Saturday, January 30, 2016

When Someone Close to You Has Chronic Mental Illness

If you have a spouse, friend, family member, student or colleague who has a serious mental illness, such as schizophrenia, bipolar, major depression, personality disorder, PTSD etc. your life has been impacted to one degree or another. If you’re asking, “what can I do?” read on.

While stigma and misinformation is attached to disease in general, mental illness represents a whole different class of stigmatization with those affected being shunned, blamed, shamed and worse. It’s often kept secret, and when people do know, they’re unsure how to respond and/or are secretly, or not so secretively, judgmental, believing that the person is having such problems because they “brought it on themselves.”

Many people, including health professionals, have limited information about how to help those whose lives are being impacted by mental illness. However, thanks to the Internet, Apps and social media, the isolation is being significantly reduced. In addition, research is identifying causes as well as effective treatments. In fact, just this past week a major breakthrough was announced in schizophrenia- Scientists open the ‘black box’ of schizophrenia with dramatic genetic discovery.

Two caveats to this post: This blog is written for those dealing with any type of chronic condition so checking out other post is recommended, such as Healing the Whole Person: Ways to Increase Well Being, which is equally helpful for those living with a chronic condition and those affected by one. The Wednesday “take a breaks,” are designed to help distress, relax and provide a respite from the worry that can accompany a chronic condition. Use the Take a Break Pinterest board for over 200 ways to do so.

Periodically I find it helpful to remind readers, this is information to consider, recognizing that there is no “one way” that works for all situations.

 In general, serious mental illness has nothing to do with something you or someone else did or didn’t do. It’s not because of a “personal weakness” or “lack of character.”  As with other conditions, mental illness can occur due to a combination of factors such as genetics, environmental stressors, biochemical imbalances etc. For example, the majority of combat veterans do not develop PTSD (post traumatic stress disorder), but among those that do, there are multiple risk factor such as younger age, combat situation, family history of substance abuse, childhood physical abuse etc. That noted, there are those vets with all the “risk” factors who don’t develop it and others with none that do. Those who develop PTSD are not lesser soldiers, people or vets because of it. In some ways it really is the luck of the draw.

Addiction is often an indicator of mental illness. Self-medication with alcohol, marijuana and other drugs is more common than many realize, and when the root issues are dealt with, addiction issues can be more effectively treated. This is a bit of a “chicken and egg situation”-did the person become addicted as a result of an underlying mental illness or did the addiction create the problem? Whatever the case, if a person has a dual diagnosis of mental illness and addiction, they need to be in a program that addresses both.

The good news is that with proper treatment, many people can learn to deal with their condition and lead full and productive lives.

Learn about the various types of mental illnesses and treatments:

If you are a caregiver or significant other (e.g. parent, spouse, sibling) of a person with severe mental illness your role and responsibilities differ than someone who may be a teacher, work colleague or friend. Check out Talk About Mental Health from MentalHealth.Gov, which provides specifics for parents and caregivers, friends and family, educators etc. 

Check out other ways to help

While it can be very obvious that something is wrong, getting the right diagnosis is important in helping the person finding a treatment regiment that will work for them. Unlike cancers and other diseases, where blood markers and changes in cells indicate a diagnosis, it’s not always that straightforward to correctly diagnosis a mental illness. In fact, you may see multiple providers before you find one that can adequately address the issues. You can help by being a strong advocate. Learn more: Health Advocate-Who, What, When and Where 

Keep a health notebook. The health care system is a maze that’s hard to navigate in the best of circumstances and yet information from visits, hospitalizations, treatment failures as well as successes all need to be readily available to see that someone receives appropriate care. The best way to make this happen is by using a health notebook and keeping it updated. Learn more: Managing Health Information: Yours/Theirs 

Compile a directory of resources in your community. The easiest way to identify them is to “Google” the name of your town, city or state + mental health resources. Check out National Association of State Mental Health Program Directories for links to all federal and state mental health programs. States and larger municipalities will have already compiled on line and in print resource lists. You can also call 211 and ask for resources. If the person is a veteran, be sure to contact the local, state and national chapters of Vet organizations, such as the VFW. Don’t overlook community based organizations, such as churches, schools and civic groups, which can be sources of help.

You will want to know about the following at the very least:
• Treatment facilities, including inpatient/outpatient, crises centers, addiction, rehab etc.
• Crises and suicide hotline
• Poison Control Hotline
• Nearest hospitals and which ones have programs that could be of help
• Temporary and long term housing for those with mental illness/addiction
• Therapeutic Communities-Residential treatment programs with a variety of transitional options for people with mental illness/addiction
• Drop in centers
• Disability Rights groups
• Centers for Independent Living
• Legal Aid
• Self help mutual aid groups
• Prescription assistance programs
• Support groups (see more about them below)
• Local chapter of non profit mental illness advocacy organizations, such as Schizophrenia andRelated Disorders Alliance; Depression and Bipolar Support Alliance 
• Organizations that may be relevant to your situation, such as veterans programs

Keep this information in a binder or in a special file on your computer/tablet. When you contact various programs, write down names, dates and other relevant information so that you have a record of which you’ve called, when and outcomes.

Compassion and caring are important, yet each situation is unique and solutions vary. Fear, guilt and hope are big motivators for helping/enabling- “What if,” “If only,” or “It won’t happen again.”

 It’s important to understand the difference and realize there is a fine line between the two. Helping is assisting the person when they are truly unable to do so. Enabling is doing something when they can or should be doing it. Enabling can be very detrimental to both you and the person you want to help. To have a better sense of whether your interactions are helping or enabling answer the following questions:

• Do you often ignore, rationalize or excuse their unacceptable or irrational behavior?
• Do you find yourself resenting the responsibilities you take on?
• Do you consistently put their needs and desires aside of yours? Are you worrying so much that it consumes all your time?
• Do you have trouble expressing your own emotions?
• Do you feel you have been manipulated?
• Do you ever feel fearful that not doing something will cause a blow-up, make the person leave you, or even result in violence, including suicide?
• Do you do anything to keep the peace?
• Do you ever lie to cover their mistakes or to avoid embarrassment?
• Do you consistently assign blame for problems to other people rather than the one who is really responsible?
• Do you continue to offer help when it is never appreciated or acknowledged?
• Do you blame yourself for their behavior/addictions?

If you find that you are answering “yes” to more than one of these questions, even if you list a number of qualifiers to your answer, then you need help in dealing with the situation.

Regardless of how it may feel at times, you are not alone. The anger, fear, frustration, anxiety and despair you may feel are not uncommon. For a multitude of reasons it’s important to connect with others in similar situations. This is not only a good sounding board, but it can help with problem solving, be a source of important information and can even help “reign in” as well as encourage helpful actions.

Check out some of the following websites and apps for ways to connect to others in your situation

NAMI (NationalAlliance on Mental Illness)  is a good place to start. Every state has a chapter where you can attend support groups, learn about available resources etc. NAMI offers a toll free helpline M-F 10 am-6 pm Eastern Time-800-950-NAMI (6264).

NAMI’s AIR (Anonymous, Inspiring, Relatable) App  allows users to anonymously share their stories and receive feedback in the form of social interactions; access information on how to get help; and facilitates personal connections with others who share similar situations. Users are anonymous but not alone.

• Code Blue: Designed for teens with depression or bullying get immediate support.

• PTSD Coach: Developed by the Department of Veterans Affairs’ National Center for PTSD, intended for use by veterans, military personnel, and civilians experiencing symptoms of post-traumatic stress disorder. It provides a self-assessment tool that allows users to track symptoms over time (though it does not clinically diagnose PTSD) as well as tools for managing symptoms. Users can also store contacts for personal support, locate nearby treatment programs, and contact the National Suicide Prevention Hotline quickly in emergencies.

Big White Wall:  Provides safe, anonymous support 24/7 to anyone struggling with a range of common behavioral health issues, or who feels burdened by everyday worries and concerns.

• Operation Reach Out Helps people who are having suicidal thoughts to reassess their thinking and get help. Recommended by followers of @unsuicide, who report that this app has helped in suicidal crises. Developed by the military, but useful to all. Worth a download even if you’re not suicidal. You never know if you might need it.

Prison Talk: The global communications, support and information nexus for inmates’ family and friends. 

The Mothers of Inmates: A support group for the incarcerated and their families, particularly those with mental illness. 


Wednesday, January 27, 2016

Take a Break: Try Animal Tracking

With all the snow on the ground it’s the perfect time of year to go for a walk or snowshoe and be amazed at the animals that travel through your neighborhood. If you live were its warm and sunny, there are still many ways to track animals in sand, dirt, mud etc.

In addition to the guides listed below, it’s helpful to see if your state or region has a specific guide. Googling “Vermont animal track guide” turned up a wonderful resource from VT’s Fish and Wildlife Dept. 

Outdoor Action Guide to Animal Tracking: Based on the workshop at Tom Brown’s Tracking School. 

Not interested in today’s activity? Check out the Take a Break Pinterest for lots of Take a Break ideas. 

Saturday, January 23, 2016

Suffering: How optional is it?

“Pain is inevitable; suffering is optional,” a popular expression that appears in many different places, implies that while we all have pain, it’s how we deal with it that determines the course of our suffering.

Desire, fear and ignorance are often at the core of suffering. The inability to accept things as they are, recognizing that change is a constant, and deep seated fears that reflect themselves in desires that can be unrealistic creates considerable unhappiness for many.

The research indicates that the more chronic the “pain” the more difficult it becomes to ease and stop suffering. Consequently, it’s not uncommon for people affected by chronic conditions to experience anxiety, irritability, anger, fear, depression, frustration, guilt, shame, loneliness, hopelessness and helplessness, all symptoms of suffering.

Viktor Frankl, the psychiatrist who survived the death camps of the Nazi regimen, has written extensively on suffering and even developed a type of psychotherapy to help those dealing with it. He notes “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

In August, Frankl’s book Man’s Search for Meaning was the inspiration for the post Searching for Meaning When You are Chronically Ill. It’s interesting to note that Frankl’s recommendations for easing suffering are quite similar to some of those outlined in Buddhism’s Eight Fold Path that leads to Awakening

Consider the following for reducing or stopping suffering, recognizing that there is no one way that works for everyone.

• Recognize that nothing is permanent and that change is an important part of life. We’re designed to be resilient and we can build on that by maintaining a broad repertoire of possible responses to challenges such as talking, distracting oneself, writing, finding ways to laugh about it, doing something to change the situation, deep breathing, and so on.  

• Accept things as they are. When we are no longer able to change a situation, we are challenged to change ourselves.” Viktor Frankl

• Practice mindfulness.  Mindfulness Based Stress Reduction is one of the few proven therapies that work for chronic pain patients, as well as for many other types of chronic conditions. Frankl practiced aspects of this while imprisoned, as did the prisoner Shukhov in Aleksander Solzhenitsyn’s “One Day in the Life of Ivan Denisovich.” 

• Cut back on news feeds and social media as these venues focus on information, which can unnecessarily increase fear.

Recognize negative thinking and when you are ruminating. Our thoughts have the capacity to make us miserable. The post How to Stop Obsessive Thinking About Illness provides a number of techniques for stopping such thinking.

Find meaning and purpose in your life. As Fankl noted in working in the death camps with inmates it didn’t really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life — daily and hourly. Our answer must consist, not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual. Check out Searching for Meaning When You are Chronically Ill

As to the original question posed by the title of this post, just how optional is suffering? Because there is pain, there is always going to be some type of suffering involved. The extent of it though can be dictated by how we choose to deal with it.  

If there is a meaning in life at all, then there must be a meaning in suffering. Suffering is an ineradicable part of life, even as fate and death. Without suffering and death human life cannot be complete.

The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity — even under the most difficult circumstances — to add a deeper meaning to his life. It may remain brave, dignified and unselfish. Or in the bitter fight for self-preservation he may forget his human dignity and become no more than an animal. Here lies the chance for a man either to make use of or to forgo the opportunities of attaining the moral values that a difficult situation may afford him. And this decides whether he is worthy of his sufferings or not. … Such men are not only in concentration camps. Everywhere man is confronted with fate, with the chance of achieving something through his own suffering. Viktor Frankl

Wednesday, January 20, 2016

Take a Break: Create an Inspiration for Someone to Discover

Stopping by our friend’s house and not finding her home, my husband decided to leave her a token of his visit. He took stones from the driveway and made a heart on her dinning room table, which she thoroughly enjoyed even though she was unsure whom it was from.

 At this time of year in Vermont, after a snowfall, it’s wonderful to see cars with hearts and other signs “mittened” in. Certainly much better than salt drenched cars with “wash me” scrawled into the dirt that are popular during mud season. Before long, some adventurous folks in town will create snow sculptures that just make you stop and smile.

So today’s “take a break” is about creating an inspiration for others to discover in unusual ways and places, without resorting to posting them on Facebook or Twitter. The idea is that people going through their day will stumble upon them and it will make their day just a bit brighter.

• Use objects on a refrigerator door. Sometimes you’ll even find letters and words

• Sand is a great place to build or write a message

• Chalkboards and white boards

• Community boards are just begging for small little notes that are mysteriously posted

• Use a stone and write or draw something on it. Place it in a waiting room, library bookshelf, co-worker’s desk, in-book. The possibilities are endless

Not interested in today’s activity? Check out the Take a Break Pinterest for lots of Take a Break ideas.