Bipolar 2 From Inside and Out

Posts tagged ‘depression’

Living With a Bipolar Family Member

Let’s start with this: A bipolar family is like any other family. They have good times and bad. They live with each other; they fight with each other; they care about one another. They deal with each other’s differences and problems. But they have the added stressor that one or more members of the family have bipolar disorder.

What does this mean for a family? It does mean that there are likely to be difficulties that other families don’t face. Depending on how severe the disorder is, whether the family supports their relative in getting treatment, and the resources available to them, their lives will look quite different.

My Family

My family was unprepared for me to develop bipolar disorder. They knew that I was different, and often didn’t know what to do with me, particularly when I went into depressive episodes and retreated from the world, crying hopelessly. I remember this happening in seventh grade in particular. I had been publicly humiliated at a birthday party and spent days curled up in a bean bag chair, sobbing uncontrollably. My parents knew that something was very wrong.

Nothing happened for quite a while. When I was in high school, my behavior had gotten so off-kilter that it was recommended I go see the district psychologist. My parents left the choice up to me, and I didn’t go, for reasons that now seem completely ridiculous. I should have taken the opportunity.

Later still, when I was diagnosed and medicated with Prozac, my family was encouraging, but had some issues. My mother, who got a lot of her information from TV talk shows, said she had heard that Prozac was a “ticking time bomb.” My father had no objection to my therapy as long as he didn’t have to go (which no one had ever mentioned). But they continued to give me love and emotional support throughout, though they never really understood my condition or what I was going through. I don’t think they ever did, but they never gave up on me.

Other Families

I think it’s vitally important for family members of someone with bipolar disorder to learn all they can about the disorder. This will require bravery and openness on their part. But learning all you can about bipolar disorder will help you help your family member in the best possible way.

Of course, the kind of support a person with bipolar needs will differ greatly depending on how severe their symptoms and their disorder are. If they are subject to mild to moderate depressive phases, don’t try to “cheer them up.” It won’t work. Instead, talk therapy and/or medication, or, if they’re in a more severe depressive phase, an alternative therapy like TMS or ECT may be called for. Hospitalization is definitely an option if the family member has suicidal ideation.

If they’re in a manic phase, don’t just tell them to “calm down.” That won’t work either. Instead, help them be more grounded and keep potentially harmful behaviors in check. How you do this will vary depending on how their mania manifests. If they are given to reckless driving, for example, you keep the car keys and drive them where they need to go. If they’re an overspender, keep the credit cards and PIN numbers out of reach.

Help your bipolar family member in specific ways. Encourage them to seek therapy. If needed, drive them to their therapist appointments. Pick up refills of their medications for them. Get them a pill caddy to make it easier to take their medications as prescribed.

If your family member is experiencing delusions or psychosis, don’t argue with them about hallucinations, which are very real to them. They may also be suffering from anosognosia, which means they don’t even recognize that they are ill. You may have to intervene more directly, whether that means taking them to the emergency room or admitting them to a psychiatric facility. Do all you can while keeping yourself and the rest of your family members safe. If you or your loved one is in immediate danger, don’t wait—take action!

Kinds of Support

It may seem that you are taking agency away from your family member, and that is to some extent true. But until they’re more stable and able to demonstrate agency over their own condition, helping them negotiate the practicalities of their illness is likely the best thing you can do. You can’t change your family member’s disorder or change them; in most cases, all you can do is support them.

Remember there’s help available. In addition to your local or county National Alliance on Mental Illness (NAMI) chapter, you can get in touch with Depression & Bipolar Support Alliance (DBSA), the Bipolar Caregivers website, or bphope.com, which has online support groups. That last link will take you to a page that lists other organizations and resources that may be available to help you.

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Wealth and Mental Health

It’s becoming more and more apparent that your socioeconomic status has a significant effect on your mental health. This is not to say that money buys happiness. It does mean that wealthy people can have mental health conditions related to their abundant resources, and that people who have mental disturbances often find their suffering to be greater if they are poor.

Little to No Money

It only makes sense that having severely limited funds can take a toll on a person. Finding money for rent, medical bills, childcare, retirement, or other recurring or one-time expenses can increase your worry and seriously affect emotional well-being. Financial hardship and mental distress often reinforce each other. These difficulties can be difficult—or even impossible—to escape.

But dealing with the problems of inadequate money can strengthen connections among family members and close friends. Shared hardships foster shared sacrifice, as well as negotiation and compromise skills. People with little money must work through problems and conflicts because they have few alternatives. This process can be distressing, but it also fosters trust, resilience, and intimacy. The Harvard Study of Adult Development has found that strong social bonds predict long, happy lives better than intelligence, genetics, or money.

Perhaps surprisingly, socioeconomic difficulties may also lead to alterations in the brain, particularly in children. This link seems to run through parts of the brain that keep a person awake and alert. The circuits change in children who get less sleep, face more stress, or spend lots of time on social media. All of these factors increase with lower economic, educational, and social opportunities. It’s been noted that preteens who grow up in areas with fewer monetary resources and less social support particularly show brain differences that are measurable on MRI scans. Researchers have voiced surprise at how strongly socioeconomic opportunity correlates with brain differences. Studies that link cognitive performance to brain differences without taking socioeconomics into account “may require reevaluation,” according to experts. “We need to find out how socioeconomics is becoming biologically embedded.”

Lots of Money

Many Americans believe that more money would improve their mental health. That can be true some of the time. Money can alleviate many of the problems that people on lower socioeconomic levels face. The wealthy don’t worry about where rent and food money will come from, how to get a job, or how to get to their job. They don’t have the problem of even a relatively minor illness or injury plunging them deep into medical debt.

When problems do arise, notes psychologist David H. Rosmarin of Harvard, the well-off assume that they can make problems (he gives as examples a son’s gambling losses or a daughter’s extreme depression) disappear via the application of money. “Parents with less resources would have no choice but to quickly confront the painful realities their children were facing,” Rosmarin observes.

Money can resolve most of those problems, providing stability and freedom. However, the ultra-wealthy can find themselves lacking hardship-developed strengths and descend into family conflict and emotional disconnection. Their relationships rely on control and expectations rather than shared bonding experiences.

Though they may have family, friends, coworkers, and even servants around them, the wealthy can easily feel isolated and alone. And loneliness has been shown to increase the risk of health problems such as cardiovascular disease, stroke, depression, and early death by roughly 30%, despite wealthy people’s broader access to top-quality health care.

My Experience

I grew up in a middle-class family, and local schools were among the best in the area. It seems that socioeconomic factors didn’t contribute much to the brain illness I began to develop as a child. The only time I experienced distress at a lack of money was when I was told that there wasn’t much money for higher education and that I should go to a community college. (I reacted to this with tears and distress at first, then applied for good schools and scholarships. Eventually, I went to an Ivy League school with multiple financial supports.)

When my husband and I got married, we were both out of work and on food stamps (as they were known back then). Later, we both got jobs that had good salaries attached to them. Rather than experiencing loneliness and disconnection, we had already built a basis of cooperation and negotiation as we worked through the hard times. We enjoyed each other and our families’ and friends’ love and support throughout. When we began to get ahead in our finances, we traveled, but felt the strain of not seeing each other often enough when we were home because of long hours working. All through this period, though, in bad times and good, I suffered from bipolar disorder. Money seemed to make little difference in that.

Now that I’m mentally more stable, I find that I am able to deal more effectively with financial crises, which, given the economy, arise fairly regularly. I do experience severe anxiety and worry at times, but have so far been able to work my way through them.

I’m not denying what the researchers say about brain differences in children from lower socioeconomic levels or that the wealthy have different sorts of emotional problems. But being aware of the possibilities of such problems and getting mental health assistance when necessary can make the difference between a distressed situation, whether well-funded or not, and a tolerable one.

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Remote Work: Help or Harm?

Many people recommend that people who are no longer able to work a full-time job in an office try working from home. (There are ads that say you can make $500 a day doing it, but these claims are dubious at best, scams at worst.) The COVID years demonstrated that it was possible for someone to work from home even at a 40-hour/week job. So what are the benefits and drawbacks of working from home if you have bipolar disorder or another mental illness?

Pros

The benefits of working from home are apparent. If your condition makes it difficult to deal with high-pressure situations with extended contact with other people, remote work is quite appealing. You gain independence, the ability to cut down on distressing social interactions, and time to spend with family members or doing other chores and projects. Working at your own pace without so many distractions may mean that you can complete what’s considered 40 hours of work in less than that. And Zoom meetings are generally more efficient and less stressful than the in-person kind.

When you decide to work from home, you have many more options open to you. You can work part-time, for example, or start your own business. You can even structure your days so that you work for a company part-time and for yourself the rest of the time. You can take on a job that involves no in-person contact with others, such as phone or computer-based customer service, telephone sales, or order-taking. Then there are jobs you can accomplish almost completely on your own, like transcription and other forms of keyboarding, writing articles for clients or instruction manuals for manufacturers, or formatting and editing résumés and other documents. Perhaps you could team with another person who does client contact. If so, you can make a business of graphic design, for example.

Cons

On the other hand, remote work has been blamed for increasing isolation and distress. A study reported in Science revealed that remote work “worsens mental health, particularly for those living alone. Although a large body of research finds that workers want to work remotely, our findings suggest that workers may not realize the costs of remote work for their well-being, which may take time to accumulate….Our estimates indicate that remote work explains a third of the deterioration in mental health between 2011 and 2024.”

It’s true that people who work at home generally have only sporadic contact with other people, except in emails, Zoom meetings, and phone calls. The Science study says that “84 percent of remote workers spend their workday entirely alone. Even when communicating online, people working from home receive less feedback from their co-workers and contact fewer people outside their immediate teams.”

They add, “Despite its advantages, remote work has significantly deepened Americans’ isolation and distress. Our research doesn’t suggest that work can occur only in the office. But it does mean that employees and companies should make a greater effort to prioritize face-to-face time with colleagues.” Any contact with other people seems to make the difference: “People who lived with their spouse and kids saw their mental health hold fairly steady, while those who lived alone experienced a 20 percent decrease in mental well-being.”

My Experience

I used to work full-time in offices, spending a full 17 years at one office job and some time at others. During that time, I struggled with isolation and detachment from my coworkers. I tried. But the corporate culture of “mandatory fun” such as company picnics and parties struck me as challenging and empty, and only a few coworkers included me in their lunch hours and casual conversation. I blame myself as much as anyone. My social skills have never been terrific, especially when it comes to small talk.

Before I was let go from the 17-year job, I increased my own isolation by keeping my office door closed. My job did entail some aspects that required close attention to detail without interruptions. But that was an excuse. I preferred privacy even when doing normal busy work. Although closing one’s door was not strictly forbidden, an open-door policy prevailed. My closed door meant cutting myself off from interaction.

Since leaving the corporate world, I have worked at home at a series of jobs—transcription, editing, ghostwriting, book reviewing, and the like. In most of these jobs, I set my own hours, but I am indeed alone most of the day. I get regular calls from my husband when he’s on his breaks at his outside, people-y job. It helps. And I keep up with remote friends via email, Facebook, phone, and occasional visits.

Has my mental health deteriorated? Not appreciably. I have work to do some of the time and my blogs to write, emails to respond to, books to read, and friends to chat with. I’m occasionally unfocused, and I do experience mild depression and hypomania, but the depression is not anything like the depths of it when I worked in an office.

I can’t imagine going back to office work at this time in my life. I’m happy and stable enough where I am. I don’t want to mess with that.

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Having Both a Child and a Mental Illness

The New York Times recently ran an article by Christina Caron saying that scientists have begun “to study how adults with challenging health conditions weigh parenthood.” Readers of the Times reported that “they were worried about the possibility of passing along mental illness to a child or maintaining their own well-being under the stresses of raising a family.” In one study, people who said they had poor mental health also said that they were less inclined to have children.

Here’s how this has played out in my life.

When I got married, I was in my 20s. My husband wanted children, and I figured if I had a baby, I should have it before I turned 30. Later on, I moved up that timetable. My father was terminally ill, and I thought it would be a good thing if he could see his grandchild before he died.

That was before I was diagnosed with bipolar disorder. After that, I began questioning the wisdom of having a child. My husband, Dan, not to mention his mother, still wanted one, and this became a point of contention. Dan felt the lost potential of a child for many years. When the recession hit, we didn’t have the money to have a child. (We could barely keep up with our own and our cats’ needs for food and health care.)

When my major depressive episode hit, it became apparent to me, at least, that I should not become a parent. I wasn’t able to cope well with my regular, child-free life. How could I possibly cope with the demands of being a mother? Would it be fair to be a mother who was so depressed she couldn’t care for a child properly? Would it be fair to Dan to ask him to do the majority of the many tasks associated with a child?

Even after I pulled out of that depression, I knew there was no guarantee that it wouldn’t happen again. I gave up on the idea of becoming a mother.

Why does mental illness prevent many people from considering parenthood?

There’s the problem of genetics. We know that anxiety and depression, as well as schizophrenia and other brain illnesses, run in families, leaving potential parents to worry that their child might have those diagnoses, too. If I had a child, would I be setting them up for a lifetime of mood swings and medication? Once Dan started on antidepressants, too, after an alarming spell of depression, passing along our disorders seemed even more possible.

Another question is about physical as well as mental health during pregnancy. Once I was diagnosed, I was put on a revolving regimen of multiple psychotropic drugs. Would it even be safe to take them while pregnant? Would they harm the fetus? Cause problems like too-high blood pressure for me? Make the chance of a miscarriage more likely?

And if I stopped taking the meds while pregnant, what would that do to me? Would my fluctuating hormones combine with my fluctuating moods to make my mental health even worse? And once I had the child, would I be more prone than the average mother to experience postpartum depression? Given my history of depression, it seemed a real possibility.

The Times article also discussed societal and family pressure to have a child.

This pressure can make a woman feel guilty or unnatural if she doesn’t want to have a child. There’s already stigma surrounding mental illness. Add the stigma regarding being child-free, and you’re doubling down on guilt, shame, and denial.

Fortunately, my parents didn’t pressure us, and Dan’s brother provided the Reily family with a suitable number of children and grandchildren. But we did get the usual inquiries: When are you going to have a baby? (Note: It was when, not if.) The young daughter of a friend asked why we didn’t have children. Her mother told her that not every couple does, and she seemed to accept that without further questioning. A couple of friends talked about how we had good genes and should pass them along.

Now I’m well past the age at which I have a choice to make. My same-age friends are revelling in their recent grandchildren, and I heartily celebrate their happiness with them.

The people interviewed for the Times article said they had no regrets about their choices.

Neither do I.

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Book Roundup

I read a lot. I mean, a lot. Of course, my bipolar disorder has a thing or two to say about that. When I’m depressed, I don’t have the energy to read. And when I’m hypomanic, I don’t have the attention span to read. During my worst episode, which lasted over two years, I read practically nothing. Fortunately, I came through that and am now reading again, if not with the speed of consumption that I had when I was younger, at least with the same satisfaction.

I read my books on an e-reader so I can take 1,000+ books with me wherever I go. (I can also read on my phone, if necessary. I’m never without something to read close to hand.)

Among the books that fill my virtual shelves are many on psychological, psychiatric, and assorted mental health topics. I thought I’d share with you a list of what I have, and I invite you to share any others you know of with the readers of this blog. To be sure, I haven’t listed or read all of them. My TBR list is so long that, if it were made of physical books, I could easily be crushed if they toppled over on me. But here’s a look at an assortment of what’s available. Let’s start with Jenny Lawson, one of my favorite writers, and go on from there.

• Let’s Pretend This Never Happened: A Mostly True Memoir; Furiously Happy: A Funny Book About Horrible Things; Broken (in the Best Way Possible); How to Be Okay When Nothing Is Okay, by Jenny Lawson; Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and Other Things That Happened and Solutions and Other Problems, by Allie Brosh.

The four books drawn from Lawson’s chaotic life present astoundingly funny takes on depression, anxiety, and other illnesses and treatments. Her most recent, How to Be Okay, is a compendium of “tips and tricks” for fighting against these conditions, neatly packaged in chapters that each deal with one aspect of them. Also notable are Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and Other Things That Happened and Solutions and Other Problems, both by Allie Brosh, who gives very accurate accounts of depression, embellished with cartoon drawings. Other books attempt the same feat with less success: The Hilarious World of Depression, by John Moe; and Surviving Mental Illness through Humor, by Alyson Herzig and Jessica Azar.

• Coming of Age on Zoloft: How Antidepressants Cheered Us Up, Let Us Down, and Changed Who We Are – Investigative Journalism on Psychiatric Medication and Identity, by Katharine Sharpe. Prozac Nation, by Elizabeth Wurtzel. Prozac Monologues: A Voice From the Edge, by Willa Goodfellow. Prozac Diary, by Lauren Slater.

These books, taken together, give accounts of the lives lived and societal effects of the group of antidepressants that most people have heard of. From success stories to denunciations and questioning, together they provide an in-depth look at how Prozac and Zoloft have affected both patients and our society.

• Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case, by Debbie Nathan; The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness, by Susannah Cahalan; The Psychopath Test: A Journey Through the Madness Industry, by Jon Ronson.

Exposés of two of the most famous psychological narratives of our time, both shine a light on the narratives and point out serious flaws. Nathan‘s Sybil Exposed discusses the book Sybil: The Classic True Story of a Woman Possessed by Sixteen Personalities, by Flora Rheta Schreiber, and the flaws with that narrative and the dependence “Sybil” developed on her psychiatrist and the author. The Great Pretender is about the Rosenhan experiment, in which volunteers were admitted to psychiatric wards for minimal reasons, and examines their difficulty in being let out. Ronson‘s book is lighter, with interviews detailing when “a potential hoax being played on the world’s top neurologists takes him, unexpectedly, into the heart of the madness industry.”

• Switching Time: A Doctor’s Harrowing Story of Treating a Woman with 17 Personalities, by Richard Baer.

Switching Time is an account of a woman with Dissociative Identity Disorder (multiple personalities), written by the doctor who undertook her treatment.

• An Unquiet Mind and Touched With Fire, by Kay Redfield Jamison; Manic: A Memoir, by Terri Cheney; Madness: A Bipolar Life, by Marya Hornbacher.

Jamison‘s books are the gold standard for accounts of mania and mania’s association with creativity, respectively. Cheney‘s memoir focuses on her own experience with bipolar disorder. Hornbacher is also the author of Wasted: A Memoir of Anorexia and Bulimia. Her book on Type I rapid-cycling bipolar disorder illuminates her diagnoses.

• Darkness Visible: A Memoir of Madness, by William Styron; The Noonday Demon: An Atlas of Depression, by Andrew Solomon.

Literary greats Styron and Solomon discuss their experiences with depression and recovery in a pair of important books. Darkness Visible conveys “the full terror of depression’s psychic landscape.” The Noonday Demon is particularly thorough and “examines depression in personal, cultural, and scientific terms.”

• No One Cares About Crazy People: The Chaos and Heartbreak of Mental Health in America, by Ron Powers; Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, by Lynn Nanos.

These two books are searing indictments of the societal response (or lack thereof) to mental health care in the United States. They’re important, and they lay bare the many difficulties that patients, families, and clinicians have within the “system.” Another book from a different era, Ten Days in a Mad-House, by Nellie Bly, is an exposé of conditions in a “lunatic asylum” in 1887. Her revelations led to reforms in the treatment of psychiatric patients in what was also a broken system of the time.

• The Bell Jar, by Sylvia Plath; Red Comet: The Short Life and Blazing Art of Sylvia Plath, by Heather Clark.

Confessional poet Sylvia Plath wrote with raw feeling about her psychological troubles, leaving a document that still resonates down the years. Clark‘s biography is a much-needed examination of Plath’s life and her marriage to poet Ted Hughes.

• Girls and Their Monsters: The Genain Quadruplets and the Making of Madness in America, by Audrey Clare Farley; Hidden Valley Road: Inside the Mind of an American Family, by Robert Kolker; Schizophrenia: A Brother Finds Answers in Biological Science, by Ronald Chase.

Both Girls and Their Monsters and Hidden Valley Road are about familial patterns of mental illness. Kolker‘s book, about schizophrenia, is particularly good. Schizophrenia approaches the disorder from the perspective of a brother who is a scientist wanting to discover answers.

• Tangentially Related

The Neuroscientist Who Lost Her Mind, by Barbara K. Whitaker; Another Kind of Madness: A Journey Through the Stigma and Hope of Mental Illness, by Stephen P. Hinshaw; Life of the Mind Interrupted: Essays on Mental Health and Disability in Higher Education and Even If You’re Broken: Bodies, Boundaries and Mental Health, by Katie Rose Pryal; (Don’t) Call Me Crazy, by Kelly Jensen; The Woman They Could Not Silence: One Woman, Her Incredible Fight for Freedom, and the Men Who Tried to Make Her Disappear, by Kate Moore; Rosemary: The Hidden Kennedy Daughter, by Kate Clifford Larson; My Lobotomy: A Memoir, by Howard Dully and Charles Fleming; Just Like Someone Without Mental Illness Only More So, by Mark Vonnegut; Girl, Interrupted, by Susanna Kaysen; The Man with the Electrified Brain: Adventures in Madness, by Simon Winchester.

Whitaker‘s book relates how her brain tumor mimicked schizophrenia. Hinshaw‘s is about his father’s recurring mental illness, but has a lot to say about stigma. Pryal’s two books talk about the difficulties of navigating higher education while living with a mental illness; and about sexual assault and mental illness. Jensen presents essays and other writers’ perspectives on mental illness. The Woman They Could Not Silence presents the life of Elizabeth Packard, committed to an asylum in 1860 by her husband, on flimsy grounds, and her decades-long struggle to escape and to shine a light on the abuses of the system. Rosemary tells the story of Rosemary Kennedy, who was “different” from a young age and kept out of the limelight. The book details her lobotomy and tragic life with its aftereffects. My Lobotomy recounts Dully‘s lobotomy at a very young age and his struggles to recover from it. Vonnegut, son of the famous writer, details his chaotic upbringing, manic episodes, and decision to become a pediatrician. The basis for the famous movie, Girl, Interrupted, recounts the author’s two years in a ward for teenage women and the other patients she meets there. Noted author Simon Winchester describes a series of several nine-day periods of psychosis or dissociative states, and how ECT allayed them or failed to.

• Books I Don’t Recommend

The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, by Thomas S. Szasz; Committed: Dispatches from a Psychiatrist in Training, by Adam Stern; A Bipolar Life: 50 Years of Battling Manic-Depressive Illness Did Not Stop Me From Building a 60 Million Dollar Business, by Steve Millard; I Never Promised You a Rose Garden, by Hannah Green (Joanne Greenburg); Shrinks: The Untold Story of Psychiatry, by Jeffrey A. Lieberman; Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker.

Szasz questions the whole notion of psychiatry. Stern presents a very superficial look at an intern’s experience on a psych ward. Millard barely acknowledges his disorder in his “you-too-can-succeed” narrative. Rose Garden was wildly popular in its day, but presents a now-discredited explanation of schizophrenia. Shrinks purports to tell the “‘astonishing’ story of psychiatry’s origins, demise, and redemption.” Anatomy of an Epidemic blames the rise of psychiatric disorders and medications on psychiatry.

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Men and Mental Health: Two Stories

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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Self-Care Definitions

It used to be that when you said “self-care,” you were talking about spa days, shopping sprees, mani-pedis, indulgent desserts, or wine tasting. Or, as Marge Simpson so eloquently put it while ensconced in a bubble bath, “a banana fudge sundae! With whipped cream! And some chocolate chip cheesecake! And a bottle of tequila!”

Pretty quickly, that definition of self-care was recognized as a bougie, upscale fantasy available only to a wealthy person. Not to say that it isn’t relaxing or restorative, but it’s clearly not for the majority of those overwhelmed, traumatized, or otherwise suffering psychologically. They need something more than a beauty regimen and a spending spree.

A Better Definition

The next definition of self-care adds up to basic physical health and hygiene. You know, all the things you’re supposed to do to lead a healthy life: eat right, hydrate, get enough sleep, take showers daily, walk daily. And the things we’re supposed to do for mental health and hygiene: get outdoors, reach out to friends and family, take your meds, exercise, go to therapy, journal, practice affirmations.

All those actions and activities can help your mental health, it’s true. But they work best if you’re already fairly stable. There have been times in my life when all I could do was eat Cocoa Puffs and take my meds. When you can’t even get out of bed, telling you to get out of bed isn’t likely to work. It can even make you feel worse because you know you should do those things, someone’s telling you to do those things, and you’re so deep in the hole that you can’t do those things. Then you beat yourself up for that.

The Self-Care Box

I think that when it comes to self-care, you should start small. When you do begin to see a ray of light, take note of the things around you: comfort objects, things that have distracted you and pulled you out of your misery for even an hour or two in the past. Surrounding yourself with these items or knowing where to find them is, to me, a valid form of self-care.

I’ve seen recommendations that you prepare a self-care shoebox containing the things that soothe your five senses: ones that you can touch, taste, hear, see, or smell. That’s a good idea, but the things that soothe me don’t fit in a box, especially my blue blanket, my cat (just try to put a cat in a box not of his own choosing), a DVD player, and discs of The Mikado, The Pirates of Penzance, and The Three (and Four) Musketeers. I could probably fit a bag of ginger snaps in a self-care sensory box.

Instead, I just make sure I know where these things are. They’re all in my study (except sometimes the cat), which is, in effect, a large sensory box itself. My husband knows my self-care regimen and steps in as needed to provide the items I don’t have. And, after I’ve restored myself a bit, he’ll try to coax me out of the house with the promise of lunch at a favorite restaurant. Or even Waffle House, which is very close by and doesn’t require much effort, like getting out of sweatpants and into a skirt.

If you don’t have a study, keep your comfort objects in one room of your house: bedroom, living room, basement, rec room, or wherever. The important thing is to know where to find them when you need them.

Today’s Self-Care

I do journal, or at least I write in my blogs and post them weekly. When I’m overwhelmed, my schedule keeps me tied to the world. I know I have to have something written by Sunday at 10:00 a.m. It motivates me to get out of bed and kick my brain into gear. It’s less random than journaling, which can easily fall by the wayside. And if I’m still depressed, anxious, or overwhelmed, I can write about that. Thanks to my bipolar disorder, I have a ready supply of topics.

Right now, today, I have my blue blanket and my word processing program. The cat is in the doorway and likely to curl up on my comfy chair or my lap and sleep. I have a bag of ginger snaps on my desk and more nutritious things like fruit within easy reach. I’ve taken my morning pills, which live in a bag that hangs on the doorknob near my bed. I’m set for the day. I don’t need cheesecake or tequila.

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AI and Mental Health Concerns

I read a lot of news and commentary regarding mental health and mental illness. There are sources I return to again and again because of the quality of their reporting and the consistency with which they address difficult topics. Two of my favorite sites for timely information are The New York Times and MindSite News.

Here’s a brief look at what they’ve published recently on the topic of AI and how it impacts mental health.

AI as Therapists

AI in general, and chatbots in particular, are being used to assist human therapists or even take their place. It’s true that therapy bots and chatbots are available whenever a person needs their services. There’s no waiting for an appointment.

But what is happening during those “sessions”? Many of the therapy bots use “generative AI,” which means that they can answer questions with output they have gleaned from thousands of input sources available throughout the internet. There is at least one therapy bot, however, that uses responses that have been vetted by actual human therapists. It’s designed to provide discussions of a problem or emotion between in-person appointments. The user gets a hybrid therapy experience that includes follow-up questions, affirmations, or short lessons.

General-purpose chatbots like ChatGPT can respond to sensitive questions about topics such as self-harm with responses that may encourage such behavior. Teens have found ways to avoid the safeguards that chatbots are supposed to have regarding these topics.

One thing that therapy bots cannot do is offer a diagnosis. They may be better used for persons with mild symptoms.

Chatbots as Friends

AI chatbots can also take the place of sympathetic friends who can provide connection and conversation. Paradoxically, however, this can lead to greater isolation for users whose human contacts are replaced by AI. You can’t share a meal with a chatbot, although you can chat virtually on your phone while you’re in a café. (Not that I recommend this.)

Some chatbots provide companionship as they have conversations with users who feel isolated. There are drawbacks, however, as some of the bots offer paid upgrades to the program or in-app purchases, including “gifts” for the online “friend.”

AI and “Brain Rot”

“Brain rot” has become a euphemism for over-reliance on technology, including computers, smartphones, video games, and especially social media. While most of the concern is focused on children and teens, adults can be afflicted with brain rot as well. After all, grown-ups spend time online for work, communication, recreation, research, news, and other purposes. The working definition of brain rot is a condition of “deterioration of a person’s mental or intellectual state,” or associated with “engaging with low-quality internet content,” without reference to age.

Media, especially short-form video, can reduce a person’s attention span and lower academic performance. Interaction with social media has also been associated with emotional conditions such as depression, anxiety, stress, and loneliness. Experts warn that, so far, they’re talking about correlation rather than causation. That is, they haven’t proven that absorbing short-form video causes the negative results regarding reading, memory, and language, but it is associated with them.

Other Hazards of AI

There have been reports that a few people who use chatbots begin to suffer from delusions. Where before, a person might have eccentric thoughts, using a chatbot can escalate the person to paranoia, for example, or psychosis, suicidal thoughts, or even violent crimes.

ChatGPT faces lawsuits related to harmful outcomes when people use it. While the percentage of people experiencing these ill effects is small, the sheer number of people who use ChatGPT means that the number of people experiencing psychosis or mania may be quite high.

Other, less dire effects are also possible. People who live with anxiety, depression, or OCD can find that the chatbot may provide validation for their symptoms rather than encouraging them to face their problems. A chatbot can also fuel grandiose thoughts by reinforcing them. Or a troubled user may come to rely on the chatbot to help them calm down, which is less healthy than addressing the source of the person’s anxieties.

Of course, chatbots have many positive uses, and not all interactions with them will lead to problems. But both children and adults should monitor their use of chatbots to make sure they aren’t going too far “down the rabbit hole.” A “digital detox” can be good for both adults and children.

If you’re interested in exploring topics like these, you might want to consider subscribing to MindSite News at mindsite.org.

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Diagnosing Yourself

It’s hard enough for a mental health professional to properly diagnose someone. For someone with no training in psychology or psychiatry, it’s virtually impossible. Nonetheless, every day, there are people who decide that they are bipolar, or have autism, or ADHD, AuDHD, or some other diagnosis.

Many of them decide this based on the pop psychology that permeates our society. Some base their “diagnosis” on tests or surveys they take online. Perhaps others simply feel that the differences they see in themselves equal neurodivergence. It’s trendy, in other words.

Elizabeth M. Ellis, Ph.D., an ADHD specialist, wrote an article that was published in July 2025 in Medium, titled “No, You Don’t Have ADHD, and Here Are 5 Reasons Why.” I’ll summarize, in case you don’t have access to Medium.

Her five reasons are:

  1. ADHD is a neurodevelopmental Disorder. You do not “get” ADHD past the age of 12.
  2. You don’t have ADHD because part of the diagnosis is the fact that the symptoms of ADHD are evident in childhood.
  3. Functional Impairment. You do not have ADHD because you were/are not functionally impaired.
  4. ADHD has a chronic course with most cases persisting into adulthood, negatively affecting a person’s ability to use their strengths and abilities to live successfully. You have had a successful life. You do not have ADHD.
  5. Responding positively to stimulants does not mean that you have ADHD.

Basically, an adult who says they have ADHD is not familiar with what ADHD really is—the criteria for a diagnosis by a professional, when the condition appears, the impairments of ADHD that occur, and why taking ADHD medications that seem to make you more productive with less effort doesn’t mean you have such a disorder.

Why do people claim a diagnosis that they don’t actually have?

First, they may have a lack of understanding of what the condition is. They may think, for example, that ADHD makes a person extra-productive because they don’t get a “normal” amount of sleep. They like the idea that they are a genius who has turned the diagnosis to their advantage. Or they think that they have OCD because they are obsessively neat. They don’t know about the obsessive thoughts that are a hallmark of OCD, the reason for rituals other than cleaning, and the harm they fear will happen if they do not perform these rituals.

Similarly, they may believe they have bipolar disorder because their moods change quickly, sometimes more than once a day. But even ultra-rapid-cycling bipolar disorder doesn’t really work that way. What the person is feeling may be normal reactions to the world around them. They’re happy in the morning because they received a compliment on their work. They feel sad in the afternoon when a friend cancels a dinner date. But bipolar disorder, in general, means that moods change over days, weeks, months, or even years, often without a visible cause. The DSM lists the symptoms that go with bipolar disorder (and other disorders), how often they occur, how long they last, and how many of those symptoms add up to a diagnosis of bipolar disorder.

Most online quizzes that purport to diagnose whether you have any of these psychological or psychiatric disorders present questions that are superficial and shallow. They lack important elements. Even the depression screener that doctors’ offices now use ask how often a person feels a symptom and how long it lasts, and have a better chance of suggesting a possible diagnosis, and allow the doctor to interpret the results and advise the patient on what to do about it. Online quizzes can’t and don’t.

As far as I can tell, online quizzes regarding psychological issues are no more useful than those that ask what Star Trek character you most resemble or whom you should date. They may be interesting, but they are valueless. That’s why we have professionals and leave actual diagnosis to them.

And, for people who simply decide on a condition they think they have, they’re not merely inaccurate; they spread false ideas of what it means to have a psychological disorder. Their misunderstanding makes life more difficult for those who actually have the conditions.

Nor are online quizzes the only culprits. There are also TV shows that have neurodivergent characters. I suppose I should be grateful that neurodiversity is mentioned at all, but the portrayals are often caricatures. Autistic people are seen, but only as nonverbal children who act out a lot or as savant doctors. People with Dissociative Identity Disorder (multiple personalities) are either sadistic killers or played for laughs. And I have yet to see a good portrayal of a person with bipolar. It would be awfully boring to have a show about a person who can’t get out of bed for weeks, then spends money or drives recklessly.

So, you’re not the person who can diagnose yourself. A psychiatric or psychological practitioner needs to do it. You might, of course, go to a psychiatrist and say, “Dr., I’m having these symptoms. Do you know what could be causing them, and can you help me deal with them?”

That’s the way to get diagnosed.

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Lifelong Meds?

I was in my 20s when I started taking Prozac. Now I’m nearing 70 and still taking SSRIs, though the names have changed over the years.

When I was first diagnosed with depression (which was before I was diagnosed with bipolar 2 and anxiety), I understood it to be a lifelong condition. When my diagnosis changed, I still thought of it as a lifelong disorder requiring lifelong treatment. So far, that has proved to be true. I have been on antidepressants ever since and fully expect to stay on them forever, or at least until a cure is at last found.

Recently, however, the New York Times published an article that examined whether the received wisdom was still true. Did someone, once prescribed antidepressants, whether for depression, OCD, PTSD, or another mental illness, have to continue taking them for the rest of their life? The article noted that the FDA’s approval of the drugs was based on trials that lasted only a few months. Other “in-depth” studies lasted two years or fewer. The Times also noted, “Current clinical guidelines do not specify the optimal amount of time they should be taken for.”

Many people stop taking antidepressants on their own, based on side effects and a dislike of them, the fact that the drugs seem to stop working (either fairly quickly or over the long term), or simply because they dislike taking pills. According to the Times, however, “The answer depends on your symptoms, diagnosis, response to the medication, side effects, and other factors—all things to discuss with a medical professional.” In other words, cold turkey isn’t the way to go. With psychotropic drugs such as benzos, it’s positively dangerous, and quitting antidepressants brings the risk of falling back into the depression you and your doctor were trying to alleviate. Tapering off the drug with the help of your prescribing physician is recommended.

And about those side effects—some disappear over time as the body gets used to the medication, but others, particularly annoying ones like weight gain, sexual dysfunction, and possibly increased heart symptoms, linger. A doctor can prescribe a different drug in hopes that the side effects will not be so severe, but they may only be similar or worse. Patients generally don’t like tinkering with their medication and having to wait weeks until the effects appear and the side effects disappear. It’s a tedious and discouraging prospect.

What do the clinical guidelines say? Experts say that antidepressants, once they work, should be taken for four to nine months. Any quicker than that, relapse may occur. To maintain the positive effects, they should be taken for two to four years. Taking them for longer periods is sometimes advised, depending on how long the depression lasted and whether the patient has had several depressive episodes. Long-term use depends on whether the illness has continued for a long time and whether the depression is very severe, causing hospital stays and a loss of the ability to perform daily functions.

All in all, says Dr. Paul Nestadt, the medical director of the Center for Suicide Prevention at the Johns Hopkins Bloomberg School of Public Health, “I’m still of the opinion that, in people who have real depression, the benefits outweigh the risk.”

So, continuing to take antidepressants is really up to me and my doctor. At this point in my life, I see my doctor quarterly for a med check. We sometimes tinker with the dosages, based on my symptoms at the time, but for the most part, we stick with what has been working. As the saying goes, “If it ain’t broke, don’t fix it.” And since it ain’t broke, I’m content to keep taking my antidepressant (and other medications) for the foreseeable future.

Note: This post is not medical advice and should not be taken as such. Discuss medical questions with your physician, especially before stopping a medication.

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