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 “Unipolar v. Bipolar & the great error”

After a school shooting or shopping mall attack, we nod and say; “Oh the perp was Bipolar (or schizophrenic).”

For those who are Bipolar (or Schizophrenic, discussed in a later post) this is the worst kind of association and thus, stigma imaginable.

Ironically throughout my life, I have been friends with a great number of Bipolar people and can attest that assuming all Bipolar people are gun-toting and ready to blow you away is a little like thinking all feminists want to castrate men.

Sure, mental illness can exacerbate another condition such as anger, and be part of the impetus that leads to an unacceptable outcome. However, this alone doesn’t logically mean all people with certain mental illnesses ARE going to do that. Just as the vast majority of those who are Islam would NEVER be a terrorist, the same is true of those with Bipolar (or other mental disorders)

But try telling that to the media who irresponsibly fuel this stigma.

It’s like the whisper game, you whisper to a friend and by the time you’re at the end of 20 people meaning has changed.

Ask most people and they will say that they think the majority of shooters of that kind are mentally ill and typically Bipolar or Schizophrenic. How could that not impact how they see those people?

As discussed before, stigma is the worst element of any ‘label’ and is carried even when you dismiss it, as a permanent stain in our society so fond of judging others.

Bipolar, previously known as ‘Manic Depression/Manic Depressive’ is a disorder of two parts. Typically you are either Bipolar 1 or ll or mixed-effect meaning not clearly defined by either category. The problem with categorizing is obvious, the benefit is for those trying to establish treatment protocols but like anything else, mental disorders go in swings and roundabouts of popularity, and at times, it’s almost the illness-du-jour to label a higher number of people Bipolar.

I question diagnosis for the simple reason that having seen it implemented I have seen a great many mistakes in those diagnosis. At times it can seem comforting to be ‘told’ what you ‘are’ and ‘treated’ and has saved lives. I don’t dispute that. I do however, worry that the tools by which we diagnose are faulty.

A diagnosis of Bipolar is based upon several criteria, one being that you must have had a manic episode. Bipolar ll requires a manic episode of less severity. A manic episode can be characterized by many behaviors, typically including, insomnia/wakefulness for several days, excessive impulse behavior such as spending money, making rapid and interchangeable big life changes, impulsivity and promiscuity.

Of the MANY bipolar people I know intimately, and have met throughout the years, I have yet to meet two who are alike. What that tells me is labels are usually as counter-productive as over medicating can be and Bipolars are often over-medicated. However unlike Uni-Polar (Depression and/or Dysthymia) Bipolars really respond to medication and are perhaps most likely to benefit from medication of all mental illnesses. As one who doesn’t believe in the ‘magic pill’ I would stand by anyone who has Bipolar taking medication but caution against over-medication and/or not considering other options in tangent, such as diet-change and therapy.

Many people who become Bipolar do so during puberty/late teenage years. It comes on usually as an extreme manic or depressive episode that can lead to hospitalization, suicide attempts or dangerous behavior. In the past Bipolars were characterized from depressives as being ‘delusional’ and thus, ‘clinically insane’ during manic episodes, and thus, their diagnosis was higher up on the ‘illness’ scale of mental illnesses and it was easier to declare them legally unfit.

In this I would agree. Uni-polar depression is basically that, depression. Bi-polar is a mixed cycle (of varying length, degree and frequency) of mania versus depressive symptoms. As such during the manic-period of Bi-polar, individuals can be clinically delusional and suffer delusions of grandeur, extreme expansive thinking and other exaggerated and not literal feelings. One could argue when someone is depressed they are delusional also, but ask a depressed person they will tell you they know it’s depression. Ask someone in a manic episode, they don’t know it until they ‘come down’ and thus, it’s hard to reason with someone during a manic episode. Consequently they can unintentionally do a great deal of harm to others and themselves.

What it takes to push ANYONE to the edge where they choose to shoot people, is more than any mental illness alone. It takes a CHOICE. If you are delusional you don’t have the same kind of choice system as someone sane, so to some extent you can appreciate the diagnosis of clinical insanity when a very ill person shoots other people BUT despite this, Bipolar has more consciousness than say, a full on Schizophrenic delusional episode, and as such, I would argue, most people with Bipolar can choose (not to shoot people) and are more likely to hurt themselves than others (explaining the very high rate of suicide comparatively).

Does that mean they are not capable of making some VERY bad choices? Of course not, they often will, but it is often rooted in self-destruction than destroying others. Some exceptions exist but that is true of everyone. You cannot say someone with Bipolar is more likely to kill than anyone else, because statistically more murders are committed by people without Bipolar than with. As with anything, there is a tendency to push someone over the edge if they are ostracized, shamed, judged, stigmatized and bullied. At that juncture they may act out of their norm because that’s how far they have gone down the rabbit hole.

Bipolar is a very painful disease to live with because on the one hand it can produce the highest elation and feelings of wellness, ability, skill, intellect, foresight, emotion and productivity, followed by a massive crash and the exact reverse. It is the rollercoaster of emotions that cause the higher risk of suicide, imagine feeling on top of the world followed by feeling like you want to die? How is anyone supposed to live with that? This is why medication does work because it can suppress the extent of mania and the extent of depression and level off that individual to a safer plato. But of course ask any Bipolar they will tell you it also curbs the intensity and feels a lot like castration of the mind and emotional pallet which is why periodically Bipolars will ‘go off’ their medication in an attempt to ‘feel’ authentic.

In my own experience, the vast majority of people with Bipolar are considerably above-average in intelligence, and can produce in short periods of time literally incredible outcomes be it artistic or another form. They often have an addictive intensity and are highly likable in those moods, and then quite a different person when crashed. It can be challenging being friends because even when medicated there are up and downs and these medicated shifts, are often characterized by irritability, argumentive(ness) and ‘bitchiness’ which can be difficult.

But all in all Bipolars are given an unfair ‘rap’ by society and struggle every day to achieve an equilibrium that is false to their very natures. In some ways their lives are more interesting than a uni-polar depressive who fights to ever feel that euphoria or happiness, but on the other hand, the swing and mercurial dive into darkness can be more life-threatening. Stupidly I used to envy my more manic friends who seemed to have endless energy and enthusiasm, but there is definitely a high price for this.

Diagnosis is an imperfect science and it is worth noting that more and more people are being diagnosed as suffering from Bipolar 1 or ll and I find this highly suspect. If you are diagnosed you may want to double-check by getting a second-opinion. If you asked anyone if they had a manic episode, chances are they have, be it in a fever-dream or otherwise. People can be promiscuous or manic for other reasons than Bipolar and given that the medication is often strong and has serious side-effects it’s dangerous to accept a diagnosis without being absolutely sure.

Additionally, Bipolars are often diagnosed in their 60’s and beyond which I believe is a misnomer and incorrect. Bipolar disease is a manifestation of the young, and it can worsen as you age, but rarely if ever occurs in older age. If it does this could be the result of something else and that should be treated before the symptoms of Bipolar. Bipolar without a co-morbid primary causality does not just ‘suddenly’ strike a 60-year-old or I would argue, even a 40-year-old. Yes you can go many years ‘un-diagnosed’ but to suddenly start exhibiting symptoms? That’s something else and you should not accept a doctor fobbing you off.

Some Bipolars can function without medication and if you are in that category that may save you the long-term side-effects of medication and the tendency of over-medication by medical professionals, but there is no shame if you are not able to function without some medication and many Bipolars find it helps so much to get on a regiment of medication that works for them, like anything, Bipolar is a disease of extremes and can be ‘mild’ or ‘severe’ just like depression can.

I cannot tell you the number of people I have known who were let-go, fired or forced to leave their jobs when their diagnosis was found out. Equally there are examples that concern me, of Bipolar Psychotherapists hiding their diagnosis and treating patients. I have a lot of compassion for this but from my own experience I think it’s best not to hide a diagnosis even if it means not being able to be a therapist. The same is not true of other jobs, we cannot expect most bosses to understand and we’re only increasing the likelihood of stigmatization to reveal it to them. That said, in some instances with healthcare insurance tied to employment it’s impossible not to.

Contrary to Bipolar stereotypes most with Bipolar are functioning pretty well all things considered and can be supportive to others, and often leaders in innovative, creative expression. But for every success story there are many who suffer so extremely and do not respond to medication and those people are often left feeling they have ‘failed’ where others have succeeded which only makes them feel worse. This is not the case. There is no failure there are degrees of illness. For some, Bipolar can be managed, for others, it cannot just as with varying degrees of depression. If you are not able to function ‘normally’ (whatever that is!) that’s not a personal weakness or indictment of YOU.

Try convincing someone of that … not easy especially when they are bombarded with stories of over-coming Bipolar. Bipolar cannot be eliminated but it can be dealt with. The extent to how much it can be dealt with depends entirely upon the severity of Bipolar and NOT the personal weakness/strength of the individual. It’s imperative never to compare those suffering from Bipolar unfavorably and make someone feel they are failing or not trying.

Typically Bipolars are more at risk for co-morbid diseases such as Borderline Personality Disorder (BPD) Anxiety, Attention-Deficit-Hyperactivity-Disorder (ADHD), alcohol and substance abuse. Again, this is not because they are ‘choosing’ these co-morbidities but because of the interrelationship between some mental diseases. Consequently Bipolars also report higher rates of sexual assault, and injury.

Our understanding of the facets of any mental illness is our way of being an inclusive and supportive society for those among us who suffer. What does it take to read this and learn more about a disorder that affects so many people in our society today? What does it take to become more aware of the pitfalls in hope that you could help someone in crisis in the future?

Finally, it is worthwhile considering holding off on a diagnosis of Bipolar in children unless ABSOLUTELY certain because many manifestations that ‘look like’ Bipolar are in fact not, and medication has a deleterious effect on growing-brains that is little understood. Therapy and treatment for the effects is a less dangerous way of dealing with symptoms that resemble Bipolar in children. It is uncommon to manifest as Bipolar before puberty and I personally though not a Psychiatrist, caution against diagnosis until late teen age years (17+).

Mental Health Month “Borderline”

This may offend some people.

I truly do not mean to offend but I must be honest. At this juncture I will not consciously be close friends with someone who suffers from Borderline Personality Disorder.

I realize that goes against almost EVERYTHING I have ever said about accepting people for who they are. It’s a giant screw-you to a group of people who have done nothing wrong and do not deserve exclusion of any kind.

But I’m being honest. I cannot.

I truly believe we should embrace and not judge people with mental illnesses. I believed this before I knew I had one. I believe that STIGMA is the single-most damaging phenomenon in the world virtually.

So why am I such a hypocrite?

Because I tried and tried, or maybe I just knew quite a few people who happened to be Borderline. I didn’t judge. I didn’t condemn. I didn’t ostracize. To me, a person with a mental illness is NORMAL and EQUAL to anyone else.

But I couldn’t do it. I admit this. I couldn’t hack it.

Why?

For me, people who are severely Borderline to the point where the symptoms show (some may be mildly) have messed me up too many times. I end up realizing this. If I keep on doing something – whatever it is – again and again with the hope of the outcome being different but every time I do it, the outcome is EXACTLY THE SAME then it’s my fault and my duty to myself to stop the behavior.

Unfortunately the behavior was befriending people with Borderline Personality Disorder. If you have it, and are reading this, you can say fuck you right now.

I’m sorry. It is not a happy choice. I don’t believe it’s right but I have to. Why?

Whilst training I kept hearing about Borderline patients. Most therapists dreaded them. That’s not an exaggeration. Truthfully I didn’t know much about Borderline. I only heard about it around that time, it wasn’t properly understood. I learned Borderline is a personality disorder often characterized by the “I love you / I hate you” extremes in behavior. It is often caused by some severe trauma in childhood and is hard to treat as with any personality disorder. Often times Borderlines will turn on a person not because they are evil or wicked but out of a ‘bites the hand that feeds’ set of responses, or because they perceive the other person to be betraying them.

They are not ‘bad’ or wicked or evil people. They are hurting. They are crushed by the things that caused them to develop this disorder. It is not their fault.

So according to how I live my life, I should be inclusive and welcoming and I was. The only problem was the same thing kept happening. It went like this;

A Borderline person befriends me or I befriend them. We get on well. We are friends nothing more. At first, the Borderline friend really likes me and I really like them. We have a good friendship and things are great. At some point the Borderline perceives that I either do not mean what I say, or I am ingenuous or I am a liar or I am fickle. It could be for a perceived reason or paranoia. It could be based on some degree of reality and then amplified by 1000 percent. The outcome is they switch, they turn on me, I become the ‘enemy’ the perceived reason for bad feelings they have. The bad things that have happened in their life become my fault because I am here, and their past is not. Their response to this is extreme. It can involve a great deal of abuse verbally. We end up not being friends anymore. I am hurt, they are hurt.

If I let this keep happening, though I no longer get hurt anymore, I would be exhausted! I cannot do this. Nobody could. That doesn’t mean Borderline sufferers could never have friends. I believe certain friendships are impossible and that includes me.

I am not blaming myself. If I did I would be buying into the most common accusation a Borderline will throw at me THIS IS YOUR FAULT ENTIRELY YOU DID THIS. I know that is not true.

But .. I accept that I am a certain ‘kind’ of person just as a Borderline is a certain ‘kind’ of person and we – do – not – work.

Why? I don’t know. Maybe I’m too high on the sensitive scale, or the intensity scale, or the closeness scale, maybe I’m too affectionate, maybe I’m too effusive, maybe I’m not effusive enough. Maybe it doesn’t matter.

One thing I know. I can’t do it. And they can’t do it. So unfortunately, contrary to anything else I believe in, I shy away from making friends with someone who admits they are Borderline and that is very sad and I feel very badly about that. But there is no choice. Just as many therapists refuse to see or are reluctant to see, Borderline patients, I am basically avoiding a problem I cannot solve. I realize that is wrong on many levels I just don’t know what alternative exists besides me being a punching bag and I will not let that happen.

Classic Borderline symptoms include; Too much intensity, an extreme adoration of a person that is over-kill and too sudden, the opposite response of extreme dislike/rejection/hate of a person that is sudden also. Many times someone with Borderline is a survivor of childhood sexual or physical or emotional abuse of the worst kind. Borderline is more common among those who suffer from Bipolar Disorder 1.

I feel Borderline people have a really hard time of living in this world. They almost didn’t have a chance, and I admire them for surviving. I would like to help them, befriend them, support them. I do support them in believing them equal to every dignity and right anyone else has. They are not bad people. But the hardest part of being Borderline is that you drive people away. You don’t mean to but you do it. You end up isolating yourself when you least want to. You are lonely but cannot keep lasting relationships. You don’t want to be angry or hateful but you end up being because you perceive that’s what is being done to you.

It’s incredibly unfair.

A friend of mine who was Borderline told me a very valuable lesson. She said, when you are friends with a Borderline person you had better have immaculate boundaries. By that she meant – don’t send mixed-messages of any kind. Do not contradict yourself. Do not say one thing to a Borderline and the opposite to someone else. Do not act like a lover if you are a friend. Do not say you are a friend if you are an acquaintance. Borderline people are very literal. They will take you at your word and if you diverge from your word they will hold you to it.

That might sound like a good thing and in theory it is. Sometimes we have awful boundaries and can be real teases or send mixed-messages. So having healthy and well stated boundaries can really help any friendship. But in the case of Borderline sufferers, people who do not have well-defined boundaries or are very needy, very insecure, very anxious, may inadvertently clash with a Borderline and cause their symptoms to be exacerbated or triggered. In other words not everyone is a good match to be friends with a Borderline. This is not just on them. It’s on us.

I recognize I am not a good match for a Borderline. When I look at my friends they actually do fall into distinct categories. They are either; Very secure and confident. Very sincere, stable and compassionate or very messed up and mentally ill and lonely. The latter is the group I have struggled with the most. If I’m depressed and my friend is depressed it can often work because we can mutually support the other, and understand. A Bipolar friend may get exasperated with me because I’m never manic. A Borderline friend will find me to be imperfect.

I am. I’m imperfect and I’m not super-secure and confident.

So – note to self and note to any Borderline people – we don’t mix well.

This is the first time in my life I have actually realized a good boundary is not being friends with or their being friends with me, a certain group of people. It feels wrong. It feels discriminatory. But it isn’t. It is the setting of those boundaries and the accepting that not everyone gets on and if we know we don’t get on with a certain kind of person then be respectful, we kind, be good, but don’t go the full hog and befriend them with the expectation your friendship will work.

That is growing up. That is experience. That is logic and ultimately, it’s more merciful than keep on doing the same thing expecting a different result.

As for those who suffer from Borderline Personality Disorder. I won’t be the one to write about you because that would be insulting and insensitive. But I will say this, in this Mental Health Month period I hope much is written about BPD people to help them and help others not stigmatize or judge them. A personality disorder is a mental disorder and requires the same level of compassion and treatment as any other.

Mental Health Month “Inferiority”

The next time you come across someone who has a mental illness, consider the following…

We poke fun at people calling them mentally ill (Trump) without really considering the effect such labeling may have on someone who IS mentally ill. In poking fun we are looking to someone we do not respect and saying ‘they’re mentally ill’ by implication, someone we do not respect is mentally ill – this is all bad.

Just like saying ‘he’s so gay’ or ‘that’s so gay’ you may mean nothing by it, (good grief who hasn’t said it at least once?) but it is implying a negative connotion.

White people cannot and rightfully so, use the N word, but black people can because they own the rights to that word over anyone else. Likewise if you are gay, you could say to another gay person ‘you are so gay’ and it wouldn’t be offensive because it’s about who is saying it to who. So the same applies to derogatory statements about mental health. If two people are sitting in a psych ward and say “Trump is mentally ill” that doesn’t have the same emotional fall out as if someone who is not mentally ill makes the claim.

That may be hard to undesrtand but it’s about sensisitivity and it’s just like any category of people. A Native American can make jokes about Native Americans but an Anglo person cannot. Is that Political Correctness run amock? Not really, when you consider the history behind this.

Much as I have heard some awful sexist jokes and the only person who could tell them should be a woman, and not even then. Bottom line; Don’t go there, it’s not worth it.

I would argue, black people are better off NOT using the N word, and the same applies to any group who may use derogatory jokes/statements about their group in jest, it’s probably not very funny. If that’s too PC then so be it, I don’t see it as a detriment to world humor if we reduce how many off-color jokes we tell.

Ultimately what we relate things to says a lot about what we think of them. If we compare mentally ill people to someone they know we despise, then it’s a criticism whether wrapped up in a joke or not. Next time you are tempted to joke about mental illness consider whether it’s really worth the punch line and the laughs, and whether it’s really funny or just a means of exploiting an already stigmatized group of people. If that seems too serious, so be it, mental illness IS serious just like racism is, sexism is, prejudice is.

What does the mentally ill person feel when they hear jokes and put downs related to mental illness? Inferior.

One may say, a person who suffers from a mental illness is already subject to feeling of inferiority and this is probably the case, therefore they are vulnerable to begin with, and every subsequent insult and attack adds to that feeling.

Again, I have heard people lament the ‘weakness’ and over-sensitivity, of mentally ill people. The typical taunt being; “Why do you have to be SO over-sensitive?”

I would argue, what does it take to be a little sensitive around someone you know is going through a hard time? What does it actually TAKE?

There are many people who identify or are HSP (Highly Sensitive People) and this is not always related to mental illness but the two have a relationship because of the difficulty  of being an HSP in a world of mostly harder-nosed types, proud of their ability to not be sensitive, who see any sensitivity as a weakness and are not afraid of saying so.

I’m not going to labor the point about the value of having sensitivity or the obvious detriment to compassion if we do not have any, because I know there are two sides to this, and with such extremes it is unlikely they will agree. I would only ask that less judgement and condemnation exist, permitting those who are sensitive to go about their lives unmolested.

If you are a HSP and have a mental illness, your struggle is often magnified by the accute awareness of your situation and others reactions and responses to you. If someone makes a joke at your expense that wounds you on a deeper level than those who are able to shrug it off. For some, sensitivity is perceived as a weakness of character and their attitude is one of a bully who takes pleasure in seeing the sensitive person react. If you know someone like that, maybe now is the time to call them on that.

The TV show Thirteen Reasons Why may not be a good example of mental illness, and is lacking in many ways, but one truism is the development of hurt in the main character by the insensitivity around her. This can be a determining factor that leads to the taking of your own life, as in her case. I would argue that she also hurt others, and this was not explored in the show sufficiently, nor was mental illness really examined which it should have been. But irrespective, it highlights the progression of hurt to someone with presumably a pre-existing mental condition, that acts as a trigger to take her own life.

We can be part of a reason why someone is crushed. We may not realize we have that power, and maybe knowing we do, will make us a worse tormenter, but if we want to avoid hurting others, which I hope most of you do, then considering what our words do to those who are more sensitive, doesn’t take very long, doesn’t cost anything and can literally make such a difference. It can stop someone who already is feeling inferior from feeling so inferior that they see no purpose in going on.

Everyone is equal. Nobody is inferior to someone else until they act badly and show their true colors.

 

Mental Health Month “The Workplace”

Ask many people with mental illness, how’s the workplace? Many will describe the frustrations of trying to work alongside people who either do not know or do not understand the struggles they are going through, the high rates of unemployment, underemployment and patchy employment relating to mental health.

We hear how many working days are lost to mental health, we know this, but as a society we do nothing to improve the resources for those experiencing mental health challenges. Again, for those who have not experienced any mental health issues, they may wonder, what could be so bad as to take people out of the work place?

Where to start? Panic attacks can make going to work feel like a torture. Anxiety can cause reduced career opportunities because of fear, phobias including agrophobia may make it hard to actually venture beyond the house to a place of work, depression may keep a sufferer in bed on days when they are most needed at the office, bipolar can cause a worker to shift from highly productive to shut down over night. Without a full understanding of the complexities of mental disease, your boss is likely as not, ill equipped to handle these things and that is why so many people with mental illness struggle in the work place.

But what are we doing about it?

In recent years, bullying in the workplace has been a topic of discussion and highlights that we have not progressed as far from the playground as we may think. Typically people with mental illnesses are far more likely to be the object of bullying both in the school yard and work place. We hear about work place violence and assume some ‘crazy person’ came and gunned down some innocents, and whilst there is no justification for work place violence, is there any excuse for work place bullying?

It is worth considering this if you work with someone who is being bullied. Stand up for them, let someone know it’s happening, don’t let those tensions get out of hand, and then wonder what you could have done about it after it’s too late and that person commits suicide or brings a gun to work. Equally, if someone is mentally ill and they’re making it hard in the work place let your boss know, so that they (whose job it is) can do their best to resolve the issue.

Let’s look at an example;

One

Jemima is a closeted lesbian who suffers from anxiety. Her work colleague grows suspicious of her ‘life style’ and watches her type in her password, when Jemima is out at lunch, her work colleague ‘hacks’ her email account bringing up private emails of Jemima’s to her girlfriend. The work colleague prints them out and everyone in the office giggles over their content, unbeknown to Jemima. One person in the office feels this is wrong but doesn’t know what to do. What should they do?

This is a true story. The outcome was, nobody did anything, and Jemima ended up leaving her job, feeling that she had no choice after she found out what had happened and experienced severe anxiety and feelings of shame and bullying. Some would blame her for being in the closet, whilst others would understand, sometimes it has to be that way. But what could have changed to prevent this? If one person had stood up and told Jemima’s boss, then thanks to legal changes protecting people’s private-lives, her boss, whether approving of Jemima’s ‘life style’ or not, would be legally bound to act. If they did not act then this could be protested. Additionally, Jemima’s colleague who objected to this hacking, could have told Jemima and urged her to go to HR and report this as a violation. By doing nothing, nothing gets better.

Sometimes when you stand up. You make a difference. It really can take one person to do it, think of Rosa Parks.

Case Two

Jose is Bipolar but feels if he tells anyone at work he will be fired because that’s happened in two previous jobs so he says nothing. When he gets insurance through his job he does not go to see a psychiatrist because he fears his disease being part of his permanent record and worries this will stigmatize him in the future. Consequently he pays for private care and spends a lot of money on medication.

One week he does not have any medication left and doesn’t have the money to replace them. He begins to get the side-effects of not being on his medication including being unable to sleep at night, paranoid thoughts, inability to concentrate and feelings of mania. He is not able to tell anyone what is going on, tries to do his work at home but because of not being well doesn’t do a complete job.

When he returns to work after getting paid and getting more medication his boss tells him he has to let him go because of poor performance. Jose loses his job and now does not have the money for his medication or any health insurance.

What could have been different here?

The American laws concerning healthcare protect us somewhat from workplace discrimination. This is not inclusive and it’s fallible because people can and do make up other reasons for firing their employees. If in doubt speak to the workplace commission in your state about what your rights are, knowing your rights is half the battle. Likewise, Jose’s boss would be breaking the law if he chose to disclose Jose’s health status to anyone else at his work place, so in this sense, choosing to speak to his boss about what was going on, protects Jose more than staying quiet.

The reality is however, that until stigma around mental health is gone, there are always ways to subvert someone based upon prejudice. If your boss is predisposed to thinking ‘everyone with bipolar is a nut-job’ they may circumvent the law and find a way to get rid of you despite your best efforts. Having anyone else on your side improves your chances, as well as letting the proper legal channels know. Ultimately however, not enough is done to self-guard those with mental illness in the work place and this is one failing that needs serious remedy. After all, we need an income to afford health care one way or another, if we cannot get a job, how are we expected to get treated?

The reality of mental illness is many people are in the closet about it, for a plethora of reasons, and until we reduce the stigma and judgement as a society, they have no incentive to come out. Mental illness does not mean you cannot be an asset to any job, but a level playing field means a fair one, where there is no condemnation or presupposition based upon a mental illness diagnosis.

For a GREAT example of mental illness at work – watch the TV series HOMELAND with Claire Danes. It’s one of the most realistic (as far as anything on TV goes) portrayals of the struggle against the system by a young woman with Bipolar 1.

 

Mental Health Month “If you weren’t so lazy!”

We’ve all heard the mom of a teen accuse them of being lazy. If you just did more, you could accomplish xyz.

For a teen who prefers bed to getting up going to school it’s not a big deal. When it’s a depressed person or anxious person who is told this, it’s tantamount to character assassination but how can we tell the difference between laziness and the inertia that is one of the side-effects of prolonged depression?

Laziness is where you don’t want to do something enough to do it.

Inertia is where you may wish to do something but cannot summon what it takes to do it.

And if you are able to get up and do something, then does that mean you’re lazy when you cannot? If you have the strength to achieve one day but not the next, is that saying something about your will power?

With the best will in the world anyone who has had anxiety/depression or some other mental illnesses, will attest, they’d like nothing better than to wake up feeling like they want to go jogging with their friends along the river side, or take a boat ride out on the lake, or read a book they’ve been dying to read, or start fixing up that DIY home-project of replacing the windows.

A lazy person chooses not to do these things, they may not even want to and prefer to have someone else do them.

It isn’t a choice if you simply cannot do it despite every desire to.

But surely if you put more effort in?

The impact those kinds of statements can have is dangerous. What’s the implication? Someone who doesn’t (fill in the blank) is not pushing themselves, making enough effort. Bottom line – failure.

If you are feeling depressed or anxious, chances are you are quite aware already of how disappointing it is, not to be able to do what you want to do. Being reminded of it, doesn’t motivate a person. It is not the same as pulling the teen out of bed because they are sleeping in and wasting the day, and we do a disservice to those who are depressed by thinking they can snap out of it ‘if only they do this’

But like anything it’s a fine line, because on the other hand, allowing someone we care about to be depressed and ‘wallow’ is not the answer either. Numerous studies attest to the benefits of not locking yourself away from others, avoiding the world and stimulation, when depressed. It may feel bad to get out and do things but guaranteed, it is worse to stay home and dwell. The distinction is in how we use language, avoiding blame phrases to ensure we’re not condemning someone inadvertently.

Depression like any disease can lead people to feel ‘half-alive’ and the last thing you want to do when you are half alive is go swimming or BBQ or socialize. Sometimes if it’s really bad there is nothing for it but call in a mental health day and spend it doing something comforting, hoping the crisis will pass. But if you find yourself in a rut, the loathed things may be the very things you do need to try to do.

If someone in your life makes you feel badly for not ‘trying hard enough’ explain to them depression is a consistent effort, of trying to do things others don’t even have to try to do. Help them understand the analogy of trying to push a bolder up a hill single-handed each and every day. Then next time they imply you’re just too lazy, maybe they’ll catch themselves.

Equally, take responsibility, if history proves that getting out even if it seems impossible, may be beneficial in some ways if only to get your blood flowing, try your hardest to make it happen and if you cannot do it today, aim for tomorrow. Never give up.

If the people who are in the lives of those suffering from depression and anxiety stand in solidarity and do not give up on them, there will be less feelings of hopelessness and isolation. Patience really can be a virtue, as well as considering that how and when we say things impacts a vulnerable person far more than we might be aware of.

Lastly, if you’re not able to move from the sofa today, don’t berate yourself, you tried, you did your best for today and tomorrow you’ll try again. If you see life as a series of efforts, you will soon see that some of those efforts pay off and you do keep moving, maybe at your own pace but nonetheless a pace. Don’t try to be like others who are not going through what you are going through, it doesn’t mean you are less than it means you are listening to yourself and your needs and being realistic about things. Motivating yourself as much as you can does work, but holding yourself to impossible standards, usually sets up feelings of failure.

We live in a society that reveres being ‘too busy’ and condemns ‘not being busy enough’ but if we see this as shallow advice and find a balance that works for us, instead of guilting ourselves over not being enough we can stop and appreciate our own rhythm. We are after all supposed to be living, not just running through life. Finding our own pace and avoiding the stigma of being judged for being at a different pace, means less guilt all round.

Mental Health Month “Shame”

SHAME

“Shame on anyone who provokes unnecessary shame.”

For those who have never experienced mental health issues, it may be possible to consider a mentally ill person as wallowing lazily in their feelings of elected sadness. This may provoke a feeling of ‘isn’t it a shame?’ a sense that they are wasting their life choosing to act and behave this way.

Many times the mentally ill person will be quizzed;

Do you work out?

Do you eat right?

Do you sleep enough?

Sometimes those quizzes are not kind queries but have the double-headed effect of sounding like criticisms. The implication being; If you worked out (better or more often) if you ate better (your fault) if you slept well (rather than badly, by choice) you’d not be sick.

I go back to my earlier point, barring cigarette smokers, would we say this to someone who told us they suffered from cancer? (And is it even morally right to condemn a cigarette smoker for his/her part in their disease?).

Who the hell do we think we are?

Well … we think we are the well ones, the ones who have the answers to the malady of elected depression and/or mental-illness. We think this because we have no ability to empathize with a different way of feeling, because we have no experience of it ourselves or we do and we ‘got over it’ so we assume everyone else can.

It’s worth noting, there are differing types of mental illness (no shit Sherlock!) and of those, differing degrees and/or cause/effects. By this I mean the following;

If you are raped, you may suffer depression, anxiety, flash-backs and PTSD afterward. If you don’t that doesn’t make you stronger. If you do that doesn’t make you weaker. Those symptoms may go in a short time, they may persist, they may last ages. It will depend upon a myriad of factors, mainly, whether you had a pre-existing mental illness or not.

If you are already anxious and depressed and you are raped, then it stands to reason, it will exacerbate pre-existing symptoms. If you are not anxious and depressed and you are raped, you may have fewer symptoms because you are not adding to an existing list of symptoms. Again, taht doesn’t reflect how strong you are.

See it this way … if you have an auto immune disease like thyroid, you are at higher risk of getting another auto immune disease. That’s because whatever propensity predisposes you to the development of the auto immune disease, makes you vulnerable to others because they work similarly as they have ‘auto immune’ in common.

With mental illness, people with bipolar often experience Borderline Personality Disorder at the same time, and ADHD. People with Depression often experience Anxiety at the same time.

Sounds bad?

The propensity is by no means a death sentence, it’s just like saying if you have red hair you are more likely to get skin cancer than if you have dark skin, but dark skinned people CAN get skin cancer and not every red head does. Propensity is not a certainty as there are other (epigenetic) factors at play as well as our friend CHANCE.

And chance, almost rhymes with choice – bringing us back to the point. Shame is a choice. It’s a choice we as people who experience mental illness can make, to avoid as much as possible, and it’s a choice people who know mentally ill people can make when they deal with them.

You can choose to treat others as you would wish to be treated. The law of karma let’s call it.

Or you can choose to satisify some blood lust within you and make someone else feel very, very bad. Yeah you have that power, you are almost a super hero – not.

Shame is inextricorbly linked with sexual abuse in childhood, rape, molestation, illness, rejection, certain religions, gender, sexuality and other societal conventions that often it appears, seek to remind us we are not good.

As women we are told, we are dirty if we sleep around.

As children we are told, we are perverted if we masturbate.

As loners we are told, we’re weird because we prefer a book to company.

The list goes on. It’s safe to say, it appears a fond past-time of humanity to judge and to shame. And we don’t have to be in 1600’s Salem!

Just because it’s 2017 don’t think this practice has stopped. We can find it in bullying, which incidentally, is the number one cause of teen suicide. We can find it in work-place bullying which owes a distinction because it affects older people and is growing in prevelency world-wide. We can find it in older populations who are ignored, neglected, considered less important and ‘past it’ to be contributors. We can find it in minority groups and ethnic groups, same-sex relationships, gender roles and identity or lack of, and all the shades inbetween.

My grandmother used to say; People don’t like what they can’t understand and they don’t like difference.

So I guess, if you’re left-handed, queer, red-haired, freckled, hazel-eyed and autistic you might feel left out.

Okay so that’s an extreme but how many of us don’t entirely fit in some way?

You only need to be into one thing others aren’t, or not like wearing dresses, or burn instead of tan, or have darker pigment than your other family members, to experience the feeling of shame imposed upon you by a bizzare set of ideals and rules.

In other words it’s modern society or as I like to call it, torture.

Except this didn’t start just recently, it started when we began to communicate with each other (read Vanity Fair the novel if in doubt) we use shame and shaming as a coping mechanism (attack other before we are attacked) a weapon (divide and conquer) and a tool (defeat the others first, win). Society is a battle-field. For the mentally ill they are easy targets, who among us who struggles to get out of bed in the morning can handle much more?

Even when someone doesn’t know it, they can shame others. It is very common place to say things without meaning them in a bad way. Perfectly ‘good’ and kind people can inadvertantly say something that can be taken the wrong way ‘I wish you felt better!’ and pain ensues.

Obviously you don’t want to walk around on tiptoe when talking to someone who is suffering, but at the same time, just as we should be aware of the sensitivity of other subjects we should consider the sensitivity of how we address depression and other mental diseases.

Not everyone who is bipolar is a mass murderer or school shooter

Not everyone who is schizophrenic will kill their parents

Not everyone who is depressed will jump off Golden Gate Bridge

But some may and those tiny minorities are but the extremes. Beneath those few extremes lie shades of grey. The depressed person who cuts themselves, the anorexic who develops heart problems, the BPD who alienates people and ends up alone, the bipolar or cannot read a book, and so it goes on.

Everyone has something. If we remember that, then we can treat mental disease the way it should be treated, as a disease, an illness, but not the sum of a person, only an element of their whole. Something to be conscious of, aware of, sensitive to, without stereotyping the whole.

The best technique in the world? Listen to what a person has to say. You can learn a lot. And by doing this, you afford an opportunity for your friend to speak about things without a feeling of shame or judgement. In the long run this acts much like talk therapy and can be incredibly cathartic as well as a really good way of realizing, mental illness doesn’t define you.

Mental Health Month “the invisible mentally ill”

Most people when faced with the knowledge someone is mentally ill says

why don’t you just get some help?

therein lies the rub

this writer can attest, ‘getting help’ isn’t as easy as clicking your red shoes together

In the US today there are large portions of what I term ‘shut-in depressives’ those people who are under-or-un diagnosed as suffering from Major Depressive Disorder. They are typically under-employed/unemployed/self-employed or on a pension. They do not factor into many of our statistics in this country. If we added them, imagine how much the landscape of mental health in this country would change? IE; More sick people than we realized.

Why aren’t they counted?

Many times if you aren’t insured by your full-time job you don’t have access to mental health resources. Even with insurance you are severely restricted to how much you can obtain. Individuals with this coverage often fear being discovered and do not use it, or fear the stigma from doctors who if they see ‘anxiety’ on your medical chart, will literally see any illness you have as being psychosomatic (in your head) so … chest pain? Anxiety. Headaches? Anxiety.

My friend who had headaches and was mentally ill was told, it’s anxiety.

It was a brain tumor.

Secondly; Those who are not full-time employees of a company who still insures their workers (and this is growing daily) has to purchase their own insurance. If you consider the cost of say, one of the lowest plans, at $450 a month, a car payment, plus a $8k deductible that has to be paid out of your pocket before you can begin being covered, how many people working say, part-time or a low to medium wage job can afford that? May as well not have insurance!

Of course if you want to pay out $900 a month like a friend of mine, you get great insurance. $900 will also pay for a rented apartment per month.

Thirdly; Those who choose not to go with the self-pay medical insurance are not irresponsible they are normal working folk who cannot afford to pay that much per month. They rely upon pay-as-you-go services like walk-in-clinics. Such clinics cannot refer you up the chain, so they’re great for a sprain or ant bites, not so good if there’s something seriously wrong.

Forth; The ER. The USA has seen huge numbers of people coming into local ER’s with mental health problems, they are second to major car accidents seen at ER’s and typically include the homeless, the low-income, the undocumented, and students. This is a short-term solution. If you are having a manic episode they will pump you full of pills, give you a script, a few lists of people you can follow-up with and send you on your way after a 3 day hold. Given that most state-run hospitals for mental illness were closed in favor of ‘care in the community’ more mentally ill people can be found in jail and prison than anywhere else. Second to that, the streets.

But what we do not consider, are the numbers of invisible mentally ill who fall through the cracks and defy the stereotypes. I will call those people high-functioning mentally ill, by this I do not mean they are ‘better’ than the mentally ill man on the street, but they are able to cover their mental illness a little more, and ‘act’ more functioning. This is the same as a high-functioning alcoholic, and it does in no way suggest those who are not, are weaker.

The high-functioning depressive is typically older. We hear a lot about teen depression because of the higher rates of suicide upon early diagnosis among teens. There are more resources for teens and young people than middle-aged brackets because the two age groups highest for suicide are the very young and the very old.

Where does that leave the 30-year-old mother suffering from postpartum depression or the 35-year-old man who is living in the back of his parents garden in a trailer or the 45-year-old wife who drinks during the day to cope?

The invisible and the high-functioning (because both are not mutually exclusive) walk among us. Typically if you ask them how they are doing they will say ‘fine’ and you will know they do not mean it but you will not ask them more and they will know they do not mean it and will not offer more. Why? Because unlike at 16 when you trust the world to want to listen, a few years down the road you get it, nobody wants to know.

And it’s not just that nobody wants to know about depression it’s that nobody wants to know a depressive, or be friends with a depressive, or be married to a depressive, or date a depressive, or hang out with a depressive.

Does that sound harsh? Do you feel the need to defend?

It’s a harsh truth because if you asked anyone, yourself included, would you rather be friends with someone who is depressive or not, most people statistically check the ‘not’ box. Does that mean if you are dating someone who reveals they are depressed you will automatically dump them? No because you are invested and loyal. But if you went on a dating site, would you choose the profile of someone who says they are depressed most of the time? A few will say yes, and mean it, but the majority, will not.

And that’s the crux of it. It’s a circular self-fulfilling prophecy.

The depressed person – puts off the non-depressed – by their sense of isolation and loneliness – and becomes more lonely and isolated because their depression causes others to avoid them.

So feeling isolated breeds more isolation in effect.

And they still say … snap out of it (like anyone who feels this way, is choosing that for a fun buzz)

Now, to be fair, isn’t it understandable and isn’t it unfair to expect people who are not depressed to ‘friend a depressive’ and be responsible for cheering them up? Sure. But that’s not what a depressed person needs. They know their partner, sister, mom, aunt cannot ‘cheer them up’ because it doesn’t work like that, and neither do magic wands.

What a depressed person wants is the same as what everyone else wants. They want to be accepted for who they are, they want to be respected, they want to be liked, they want to be loved.

But on the other hand they are battling feelings of isolation, alienation, despair, panic, anxiety, fear, nightmares, terror, self-hate, phobias, sensitivity and paranoia.

You may say, well if someone is paranoid then how am I supposed to help them?

Again, it’s not your job to ‘help’ it’s your role if you choose, to be in their life, just like you would anyone else.

For most this is a difficult chore. They find it hard when the depressed person bails on them because they cannot get out of bed, when they have a melt down for no apparent reason, when they are quiet and not talkative, when nothing they do seems to make them happy.

Oh happiness, the illusive demon for the depressed, always out of reach.

Or in the case of the bipolar, there, gone, there, gone, there, gone.

No depressed person or mentally ill person chooses their burden, and yet, the world is intolerant of their disease in a way that is unique to mental illness.

The next question has to be … why? We’ll deal with that in a future post.

So the bottom line is – among us today are many who are invisible to mental health services (of which there are precious few). They are not poor enough for the very lowest income options, they are not well off enough to realistically afford their own insurance, coverage or get a job that will provide that, and as America was founded on the work ethic and our health care was tied to our ability to work this was a problem that bore the need for alternatives, which we now have, but they are so expensive it defeats the point.

Where does the stay at home mom or stay at home wife, or part-time-worker with depression go to get help and treatment that is reliable, cost-effect, consistent and long enough in duration to have any effect?

Having lived in several countries I am in a position to attest, it’s not that much better in other countries. There are more services literally speaking in countries with socialized healthcare but they are so full as to be practically redundant for the complex needs of their societies. I have yet to find a model I would use to base future health care ideals upon.

Then of course you have countries like India, China, Russia, that have a mixed-bag in terms of their approaches to the issue of mental health. For some, it’s almost akin to a crime, for others, admitting it will effectively condemn you to forced inadequate treatments and large-scale stigmatization (more on stigma and shame in future posts) and others socially encourage the condemnation of the mentally ill so that it’s not even discussed and acknowledged.

So as a whole, when we look at all the countries that make up our planet, we are failing to help those who have mental illness, really, really failing. And worst still, there are those among us, who we don’t even know are suffering, who have nowhere to turn, and effectively subsist rather than exist.

You can see them if you look close enough. But most of us don’t want to, or are too ‘busy’ to care. With everything in our ever-busy lives, when do we have time? The only ones who may really try to do something, are going to be our nearest and dearest and for many depressed people there are no nearest and dearest.

What if you are alone more or less and you are mentally ill and you don’t have money, where do you go?

Posing this question to a mentally ill person in the midst of a crisis they are likely as not to say, I’d just give up and take my own life.

Next time you judge someone for being suicidal, consider, have we left many other options for them?

Mental Health Month

Fortunately quite a few people are making time for this important subject. Raising awareness.

Before you click off thinking; “I’ve heard this before / I know this already” consider the following;

  1. If you have not suffered from a mental health issue you’re in the minority

2. More people die from mental health influenced factors than anything else

3. There is today more depression in the western hemisphere than ever before and our answer is to medicate using medication that is poorly proven to resolve depression and was only ever meant as a temporary solution, with therapy a rare and restricted ‘luxury’

4. We are cutting back so many mental health resources we now have less than we did in 1970, yes that means we’re going backwards not forward

5. Whilst some mental health issues are better known and understood today than 40 years ago, the terrible truth is … they are judged just as much as they were before people knew more about them and those who suffer from mental illness are often pushed to breaking-point by others who see mental-illnesses as a “choice” even by carelessly chosen words.

Words like – Depression is looking back / anxiety is looking forward / wellness is in the present.

People may say things like ‘snap out of it’ and be well meaning even but imagine saying that to someone who has cancer?

The implied condemnation / judgement / criticism or just put-down in many ‘helpful’ comments furthers the progression of the disease.

Ultimately mental health is seen as a sign of character. If you are mentally ill you have a weak character. If you are not mentally ill you have a strong character. Follow the progression of that.

Strength does not come into whether someone is mentally ill or not, any more than if someone has breast cancer. But like blaming a smoker for their lung cancer, most people see mental illness as something that someone can change ‘if they just tried’ and more of a character flaw, a negativity, a bad attitude, than a crippling, life-reducing disease.

Still think we don’t need to talk about mental illness?