Cut the crusts off

038-048 BeautyPapers#2_TomJohnson_SY.inddWhen they say

You’re so beautiful

I’d prefer they

Get a needle

And stitch their mouths

Shut

It isn’t true

I have a horse for a jaw

A mountain for a forehead

And my eyes are

Continually watering

With their words

Some do not feel like kindness

They are broken pieces of yourself

Irreconcilable

Don’t call me that

Can’t you see beneath the layers

A scream is

Not beautiful

You only say that

Because words have become filler

For silence

And

Often for truth

But the truth is

I am an animal

My jaw continually muscular

You chew

This artificial sweetener as we

Press ourselves obedient

Sitting in high chairs at empty tables

Void of nourishment

The formal hedges of the maze, flower late this year

Too little rain save saline, and crackers, left to dampen in the tree house

I always said

Cut the crusts off

Take a plunge

Underwater you can see better when they come

Patent toes incased in skin, cramping their march

Like wooden soldiers who

Briefly lent life’s lumbering

Will grow flushed and warm

Retaining their glimmering uniforms

Dyed into the marrow of their grain

Did you see the imprint of the pillow where I have lain?

Watching for night markets among the trees

Hawking their jewels as magpie thieves

A glimmer of willow the wisp

Forfeiting glamor for real magic

Vaporized by the sound of reality

Clicking like an old boiler trying to knit her self the semblance

Of youth

Glazing the russet bleed of nightfall

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Sent off

I licked

the envelope

containing myself

shut

and before I knew it

standing by the metal post box

let it drop

heavy and thinly covered

composed of filigree

a sound I am reminded of

with each urge

to be enclosed and

sent off

I know not where

but it will have

sail boats that knock against each other

with gentle shoreline waves

and at night

a lute

plays reedy and low

as dancers without shoes

as slim as whiskers

bronzed by day

slip in and out

of wet candlelight

 

Be the friend you would like to have

On the surface I may not seem like much but I have always held this truth;

“Be the change you want to see” (Gandhi)

That means be the friend you would like to have.

I used to be the typical teenager, self-involved, over-sensitive. I thought I was being a good friend but looking back I can see some easy mistakes I made such as always putting my feelings first and not being able to empathize enough with others.

Now that I’m a bit more empathetic I really try, but I must admit it has been hard to make friends as an ‘adult’ because so often people lie and let you down.

More than anything I wish I had friends where I live now, when I moved to America I really lost the ones I left behind, as distance tends to do that, and I didn’t make new ones. I know I should ‘join a club’ but I’m an introvert and that’s really hard for me to do.

Friendship is so underestimated and one reason adults can be lonely especially if like me they don’t have kids.

I would never treat a friend badly and I really don’t understand those who do. Even on WP I have had some people mistreat me, those days are over, I’m too guarded now, which really if you think about it, is a shame.

If we all treated others as we would wish to be treated and we were HONEST the world would be so much better. Period.

Anxiety & how to survive surviving

Anxiety as anyone who has experienced it, which most of us have intermittently, can be rough. When it doesn’t go away it becomes a mental illness rather than a mere short-lived symptom and can be debilitating as you attempt to do the things others do.

Wading through mud is how we experience life is one way people with anxiety describe the feeling.

Watching others able to do things without hesitation, then attempting it yourself and finding it akin to holding your breath for a prolonged period of time, or experiencing a heart attack, makes living with anxiety an isolating hardship.

Typically people who experience anxiety keep quiet about it, due to social stigma and the embarrassment of admitting that they are anxious about something that others do not appear to be.

Some people who experience anxiety are able to work through it and ‘feel the fear and do it anyway’ and because of their success, it may lead others who are not able to follow at the same speed, to feel like they have failed. But there are many layers and degrees to anxiety and this will always impact a person’s ability and how far their efforts take them.

Picture this; It is possible to be standing still trying with every pore of your being and yet not appear that you are (trying) to anyone else.

Picture this; It is possible to do something without trying and thus, expend no effort whilst someone with anxiety has to work ten times as hard to produce the same outcome.

Working ten times harder to do something is pretty exhausting. It can lead you to feel inferior because you perceive others finding things easy, and you conclude, therefore it’s me there is something wrong with. I am weak.

But anxiety is no joke and living with anxiety is a daily battle for those who do not respond to medication or therapy and/or have found the long-term side-effects of medication unacceptable.

We’ve all heard how anxious people are more prone to certain diseases (heart disease primarily) and struggle with jobs that are high-stress as so many of ours are these days. Anxiety can impact academic performance, test-taking, public-speaking, relationships, communication, authenticity and sleep. Often people can only tell we are anxious when we confess, otherwise they may perceive us to simply be avoidant, aloof, quiet or shy.

Shyness and anxiety can go hand in hand but one does not beget the other. The ‘bad rap’ both get in American society especially, is unfortunate. Just as the world does not need to be completely filled with extroverts, we should not expect shy people to become outgoing nor anxious people to stop existing in favor of daring people. Diversity is a good thing, that includes the types of people we are. Anxiety only ever becomes a problem when it begins to rule you and dictate to you, rather than the other way around, some anxiety is natural and we all experience it. In fact, the only people who experience almost no anxiety are psychopaths and sociopathic, meaning, if you have a conscience you invariably experience some anxiety and that’s a sign of being balanced.

Mental illness is when something becomes too much that it controls behavior in a detrimental way. I see it like the snake and the snake-charmer, the mental illness is the charmer, the result is the hypnotic snake that lulls us into altered behavior. In the case of anxiety this can manifest in our missing out on things we might actually like to do.

The first port of call is to establish, are you overly anxious and is it negatively impacting your life? If you are simply an introvert who loves your own company or smaller groups of people, and would prefer to read than say, go to a party, that is not a mental illness it’s a great choice and you will probably be very successful! If you are not going out because you are paralyzed by social anxiety that’s cutting the pleasure out of your life and something should be done about it.

Fortunately unlike some other mental illnesses, anxiety is relatively treatable. That does not mean everyone with anxiety will benefit from treatment but the success rate of treatment is higher with anxiety than any other mental illness. Nobody knows why this is for sure, but some reasons could include, responding well to medication and better options for therapy. Equally, in the milder forms of anxiety there is less morbidity, meaning some mental illness is very intrenched and hard to treat.

For some however, anxiety does not dissipate and this is true of all treatments there are those who do not respond. It’s not their fault, and it makes it very hard for them because it acts as a double-whammy, firstly they have something they see others may not, secondly they do not respond to treatment, two negatives. If you know someone like that, consider the impact of a flippant remark like “you may be anxious but just relax” and how that could add to feelings of inadequacy and error.

Anxiety is heightened by stress and what constitutes one person’s stress differs from another. Personally, the work place was my stressor. I related it subconsciously and consciously to stress because of bad experiences. Anxiety is often ‘the fear of what could or may happen’ rather than what’s happening right now. You can experience anxiety in the moment, but often it’s more of a preview feeling. In the case of work place anxiety, you can get very anxious on say., a Sunday night, imagining the potential stressors Monday morning.

Unfortunately whilst therapy can help you become aware of your ‘internal scripts’ and dialogue and seek to change how you self-talk by changing the meaning of what you internalize, it’s not a certain cure. I can tell myself, Monday may not be bad, Monday could be good, one bad experience does not equate to all bad experiences. And I may logically believe that, but emotionally it is harder to translate the logic to the emotion. The pathway is often fraught with long-learned anxiety triggers and it’s almost a battle of the wills.

Sometimes you hear that someone has been ‘strong enough’ to over-come their negative self-talk and I say, good on you if you’re one of them. Equally, this can lead to feelings of failure for those who are unable to quit the long learned script in their head that manifests dread. Sometimes it’s not even a palpable ‘fear’ so much as a generalized anxiety and it can manifest in more ways than an internal script. Anxious people often sweat, have trouble sleeping, may seek drink/drugs/bad habits to assuage their anxiety without even being aware of it, may increase their heart rate or worse case scenario have a panic attack.

All these things are symptoms of an anxiety disorder that can if left unchecked, control and dominate the strongest people. Whilst much can be done and should be done to limit anxiety, there is always going to be a difference between a laid-back person and an anxious person. This is as much as anything, personality, life-experience, coping, DNA and possibly even biology. The latter because anxiety can be learned, and can run in families (inherited) through a mixture of biological and social traits. Depending on how much is biological it may be impossible to completely eradicate.

Epigenetics is the study of whether something is biological in origin or ‘learned’ (socialization) with the belief being, it is a mixture of the two, and by understanding the relationship between two, you can better predict and understand, outcome. Studies done on twins show that whilst they have the same DNA their ‘life experiences’ and where they live and with whom, influence their outcomes. This is true about every facet in life, including what we eat (we are what we eat) how many children we have and tons of other little nuances. Epigenetics is complex and we can never know for sure, how many factors make up the differences and similarities in people and studied populations.

Whilst a researcher may need to generalize to create a working theory, within that generalization are many differences that do not get picked up by mass studies, this is true of the layers of anxiety and each person will vary in their response to treatment and cause. What may cause anxiety in one, does not in another, but equally, they may become anxious about something else entirely. Ensuring we are sensitive to those who experience anxiety will obviously decrease their anxiety! Thus, we can be the change we want to see!

Mental Health Month “Personality Disorders”

The first day I was interning in a crisis center, I heard two women talking, and one said; “Whatever you do, don’t ever see a client who has Borderline Personality, they’re the WORST”

Shamefully I had studied but didn’t know very much about BPD yet, as I was only a year into my studies. I went home that night and read up on it and subsequently read some books devoted to BPD including the well-known book “I love you / I hate you.”

Shortly afterward I found out a friend of mine was BPD (BPD often goes hand-in-hand with Bipolar, as we often see Anxiety and Depression co-morbidly). She educated me significantly in a first-person account of what it was like to suffer from a personality disorder.

The very words ‘personality disorder’ strike me wrong. It’s not really giving someone a chance is it? If we label them as being disordered in some way?

It is thought personality disorders ‘grow’ in childhood and upon reaching maturity can be responsive to treatment or not, depending on the depth and extent they were reinforced in childhood. They usually have triggers such as the link between BPD and being sexually abused in childhood.

Why this is – isn’t so hard to understand if we consider, we all have personalities that are shaped by our experiences – any wonder then that certain experiences will commonly shape certain personalities and responses/reactions. If we take this to an extreme, a ‘disorder’ is a disorder of that personality caused by something wrong and traumatic that occurs to a child.

Why then doesn’t every child who is sexually abused BPD?

Because BPD and other personality disorders must be reinforced. If you are abused as a child but someone finds out, the person is taken away, you are told it was not your fault, the trauma is made better by a rectify and love and lack of shame, then you may well be affected by that abuse but not altered by it in terms of your personality.

If however, the opposite occurs and that trauma is reinforced, then by its very nature of reinforcement, the personality ‘disorder’ forms and every bad thing that happens afterward goes to continue that reinforcement.

It can work something like this;

Child A gets raped by her step-father. Child A tells her mom. Her mom calls her a dirty little liar and beats Child A. Child A is then raped repeatedly by her step-father who threatens to kill her if she ever talks again. Child A remains silent to her abuse for years and it goes on, unpunished. At 15 Child A goes to a party, gets drunk and is raped by a friend. Child A is told by her friends she is a slut and deserved it. Child A internalized all of this and develops BPD which among other things is characterized by a profound lack of trust in others.

Phrased like this, are any of us surprised?

In other words, a personality disorder is a consequence to abuse. As such I find the use of ‘disorder’ punitive because we’re saying the person has something wrong with their personality we are focusing on that, without really considering how this occurred.

Why? Because BPD can be very destructive, both to the person with BPD and those who know them. When you are dealing with someone who is capable of throwing everything into flux, it’s hard to make time to consider the background. You are too busy putting out the fires. And that is why BPD is so feared by therapists and wrongly, stigmatized as being a personality disorder people dread. Whether people dread it or not, any health care worker should aim to help those under their care and treat everyone equally. Perhaps that is easier said than done, but this is why more time should be spent learning about the formation of personality disorders.

Later on in my training I was warned again about BPD folk and told that they can be highly manipulative and destructive, they can and will always try to bring you down. I recall thinking ‘I can’t see how anyone could do that’ but later on I saw several colleagues have to defend their licenses against false accusations by BPD patients who were ‘testing’ them or flexing their muscle.

It appalled me to think anyone, even someone mentally ill, could deliberately go after someone with the sole purpose of trying to ruin their life. I found it hard to understand and empathize with them on that. Which is why I now understand why mental health workers can fear certain diagnosis in people. But despite this, I believe, given the right training and awareness, people can find ways to help those who even lash out at them.

BPD is characterized by a pull-push approach to relationships, an intensity, followed by a rejection, both of which are extreme, due to an inability to trust people shifting from intense attraction/like, to repulsion and hate. For most of us, this extreme is not impossible to imagine, perhaps if we have fallen out with a friend who back-stabbed us or a relationship went wrong because someone cheated on us, we went from love to anger at very least. With BPD those emotions are amplified and far more aggressive, with anger as the source. BPD individuals stoke the flame and are among the most angry and vitriolic of the mental spectrum.

For this reason when befriending someone with BPD it’s important to secure firm and unwavering boundaries. Ensuring the BPD knows the ‘ground-rules’ in other words, don’t flirt one day, and be cold the next, don’t be close one day and distant the next, because by doing that, you are feeding into their fears that nobody is trustworthy, and that will only bring on an extreme response.

Many BPD’s confess that the hardest part of the illness is the social disapprobation and isolation. They do not maintain long-term friendships or relationships, they are at high risk for suicide and self-harm, they vacillate between self-incrimination and feelings of persecution. In short, it’s an instability of their psyche due to being fractured in childhood.

This is among the myriad reasons I condemn child-abusers unreservedly. It is not just rape and abuse, it is messing a child’s life forever when you take someone and you fracture them. If we can take child abuse more seriously and catch more of them before they go on to ruin more people’s lives, this will have the knock-on effect of reducing the numbers of people who grow up to develop BPD and save them from difficult and unfair experiences in life. The one positive of a personality disorder is you can prevent it from happening, we cannot do that with all mental illness but when we can, we have no excuse but to try our hardest.

Mental Health Month “HIV/AIDS”

I decided to write about HIV/AIDS during Mental Health Month because whilst mental health and HIV/AIDS has a relationship, there are many other diseases and conditions with more of a relationship than HIV/AIDS and mental health. So more is talked about say, Alzheimer’s and mental health, Parkinson’s and mental health, menopause and mental health, etc.

As a neglected relationship I wanted to talk about the links with mental health and HIV/AIDS as much as anything, to be mindful of this fact; HIV/AIDS may be less of a world scourge than it was in the eighties and nineties but it has by no means gone. In fact, many who work in the field believe it is only a matter of time before the current cocktail that keeps HIV/AIDS as a manageable disease for the majority, will start to fail and require further research and medication. Additionally though we are on the cusp of a quasi-cure it would not in its current state, be do-able for the vast majority, most particularly, the poor. In addition, HIV/AIDS speaks to a larger issue, that of the continual zoonotic transmission of a disease from animals to humans (or equivalent).

Recent studies demonstrate, the rate by which potentially fatal pandemic diseases can be transferred interspecies, is far higher than previously thought. Researchers believe it is a matter of time before another HIV/AIDs style disease, will occur and spread. Whilst we may dismiss this as fear mongering, history shows us otherwise. Considering this and the history of HIV/AIDS the entire subject requires more in-depth analysis to ensure if this happens, all those infected are offered treatment rather than the select who can afford the Big Pharma monopoly prices.

If India had not stepped in, the ten million who died in Africa (and the number was in actuality far higher) would have continued to climb. If a Western country were to lose ten million to a disease, there is no way the monopoly of Big Pharma would have been permitted and as with the Anthrax scare the patent would have been lifted on the medication to ensure everyone had access to cheaper generic versions of the drug. India told this to the WHO years beforehand and offered to help those struggling countries like africa by supplying generic medication as less than one dollar a day, WHO and effectively, the Western world, ignored them and millions died.

Now the WHO and others are trying to force countries like India into not producing generic versions of existing medication in order to save lives. This at the behest of the already massively profiting pharmaceutical industries of the Western world. Profit it seems, literally comes before lives.

What does this have to do with mental health?

Having a disease like HIV/AIDS has a myriad of outcomes, not least a deleterious effect on our well-being and mental well being. Even if the disease is ‘managed’ the trauma of having a disease that is communicable, stigmatized and life-threatening, alongside the inevitable connection to sex, drugs, homosexuality and other stigmatized and judged things, causes a great deal of psychic stress.

When our bodies are unwell our minds are unwell.

Living with a disease like HIV/AIDS or hepatitis C can literally cause depression.

Surviving a disease like HIV/AIDS can cause similar issues known as ‘survivors guilt’ and the suicide rates both during the AIDS crisis AND afterward were extraordinarily high for this very reason.

Some people in power at the time felt that saving Africans was not a priority because quote; They would not know how to read the instructions on the medications, they would not take the medications properly, they would possibly cause the medication to work less effectively and even cause the virus to mutate and become resistant and put everyone else at risk’ so they chose to ignore the plight of Africa and other countries. It was essentially the worst kind of racist discrimination possible. On the other extreme, China did a disservice to their citizens by ignoring the problem saying they had no problem and thus, permitting no discussion or help.

Back to mental health. Imagine if you had HIV/AIDS today, would you feel ‘okay’ about it? Even if you had medication (with its side-effects) and you knew you may live a relatively normal life span? It would still affect you in so many ways, you would have to inform anyone you were intimate with, you would have to consider it when having children, you would have to let those you worked with and your insurance know. Even if you did not see it as a stigma, some people invariably would (because people love to judge) wouldn’t that cause at the very least, some anxiety and possibly other mental health issues?

A friend of mine contracted Hep C during college, he was deeply ashamed and despite therapy he ended up being celibate. That may be an extreme but it’s also one example of how illness, disease, viruses, and medical conditions can exacerbate mental health even when they don’t do so biologically like Parkinson’s does.

Many years ago after a sexual assault I was told my assaulter was HIV positive. I didn’t at that time have any idea of prophylactics for those exposed to HIV. Fortunately a professor of mine did and she told me where to go. I think to this day, if I had not met her, told her, and she had told me where to go, I may today be HIV positive. Maybe not a big deal if you are, but when you are not, a huge deal, which speaks to how people really feel about HIV/AIDS.

Taking the prophylactics which are basically the HIV/AIDS medication, for six weeks, demonstrated to me and gave me more empathy for, those who have to take them for the rest of their lives. They talk about how good they are at extending and maintaining life but they are rough on the body, and having to take quite a few every day, as well as the cost, is all round hard. I learned then, firstly never take your health for granted, secondly never judge someone else because you don’t know what they are going through and third, we in the Western world have an innate privilege that other countries do not have and we take it for granted.

The six-week supply of medication at the time cost around $3,000. Most of the world doesn’t earn that in a year.

This is going to happen again. And when it does, more will die and more will close their eyes to this because it’s not on their door step. We choose whom we empathize with and it’s almost a trend. If everyone else is donating we donate, if nobody cares, we don’t care, en mass this is our approach to charity and change.

HIV/AIDS hasn’t gone away. Other diseases will come that are possibly more devastating. It impacts entire generations, kills and destroys entire family trees, obliterates the ‘luxury’ of considering mental health fall out afterward because resources are so precious. Think now how many are dealing with mental health issues concerning the death of half of their families from HIV/AIDS and have no resources.

We see mental health treatment as a luxury because in many ways that’s what it is. And this is wrong. The domino effect of poor untreated mental health issues, causes loss of productivity and health, it is a vicious circle, if we ignore it, we do so with the knowledge ignoring it costs us more in the long run.

Stigma alone, social exclusion, judgement, blame, condemnation and fear, can strike illness in the heart of any sufferer. Suffering in silence, unable to share your diagnosis freely, even with the protection of the law, makes those with such diseases feel they are not the same as everyone else and in some ways that ‘secret’ they carry does set them apart. Imagine for a moment how that feels? Many of us cam emphasize somewhat, we may carry our own secrets, but that one is a pretty big secret and a heavy burden. We can help with that burden just by being good to those we meet, aware that we never know the extent of their burden.

When the next HIV/AIDS comes around, I hope everyone will stand up and demand that Big Pharma not prevent the treatment of all sufferers in all parts of the world. Your economic status or skin color do not reflect what your level of care should be. The only way this changes is if we, the people, change it by not ignoring what the inequality occurring in other parts of the world in part, due to our economic monopoly.

Mental Health Month “All queered out”

The relationship between the LGBTQ community and Mental Health has long existed. Someone who believed same-sex relationships to be a sin, may point to the mental health ‘sickness’ of those who are attracted to partners of the same gender. This goes back to the seventies where mental health and being queer or transgender, was considered a mental defect/illness. It was not until the early seventies that the bible for Psychiatrists changed this diagnosis and it no longer was considered a mental illness.

During this time of stigma, those who admitted to being queer or transgender were often subjected to camps and programs that attempted to ‘cure’ them of their ‘proclivity’ of course they were unsuccessful but they did a great job of messing up generations of queers, so much so that many stayed in the closet, marrying and having children and never ever admitting who they really were.

Someone who is anti-gay may argue, that means they have a choice because they choose to stay in the closet and marry, they can be normal after all!

There is however, nothing normal about pretending to be someone you are not, and this definitely can be one reason LGBTQ people suffer from a higher than average degree of mental illness.

If it’s an argument of which came first, the chicken and the egg, then you can cross-compare to other studies looking at marginalized and condemned groups such as racial minorities, and see that levels of mental illness rise when bigotry and condemnation in the larger society are directed toward that group. No surprise, hate begets mental illness. It’s not all in your head!

How can hate cause someone to be mentally ill if mental illness is not a mailable and ‘chosen’ ailment? Hate cannot cause someone to get cancer, so how can we argue mental illness is as serious as cancer?

Hate can lead someone to drink too much, smoke too much, and that can cause cancer. It is called an indirect relationship. Cause and effect. The same is true of hate and the LGBTQ community, if you are condemned, judged, shamed, picked on, hated and treated badly day after day, that can literally drive you out of your mind. More commonly, a pre-existing tendency toward certain mental illnesses is exacerbated and tipped over the edge.

This does not mean, anyone ‘chooses’ to be mentally ill, but like anything in life, extreme stress CAN bring on symptoms. They have long known this with Schizophrenia, Bipolar and Borderline Personality Disorder and of course, PTSD has its roots in society as does anxiety. You cannot remove societal influence from the development of a mental illness yet it is as ‘real’ as any other disease in terms of true manifestation and side-effects.

Historically gay and minority populations experienced a high degree of stress and fear. They were having to hide who they were, meet in secret, they could be arrested because their emotions were illegal if expressed physically, and they often had other concerns such as low-income, poor access to care in the community, nobody to talk to honestly and unanswered questions about their own identity.

Our society is typically Heterosexist and Heterodominant because the vast majority of people in our society are heterosexual. It is one thing to show two women kissing, and have a bit of bisexual fun, quite another to be a committed full-time lesbian. Most people don’t relate to that, they may try to understand but that’s like a white person understanding the experiences of a black person, you can only go so far with that.

Thus, LGBTQ are misunderstood at best, and not understood at all at worst, with pastiche and parody being the status-quo. Historically this was even more so, as it was an illegal ‘act’ to be with someone of the same gender sexually (and everyone considered the deviancy of gay sex to be the key to being homosexual rather than thinking for a moment it could be about something other than sex).

Unfortunately a large portion of gay men were so promiscuous it did not help the ’cause’ because they really did live the life style that heterosexuals feared. I do condemn this in the sense that I see no good coming out of sleeping with twenty strangers a night, and whilst that may seem homophobic of me to say, having read the history of HIV and AIDS I see a causal history there as to why homosexual men became one of the earliest groups to be significantly infected by HIV/AIDS. This set the gay cause way back because straight people condemned all gays outright for the actions of the few, and believed HIV/AIDS to be a gay-plague, which of course it was not.

Reading the history of this time, I tried to better understand what would lead gay men to be that promiscuous, my first thought was, a lot of straight men would do the same thing given half the chance! My second thought was, it’s about reaction. Gays were subjected to such strict secrecy and condemnation they could not really be ‘out’ and when finally some cities were tolerant enough to be relatively out, certain populations ran with it. I understand the reaction/action/reaction cycle it exists in every subjugated population to some extent, and every new generation reacts to their parents, it’s a cycle of over-throwing the old for the new. But the level of promiscuity in cities like NYC and San Fransisco was a contributing factor as to why HIV/AIDS initially hit the homosexual male population so hard.

When we consider what a heterosexual who knows little about homosexuality must have thought upon hearing that some homosexual men with HIV/AIDS were sleeping with twenty plus partners a night, as well as doing drugs, it’s not hard to see why there was another wave of backlash against the gay community en mass.

That said, times have somewhat changed and whilst you can still find ‘bath houses’ and gay men (and some lesbians!) who wish to be as promiscuous as those early days, there is also a greater appreciation for actual relationships among the homosexual population. This should be emphasized more in our culture, as heterosexuals still believe homosexuality is about sex, and it is often a very small part of what goes into being a homosexual. The stereotypes are hurtful to the community as a whole, those include the idea that all lesbians are ugly, all queer men are paedophiles, all lesbians are men haters, all bisexuals are sex-addicts, all gay men are perverts.

Going back to mental health … when HIV/AIDS first hit, there were not enough resources to help the gay community, and there was therefore, even less help mentally. After the crisis began to die down and some treatments that worked began to help people live longer and HIV/AIDS was no longer a literal death-sentence a strange thing occurred…. there was a mass influx of extreme depression among the survivors of the ‘gay plague’ as it was known.

Survivor guilt and the depression that comes from severe illness and PTSD (seeing all your friends die) are HUGE factors in the development of mental illness. Some survivors actually deliberately stopped taking their HIV/AIDS medication and let themselves sicken and die because of not being able to stand surviving. They felt they didn’t deserve it. Why me and not my friends?

This was exacerbated by virtually NO resources for gay individuals who needed to talk about what they experienced, witnessed and felt. This still stands, in most cities throughout the US there are no specific mental health services for the homosexual and bisexual and transgender populations.

During my studies as a psychotherapist I sat in a large room with over a 1000 counselors on a briefing about ‘homosexuality and mental health’ during which everyone was told that to be homophobic or intolerant of homosexuality, was incompatible with being a mental health professional. Sounds good huh? Not so good. Of the 1000 there I would easily hazard a guess and say that a third, possibly half, were somewhat prejudiced, very ignorant and possibly homophobic. I say this after hearing them speak, the questions they asked, the people they were.

This is not condemning someone who is homophobic, any more than I would someone who is racist. It is your right. But it’s not legal and it’s not moral. So given this, those people have the difficulty of being legally required NOT to be what they actually privately are. Do you think many of them would admit this? Do you think they would stand up and say ‘I am against homosexual relationships’ and possibly lose their license? For those who are homophobic or anti-gay, you may be shaking your heads and saying ‘this is why it should not be legalized, you are forcing people to feel what they do not’ and I agree with the latter statement.

If you are homophobic you probably shouldn’t be a therapist with the exception of working in a religious community for like-minded people.

If that sounds extreme, well it is. Just as I would say if you are racist you should not work in a public setting but you would be fine in say, a community that supported your views and this cuts both ways (white and black).

LIkewise, if you are sexist, don’t work with the opposite gender.

I’ve been told that when you are a ‘ist’ you should work through your feelings and you should take clients who push your buttons. I don’t agree. Therapy is a fragile experience, and people pick up on intolerance. When I was training I saw and heard enough people to see, they KNOW when you are not comfortable with them. The same goes for ignorance, there is no place for ignorance and therapy when it comes to treatment. If you don’t understand it, refer, refer, refer. To someone who does.

The problem is funding, there are no funds for the queer community because it’s seen like Planned Parenthood as a problem more than anything else.

So if gays don’t have access to good mental health services (and other services) is it any wonder they have higher percentages of certain diseases and mental health issues?

The bottom line is; LGBTQ populations exhibit higher levels of anxiety, depression and alcohol/drug abuse than the standard population. This is not because they are all sex-addicted club fiends who pour drugs down their throats whilst sleeping with twenty partners a night. But the reality of this does lead ignorant people to label mental health as a weakness and point to this as an example. Some even go back to the idea that mental health is a perversion of nature, just as the pilgrims did when they put mentally ill people to death or locked them up.

It doesn’t take long to learn about a group of people you have nothing in common with and it can go a long way. Typically Native Americans ask that therapists working on reservations be of Native American heritage. Some say it should not matter who the helper is, it is more about their willingness to help.

I disagree. It does matter. Just as if you are black and you have been subject to racism you may wish to see another person of color, there’s nothing wrong with that, just as there is nothing wrong with being female and wanting a female gynecologist or therapist.

More gay people need to educate the majority about the specific issues relating to their population so those heterosexual therapists can actually be of some help to queer populations. Even more than that, those therapists who are anti-gay or prejudiced should recuse themselves. Yes – step away – don’t see homosexual patients – do them a favor!

Currently the accepted protocol is to be objective and even if ‘you are personally anti-gay’ you can be objectively helpful to a gay client. That’s ridiculous, no you cannot. I have a friend who is fairly anti-gay and works as a therapist and he is not ever going to be helpful to a gay client and can do more damage than good. Period. I have told him this but until the system changes, his boss and other leaders will insist that anyone, irrespective of their personal beliefs, treat gay clients.

Let’s change this…. and some other things and maybe the rates of mental illness will begin to decline in the LGBTQ population and with it, the high rates of suicide.

 

When it’s not a mental disease

America and increasingly, other Western countries, are fond, nay passionate, about diagnosis and labeling any disease.

In 2017 we have diseases we never thought were diseases. Restless Leg Syndrome, Dry Eye Disease, the list goes on. Soon we’ll have ‘bad hair disease’ and ‘thin nail syndrome’ too.

If this were for altruistic reasons I’d say, well at least there’s an upside. If it is for profit and expansion of profit then I find it sinister.

The profit of producing a medication that ‘can’ help with a ‘disease’ is enormous. Don’t underestimate the incentive for a company to literally further their profit cause by jumping on the bandwagon and getting a condition codified as ‘disease’ or ‘syndrome’ or ‘disorder’ and then offering a ‘cure’

Firstly, few pills if any are cures. They are placebos, they veil and hide conditions, they assist, but they rarely cure. Those that do are typically not in the mental health field, there are not many cures for mental health, there is management.

But management whilst sometimes essential and good, can also go too far.

A friend of mine is on four pills for their mental health issues, and yet, in my humble estimate they do not need to be on but one if that (for anxiety). The others they have been given because the system perpetuates our belief that a pill is all we need to ‘feel better’ and it takes away our personality responsibility and gives us an out. When we feel desperate and we are struggling, who isn’t going to take that option? My friend may think four pills for psychotropic medication isn’t very much but think about the side-effects of each one of those pills and the long-term effects. Think about how changed you are with one pill and then multiply by four.

The deleterious effect of over-medication is well documented but does not seem to trickle down into our decision-making. When suffering from a frozen shoulder I was given a total of eight pills to potentially help me. I didn’t end up taking seven because every time I read up on the side-effects I realized, it simply wasn’t worth it. The one I tried, when it was very painful was a muscle relaxant, it helped, it felt great, but it was also by way of side-effects an anti-depressant and it paralysed the bladder muscles. I got a bladder infection and haven’t touched it since.

I see this as a good example to compare to any over-medication or even, unnecessary or too strong medication. The side-effects often outweigh the benefits. antidepressants especially SSRI’s were only ever invented and meant to be used for six months maximum, I know people who have been taking them for over ten years. But if you are suffering and a pill helps, it is hard to take the high road. My shoulder hurt, I wanted relief I wasn’t sleeping, the pill gave me relief. I only stopped because the side-effects outweighed the relief but what if they hadn’t?

I’m not knocking those who are in chronic pain, that’s a different issue altogether, and few of us can know how bad it is to live in chronic pain until we have been there.

But going back to mental health prescriptions, it’s my belief that we dose too frequently without due consideration of alternatives, which are often not available because we pour our resources into medication rather than other treatments. If you have insurance, you can get six weeks of therapy which is usually nowhere near enough, and you can get year of medication. This seems deeply skewed in favor of medication.

The VA had many issues with over-medication and suicides as a result of over medication returning vets and not offering other forms of therapy aside medication. This is true nation-wide and explains why people take more and more pills. The first one works for a while, then it does not, the placebo effect wears off, the doctor gives them another pill to take in addition to the first pill and so it goes on.

But we know doctors over-prescribe and we know they do this because they are incentivized to do this. We know they have a motive for doing this and we know the manufacturers have a motive and we know the system is built upon that motive (profit) thus, profit over health should make us suspicious enough to question our medication regiment at every turn. But when you are not feeling in your right mind, how likely is it you will do that? More often, you’re just trying to survive and get out of bed each day, can you be expected to really check every medication you receive and balance it against the side-effects?

Likewise, if the system is biased toward medication our entire societal rhetoric is going to be slanted in favor of medication. We literally are indoctrinated to believe medication is the answer. But what if it’s not?

I won’t argue that in some cases it is the ONLY viable option and this would include, short-term panic/PTSD/grief/anxiety/delusion/psychosis because medication to reduce these symptoms and get someone back on track appear to work very well. Likewise, there are no existing alternatives to the treatment of Schizophrenia that I know of, that can replace a medication regiment and this can be true in the case of extreme Bipolar and some other mental health problems.

But for others, taking a plethora of anti-anxiety medication doesn’t actually in the long-term do very much and it can have very negative side-effects such as reduced or lost libido, weight-gain, thyroid disturbance and metabolic changes. Ultimately if it’s not working then we’re only taking it as a placebo, and if we’re only paying for it because of a system that encourages this, we’re handing money to Big Pharma and not trying to change the way we respond to mental health needs.

EMDR and other methods that are natural and not medication can be as or more useful for the treatment of trauma, PTSD, anxiety, depression, mania, episodic psychosis and other disorders than medication and studies evidence this but are suppressed by those who stand to profit from medication. There simply is not sufficient money in other methods for Big Pharma and Big Business to change their inculcation of our society. Likewise, without profit there is less research into alternatives. It is a vicious cycle.

Examples of this include;

ADHD has been shown to respond better to diet-modification than any existing medication.

PTSD has been shown to respond better to EMDR and biofeedback therapy than any existing medication

Anxiety has been shown to respond better to exercise and meditation as well as Cognitive Bias Modification (CBM) therapy than the side-effects of existing anxiety mediation that can be emotionally and physically addictive.

Adults survivors of sexual abuse have responded better to talk therapy than long-term medication alone.

Studies of schizophrenics show diet-modification can reduce symptoms on par with existing medication.

So if we know that diet changes can alter mental health as can exercise, meditation and other natural therapies, the only reason our society doles out the medication is because there are larger profit margins in medication than alternative treatments. In other words, we don’t care about cures or best case scenarios we care about profit.

What this means is when you visit your doctor especially in the case of seeking a diagnosis you need to bear this in mind. I realize that is hard if you personally are the one suffering, and that’s why having someone who understands this going with you, can be useful. It doesn’t mean don’t ever trust doctors but take what they say with the knowledge that they may be biased, ask questions, don’t accept what you are told without doing your own research and querying anything you are concerned about.

More people die from medication side-effects than we realize and this can include the more subtle side-effects such as increased suicidal ideation. It is also worth noting that ethnic differences may play into how we respond to medications just like Native Americans are sensitive to alcohol. Fewer studies are done on women than men, fewer studies are done on people of color, or non Anglo patients, and thus, we really don’t know the long-term effects of certain medications on say, an Asian or Black patient.

Often after some public act of violence we find out the person involved had been taking many medications, which proves that those medications were not doing their job at all and were if anything, pushing that individual over the edge. If medication were a cure, concerns like long-term depression and bipolar would be a thing of the past. At best they can mask or manage and it is well-known that there are other methods of managing that we can take personal control over and thus, feel we are part of our effort to get well.

The Big Pharma profit bottom line taints the idea of taking medication simply because it’s the right choice, as we can never be sure this is the right choice so much as the status quo or the choice the system has put into place as an efficient money-making scheme. If that sounds paranoid, consider the plethora of drugs that are continually bombarding our marketplace and the continual advertisements for drugs on TV and in the media. How can Big Pharma be so successful without having sufficient people taking their medications? Surely this means, some who are taking it, have been influenced to do so, without due consideration of other options?

When you hear on TV the side-effects of medication read quickly in a quiet voice at the end of an advertisement, consider that these are but some of the typical side-effects and how much your body and mind change under the influence of drugs. Just because these drugs are legal doesn’t mean they don’t have that effect and many times people point to the high numbers of individuals taking say, anti-anxiety or anti-depressant medications and how we have become more acquiescent and prone to influence as a result.

Trying to do meaningful talk therapy with a medicated patient is tough, I can vouch for that, and yet, the majority of patients I saw were medicated. If then people believe talk therapy is not effective, we may want to query what came first, the meds or the therapy and if the latter, how can we know the true effectiveness of talk therapy unless we can conduct it without the influence of medication. In such cases, talk therapy in my estimate was more successful because it takes a sharp and clear mind to process and not a dulled and medicated mind.

Again, I realize some instances require medication. But for those that may not, even if all you do is get a second opinion you may save yourself being over medicated. There is no one size fits all. Sometimes mental problems are not diseases, they are problems that we can solve. Other times they are unyielding and become as much a disease as say, cancer, but knowing the difference between those two extremes is crucial. Too many teenagers are over medicated before their growing brains even finish growing, we don’t know the effect taking this medication will have long-term nor the effect of labeling them with a mental disease. Many times it’s hard to know if someone has a mental disease or is just going through difficult times / teenage years and thus, jumping to the conclusion that they have a serious mental disease should not be our first port of call.

Medicating kids for ADHD is likewise, our easy ‘go to’ option, but how many of us consider the studies of diet and supplements as an alternative to mediating young brains? Sure, it’s harder to be watchful of diet and sometimes prohibitively expensive but then, so is medication. The rise of certain disorders could be true or could be a manipulation of the drug companies who wish to medicate a larger percent of the population. As diagnosis goes through trends, we see great numbers labeled bipolar at one juncture, only to shift to another diagnosis later one, it begs the question, is diagnosing an imperfect science? Given that it varies from person to person I would say it most certainly is, and we should not treat a diagnosis of mental health in the same way we would say, an X-ray showing a broken bone. Always check and double-check. If in any doubt, seek a second opinion, the cost of having an imperfect diagnosis could be life changing.

 

Avoidant Personality Disorder

Avoidant Personality Disorder (APD) is fairly unknown and as a personality disorder, is a mental illness but not in the same way Depression or Bipolar or Schizophrenia is. For most people they think of it as either; it’s a state of mind, a response, or an outcome (of negative events).

State of mind: Implying choice. I choose to avoid society and others.

Response: Events cause me to respond by avoiding society and others.

Outcome: Negative events cause me to develop the avoidance of others and society.

In many ways the truth is a little of all three. Some choice may exist, but soon becomes intrenched behavior. Some responses may have started the behavior, and negative events can cause children and adults to develop the avoidance of others and society.

How do we distinguish between say, an introvert, a private person, someone who prefers solitude to socializing and someone who is Avoidant personality?

That’s the hard part as with all personality disorders what is one person’s diagnosis is not necessarily the other. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a person diagnosed with Avoidant Personality Disorder needs to show at least four of the following criteria:

  • Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection.
  • Is unwilling to get involved with people unless they are certain of being liked.
  • Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
  • Is preoccupied with being criticized or rejected in social situations.
  • Is inhibited in new interpersonal situations because of feelings of inadequacy.
  • Views self as socially inept, personally unappealing, or inferior to others.
  • Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

That said, when we think of Avoidant Personality Disorder we think of people who don’t like others, who don’t like society, who want to avoid both. In that sense, there could be many more people who fit this category. I may raise some feathers saying this, but in many ways I couldn’t blame anyone for being APD. Society can be a cruel place, people can lie. Is it any wonder? Is it even the ‘wrong’ response or a natural response!

I’m biased because I have struggled to understand why people prefer socializing to say, reading a book. I am biased because I find it hard to trust people, often I just don’t think it’s worth it, sometimes I feel humanity as a whole is over-rated and stuck on themselves and I often fantasize about a much smaller population. I don’t like that there are so many people (read the book The Population Bomb for more on this), I think they’re often more negative than positive and I get very easily tired of social-discourse and demands. Ironically I’m happiest when not online, and I’d be glad never to go online ever again if it were not for the modern necessity if your job requires it.

additionally I don’t like wasting my evenings on the phone, I dislike having social obligations and things to attend, I prefer smaller groups or one on one and I get very easily bored in social settings. Does that make me APD? Apparently not, because the clinical definition is different from say, a social idea of what it means to be truly avoidant. In a clinical diagnosis I would not be considered truly avoidant because;

I have empathy for others and care that they are not suffering / I would help another person and go out of my way to do so  /  I care what happens to other people and am affected if they are hurting   / I don’t wish to be entirely alone and can get close to people /  I may fear rejection but I won’t stop living because of that

What this tells us is, understanding a personality disorder from say, a personality trait is very important. Avoidance is different to say, anti-social, just as anti-social is different to a diagnosis of Anti-Social Personality Disorder which is the disregard of others not just a desire to not socialize. We can all of us at times have traits but to actually qualify for a disorder the behavior is usually more extreme. It was once thought because introverted was a negative personality trait, now it’s understood approximately half the population are introverted or ambiverts, and the only reason this was unknown was the extroverts sought and received all the attention! Makes sense really.

Society requires the balance between two types of people to maintain status-quo, if everyone were the same, contrary to ideas of normalization, it wouldn’t work as smoothly. Having those who are less social with those who are more social acts as a balancing force. Many reasons occur throughout our lives for where we end up on the spectrum and equally this can change according to our circumstances, experiences nad age.

Thus, if you work from home, have a cerebral demanding job that doesn’t require working with others, and live far from a major city, you are inevitably going to appear less involved than say, someone who worked with others, lives in the heart of the city and has a big family.  A disorder would not discriminate, if you had APD you would act this way irrespective of your personal circumstances because it would be deeply entrenched.

Does APD hurt people in the same way Narcissistic Personality Disorder does? Not all of the time. But it can explain why it can be harder to befriend someone, why it can be harder to work with someone, or why it can be harder to be married to someone or a child of someone with APD.

Typically kids of parents with APD describe feeling their parent was ‘absent’ even when present, during their childhood. They and their other parent, felt they had to walk on egg-shells and usually they changed their behavior to suit the comfort level of the parent with APD.

If you have a boss with APD or co-worker it can be incredibly difficult to effectively communicate and work with in a team manner, that individual. More often than not, people with APD suffer from employment retardation due to poor social skills and do not advance as much as say, their merit may otherwise have taken them. In that sense they are the opposite of NPD individuals who often succeed very well despite having a selfish delusion of grandeur perspective.

Shyness is different to APD because shyness can mean you want to do something but are too shy to. This can often be overcome. Other times you don’t want to stop being shy but you can learn to do some of the things that you fear. With APD it is harder to do this and often you are unable to and can socially and economically suffer as a result because in society we work with each other and if we are not able to do this, it makes it hard to succeed conventionally. APD can manifest like forms of Autism and often was misdiagnosed as Asbergers but it is not the same because they are actual changes in the brain and a personality disorder is more focused in the personality (though it must be said both must share traits and over time could become co-dependent).

When we think of people who want to avoid society we think of those men who grow huge beards and take to the woods. They are often perfectly nice people who simply do not want to talk with others or have any need for it. I can actually relate to and appreciate that, and I admire a person who is self-sufficient though I know sometimes it comes about for the wrong reasons such as an abusive childhood. As we grow less overtly social as a society it is predicted that APD will become a more common diagnosis. As with other mental illnesses, it’s worthwhile seeing that people who experience APD should not be judged or meant to feel badly about their differences, it only makes it worse. Some even argue that APD should not be a personality disorder because it doesn’t necessarily qualify literally as mental illness. The definitive exception is in the case of brain trauma and injury that can render someone with the symptoms of APD over-night.