Monthly Mix – March

Revenge of Eve

Revenge of Eve is kicking off a monthly mix including her affirmations and Wednesday words of the day.  I’m going to join in the fun, so here we go!

When you combine an ailurophile brother and a guinea-pig-o-phile sister (aka me) and their familes, you get quite the assemblage of little critters.  Twies the cat boldly roams around looking for things to chew, from bamboo to aglets.  The guinea pigs are far less brave and prefer to snuggle under their fleecy blanket, which is their most valuable possession.  After a nice visit with everyone on their best behaviour, the critters are all worthy of some yummy treats.

Twies the cat sitting in a laundry basketthe guinea pigs  begging for food

Journalling update

 

I first started journalling a little over 2 months ago, and I’m still loving it.  The small notebook I started with just didn’t have enough room to hold all that I wanted to cram in, so now I’ve got two notebooks on the go.  I found it was easiest to do a lot of day-to-day tracking in the smartphone apps I was already using, so I settled on a monthly calendar with symbols coding for important things that I want an easy at-a-glance view of.  These symbols look absolutely ridiculous because I can barely draw a straight line, but it’s working for me.  The monthly calendar and my 365 days of gratitude section are in my first notebook, which just seemed easier to keep up than to transfer everything over to my second notebook.  I also have pages for weekly summaries, including major events, goals, self-care, meditation topics, and challenges.  I am very non-artistic, so I rely on colored pens and stickers to bring some aesthetic value to the whole undertaking.

Initially I had intended to keep my journal pretty positive-focused, but as I’ve progressed I’ve ended up including a lot more related to the hard stuff  I’m working on.  I have pages set up with headings, and then add stuff to those pages as it comes along.

Some of my positive-focused page headings and lists:

  • things that make me smile
  • accomplishments
  • inspirational quotes
  • goals
  • affirmations
  • self-care favorites
  • the kindness of others
  • my values
  • favorite foods
  • places I want to travel to
  • great analogies
  • favorite words
  • things that make me feel beautiful/sexy/confident

There’s stuff to do with my illness:

  • current treatment plan
  • treatment options to consider
  • my treatment history
  • my illness symptom history
  • treatment provider visits
  • essential elements that would be part of recovery
  • what I’ve learned/gained from my illness

Then there’s lots of therapy kind of stuff:

  • skills I’m working on and outcomes of practicing them
  • checking my misinterpretations
  • insights from meditating on various topics
  • recognizing the use of avoidance
  • identifying cognitive distortions

It’s very different from the free-flow narrative style that I’ve sometimes used in the past, but I’m liking it.  Every day I go through both of the journals I’ve got on the go to see where I might have things to add.  An unexpected benefit of this has been that I get reminded each day of the work I’ve already done and the positive stuff I’ve come up with.  I think there’s a lot of value in that, and this sort of structure works well for me.

Do you journal?  And has your approach to journalling evolved over time?

Profiles in tremendousness: The uncommon sense edition

The Daily Show Profiles in Tremendousness screenshot

In the Profiles in Tremendousness series, I borrow an idea from the Daily Show with Trevor Noah to celebrate the best of the worst in mental health care.  In this edition, I’ll take a look at some of the weird shit that’s gone on in places where I’ve worked, proving yet again that common sense really isn’t very common.

I used to work for a short-term crisis intervention outreach team.  Because we were rarely in the office, each day the main office phone line was forwarded to one of the team clinicians’ cell phone.  Then the powers that be decided they were going to transition this program into part of a new psychiatric urgent care centre they were starting up.  Because the secretary would be answering phone calls that came into the urgent care centre, they wanted her to get practice on the phones ahead of time.  So they decided to have her answer the phones for the crisis intervention team, even though 90% of the time there would be no clinical staff around for her to transfer the calls to.  I brought up how potentially dangerous this was; what if a client called experiencing suicidal ideation?  This was pretty realistic given that we were, after all, a crisis intervention team.  Was the secretary supposed to talk the client through it?   My email to the team was met with a derisive response from management that dismissed my concerns (and me in general, for that matter) as entirely unreasonable.  So I guess it was supposed to be up to the secretary to help out people in crisis…  Why not, right?!?

So, confidentiality.  It matters.  But at place I’ve worked, there is a pervasive lack of understanding of where and when confidentiality applies.  They are mad for initials, to the point of utter insanity.  In emails and in client charts, staff are regularly referred to by their initials; no one ever stops to think that not only do staff not require confidentiality, but quite the opposite; staff are responsible for the care they provide and if things ever went sideways it would be crucial that the staff involved be identifiable.  Also, staff will use a client’s initials when documenting in that same client’s chart.  I asked some coworkers about this once, because it’s completely ridiculous; the client’s name is firmly, permanently attached to their own medical record, and it’s asinine to think there’s a “confidentiality” issue using the client’s name in their own chart.  All these coworkers could come up with was that they’d been told it was necessary in case the medical record was ever subpoenaed.  Great, so the management who should really know better are spreading idiocy en masse.

Now, I could rant at length about this photo, but instead I’m just going to let it talk for itself.

IMG_0474

Interestingly enough, this is a “recovery program”, although apparently management thinks I’m just too darn recovery-oriented.  I told management that I believe clients are the experts in what they are experiencing…  Gasp!  Well, that’s just not acceptable!  After all, we’re the nurses who know best, and who are they?! …  I believe in empowering clients….  Gasp!  No, they need us to tell them what to do!  …  If a client asks for a prn medication, including a benzo, and I think it’s appropriate because they’re experiencing distress, then Im going to give it…  Gasp!  No, we don’t give benzos here! …  But the client has a doctor’s order for it …  Gasp!  But you still shouldn’t give it!  Benzos are bad!

The non-recovery recovery approach leaves me frequently shaking my head.. Clients are regularly discharged to places they don’t want to go, including cities they don’t want to live in, because “the team” decides that’s what’s most appropriate.  There are arbitrary rules galore, and if a client isn’t falling into line, they meet with “the team”, which from what I can gather is like the bloody Spanish Inquisition: a roomful of “the team” stacked up against a defenceless client.

If I sound bitter, it’s probably because I am.  This kind of insanity is everywhere, but it really runs rampant at one of the places I work now.  Unfortunately a change of job isn’t feasible right now for a number of reasons, so all I can do is soldier on.  And maybe try to find a little humour in it wherever I can.

The neurobiology of traumatic fight/flight/freeze

purple-hued image of a brain

A couple of years ago I was thinking about applying for a nursing job with a sexual assault support team, so I decided to learn more about the body’s response to trauma such as sexual assault.  What I found out was really interesting, and it’s been brought to mind lately reading about fellow bloggers’ experiences of sexual assault, so I thought I’d share.

The amygdala is a primitive part of the brain that processes emotional reactions and memories related to threats.  The amygdala automatically reacts to rape as though it is potentially life-threatening, regardless of whether the perpetrator is known to the victim or not.  It then triggers what’s known as the hypothalamic-pituitary-adrenal axis to release a rush of hormones, including cortisol, norepinephrine, endogenous opioids, and oxytocin.

The prefrontal cortex, the most evolutionarily advanced part of the brain, takes a backseat when the amygdala starts going full-throttle.  Norepinephrine starts flooding the prefrontal cortex, and logical reasoning, rational decision-making, and higher-level regulation of thoughts and emotions all go right out the window.

The body naturally makes its own opioids, including endorphins.  In threatening situations, the amygdala triggers the release of these opioids, which makes sense if you’re a caveman running from a tiger and you don’t want pain slowing you down.  This also tends to flatten people’s affect (facial expression of emotions) for several days, which might seem curious to those that think that a victim “should” have a visible emotional reaction to the trauma they’ve just experienced.

Oxytocin tends to be known for its role in pregnancy and mother-infant bonding, but it also functions to counteract pain.  It is released as part of the hormone soup of trauma, and one of the odd effects is that it can cause victims to laugh while recounting the traumatic events.

The freeze part of the fight-flight-freeze response is impacted by cortisol and the simultaneous activation of both the sympathetic and parasympathetic nervous system.  One source I looked at said up to 50% of rape victims (particularly if they’ve had a previous assault) experience what’s called “tonic immobility”, which involves muscle paralysis while maintaining awareness.  Another source said that this happens in up to 85% of victims.

There is also an effect called “critical incident amnesia”  This begins to improve after the first night of sleep post-incident, but it is only after the second night of sleep that all of those memories become fully accessible.  Alcohol can impair the encoding of contextual details of memory, but sensory information still gets encoded (particularly smell due to the location of the olfactory bulb).  Those sensory details can serve as a gateway to access memories of the event.

Society has so many expectations of how people “should” look/feel/act.  People think that they can predict how someone “should” “rationally” react to trauma.  But that caveman amygdala has been around a heck of a lot longer than all these “shoulds” and rationality, and when it’s in the driver’s seat, it’s doing its own thing.  What people “should” do, including police and judges, is educate themselves.

 

Image credit: sbtlneet on Pixabay

TED Talks on depression and suicide

TED Talks logo

Somehow, the folks at TED manage to gather amazing individuals with powerful voices to speak up about difficult topics.  Here are some talks related to depression that grabbed me.

 

Nikki Webber Allen: Don’t Suffer Your Depression in Silence

When  Nikki Webber Allen was first diagnosed with depression, she didn’t tell anyone, because “I didn’t think I had the right to be depressed.”  She attempted to self-medicate through high achievement.  It wasn’t until her nephew, who she hadn’t known was depressed, died by suicide that she decided to share her story.

 

Andrew Solomon: Depression, The Secret We Share

Andrew Solomon described depression as something “braided so deep into us there was no separating it from our character or personality”.  He observed that depression makes it seem like a veil of happiness has been removed from the world so that the depressing truth is made visible.  He described the current state of treatment as “appalling”.

 

Kevin Breel: Confessions of a Depressed Comic

Kevin Breel points out that depression often happens to people who don’t seem like they should be depressed.  He spoke passionately about the silencing effect of stigma, and the need to shatter that silence.  He described depression as society’s deep cut that we simply slap a bandaid on.

 

Sherwin Nuland: How Electroshock Therapy Changed My Life

Sherwin Nuland shared how his life was saved by ECT in the 1970’s.  At that time, most of his doctors had identified a lobotomy as the only option, and it was a medical resident that actually pushed for ECT.  After 20 treatments he’d experienced a significant response and finally was able to feel hope.  He came up with safe words to manage obsessive thoughts, and I think they’re just perfect: “Ah, fuck it”.

 

Kevin Briggs: The Bridge Between Suicide and Life

Kevin Briggs worked for many years for California Highway Patrol, and was often called to suicide attempters on the Golden Gate Bridge.  He was struck by how well people responded to being listened to.  He sends a strong message that there is hope, and suicide is preventable.

 

JD Schramm: Break the Silence For Suicide Attempt Survivors

In this short talk, JD Schramm addresses the taboos around suicide that silence and isolate people.  He brings up some disturbing statistics, and issues a call to speak up about suicide and provide resources to those who have survived suicide attempts.

 

Have you seen any TED Talks that you would consider must-see?

My fav – animal!

What's your favorite tag

What's your favorite animal?

It’s What’s Your Favorite #wyf day over at Revenge of Eve.  Today’s theme is fav animal.  This is a no-brainer for me.  I’m crazy guinea pig lady, with five little balls of fur that rock my world.  I’m temporarily distracted by the family of woodpeckers roosting on my balcony, but guinea pigs will always be #1

Cookie, Oreo, and Casper begging for food

When they want food, the girls stick their faces out the cage door and make loud squeaking noises.

Squeaky sitting on top of Zippy

Double-decker stack of guinea pig boys.

 

Guidelines 4 #wyf:

  • Title your post My Fav!
  • Give your answer to your favorite and why it is so.
  • Link to Monday’s, What’s YourFavorite? post for pingbacks
  • Use the hashtag #wyf

My self-care box

my self-care box

I’ve seen other bloggers talk about having a self-care box (also referred to as a coping box or various other names), and I decided I want to give it a go myself.  I decided to make it small and easily portable, because it’s when I’m away from home that I feel the most lost in episodes of crisis.  My hope is that this little box of goodies will make it a little easier.

Here’s what I decided to include in my box:

  • The box itself: It’s cute, red, and heart-shaped
  • Cozy socks:  I tend to have cold feet, so I love the feel of warm, soft, fuzzy socks
  • Avocado and clay face mask: This won’t always be useful when out and about, but could be nice on those occasions when I hide out in a bathroom to cry.
  • Mini jigsaw puzzle:  The puzzle itself can be a nice distraction, but the best part is the pieces are made from cedar wood, so it smells amazing.
  • Quatchi: This little guy was one of the mascots for the 2010 Winter Olympics in Vancouver. Quatchi  is soft and cute, and I have good memories associated with that time.
  • Strawberry lip balm: This smells and feels nice.
  • Photos:  Several photos of positive things, including some guinea pigs and childhood pics.

Do you have a self-care box?  If so, what do you have in it?

Liebster and Versatile Blogger Awards

Liebster Award nomination badgeversatileblogger3

It truly warms my heart to be recognized by fellow bloggers.  Love you guys!!!  LivinglifewithmentalhealthBipolar – Notice Me Aliens, and A Guy Called Bloke nominated me for the Liebster Award, and Life With an Illness and The Jessica Effect nominated me for the Versatile Blogger Award.  If you aren’t already familiar with these blogs, definitely check them out, because they’re fabulous.

These awards are a fun way to get to know each other and also to spread the love around.  I’ve picked as nominees people that I haven’t nominated for awards before (at least according to my all-knowing blogging spreadsheet), and hopefully I can give you some ideas of cool new blogs to follow.  For those I’ve nominated, please don’t feel obligated to do an award post, or take your sweet time doing one…  I know they can be time-consuming!  Oh, and if you’ve already been nominated for the one that I’ve nominated you for, please feel free to switch your nomination over to the other award.  As you can probably guess from the alphabetical order, no thought went into which award to nominate you for 😉

So, time to dive right in.

Liebster Award

“The Liebster Award is an award for bloggers that is given by other bloggers. It exists only on the internet and gives recognition and exposure to new and promising blogs. Liebster is a German word that means sweetest, kindest, nicest, dearest, beloved, lovely, kind, pleasant, valued, cute, endearing, and welcome. The winner is chosen and awarded at the end of each year.”

The official rules of the award are as follows:

  • Acknowledge the blogger who nominated you and display the award logo.
  • Answer 11 questions that the blogger gives you.
  • Nominate 11 blogs that you think are deserving of the award.
  • Create 11 questions for your nominees to answer.
  • Let the bloggers know of their nomination!

 

Questions from Livinglifewithmentalhealth:

  1. When you are old, what do you think children will ask you to tell stories about?  When I’m old I dream of having a farm with a bunch of  critters, so kids will want stories about the critters.
  2. What animal would be cutest if scaled down to the size of a cat? A komodo dragon.  That’s not actually the cutest, but it just popped into my mind.
  3. What weird food combinations do you really enjoy? I’m sure there are a few, but what’s jumping to mind isn’t actually a food combination, but a combination of pancakes and cold temperature.  I love cold pancakes.
  4. What are some red flags to watch out for in daily life? Guinea pigs who aren’t interested in food.  Huge red flag.
  5. If your job gave you a surprise three day paid break to rest and recuperate, what would you do with those three days? Chill out at home.
  6. What’s the most creative use of emojis you’ve ever seen? I’m a bit baffled by emojis beyond the basic ones.
  7. What “old person” things do you do?  Go to bed by 8pm.
  8. What’s something you really resent paying for?  Parking.
  9. What riddles do you know? None that I can think of.
  10. If someone narrated your life, who would you want to be the narrator? Sean Connery because he has a cool voice.
  11. If you were moving to another country, but could only pack one carry-on sized bag, what would you pack? Laptop, passport, wallet, pills.

 

Questions from Bipolar – Notice Me Aliens

  1. What is your favorite hobby/passion? Probably travelling.
  2. How many languages can you speak?  Just English, but any time I travel I learn a handful of words in the local language.
  3.  You like animals?  Yes!!!!!!
  4. You ever play a videogame? If yes what is your favourite?  I haven’t played video games since I was a kid, at which point I liked Legend of Zelda (or whatever it was called).
  5. You have any piercing?  I have both ears pierced, but don’t actually wear earrings that often any more.
  6. You have any tattoo? I have 3.  My favorite is a large phoenix tattoo.
  7. The last book you have read? The Introvert Advantage.
  8. Your goals/dreams for the future? Do more travelling.  Find a job I like (same career, just different job).
  9. What you think about the “stigma” to mental illness?
  10. Favourite flavor of pizza?  “Canadian”, i.e. pepperoni, bacon, and mushroom
  11. Morning or night? Morning morning morning

 

Questions from A Guy Called Bloke:

  1. What’s the funniest thing that has ever happened to you?
  2. Do you own a pet if so, what? I have 5 guinea pigs, which may officially make me a crazy guinea pig lady.
  3. What is your favourite game – this can be old fashioned board games all the way up to current? Colonel Mustard with a rope in the dining room… Clue!
  4. Have you ever had to make a decision that you didn’t like? Discuss if you wish or simply answer Yes/No?  Yes.  Quit my job or continue to be bullied.
  5. What animal would be cutest if scaled down to the size of a guinea pig?  It doesn’t get any cuter than a guinea pig, so that’s that.
  6. What movie can you watch over and over without ever getting tired of? Dirty Dancing.  Patrick Swayze just keeps getting sexier and sexier every time.
  7. Where are some unusual places you’ve been?  Riding on horseback and staying in a yurt in Kyrgyzstan.
  8. Do you think that aliens exist? I think the chances of Earth being the only planet with life are very slim.
  9. What mythical creature do you wish actually existed? A unicorn.  and I would braid purple ribbons in its hair.
  10. Which of your teachers at school resembled the dragon or a dragon? Who is the dragon?  I feel like I’m missing something….  But my grade 6 teacher was Maori and he struck me as a warrior-like individual who could kick some dragon ass.
  11. If magic was real, what spell would you try to learn first?  Making icky people disappear.

 

My nominees:

I like the questions that were posed to me, so for my nominees I say pick at random from the 33 questions above.


Versatile Blogger Award

The rules are simple:

  • Give 8 interesting facts about yourself.
  • Nominate few versatile bloggers and you’re done.

Facts about me:

  1. I have one grandparent still living: my grandma, who is 101 years old.
  2. Longevity runs in the family, and I have little hope of dying of natural causes before I’m 90.
  3. I’m thinking about getting a new tattoo of a Celtic oak tree design.
  4. I’m a notorious plant killer but I have 2 happy prayer plants in my bedroom.
  5. Bedtime is often my favorite time of day.
  6. At this moment I can see my iron sitting in my closet, and realize that it has been several years since I last used it.
  7. I have cold feet so I prefer to wear socks even in the summer.
  8. I’m glad that I’m part Arabic, because it means I tend to tan rather than sunburn.

 

My nominees:

 

So, there you have it!  Thanks again to LivinglifewithmentalhealthBipolar – Notice Me Aliens,  A Guy Called Bloke, Life With an Illness, and The Jessica Effect for the nominations.  Please have a  look at these blogs and the blogs I’ve nominated…. they’re well worth a read!

Weekend wrap-up

wrapping paper, ribbon, and twine

Last week was the best week I’ve had in a while, and it’s odd what that can stir up.  I have a poor emotional memory, so I wonder was I just making it up that I was feeling shitty before?  But at the same time I’m also reluctant to let myself believe that things are actually getting better, because I’m always expecting to be hit by the crazy train.  This week was a dip compared to last week, but it was manageable.  Here’s a look at what happened in my world this week:

  • I saw clients for my non-mental health nursing job four days this week; this involved seeing them in their homes to teach them how to self-inject medication.  I was feeling kind of scattered, and there were multiple occasions when I’d start saying something, lose my train of thought, and not be able to find it again.  I know I’m doing the best I can, but my confidence really takes a hit when that happens.
  • My tummy hasn’t been that happy and I’ve been kind of bloated, which has fed into some body-hating moments.
  • I began the process of tackling my trauma through the creation of a trauma account, with the goal being to identify and peel apart the thoughts and emotions and put them into a coherent narrative of the events associated with the trauma.  I’ve done 2 writing sessions so far, and while it’s tough, I think it’s going to be productive.
  • My mood has been lower than last week, I’ve been anxious, and I’ve felt more tired and physically tense.
  • I’ve done a fair bit of writing this week, which has been good, but I’ve got a few pieces that I’ve been working on for a while that just aren’t getting finished, and that’s a bit frustrating.
  • A couple months ago I had a meltdown and walked out of a suicide awareness presentation I was doing in a high school class.  At the time I’d emailed the community service agency that arranges these presentations to say I was done, and then I didn’t respond to their attempts to contact me.  Yesterday I got a letter from them that sounded rather condescending, saying that suicide was a difficult thing to talk about and maybe I would like to do the presentations they have on other topics instead.  They said the letter was not intended to be negative (if you feel the need to throw that in, to me that’s a pretty strong indicator that it’s not true).  Anyway, it made me feel shitty, and I resent that they felt the need to send this stupid letter.

How has your week been?

Botox update

Forehead frown lines

Around 5 weeks ago, I blogged about deciding to get Botox injections in my forehead to hopefully help in the management of my depression.  I got the first injections at that time, and then got round two a couple of weeks later, for a total dose of 29 units, which was the amount used in the research studies that shown that Botox can have a beneficial effect on depressive symptoms.  The Botox was injected into the frown line areas, and the idea is to block the feedback loop of frowning reinforcing negative mood.  For anyone who’s curious, botulinum toxin comes from the Clostridium botulinum bacteria and acts at the neuromuscular junction to cause muscle paralysis.  Besides cosmetic use, it’s used for a number of different muscular disorders, hyperhidrosis (excessive sweating), and the in the prevention of migraine headaches.  Effects are expected to last 3-4 months, although in the studies for depression the beneficial effect was found to last even longer.

It takes about 2 days to start noticing the effects of Botox injections, and 2 weeks to get the full effect.  I would describe the feeling as numb but not numb.  It feels numb much the same way as if your mouth was numb after going to the dentist and you couldn’t move the area.  When I try to move the muscles in my forehead, I get that same sort of numb feeling.  It’s not numb to sensory input, though, so I still feel touch, pressure, temperature, and other sensations.

What I’ve really noticed is how often I was frowning before.  Because I get that numb sort of feeling when I try to move my forehead, I notice when my face is trying to frown. And it happens often, far more often than I would have guessed.  In terms of outward appearance, when I try frown there are some little crinkles visible above the outer half of each eyebrow, but that’s it.  When I raise my eyebrows in a surprised sort of expression, there’s limited movement, but one eyebrow raises more than the other one, a fun little quirk that my naturopathic doctors said she could fix but I actually kind of like.

So, is it helping with my mood?  I’ll say a cautious maybe.  I’m still having bad days and I have no resilience when it comes to situational stressors, but looking at my mood tracking app there has been a bit of an improvement over the last couple of weeks.  It’s always hard to know what’s causing what, and there are probably other things that are helping, like the approach of spring probably and some more positive interpersonal interactions.

I’ll probably never really know for sure what effect if any the Botox is having, but I do like the idea that it’s getting in the way all the frowning I was apparently doing before.  And at this point I’m willing to do pretty much anything, even if it’s only having a small impact.

 

Images from Botox Cosmetic

Spreading your writing wings

duck

So, you’re loving writing your own blog but you’re looking to try something new and expand further out into the world?  Well, there’s actually a lot of opportunities to do just that, so I thought I’d share with you what I’ve been able to find.

Guest posts

There are lots of sites that publish guest posts related to mental health; some are looking for your personal stories, while others are open to writing focused on various mental health topics.  There are blogs on WordPress where you can do this, but here I’m going to focus on sites outside of WordPress.  My impression is that you don’t have to be an experienced blogger or have lots of followers to get a guest post published; what matters is writing something that will resonate with people.

  • American Foundation for Suicide Prevention – Lifesavers Blog: publishes posts that educate people about suicide and convey hope/healing/resilience
  • Bring Change to Mind: share your personal story in writing or on video
  • Buddy Project: share your story as part of the You Are Not Alone campaign
  • Defying Mental Illness: share your story in the form of a loosely structured interview
  • Healthable; accepts articles on a variety of topics
  • I am 1 in 4: tell your story; prompts are provided to help give you ideas
  • Mental Health Matters: informative posts related to mental health.  They’ve just published an article I wrote about supplements for depression that are supported by research evidence.
  • Mental Health Talk: share your story and become one of their Superhero bloggers
  • The Mighty:  The Mighty is a very popular site with some amazing content.  I haven’t felt confident enough to submit an article to them yet, but it is a goal of mine.
  • Mind: This UK-based mental health charity gives you the opportunity to share your story on their site, and offers lots of guidance on how to go about it and what to write about.
  • Mind Body Green: they’re looking for articles related to wellness
  • National Alliance on Mental Illness (NAMI): share personal stories
  • NoStigmas: share your voice in the fight against stigma
  • OC87 Recovery Diaries: share your mental health recovery story
  • Outrun the Stigma: looking for personal stories, and provides prompts to guide you
  • Pick the Brain: welcomes posts on self-improvement for their community blog
  • Respect Yourself: publishes guest blog posts related to mental wellness in youth.  They published a post I submitted on youth suicide prevention.
  • SANE: this UK-based mental health charity has monthly blogging themes
  • #SickNotWeak: tell your story
  • Stamp Out Stigma: share your story
  • Stigma Fighters: share you personal story.  They published a story I submitted about experiencing stigma in the workplace.
  • This Is My Brave: share your recovery journey in written or video form
  • Time to Change: publishes personal stories geared to the general public with an aim of changing people’s views of mental illness.  They published a story I submitted for their #Inyourcorner campaign about how a friend with mental illness and I supported each other.

Other ideas

  • Feedspot: The cool thing about Feedspot is they do ranking lists, including a top 60 mental health blogs list.  When I submitted my blog to their directory a few months ago they offered to feature my blog if I paid them (which I didn’t do), but then this month I ended up on their top 60 list (I’m not really sure what the criteria are for this, but presumably you need to have submitted your blog to them).
  • Psych Central: Psych Central has a lot of great content of their own, but they also have a resource directory that includes links to mental health blogs that have been submitted.

It’s easy to stay in my comfort zone and write for my own blog, but I’m glad that I’ve pushed myself to try new things   There’s a fear of rejection that goes along with submitting a guest blog, but that’s probably good practice.  Hopefully it will help move me forward towards my goal of submitting more work to academic journals.  And really, any excuse to write is a good thing.

 

Image credit:  John Fowler on Unsplash

Why is Netflix jumping aboard the stigma train?

Netflix Take Your Pills

Sigh.  This again?  I’ve written before about documentaries that portray psychiatric medications in a problematic way that tends to promote stigma (A Prescription For Murder and Stigma and the Pathologization of Normal).  Now Netflix has come out with Take Your Pills, which looks at the use of stimulant drugs like Adderall and Ritalin for mental performance enhancement.

I started watching this documentary and gave up in disgust.  But after I read a critique by Mental Health: Let’s Stamp Out the Stigma, I decided it was important to speak up about it, and to do that I thought it was important to give it another go and watch the whole thing.  While a somewhat more balance perspective was conveyed when I watched the film in its entirety, I was still left with a lot of concerns.

The documentary describes psychostimulants as a tool for cognitive enhancement, enabling people to get an academic or career edge, get higher grades, perform in a way they perceive as ideal (particularly in the tech and finance sectors), do more detail-oriented work, and control weight.  Medications like Adderall are described as enabling people to “get to perfect” or be “jolted back to life”.  One psychologist says that these medications prime people to to expect that a pill will give them what they want.  A researcher who was interviewed jumped on the bandwagon, saying he’d tried Ritalin once and it felt like “such an enhancement of my day; it was a good experience”, something it strikes me as irresponsible to say when being interviewed as an expert on the topic.

A university student said that her parents told her she should get a lockbox for her stimulant medication.  “It’s RX gold” she said, adding “I don’t think I know anyone who’s prescribed it who doesn’t sell a little on the side”, and “everybody takes Adderall.”  One male interviewed said that as a millennial who went to a great college and worked in finance, “it’s impossible to avoid stimulants”, and loopholes would be found and taken advantage of in order to obtain them.

Taking stimulants to be more productive was documented as early as the “pep pills” of the 1930’s.  ADHD was described as something that developed out of the marketing of stimulant medications as a way to improve children’s behaviour and grades.  The documentary explains that more children are diagnosed with ADHD in the United States than in any other country in the world, and the majority of them are medicated.  The implication was that ADHD was a mostly artificial condition created by drug companies’ marketing campaigns.  This is certainly not the first time I’ve seen this logical fallacy; misleading advertising does not invalidate the medical condition just because they falsely suggest that everyone suffers from it.

Serious side effects such as addiction are mentioned but the film doesn’t do a good job of contextualizing this as an individual risk vs benefit decision.  A political theorist interviewed suggested that stimulants blunt the human experience and creativity (I’ll just say that a PhD in one field does not qualify someone to speak as a subject expert on an unrelated field).  One student believed her stimulant medication made her more boring and angrier.  These examples provide a very limited context by which to judge the appropriateness of these medications.

A psychotherapist featured in the film said that “just like opiate painkillers are heroin in a pill, ADHD medicine is a very small dose of meth in a pill.”  A psychologist suggested that as a society we make a false distinction between licit amphetamines and illicit methamphetamine, and pointed out the chemical similarity of prescription amphetamines and illicit methamphetamine (which has an added methyl group consisting of 1 carbon and 3 hydrogen atoms).  To me this was an astonishing display of ignorance from someone whose doctorate in psychology doesn’t necessarily necessarily confer expertise in medicinal chemistry.  You know what also differs by a single methyl group?  The ethanol that you find at a liquor store and the poisonous methanol that’s in the antifreeze and can kill desperate alcoholics looking for a fix, including a former patient of mine.  Never mind a full 4-atom methyl group, think of what happens when you throw a few subatomic neutrons on an atom and create a radioactive isotope.  One need only look so far as Wikipedia, which points out that, “unlike amphetamine,  methamphetamine is directly neurotoxic to dopamine neurons in both lab animals and humans”; this statement is backed by 3 references from scientific journals.

I cheered a little inside my head when one student who was interviewed expressed concerns about people saying things like “everyone has a little ADHD”, as this delegitimizes the actual illness.  Another student with ADHD had chosen to go off of Adderall, even though his mother believed he likely wouldn’t have made it through high school without it.  It appeared from the documentary that those with a genuine medical need were actually the most reluctant to take medications.

In a study of college students without ADHD, using Adderall didn’t lead to objective improvements in cognitive performance, but participants did report a subjective sense of performance improvement.  A journalist interviewed in the film said that “what you have here is a dynamic of not only people using what is, you know, a dangerous drug… but you also find a bit of an arms race building up where if enough people see that their competition is doing it, they feel like they kind of have to do it too.”  The societal pressure  to always be competitive and outperform others is well worth exploring, but to me that got lost in the focus on stimulant medications.

I freely admit my own bias viewing this documentary, as I take Dexedrine (dextroamphetamine).  I first started taking it for significant psychomotor retardation (slowing of movement and thoughts) that I experienced as a symptom of depression.  When that resolved, I cut down on my Dexedrine dose, and my mood worsened.  I’ve tried a few more times since then to cut back the dose, and it’s become clear that it’s definitely having a beneficial effect on my mood.  My doctor is very comfortable keeping me at a dose of 10mg in the morning and 5mg at noon because it is obviously having a therapeutic benefit.  I don’t feel “high” from it and never have.  Dexedrine isn’t enough to fully compensate for the cognitive slowing and low energy I experience with depression, and my overall cognitive performance and energy level remain lower even while on Dexedrine than they are when my depression was previoulsy in remission.

So when Netflix portrays my medication as either a performance enhancer or a legal version of crystal meth, it does not sit well with me.  There is already so much stigma against mental illness and psychiatric medication, and this sort of messaging is not helpful.  There was a really valid point buried underneath the performance-enhancing pill-popping message, and it would be great to see a documentary that truly addresses the issue of societal hyper-competitiveness.  Unfortunately Netflix missed the mark.

#wyf – My fav – scent!

What's your favorite tag

#wyf tag: what's your favorite scent?

It’s What’s Your Favorite #wyf day over at Revenge of Eve.  This week’s fav is scent.  Make sure to check out Eve’s post, because her pick is definitely something unexpected.

There are lots of pretty scents out there, but I think my favorites have got to be food smells.  Burgers sizzling on the bbq, stew bubbling away in the oven, bread baking, cookies and other sweet treats baking….

freshly baked chocolate chip cookies

 

Image credits:

Revenge of Eve

Photo by Jennifer Pallian on Unsplash

3 Days, 3 Quotes: Day 3

"Maybe you have to know darkness before you can appreciate the light"

“Maybe you have to know darkness before you can appreciate the light” – Madeleine L’Engle

Thanks to A Guy Called Bloke for tagging me for 3 days, 3 quotes.  We’re both on day 3 🙂

The rules are simple:

  • Thank you note to the person who nominates you
  • Post one quote per day for 3 consecutive days
  • Nominate three new bloggers each day

Rather than tagging specific people, I’m going to invite anyone who wants to participate to join in and spread a little hope and inspiration.  The more the merrier!

3 Days, 3 Quotes: Day 2

"The most beautiful people we have known are those who have known defeat... and have found their way out of the depths"

“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths” – Elisabeth Kubler-Ross

Thanks to A Guy Called Bloke for tagging me for 3 days, 3 quotes.  We’re both on day 2 🙂

The rules are simple:

  • Thank you note to the person who nominates you
  • Post one quote per day for 3 consecutive days
  • Nominate three new bloggers each day

Rather than tagging specific people, I’m going to invite anyone who wants to participate to join in and spread a little hope and inspiration.  The more the merrier!

Weekend wrap-up

wrapping paper, ribbon, and twine

This has been one of the best weeks I’ve had in a while.  Here’s what happened this week:

  • I made Feedspot’s list of top 60 mental health blogs.
  • I made it through a 40-hour work week unscathed.
  • There were some minor blips, but I didn’t have any major emotional or cognitive shitstorms.
  • I had a massage.
  • Wore pretty lingerie all week.  No one else saw it except me, but that’s all that matters.
  • Had some yummy indulgences: DQ blizzard cupcakes and Starbucks strawberry acai refreshers.
  • Had some really good conversations with a person I feel safe with.
  • My body hasn’t been as unhappy with me.

Hope all of you had some good stuff in your week ❤️

3 Days, 3 Quotes: Day 1

"When you go through hardships and decide not to surrender, that is strength"

“When you go through hardships and decide not to surrender, that is strength” – Mahatma Gandhi

Thanks to A Guy Called Bloke for tagging me for 3 days, 3 quotes.  This is day 1 for him as well, so you can look forward to 2 more days of inspiration from both of us 🙂

The rules are simple:

  • Thank you note to the person who nominates you
  • Post one quote per day for 3 consecutive days
  • Nominate three new bloggers each day

Rather than tagging specific people, I’m going to invite anyone who wants to participate to join in and spread a little hope and inspiration.  The more the merrier!

On a side note, I used Canva (for the first time) to make this quote image.  Does anyone have any favorites they like to use for this kind of thing?

Book review: The Introvert Advantage

TheIntrovertAdvantage

The Introvert Advantage: How Quiet People Can Thrive in an Extrovert World is written by psychologist Marti Olsen Laney, who is herself an introvert.  She observes that we live in a culture that values extroversion, and cites Dr. David Myers, who identified extroversion as a prerequisite trait for happiness in his book The Pursuit of Happiness.  So, what is an introvert to do?  Being very much an introvert myself, I was curious to find out what the book had to say.

The book begins by describing some of the differences between introverts and extroverts.  The major difference being that introverts draw energy from the internal world, while extroverts are externally energized.  Introversion is sometimes confused with social anxiety, schizoid personality traits, or being a highly sensitive person, but the author outlines how these are all distinct.  The author observes that introverts tend to be concerned about how others are impacted by their actions, and may feel guilty that they have mistreated others when in fact they haven’t.  They may also tend to think that the things they find bothersome, such as interruptions, are bothersome to everyone.

The book also covers some of the biological differences that may exist between introverts and extroverts, including differences in blood flow patterns in the brain and neurotransmitter activation.  The parasympathetic nervous system (responsible for resting and digesting-type activities) appears to be more dominant in introverts.

The second section of the book considers how introverts can adapt in an extroverted world.  Suggestions are given for navigating relationships, parenting, socializing, and the work environment.  For those who aren’t sure if they are introverted or not, this section may be helpful as it characterizes typical introverted reactions in these types of situations.  I found some of the points made in the chapter on work quite interesting.  The author says that extroverts need to be told in detail what introverts are doing at work because otherwise they might not think anything is happening.  This surprised me, but perhaps it’s because, as an introvert, I’ve simply been missing the boat.  The author also suggested that an introvert’s openness to others’ opinions may be misconstrued as a lack of conviction in their own beliefs.  Interesting.  Other things didn’t ring true for me personally, such a dread of deadlines.

The final section was on “coping with introversion”.  The author suggested a 3-P’s approach, involving personal pacing, setting priorities, and setting parameters/boundaries.  She characterized introverts as slower-paced and slow-moving, requiring careful pacing to conserve energy.  I don’t find that to be a very accurate description of my own particular brand of introversion.  She suggested that nurturing was important for an introvert’s delicate nature, and recommended a variety of self-care strategies including scheduling regular rest breaks, increased light exposure, aromatherapy, and exercise.  While I’m all for self-care, being an introvert doesn’t necessarily make me a delicate flower (tulip is the specific analogy the author uses).  Finally, the author presented strategies for “extroverting”, i.e. behaving in a more extroverted manner.

While the book is pro-introvert, a lot of attention is paid to making oneself extrovert-acceptable.  Granted, the title gives fair warning of this, but it felt a bit off to me.  There’s a fine lining between adapting to minimize  personal distress and changing to be more acceptable to extroverts.  While the experience of introverts is validated and strengths are identified such as the ability to reflect, the author also seemed to characterize introverts as fragile, slow, low energy, and not functioning particularly well in the world at large.  It seems unlikely that this was the intent, and perhaps my reaction stems from my own decision quite a while ago that I was going to allow myself to be a proud introvert and not “play at” extroversion  to suit others’ expectations.  Suggesting that introverts are low energy seems to contradict the author’s earlier assertion that introverts simply find energy in different ways than extroverts.

One thing I was quite uncomfortable with was the idea of packing an introvert survival kit, consisting of what sounded like a suitcase-full of items including earplugs, snacks, water, a music player, a note card with an affirmation, a cotton ball with a soothing scent, medication for motion sickness, a parasol/umbrella, sunscreen, hand cream, lip balm, a battery-operated fan, a small spray bottle, a large-brimmed hat, sunglasses, a sweater/blanket, self-heating pocket packs, and earmuffs.  To me this verged on insulting; being an introvert doesn’t mean I can’t handle being outside of the house.  I carry lip balm around with me, but it has nothing whatsoever to do with my introversion.  If anything, this suitcase-load would be more appropriate for when I’m depressed, except then I wouldn’t have the energy to carry it all.

I think this book could be worth a read for anyone who’s introverted and uncomfortable about it or introvert-questioning, so to speak.  It offers some practical tips for fitting in with a largely extroverted world.  Overall, I found it didn’t really pull me in, and I ended up skimming through some sections.  I was glad I picked up a copy from the library rather than buying it.

 

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You can find my other book reviews here.

 

Judging a book by its cover

antique book

We live in a world that judges us on how we look.  Our body shape, our clothing, and any sign that we somehow deviate from what is “normal”, expected, or otherwise considered acceptable.  Mental illness is not always overtly obvious, but sometimes the effects of it are.  Hygiene may go out the window, and we emerge from our homes in dirty sweats and greasy hair.  Illness may slow us down or speed us up.  Eating disorders and other mental illnesses can affect our body shape, as can psychiatric medication.

I have a lithium-induced tremor, and I’ve been surprised by how often people comment on it. My tremor is worse with intentional movement than at rest, and this gets noticed often when I am paying for things in shops.  Clerks may come out with a condescending “take your time” or a concerned “are you ok?”  If I’m at a coffeeshop and carrying a wobbly mug to my seat, this will often elicit comments, either from staff or other customers.  I’m not sure why it’s anyone’s business, but it makes me feel very conspicuous.  I have a mostly invisible illness whose treatment has visible side effects.  I’m lucky that the antipsychotic that’s worked best for me (quetiapine) has a low potential to cause movement-related side effects like tardive akathisia.

Yet it’s hard sometimes to remember that I’m lucky.  One of my nursing jobs involves administering injections and teaching clients how to self-inject medications.  My hands are very much on display.  My tremor is worse with intentional movement than it is at rest, and I worry that clients will think I’m either nervous or incompetent.  I don’t really like either of those options.  I usually take propranolol before doing this kind of work to put a damper on the tremor, but if I’m tired/stressed/caffeinated the propranolol doesn’t do a whole heck of a lot.  I’ve seldom had clients comment, and if they do I brush it off as too much coffee, but the rest of the world seems to feel quite free to comment.

Another way I’m lucky is that I’ve never experienced a disordered relationship with eating.  I haven’t always been happy with my body, but it hasn’t impacted my relationship with food.  I’ve written before about illness, meds, and weight, but what comes to mind now as I’m writing this is questions about pregnancy.  My meds have caused the weight to pack on disproportionately on my lower abdomen.  The proportions have shifted around over time, but there was one particular summer that I was asked multiple times about my non-existent pregnancy.  I’m of the opinion that you should never ask a woman about being pregnant unless it looks like she’ll probably give birth tomorrow.  When others commented on my “pregnancy”, I felt like I had totally lost control over my body.  I felt really offended, less because of the very real psych med baby I was carrying around and more because others felt they had the right to talk about my body.

When I recently made the decision to add Botox to my depression treatment plan, a friend mentioned that they had thought about getting it cosmetically.  For some reason that made me feel icky.  And it’s not (at least I don’t think) so much that I would judge someone for getting a cosmetic procedure; it’s more that I don’t even care enough to wear makeup, and the thought of doing something to my body for cosmetic reasons seems utterly bizarre.  Maybe the issue is that I worry others will judge me for getting Botox.

This post has been a bit all over the place, but I guess my point is that we are judged.  No matter what we say, what we do, or what we look like, others will judge us.  We can’t stop it, much as we might wish to, so all that’s left is managing our own reactions.  And sometimes that’s much easier said than done.

Profiles in tremendousness 2: The coworker edition

profiles_tremendousness2

 

Not long ago I posted Profiles in Tremendousness round 1, which borrowed an idea from the Daily Show to identify some of the non-rockstars I’ve encountered in my own experiences of mental health care.  In round 2, I’m going to touch on some of the anti-superstars I’ve encountered in my work as a mental health nurse.

Let’s start with one of the biggest non-rockstars of all.  I’ll call him Kevin.  Kevin had a very high opinion of himself and of his ability to get to the root of what was going on with a client.  He firmly believed that bipolar II was not a legitimate diagnosis, and instead was just another name for borderline personality disorder.  He never came right out and said it, but it was pretty clear that he thought any female diagnosed with a mood disorder actually had borderline personality disorder.  He would tell these women that they needed to do some reading about DBT.  They did so, and of course ended up reading about borderline personality in the process.  If I was the next clinician to see these women, they would tell me how confused and distressed they were, because BPD didn’t sound at all like what they were experiencing (which it wasn’t).  I’d try to shift focus onto how DBT has useful skills for anyone with mood regulation difficulties (which is true, but not why Kevin was recommending it), and bite me tongue to keep myself from telling them that Kevin was an idiot.  One of his go-to’s for evaluating whether someone was seriously ill or not was the “bus stop test”, i.e. if you were standing at a bus stop next to them would you be able to tell they’re mentally ill.  Cue disgusted eye roll now.  And if he was unhappy with a client’s behaviour, he would “read them the riot act”, whatever that meant.

While a lot of mental health nurses are very knowledgeable about psychiatric medications, some are frighteningly clueless or prejudiced.  Kevin referred to clozapine as “poison”, while Janet was firmly anti-medication across the board.  Karen made medication recommendations to clients despite having astonishingly little knowledge about those same medications.

Brent was a big fan of CBT.  Which would have been great if he actually knew what CBT involved.  He believed that CBT involved distracting yourself from your thoughts.  End of story.  And this one-trick pony would be trotted out for almost every client.  His other standard recommendation was that clients read Eckhart Tolle’s The Power of Now.  I won’t deny that there’s some good stuff in there, but there’s also some stuff that’s a little out there.  Brent actually agreed with me on that, but didn’t bother tacking this bit of information on when he made the recommendation to clients.

Some nurses are overly keen on pushing the prn medications.  A couple of nurses that I used to work night shift with firmly believed that if a client was up during the night, they should be medicated back to bed, and if the client wouldn’t accept the prn orally, they’d call security and do it by injection!!!!  There was one time I was coming on for a night shift, and the evening nurse told me that she’d given a client a prn during the evening because he was quite psychotic, and she wanted me to wake him up to give him another prn in an hour or so.  I just kept my mouth shut and ignored her.

Then there was Sandra, who thought clients asking for prn meds were just being med-seeking.  She would never give prn benzos (even when the client had an order for them) regardless of how distressed or psychotic they happened to be.  She had no use for clients with personality disorders, and thought they were just being manipulative.  She thought that the only way to handle these clients was with her idea firm boundaries, which translated to being flat-out rude.  Clients would tell me that they just didn’t bother going to Sandra about anything because they knew they’d just be shot down.

These anti-superstars have thankfully been the exception rather than the rule.  Most of the mental health professionals I’ve worked with have been quite competent, and some have been truly exceptional.  But keep an eye out for the Kevins and the Sandras of this world – and when you see them, run as far and as fast as you can in the other direction.

BPD: Are the helpers actually hurting?

artistic rendering of faces dialoguing

People with borderline personality disorder (BPD) face a lot of challenges.  Unhelpful treatment providers shouldn’t be one of them, but I suspect this is the case more often than it should be.

One of my jobs is at a mental health and addictions transitional program.  While some of the staff are licensed mental health professionals, most are not.  For many  of the support workers, their only formal training is a one-semester community mental health worker certificate program.  Some of these support workers do a great job, but their lack of training limits the range of skills and knowledge they have to draw upon.

There are a number of clients with BPD in this program, and I think it would be safe to say that all of these individuals have a considerable trauma history.  This may be a gross over-generalization, but in my experience that pose the greatest challenge to service providers, and I would like to see more service providers take ownership of that rather than shifting blame to the clients.  I’ve been lucky enough to have worked with clinicians who were highly experienced in working with clients with BPD and providing dialectical behavioral therapy (DBT).  It was so powerful to see them in action and the impact this had on clients, and I learned a great deal from them.

What I see more often in support providers who don’t have that level of knowledge, skills, and experience is a rigid approach to clients with BPD that involves a focus on limit-setting, challenging (i.e. invalidating) clients’ beliefs/emotions/experiences, and establishing a clear hierarchy and power differential.  In my mind this comes from misinterpretations arising from limited understanding of some of the principles of working with clients with BPD.  And my observation has been that this approach doesn’t work.  Time and time again I have seen it develop into a combative relationship with the client, but I can’t think of a single time when I’ve known a care provider to take responsibility and acknowledge that by using this type of approach they have contributed to the problem rather than the solution.  It’s always the client that gets blamed, and this ends up becoming a self-fulfilling prophecy by reinforcing stigmatized ideas.  If you treat someone like a bratty child, then it’s likely they will react like a child; I’m not sure why this is so hard to grasp.

This came to mind recently because of some interactions I had with a client with BPD.  She had approached me and expressed irritation with certain things.  It quickly became clear that she was feeling invalidated, and the irritation had nothing to do with me.  As we talked, I took advantage of every opportunity I could find to provide any sort of validation, and it was clearly effective.  Yet this is a client I always hear other staff talk about as being difficult, and often when I hear them talk about their approach with her I think wow, no wonder you find her difficult.

It reminded me of a former client of the program, another female with BPD.  Staff often described her as game-y, and trying to negotiate around things like which meds she would and wouldn’t take.  All of the other nurses took a paternalistic, you-must-do-as-I-say approach, and they found her difficult to deal with, and she often refused at least some of her meds.  I approached everything I did with her as a collaboration, and explained my rationale for anything I was recommending.  She felt empowered, and ended up going along with my recommendations; by giving her the power of choice, I got meds into her 100% of the time.

It fundamentally bothers me that there are care providers out there who are making things worse for clients with BPD, and instead of taking professional responsibility they are blaming the clients.  That’s just not cool.  Unfortunately, the rigid limit-setting types generally don’t seem to be very open to suggestions that another way could work better.  In my current workplace culture, any attempts to rock the boat are considered totally unacceptable, and I feel powerless to bring about change.  I seem to be viewed as the nurse who is “too easy” on clients with BPD, and it really saddens me that there are people who think they need to be “hard” on that same group of clients.

I’ll put it out to my blogging buddies with BPD – have you encountered the rigid limit-setting type of care provider, and what has that been like for you?

 

Image credit: geralt on Pixabay

Legislated stigma

infographic of scales of justice

Stigma can be found in many places, even places where we might like to think it shouldn’t be.  One such place where I have found it is in government legislation, hence the title of this post, “legislated stigma”.

As a registered nurse, my professional license is through the College of Registered Nurses of my Canadian province, which is covered by the provincial Health Professions Act.  This legislation applies to many different health professions, and addresses multiple aspects of professional practice, including health professionals whose ability to practice is impaired.  Health professionals are required to report to the appropriate regulatory college if they have reason to believe another health professional poses a risk to the public related to impairment due to any sort of health condition.  A provision along these lines is typical for health professions legislation in many jurisdictions.

My province decides to take things a step further with its legislation by including a provision that doesn’t exist in any form in any other province in Canada.  If a health professional is admitted to hospital for psychiatric reasons or substance abuse, the hospital is required by law to inform the patient’s regulatory college, and the regulatory college is to treat this as a complain about the individual’s fitness to practice.  Full stop.  No assessment of risk, just mandatory reporting based on diagnosis.

I initially found out about this during my first hospitalization in 2007.  My mom was regularly checking my mail, and brought me in an envelope that had come from the College of Nurses.  The enclosed letter stated they had “received a complaint about [my] fitness to practice”, and I was given the non-choice of voluntary giving up my professional license or having it taken away.  I was gobsmacked.  Who had complained and how could I possibly be a risk to anyone but myself?  It’s not like I could have wandered away from my involuntary hospitalization and  somehow found some patients to start providing care to.  Oh yeah, these aren’t hospital PJ’s, they’re nurse’s scrubs, and the hospital socks are just because they’re comfortable!?!?   I was frantically asking different hospital staff, trying to find out who had been low enough to do this behind my back.  Eventually I found out it was the nurse manager of the unit, and her explanation for why I hadn’t been informed was that it had happened shortly before I was being transferred to the psych ICU.  Great.  Thanks a lot.

When I (and my community psychiatrist) eventually managed to convince the College of Nurses that I was no longer crazy, they slapped a bunch of conditions on my license. One of these was that I share those same conditions with my employer.  Even though the conditions didn’t spell out details of my mental illness, the condition that I had to see a mental health team and get regular reports submitted by my psychiatrist blew any chance of privacy I might have hoped for straight out of the water.  And those quarterly reports the College required my psychiatrist to submit meant that I ended up lying through my teeth to him.  When I decided to go off meds, I didn’t say a word about it and kept picking them up from the pharmacy at regular intervals to back up my lie, because I didn’t want the College of Nurses or my employer to know what I was doing in terms of my own health.  I’m not sure how that situation helps anyone…

My next two hospitalizations were at a different hospital, where either they didn’t know about or chose to overlook the mandatory reporting requirement.  During my fourth hospitalization, I was again reported to the College and given the non-choice of giving up my license or having taken it away.  The doctor who initially reported me didn’t have the cojones or consideration to actually tell me; I had to find out about it later from someone else.

So, privacy is all fine and dandy right up until the government decides it isn’t.  It’s worth mentioning that at no point did anyone treating me ever express concerns that I was posing a risk to anyone besides myself.  If I was hospitalized for a neurological condition like brain cancer or epilepsy, there would be no requirement to report me, but because my brain condition happens to be psychiatric, all of a sudden I am deemed to present a risk to the public, full stop.   No professional judgment allowed on the part of treatment providers; if I am hospitalized for depression then that is more than enough to determine that I am dangerous and people need to know about it.

Add this to the rest of the negative experiences I’ve had in hospital and I’ve come to a few conclusions.  One, I will never voluntary admit myself to hospital.  And two, I will never knowingly say anything to a doctor that is likely to get me committed to hospital.  That means I never disclose to doctors when I’m having thoughts of suicide.  Again, not sure how that situation helps anyone.

When I was a little younger and a little less jaded, I tried to campaign to change the legislation.  I was in grad school at the time and one of my courses touched on policy briefs, so I wrote a policy brief citing legislation from other jurisdictions and relevant case law.  I sent it to anyone that I thought might be willing to read it.  My provincial nurses union and professional advocacy association didn’t even have the courtesy to respond with an acknowledgement.  A couple of organizations expressed an interest and did take the issue to the government, but didn’t get anywhere.  I don’t know what else is in my power to do.

The fact remains, though, that this is discrimination specifically against people with mental illness that is enshrined in provincial legislation.  And no one seems to care.  For all the talk by government-mandated organizations like the Mental Health Commission of Canada about addressing stigma, I’m living in a province where, because I struggle with depression, I am considered a second-class nurse who doesn’t deserve the right to have my private medical information stay private.  There is something really fundamentally wrong with that, and it means that indirectly the government is putting my health at risk.  And that should never be ok.

 

Image credit: johnhain on Pixabay