Weekend wrap-up

wrapping paper, ribbon, and twine

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

  • My mood has been shit.
  • I got exempted from jury duty, which is good.  I couldn’t make a decision about what to do about the jury summons, so I did an exemption request but explained that I didn’t know if I should actually be asking for an exemption.  I guess they figured someone who’s too nutty to make a decision about a jury duty exemption is too nutty to be making a decision about someone’s guilt or innocence.
  • Although my follower numbers have gotten higher than I had ever expected and are steadily increasing, my actual visitors and views numbers have been steadily dropping.  I don’t blog for the purpose of stats, but it’s hard not to feel discouraged by that kind of mismatch in numbers.
  • I’m so not impressed with my new job.  They’re pretty sporadic when it comes to actually responding to emails, and the pay is shit, although they seem to be in denial about that.
  • I didn’t work much this week, and I’ve been having a bit of a hard time keeping myself occupied because I just don’t feel like doing anything.  I find myself wishing I could just sleep 24 hours a day.
  • My regular doctor was away so I ended up seeing a different doctor to get my meds refilled.  Without even so much as a “how are you?” she refilled my meds for 9 months.  Last week my naturopath was away so the other naturopath in the clinic did my methylfolate/B12 injection.  She also didn’t ask how I was doing.  I don’t actually have any desire to talk to health care professionals I don’t know, but I’m sensing a theme here.
  • I went to yoga twice hoping it would give me a bit of an escape from myself.  It didn’t.

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… gaslighting

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: Gaslighting

Perhaps I was living under a rock, but I’m fairly certain I hadn’t heard the term gaslighting before I entered the blogging world.  Let’s start off with a definition from Wikipedia:

“Gaslighting is a form of psychological manipulation that seeks to sow seeds of doubt in a targeted individual or in members of a targeted group, making them question their own memory, perception, and sanity. Using persistent denial, misdirection, contradiction, and lying, it attempts to destabilize the victim and delegitimize the victim’s belief.”

I also wondered about the origin of the term, since I wasn’t sure what the connection was between a gas light and emotional abuse.  Gaslight was the name of a 1938 stage play that was later made into a movie, and when the lead female commented to her criminal husband about the gas lights dimming, he denied this had happened (although he himself had dimmed them) and insisted that she had imagined it.  Its a term that has been used colloquially rather than one that stems from the field of psychology.  The references cited on the Wikipedia page on gaslighting reflect this.

I found an article by Kate Abramson in the journal Philosophical Perspectives that had a lot to say about gaslighting, and she seemed to take a fairly objective view of the phenomenon.  Gaslighting undermines “the target’s basic rational competence— her ability to get facts right, to deliberate, her basic evaluative competencies and ability to react appropriately: her independent standing as deliberator and moral agent” (Abramson, 2014).  The author likened gaslighting to torture, as it aims to destroy the target’s sense of self.

Abramson writes that while there’s nothing inherently sexist about gaslighting, men are most often the perpetrators and women are most often the targets, and successful gaslighting can reinforce sexist norms.  From a psychoanalytical perspective, gaslighting is seen to be a form of projective identification, where the gaslighter projects things about himself that he is uncomfortable with onto the target, and then needs that target to identify with what has been projected.

Gaslighting typically serves multiple aims for the perpetrator.  Those who gaslight are unwilling to tolerate any possibility of challenge to the way they view things.  The gaslighting has an interpersonal aim in this sense, as the perpetrator requires the target to respond in a certain way.  The gaslighter “aims to destroy the possibility of disagreement by so radically undermining another person that she has nowhere left to stand from which to disagree, no standpoint from which her words might constitute genuine disagreement” (Abramson, 2014).

Abramson identifies several strategies used by gaslighters: love, empathy, self-doubt, authority, leveraging practical consequences of resisting, and sexism.  These may all be drawn upon to serve the primary aim of destroying any possibility of resistance.

Much of what’s out there on the internet about gaslighting is quite emotionally charged, understandably so.  It’s a devastating type of emotional abuse, but like any trend of the moment on the internet I wonder if the genuine destruction of this form of emotional abuse is being diluted by overuse of the term.  I have nothing to back that up and it may not be the case at all; it’s just something I’m curious about.

What are your thoughts?

 

Sources:

https://en.wikipedia.org/wiki/Gaslighting

Abramson, K. (2014). Turning up the Lights on Gaslighting. Philosophical Perspectives, 28(1), 1-30.

Image credit: GDJ on Pixabay

How trauma-informed practice can improve mental health care

So, what is it to be trauma-informed?  Trauma-informed practice recognizes the intersectionality of trauma, mental health, and substance abuse, and involves an awareness that anyone may have experienced trauma, whether they have disclosed it or not.  Trauma-informed practice aims to create environments that prevent re-traumatization and promote a sense of safety.  The individual client’s safety, choice, and control is prioritized throughout services, and an approach of collaboration, learning, and building trust is used.  There should be a non-hierarchical and supportive organizational culture, and there is a focus on strengths and building resiliency, and hope that recovery is possible.

One area where being trauma-informed has the potential to make a huge difference is when it comes to seclusion and restraints.  The use of seclusion and restraints can lead to significant psychological or physical harm, and can be a major source of traumatization or re-traumatization.  The British Columbia Centre of Excellence for Women’s Health identified several strategies for a trauma-informed approach to seclusion and restraints:

  • staff training in de-escalation
  • have comfort rooms with low sensory stimulation
  • promote the development of crisis plans or advance directives to identify triggers and preferred interventions
  • assess for and address any unmet needs that may be influencing behaviour
  • debriefing following any use of seclusion or restraint to identify why it happened and what was learned.

When I was doing my masters degree one of my classmates was working in a psychiatric intensive care unit where they had instituted changes in their approach to seclusion and restraints in order to provide trauma-informed care.  My classmate had nothing but good things to say about this, and the unit had achieved very significant reductions in trauma and restraint utilization.

My most memorable occasion of being in seclusion was when I had taken myself into hospital, with the support of my community psychiatrist, and said that I was feeling suicidal and needed ECT.  They decided to commit me under the Mental Health Act and put me in seclusion, even though I had gone in voluntarily.  When I was informed I would be locked in seclusion I asked to be sedated, because I didn’t want to be trapped with nothing but my thoughts.  The nurse said there was nothing ordered.  I asked if it would make a difference if I told her that I’d throw my tiny tube of hand cream at her.  She disappeared, I heard a “code white” (aka violent patient aka me) being called over the PA system, and she returned a few minutes later with a bunch of security guards to give me the injection I’d asked for in the first place.  How very therapeutic.

Sometimes in the field of mental health care certain approaches or practices will become buzzwords, and many organizations will jump on board.  I think this has happened, at least to some extent, with trauma-informed practice, and it’s generally seen as something desirable.  Where the problem lies, though, is that there’s a difference between claiming to be trauma-informed and actually being trauma-informed.  I’m sure that the mental health and addictions program I work for would claim to be trauma-informed, just like they claim to be recovery-oriented.  But in practice, it’s just lip service, although I highly doubt the people running the place would see it that way.

I think all mental health care organizations should be trauma-informed, but it’s essential that it look trauma-informed from the client perspective, not just the staff or management’s perspective.  While individual care providers for the most part try (with varying degrees of success) to be empathetic, it’s difficult for some clinicians, and particularly for organizations, to have any real understanding of what the client perspective looks like.

Would you consider the mental health services that you’ve accessed to be trauma-informed?

 

Sources: British Columbia Centre of Excellence for Women’s Health Trauma-Informed Practice Guide and Trauma-Informed Approaches to Seclusion and Restraint Reduction

Identifying emotions

What exactly are emotions?  Well, there’s no easy answer to that; it depends on who you ask and what their theoretical perspective is.   But regardless of how we define them, how do we describe them?  That can be easier said than done.  There’s even a psychiatric term, alexithymia, for difficulty identifying and articulating emotions.  Wikipedia has an entire page dedicated to contrasting and categorization of emotions.

Several researchers have suggested that there are basic universal human emotions that remain consistent across cultures.  Psychologist Paul Ekman identified anger, disgust, fear, sadness, happiness, and surprise.  I like the emotion wheel diagram above because it takes these basic emotions and further subdivides them into more detailed descriptors.

Labelling emotions and mood tracking

bullet journal mood tracker pageWhen I’m feeling quite low, I tend to have a number of emotions going on at the same time.  When that happens, I can usually identify the basic emotions I’m experiencing, but to really get into detail it’s helpful to have a list.  I’ve never found rating my mood to be all that useful, but I do like to keep track of the mix of emotions that I’m experiencing.  I came up with this colour-coded list in my bullet journal, so each day I record a mood rating plus the coloured letters to represent the emotions I’m feeling.

I think that by glancing through the list each time I’m doing an entry, I’m identifying the more subtle emotions as well as the ones that stand out the most obviously.  Sometimes I’m able to identify where these emotions are coming from, and other times it’s harder.  I may think I’m feeling a certain emotion in relation to a certain event, but with more reflection I may realize that I’m actually reacting to something entirely different.  Journalling has helped a lot with identifying that kind of thing.

One thing that stands out to me with my emotion list is the lack of positive emotions.  I guess it’s just been so long that there hasn’t been an occasion that prompted me to add positive emotions to the list.

Emotions and bodily sensations

I typically don’t feel a strong connection between emotions and bodily sensations.  I’m not sure if this is me not being in touch with my body, or if it’s just how I tend to experience emotion.  The most notable exception to this is anxiety, which I’m more likely to feel in a physical sense (e.g. chest tightness, heart pounding) than an emotional one.  Stress can manifest itself in tension in the shoulders, back, and jaw, but I get regular massages so that’s kept from getting out of control.  I do have physical symptoms with my depression sometimes, like slowness and GI disturbance, but it seems to be more connected with the illness in general rather than reflecting specific emotions.

Facial expressions

Then there’s the matter of facial expression of emotions.  Mental illness can sometimes have a significant effect on this.  My expression (or “affect” to use the psychiatric term) gets very flat when my depression is causing a lot of physical/mental slowing.  I remember times when I’ve stared at myself in the mirror, trying to contort my face into a smile, and simply couldn’t do it.  Aside from the ultra-slow movement, this is a pretty obvious sign to those who know me that I’m not well.  By contrast, when I am well, I smile a lot.

 

Do you try to pay close attention to the emotions you’re experiencing?  Does it come easily to you, or are there certain strategies you use to help you?

 

If you’re looking for a list of emotions, here are a few options:

  • Tara Brach (author of Radical Acceptance): broken down into feelings when needs are satisfied vs unsatisfied
  • Therapist Aid
  • Hoffman Institute: this list also includes physical sensations
  • Plutchik’s wheel of emotions (see below): while this is pretty, it just doesn’t feel quite right to me

Plutchik's wheel of emotions

Wikipedia

 

Vaccines and autism: The link that doesn’t exist

teddy bear with a syringe and vial

Chances are, you’ve heard the idea that vaccines can cause autism.  This notion is championed by various organizations and individuals, one of the most prominent being actress Jenny McCarthy, whose son was diagnosed with autism at age 2.  She has an autism-related organization called Generation Rescue, and on its website is a guide to vaccine safety.  I was a bit surprised by how relatively toned down it was, but I got  more along the lines of what I expected with one of the places it directed people to go to for more information, the National Vaccine Information Center.  It includes a “cry for vaccine freedom wall” and a “vaccine victim memorial”.  They have a MedAlerts database of people’s reported adverse reactions to vaccines, and a search for autism spectrum disorder yields 391 case reports.  One thing that struck me as interesting was the seemingly random grab bag of multiple symptoms/conditions that were also being attributed to the vaccine at the same time in these case reports.

So where did this idea come from that autism can result from vaccination?  In 1998, the prominent medical journal The Lancet published an article by Dr. Andrew Wakefield and 12 other scientists that looked at 12 children who had bowel disorders and autism.  It stated: “Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children.”  However, in 2004, 10 of the original 12 authors published a retraction in The Lancet of their interpretation of the results of the 1998 study, including the link between MMR vaccine and pervasive developmental disorder.  In 2010, The Lancet retracted the published article entirely, stating that parts of it were incorrect or blatantly falsified.

In 2010, the UK General Medical Council found that Andrew Wakefield had committed scientific dishonesty and breach of duty, and was “guilty of serious professional misconduct”.  Because of a variety of reasons, including his “wide-ranging transgressions” and “disregard for the clinical interests of vulnerable patients”, his name was erased from the Medical Registry, an extreme action that they justified in part by his lack of insight.  Clearly, this is not an individual whose ideas should be considered credible.

A 2007 paper in Current Opinion on Infectious Diseases dismissed papers that suggested a link between autism and MMR vaccine as “not scientifically stringent” and having “serious methodological limitations.  A 2007 article in The New England Journal of Medicine addressed concerns about thimerosal, a vaccine preservative that contains small amounts of mercury well within the World Health Organization’s acceptable limits.  The article concluded that the baseless association between thimerosal and autism “has given rise to a cottage industry of charlatans offering false hope, partly in the form of mercury-chelating agents.”  A 2014 paper in the journal Vaccine found no relationship between autism and vaccination in general, MMR vaccine, thimerosal, or mercury.  A 2010 article in Clinical Infectious Disease stated that:

“Twenty epidemiologic studies have shown that neither thimerosal nor MMR vaccine causes autism. These studies have been performed in several countries by many different investigators who have employed a multitude of epidemiologic and statistical methods. The large size of the studied populations has afforded a level of statistical power sufficient to detect even rare associations. These studies, in concert with the biological implausibility that vaccines overwhelm a child’s immune system, have effectively dismissed the notion that vaccines cause autism.”

Yet the overwhelming evidence hasn’t been enough to convince the anti-vaxxers.  Part of the problem is that children can begin to show signs of autism around the time they’re getting some of their childhood vaccinations, and people mistakenly assume that just because something is temporally correlated (occurring at the same time) there must be a cause and effect relationship.  This kind of thinking is fundamentally flawed, and anyone with some degree of research literacy knows that correlation and causation are not the same thing.

This matters because in an unreasonable attempt to avoid autism, parents are not vaccinating their kids and this is putting other people at risk.  Certain individuals can’t get vaccines due to medical reasons, including a compromised immune system, and this is where the concept of herd immunity becomes particularly important.  Herd immunity refers to the idea that if a high enough percentage of the population are vaccinated, an infectious organism has a hard time moving through the population, which serves to protect those who aren’t vaccinated.  The percentage of the population that must be vaccinated depends on how contagious the infectious agent is; for a highly infectious illness like measles, 90-95% of people must be vaccinated to achieve herd immunity.  If the anti-vaxxer movement gains enough steam, this means some of the most vulnerable members of the population may suffer.

Imagine how much good could be done if all the energy and money that goes into anti-vaxxing could be diverted into better understanding autism spectrum disorders and how parents of neurodiverse kids can help them thrive.

 

Image credit: Myriams-Fotos on Pixabay

Gratuitous guinea pig post

I adore my guinea pigs, and seems like other people like them to, so here are some more guinea pig photos.

guinea pig wearing glasses

Cookie the intellectual

 

guinea pig on a leash

Oreo in her harness at the park.  Guinea pigs can’t be taken for a walk (trust me, I’ve tried), so the harness is more to make sure she doesn’t get startled and try to run rather than freeze.  It’s a pretty low-budget harness, though, and not too hard to squirm out of if they’re so inclined.

 

guinea pigs in love

On the left is Cookie and on the right is Sienna, who passed away a couple of years ago.  Sometimes guinea pigs will just fall head over heels in love with another piggie, and Cookie adored Sienna.  If Sienna was in the hidey-house, Cookie would usually be there guarding the door.

 

glat as a pancake guinea pig

With vigorous petting piggies like Squeaky will flatten out like a pancake, and will remain in pancake shape for several seconds afterwards.

 

guinea pig looking at a laptop screen

This is Zippy, who passed away earlier this year.  He liked to check out what was on my laptop screen.

 

guinea pig sitting

Casper was quite young when I first got her, and she had a variety of crazy tricks, including leaping into the hay manger.

 

guinea pig with a mullet

Oreo (the one in the harness above) likes to chew hair, also known as barbering.  I haven’t yet figured out what prompts her to go on her designer cutting sprees.  This picture of Cookie with a mullet is a fine example of Oreo’s work.  Her head is facing to the left.

 

Hope you have enjoyed a little bit of cuteness!

20(ish) Questions

pile of question marks

I’ve decided to take 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 Liz at My Wellbeing and Learning Journey:

  • Are you a city, beach, or country girl?  I’m a city girl.  I grew up in a small town and was not at all impressed.  I do have this unrealistic dream, though, of spending my later years on a little hobby farm in the middle of nowhere surrounded by various furry critters.  I would be completely incompetent at maintaining said farm, but hey, a girl’s gotta dream.
  • If you could choose to live anywhere, where would it be and why?  I think where I live now (Vancouver, Canada) is pretty great.  For one, it’s in Canada, but also it’s pretty cool that you can go from the beach to being on top of a ski hill in less than an hour.
  • Do you have tattoos?  I have 3.  A dolphin on my right hip, Chinese characters on my left hip, and a phoenix on the left side of my ribcage.
  • What are your favourite hobbies?  I think blogging is my only hobby.
  • After a stressful day, what do you do, to help you relax at the end of the day?  Snuggles with the guinea pigs, plus maybe a funny video for distraction.
  • Are you a spring, summer, autumn, or winter person?  I like early autumn, when it’s still sunny and warm-ish, but the leaves are starting to change.  I hate winters where I live – it rains for weeks at a time and sunny days are very few and far between.
  • Sweet or savoury?  I don’t think I could pick just one – both are so yummy!  What I’m not keen on is spicy or bitter.

 

Questions from Marie-Céline:

  1. What is your top tip for writing a blog post?  Write with yourself and what you want to express in mind, and try not to focus on what other people are likely to think.
  2. Which Country do you live in?  Canada – best country in the world!
  3. Do you like to travel?  Yes, I’ve always liked travelling, and it’s probably something I picked up from my parents.  I try to do an international trip almost every year, although sometimes my illness gets in the way.
  4. What is your favourite music?  I don’t really have a favourite.  I’ve got a bunch of songs loaded on my iPhone, and listen to whatever I’m in the mood for.
  5. What is your favourite food?  Cheeseburgers!  And I answer this question often enough that I’ll spice it up and add toppings of the day.  Today will be the oldie but goodie combo of bacon and cheddar.
  6. If you could collaborate with another blogger, who would you choose?  Maybe the author Jenny Lawson, who wrote Furiously Happy, because I think she’s totally hilarious.
  7. Do any of your friends or family have a blog?  Not that I know of.  Then again, I don’t have many friends or a lot of family, so it’s a pretty small pool of potential bloggers.
  8. Do you prefer handmade or shop-bought presents?  I’d probably do more handmade stuff if I had more talent in that department.  There was one year that everyone got scarves for Christmas, but there’s only so many scarves people need, right?  I usually try to get either something that’s useful or something that tastes good.
  9. Besides blogging, do you have any other creative skills?  Writing is really my only creative ability.  I’ve done artistic things before, like dance and playing musical instruments, but I was never inclined to do my own choreography or composition or anything like that.
  10. Would you rather text or talk?  Text, hands down.  I hate talking on the phone, and always have.
  11. If you were asking the questions, what would you like the final question to be? I’m fascinated with animals, so I’m going to pick an animal-themed question.  If you could have one wild animal magically be tame and live with you, what would it be? And I’m going to be very Canadian and choose a moose, although he’d probably find my living room a little too cramped for his liking.  He’d probably want to jump off my balcony, and I’d have an excuse to yell out “there’s a moose on the loose!”

 

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’ve been pretty slowed down, both mind and body.
  • I only had 2 patients to see this week.  One was for my new job, and they pay me a pre-determined amount per visit.  Except they seem to be calculating travel time based on an assumption that I am going to the patient’s home via magic carpet rather than driving through rush hour traffic, so the hourly rate this appointment worked out to was $13/hour less than the minimum they told me I’d be making.  I emailed the manager, and in response got a brush-off email saying they’d be sending out a memo next week about how the per-visit amounts are calculated.  Not impressed.
  • I went to yoga once this week, and had a massage with my lovely new massage therapist.
  • I’ve firmed up pet-setting arrangements for when I’m away next month, which is a relief.
  • I check my comment spam regularly to make sure I catch the legit comments that somehow end up in spam.  I had several spam comments that said “Don’t wear seat belts lest you drown in you own urine?”  Um, okay then.
  • I got a summons for jury duty in the mail yesterday.  I’m not sure yet if I’ll do it or apply for an exemption for medical reasons.  Probably the latter.

 

1 Year Anniversary Achievement It was my (sort-of) 1 year blog anniversary this week.  I say sort of because my go-public date wasn’t October last year.  It’s been a pretty cool journey that has introduced me to some amazing people!

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… vulnerability

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: vulnerability

Wikipedia has a couple of different pages related to this topic: one on social vulnerability, the other on cognitive vulnerability.  It says that the work vulnerable derives from the Latin word vulnerare, which means to be wounded.  The diathesis-stress model explains psychological disorders as resulting from a combination of predisposed vulnerability and external stressful experiences; protective factors help to mitigate this risk.

Cognitive vulnerability results from erroneous patterns of thinking, which makes people more vulnerable to certain psychological problems, such as mood disorders.  Insecure attachment and stressful events contribute to this process.

Social vulnerability refers to the inability to handle the external stressors that one is faced with.  Structural factors, including social inequalities and political factors, can play a role.   Entire communities may be vulnerable in what’s known as collective vulnerability,  “a state in which the integrity and social fabric of a community is or was threatened through traumatic events or repeated collective violence.”

I don’t think it would be unfair to call author Brene Brown the queen of vulnerability.  She has written multiple books and given TED Talks, and is pretty all-around amazing.  In her book Daring Greatly, she challenges the idea that vulnerability represents weakness, and instead says that “vulnerability sounds like truth and feels like courage”.  She explains that vulnerability involves emotional exposure, and while this may not feel comfortable it is at the core of all emotions.  Daring to be vulnerable requires a sense of worthiness to combat shame and beliefs that we are not good enough.

I am highly selective about who I’m prepared to be vulnerable with.  I’ve had some negative experiences, and these are hard to overcome.  I suppose I’m vulnerable on my blog, but there’s really not much that could happen in terms of negative repercussions with that.  I suppose all I can do is look for ways that I can be vulnerable, and at least try to push myself.

Is being vulnerable something that you struggle with?

 

Sources:

https://en.wikipedia.org/wiki/Social_vulnerability

https://en.wikipedia.org/wiki/Cognitive_vulnerability

Daring Greatly by Brene Brown

 

Image credit: GDJ on Pixabay

How can we help those in mental health crisis?

Recently I did a post expressing my concern about learning that a local police force routinely handcuffs people that they are taking to hospital under a Mental Health Act apprehension.  That got me thinking about what it shoulds look like to help people in mental health crisis.

The police force in the city where I live (different from the one referred to in my previous post) has a partnership with the local health authority to operate what’s referred to as car 87/88.  This involves an unmarked police car, a plainclothes police officer, and a mental health nurse.  They attend mental health emergency situations, and track down people who have been certified under the Mental Health Act in the community but left before they could be taken to hospital.  If they’re attending a call and someone needs to be taken to hospital involuntarily, either the police officer will do a Mental Health Act apprehension or the on-call psychiatrist will be called to assess the person and do a Mental Health Act medical certificate if appropriate.  An ambulance is then called, and the person is transported to hospital in the ambulance, with the car 87/88 police officer accompanying as needed and the nurse following behind in the police car.

I really like this system, and the biggest problem I see is that there is only one car for afternoon shift and one for night shift in a large urban centre.  It seems much more civilized to have a more subtle police presence (unmarked car, no uniform), a highly experienced mental health nurse, and transportation in an ambulance (what with mental illness being a medical issue).  I understand why police need to be involved sometimes if someone is being taken to hospital on an involuntary basis, but I don’t think that’s any excuse to take the health out of health care.  Mental illness crisis is an emergency medical issue, and I strongly police should be involved in a primarily supportive role unless there is an imminent safety risk.

Speaking of which, I think it’s crucial that police attending situations where a mentally ill person poses an imminent threat be well trained in the use of less lethal force options, such as weapons that fire rubber bullets or bean bags.  A number of years ago at a mental health clinic where I worked, a client had come in who was highly suicidal and wished to commit “suicide by cop” (i.e. goad police into shooting and killing him).  The team of police officers that attended handled the situation extremely well trained and were able to utilize these less lethal options to make sure that nobody got hurt, including the client.

Because mental illness is unpredictable, mental illness crisis situations are equally unpredictable.  However, I think having a well-designed crisis response system can go a long in in both promoting safety and preserving dignity of the mentally ill person in crisis.  A system that further traumatizes mentally ill individuals does no one any favours, and we need to do better than that.

Book review: I Am the Architect of My Own Destruction

book cover: I Am the Architect of My Own Destruction by Juansen Dizon

I Am the Architect of My Own Destruction is Juansen Dizon’s second book of poetry.  The book opens with a letter to the reader, which begins “It’s hard to write when you want to kill yourself. It’s harder when you don’t really know the reason as to why.”  Throughout the book I felt like I as a reader was being directly spoken to.

The poems capture the darkness and depth of mental illness, and often I was left thinking wow, that’s exactly how I have felt.  Thoughts of suicide are shared in a way that feels very genuine and non-triggering.  The book touches on a range of topics including body image and the difficulty of self-love.  Along with the difficult part of mental illness, Juansen also writes about healing and happiness.  This provides a good balance to some of the darker poems.

Many of the poems were quite short, which I really appreciated because as I was reading the book depression was doing a number on my concentration.  Some are only one line, but carry profound meaning in those few words, like Numb and Casket.  I was impressed by the emotional depth that could be captured in just a few words.

The book explores love and navigating relationships, and how challenging this can be when in the depths of mental illness.  Juansen clearly bares his soul as he writes about this.  The book also includes touching letters to his girlfriend and his brother.

I particularly liked the one-line poem Seraphim: “Melancholy is an angel that fell in love with a demon.”  Another favourite was Warriors, which talks about the strength it can take to stay alive.

This book carries the reader on a poetic journey into the author’s mind and heart, giving an intimate look at the experience of mental illness.  The poems are very accessible, in the sense that even people who don’t normally read much poetry would likely find it easy to engage with this book.  It’s well worth checking out.

 

You can find Juansen on his blog Lonely Blue Boy.

 

Note: I was provided with a free copy of this book in exchange for an honest review.

Image credit: Amazon.com

Is the law of attraction real?

At one point I had come home from an extended stay in hospital, and because ECT had wiped out a chunk of memory, I discovered things in my house that I had no idea how they had gotten there.  One of those things I found was a book on the law of attraction.

On first glance, the idea of the law of attraction is very appealing – you get back from the universe whatever you put out into it, because like energy attracts like energy.  According to the film The Secret, it’s not only thinking about what you want to get back but also pouring emotion into it that will get results.  But when you poke at it a bit, the whole idea starts to crumble.

I watched The Secret for the first time recently and thought there were a number of things that seemed unreasonable, such as the idea that the universe is like catalog shopping, and as long as you think and feel a wish for something, you just need to sit back and wait because the universe will turn your thoughts into things and just drop them in your lap.  Apparently “the law of attraction will give you what you want every time”.  Are you getting bills in the mail?  Well, that’s not because you owe money, it’s because you’re expecting to get more bills.  Change your thinking to expect a cheque, and your credit card company will just forget about those overdue payments and some random person will start sending you money on behalf of the universe!  No need to worry about how it will happen; the universe is going to figure that out for you.

The Secret contains some fishy ideas about how the brain works.  Some examples: “Every thought has a frequency”; “Thoughts are sending out the magnetic signal that’s drawing the parallel back to you”; “It has been proven now scientifically that an affirmative thought is hundreds of times more powerful than a negative thought”.  A 2007 issue of Scientific American questioned the accuracy of how the law of attraction represents brainwave electrical activity, and multiple authors have questioned other aspects of its purported scientific basis.  According to a 2010 New York Times book review cited by Wikipedia, The Secret is pseudoscience and an “illusion of knowledge”.

I’m not questioning the power of positive thinking to shape our experience.  While the law of attraction may have some similarities to positive psychology concepts, there are some fundamental differences.  Let’s consider Elie Wiesel, a remarkable, Nobel prize-winning Jewish author who survived detention in Nazi concentration camps.  He is a powerful example of maintaining a positive attitude in order to survive unimaginable horrors.  Did his attitude make the horrors go away and attract only positive things?  Of course not.  But it changed the framework of meaning through which he interpreted his experience.  However, this does not seem to be what the Law of Attraction is getting at.  The law of attraction seems to suggest that people ended up in concentration camps because somehow that’s what they were asking the universe for, and they stayed there and suffered because they just weren’t asking the universe properly to be free.

One area where the law of attraction really falls apart for me is serious illness, be it mental or physical.  “Everything that’s coming into your life, you’re attracting into your life” says “philosopher” Bob Proctor in The Secret (I could find no evidence of him having no background in philosophy).  So what, have we somehow put crazy energy out there into the world in order to attract mental illness our way?  If we are gripped by psychosis, is that because of something we’ve put out there into the ether?  And when we try to end our lives, is that because we’re not shooting out enough good vibes?

I get that it’s good to try to be positive.  There’s a whole field of positive psychology that leans in that direction without the pseudo-scientific talk of thoughts radiating frequencies and positive and negative energies attracting each other.  But how far can thinking/emoting get you without action?  I can think wealthy thoughts all I want, but unless that spurs me to work on money management and pursue opportunities for growing wealth, it seems rather implausible that the universe would a) care, and b) throw money down from heaven and say “this is for you!”  If the positive thought acts as a motivator for action, I can see how that would be very powerful.  But just hanging out eating, peeing, and sleeping dollars seems unlikely to get me very far in the wealth department.

I’m not interested in mincing words, so I’ll conclude that the law of attraction as a whole is a load of BS, but there are still some positive things to take away from it.  Make sure your attitude is helping you, not getting in your way.  The vibes that you put out towards other people are likely to end up being reflected back to you in some way, so follow the golden rule and do unto others, etc.

Do you think the law of attraction is real?

My experiences of going off meds

I have never had  a problem with medications in general, and in my work as a nurse I’ve seen how much good they can do.  Despite that, I’ve gone off the meds I take for depression a few times, and that’s what this post is about.

My first episode of depression was in 2007.  I ended up hospitalized following a suicide attempt, and spent 2 months in hospital.  I continued taking my meds for a few months and I then I had another suicide attempt, this time by overdosing on my psych meds.  I didn’t do any significant damage, so I chose not to tell anybody at the time.  I decided that to hell with it, if I was on meds and still feeling shitty, what was the point of continuing meds?  Continuing on my deceptive theme, I didn’t want my treatment team to know I wasn’t taking meds, so I continued to pick them up regularly from the pharmacy.  I ended up getting into full remission without meds, and I remained well for almost 4 years.

My plan all along was that if I started to have signs of getting worse, I would restart meds.  When the depression started to hit me in 2011, I quickly recognized the red flags of poor sleep and low mood, and made an appointment to see my GP.  I had to practically beg for meds, and he begrudgingly gave me 10mg of citalopram, although his preference was that I attend group therapy.  2 weeks later I ended up in hospital.

It took a year and a half to get fully well again, and I ended up on multiple weight gain-inducing meds (lithium, quetiapine, and mirtazapine).  The weight gain was hard to adjust to, although I recognized it was probably a fair price to pay for being well.  After 2 years in full remission, I decided I wanted to try going off the quetiapine, and my psychiatrist was agreeable.  We tapered down the dose gradually, and at first it seemed like I was going ok, until suddenly it wasn’t.  I got really slowed down, and ended up having to go back on the quetiapine as well as up my dose of lithium.  Clearly I needed my full med cocktail.

It wasn’t too long afterwards that my workplace bullying debacle began.  This culminated in me deciding to quit my job, and I became quite depressed again.  My psychiatrist ‘s reaction was tremendously invalidating, so I stopped seeing him.  I had recently begun seeing a new GP, and when I told her why I wasn’t seeing the psychiatrist any more, she came out with the same invalidating comments he did.  I refused to see her again, so she booked me in to see another GP at the same clinic, who ended up being even worse.  I couldn’t bear the  thought of going to see another doctor, so I decided that with the meds I still had at home I would do a gradual taper and then stope them.   It wasn’t that I wanted to stop taking meds, I just wasn’t willing to see another doctor.  Not surprisingly, that strategy didn’t work out very well for me.  I was barely sleeping despite taking everything over-the-counter I could think of.

It was when I decided that I needed to go back on meds that I found my current GP, who’s very reasonable and pragmatic.  Even so, there have been a couple of times that I’ve thought screw it, there’s no point going in to get my meds reordered because I just feel like crap anyway.

My logical mind is very adamant that I need meds.  Unfortunately, sometimes depression sneaks in and twists things around, and for me I don’t think that’s something that will ever go away no matter how pro-meds I am most of the time.

Have you gone off meds before?  What was the experience like?

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 DM at Pointless Overthinking:

  1. What is your biggest fear?  Being unemployed and running out of money.  It may seem like catastrophizing, but it would have been my reality a couple of years ago if I wasn’t such a diligent saver.
  2. What would you like to achieve with your writing?  I’m not particularly goal-oriented when it comes to my writing, but I do want to continue to connect with other bloggers and tap into this sense of community.
  3. On a scale from 1 (hell would be better) to 10 (everything is more than perfect), how satisfied are you with your life right now and why do you think so?  Hmm, that’s a very tough question.  Right now I feel like I’m coasting along on momentum rather than feeling much overall satisfaction.  I’m definitely below a 5, but how much below varies depending on how I’m feeling.
  4. What is the first thing you do every morning?  Feed the guinea pigs.  If I try to stay in bed for a while but they hear me rustling around, they’ll start squeaking to remind me to give them their breakfast.
  5. How do you like to spend your weekends?  At both of my jobs I work casual, so there’s really no difference in my world between weekdays and weekends.
  6. What are you grateful for?  Those same 4 little balls of fur that kick up a ruckus if I don’t feed them exactly when their little hearts desire.
  7. What things do you have on your bucket list?  I’m leaving very soon for a trip to Italy, which has always been on my bucket list.  Roman ruins, renaissance art, good food, good wine… what more could you ask for?
  8. What’s the craziest dream you ever had?  This question would require that I remember my dreams, which I rarely do.  Maybe that’s a good thing, maybe it’s a bad thing… I’m inclined to think it’s a good thing.
  9. What’s your core belief?  I think the belief that has stayed the most consistent through my life is the belief that it’s important to always be expanding my mind, by learning more and seeing new things.  That’s a big part of why travelling has always been very important to me.
  10. What is your biggest desire?  The problem is that would require me to feel desire, which I just don’t.  I guess what I want the most falls more into the category of not wanting – I don’t want harmful things to happen to me.  I feel like I’ve met my quota on that for a while.

 

Question from Have You Ever Noticed? blog:

Talk about an incident that impacted your life in a really positive way.

There have been a lot of occasions while I’ve been travelling that people have decided to take the dazed and confused solo white girl under their wing.  In Hanoi, Vietnam, I was visiting a museum and came across the board of directors of the museum (or something along those lines) having lunch.  They decided I should join them, and they were showing me how to eat the food properly and telling me all about their museum.  In India, I had gotten confused and thought I’d missed my train in the middle of the night.  Turned out my train was just pulling out of the station, and they radioed and told it to stop.  One of the staff picked up my backpack and starts running toward the train, with me huffing and puffing along after him, and I made it on the train – a great Bollywood moment.  When my friend and I were travelling in Romania, we got to a town where the guesthouse mentioned in our guidebook simply didn’t exist.  We were trying to ask directions, and a lady took pity on us and invited us to stay in her house.  She spoke maybe 5 words of English but she was thrilled to have us there.  This is why I love travelling; it’s such a good reminder that there really are kind people in the world.

 

A few questions from A Guy Called Bloke and K9 Doodlepip‘s Game On series:

What is the funniest first name you have ever heard used in the real world?[as in not cartoon or films and so on]  When I was younger, my friend had a crush on a guy named Tree, who had one brother named Ember and another sibling named something tree-related.

Why did 6 cry?  Because 9 was a useless lover.

If you awoke one morning and found your five year old self in your current body, what would be the first thing you do?  Probably gaze at the mirror in confused fascination about having breasts.

If animals could talk which one do you think would be the rudest?  My guinea pig Squeaky.  He can be a grumpy old man.

What is your most favourite funniest film – provide link please.  The Heat with Melissa McCarthy and Sandra Bullock.  It’s one of my main go-to’s to lift me up if I’m feeling shitty.

How many mice would it take to lift an elephant?  Only one if the elephant is hooked up to a crane and the mouse is qualified to operate said crane (the guinea pigs would be willing to help out).

Ok, somehow you have found yourself in front of a panel of doctors in the local insane asylum and you have to convince them that you are not mad, even though you are acting quite bonkers – how would you convince them that you really are ok?  I would recite pharmacology info while doing the hokey pokey and balancing a DSM on my head.

How much did the polar bear weigh?  The square root of the weight of the elephant divided by the combined weight of the mouse and any guinea pigs helping out.

Blimey!! You have just landed the task of making a room filled with straight faces laugh – how are you going to achieve it??  Show an episode of Seinfeld, maybe The Contest.  Are you still master of your domain?

Who is your favourite comedienne?  Probably Melissa McCarthy.  I loved her Sean Spicer impression.  Plus she was great in The Heat, as mentioned above.

Do butterflies remember their life as a caterpillar?  They’re too busy being pretty to worry about caterpillar-hood.

Why is a carrot more orange than an orange?  I think an even better question would be if an orange is called an orange, why isn’t a lemon called a yellow?

Why does grass smell only when it’s been cut?  Insert fart joke here.

If a word is spelt incorrectly in a dictionary – how would you know if you didn’t have any way of checking it?  My question here would be what if you don’t know how to spell a word, how the heck are you supposed to find it in a dictionary?  Say you don’t know phone starts with a ‘ph’ and you’re looking under ‘f’ – you’re truly f’ed!

What was Captain Hooks name before he got the hook?  Let’s just hope he wasn’t born with hook.  Now that would feel pretty damn awful coming out the vagina – kind of like an episiotomy on steroids.

 

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:

  • Mood-wise I’ve been better than last week.  Concentration is still not very good, and I get very easily overwhelmed.
  • I had to switch massage therapists last month because my previous therapist had left the clinic.  I wasn’t happy with the new therapist, so this week I saw another therapist at a different clinic.  She was fabulous, and she used a weighted heated blanket, which I really liked.
  • I spent more time in the kitchen this week.  Fall is such a nice time to make hearty foods like soup.
  • I saw my first patient for my new job.  I was teaching her to self-inject a medication that I was already familiar with, so there was no reason for me to be nervous, but I just felt really overwhelmed.  I had an odd experience when I was there.  We were both sitting on the couch, and then she had gotten up to look for her reading glasses.  I felt the cushions moving behind me, as though there was a cat walking across the top of them.  I looked behind me.  Nothing.  It happened several more times, and I kept looking back.  Still nothing.  And that got me thinking on my drive home that this isn’t the first time I’ve had weird perceptual stuff going on.  Like sometimes I feel my bed vibrate and the thought that comes to mind is that the guinea pigs caused it, which makes no sense.  Is it mild psychosis?  Friendly ghosts?  I really don’t know.
  • I continue to struggle with a good friend who unintentionally does things that upset me.  It’s exhausting.
  • I’ve got reservations/tickets for everything that I wanted to book ahead of time for my Italy trip.  I’m a bit concerned that if I’m feeling so overwhelmed by not much of anything at home, I’ll be really overwhelmed by dealing with all the daily logistics while I’m away.

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… invalidation

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: Invalidation

According to Psychology Today, validation involves conveying acceptance, and recognizing that the person’s thoughts/feelings/reactions are understandable.  It also serves to communicate that the relationship is important.  It doesn’t necessarily mean agreeing or approving, something I think is a major stumbling block for people who aren’t very familiar with the idea of emotional validation.

The developer of dialectical behaviour therapy (DBT), Marsha Linehan, identified six levels of validation, with the level called for varying depending on the situation:

  1. Being fully present
  2. Accurate reflection from a non-judgmental stance
  3. Mind-reading: unlike the cognitive distortion that’s also called mind-reading, this involves trying to read the person’s behaviour and imagining what they could be feeling/thinking, and then checking for understanding
  4. Understand the person’s behaviour on the basis of their history and biology
  5. Normalizing the person’s emotional experiencce
  6. Radical genuineness, accepting the person how they are while seeing their struggles and pain

Psychology Today explains that invalidation happens when “a person’s thoughts and feelings are rejected, ignored, or judged”.  This creates emotional distance in relationships, and self-invalidation makes it difficult to construct one’s own identity.  People are more likely to be able to acknowledge when they are self-invalidating as opposed to invalidating others.

Emotional invalidation may contribute to the development of emotional disorders.  According to an article on Very Well Mind, Marsha Linehan proposed that when children with a biological predisposition to intense emotions have those emotional experiences invalidated by caregivers, they may be prone to developing borderline personality disorder.

A doctoral dissertion I came across on emotional invalidation proposed a 3-step process: invalidating behaviour (consisting of minimizing, ignoring, blaming, or neglecting) can lead to perceived invalidation (the person interprets that their feelings are unimportant, inconsequential, incorrect, or incompetent), which then leads to emotional invalidation.  From this perspective, invalidating behaviour may not lead to a subjective sense of being invalidation depending on the individual’s response.

People may be invalidating in a variety of different ways.  They may mistakenly assume that they can’t validate if they don’t agree with whatever it is the other person is expression.  They may want to try to fix your problems, or lie trying to avoid hurting your feelings.  More overtly harmful ways of invalidating including blaming, minimizing, judging, or denying.

I was lucky in that I grew up in a very validating environment.  I’ve become a lot more sensitive to invalidation after the workplace bullying I experienced a couple of years ago.   The overt invalidation directly related to the bullying was bad enough, but I also struggled a great deal with the people who supposedly supported me being very invalidating, albeit in a very well-intentioned way.  It probably would never have crossed their mind that “It’s not that bad” or “Everything will be ok” would be invalidating, but it was.  My psychiatrist at the time was invalidating in much the same way.  So I ended up with this mass forced exodus of people out of my life, and that fear of invalidation is a big part of why I don’t want to let people back in.

What role has validation or invalidation played in your life?

 

Sources:

Elzy, M.B. (2013). Emotional Invalidation: An investigation into its definition, measurement, and effects. Doctoral dissertation.

Psychology Today

Very Well Mind

 

Image credit: GDJ on Pixabay

Why isn’t Complex PTSD in the DSM-5?

While many sources of trauma are time-limited, some occur repeatedly over prolonged periods of time.  The term complex PTSD is used to capture the profound psychological harm these people exposed to the latter have experienced, including changes in self-concept, problems with emotional regulation, distorted perceptions of the perpetrator, and impaired relationships with others.

There are two major diagnostic symptoms used in psychiatry.  These are used to standardize diagnostic criteria, and are used for such things as insurance billing.  The American Psychiatric Association puts out the Diagnostic and Statistical Manual (DSM), which is currently in its 5th edition.  It is the diagnostic system that tends to be used in North America.  The World Health Organization publishes the International Classification of Diseases, which is now in its 11th edition, and it is used in various areas worldwide.  The recently released ICD-11 considers complex PTSD to be a distinct diagnosis from PTSD, but the DSM-5 does not.  Why is that?

According to the ICD-11, complex PTSD is:

“a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible… The disorder is characterized by the core symptoms of PTSD; that is, all diagnostic requirements for PTSD have been met at some point during the course of the disorder. In addition, Complex PTSD is characterized by:

1) severe and pervasive problems in affect regulation;

2) persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event; and

3) persistent difficulties in sustaining relationships and in feeling close to others.

The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”

There were a number of changes in the diagnostic criteria for PTSD in the DSM-5 compared to the DSM-IV.  The DSM-5 added a symptom cluster of negative alterations in cognition and mood, along with symptoms related to intrusion, avoidance, and alterations in arousal and reactivity.  This new symptom cluster includes:

  • “Overly negative thoughts and assumptions about oneself or the world;
  • Exaggerated blame of self or others for causing the trauma;
  • Negative affect;
  • Decreased interest in activities;
  • Feeling isolated;
  • Difficulty experiencing positive affect”

There is some overlap with the symptoms described in the ICD-11, but the DSM-5 doesn’t seem to fully capture those symptoms.

According to the National Center for PTSD, complex PTSD was not included as a separate diagnosis in the DSM-5 because 92% of those with C-PTSD also met the criteria for PTSD.  A review of the literature by Resick in 2012 found insufficient evidence to support complex PTSD as a distinct diagnosis from PTSD as defined in the DSM-5.  This is in spite of a significant body of research literature supporting complex PTSD as a separate diagnosis.  For example, a study by Powers et al. of African women found “clear, clinically-relevant differences” between the two conditions.  C-PTSD was associated with lower likelihood of having secure attachment, greater comorbidity with other mental illnesses, increased emotional dysregulation and dissociation.

Of course the DSM needs to consider research evidence in making decisions about what diagnoses to include, but I’m concerned that their choices with regards to research findings may have been biased.  Solely from a common sense perspective it seems like someone who was a victim of incest throughout their childhood will probably have a different presentation than a soldier returning from war.  Whether complex PTSD is considered its own diagnosis or a subtype of PTSD, it seems useful to make that distinction in order to ensure people living with post-traumatic stress disorders are getting the best possible services.

What are your thoughts on whether PTSD and complex PTSD are distinct entities?

 

If you’re interested in reading about some of the individual research studies on the topic, the National Center for PTSD has a concise overview of the literature.

Sources:

Book review: Be There For Me

Book cover: Be There For Me by Faith Trent

Faith Trent explains that she wrote Be There For Me: An Insight Into My Journey With Depression to “1. Show sufferers they are not alone. 2. Provide advice and guidance for those trying to support a sufferer. 3. Try to remove some stigma around depression.”  At the time of writing she was in the midst of a depressive episode and was off work, and she thought writing would be a good way to make something positive out of something horribly difficult.

The author’s depression journey captures common elements shared by many of us living with depression.  When she first became depressed, she had no idea what was happening, especially since there was no identifiable trigger or reason for her to be depressed.  She was initially reluctant to try medication, a view that she’d picked up from her mother.  There are chapters devoted to various different features of her illness, including anxiety and self-harm.  For her, self-harm was a way to somehow legitimize the way she was feeling.

She describes what it feels like to live with depressive symptoms such as fatigue, apathy, poor concentration, and the pervasive shadow of guilt.  She also explains common thought patterns in depression, including self-doubting, feeling like a burden, and drowning in shoulds.  These are not textbook definitions, but rather descriptions of the subjective experience.

She writes about the challenges of parenting young children with depression, and how the illness makes the daily parenting tasks feel like a mountain that must be climbed.  She finds it hard to be fully present with her children, and she regrets the distance from them that has created.  She also crying in front of them.  I’ve always wondered, though, if there isn’t benefit in children seeing what mental illness actually looks like, and perhaps this helps to prevent the propagation of stigma.

She identifies the essential elements she has found for managing her illness: becoming aware of her triggers and early red flags of worsening illness, maintaining work-life balance, getting enough rest, talking to a close circle of friends, exercising, and doing things that make her happy.  When her illness hits hard, she says “it cripples my whole life…  It causes me to question every part of my life, doubt my value, and make me feel like I am a burden to all I encounter.”  This struck me as such classic depressive thinking.

As is far too often the case for those of us living with mental illness, the author has experienced stigma directly.  Some people made her feel “truly inadequate and small for suffering from something that I feel they didn’t believe was real. I was patronised and made to feel like I was making it up at times.”  It was disturbing to read that a teaching colleague of hers questioned whether she should be allowed to be at work because she might pose a danger to her students.  As a nurse I have faced questions about my safety to my patients, but somehow no one realizes (or cares?) that with depression most often the real risk is to ourselves.

The main focus of the book is breaking down stigma.  She concludes that the only way to do this is for people with depression to share their stories to counter the misconceptions others may have.  I wholeheartedly agree.

 

You can find the author on her blog Shatter the Stigma.

 

You can find my other book reviews here.

Some thoughts on suicide

AFSP National Suicide prevention week 2018

Content warning: This post openly discusses suicide and suicide attempts

You can find info here on where to reach out for help if you’re in crisis.

 

It’s suicide prevention week, so it seems like an appropriate time to talk about suicide in all its ugliness.  I have attempted suicide multiple times; most were associated with my first episode of depression just over 10 years ago.  Suicidal thinking is a symptom of my illness, and one that will most likely continue to pop up when things get really dark.  It’s something abnormal that unfortunately has come to be all too familiar.

In 2007 I had three suicide attempts outside of hospital, plus multiple attempts while in hospital that resulted in me being sent to psych ICU.  At the time of the first attempt. I hadn’t been diagnosed with depression yet, but I was fairly certain that’s what was going on.  The suicidal thinking had been building, and then it got to the point where I had a plan.  The next step was getting pills, and finally I ended up taking those pills.  Each of these steps was well thought out and took some time; there was nothing impulsive about any of it.  I tried to hold off as long as I could out of a sense of responsibility to my family and other people in my life, but things were just so bleak and hopeless that the idea of remaining alive seemed totally untolerable.  The suicidal thinking was something new to me at that point in my life, so it was hard to figure out ways to cope with it.  I went through a brief phase of cutting in an attempt to find an alternate way to deal with the pain.

When I became depressed in 2010, initially suicidality wasn’t among the symptoms I was experiencing.  However, as the episode extended over the next year I began having ever-increasing thoughts of suicide.  I took myself to hospital voluntarily, but had a very negative experience and ended up being discharged without feeling any better.  I developed a suicide plan involving my psych meds.  At the time, I was working Monday to Friday with every other Friday off, and my plan was to take the pills on one of my Fridays off so no one would notice anything out of the ordinary until Monday.  Each Friday off, I would evaluate whether or not I thought I could make it through until the next Friday off.  Eventually one Friday I decided I just couldn’t take the pain anymore, and I took the pills.  Over the next few days I alternated between sleeping and wandering around delirious, and then when I didn’t show up for work on Monday they called the police.  When the police showed up at my door I was totally loopy, and they hauled me off to hospital.

I haven’t attempted suicide since then, but there have been a few occasions when I have taken steps towards enacting a plan to kill myself.  What has stopped me has been fear – not fear of dying, but fear of “failing” to kill myself.  I generally don’t tell people when I feel suicidal, partly because I don’t feel like talking will help, and partly because I have a strong aversion to going to hospital.  I’ve come to the conclusion that given the history of my illness, chances are fairly good that I will eventually, at some nebulous point in the future, end up dying by suicide.  I don’t say this because I desire this outcome or because I’m suicidal right now, but in terms of simple probability it seems the most likely.

That brings me back to what I said in my post yesterday.  To really decrease the risk of suicide in those of us living with mental illness, we need better treatment.  We need more than just an ear to listen to us; we need something tangible that will truly make a difference and create a bright light of hope.  And that can’t come soon enough.

 

Image credit: American Foundation for Suicide Prevention

How do we prevent suicide?

AFSP world suicide prevention day

You can find info here on where to reach out for help if you’re in crisis.

Today is World Suicide Prevention Day.  It’s great to raise awareness, but the problem is, people are still dying.  We can talk until we’re blue in the face about why and how people should reach out, and there are lots of great crisis lines out there doing excellent work, but why is there still a gap between that talk and the actual statistics?

The way I see it, there are two broad groups of people that it’s important to connect with when we consider suicide risk.  One is the people who are suffering in silence, and not reaching out for help because of stigma, fear, or whatever the reason may be.  I think initiatives such as World Suicide prevention Day can potentially do a lot of good in reaching this segment of the population and encouraging them to access support.

Then there are those of us who are living with a mental illness diagnosis and doing our best to access the services that are available to us, but we are still suffering.  If you’re like me, maybe the talk about suicide prevention further reminds you of the role that suicidal thinking has played and will continue to play in your life.  It’s important that we talk about it and get it out in the open, but talking isn’t enough.

To truly prevent suicide, we need better treatment for mental illness, and faster access to existing treatment.  The current treatments we have available for mood disorders are okay, but a lot of us are still experiencing symptoms, and that shouldn’t be the only outcome possible.  It can be very hard to maintain hope  when the best available treatment doesn’t take the suicidal thoughts away.  Me calling a crisis line changes nothing about my depression, so why would I even consider it?  My doctor is happy to see me more frequently when the suicidal thoughts come up, and I appreciate that, but there’s not all that much we can really do about them other than me riding them out.  Sadly, I’ve come to accept that this is part of my reality.

So if we are truly going to prevent suicide, we need a multi-pronged approach.  Yes, we need to get people talking and break down stigma.  Yes, we need to make people aware of existing crisis resources.  But we also need better treatment for mental illness, and that means more research dollars.  Because talk doesn’t do much for the many people in the same boat as I am and many of us in the mentally healthy blogging community are.

 

Image credit: American Foundation for Suicide Prevention

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 Quick Fire Round 10:

  • What is the one meal you could eat all day every day for the rest of your life if you had to?  Cheerios.  I’ve been eating them since I was a kid, and will keep eating them til the day I day.
  • If we lived in an all grey world what three colours would you introduce as the first and only colours to our world?  I’m a little blue-crazy, so let’s go with navy blue, sky blue, and teal.
  • Have you ever been starstruck?  Back in the day I was a big ice hockey fan (how very Canadian of me).  I went to a few Vancouver Canucks games and was oh-so-starstruck by the team captain at the time, Trevor Linden.   I had decided that somehow, eventually, I was going to marry him.  It hasn’t happened yet, but you never know.
  • What is the best present you have ever received?  An ex-boyfriend was totally broke but managed to scrounge up the money to buy me a digital camera because I was going on a trip.  I have to add the caveat that this was 10 years ago, back in the day before everyone had smartphones.  Yes, that day did actually exist, and I had a Nokia flip phone with a camera that was absolute crap.
  • What film would best describe your life?  I’m going to say Dirty Dancing, not because it actually describes my life, but because I’ve always wished that it did.
  • What song would best describe your life?  Sticking with the Dirty Dancing unreality theme, I’ll go with (I’ve Had) The Time of My Life.
  • What is the next book you are thinking of reading?  The Mind’s Own Physician by the Dalai Lama is loaded on my eReader, ready to go.
  • If you NEVER had to sleep and could sail through each and every day without getting tired, what would you be doing with all that extra time?  I would sleep anyway.  I love sleep, and bedtime is my favourite time of the day.
  • What question would you ask of a stranger to get to know them better quickly?  I don’t actually like people, so I would most likely pretend said stranger didn’t actually exist.  But if I did have to, I would ask who they fantasized about the first time they masturbated.  Chances are that would send them running in the opposite direction.  Mission accomplished.
  • Worst holiday you have ever had?  There was definitely good stuff about it, but when I went to India in 2015 I had a month of diarrhea while I was there and 2 months more once I got home.  Those 3 months included many, many times more diarrhea than the other 39 years of my life so far.  I could go into detail, but I’ll spare you the disgustingness.
  • You have the choice at dying at 100 or living to 200 but still go through the ageing process what would you select and why?  100? 200?  Dear lord is dying at 50 not on the menu?
  • How will humans evolve in the next 1000 years – as in what do you think we will look like?  I hope we’d look like butterflies.  It would make the world so much prettier.
  • What’s the website you visit most often?  Duh, WordPress!
  • If these were only two choices what would you pick and why: A planet with no fruit or a planet with no vegetables?  Can I pick the planet with neither of the above?  As long as there are cows.  I love me some dairy.
  • In a world that is constantly changing on a daily basis what one thing do you hope will never change?  Guinea pigs.  I hope they stay as furry and silly as they are now.
  • What is your astrological sign and do you think you are close to that personality type?  I’m a Pisces, and even though I don’t believe that kind of thing, it’s actually reasonably accurate.
  • It is said that every one of us has a book waiting to be written, what would your book be?  I don’t know the topic, but I think it would be written in a dead language.  Perhaps Aramaic.
  • What is something you will NEVER do again?  I did an aerial tour of the Nazca Lines in Peru.  I barfed, barfed, and barfed some more, despite significant pre-meditating.  Never, ever again.

Answers please on the transparent side to a droplet of water!

I would need Alice’s looking glass for that complex procedure…

 

ABC Tag from Flowers in the Brain: This looked fun, so I thought I’d join in.

  • Age: 39
  • Books: Over the last couple of years I’ve mostly been reading non-fiction.  I also like classics like Pride and Prejudice and A Tale of Two Cities.
  • Colours: blue, blue, and more blue
  • Dream: happiness
  • Everyday start with: 1) feed the guinea pigs 2) pee 3) tea
  • Flower: I’m a bit clueless about flower names, but I like lilacs and irises because my mom grew them in our back yard when I was a kid.
  • Goals: Find a job that’s more fulfilling (same career, just different workplace)
  • Height: 5’8″ (oddly enough, we’re mostly metric in Canada, but for people’s height and weight we always use Imperial)
  • In love with: guinea pigs!
  • Job: nurse
  • Kids: only of the guinea pig variety
  • Last thing I ate: corn flakes (although unlike Flowers in the Brain, they’re not homemade)
  • Magic power: Being able to fly, especially since flying in airplanes is so unpleasant
  • Number of fears: There are a variety of things that I’m afraid of, but the only one I get totally irrational with is spiders
  • Outfit: pyjamas
  • Passions: guinea pigs!
  • Quotes: everything that comes out of the mouth of the Dalai Lama seems wise and profound.  I bet he could be talking about needing to pee and make it into a deep recognition of our shared humanity.
  • Reasons to smile: yet again, guinea pigs!
  • Season: late summer/early autumn – kinda like right now!
  • Travels: I’ve got a trip to Italy coming up next month
  • Underwater animals: Dolphins.  My first tattoo was of a dolphin.
  • Vacation: I like to travel overseas when I go on vacation and experience something new and different.
  • Worst habit: Like Flowers in the Brain, I’m a skin picker.  It’s less of a psychological thing and more because of my eczema.
  • X men character: I would have to know who the X-men characters are before I could answer this one.
  • Your favourite food:  Cheeseburgers.  No wonder it’s hard to control the psych med weight gain!
  • Zodiac sign: Pisces

 

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:

  • My brother’s wedding was this past Sunday, which was really stressful.  It was also hard to be reminded how much lower my level of functioning is now compared to when I’m well.
  • I’ve been having quite a bit of anxiety this week.  Not anxious thoughts, but physically anxious.  There’s nothing for me to be “anxious about” with the wedding being over and one with, so I’m not sure what’s going on there.
  • My concentration has been quite bad, which has made it hard to get much of anything done.
  • I had gotten Botox in February because there have been a few studies that found Botox injected into the frown lines on the forehead could help with depression.  While it’s hard to say how much it did or didn’t help, it did make me realize just how much I had been frowning before.  The effect of the previous injections started wearing off a little while back, and recently I started to notice I was frowning again, so I got Botox round 2 this week.  It can’t hurt, anyway.
  • I need to arrange a pet-sitter to take care of the guinea pigs when I go to Italy next month.  Figuring out how to choose someone feels really overwhelming.
  • I’ve gone to yoga twice this week and gotten out for walks almost every day.

 

How has your week been?

 

Image credit: Rawpixel on Pixabay

What is… love

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: Love

“How do I love thee?  Let me count the ways…” began a famous sonnet by Elizabeth Barrett Browning.  So how many different ways of loving are there?

From a psychological perspective, love is a social and cultural phenomenon as well as an individual emotional and cognitive experience.  Love may be interpersonal, impersonal (i.e. focused on an object or a principle), or directed toward the self.  Interpersonal love may be mutual or unrequited.  Extremes related to love include narcissism and erotomanic delusions (believing that another person, often famous, is in love with them).

Psychologist Robert Sternberg’s triangular theory of love includes intimacy, commitment, and passion.  Different types of love, e.g. romantic or companionate, involve different combinations of these three elements.  Consummate love has all three of these elements present.

In psychologist Erich Fromm’s book The Art Of Loving, he argued that any sort of feeling of love is less important than the actions that demonstrate commitment.  While sensations of love may initially be involuntary, as time goes on it becomes a conscious choice of commitment.  So we may fall in love, but ultimately we make a choice to stay there.

From an evolutionary psychology perspective, love is seen as a means to promote ongoing parental support of children and therefore increased survival of offspring.  From a biological viewpoint, love is a primal mammalian drive along the lines of hunger or thirst.  Parental attachment is promoted by hormones including oxytocin, while pheromones are involved in sexual attraction.  During the falling in love stage there is a rush of  neurotransmitters including dopamine.

Love may also be examined from a philosophical perspective.  This includes questioning the nature, function, and value of love, distinguishing between different kinds of love, and considering the effects of love upon autonomy.  One might consider how they would go about explaining the apparently irrational behaviour associated with love to a hypothetical person who had never experienced love.

Love is a frequent theme in various ancient cultures as well as religious traditions.  Ancient Greeks described four types of love: kinship, friendship, sexual/romantic love, and divine love.  In ancient China, the concept of benevolent love was an important part of Confucianism.   In Christianity, love is seen as coming from God, and in Judaism, love between marital partners is seen as an essential part of life.  In the Quran, one of the 99 names for Allah is Al-Wadud (The Loving One).  In Buddhism, there are several different terms to denote different kinds of love, which may range from selfish to selfless/elevated.

If there are so many different ways of looking at love, does it make sense to use the same word for all of them?  And while some forms of love, such as parent-child love, seem to be viewed much the same way universally, I wonder to what extent our notions of romantic love are culturally derived.  Does romantic love fit in with the (at least from what I remember) teenage binary view that there is a specific point where the great heart-bulb goes on over your head and you’re in love?  Should falling in love happen before or after (as may be the case in arranged marriages) the wedding?  And can you love someone and dislike them at the same time?

Do you have any thoughts to share on the great questions of love?

 

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

Image credit: GDJ on Pixabay

What’s God got to do with it?

This post is only loosely associated with mental health, but it’s a topic I wanted to explore anyway.  I hope that this isn’t offensive to anyone, and my intent is not to criticize anyone’s belief system.

I was raised in an atheist family, and never set foot in a church as a child.  As I entered my 20’s and began travelling, I started to experience religious practice as a detached observer.  I would go into sites of worship, and observe religious services (always in non-English languages though).  I’ve been an array of churches, mosques, and temples of various sorts.  I’ve been to Jerusalem and seen the three major Abrahamic religions co-exist in an uneasy juxtaposition.  I’ve read the Quran and parts of the Old and New Testament.  And it all fascinates me.

I tend to be a left-brained, logical, scientific kind of person, and from that perspective, there just seem to be so many holes in the whole idea of religion.  There are all of these various monotheistic, polytheistic, animist, and other spiritual points of view held by people throughout the world, but for the most part it would seem they can’t all be true/right at the same time, so who’s right and who’s wrong?  If there is one God, wouldn’t he/she/it have everyone dancing to the same tune?  I understand that faith is supposed to be about belief, not logic, but I can’t help but see holes.

It also puzzles me when religions are highly prescriptive and proscriptive.  I’ll be completely facetious here for a second, but why would a spiritual belief system need to tell me that I should hop twice on the right foot, twirl around, and then do a two-footed hop?  If there is a higher power, does he/she not have more important things to do than ask me to do that little dance regularly?  And I’ll reiterate that this particular example is entirely ridiculous, but the point remains that I have a hard time accepting highly literal interpretations of holy works, particularly when they dictate individual behaviour aside from behaviours that are reflective of fundamental moral principles.

Now that I’ve gotten that out of my system, let’s talk a big about religion and mental health.  It seems very clear that religion can be a good thing.  Religious beliefs that don’t condone suicide are recognized as a protective factor against suicide.  Turning to a higher power seems like a good way to find hope and establish a framework of meaning.  I’ve certainly read bloggers who have gained a great deal of strength from their faith.  But from what I’ve read, sometimes members of faith-based organizations will offer only a very narrow form of support to those with mental illness, like the argument that meds aren’t necessary and more prayer is the only way.  I would imagine there’s a great deal of variability not only among faith traditions but among individual community-level groups, and so the problem is likely not religion per se but what some particular groups choose to do with it.

To further complicate matters, religion is sometimes incorporated into people’s mental illness.  I’ve had various clients who thought they had a direct hotline to God.  My last boyfriend, who had schizophrenia, was not normally religious, but in the context of his illness he believed that he was able to interpret the bible in a special way.  Sometimes he would spend hours writing nonsense messages he thought he was receiving from the bible.  What does become interesting, though, is trying to tease apart genuine religious beliefs from religious-themed delusions or hallucinations.  In some cases hearing the voice of God may be considered religiously or culturally appropriate, and the DSM cautions that this sort of thing needs to be taken into account in determining whether someone is having experiences consistent with a psychotic disorder.

It’s highly unlikely that I’ll be signing up for any religion anytime soon, but I will probably maintain my sort of detached fascination with all of it.  What I do hope, though, is that all faith traditions will take advantage of the power they have to promote the healing journey of people living with mental illness.  Rather than blaming mental illness on things like lack of faith or prayer, religious organizations should step up to the plate and make sure they are part of the solution rather than part of the problem.

Your thoughts?