Bipolar 2 From Inside and Out

Posts tagged ‘public perception’

What Kids Should Learn About Mental Health

The stigma and the misinformation surrounding mental illness are staggering.

How many adults believe that depression is “just being sad”? That the weather can be “bipolar”? That you can call yourself OCD because you’re a little too organized? That suicide threats are never acted on? That mentally ill people are dangerous? That prayer, or sunshine, or positive thinking will cure all mental disorders?

We can’t do much about educating and informing the adult population that all those beliefs are false. But we can avoid raising another generation that buys in to these misconceptions – if we start now with mental health education in schools.

Whenever someone proposes this idea, there are common objections. You want kindergartners to learn about schizophrenia. You’ll have impressionable kids thinking they have every disorder you teach about. Discussing suicide will give teens ideas.

Again, those are misconceptions. Mental health education in schools could look like this:

In kindergarten and grades 1-2, part of the health curriculum should be a unit about understanding emotions and how to deal with them. This is already being done when teachers tell kids to “use your words” or “use your indoor voice.” But more could be done in the area of teaching children how they can keep from letting anger, sadness, frustration, and other emotions cause them difficulties. Yes, this may involve techniques that resemble meditation and yes, these may be controversial, but the outcomes will be beneficial.

I also think that young children ought to be taught about autism, though it’s not strictly speaking a mental illness. They will certainly meet autistic children in their classes at this age. Helping them understand the condition at their age level will, one can hope, lead to more inclusion and less bullying of kids who are “different.”

Older elementary children can learn about mental illness in their science or health classes. This should be a unit that covers the basic facts: that mental illness is like physical illness in some ways, that treatment is available, that mental or emotional disorders will affect one in four Americans in their lifetimes, and that mentally ill persons are not generally dangerous.

Middle schoolers can be taught some more specifics: the names and symptoms of some of the most common disorders, the kinds of treatments available, famous people who have succeeded in spite of mental disorders and ordinary people who live fulfilling lives despite them. Speakers from local mental health centers or the school guidance counselor would be helpful.

The topics of self-harm and suicide should be brought up at the middle school level. It is sad but true that children in the middle school age range are affected by both – if not directly, by knowing a classmate who is. And suicide is the third leading cause of death for children ages 10-14. Learning the facts may help students who need help find it before it is too late.

In high school, the focus can shift to human psychology; more detail about serious psychological conditions; and the possibility of careers in mental health treatment, nursing, or advocacy. Topics of self-harm and suicide should be covered in greater detail, with discussions of how suicide affects the families and loved ones of those who die by suicide, how to recognize possible signs that a person is thinking about suicide or self-harm, and what does and doesn’t work when a person shows those signs.

The details of mental health education in schools still need to be worked out. These suggestions come from my experience as a person with bipolar disorder, who began showing symptoms while I was a child. Organizations such as NAMI (National Alliance on Mental Illness) and NIMH (National Institute of Mental Health) provide resources that can help in understanding the need for mental health education among school-aged children.

Understanding mental health is as important for schoolchildren as understanding physical health. Why should one get all the attention and the other virtually none? Mental health education that begins early can help children and their families in ways that will resonate far into the future.

Most adults have little to no understanding of the realities of mental illness. It doesn’t have to be the same for the next generation.

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Mental Health

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Inspiration and Mental Illness

high angle view of pencils on table

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I was manicky this week and it affected my blog writing. I had a post all ready to go this morning, but last night I thought about it and realized it was crap. It meandered, without focus. The ideas were confused. It sucked. So I got up this morning to write something different instead.

Many of you may recognize this aspect of mania or hypomania. You do something that you think is fantastic  while in the grip of mania and when you come down, you can’t see what you ever saw in it. Or you begin an ambitious project that you work on and work on but never can complete.

I was toying with the idea of “inspiration porn” – the sort of post or story or TV show that holds someone up as an ideal, usually because they’ve lost a bunch of weight and gotten themselves into shape, or have an illness or disability and managed to do – whatever – again. Think “The Biggest Loser.” Or amputees who’ve learned to eat with their feet. It’s put out there for entertainment and to make everyone feel good that whoever it is conquered whatever it was. It takes a regular person out of the context of their lives and reduces them to their condition. And the subtext is that if this brave person can become able to do or be whatever again, so can everyone else with the same problem.

It happened to a friend of mine who was at a gym on a treadmill. A woman came up to her and said how inspiring it was to see her working so hard to lose all that weight. “Excuse me?” was my friend’s reaction. She was doing it for herself, not for anyone else, and especially not to inspire some random stranger.

The thing is, there really isn’t any mental health inspiration porn. For one thing, it would make lousy TV. Oh, they’d get advertisers – all those purveyors of psychotropics that clog the airwaves. But who would watch a depressed person finally getting out of bed and taking a shower, unless she had a coach yelling at her?

Inspiration for those of us with mental health problems takes other forms. Celebrities who speak about their struggles with mental illness are one. They are inspiring because they break the taboo about talking about mental illness in public and because they have done so to help other people.

Then there are the superstars of mental health inspiration. Carrie Fisher, Glenn Close, and Jenny Lawson, to name a few. These are people who focus light on the difficulties and struggles of mental illness. Their communications don’t stop with the announcement that they have a condition and encouraging people to get treatment, though those are also good things. But the real inspirations are those who open their lives, take others with them through the journey of symptoms, treatments, relapses, small triumphs, and bigger successes. They speak and keep speaking and keep speaking their message. They don’t make the process sound easy, because it isn’t. And they speak with authenticity and authority because we know they’ve been there.

They do inspire us because they are honest and open, and they clearly care about helping others in the same proverbial boat.

We lost a true inspiration when we lost Mama Carrie. No one will ever really take her place. But you can tell that she was an inspiration by the many people whose life she touched and how they remember her. If someday they make a movie of her life, I hope it features not only her personal struggles, but all that she did for others. Her speaking and continuing to speak despite – or because – of her ongoing struggles.

We can carry on her work by doing the same, by shedding the stigma, by talking to others, even family and friends. Recently a friend “came out” to me that she takes an antidepressant and an anti-anxiety med (the same ones I take). I was proud of her, but I didn’t make a big deal of it. But I was impressed and pleased that she was able and willing to share even that much. She was saying that she was part of our tribe.

As Jenny Lawson reminds us, in this we are alone together. And that’s inspiring. 

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Talking to Ourselves

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Recently on Facebook I asked how many of my friends knew the meaning of the semicolon – other than as a mark of punctuation. About two-thirds of those who responded did. The rest either didn’t or had some vague idea but no real knowledge. But I’m pretty vocal about mental health issues and a fair number of my friends have similar problems and difficulties, so that two-thirds figure is likely not representative of the population at large.

Yet I see increasing numbers of t-shirts, bracelets, and other paraphernalia adorned with semicolons and sometimes colorful butterflies or the word “warriors.” But nowhere does it say what the semicolon stands for. For those of you who don’t know, the semicolon marks that place in a sentence where a writer could have stopped, but chose to go on. As such, it has become a symbol for suicide prevention and mental health awareness.

I have a semicolon tattoo myself. I don’t regret getting it. It reminds me, as the saying goes, that my story isn’t over. But when I got it, I also hoped it would be a tool for education – that I could explain to those who saw it and asked what the symbol meant.

Unfortunately, no one has asked.

I’d hate to think that the semicolon has become like a secret handshake that identifies members of our tribe to one another, but leaves out the rest of the world. As stigma-fighting symbols go, it doesn’t seem terribly effective.

The political conversation has become so fraught that no one talks to anyone who doesn’t believe in the same things. And I’m afraid that, like them, we’re largely talking to ourselves.

Self-talk is important – definitely something we should pay attention to and work on improving. But if we really want to fight stigma, we need to talk to other people about it.

I see a fair number of stigma-fighting memes and discussions, but unfortunately, most of them take place in mental health support groups, where the message is not as much needed as in the larger world outside our band of the mentally ill.

Of course, there are organizations such as NAMI, Bipolar Awareness – Stop the Stigma, and Stigma Fighters that dedicate effort to reducing stigma. And they are doing a good, necessary thing.

But what about the rest of us? What can we do to break out of our shells and involve the rest of the world in our cause?

One thing is to question other people’s assumptions when we see or hear them. When you read a post that calls the weather bipolar, answer it. Explain why that’s not a good comparison – that it trivializes a very real problem that millions of people face every day. And when someone assumes that a mass shooter or other terrorist must be mentally ill (or “off his meds”), remind them that those with mental illness are more often the victims of violence that they are the perpetrators of it.

Will people get the message, or will they just dismiss you as “politically correct” or a “social justice warrior”? Personally, I can think of worse names to be called, and many of us have been called them. But just as “retarded” and “gay” are no longer acceptable as synonyms for “weird” or “stupid,” we should try our best to make “crazy” and “mental” and “psycho” and that annoying little twirl of the finger by the temple no longer acceptable as shorthand for behavior that one doesn’t understand. (I still haven’t figured out how “dumb” and “lame,” both ableist language, have managed to skate by.)

What I’m saying is that to fight stigma we need to engage with the world outside. We need to explain why certain uses of language are hurtful and what the truth is about the many people who are affected by mental illness.

I’ve had to smack a few friends on the nose with a rolled-up newspaper when they get it wrong and I try to put my two cents into other discussions that are portraying the mentally ill insensitively. I think about what I’m going to say and even practice it before I speak or press send. (Sounding well-informed and reasonable is the way I want to express my message.) I post my blog entries to “public” as well as to friends and support groups. Sometimes I even talk to my family about stigma.

As a group, we need to do a whole lot better at not hiding from stigma but confronting it wherever we see it. We can live with stigma or we can fight it.

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The Compliant Patient

My mother was not a compliant patient. She would have side effects from medication and just stop taking them: The meds gave her sores in her mouth or nauseated her.  And that’s valid. We’ve all had medications that we couldn’t tolerate because of the side effects. But Mom stopped taking them without telling her doctor. Once she went to the emergency room, where they had a list of the meds she was supposedly still on and I had to tell intake, “No, she stopped taking that one. And that one too, I think.” (She was not mentally ill, but that’s where I’m going with this.)

There is only one psychotropic medication I know of (though there may be others by now that I haven’t heard about), where the potential side effects are so horrible – potentially lethal – that patients are advised to stop taking them immediately and get medical help right away.  The side effect is called Stevens-Johnson Syndrome and it is a potentially fatal rash.  I wrote about it a few years ago, (https://wp.me/p4e9Hv-1g)

Other than that one instance, psychotropic medications should never be discontinued unless you have consulted your physician. You never know what withdrawal symptoms lie in wait for you, but they’re bound to be unpleasant, even if they don’t cause you to relapse, which could easily happen. Withdrawal from any drug is not fun; it’s to be avoided.

Nonetheless, I read posts in support groups all the time which say that people have decided by themselves to stop taking a medication, or even all their medications on their own. I have friends who have taken their treatment into their own hands this way.

There are several reasons they sometimes give for giving up medications. One is that the meds aren’t working. What they really mean is that the meds aren’t working yet. Many psychotropics don’t show positive effects until they have built up in your bloodstream, which can easily take four to six weeks. Expecting results in a day or two is unreasonable.

Others stop taking their meds because they “feel better” and think they no longer need the pills. This is just ridiculous. The meds are the reason that you feel better. Your psychiatric condition does not just go away, like the flu, when you feel better. Your disorder may soon come roaring back (or creeping back). And the thing is, when you restart a medication, it sometimes no longer works as effectively. Then you have to start all over with a new prescription and have another four to six weeks of symptoms while you wait to find out if it works or doesn’t.

Still other people simply don’t like taking medications.  This I don’t understand.  People take meds for flu and infections and such conditions and never seem to resent them. Maybe it’s the idea that you could well be – will likely be – on psychotropics for the rest of your life. But lots of people have meds they need for life – insulin, cholesterol meds, anti-inflammatories, asthma meds, thyroid meds, and others. People don’t quit taking those just because they don’t like to take pills or injections.

I think the real reason people don’t like to take their psychiatric meds is that they’re psychiatric meds. There is still massive stigma around the subject of mental illness. Taking medication for a mental illness means admitting you have one, which some people are reluctant to do.

Or they may be giving in to “pill-shaming.” There are plenty of people, perhaps in your own family – and certainly across the Internet – who will tell you that all you need is self-love or affirmations or sunshine or exercise or vitamins or meditation or willpower to banish your mental illness. Funny how they never tell people that sunshine will cure their broken leg or that exercise will cure their breast cancer.

I hesitate to say that I love my psychotropics, but in a way I do. They have brought me out of states of mind that were harmful to me. They have made it possible for me to function and create and communicate. They probably have saved my life.

Occasionally I let my psychiatrist know that I may need a change in dosage or that one of meds is no longer working. I’ve even reviewed with him whether there are any meds I could quit taking (there aren’t at the moment). But I keep taking them faithfully, every day, morning and night.

I need the psychotropics. So I am a compliant patient.

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Where Churches and Mental Illness Meet

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Lately, I’ve been thinking – and writing – about the place where faith and mental illness intersect. (See Mental Illness, Faith and Sin – https://wp.me/p4e9Hv-DB; Prayer and Bipolar Disorder – https://wp.me/p4e9Hv-B6.) I’m still thinking about it, so I’m still writing.

Churches, among other groups, have outreach ministries to the homeless mentally ill, providing sandwiches, socks, and hope of salvation. And the stereotype of the soup kitchen is that patrons “pay” by listening to a hymn or a sermon.

But what about the rest of the mentally ill community – those like me who have homes and families and a certain degree of function? What are churches doing about us?

The answer is: They struggle, but at least some of them are doing something.

Of course, some of them are doing the wrong thing. Andrea Jongbloed reported in Relevant magazine:

I sat in the chair in my pastor’s office, listening to him list off strange things I had done recently. My pastor informed me, “the church leadership is not convinced you are mentally stable enough to continue leading your bible study.”

It wasn’t supposed to happen this way. I had come here to talk about the book I was writing, on mental health and spirituality. Instead, I felt bombarded with accusations…. I left feeling judged and misunderstood.

An article in Christianity Today notes, “In many ways, the church, the supposed haven for sufferers, is not a safe place for those who struggle with mental illness.” The author adds:

The more Christians struggle with how to deal with mental illness, the more we fail to create a safe and healthy environment in which to discuss and deal with these issues. As a result, many of our Christian churches, homes, and institutions promulgate an aura of mistrust, guilt, and shame.

Amy Simpson, writing at qideas.org, outlines what is wrong with churches’ relationship with the mentally ill:

In general, the church tends to handle mental illness in one of three ways: ignore it, treat it exclusively as a spiritual problem, or refer people to professionals and wash our hands of their trouble.

Like it or not, the church is the first place many turn in crisis. And fair or not, the church’s silence or rejection feels like rejection from God. We cannot keep turning away from the most vulnerable among us.

According to Lifeway Research, however, 66% of pastors speak to the church about mental illness in sermons or large group messages “once a year, rarely, or never.” And 74% of pastors say that they are “reluctant to get involved with those with acute mental illness because it takes too much time and resources.”

But some churches are taking on the challenges, or at least trying to.

In a PBS interview, Deborah Potter, a correspondent from Religion and Ethics Newsweekly, explores how Holy Comforter Episcopal Church in Atlanta and St. Catherine-St. Lucy Roman Catholic Church in suburban Chicago are providing not just outreach, but community to the mentally ill.

According to Potter,

Holy Comforter responded … when a group home opened nearby and the priest at the time invited the residents to church. Today, almost two-thirds of the congregation is made up of people with mental illness—including bipolar disorder, clinical depression, and schizophrenia—who worship together and pray together.

The video also features Connie Rakitan, who founded the program at St. Catherine-St. Lucy, “helping to design worship that’s welcoming to all.”

Rakitan explains:

Walking into a church with a long service and a long sermon and lots of music and lots of people could just be so overwhelming that it’s just not doable….We would never, ever use a healing passage, because we would not want to set somebody up for an unrealistic disappointment, because the fact is not everybody gets cured.

Rakitan also points out that the church community offers something that the mentally ill may not find elsewhere: “Their families might be alienated from them or estranged or whatever. They might not have work communities. What do they have left but their faith in God?”

Lorrie Lattimore, of the Baptist Press, tells about a weekly “combined Sunday school and worship time” at First Baptist Church, Tuscaloosa, Ala.

It’s not an ordinary class. Some get up and pace during the Bible lesson. Some rock steady in their chairs. Some mumble to themselves. But all love God and know God loves them in spite of being consumers [sic] of a mental illness, those who have schizophrenia, for example, or depression or bi-polar disorder. Jimmy Tilley, the leader of the class, who also suffers from depression, chronic anxiety and obsessive-compulsive disorder, wouldn’t want the group to act any other way.

She adds:

Few Baptist churches offer some kind of outreach for mental illness consumers. Jim Hightower, minister of pastoral care at First Baptist Church…. noted more churches should have education programs and even ministries because “every church has members who have a mental illness.”

The best advice for churches? Amy Jongbloed sums it up nicely:

Be open to learning about mental illness. Have potentially awkward conversations with newcomers who struggle with their mental health. You won’t regret stepping outside your comfort zone. You will be blessed with stories of struggle, resilience and redemption. If you’re lucky, maybe you’ll even become part of someone’s story of recovery and reconciliation with the Church.

References

http://www.pbs.org/wnet/religionandethics/2012/06/22/june-22-2012-churches-and-the-mentally-ill/11386/

http://qideas.org/articles/mental-illness-what-is-the-churchs-role/

http://www.villagelife.org/church/archives/baptist_mentalhealth.html

https://www.christianitytoday.com/edstetzer/2016/may/christian-struggle-with-mental-illness.html

https://relevantmagazine.com/god/church/4-misconceptions-about-mental-illness-and-faith

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Would You Try Electroshock?

Photo by Mike T

In the course of dealing with my bipolar disorder, I had a near brush with electroshock. I managed to avoid it, but I did give it serious thought.

Now 60 Minutes has come out with a piece called “Is Shock Therapy Making a Comeback?” You can see the segment here: 60 Minutes.

ECT(electroconvulsive therapy, the modern name for the procedure), which is often done on an outpatient basis, works by inducing a brief seizure in a patient. The seizure, which lasts about a minute, releases multiple neurotransmitters in the brain, all at once. The patient is required to have someone to transport them to and from the appointment. Treatments are typically applied one or two times per week for 6-8 weeks.

In a brief article excerpted from the news show segment, Dr. Charlie Welch, of McLean Psychiatric Hospital, explains how ECT differs from how it was performed in the past: “What’s different first of all is that it’s done under general anesthesia with a muscle relaxant. So when the treatment is done, the patient is sound asleep and completely relaxed.” Call it a kinder, gentler shock treatment.

That was the procedure that my psychiatrist offered me after he had spent a number of years trying me on various medications that either didn’t work, or helped only partially.

My immediate reaction was negative. I recall thinking, “Fuck, NO! Keep away from my brain, you Nazi sadist!” After I calmed down a bit, I did some research.

ECT, my sources said, was a long way from the cruel, stigmatizing procedure portrayed in One Flew Over the Cuckoo’s Nest. The Internet was little help, though. The opinions and experiences of people who had undergone electroshock ranged from “It was hideous” to “It was a miracle.”

Truthfully, I was appalled by the notion of electrical jolts surging through my brain. My precious brain, which had both sustained me and betrayed me throughout my life.

Then I thought some more. So ECT sometimes causes memory loss. I already had that, thanks to some of my meds. I would be altering my brain with electricity. But hadn’t I been altering it for years with chemicals – medications that no one seemed to know how they worked?

So I went back to my doctor and said I would at least talk to the doctor who would perform the procedure. And I lined up a journalist friend to write about my experiences if her editor approved. (Note: In the 60 Minutes piece, former Massachusetts First Lady Kitty Dukakis gave permission to have her treatment filmed and broadcast.)

My psychiatrist, however, had one more medication that he wanted me to try before we took that next step. And it worked. So much for electroshock.

Now as to that side effect of memory loss – Dr. Sarah Lisanby of the National Institute of Mental Health in Maryland has developed a new treatment that seems to avoid that particular consequence.

The procedure is called Magnetic Seizure Therapy (MST) and it uses magnets (duh!) to stimulate more precisely focused seizures than ECT does. These focused seizures seem to avoid the parts of the brain associated with memories. As Dr. Lisanby told the 60 Minutes reporters, “For some people, ECT may still be needed. But if Magnetic Seizure Therapy could be effective without the memory loss who wouldn’t want to try that first?”

Would I try MST if I relapsed into treatment-resistant depression? I would certainly consider it, if it were out of the testing stage by then. And I’d do that before I signed up for ECT. While I have memories I’d prefer to forget, with my luck, those would be the ones left unaffected.

The cynical side of me says that these seizure-causing therapies are becoming more popular because insurance companies like the notion of a short course of 6-8 weeks of treatment instead of years of talk-and-medication. (Although Kitty Dukakis said that she has done ECT for years now and expects to continue into the foreseeable future.)

But I could be wrong. It is possible that some kind of treatment could be short in length but longer-lasting in effectiveness. I’m not ruling it out. At this point I’m not ruling out anything that could aid in my progress and my healing.

 

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Mental Illness and Gun Violence

photo by Thomas Hawk

There’s been a lot of talk lately that not allowing the mentally ill to own guns would curb the trend of gun violence in the U.S. There are just a few things wrong with that theory.

Are background checks the answer? They aren’t. Such checks at certified gun dealers screen out only the very few who have been hospitalized for mental illness – involuntarily committed, that is, not just referred for a 72-hour hold for observation or self-referred. That’s only a very small portion of those with mental illnesses. Most people with mental disorders are never hospitalized and some never receive any diagnosis or treatment from a psychiatrist, psychologist, or another counselor, which means that background checks would never turn them up. And there are loopholes in many states’ versions of background checks that, for example, allow private sales of guns without them.

To take this to the next level of absurdity, it would be a severe breach of confidentiality if therapists had to report every client to a database somewhere, just in case, and would lead to fewer people being treated for mental health issues, for fear of being put on a registry that might be used for any purpose eventually, even employment. Gun owners don’t want to be on a nebulous registry “somewhere,” and neither do the mentally ill.

Can psychiatrists and other counselors report to the authorities clients they fear may become violent? Again, laws differ from state to state. Usually, the question comes up only when a client makes specific threats against a specific person or a government official. The therapist must make a judgment about whether the client is a danger to self and others, which could result in a 72-hour hold, and may of course be correct or incorrect. A client with generalized anger issues is probably not mandated to be reported.

And to whom and for what purpose would the person be reported? To the police, when no crime has been committed? Is a therapist’s report of a client’s report of feeling angry enough to shoot “someone” sufficient to justify a search warrant of the person’s house for a legally owned firearm?

Are mentally ill people more likely to be violent than other people? No. In fact, mentally ill people are much more likely to be the victims of violence than they are to be perpetrators. But no matter how many times we say that, few listen or believe it. Some mentally ill people turn violence – and guns –against themselves. Some are killed by police officers with no training in handling confrontations with differently abled people, including the mentally disordered.

Not only are mentally ill people more likely to be accused of violence, violent people are more likely to be accused of being mentally ill. That’s practically the first thing anyone says after a mass shooting – “Oh, he must be crazy” (or on psychotropic medications). Of course, with one in four adults being likely to experience some form of mental distress in their lifetimes, it is possible that a shooter is one of those people.

But newscasters and politicians and people on the street are, by and large, not psychiatrists or psychologists. They are no more able to diagnose mental illness than burger-flippers, dairy farmers, lawyers, or business executives. Not that that stops them. Mental diagnoses are flung about indiscriminately nowadays, from people who call themselves OCD because they straighten pictures to psychiatrists who claim to diagnose public figures without having spoken to them once, much less having developed a therapeutic relationship with them.

But can’t potential violence be predicted? No. It can’t. The prison system can’t do it, or there wouldn’t be so many parolees and probationers and those who have served their time who go right back to crime and violence. Mandatory sentencing laws and the political climate have reduced the problem in some areas, but there are still plenty of cases in which the system fails. At trials and parole hearings and sentencing hearings, there is always someone – doctor or lawyer or family member – to say that the offender will not offend again.

But the only known predictor of violence is past violence. That’s why some people think it’s more sensible to restrict the gun ownership rights of domestic abusers rather than someone mentally ill who has no record of violence.

Can’t mentally ill people who’ve proven to be violent be required not to own guns? Theoretically yes, but we know how well it works to tell people on probation who have no record of mental illness that they can’t own guns, drink liquor, or associate with known criminals. The probation system is too understaffed to enforce these requirements already. Who would be willing – or should have the responsibility – to check up on everyone, even the small proportion of the mentally ill who have been involuntarily committed or convicted and then released, and make sure they don’t acquire any guns? If the parole and probation people can’t handle the caseload they already have, why would we think that mental health professionals have any more time, capacity, training, or know-how to do it?

Would banning guns prevent gun violence by the mentally ill? In a word, no. There are already too many guns in circulation in this country for that to be possible, and those guns are too easy to get. And again, there would still be the problems of determining who is mentally ill, by whose definition, and how such a gun ban could be enforced.

So, I hear you asking, you’ve told us all the things that won’t work. Is there anything that will?

Not if you think that the problem of gun violence and the problem of treating the mentally ill overlap. Gun violence is one topic and the mental health system is another. There is a lot that can be said about fixing one or the other, but nothing that would solve both at once.

Not that a lot is being done now, unless you count blaming, finger-pointing, and spreading stigma.

 

For more discussion on the topic, see http://www.amhca.org/blogs/joel-miller/2017/10/03/gun-violence-and-mental-illnessmyths-and-evidence-based-facts from the American Mental Health Counselors Association.

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On Pain and/or Suffering

Recently, when I was reading Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis by Lisa Sanders, I came across this:

Eric Cassell, a physician who writes frequently about the moral dimensions of medicine, argues, in a now classic paper, that pain and suffering are very different. Pain, according to Cassell, is an affliction of the body. Suffering is an affliction of the self. Suffering, writes Cassell, is a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted.

Later, when I was reading M Is for Malice, by Sue Grafton, I read this: “Pain was better than anxiety any day of the week and sweat was better than depression.”

The universe seemed to be telling me to focus my attention on pain and/or suffering.

Cassell (as quoted by Sanders), could have been (but probably wasn’t) talking about bipolar disorder when he defined suffering as “a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted.” I certainly don’t feel intact or integrated while in the midst of a bipolar episode – either hypomanic or depressive. I suffer. My personhood is certainly threatened and disrupted.

It’s common to hear bipolar described this way: “I suffer from bipolar disorder.” I prefer to say “I live with bipolar disorder,” which I feel is more accurate. It’s always there, but I’m not always suffering. I live with it and it lives with me.

I think Cassell was wrong, though, about pain being a purely bodily sensation. I addressed the concept back in the early days of this blog. with a post called “Depression Hurts” (https://wp.me/p4e9Hv-6Z). In it I claimed that bipolar (or depression specifically) caused physical pain as well as emotional pain. I still maintain that one is as valid as the other and that they are virtually inseparable. The mind and the body not being entirely separate, or separable, you see. You get both for the price of one.

Grafton, on the other hand, through her character Kinsey Millhone, was talking about the physical act of running. We all know by now (or should) that exercise is recommended for those who have bipolar disorder or other mental/emotional conditions. But again, there is this idea that physical discomforts (pain and sweat) are better than emotional distress (anxiety and depression). She seems to be saying that pain is the antidote for suffering.

This can be dangerous territory. As someone who used to self-harm, I can easily see how one might think that pain is preferable to anxiety, or numbness, or dissociation – to suffering, that is. But in such cases, pain is really just another aspect of suffering, expressed in bodily terms. Again, the two are inextricably intertwined.

Personally, I would be delighted to avoid all four sensations – pain, anxiety, sweat, and depression. But I don’t think that’s possible, even with avoiding both exercise and self-harm. Sweat is the easiest to dispense with, thanks to modern toiletries, but there have been plenty of times when my anxiety has caused me to sweat. Think about being summoned to a tax audit, for instance, and you’ll see what I mean. Pain is unavoidable; no one goes through life without stepping on a nail or some such. Anxiety and depression occur at least occasionally in the neurotypical as well as the mentally disordered.

The human condition itself involves feeling both pain and suffering. Bipolar disorder involves both pain and suffering. Well, what do you know? We’re only human, after all.

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Do I Disclose or Don’t I?

As I’ve mentioned before (even on my other blog https://wp.me/p4e9wS-zY), I’m running low on money and clients in my freelancing business. Therefore, I’ve taken up searching job ads online for part-time, work-from-home gigs. (So far, Indeed is the only service that has presented me with reasonable options. I sometimes apply for as many as three a day.)

It’s filling out the applications that has me stumped. Oh, I’ve got a fine resume – one on Indeed and another file I can send to jobs not listed with Indeed. I can write a decent cover letter. If there are editing or writing tests, I can handle them too. I have way more education and experience than I need, but I explain in the cover letter that part-time, contract, or freelance work is what I really want at this time in my life.

Then come the other questions that many ask.

Am I a veteran? No.

Am I a U.S. citizen or do I have the necessary documents to work in the U.S.? Yes.

Is English my first language? Yes.

Am I male or female? Yes.

What race do I identify with? Yes.

(Those aren’t really yes/no questions and are usually marked as optional, but I answer them anyway.)

Then comes the real stumper. Am I disabled? Well, that depends.

Most of the application forms state that they abide by EEOC regulations. Some of them even have a handy list of what are considered disabling conditions – and bipolar is one.

So. Do I take them at their word and believe that they do abide by EEOC regulations, in which case I can reveal my bipolar condition without penalty. In fact, if the company is trying to prove to someone that they are abiding by those regulations, the answer is probably yes, I should.

But we all know that such questions, while well-meaning on the surface, may actually be used to screen out disabled candidates. So perhaps I should answer no.

The deal with the regulations is that employers must offer “reasonable accommodations” to let disabled employees do their jobs, unless the accommodations for that condition are not feasible because of expense or other reasons.

So, as a person with bipolar disorder, what actual accommodations would I need?

The main ones I would need are the ability to work remotely, from home, and to have flex time. Those cost an employer nothing, usually.

And those are precisely the kinds of jobs I am applying for – work-remotely jobs in which you can make your own hours, or at least partially.

So when it comes to “The Question,” I have been answering “yes.” For the purposes of work, I am at least partially disabled by my bipolar condition. I cannot work full time. I have trouble working in a bustling office with lots of people around. I need flex-time to work around my symptoms. (I can still meet deadlines, though.)

Funny, but the forms don’t have spaces or yes/no questions on those subjects.

I have considered the idea that I am doing this all wrong. That I should not disclose my bipolar disorder until I have the job (and for those who don’t ask the question, that’s what I’ll have to do). That after I have the job is when I should discuss accommodations.

But dammit, all evidence to the contrary, I am a cock-eyed optimist. Those EEOC rules are there for a reason and I am that reason. I know that when most employers think “disability,” they think “wheelchair” or “impaired hearing.” But there it is, listed right among the possible disabling conditions – bipolar.

So far I’ve gotten a few form rejection letters and mostly a resounding silence. And in the meantime I’ve been scrambling for other clients and other assignments.

But I hope the day will come when just one of my potential employers means what it says about disabilities.

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Mental Health

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Why I Hate TV Drug Commercials

Just as a general rule, I dislike commercials for any drugs. They impede the doctor/patient relationship. (I’ve often considered saying to my doctor, “I’m supposed to ask you if Latuda, Humira, Prolia, Viberzi, Lunesta, Cialis, Trulia, Trintellix, Keytruda, and Boniva are right for me.”) TV – and to a lesser extent print – ads encourage people to act as unpaid drug reps. And they only advertise expensive drugs until they go generic, which is when they stop being expensive and the drug companies stop making so much money.

(If you want to read more on the issue, go to https://www.medicinenet.com/script/main/art.asp?articlekey=106198.)

But there are other things about TV drug ads that make me more than a little cranky. Like where are the ads for drugs to treat bipolar disorder?

Oh, there are ads for drugs to treat bipolar depression, as well as ones for treating non-bipolar depression. You’d think that with approximately 2.8 million people who have bipolar in the U.S. and Canada (http://www.pendulum.org/bpfacts.html), there would be a market for bipolar treatments.

Also, the ads for depression treatments don’t always get it right. A few of them say that depression is more than just sadness, or that it lasts for several weeks at least. One even says that depression is a “tangle” of symptoms, which is certainly true. (Although the tangle is shown graphically in primary red, yellow, and blue, which don’t really say “depression” to me.)

Most, however, treat depression simplistically, with hidden depression represented by a smiley face mask hiding a frowny face mask. (The colors in that ad are muted during the “before” scenes and more vibrant during the “after” scenes, which is an old advertising trick.)

The ads also make it look like the most important thing about depression is not spending time with your family or not enjoying it if you do. While that certainly is one symptom of depression, it is by-and-large irrelevant to people like me, who don’t have 2.1 school-age children to take on picnics. And it’s pretty much a guilt trip for people who do.

Then there’s how the people in the ads are represented. Oh, they almost always show one POC and one slightly older person (frolicking with the grandkids). But all of them are attractive. All of them are models. Are we supposed to identify with them? Or just expect to look like them when our depression lifts?

I wouldn’t be so annoyed by this issue if it weren’t that ads for other kinds of drugs – those for psoriasis and diabetes, for example – have actual people with the disorder in them. Testimonials from those who’ve been there, as it were. Even real-life cancer patients are now featured in ads for treatment centers.

What’s up with that, I wonder? Surely they don’t imagine that only pretty people get depression or bipolar. It can’t be that they can’t find any well-spoken, real-life people who can relate their own experiences. I for one would feel more reassured if I heard about a treatment from someone who’s lived with the disorder instead of from someone selected at a casting call. Are we all homely and illiterate? (I meet the qualification for literacy, at any rate.)

Instead of trying to convince us what medications our doctors might prescribe us, the airtime would be better spent on ads that educated the public on depression and bipolar disorder. But those would be PSAs, of course, appear only at 3:00 a.m., and not make anyone any money.

Update: I have finally seen an ad for a drug to treat bipolar 1 mania. Everything else I wrote here remains the same.

 

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