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.

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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.

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 “Dying in secret”

Body Dysmorphia / Anorexia / Bulimia / Dieting / Shame / Overweight / Underweight / Orthorexic

For many, dealing with ‘real world problems’ an eating disorder or unhealthy relationship with food or self-image, is going to seem vain, unnecessary, small-minded and petty. If you’re one of those people, reading this won’t be interesting.

For the rest of us who at some point or another have experienced one or more of the above and/or been close to someone who has, this has a real world relevance and to dismiss it as a ‘rich white girls disease’ is to ignore the many people who die indirectly or directly or get sicker, every year. What good is shaming someone if you perceive their ‘problem’ not to be worthy enough for inclusion?

Let’s assume for a moment, any eating disorder or body-image issue, IS taken seriously and isn’t derided, insulted, demeaned and made fun of. Let’s assume people feel they CAN talk about it without pretending they have no idea what it is, because of fear of being judged and told; ‘Get a REAL problem rather than a made-up one!’ Tell that to the kids who die in hospital EVERY DAY from issues related to body-image.

It’s easy isn’t it? To condemn someone and say they’re petty and vain for having any type of body image disorder. Do you imagine they chose that life? That they want to be held hostage by a strange madness that seizes their otherwise rational faculties and enslaves them?

I’m not going to say vanity cannot play a part, but the vast majority of kids and adults who experience this of both genders because it affects men and trans also, feel this way because of a build up of reasons not just self-consciousness about the way they physically look. We can prove this though we should not have to, by showing the relationship between parents with eating disorders and their off-spring and the increase in likelihood their off-spring will go on to develop some kind of eating disorder. Likewise this is true even when that off-spring is adopted away from their family. In other words, it’s not just socially learned – some of it is inherited/biological.

The most recent body-issue out there is Orthorexia, and it’s trending because it has formed around a phobic over-response to the ideals of health and the fears of ‘bad’ food that dominate our society. Orthorexics will literally fear eating certain types of food because of everything written about them. For example if we took the various guidance of health gurus we would not eat; Any gluten, any fried food, any sugar, any non-organic produce, any alcohol, any dairy. We’d be left with rice-crackers, seaweed, vegetables and apple puree. Yum.

It may seem absurd, or an over-reaction but if you take health seriously it is easy to develop without intending to, a phobia of eating most foods because of this. You feel everything you eat is bad for you, so why eat it? You only want to eat things that are good for you and if you cannot then you skip eating. You may not be able to afford to eat what you want to eat and that presents problems as well as finding it hard to socialize because of your restricted diet.

More people than ever before have ‘restricted’ diets. Maybe they are gluten-intolerant, allergic to dairy, celiac, have a peanut allergy, are on a diet, have diabetes etc. Many menus calorie count, some break down the fats and ingredients. It is easy to obsess more than ever, and social media fuels this. There are sites devoted to this and other extremes as well as an increase in hard-core fitness programs that exclude many foods.

When someone has a tendency toward obsessing over this, maybe due to a pre-existing condition like body-dysmorphia, it’s not hard to become Orthorexic and fear eating a lot of food. The hard part is because it’s based upon health, it’s hard to find a healthy way of quitting being Orthorexic. How can you tell someone, eat less healthy food sometimes! The jury is still out on the ‘cure’ for this, but usually it comes to a crisis point and the sufferer realizes they are being controlled and they either embrace that and continue or let it go a bit and become less fanatical about how and what they eat. But it is not easy.

Anorexia is the fear of eating and the equating of food with weight-gain and negative feelings/experiences. Anorexics may eat but they often avoid it and limit their intake. Some purge afterward. They usually lose weight sufficiently that people will begin to notice. At first they are praised for being so ‘beach body ready’ and later on when they begin to grow hair on their skin as an extreme response to starvation they are made fun of. Anorexics have the highest risk of dying due to the lower rates of a ‘cure’ and they are often hospitalized.

Bulimia is characterized by bingeing and purging or even simply throwing up after eating. Typically a bulimic has many of the attributes of an anorexic and may starve themselves also or be an anorexic who purges. Other times they may purge but not necessarily lose sufficient weight to be seen to be anorexic although health-wise they are at great risk because of the strain throwing up does to our heart. Combined with inadequate nutrition and the strain of throwing up typical side-effects include broken veins in the face and hands, digestive disease and scarring, tooth decay and stomach problems.

Many people with eating disorders are on a ‘spectrum’ that doesn’t fit the absolute diagnosis of one specific disease, they are considered to have an eating disorder and then it is characterized individually.

Over eaters / binge eaters – an eating disorder characterized by over-eating to cope with stress much like anorexia that is heightened by anxiety and stress. Over-eating can include periods of extreme denial and starvation, it can also include purging. Over-eating can cause fluctuations of weight that put pressure on vital organs, and also can be a very isolating disease with a higher risk for suicide for all types of eating disorders. Sufferers may also gain extreme amounts of weight and suffer the judgement and ridicule that many over-weight or large people suffer because of our societies obsession with lower weights and their stigmatization of ‘fat’

Working out – Sometimes people who work out to lose weight or become fit can become obsessed with it. Whilst not always connected to an eating disorder, this can relate closely to body dysmorphia and shares the ‘control’ factor crucial in all eating and body disorders because it is thought, they all seek to control their surroundings because they do not feel they are in control in other ways.

Body dysmorphia is not an eating disorder but it can lead to, cause or exacerbate an eating disorder. Body dysmorphia is the incorrect transmission of an image of oneself. You can see a photograph, a mirror reflection, a film, of your body and you will not see your body the way others do.

How is that possible?

I have no idea. It seems absolutely impossible. I would NEVER believe it IF I had not A. Experienced it directly and personally B. Known so many others who did C. Professionally worked with many who did. Just like those who are not raped cannot always understand how life-changing rape can be, we seem to struggle to empathize and understand unless we have directly experienced it, which is sad.

To some extent it seems like a delusional disorder, or type of madness. I mean if you think you look a certain way but do not, how can you see yourself physically that way? And yet you do.

People suffering from any of the above, often have other conditions such as anxiety, low self-esteem, they may be survivors of sexual abuse, they may have been raped, they may be being bullied. Depression Borderline Personality Disorder and Bipolar are other co-morbid conditions that often occur simultaneously. The secretive life of someone with this can be so secretive nobody ever knows they suffered.

Any type of eating disorder is pretty hard to ‘cure’ it was once thought Anorexia could never be cured it could be lived with. Nowadays anorexics and others, have access to treatment if they have the money for the often expensive treatment centers or if they are insured. Treatment can include hypnosis, group therapy, aversion and its opposite ‘exposure’ therapy, cognitive-behavioral and many other methods. Nobody knows the exact ‘cure’ rate but many go on to live healthy lives.

Then again like any addiction or disease, it is possible to switch one for the other. When someone who was say, formerly bulimic is ‘cured’ they may simply take their need for control and place it elsewhere. They may become obsessive-compulsive, they may generate more anxiety, they may take up smoking. It is important to look closely at this because some of the alternatives are as if not more dangerous.

Please note, this is the first time I have ever talked about my own experience in relation to eating disorders or body dysmorphia and my teeth are clenched because it’s like standing naked in public and goes against a history of being expert at hiding these things when they existed.

In my own case, I met a girl I thought was so beautiful around 14 years of age, she was bulimic and anorexic. I recall clearly that I wanted to be like her so I copied her, stupid, immature, but that’s what I did. At first it didn’t mean anything I was just copying her, until my grandmother said one day that I was thick around the waist and would never look good in 1950’s dresses (I was 14) and in the same week my dad told me I was ‘chunky’. Sometimes words have no effect, other times they do. When you are already insecure, and have had a rotten time, sometimes they have too much of an effect and it doesn’t go away.

My friend and I had a secret group where we would binge, purge, starve. Eventually we stuck with starving because we felt badly for wasting food. At 16 a gym teacher said I needed to drop a few pounds, a dance teacher said the same thing and so I entered the world of starving for the sport, which many can relate to. At 17 I began swimming four times a week and during this time of a year, I didn’t starve myself, I was simply too hungry to! It felt great, I was free of the demon.

Except that’s never what happens. The reason we know such things are mental disorders is because they are inherited (children of anorexics have a higher risk) they exist irrespective of culture or income (yes, Hispanics and Blacks have eating disorders too, they were just ignored by the main-stream who believed it to be an Anglo middle-class disease, likewise with boys and men) and it’s usually deeply hidden and never talked about and is a form of delusion-disorder, you SEE things that are NOT there. IE: You are skinny and you see fat.

I can remember being in a dance class and watching all the tan girls in their leotards with their long legs and necks, so graceful and then looking down and seeing my inner thighs all flabby and squishy. It wasn’t true, they weren’t, but that is what I SAW. I remember being at a dinner party and suddenly running to the bathroom and throwing up everything I ate, and covering it expertly with a breath mint, nobody knew and it seemed like a super-power, in fact it was a sickness, an invisible and terribly destructive sickness invading my every thought.

At 18 after my boyfriend had left me, the old demon returned (a need to control) and I began to throw up whenever I ate until I was a dangerous weight. Few people knew, including my parents because I was excellent at hiding things related to my eating disorder. I went to college and in that first year it was the worst it was ever. I realized I was going out of my mind and it controlled me completely, I sought help. I went to a therapist about it and how it related to being abused as a child and other things that had happened in my life. This helped.

The main ‘cure’ of my eating disorder though was not what the magazines would like me to say. It wasn’t that I saw the light, I got better, I’m a shining example. Oh no.

I was ‘cured’ because I was in a relationship and I had nowhere to purge, or throw up after eating and I couldn’t not eat because I lived with four people and they would have noticed. there was only one bathroom, the house was small the walls paper-thin. After a while I realized I just couldn’t hide my disorder and as I was also sharing my bed and happy in my relationship I stopped.

That seems a pretty pathetic reason huh? I thought so.

It also wasn’t true, it was another layer of the delusion.That’s like an alcoholic not drinking in public, doesn’t mean they are not an alcoholic. People say, if it’s a disease you cannot control it, but who said that? Of course you can! You think you can anyway, but really it controls you. When I was alone, even for one night, I would stuff things in my mouth until I nearly burst and then throw up, or I would eat absolutely nothing or I would stare at myself and see something hideous. I didn’t and couldn’t talk about it because we all know what others would say. You are vain. You are shallow. You are pathetic. You cause this. You waste food. You deserve what you get. But it wasn’t vanity it was self-hatred and self-loathing, a desire to be that eight year old again, free of everything. I didn’t know why, I didn’t connect it to sexual abuse and other things that so often are the triggers and markers for at-risk youth to develop eating disorders.

But years later when I was single again I began to starve off and on. I saw that the ONLY thing keeping me from having a full-blown eating disorder again was circumstance! I wasn’t cured at all! I was simply living with the secrecy like a double-agent, patting myself on the back for my success when really it was underneath the surface controlling me. For someone who was so open and honest I was a huge liar, nobody knew, and the more they didn’t know, the more I couldn’t say.

HOW can we have so much control that if we live with someone else it may help and if we are alone we immediately fall back to it? How serious and real can it be then? I think it’s very serious and very real, imagine looking in the mirror and seeing someone who isn’t there! I still do. I cannot see the ‘real’ me in the mirror but what I try to do is surround myself with people who eat healthily but normally, and ensure that I don’t let ‘the voices’ lure me back into bad habits.

I have slipped a few times, notably in times of high stress. I realize for some it is impossible to live with the disease relatively well, for some they are so sick they really do benefit from more intensive treatment and/or hospitalization. I was never as sick as some of the girls (and one boy) whom I knew with eating disorders but that doesn’t mean I was well either. After a very serious bad experience I fell back into starving myself the denial felt redemptive, in my twenties I felt I was far too old to be doing this, and yet I was (many anorexics are over forty, everyone assumes they are 18, the age-bias means many do not ever get treatment). That year I went to visit school friends back in Europe, they all told me how unhealthy I looked, how I had no chest, no flesh, and I felt like I lived with a chimera inside of me, dictating this awful tendency to reduce everything to controlling how much I ate.

In our society if we perceive a disease to be ‘chosen’ or ‘self-selected’ and the person had a choice, then we blame the person who has that disease. We say “I’m not going to understand this disease or empathize because I blame you for causing it, therefore it’s not like a disease you didn’t cause.” What we fail to understand is, while we judge, we judge a far wider number of people who witness that judgement and thus, never seek help, we also instill a sense in the disease-sufferer that their disease is a choice, a bad habit, and their fault. In other words we compound the problem all because we condemn people for something we don’t understand. How many times have you heard someone say; “Those damn anorexic models I have no sympathy for them” We believe that kind of illness is essentially a weakness of character or worse, enviable and thus, we resent them. Would we say that if someone disclosed they had ovarian cancer?

I use my own example because I have NEVER publically talked about having an eating disorder before. I would say it’s a lot like being an alcoholic, you are ALWAYS an alcoholic just like you are always someone with a potential for eating disorders. I did go down the road of Orthorexia and left to my own devices would be merrily heading down it now (except it’s not merry, it’s ridiculous and it’s crazy) and equally I still have body dysmorphia. I can only believe that by admitting this as I have here, I encourage others to get treatment. I personally found therapy very helpful and the other thing that helped was ensuring I took the right vitamins and minerals to balance myself and become less unhinged which I was exacerbating by poor nutrition. It is a vicious circle.

It is very hard for me to recount this, I have tried to delete this several times, feeling that if it gets ‘out there’ I will lose control and I realize, that’s what I have to do and what we all have to do if we experience these feelings. For a long time I could not hang out with people with eating disorders, they triggered me. I am such an independent person ask anyone but when it comes to eating I’m not at all I’m a complete follower and that baffles me. I still struggle to eat when I’m alone or at dinner parties, there are things I will always have and need to always remind myself I have, to face them and not deny them, because then they win.

The grand irony is, I have always been genetically thin, so even if I never had this, I would have been picked on for being underweight, and that’s the farce of it, you can look any way and nobody really knows what’s going on for you, they accuse you of being anorexic when you’re not, and commend you for having a good figure when you’re starving yourself, the mixed-messages of our society increase our propensity to be sick. For some they are genetically wired to not respond to those triggers, whilst others are genetically engineered to respond to them, recent studies show there is a definitive link between DNA and the development of any type of eating disorder. Therefore it’s not all in your head and it is all in your head. But for years we were told it was the spoilt princess syndrome, would that make anyone want to admit it?

It is a form of madness I am certain of it, and as such it belongs in the mental health category almost more than anything else. Society does not help, the continual bombardment of thin bodies really doesn’t help. I have been told I was thin my entire life, and I realize, thin doesn’t even MATTER it’s not IMPORTANT and I don’t even find really thin women attractive! Sometimes it’s not about wanting to be thin, in my case it never was, it was about seeking control and having a really bad relationship with food that was very love-hate. Personally I think bigger women are far more beautiful, proof that an eating disorder or body dysmorphia is not always about weight or thinness, although for some it is.

I had a fear of letting go of being a child, of growing up, of intimacy, of body-shame due to sexual abuse, of self-hate due to low-self-esteem. Those were my triggers, those were my things that led me to develop eating and body disorders. For others it may be the same or different. The thing we all share is a need to control what we feel we do not control – a feeling of being out of control. Sometimes people cut themselves, sometimes people do drugs, sometimes people control what they eat. Equally, if you do not see yourself accurately in the mirror this can be a manifestation of self-hate that was inculcated or indoctrinated and it can lead to a skewed self-image which is at the root of body dysmorphia.

I feel an intense embarrassment and shame at admitting this about myself. I know when I press ‘publish’ I will immediately regret this. And that’s why I’m doing it, because it’s time. Time to end the shame. If you read this and think I’m another white-middle-class-whiner who invents a disease, good day to you, but for those of you who ‘get’ what I’m saying here, I say to you, let’s talk about it, let’s get the monster out of the closet and get to the bottom of it, because the one thing that we hate most of all is admitting it and coming clean, that’s what we avoid at any cost, and that’s exactly why we must.

I’m sorry this is all about me, it was the only way I could find to truthfully tell the story.

 

Mental Health Month “Military secrets”

It struck me during a normal day working at a Rape Crisis Center when I got a call from a young woman who was a recent recruit stationed at a local military base. She told me she had reported being raped by her supervisor, it was dismissed and she was told to drop it or lose her military standing and be dishonorably discharged. She didn’t know where to turn.

I ended up seeing her for over a year, during which time we tried to find out how she could circumvent the military ‘establishment’ and obtain some fair treatment with regards to her sexual assault. Sadly we were not successful and her only recourse was to come see me privately and in secret for fear of people finding out in the military. Her rapist was never prosecuted. Some years later a large national scandal erupted concerning the number of new recruits who were being raped and sexually assaulted en mass on US military training bases and how they were being covered up.

This is one way joining the military can provoke a mental health crisis.

A friend’s brother signed up for the Army at 18 and was deployed overseas to Afghanistan. He came back the only survivor of his platoon, injured but relatively physically well, with crushing PTSD. He developed chronic insomnia, anxiety, clinical depression and had a host of issues that had never existed before, among them, survivors guilt. When he sought help through his local VA he was told he had not served long enough to qualify for many things and his only option was a crowded PTSD group for men, he went a couple of times, there was never enough time to talk about things individually and the anger and tension in the room was overwhelming. He never went back and his VA psychiatrist loaded him up on five medications instead. A couple of years ago another scandal rocked the VA for the over-dosing of soldiers and military personnel of medication for mental health issues, with little therapy or other options being given.

I read about a young man who committed suicide after returning from his deployment upon finding his wife had left him for someone else, and being isolated and unable to re-adjust back into society after being ‘in’ so long. He felt he had nothing to live for, and whilst he did have some old buddies from the tours he did, they were scattered. His isolation and PTSD was untreated and eventually he took his own life. Afterward everyone lamented that more had not been done but nobody thought about that when he was alive. The paltry mental health resources through his local VA which was miles away, were insufficient and outdated. Again, excessive quantities of medication was the norm.

This is the reality of mental health for so many of our soldiers and military who return from dangerous tours and find little by way of mental health support in their communities. The bottom line being, we can’t afford it. Yet, the VA manages to afford many other things, so it is more likely that the priority as is the case world-wide, is not on mental health, despite every published known statistic pointing to the relationship between suicide, illness of all kinds and violence and an inadequate treatment of PTSD and other mental health concerns.

Why don’t we fund mental health?

For those in the military this is crucial because they are being used up and spat out only to be over-medicated and forgotten. Young men who have lost limbs and vigor, get extensive physical rehab but next to none by way of mental rehab. Who doesn’t know that if you lose a limb you will need as much mental as physical ‘work’ to get better? What of the VA and their priorities? Happy to dispense medication or operate, but when it’s a malady of the mind, unable to offer further options? Whilst the VA can be a life-saver it is woefully inadequate as a mental health provider.

The chain reaction of this neglect trickles down. Higher rates of divorce, poverty, disability, inability to work, drug-use, alcoholism, spouse abuse, violence, crime, the list goes on.

If we worked at the source of the issue we would not have to spend most of our time trying to chase the consequences. If you solve the problem to begin with, things would not escalate. How much does it really take to offer better mental health services to our returning forces? Apparently this is not a priority, for counselors regularly apply and are turned away, either because they do not fit the narrow qualifications set out by the VA or they are not hiring, despite a burgeoning need! Psychiatrists see so many VA patients in a day they are overwhelmed and unable to be truly responsive (and responsible!) for each individual. Many times they are done via a satellite link and are not even present in the room.

If you had PTSD would you open up and be candid with a person on a screen?

We exult the bravery of those who join up, and we sing the praises of having a VA system, all well and good, but we need to reinforce this when military return from tours or are impacted by issues that lead to mental health just as much as physical health. Equally, the fears people have when raped, of not getting adequate justice through the military system must change, so that anyone no matter their position and the position of their attacker, can seek justice.

If left unchecked, mental health consequences of rape, PTSD and other mental impacts from working in this field, will go on to have a life-long effect on both the affected individual and their family. Many times we do not realize the family bears the brunt of that person’s return to normalcy. How easy is it to return to normalacy after seeing your platoon shot down and die in front of you? Support for the entire system prevents that system from fracturing, causing a myriad of cracks to appear in a previously sound foundation and this ripple effect can be carried through generations. It goes without saying this applies to both genders, and all law-enforcement as well. More, not less, mental health funding could fix this, but we allocate money elsewhere, thinking mental health is ‘optional’ – try telling that to someone who just saw their friends blown up in front of them.

Mental Health Month”Grow up & forget about it!”

Do you know anyone who was sexually abused as a child? Were you? Was your daughter? Sister? Wife? Neighbor? Brother? Son?

Childhood sexual abuse and adult survivors of childhood sexual abuse (ASCSA) are in every society in every corner of our planet. It is often assumed children are resilient and can put up with a lot, and this is true, but childhood sexual abuse can destroy and does destroy so many parts of a child’s psyche we can honestly never know with any certainty how much was taken by the act of abuse.

What we do know is abuse, any kind of abuse, including sexual abuse, is going to have after effects that last long after the actual abuse ends. One of the ways this occurs is an unconscious attempt on the part of the child grown to adulthood (or near enough) in acting out the abuse in an attempt to understand it.

Does that seem crazy?

Very often organizations working with adult survivors noticed a pattern of repeat sexual and physical and mental abuse among populations who had endured these things. At first they believed a person who say, was raped was more likely to be raped a second time and this is borne out by statistics. But in addition to this increase likelihood of further victimization there was another pattern emerging; the unconscious re-enactment of aspects of the abuse by the survivor.

What that means in plain terms is, sometimes survivors will create situations similar to the abuse and actually reenact elements of the abuse, and go through those scenarios and possibly be re-victimized as a result. They will do this without being consciously aware of doing it.

Why would you ever want to do that?

It is thought this unconscious behavior is much like an unconscious wish to understand and reclaim what happened. Without intervention the individual is not aware they are doing it, and thus, when it happens is genuinely surprised (and re-traumatized) whereas when they are made aware this is a process of the mind trying to make sense of something that is hard if not impossible to make sense of, they can break the cycle.

Like many survivors who may turn to prostitution because of feelings of worthlessness and devalued degradation and shame, some will go in the opposite direction and have absolutely no sexual desire. These extremes are one form of ‘reacting’ to something the mind and spirit are trying to reconcile. Another way is the reenactment of the experience on some level. It has even been postulated that BDSM is one outlet for survivors to ‘act out’ their feelings and possibly reclaim their lost power.

Whether true or not, for others who have not had this experience, it may appear the individual is seeking to be abused on some level. It may even be an accusation thrown at the individual. Statements like; “You must want this / you keep putting yourself in these situations and letting it happen!” The individual will perceive this as being another condemning, blaming, shaming comment.

Abuse is hard to understand. I cannot understand why someone would sexually abuse a child, a woman, a man, an animal. I don’t think I could ever understand. So in absence of understanding, we sometimes go to great lengths to try to make sense of what happened to us.

I knew a woman who would drink a lot and go home with men and wait to see if they raped her. She was not aware she was doing this, until she really stopped the compulsion and thought about it. Then she realized she was seeing if she would be ‘betrayed’ again by a man who she had trusted and who had raped her when they had been drinking together. She had tried to talk to her friend who had raped her afterward about why he would have done this, he refused to say, and so she unconsciously put herself in similar situations to see if it would happen again and maybe understand it better. Of course when she realized what was happening she realized she did not want to be raped again! But until she came to that point she was unawares this was even happening.

Legally if she had been raped whilst drinking even if she consented to go home with someone, it would be rape if she did not give consent for sex and some would argue, if you are drunk you cannot give consent so with the exception of committed relationships where many times, partners will have sex when inebriated, the rule of thumb is, if you are not in a relationship and you or your partner are inebriated do not have sex with them because you cannot guarantee consent (unless it’s very obvious). Of course this is a difficult thing to gauge and it’s unrealistic to expect nobody to drink, so that’s where the legal system can get unstuck in issues of consent. However in most cases it is obvious for example if you are passed out drunk and someone has sex with you, that’s rape and you did not give consent, if you changed your mind and didn’t want to sleep with someone you withdraw your consent.

Therapy can be useful in working through trauma that involves enacting out parts of the abuse. Childhood survivors of sexual abuse go through triggering phases in their lives where it becomes challenging to deal with the history of their experiences. Typically these occur at puberty, during your first serious relationship, in pregnancy, during your child’s puberty and other occasions. It can be hard talking to family members about this, especially if the abuser was a family member. In a healthy marriage, talking about past sexual abuse histories helps you communicate what is and is not acceptable and what boundaries need to be respected, as well as bringing you closer.

Survivors of adult sexual abuse can have large issues with rage – anger – helplessness and anxiety.

Rage – anger at the perpetrator, at those who didn’t do enough to stop it, at oneself for being a victim, at people who trigger a reminder in any way.

Helplessness – feelings of impotence, uselessness, weakness, a feeling that nothing you do no matter how hard you try will change things or count.

Anxiety – fear, phobias, self-hate, secret-keeping, terror, flashbacks, nervousness, triggers, and general anxiety around anything related to or reminding of, the abuse.

Those as well as other symptoms can lead to severe mental health challenges, not least, depression and difficulty with trust and emotions. Unlike some who if raped may hopefully get some degree of immediate support, many times adult survivors of childhood sexual abuse, may never report what happened, may be disbelieved, may suppress it and keep quiet about it. Others may feel it was dismissed, forgotten about, considered unimportant and feel that people think they should ‘get over it’ by now. Those who are raped as adults and receive no support will probably also experience this isolation. That feeling can lead to mental illness if left to fester and remain unresolved. Rape Crisis Centers will see ANY child or adult of either gender who was raped or sexually abused in any way at any age at any time in their life. They have therapists who are trained in the legal ramifications, and also how to actually help those who have experienced this.

A fellow blogger reminded me to be mindful of male-rape and male sexual abuse and assault and how even if it does not happen with the same frequency it may suffer greater stigma because males are less likely to report any kind of sexual abuse, for similar reasons, but also because they are not as typical a victim and thus, they fear the condemnation of others who may think ‘you’re male, why were YOU raped? How could you have let that happen?’ As with women, and children, nobody LETS rape happen, they are victimized by a rapist and they survive that rape.

Men and boys of all ages can be raped by other men and boys. Men and boys can be raped by women, although this is the rarest form of rape and sexual abuse/assault it does and can happen. Typically the most common form of sexual abuse perpetrated by a woman toward a man is between a female relative (older) to a male relative (younger) when the power balance and physical strength is on the female’s side. The male relative may be told ‘that’s a fantasy come true’ when he tells his story of being raped by an older woman, but of course, for many young men this is no sexual fantasy, this is rape.

A man or boy can obtain an erection even against their will, because our bodies respond whether we emotionally wish them to or not, this is also true of women. A man or boy may be able to be touched to erection and then raped, and orgasm, and thus he may feel he was not raped even if he emotionally feels he was. A woman or girl can also experience this. The fear of ‘I came so I must have liked it’ is one big reason why males in particular do not talk about their sexual abuse. Another reason is, if a boy is raped by another boy, he feels people will think he is gay and whether he is or not, this can be a palpable fear in many social settings that perceive being gay negatively in some way.

For a boy who is not gay, being raped by a male, to the point of ejaculation is horrifying and leads them to have many internalized fears of ‘I must be gay / I must be twisted / I liked being raped’ instead of seeing that climaxing is no indicator of pleasure, it is a physical response to stimulation. Likewise, if raped by a member of the same-sex, the rape can be physically damaging, and emotionally scaring because that male may never have considered that they too could be raped. For girls and women we’ve always known it was a possibility, it doesn’t make it easier BY ANY MEANS but it’s a socially known phenomena, less for male-on-male-rape and yet, it has been used for years on the battlefield with both sexes.

Rape isn’t about sex it’s about domination, control, sadism, anger, violence.

Sometimes sexual pleasure is another reason that is gained by the rapist who inflicts pain, control, domination, fear, anger, violence. In other words, they get off on it. That’s the definition of a sadist and probably a sociopath (someone who has no empathy or regard for others). Equally narcissists can be deluded into thinking anything they do to anyone must be good because it feels good to them.

Those kinds of people capable of rape are our norm. But what about the good person who rapes? Is that possible?

Many times a best friend rapes their friend. In such incidences, everything you thought you knew flies out of the window. How could my best friend do this to me? What did I do to deserve this? You didn’t do anything. Sometimes people, even good people, do terrible things. We should not excuse a good person who does a terrible thing, because they committed an act that will stay with us forever. Oftentimes though, these are the very rapes that go unreported and can occur before adulthood.

Of course who wants to report rape when the system is broken? Ideally everyone should, that is the only way rapists are stopped. But even if you don’t, seeking therapy to work through the messed up feelings you will have afterward, as well as checking yourself physically and ensuring you are protected as much as possible from disease and injury is essential. This can and should include, an examination, evidence collected for should you proceed with a case (and you may not know if you want to at the time so get it taken so you have that choice) documentation of damage (for future reference in relation to your long-term health, blood tests for contracted sexual diseases and treatment if applicable including but not limited to, prophylactic treatment.

prophylactic treatment can include certain antibiotics that work to counter certain STD’s that are commonly transmitted. Others include The Morning After Pill which is not an abortion pill but a pill that prevents conception much like the regular pill but is taken once during the first 72 hours after a man has ejaculated inside you, to prevent unwanted pregnancy.

The least well-known prophylactic treatment is a HIV prophelactic. If you believe your rapist may have had HIV this is one measure to prevent contraction. You are given a large quantity of medication similar to the HIV treatment for up to six weeks typically a month, they have side-effects but they are reliable in preventing HIV transmission. Many people do not know about this and if it is applicable, it should be requested.

What about adults of childhood sexual assault? They are often raped in childhood, it is often a secret, as adults they may have scars and side-effects from this abuse including STD’s which further the shame and humiliation they feel. Seeing a good doctor who can go through your history and check on you regularly as well as prescribing appropriate medications can help though often the damage can be lasting and far-reaching which is why children abused in secret is so devastating as many are never treated until it’s too late.

With therapy it is never too late. I have seen people in their eighties who until that moment had never spoken about being abused as a child and at the termination of therapy they were glad they spoke out. It is never too late. Never.

But if you don’t get therapy for someone you love, it might lead to things you couldn’t imagine like them becoming the predator and abusing another child, as I saw many times happen, not because they were evil but because it’s a taught, learned maladaptive behavior that can be acted-out to the extent that the line between ‘abused’ and ‘abuser’ is blurred and finally, lost.

If you are friends with someone who has gone through something like this, be a friend to them and talk with them about it, don’t side-step around it, let them know you care and want to talk about it and encourage them to talk to a professional also.

Childhood sexual abuse survivors can be among the strongest most resilient souls you could ever meet, they are often the most inspirational and giving and helping. Nobody has to be destroyed by childhood sexual abuse, it is very rare that they are, but those who are, need the voice of us all, to prevent as much as we can, this quiet abuse that can be occurring right next door to us. We should all know the signs and symptoms of an abused child and not be afraid to check on a child we fear might be at risk of abuse.

That said, temper enthusiasm for helping with caution. Being brought up by a single father, many assumed I was at risk for being sexually abused by my father. He never did and never would, but I could see why they may have found it unusual for a small female child to be reared by their father. I was appreciative of their caution when I look back, but glad it didn’t cause further enquiry as that can be as damaging as doing nothing. It may be a fine balance but together, we can lower the number of children who are invisibly being abused in our society right now.