Is “natural” better when it comes to health?

Recently I watched an episode of the Netflix docuseries A User’s Guide to Cheating Death that challenged the idea that “natural” is always good for you.  I also saw a post by Trish on The Introspective Salon on the same topic, so I decided to throw in my own two cents about the issue of whether “natural” is actually a good thing.

“Natural” is not a term that’s regulated in any way, so if a product claims to be natural on its label that should be taken with a grain of salt because it’s essentially meaningless.  If we take natural to mean things that are normally found in nature, we’re talking about an extremely broad range of substances.  There seems to be this idea floating around that natural is always better, except it ignores a whole lot of not so nice things that are found in nature.

One need look no farther than the basic elements like arsenic, lead, and radon, or a simple compound like hydrogen cyanide.  There are many plant and fungal species that are toxic to humans, along with venom and other toxic compounds from critters like snakes and pufferfish.  Plus there’s all the non-toxic but just a bit yucky things that nature comes up with.  Then again, maybe I should be marketing ground-up guinea pig poop as some sort of healing product.

Some people take it to extremes.  In Canada a few years ago, two parents were convicted of failing to provide the necessaries of life after their infant son died of meningitis.  Rather than seeking medical attention for him, they were trying to cure him with herbal and dietary supplements.  Other harmful “natural” techniques that some parents inflict on their kids include administering substances like bleach with the belief that it will supposedly treat autism

Like Trish mentioned, it’s easy to find people attacking the big pharma machine, but the same critical eye isn’t being directed toward the natural products industry.  These supplements may be “natural”, but they’re also big business.  According to GrandView Research, global sales of dietary supplements in 2016 were valued at $133.1 billion USD.  Not only is there big money involved, but they also don’t have to go the same stringent regulatory process that prescription drugs go through.

In Canada, natural supplements fall under Health Canada’s Natural Health Products Regulations.  Health Canada assesses “whether there is reasonable assurance that benefits of the product outweigh any risk” and whether there is evidence to “support the reasonable association of the medicinal ingredient(s) with the health claim(s) and demonstrate that therapeutic efficacy of the product will be supported by at least one medicinal ingredient or the combination of more than one.”  The requirements are even looser for products used as “traditional medicines”.

The U.S. Food and Drug Administration (FDA) uses the term “dietary supplements“.  It seems to take a fairly hands off approach:

“Federal law does not require dietary supplements to be proven safe to FDA’s satisfaction before they are marketed.”

“For most claims made in the labeling of dietary supplements, the law does not require the manufacturer or seller to prove to FDA’s satisfaction that the claim is accurate or truthful before it appears on the product.”

Essentially, you could be something that may or may not contain the amount of a substance that it says it has, and it may or may not do what it claims to do.  The consumer isn’t given any idea of other substances that it may interact with.

That’s not to say that we should dismiss these natural supplements entirely.  Some vitamins, minerals, and other supplements are useful for certain populations.  There is scientific evidence to support certain claims, like omega-3 fatty acids being helpful for mood disorders.  Unfortunately, it’s hard to separate out the fact from the fiction without doing some in-depth research, and even if there is some scientific fact underlying a claim it doesn’t mean that the interpretation hasn’t blown things out of proportion.

I liked A User’s Guide To Cheating Death, but at times it seemed to go a little too far in the anti-natural direction.  I don’t think that extreme views in either the anti-natural or anti-drug direction are particularly useful.  It’s  possible to be a discerning consumer and at least try to separate the solid evidence from the hype and marketing; it’s just a matter of keeping that radar active just as much for natural products as for drugs.

How do you respond to stigmatized language?

Crazy.  Psycho.  Schizo.  Nutbar.  

Mad.  Retard.  Lunatic.  Loony tunes.  

Insane.  F***ed in the head.  Bonkers.  

Whack job.  Batshit crazy.  Certifiable.

These are just a few examples, but when it comes to derogatory mental-health related terms, there are many of them and we hear them often.  Sometimes we even use them ourselves. A study by Rose and colleagues identified 250 stigmatizing terms used by 14-year-old students in England to describe people with mental illness, including some I’d never heard of before (e.g. “window licker”).  Clearly these terms are quite pervasive if  they’re already well known in 14-year-olds.

So how do we address the use of these words that have become entrenched in common usage?  Is it as simple as advocating for these words to be completed removed from the social lexicon?  Perhaps a good place to start is by asking a few more questions to figure out exactly what we’re talking about.

Does it make a difference when terms are reclaimed by the target group?  

A term like “nigger” is highly racially charged, but the connotations are far more nuanced when it’s used within the black community.  “Dyke” was considered a derogatory term, but has since been reclaimed by people in the lesbian community.  “Queer” is another term reclaimed by the LGBT community.  “Bitch” is sometimes used to describe strong feminist women.  Is this sort of language reclamation happening within the mental illness community?  I sometimes use “crazy” as a humorous way to refer to myself and other members of my in-group (i.e. mentally ill).  Does that  contribute to stigmatization?  Does it make a difference that I’m applying that language to myself as well?

Does it matter how close we are to the person talking?

I think the closeness of one’s acquaintance can affect both the ease and importance of calling out discriminating language, but there are other factors as well.  My 101-year-old Grandma grew up in a time when people with mental illness were locked up in institutions, and there was really no such thing as political correctness.  She’s unable to remember that I have a mental illness, and even when she was aware of it she really had no frame of reference to understand it.  Sometimes stigmatized language will pop out in relation to something we’re talking about, but in that context I don’t see any real reason to point it out.  With other family members I would be quick to call out inappropriate language, whereas with strangers I might be more likely to let it go, depending on the situation.

What if we overhear it at work?

This is probably the context that is most likely to cause challenges.  I recently read a post on Dangerous Voyage about a colleague using the term “retard”.  Clearly the use of the term was offensive and inappropriate, but to be honest, I doubt I would have said anything in that situation.  However, had a colleague used the term retard to refer to someone with an intellectual or other disability, it would be quite a different situation.

Still, even when highly inappropriate language is used, multiple factors come into play.  Is the stigmatized language being used to discriminate against a disadvantaged group the target belongs to?  Would speaking up be likely to create positive change?  Is there a power differential that could lead to negative consequences not just for calling out the stigma but also simply because you’ve challenged them?  While it would be nice to think that we would take the moral high ground and challenge offensive language, pragmatic considerations often weigh heavily on us.

I work in mental health, and don’t hear a lot of slang terms used by colleagues, probably because of the level of familiarity with proper medical terminology.  What I do hear, though, is stigmatized descriptions, such as patients with borderline personality disorder being described as attention-seeking or manipulative.  In situations like this I would generally express my disagreement in interpretation of the behaviour, but I don’t think I’ve ever actually called anyone out on the underlying stigma.  Mostly that’s because I feel like it has little likelihood of bringing about change, but also for selfish reasons – I don’t want someone pissed off at me for calling out their BS.  I also feel that reinterpreting a client’s behaviour is actually more productive, not to mention client-centred, than calling out the professional on their bad attitude, which would likely result in them getting defensive.

What if it’s directed at us or others online??

Luckily I haven’t been the direct target of overtly insulting language online, which probably has a lot to do with my relatively limited social media presence.  The stigma that I’ve experienced has been more subtle than that, and has tended to happen in “real life” rather than online.  There have been multiple occasions where I’ve witnessed others in the mental illness community being targeted with this type of language, and they have reacted strongly to condemn it.  More of than not, though, this can get into a feeding the troll kind of situation that becomes very upsetting for the person targeted.  So how do we decide when to speak up and when to block and ignore?

Personally, I believe that people who are ignorant due to a lack of information are worth trying to talk some sense into.  People who deliberately choose ignorance are probably a lost cause.  They’re not going to listen to reason, and they’re probably going to actively fight back against attempts to get them to see the light.  Is that giving up?  Maybe.  But by picking our battles we can divert our energy to the areas where it’s likely to have the greatest effect.

Do words used as insults become disconnected from their original meaning?

I have a potty mouth.  Motherf***er tends to come flying out of my mouth inadvertently. When I use that word I’m not talking about incest and I don’t imagine anyone around me is likely to interpret it that way.  Canadian French has some quirky profanity related to the Catholic Church, such as câlice (chalice) and tabarnak (tabernacle).  So if I say “Tabarnak!  That crazy ass mofo just cut me off!” does the actual meaning of each individual word come into play?  Or maybe the original meaning begins to disappear, especially when terms are used in combination with other insults.

Donald Trump, particularly in relation to his bizarre Twitter behaviour, is often accused of poor decision-making, and mental illness-related terms get thrown around quite often by his critics. Personally my term of choice would be batshit crazy to describe his Twitter carryings-on.  Yet this is a situation there is a potential blurring of that line between insult and literal meaning, as some people do question whether he has a mental illness.  Personally I think that’s very unlikely, but it’s problematic if his erratic statements/behaviours are seen as being what mental illness looks like on a broader scale.  Regardless of one’s political affiliation, I don’t think that’s a good thing.

 

The simple answer to all of this would be to try to eradicate the use of these sorts of words entirely, but I’m not sure that will ever be possible.  Perhaps the next best thing is to focus our efforts in the areas where we can bring about change, and focus less on the language itself and more on the stigma and lack of information that underlies discriminatory language.

Thoughts as leaves on a stream

beaver dam on a stream

Graham-H on Pixabay

Thoughts as leaves on a stream is a popular metaphor used in acceptance and commitment therapy (ACT) to represent noticing thoughts and letting them pass by without attaching to them.  I like this metaphor, since it’s not about fighting the thoughts or trying to make them go away, but just riding them out.

I got thinking about recently this after reading a post by Meg at Why does bad advice happen to good people?  A person had written a letter to an advice columnist about the same-sex fantasies she’d been having while in a heterosexual marriage, and she was distressed because she didn’t think she should be having these thoughts yet she couldn’t control them.  She was trying her hardest to fight the thoughts, and it just seemed to make the thoughts more intrusive and make her feel worse.

I know there are certainly times when I try to fight thoughts.  Sometimes it’s by ruminating and trying to think my way out of them, and other times it’s by trying to shove them into a box in the corner where, like Pandora’s box, they’ll stay hidden away until something prompts them to suddenly get released back out into consciousness to wreak havoc.

Building on the leaves on a stream metaphor, maybe sometimes are minds are overly eager beavers and instead of letting the leaves float by, they start making a dam to try to keep them awaay.  The thoughts get caught up in the dam rather than being able to float by.  When we try to fight the thoughts, our beaver mind thinks it’s going to be helpful and strengthen the dam, but that just makes the situation worse by getting those thoughts even more entangled.

I think the biggest dam getting in the way in my mind is an amplification of the brain’s natural negativity bias.  We’re hardwired to be on the alert for danger, but after accumulating a lot of negative experiences in recent years my beaver brain has tried to shore up some extra protection.  What that means, though, is that thoughts related to transient, minor safety threats get caught up in my head and stick around far longer than they should.  Even if my beaver brain thinks that’s keeping me safer, it’s really just making me feel worse.

Do you try to let thoughts float by, or are you a dam builder?

Weekend wrap-up

wrapping paper, ribbon, and twine

Rawpixel on Pixabay

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

  • It’s been a slow week for me.  Again, I haven’t had any work, which is getting concerning.
  • You know you’re moving up in the world when…  I was searching on Google Images for a picture to use for a tweet.  I had entered “blue Christmas depression”, and I didn’t get far into scrolling before lo and behold, I saw the image and link for my post on Christmas and depression.  Cool!
  • I was thinking during my massage this week how safe I felt.  This is perhaps an odd way to describe it, but I felt like a fetus secure in the womb.  My massage therapist always keeps me tucked in and cozy.  She always initiates touch very gently, which is good since I have a strong startle response.  I’ve only been seeing her for a couple of months but I’m thrilled that I found her.
  • I’ve been noticing that I have lulls of a kind of numbed-out momentum, but these are punctuated by breakthrough bursts of hopelessness.

 

This is what I’ve gotten up to outside of my blog this week:

 

How has your week been?

What is… Autonomy

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

This week’s term: Autonomy

While autonomy falls more under the umbrella of philosophy than psychology, it’s also has significant implications when it comes to mental health and mental health care.

The philosopher Immanuel Kant identified several key elements of autonomy, including both the right and the capacity to make one’s own decisions independently after personal reflection, and without interference.  He believed that autonomy is necessary for a meaningful life.

In the field of medicine, informed consent is based upon the principle of autonomy.  Autonomy runs counter to a paternalistic doctor-knows-best kind of approach.  Complications can arise when a person’s capacity for autonomous decision-making is limited in some way.  Other ethical principles may come into conflict with autonomy, such as beneficence (do good) or non-maleficence (do no harm).  An article in the Canadian Journal of Psychiatry describes a concept called “supported autonomy”, which comes from the belief that “to support autonomy in the long term, it may be necessary to compromise autonomy in the short term”.

The Oxford Handbook of Psychiatric Ethics states that:

“The lack of a neat, necessary connection between irrationality and mental disorder calls into question the assumed, straightforward, link between psychiatric diagnosis and decision-making abilities.”

It adds that some jurisdictions take the view that mental illness impairs insight, autonomous control, and rationality, and as a result the presence of a diagnosis “eliminates the need to assess the person’s decision-making ability”.  Other areas use a mental capacity approach that requires a separate functional assessment rather than the diagnosis alone to evaluate the individual’s capacity to make decisions.

Autonomy is popular for government and health care organizations to talk about, but how well does this translate into reality?  The Australian Department of Health has a non-binding National Framework for Recovery-Oriented Mental Health Services, and it describes “promoting autonomy and self-determination” as an element of recovery-oriented services.  It lays out what this might look like in practice, but as a non-binding document it’s really just a suggestion.

Ireland’s Health Information and Quality Authority has a guidance document for supporting people’s autonomy; again, this is non-binding.  It rather euphemistically states that there are a “number of factors potentially affect the extent to which a person’s individual choices can be facilitated”.

I’ve had three involuntary hospitalizations, and I really struggled with the loss of autonomy.  The power imbalance was huge, and while I didn’t necessarily have a problem with the medications or the ECT treatments that were ordered, having the choice of whether or not to be in hospital taken away from me was devastating.  I’ve always been a very independent person, and it drove me crazy (crazier?) to be told that these doctors, whose competence I had serious concerns about, were in a better position than I was to make decisions about what happened to me.  The powerlessness brought out very primitive behavioural responses, and I went so far as screaming at my doctors when they tried to exercise their power and suppress my own.

From my experience working as a mental health nurse I know there are times when hospitalization is absolutely necessary to protect someone.  However, I believe that when an individual is being treated involuntarily the treatment team should be bending over backwards to allow the patient to exercise as much autonomy as possible within the confines of what needs to be done to keep them safe.  In reality, that is seldom if ever the case.  I think that somehow we need to find a way to convey to those who are not afflicted with mental illness how soul-destroying it can be to have one’s autonomy stripped away.

Autonomy is not just lost because of others, though.  The illness itself erodes the ability to freely make choices and then enact those choices.  While this effect is perhaps more pervasive in my life, it’s still easier to wrap my head around than externally imposed limitations on autonomy.

Have you experienced a loss of autonomy related to your mental health condition?  How have you dealt with it?

 

Sources:

Australian Government Department of Health

Craigie, J., & Bortolotti, L. (2014). Rationality, diagnosis, and patient autonomy in psychiatry. In The Oxford Handbook of Psychiatric Ethics, volume 1.

Health Information and Quality Authority

Neilson, G., & Chaimowitz, G. (2015). Informed consent to treatment in psychiatryCanadian Journal of Psychiatry, 60(4), 1-11.

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

Book review: How to Stop Feeling so Damn Depressed

Book cover: How to stop feeling so damn depressed

How to Stop Feeling so Damn Deporessed: The No BS Guide for Men by psychologist Jonas A. Horwitz is a how-to guide that aims to tell men how to take on depression and win.

The author explains that this book is for men with severe depression.  I found the use of the term “severe” a bit unclear as it did not seem to be used to specify a severe major depressive episode; rather, it was used to refer to a major depressive episode of any severity.  It may well be that much of the audience of this book isn’t going to be aware of this distinction, but to me it still felt a bit sloppy.

The central metaphor used throughout the book is of depression as a “Beast”, an entity that is separate from you as a person and lies to you in order to feed itself.  It can be starved by not engaging in the behaviours that it pushes you to do.  This metaphor is leaned on heavily.  Some of the ideas incorporated into it are not exactly true in a literal sense, but the book does not make this clear, which could potentially result in readers making some inaccurate assumptions.

In some parts of the book information seems to be either oversimplified or exaggerated to the point that it pushes the boundaries of accuracy.  The author writes: “One of the most basic ways your Beast gets more energy is to trick you into flooding your brain with chemicals that directly cause depression.  Let’s start with the most common: alcohol.”  Yes, alcohol can have a negative impact on depression, but it is a central nervous system depressant, which is not the same thing as a direct mood depressant as the book implies.  The author also warns that every time you drink it will make you feel “much, much worse”.  While the aim here is a good one, realistically a single drink is not going to have that significant an effect, and presenting the message in this way may actually serve to weaken what is a very valid underlying argument.

There were a few things in the book that struck me as a bit gimmicky.  I can be fussy about the written word, and arbitrary capitalization (e.g. Beast) is a pet peeve of mine.  When talking about sleep hygiene, he referred not to one’s bedroom but one’s “cave”.  In the section on alcohol, the author cautions that alcohol can decrease testosterone levels and lead to “man boobs”, i.e. gynecomastia.  It seems a bit like offering up decreased breast size to warn about the dangers of anorexia nervosa.

The author focuses heavily on the importance of physical activity.  He recommends that for severe depression, the most important treatment strategy is exercise, ideally 30-60 minutes per day 4-5 times per week.  While exercise matters, it’s also important to be realistic and recognize the substantial limitations that depression can create.  Those experiencing severe depressive episodes may feel exhausted by previously easy tasks like getting out of bed and showering.  Having been in that place myself where taking a shower feels like climbing Mt. Everest, this blanket suggestion about exercise seems woefully out of touch.

While I do have a number of concerns about this book, there were certainly positives as well.  The book gives a useful explanation of cognitive behavioural therapy, and gives good examples of some of the common cognitive distortions.  Various other treatment options are covered, and there is a helpful section explaining what to expect from psychotherapy.  The author touches on the important point that we need to address social expectations that men shouldn’t talk about their feelings.

In terms of organization, there are concise point-form summaries provided at the end of sections.  My preference would have been to see the book broken down into smaller chapters, particularly given the adverse effects depression so commonly has on concentration.

Clearly I’m not the intended audience of this book.  While the book states it’s for men with severe depression, I actually think it would be much more appropriate for people experiencing mild depressive episodes.  Even though the beast metaphor didn’t work for me, it may resonate with some people and make it easier for them to conceptualize their depressive illness.  But if you’ve ever been so weighed down by depression that dragging yourself into the shower felt like an insurmountable obstacle, this book is not for you.

 

I received a reviewer copy of this book from the publisher via www.netgalley.com.

Master of my domain? A look at depression and masturbation

While this may seem like a bit of an odd topic, it’s something I’ve vaguely wondered about for a while.  My line of thinking goes, if orgasms get the feel-good chemicals flowing, might that have any sort of benefit for depression?  And especially for single folks like myself – could masturbation have any positive effect when it comes to depression?  It’s well known that both depression itself and antidepressant medication can dampen sex drive, but is it like any other kind of behavioural activation where you try to fake it until we make it?

I was curious to see what science had to say about this, and was actually a bit surprised to see how little research has been done on the topic.  What I did find was a mix of interesting information and rather dubious scholarship.

In the Victorian era, masturbation was seen as a potential cause for an array of different medical conditions, including epilepsy, insanity, neurosis, and neurasthenia (a condition characterized by weakness and fatigue).  Thinking began to change in the 20th century, as some sex researchers argued that masturbation was healthy and normal.  This became a topic of interest in the field of psychoanalysis, and while Sigmund Freud argued that masturbation caused neurasthenia, he later concluded that it may help to prevent neurosis.

Negative views of masturbation still exist, both socially and in academic circles.  In the academic journal articles I looked at for this post, these negative views seemed to be most associated with studies that had considerable flaws.

In a 2010 paper, researcher Stuart Brody expresses his opinion that: “It is likely that only unfettered, real [penile-vaginal intercourse] has important mood-enhancing benefits.”  In describing the findings of another research study, he confuses correlation with causation in his attempt to argue that semen-vagina contact is important, and he does a rather odd connect-the-dots with the statement that “more condom use means more depression and more suicide attempts.”

A 2013 paper coauthored by Brody claims in its title that “immature psychological defense mechanisms are associated with women’s greater desire for and actual engaging in masturbation”.  The authors erroneously interpreted the findings of two research studies, incorrectly stating that masturbation was associated with an increased risk of depression.  They also suggested, with no clear basis for their claim, that there are multiple links “between masturbation, character, and risk of depression”.

A paper by Das reported that self-rated happiness is inversely correlated with masturbation, i.e. there is greater happiness with less masturbation.  He stated that in a subsection of depressed men, negative mood has been linked to increased masturbation.  However, the  paper he cites to support this claim actually says no such thing.

Cyranowski and colleagues found that women with a history of depression, particularly those with recurrent depression, had a higher frequency of masturbation than women who had never been depressed.  This correlation remained constant even when they controlled for a number of other factors, including current depressive symptoms and the use of psychiatric medications.  The researchers wondered if this might be related to decreased sexual pleasure from intercourse with a partner, but found that the data didn’t support this conclusion.

Frohlich and Meston learned that women with higher depression scale scores reported an increased desire for masturbation and were more likely to have masturbated within the past month.  These women also reported a decreased desire for partnered sex, and difficulties with arousal and pain.  The researchers speculated that masturbation may provide a reliable form of pleasure or self-soothing even when depression has decreased interest in other activities.

In contrast to these results, in a study by Kennedy and colleagues, 40% of men and 30.4% of women with depression reported a reduction in masturbation.  This finding seems consistent with what one might tend to expect given the nature of depressive illness.

None of the literature that I came across definitively answers my question about whether masturbation could be helpful in some way in depression, although Frohlich and Meston gave some supposition in that direction.  It’s interesting how our society is in many ways hyper-sexualized, yet we don’t talk much about real-world sex, much less masturbation.  It would be nice to see more research and dialogue to address both sexual dysfunction and healthy sexual function in people experiencing mental illness.  In the meantime, to borrow a classic saying from Seinfeld I, for one, will not be master of my domain.

 

Sources:

  • Brody, S. (2010). The relative health benefits of different sexual activities. The Journal of Sexual Medicine, 7(4.1), 1336-1361.
  • Brody, S., & Nicholson, S. (2013). Immature psychological defense mechanisms are associated with women’s greater desire for and actual engaging in masturbation. Sexual and Relationship Therapy, 28(4), 419-430.
  • Cyranowski, J.M., Bromberger, J., Youk, A., Matthews, K., Kravitz, H.M., & Powell, L.H. (2004). Lifetime depression history and sexual function in women at midlife. Archives of Sexual Behavior, 33(6), 539-548.
  • Das, A. (2007). Masturbation in the United States. Journal of Sex and Marital Therapy, 33(4), 301-317.
  • Frohlich, P., and Meston, M. (2002). Sexual functioning and self-reported depressive symptoms among college women. The Journal of Sex Research, 39(4), 321-325.
  • Kennedy, S.H., Dickens, S.E., Eisfeld, B.S., & Bagby, R.M. (1999). Sexual dysfunction before antidepressant therapy in major depression. Journal of Affective Disorders, 56(1999), 201-208.
  • Patton, M.S. (1996). Twentieth century attitudes toward masturbation. Journal of Religion and Health, 25(4), 291-302.

White elephant challenge, guinea pig style

stuffed white elephant in a carriage

I (or more accurately, my furbabies) received the funky playhouse below from Rory at  A Guy Called Bloke and K9 Doodlepip as part of the white elephant challenge created by Teresa of The Haunted Wordsmith.  This is what the white elephant challenge is all about:

Every day I kick the party off by listing three fellow bloggers and the gift I give them. No one is obligated to participate (though if people do, it’ll be more fun). If the gift recipient wants to participate, they will pick three bloggers and give them gifts. And so on until the following day. At that time I will share some of the funnier gifts that people have given or received.

creepy treehouse

Instead of gifting three specific bloggers, I’m going to give one gift to everyone, because we could all use a little more cuteness in our lives.  And no, this isn’t one of my own guinea pigs, because alas I don’t have a mini Santa hat. Merry Christmas!

How to build a mental health blog

It’s easy to get caught up in the numbers game, but I think what’s really important in building a high quality mental health blog is engagement with the mental health community.  This has little to do with numbers and a whole lot to do with human connection.  I’m by no means an expert on any of this, but here are some strategies I’ve stumbled across in my time blogging that hopefully you might find useful when it comes to engagement.

Interact with the blogging community

This is my biggest recommendation.  Read other blogs that are in your niche, and like and comment on those blogs.  Search in the WordPress reader for blogs in that niche that you’re not following yet.  Also, check who else is commenting on the blogs you’re following; that can be a good way to connect with some new people who are interested in the same kind of topics.  Be genuine about trying to engage, because if you get spammy about it, you’re only likely to generate eye rolls.

Make sure your gravatar is connected to your blog site.  Click on your gravatar image on the top right corner of the WordPress reader website, and scroll down to profile links.  Make sure your correct blog address is there.  Sometimes I’ll see someone has followed me and I’m interested in checking out their blog, but I can’t get to it because I get a message saying the blog no longer exists.

If you get an idea from someone else’s post for a topic you want to write about, run with it.  Just make sure to include a link to their post in your own post.  It’s a good way to show you appreciate other bloggers and are part of the community dialogue.

Make your blog easy to read

I think this is particularly important in the mental health blogging niche, since a lot of us have problems with concentration related to our illnesses.  Pay attention to the length of your paragraphs.  With really long paragraphs you run the risk that the reader (such as me) won’t be able to maintain focus through a long unbroken wall of text and will give up on reading that post.  That doesn’t mean you can’t have long posts; just break them up into smaller paragraphs, and maybe throw an image in there somewhere.

Also, think about whether your choices of font and background colours are are easy to read.  Bright colours may add visual interest, but if they’re making it harder to focus on the text readers may be less likely to finish the whole post, which means they’re not going to be interacting with what you have to say.

Include some evergreen content

Evergreen content doesn’t go out of date, and people will continue to read and engage with it well after it’s first published.  A sign that you’ve got some evergreen content is when you keep getting a trickle of views/likes/comments weeks or months after you’ve published a post.  Consider doing a follow-up posts on those topics or doing similar kinds of posts every so often to get a mix of evergreen and right-now kind of content.

Use social media

I’m not on Facebook or Instagram, so I can’t comment on those.  On Twitter, you definitely get back what you put in.  I tend to find Twitter overwhelming so I’m not very active on it, and that’s reflected in the amount of traffic that it directs to my blog.

With Pinterest, I used to pin straight from my published blog posts, and got very little traffic.  At some point I started creating designs on Canva and using those to make pins connected to my blog posts.  This bumped up my traffic from Pinterest considerably.  It’s hard to say how many of those people are actually engaging with my posts, but at least there’s the possibility.

Consider SEO

I’m certainly not a search engine optimization (SEO) guru.  Wordpress doesn’t offer advanced SEO tools on the free plan, so I have no experience there, but there are still some things you can do.  I got almost no traffic from search engines in the early days, and it wasn’t until my blog had grown substantially that I started to see that it was reaching people doing mental health-related searches  Still, I think it’s worth getting a foundation of some basic SEO strategies in place right from the get-go.

Google loves external links to your site; these show that not only are you active on your blog, but you’re out there in the broader online community.  These links can be hard to accumulate, but guest posting on other sites (see the next section) can definitely help.  Internal links also matter; this refers to links you include in a post to other posts on your site.  These links can also help your readers to refer back to your other content they may have missed originally.  Google Search Console is a useful tool for keeping track of all this, although I’ve noticed for my blog it seems to be overlooking a lot of my internal links.

Google (and of course blog readers) pays attention to your post name and headings, so make sure those accurately reflect your content.  You can also use tags for your posts, although keep in mind WordPress allows a maximum of 15 tags, after which it will just ignore all your tags.  Making sure your tags are relevant helps people to find your posts.  Google can’t see the images on your site, but what it can see is the “alt text” for each image, so you should enter a descriptive alt text for every image you use.  This is also helpful for any of your readers who are visually impaired.

Share your story

If you share your story with popular mental health sites like Stigma Fighters and Time to Change you can reach a much broader audience, and that can bring some brand new readers back to engage with your blog.  You can find listings of a variety of sites you can submit your writing to in my posts Spreading your writing wings and Ways to share your story.

Another option is to keep an eye out for fellow bloggers looking for a guest poster, or talk to a blogger you engage with regularly about doing a collaboration.  It can help you connect with other bloggers you might not have encountered yet.

Other sources of information

There are countless sites and articles with tips about increasing blog traffic.  Probably the most useful I’ve come across is a post on Startbloggingonline.com.  It has an extensive list of options, and while some of them are more business-oriented, many are also useful for the casual blogger.  A lot of sites focus on monetization, and it’s easy to start feeling like you’re drowning in the sea of information when it comes to that.  Keep in mind whether tips on a given site are geared toward a blog with the same purpose as yours, because pushy marketing strategies are probably not going to be very successful with a smaller-scale mental health blog.

Conclusion

There is no one right way to blog.  The most important thing is that it feels right for you.  Having engagement on your blog, whether that’s 10 loyal followers or 1000, can help make the blogging experience more meaningful.

What has helped you to generate engagement on your blog?

Choosing the right tone to write about chronic illness

notebook sitting in front of a laptop

Photo by Nick Morrison on Unsplash

As I’ve been trying to expand more with my writing recently, I’ve run into the question of how to decide on the right tone when writing about mental illness.  I try to be very open on my blog, but it’s harder to be sure if that’s the right fit outside of the blog.  You can check out this piece I wrote for The Writing Cooperative on the topic:

https://writingcooperative.com/choosing-the-right-tone-to-write-about-chronic-illness-425fdd5df81f

Weekend wrap-up

wrapping paper, ribbon, and twine

Rawpixel on Pixabay

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

  • On a post about suicide I did earlier this week, someone left a comment that suicide is the epitome and selfishness and cowardice.  Initially I was gobsmacked, but then I realized that I don’t want that kind of crap on my blog and there’s no reason why I should put up with it.  Person blocked, end of story.
  • November is now done and I did not work a single day in it.  Both of my jobs I work casual, and there just hasn’t been much available this month.  Going this long without working makes me feel less able to work.  But I guess it is what it is.
  • I submitted a piece to an online publication that pays well.  There’s about a 0% chance it will be accepted, and that’s totally ok; for me the victory was having the ladyballs to press the send button on the email.
  • This week I decided to diversify a bit on the Vocal Media platform, and published posts on Psyche (about disclosing mental illness), Petlife (about the therapeutic value of pets), and Humans (about introversion).
  • Normally I think things through for a while before making a decision, but I spontaneously decided to upgrade to the WordPress Personal plan because I wanted my own domain.  it’s probably not going to actually change much of anything, but it’s still kinda cool.  GoDaddy is sitting on the .com version of my site name, so went with mentalhealthathome.org.
  • I’ve been feeling kind of achy all over for no apparent reason.  Maybe I’m just getting old?
  • Despite getting old (😉) I’m venturing further into the digital world and had my first Skype session, to talk blogging ideas with the lovely Candace from A Chick Click.

 

How has your week been?

What is… Perfectionism

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

This week’s term: Perfectionism

Perfectionism is “a set of self-defeating thoughts and behaviors aimed at reaching excessively high unrealistic goal” according to a Brown University site.  It tends to be learned through messages early in life that value is based on achievement, and as a result self-esteem becomes based on external standards.  Distorted thoughts associated with perfectionism include:

  • fear of mistakes and failure, and a belief that making a mistake equals failure
  • fear that others will not approve
  • all-or-nothing thinking
  • heavily focusing on “shoulds”
  • perceiving that others achieve success easily

Perfectionism often develops into a vicious cycle:

  1. setting unattainable goals
  2. failing to achieve those goals
  3. chronic pressure and failure lead to decreased productivity and effectiveness
  4. self-criticism, self-blame, decreased self-esteem; possibly anxiety, depression
  5. think they will do better if they just try harder next time, and this repeats the cycle

An article on Psych Central differentiated between adaptive/healthy and maladaptive/unhealthy perfectionism.  Adaptive perfectionism is associated with high standards, conscientiousness, and strong organizational skills, and tends to be viewed as helpful by those who possess the trait.  This is similar to the Brown University site’s description of “healthy striving”.

Maladaptive perfectionism, on the other hand, is associated with worry, doubt, preoccupation with actual or potential mistakes, and an unhealthy need for control.  This unhealthy type of perfectionism is common in people with obsessive compulsive disorder (OCD).

According to the chair of the psychology department at Ryerson University, perfectionism show up across multiple different mental health diagnoses in addition to OCD, including anxiety disorders, obsessive compulsive personality disorder, eating disorders, body dysmorphic disorder, and depression. While there is limited research on the biology of perfectionism, there’s some indication that it is moderately heritable.  There are a number of different therapeutic options that can be helpful for perfectionism, including cognitive behavioral therapy, mindfulness, and acceptance-based approaches.

Common psychological tests used by psychologists to assess perfectionism are the Frost Multidimensional Perfectionism Scale and the Hewitt and Flett Multidimensional Perfectionism Scale.  Psychology Today has an online 46-question perfectionism test that gives a brief summary of results for free.  I took it, and it said I had a “healthy” level of perfectionism (although it wasn’t clear what the alternatives were).  It pointed out that the standards I apply to myself are variable depending on the situation.  There was also a very interesting observation:

“You don’t feel pressured to live up to society’s expectations of what is “perfect”, which is healthy – however, you may want to consider whether your rejection of societal standards might be jeopardizing your chances for success out of a desire to be a nonconformist.”

When I was younger I was never the cool kid.  I was more the geeky type.  It’s funny, I still remember from grade 7 a friend of mine had decided to tell the boy I was crushing on that I liked him, and he said he didn’t want to be my boyfriend because I was “too smart”.  While I got plenty of positive feedback at home, I figured out pretty quickly that if I was going to try to be perfect, I was going to fail.  I also figured out that if I was going to try to be a “cool” kid, I was going to fail miserably.  Add into the mix that I’m intelligent and capable when it comes to some things and an absolute doofus when it comes to some basic practical things, imperfection was always going to be a better fit for me.

Are you a perfectionist?  If so, has it helped or hindered you?

 

Sources:

Brown University Counselling and Psychological Services

Canadian Counselling and Psychotherapy Association

Martin M. Antony, Chair of Psychology at Ryerson University. Cognitive Behavioral Therapy for Perfectionism.

Psych Central

Is mental illness more of a reason or an excuse?

This post was inspired by a recent post on Mindless Overthinking about the psychology behind excuses.  I left a comment about distinguishing between reasons and excuses, and I thought the idea was worth some further expansion.

The Oxford English Dictionary includes many definitions for “reason”, but these are the most relevant for this purpose:

A cause, ground, or motive

  • Of a fact, event, or thing not dependent on human agency

It defines an excuse as:

That which is offered a reason for being excused; sometimes in a bad sense, a (mere) pretext, a subterfuge

  • A plea for release from a duty, obligation, etc.

The differences may be subtle, but I think they’re actually really important.  The word excuse carries with it a lot of negative overtones.  It sounds like an attempt to get out of something that you really should be doing but just don’t want to.  I find the sub-definition of reason very interesting, i.e. that reasons aren’t dependent on human agency.  Agency refers to the capacity to freely make choices and enact them, so if a reason is not dependent on agency then it is outside the realm of our control.  Mental illness in many ways falls into that category; yes, we have some ability to bring about change to a certain extant and in a way that varies over time, but we can’t control the fact that we have an illness.

It seems like peoplee with limited knowledge about mental illness or other invisible disabilities often have a hard time grasping why we can’t do something because of our illness.  As a result, they may think we’re being lazy or making excuses if we call in sick or are unable to work due to our illnesses.  This is a very different kettle of fish from what I would consider a reason – recognizing that our illness is causing problems for us, and proactively making decisions about what choices will be best for our mental health.

Mental illness can also twist our own thinking so that we start limiting ourselves with excuses but justifying those limits as being bona fide reasons.  Depression might make showering really, really hard, and once a week is about all that’s manageable.  But maybe depression starts to become an excuse if it’s used as justification to quit trying altogether, and maybe reconsider next month.  It can be a tricky balance to find.  For me it comes down to making an effort.  Maybe I’ll try and then give up today, tomorrow, and the next day, but if I try and get it done the day after that, that’s not about excuses.

The way I see it, excuses are about running away.  Reasons are about acceptance of what is, and figuring out how to do the best we can given realistic constraints.  Excuses look for ways not to try, and reasons are the opposite.  Relying on excuses is disempowering, while acknowledging reasons can be very empowering.  Excuses show a lack of insight, while reasons demonstrate that we do have insight into our illness.

What do you think?  Is there a difference between reasons and excuses when it comes to how we handle mental illness?

Book review: My Wellness Toolbox

Book cover: My Wellness Toolbox by Alison Swift

My Wellness Toolbox by Alison Swift is a collection the strategies that she gradually accumulated through her recovery journey after hitting her own rock bottom.  Rather than preaching what does work, she shares what has worked for her so others struggling with their mental health can get some ideas to try out for themselves.  The book feels like the author is talking with rather than at the reader.

The book is short at only 49 pages, and provides bite-sized chapters for each individual tool, making it very easy to read.  Each tool is given effectiveness and ease ratings out of ten, and an approximate cost is provided.  The author also describes how different tools can be used together, and gives practical examples of how the tools can be implemented.  Inspirational quotes are used to support several of the tools.

The tools include a broad range of different activities.  Some take very little effort, like using essential oils.  Other tools take more work but have a big potential payoff, such as cognitive behavioural therapy and working on acceptance.  There are tools that can be used solo, as well as some that can be used interpersonally.  Most of the tools can be used by anybody, with the notable exception of hypnobirthing.

Not all of the tools are things that work for me, but that didn’t detract from my appreciation of the book overall, and I think there’s enough of a range that there is something for everyone in this book.

While this book would probably be the most useful for people in the earlier part in their recovery journey, it still includes good ideas for anyone, as well as good reminders of the tools we may already be using.  We all need to have a wellness toolbox, and the more tools that we can find that work for us the better.

 

I received a reviewer copy of this book from the publisher via www.netgalley.com.

Privacy and completed suicide

person handwriting in a notebook

terimakasih0 on Pixabay

Trigger warning: As the title says, I will be talking about death by suicide.  Please consider skipping this post if it could be triggering for you.

 

I was recently reading the book Suicidal: Why We Kill Ourselves, and it included excerpts from the diary of a teenage girl who completed suicide.  The diary was kept on her laptop, and in it she was very open about the thoughts and feelings she was having leading up to her death.  The inclusion of the diary in the book was of course done with the permission of her parents, but still I found it intensely disturbing.  This girl did not in any way consent to this, despite the author’s interpretation that it had been written as though she expected someone to read it.  What happens to privacy when someone dies by suicide?  Is that something that’s automatically forfeited?  Do personal writings suddenly shift into the public domain?

It makes me sick to think of people reading my private unfiltered thoughts.  A few years ago when I was having very intense thoughts of suicide, I threw the years worth of journals I’d kept in the trash because I was adamant that no one should be able to read them after I was dead.  Logically I know it doesn’t make a difference at that point because hey, I’m dead, but that doesn’t at all lessen the heebie-jeebies factor.  At the same time I password-protected my computer, something I’d never done before.  I’ve kept the password protection ever since, with that same reason hovering in the back of my mind.

My last suicide attempt was the only one in which I had written a suicide note.  The police took the suicide note and gave it to the hospital, and it was read aloud by my hospital psychiatrist during a review panel hearing in which I was challenging my involuntary commitment to hospital.  It was strange hearing him read it, and somehow it felt extremely invasive.

The reality is that if someone becomes desperate enough that they attempt and complete suicide, they no longer have control over anything they’ve left behind.  Loved ones are obviously going to want to try to understand what motivated the act, and there’s no question they’ll be reading anything written that was left behind.  That makes sense and I would never expect that a loved one would choose not to read journals and that type of things.  Yet it still disturbs me, and now that the thought is in my mind, I don’t know that I would ever be able to push it out.  Maybe that’s morbid, maybe I don’t know what it is.  But for me it’s real.

Is this something that you’ve ever thought about?

 

If you’re having thoughts of suicide and need support, please see my list of crisis resources to find different ways you can reach out for help.

 

Is the antipsychiatry movement helping us?

From abuses in asylums to horrific “experiments” in Nazi Germany, the antipsychiatry movement arose in response to what were seen as abuses within the mainstream psychiatric establishment.  Yet has the movement actually brought about any sort of positive change for those people living with mental illness?  Or has it generated more of an academic debate that’s had a minimal impact on the people served by the mental health system?

The term anti-psychiatry appears to have been coined by German doctor Bernhard Beyer in 1912, and gained popularity in 1967 with its use by psychiatrist David Cooper.  Psychiatrist R.D. Lang was another vocal critic of psychiatry, although he eventually rejected the antipsychiatry label.  He argued that psychosis was not a medical illness but an understandable response to injuries inflicted by schizophrenogenic parents.  Well-known philosopher and sociologist Michel Foucault argued that psychiatry, whether inpatient or outpatient, was used primarily for social control.  Sociologist Erving Goffman, who did pioneering work on stigma, argued that asylums were “total institutions” that controlled and oppressed those within them.

The role of Thomas Szasz

Psychiatrist Thomas Szasz was a prominent critic of mainstream psychiatry, although he did not identify as being part of the antipsychiatry movement.  In his 1961 book Myth of Mental Illness, he argued that what was referred to as “mental illness” was not actually a biological disease but rather a pattern of behaviour that was viewed by society as problematic.  He accused mental hospitals of being more like prisons than hospitals.

Szasz was particularly focused on the role of coercion in psychiatry, likening coerced psychiatric relationships to slavery and rape.  He also argued that “suicide prevention is a euphemism for psychiatric coercion.”  He added that “To the psychiatrically enlightened, anything connected with death is now a symptom of mental illness.” In The Myth of Mental Illness: 50 Years Later, he wrote that “Today, the role of the physician as curer of the soul is uncontested.  There are no more bad people in the world, there are only mentally ill people.”

In the book The Therapeutic State, he argued that mental illness was a myth and society viewed psychiatry as useful because it removed unwanted persons from the social milieu.  He wrote that Nazi Germany implemented a “therapeutic state”, and psychiatry provided “scientific” justification for mass murder.  He wrote that although this was later dismissed as an “abuse of psychiatry”, Nazi and American health ideology actually closely resembled one another, as they were both based on the premise that “the individual is incompetent to protect himself from himself and needs the protection of the paternalistic state”.

Not only did Szasz not identify as being antipsychiatry, he was openly critical of the movement.  In the book Antipsychiatry: Quackery Squared, he wrote that the individuals associated with the antipsychiatry movement had joined forces with the “therapeutic state” instead of rejecting it, and the movement left an “accursed legacy” of silencing serious criticism of the field of psychiatry.

In Debunking Antipsychiatry: Laing, Law, and Largactil, Szasz expressed his belief that the antipsychiatry movement had actually undermined his own cause.  He was openly critical of others who took an antipsychiatry stance.  He accused Laing of “psychiatric gobbledygook” and “charlatanry”, and called Cooper, Laing, and Foucault “power-hungry left-wing statists who were interested in taking over psychiatry.”

The Church of Scientology

In 1969 the Church of Scientology established a Citizens Commission on Human Rights, which was co-founded by Thomas Szasz.  According to its website, the group  “works to expose psychiatric violations of human rights and clean up the field of mental healing.”   It accuses the field of psychiatry of “wholesale drugging of children for obscene profits”.  The group has established a museum called Psychiatry: An Industry of Death.

In a 1969 article, Scientology founder L. Ron Hubbard claimed that psychiatrists did not actually have any idea how the mind actually worked, and he accused them of hypnotizing politicians.  He wrote that: “There is not one institutional psychiatrist alive who, by ordinary criminal law, could not be arraigned and convicted of extortion, mayhem and murder.”  Chillingly, he went so far as to urge that:  “We want at least one bad mark on every psychiatrist in England, a murder, an assault, or a rape or more than one.”

Modern anti-psychiatry groups

Aside from Scientology, various organized groups have advocated against psychiatry.  One, antipsychiatry.org, specifies that it wants no affiliation with Scientology, and members of the Church of Scientology are not permitted to become members of their organization.  MindFreedom‘s stated goal is “a nonviolent revolution in mental health care”, and they oppose “coerced, forced, and fraudulent medical procedures”.

There are also a number of ex-patient groups identifying themselves as psychiatric survivors, including the World Network of Users and Survivors of Psychiatry.  The ex-patient organization National Empowerment Center deliberately distances itself from the antipsychiatry movement, describing it as “largely an intellectual exercise of academics and dissident mental health professionals”.

The University of Toronto in Canada has a scholarship in antipsychiatry that was established in 2016 by U of T professor Bonnie Burstow to promote antipsychiatry inquiry.  The U of T website states that Burstow’s research group is the “largest single group of antipsychiatry scholars anywhere in North America.”

Criticism of the anti-psychiatry movement

Controversy persists, and perhaps unsurprisingly the Wikipedia pages on anti-psychiatry as well as Scientology and psychiatry have multiple flags for such issues as disputed neutrality, limited worldview, and lack of solid references.

In a pro-psychiatry editorial for Current Psychiatry, Dr. Henry Nasrallah writes that “the original ‘sin’ of psychiatry appears to be locking up and ‘abusing’ mentally ill patients in asylums”.  He puts forth lobotomies and labelling homosexuality as a mental disorder as examples of the “perceived misdeeds of psychiatry”.  He comments that the anti-psychiatry movement is seen by some as “intellectual halitosis”.  This sort of stance minimizing the abusive practices that have been carried out under the guise of psychiatry seems unlikely to provide a strong counterpoint to antipsychiatry rhetoric.

Conclusion

My biggest question is whether the antipsychiatry movement has brought about any sort of positive change for those of us with mental illness.  If so, I’m not seeing it.  Are there problems within the field of psychiatry?  Absolutely, but those issues are likely best addressed by narrowing the divide between patient and professional, us and them.  The antipsychiatry movement’s polarizing approach is more likely to shut down dialogue rather than promote it, and this extremist stance actually makes it less likely that the psychiatric establishment will listen to the voices of people dealing with mental illness every day.

Perhaps the most important way to challenge abuses of power that exist within the mental health system is to use our voices.  The internet age offers unprecedented opportunities to speak up, and in doing so we are more likely to affect positive change than by trying to fundamentally undercut the very notion of psychiatry and mental illness.

 

Sources:

Decision time – Christmas and depression

Recently my grandma was asking me what I was planning on doing for Christmas, and it made me shudder inwardly.  Of course it didn’t help that her short-term memory is awful and she kept asking the same question over and over.  It’s not something I have any desire to think about, but I suppose I have to.

I used to love Christmas.  I loved putting up a Christmas tree, eating yummy Christmas goodies, listening to Christmas carols, watching Christmas movies, and spending time with my family.  It was never something stressful; rather, it was always one of the happiest parts of the year.  Depression has stolen that away, and this will be my third Christmas in a row just not giving a crap.

Last year I stayed at my Grandma’s over Christmas, and had Christmas dinner at my parents’ place.  My brother and his now-wife were there too, and it was just way too much.  Not that there was any real drama; it was just over-stimulating and a difficult reminder of how much depression has taken away from me.  It was really, really hard.

This year Grandma is in a care home.  My brother and his wife will be spending Christmas with her family.  So if I were to go home, it would be me and my parents, with me not even able to pretend to care, and my parents pretending not to notice me not caring.  Grandma would probably spend Christmas with my uncle, but my parents wouldn’t be involved in that because my mom never had much contact with her brother but even less since me dad threw a random shit-fit at him a couple years ago and has refused to see him since.

Probably I will end up staying put and doing nothing for Christmas.  Putting up the tree seems like more effort than I have any interest in spending, but maybe I’ll string up some Christmas lights in my bedroom.  And maybe I’ll making some of my favourite Christmas baking classics, like shortbread cookies and butter tarts (which apparently is a Canadian thing – I don’t know why the rest of the world hasn’t caught on).  Maybe I’ll gain 10 pounds from drowning my sorrows in rum and eggnog.  ‘Tis the season, after all.

Weekend wrap-up

wrapping paper, ribbon, and twine

Rawpixel on Pixabay

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

  • Emotionally I’ve felt pretty numb for much of this week, but hey, I suppose that’s better than feeling really low.
  • I continue to be pretty spacey cognitively.  I wonder how much of that is related to my decision a few weeks ago to stop getting biweekly methylfolate/B12 injections.  I know they were helping, but it was a lot of money to be spending given that I haven’t been working much.
  • With the colder weather, one day I put on my cute leather jacket and discovered that I couldn’t zip it up, mostly because my boobs are too big.  I never would’ve thought I’d say that, but I guess the psych meds aren’t just adding weight to my tummy.
  • I made a $50 mistake, which annoyed me.  I have to do annual CPR training for work, and a few weeks ago when I was really spacey I had registered for a class.  Instead of putting it on my calendar for November 16, I entered it for December 16.  I didn’t realize the mistake until the 16th had already passed, and there was no way I was going to try asking for a refund when it was my own (my depression’s, to be exact) dumb mistake.  I ended up doing a different class this week, and even though it flew by because we were all nurses recertifying, I had a really hard time staying present.
  • For self-care, I went to yoga and had a massage.  I’ve been using my aromatherapy diffuser a lot.  I’ve also been cooking yummy fall comfort foods.
  • I have a lot of things that I’ve started writing, but have had a hard time focusing on anything enough to be very productive.  It’s not a lack of ideas; it’s more a lack of productivity.  That’s fine, but it’s just kind of annoying because I have a lot of time on my hands right now.

 

How has your week been?

What is… Operant conditioning?

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

This week’s term: Operant conditioning

Operant conditioning relates to how actions are affected by stimuli from the environment.  The concept was developed by B.F. Skinner in the 1930’s, and builds on Pavlov’s classical conditioning experiments in which dog were observed to salivate in response to the conditioned stimulus, i.e. a bell.

Operant conditioning uses rewards and punishments to influence behaviour.  It’s worth noting that from a behaviourist perspective these responses are not based on the person as a whole but rather specific behaviours.  There are 5 different types of responses to behaviours, and the terminology can be a bit counterintuitive:

  • Positive reinforcement: a reward is given, with the aim of increasing the frequency of the behaviour
  • Negative reinforcement: an unpleasant stimulus is removed, with the aim of increasing the frequency of the behaviour
  • Positive punishment: an unpleasant stimulus is applied, with the aim of decreasing the frequency of the behaviour
  • Negative punishment: something positive is withdrawn, with the aim of decreasing the frequency of the behaviour
  • Extinction: a behaviour that was previously reinforced is no longer given reinforcement, and eventually the associated behaviour no longer occurs

 

There are a variety of factors that influence the degree of effectiveness of these measures, including the timing and consistency with respect to the behaviour.  Operant conditioning can get quite complex, involving chains of different behaviours.  Praise has been shown to be very effective as a positive reinforcer.

According to Wikipedia, some research has shown that certain neurons that release the neurotransmitter acetylcholine and others that release dopamine are activated following a conditioned stimulus.  Individuals with Parkinson’s disease (which affects the dopamine/acetylcholine balance) respond differently to reinforcers and aversive stimuli depending on whether or not they are on their medication.

Operant conditioning is the foundation of Applied Behavioural Analysis (ABA), which is best known for its use with children who are on the autism spectrum.  This approach is controversial and has been challenged by many autism advocates as a misguided attempt to “cure” autism.

There are various overtly harmful applications of operant conditioning.  It can be used as a tool for psychological manipulation, and the intermittent use of reward and punishment can be especially damaging in this sort of abuse.  This pattern can be seen in trauma bonding.  Partial or intermittent negative reinforcement in the workplace can contribute to a climate of fear.

Awareness of the basic principles of reinforcement and punishment can help us to understand how our responses to the behaviour of others can affect future repetition of that behaviour.  Once I was doing a night shift at the concurrent disorders program where I work, and a client had been clomping up and down the hall like an elephant.  I told him that he needed to stop.  He was openly defiant and kept on pacing.  The next day, a counsellor working with him told him that it’s okay, he can pace as much as he feels he needs to.  The problem is, from an operant conditioning perspective, she was not only giving positive reinforcement (in the form of praise) to the pacing, she was also positively reinforcing the defiance, making it more likely that the behaviour will be continue.

Clearly there are ethical issues that can arise from trying to use operant conditioning to manipulate someone.  However, if we’re not aware of the impact of our reactions then we’re not doing anyone any favours.

Do you having any thoughts on whether this kind of conditioning is useful or problematic?

 

I got the idea for this post from a discussion with Meg at Why does bad advice happen to good people?

Sourcehttps://en.wikipedia.org/wiki/Operant_conditioning

Happy Thanksgiving!

Canadian Thanksgiving actually happened a month ago, but I missed the boat on  that, so I thought I’d wish everyone a happy American Thanksgiving.  It’s also a good time to say how thankful I am for all of you.  This is an amazing community we’ve got going on, and I appreciate all of you every day.

Some other things I’m thankful for today:

  • my guinea pigs
  • my cozy home
  • my massage therapist
  • yummy fall comfort food
  • cozy slippers
  • being able to express myself through writing
  • being able to watch the birds outside my window
  • essential oils

What are you most thankful for today?

 

 

Book review: Suicidal: Why We Kill Ourselves

book cover: Suicidal by Jesse Bering

Suicidal: Why We Kill Ourselves by psychologist Jesse Bering is an attempt to make sense of the complex phenomenon of suicide from a variety of different angles including psychological, biological, spiritual, and evolutionary.  The author admits that he takes an intellectualized, scientific perspective to try to gain a broader understanding, and he does a good job of examining both the strengths and weaknesses of various ideas on the subject.  He encourages the reader to set preconceptions aside and consider the array of different experiences of those who struggle with suicidality.  He also brings to the table his own “recurring compulsion to end my life, which flares up like a sore tooth at the whims of bad fortune”.

The book covers a broad range of biopsychosocial contributors to suicide risk.  Some information may be familiar to the reader, such as the genetic component to suicide risk, while other information may be new, including anthropological evidence that indicates that suicide occurs across many different cultural groups.  The risk of suicide contagion is also discussed, and the Netflix series 13 Reasons Why is considered in this context.

Certain phrases in the book resonated very strongly with me and my own experience with suicidality.  Bering writes: “For the truly suicidal, consciousness is incapacitating.”  He also writes about the agonizing slowness of time when one feels suicidal, part of a process called cognitive deconstruction: “When each new dawn welcomes what feels like an eternity of mental anguish, the yawning expanse between youth and old age might as well be interminable Hell itself.”

This is not a book that sidesteps around the grim reality of suicidality.  The author points out the while suicide may appear to come out of nowhere, this is because of the tendency to stay silent about our own unravelling.  He also acknowledges the reality that sometimes people will find themselves in “very tricky situations where, frankly, it’s hard not to see suicide as a rational decision”.  He expressed his view that over-emphasis on the semantics of suicide does nothing to actually combat the problem of suicide, and may potentially restrict discourse.  While this may be controversial, I’m actually inclined to agree with him.

The book includes some controversial and even distasteful ideas, but they are presented in a way that seems geared to inform and examine rather than persuade.  Bering cites one researcher who suggested that from a purely ecological perspective, suicide could be considered adaptive, as it may not ultimately affect the likelihood of that person’s genes propagating.  He also mentions the view (although he disagrees with it) that depression results from social problems, and “should abate when a problem is perceived to be truly unsolvable”.  The two researchers that put forward this idea described suicide attempts as a sort of trading card to be played to motivate those close to them to help, something one anthropologist referred to this as the “social bargaining hypothesis”.

One chapter that disturbed me examined the diary left behind on the laptop of a 17-year-old girl who killed herself, which the parents had shared with the author.  It is considered in terms of a theoretical perspective of the stages of suicidality.  To me this felt like a profound invasion of privacy, and I would be horrified at the idea of my journal being shared with the world if I were to die by suicide.  It was not the content of the diary that I found distressing, but the fact that these were her most private, vulnerable thoughts not intended to be shared.

A chapter I found fascinating looked at suicide in the context of religion.  The author explains that the Christian bible actually does not explicitly mention suicide, and takes a matter of fact tone with regards to the suicide of such biblical figures as Judas, King Saul, and Samson.  The Catholic church took a strong stance in the fifth century when St. Augustine deemed suicide to be a sin; later in 1485 Saint Thomas Aquinas declared suicide to be one of the worst mortal sins.  The Islamic hadith (sayings of the prophet Mohammed) denounce suicide, and in several Muslim countries attempting suicide is a criminal offense.  Hindu scriptures are ambiguous regarding suicide, but for centuries there was an expectation that widows should self-immolate on their husband’s funeral pyre.  The chapter covered a range of other religious traditions, and presented facts rather than making religious arguments.

In the acknowledgements at the end of the book, the author admits he was having thoughts of suicide when he began the book, but found the writing of it cathartic.  I was actually experiencing suicidal thoughts as I read the book, but perhaps surprisingly I didn’t find it overly triggering.  I freely admit to being very much a geek, and the intellectual aspect of this book certainly connected to that inner geek.  It was highly informative without having any of the dryness and impersonality an an academic work.  I would definitely recommend this book for anyone who’s interested in finding out more about the phenomenon of suicidality from a broad perspective.

 

I received a reviewer copy of this book from the publisher through NetGalley.com.

You can find my other book reviews here.

Where did our meds go?

pills spilling out of a bottle

nosheep on Pixabay

I recently saw an article on the Canadian news site cbc.ca.  It warned that there was a manufacturer’s shortage of the antidepressant bupropion, both brand name and generic.   No reason was given for the shortage, and Health Canada doesn’t require this information.  The brand name manufacturer told CBC that the shortage had been resolved and the medication would be appearing in pharmacies “imminently”.  Earlier this year, there was a Canadian shortage of Epi-Pens, the life-saving medication to treat anaphylaxis.

Canada is certainly not the only country to have drug shortages.  The blog Vision of the Night has mentioned shortages of the antidepressant clomipramine in the UK.  A 2017 article in The Lancet said that the antipsychotic haloperidol was one of the most commonly shorted medications in South Africa.  A 2017 study in the Saudi Pharmaceutical Journal found that over half of the community pharmacies surveyed had shortages of  psychiatric medications including amitriptyline, aripiprazole, bupropion, buspirone, duloxetine, haloperidol, and lithium.

Unlike Health Canada, the Food and Drug Administration (FDA) in the United States requires that manufacturers report the reasons for drug shortages.  2017 statistics from the FDA show that the reasons given were manufacturing (30%), supply/demand (8%), natural disaster (3%), raw material (2%), discontinuation (2%), and the most common reason unknown (53%).  It seems rather unlikely that more than half the time someone suddenly woke up at the factory and realized they’d stopped producing pills, and called the Ghostbusters to come investigate.

Sarcasm aside, it doesn’t seem as though the pharmaceutical industry is very motivated to address this issue.  Presumably there is a business case for this, although at first glance it would seem that the best way to make money is to actually sell the product.  While I’m not strongly anti-Pharma overall, the frequency at which drug shortages are occurring has a rather unpleasant smell to it.

Drug shortages impact health conditions across the spectrum, but I think the potential impact of psychiatric medication shortages is quite high.  Medications are often grouped into classes based on their mechanism of action, such as selective serotonin reuptake inhibitors (SSRIs).  For some classes of medication, a person can switch between drugs in the same class without much difficulty.  It’s not that simple with psychiatric meds.  Someone might respond well to one SSRI, but have poor effect and considerable side effects with another.  For some psychiatric medications, like bupropion, mirtazapine, and lithium, there are no other medications that have exactly the same mechanism of action.

Aside from hoping that our meds won’t be shorted, there’s not a lot we can do.  If you hear about a shortage, coverage issues can make it hard to follow the example of Elaine on Seinfeld in her quest to buy up every remaining Today sponge from every pharmacy in the area.  I don’t know what the answer, but I think our national health regulators need to lean on Big Pharma a little harder than they’re doing right now.

Have you ever experienced a shortage of your medication?  How did you manage?

 

I admit it – I’m a ghoster

Yes, that’s right, I’m guilty of ghosting.  Ghosting is not a nice thing to do to someone, but are some forms of ghosting worse than others?

I would like to propose two different types of ghosting: offensive ghosting, which serves to actively reject another person, and defensive ghosting, which is done for the purpose of self-protection.  I say this because depression has made me a ghoster.  If I am feeling uncomfortable or invalidated in an interpersonal relationship while I’m depressed, I get really overwhelmed, and my first instinct is to retreat into my hermit cave.  I’m not wanting to hurt the other person, I’m just trying to feel safe. Depression means that some of my more mature coping mechanisms just aren’t available to me, and when I’m feeling really low, avoidance is about all I’ve got to draw on.

I used to have friends, although now that seems like a whole lifetime ago.  When I became depressed a couple of years ago after experiencing workplace bullying, my depressive urge was to isolate.  I tried the opposite action direction to push through and try to socialize anyway.  But these friends, though I know they were trying to be helpful, were being really invalidating.  The pressure of trying to stay connected with these people eventually became too much, and I snapped.  I blocked numbers on my phone.  I didn’t respond to emails.  I tried to hide from the world.  It’s not that I was trying to reject these people, I was just trying to hold onto a shred of sanity.

I also ghost my family.  I find it very hard to feel connected to them when I’m unwell, so it feels quite uncomfortable when I have contact with them.  That means that when I’m feeling really low, I just fall off the grid completely.  Unsurprisingly this is very stressful for them, and they worry that the next thing they’re going to hear about me is a call from the police.  I know that, yet when I get the phone call and see the number on my call display the thought of answering makes me feel ill.

I suppose ghosting can be appealing because it feels safer than any alternatives.  It’s very hard for me to feel safe with people, and especially hard for me to feel safe in any sort of conflict with people.  I wish that I didn’t frequently feel under attack when interacting with others, but that’s a sense of safety that I just haven’t been able to rebuild.  And until I do, I’m sorry to the people that I run away from, but I’m the only one that can look after me.

Do you ever ghost people?  Do you think your illness plays a role?

God Knows Where I Am: Death by mental illness

God Knows Where I Am film

This disturbing documentary tells the story of Linda Bishop, and her death after being released from a state psychiatric hospital. The film includes readings from Linda’s journal, and commentary from people who knew her, including her sister and her daughter.  Their words powerfully captured the pain and frustration of a family seeing their loved one deteriorating without having any power to stop it.  The sweeping visuals and music that accompanied slow, dramatic readings from the journal were effective in the later part of the movie, although to me they seemed overly drawn out in the first half.

After Linda was first diagnosed with bipolar disorder with psychosis, she was put on medication, although she didn’t stay on it for long.  Subsequent attempts at getting her treatment also eventually resulted in her discontinuing medication.  Over the years she became increasingly delusional and her behaviour grew more and more erratic, and as a result a court in New Hampshire committed her to the state psychiatric hospital for a period of up to 3 years.

In hospital she refused to take medications, and in New Hampshire medications can’t be forced upon someone without a guardianship order.  Linda appeared in front of a judge and managed to keep her delusions contained during her testimony, and the judge decided she didn’t meet the criteria for guardianship.  After some more time in hospital without any medication, she was deemed “clinically suitable for absolute discharge”, although her psychiatrist described her as having very poor judgment and insight.  Linda had refused all along to give consent for the hospital to speak to her family, so they were not informed of her release.

She was discharged in early October, and when she left the hospital she didn’t even have clothes suitable for the weather.  After some roaming about she found an empty farmhouse for shelter.  Winter soon set in, and it was unusually cold and snowy. For two months she lived off of apples from a tree outside the house, until she ran out of food on December 6, 2007.  She had a supply of water from the snow outside.  Although the farmhouse was within sight of another house and a major highway, Linda’s presence was never noticed, and her delusions prevented here from seeking help.

Throughout this time, she kept a journal.  It was eloquently written, but clearly showed the she was unwell.  She had the insight to recognize that she was starving to death. On December 14th, she wrote a note that began “To whomever finds my body: My death is the result of domestic violence/abuse”, although this was not based in reality.  She continued daily journal entries as she grew progressively weaker.  She wrote that she would keep praying since “God knows where I am.”  January 13, 2008 was the last entry, with only the date written.

I was left feeling ill at the end of the movie.  This poor woman died a torturous death, drawn out over more than month without food in an already weakened state.  Her mental illness killed her after the mental health system utterly let her down.  While it was a perfect storm of circumstances, this is something that could happen again.  It could happen to one of us.  I’m aware that my illness could take my life via suicide, but the thought of undergoing this sort of ordeal is bone-chilling.  We as a society should not be allowing this to happen to the most vulnerable among us.  And yet where do we find a balance between allowing autonomy and enforcing desperately needed treatment?  I’m a bit too shaken right now to have any sort of articulate idea.

 

You can watch the film on Netflix.  The official film site is here.  There’s also a good article in the New Yorker from 2011 with the same title.