Tag Archives: mental illness

Someone You Know Is Mentally Ill

etc., family, health, mental health, , , , , , ,


Let’s say you have five people in your family and another five who are close friends. Or four and six – enough to make up ten people in your life, anyway. Statistically speaking, two of those people will experience mental illness at some point in their life. Or the person experiencing mental illness could even be you. The National Association for Mental Illness (NAMI) reports that one in five – or maybe even one in four – people will experience mental illness. That’s 20% to 25% of Americans.

Don’t assume you know who those two people are. Many people with mental illnesses never talk about their difficulties because of the stigma attached to living with a mental disorder. Many others are high-functioning, able to have relationships and work and lead a relatively normal life, especially if they receive proper treatment. 

So, what are we talking about when we talk about “mental illness”?

We’re not talking about the person who straightens pictures and has a neat desk.

We’re not talking about the person who is sad after the death of a pet or grieving after the loss of a loved one.

We’re not talking about the person who is overly bubbly and laughing most of the time.

We’re not talking about the person who always seems to be on a diet, no matter how thin she is.

We’re not talking about the person who has some mood swings.

We’re not talking about the person who’s afraid of spiders and germs.

We are talking about people with serious mental conditions like OCD (Obsessive Compulsive Disorder), major depression, mania, anorexia, bipolar disorder, and anxiety disorder. (There are other psychiatric illnesses, but they are much more rare.)

For harmless habits to be actual mental illnesses, they must persist over time and usually interfere with people’s abilities to accomplish the ordinary tasks of daily living. If a person’s depression lasts for weeks or months (or even years), he may have Major Depressive Disorder. Some of the symptoms are low mood, isolation, feeling hopeless or helpless, and changes in appetite. Of course, all those things happen to most of us at one time or another, but if they last for a long time and keep a person from going out or doing their work, they may be signs of a serious mental illness.

This is not to say that you can diagnose mental illness on your own. A psychiatrist or psychotherapist is needed to tell whether any condition is severe enough to be called a mental illness. And only a doctor can prescribe the medications that can alleviate the symptoms, lessen the effects, and help the person back to stability or mental health.

But if you do have a friend or loved one experiencing mental difficulties – and you probably do – what should you do?

If you are sufficiently close to the person, you could gently express concern and suggest that he might want to tell a doctor what is going on. With an acquaintance, it may be best to simply be understanding and supportive. Don’t be offended when she cancels an outing or can’t make it to a party. Her disorder may be preventing her from going, much as she would like to.

If the person seems to be in danger of harming himself, definitely have a talk with him. Tell him how worried you are and how you’re upset to see him suffering. If the situation warrants, make sure your friend has the number of a suicide hotline or knows that he can call you when he is having excessive bad feelings.

The best thing you can do, though, is to educate yourself about mental illness from reputable sources like NAMI. You’ll find that mental illness is treatable and not likely to lead to violence unless it is very severe. Don’t joke about mental illness. Once I did and it prevented someone with depression from speaking about her condition. Sharing our stories with each other might have brought us both connection and comfort.

Think of a mental illness the way you would think about a physical illness. If a person you know had a broken leg, you wouldn’t ask him to go skiing. If a person you know had cancer, you wouldn’t make jokes about it. If a person you know had the flu, you would understand and might offer to run errands.

Dealing with mental illness is not easy, but it is important. And I assure you, someone you know needs help and support. Think about how you can provide that. Then follow through. It’s often lonely having a mental illness. Do your best to be a good friend. That will help, even if your friend or loved one doesn’t acknowledge it at the time.

 

 

Gaslighting America

government, journalism, social policy, , , ,

Gaslighting appears to be the latest “trend” in emotional abuse. Articles abound on the subject, from definitions of the term to checklists of signs to analysis of the abuser and the abused. I’ve written a number of times about gaslighting, in particular how it relates to mental health.

The next topic that has been appearing under the headline “gaslighting” is whether the American people as a group are being gaslit. Let’s take a look, shall we?

To start with a definition, gaslighting is a form of emotional abuse in which the gaslighter denies the other person’s perception of reality, with the intention or the effect of making that person think that she or he is crazy. There are a number of classic emotional abuse techniques involved such as isolation, projection, dehumanizing, and others. It is usually an intensely personal interaction between two people, though it can also happen when more than one family member “gangs up” on a relative, for example.

But increasingly now it is being said that an entire group – the American people (or some subset of them) – is being gaslit by another group.  Call them the Powers That Be or more familiarly the Government with a capital G.

Let’s take one example, climate change. We know, according to almost every climate scientist, that climate change and global warming exist. Yet the Government has instructed various of its agencies to remove any mention of climate change from their documents and websites.

Is this gaslighting? No. The statements that deny what we know to be happening do not lead us to believe that the Government’s version of reality is true and that we might be crazy. We merely believe that the Government is wrong. These are examples of obfuscations, misstatements, hiding information, or outright lies. But they are not gaslighting.

Take another example of denying reality, statements by politicians. Some of these are untrue (that is, lies), but in many cases, video or audiotapes exist that prove them wrong. Either the politician did not say what she or he claims was said, or has changed stances since the original statement.

Is this gaslighting? No. We either believe the original statement or we believe the new statement. At no point do we consider our beliefs, our perception of reality, to be crazy. We believe either the old statements or the new statements, but they conform with our perception of reality and we resist believing the statement that denies it.

What about general statements about reality? Suppose the Government says the economy is booming, but all you see around you are failing businesses, people out of work, people working multiple jobs to get by, or working people living below the poverty line. The Powers That Be are denying your perception of reality and they usually have statistics to “prove” it.

This may indeed be gaslighting. We are left to wonder which is true – our perception of reality or the Government’s. The Government has an ulterior motive for denying our perception of reality – to put forth their own vision and say that theirs is true and ours is wrong. We might indeed be tempted to doubt the evidence of our own perceptions and wonder: Is that true? Is the economy really in great shape? Maybe I’m mistaken. Maybe I’m crazy to hold the view I do.

The antidote to this kind of gaslighting is to do work that few of us are inclined to or able to do – our own research. Most of us are unequipped to do in-depth research on economic theory and the sociological implications. All we can do is rely on the perceptions of others, perhaps people we consider to be experts or people who share our perception of reality. Support of this kind is one of the ways to defeat gaslighting.

The temptation here is to pinpoint one specific area of the Government – one politician – and claim that he is gaslighting us. I won’t go into specifics because I fervently dislike diagnosis as a distance (https://wp.me/p4e9wS-AT). But let’s say that a politician denies nearly every perception of our reality and calls the people who disagree crazy.

This is only gaslighting if we are tempted to believe that we are crazy. The essence of gaslighting is that the abuser replaces our perception of reality with his or her own. There may be people who disagree with said politician, but few of them are tempted to abandon their own views of reality in favor of his.

I would call what is happening in these cases “attempted gaslighting.” If we do not give in and accept or consider that the other person’s point of view is or might be valid, we cannot be gaslit.

Strength, support, and the light of day are the antidotes to gaslighting. As long as we keep a firm hold on our reality, or belief in our own sanity and the validity of our perceptions, we can resist attempts to gaslight us.

 

What Kids Should Learn About Mental Health

education, etc., health, 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. 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 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 it find help 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.

What’s With All the Crazies? Are They Crazy?

etc., government, journalism, language, mental health, racism, social policy, , , , , , , ,

Yes. Yes, they are.

And no, they’re not.

I say yes, because so many political extremists out there are acting, well, crazy.

And you can define  “crazies” any way you want – alt-right, alt-left (two handy meaning-free terms), in-office, out-of-office, politicians, your Facebook friends, your Uncle Ned, whatever. We’ll just leave out for the moment the tin-foil hat squad.

Whoever your opponents are, there’s more than a fair chance that some of them are acting irrational, delusional – some variety of crazy. Is it crazy to run down peaceful protestors? Yes. Is it crazy to still be battling over the outcome of an election that happened close to a year ago? Yes. Is it crazy to carry rifles in Walmart? Yes. Is it crazy to spend news air time on the First Lady’s shoes? Yes.

Most of all, though, people are acting paranoid. Everyone on the “other” side is out to get us, destroy America, or at least scare the pants off us. Conspiracy theories abound. And nearly all of them are crazy. (I wrote about this a short while ago: http://wp.me/p4e9wS-AH).

And paranoid means crazy, right? (Unless, as the saying goes, “they” are out to get you.)

Well, not actually. “Paranoid” is a clinical term from psychology, and it has a specific meaning: Paranoid Personality Disorder is an actual psychiatric condition, manifested by, among other things, “generally unfounded beliefs, as well as … habits of blame and distrust, [which] might interfere with their ability to form close relationships,” as WebMD says.

Those traits your political or social opponents may have, but most of them don’t also:

  • Read hidden meanings in the innocent remarks or casual looks of others
  • Perceive attacks on their character that are not apparent to others; they generally react with anger and are quick to retaliate
  • Have recurrent suspicions, without reason, that their spouses or lovers are being unfaithful

The fact is that none of us (except perhaps psychiatrists) can diagnose a person as paranoid or any other variety of mentally ill without having met the person and performing detailed interviews and tests (I’ve written about this too: http://wp.me/p4e9Hv-6F).

So, if by “crazy” we mean “mentally ill,” then no, the political and social “crazies” are not “crazy” as a group. Their tweets and posts and dinner table conversation are simply not enough to declare them mentally ill.

This is also true of public figures. We can say that Donald Trump, to choose an example not entirely at random, has narcissistic traits, or is a narcissist in the garden-variety meaning of the word, but we cannot say that he has Narcissistic Personality Disorder, an actual clinical diagnosis. We may think he’s crazy, but we can’t say whether he’s mentally ill.

Our readiness to label people, both our acquaintances and public figures, with loose pseudo-psychiatric terms raises a number of problems, particularly stigma.

Labeling is a convenient way to dismiss a person who disagrees with you without listening to what he or she has to say, or considering the possible validity of an argument or even a statement of fact. He’s a Southerner; of course he’s a racist. She’s a liberal; of course she’s a snowflake. If we can apply a label, we can make an assumption about a person that may or may not be true. (It can also lead us into “Not all X are Y” arguments, which are seldom productive.)

Stigma comes with the label “crazy” or mentally ill. People with diagnosed mental disorders are too often assumed to be violent, out-of-control, homicidal (or suicidal) maniacs – and therefore not worth listening to, despite the fact that their cognitive abilities are generally not impaired.

As for terrorists, they are in common understanding automatically mentally ill, so anyone you label as a terrorist is automatically insane. And we’re far from agreeing who is and is not a terrorist. (Antifa? Greenpeace? The NRA? The DAR?)

So, bottom line. “Those” people may be crazies, may act crazy, talk crazy, believe crazy things, but it is not accurate or helpful to call them crazies. I know I’ll catch hell for this. But I’m not being an apologist for reprehensible behavior.  I just think that how we talk about people affects how we treat them. And that matters.

Now, as for the tin foil hat squad, they’re mostly harmless. Let’s leave them alone.

 

 

 

 

Creative Genius? Are You Crazy?

etc., mental health, , , , , , ,

It is often said that there is a thin line between genius and madness, usually with a further remark about someone who is straddling that line. But do genius and madness really have anything to do with each other?

For a start, let’s use the terms creativity and mental illness. When we talk about genius, we often think of Stephen Hawking or Albert Einstein, geniuses in mathematics and theoretical physics. Or we think of prolific and significant inventors, like Thomas Edison and Elon Musk. And when we talk about mental illness, we usually envision killers – suicide bombers, spree killers, sociopaths, and the like.

Those views are limited, however. Creativity – or creative genius – encompasses art of all kinds. Picasso’s paintings, Johann Sebastian Bach’s music, Frank Lloyd Wright’s architecture, Rodin’s sculptures, and so many others are works of creative genius as well.

Now we come to the intersection of creativity and mental illness.

Emily Dickinson had Social Anxiety Disorder.

And Abraham Lincoln suffered clinical depression. So did Charles Dickens.

Bipolar sufferers include Beethoven, Schumann, and Isaac Newton.

Charles Darwin, Michelangelo, and Nikola Tesla were all obsessive-compulsive.

Autism, dyslexia, and various learning disabilities affected Einstein, Galileo, Mozart, and even General Patton.

And Van Gogh! Let me tell you about Van Gogh. He had epilepsy. Or depression. Or psychotic attacks. Or bipolar disorder. Or possibly some combination thereof. Something, anyway.

They must have been! They were geniuses! And some of them acted crazy! Van Gogh cut his ear off! Surely he was insane!

Well, really, no one can tell if any of those diagnoses is true. None of those greats is known to have undergone psychoanalysis by a real doctor who actually met them. Some of the diagnoses didn’t even exist while the creative geniuses were alive. We make assumptions based on what we know about the famous and what we know of psychiatry – very little, in most cases.

The same is true for famous villains and criminals. Nero was a pyromaniac. Saddam Hussein was a narcissist. The Marquis de Sade was, well, a sadist. Ted Bundy was a sociopath, or a necrophiliac, or had antisocial personality disorder, or, well, something. He was crazy!

(In point of fact, mentally ill persons are much more likely to be victims of violence than to commit violence.)

What do we actually know about creativity and mental illness? Damn little. Get five people in a room and try to get them to agree on a definition of “creativity.” Design a scientific experiment to measure the connection between creativity and mental illness. You can’t do it without a definition of creativity and a list of which mental illnesses or conditions you are studying. And any results would therefore be subjective.

One thing I do know about creativity and mental illness is that creative people can be reluctant to admit their diagnoses for fear of being dismissed as a “crazy artist” or stigmatized. Brilliant glass artist Dale Chihuly only recently revealed that he has had bipolar disorder for years. In an interview with the Associated Press, his wife, Leslie Chihuly, said, “Dale’s a great example of somebody who can have a successful marriage and a successful family life and successful career — and suffer from a really debilitating, chronic disease. That might be helpful for other people.”

Indeed. Many people who have psychiatric diagnoses – or who suspect that they might – are reluctant to seek help. Many believe that taking medications for a mental disorder, in particular, might impede their creative flow. That is, they too are equating their creativity with “madness” and refuse to treat one for fear of losing the other.

In fact – and as a person with bipolar disorder I say this from experience – getting treatment can actually improve a person’s imaginative, creative, or scientific output. Level moods, time not lost to depression, freedom from the pain and fear of worsening symptoms, and other benefits of psychological and medical help can increase the time and the vigor and the passion that a creative person puts into her or his work.

That’s one of the reasons that it’s so important to erase the stigma associated with mental disorders. We could be missing out on the next creative genius.

For Caregivers Everywhere

etc., family, health, mental health, , , , , , , ,

I have bipolar disorder. My husband is my caregiver. He didn’t sign up for this gig when we met, except for later vowing the part about “in sickness and in health” when we married. I could not negotiate life without him. I try to thank him daily.

My mother was my father’s caregiver when he was dying of multiple myeloma. She knew she was doing a good job of taking care of him, but she asked me to tell her that. She needed someone to tell her she was doing it right.

So this is for my husband and my mother, and for caregivers everywhere.

Thank you. Good job. We need you and we know it.

Some of you are unpaid caregivers who help loved ones for the necessity of it, for the obligation of it, or for the love of it. All of you deserve our thanks.

Some caregivers receive pay, and you deserve our thanks, too. There are many other professions or jobs you could be doing, but you chose to help those who needed it most.

All parents are caregivers, but the parents of special needs children are extra special. You share a task and a worth that few others recognize. You didn’t ask for the job, but you step up to it every day.

You work in homes, rehabilitation facilities, hospitals, schools, and group homes. Your work matters more than most people realize. You help not just the sick, but the struggling, the frail, the dying, and the trying.

Respite care workers deserve recognition too. You allow caregivers to continue their work refreshed – give them a space to catch their breath and recharge their spirits. You are caregivers as well.

The care you all give is not easily definable. It involves the physical, spiritual, mental, and emotional needs of the medically, mentally, or emotionally fragile. It provides sustenance, both literal and figurative. It keeps the people you care for going, or helps them lay down their struggles.

Recently I wrote a blog post called “Caregivers Need Care Too,” specifically about people who care for the mentally disturbed (http://wp.me/p4e9Hv-wh). It talked about what caregivers need in return for the attention, care, support, assistance, and love they give.

In it I said that those who care for others need something from those they care for, and from the rest of society. They need appreciation, validation, time away to refresh and re-energize themselves, understanding, support, and recognition. Not all of the people you care for are capable of giving back, for whatever reason.

So, please accept this from me, one who has known caregivers and benefited from caregivers, and loved caregivers. Your work and your devotion do not go unnoticed, Even if the ones you care for are not capable of saying “thank you,” I say it for them.

You are appreciated. You are worthy. You are loved. You are respected. You make a difference. You have value. You are valued. Even if you never hear these words from those you care for, please accept them from me.

I am grateful.

 

 

The Weather Is Not Bipolar. I Am.

etc., language, mental health, , , , , , , , ,

Yeah, I get what you’re saying. The weather changes a lot, and sometimes drastically, so you say it has mood swings. And what’s more associated with mood swings than bipolar disorder?

I know, it’s a metaphor – a shorthand way of comparing things to each other, like comparing a choice to two roads diverging in a yellow wood.

The problem is, there are people on one side of this comparison, and they have a mental disorder. Bipolar literally means a neurochemical disorder of the brain that a person cannot control.It isn’t warmth in December and snow in April. It’s not just a matter of feeling happy one day and sad another. Everyone gets that.

Not everyone has bipolar disorder.

I do.

I have no control over whether I will wake up in the morning eager to get out of bed and start my day, or unable to get out of bed at all. No, you can’t control the weather either, but that’s nothing compared to being able to control your own moods, thoughts, and even actions.

Bipolar disorder, obsessive-compulsive disorder, and other mental disorders are conditions that affect, inhibit, and even ruin people’s lives and relationships. They are not conditions to be made light of, any more than developmental disabilities are. Bipolar is a disorder – a disease, if you will – that can confuse, terrify, and impair you; unsettle, disrupt, and destroy your relationships; shred your memory; take you to the brink of suicide and beyond, if you’re unlucky or untreated.

So, no. Your picky friend probably does not have OCD. OCD is a psychological condition that inhibits a person’s actions based on a complex series of numbers, behaviors, and rituals. It’s lots worse than simply straightening picture frames. Narcissism is not just being vain. Just like high blood pressure is not just someone who avoids salt or diabetic is someone who just avoids sugar. They are medical conditions. We may joke about needing insulin when a new couple overdoes the endearments, but that’s a far cry from really needing insulin. 

Many mental disorders involve neurons and synapses and neurotransmitter chemicals in your brain, and maybe genes. Can you control those by yourself? I thought not. Neither can I.

What I can do is go to a psychiatrist who gives me medications that help control those pesky neurotransmitters. And a psychologist who shares with me ways to cope with the messiness of the life I have to deal with.

And, make no mistake, those professionals and those chemicals do help. They give me more control over my emotions than you have over the weather.

So if you shouldn’t call the weather bipolar or your picky relative OCD, what about public figures? Aren’t they fair game? Can we say, for instance, that Donald Trump is a narcissist? Most likely, yes. Can we say that he has a psychological condition called Narcissistic Personality Disorder? Or Borderline Personality Disorder? Or Sociopathy?

No. The most we might say is that he displays some narcissistic traits, or that he is, in colloquial terms only, narcissistic. But can we diagnose him, say that he has one or another of these psychological conditions? It’s tempting to diagnose from a distance. That’s dangerous. Actual psychological disorders can be diagnosed only by a professional who has actually spoken to the person in question. Anything else is pop psychology and a disservice to the mental health profession. Not to mention a disrespect to people who actually live with those conditions.

I know that psychological terms get tossed around loosely, especially in everyday, colloquial English. I get that they’re shorthand for more complex ideas. Still, it bugs me when someone says weather is bipolar or Trump is a sociopath. I like precision in language. I like it especially when it hits close to home.

What I have is not like the weather. Oh, it comes and goes. But I can’t get away from it just by going indoors. I can’t lessen its effects by putting on or taking off layers of clothing. I can’t turn on the Weather Channel for a prediction of how I will feel later in the week. I can’t move to a place where bipolar is more pleasant.

That would be crazy.

 

 

 

 

Poor? Mentally Ill? Sorry, You’re on Your Own.

etc., government, health, mental health, social policy, , , , , ,

Poverty and mental illness have something in common.

There is a stigma attached to both.

Both are seen as moral failings. If only people tried harder, worked more, improved themselves, they could lift themselves out of poverty. Without relying on anyone else’s help, which would be shameful.

And if only people stopped being so negative, looked on the bright side, smiled more, thought more about others, their positive mental attitude would make all those shrinks and pills unnecessary. They wouldn’t be shooting people with assault rifles and sucking up tax dollars for disability payments, which is shameful.

Society can’t afford poverty and it can’t afford mental illness. Why should we make the effort when the poor and the mentally disturbed don’t?

Why should these two conditions both be associated with such stigma and for such similar reasons? It’s simple. People don’t want to think that poverty or mental illness could happen to them.

The truth, however, is that a vast number of Americans are living one paycheck or one illness away from poverty, and one in four or five Americans will face a mental or emotional disorder at some point in their lives. And they are afraid. So they tell themselves that the conditions only affect Other People. And those people must be stupid or lazy or unmotivated or something, or they wouldn’t be poor or mentally ill in the first place.

And that’s where stigma begins.

And what are the consequences of stigma?

Well, first of all, it means that no one wants to spend money alleviating either condition. If these Other People can’t pull themselves up by their bootstraps and improve, the thinking goes, why should we pay them not to? Job training programs, child care, higher minimum wage, insurance coverage, community mental health centers, treatment programs for addiction, need to be paid for some way, but not with our tax dollars, by God!

And it means we don’t want to look at the Other People for fear of seeing ourselves. Don’t put halfway houses, group homes, unemployment offices, treatment centers, psychiatric hospitals, and other reminders in our neighborhoods. Not In My Backyard!

It’s not just a failure of compassion, though it’s that too. It’s not just a failure of the social “safety net,” though it certainly is that as well. It’s also a failure of the imagination – what would it be like if poverty or mental illness should happen to me? The reality is too unpleasant to think about, so don’t.

And while we’re talking about unpleasant, let’s mention the place where poverty and mental illness intersect – homelessness. Don’t we assume that homeless people are both poor and mentally ill? As such, spending money on them is doubly wasted. Why bother? It’s not like it’s going to help. Poverty, homelessness, and mental illness are incurable, after all. (Unless a person can cure their problems without outside help, of course.)

So what’s my stake in all this? Am I a bleeding-heart liberal do-gooder who wants to cure society’s ills and make us all foot the bill for it?

Well, yeah.

But I’m also living month to month on my income. My husband makes only a bit over minimum wage. We have both, at one time or another during our lives, been on unemployment and/or food stamps. We have no nest egg or emergency fund. It wouldn’t take much in the way of reversals to wipe us out. Even at that, we’re relatively privileged.

And I have a mental illness – bipolar disorder 2. Without insurance, I could not afford to see a psychiatrist, or buy medication (one of mine costs $800 per month), or get inpatient treatment if I ever need it. Right now my condition is moderately well controlled, but if I should suffer a setback, I might not be able to work at all. And there we are, back at poverty.

These two unfortunate conditions – poverty and mental illness – affect me directly, so I can’t look away and say they only happen to Other People. I know that they affect others more severely than they do me, and I don’t know how those people make it through.

But I do know that stigma isn’t helping any of us.

When Your Friend Is Depressed

etc., health, mental health, , , , ,

…And by “depressed,” I mean clinically depressed – the sort that has no apparent reason and lasts for weeks or even months. Your friend is not just sad, but feeling hopeless, helpless, discouraged, defeated. even immobilized. She or he may not want to go anywhere or do anything that used to bring happiness. You may even detect a dullness – called “flat affect” – in the person’s voice, a lack of animation, often combined with monosyllabic responses.

What can you do to help your friend?

At first it may seem like the answer is “not much.” And that’s partly true. What your friend really needs is probably help from a mental health professional and possibly from antidepressant medication.

There are, however a few things you can do to help your friend – and a few things you shouldn’t do, not because they will make your friend’s condition worse, but because they simply won’t help.

Let’s start with the things you can do.

Keep reaching out. Even if your friend doesn’t respond, refuses your invitations or doesn’t show up, know that the simple act of staying in touch says that you like the person even though she’s having a hard time and that you won’t abandon her. Make no mistake, many people will. Even if your friend is unable to respond, when she finally does get some relief from the depression, she will realize and remember who stuck by her during the depths. Surely you can spare a minute or two for a phone call or email a couple of times a month. You may think it won’t make a difference, but it will.

Offer to help with practical matters. If your friend has decided to get professional help, you can make doing that easier. You may not realize it, but the simple acts of getting up, dressed, and out of the house can seem insurmountable to him. Offer to drive him to his appointments or to the pharmacy to pick up his prescriptions. Give him a pill caddy to help him remember to take his meds every day.

Imagine your friend is physically ill. In a way, she is. The depression is a result of a neurochemical imbalance in her brain. What would you do if a friend were recovering from an illness or perhaps surgery, or even the death of a loved one? Bring her a hot meal once in a while or pick up an extra sandwich if you’re getting one for yourself? Offer to do laundry or another household chore? Enlist other friends to help? Pray for her healing and tell her you are doing so? None of this will make your friend magically well, but they can help her through the worst phases of a depressive episode while she’s waiting for medication to take effect (which may take as long as six weeks).

There are also some things that you shouldn’t do for your friend because they simply will not work. Here’s a brief list.

Don’t try to “fix” him. As much as you may care, you do not have the power to make it all better. Trying to do that will only frustrate both of you. Leave your psychological theories and miracle cures at home.

Don’t give “pep talks.” Telling your friend to snap out of it or to smile more or to think of others who have it worse will not alter his brain chemistry for the better. He most likely won’t be able to appreciate jokes and humor, either, even if he did before the depression.

Don’t expect quick results. Clinical depression lasts for weeks or months, or in some cases even years. It’s frustrating to see your friend suffering for that long, but if your friend sees you give up, she may too.

Don’t ignore suicidal talk. Suicide is a real risk for a depressed person, even if he is getting professional help. Most people who kill themselves give warnings – they talk about being better off dead or give away their possessions. Stay with your friend. Make sure he has the number of a suicide hotline. Call his therapist. Take him to an emergency room.

My advice for someone who lives with a depressed person is similar: Do what you can and realize what you can’t do. If you truly care about the person and stick with him or her through the bad times, you may find one day that you have your friend or loved one back – maybe not as good as new, but on the way to getting better.

That’s when you’ll find that all your efforts have been worth it. Helping a depressed friend survive and heal is an accomplishment not to be taken lightly.

The Other Bipolar Disorder

etc., mental health, , , , ,

I have bipolar disorder type 2. This is my story.

First, some background. Bipolar disorder used to be called manic-depressive illness, and many people still know and refer to it that way. The term “bipolar” reflects the concept that there are two extremes to the continuum of mood disorders, and some people swing dramatically from one to the other. According to this definition, clinical depression by itself is “unipolar” – occupying only one end of the spectrum.

Depression is to ordinary grief or sadness as a broken leg is to a splinter. Depression sucks the life from a person, mutes all emotions except misery, denies any possibility of joy or even contentment, makes life seem meaningless or impossible. This is hell.

Mania is to ordinary happiness as diving off a cliff is to diving off a diving board. Mania brings exhilaration, ambition, confidence, abandon, and invincibility, with no brakes. It is hell on wheels.

Oscillating between the two extremes – that’s bipolar disorder, type 1. It is a very serious illness. Left untreated, it can cause destruction of families, careers, and more. It can lead to psychosis or suicide.

The treatments for it are no picnic either. Bipolar disorder that severe often requires hospitalization. If the symptoms can be controlled with medication such as lithium or newer formulations, the patients must have frequent blood tests to assure that the drug is present in the right quantity. Electroshock is also a possibility, especially for deep, drug-resistant depression.

When I was (incorrectly) diagnosed with unipolar depression, I used to wish that I were bipolar, on the theory that at least then I could accomplish something. Boy, was I wrong about that. Plans made in mania never come to fruition. They are started, rethought, abandoned, exchanged for something grander, and ultimately fizzle out when the mania wears off.

My diagnosis actually made some sense at the time, as I never experienced anything like the manic highs. All I got were depressive lows.

This leads us at last to bipolar disorder, type 2. Some people think of bipolar 2 as “Bipolar Lite.” The mood swings are not as extreme, the lows less debilitating, the highs less overwhelming. The person with bipolar 2 stays closer to a baseline of normal mood, but still experiences swings back and forth.

Technically the mini-lows are called dysthymia and the mini-highs are called hypomania. In my case, the lows were just as low as in unipolar depression, but I never got the mini-jags of buoyancy that accompany hypomania. Instead, these feelings, came out sideways – as anxiety.

My brain was still racing with little control but in a different direction. Instead of elation and purpose, I was beset by in worries, fears, and catastrophizing.

One of the difficulties with treating bipolar disorder of either type is trying to find a medication or a combination of medications that will level out the person’s moods. Usually this requires more than one drug, and finding the right mix or cocktail of chemicals takes usually requires more than one drug. It takes a great deal of trial and error. In the meantime, the mood swings continue.

At this point, my bipolar 2 disorder is fairly well controlled on medication. I still have spells of depression, but now they last at most a week, and sometimes just a day or two. Untreated, they could last months or years. I still have anxiety too, but I have the medication I take for that, so that I don’t feel like I’m about to jump out of my own skin.

Most of the time I’m fairly high-functioning. I can write, work, earn a living. I have a great marriage and a number of friends, including some who are closer than family to me. I have never been hospitalized, nor have I had electroshock (though that was a near thing). Before I got my proper diagnosis and treatment, I would have not believed this to be possible. My goal in life was simply to stay out of a psychiatric hospital as long as I could, or at least until I qualified for Social Security Disability.

I’m sharing these experiences with you today because I believe that mental disorders should not be hidden or viewed with shame and horror, as they have been in the past and sometimes still are.

It’s undeniable that there is a stigma associated with having mental illness. Going public with it entails a risk. I’ve seen the fixed-smile-back-away-slowly reaction. I’ve seen sudden turn-arounds in my work performance evaluations. But I’ve also seen the “Me too!” response. There is strength in numbers. As more of us who live with psychiatric conditions talk about it, and share our stories, the more we build understanding and perhaps encourage those who are roller-coastering to seek treatment.

So that’s the nuts and bolts of it: Bipolar disorder type 2 is a mental illness. I have it and live with it every day. I do not go around shooting people or trying to jump off buildings. I take medication for it and know that I will likely have to for the rest of my life. And I’m okay with that. I hope that eventually the rest of the world will be too.