short because I didn’t have immediate issues that needed to be addressed. And her advice consisted of “Look how far you’ve come” and “Keep doing what you’re doing.” When she moved to a new practice, I had one or two more sessions, then ended therapy. I kept her number, though. You never know.

Right now, I am considering leaving therapy with my psychiatrist for purely practical reasons. Dr. G. only sees people on Thursdays and Saturdays till early afternoon. At the moment, my husband works both those days and hours and we have only one working car. I see Dr. G. four times a year for med check, but it’s becoming increasingly problematic for Dan to get time off work to take me to appointments. I suppose I could take a Lyft, but it’s another expense I can’t afford. Perhaps I should look around for another provider closer to me with better hours. If I can find one that doesn’t have a years-long waiting list, I mean. (I’m told that I need to get a referral from my PCP to get one in-network.) Or someone else in Dr. G.’s practice who would be willing to take me on. (I have to go to the office and fill out a form to accomplish that.) Either way, no guarantees.

There have been times in my life when I felt stable enough to go without a therapist or psychiatrist. Right now, though, I’m having issues with anxiety, hypomania, and insomnia, so I need someone at the very least to prescribe or tweak my dosages.

Most of all, though, I hate the process of finding a new psychiatrist—interviewing them to see if we’re a good fit, telling them the Reader’s Digest version of my screwed-up life, getting my records transferred, and the rest of the tap dance involved.

Wish me luck.

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Why Can’t You Just Get Over It?

That’s a question we all get—and we all hate. It implies that we can just get over it, but haven’t, for whatever reason.

The questioner may believe that we just aren’t trying. That we can pull ourselves up by our metaphorical bootstraps or choose to be cheerful. That we aren’t doing all we can to “regain our sanity.” That we haven’t tried the right diet, the right exercise, the right supplements, or the right therapy. Everyone has an answer.

Parts of their answers may be part of our answer, sort of. Diet and exercise are important, to be sure. But one food, like apple cider vinegar or acai berries, is not a secret remedy. A healthy, balanced diet of meat, veg, fruit, and grains is ideal. But many of us are simply not able to cook like that. I’ve had days when all I could manage to eat was Cocoa Puffs straight from the box or peanut butter straight from the jar.

Exercise and fresh air are good, of course, but again many of us are simply not able to accomplish it. Some can’t leave the house except for absolutely necessary errands and appointments. Then we bustle back to the safety of home. Or, if we have someone to help, they can do the errands for us. My husband can sometimes get me out of the house for a meal, but usually not a healthful one. If a friend invites me over for dinner, it’s a very special occasion and I make sure to hoard my spoons for it. Those are times I’ll even take a shower and get dressed for. As for exercise, I just can’t. I have severely arthritic knees that need to be replaced, so I can’t even do yoga or tai chi. Plus the whole getting out of the house thing.

Another common comment is, “Get some therapy.” I have and am and most of us are. What people who say this don’t realize is that therapy doesn’t work quickly, even if you can find the type that’s right for you. Personally, I can’t handle group therapy. I’ve tried. I have problems with the idea of CBT and DBT, currently two of the most favored forms. Talk therapy is the one I choose, and that helps, but I’ve had to go to the same therapist sometimes for years. A quick fix is not what I need or can get.

Also, there’s “Have you taken your meds?” which really pisses me off. First, there’s the assumption that I’m even on meds (I am, but it’s rude to assume that), plus the idea that a layperson can tell me when I need them.

No, I can’t just “get over it,” and neither can most people with depression, anxiety, phobias, bipolar, PTSD, or schizophrenia. They’re just too complicated.

Think about it. There are three causes considered likely to be the cause of brain illnesses: genetics, psychological trauma, or brain chemistry. None of those is something that can be gotten over by choosing happiness. If the origin is genetic, pulling yourself up by your bootstraps is not even a possibility. It will likely take years of therapy and medication to achieve stability, if that’s possible. If the cause is trauma, you can’t just forget about it. Imagine all your worst nightmares hitting you suddenly, asleep or awake, as though you’re experiencing the triggering event just as you did when it happened. Think about how it would feel to have grown up with repeated abuse that you couldn’t escape because you were a child. And if your brain chemicals are out of whack, there are dozens of meds that might work and dozens more that won’t. Finding the right combination is a lot more complicated than just popping a pill.

When you get hit with the question of why you can’t just get over it, you might be able to take ideas from this discussion and try to educate the person who asked it. Or you can print out the whole post and give it to them. (I give you permission.) They probably won’t realize they’ve just insulted you. At the least, you can tell them that they have. Maybe that will stop that one person from coming at you with the same question over and over.

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Where to Go First

Most of the advice about depression that’s out there says that the first place to go for help is your primary care physician. That may seem counterintuitive. After all, doctors are notorious for being oblivious to psychiatric problems. Either they dismiss them, assuming that all their complaints (especially those of women) are “all in their head,” or they over-diagnose mental illnesses and pass out pills indiscriminately. At least, those are the stereotypes.

The reality can be far different. Family doctors can absolutely have a positive role to play in diagnosing and treating mental illness.

The last time I went to my primary care physician (for a nail fungus), the nurse practitioner, after taking my vitals, proceeded to ask me the questions collectively known as the Depression Screener. “Do you feel like a burden to your family/do you no longer enjoy things you used to All the time/Most days/Sometimes/Once in a while/All the time” and so on.

My blood pressure was high that day and I see a psychiatrist and take all kinds of psychotropics. I’m sure all that is in my file. “Can’t you just put down that I’m anxious and depressed and leave it at that?” I asked.

“Let’s go through it anyway,” she said. And so we did. No surprises. I was anxious and depressed.

The depression screener may not have been useful for me, but it is for lots of people. There are a lot of seniors, for example, who are living with depression without realizing it. Children, too. Teens. People of all ages. Finding them and getting them help when it’s in the early stages can help them avoid a life of misery and despair.

Not every person gets to find out through the screener. My mother, who was in a nursing home, made some remarks that suggested to me that she was depressed—extremely depressed, including suicidal ideation. I excused myself, found her doctor, and told him what she said, and that I believed she needed antidepressants. Rather than pushing back, he believed me and prescribed them.

Of course, it’s easy enough to beat the screener. The answers are fairly obvious. In fact, I know one person who gave all the answers that would keep him out of the psych ward. But fortunately, most people answer the questions truthfully and get the help they need.

But back to primary care physicians. They’re also helpful in cases of depression, anxiety, and other mental disorders. They know about the most common antidepressants and other psychotropics and can prescribe them to get you through until you can see a psychiatrist. They can give you a referral to a psychiatrist. And, difficult as it is for a first-timer to get a prompt appointment, they can keep monitoring your condition, prescribing as needed, until there’s finally someone who’s taking new patients. My own family doctor was willing to keep prescribing all my medications when one psychiatrist retired and I had to find a new one and wait for an appointment.

My primary care physician is part of my treatment team.

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Finding Intimacy

What do you think of when you hear the word “intimacy”? Sex, right?

That’s a part of intimacy, but it appears nowhere in the American Psychological Association’s definition. There, it says, intimacy is “an interpersonal state of extreme emotional closeness such that each party’s personal space can be entered by any of the other parties without causing discomfort to that person. Intimacy characterizes close, familiar, and usually affectionate or loving personal relationships and requires the parties to have a detailed knowledge or deep understanding of each other.”

Let’s take a look at that definition. “Extreme emotional closeness” is pretty understandable. But note the word “extreme.” It implies that intimacy is more than ordinary closeness. We have friends whom we are close to, but not intimately close to. They may be friends we can talk to about our troubles, share our stories with, be close to, but still not share that extreme emotional closeness. You’re not necessarily intimate with a best friend, though of course it’s possible.

The next part of the definition is more troubling to some. That part about “personal space” being entered by “any of the other parties.” It implies that there can be intimacy among more than two parties. To some people, that sounds like cheating or polyamory. But that’s when intimacy implies only sex.

Personally, I have a number of intimate friends, both male and female. That’s not to say that I’m promiscuous, bisexual, polygamous, or polyandrous. What I mean is that, as the APA definition states, we “have a detailed knowledge or deep understanding of each other.”

What does it take to get that detailed knowledge and deep understanding?

What are the qualities that foster intimacy?

Time. I’d say that, for non-sexual intimacy anyway, time is required. I can’t say how long that is exactly, but I do know that it isn’t instantaneous. You may feel an instant connection with someone you meet, but that’s not intimacy. I felt an instant connection with someone I helped through a public breakdown, but our intimacy had to grow over the years. Now I do count him as an intimate friend.

Sharing. You don’t have to share everything, but some sharing is essential. It may be seemingly superficial things like a love of country songs or a television show, but that’s only part of it. The intimacy kind of sharing involves actual sharing of thoughts, ideas, and experiences. You don’t have to agree on everything, though there are usually some non-negotiables. But for intimacy, you shouldn’t be afraid or embarrassed to share the truths about and inside you.

Laughter. Nothing bonds two (or more) people like laughter. Intimacy can be enhanced by laughing at the same things. A good belly laugh, the kind where you can’t stop and can’t breathe, is what I’m talking about. Or the snickers that you both have to suppress because you know you’re in a place where you can’t express it until you’re alone.

Help. For true intimacy, this is probably the most important quality of all. Someone you feel intimacy with is someone you can turn to when you’re at your lowest. Someone who understands or even if they don’t, will hold you closely in their heart or spirit. Physical help or financial help is good, but it isn’t required.

For those of us with SMI, it can be hard to feel intimacy. We may even fear intimacy because we’ve been betrayed by someone we’ve felt intimacy for. It’s difficult—or sometimes impossible—to get past that, but if you can, and you can open yourself to that extreme emotional closeness once again, intimacy with someone new is possible. Looking for someone to share intimacy with may not work. Sometimes intimacy has to find you.

Be open to it if it does.

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Overthinking Night and Day

Like many people with SMI, my superpower is overthinking. In fact, even as I write this, it’s 2:30 a.m. I can’t sleep because I have hamster brain, a phenomenon I’m sure will be familiar to most of you.

I’ve got plenty to overthink about. I’m starting a new writing assignment and am confronted with a big, messy outline that I didn’t write and have to make into a coherent book. We don’t have the money to get a plumber, only the downstairs toilet works, and there’s only a trickle in the showers. Between the two of us, over the next six weeks, we have a total of six assorted doctor appointments coming up, for everything from nail fungus to heart meds to psych meds to test results to steroid shots. There’s the trip we have booked in January to see Dan’s 96-year-old mother. There’s our senior cat whose health is holding for now, but who knows? Pick any one. Or two. Or more.

If only overthinking were productive. Wouldn’t it be great if all that thinking led to creative problem-solving? But no. The problems remain and continue rolling over and over.

Overthinking is tied to anxiety, at least in my case. I do have an anxiety disorder, so my overthinking is something prodigious. And, as exemplified by the hamster brain analogy, it’s cyclical. Anxiety causes overthinking causes anxiety and so on and on. The more out-of-control your problems are, the more out-of-control your thoughts become.

Overthinking is also a symptom of other mental disorders, such as PTSD, OCD, and depression. Another perhaps related phenomenon is intrusive thoughts, the ones that seem to appear spontaneously in your mind for no apparent reason. Perfectionism can be involved, too, if you obsess about doing everything just right. Catastrophizing and all-or-nothing thinking can also contribute to overthinking.

But those are facts. And overthinking has little to do with facts. Take that upcoming trip, for example. The flights are booked, the accommodations are arranged, the rental car is reserved. All three are already paid for. All this was taken care of months ago. But I still overthink. I check the airline reservations to make sure they haven’t changed (they did at least once, with a layover in a different city). I hope we can get an accessible condo. I worry about paying for gas and food. I feel panicky about getting to the next gate during layovers. I have done everything I can think of to make sure the trip runs smoothly, but still…

It’s exhausting, so it’s ironic that I can’t sleep.

How to stop overthinking? Mindfulness and meditation are often recommended, but those don’t work for me. I just can’t shut off the over-thoughts long enough to accomplish them. Distractions are another recommendation, and I try that, but they only provide temporary relief. Reframing negative thoughts is yet another suggestion, but I don’t know how to reframe having to go downstairs to pee in the middle of the night. Self-acceptance or self-compassion, forgiveness, and gratitude—nothing seems to work.

I do take antianxiety meds, and I do have permission to take an extra one if I have more than usual anxiety. I have a prescription for a sleeping aid, but I don’t like to take it very often. More often I just say the hell with it and get up, read or write or watch TV. My sleep-wake schedule is off for days, along with my meals, but if I can just stop the thoughts for a while, I’ll take it.

For me, overthinking happens mostly at night, but it doesn’t have to. There’s plenty of fodder for overthinking during my waking hours. Perhaps I just don’t notice it as much because during the daytime I’m usually doing something that distracts me from my thoughts. Today I was overthinking how to get an accessible room at the condo where we’re staying in January. I made phone calls and stayed on hold, but I got put off until four weeks before the trip. That started me overthinking about what to do if we can’t get an accessible room. I’d have to get one of those shower substitute wipes they use for people who are bedridden. Then I started looking those up online. Maybe I should order some, just in case. Or, I thought, I could wash up in the sink every day. Or some combination of the above. It’s ridiculous how long I spent contemplating the possibilities. All I really have to do is request an accessible unit when I show up, and they’ll tell me whether one is available that day. But do you think I’ll be able to wait until we show up? No, I’ll keep overthinking it. And get the wipes just in case.

Because that’s just what I do.

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When Couples Therapy Works

Couples counseling is never easy. It’s hard enough to have one person discussing their problems with a therapist, much less two. Two opinions. Two versions of reality. Two sets of problems. Two emotional whirlpools. Two perspectives. Two of everything.

And one therapist. One person trying to understand the dynamics. One person listening to two stories. One person trying to help two individuals and to help a couple.

It’s a wonder it ever works.

But it can. It does. Not always, but sometimes.

My husband and I have been to couples counseling three different times. Two of them helped. One didn’t.

One was a long-term round of therapy when we were much younger, trying to work out some of the typical problems that young couples face. We weren’t fighting, but we didn’t know how to live and work together well.

Our therapist was an older lady, very dignified and comforting. A good listener, she gave us as long as we needed to talk before she did. It was a productive relationship and helped a lot.

The second time didn’t go so well. It was short-term therapy, under the auspices of an Employee Assistance Program, so we had six weeks to work things out.

Except it didn’t work. The therapist took sides, and sided with my husband. She ignored my bipolar disorder (or depression, as it was diagnosed at the time) and suddenly, he was the sane one and I was damaged. She expected me to accommodate him. After every session, I felt shredded. I didn’t make it through the six weeks. At some point before that, I refused to go.

The third time was after we had a major blow-up, one that threatened to ruin us. My therapist recommended a counselor who could work with both of us. We had opposing views that were incompatible. There was bitterness and anger on both sides. The therapist gave us a safe space to say what we needed to, question each other’s perceptions, and work out a way to go on from there. Mostly, she listened. After only a few sessions, we achieved a detente and were calm enough to continue without outside help.

Three examples—uniquely ours and not representative of anyone else’s experience. Three dynamics. Three outcomes.

What made them different? Two were safe spaces for both of us, and one wasn’t, for me at least. One was long-term and might have been even longer if the therapist hadn’t retired. One was short-term and even shorter because I couldn’t continue with the process. One was positively episodic, three sessions only.

Of course, I don’t know what couples therapy is like from the therapist’s side. From my own perspective, it seemed that the process only worked when there was space—space in time, as long or as short as needed, neither cut off artificially or drawn out more than necessary. And when there was someone who listened to both of us. Comfortable physical spaces, too, not impersonal offices but welcoming rooms that looked like someone could relax in them.

Two people with multiple problems. Two processes that worked for both of us and one that didn’t.

I can’t pontificate about the process. All I can say is that couples therapy can work, and does work, and did work for us—at least two times out of three. What made the difference? I think it was the ability of the therapists to step back, listen to both of us, and not tell us what to do. They talked too, of course. They recommended books for us to read. They suggested new ways to think about things and talk about them. They absorbed the bad feelings in the air and didn’t deny them. But in their presence, it was possible to think, to listen, and to talk. To disagree, to argue, to come back together. To heal and discover. To grow.

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It’s Not That Simple

I’ve bitched before about the ads on TV for psychotropic drugs, and I’m about to do it again. The first ones that caught my eye were the ones that compared depression to holding up a smiley face mask in front of their face, while the person’s actual face exhibited sadness.

But it’s not that simple. Smiling depression is a thing, of course, but treating it is not as simple as taking away the mask and replacing it with a real smile. Psychotropics don’t work that way. Of course, since the ads are for psychotropics that are supposed to work quickly (though not as quickly as the ads imply), we can’t expect them to mention the years of struggle and therapy that go into improving the condition.

The next kind of commercials are a tiny bit better. They mention actual symptoms of depression: sadness, loss of focus, lack of interest in fun things, or an inability to do chores.

But it’s not that simple. Personally, I don’t think it’s a tragedy if the barista has to wait two seconds while I remember whether I want oat milk or if the family has to put away the laundry. These are obvious but probably not major symptoms of depression or symptoms of major depression. What about not getting out of bed for three days or not showering for a week or more? Crying all day about nothing or everything? Thoughts of self-harm or suicide? They just don’t make for good 60-second television. The long, lingering effects of depression are glossed over or ignored.

There are also ads for treatments for bipolar disorder, both types I and II. Most of them concentrate on the mania or hypomania side of the problem. Most of the ads use metaphors—climbing a tower of cards or going from darkness to light. Overspending is the issue most illustrated in regard to bipolar if you don’t count all the depression ads. I recall one that showed a woman who had bought a lot of expensive cameras and came to realize that she had overdone it.

But it’s not that simple. Bipolar disorder is a complex disorder that metaphors just can’t capture. Like depression, the ads concentrate on only one symptom, and don’t do a good job of creating those metaphors. (I’m just glad they don’t use a metaphor of someone on a swing.) I realize that it’s not likely that ads on TV will address hypersexuality, but what about the pressured speech, euphoria, irritability, bad decisions, and reckless behavior that go with mania?

Schizophrenia is probably the worst. The ads show not the disorder, but the lack of it—women saying, “I’m glad I don’t hear voices anymore” and “I’m glad I don’t still think everyone is looking at me” or men playing guitar to illustrate how “normal” the drugs make them.

But it’s not as simple as that. I admit that it’s not possible to portray some of the more frightening aspects of schizophrenia, which would probably only add to the stigma surrounding schizophrenia. But making it seem like one pill will cure it isn’t reasonable or accurate.

Then there’s tardive dyskinesia, also called TD. The ads do a competent job of giving examples of uncontrolled movements and how they interfere with a person’s life. The drug being advertised may indeed help with those.

But it’s not that simple. If you read the fine print at the bottom of the screen or listen to the rapid-paced list of possible side effects, you’ll notice that one of them is uncontrolled movements. WTAF? It gets rid of uncontrolled movements but may cause uncontrolled movements? Why take it and take the chance?

The ads I may hate the most are the ones that emphasize family. We see a woman folding the family’s laundry, grandparents romping with the kids at a park, and other idyllic scenes.

But it’s not that simple. Treating a mental illness is not something you do for the benefit of other people. It’s something you do for yourself, even if you don’t have a nuclear family or grandchildren or a large circle of friends. Granted, the people around you may be happy that you’ve found a therapy that works (and the ads almost never show a combination of drug therapy and talk therapy). That’s a side effect—a good one, but still not the intended effect of the psychotropic drug.

I attribute this primarily to the lack of inventiveness and understanding shown by people at the advertising agencies, as well as the tiptoeing around the whole subject of SMI. But what happens is that the viewers get an unrealistic view of both the disorders themselves and what the drugs can do to relieve them. It’s not simple, and the ads simply don’t reflect that.

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Dual Diagnosis and AA

Dual diagnosis, also called co-occurring disorders or co-morbidity, is one of the most complicated conditions that affect people with mental illness. The heart of dual diagnosis is that the person has both a brain illness and a substance use disorder (SUD). Estimates differ wildly as to how common dual diagnoses are, depending on differing definitions of dual diagnosis, for example. According to SAMHSA, 21.5 million Americans experience both SMI and SUD.

Alcoholics Anonymous, of course, is the best-known support group for alcohol abuse disorders. Narcotics Anonymous focuses on illegal drugs rather than alcohol. But there are fewer opportunities for people with dual diagnoses to find similar kinds of support. There is a group called Dual Diagnosis Anonymous (DDA), but it doesn’t have nearly the reach of the older, more familiar organizations.

So, how do dual diagnoses and substance use disorders share the support group space? Is the standard AA model open to or beneficial for people with dual diagnoses?

I recently spoke with Tony, a friend who has bipolar disorder and alcohol addiction. He’s currently in recovery in a treatment program that addresses both problems. Tony, who has been in the program for around six weeks, has started out in a sober house and with AA meetings. While he discusses his SMI, for now the primary focus of his treatment is substance abuse.

According to Tony, the relationship between AA and SMI support is sometimes fraught with contention. The history of AA doesn’t prohibit people with co-occurring disorders, but in practice, the situation can be different. Tony, in his early years of association with the organization, was dropped by his sponsor when he revealed his dual diagnosis.

Part of the problem Tony has found is that many people involved in AA are biased against the use of psychotropic drugs, even those properly prescribed by a psychiatrist and taken as prescribed. To them, drugs are drugs, and they are universally thought to be addictive. This is, according to Tony, an old-school and literalist interpretation of AA’s principles.

But if a person with a dual diagnosis goes off their psych meds, their condition can deteriorate. And untreated SMI can cause a person to self-medicate with alcohol, creating a vicious cycle. AA literature says that group members should not stop taking doctor-prescribed meds, but the problem persists. People with dual diagnosis may therefore avoid AA.

Of course, people can be addicted to prescription medications (whether they get them from their doctors or not). AA and NA can be extremely beneficial for them. Still, according to DDA, people with dual diagnoses can experience “a sense of ‘symptomatic difference’ between addicts and alcoholics and dually diagnosed persons. Some symptoms may result in disruptive behaviors during meetings, further alienating the dually diagnosed. Many dually diagnosed people experience increased levels of fear, anxiety and/or paranoia in group settings. Additionally, there is a common perception among some more traditional 12 Step members that medical management represents the ‘easy way,’ and do not consider those individuals who take prescribed medications to be ‘clean and sober.’ For these reasons, the feeling of ‘not fitting in’ at traditional 12 Step meetings is common for many individuals with dual diagnosis.”

A report published by the Veterans Administration of Virginia focuses specifically on the combination of PTSD and SUD. It notes, “Substance abuse co-occurring with PTSD is often a chronic disorder that
requires long-term help, which AA may provide” and that “aspects of 12-step activities may address core issues of trauma-related symptoms and enhance treatment outcomes.” However, it also discusses how the faith component of AA can be problematic: “Trauma, and PTSD-specific symptoms of loss of faith and hope for the future, may deter individuals from embracing the concept of a higher power and the directive to surrender…. Trust is shattered such that a benevolent spiritual force is hard to imagine, and so surrender to a higher power may be seen as impossible. Further, hypervigilance and the need to
maintain control are integral parts of a traumatic stress reaction, creating hardships in turning
over one’s will and life to God.”

DDA has developed 5 steps that coordinate with AA’s 12:

1. We admitted that we had a mental illness, in addition to our substance abuse, and we accepted our dual diagnosis.

2. We became willing to accept help for both of these diseases.

3. We have understood the importance of medication, clinical interventions, and therapies, and we have accepted the need for sobriety from alcohol and abstinence from all non-prescribed drugs in our program.

4. We came to believe that when our own efforts were combined with the help of others in the fellowship of DDA, and God, as we understood Him, we would develop healthy drug- and alcohol-free lifestyles.

5. We continued to follow the DDA Recovery Program of the Twelve Steps plus Five and we maintained healthy drug- and alcohol-free lifestyles and helped others.

Tony’s treatment program is focusing first on substance abuse programs, specifically achieving one year of sobriety, though in his shares at group, he does discuss his dual diagnosis. And he finds the spiritual component of his recovery to be essential. After his formal treatment ends in mid-January, Tony wants to continue working in faith-informed service to workers in the field—perhaps in a virtual capacity with the intention of helping prevent burnout.

I’m not in AA or DDA, but it seems to me that some discussion and communication between the two organizations would help matters.

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What Gaslighting Isn’t

Gaslighting is a form of emotional abuse, but it’s not the only one.

Gaslighting is a very particular kind of emotional abuse in which the perpetrator tries to make the victim think she (or he) is crazy. They do this by denying their perception of reality.

Gaslighters say things like, “I (You) never said that.”

“You’re making that up.”

“That never happened.”

“I don’t remember saying (doing) that.”

And of course, “You’re crazy.”

There are other kinds of emotional abusers, however. One of them is the puts the victim in a position of “learned helplessness.” This often starts with “love bombing,” or flattering and professing love until the victim is hooked. This often happens when the two people live together.

Suddenly, there’s a change. The victimizer turns hateful, putting the victim down. They say things like, “You’re stupid.”

“You’re ugly.”

“You can’t do anything right.”

“You’re lucky to have me. No one else would have you.”

The, just as suddenly, the victimizer changes. Again, they’re all love and kisses, flowers and gifts, positive messages. The victim thinks they’ve changed. They believe the promises to do better, to be more attentive and loving.

These are lies. The victimizer has no intention of changing .hey’re just stringing the victim along. This is called “intermittent reinforcement.” The victim goes on hoping that the good side of their partner is the real one and all the losing statements and gestures are true. So they keep hanging on.

The situation is even more complicated if there is physical abuse—battering—going on. The victimizer is likely to do the same things as the emotional abuser. They apologize extravagantly and promise never to do it again. They can also blame the victim, saying, “I wouldn’t hurt you if you didn’t make me so mad.”

There are other tactics the abuser uses to tie the victim to them. They cut off the victim from their family and friends. They keep tight control of the finances. Children and pets are also obstacles that keep the victim helpless (this is also called “learned helplessness”).

But that’s not gaslighting. That’s emotional and physical abuse. For it to be gaslighting, the quality of tricking the victim into believing they’re going crazy, that their reality is false. Of course, the gaslighter may also use some of the techniques of the emotional abuser in addition.

The word “gaslighting” is a trendy word these days. Most of the time, what someone means when they use the word is emotional or physical abuse, or living with a narcissist.

However, as different as these problems are, there is one solution to all of them: Get out. Staying with a gaslighter, emotional abuser, or physical abuser is a losing proposition. They won’t change, no matter how many times they say they will.

Getting out will be difficult. The abuser will usually have the situation rigged so that’s difficult for the victim to do. Lack of money, lack of friends, isolation, maybe no transportation, no place to go are all impediments to escape. And though police response may be improving, it’s often not, especially if there hasn’t been battering. And we know how well restraining orders don’t work.

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Mental Health

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Say It With Casseroles

In the South, casseroles are known as “funeral food.” After a funeral, people gather at the home of the bereaved and bring casseroles for a kind of potluck. The idea is that the family shouldn’t have to entertain the mourners and shouldn’t have to cook for basically the rest of the week. Some people even bring frozen casseroles to extend the usefulness of the food offerings. Tuna noodle casseroles are popular. Chicken rice casseroles. Green bean casseroles. Shepherd’s pies. Eggplant parm. Tater tot casseroles. Frito pies. Lasagna. Sweet potato casseroles. Ham and potato casseroles. Broccoli cauliflower casseroles. Moussaka. Even one that’s simply called “Funeral potatoes.” There are plenty of cakes and pies, too.

Food is an essential when there’s a new baby as well. It’s assumed that the new parent or parents won’t have time to cook substantial meals, so plenty of frozen casseroles are supplied. Visitors don’t arrive en masse and don’t expect to be entertained. They often bring useful items like diapers and wipes. They expect a few minutes of conversation, a look at the infant if they’re asleep, or a chance to hold them for a minute. What they mostly offer is help. Cleaning. Babysitting for older children. Running errands. Preparing bottles if needed. Emotional support is a big form of support as well. Helping the new parent with self-care. Comfort items. Listening. Offering encouragement.

Even an illness or operation generates plenty of contact. People visit in the hospital, bringing flowers, treats, plushies, prayer circles, and more. They stay as long as you want or leave when you’re feeling tired. They ask if there’s anything they can bring you, and then they do. They ask if your plants need watering. When you come home, there may again be casseroles, especially if it’s been a major operation like knee replacement. There are offers of picking up groceries or medication. They ask what you need and, nine times out of ten, they follow through. They call to check up on you or just to talk.

It’s all different if you have SMI, however. SMI is just not a “casserole illness.”

If you have a public meltdown, no visitors, no encouragement. No casseroles.

If you spend time on a psych ward, no visitors, no flowers. No casseroles.

If you aren’t able to go to an event or meet for coffee, no sympathy, no prayer circle. No casseroles.

If you’re not able to get out of bed all week, no housekeeping, no errands run. No casseroles.

And if you survive a suicide attempt, no understanding, no acknowledgment. No casseroles.

I get it. I do. People don’t know what to say, so they don’t. They don’t know what you need, so they don’t offer it. They don’t know how to cheer you up (and they can’t), so they stay away. They’re afraid of psych wards, so they don’t visit.

Casseroles can’t hurt and might help.

What it all comes down to is stigma and ignorance. There are no social conventions that apply to those with SMI. Except for the most fortunate among us, we’re on our own.

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