Bipolar 2 From Inside and Out

Posts tagged ‘psychotherapy’

Men, Women, and Mental Health

My husband is no stranger to situational depression. He experienced it when his father died, when a beloved pet passed unexpectedly, and when his job turned suddenly more stressful and meaningless.

But he didn’t understand clinical, chronic depression. “What would it be like if those feelings lasted for months at a time, or even years?” I asked. He said he couldn’t even picture it. “That’s the way my life is,” I explained. Then he lost his job, and after a brief period of relief from the stress, he finally experienced depression that lasted more than two weeks – two years, in fact, during which he was unable to work.

He did not seek help for it until his best friend and I both proactively encouraged (i.e., nagged) him to do something about it. He’s been on an SSRI ever since and has occasionally seen a psychologist.

Lately, there has been a movement to educate men about mental illness and mental health. Primary among its goals is to help men understand that mental illness is a thing that can affect them and that there is no shame in asking for help.

Certainly, the statistics bear out that the majority of mental health consumers are women. Psychology Today reports: “Research suggests that women are about 40% more likely than men to develop depression. They’re twice as likely to develop PTSD, with about 10% of women developing the condition after a traumatic event, compared to just 4% of men. It’s easy to write off this epidemic of mental illness among women as the result of hormonal issues and genetic gender differences, or even to argue that women are simply more ’emotional’ than men. The truth, though, is that psychiatrists aren’t really sure why mental illness is more common among women.” Perhaps the answer is that seeking treatment for mental illness is more common in women.

Prevention magazine says that there are four mental health conditions that affect women more than men: depression, anxiety, PTSD, and eating disorders. That PTSD is twice as common in women may surprise you, though the stats about eating disorders are not likely to. The fact is that, although few women experience the traumas that soldiers do, they are much more likely to experience other sorts of trauma, such as rape, which can also lead to PTSD.

But men experience societal and psychological barriers to getting help when they need it. Among the excuses you hear are these:

  • I don’t really need help.
  • I can handle this myself.
  • I don’t want to appear weak.
  • I might lose my job if anyone finds out.

In other words, a lot of bullshit that boils down to “I’m a man and mental illness is not manly. Asking for help is not manly. Talking about emotional problems is not manly. Taking medication for a personal problem is not manly. Not being able to deal with my problems, especially emotional problems, is not manly. Therefore I have no mental problems and don’t need treatment for them because I’m a man.”

Or, looked at another way, the campaigns against stigma around mental illness have been less than effective for most men. Now the attention to that problem, which is surely needed, is beginning to be heard and, one hopes, acted upon.

Still, it’s important to remember that mental illness is not just a men’s problem or a women’s problem. It is a human problem, affecting both genders (and all ages and races) if not equally, then without discriminating.

It is important to get men the mental and emotional help they need, in a timelier and more comprehensive fashion.  I would have liked to see my husband be willing to recognize when he needed to get help and to get it without being pushed. But it would be wrong to push the needs of women aside to accomplish this. This is a societal problem, and while right now spreading the word to men is particularly important, our goal should be to make sure that all people are aware of the prevalence of mental illness, the fact that it can happen to them, and that there are places to get help. That message, at least, is not gender-specific.

Big Box Mental Health

photo by rawpixel.com from Pexels

According to an article published on the blogsite She Knows, “a Boston-based company that manages mental health care for 40 million people, has opened a small clinic in a Walmart location in Carrollton, Texas, and has plans to expand the program in other retail locations throughout the country.”

And I don’t know whether to vomit or applaud.

Walmart’s ubiquity is one point in its favor. They’re everywhere. And for some people, whether they love or despise Walmart, it’s the only choice they have for groceries, household goods, or much of anything else. Those areas are also likely to be underserved by the mental health system, such as it is.

And sparse as the options offered by the Walmart walk-in clinics is – treatment for anxiety, depression, grief, relationship issues, and stress management – it’s more than a lot of people have access to now. The trial site is said to be staffed with one licensed clinical social worker, has a sliding fee scale for those with no insurance, and will soon be approved for Medicaid reimbursement (it is hoped). There will even be remote Skype therapy services if necessary.

All that is good, as far as it goes. But does it go far enough? Will people be able to get more than a pat on the head and a pep talk as they do their weekly or monthly shopping? How will the walk-in clinic handle referrals for people with serious mental illness or a need for psychotropic medication, something that clinical social workers can’t provide? How many people can get help from a single professional? How good is internet therapy? And what percentage of Walmart shoppers have access to the internet?

The walk-in clinics are touted as reducing stigma around mental health issues. After all, the thought is, getting your mental health services at Walmart will become as natural as getting a haircut or an eye exam there. Well, maybe. On the other hand, how many people are willing to have their friends and neighbors see them publically, sitting in the waiting room or ducking surreptitiously through the door? It seems to me it might perpetuate stigma, rather than lessening it.

Besides, Walmart is hardly a bastion of high-quality goods and services. Will the mental health services be second-rate as well? It could be that even second-rate care is better than no care at all. But it’s surely not enough to deal with issues that require long-term therapy with actual treatment plans; scheduled repeat visits; building a relationship with a particular therapist; access to medications; and all the other aspects of more effective treatment, especially considering complicated disorders like bipolar, OCD, or anorexia.

I fully admit that I hate Walmart – the way they have driven out local Mom and Pop stores, for example, and the way they treat their employees. But I have many choices of where to shop near where I live, and access to both therapists and psychiatrists, and insurance that covers my appointments and medications. If I weren’t looking through the lens of privilege, I might see things a lot differently.

So for now, I guess my attitude is to wait and see. One test location does not a Walmart Psych Empire make. Perhaps it will succeed; perhaps not. Perhaps it will become the Great Clips of the psychotherapy world.

But while I’m waiting, I’m hot holding my breath.

 

When Your Therapist Tells You What to Do

The classic examples of non-directive therapists are Sigmund Freud and his disciples, who legendarily sat at the head of their couches and made comments like, “Hmm,” “Tell me about your dreams,” and “How do you feel about your mother?”

Freudian psychiatry is, thankfully, now out of vogue. But there are still therapists who believe that their job is to listen, not to instruct.

On the other hand, there are more directive therapists who assign homework. This can be anything from “Listen to this podcast on mindfulness” to “Write a letter to your ex telling him/her what you truly feel.” They probably won’t tell you to kick the bum to the curb, but if you decide to do so they’ll help you prepare for it.

But, although I am far from a Freudian and shy away from those who are (not many these days), I prefer non-directive therapists. I am not averse to doing a little homework or having a therapist ask me in a session to vocalize what I would like to tell a person or even to write a list of the coping mechanisms I’ve developed. My preferred dynamic, however, is to give-and-take with the therapist and then go home to contemplate what was said and how I feel about it.

I have had therapists who have given me homework and I can’t say they were wrong to do so. Sometimes writing something down or throwing teacups against the basement wall (or whatever helps you get your anger out) is a good thing.

My most recent therapist was a combination of the two. She mostly listened while I rambled on about what was happening in my life or what had happened in my past. Then she suggested ways that I could think about the events or pointed out coping mechanisms that I had developed or suggested ways I could put those coping mechanisms to use.

All in all, I felt that our sessions were mostly non-directive. She did suggest that I listen to a podcast on mindfulness, but she never quizzed me on whether I did and only listened when I told her what I got from it. She never told me that I should delve deeper into mindfulness or listen to more podcasts. She left that up to me, if I thought it might be helpful.

I understand that some therapists, particularly those that work in community mental health facilities, are required to file treatment plans and I can see where giving homework can flesh one out more than “talk about feelings.”

Perhaps there is something I’m missing. Perhaps at different stages of therapy, directive psychological interaction is more beneficial. Perhaps my particular problems lend themselves more to non-directive therapy. Perhaps I just have an aversion to being told what to do, especially where it concerns my memories and my feelings.

Of course, everyone has the option not to do the homework. This can be seen as resisting treatment, or disagreeing with the treatment approach, or simply lacking the wherewithal to carry it out. Sometimes it may be more helpful when the therapist sacrifices part of the session to doing the assignment there instead of leaving it to be done at home. In this case, the therapist is being really directive, though of course the client always has the choice not to do the assignment. It’s much harder, though, when the therapist is sitting there waiting for you to make a list of your dreams, your feelings, or your interactions with your mother, or to bash an empty chair with a pool noodle.

What it comes down to, basically, is therapeutic philosophy and therapeutic style. And a client is not bound to pursue whatever style of therapy that is favored. Although it is sometimes difficult to realize, a client has the option to request or to seek a therapist whose therapeutic style matches what the client feels is most helpful.

Remember, your therapist works for you, not the other way around. If you need a more or less directive therapist, it is your right to seek one out. Therapy has been known to stall and a different approach or philosophy may be just what you need.

 

Healing From Gaslighting

Apparently, gaslighting has become the new “thing” in pop psych circles. We see article after article warning of the dangers of gaslighting and how to spot a gaslighter. I have written a few such articles myself:

Who’s Crazy Now? A Guide to Gaslighting (https://wp.me/p4e9Hv-pm)

Gaslighting and Bipolar Disorder (https://wp.me/p4e9Hv-C2)

When Men Aren’t the Gaslighters (https://wp.me/p4e9Hv-Cu)

Is it time for another? I think so. Now that more people know about gaslighting, they need to know how to heal after the experience, as they would after any kind of emotional abuse.

Because that’s what gaslighting is – emotional abuse. But it’s a specific kind of emotional abuse. In gaslighting, one person in a relationship (romantic or familial) denies the other’s perception of reality and works to convince the gaslightee that he or she is the crazy one in the relationship. As in other forms of emotional abuse, the gaslighter may try to isolate the victim from friends and relatives, give intermittent reinforcement (insincere apologies) that draw the victim back into the relationship, or denigrate the person with insults.

But the heart of gaslighting is that denial of the other person’s reality. The abuser says, in effect: You can’t trust your own feelings. My view of the world is accurate and yours isn’t. You’re crazy. (Of course, the gaslighter may also use the familiar techniques of emotional abuse as well: isolation, insults, projection, and belittling.) But gaslighting is unique because the perpetrator distorts a person’s world view, sense of self-worth, and belief in him- or herself.

Healing from gaslighting is not easy, but it can be done. Here is some advice from me, a person who was a victim of gaslighting but is now healing.

Get as far away from the gaslighter as you can. Yes, this may mean cutting off contact with a family member, if that’s who is doing the gaslighting. It may mean leaving town. It does mean making a sincere and lasting emotional break.

Do not maintain contact with the gaslighter. You may think that once you have broken free from the gaslighter, he or she can do no further harm. This is just an invitation to more emotional battering.

Name the abuse. Say to yourself – and possibly to a trusted person – this was gaslighting. I was emotionally abused and tricked into thinking I was crazy. My worldview was denied and my thoughts and emotions were said to be invalid.

Feel the feelings. It may be some time before you can admit to or even experience the emotions that gaslighting brings. Your first reaction may be relief (at least I’m out of that!), but there may be years of anger, frustration, fear, and rage lurking behind that. It may take work to surface those feelings and feel them and recognize that they are valid.

Get some help. This can be a therapist who specializes in treating victims of emotional abuse or it can be a supportive friend, family member, or religious counselor. It should be someone who can listen nonjudgmentally, validate your perceptions of reality, and sympathize with your situation.

Do not try to get revenge. This is just another way of reconnecting with your gaslighter. It gives the person another opportunity to “prove” that you are crazy.

Develop new relationships. It may seem like there is no one in your world who will understand and be supportive. For a while, you may not be able to trust enough to have another close friend or lover. You may have a lot of healing to do first. But remember that gaslighters are in the minority; most people don’t do that to people they profess to care about.

Give it time. It may take years to fully get over the experience. (I know it did for me.) Maybe don’t go directly into a rebound relationship. You need time and space to work through your feelings and rebuild your perception of reality.

Just know that gaslighting doesn’t have to be a way of life. It can end when you gather the strength to break away from it. You can heal and take back what you know to be true – that you are a person who is worthy of love. That your perceptions and feelings are valid. That you don’t have to live by someone else’s view of what is real. That you are not crazy.

 

Low-Jacked Pills and High-Tech Mental Health

I’m a known geek and ordinarily a fan of technology – though not technology for its own sake. It has to do something useful and needed.

Imagine my surprise to learn that tech companies are now doing what so many of our public institutions aren’t, and devising possible solutions to assorted mental health problems. Stat reported (in their Business section) that now:

with an influx of funding, companies are revamping pills with digital sensors, designing virtual reality worlds to treat addiction and other conditions, and building chatbots for interactive therapy.

But are these techno-wonders likely to be any help? Let’s take the innovations in reverse order, shall we?

Chatbots. We already have remote counselors, which may be a godsend for people with no access to mental health clinics (although they charge a fee, which may be prohibitive for some). I’ve never investigated this service, so maybe some of you who have can tell me how they work and how well.

Remote counselors rely on already existing technology, however, and are therefore not of interest to tech innovators (or potential funders). Chatbots are something else. They are, essentially, computers that respond to human input with output that is supposed to simulate human responses.

To my knowledge, no computer has ever passed the “Turing Test,” which means that a person has no idea whether they’re chatting with a real person or a computer. A psych computer is likely to respond with generic responses such as, “Why do you feel angry with your sister?” “What do you mean when you say anxiety?” “Explain how depression affects you,” and “Tell me more about your mother.” The supposed AI is in no way trained in psychology or any therapeutic techniques.

One company that received funding for “telepsychiatry” (called Regroup Therapy and Woebot Labs) brands their idea as “Your charming robot friend who is ready to listen, 24/7.” Admittedly, many persons with mental health issues need someone who’ll listen, but that’s far from all they need.

Virtual reality for addiction (and other conditions). Startup Limbix wants to sell its programs to therapists and clinics. According to Stat,

Among the company’s VR programs is an exposure therapy for patients with phobias or trauma associated with driving. While patients strap on the headset, clinicians can work with them to introduce different conditions (a clear or rainy day) or different road situations (a bridge or a tunnel or blind left turns).

This sounds promising, though the cost of VR headsets and the programming for various conditions again might be prohibitive for your average community or campus or rural mental health clinic. I’m not clear on how it would work for addiction, unless combined with aversion therapy, which is generally brutal.

Pills with digital sensors. Aren’t psychotropic medications already too expensive, especially for people who have no insurance? Now we need technological pills that must make a profit for both drug and tech companies?

And what a pill they’re talking about. Basically, it’s a pill that rats you out if you don’t take it, or rather alerts your doctor when you do take it. Presumably, your doctor has enough staff to monitor whether clients take the pills and record it if they don’t. Then what? A robocall telling you to take your meds? A visit from a social worker?

Admittedly, such low-jacked pills might have a place in situations where schizophrenics are court-ordered to take their medication, but again there is the problem of what to do about non-compliance.

Another company plans to sell “a cardiac drug meant to be popped like a mint to people anxious about public speaking and first dates.” Would people need prescriptions for those, or will they be dispensed like Tic-Tacs? Even anti-anxiety drugs aren’t meant to be “popped like a mint.” And a cardiac drug? I can’t see any possible downside there.

If only the ingenuity and investment that goes into these products were instead available to fund and repair the shaky mental health system instead. What we need are more psychiatrists and therapists, more hospital beds for psych patients, less expensive drugs, better insurance, more education for the public about mental illness, and an end to stigma.

But those would require systemic reform and political backing, not just some new-fangled gadget. And good luck getting investors for those.

Reference

https://www.statnews.com/2018/07/20/tech-developers-tackle-mental-health/

Picking Up on Feelings

As if it weren’t difficult enough to deal with my own feelings, at times I’ve had to wrestle with the feelings of others.

It started when I was a teen. I had already experienced my first major meltdown and was trying to put myself back together. Like most teens, I wasn’t really sure who I wanted to be. But unlike most teens, I was dealing with undiagnosed bipolar disorder and a shredded sense of self-esteem that made me even less sure of who I was, who I wanted to be, and who I ought to be.

I began to notice that I was picking up the characteristics of whomever I was with. When I was around Binky, I was light-hearted. When I was around Marie, I was a misfit. When I was around Fran., I was trying to fit in. And so on. Intellectual, silly, moody, outdoorsy, smart-alecky, boisterous, quiet – I became them all, in turn. None of them, it turns out, was really me. Or at least not completely me.

And when I was alone – who was I then? I was alone a lot of the time, and my default setting was depressed. I cried at unlikely songs. I hid in books. I cocooned before cocooning was a thing. I had a banner on my wall that said, “I’ve got to start acting more sensible – tomorrow!” I blamed my troubles on living in Ohio. I got drunk on ginger ale.

I was a fractured mess.

Later, in my 20s, as I went out in the world and began to interact with different people, I realized that I was picking up on their moods, rather than their character traits.

Most of those moods were unpleasant ones. And I reacted to them with – you guessed it – fear and depression.

Even if I was in a hypomanic state, I couldn’t maintain it if anyone around me was angry or depressed or resentful, or even just crabby. It felt like I was hanging on to my good feelings by my fingernails, and the least inattention would cause me to lose hold and crash.

As for anger and blame, there was no way I could do anything but cringe and apologize endlessly. (It was only much later that I learned how annoying apologizing and self-deprecation can be to those in the vicinity.)

One person became a master at using this to control me. A sigh and a glare were all it took.

Nor did the bad feelings have to be directed at me. I couldn’t be in a room with people who were yelling at each other. At times even disagreements on television would bother me.

I did develop a few coping mechanisms. If other people were the source of the bad feelings, I would make an excuse to leave the room. A breath of fresh air was usually too transparent, and you can only plead a bathroom break so many times, so making myself a cup of tea was my go-to excuse (which also led to a believable increase in bathroom breaks).

My husband has caught on to my interior mood sensor and reactions. Since even raised voices can trigger me, we’ve developed a signal that he needs to take it down a notch, usually when we’re talking politics – sometimes he even manages to chill out the emotional temperature of an entire room. And if he’s having a snit, I can ask him how long it will be till he gets over it and he lets me know whether it’s a big deal or not.

Now even sighing and glaring is a joke with us. He’ll puff like a steam engine and lower his eyebrows until they touch. Then we’ll both start laughing.

After my most recent and worst meltdown (which I’m surprised to realize was about ten years ago), my therapist told me that my shattered, scattered emotional state gave me a rare opportunity to choose which pieces of my former life I wanted to incorporate into my rebuilt self.

Maybe it’s a good thing I tried on those different identities as a teen, so I don’t have to now.

I know it’s a good thing that I’ve learned better ways to manage what emotions I allow into my life.

Parts of My Life I Miss the Most

Last month I wrote about how bipolar disorder had cost me – well, not the ability – but the capacity to read (http://wp.me/p4e9Hv-qp). I am intensely thankful that the concentration, focus, and motivation to read have returned as my healing has progressed.

But there are some other things that are missing from my life that I wish desperately that I could get back. Or wish I had never lost in the first place. (Depression is very much with me right now, so forgive me if I dwell in the past with my failures a bit.)

First are friends. I’ve written about this before too (http://wp.me/p4e9Hv-2W), but the subject was brought home to me recently when I received a fuck-off letter from a former friend I was trying to reach out to, in hopes of reestablishing the relationship. One of her main reasons for cutting me off was that every time we went out, she felt it was “her and me and my misery.”

She did acknowledge that at times our friendship had been burdened by her misery too, but evidently that either didn’t count as much, or else mine lasted too long. (If it was too long for her, it was even longer for me.) I am very disappointed that, now that my “black dog” is smaller and on a leash, she found other reasons not to associate with me. To make it more ironic, she has been a therapist and now teaches psychology.

I also miss having a steady paycheck. My last 9-5 office job was over ten years ago, and since then my mental state has not allowed me to get and keep another such position. The security of knowing how much money I would have every month allowed me to plan.

And to travel. I really miss traveling. Admittedly, part of my inability to travel now is determined by my physical health. But my anxiety would make it just that much more difficult. Now I can barely get away for a weekend, and even then I must carefully monitor my moods, limit my activities, track my eating and sleeping, and avoid crowds.

One of my deepest regrets is that when I was undiagnosed and untreated, I couldn’t fulfill my potential. I attended an Ivy League university, but I can’t say I got out of it what I could or should have. I feel now that I skated by, impeded by many depressive spells, lack of focus and concentration, and confusion. I even took a year off to get my head together, but since that didn’t include getting help for my bipolar disorder, its value was questionable.

Lest this seem like nothing but whining (which my depression is telling is what it is), there are also some things that bipolar disorder has taken from me that I don’t miss at all.

Oddly, one of them is a 9-5 office job. While I do miss the steady paycheck, I absolutely don’t miss the things that came with it. Now, doing freelance work, I can fit my work around the things I need to do (like seeing my therapist) and the things I have to do (like slowing down when depression hits). I don’t have to get up at the same time every day and dress appropriately (if at all) and try to fit in and socialize with my co-workers. That was never easy for me and became nearly impossible after my big meltdown.

And, as much as I miss travel, I don’t miss business travel. Again, being “on” all the time, for days at a time, with no time or place to decompress, would be impossible now. Since we usually had to share hotel rooms, there wasn’t even a chance for any alone time, which I need a fair amount of. I could never get the hang of “team eating” either.

Finally, I don’t miss the boyfriend who took an already broken me and broke me worse. (I wrote about him in my post about gaslighting http://wp.me/p4e9Hv-pm.) My self-esteem was not great before the relationship, but afterward it went into negative numbers. Self-harm, self-medication, self-doubt, and negative self-talk were what I had instead. But Rex didn’t do it alone. He had my bipolar disorder there to reinforce his words and actions. And to not let me see what was happening.

Bipolar disorder is a balancing act, in more ways than one. It takes away good things from our lives. But my therapist reminds me that it also gives an opportunity – as I rebuild my life, I can choose which pieces I want to reclaim and which I want to discard. And the parts I can rebuild are what I should concentrate on.

And I will, once this spell of depression releases me.

 

 

 

 

 

 

 

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