Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I worked 4 night shifts this week and only had one client for my other job, and it all went smoothly.  I wonder, though, about people who leave a mess for their coworkers to clean up.  Did they grow up in a barn or do they just not give a shit?
  • Someone did something that upset me, but I was able to make a conscious choice to keep my reaction contained (as opposed to a shove it under the rug and ignore it choice).  That felt like progress.  Of course I later ended up ruminating about it for a few days, so there’s definitely still work to be done.
  • I’ve been craving sugar, and giving in to those cravings more than I probably should.  Ever since I had a big dip in my mood a few weeks ago I just haven’t cared enough to try to throw healthy food into my body.  I just want gummy bears.
  • I was reading through my WordPress reader and came across an article about the same topic I’d written a couple of weeks ago.  I started reading, and realized that most of the words were mine.  Entire paragraphs of words were mine, verbatim.  Now I’m totally cool with people reblogging my work or using an idea of mine to create their own post, but this was full on plagiarism.  And when I called the person out on it, they denied it.  The whole thing left a rather yucky taste, particularly because not only were they passing off my words as their own but also my thoughts, feelings, and experiences.
  • Went to yoga once and out for a few walks.
  • My weekend wrap-up posts come from my weekly summaries in my bullet journal. I had been including sections for goals and self-care, but I haven’t been keeping that up over the last few weeks.  It’s time for that to change, and today I wrote out my goals for next week.

 

That’s about it; it’s been a pretty quiet week for me.  How has your week been?

 

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What is… the Myers-Briggs Type?

psychology word graphic in the shape of a brain

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: Myers-Briggs Type

The Myers-Briggs Type Indicator (MBTI) was created by mother-daughter team Katharine Cook Briggs and Isabel Briggs Myers, neither of whom had formal training in psychology or psychometric testing.  The test was partially based on Jungian personality theory.  It’s not considered to have strong psychometric properties due to poor validity and reliability.  For each of the 93 questions posed, the test-taker is given a choice of two possible responses.

There are 16 types based on a combination of 4 letters:

  • Introversion / Extroversion: expending vs drawing energy from outward action
  • iNtuition / Sensing: relying on hunches vs concrete/tangible information
  • Feeling / Thinking: decision-making from an empathetic or logical perspective
  • Perception / Judging: reflects preference for using sensing/intuition or thinking/feeling function when relating to the outside world

The actual MBTI is copyrighted and isn’t available for free, but there are a number of adaptations that are free: 16Personalities, PsychCentral, Truity, and Humanmetrics.  Three of these told me I’m an INFJ, while one told me I’m an INTJ.  They all showed I lean heavily toward introversion and judging, while I had relatively more balance between intuition/sensing and feeling/thinking.

In general, I’m not all that keen on these sorts of typologies.  Yes, they can give us a clearer picture of how we tend to interact with the world, but I’m not convinced that all people can be divided up among 16 neat little boxes.  We all have natural tendencies, but it seems overly simplistic to think that we are unlikely or unable to venture beyond that.

What are your thoughts on the Myers-Briggs Type Indicator?

 

Image credit: GDJ on Pixabay

Should mental illness be used to explain bad behaviour?

illustration of an angry germ

When people see and hear statements or actions by others that seem to make no sense or are morally abhorrent, all too often mental illness is tossed around as a possible explanation.  Take mass shootings, for example.  For someone to do something like that, they must have something wrong in their heads, they must be disconnected from reality, they must have mental illness, right?  Yeah not so much.  Yet far too many people don’t understand this.  I even remember speaking to a fellow mental health nurse several years ago who thought mass killers must be psychotic to do something so unimaginable.  If even someone that works in mental health is that misinformed, is it any surprise that the average idiot out there in the world doesn’t get it?  I’ll warn you right now, this post is perhaps not the most cohesive; instead it touches on a variety of unpalatable subsets of the population that have crossed my mind recently.

Incels

It seems as though there are a lot of angry white men making themselves visible these days.  They come in a variety of flavours, including neo-Nazis, but it was only after a recent mass killing in Toronto that I became aware of the term “incel”, or involuntary celibate. This particular breed of asshole blames women who won’t sleep with them for all of the problems in their lives.  Men who have expressed such sentiments have engaged in mass killings in the past, but the incel term was new to me.  Apparently in November 2017 Reddit banned an incel subreddit due to violent content.  Some of this lot believes that women who are having sex but aren’t willing to have sex with them (Stacys) should be punished, and deserve to be raped.  Men (Chads) who are getting laid are another target of their violent ideation.  The incel mindset is repulsive and abhorrent, but that doesn’t mean that there needs to be a “thinking too much with your penis” mental illness whipped up to describe these characters.

Psychopaths

Pyschopathy isn’t a diagnosis in the DSM, although its closest equivalent would be antisocial personality disorder.  Much of our understanding of psychopathy comes from Dr. Robert Hare, who developed the Hare Psychopathy Checklist (more info here).  A psychopath knows exactly what they’re doing.  They know that things they do are considered “wrong” by society, but they just don’t care; it’s not their problem.  While many psychopaths are criminals and end up in prison, there are also psychopaths leading apparently successful lives.  In my nursing career I’ve only encountered one patient who was quite clearly a psychopath.  He was a master puppeteer, and it was chilling to see how he smoothly manipulated the world around him, using violence whenever it suited his needs.  There is some debate as to whether psychopathy is a form of mental illness, but unlike mental illnesses which tend to impair one’s control, psychopaths have the control of a finely tuned orchestra.  The psychopath is very much in touch with (and in control of) reality.

Pedophiles

Pedophilic disorder is listed in the DSM, and my personal prejudice is to call BS on that. To me it’s along the lines of homophilia, which was previously included in and then removed from the DSM.  Haven’t we established that sexual preference is not a mental illness?  People can fantasize about whatever they want in their heads, but I strongly believe that the monsters who act on pedophiliac fantasies do not deserve the excuse of getting a mental illness diagnosis.

Narcissists

There’s lots of talk on the internet about narcissists and narcissistic abuse.  This has always concerned me a bit.  First, let me say that my issue is not with those who talk about being victims of narcissistic abuse; I don’t in any way doubt that these people have experienced serious psychological and emotional abuse.  What I question is whether it’s useful or appropriate to attribute the abuser’s behaviour to a personality disorder, particularly when it would seem that in many cases a diagnosis of narcissistic personality disorder is not something that’s been made by someone qualified to do so.  I feel like it’s a slippery slope that seems to take responsibility for one’s actions away from the abusive individual’s conscious intentionality.  I’m guessing that it’s a way for those who have been victimized to understand and contextualize their experience, but I would worry that focusing on the abuser’s mental health (or lack thereof) shifts focus away from the abuse victim’s own mental and emotional wellbeing and the attention it deserves.

Unfortunately the world we live in includes some pretty despicable human beings.  When mental illness is implicated in their horrible acts, this is likely to only further promotes stigma.  Sometimes an awful person is just an awful person, end of story; no need to drag mental illness into it.

 

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Book review: Daring Greatly

Daring Greatly by Brene Brown

In Daring Greatly, Brene Brown borrows the words of Theodore Roosevelt to encourage us to find the courage to be vulnerable.  Vulnerability, which she says encompasses uncertainty, risk, and emotional exposure, “sounds like truth and feel like courage”.  The book takes a very common sense, practical approach.  Findings from the author’s extensive research are presented, and this is done in a way that is engaging and didn’t feel like reading about research.

The author challenges several myths about vulnerability, including the idea that it is a weakness.  She points out that daring greatly requires challenging shame and the gremlins it fills our heads with.  She has come up with term “gremlin ninja warrior training” to describe how to build shame resilience; this includes recognizing shame, talking about how you feel, and reaching out for help.

She identifies varies strategies (e.g. perfectionism and numbing) that we use to shield ourselves from vulnerability, and ways that we can break down those shields that are holding us back.  She believes that disengagement underlies many social problems, and this is influenced by the gap between our the values we practice and the values we aspire to.  She offers “minding the gap” as a daring greatly strategy to combat this.

The section on rehumanizing education and work resonated particularly strongly with me, as I have experienced workplace bullying.  A culture of shame in the workplace may be demonstrated through behaviours such as blaming, gossiping, favouritism, name-calling, and harassment.  It can be even more overt when shame is used as a management tool through the use of “bullying, criticism in front of colleagues, public reprimands, or reward systems that intentionally belittle people.”  This kind of shaming “crushes our tolerance for vulnerability, thereby killing engagement, innovation, creativity, productivity, and trust.”

There is also a chapter devoted to parenting.  Parenting has been shown to be a key predictor in how susceptible children are to shame, and children need to experience compassion, connection, worthiness, and belonging, not fear, blame, shame, and judgment.  None of the recommendations she makes are new and earthshattering, but they are all powerful and remind us to be aware of the messages we are conveying and behaviours we are modelling.

Society often tells us that being vulnerable is a sign of weakness.  This book does an excellent job of challenging that and demonstrating how courageous and powerful being vulnerable really is.  Mental illness in particular tends to make us fearful of being vulnerable, and this book offers some very good food for thought.

If you’re interested in finding out more about Brene Brown’s ideas on vulnerability, you can find her TED Talks here.

 

You can find my other book reviews here.

3.2.1 Quote Me!

lit up sign with the word "change"

Thanks to Bipolar Barb and Beckie’s Mental Mess who’ve tagged me for A Guy Called Bloke‘s 3.2.1 Quote Me game for the topic of change.  You can find the rules (which I haven’t really followed) on their posts.

 

“Here’s to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They’re not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can’t do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.” – Rob Siltanen

 

“One child, one teacher, one book, one pen can change the world.” – Malala Yousafzai

What the STAR*D study means for depression treatment

brain shining like a star

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial studied 2876 people with major depressive disorder to evaluate their response to depression treatment in a real-world setting.  Unlike the randomized controlled trials that are often used to evaluate a drug’s efficacy, there were few exclusion criteria, the patient and their physician knew which drug they were taking, and patient choice was incorporated.  Four sequential levels of treatment were established, and if a patient failed to achieve remission after 12-14 weeks, they would be moved to the next level.  The target was full remission, unlike many other studies which measure response (i.e. a ≥50% reduction in symptom rating scale scores).  Remission rates can be substantially lower than response rates, but are useful because there are better long-term outcomes for people who do achieve full remission.

Level 1 treatment consisted of citalopram, and 28% of patients achieved remission based on the Hamilton Rating Scale for Depression (HAM-D).  Certain factors were identified, such as other comorbid mental illnesses, that were associated with lower or higher remission rates.

In level 2, patients were offered cognitive psychotherapy, a switch to another antidepressant (randomly selected), or the addition of another medication to augment the treatment.  Among level 2 patients who switched to another medication, remission rates were 21.3% for bupropion, 17.6% for sertraline, 24.8% for venlafaxine.  Rates were similar among those patients who switched to cognitive psychotherapy.  Among the patients who received augmentation treatment, the remission rates were approximately 30% for both bupropion and buspirone.  Augmentation with medication produced more rapid remission than augmentation with cognitive psychotherapy.

In level 3, patients who switched medication were randomly assigned to mirtazapine or nortriptyline, and patients who received an medication for augmentation were randomly assigned to lithium or the T3 form of thyroid hormone (liothyronine).  Remission rates were 12.3% for mirtazapine, 19.8% for nortriptyline, 15.9% for lithium, and 24.7% for thyroid hormone.

In level 4, patients were randomly assigned to switch to either tranylcypromine (an MAOI antidepressant) or venlafaxine plus mirtazapine.  Remission rates were 6.9% for tranylcypromine and 13.7% for venlafaxine plus mirtazapine.

Altogether, 67% of patients were able to achieve remission.  The study found that people may still remit by 12 weeks even if there’s only a modest symptom reduction at 6 weeks.  However, the more treatment steps that are required, the lower the chance of a patient achieving remission and the higher the chance of intolerable side effects and relapse.

Personally I found the take-home message from this study rather discouraging.  During my last hospitalization I argued that my suicide attempt was supported by the STAR*D’s not so subtle hint that I was shit outta luck.  I think it’s crucial that we find new kinds of treatment that will help that 33% of people who are treatment-resistant and just aren’t achieving remission with many currently available antidepressant medications.  This study doesn’t consider all potential treatments; for example, atypical antipsychotics, ketamine, and ECT aren’ included, and psychotherapy plays a limited part.  Still, we deserve better.  A lot better.

 

For more info on the research terminology I’ve used in this post, see my post on research literacy.

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G2K – Get 2 Know me

Revenge of Eve G2K

It’s G2K (Get 2 Know) day over at Revenge of Eve, a series of questions intended to bring the reader closer to their favorite bloggers.  This week’s questions:

  1. How would you say others perceive you?  Confident or insecure?  I think generally people perceive me as fairly confident.
  2. Are you confident or insecure?  I don’t know that I have an easy answer to this.  I’m confident in myself and my abilities when I’m well, but when I’m depressed I felt insecure about my limitations compared to when I’m well.
  3. If your answers to 1 & 2 are opposite, define your behaviors that make this so.  I tend to avoid the types of situations in which I would feel most insecure, so people don’t necessarily see that side of me often.
  4. Who do you attribute your confidence or low self-esteem to?  The insecurity comes from my illness, and the confidence probably comes from my parents.
  5. Write them a note in 20 words or less expressing your gratitude or feelings of injustice.  Mom and Dad, thank you for always believing in me.

 

How to participate:

  • Create a post and title it G2K
  • Use the tag #g2k
  • Create a pingback to this post to notify me of your participation
  • Answer questions honestly

Quotes from bloggers

red rose sitting atop a book

I have a section in my journal where I write down some of the lines other bloggers write that grab my attention.  Here’s a selection:

“First I need to get to know you more before you start to finger me” – My Inner MishMash

“Nothing better than killing two pterodactyls with one boulder” – Bella’s Babbles

“They feel like you’ve overstayed your welcome at the pity party” – Ease the Ride

“Just because your ass is numb and you feel fine doesn’t mean that sitting on the tack is good for you” – Laina Eartharcher

“I wonder if the folks who say [happiness is a choice] know that I also think them not choosing to undergo emergency cranial rectal extraction – when they so obviously need it – is a choice I blame them for” – Lavender and Levity

“I tend to judge people on their personal merits, so if you’re an asshole, you’re an international asshole” – Ultra Regret

“Don’t have a bucket list, fuck it list is huge” – Liz at Therapy Bits

“In living with mental illness, the mind, like a castle, has many defences.  We are the opposing army laying siege…  But as we make progress we become stronger and the walls become weaker.” – Blue Sky Days 365

 

Image credit: Katzenfee50 on Pixabay

20(ish) Questions

pile of question marks

I’ve decided to take a bit of a break from blog awards, but when I’m nominated for awards I’ll answer the questions posed to me in this 20(ish) questions format, along with assorted other question tags and the like.  Feel free to join in the fun with your own answers to any or all of the questions 🙂

 

Questions from A Guy Called Bloke and K9 Doodlepip:

  • Do you read question lists from the top, the bottom or from the middle first?  From the top because that takes the least effort.
  • Did you ask yourself why l asked you that first?  There wasn’t actually that much thinking going on in my brain.
  • If l didn’t want an answer for question 4 would you supply it anyway?  That depends if I’m in the mood.
  • Can you see what question 4 is yet?  Ha ha.
  • How many questions are asked on this nomination in total?  I don’t count beyond 3.
  • If there was one big question you wanted this list to ask of you, what would it be?  If you had a taxidermied animal, what would it be?
  • What would your answer be to that question?  A sheep.  And I would take it to bed with me.
  • I don’t want you to answer any of these questions with the exception of number 7 and maybe 11, ok?  Again, that comes back to counting beyond 3.
  • Who invented FAQ’s?  Some poor bugger who was ready to go postal on the next person who asked a dumbass question.
  • For this Liebster Award nomination who asked the 12th question?  The tooth fairy.
  • What was it, and more importantly of all the questions asked, how would you answer the 12th question found in question 2?  My sheep will handle that question for me.
  • Think about it numerically…  And now we’re counting sheep.  Goodnight!

 

Questions from Beckie’s Mental Mess:

  1. What is your favorite holiday, and why?  Christmas, because of the food.
  2. When you blog, where do you write from (examples: kitchen table, desk?)  Most often my bedroom.
  3. Do you ever experience writer’s block? If so, what do you do in order to work through it?   Yes but I make sure I’ve already got at least a week of scheduled posts so if I have non-writing days I can just ride it out until I get back in the swing of things.
  4. What was the highest point of your life?  I don’t know that there has been specific highest and lowest points in my life, so I’m going to go geographic with my answers.  La Paz, Bolivia.
  5. What was the lowest point of your life?  Going with the same theme as #4, the Dead Sea, Jordan.
  6. If you were to come back as an animal, what animal would that be and why?  A guinea pig, because their life is so simple (eat, poop, sleep, repeat).
  7. What is your favorite scent?  Salty ocean air.
  8. What was the last thing you ate today?  Chocolate chip cookie dough.  Classy all the way.
  9. If someone handed you 1 million dollars, what would you do with it?  Put it in the bank.  At this point security and stability is most important to me, and I’m okay with being boring.
  10. What famous person (Dead or Alive) would you want to meet, who would that be and why?  The Dalai Lama seems like a very wise and inspiring person.
  11. How do you want to be remembered?  I don’t necessarily want to be remembered.  After all, I’ll be dead, so it wouldn’t really matter if I was remembered or not.

 

Come on, you know you want to answer a few – that’s what the comments section is for!

 

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3.2.1 Quote Me!

cartoon face looking bored

Thanks to Rory at A Guy Called Bloke and K9 Doodlepip for tagging me for his 3.2.1 Quote Me game.  If you want to join in the fun, you can’t get this details on his post.  Today’s topic is boredom, and I decided to go with some quotes from BrainyQuote that left me thinking “huh?”

 

“Boredom is a fearsome prospect. There’s a limit to the number of cars and microwaves you can buy. What do you do then?” – J. G. Ballard

That’s when you get a snuggly llama (preferably one that doesn’t spit on you).

 

“Morality is a venereal disease. Its primary stage is called virtue; its secondary stage, boredom; its tertiary stage, syphilis.” – Karl Kraus

If boredom is sexually transmitted then I guess I’m safe!

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I worked 5 night shifts this week, but stuck very closely to my med/sleep schedule that works best and it was manageable.
  • Only saw 1 patient this week at my other job.  I was doing a hormone injection for him as part of his prostate cancer treatment, and unfortunately he is losing his battle with the cancer.  I’ve had more of my patients die in the last year and a half at this job compared to my whole career prior to that.
  • I was perhaps not as observant as I should have been when piping up in support of a friend, and got some mud hurled at me as a result.  Fun times.
  • My gut has not been happy with me this week, and I’ve been bloated and crampy.  I’m sure my lousy diet lately hasn’t been helping, but neither has the heat.
  • Speaking of which, the weather’s been pretty hot here this week, and my lithium seems to make me particularly prone to wonky hydration and electrolytes when I’m hot and sweating.  I’ve been drinking coconut water, since it’s packed with electrolytes, and that seems to help.
  • My springtime attempt to grow a balcony garden failed, so I’ve planted some more seeds and hoping at least one or two will sprout.

I’m used to getting spam comments/likes from automated bots on my blog.  I’ve gotten a few odd messages before through my blog contact form from random non-Wordpress people, but this week for the first time I got a message that was directly targeted with what I suspect were malicious intentions.  This person started off praising my blog and saying he also had depression, etc, etc.  The tone was what you’d expect from a regular person and not a spammer.  Then he mentioned that in one post I had talked about getting a large sum of money from my grandma, and he encouraged me to be cautious about putting something like that out there because people might try to take advantage of me.  But that post was from back in December, and a dig through my stats showed that post hadn’t been viewed any time recently, so somehow this person managed to look at it without leaving a digital footprint.  There were a few other subtle red flags that something fishy was going on, and  I came to the conclusion that this person had looked at my blog and decided to deliberately try to connect with me by making himself appear to be vulnerable and then try to scam me.  That really gave me the heebie-jeebies.  Now it’s possible that I’m being overly suspicion and have chosen not to ignore some poor innocent person, but my spidey-senses tell me otherwise.

 

How has your week been?

 

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What is… Resilience

psychology word graphic in the shape of a brain

In this series, I will dig a little deeper into the meaning of psychological terms.

This week’s term: Resilience

I used to be at least moderately resilient, but when depression is doing it’s thing I feel like I have no resilience at all, and the slightest little hiccup will knock me on my ass.

Wikipedia defines resilience as an individual’s ability to “successfully cope with adversity” and “bounce back from a negative experience with ‘competent functioning'”.  It is considered a learnable ability that can vary over time rather than a static personality trait.

There are various biological factors that can impact resilience  The sympathetic nervous system is involved in stress reactions including fight/flight/freeze, and the hypothalamic-pituitary-adrenal (HPA) axis is involved in the release of the stress hormone cortisol.  There is growing evidence that these systems are impacted by factors in the brain including neuropeptide Y.

One study found six major predictors of resilience: positive and proactive personality, experience and learning, sense of control, flexibility and adaptability, balance and perspective, and perceived social support.  Other studies have identified other factors that contribute to resilience: supportive and loving relationship, the ability to make realistic plans, self-esteem, strong communication skills, and the capacity to manage strong feelings and impulses.

The American Psychological Association recommends 10 strategies to improve resilience:

  1. maintain good relationships with others
  2. don’t view stressful events as being unbearable problems
  3. accept that some circumstances can’t be changed
  4. set realistic goals
  5. take decisive actions in stressful situations
  6. engage in self-reflection and self-discovery following losses
  7. build self-confidence
  8. take a long-term perspective
  9. maintain a hopeful outlook and visualize positive outcomes
  10. engage in self-care of both mind and body

Looking at this information, what jumps out at me is my lack of interpersonal relationships.  Yet while it’s the most obvious factor that I’m missing, I’m not quite sure how to address it.  My inability to trust others was not learned over night, nor will it be unlearned overnight.  But perhaps recognizing the connection between relationships and resilience will help motivate me to work harder at this.

Is resilience something that you have challenges with?

 

Source: https://en.wikipedia.org/wiki/Psychological_resilience

Image credit: GDJ on Pixabay

Our complicated relationships with medications

capsules filled with sparkles

I can’t think of any other type of health condition that has as polarized a relationship with medication as mental illness.  In some ways, to medicate or not to medicate has become a moral issue, with various involved parties taking a stance based on principle.  Often this stance is very broad, making sweeping generalizations.  I recently read and reviewed the book Lost Connections, which argues that all depression is situational and medications should not be used.  Some people connect psychiatric medication use to violence, such as the incoming director of the National Rifle Association (NRA) who has suggested a link between school shootings and Ritalin (methylphenidate).  I’ve seen Twitter comments blasting people who wrote about the positive effects they experienced from medication.  We would never hear any of this kind of thing if we were talking about blood pressure medication, so why are there so many eager to shout from the rooftops when it comes to psychiatric meds?

My own view is certainly shaped by my professional training; I used to be a pharmacist, and now I’ve been practicing as a nurse for 13 years in mental health settings.  I understand how medications produce the effects (both positive and negative) that they do, and have the research literacy to separate the BS from legitimate information.  I look at medication as a tool, and any given medication may or may not work for any given individual, and may or may not be tolerated by that individual.  I have seen medication be life-saving for people, and it certainly has made a huge difference in my own illness.

In general it seems like people tend to speak up, both online and in person, more often about things that go badly for them than things that go well.  The same appears to be true with medication.  I’m a bit fuzzy remembering the details, but not too long ago someone had written a post about antidepressant withdrawal, and someone else commented about how venlafaxine is a garbage drug that no one should take because of the withdrawal effects.  I’m sure that individual’s experience was very negative, but it’s easy to see remarks like this about side effects and overgeneralize, making the assumption that they occur for all/most people taking the drug.  Unfortunately we don’t yet have a way of predicting who will respond to or tolerate particular drugs (although I’m sure the science will get there as the role of pharmacogenomics expands), but to allow treatment decisions to be based on people’s negative comments online doesn’t seem particularly helpful.

I suspect that some of the time meds are demonized because of poor clinical practice by prescribers.  If physicians aren’t responsive to the side effects people are having, ordering any necessary bloodwork, or prescribing drugs that are actually appropriate and effective for the condition being treated, those things don’t mean the drug itself is inherently bad.  Instead, it means that the prescriber is being irresponsible.  I can’t help but think of a blogger with bipolar disorder who was treated for many years with high-dose clonazepam, and then had it discontinued abruptly.  In my mind that is shocking malpractice and a gross misuse of a medication that is not even indicated for treatment of bipolar disorder (but can be very useful when used carefully and appropriately).

It’s also problematic when doctors prescribe a medication and make it out to be a sort of panacea that will fix everything.  We all know there’s a lot of different things involved in getting well, whether we’re on medication or not.  Psychosocial stressors and underlying trauma aren’t going to disappear with a wave of the SSRI wand, and that’s fine, but doctors should be open with their patients about what medications will and will not do.  If patients are coming in misinformed and expecting to pop a happy pill, the health professional has a responsibility to educate them about the nature of mental illness and its treatment.

As Shakespeare’s Hamlet might say:

To medicate, or not to medicate: that is the question:
Whether ‘tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles,
And by opposing end them?

Where do you stand when it comes to medications?

 

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Book Review: My Age of Anxiety

Book cover: My Age of Anxiety

My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind is written by Scott Stossel, who lives with generalized anxiety disorder (GAD) as well as several phobias.  The book looks at his own experience but also contains extensive research on theoretical perspectives on anxiety and how these have evolved over time, the evolution of diagnostic categories, and the history behind various treatment approaches including the development and marketing of anxiolytic drugs.  While it offers wide-ranging information, at times it struck me as a bit excessive.

Something I struggled with in this book, and I feel bad saying this, was that it felt kind of like when I’m reading a novel and I just don’t like the character you’re supposed to like.  Sometimes this just happens, but I also think I need to question whether there’s there’s an underlying bias in play as well.  The author is a man who seems to have high levels of neurosis as a stable trait.  He wrote: “Writing this book has required me to wallow in my shame, anxiety, and weakness so that I can properly capture and convey them – an experience that has only reinforced how deep and long-standing my anxiety and vulnerability are.”  I’m usually a pretty compassionate, empathetic, and not overly judgmental person.  Perhaps it’s the wallowing bit that gets to me, or perhaps it’s that the anxiety and shame seems so fused with who he is and who he always has been.  Yet temperament isn’t something we choose, so why should that make a difference in how I react to someone?  

Perhaps it’s to do with changeability, and that brought to mind a question: if you’re highly neurotic by nature, does anxiety treatment work or are you shit outta luck?  Stossel looked at the question of nature versus nurture, both of which play a role.  Temperament is thought to be innate, there is certainly evidence of a genetic element to anxiety disorders, and parenting styles are also believed to have an impact.  The development of phobias in childhood is a predisposing factor for the development of adult psychopathology.  For the author, who has a strong family history, the cause is likely a combination of a heaping helping of all of these.  He admits that judges himself for being anxious, and worries that “resorting to drugs to mitigate these problems both proves and intensifies my moral weakness.”  He has done many years of psychotherapy, including Freudian-style psychodynamic and cognitive behavioural, and tried various medications, “but none of these treatments have fundamentally reduced the underlying anxiety that seems woven into my soul and hardwired into my body and that at times makes my life a misery.”

It was clear from an early age that the author had an anxious temperament, beginning with frequent temper tantrums as a toddler.  He experienced significant separation anxiety, which intensified at age 6, coinciding with his mother starting night school.  He began experiencing emetophobia (fear of vomiting) around the same time, and this worsened in grade 7 after he overheard a teacher describing vomiting due to food poisoning.  Grade 7 was also when he had to attend a new school, which resulted in daily battles and social withdrawal, and at that time he was put on medications (chlorpromazine and imipramine).  

anxiety written in Scrabble tiles

Stossel’s mother was highly over-protective and over-involved, but he writes that she deliberately withheld affection in the hope that might prevent anxiety similar to what she herself had experienced as a child.  She physically dressed him until age 9 or 10, picked out his clothes every night until age 15, ran baths for him while he was in high school, and didn’t allow him to walk anywhere that streets might be too busy to cross or neighbourhoods might be dangerous.  As I read the chapter that covered this I freely admit I judged, thinking no wonder this kid had problems.

It has been shown that people with IBS (irritable bowel syndrome) and/or panic disorder are more physically reactive to stress and tend to convert emotional distress to physical symptoms.  The author describes significant physical symptoms with his anxiety, particularly gastrointestinal symptoms, which then feeds into his emetophobia.  As an adult, a therapist had attempted to do exposure therapy using ipecac to make him vomit.  The ipecac was ineffective, and the experience only contributed further to the emetophobia.

The book covers the history of various types of medications used for anxiety, including opium, barbiturates, and benzodiazepines.  When chlordiazepoxide became the first benzodiazepine on the market in the United States in the 1960’s, it quickly became the most prescribed drug in the country.  Medication use for anxiety increased even further with the introduction of the SSRIs (selective serotonin reuptake inhibitors).  The author observed that “the explosion of SSRI prescriptions has caused a drastic expansion in the definitions of depression and anxiety disorder (as well as more widespread acceptance of using depression and anxiety as excuses for skipping work), which in turn caused the number of people given these diagnoses to increase.”

The book covers an array of research studies that have been conducted on anxiety as well as a wide range of relevant theories, from Freud who thought anxiety was the basis of all mental illness to attachment theories to Klein’s false suffocation alarm theory of panic attacks.  Societal views on anxiety over time are also discussed, including American General George Patton’s belief in World War II that in order to prevent the contagion of “combat exhaustion” from spreading it should be punishable by death.

At 401 pages including footnotes, this book isn’t a quick light read.  It took me over three months in fits and starts to read it, in part because my concentration wasn’t always up to it.  It’s jam packed full of information, so it’s a lot more to absorb than just a first-person account of mental illness.  I think what I appreciated the most about it was how it forced me to reflect on and question my own ideas and judgments.  It’s well-researched, and I would say it’s a good choice for anyone who’s looking for a broader historical view to help contextualize their own experience as the author does in this book.

 

You can find my other book reviews here.

Image credits: Amazon.com, Wokandapix on Pixabay

To avoid or not to avoid, that is the question

woman sitting in dark room with light shining through blinds

Sometimes avoidance is adaptive.  If we see a mama bear and her cubs, we know we need to steer clear.  This is when our caveman brain is programmed to kick into fight or flight mode, and we probably never would have moved far beyond the caves without it.  But a lot of avoidance is maladaptive, and often it’s hard to see the difference.  Cognitive behavioural therapy talks about safety behaviours, which are behaviours that we deliberately engage in to try to keep ourselves safe from whatever causes us to feel fear or anxiety.  However, these behaviours actually serve to reinforce anxiety rather than keeping us safe from actual dangers.

I think avoidance can be a reasonably good thing if it is consistent with underlying values.  As an introvert, I know that large group social situations are very unpleasant and exhausting for me, and I would much rather spend time one-on-one with close friends.  It felt quite empowering when I decided to limit my exposure to unpleasant social gatherings and focus on the kind of socializing that I valued.  On the other hand, my depression makes me avoidant of people in any context, which really isn’t consistent with who I am as a person.

Some approaches to dealing with trauma, like cognitive processing therapy, suggest that avoidance serves to perpetuate incomplete processing of the trauma, and avoidance must be addressed and overcome in order to proceed with processing of the traumatic memories.  I have tried to push through this in creating my own trauma account, but I’ve taken a break from that process over the last couple of weeks because I haven’t been feeling very well.  It’s hard to tell if that’s just me giving in to avoidance, but right now I don’t feel like I’d  be able to create a psychological safe place to contain that.

Avoidance tends to be my fall-back coping mechanism when I don’t have the mental/emotional capacity to deal with a given situation at a given time.  I try to give myself permission to be ok with using avoidance in those contexts, but it’s also a signal that I need to work on building resilience, which I’m really not sure how to do.  Avoidance gets me out of a situation I can’t cope with, but if I’m not somehow building my capacity to cope, the pattern is just going to keep repeating.  I don’t know that it’s necessarily a matter of learning new skills, because I think I manage pretty well when I’m not depressed.  But when I’m not well it feels like I lose access to a lot of things that would normally be available when I’m well.

I really don’t have any answers right now.  Avoidance is probably going to continue being my fall-back for the near future, and I’ll just have to see how things evolve.

What role does avoidance play in managing your mental health/illness?

 

Photo by Xavier Sotomayor on Unsplash

G2K – Get 2 Know

Revenge of Eve G2K

It’s G2K – Get 2 Know day over at Revenge of Eve.  I found this weeks questions very thought-provoking, and I had to chew them over in my head for a while before I came up with answers.  This week’s questions:

  1. In what areas of your do you find it hard, to be honest with yourself?  I sometimes allow myself to wallow in unhealthy thinking patterns and pretend that it’s just a temporary dip rather than getting sucked into mental quicksand.
  2. Have you put in an effort to change this or do you ignore it in hopes it disappears?  I guess I hope that I’ll learn from the past and grow out of it, but I don’t think it really works that way.
  3. How does this affect other areas of your life?  I can get so focused on whatever (or more often whoever) it is that I lose perspective on the bigger picture.
  4. Can you define the underline fear in regards to this?  If so, explain.  I’m not sure if it’s fear; I think it stems more from my tendency to rehearse interactions in my mind ahead of time, and then that ends up spiralling out of control.
  5. Do you find that you are more of an honest or dishonest person around others?  I used to be mostly.  Now I wouldn’t necessarily say I’m dishonest, but I’m quite guarded (except on my blog).

To participate:

  • Publish a post answering the above questions and title your post g2k
  • Use the tag #g2k
  • Create a pingback to this post
  • Answer each question honestly

What would recovery look like?

silhouette of a man standing atop of a hill

Recovery means different things for different people.  Here’s what my recovery from depression would look like:

  • confidence
  • the ability to feel joy/pleasure
  • resilience
  • hope
  • a sense of purpose and meaning
  • feeling strong
  • having a sense of control over my life
  • being able to smile and laugh, and mean it
  • looking forward to things
  • being able to generate emotional responses to events in a way that is consistent with my values
  • feeling open to new things
  • being able to look to the past or the future without being overwhelmed by pain

 

What are the essential elements of what recovery would look like for you?

 

Photo by Pablo Heimplatz on Unsplash

20(ish) Questions

pile of question marks

I’ve decided to take a bit of a break from blog awards, but when I’m nominated for awards I’ll answer the questions posed to me in this 20(ish) questions format, along with assorted other question tags and the like.  Feel free to join in the fun with your own answers to any or all of the questions 🙂

 

Questions from A Guy Called Bloke and K9 Doodlepip’s Quick Fire Round #6:

  • If you swallowed a complete ice cube, how long before it leaves the body as an ice cube again?  Until hell freezes over.
  • We are told that we cannot look at the sun directly, but is it therefore safe to look at an image of the sun with our naked eyes, 3 minutes after it is taken?  Eyes shouldn’t be naked – that’s just obscene.
  • If money doesn’t grow on trees, then why do banks have branches???  The money is stored in the hollow area the woodpecker has pecked out of the tree.
  • Mm, a real ponderer here, but if quizzes are quizzical, what are tests?  Well if we’re going to get grammatical, quizzical is an adjective, so my answer is testicular.
  • Why does Donald Duck wear a towel when he comes out of the shower when he doesn’t usually wear any pants?  Because he’s contemplating adding skirts to his wardrobe, and a towel works as a kind of trial run.
  • Why does it hurt like hell to hit your funny bone?  Because it’s only funny for the person who’s watching you do the dance of pain.
  • Why does does Goofy stand erect when Pluto is on all fours, are they not both dogs?  Standing erect should be reserved for X-rated viewing.
  • Remember Gilligans’ Island? So how is it the professor could make a radio out of  a coconut but not fix the hole in the Minnow???  It would take MacGyver to fix the Minnow.  The professor just isn’t quite at his level.
  • Why??? Hippopotomonstrosesquippedaliophobia is this so long considering what it means?  I know, right!!!!!
  • What colour is your toothbrush?  White and blue and I got it free from my dentist.  It’s against my religion to pay for toothbrushes.
  • What was your favourite toy growing up?  Hard to say, but I quite liked my Popple, plus I just enjoy the sound of Popple.
purple popple

Image from Pinterest

  • Three of your favourite movies?  Dirty Dancing, Top Gun, and Girls Just Wanna Have Fun.  Yep, that’s an 80’s theme you’re sensing.
  • If you could live somewhere else, where would you choose and why?  Kyrgyzstan in a yurt, and if you need to ask why, then there’s just no hope for you.
  • Everyone has a food they simply cannot eat for whatever reason, which is yours?  Olives.
  • Why?  Because I think they smell like manure.
  • If your life was to be made into a movie what genre would it slot into?  Is tedious a genre?

Answers please on the reverse side of the reverse side of the two way mirror!  I had to Google this, and it turns out a two way mirror is the same thing as a one way mirror.  Now please tell me how on earth that’s supposed to make any sense!  I feel like somewhere there’s an imaginary number involved…

 

Questions from Carol Anne at Therapy Bits:

1 what is the longest you’ve gone without sleep?  I’m not sure actually.
2 do you like ice cream? Yup.  Ben & Jerry’s peanut butter half baked please!
3 what is your favourite type of food?  Unhealthy!
4 are you a fast reader?  Pretty fast, I guess.  The problem these days is I can’t concentrate well enough to read much in one sitting.
5 what is your favourite kinda weather?  Sunny and low 20s Celsius.
6 do you have netflix?  My whole family uses my brother’s account.
7 are you glad to have the internet or could you do without it?  Without the internet I’d be even more of a hermit than I am now.  Blogging and Google are necessities, but social media I could do without.
8 do you own an amazon echo?  No.  Aside from my laptop and iPhone I’m fairly low-tech.  And I’m a bit suspicious of having a device in my home that’s listening to me.  I’ve got my iPhone set up so that I actually have to press a button to activate Siri, and I’ve got a sticker over the camera on my laptop.  Next up, tinfoil hat…
9 where do you see yourself in 5 years from now?  The guinea pigs knocked over my crystal ball and it broke, so I have no idea.
10 do you have a best friend?  I only have one in-person friend, so by process of elimination…
11 what is your favourite personality trait in your friends?  Genuineness.

 

Come on, you know you want to answer a few – that’s what the comments section is for!

 

Image credit: qimono on Pixabay

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I worked 4 night shifts in a row this week at my job at a concurrent disorders transitional program.  I stuck to the sleep and med schedule that I’ve figured out works best for me when I’m doing nights, so it was manageable.  I’m working a lot of nights over the next month and a half, and I’m hoping that it won’t have too much of an impact on my mental health.
  • One morning at work we were doing our last round of patient checks at 6am and found a patient lying on the floor in his room only partially responsive.  It was later determined he’d overdosed on fentanyl.  I’m normally very on the ball when it comes to crisis situations, but I’m not particularly normal these days.  I’ve been a nurse long enough that the taking care of the patient part of it still came naturally.  What I struggled with was communicating to others.  When I was on the phone with 911 requesting paramedics, I was having a hard time putting sentences together.  I think I forgot to say I was a nurse and I guess the 911 operator assumed I was dumb as a post, so he was talking to me like I was an idiot, which threw me off even more.  I was able to be somewhat more coherent with paramedics when they arrived, but still a far cry from my “normal”.  It’s hard to be reminded of just how impaired I am now compared to the way I am when I’m well.
  • The next night I was talking to my coworker, who also happens to be my only in-person friend, about how I was feeling.  His first response was that I’d done well and I was being too hard on myself.  That was sufficiently frustrating that I snapped at him “that is really not helpful!”  I felt kind of bad about getting irritated, but what I really needed at that point in time was validation, not rah rah let’s be positive.
  • I’m also feeling frustration with my other job.  Nothing major, just annoying stuff that tends to crop up every so often.
  • My concentration hasn’t been great.  I’ll come to the end of reading a blog post and think wait a minute, I have no idea what I just read.
  • I continue to eat absolute crap because I don’t care enough to put any effort into food preparation.  I think this coming week I really need to get that under control before sugar starts exploding out of my orifices.
  • I made it to yoga for the first time in 3 weeks, so that was good.  I also had a massage.

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

3.2.1 Quote Me

Wisdom written on a sign posted on a tree trunk

Thanks to Rory from A Guy Called Bloke and K9 Doodlepip for tagging me for his 3.2.1 Quote Me game.  Today’s topic is experience.  If you want to join in, you can find the details on his post.

 

“Experience is not what happens to a man; it is what a man does with what happens to him.” – Aldous Huxley

 

“Experience is what you get when you didn’t get what you wanted. And experience is often the most valuable thing you have to offer.” – Randy Pausch

 

And one more for good measure:

“Good judgment comes from experience, and experience comes from bad judgment.” – Rita Mae Brown

Things that make me smile

smiling child holding an ice cream cone

Amidst the hard stuff, there are still positive things floating around to enjoy.  Here are some of the things that have made me smile:

  • my pet guinea pigs, their silly play, and the cute ways they beg for food
  • comedy: The Late Show with Stephen Colbert, The Daily Show with Trevor Noah, Russell Peters, Chelsea Handler
  • no other tv show has ever made me laugh as much as Seinfeld
  • the woodpecker family that took up residence on my balcony in the early part of the spring
  • cats that try to climb in my purse
  • doggy kisses
  • going for walks in the snow
  • spring coming into bloom
  • funny stories from bloggers
  • cute animal videos on Youtube
  • getting positive feedback from my patients
  • babies – I’ve never had a strong desire to have my own munchkins, but I’m that crazy person in line at the grocery store behind you making silly faces at your little one

 

What are some of the things that make you smile?

 

Photo by Jared Sluyter on Unsplash

Online mental health workbooks

person writing in a notebook

There was a lot of interest in my previous post Mental health worksheets galore, so I thought I’d do a follow-up post with some more resources.

Cognitive behavioural therapy (CBT)

Dialectical Behaviour Therapy

Other

 

Image credit: Free-photos on Pixabay

Book review: After Suicide

AfterSuicide

In After Suicide, author Charlotte Underwood describes her journey following her father’s suicide.  The book also serves as a how to guide to picking up the pieces after the suicide of a loved one, both practically and emotionally.  She shares the lessons she learned along the way, and speaks openly about some of the destructive coping strategies she turned to.  There were significant negative consequences in her own life as a result of her father’s suicide, and this serves as a good reminder that suicide never just affects the person who dies.

This book is very moving and has quite an intimate feel to it.  In the conclusion, Charlotte writes that the book is her way of reaching out a hand to support her readers, and this is very much what it felt like.  This short ebook is available as a free download and is well worth a read for anyone whose life has been touched by suicide in some way.

 

You can find Charlotte on her blog Charlotte Underwood.

 

You can find my other book reviews here.

Suicide and barriers to help-seeking

brick castle walls

There’s lots of information out there about crisis resources for people thinking about suicide, but resources accomplish very little if we don’t reach out to access them.  There are many reasons people don’t seek help, and I wanted to talk about a few of them here based on my own experience with major depressive disorder and suicide attempts.

Fear of being a burden

No matter how much anyone might say “you’re not a burden”, I wouldn’t believe them.  The suicidal thoughts were such a heavy burden for me to carry, so why would I want to place some of that burden on anyone else?  And it doesn’t feel like it is with pack animals where I can shift my rocks to someone else’s donkey and make it lighter for my donkey.  It feels more like extra rocks would be getting dumped on both donkeys, so I’ve got extra weight weight that I have to carry as well.

Fear of others’ responses

There’s a lot of stigma out there in the world, about mental illness in general and suicide in particular.  When the word “selfish” gets tossed around in relation to suicide, that’s certainly not going to make it more likely that people will speak up.  Being judged is the last thing someone needs when they’re feeling desperate.

For those of us who have been open with others about our illness, even if we’re not necessarily worried about stigma there’s still uncertainty about how others might respond.  People say well-meaning but just plain stupid things about depression all the time, so what kind of supportive idiocy is likely to come out of their mouths when faced with the topic of suicide?  That I should be grateful for what I have, even though none of it matters?  Or maybe something along the lines of oh, you should go out for a walk in nature?  #SickNotWeak #FuckTheWalk

Hopelessness

My illness makes me feel like there is no hope for the future, and it’s when that hopelessness gets particularly intense that I want to end my life.  I’m not thinking oh, if only I could get help things would be so much better.  At that point, I have given up and don’t want anyone trying and failing to help and in the end just making things more difficult.

Over the entire course of my illness it has proven to be very hard to treat.  In the past I was able to achieve full remission eventually, but now it seems like that may be a thing of the past.  Because of my professional background I know what my options are, and I know there aren’t a lot of them, which tends to really reinforce those feelings of hopelessness.

Worthlessness

When mental illness steals away your whole sense of worth as a human being, it can start to feel like people would barely notice, much less care, if you weren’t around any more.

Crisis lines/services

The only time I’ve ever used a crisis line myself was in the first few weeks after my first hospitalization.  I had discharged myself against medical advice after they decided not to renew my involuntary committal.  I’d been in hospital for 2 months, and out I went, with no discharge plan in place.  I was cutting as a strategy to cope with suicidal thoughts, and mostly when I called the crisis line I talked about the cutting rather than what was underlying it.  I guess it was nice to have someone to talk to, but I remember feeling like their responses were kind of formulaic, as if they’d been told these are the things you should say in these situations.

A lot of crisis lines have volunteers providing support.  I’m sure they’re great, they care, they want to listen, but they don’t have the level of expertise of mental health professionals.  Part of that is that they don’t have training in assessing mental status, which makes me inclined to think they have a lower threshold of concern to call the police.  I may be overestimating the risk of this, but if I’m thinking about ending my life the last thing I want is the police banging on my door.

In some ways it works against me that I’m a mental health professional, because it means I know a lot of people working in local emergency and non-emergency mental health services.  I have no desire to call the emergency mental health service or go into the hospital emergency department and have to deal with some asshole that I’ve worked with before and know is useless at their job.

Fear of hospitalization

This is the single biggest reason I keep my mouth shut when I’m thinking about suicide.  I’ve been hospitalized four times, and these experiences were extremely difficult.  When I’m at my lowest, given the choice between death and hospitalization, realistically death is going to win out.  This reflects fundamental flaws in a system that disempowers and traumatizes patients, but there’s also a sense of personal failure that I connect with hospitalization.  This isn’t a judgment I pass on others, but probably part of why I apply it to myself is that three out of four of my hospitalizations were involuntary, so it’s kind of a failure to maintain the ability to make choices for myself.  This fear of hospitalization is deeply ingrained in me, and over the years it has made me tell lies and keep secrets.  I realize that this is something that puts me at risk, but I don’t see that just spontaneously changing.

 

I know that reaching out for help dealing with thoughts of suicide is the right thing to do, and it’s certainly what I would urge to anyone reading.  But realistically it’s just not alwawys that simple, and I think it deserves some thought when we’re not in the midst of our deepest lows.

What has been your experience of accessing help in crisis?

Click here for info on crisis support resources.

 

Image credit: pcdazero on Pixabay

G2K – Get 2 Know

Revenge of Eve's Get 2 Know G2K

It’s Get 2 Know day over at Revenge of Eve.  This week’s questions get up close and personal:

  1. How old were you when you lost your virginity?  20
  2. Who initiated the act?  Alcohol.
  3. Did you feel the same about the person after sex as you did before?  This guy was one of my buddies from university.  A group of us were out drinking, and he and I got flirty and I ended up bringing him back to my place.  I found out afterwards that this jackass was engaged, although he’d been keeping it on the down-low and there was only one person in our group of friends at school who knew about this.  I was not impressed, to say the least.  I hope his fiancée ended up dumping his sorry ass, but I don’t know how things turned out.
  4. Where did you have sex the first time?  My dorm room.
  5. What do you remember about the occasion?  Dumbass had been drinking a lot that night, which caused a lot of technical difficulties.  It’s a good thing I wasn’t expecting my first time to be some magical occasion.

 

How to Participate

Create a post titled G2K

Answer each question honestly or to the best of your ability

Create a pingback to this post

Use the hashtag #g2k