Bipolar 2 From Inside and Out

Posts tagged ‘SMI’

I Don’t Need a “Pep Talk”

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Here’s the thing. Many people, when you mention a problem, feel obliged to help you fix it or fix it for you. When the problem is related to mental illness, though, that can be counterproductive.

The fact is, most serious mental illness can’t be fixed, at least not by a friend or loved one. To try is to invite frustration on the part of the fixer and worse feelings on the part of the fixee.

Some of the worst help we are offered are pep talks, which are meant to be encouraging. Smile more. Keep trying. Other people have it worse. Everyone goes through this.

No, says my stubbornly glitchy brain. Everyone does not go through a major depressive episode. And when I’m having one is not the time I can concentrate on what constitutes “worse.” I can try all I want, but my bipolar disorder isn’t going to just go away. And smiling when I’m ready to cry is a suggestion that denies my perception of reality and encourages me to lie about my feelings.

You can see much of this kind of advice on Facebook, for example. There are always memes that exhort you to look on the sunny side, have a positive mental attitude, or choose to be happy. But it’s easy enough to scroll by them.

These pep talks hurt more when they’re offered in person by someone you know or even love, especially when that person knows you have a mental disorder. You can’t just scroll by someone you love telling you that, in effect, it’s your own fault that you don’t get better.

I know these sentiments are kindly meant (except for the ones that blame you for your own condition). But the reality is that we can’t cure ourselves of SMI by smiling, or jogging, or thinking happy thoughts, or eating turmeric. We can’t cure ourselves at all.

But we can make things better, through therapy and medication, and yes, through some things that are not cures themselves but adjuncts to healing – physical activity, engagement, mindfulness, self-care, and the like. Who knows? Maybe even turmeric.

So, if pep talks don’t work, what can you do instead? What might actually help your friend or loved one? Here are a few suggestions.

Treat the person with mental illness the way you would treat a person with any other illness. I’m not suggesting sympathy cards are appropriate, but a phone call or text message saying you care is usually welcome.

Listen without judgment. Don’t offer advice. If the person opens up to you, respect that. Don’t minimize the problems. If the person doesn’t respond, wait a while and try again.

None of that will “fix” the person, but you know what? Neither will a pep talk. My brain, for one, is simply unable to process them, digs in its metaphoric heels, and says, “Oh, yeah?”

So, what are some things you can say instead of giving a pep talk? Try these.

I’m here for you.

You can always call me.

I’m sorry you’re hurting.

Tell me if you need anything.

Do you need distraction?

Do you need to be alone for a while?

Do you need to talk?

What can I do for you? (The answer may be, “nothing,” but at least you cared enough to ask.)

If you are also suffering from SMI, there is even more you can do. You can say, “I understand how you feel,” and mean it. You can recommend a therapist. You can congratulate the person on any accomplishment, the kind that wouldn’t seem like an accomplishment to anyone else.

In general, stay away from platitudes, feel-good sentiments, and quick fixes – unless you know that the person responds well to that kind of encouragement. They’re too easy to say and too hard to follow through on. Save them for people who are simply having a bad day, not someone who has mental illness.

What Should Medical Students Learn About Mental Illness?

I recently saw a news story reporting that a single medical school, Des Moines (IA) University, has made it mandatory for medical students to learn how to care for patients with mental illness.

Funny. I would have thought that was already happening in medical schools across the country. Apparently not. Although medical schools teach prospective doctors to diagnose mental illness, the article notes, they do not require students to learn how to care for the mentally ill. When the class started in 2018, it was an elective, but it later became a requirement.

The curriculum includes having people in recovery from mental illness, loved ones of patients, and healthcare providers speak to the class. It is hoped that this will combat the stigma that arises from student doctors only seeing mental patients on locked wards when they are in severe crisis.

Of course, confinement on a locked ward is not typical for people with SMI. Many people with bipolar disorder and even schizophrenia, for example, require inpatient treatment only occasionally, spending the majority of their lives receiving treatment, medication, and therapy as outpatients. One wonders if the stigma surrounding mental patients extends to them as well. Do some GPs tend to ignore physical disorders while focusing on the mental ones? It’s fairly well known that doctors sometimes focus on a person’s weight as being the cause of all their symptoms instead of looking for (or testing for) other conditions. Might there be a similar narrowing of focus regarding mental patients?

Looking at the course, the answer may be yes. Interestingly, the main concern in developing the course seems to be that because doctors were so uncomfortable treating psychiatric patients that they focused on the SMI and never diagnosed and treated conditions such as heart disease, hypertension, and other medical problems. Professor Dr. Lisa Streyfeller cites what she calls “really horrifying statistics that folks with severe mental illnesses die on average 15 to 30 years earlier than people who don’t have those illnesses.”

As important as it is that people with SMI receive treatment for their psychiatric conditions, physicians need to be aware that such people have physical needs and illnesses as well. And as encouraging as it is that mental patients themselves, and their loved ones and caregivers, are included in the curriculum, the article made no mention of teaching prospective doctors how to interact with mental patients they encounter in their practices. If such courses do not exist in medical schools other than DMU, where are doctors going to learn how to talk with and understand the many, many patients they will have who suffer with anxiety, depression, mania, anorexia, and the dozens of other diagnoses?

In some communities, first responders such as police and EMS workers are beginning to have mental health practitioners go on “ride-alongs” to help educate emergency personnel on how to handle situations involving the mentally distressed. Classes like the one at DMU (if others existed) could benefit from having students “ride along,” doing internships or rotations with established doctors who treat the physical as well as the mental symptoms of their patients. Perhaps psychiatric rotations in medical schools could include student practice in community or campus mental health centers instead of just locked wards. Perhaps medical schools could involve students in role-plays involving speaking with and treating the mentally ill, the way they sometimes do for prospective doctors’ encounters with terminal patients.

With NAMI reporting that 1 in 5 U.S. adults – 20% – experience mental illness each year and that
1 in 25 U.S. adults – 4% – experience serious mental illness each year, the odds are overwhelming that future doctors will need to learn how to treat patients both physically and mentally, as well as simply on a human level.

Here’s hoping that the DMU model class idea spreads – and that medical school education on mental health someday will be covered more thoroughly than a single class and a visit to the locked ward.

 

Reference:

DMU Becomes First Medical School to Require Mental Health Course for Students

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