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.

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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.

 

 

Empty

1082119593Give it up

Pour it out

You can’t be another person

Staring beneath banyan

Or swap yourself for more noble

Peasant free of western privilege

With less blood on your hands

Or inheritance of oppression

Walking on backs with your well nourished life

Except your soul

May eat whole grains

But remains sickening

For starvation is a symptom of not having enough

Not always expressed in empty stomachs

 

I have given up writing poetry. I want to close all my social media and end. I don’t know where the ending is or how to get there. I feel so tired. More tired than afraid.

I’ve done what I set out to do. This was it.

I don’t have any questions. I only seek silence.

Mental Health Month “Carers of those with mental illness”

We often talk about how hard it is for say, a person who is a relative and carer of someone who has dementia or Alzheimer’s. The toll it takes on them economically, emotionally and physically. In fact it is understood that many times the carer will die before the patient if they are of equivalent age, in the case of elderly couples where one is looking after another who is sick. This is because the stress upon that carer is enormous and not enough help and resources exist to off set that.

In America because we don’t have a socialized health care system we have less affordable or Government paid resources than any other Westernized country.

If it is true that many will go on to develop Alzheimer’s (1 in 3 by age 85) then it beggars the question, what will become of those people?

Whilst Alzheimer’s is not literally classified as a disorder of mental health, it affects mental faculties and health, and especially has a negative impact on the mental health of carers.

Take a typical example.

With people having kids older in life, let’s say someone has a parent who is 80 they are 40, the parent gets Alzheimer’s. The 40-year-old is working in a high stress insecure job. Most jobs today have less guarantees than ever and are ageist. The 40 year old has two kids, and a husband who doesn’t make very much money (another common feature in today’s economy) the cost of sending the kids to college is already almost impossible. The family lives in the city, their home is small because homes are so expensive in the city. When the parent is sick enough that they cannot take care of themselves the 40 year old is stuck not knowing what to do.

There are not free resources for the parent.

There are no affordable care-facilities and the cheap ones are tantamount to prison.

The house is too small to bring the parent into and both adults work, who would look after the parent?

Hiring help is too expensive.

What does that family do?

This is what we are seeing more and more. This is becoming a burgeoning problem of epic proportions but nobody seems to be doing anything to off set the disaster that will occur.

The only possible outcome in the above scenario would be to put the parent in a really awful care-facility that was still expensive and was well below par in terms of what you would ever wish your parent to experience. It would literally torture those who loved that parent and make that parents last years horrendous.

The only other outcome for those who could not live with themselves, would be that one adult in the family (if there were even two adults to begin with) would give up working. That would impact all members of the family and create a financial crisis. The kids couldn’t afford college. If the parent were a single parent as so many are, they would not be able to quit working, therefore this option would not even exist.

Can you imagine being FORCED to put your parent in a home that has feces on the floors, a record of patient abuse and rape, and where the patients are restrained and ignored?

It may come to that and it may come to kids euthanizing their parents out of feelings of hopelessness and despair. If that sounds melodramatic, believe me when I tell you not only have I witnessed that but I predict it based upon the lack of other options.

Despite this nothing is being done and increasingly, carers are effectively giving up their lives, their financial security, and their other responsibilities such as parenting and working, to care for elderly (and sometimes surprisingly youthful) members of their family with Alzheimer’s.

The long-term impact of this hasn’t been properly evidenced yet but it will and is revealing itself. Our generations have less savings, less security and less money than our predecessors and this will be a house of cards.

The mental health impact of caring for loved ones with such diseases can cause the carer to resent even those they deeply love and also cause depression, anxiety, feelings of helplessness, isolation, guilt, inadequacy, panic, anger, and other negative mental feelings that can impact the effectiveness of the care and the carers own personal life.

As much as we may as a nation be against anything with the word ‘socialized’ what alternative exists but some socialized healthcare whereby we have resources to care for these expected high populations?

Likewise, where are our resources for carers such as social workers and nurses who can at least, take some of the pressure off 24 hour care.

Even those countries with socialized healthcare are experiencing an unpresidented rise in patient need and struggling to cover this. Imagine what will happen in ten or twenty years time when our workforce will be negatively impacted, our economy will flounder and people’s mental health will be affected by this pandemic. What are we really doing to prepare for that? Why isn’t this considered of crucial importance but we can find time to pour money into one-sided wars in far-flung countries? Are our priorities very wrong?

Thanks to Johann for inspiration on this one.

Mental Health Month “I can deal with it / why can’t you?”

Want to hear a horrible truth? Some of the worst judges of the mentally ill are former mentally ill (or current!) people!

How can that be? Think of ex-smokers and it will become apparent.

There is something in the human psyche in some people, where if ‘WE’ have conquered something, we become intolerant of those who do not.

Why? Maybe it’s a defense mechanism, maybe it’s a feeling that if you’re able to, others are weak for not being able to, maybe it’s just the euphoria of knowing you have, or perhaps it’s denial, you think you have, you say you have, you condemn those who have not, because you’re trying to believe it yourself.

Whatever the reason (and it is important, but it’s very complex) the outcome is if you are mentally ill and another mentally ill person or someone who ‘was’ tells you that you need to get over it, that hurts twice as bad, because you know they know! Or you think well they must do, right?

Wrong.

Just like women will sometimes tell you they cannot recall the extent of the pain they experienced in child-birth because we have hormones that specifically block some of those memories so that women will not be put off having children again, this can be the case for the ‘formerly’ mentally ill. They forget how they felt, they forget how bad it was, they are over it now, they have moved on!

Except, if they have moved on, then why are they so keen to judge?

The truth is, it is too close to home, and a part of them knows they could feel it again, maybe even already does, and so, they lash out because .. they’re frightened.

And that’s why most people do bad things, out of fear.

The man who is in the closet for being gay may tell others it’s wrong to be gay.

The person who is abusing children may be one of the loudest condemnor of sexual predators.

Humans can be hypocrites, never more so than when fear or fear of judgement is involved. We will deny our very selves and turn on those who have the most in common with us, just to save ourselves.

There are of course, other reasons, but fear is a big motivator. Denial is another. And fear and denial can, as we all know, be a great breeding ground for extremist thinking.

Think of those who join extremist cults and their stories and this will be painfully apparent.

So one of the worst things to happen to mentally ill people is … other mentally ill people.

Sad but true. When you think the one person who will ‘get it’ doesn’t, that can really leave you floundering. You may be able to ignore someone who doesn’t get it, but if someone who ‘should’ get it, still doesn’t, that can leave you thinking it really is my fault, it really is something wrong with me.

A bad recipe.

So if you have ever experienced a mental illness and you feel better now – good on you – but spare a thought and better still spare some mercy and empathy for someone who isn’t there yet and may never be.

After all, there are degrees of mental illness, and how bad it gets. There are biological reasons. There are physical reasons. There are emotional and literal reasons. No two people are the same. Some of us by our very DNA are more likely to be addicts, others are more likely to be suicidal. Studies show time and time again, we are not simply bound by the same rules, but our biological legacies. It is literally true that if you have not walked in that person’s shoes you cannot know what they are going through.

If you feel you are stronger than others because you once had a mental illness and now you do not, if you believe you ‘cured’ yourself by sheer will power and effort, and you are ready to condemn and criticise others and tell them that they need to get with the program, consider the above, and hold your tongue. It is one thing to support and encourage, it is quite another to make someone feel that if they just tried as hard as you have, they will not have whatever is wrong with them any longer.

Sadly for many with mental illness it is a recurring, cyclical or intermittent disease that will return. For others it goes away and never comes back. Much of this has to do with the type of mental illness and why it occurred. For example if someone has PTSD from witnessing a brutal attack, the prognosis for them long-term is good, if they did not have a pre-existing condition.

But for someone else with life-long anxiety or depression, being told they should be able to get over it, by someone else who has, but for differing reasons, is counter productive and damaging. It can act as a disincentive, just like the focus on being happy all of the time in our society, can be a thorn in the side of those, who are attempting to just cope with getting out of bed.

We come at things from a myriad of differing directions, lest we forget this, consider long and hard before ever judging, every single time and maybe you’ll find, there is never a good reason (to judge).

Mental Health Month “Narcissism”

Social Media has spates of trending headlines and buzz-words. Periodically, ‘Narcissism’ will be among them. We know the basic meaning, the mythological story and how a modern narcissist can hurt relationships be they friendships or otherwise. But if we were asked to clearly define the process it might be tricky. That’s because the issue with a buzz-world is we gloss over the deeper meaning, we stereotype it, until we’re using it out of context and it loses the potency of its original meaning.

Thus, you will hear many people calling out narcissists, and in truth, fewer people are true clinical definitions of narcissists than we would imagine. Equally, some of those who labor the point regarding narcissism, are in fact guilty of the very thing they decry.

A narcissist as their core, is someone with low empathy for others, high self-regard, an inflated and delusional sense of self, an entitlement and sense of superiority to others. They can be charming and appear popular and ‘normal’ in some settings, only to be a down-low narcissist, or they can be an overt example. typically a narcissist is considered to have some sociopathy and inability to care for others meaningfully, as well as a belief they deserve more than others and others should act accordingly. Likewise, a narcissist will seek adoration and forms of worship over say, maintaining a give-and-take relationship. If they do something that appears giving it is with the knowledge they will get something in return, thus it is insincere.

Narcissists can also be very successful because they have less quam about their actions, they are confident, bullish, determined and strive for what they believe they are ‘owed’ as well as not being perturbed about the cost of achieving this or the damage inflicted upon others. Some narcissists will play games with people to manipulate them, in this sense they can be also described as sadistic and cruel.

As with any mental disorder, narcissism is on the spectrum and varies a great deal. It is a personality disorder manifested often early in life, and can be controlled, hidden or overt, depending upon its specific characterization within an individual. In other words, one size does not fit all. Typically with any personality disorder, it cannot be completely ameliorated but you can lessen its outcome if you are open to that, which many narcissists will not be because they suffer the delusion of self-aggrandizement.

Most of the time if someone hurts us, and we call them a narcissist they are not. Sometimes when someone calls out narcissistic behavior they are enabling it by their reactions to it. An example would be, if you call someone narcissistic but you do much the same in your own interpersonal relationships with people. It is possible to be  narcissist and not be aware of it.

With varying degrees of personality disorders, it is very hard to definitively say someone is a narcissist because many times you can display narcissistic behavior but not have enough to qualify for the actual personality disorder. With any mental illness it is dependent upon frequency, duration and extent of (symptoms).

If you are in a relationship of any kind with someone who is a narcissist you will expect to experience some of the following;  A sense that you are not entirely worthy of the individual and they feel you are lucky to be with them, difficulty in expressing successfully your perspective and that being understood. It is not as simple as being vain, confident, or even arrogant, narcissism is at the very core of a person’s nature and decision-making process.

Likewise, those subject to the natural manipulations of a narcissist will become versed in how to respond ‘correctly’ to their needs and thus, alter their behavior accordingly. It can take years to re-train yourself out of responding this way to a figure-head such as a narcissistic parent, or lover, and the beating it gives a person’s self-worth and confidence can require a lot of work to re-balance. This is because a narcissist is so confident they convince others they are right, even in the face of common sense. A narcissist parent will rear a child who is always considering the parents needs rather than the other way around, and thus, does not develop fully because they are attuned to the needs of another and not so much, their own.

We have been discussing how judging any mental health manifestation is wrong, and should be avoided at all cost. With Narcissism it is somewhat different. Narcissism, along with Sociopathy, Psychopathy, and other extreme personality disorders and mental disorders, has a poor cure or treatment rate, it often causes a great deal of harm and pain to others, and many who are ultimately imprisoned share these traits. While no good comes from judging, it is worthwhile considering whether becoming close to someone who is unable to treat these symptoms is a good idea, given the likely outcome.

Obviously someone who is a sociopath or narcissist shouldn’t be precluded from having a relationship or a life, but unfortunately in some ways, the damage of their personality can be so bad that it does come to that. Of course I feel some compassion for this, but it is tempered by the fact that someone who is a sociopath or narcissistic does not experience compassion or empathy and simply goes through life feeling they deserve what they want at any cost. Some milder forms that are say, manifested by trauma, can be treatable, but if they are entrenched, it is often a poor prognosis.

I have met some people who repeatedly are attracted to narcissistic types, this is because they learn patterns and unconsciously respond and repeat them without meaning to, because of early exposure to that kind of behavior. You could almost say it was masochistic and it is, though not consciously. It is a little like ‘better the devil you know’ because the familiar patterns of treatment become instilled and it is hard to break the cycle. In this regard, the victims of narcissists are more likely to be seen by mental health professionals than the perpetrators.

Ultimately then when we talk of narcissists we usually refer to the damage they wrought upon others and how best to help those people.

Learning to spot the signs of a narcissistic personality as well as increasing self-worth are the keys to overcoming the damaging cycle. This can include watching for people who only know how to talk of themselves, rarely show interest in others, and if they do it’s very much crafted toward gaining trust to get what you want. This is of course hard to gauge as it can be subtle and most of us have been on the losing end of a friendship with a narcissist.

There is no cure-all but the more self-respect we have, and the greater awareness of being taken advantage of, as well as looking out for people who are self-obsessed, will help us circumvent typical narcissists. This can include setting boundaries, ensuring that friendships are relatively equal (give-and-take) watching for obvious signs such as being self-obsessed, lack of empathy, lack of interest in anything but self, self-aggrandizing behavior, a need to be worshipped and/or continually praised and excessive vanity.

Just as those who are raped as children, can sometimes go on to rape children when they are adults because they are subverted into a twisted parody of their own abuse, and act it out, the same is true with narcissists. The victim of a narcissist will often exhibit narcissistic behaviors also. They will assist without knowing, the antagonism with the narcissist by responding/reacting in such a way that feeds the ego of that narcissist, they will also expect some of the same things their narcissist expects such as attention and adoration. It’s almost as if they learn from their oppressor and take on some of the traits.

This can be ‘fixed’ and is highly receptive to therapy, the first step being, admitting you have done this and wanting to stop doing it.

Breaking the cycle including your own reaction/response to narcissists is key. In some ways if you do not do this, you will aid and abet the narcissist and even attract others to treat you this way, just as you would any addiction. The behaviors are learned and highly addictive as all extreme forms of behavior are, especially if learned in childhood which they often are, such as in the case of a narcissist father and their children. The kids are literally trained into subservience, into blaming themselves as a narcissist will not take blame on themselves and are very good at displacing blame onto their victims.

Learning to be attracted to non-narcissistic people can be challenging when you are taught to be drawn to the magnetic inflated personality of a narcissist. Other people may appear ‘boring’ and ‘bland’ and not push your buttons including your sexual-desire, attraction buttons. It may seem ‘sick’ to be attracted to a narcissist but they are very adroit at becoming attractive enough to gain many followers. this is why narcissists are often in positions of power and/or lead others. They do have a magnetism and charisma that superficially impresses others. Sadly in some cases they are revered and never held to task for their less desirable traits.

It could be said our society is sick for our worship of certain narcissistic figure-heads and we should question the message we are sending by glamorizing narcissistic people in the media en mass. In many ways it is our society that creates a narcissist and certainly, we perpetuate them. What this also means is, we can change that.

 

Mental Health Month “Mental illness in education”

It may have the same rules and the same applications, but as anyone who has left home to attend a college will testify, college-life is a world of its own. Thus, the usual rules of society are different and that applies to the handling of mental health.

When I first went to college I was surprised at how good the mental health facilities were but I was not in America. Even during post-grad studies in America I was glad there were some mental health facilities for students that were an improvement to what was out there for everyone else.

But that’s just my experience. Since then I have come to see many failings in the provision of mental health resources and support for many students. This includes people of color, foreign students, exchange students, different age students, transgender students, homosexual students, females, males, androgynous students and many more.

By this I mean, one size does not fit all. My own relatively positive experience is not everyone’s.

Girls who report rape on campus, historically were quashed, played down, underreported and asked inappropriate questions. Counselors are often not equipped or trained specifically in sexual assault and sexual trauma, despite that being one of the key reasons a student may seek counseling (exam stress being the number one reason). This goes double for boys who are raped on campus, and transgender students who are raped.

A foreign exchange student unfamiliar with the laws of the land, with their own cultural biases and experiences may not have the kind of emotional support they would get in their country of origin, equally the support may be better.

Stigma and shame are infrequently addressed as leading causes of student drop out rates.

Having taught this age-group I found teachers were picking up the slack and acting as surrogate counselors because of huge cut-backs in school/college/university counselors. It is simply not considered a priority. Example; A local university to me, has cut their counselors from previously 15 to wait for it …. ONE. Yes ONE counselor for the entire student population.

Having academic advisors is equally important as they act as academic counselors, and can also defray some of the potential issues that could turn into mental concerns. Anxiety being the most common symptom reported among students nationally, this dual approach to helping students could reduce drop-out rates but maybe that’s not what universities want? It is known many universities use the first semesters as a form of culling high student bodies, but these are people’s lives? Is that our best approach?

The increasingly difficult and narrow world of work and our work force are causing more and more students to become anxious about what awaits them upon graduation, we cast them out with their degrees and do not offer them any follow-up counseling which they may not be able to afford once they are out of the system. It’s no good patting ourselves on the back for graduating students if we are literally leaving them to sink or swim.

More and more students struggle to pay for increasingly inflated student fees and universities are literally profiting off student accommodation and meal plans, they are becoming real estate magnates owning vast swaths of land that are worth millions and not putting enough investment in the students that make this possible.

Suicide, rape, and the onset of many mental health issues often become apparent during these crucial years away from family often for the first time. It is now that we need to support our young future work force in making the right decisions and helping them with any encroaching mental health issues or we risk having a fall out that will last far longer and cost far more.

Having to personally pay for disability testing as is the case in many universities is wrong because students should not be expected to foot the often prohibitively high costs of disability testing to ensure they are covered by the disability act. This applies to all learning disorders and stress related complaints. For those who believe this is letting students off lightly, ask yourself, what would you do instead? Do you want an uneducated mentally ill workforce instead of one you are trying to help be their very best?

Equally, not everyone should go to university, though all should have the chance, and as such, we should be offering better academic counseling before students enroll at university, because we send them into a system of one size fits all without due regard to individual strengths, interests and needs. Often times someone training in a profession rather than obtaining a degree can earn more and has a more realistic chance of getting a job after they graduate.

Minority students of all walks of life run the risk of isolation, exclusion, racism or prejudicial behavior. Many first time university students whose parents did not go to university have no guidance and can flounder in unfamiliar territory. when I went to a foreign university I had no idea about certain things and it would have helped to have some mentor or guidance for questions.

Finally, resources should include counseling not just medication because we still do not know the long-term effects on the developing brain of strong psychotropic pills.

Students can achieve much of this by petitioning their student council to make this a priority and close the gap between those high functioning students and the attrition rate.