Bipolar 2 From Inside and Out

Posts tagged ‘SMI’

Green Flags, for a Change

I recently saw a meme that pointed out the red flags in a relationship, such as getting rid of friends and family; financial control; insisting on knowing whereabouts; gaslighting; intermittent reinforcement; and, of course, physical, sexual, verbal, or emotional abuse.

But the meme went on to say that, just as there are red flags of a bad relationship – one you shouldn’t get into or should get out of – there are green flags that indicate when a relationship is healthy and positive.

I’ve had relationships of both kinds and, although I didn’t recognize them at the time, have learned the hard way to notice and avoid the red flags. But I’ve also learned how to recognize the green flags.

It’s only fair to say that recognizing both red flags and green flags is more difficult when you live with SMI. It clouds your perceptions. It makes it harder to recognize when and why you should get out of a bad relationship and when a new one is a safe space to be in. We doubt ourselves so much that our vision gets clouded.

So, what do I see as the green “go ahead” flags in a relationship? Besides the absence of all the red flags, I mean.

Listening to you is the first one and maybe the most important. Along with that comes validating your perception of reality. It’s a hard thing to find, especially if you and your new partner have disagreements – which all couples do. You can disagree with someone without tearing them down, even if you have an emotional reaction to whatever you’re disagreeing about. It can actually be easier to agree on religion and politics than it is when the topic pushes one of your buttons. Realizing that you disagree but respect and love the person anyway is a hard thing to do and a harder one to say, but it’s important.

It’s also very important to act on what you say and to make your words and actions congruent. This is the very basis of integrity and trust. We’ve all met someone who says one thing and does another. It’s beyond disappointing. In fact, it’s one of the biggest red flags there is. Not being able to rely on your partner to do what they say they’ll do is a breach of trust. To cite one example (not completely at random), there’s the person who says that an open relationship is the ideal but then demeans you when you act on it – the same way they have always done.

Laughter is vital in any relationship. In order to share jokes and laugh with a person, you must be able to relax with them. Trust is involved here, too. You have to be able to trust that the other person won’t use “humor” to attack you, especially in front of other people. Sarcasm directed at you sours the good feelings you may have had. But genuine laughter, whether at a joke, a silly song, or a funny movie, brings people together. If you have SMI, laughter may have been long absent from your life. Getting back the capacity to laugh is a revelation.

Another aspect of a relationship that can be pivotal is understanding each other’s “love language.” This idea comes from a book by Dr. Gary Chapman that was published in 1995, The Five Love Languages. The five languages – ways that people communicate their love – are words of affirmation, quality time, gifts, acts of service, and physical touch. Problems happen when one partner doesn’t speak the same language as the other; for example, when one gives the other literal gifts while the other yearns for time together or physical touch. Figuring out your partner’s love language and adjusting yours to match theirs can be difficult.

Most important, I think, is perseverance. I often say that we could describe ourselves as “The Couple Too Stubborn to Quit.” We’ve been married now for 40 years. We’ve had bad times when we went to couples counseling – more than once. We’ve even tried to work out if each of us could make it if we separated.

So, those are my “green flags” for a relationship: listening, trust, laughter, understanding, and sticking with it. There may be more, and I’d love to hear from you what others you’ve found.

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Mental Health

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Mental Illness or Autism?

The other day I inadvertently created a firestorm on facebook. Someone posted: Question: What makes schizophrenia a mental illness and autism not a mental illness? Answer: Politics, advocacy, and marketing.

I didn’t understand the thrust of the post, so I asked a question: “Are you saying that autism should be classed as a mental illness or that schizophrenia shouldn’t be?”

Then the floodgates open. There were over 100 responses to the post, of which mine was just one. They ranged from “autism is not a mental illness” to “autism is a form of mental illness” to “autism is a developmental disorder” to “schizophrenia and autism are both neurodivergent conditions.” Few, if any, seemed to address the original question of politics, advocacy, and marketing. (I have no knowledge whether any of the responders were medical or other professionals; persons with one or the other diagnosis; or family members of those with the, let’s call them conditions for now.)

Some people responded that the term “mental illness” should not be used, because it was inaccurate, or stigmatizing, or both. They found the phrase “mental illness” offensive. “Mental disease” was suggested as a better alternative, though for the life of me I can’t see much difference between them. To me, “illness” and “disease” mean basically the same thing. One can go down the rabbit hole here. Is MS a condition or an illness or a disease or a disorder? Is a broken leg a condition? It’s certainly not an illness – unless it gets infected – or a disease. Someone said that mental illness implied a permanent condition, rather than a challenge that can be treated. My bipolar disorder can certainly be treated, and is. But it is also a permanent condition.

Some of the phraseology that was most often used to define autism were neurodivergent, neurological condition, developmental disorder, neurological condition that often presents with mental illness like anxiety. But neurodivergent was also used to described schizophrenia, which was sometimes linked to brain anatomy and genetics. Some classed them both as “disorders of the brain.”

Others pointed out societal or functional differences or other definitions – schizophrenia can be used in court for a “diminished capacity defense”; autism is listed in the DSM-V (Diagnostic and Statistical Manual, considered by many the gold standard for definitions and symptoms of mental illnesses); the age of onset for autism is three, or three to 18, while schizophrenia is usually diagnosed at 18 and over, but not always; autism used to be called childhood schizophrenia; schizophrenia is caused by over-pruning of the neurons, which disrupt the normal growth of the brain; ASD could be a result of disruptions in normal brain growth. Someone pointed out that with both autism and schizophrenia, there are different levels of severity.

Various books and articles were cited. Challenging questions were asked: Do those who insist that autism is not a mental illness think having a mental illness is shameful, whereas having autism is not shameful or perhaps is not an illness at all. Others considered treatments: Medications can help with mental illnesses but are not generally prescribed for autism. People with one or the other condition do not qualify for treatment.

And some responses were entirely cryptic: B careful what you wish 4.

But back to the original post. I think the poster was trying to say that the autism community did a better job of spreading the word about the condition and thereby defining it, in this case as not-a-mental-illness.

And it’s true that – whatever you think of them as an organization – Autism Speaks has gotten the word out about autism. They excel at awareness (of themselves as well as autism). They organize huge charity walks. They have numerous TV commercials. Their puzzle piece symbol – again, whatever you think of it – is for many the easily identifiable graphic that says, “autism.”

Mental illness, whatever you prefer to call it, does not have that same kind of presence in the public eye. For one thing, there are so many different conditions that it’s hard to choose one to spotlight. Depression seems to be the condition-du-jour. The conversations around it are that anyone can have it and there is help available, which is all well and good. But the vast majority of these messages come from people who are selling or associated with medications or call-a-therapist lines – money-making operations. Nor do the ads always get depression right, many making it seem like no worse than a mild hangover.

SMI (serious mental illnesses such as bipolar disorder and schizophrenia) are only now entering the public discourse, and again, mainly for advertisements of drug treatments. The ones for schizophrenia seldom discuss any symptoms of the disorder – they just show a happy person playing a guitar or some such desired outcome. They don’t convey much about the condition of schizophrenia, its symptoms, how it affects families, or much of anything else.

As for other psychiatric conditions, there is much silence. PTSD is discussed, but only of the “wounded warrior” variety, not the kind that can result from other traumas. Anorexia/bulimia, OCD, social and generalized anxiety, narcissism, and the whole spectrum of personality disorders get little to no screen time.

There is growing discussion about things society – and especially first responders – should know or do about people with psychiatric conditions, but those are largely at the talking stage and a few pilot projects. When the subject hits TV, it is usually triggered (sorry) by an individual incident and is more likely to involve unorganized protests rather than coordinated efforts to address the larger problem. And at times, it seems that no one is listening.

Especially to the people with “forgotten” mental conditions – those that don’t have drug treatments or celebrity proponents or coordinated responses. It’s not that I think autism doesn’t deserve the attention it gets – though clearly there are more discussions to be had around the subject. I just sometimes despair of getting attention for mental illnesses.

But to go back again to the original post, mental illness and autism are two different things that cannot be easily compared. But it is true that autism, at the moment, has an organization with a loud voice behind it. Mental health, not so much.

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Mental Health

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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.

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Mental Health

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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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Mental Health

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