Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

The Overwhelming Problem

screaming (Uma painting)It’s been said that time is nature’s way of keeping one damn thing after another from being every damn thing all at once. I know that taking things one at a time—eating the elephant one bite at a time—is a sound idea.

However, every now and then the damn things gang up on you. The elephant is starting to go bad and you have to eat all you can right away – to use a disgusting metaphor that I will not take any further. (You’re welcome.)

Last month was one of those months. They happen every so often. But if they happen very often, I tend to get overwhelmed. And when I get overwhelmed for too long, my brain breaks. I have a meltdown, or I decompensate, or whatever the proper psychiatric term is. In practical terms, it means that I’m severely depressed and non-functional, for longer than usual. Days. Weeks. Months. Even years.

The things that overwhelm me are quite predictable – financial difficulties, health problems, relationship glitches, and free-floating anxiety of all sorts, either my own or my loved one’s. I know that these are situations that cause difficulty for everyone, but to a person with bipolar disorder, they can seem—or even be—insurmountable. Especially when they cluster and refuse to go away.

Over the years I have become good (or at least better) at recognizing when I am about to be overwhelmed. I know the symptoms—the whirling thoughts, the jumping-out-of-my-skin feeling, the insomnia, the inability to concentrate, and the feeling that doom or disaster is impending.

There is little I can do to stave off these feelings. But I know I have to. I have to keep functioning at some level, higher or lower, to maintain the things that I want to have – productive work, a loving relationship, a nice house, caring friends, and so forth. At the time of my last major breakdown, I came uncomfortably close to losing much of that.

I try my usual remedies for anxiety, of course. I distract myself. I color. I watch mindless TV. I play stupid clicky games on the computer. I turn off my phone. But if the anxiety builds up too much, if the feared disaster is real and really is impending, none of these works. The anxiety shreds my last nerve, and the depression starts to settle in. I isolate. I stay in bed. One task at a time, I stop being able to function.

I have taken one step that has helped, however. An anti-anxiety pill is one of my daily medications—one in the morning and one at night. A few years ago, as the stress was building and approaching overwhelming, I asked my psychiatrist if I could have permission to take one more a day if I needed it.

He agreed.

I have not needed to take the extra pill every day. Sometimes I take one in the mid-afternoon if I start feeling jumpy, twitchy, or panicky. Sometimes I take one at night if I haven’t gotten to sleep within 2 – 3 hours after taking my regular nighttime pills. I know it sounds strange that a depressant helps me stave off depression, but my diagnosis is actually bipolar disorder and anxiety disorder. The med catches me at the point where the one starts to turn into the other.

I’m glad my psychiatrist trusted me not to abuse what I consider a privilege as well as a necessity. By the time I made this request, of course, we had been working together for a number of years and had built up a certain trust. I think there have been only a couple of times when I have had to take two extra pills in a day—one in the afternoon and an additional one at night. And both times, I felt guilty about it and made sure I didn’t make it a habit.

I don’t want to start gobbling pills at the least sign of difficulty. All I want is to be able to eat my elephant in peace and in pieces.

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Side Effects: TD and Stevens-Johnson

We all hate side effects. They go from bad to worse to horrible. (A popular meme says that people wish they had side effects like multiple orgasms. Alas, no one’s invented a drug with that side effect yet.)

In my journey through the process of settling on reasonably effective medications, I’ve experienced a number of side effects, including violent nightmares, paranoia, and feeling numb all over. I switched to other meds, but really, those weren’t so bad.

Two of the worst side effects are Tardive Dyskinesia (TD) and Stevens-Johnson Syndrome.

TD, according to Penn Medicine, is “stereotypical involuntary movements of the tongue, neck, and facial muscles, truncal musculature, and limbs.” These movements “can range from slight tremor to uncontrollable movement of the entire body,” explains NIH. Basically, these movements often consist of facial movements like grimacing, sucking, sticking out the tongue, rapid blinking, and chewing motions. The bodily movements can include ones of the arms, legs, and pelvis, from tapping your feet or fingers to rocking the pelvis, swaying, and uncontrolled movements while walking.” (One description of it was “waddling.”)

The medications that can bring on TD include antipsychotics such as Haldol, Risperdal, Abilify, and Seroquel; antidepressants including (but not limited to) Sinequan, Elavil, and Prozac; antiseizure medications such as Lamictal and Dilantin; and, of course, lithium, particularly if taken along with other medications. (I’m currently taking meds in three of these categories and have in the past taken others, though never lithium. I’ve never experienced TD.)

You may have seen commercials on TV with information on treatments for TD. Although they’re designed to prevent a particularly troubling side-effect, they have side effects of their own. A list of these includes depression, suicidal thoughts, mood symptoms, heart abnormalities, allergic reactions, dizziness, weight gain, loss of balance or falls, stomach pains, frequent urination, and constipation. Oh, and there’s one more—uncontrollable body movements that may become permanent. That’s right. The anti-TD meds can cause exactly the symptom they’re supposed to alleviate. Sounds like a good deal to me. Admittedly, the incidence of these side effects is likely less than the incidence of TD from lithium, but would you be willing to roll the dice? Maybe you would, if there’s a chance it could protect you from TD. It’s up to the individual. Me? I’m not sure.

Another undesirable side effect is Stevens-Johnson Syndrome. It’s a condition that at first causes a skin rash that isn’t really itchy and often first appears around the nose and mouth or other mucous membranes. Unless you get immediate treatment, the rash can spread and turn into blisters and painful sores. It can develop into toxic epidermal necrolysis (TEN), a condition in which skin all over the body peels off. It’s potentially fatal. In 80% of cases, a psychotropic medication is the cause. (My psychiatrist prescribed me an antipsychotic particularly associated with the disorder and told me, “Don’t look it up on the internet. It’s gross.” Of course, I did look it up, and he was right. It is gross.)

I’ve had my bouts with side effects over the years. In every case, my doctor listened to me, weaned me off the drug that was causing the problem and titrated me up on a different one until we finally found a regimen that works. I’m fortunate that none of the side effects have been TD, Stevens-Johnson, or TEN. And I’m profoundly thankful.

The only advice I can give is to be mindful of the potential side effects of the drugs you take. On TV commercials, they run through them so rapidly and print them in such small type that they’re difficult to notice. But they matter. It’s your physical health as well as your mental health that’s at stake. If that means you need to do research on the internet, do it. I know there’s a danger that you’ll expect the side effects you read about but, in my opinion, it’s a trade-off worth making, especially with all the new drugs on the market and the potential severity of the side effects you’re facing.

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Is It Bipolar or BPD?

When I first started looking at the literature regarding SMI, I became confused by the abbreviation BPD. At first, I thought it was a typo or an alternative for Bipolar Disorder. Of course, I found out that it wasn’t—BPD stood for Borderline Personality Disorder.

Even if you know what the abbreviation means, it’s easy enough to get confused between the two. In fact, bipolar is often misdiagnosed for borderline, or vice versa. There are some similarities between the two disorders as well. Both involve mood swings. Both can cause reckless behavior. Both can be associated with childhood trauma. And both can lead to suicidal ideation or completed suicide. They’re both very serious diagnoses.

Johns Hopkins says that Borderline Personality Disorder “may also be called emotionally unstable personality disorder. People with BPD have unstable moods and can act recklessly. They also have a hard time managing their emotions. If you have BPD, you may have problems with daily tasks, obligations, and life events. You may have trouble keeping jobs and relationships.”

Sounds familiar, doesn’t it? The same could be said of bipolar disorder. So what’s the difference between the two?

VeryWellMind says the difference lies in the fact that “People with bipolar disorder tend to experience mania and depression, while people with BPD experience intense emotional pain and feelings of emptiness, desperation, anger, hopelessness, and loneliness. In BPD, mood changes are often more short-lived. They may last for only a few hours at a time.”

Not to get picky about it, but as a person with bipolar, I’ve experienced intense emotional pain and feelings of emptiness, desperation, hopelessness, and loneliness while in the throes of a major depressive episode. (Not so much anger.) They did, however, last for months rather than a few hours at a time.

People with BPD can also experience dissociation and paranoia, and reckless behavior. They tend to have intense, unstable relationships. Dissociation is sometimes also seen in manic episodes of bipolar disorder and reckless behavior is a symptom of bipolar mania as well. Bipolar disorder can cause difficulty with relationships too. In between mood episodes, the person with bipolar can achieve stability, while that’s less likely for BPD.

So it seems that BPD might be seen as “bipolar on fast-forward.” The short time span of BPD episodes is one of the major differences between the two conditions. (It’s been described as “pervasive instability.”) But since the two sets of symptoms overlap, even clinicians sometimes mistake one for the other. BPD appears to have a strong genetic component; the cause of bipolar is thought to be a combination of brain functions, genetics, and early trauma.

When it comes to treatment, there are more options for bipolar than BPD. With BPD, medication is generally limited to symptomatic relief, such as with antianxiety agents. Dialectic behavioral therapy is the treatment of choice, along with psychotherapy. There are dozens of medications available for bipolar, as we know from TV commercials if nothing else.

It’s important to note that the two diagnoses can coexist. When they both affect a person, which is possible, they can be even more difficult to diagnose and treat. It’s easy to see how that can happen. Mood swings, reckless behavior, and potential dissociation can be effects of either one. Seeing a person only once a week, as many therapists do, can make it difficult to track the symptoms and see the patterns. And if the person sees a therapist or psychiatrist less often than that, the difficulty is compounded. Symptomatic relief may seem sufficient at first, but long-term is no solution.

Am I satisfied with my bipolar diagnosis? I’d have to say I am. While I despise the long-lasting mood swings, those are now largely controlled on medication. My destructive relationships haven’t been quick but have still been intense, and now I’ve achieved stability in that too. All things considered, I’ll stick with what I’ve got—not that I have a choice in the matter. If I had been afflicted with BPD, I hope I would have done as well.

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The Power of Awe

My husband asked me if I wanted to watch this movie, Operation: Arctic Cure. He knows I love stories about people who face hardship. Sometimes they triumph. Sometimes they fail. But they’re always out there trying. Dan also knows that I like stories of Arctic adventure—mountain climbers, exploration ships, races to the pole, and the like. So he figured the movie would be perfect for me. And it was.

It was a documentary telling the story of a handful of people cross-country skiing across Baffin Island, Canada, to reach Mount Thor, pictured above. What made this expedition different was that the participants were all people who had been injured in the wars in Afghanistan and Iraq. Most were soldiers, but one was a news correspondent who had been caught in an IED explosion and suffered traumatic brain injury (TBI). The other people on the expedition also had TBI or amputated limbs. And PTSD.

The people who conceived the expedition were hoping that the experience would somehow help them alleviate the PTSD. The teamwork, the effort, the hardships for a cause were all hoped to be therapeutic.

Another inspiration for the trek was Dacher Keltner’s book Awe. In it, the researcher on emotions posited that encounters with the wonders of nature could have beneficial effects on the brain and body. These outcomes would be largely self-reported, of course, but were backed up by scientific data. The participants took their cortisol levels, a measure of stress hormones, before the trip and twice a day during it. They also had sensors that recorded the length and quality of their sleep. And they kept video diaries, with their faces computer-analyzed for symptoms of stress through eye movement and changes in facial expression.

They did indeed encounter hardships. The skiers pulled heavy loads of their gear behind them. There was the numbing cold, vicious winds that held up their travel, and one amputee whose prosthetic caused so much pain that for one day she couldn’t walk. One of the men pulled her along with his own pack so she could stay with the expedition until she was able to adjust her foot the next day. They talked, of course, sharing stories of their war experiences and their families. One participant came to realize that he hadn’t been in touch with people he knew during the war and that he needed to be.

Where did Keltner’s book fit in? It proposed that the experience of awe, perhaps best encountered in nature, had healing properties. The expedition certainly had those awe-some experiences. They were far enough north to see huge displays of the Northern Lights. They conquered milestones such as reaching the Arctic Circle. And they made it to the foot of Mount Thor, a rugged landscape that features the world’s highest vertical cliff.

But those were subjective experiences. Was there science to back up Keltner’s claim and to validate the emotions described by the participants?

The measures of cortisol provided interesting feedback. In normal individuals, cortisol levels start high in the morning and decline through the day, leaving the body ready for peaceful sleep at night. The participants started the journey with cortisol levels significantly lower than average and rapidly declining throughout the day. By the end of the trek, their cortisol levels approached normal. And their sleep quality and length improved as well. One participant had a 40% increase in his sleep stats.

The movie followed the injured warriors during their trek, but not afterward, so it’s unclear whether the gains lasted. But they evidently experienced something profound. They spoke of the clarity from being in nature and the feeling of being a part of the world around them.

Many books and articles on self-care recommend being out in nature. Most of them talk about the benefits of sunlight, motion, and exercise. Keltner’s book and the film suggest a broader effect. The feeling of awe, of being one with the natural world, could increase a person’s peace, happiness, and a deeper connection to other human beings.

It was pointed out that you don’t have to travel to extreme environments to experience this awe. It’s all around us, if only our eyes are opened to it.

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Self-Care and Social Care

We hear a lot about self-care these days. Much of the mainstream media seems to think that it means “shopping therapy,” indulgent desserts, spa days, and mani-pedis. Expensive things. Ones that you need to be able to leave the house to do. (Except for online shopping, of course.)

Businesses are also quick to suggest self-care for their workers who are experiencing stress. What they mean by self-care is to take up yoga or meditation—on your own time and your dime.

Real self-care may include yoga and meditation and even the judicious use of ice cream, but it’s much more than that, of course. Self-care begins with the things that we all know are good for both body and mind—exercise, healthful food, good sleep, and stress reduction. Other good habits often mentioned are a digital detox, mindfulness, journaling, gratitude, affirmations, prayer, fresh air and sunshine, and hobbies.

Those are good things, of course, but they are primarily solo things, or at least were while the pandemic had us cooped up. Now we can get out and about more easily, go jogging or hiking with a friend, invite people over for dinner, and generally add human companionship to our list of self-care techniques.

But maybe what we need is social care (also known as community care). It’s hard to define social care. One source I looked for mentioned advocacy. But that’s pretty much something we have to do for ourselves. There are organizations like NAMI, and they do a great job at advocacy, but there’s only so much they can do. There aren’t brain illness support groups the way there are for alcoholism, narcotics addiction, and other kinds of afflictions that require outside support. There aren’t Meals on Wheels-type services for people who can’t leave their homes because of crippling anxiety. (Of course, grocery stores deliver now, but it gets expensive.)

There are very few group homes for people with SMI who need to transition between the hospital and living alone. There are group homes (sober houses) for those with alcohol or other addictions and even prisoners on parole. Many people with psychological or psychiatric needs rely on family members as long as they are able. I know a woman who lives with her father because of her assorted diagnoses. We’re all worried about what will happen to her when her father, who’s not in good health, dies. Her mother, when she was alive, tried to get her into a group home, with no success.

For those who are able to leave the house on occasion, social networks are recommended as a form of self-care. And even for people who can’t go out, there are social media, email, and video chats, which can fill some of the gaps.

But social services are thin on the ground, at least near me. I live in a suburb near two medium-sized cities. Most of the services available are for the mentally disabled, physically disabled, seniors, and some respite care for caregivers. People with SMI get a list of the crisis numbers. And, of course, psychiatric beds are limited and even psychiatrists have months-long waiting lists.

I know funds are limited and that the other groups need care, too. But social care is needed for those with SMI, too. We’re dependent on tax dollars, which are hard to come by.

It’s worth noting that the National Health Service in the UK has many more programs accessible to those with SMI at little or no cost. Of course, those are functions of socialized medicine, which is not likely to be enacted in the US anytime soon.

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Is It Narcissism or Gaslighting?

We know that narcissism and gaslighting both lend themselves to abusive treatment, but they are actually two different things. They’re both extremely destructive. They both have serious negative effects on the people around them. And people who are victims of narcissistic abuse or gaslighting face similar problems in determining what to do about it. Let’s take a deeper dive.

Narcissism is a psychiatric condition—a personality disorder—that’s included in the DSM and has been recognized for years. The DSM says that NPD involves “a pervasive pattern of grandiosity (in fantasy or behavior), a constant need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts.” Diagnostic criteria include a need for excessive admiration, a sense of entitlement, interpersonally exploitive behavior, a lack of empathy, a belief that others are envious of them, and arrogant and haughty behaviors or attitudes. Narcissism is a personality trait, while clinically, Narcissistic Personality Disorder is a psychiatric condition.

(I will not now be discussing politics. Diagnosis-at-a-distance is not valid or desirable. Diagnosis can only be made by a mental health professional who has actually spoken to the person in question.)

Gaslighting, on the other hand, is a form of psychological manipulation that narcissistic abusers sometimes use to control another person by making them doubt their own reality and sanity. But people other than narcissists use gaslighting as well. They could simply have narcissistic tendencies but not be diagnosable or diagnosed with NPD.

In other words, narcissism focuses on a sense of grandiosity and superiority, while gaslighting focuses on the way one person manipulates another in an abusive manner.

Gaslighting gets its name from a movie that showed a husband who tried to convince his wife that she was insane, for personal gain. The term has entered the non-psychiatric discourse and is used very loosely to mean any kind of abusive tactics rather than the specific one of causing another person to doubt their own reality.

Gaslighting can be one tactic that people with NPD use when they do abuse others, but there are a number of other toxic behaviors they demonstrate as well. Someone engaging in narcissistic abuse can use a variety of techniques to emotionally manipulate another person. They may belittle and demean their victim, isolate them from friends and family, and use intermittent reinforcement (in which they sometimes praise and show love for the victim, then take any opportunity to insult and blame them).

A gaslighter denies the victim’s perception of reality. They may explain their abusive behavior as “just a joke.” They may deny that their victim’s memory of an incident is true. They create a sense of cognitive dissonance in which the victim’s lived experience is at odds with what the abuser says really happened. There is obviously a great deal of overlap between gaslighting and narcissistic abuse.

The effects of narcissistic abuse or gaslighting can be severe. Victims can feel low self-esteem, internalize the abuse and believe they are to blame for it or brought it on themselves, feel alienation from friends and family, have difficulty trusting others, be unable to make decisions, and not feel able to maintain a sense of self. They frequently stay with the abuser, unable to recognize what is happening. They may feel they can change the abuser. They can’t.

The best way to counteract the harmful effects of narcissistic abuse or gaslighting is to get away from it. Admittedly, this is difficult to do. The victim may have been conditioned to believe that the abuser loves them and not want to give up on the relationship. Even if the victim does leave, it may take a long time and most likely therapy for them to realize what actually happened and define it as abuse.

Setting boundaries can help, though an abuser is not likely to respect them. Seeking support from friends, family, a psychologist, or group therapy may well be necessary. Couples counseling is not likely to help. The abuser may not admit that they need help. Education can be empowering. Once you learn about the dynamics and techniques of abuse or gaslighting, you’re less likely to be susceptible to them.

But the best thing to do is not to get involved with a narcissist or a gaslighter in the first place. It’s a situation that’s a lot easier to get into than to get out of. Watch for red flags, then keep your distance. They may seem attractive at first, but they’re trouble waiting to happen.

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Running Out of Meds

Isolated Empty Pill BottlesRunning out of your medications is scary.

I know. It’s happened to me several times.

Sometimes it was a matter of supply. My usual pharmacy ran out of a sleep aid and wasn’t going to get any more until after the weekend. Fortunately, they recommended a mom-and-pop pharmacy (yes, such things do still exist) just down the street and helped me transfer my prescription there.

Another time the problem was the prescription. I ran out of an anti-anxiety med, but when I called in for a refill, I was told that it wasn’t time for one. When I looked at the bottle more closely, I discovered that they had given me 60 pills, as if I were taking two a day, instead of the three a day actually prescribed. (I was changing doctors about that time and there was miscommunication.)

Yet another time, it was money. I ran out of an antipsychotic and was told that even with insurance, it would cost me $800 for a month’s supply because of the out-of-pocket required minimum. I spent a couple of days arguing with the insurance company, researching solutions online, and making sure a local pharmacy would take the coupon I found, which lowered the price to under $200. That was still a hefty chunk of our budget, but we managed to scrape it together until the drug went generic a couple of months later. (I also had to stand in line while the pharmacy called the coupon people and the insurance company to see how to enter it all in their system.)

And of course there are the everyday screw-ups. My husband forgot to pick up my scrips (one time he remembered to pick them up but left the bag in the car and drove 500 miles away), or he forgot which pharmacy they were at, or he didn’t hear me say that I was completely out, or the pharmacy didn’t open until 10:00, or they had my pills in two different bags and only gave us one. There are lots of ways it can happen.

Once I even took my entire supply on a weekend getaway and left them in a drawer at the bed-and-breakfast. I know. Stupid.

Most of the time running out of drugs isn’t a crisis. It just feels like one.

Of course, there are exceptions. It is a crisis if you run out of certain anti-anxiety drugs and you don’t get any for several days. You can have withdrawal – actual, physical as well as psychological withdrawal. I’ve heard that benzo withdrawal can be as bad as opiates. That’s one reason it’s important to replace your meds as soon as possible.

A lot of psychotropic medications build up to a therapeutic level in your bloodstream, so a day or two without them probably won’t even be noticeable. When you start taking them again, your levels will even out.

But even if the med you run out of is one that you can easily tolerate a day or two without, you may have some psychological effects. When I run out of a prescription, even for a short time, I become twitchy and agitated – my hypomania kicks in and comes out as anxiety, the way it usually does for me. I fear crashing back into that deadly unmedicated space where all is misery and despair. Intellectually, I know that likely won’t happen. But it sure feels like it will. This is one way my none-too-stable mind plays tricks on me.

It’s like the opposite of the placebo effect – believing that a sugar pill will help you and experiencing gains until you learn that the pill is fake. In my version, I believe that not taking the pill will cause relapse, even though it actually won’t.

Whatever else you feel or do, DO NOT use missing a couple of pills as an opportunity to go off your meds entirely. This is another lie your brain can tell you: “You’re doing fine without it. Why keep taking it?” It may not in the short term, but you will feel the effects of not taking your meds, and then there you are, back in the Pit of Despair or rocketing to the skies. It won’t be pretty.

For me and a lot of others like me, the key to effective medication is consistency. Once you find the right “cocktail,” stick with it. But if you run out, don’t panic. Keep Calm & Get a Refill.

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Grippy Socks and Sour Candy

My husband is a great help when I write my blogs. He keeps an eye out for news stories that deal with mental health in some fashion. So when he saw an article on new words related to the topic, he made sure I saw it. Then he asked me how I felt about it.

The story was about new language that young people were using to describe various mental health concepts.

First and foremost among them was “grippy socks vacay”—a reference to the footwear issued to people who have been committed, voluntarily or otherwise, to psych wards. But “vacay” is short for “vacation.” I can just picture a conversation using it: “Where’s Janet been?” “Oh, she’s been on a grippy socks vacay.” Or “I’m stressed. It’s time I went on a grippy socks vacay.” It seems unlikely that the people who say these things are always referring to an actual stay in a psych ward.

I was more than slightly appalled. It’s true that grippy socks evoke the image of a hospital stay. But grippy socks are a part of any stay in any department of a hospital, not just psych wards. And such a stay is hardly a vacation. It’s likely, I think, that people use this to mean something like “relaxing getaway” or “time to clear my head.” An actual stay in a psych ward, however, is not a relaxing getaway. It’s intense. It’s not supposed to be relaxing. And while it does provide time to clear one’s head, that’s still far from accurate. Medication, group therapy, and individual therapy may eventually clear one’s head or at least change one’s perspective, but it’s hardly just a time away from work and day-to-day stresses.

The article went on to discuss whether the phrase increased or decreased stigma. Some said one, some the other. I think it perpetuates stigma. It implies that someone who is in a psych ward is there to have a good time. “Grippy socks vacay” is demeaning when the hard work that mental patients must accomplish is considered.

If it’s used as a euphemism for an actual psych ward stay, it’s insensitive at the least. If it just means time off from daily cares, it’s still inaccurate and discounts the real experience. Those things can’t be good for reducing stigma.

Now, my friends and I have been known to use irreverent language to refer to our conditions. Robbin and I used to say on occasion that we needed a “check-up from the neck up.” We used it just between the two of us (well, I’ve also used it with my husband) to indicate that we needed to see our therapists. But I don’t see it as being demeaning, especially since we never used it in the context of anything but our own disorders, not a general description of someone the general populace would slangily describe as “crazy.” If we had said of any popular figure that they needed a check-up from the neck up, that would have been something else. But we didn’t.

Of course, you may disagree with this and I’d love to hear from you regarding your opinion.

The other article my husband shared with me was one that indicated that it was a trend on TikTok to use sour candy to ward off anxiety. The article even said that experts backed up the theory.

The idea is that the intense sensation of sourness distracts the brain from the cause of the anxiety. It’s a distraction technique, like snapping a rubber band on your wrist to take your mind away from unwanted thoughts. One expert interviewed for the article said, “Panic ensues when our amygdala triggers the flight or fight response. One way to dampen our amygdala’s response and mitigate panic is by turning our attention to the present moment through our senses: taste, smell, touch, sight, and hearing.” Mindfulness through candy, I guess, would be a way to describe it. The experts also advise grounding yourself with other sensations such as the scent of essential oils.

Other experts noted that sour candy is a kind of crutch and not a long-term solution. One called it “maladaptive.” Sensory distractions, they said, were most effective in conjunction with acceptance rather than avoidance.

What’s the takeaway from this? Aside from the potential boost in sales for Jolly Ranchers, I mean. I think it’s a good reminder that there are ways to short-circuit anxiety and panic. And for people who only experience occasional, momentary anxiety, it’s probably a good thing. But for someone with an actual anxiety or panic disorder, it’s likely to be only one tool they use — and a minor one, at that.

What have you been reading recently about mental health trends? I’d love for you to share that, too.

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Mental Illness: Poverty and Privilege

Mental illness is not just an American problem. In fact, it’s a problem around the world, and perhaps much more acute in other nations, especially those plagued by poverty.

There’s no way to know for sure, but many – perhaps most – of the world’s mentally ill are undiagnosed, untreated, ignored. Because what do you do when you live where there’s no psychiatrist? No therapist. No medication. No help.

Your family may support you, shelter you, or shun you, depending on their financial and emotional resources and those of the community. But for many people, there is simply nothing.

Psychiatrist Vikram Patel, one of Time magazine’s 100 Most Influential People for 2015, is working to change that.

As a recent profile in Discover magazine put it, Patel and others like him have set out to prove “that mental illnesses, like bipolar disease, schizophrenia, and depression are medical issues, not character weaknesses. They take a major toll on the world’s health, and addressing them is a necessity, not a luxury.”

In 2003, Patel wrote a handbook, Where There Is No Psychiatrist: A Mental Health Care Manual, to be used by health workers and volunteers in poverty-stricken communities in Africa and Asia. A new edition, co-written with Charlotte Hanlon, is due out at the end of this month.

Patel, in his first job out of med school, in Harare, Zimbabwe, says he learned that there wasn’t even a word for “depression” in the local language, though it afflicted 25% of people at a local primary care clinic. There was little study of diagnosis and treatment in “underserved areas.”

Later epidemiologists learned to their surprise that mental illnesses were among the top ten causes of disability around the world – more than heart disease, cancer, malaria, and lung disease. Their report was not enough to spur investment in worldwide mental health.

Patel developed the model of lay counselors – local people who know the local culture – guiding people with depression, schizophrenia, and other illnesses through interventions including talk therapy and group counseling. By 2016, the World Health Organization (WHO) admitted that every dollar invested in psychological treatment in developing countries paid off fourfold in productivity because of the number of people able to return to work.

One objection voiced about Patel’s model is that the real problem is poverty, not depression or other mental illness. The argument goes that the misery of being poor, not a psychiatric illness, leads to symptoms and that Westerners are exporting their notions of mental health to the rest of the world, backed up by Big Pharma. Patel responds, “Telling people that they’re not depressed, they’re just poor, is saying you can only be depressed if you’re rich … I certainly think there’s been a transformation in the awareness of mental illnesses as genuine causes of human suffering for rich and poor alike.”

Of course the problem of underserved mentally ill people is not exclusive to impoverished nations. There are pockets in American society where the mentally ill live in the midst of privilege, but with the resources of the Third World – the homeless mentally ill, institutionalized elders, the incarcerated, the misdiagnosed, those in rural areas far from mental health resources, the underaged, the people whose families don’t understand, or don’t care, or can’t help, or won’t.

I don’t know whether Patel’s model of community self-help can work for those populations as well as they do internationally. This is not the self-help of the 1970s and 80s, when shelves in bookstores overflowed with volumes promising to cure anything from depression to toxic relationships. It would be shameful if the rich received one standard of care for mental health problems, while the poor had to make do with DIY solutions, or none.

But, really, isn’t that what we’ve got now?

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Mental Health

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Stigma, Prejudice, and Discrimination

Those of us with brain illnesses such as bipolar disorder, OCD, PTSD, and schizophrenia often speak of the stigma associated with our problems. It’s no wonder—stigma affects our lives in both predictable and unpredictable ways.

For instance, say you’ve become comfortable talking about your disorder. Then one day when you’re at a reunion or some other gathering, you happen to mention it and get the glazed-eyes-fixed-smile-back-away-slowly response. Sure, a lot of people don’t know what to say to you, but that reaction just makes it clear that you are different and, to that person, potentially a source of danger. Someone to be avoided. Someone not to engage with.

That’s stigma.

Prejudice is related to stigma. It’s just a short step away. Prejudice happens when people have a preconceived idea of what brain illness looks like. (That’s what prejudice means.) This could be a person who assumes that a serial killer or mass shooter is obviously “insane.” Their assumptions are reinforced when it’s revealed that the perpetrator had a history of psychological problems or had taken medication. They’re ignorant of the facts—that most killings are prompted by motivations such as rage, gender or racial hatred, jealousy, or fear. They don’t know that the mentally ill are much more likely to be the victims of violence than to be perpetrators.

People with prejudice against people with mental illness can also assume that psychiatric diagnoses are not “real.” They think people with these conditions can—and should—just “snap out of it,” “pull themselves up by their bootstraps,” or “get over” their problems. They look down on people who seek help. They make jokes about “crazies” and “lunatics.” They believe that anyone with a “real” mental illness is in a locked ward in an “insane asylum,” or should be. They don’t know that straightjackets aren’t used anymore and feel they’re funny Halloween costumes.

In other words, people who are prejudiced lack understanding and empathy.

Discrimination takes it one step further.

When people with brain illnesses suffer from discrimination, they lose opportunities because of their condition. If they are open about their diagnosis on applications, they may never receive a callback or an interview for a job. They may start receiving bad evaluations at work if they have to leave for doctor’s appointments or be let go for not getting along with other workers, many of whom may have prejudice against them. They don’t receive the accommodations required by the Americans with Disabilities Act (ADA).

Discrimination can also be involved with decisions from Social Security Disability. It’s not supposed to be that way, but people with mental illnesses are likely to have more difficulty “proving” that they have a disability severe enough to warrant supplemental income.

So what’s to be done? Education is the solution we always advocate. But it’s a hard ask. It’s difficult to get anyone to learn about the realities of brain illnesses. They don’t learn about it in school, and the messages they get from the media do little except reinforce the stigma surrounding the various conditions. In fact, they perpetuate much of the stigma.

Pushback is another strategy. We simply cannot let it pass when someone makes a prejudiced remark or demonstrates a lack of understanding. We can speak up about inappropriate Halloween costumes or assumptions about violence and the mentally ill. We can inform others that not all homeless persons are mentally ill. In fact, most homelessness is caused by a lack of affordable housing and low wages.

When it comes to discrimination, legislation and activism are often the solutions or at least the beginnings of them. Lobbying efforts regarding policy and treatment will help. Lots more needs to be done to inform legislators about the very basics, much less the possible ways to address the problems. Reporting violations of the ADA may not lead to resolutions, but it still needs to be done.

Of course, it’s difficult for many people with brain illnesses to do these things. We are frequently isolated and doubt our own abilities. Confronting legislators, educating them, and lobbying for their attention is daunting. Neurotypical people have trouble doing it, especially without an organization that gives them leverage. But it’s work that needs to be done. I admit that I’m not at the forefront, though these blog posts and my books are intended to help educate, and the groups I belong to try to do likewise.

It’s not enough. But it’s a start.

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Mental Health

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