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.

Advertisements

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”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.

Mental Health Month “Suicide”

The first time I was personally touched by suicide, a friend’s mom took her own life, her kids found her in the bath, I heard about it second-hand around the age of eight. I remember thinking how I would feel if I found a family member dead, and I tried to be nicer to my friend whose mom had died. I remember other kids said things about how the mom was selfish for doing it, I didn’t join in, there was even then, a part of me that didn’t see it that way.

The second time I was personally touched by suicide, my grandfather took his own life. He overdosed on Valium and was found the next morning when he hadn’t come down for breakfast. He was an artist and a long time Depressive, but despite that, everyone was shocked that a man still in his prime would consider death a better option. I remember people saying; “What a waste, he was so talented” and “How selfish, he had two children and a wife.” Although I didn’t think it at the time, I now wonder, does that mean it’s not selfish if you have no one? Is it more understandable or acceptable if you are not talented? Again, how things are phrased can stick with you.

At the time I saw my grandmother trying to come to terms with it. She ended up drinking the pain away, and developed an addiction to drinking for many years before she joined a cult and through this new-found sense of belonging quit drinking and became happy once more. Whilst we didn’t particularly like her being part of a cult we were glad for her restored peace of mind, but when I think back on it now, I also think we were relieved, we didn’t have to look in the face of grief anymore, everyone wanted to get on with things.

And that’s the hardest part of suicide, how people cope or do not cope after the fact.

Who is left behind, what fall-out carries on sometimes for generations.

One of the first questions a therapist asks is if anyone in your family has committed suicide, there is a reason for that. People whose family members commit suicide have a far higher risk of committing suicide themselves. Some have postulated whether this is ‘learned behavior’ or ‘permission granted’ or biological/in our DNA.

I can definitely see why people who have relatives who commit suicide would go one of two extremes. They are either going to be the last person to commit suicide, because they know first-hand its fall-out, or they may feel that because someone close to them did, it gives permission for them to follow suit. I can also see how some people are genetically at higher risk because something within their DNA makes it more favorable than for others. This doesn’t seem so very different from say, the God Gene.

There definitely are, as with addicts, two camps, the person who just won’t kill themselves under any circumstances and those who will. We may never quite know why, there may be many factors that go into that, but the people who are ‘at risk’ versus those who are not, are often hard to distinguish because in many ways they may both exhibit the same symptoms.

Many times I hear people say that those who commit suicide are ‘weak’ and ‘selfish.’ I have never thought they were. I see no good coming from condemning someone who was sad enough to take their own life. If we do it to discourage others, well it’s not really working, and whilst I would never advocating encouraging anyone to commit suicide or over-justifying those who do, I see no good in criticizing them after the fact. They made a decision, they chose to do it, who are we to say they are weak?

At the same time, we all hope someone will find the ‘strength’ or conviction to keep living. Nobody really approves of suicide except in extreme cases such as euthanasia for those who are suffering and in agonizing pain. Even then, in America, this is a very divided subject with those against, believing no murder is justified including the taking of ones own life, whilst others, often those who have seen it personally, can attest, some terminally ill people have the right to end their suffering.

So if we look at suicide of ‘healthy’ individuals, where do we place the depressed and the mentally ill on that scale? In some Scandinavian countries there have been people who have petitioned the Government to be euthanized based upon mental-illness. This has sparked outrage among those who believe this is tantamount to murder, and in no way qualifies as a terminal illness. Technically mental illness is rarely terminal although many ways, mental illness accompanies terminal diseases and exacerbates their symptomatology.

But even without being terminal, can mental illness ever be ‘bad’ enough to warrant or justify the taking of ones own life? And if we open that flood gate, how do we close it again?

I don’t claim to know the answer, I’m not sure anyone knows the answer yet but the side of suicide we don’t consider as often, isn’t just prevention or reason(s) behind suicide, but the aftermath.

Another friend of mine lost her mother to suicide. If I had to say, without hesitation I would say she became a more responsible, compassionate person as a result. But that doesn’t negate the extreme pain she still feels with the loss of her mom. Given a choice, every day she would wish for her mom’s return over any compassion she may have. The positives cannot outweigh the negative reality of losing someone you love.

If her mom had been deathly ill maybe she would have held a different view, I have never asked her, but either way, it is hard to imagine being ‘okay’ with someone’s suicide. That said, when Brittany Maynard committed suicide (euthanasia) in Oregon a while back I was profoundly moved by her videos and writing on the subject prior to her choice to end her life. Still very young and with a beautiful family, Brittany was terminally ill and knew in a matter of months she would be in excruciating pain and there was no cure and only awful suffering.

Many people condemned her for ‘taking the easy way out’ or ‘going against the will of God’ but I recall admiring her so much for her resolve and strength. I simply could not imagine making that choice, let alone going through with it. Her family moved to another State where Euthanasia is legal in order to be eligible and she made her plight and story public in an effort to educate people on the right to die. I believe in the right to die in part because of her efforts to show it is not the same as suicide.

With depression and other mental illnesses that are not responsive to treatment, it is not hard to imagine why people can be pushed to the brink and wish to end their lives. Should we consider euthanasia for severe cases of mental illness? Currently I don’t think we should but I recognize I may change my mind as more information becomes available. When I stop and think about living with say, Schizophrenia and other illnesses your entire life, in misery, without respite, and medications not working, I can definitely see why someone may wish to end their life. So why do I hesitate in condoning suicide or euthanasia in those cases?

Maybe because whilst we see mental illness as a disease, it’s not terminal and until something is actually ‘definitely’ going to take your life, we have this belief that there is hope, and we should not end our life based on feeling badly. Is this dismissive? I would say in some instances, yes, because there are chronic pain conditions that may include mental disease, that it could be argued, are as devastating to someone as a terminal illness. Perhaps we should give everyone the ‘right’ to choose if they live or die, and I would agree with this except for a worry that sometimes in certain mind-sets we don’t have the right objectivity to ‘choose’ without bias.

Mental illness is one of those biases. When you are mentally ill you can really see the world through a different lens. If you have not ever experienced that, believe me when I say, one day you can feel hopeful, the next it’s like the color was sucked out of the world and the pain you feel inside is unbearable and often without any cause. When that goes on for a prolonged period of time each day can be agonizing. It is definitely understandable that when people feel this way they may contemplate suicide.

The argument against this is – people typically commit suicide or attempt suicide when they are panicking or have calmly given up (the two extremes) they either panic that they will never feel differently and ‘stop the pain! stop it now! stop it any way you can!’ or they feel reconciled to their fate, they do not believe it will ever change, and so they give themselves permission to let go.

Perhaps that is why the very young and the very old are the two groups most likely to take their own lives.

As mentioned earlier, there are many who no matter how bad it got, would never commit suicide. That isn’t necessarily anything to do with personal fortitude or strength, it may be a genetic proclivity, or several factors, but they often perceive those who take their lives as inexplicable. They cannot and will not understand, and they feel understanding is condoning. I would argue, understanding is NOT condoning it’s understanding. We need more understanding.

Mental illness is not always visible, so we often do not know someone is suffering from it until it’s too late. Signs to look for include giving away what we own, a sudden sense of peace and feeling good, high anxiety and stress and the bequeathing of things previously withheld. Of course that’s not going to ensure you accurately predict whom among us is at risk, because just like in the film 13 Reasons, so many people exhibit signs and so many do not, and that’s no guarantee of anything. Additionally suicide can be a sudden choice, you literally realize in a moment and bam, it’s too late.

One population aside teenagers that I believe will increasingly be at risk for suicide is the elderly. More so because our grandparents social security and pensions were more robust than ours will be with some exceptions. It is simply more expensive to live nowadays and the money we will need to live even relatively well in old age, is often more than we can save and invest. Poverty and loneliness are two of the main reasons the elderly choose to take their lives. The third is illness. This can include mental illness. We sometimes believe the value of a person’s life diminishes with increasing age, but every life should have the same value.

The elderly have less resources than teens and in a way, less hope, because they are ageing toward death, whereas a teen has their entire life ahead of them. Sometimes hastening ones death can seem a good choice, to end suffering, loneliness, worry, financial concerns. The elderly can feel they are a burden, they can feel they are not wanted in our ever busy society that highlights youth. Additionally, are we ready as a society to take care of the many who will devleop dementia, which often carries alongside it, chronic depression? Is loading an eighty year old with heavy duty medications and antidepressants all we can to do help them?

Caregivers of the elderly will also experience mental health issues as a result of the hard work they do. Presently elderly patients are over medicated and have less resources for talk-therapy or other treatments. It is deemed simply easier to stick them on a lot of medications and hope they’ll die than treat their suffering compassionately and with an understanding their lives, however long, still hold value. Is it any wonder then that so many elderly are at risk of suicide and premature death? As long as we judge people based on their economic ‘worth’ and believe the elderly ‘had their time’ we will never improve this and rates of elder-abuse will grow.

So whilst we can do more to look out for people, we will never prevent someone from committing suicide if they are absolutely set on doing so. What we can do is save the ones who do not wish to and need a reason not to. It may seem absurd that anyone should really want to die, but there will always be people who do, they find different ways, they take risks, they drive their cars too fast, they may join a terrorist group. Often very unhappy people choose suicide by proxy, by putting themselves in danger and waiting to see if it will take them.

Suicide and mental health are always going to be interrelated and there is a lot the people around those people can do to prevent a successful suicide, but ultimately the best we can do is not judge those who die, for what possible good comes from that? Sometimes the hardest thing in the world is to try to understand why someone did what they did. Sometimes there is nothing to understand. But with understanding we can learn, whereas if we simply condemn, we learn absolutely nothing.

Mental Health Month “Just die already”

Another blogger is to thank for today’s subject because she wrote a superb piece about what it felt like to have someone wish you dead when you are depressed.

I’m going to carry the subject on and share my own story.

Many times we hear in teen movies when someone has threatened suicide, some awful person say something to the effect of; “Go on then! Just die already!”

But what if that actually happens?

In my story a friend of mine experienced this that. This is his story.

Steven was 15 years old, good-looking, dyslexic and with a disruptive home life he had begun to experience the first signs of clinical depression as he came into puberty and he was turning to marijuana to numb his feelings.

Boys of that age tend not to be very responsive to therapy and this was the case with Steven when his mom took him to talk to someone after he failed most of his exams and began to wear a lot of black. It turned out Steven wanted to be a Goth (Emo) for a while and that led to him being picked on by others, which only exacerbated his feelings.

One may ask; Why choose something that is going to set you further apart from others? But that is exactly what people often do, it’s as if they have to act out how they feel inside, and they often do it unconsciously.

Steven met a girl three years older than him, she was mentally ill (Bipolar) and really beautiful and he had a huge crush on her. They did some drugs together including LSD that he had never tried before. During his ‘trip’ the beautiful girl had sex with him. He wasn’t sure how to feel about this first time, he felt both violated and excited and flattered and then guilty for feeling such opposing feelings. He didn’t really understand what he felt and when he had feelings of upset about it, he would berate himself because he worried it meant there was something wrong with him for not enjoying the experience.

He ended up getting VD (sexually transmitted disease) from her and he had to go to the clinic, his mom found out, his sister found out, even someone at school whom he had confided in, told everyone else and soon he was taunted even more at school. He was treated for it and over it, but the legacy of this carried on, with taunts of “VD Steven” being hurled at him.

Soon afterward Steven tried killing himself, he slit his wrists. He cut them side-ways not downward not realizing this was the less effective method, he bled a lot and ended up in ER where he was stitched up. The nurse was rude to him and made him feel like he was in the wrong for what he did and wasting resources. His mom was hysterical and angry, his father said nothing, his sister told him that he was weak. Two weeks later he returned to school and because it was Summer wore shorter sleeves, others saw his wrists and soon it became known what he tried to do.

Soon the taunts turned to; “Why didn’t you succeed you fucking idiot”

Steven tried an overdose the next time.

Around this time I met him and supported him back to a better place, along with some of his other friends who were not part of the campaign against him. It was his friends who told his parents not to guilt-trip him and explained what had really been going on.

If Steven had not had those friends to this day I believe he would have succeeded in his suicide attempts.

This for me is another example of the clear-cut connection between how people respond to mental illness and / bad situations and how this can push someone already vulnerable to take their own life (or attempt it). Parents should be aware of this and educate other siblings in how to approach the subject where they are not inadvertently making things worse. The best intentions in the world can come out wrong.

It really can save lives and sharing real-stories of real life people who have literally been saved can demonstrate to all of us the importance of how we treat each other. There should never be anything okay about telling anyone, suicidal or not, that their life does not have worth, or that they should go ahead and kill themselves.

Mental Health Month “Rape”

Rape isn’t a subject people talk about very often. Sadly it’s a subject people joke about quite a bit.

The first time I heard a rape-joke I didn’t get it. It was too disgusting to ‘get’ and I am glad I didn’t. Everyone else did though and they all laughed. At the time I didn’t think how someone sitting there who had been raped would feel, but statistics tell us, that likelihood is quite high considering that 80 percent of rape goes unreported and even the reported numbers are staggering.

How a rape joke could hope to be funny, baffles me, but it maybe is more telling of our society as a whole, that we can laugh at true misfortune and tragedy. That’s not gallows humor, that’s just sick.

Rape is never funny. Rape is never something that doesn’t matter. Perhaps if we acted like it mattered more, those who were rape survivors would not be more subject to a plethora of mental illness.

That’s why rape is a subject this Mental Health Month. Because the link between rape and mental illness exists. Rape can among other things, be a cause or contributing cause or exacerbation of; PTSD, Anxiety, Eating Disorders, Depression, Phobias, Suicidality and Suicide, Cutting/Self-Harm and many other conditions.

We’ve talked in earlier posts about how that doesn’t diminish the very real and medical ‘illness’ of mental disorders, and just because an act pushes someone toward feeling a certain way, does not decrease the legitimacy of the illness part of any mental disease. Illness can and is caused by trauma, and there are few things more traumatic to a girl or woman (or boy or man) than rape.

Perhaps though there is one thing worse and that is not being believed, or the act of rape being diminished or ignored.

I hope most of you have watched The Hunting Ground, a documentary on Campus rapes here in America, but if you have not yet, and you have children, know college age kids, or people who work on campuses, it is compulsory viewing not to be missed.

Ultimately the numbers of rapes committed in any situation are underreported, under prosecuted, and not punished. Some judges do not believe a rapist should go to jail. It is often said ‘but he’s such a good boy and he has his entire life ahead of him’ and this stands as a perfectly reasonable explanation for not giving a rapist a harsher sentence.

The other big let-down as far as rape in the legal system goes, is that rape has a statute of limitations and thus, if five years pass and you do not report your rape you are not protected under the law anymore and cannot prosecute your rapist. This is not true for many other crimes including murder, and financial embezzlement. In other words, you can prosecute someone for stealing from you years later, but you cannot prosecute someone for raping you after a certain time period. Great message you’re giving the survivor!

In the interest of fairness, it should be pointed out this exists because the likelihood of having proof after five years is diminished and it is to protect those falsely accused many years later. But that relies upon a significant swath of false accusations and assumes that proof must exist to punish a rape rather than taking the word of the survivor. Therein lies the rub. It is a difficult subject to prosecute when it’s one person’s word against another and historically women have not been believed over men who were upstanding and respected in the community. So if you’re a prostitute and you are raped by a politician, don’t expect anyone to believe you.

Maybe we cannot do enough about this to change it entirely, but speeding up the rate of prosecution cases, ensuring all rape kits are tested (when so many lie untested due to lack of funding) ensuring the survivors are not ‘blamed’ during their legal ordeal, and educating everyone about the low figures of false reporting, may make some difference.

As with anything we can find examples of those who cried wolf, but that is literally true of anything human. It is singular to rape survivors that they are accused of ‘making it up’ as if everyone involved knows of 1000 x cases of liars who pretended they were raped for whatever gain. We should as we do with ‘innocent until proven guilty’ assume someone is likely to be telling the truth when they pluck up the courage and report being raped. If nothing else, something is wrong.

No more so than on campuses across America today, where so many young people are raped and do not report it knowing it will not go anywhere, or do report it and find those who raped them are not penalized sufficiently because they are a star football player. This inequality of punishment needs to be eliminated because what you are effectively saying is, you are not worth as much as the rapist or we do not believe your rape mattered enough to punish this person.

Sometimes I have heard people say ‘she’s too ugly to be raped she must be lying’ and awful things like that. I had one person told by a police officer that because she admitted she was gay, she had obviously chosen to ‘try the other side’ for the night when she was dragged along the street at night and raped by a stranger in an abandoned warehouse. Sure. She wanted it.

Seeing why people who survive rape, are at high risk for some kind of short-term mental illness or at high risk for exacerbating a pre-existing one, is obvious when you look at the details of what someone really goes through. The aftermath of rape is nearly always the worst part. We need to bring our ability to empathize and our compassion to the table and treat all rape cries seriously.

I have worked in two Rape Crisis Centers and the second one I worked in, only prosecuted a handful of cases via the authorities, due to the enormous back-log of DNA testing (rape kits) and the desire of the authorities to plea deal rather than prosecute. Let us not forget a plea deal is often a free pass for a rapist and his offense is often knocked down to a smaller crime that will not indicate to someone looking at his record, that he is a serial rapist. Typically those who rape do so again and again, so if we do not incarcerate them, reeducate them and rehabilitate them if possible they will go out and do it again.

Likewise those who are beyond our help are still let out onto the streets along with paedophiles whom they know will re-offend it’s just a matter of time. How does this happen? How can we justify this?

For those survivors who tell others that they were raped, it is on our shoulders to be as supportive and gentle as possible with someone who confides in us. So often rape is a subject of humor and fun making and there is literally, nothing funny about rape.SAAMP2017 (SM)7

https://merrildsmith.wordpress.com/

https://www.rainn.org/

National Sexual Abuse Hotline: 800-656-HOPE

How to respond to a survivor: https://www.rainn.org/articles/how-respond-survivor

 

Mental Health Month “Inferiority”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Mental Health Month “the invisible mentally ill”

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

why don’t you just get some help?

therein lies the rub

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

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

Why aren’t they counted?

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

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

It was a brain tumor.

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

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

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

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

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

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

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

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

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

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

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

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

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

So feeling isolated breeds more isolation in effect.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mental Health Month

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

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

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

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

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

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

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

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

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

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

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

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

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