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Tag Archives: anxiety

An Illness In The Family

 

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Periodically, most often prompted by crisis, mental health pops up in our cultural conversation. Pundits point out the obvious flaws in our care system, medical professionals speak of conflicting and vague diagnostics, and some families share heart wrenching personal tales. This flurry of post-crisis activity is actually a microcosm of the complex issues of mental health care: People state the obvious, others admit to the complexity and the people in need are suffering.

Family members (and by ‘family’ we mean everyone who shares love) are often in the direct line of fire of mental illness. Their lives can be upended by the illness of a loved one and their every moment consumed with pursuing effective care. It is those closest to someone ill who will witness and be subjected to troubling behaviors. And unless the ill person is a minor or the behaviors so blatantly outrageous, it is difficult to judge when it’s appropriate to intervene and to what extent. We are a culture that holds personal freedom and autonomy in the highest regard. And while we like to tell people what to do with their lives in the abstract, we shrink from doing so in reality. We don’t want to unnecessarily offend and even if we did, it’s difficult to know what to say or do. It might be helpful to think of behaviors and approaches categorically.

Danger to self or others – There’s no wiggle room here. Our society has agreed that impending physical harm trumps personal freedom. While the “danger to self or others” definition is meant to be applied in crisis, the philosophy applies more universally. When asking ourselves; “Is it time to seriously intervene?” we can use this statement as a guide. It is time to move on from nagging and/or cajoling a family member to eat when you see/feel that their weight loss is dangerous. If someone is driving when drinking, passing out and/or injuring themselves when drinking, they are a danger. If someone cannot get out of bed and has vulnerable people in his/her care he/she is a danger. The question to ask when making this judgment is; “Is someone going to get hurt?”

In crisis is probably the most common presenting challenge. There is no immediate danger but instead a person who is simply not well. For the most challenging mental illnesses (i.e., schizophrenia, bi-polar, personality disorders) a state of crisis is a common occurrence. For people faced with depression or anxiety, crises can be one-offs or few and far between. Depression is a real and debilitating illness, it should not be confused with sadness. Being sad is prompted by incident: a death, a world event, a hormonal event all can trigger sadness. Of course these events can also trigger depression. The key is how long is the darkness lasting and has it changed the very nature of the individual? The same is true for anxiety. When a response to real and present danger morphs into sustained hyper-vigilance it is not serving the individual well.

Intervention – Erase any image you might have of corralled family members confronting someone while shakily holding index cards. It’s a powerful scene for television and movies but is flat out surreal in real life. If there are other caring people who can assist in getting the person in need appropriate care, so be it. But folding chairs and prepared statements are not necessary. If the person is in crisis (danger to self or others) they need immediate professional assistance. If someone has demonstrated a desire to hurt themselves or others they can and should be hospitalized and treated until they are stable. If the person in crisis is compliant you can take them to an emergency room yourself. If they are violent the police will help them to the hospital. *Note: It is best to assume that each and every threat of harm is valid. There is nothing to gain from assuming someone is crying wolf. If nothing else the emergency room staff will become more familiar with the person in crisis and be able to provide more specific care with each return trip.

For people not in crisis, intervention can be a hairy and anxiety provoking business. Every situation, relationship and individual is different. There are no universal guidelines on what to do, but there are some pretty clear guidelines on what not to do. Do not make it easy for someone to not get help. Do not take on the role of amateur therapist. Do some research and find a therapist in the right price-range (any doctor’s office, school, women’s health clinic, or divorce attorney will have referrals.) When the individual seeks to emote or purge have a contact number on hand and take full responsibility; “I want to help in a meaningful way, I’m your friend/family but not a therapist.” If an individual refuses professional help do not abandon them but do not engage in the fiction (i.e., “it’s just a phase, the season, pesticides, politics, etc.) Keep in mind that they are not entirely themselves and may not be the most reliable narrator. Bring them into the world (perhaps kicking and screaming.) Do not sit by their side and watch television. Go for a walk; remind them of the world they’re missing out on. Do not lose sight of the goal of professional help. Do not give up until you’ve exhausted every argument and yourself.

Someday we will treat mental health as we do dental or physical health. Blame and shame will dissipate and systemic effective care will be available to all. Family (in all its definitions) will always be at the front, but in time they will have proper support. There simply is no sane alternative.

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Posted by on January 7, 2013 in Cultural Critique, Well-Being

 

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The Stigma of Psychopathy

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It’s fascinating to consider how our attitudes change over time. It is almost amusing to flip through a magazine from more than 40 years ago. Advertisements, editorial content and choices speak volumes about our priorities and concerns at the time of publication. Old movies also tell us much (often in the guise of propaganda or by virtue of what’s left out of a story.) While it’s doubtful that any newlywed couple ever slept in separate twin beds it is for certain that Hollywood wanted us thinking so. A study of older cinema is illuminating in what it tells us about what people held dear and what they scorned. Some of these values are practically foreign to many of us. You might need a crib sheet to understand the subtlety of a woman scorned for working outside the home, or the degenerating effects of a broken home. You may very well need to hit the pause button to consider what exactly ‘ruined’ a woman or what a ‘deserter’ was and what it supposedly said about a person.

How intriguing that we once felt so strongly about issues that have lost their power to shock or hurt. It must be a sign of some sort of progress? Our attitudes about marriage, relationships, parenthood, working, religion, and the public versus the private world have changed drastically since married people were shown sleeping in twin beds. If they choose to be relevant, media (in all forms) must somewhat reflect the realities of the time. Slowly but surely families are depicted as the freeform drawing they often are, rather than the coloring within the lines they might have once been. The melding of the public and private means most of us now know far more than we care to about strangers. Diseases and ‘conditions’ that were once private, feared, or barely noted, are discussed in loud outdoor advertising voices. There really are no private parts anymore. Except one: the mind.

Mental illness, despite all of our progress is still quite demonized and stigmatized in our media. Certainly we can all comfortably bandy about pop-psycholoigy terms. We could probably rattle off the names of a handful of medications for depression or anxiety. Thanks to reality television we think we know what obsessive compulsive disorder is. What we know and what we’re comfortable discussing is cocktail party chatter. Any mental illness serious or complex enough to not warrant a television commercial, magazine advert, awareness campaign or walkathon is a no-go zone. Shrouding mental illness in shame in secrecy only fuels our misunderstanding yet we hold onto this attitude.

When the newsreader intones (in sotto voce) “The suspect sought counseling” we get the message: ‘Oh, he/she is crazy.’ (For the record you know what’s actually crazy? Thinking you’re not crazy.) The toxicity of this message; 1) seeking help for mental health is suspect 2) mental illness is synonymous with criminality is the very definition of stigmatization. The only thing all criminals have in common is that they committed a crime. Mental illness takes many forms and very few of them involve any violent behaviors. People with illnesses are much more likely to hurt themselves (passively or actively.)

It’s the ambiguity of mental illness that is at the core of these attitudes. The mind is confusing. It is difficult to talk about personality disorders in 60 seconds. Many mental illness can be quite complicated and often incurable. A true understanding of the subtleties and complexities is probably best left to the professionals. But we don’t need to understand something to accept it. What we need to do is rebrand mental illness. Newsreaders think nothing of loudly broadcasting starlet rehabilitation for drug addiction or eating disorders (psst: nice lady reading the teleprompter – addiction and eating disorders are mental illnesses.) We speak publicly and loudly about post-traumatic stress disorder and post-partum depression (mental illness, mental illness.) If all mental illnesses were called by their proper name(s) perhaps we could shed the shame. Words are powerful (just think of all the ones you no longer feel comfortable using.) Once mental illness is seen as diverse expansive and existing any and everywhere, we can celebrate and support treatment in a meaningful way.

 
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Posted by on December 10, 2012 in Media/Marketing, Well-Being

 

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Putting One Foot In Front Of The Other

Life is not a spectator sport. Life is to be embraced, battled, survived and celebrated. Yet there are times (perhaps long stretches of them) that life is barely tolerable. The world, if it must exist, is best viewed from under a blankie from the vantage point of the couch. There are variations on this lookout. Perhaps a box of Cap’n Crunch (crunch berries optional) is involved. There may be an 18-hour background chatter of Law & Order employed. The constant of course is the elastic waist pant. No respectable day of sloth can be had in real pants.

Self-imposed solitary confinement is nothing to aspire to, but it’s not shameful either. One need only be concerned if frequency or duration increases (like an erectile dysfunction drug side effect; after four days one should seek medial attention.) If we are relatively healthy people, our forays into fleece and foods of childhood are sporadic and strangely motivating. But what of the everyday less-than-fleece malaise?

If life is lived with any participation: sh*t happens. Things come up that are not of our own making and that make us miserable. Even good things (new; jobs, projects, relationships, etc.) can make us feel overwhelmingly uneasy. Dread, misery and anxiety are often lumped into the category of “stress.” Since “stress” can also result from happy things, we sill stick with specifics; dread, misery and anxiety.

  • Dread – Channel your Scarlett O’Hara
    • Don’t think about it until tomorrow. Dread is one of the all time biggest thieves of happiness there is. Weeks will be wasted dreading an event that at most will encompass 24 hours. Each time a lump in the pit of your stomach starts to form, grab your phone, notebook, slab of stone and write down your specific concern (i.e., my cousin-in-law will use the funeral as a platform for subtle anti-Semitic rhetoric) and go back to the business at hand. Trust that the specific concern has been properly mulled.
    • Focus on getting back to Tara. Yes that root canal or colonoscopy is going to be wretched. Nothing will change that. Focus on what you will do after the event (and after the narcotics wear off.) Plan something enjoyable.
  • Misery
    • Awful things happen, that is the burden of survival. Disease, death, desertion are often unavoidable. Sadness and often mourning is wildly appropriate, but should not become a lifestyle. There’s really only one way out; take a shower. Get up, put one foot in front of the other and fake it ‘til you make it. Pretend you are functioning and before you know it, you will be.
  • Anxiety
    • High anxiety (as it relates to a state of being not a Mel Brooks’ film) is a very uncomfortable state. Sustained non-specific anxiety (not related to an event) warrants medical attention.
    • The remedy for event specific anxiety is often directly related to the event:
      • Public speaking? Rehearse, rehearse & remember that most people aren’t really listening
      • Job interview? Research and keep in mind that you are interviewing them as well
      • Blind date? Have an exit plan
      • Socializing with people you do not know? Think of yourself as Jane Goodall and discover everything you can about these people and their ways

Often the best way out or through is to consider what we’d advise a friend. Most likely we would not encourage a friend to perseverate, we’d encourage them to get up and get out. We would lift the afghan from their shoulders, brush the crumbs from their chest, wipe the melted ice cream from their chin and whisper; step into the sun, step into the light.

 
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Posted by on September 30, 2012 in Well-Being

 

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