Bipolar 2 From Inside and Out

Posts tagged ‘public perception’

Questions (And Some Answers)

They say there’s no such thing as a silly question. But I’ve heard a few that come darn close. I understand that some of the people who ask them are genuinely confused about brain illnesses in all their variety. But some of them – I just don’t know. Here’s a look at some of the questions I’ve encountered.

Some people are concerned that various practices can affect mental illness or its treatment. I’ll tackle a few of these.

Can chanting a mantra harm someone who is mentally ill or has schizophrenia?

Can people with mental illness practice mindfulness meditation without hindering their treatment plan or making symptoms worse?

To these questions, I would say that chanting a mantra or practicing mindfulness meditation poses no threat. In fact, these practices are often encouraged as ways to reduce harmful stress.

Does astrology have any cure or remedies for mental illnesses like schizophrenia and bipolar disorder, etc.?

As to astrology, I’d have to say no. It has no place in the treatment of brain illness. It’s not science and has nothing to say about the inner workings of the human mind.

Can mental illness be caused by external factors such as mind control or manipulation?

While manipulation exists, mind control doesn’t, unless you’re talking about cult indoctrination. Manipulation in the context of gaslighting can cause stress-related disorders or possibly trauma.

Can too much intellectual curiosity cause mental illness or psychological problems later in life?

Intellectual curiosity is a good thing. Honestly, I don’t see how anyone can have too much. At any rate, it has no relation to mental problems.

Some questions come with relatively simple answers.

How can you find out if a doctor has diagnosed you with a mental disorder?

Your doctor will tell you what the diagnosis is. They won’t keep it a secret.

Can someone with bipolar disorder join Alcoholics Anonymous (AA)?

Sure, they can join. But not all AA groups are comfortable working with people who have psychiatric diagnoses. They concentrate on alcoholism and not mental disorders, so the bipolar disorder likely won’t be addressed in many meetings.

Can covert bullying and gossip harm a person? Would the said person seem mentally unstable or unwell?

Absolutely, bullying and gossip can harm someone. Some people even see bullying as a contributor to teen suicide. The victim is likely to show symptoms of depression and anxiety.

There are questions that ask about specific populations.

What can be done to help teachers that have mental disorders?

The same treatments that work for other people will work for teachers, too. The teacher may need to take a sabbatical to work on their issues without the pressures of their job.

How do the constant pressures of fame and scrutiny affect the mental health and overall well-being of celebrities, and what steps can be taken to better support their mental health and prevent the negative effects of celebrity culture?

While I’m sure there are special pressures on celebrities and they certainly can have mental illnesses, there really isn’t much chance of changing celebrity culture. Supporting their mental health might involve not penalizing celebrities for taking time off from their careers to seek treatment.

What are the most common mental problems among thru-hikers?

I’ll be honest. I had to Google “thru-hikers.” They’re people who hike a long, multi-state trail like the Appalachian Trail from end to end. That said, their most common mental problems are the same as the most common problems of the general population. There’s nothing about being a thru-hiker that poses a special risk.

Then there are questions about family matters.

Does being raised by a single mother cause mental illness or personality disorders?

Just being raised by a single mother doesn’t cause any mental illness. Single mothers are perfectly capable of raising happy, healthy, well-adjusted children. That said, any parent – single, married, mother, father – can have a child with mental problems.

Can tough love from parents prevent mental illness in children?

No. There is no one technique to ensure that children do not develop mental illness. Tough love may not be the best approach for a child who already shows signs of mental difficulties. Tough love can be traumatic, which can make a mental illness worse.

There are the questions that simply perplex me.

What are the effects of watching cute animal videos on mental health?

Aside from saying “Awww” a lot, none that I can see.

What are the effects of reading creepy pastas on mental health?

WTF? Is this about alphabet soup controlled by a Ouija board? A reference to the Flying Spaghetti Monster?

What is the worst diagnosis made by a fictional doctor?

Fictional doctors can’t diagnose fictional characters. They’re fictional.

Did Fred Flintstone ever experience mental illness? If so, what was the reason for it?

See previous answer.

Then there’s the ultimate question.

How can we address the mental health crisis in our society?

A simple blog can’t answer this question. No one person can. It will take the work of thousands of people (or more) to convince the rest of the people to take appropriate action. It won’t be easy and it won’t be quick. We need to convince the general public that, first, there is a problem, and then, that there are things we can indeed do to address it. Even making a dent in the problem is a long-term project. So we’d better get busy. The problems aren’t going away on their own.

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Does It Matter What We Say?

Words matter. I preach that all the time. Language is what gives our thoughts reality and how we make essential connections. Ideas become more concrete when they have words attached to them. It’s hard – perhaps impossible – to convey a thought without language of some kind. And how we use words is dependent on how and what we think.

Words matter. Think about how the terms “rioters” and “protesters” reveal a person’s opinions about the motivations of the people in the “mob” or “crowd.”

Words matter. Our community has been pushing back against words such as “psycho” and “crazy” when it comes to referring to people who need psychiatric help. Many people are gradually realizing that such words are equivalent to slurs and are no longer acceptable. (Except in the aftermath of violence, of course. Then, those terms are tossed around indiscriminately.)

Words matter. But how do we in the community refer to ourselves? What words are advocates using? And how do we want the general public to refer to psychiatric problems?

I’ve written before about the terms “behavioral health” (bad) and “mental illness” (better). But what’s best? Increasingly, the words du jour are “brain illness” and “brain disease.” We’re watching linguistic change in action.

But linguistic change happens at a glacial pace. Words that were used in Elizabethan England are still used today. Think about all the words and phrases that Shakespeare invented that are still used today, and with the same meanings – unreal, lonely, and green-eyed (as in jealousy), for example.

Linguistic change, on the other hand, also happens blindingly fast. Slang, tech terms, and jargon in particular appear and disappear in the blink of an eye (as it were). Think about the terms that refer to female beauty. There were times when “phat,” “fresh,” and “fly” were all applied to women. (Yes, I’m dating myself. I don’t even know what the current term is, but I bet it’ll be gone next month. At least I know that “fire” has replaced “awesome,” “boss,” and “da bomb.”)

So, where are we in the (something) community now that we’ve left “behavioral health” behind? “Mental health” was the clear frontrunner for a time. Then it was “mental illness,” then “serious mental illness.” Now the term being put forward is “brain illness” – or even “brain disease.”

I’ve talked about the implications that various words have. What are the connotations of the new terminology? “Mental illness,” as opposed to “mental health,” drives home the point that “mental health” is a euphemism. It’s not health that’s the problem – it’s the opposite of health. “Brain illness,” as opposed to “mental illness” says that the problem is not in the mind, it’s in the brain.

I think that’s a tough concept for the general public to take in. To most, the mind and the brain are synonymous. Whether that’s accurate or not is hard to say. It’s true that the brain is the physical embodiment of thought, emotion, and cognition. These things can’t exist separate from the brain. They are so intertwined that it’s hard to think of one without the other – especially for laypeople.

But “mental illness” implies that the mind – the thinking – is what is disordered. “Brain illness,” on the other hand, says that the problems lie in the functioning – the physical structure – of the brain. In my opinion, it’ll be tough sledding to make the public understand the sometimes subtle difference between the two.

Recently I saw an online post that decried the fact that advocates and professionals aren’t yet using the terms “brain illness” and “brain disease.” And there’s some truth in that. My own therapist doesn’t. But practitioners are engaged in dealing with the general public as well as those in the community. There’s something to be said for addressing those people in language they understand better. There’s the possibility that when hearing “brain disease,” most people will think “brain tumor” rather than what we are really talking about. And there’s the problem with the slowness of linguistic change.

Words matter. But so does the speed of change. Of course, if we want to change the dialogue, we need to use more accurate terms to promote our message. But it’s probably too soon to expect everyone to be on board. I’m not saying that we should give up on the process of fostering change. I am saying that we shouldn’t be beating each other up for not yet having made that progress, even among ourselves. It’s a process, and not everyone progresses at the same rate.

Incremental change is better than none. Indeed, unless you’re talking about a fad, it’s the only way change happens. And we’re not talking about a fad here. We’re talking about a fundamentally new understanding of what it means to have schizophrenia, bipolar disorder, major depressive disorder, and other illnesses.

That’s going to take serious time.

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What Is Resting Sad Face?

Resting bitch face is a thing, you’ve probably heard. Some people – usually women, though I suppose some men have it too – look mean when their face is still and their muscles are slack. People who see them assume that they are grumpy at the least or maybe sulky or angry – hence the name resting bitch face.

I have resting sad face. Once when I was working at a restaurant, the manager saw me sitting while on my break and told me that I should smile. I replied that I was paid to smile at the customers, not on my break. Of course, that was a bad response, though I know that women are often told to smile more (men, not so much). I probably would have gotten along better with my coworkers if I had smiled more.

But I was suffering from depression at the time, or at least the depressive phase of bipolar disorder, and was untreated. Smiling was something I had neither the inclination nor the energy to do. Sad was my natural expression.

When I didn’t have resting sad face, I had resting worried face. (A different manager asked me, “What does a girl your age have to worry about except ‘Am I pregnant?'” As it happened, that was the one thing I knew I didn’t have to worry about.) I was also suffering – again, untreated – from an anxiety disorder.

What I haven’t had is the mask of “smiling depression.” Many people with depression pretend to be happy most of the time, at least in public. You can see it dramatized in depression medication commercials when someone holds a happy face symbol in front of their face. (In real life, I’ve noted that the depression or sorrow sometimes leaks out around the eyes, though, even past the mask.)

There are two different kinds of smile – the “Duchenne” smile (named after a 19th-century scientist whose major contributions centered on mapping the muscles that control facial expression) and the “Pan Am” smile. The Duchenne smile is the sincere smile of a truly happy person. It’s easy enough to tell when someone is giving you a Duchenne smile. The muscles at the corner of their eyes crinkle, making little crows’ feet. It happens automatically when you think of a happy memory or greet a person you like a lot.

The Pan Am smile is the one where the smile does not reach the corners of the eyes. (It got its name from airline attendants who were required by their job to smile at all times, whether they were at rest or not, happy or not.) No one has resting Pan Am smile face. It’s impossible. It takes a number of facial muscles to smile and when you’re resting, you don’t use those muscles. No, the Pan Am smile takes intention.

The Pan Am smile, however, is the one a person uses when they do have smiling depression. (I used it once when, at a different job, we were all posing for individual portraits. My results were so fake-looking that the photo was never used. They didn’t even let me see it, much less anyone else.)

I’m kind of hoping that these days, I have at least resting neutral face. That sounds like the right expression for a stable person.

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The School Shooter Problem and the Mental Healthcare System

It’s been reported lately that there is a mental health crisis among young people in the US. Depression and anxiety are on the rise. Some claim they know what causes it, and some don’t. The usual suspects include social media, bullying (especially bullying on social media), academic pressure, the COVID-19 pandemic, isolation, and uncertainty about the future. Fear of and reactions to school shootings are in the mix, too. The problem has garnered interest among the people who have the capacity to address, if not actually solve, the problems.

President Joe Biden announced in his 2023 State of the Union address that the Department of Education will divvy up $240 million in grants to help schools tackle the crisis. If you average that by 50 states, it comes to around $50 million per state. A more accurate estimation considers that, since there are 16,800 school districts in the US, that, on average, each district would get roughly $141,000 for youth mental health to be spread around all the schools in each district – not really very much. That money, plus the billion dollars invested last year, is earmarked for more mental health counselors and mental health professionals in the schools.

All that is well and wonderful, but what are the problems that lawmakers want those funds to solve? Apparently, many lawmakers and public policy boffins think that preventing school shooters should be the primary goal. Identifying the kids that are likely to resort to weapons to settle their differences with schoolmates and teachers seems to them to be the most effective use of the funds. The basic debate is whether those funds should be used to identify and treat potential school shooters or help the students who are traumatized by the incidents and by the looming threat of more – prevention of violence versus reaction to the threat itself. In general, Republicans want to address finding and preventing the shooters, while Democrats seem to prefer ministering to those affected by the shootings – and enacting gun control. (I’m not getting into the gun control debate right now.)

Democratic senator Chris Murphy raised the issue in the wake of the school shooting deaths in Uvalde, Texas. “Spare me the bullshit about mental illness,” Murphy said. “We don’t have any more mental illness than any other country in the world. You cannot explain this through a prism of mental illness because we’re not an outlier on mental illness.” Biden also played up the necessity of dealing with the repercussions of the school shootings: “Address the mental health crisis deepening the trauma of gun violence and as a consequence of that violence.”

When it comes to getting shooters into treatment, though, there are problems. Differences in opinion are rampant on whether psychological treatment can prevent school shootings. Partly, it’s a problem of anosognosia. The potential and actual school shooters do not think they have a problem – and the same can be said for many of their parents – so they’re not very likely to make it into the mental healthcare system or gain any benefit from it if they do.

Another reason is that CBT, the currently favored treatment option, really doesn’t have anything that would address the incipient violence of students who are so troubled that they think it would solve their problems of anger, isolation, revenge, desire for fame, bullying, or whatever other factors may be implicated. It’s also worth noting that many, many students are bullied, mocked, ostracized, or otherwise demeaned. The vast majority of them do not go on to become school shooters, or the problem would be worse than it already is. (Personally, I was subject to some extreme bullying in school – and had access to guns and no access to mental healthcare at the time. I never shot anyone or ever thought about it.)

Perhaps the best that can be expected of mental healthcare right now is ministering to the bereaved and the traumatized. Until or unless we come up with some way of more reliably identifying and treating potential shooters before they become actual shooters – something that has yet to be accomplished – we’ll be more adept at cleaning up the aftermath.

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What’s Good About Drug Commercials?

I’ve often bitched about TV (and, I assume, magazine) ads for psychotropics. I’ve said that I despise the fact that they make the entire public their own experts on what they need and shills for “Big Pharma.” I’ve complained that they hamper doctors by encouraging consumers to “ask if drug X is right for you” and to accept no substitutes. I’ve also said that the ads present unrealistic pictures of very serious mental conditions by making depression, for example, no worse than the flu or a hangover.

Nonetheless, I’ve decided that drug commercials do have some beneficial purposes and effects. They aren’t all evil after all. They send messages to the viewing public that are actually positive. These messages contradict the prevailing public conception that people with mental illnesses are different from other people – that the entirety of their lives is taken over by their illness. People with bipolar disorder change from the depths of despair to uncontrollable, laughing lunacy within the span of hours or even minutes. People with OCD are picture-straighteners and tile-counters. People with schizophrenia are violent criminals or raving crazies, often hospitalized for life. None of these brain illnesses can be treated, according to the general wisdom.

Modern drugs have improved people’s lives and improved the general public’s conception of what mental illness is like.

First, more of the commercials now present understandable views of what some mental illnesses are like. They do this primarily when they use analogies or metaphors. Bipolar mania is like climbing a house of cards that is destined to collapse inevitably at some point. Depression is like darkness, and medications can lessen it by bringing light. They even make the symptoms and side effects more understandable: tardive dyskinesia, for example, is depicted with actual twitches, intractable movements, and mobility issues.

Also, the ads do emphasize that there are treatments, if not actual cures, for disorders that the general public views in a stereotypical way. Take schizophrenia, for example. Most people associate schizophrenia with homelessness, psychosis, and/or raving unintelligibly. Yes, those are sometimes the consequences of the disorder, but they’re far from the whole story. I’ve seen commercials for schizophrenia medications that show a man with a family playing guitar, two women with schizophrenia calmly discussing their symptoms, and a comparison of daily pills and twice-yearly injections for treatment. They humanize an illness that too many view as intractable and untreatable.

I stand by most of my criticism of ads for psych meds. They are shallow and simplistic. They do promote self-diagnosing and self-prescription and demands on doctors. They minimize the good that talk therapy can do, concentrating instead on medical and pharmaceutical interventions. At the same time, though, these ads promote more accurate, healthier views of mental illnesses, even the most severe. They portray people who have the illnesses as having alternatives, socially productive lives, and “normal” interactions with others despite their psychiatric conditions.

I have no scientific evidence to support this theory, but my guess is that after viewing these ads, often several times a day, a poll would reveal changes in attitude. That, combined with the public service announcements about depression and even ads for telemedicine therapy sessions, may indeed make it more likely that people who live with these conditions without realizing it to better understand their own possible mental problems and those of their friends and family, and to have greater empathy toward them.

And those are good things. May the trend continue.

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When You Don’t Realize You’re Mentally Ill

You’ve heard the stories: A homeless man who has been diagnosed as schizophrenic panhandles for change, though few people stop because of his bizarre behavior. He refuses help from a governmental or charitable organization. His family finds him, but he won’t let them do anything to help.

Or this one: A bipolar woman has manic psychosis. She is convinced that her coworkers and people on the street are reading her mind and planting thoughts in her head. She refuses to take her medications because she thinks she doesn’t need them.

Or, perhaps worst of all, this one: A teenager who has been struggling with undiagnosed schizophrenia is convinced his mother is trying to kill him. He threatens her with a knife. The police are called and they shoot the boy.

Extreme stories? Yes. But these tragedies occur nearly every day. Most of them don’t make headlines, but they still cause suffering and even death for countless individuals and families across the US and around the world.

What these three people – and many others – are suffering from is “anosognosia.” It literally means “lack of insight,” but anosognosia is much more than that. It means that a person has so little insight that they don’t even realize that they are mentally ill. They don’t know that their behavior and thoughts are part of an illness.

Anosognosia is not the same thing as denial. Denial is when someone avoids something that is unpleasant or distressing to them. They do realize that there is something wrong – they just don’t want to deal with it. A person with anosognosia doesn’t even realize that there is anything wrong at all. They don’t realize they are mentally ill. Their brains don’t let them see that their thoughts and perceptions are not in line with reality. They don’t realize that their functioning is impaired. They think that they are perfectly normal. If anything, they think that the people around them are clueless and deluded.

Anosognosia is the number one reason that people with schizophrenia or bipolar disorder do not seek treatment or take their necessary medications. By some estimates, it occurs in up to 98% of people with schizophrenia and 40% of people with bipolar disorder. It’s also common in people with Alzheimer’s or dementia. People with anosognosia don’t get the help they need. Their condition doesn’t improve – in fact, it worsens.

So, what’s to be done? One solution may be a program that California Governor Gavin Newsom recently signed into law. It establishes CARE Courts – Community Assistance, Recovery, and Empowerment courts that make it easier for family members, first responders, outreach workers, and others to institute civil proceedings that make it possible to obtain up to two years of mental health services. The person being judged by the court will have access to a clinical team, lawyer, and “volunteer supporter.” Up to 12,000 of the most vulnerable people in California are expected to be helped by the CARE courts.

The program is controversial, however. Critics have said that the plan amounts essentially to forced treatment. Civil rights and disability groups are not in favor, though the program has been described as “voluntary.” In theory, a person would still be able to refuse treatment. And if the person has anosognosia, that might well be the case. The CARE courts plan is similar to another potential solution recommended by some clinicians – Assisted Outpatient Treatment (AOT). It’s not clear where the state would find people qualified and willing to monitor patients’ treatment and medication compliance. In Santa Clara County, AOT treatment consists of “intensive individual and group clinical services, peer support, intensive case management, housing assistance, 24/7 clinical crisis support, and medical evaluation.”

One of the most frustrating things about trying to get help for someone with anosognosia is the lack of appropriate treatment facilities, mental health workers, and other services. With many of the sickest patients being held in overcrowded emergency rooms or held for only 72 hours in a hospital ward, the situation is extremely complicated and not easy to solve. But if AOT or CARE courts keep mentally ill people out of jails and prisons, which typically provide either inadequate or no psychiatric treatment, that’s a good thing.

Most people with psychiatric disorders may hear about anosognosia and think, “Oh, that could never happen to me.” But the reality is that a person with anosognosia doesn’t realize when it is happening to them. It’s not an easy problem to solve, but educating people about anosognosia and developing plans for dealing with it are vital. It’s the most vulnerable members of society – and their families and friends – who are most affected by it. They need our help, even if they don’t realize it – or particularly when they don’t realize it.

This post first appeared on The Mighty.

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Body and Brain: Self-Image

I’m fat. I admit it. I haven’t been fat all my life, so this came as something of a surprise to me, but I’m dealing with it. I don’t know whether it’s my eating habits or my medication or some genetic thing that has caused me to gain weight, but there you have it. It could be any or all of those.

I’m not trying extreme diets or grueling workouts, though I admit that some exercise would be good for my mental condition as well as my body. I’m living with and acknowledging the fact that I am fat.

The thing is, when I think about myself, I don’t think of myself as fat. Perhaps I’m in denial about it. But I do know how much I weigh and that it’s over what I should, according to all the height vs. weight and BMI Index charts. And I don’t think of myself as thin. I just feel as though I’m still in my 30s and weigh what I weighed then, despite my body’s very clear rejection of those notions. I know I’m really in my 60s and have trouble getting up off the floor if I fall, in part because of what I weigh.

I’ve heard that everyone gets stuck in their head at a certain age and always remains that same age in their mind. It’s not quite like having an inner child of four or ten (or in my case, more like 15). I used to think I didn’t have an inner child until I remembered how much I still love chocolate milk, plush animals, and naps. And I do have that inner teen that wants to make up for all the things I missed when I was a depressed teen, like mad crushes and experimenting with fingernail polish and fake nails. But having an inner weight is different somehow. It’s like my brain and my body are clashing in some way.

At least I don’t have Body Dysmorphic Disorder. That’s when you see tiny, imperceptible flaws in yourself and magnify them until you think that’s all people see when they look at you. Technically, it’s not the same as anorexia because, in anorexia, you focus only on your weight even if you are thin. Anorexia is an eating disorder that you have as a reaction to your flawed perception of your body size. Dysmorphic Disorder is more about smaller perceived flaws such as balding or the size of your nose. (The Mayo Clinic does say that Body Dysmorphic Disorder can cause or be associated with eating disorders, low self-esteem, mood disorders, obsessive-compulsive disorder, and substance abuse. The DSM-5 does not classify Body Dysmorphia as an eating disorder. It’s confusing.)

One of the dangers of Body Dysmorphic Disorder is overuse of plastic surgery, which can be somewhat of an addiction in itself. Just watch a few episodes of the TV series Botched and you’ll see what I mean. There are always horror stories like the one in which a young man wanted to look like Michael Jackson and as a result of repeated surgery suffered the same health problems and conditions that the singer did.

If I had Body Dysmorphic Disorder instead of the ones that I do have, I might be undergoing multiple treatments of liposuction, “cool sculpting,” tummy tucks, gastric bypass, extreme fad diets, weight-loss pills, and other procedures. I don’t and won’t. I’m aware that those are only temporary fixes and leave you open to disappointment, infection, scarring, and other bad effects and complications that can be worse than your original condition and stay with you for life.

So, where does that leave me? Besides fat, I mean. I try to be body-positive about people who don’t conform to societal messages about weight, including myself. It’s a difficult thing to get over. The messages are relentless. I have found myself in the past thinking that fat is unappealing and in the present thinking that extreme thinness is dangerous. But that’s only in the abstract. Any number of men I’ve been attracted to have been anywhere from pudgy to fat, including my husband.

I realize that I may get a lot of pushback from people telling me of all the medical reasons I should lose weight. I’m not saying they’re wrong. I’m just saying that if I’m comfortable with being fat, they could at least be okay with my fatness as well. In other words, I already struggle with my mind. I don’t want to struggle with my body too.

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Are Holistic Approaches to Mental Health Useful?

Well, first of all, the answer to that question depends on what you mean by “holistic.” If you mean treatment that considers the mind, body, and soul, I certainly have to say yes. All three are inextricably intertwined and healing one tends to heal the others as well.

Certainly, the mind is involved – that’s implicit in the word “mental.” To many, this means the brain as the location of the mind. Increasingly, this also means thinking of and referring to mental illnesses as brain illnesses. And the competing theories of what causes depression and bipolar disorder, for example, have had something to do with the brain. Perhaps neurotransmitters in the brain are not behaving the way they are supposed to, or processing traumatic events causes brain illnesses (certainly true in PTSD), or genetics is responsible. whichever it is, the brain is involved.

It’s not controversial to say that the body and the mind are linked in the most profound ways. What affects one affects the other. Mental illness has demonstrable effects on the body, all the way from not being able to care for oneself physically to having a shortened life span. Treatment programs for mental illness often include an exercise component, which causes physical changes in the body and brain. Depression in particular is known to be alleviated by even small amounts of exercise. The exercise partially relieves the depression, which makes it more likely that the depressed person will be able to exercise. It’s a cycle that benefits both the body and the mind.

As far as the soul goes, I don’t feel theologically competent to make any definitive statements. I do know, however, that many people find that spiritual practices such as prayer help them cope with the effects of brain illnesses. It may be subjective, but what works, works. I personally don’t believe that prayer cures mental illness, but even if it just makes the sufferer feel more at peace and more comforted, that’s a component of healing that’s important.

Holistic healing that recognizes the interconnectedness of these three aspects of the person is, in my opinion, more likely to be more effective than any one of them alone.

Then there’s the other thing people often mean when they say “holistic healing.” To many, holistic healing means avenues of treatment beyond the scope of Western medicine. Herbal medicine, meditation, homeopathy, acupuncture, yoga, and crystal healing are among the avenues that have been explored.

There is certainly some validity to herbal medicine. It’s been practiced for thousands of years and the results are well-known, particularly by indigenous peoples who have passed that knowledge on throughout the years. Chamomile, lavender, passionflower, and saffron have been studied for mitigating anxiety or depression in cancer patients, with favorable risk-benefit profiles compared to standard treatments. Ginseng is another popular herb for relieving mental conditions. St. John’s wort has been used as a treatment for depression for hundreds of years, and so has valerian for anxiety. And there are many vitamins and supplements such as B vitamins and zinc that might have beneficial psychological effects.

Unfortunately, there hasn’t been a lot of rigorous scientific study of plant-based medicine. For people who gather herbs and plants from the wild, there’s no telling the potency or amount of the active substance that may be present. Even in herbal products sold at health food stores, there is little standardization, so you don’t always know what you may be getting in terms of dosage.

Meditation and yoga are popular adjuncts to talk therapy and/or medication for psychological problems. In fact, these days, they seem to be promoted as a panacea for mental health. They’re particularly popular recommendations in corporate settings, where they’re seen as a low-cost alternative to more expensive treatments that would affect the company’s health insurance costs.

Nonetheless, meditation and yoga do have beneficial effects on mood disorders such as anxiety and depression, and may be helpful for conditions such as PTSD as well. Any amount of exercise is commonly recommended for people with depression and bipolar disorder. The effects are cyclical. The more one exercises, the more one feels able to get going with exercise. Yoga, being low-impact, is something that can be tried by nearly everyone. I’d still say they are adjuncts to traditional treatments for mental illnesses rather than a first-line approach.

Then there are practitioners of alternative medicine. These therapies range from acupuncture to chi balancing to aromatherapy to biofeedback to reflexology to reiki. Let’s start with one that has some science to back it up.

Acupuncture and its cousin acupressure have solid adherents behind them. Johns Hopkins Medicine says that acupuncture is useful in treating anxiety, depression, insomnia, nervousness, and neurosis, though more studies need to be done. And who am I to argue with Johns Hopkins? If they say it’s effective or even promising, I’m willing to say it falls inside the spectrum of helpful approaches.

Reflexology, not so much. The idea that there are areas on the feet that correspond to body parts and can be helped by foot massage is not scientifically proven for health in any body parts, either anatomically or physiologically. (It hasn’t been disproven either, but you can’t prove a negative.) It’s based on the idea that “energy lines” throughout the body somehow combine in the feet (or hands) to produce a map of the body. It is recommended for anxiety and stress relief.

On the other hand, the massage practice of concentrating on muscles that are tensed is much more well-documented. The Mayo Clinic has said that it can reduce stress and anxiety, and even mentions it as a treatment for depression and seasonal affective disorder (SAD). The thing is, any practice that reduces stress is good for relieving anxiety. Whether or not massage has any effect on serious mental illness (SMI) is doubtful.

Relief from tension is, of course, possible when a person believes that a particular technique can reduce it. So if you believe in aromatherapy, for example, it may help you relax. It’s the placebo effect. I’d rather stick with massage.

Then there are approaches that simply don’t work. Homeopathy is supposed to work on the theory that if a substance is good for the body, introducing a single drop of it into water will be effective in the treatment of a disorder. Never mind the science (though there are rigorous studies that say homeopathy simply doesn’t work), the math doesn’t support this. Diluting a substance to the extent that there are minuscule, millionth amounts per glass of water – or even less – just isn’t sufficient to do anything. If there are larger concentrations of the substance, in which there can be alcohol or heavy metals like iron and lead, there may be drug interactions or serious side effects. In 2017, the FDA alerted consumers that some homeopathic teething tablets contained excessive amounts of the toxic substance belladonna. Belladonna is also said to be a treatment for bipolar disorder and schizophrenia.

Crystals are another way that alternative practitioners attempt to cure assorted diseases and conditions. Jasper and tiger’s eye are recommended for anxiety and lepidolite or citrine for depression. Smoky quartz is even said to relieve suicidal thoughts. I wouldn’t count on it. Again “energy fields” of the body and “vibrations” of the various stones, minerals, and crystals are supposed to combine to affect mental and physical health. I own and wear any number of crystals for their beauty, but have never felt any healing effects. The only benefit I see is if a stone is carried in the pocket as a “worry stone,” which the person can rub to induce a calming effect, an early version of the “fidget spinner,” as far as I can see.

Still, proponents of these alternatives to traditional Western medicine will continue to hope for beneficial effects. The National Center for Complementary and Integrative Health says that Americans spend over $30 billion annually on alternative health care. I say, “Let the buyer beware.”

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The 988 Hotline: How Is It Working?

The 988 hotline, designed to be like the 911 connections to emergency services, has been in operation now for a couple of months. What have been the reactions to it so far?

Well, the number is shorter than the ten-digit former one for the National Suicide Prevention Lifeline (now known as the 988 Suicide & Crisis Lifeline); is for people experiencing any emotional distress, not solely a suicidal crisis; and can be reached via phone, text, or message app. A trained crisis worker in a center close to the caller will listen and then provide information about support and resources available in the area.

All that sounds – and is – laudable. Even so, the hotline’s existence has not been universally applauded. What are some of the perceived or reported problems?

Back when the hotline was still the National Suicide Prevention Lifeline, there were difficulties with wait times before speaking to a therapist. Many people who were on hold hung up. There is little reason to believe that this problem will go away – in Illinois, it’s been reported that 30% of callers hung up before reaching a counselor. The same company that ran the former hotline, Vibrant Emotional Health, is running the new hotline. And with all the publicity around the new number, there may be an even greater number of calls. (This might be optimistic, though, since a recent survey said over 75% of Americans had not heard of it by the end of June, just before the hotline went live. Federal funding may allow them to hire more of those trained crisis workers, but will that be enough?

That federal funding is another problem. Much is left up to the states, and there are a number that are not cooperating, neither funding nor publicizing the hotline. Only 20 states have done so. And let’s do the math. The federal funding totals $432 million, far more than was formerly spent on the mental health hotline, but it still means only an average of $8.6 million for each state. States can tap additional funding through sources including Medicare and opioid crisis money. But the lack of state involvement will certainly hinder the counselors in finding and recommending resources close to the callers – and callers in rural areas, for example, may not have any resources close by.

Another major concern that has gotten a lot of pushback from the mental health community – especially expressed on social media such as Twitter and Instagram (hundreds of thousands responded with likes) – is who will respond to calls that require serious intervention. Many are afraid that the local police will be notified of a suicidal person or other mental health crisis and respond to it with the aid of a crisis response team.

Specifically, they are upset because of the number of deaths that result when police who do not understand mental illness and its symptoms get involved. The officials that run the hotline say that police or EMTs are called only as a last resort effort for suicide situations. But many potential users are skeptical.

There have been rumors that the hotline can collect geolocation information about callers, but this seems to be limited to general location by phone number and area code, or IP address, which may be helpful in putting callers in touch with local resources, but also means that law enforcement can have this information if the hotline counselors do contact emergency services. Counselors are scheduled to receive training on when to call in law enforcement personnel and the dangers of it.

Of course, not all police involvement results in death. But there are other concerns when police and EMTs are involved. Among these are people being taken to hospital emergency rooms, where they receive slow or inadequate treatment, and involuntary treatment in psychiatric hospitals. (This is a particular concern for people in the LGBTQ+ and POC communities.) When there are so few options to treat the seriously mentally ill, the likelihood of the counselors providing useful advice for sufferers or families is not great.

Nonetheless, we should not let these potential problems overshadow all the good that the new 988 hotline will do. The more coordinated effort with the easily remembered number will help those who know about it in times of crisis. When the bugs are worked out, the states get on board, and the public becomes more aware of the service, it should prove a valuable resource for those not just with suicidal thoughts, but with everyone who suffers from a mental illness and who needs a listening ear, counseling, and resources.

Of course, no new public service endeavor gets off the ground without some rocky start-up time and a few glitches. Let’s keep an eye on the new hotline and see what it can do once it shakes out a bit.

 

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Divisions in the Mental Health Community

It’s sad when communities that ought to work together for the betterment of all are divided by strife. But that’s just what has been happening in the world of mental health.

Even saying “mental health community” is controversial. There are different segments of the population who say that “mental illness” is the more accurate term. Then there are those who advocate for the term “brain illness” while advocating for adequate supports and services.

Indeed, what to advocate for is another discussion. Many people are trying to root out the stigma that goes with having a mental illness. Others say that’s a waste of time – that what is really needed is advocacy for improved treatments and more accessible services. There is, of course, the possibility that one could advocate for both, but the issue seems to be that the stop-the-stigma people are pulling focus away from those who campaign for social and political (and financial) reform. The situation seems complicated by the fact that many “It’s okay to have difficulties” promos actually promote online therapy businesses.

Then there are the different “what causes bipolar disorder?” schools of thought. For years we attributed it to a chemical imbalance – neurotransmitters such as norepinephrine, serotonin, and dopamine not performing their job properly. Now many people think it’s caused, or at least exacerbated, by something else – heredity and genetics, environmental and lifestyle issues, or some combination of them all. Treatment with psychotropic medications, which is the most common for bipolar, tends to lend credence to the neurotransmitter theory, although it’s generally accepted that we don’t have any real idea of how they work.

The drugs used to treat bipolar and other disorders such as schizophrenia are controversial too. Many people credit them with saving their lives. Some others describe them as “neurotoxins.” One typical Facebook post said, “They are powerful, toxic drugs which can cause a chemical lobotomy and terrible adverse effects such as akathisia, dyskinesia, Parkinson’s, dystonia, and many other tortuous, real effects. Many people are left on these drugs for life.” This is one of the milder posts reacting to psychotropic meds. Many also speak of withdrawal symptoms and lives ruined. They also state that Big Pharma is partly to blame: “The sale of psychiatric drugs will continue to increase and force will still be part and parcel of psychiatry….If we have hearts we will not expect psychiatry with all its terrible past of fear, force, and fraud to understand any human being or society!”

Treatment for various disorders, particularly schizophrenia, is widely debated as well. Some people are appalled by involuntary commitment or “forced hospitalization and drugging,” while others see it as a valid procedure for anosognosia (the inability to recognize that one has an illness), as this increases potential harm to self and others. “Assisted Outpatient Treatment” or AOT, a form of supervised drug administration for those who have been released from treatment facilities is gaining adherents. Lynn Nanos’s book Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry makes a strong argument for AOT.

In fact, psychiatry itself is a disputed issue, and not just by Scientologists who feel that all mental illnesses are caused by whatever it is that can supposedly be cured by their practices. (You can probably tell that I don’t give any credence to their beliefs.) But psychiatrist Dr. Thomas Szasz railed against psychiatry in books including Psychiatry: The Science of Lies and The Myth of Mental Illness. Here’s a quote from The Science of Lies:

Because there are no objective methods for detecting the presence or establishing the absence of mental diseases, and because psychiatric diagnoses are stigmatizing labels with the potential for causing far-reaching personal injury to the stigmatized person, the “mental patient’s” inability to prove his “psychiatric innocence” makes psychiatry one of the greatest dangers to liberty and responsibility in the modern world.

With divisions like these, it’s no wonder that mental illness diagnosis, treatment, and priorities are large contributors to the broken system in the United States. Is it a healthy debate? Are they irreconcilable differences? Is there something to be said on both sides? Does science back up any side or does passion prevail? And will any of these debates be resolved in the near future? I believe that until the community gets together on a lot of these issues, not much will get done that will truly help sufferers.

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