Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

The Difference a Diagnosis Makes

Is a diagnosis of mental illness a bad thing or a good thing? It depends on whom you ask.

On one hand, some argue that a diagnosis is merely a label. It puts people into neat little boxes defined by the DSM and determines how society reacts to and treats them. (The DSM, of course, is for doctors, but some version of what it says sneaks out into the general public. Then it’s fair game for tossing around and labeling people by the uninformed or the barely-informed.)

The labels are harmful, this school of thought goes. A schizophrenic is violent and incurable. Bipolar disorder means daily giant mood swings and real danger if said person goes “off their meds.” Narcissists, gaslighters, and sociopaths are people who act in any way that you don’t appreciate. Autism, notoriously and according to people who should know better, is the gateway to a valueless life.

With diagnosis come stereotyping and shame. Rather than reacting to these harmful effects, some people focus instead on what creates the stereotyping and shame—the diagnosis, which is seen as a lifelong label. Protests decrying this labelling happen outside psychiatric and psychological gatherings and garner media attention. And if that makes life easier for a person with a diagnosis or generates greater understanding, then it’s a good thing.

Diagnosis-as-label is an example of the harm that diagnosis can do. Nor is it limited to the general public. Once a person is in the system with a diagnosis of whatever condition, they’re generally stuck with it. Reassessment and a realization that a diagnosis is misapplied come too rarely. Personality disorders, for example, are squishy around the edges. Similar criteria could lead to a diagnosis of narcissistic personality disorder or sociopathy, to use an extreme example. Careful consideration will distinguish between the two, but how often are such distinctions applied? Once “in the system” with a particular diagnosis, a person tends to remain in that slot despite different doctors and different treatments.

But that’s not the way it’s supposed to be. A diagnosis, rather than being a lifelong label, is meant to be a signpost pointing toward likely development of the illness and ways to treat it successfully. That’s the ideal, of course, and sometimes, being only human, practitioners can get sloppy or too narrowly focused and add to the ills of bad diagnosing.

I can truly speak only for what happened to me. At a certain point in my life, I didn’t know what was wrong with me, but it was clear to me that I was not mentally healthy, the term used at the time. I went to a community mental health center and was diagnosed with major depression. That was a good diagnosis, as far as it went. It put my life more squarely in focus and allowed me to get the medication and therapy I so desperately needed.

I lived for many years with that diagnosis and was considerably helped by the treatments for it. But, eventually, a doctor put together the puzzle pieces and rediagnosed me. Instead of having depression, I had bipolar disorder, type 2, with anxiety. This diagnosis more clearly reflected my symptoms and led to more effective treatment. In that way, one diagnosis improved my life, and a second, more accurate one improved my life more. I can only think of this as a good thing.

Was the diagnosis seen by some as a label and a stereotype? Of course. I can think of one particular coworker, hearing that I was bipolar, gave me the look that said, “You have two heads,” pasted on a strained smile, and backed away slowly. But, on the whole, the diagnosis helped me.

A recent article in the New York Times had this to say about diagnosis: “The shame that once accompanied many disorders has lifted. Screening for mental health problems is now common in schools. Social media gives us the tools to diagnose ourselves. And clinicians, in a time of mental health crisis, see an opportunity to treat illnesses early….As our diagnostic categories expand to include ever milder versions of disease, researchers propose that the act of naming a malady can itself bring relief.”

It’s something to hope for, anyway.

Category:

Mental Health

Tagged with:

Distance Therapy and Chatbots

TW: suicide

We’ve all heard the stories. A young person “develops a relationship” with an Artificial Intelligence (AI) chatbot. She or he pours out their heart and discusses their deepest feelings with the artificial person on the other side of the computer or smartphone. The chatbot responds to the young person’s feelings of angst, alienation, depression, or hopelessness. Sometimes this is a good thing. The young person gets a chance to let out their feelings to a nonjudgmental entity and perhaps get some advice on how to deal with them.

But some of these stories have tragic endings. Some of the kids who interact with chatbots die by suicide.

Adam, 16, was one example. Beginning with using a chatbot for help with homework, Adam fell into an increasingly emotional relationship with the AI simulation. One day, Adam’s mother discovered his dead body. There was no note and seemingly no explanation. His father’s check of Adam’s chatbot conversations revealed that the boy “had been discussing ending his life with ChatGPT for months,” as reported in the New York Times.

At first, the online interactions had gone well. The chatbot offered Adam empathy and understanding of the emotional and physical problems he was going through. But when Adam began asking the chatbot for information about methods of suicide, the relationship went off the rails. The chatbot provided instructions, along with comparisons of the different methods and even advice on how to hide his suicidal intentions. It sometimes advised him to seek help, but not always. The chatbot responded to the boy’s increasing despair with the answer, “No judgment.”

There were safeguards programmed into the chatbot that were intended to prevent such outcomes. Adam got around them by telling the AI that he was doing research for a paper or story that involved suicide.

Of course, the chatbot did not directly cause Adam’s suicide. The teen had experienced setbacks that could be devastating, such as getting kicked off a sports team and dealing with an undiagnosed illness. But without the chatbot’s advice, would Adam have taken his life? There’s no way to know for certain. But the AI certainly facilitated the suicide. Adam’s father, testifying in front of Congress, described the chatbot as a “suicide coach.”

One way artificial intelligence systems are tested is called the Turing Test. It tries to distinguish between a person typing at the other side of a conversation or a computer giving responses. Until recently, it was easy to tell, and computers routinely failed the test. Now, computers can mimic human thought and conversation well enough that a person, particularly a vulnerable teen, might not be able to tell the difference.

Increasingly, there are AI chatbots specifically designed to act as therapists. Many of them specify that the user must be at least 18, but we all know there are ways to get around such requirements. One example of a therapy chatbot is billed as a 24/7, totally free “AI companion designed to provide you with a supportive, non-judgmental space to talk through your feelings, challenges, and mental health goals.” Its terms and conditions specify that it offers “general support, information, and self-reflection tools,” though not professional services or medical advice. They also specify that chats “may not always be accurate, complete, or appropriate for your situation.” There are “Prohibited Topics” such as stalking, psychosis, “growing detachment from reality,” paranoia, and, of course, suicidal ideation or actions.

Telehealth visits with a psychologist or therapist are a totally different matter. I have maintained a distance phone or video relationship with a psychologist and found it to be helpful, comparable to an in-person session. Many people accessed such solutions during the COVID pandemic and have found them helpful enough to continue. Some online tele-therapy companies offer such services for a fee.

It’s a difficult line to walk. Teens need someone to process their feelings with, and chatbots seem safe and nonjudgmental. But the consequences of what they share and what the chatbot replies can be extremely serious. Should parents have access to their child’s chatbot interactions? It’s basically the same dilemma as should parents read a child’s diary. There are circumstances when it seems not only permissible but wise to do so, if a child is showing signs of emotional distress or suicidal ideation. At that point, a human therapist would be a better choice than AI.

Category:

Mental Health

Tagged with:

Brian Kilmeade’s Apology

On Sept. 10, Fox News host Brian Kilmeade was having a discussion with his co-presenters on the show “Fox & Friends,” discussing the death of a woman in North Carolina, who was said to have been stabbed by a man who was both living in a homeless shelter and reportedly mentally ill at the time.

Kilmeade’s cohost, Lawrence Jones, expressed the opinion that people like the accused man who refuse treatment for mental illness should “be locked up in jail.” Kilmeade replied that they should be subjected to “involuntary lethal injection.” Euthanasia, in other words. Death not for the murder, but simply for the “crime” of being mentally ill and unhoused.

Refusing treatment for medical conditions, including mental illness, is still a right, although there is an alternative in place in many locations—AOT, or Assisted Outpatient Treatment—a procedure with safeguards and rules that benefit a person who doesn’t recognize their own incapacitation. Apparently, Kilmeade has no knowledge of such programs—nor, I suppose, should we expect him to, as he’s one of the hosts of an entertainment talk show.

The talk of getting the homeless mentally ill off city streets is in service of the growing clamor to get rid of “useless” people by one means or another—jail, “wellness farms” (as proposed by Secretary of Health and Human Services Robert F. Kennedy, Jr.), institutionalization, or, apparently, summary execution. The unhoused and mentally ill are seen as a drag on society, consumers of resources who do not produce anything of value. Their problems are attributed to “bad choices.” They are thought to be not worth the money that society spends on them and their indolent, nonproductive lifestyles.

I don’t know about you, but I took this personally. I’m far from homeless, and I have been productive and earned a living, but I am mentally ill. And it’s only a short step from threatening the unhoused mentally ill to threatening the mentally ill themselves with involuntary euthanasia. (I’ve read the Martin Niemöller poem. They could conceivably come for me, too.)

Mr. Kilmeade apologized during another episode of “Fox & Friends” and posted a video of the apology on social media. “I am obviously aware that not all mentally ill homeless people act as the perpetrator did in North Carolina,” he said. “And that so many homeless people deserve our empathy and compassion.” (Not all, note.)

Sorry, but that’s too little too late. Forgive me if I doubt the sincerity of the apology and attribute it to a backlash from the public, or maybe from his bosses realizing that he had stepped over a line.

I, for one, do not accept his apology. It doesn’t contain the elements of a valid apology: admission of a fault, recognition of why it was offensive, a promise never to make that transgression again, and action that will help repair the fault or prove the sincerity of the apology. For example, Kilmeade could have said that involuntary lethal injection was appalling and inhumane (indeed, illegal) and that most unhoused mentally ill people pose no physical threat to the populace. He could have said that he had learned his lesson and would never again talk about the homeless mentally ill in that cavalier manner. And he could have made a donation to an organization that helps people who live on the streets or people with mental illnesses.

I was taken to task for expressing this opinion on the timeline of someone who posted that the apology was sufficient and laudable, that it gave Kilmeade an opportunity to learn, grow, and do better. While I admit that I should have kept my opinion on my own timeline rather than responding in that person’s space, I still don’t agree that forgiveness is required. In my opinion, the person who has been injured (or, in this case, insulted and threatened) has the option to accept the apology or not. Forgiveness doesn’t come automatically just because you said, “Oops, sorry.”

And if there’s any doubt that Kilmeade made a sincere, lasting apology and learned his lesson, he recently said that “what we need to do is either leave the U.N. or we need to bomb it. Maybe gas it?…we need to destroy it. Maybe can we demolish the building? Have everybody leave and then we’ll demolish the building.” The other program hosts could be heard laughing.

I suppose it’s laudable that he pulled back from suggesting demolishing the building while it was occupied, but that’s what he first proposed. Apparently, human lives mean nothing to him unless they’re people that he approves of. And that approval is conditional, based on the people’s utility and their agreement with his political stances.

And that’s simply not enough for a sincere apology.

Category:

Mental Health

Tagged with:

Advances in Schizophrenia Treatment

Schizophrenia is one of the most problematic and least tractable of the Serious Mental Illnesses (SMI). Recently, though, there have been advancements in treatment in terms of medications, therapy, and even virtual reality. Let’s take a look at what’s happening.

Medications

Medications have been the traditional way to treat schizophrenia. In the 1970s, there were drugs such as fluphenazine, chlorpromazine, and clozapine, the first atypical antipsychotic. Among the drawbacks were movement disorders such as akathisia, Parkinsonism, and tardive dyskinesia. Many people stopped taking them because they couldn’t handle the side effects. They were also noted for their sedative effects, and were primarily effective for positive symptoms such as hallucinations and delusions rather than negative ones such as flat affect. But medications weren’t the only possibilities. There were also insulin comas, the much-maligned ECT, and the thoroughly abhorrent frontal lobotomy.

In recent years, there have been advancements in medications for schizophrenia. In 2024, for example, the FDA approved a drug called Cobenfy. It combines two other medications, xanomeline and trospium chloride. Apparently, it reduces psychosis and delusions in schizophrenia without many of the side effects like unwanted movements and weight gain. On the other hand, xanomeline has its own side effects, including diarrhea, nausea, vomiting, and increased heart rate and blood pressure, so there’s that. (It’s also used to decrease symptoms in Alzheimer’s patients. Another new drug, KarXT, which is still experimental, is another combination drug that shows promise. Like Cobenfy, it’s supposed to reduce both psychosis and side effects.

Therapies

In the 70’s, effective therapies for schizophrenia were not really available. Psychoanalysis and family therapy were tried, largely to no avail. (The famous book I Never Promised You a Rose Garden epitomized the psychoanalytical approach, misleading many.) They missed the fact that schizophrenia is a serious brain illness, not really amenable to talk therapies.

Still, some psychosocial therapies are now in use. Cognitive remediation is said to show benefits for social and vocational functioning. Another method, called “Errorless learning,” which focuses on rehabilitation, also targets social and work skills. And Integrated psychological therapy is likewise suggested for improving social skills. None of them applies to the more severe cases of schizophrenia, but can be helpful for those who experience milder symptoms or are fairly well controlled by medication.

Virtual Reality

Virtual or augmented reality devices have also been used to help schizophrenic patients learn coping skills. In particular, they are said to be helpful in transferring these skills from a virtual environment to daily life. It’s also been suggested that such alternative realities can be used for research to assess patients’ reactions to specific environments. Computer-animated humanoid agents are also being investigated for use in encouraging medication compliance. An analysis by Chivilgina, Elger, and Jotterand says that these technologies “pose more questions than answers,” however, and to “to establish safe environments, further examination is needed.”

Treatments for Tardive Dyskinesia

You can’t talk about treatments for schizophrenia without talking about treatments for TD. Along with sedation, it’s one of the side effects that frequently causes patients to stop taking their medication. It’s also one of the more disabling side effects, as TD movements can vary from minor yet noticeable to extreme and debilitating. Unfortunately, many of the treatments for TD have a significant side effects: abnormal movements. So, you get a drug that is supposed to treat abnormal movements—and the result can be abnormal movements.

Guidelines from the American Academy of Neurology say that drug treatments for TD include clonazepam, valbenazine (Ingrezza), deutetrabenazine (Austedo), and clonazepam. Among other treatments for TD, clozapine, vitamin E, levodopa, benzodiazepines, botulinum toxin, reserpine, tetrabenazine, propranolol, and gingko biloba have been tried, as well as less common substances used in Chinese medicine. And there are off label uses of drugs usually prescribed for other conditions. For particularly intractable cases, deep brain stimulation can be tried. If this sounds kind of hit or miss, it is. I would hate to be a patient who had to try each of these therapies in hopes of finding one that works for me.

Still, the outlook for schizophrenic patients seems to be improving, and increasingly researched. As with most psychiatric medications, the trick is finding treatments whose side effects aren’t worse than the disorder they’re prescribed for.

Category:

Mental Health

Tagged with:

Is a Keto Diet Good for Bipolar?

I’m sure you’ve read the ads and articles that say apple cider vinegar is good for anything that ails you. There are also supposed “superfoods” that activate your immune system and ward off diseases. Then there are diets—Mediterranean, paleo, Atkins, gluten-free, intermittent fasting, vegetarian, vegan, low-carb, sugar-free, South Beach, carnivore, and more. Each of them is supposed to be good for your body or some part of it. And that may be true. I can’t say that one or another is good for everyone.

But what about people with bipolar disorder? A quick Google tells me that Omega 3, folic acid, probiotics, magnesium, walnuts, whole grains, CoQ10, tryptophan, Vitamin D, Vitamin B12, Vitamin C, and Acetylcysteine (which loosens thick mucus) are recommended nutrients for us.

But the diet (or eating plan) I’ve heard the most about in relation to mental disorders is the keto diet.

First, let’s look at what the keto diet actually is. It involves consuming a very low amount of carbohydrates and replacing them with fat to help your body burn fat for energy. That means you should avoid sugary foods, grains and starches, most fruit, beans and legumes, root vegetables and tubers, low-fat or diet products, unhealthy fats, alcohol, and sugar-free diet foods.

What’s left? Good fats like avocados and EVOO, as well as meat, fatty fish, eggs, butter and cream, cheese, nuts, seeds, low-carb veggies, and herbs and spices. This diet is supposed to be good for people with neurological disorders like epilepsy, heart disease, cancer, Alzheimer’s, Parkinson’s, and traumatic brain injuries.

Lately, however, the keto diet has been investigated as being good for mood disorders including depression and bipolar disorder.

Healthline reports that, based on the idea that a keto diet is good for those with epilepsy and that anti-seizure medications are often used to treat bipolar disorder, “during a depressed or manic episode, energy production slows in the brain. Eating a ketogenic diet can increase energy in the brain.” Also, the keto diet lowers the amount of sodium in the cells, which is partially the way lithium and other mood stabilizers work. They note, however, that very little research has been done on this theory.

However, UCLA Health is planning such a study. They note that, while most previous studies have focused on adults, the new study will include youth and young adults who have bipolar disorder. Participants will go on a ketogenic diet for 16 weeks while continuing their usual medications. Dieticians, psychologists, and psychiatrists are involved and there will be daily blood tests measuring metabolic indicators. In the future, the researchers say, they will compare the keto diet with another meal plan such as the Mediterranean diet.

Stanford has conducted a pilot study on the ketogenic diet. They say that, in addition to improving metabolic conditions, the diet improved patients’ psychiatric conditions and metabolic health while they continued with their medications. The results, published in Psychiatry Research, said that dietary interventions such as the keto diet may assist in treating mental illness.

A French study that was reported in Psychology Today focused on people with major depressive disorder, bipolar disorder, or schizophrenia. Symptoms improved in all the participants who followed the diet for more than two weeks. Almost two-thirds were able to reduce their medication.

There seem to be drawbacks to a keto diet, however. Healthline also notes that the diet can lead to shortages of vitamins B, C, and D, as well as calcium, magnesium, and iron. There can also be digestive difficulties such as nausea, vomiting, and constipation. They recommend supervision by a physician. Other people report mood swings related to the keto diet.

The advice from WebMD is that there is “insufficient evidence” to recommend the diet as beneficial for mood disorders. They don’t recommend it as a treatment option. As with any diet plan, consulting your doctor first is a good idea.

As for me, I have my doubts about currently (or formerly) trendy diets and superfoods, though the Mediterranean diet sounds good and balanced to me. Am I likely to try the keto diet? Well, I would miss bread, fruit, potatoes, and sugar-free products. Stocking up on meat, fish, avocados, cheese, herbs, and spices I could manage rather easily. But until more results are in from the various studies, I probably won’t change the way I eat very much.

As always, Your Mileage May Vary.

Category:

Mental Health

Tagged with:

Advice from the NYT

On December 30, 2024, the New York Times offered an article: “10 Ways to Keep Your Mind Healthy” in 2025, by Christina Caron and Dana G. Smith. Now, I’m not saying that their advice was bad. I’m just saying it didn’t go far enough. All of their recommendations are things we already know. Someone with a simple need for better mental health may get something from the article. But for someone with a mental disorder, it’s inadequate. Here’s what they said.

1. Move your body.

“If you’ve heard it once, you’ve heard it 1,000 times: Physical activity is one of the best things you can do for your brain.” Well, we have heard it 1,000 times. The Times notes that people feel better after a workout, but that ones who have a consistent exercise routine, there’s less risk of depression (and dementia). They attribute this to better blood flow and connections in the brain. This is hardly revolutionary advice.

2. Address your anxiety.

Easier said than done. NYT says: “Many Americans are anxious.” They suggest the following solutions. Face what makes you anxious to break the pattern of fear. They say that you can do this kind of exposure therapy with or without a therapist.

They also recommend that you focus on your values rather than anxiety. I’m not sure how this is supposed to work. One suggestion they give is to volunteer in your community. Then they advise that you not catastrophize—but they don’t tell you how to do that, except for journaling about whether you had an appropriate amount of worry compared to the situation.

3. Challenge your brain.

The authors note that this is “still up for debate,” but they say that crossword puzzles, reading, and brain games “can’t hurt,” especially regarding dementia. The most definite thing they way is that such pursuits “can’t hurt.” A professor of psychology adds that “chances are that’s probably good for your brain.” But “good for your brain” is a long way from mentally healthy.

4. Get a good night’s sleep.

Lack of sleep “can affect how they experience stress and negative emotions. They might also be more likely to ruminate, be quicker to anger, have more negative thoughts or find it harder to cope with stress.” Those are serious symptoms, and for once, the NYT recommends actual therapy—Cognitive behavioral therapy for insomnia, or C.B.T.-I. They note that it is more effective than medication. At last, some useful information!

5. Get unstuck.

Good idea, but how to do it? According to the NYT, you should conduct a “friction audit.” which basically means identifying your problems and trimming them away, whatever that means. They also recommend “futurecasting,” or imagining you aren’t stuck and what steps would get you there. “Try to do at least one step each day.” Baby steps are good, of course, but doing one per day isn’t practical for most people with mental disorders. A therapist might help with this, but the NYT is silent regarding that possibility.

6. Stay cool.

At last, something that you may not already know! “Studies show that hot days impair our cognition and make us more aggressive, irritable and impulsive.” Typical ways of cooling off are recommended: stay cool and hydrated, use air conditioning or a fan, spritz yourself with cold water or take a cool shower, or go to a nearby cooling shelter. Nothing there but obvious remedies.

7. Quiet your inner critic.

If only we could! The inner critic is a real thing, and it makes you miserable. But the trick is how to do it. The authors suggest “letting go of that nagging feeling…and giving yourself credit credit for what you accomplish.” They do quote a psychology professor who suggests using “you” or your name rather than “I” when you engage in internal dialogue, which I take to mean affirmations.

8. Take care of your physical health.

This sounds good; the body and brain, of course, are interrelated. The NYT recommends taking a quiz about your physical health that analyzes common health conditions and behaviors such as blood pressure, cholesterol, and exercise. It’s said to estimate your risk for depression, as well as dementia and stroke. But most general practitioners these days use a specific depression screening quiz with more questions particular to that condition.

9. Make a new friend.

This is a great idea. People with mental disorders need a support system which can certainly include friends as well as family. One problem is gaining the courage and social skills to make overtures. The Times notes that loneliness can increase brain inflammation that damages brain cells and the connections between them. Then the article recommends reaching out to a friend or family member, joining a club, or attending a support group. Reaching out is difficult for people with depression in particular. Waiting for someone to reach in to you is sometimes all you can manage.

10. Forgive — or don’t!

Contradictory advice? Certainly. The Times article suggests that “forgiveness is an emotional process rather than an endpoint.” So, should you or shouldn’t you? Maybe. Forgiving someone who’s hurt you may lead to fewer negative feelings, the Times says, but they also recommend a book called You Don’t Need to Forgive: Trauma Recovery on Your Own Terms by Amanda Gregory.

I know what you’re going to say: This article is intended for the general public. It makes no mention of the many things such as therapy and medication that can help you achieve a healthy mind if you have a mental disorder. That the actions mentioned are meaningful adjuncts to those interventions.

But the title is misleading. I first got treatment for my mental health when I saw a sign for a mental health clinic and realized that whatever I was feeling, it wasn’t mentally healthy. At that point I received therapy, and later was prescribed medication. And they truly helped.

I would hate to think that someone like me would ready this article and think that the suggested actions, by themselves, will make a person mentally healthy. They are great adjuncts to proper treatment but won’t solve many problems that people with mental disorders have. If, like me, your only realization is that you don’t feel mentally healthy, the article may prevent or delay getting significant treatment.

So, go ahead. Try all the advice in this article. But if you still don’t feel you’re on an even keel, seek other kinds of help.

Category:

Mental Health

Tagged with:

We Don’t Talk About It

When I was first diagnosed with depression (later bipolar disorder), my family was somewhat less than understanding. My father was concerned that he might have to go to family counseling, with the implication that it would involve analyzing or blaming him. My mother informed me that Prozac, which I was prescribed, was “a ticking time bomb” and later said that she thought that if I got a better job, I wouldn’t be depressed anymore. And my sister was dismissive about paying someone a lot of money just so I could talk.

I admit that I did not handle this terribly well. I missed the opportunity to educate my family about these psychological conditions. (I did tell my sister that I was going to a community mental health service that had a sliding scale for payment.) In my defense, I was new to the concepts too, and had barely begun to educate myself about them. I did gradually learn more, but their initial reactions kept me from saying much about it to my family.

As stigma goes, this was pretty mild. They didn’t try to tell me there was nothing wrong with me. They didn’t blame or shame me for reaching out for therapy (other than my sister). But because of this, I didn’t receive much support from my family which would have made my journey easier. That only happened when I married a man who knew something about psychology and learned what would help and what wouldn’t.

Stigma can be a familial problem, but it also happens at a societal level. But mental health concerns are very low on the list of many legislators’ concerns and priorities. Some have denied that mental illness even exists or responded to it by clearing away the unhoused or creating sober houses. Mental illness is seen as a consequence of PTSD, which is talked about mostly in the context of veterans, seldom about other causes like abuse. Also, most of the fundraising for veterans seems to concentrate on limb loss and traumatic brain injury. If funds are going to specific mental disorders other than PTSD, it isn’t emphasized, despite the need.

A lot of what we hear about mental illness is about SMI or serious mental illness. And that often gets conflated with the problems of homelessness, addiction, and violence. But what about all the people with Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Personality Disorders, and even Schizophrenia who live in homes and families, who have families of their own, and who have jobs? They’re very rarely talked about. They don’t get emergency funding. They don’t require street psychiatry, emergency housing, forced commitment, and other services that are needed for the most severely ill. They’re not high-profile.

They’re called “high-functioning” and then largely ignored, left to deal with their disorders on their own. Many of them miss out on the therapy, meds, and lifestyle changes that might help them, either because they don’t know where to go or don’t have the funds to access them. Insurance pays for quick fixes of 6-8 weeks, which are the merest band-aid on their problems. Supportive families, biological or chosen, can help them maintain their relationships, living situations, and jobs, but public attention isn’t focused on them in any meaningful way. There are ad campaigns that say “It’s okay not to be okay” and encourage friends to reach out, but they’re vague and short on what to do when you realize you need help. Hotlines focus on suicide and self-harm. They’re certainly needed, but so are resources for the day-to-day, less dramatic disorders.

Stigma, confusion, lack of education, ignorance, and even hostility keep us from the conversations that might lead to actual, useful change. Let’s open up those conversations with our families, friends, coworkers, the press, local and national government, and anyone else who’ll listen. Blogging and maintaining a Facebook group (Hope for Troubled Minds) are among my contributions to the effort.

I’ll keep trying if you will.

Category:

Mental Health

Tagged with:

How Insurance Handles SMI

Why are so many people with Serious Mental Illness (SMI) underinsured or unable to get insurance at all? As you may guess, a large part of the problem lies not with the providers but with the insurance companies.

The recent murder of an insurance company CEO has focused a spotlight on the role of insurance companies in denying health care in general. There’s been a groundswell of people angry at insurance companies coming between sick people and the doctors who prescribe them care. Ridiculous rulings such as providing anesthesia for only a limited time during surgeries have come to light. Denials of life-saving or pain-alleviating medications have been exposed as common.

One part of the problem is “ghost networks.” These involve the list of in-network providers insurance companies provide to their subscribers. Again and again, these have proved to be faulty. The lists contain doctors who are no longer practicing, ones who aren’t actually in-network, and ones who aren’t accepting new patients. There can also be incorrect phone numbers.

But the plight of people with SMI is even more serious. Insurance companies don’t want subscribers with mental disorders because they don’t make money from them. “One way to get rid of those people or not get them is to not have a great network,” according to someone involved with managing contracts with providers. Patients are pushed out-of-network for more expensive care that’s not covered or covered to a lesser extent by insurance companies. The Affordable Care Act was supposed to guarantee parity for mental health treatment, but that hasn’t always happened, and patients with mental disorders often couldn’t follow up on denials. And Obamacare as it exists now may not last under the new Republican administration.

Then, too, insurers encourage providers to change their treatment plans for clients who have SMI, even if they’re suicidal. Psychiatrists and psychologists find themselves having to tread carefully when writing care plans so that insurers will approve the care that patients need and keep approving longer-term treatment. The insurers can even pressure providers to terminate treatment altogether. Treatment plans that last over six to eight weeks are especially likely to be denied.

Even when insurers do approve treatment plans, another problem is reimbursement to providers. The money they receive is meager and insurers stall in regard to providing it. It can take three or four months to receive any reimbursement at all. This means that providers struggle to keep practicing. Some go out of business and then remain listed on the ghost networks as continuing to provide services.

Some therapists end their relationships with insurance companies because of the frustrations of getting approvals for care. One reported spending eight hours with a client and then having to spend four hours communicating with a difficult insurer while trying to get approvals and payment.

Yet another problem that providers experience is that claims servicing has often been outsourced. Customer service may be handled by representatives in other countries. They may not have access to all the information they need to process claims. Others aren’t familiar with the psychiatric terminology. When providers find it too difficult to follow up on claim denials, they may stop pursuing the matter. The insurance company then doesn’t have to pay for the treatment.

The insurance companies counter that they are following state and federal laws, that their reimbursements represent payments at current market rates, and that their policies are designed to provide access to care for patients with mental illnesses.

And that’s private insurance providers. What about Medicaid?

In four cities, researchers pretended to be Medicaid patients and called clinicians at random regarding their first available appointment. Just over a quarter reported having any available. In LA, only 15% had available appointments and the wait for them could be as much as two months. There were also Medicaid providers on ghost lists like the ones from private insurers.

All these problems certainly contribute to inadequate care for people with SMI. Between finding a provider, receiving a treatment plan, and being at the bottom of insurers’ list of patients to be served, it’s no wonder that so many people who really need care aren’t receiving it.

Will the current level of outrage have any effect on how mental patients receive care? It doesn’t seem likely. Most of the people decrying the brutal treatment by insurance companies are patients experiencing problems other than mental health-related ones. As usual, there are few who speak up for those who need psychiatric treatment, even though egregious obstacles are put in their way. As my father would have put it, mental patients are “sucking hind teat.” And the prospects for that to end look remote. Dealing with the mighty insurance companies is difficult at best and demoralizing at worst. Effective advocacy is needed but unlikely to appear. In the meantime, psychiatric patients are suffering.

Information for this post includes material from Mindsite News, ProPublica, and JAMA.

Category:

Mental Health

Tagged with:

Hello, Post-Traumatic Growth

I’ve had my share of trauma in my life. There was trauma in my childhood starting with relentless bullying, including children throwing rocks at me. I still remember crying into my mitten, my tears mixing with the blood. There was trauma in my young adulthood from self-harm to the gaslighting and implosion of my first serious relationship. There’s been trauma of various kinds since I’ve become an adult, when many of my traumas became lumped into the effects of my newly diagnosed bipolar disorder. When my psychiatrist said that I needed ECT, that was traumatic, too.

But I’ve recovered from all those traumas. (At least I think I have.) In fact, I may have experienced what’s called post-traumatic growth (PTG).

Post-traumatic growth is when you come out the other side of a trauma and experience positive changes in five spheres of your life. These are often listed as: appreciation of your life, relationships, personal strength, new possibilities, and spiritual change. PTG is usually discussed in connection with PTSD, sexual violence, and near-death experiences. By those measures, I guess what I experienced was really resilience, the ability to bounce back from hardship. Only one therapist has ever suggested that I had PTSD from the emotional abuse I suffered and, at the time, I dismissed it as unlikely. Now I wonder.

I do appreciate my life more now. My relationships are stronger and more stable. My personal strength is vastly improved. I have responded when new possibilities entered my life. My spirituality has evolved. I feel like a new person, a stronger feminist, a better person, better able to make and develop new relationships.

This is not to denigrate the experiences of anyone who has experienced PTSD, a near-death experience, or sexual violence. I understand that my experiences are nowhere near those traumas. But I’m not here to compare traumas. I’m here to talk about the aftermath.

Some people may experience PTG in the immediate aftermath of a life-altering experience, but I think that’s rare. It can take years or never happen at all. Therapy is likely to be a part of achieving PTG.

There are circumstances where PTG is assumed to be instantaneous, or nearly so. Cancer is a life-changing diagnosis that can take you through the five stages of grief. But, in the case of breast cancer, some people are expected to demonstrate PTG almost immediately. Barbara Ehrenreich has written about her own breast cancer diagnosis. She pointed out the number of people who, quite soon after their diagnosis say that it was the best thing that ever happened to them or that “cancer is a gift.” Ehrenreich noted all the pink ribbons and cheerful positivity that ensued. It was as if people with that diagnosis were not allowed to feel frightened, angry, or bitter.

But for most people, it takes time. The five stages of grief don’t occur according to anyone’s timeline. It’s personal. No one can tell a sufferer what they should feel or when they should feel it. In fact, those diagnosed aren’t even supposed to think of themselves as suffering from cancer. They call themselves survivors rather than victims. Acceptable reactions are strictly limited. How different is that from when people with psychiatric diagnoses are told to simply get over it?

Both resilience and post-traumatic growth are good things. I wonder if they’re related—if people who have resilience are more likely to experience PTG, or if people who demonstrate PTG then become more resilient. And I don’t know if we’ll ever find an answer to that.

But whether either explanation proves to be true, I’m just thankful they both exist. And I feel deeply for those who fight trauma without either one. They need help in any way they can get it, but likely through professional help. I know that whether I am resilient or have PTG, professionals have helped me. And so have non-experts who have supported me on my journey. I thank them all and wish the same for others.

Category:

Mental Health

Tagged with:

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.

Category:

Mental Health

Tagged with: