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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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The Race To The Cure

“28 days” has become shorthand for a detoxification program.  Perhaps you doubt me.  Perhaps you grew up only hearing “28 days” intoned by a distracted health & hygiene teacher while she directed her pointer towards an image evoking more cartoon bull’s head than uterus.  Trust me, four weeks (categorized in as days) means something else now.  Feel free to give it a test run and announce to your co-workers that you’re taking some time off; 28 days to be precise.  Then sit back and watch as one by one your office mates slide up to you and give you an awkward pat on the back, or shyly tell you about their own/their spouse/their parent/their child’s struggle.  Be prepared for the happy hour invitations to taper off as well.

28 Days” has become the normative addiction treatment time to such an extent that a movie was given only that title.  No subtitle was necessary; the masses knew exactly what was in store for Sandra Bullock.  But how in the world did we get to a point of this time period being synonymous with becoming sober?

Have you ever tried to cultivate a new behavior?  Perhaps you’ve quit smoking (if not, you really should consider it) or adopted an exercise program.  Maybe you’ve tried to modify someone else’s behavior, say, trying to get an infant to sleep through the majority of the night.  The first two weeks are hell.  Pure unadulterated hell.  Every morning brings the realization that; yes, you have to do that THING again.  At two weeks a change in diet is still feeling punitive and perhaps constipating.  By three or four weeks, the sulking starts to ebb and a begrudging buy-in takes its place.  By six weeks most new behaviors have found their firm footing.  Yes, you might still find yourself with a cigarette in your hand (perhaps at your high school reunion where you become a 17 year old trapped in a 42 year old’s body.)  But, by week six, your body and mind now have a sense memory and you have gotten past some unconscious triggers.  You can have a drink without smoking, finish a meal without smoking, etc.  It may always take effort to keep from lighting up, but it doesn’t take every cell in your body to resist.

Keeping that analogy in mind; how in the world is four weeks sufficient time to a) rid the body of substance b) discover why you use the substance c) develop coping mechanisms beyond using d) learn to be in the world without substances?  I don’t think there is anyone in the medical profession who would recommend such a brief treatment stint.  Six weeks might be sufficient time for some people who do not have multiple diagnoses (ex.; addiction + bipolar) or have not been addicted for too long a period.

Abbreviated treatment, whether 28 days inpatient or 6-10 therapy visits, is the brainchild of insurance companies.  There is no doubt that there are many many people who can greatly benefit from short-term problem solving based therapy.  But viewing all psychological conditions as the same is as nutty as considering every physical condition as equal.  A hospital stay for a tonsillectomy is not the same as that for brain surgery.

Addiction treatment is tricky.  Addicts are crafty folk.  Their relationship to their substance is the most important thing in the world to them.  The substance one is addicted to is not the issue.  Removing access to alcohol, drugs, starvation, for 28 days is meaningless.  Addicts don’t use because of how it makes them feel, they use to stop feeling like they do without it.  Helping someone to find comfort in their body, soul and the world without their substance of choice is hard work.  There are no shortcuts.  Four weeks is a significant time, it is.  It’s a long time to miss a traveling spouse.  It’s a long time to wait for test results.  It’s a long time to wait for an electrician.  But I don’t think it’s enough time to change the fundamental wiring of a human being.

 
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Posted by on May 3, 2012 in Cultural Critique, Well-Being

 

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What Would Bill W. Do?

Not too long ago, there was some media buzz about the efficacy of addiction therapy.  This is not a popular subject.  If one works in the rehabilitation (rehab) industry one is understandably resistant to any metric devices that might prove the methodology ambiguous.  Addiction is a very resistant phenomenon.  There are occasions, when a society of thinking people can agree, that lacking a 100% guarantee, erring on the side of empathy and care is optimal.  For some addicts, the simple act of stopping something in motion, is enough to change their lives.  Rehabilitation can be that barricade.

Addiction to alcohol, drugs or eating disorders has never seemed quiet or private to me.  I recognize someone in the throes of the phenomenon (whether they are using or not.)  People with a Faustian relationship with food are very obvious to me, and I completely understand the entertainment value of metaphorically playing with one’s food.  Of course, when it spills into passive suicidal tendencies, all bets are off.  It is torture to be in the life of an addict.  Addicts can be very unpredictable and by definition, not reliable (their primary relationship is to their addiction.)  Empathy can wear thin after multiple incidents.  It is helpful to remember that people use drugs, food, and alcohol to the point of personal destruction, NOT because the substances or processes are so tempting, but because without them, life would be unbearable.  In other words; drugs, eating disorders and alcohol work.  They numb and distract from an inner pain that for some people is devastatingly crippling.

Posh rehab centers are part of the American lexicon.  Most of us can rattle off one or two without thought (Hazelden, Betty Ford.)  Colleges and universities now address eating disorders via education campaigns, marketing (‘all you can eat’ dining have been replaced with ‘all you care to eat’ dining) staff training and additional counseling staff.  Certainly excessive/binge drinking (which can be an indication of alcoholism) has been the bane of higher education for some time (drug abuse, because of its inherent illegality poses more of a conundrum.)  Employers contracting with treatment providers has become de rigueur.  Clearly, there is treatment available for some.

But what of the veterans?  Veterans are returning, and mercifully will continue to do so in even greater number now.  They will come back to what kind of treatments and where?  This week it was reported that 1 in 5 suicides is that of a veteran.  Now, I’d be the first to say that NOT screening people for mental illness before enlistment is absurd.  But regardless, we have a problem here.  I don’t mean to imply that veterans (or anyone) who commits suicide is an addict.  Not at all.  But there is overlap.  Suicide, most often, is not a well thought out end of life plan, but an act of someone who feels they have no options.  Addiction is also the result of feeling there are no feasible options.  Teaching people to recognize their pain for what it is, and providing them tools to pull themselves out of that pain, is effective.  Rehabilitation, at its best, does just that.

So what’s our plan?  If rehabilitation is accepted by the wealthy, the educated and corporate America, as viable treatment for addiction, shouldn’t it be available to all?

 

 



 
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Posted by on October 12, 2011 in Cultural Critique, Well-Being

 

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