Beyond Recovery to Healing

I Have Long Been Concerned …

gail louise Beyond Recovery to Healing, Real Life; Real Challenges, Shame

I have long been concerned with people who have mental illness and need care, but don’t recognize the need for treatment. Civil commitment (involuntary psychiatric care) can result if the circumstances dictate. But such involuntary care is controversial. Indeed, I have been conflicted about it for many years.

A personal experience has made me examine the issues involved with civil commitment square-on.  My father had involuntary psychiatric care when he was committed to a mental hospital in the 1950s. He always spoke negatively of the experience with feelings of anger. He was dangerous to himself at the time, threatening to shoot himself with a shotgun. One thing is clear however, as episodes of major depression reoccurred over the 1960’s, 70’s, and so on, he never sought help. He relapsed, got more depressed and Instead of getting care and treatment, he would attempt to take his own life. Surviving these suicide attempts, he would cooperate with the offered mental health care…. for a while.

In the 1950s, it was weak to be mentally ill and weak to be treated. I have always wondered whether the experience of forced care, of involuntary care, hurt and shamed my father so much that it clouded his otherwise good judgment.  Did it, finally, interfere with Dad’s asking for more help when needed?

To help me grapple with the issues, I’ve just completed reading the  book, “Committed, The Battle Over Involuntary Psychiatric Care,” written by Dinah Miller and Annette Hanson.(2016) Both writers are physicians.

In their research and writing, Miller and Hanson sought to refocus mental health professionals and others to consider this possibility: “Involuntary psychiatric care may be damaging. It may never be appreciated and the fear of forced care may prevent people from seeking help.”

The book presents a rounded picture of involuntary care. (Many times only one side of the story is featured.) I appreciated the fair handedness with which the authors addressed the issue. They interviewed former patients who had been helped as well as those who had not been helped by the process.

One of the biggest take home messages I learned from the book, was that even people who had been committed and HAD been helped found the experience to be traumatic. That was troubling to learn. Active mental illness itself is traumatic. We are talking about people living enduring a double trauma .

Hanson and Miller made the following recommendations:

  1. Encourage people with psychiatric disabilities to prepare an advanced directive. In the document it is possible to specify which medications are preferred, which facility one is to be admitted to, and even who should care for the person’s children during a hospitalization.
  2. Train inpatient and emergency room staff/personnel in the use of verbal de-escalation techniques.
  3. Crisis intervention training (CIT) should be mandatory and routine for all correctional officers and all state and city police forces. (Currently, these trainings are limited to a handpicked or volunteer teams of specialized officers in some locations.)
  4. Handcuffing patients who are brought to hospital by police should NOT be a standard practice..
  5. Support creation of mental health courts and pretrial diversion services to shorten incarceration times pending trial and to tie a defendant closely to needed community services.
  6. Expand use of mobile treatment teams, assertive community outreach, crisis centers, peer support services, patient directed initiatives, and a variety of housing options.
  7. Suicide hotlines should be made available to everyone and widely publicized. (Hotlines are available now but patients/clinicians are often unaware of them.)
  8. Increase efforts to detect serious mental illness in the early stages. Specifically: more training of primary care physicians and other non-psychiatrists so there is better recognition of when referrals should be made to psychiatrists. If mental disorders were recognized and treated earlier, involuntary treatment could often be avoided.

In 2018, we’ll examine some of these issues.

I appreciate your readership,

GL

Christmas, 2017

gail louise Beyond Recovery to Healing

I’ve been in a far better place during the holiday season these last few years than I was for most of my adult life. My expectations for a celebratory observance were too high, and I and my family suffered. I wanted everything about the Christmas holidays to be perfect: my family, my home and myself. I thought I had to be perfect and put together a perfect feast, with the house looking spectacular and our children fresh and bright and attractive. Buying and wearing new clothes was essential.

I thought perfect was happiness.

I thought perfect was a requirement for having a Good Christmas for myself and family.

I thought that perfect meant I was a good person. My family had to be ideal.

I longed for perfect.

Trying to achieve the perfect house, feast, children and all things Christmas meant control. And I tried for control with my family and house and self at Christmastime.

Actually, exerting control to achieve perfection took a toll on all of us. At times our household was a rigid environment with my husband Jim and our two children walking on eggshells. My family suffered and so did I.

I believed in perfection and believed that if I was perfect my mental health would be more resilient and my depression would improve. Control and perfection were needed for survival.

Surviving Christmas season is not living with affection, gaiety and joy. Or with thankfulness. Yes, Christmas can have hard portions for us all but not be hard throughout. Generosity of spirit, thought, word and deed were and are not possible when one’s efforts are centered on achieving control.

As I recovered my mental health the holidays became more loving, spontaneous and satisfying.

The wish for control hasn’t left me altogether, but I give control its due place. And positive cognitive and behavioral techniques help me manage the impulse to control and subdue the impulse inside me that demands I seek control.

I wish you too can share contentment, comfort and joy this Christmas and throughout the New Year.

Take care and thanks for listening. Gail Louise

Again.

gail louise Beyond Recovery to Healing ,

It’s happening again … I’ve figured it out now.

Days being near tears; a thunder cloud on my horizon.  A deep down sadness, a grief, and an ever-present fear of losing control.

I figured out what was happening to me.

IT has returned, although this year I thought my sky would remain clear until April and Spring arrived.

I have a full season to go before spring. If my seasonal depressive disorder doesn’t respond to fixes, it will be a long time to be mentally and physically at risk.  A long season trying to swim, to stay above water, to keep afloat.

Seasonal affective disorder, or SAD, troubles me most every fall and winter. You may be surprised to know that, even now, I don’t recognize it until the sun goes down on autumn.  My emotional health was trouble free and my days filled with everyday pleasures when the doom returned, and I finally figured it out.

It’s my old nemesis, Seasonal Affective Disorder, that’s got a grip on me.

SAD. Sad, so what do I do?

Well, it is not that I don’t like winter, quite the contrary—–I do like winter and many of its milestones. But if I do not practice the therapeutic responses I’ve learned, the darkest season gets pretty grim. Thanksgiving, Christmas, first snow and bright clear winter days – pleasurable milestones all – fail me.  I become depressed.

So, what do I do?

The depression may or may not respond to medication changes. I must also employ some practical adjustments.

I remind myself to deliberately pay attention as the season changes. I celebrate the fall turning of leaves. (This year the oak’s leaves were quite handsome.)  I roast hot dogs and marshmallows over an open fire.  And I plan a lovely harvest feast, inviting those near and dear to me.

Gratitude. One activity that helps fight SAD for me, is writing out a list of the things I am grateful for. Yes, construct a deliberate list, written out on paper, and do it as often as needed.

Number one on the list is Jim, my husband with his endless love and support. He is followed closely by our two children who nurture me with more love and support.

The list continues. You might guess what is next. Our grandchildren, a welcoming home, and a good appetite for literature and dining.

The idea is to express this gratitude in acts:  This year I’ve decided to host a Harvest feast.

We are having bison, a wild rice casserole baked in a pumpkin, and skillet blue cornbread with local honey. And I found a refreshing salad in one of my Native American cookbooks. (Yes, I collect cookbooks – and I’m grateful for that passion too! The Strawberry and white corn salad is out of season but I am going to serve it anyway.) Next Saturday we will all gather and rejoice in one another.  Thus, my gratitude is made visible to me.

How will you celebrate the passing of fall into winter?

What to decrease: four things that hinder mood disorders

gail louise Beyond Recovery to Healing, On Support

“There are a few things you can do that improve mood problems, and a few things you can do that make them worse.”
– Bipolar, Not So Much, Chris Aiken, MD and James Phelps, MD

As doctors Aiken and Phelps explain in their book, mood disorders affect family and friends.  Moods are catching.  And yes, you may find your friend or family member’s mood is contagious.  In my last posting I talked about things their book recommends to enhance communication; such as showing emotional warmth, being emphatic, and making positive comments, etc. (Read my March 14th 2017 post, “What to increase: four things that help mood disorders” to refresh your memory of the those helpful tips.)

Today I will emphasize the “…few things you can do that make them worse.” The authors explain that the brain is wired to react to negative events more than positive ones, so it is important to decease interactions that I talk about below.

But be patient with yourself!  What matters is getting it right most of the time.

INTERACTIONS TO DECREASE:

One. Beware Critical Comments (These are comments that point out fault and pass judgment. Sometimes they are criticisms aimed at suggesting poor motivations.)

It can be difficult, but watch the use of the word “should” in your mind and words, say Doctor Aikens and Phelps. They continue, “…try not to communicate that things ‘should’ be different. They aren’t.”

Look at your expectations, and ask: Are they realistic? If your loved one is having an episode and you haven’t lowered your expectations for now, you may need to. Critical comments spring from a mismatch between ideals, expectations, and reality.

The authors make a great suggestion, “If you cannot lower your expectations on an issue (you are not alone in that), lower the frequency with which you remind them about it.” Dr Phelps and Atkins recommend you schedule weekly opportunities to talk about your concerns rather than bringing them up unexpectedly throughout the day.  “The brain follows a psychological law called intermittent reinforcement, which means it reacts to random comments as though they are happening all the time.”

Rather, check in with your loved one! You are encouraged to ask about ways you may come across as overly critical. “Bringing this up at the weekly meeting can keep them from feeling like it’s a weekly complaint session with them as the target.”

Two. Avoid Scrutinizing Moods

While you want to monitor for relapses when someone is in recovery, too much focus on this may come across critically.  The authors recommend, “In general, you should respond to your relative’s emotions just as you would to someone who never had a mood disorder. Don’t be too quick to evaluate whether each emotion represents a new episode or medication reaction.” Again, the medical doctors  recommend asking: Ask your loved one how they’d like you to share your observations.

Three. Be Careful of Overinvolvement

Overinvolvement can happen innocently and unintentionally.  You want to take an active role in your relative’s recovery.  While it is a natural and caring reaction,  too much involvement can stress your relative. The authors state ”Mood disorders can cause people to feel guilty, controlled, or like they’ve lost their self. Overinvolvement from relatives can intensify these feelings.” Strive for positive support.  There is a fine line between positive support and overinvolvement.  For example, driving your son to his psychiatric appointment is supportive when he’s too depressed to start the car.  But the same action can be overinvolvement when he’s entering recovery.

Another hazard: it is easy to get hooked on the ups and downs of your loved one’s mood, trying to determine if what you did that made the illness worse or better. You may be taking on too much of the responsibility and burden for the illness on yourself.  Remember: But be patient with yourself!  What matters is getting it right most of the time.

Four. Steer Clear of Hostility

To avoid hostility, the authors write, watch out for beliefs that blame your loved one or that question their motivation. Dr. Aikens and Dr Phelps  cite the following examples:

  • “He wouldn’t be like this if he tried harder.”
  • “She doesn’t want to get better.”
  • “She just wants an excuse for her behavior.”
  • “He may have a disorder, but he has more self-control than he lets on. I’ve seen him change around his friends—-he’s like a totally different person with them.”

This last example is particularly important. The experts write that when someone has a mood disorder, their worst face usually comes out at home or with family. “This tendency for symptoms to vary in different settings causes two problems. One, it makes the family think that their relative with mental illness has more self-control than they actually do. Blame and hostility follow. Two, families are prevented from seeing how their relative is improving.”

Beware Critical Comments. Avoid Scrutinizing Moods. Be Careful of Overinvolvement. Steer Clear of Hostility.  Whew!

In the last two blog posts, we reviewed both interactions to increase and those to decrease. The Interactions we discussed here have been given as guideposts to family and friends.  However, they are guideposts and suggestions only, not a guide to perfect care. Dr Aikens and Dr Phelps remind us that what matters is getting it right much of the time. They clarify, “It’s the frequency and duration of your actions that matter to the brain; just as the skin is affected by how long it’s exposed to the sun.  …Focus on the basic principles above and respond to the rest with grace and acceptance.”

What to increase: four things that help mood disorders

gail louise Beyond Recovery to Healing, On Support

I have been reading a very good book this spring, called Bipolar, Not So Much written by two practicing psychiatrists, Chris Aiken, MD and James Phelps, MD.  Published in 2016, I found it to be very readable, interesting, current and best of all, hopeful for individuals with a depressive mood disorder and the friends and family who love them.

Mood disorders are now seen to form a spectrum of problems, from depression on one hand to full bipolar disorder on the other. Dr Aiken and Phelps write that between the two are multitudes of people who are in the middle of the mood spectrum, and this book is for them.

There is much to value and recommend here. This is not just another book on bipolar illnesses.  While the authors write of the basics of depressive mood disorders, they also help readers learn where they fit on the mood spectrum. There are treatment recommendations and they include discussions of medication as well as recommendations on diet, exercise, and a guide to non-medication treatments that anyone can use on their own. Information is included on a number of innovative technologies that can aid in recovery including dawn simulators, mood apps and blue light filters.  The authors willingness, indeed, eagerness to present these new technologies and their recommendations, illustrate some of the value and benefit I found in the book; good advice backed by citations referenced for our use. Plus, most references were very current, including 2016 studies.

My favorite portion of the book is the section Reclaiming Your Life:  Relationships.  Work and school.  Friends and family. Their advice on communicating with someone who has a mental disorder is right on, from my perspective as a person with a mood disorder. And as a person who deeply values her friendships and her relationships with friends and a family with mood spectrum illnesses.

Their advice is direct and candid and worth hearing. I am writing this day to share a selection of the good advice with you.

 

INTERACTIONS TO INCREASE:  (The writers note that each of the interactions below has a positive effect on the brain, and sprinkling them throughout the day can speed recovery.)

One:  Convey emotional warmth, which you do by having a gentle smile, compassionate eyes and an accepting posture. When you do so you are giving the message that you are genuinely interested and pleased to see them. Dr Aiken and Dr Phelps point out that the voice is soothing, movements are relaxed and gentle, without pressure. This body language telegraphs that you accept things as they are. They write “in its most profound form, warmth is the gleam in a mother’s eye that conveys unconditional love.”

When someone shows me warmth, I feel welcomed, accepted, safe, and yes, more willing to converse.

I’d like to add, pair warmth by saying to people “Nice to see you.” This phrase is much more inviting than: “How are you?”  The traditional question we ask – how are you – can put people on their guard   wondering just how much you want to know, if anything.  Try the greeting “Nice to see you.” I think you’ll get warm response.

Two:  Be empathic. Accept people without judgment. When we use empathy, our speech shows that we wish to understand and appreciate them rather than change them. Doctors Aiken and Phelps, MD, say “Empathy doesn’t mean you feel the same way they do, just that you understand them or at least seek understanding”. Furthermore, they advise: “Empathy goes hand in hand with emotional warmth, and both have a healing effect on mood, in part by reducing the isolation that mood episodes bring.” Try responses that communicate your empathy, like “I see your point,””I get it” as well more specific ones like: “It must be hard to go through the motions each day when you’re depressed.” Or, “Though I’ve never been through the kind of depression you’re having, I can tell it is a terrible place to be and you certainly don’t deserve it.”

Three:  Positive comments also help family and friends recover from depression. Make the comments accurate and specific, such as “I appreciate how you put the kids to bed last night.”

Doctors Aiken and Phelps reminds us, “WHAT YOU SHINE A LIGHT ON IS WHAT WILL GROW.”  They suggest that you retire from being a problem-solver, fixer and psychiatric detective. Instead make it your job to search for anything about your loved one that is not consistent with a mood disorder.  The good doctors   continue, “ Shift your attention away from the illness. If they oversleep, ignore that. Focus instead on the fact they he/she got out of bed—many depressed people never take that step.”

Four:  Optimism about the illness is something friends and family need to communicate. Depression robs people of hope and causes them to blame themselves for the disorder. If you live with someone who has depression, Drs. Aikens and Phelps warn that you not let yourself fall into that same trap.”

They write with urgency, “Always remember that the manic and depressive behaviors are what they have, not who they are ……. Instead of sleuthing for pathology, your efforts will be better spent recalling how your loved one was before the episode, and relaying the optimism that they’ll be that way again.”

I am in complete agreement with their advice here. But I urge that your optimistic responses not be “all this will soon be just a bad memory.”  Rather convey your unshakable belief in who they are, and relay the optimism you feel that they will recover that self once again.

 

We’ve just reviewed some of Drs Aiken and Phelps advice under their banner “What to Increase.”  They have much more of this good, down–to-earth advice. A next section highlights: “What to Decrease, five things that harm: Critical comments. Scrutinizing mood. Trying to win or resolve arguments. Overinvolvement. Hostility. I will present their observations and recommendations on “What to Decrease” in my next posting.

Notes from Working with a Psychiatrist

gail louise Beyond Recovery to Healing ,

I see my psychiatrist once every month, minimum, no matter how busy or how well or how poorly I am feeling!  Over the years, these regular appointments have proven their worth to me.  Recently I’ve been feeling very well – but I met with my psychiatrist anyway and we had a fruitful satisfying appointment. Just as I normally do, I’d made a list of items to discuss with her. Some of them: Updating her on a change in how I was taking my prescribed medications.  A a summary of how I have been feeling coupled with a description of my functioning this past month. And so on.

She welcomed me warmly and waited for me to start the conversation. I was able to tell her that I’d been feeling very well since our last appointment.  As we went on talking, I told her how I had managed my mood and anxiety during the challenges of Christmas and December. I had been calm, collected and in a good mood. Christmas has always been a most difficult time for me, but this year, wonderfully, I had enjoyed the holiday season with family and friends. How I feel during the holidays is a very good indicator of my brain health!

I went on to say, with enthusiasm, that I was optimistic and excited for the year ahead. To be able to say optimistic is another Very Positive Indicator of my mental health status. I also continued to be grateful for and satisfied with our move to a new house in a different community this past summer.  Before we moved there had been several months of exhausting nervousness and anxiety in anticipation (dread?) of the move and its upheavals.

I also told her of my good success dealing with a change in my medication regime. The mood stabilizer I was using had caused me to fall unexpectedly sleepy while driving.  Consequently my husband often drove for me, as he and I had decided the sleepiness was a danger to others and to me. So we wanted to stop taking the med.  I am now able to drive without sleepiness, and as a result driving has again become a pleasant, safe task.  Now my psychiatrist and I are thinking of decreasing the number or the amount of medications I take. Scary, for sure, but another plus!

Why then do I continue to see a psychiatrist: to help me with the inevitable bad days or circumstances; to check that a bad day or two doesn’t become a trend; also for medication reviews, and for affirmation of my own understanding of my mental health.  Lastly, for the great comfort that, should a trend develop into a full blown depressive episode and I become seriously, dreadfully, sick we will both be on top of it.  My psychiatrist, reflecting the caring professional that she is, will be ready to prescribe new therapies, new medications, new approaches and give me hope. I have a real respect for this doctor and a great deal of faith that together we can find workable treatments for me, no matter the challenge.

Thanks, GL

The Depressed Voice Doesn’t Sing

gail louise Beyond Recovery to Healing , ,

My Dad had a beautiful voice (as did his father, my grandfather), but he never sang in a choir. He loved song. We heard the love of song come flowing out at times, though that was unusual except during Sunday church services. I believe the love of singing and a voice to sing with was there in him.  That love and that voice was passed on to his children, three of whom sing in choirs regularly. I’m crying now, for his children get so much joy from singing.  My father with reoccurring major depression missed a world that brings so many rewards to his children and to me.  A world of joy, beauty and companionship.

As a child, I asked Dad,” How about joining the church choir?” His response was to look grave, shake his head no and say “No, I can’t read music”. It seemed as if I had asked him a really distant question. Singing in the choir seemed to be for those who deserved to sing, who were good enough (as persons) and who had friends in the choir. There was no possibility in his mind for him to join choir.

But he would have been welcome.

You see, despite the potential great reward, the risk may have been too high for my father to have sung in a choir. Risk? Singing in a choir? Yes, for Dad had high anxiety often, which is common with major depression.  The necessity of performing in front of an assembled congregation may have led to some real anxiety issues on Sundays. And something else, perhaps more subtle but more dangerous: Riding the waves of emotional highs and lows that are necessary to express when one sings the lyrics with meaning may have been too uncomfortable for my father. For there is no lack of opportunity to travel from the depths of despair to the heights of all grandeur and sublime to sweet simple unadorned joy when one sings good music. He may have been moved to tears when singing; even been unable to sing. When depression is near the surface, surging emotions are not safe.

And something else got in the way. Depression often blocks out the bearers knowledge that they have the talent to do something. “I’m not good enough” is a frequent negative thought and self-talk holding people back.

And yet singing brings great joy to many people and that passion for singing can lead to other benefits as well. Our singing brain is bathed in dopamine which brings feelings of pleasure and alertness as well as serotonin, another neurotransmitter associated with feelings of euphoria and contentment. I remember feeling that going to choir rehearsal at the end of the working day was a trying task, requiring a lot of physical and creative energy. But so agreed with a friend and choirmate who often remarked that he was dead tired and didn’t think he make it until the end of rehearsals. “But then,” he said, “something magic happens and I revive….it happens almost every time.”

Singing, I believe, can bring healing.

 My father missed this world:

The first track on Chanticleer’s “Out Of This World” CD (1994) is titled I Have Had Singing, and it touches me every time I hear it sung with such beauty for I know its meaning well. Here is the story of the song:

A book by Ronald Blythes Akenfield, Portrait of an English Village, recounts the difficult lives of the inhabitants of a tiny East Anglian village in Suffolk, England. In one interview, Fred Mitchell, an 85-year old ploughman, recalls his difficult childhood. When asked what they did for fun, he took a pause, then replied:

“I never did any playing in all my life. There was nothing in my childhood, only work. I never had pleasure. One day a year I went to Felixstowe along with the chapel women and children, and this was my pleasure.

But I have forgotten one thing —the singing.

(Here I insert the lyrics used in the composition)

“Singing, singing, oh the singing!
There was so much singing then!
We all sang, and this was my pleasure too.
The boys in the fields,
The chapels were full of singing, always full of singing.
I have had pleasure enough,
I have had singing.”

 

 

Personal Medicine. A concept formulated by Pat Deegan

gail louise Beyond Recovery to Healing, Learning to Hope , , , ,

As I was preparing my presentation (titled “Living Successfully with Depression and Suicidal Thoughts”) to be given at NAMI Wisconsin’s Family Programs Summit this November, I ran into the term “personal medicine,” meaning an activity that a person does to obtain wellness, rather than something a person takes. The term was introduced by Patricia Deegan, PhD, in early 2003 as a result of qualitative research she did through the University of Kansas – School of Social Welfare [The Importance of Personal Medicine: A Qualitative Study].  Upon interviewing individuals who were taking psychiatric medication, Deegan found that “When describing their use of psychiatric pharmaceuticals or ‘pill medicine’, research participants also described a variety of personal wellness strategies and activities that I have called ‘personal medicine’. Personal medicines were non-pharmaceutical activities and strategies that served to decrease symptoms and increase personal wellness.”

Pat Deegan writes: “Personal medicine is what we do to be well. It’s the things that put a smile on our face and that make life meaningful.” She continues “Many of us have learned that finding the right balance between Personal Medicine and psychiatric medicine is the road to recovery.” [Common Ground Toolkit and Recovery Library]

She cited three examples of personal medicine that work for her: playing with her dog, taking care of her daughter, and reading scripture. I jotted down six examples to begin with: parenting and grand-parenting, cooking and baking, singing, texting and emailing Rebecca and Benjamin, sending notecards to people, and writing. Oh -and reading is a ready seventh activity; it’s the way I start every morning! Listening to music, often at the end of the day, is an easy eighth.

Reading Pat Deegan’s research closely, I see she identified personal medicines as falling into two broad categories: those activities that give life meaning and purpose, and self-care strategies. Both types increase feelings of wellness and help keep psychiatric symptoms and/or undesirable outcomes such as hospitalization at bay.

Necessary personal medicine is sometimes serious work. There was a year in my life when I was moderately depressed. I felt I had to bake five days a week: I had to bake every day I was home alone, at the time between jobs, every day that my husband Jim was away at his work. I baked for three hours every day, minimum. Why? I needed to structure my time, to accomplish something and to knead and stir down pain and numbing thoughts. It was always a batch of chocolate chip cookies one day and bread the next day. This period occurred after the children were grown, so what we didn’t or couldn’t eat ourselves, which was a lot, we gave away.

I learned this lesson [Partners in Recovery – PIR, June 2010] from Ms Deegan:  “It is so easy to get lost in thinking that we are not good enough or that we are irrevocably flawed because we have a diagnosis of mental illness. But healing does not come from outside us; healing comes from within.”

Now I realize that at that time in my life I was using baking as a self-care strategy, without being alert to my decision to do so. Baking simply kept me on my feet, kept me “productive,” and stopped the grinding negative thoughts. The joy and creativity I normally found in cooking and baking was absent. No lofty thoughts occurred while the warm dough was molded under my hands. No images of Grandma or my Mother – my bread-baking teachers – formed in my brain that I can remember. No smell of yeast permeated my mind. I simply did the tasks and came out with good home-baked items.

Good home-baked items. And I did not deteriorate in my mental status. I improved with time, never needing hospitalization or respite care. There is something good and healthy in people with a diagnosis of mental illness. Medicine doesn’t only come from a doctor or a mental health provider team. “Discovering personal medicine is powerful medicine and connects us to the resilient, healing parts of ourselves.” [PIR]

Today, much of the time I spend cooking and baking takes the form of personal medicine that makes my (recovered) life sing with purpose and meaning. I love the seasonal foods and the celebrations that each represent. In our family, every spring, there is homemade cream of asparagus soup with a twist of lemon on the side. Summer brings ruby red strawberry shortcake with berries from the field and real whip cream, plus new leaf lettuce for many simple tasty salads. Then late summer taught me to appreciate warm peach cobbler. Fall is chili and beef stew and the first cinnamon apple pie. The December holidays are hot chocolate from scratch, my delectable Mustard Apricot Glazed Ham, baked sweet potatoes, and pecan pie. All this is done with flow and calm that brings a great deal of satisfaction and attention to detail. My mind and senses are stimulated and utilized in a very positive and reinforcing way. And my family eats well too!

May each of you find the personal medicine that connects you to the resilient healing part of yourself.

The Strengths Model: Meaningful Relationships and Reciprocity

gail louise Beyond Recovery to Healing, Chronic/SeriousMental_Illness ,

Reciprocity – and the mutuality it implies – is always present in a meaningful relationship……. Each participant sees themselves bringing something of value to the relationship.

Yes, to a relationship between a person with a mental illness and a mentor/other in a helping role. Listen to this wisdom gleaned from The Strengths Model: A Recovery-Oriented Approach to Mental Health Services by by Charles Rapp and Richard Goscha; their chapter entitled “Engagement and Relationship:”

View the relationship as an experience in Mutual Learning. Put the recipient, or the person with the mental illness, in the role as teacher. The mutual learning approach doesn’t only want to know a person’s diagnosis, for example, they want to know about a highly individualized set of experiences. The person being helped, when viewed as a teacher, enters an empowering role. As teacher he/she is engaged in meaning-making and self-understanding. The helper, by listening and learning, seeks to enter the reality of the person by knowing the objective conditions of their lives and their subjective experience of that reality.

Yet the reciprocity inherent in Mutual Learning is easily missed: When the friend/caregiver/mentor/professional is always the giver and the person with the mental illness is always the recipient, the idea is perpetuated that the helper always has what is most valuable. Most helpful relationships have a balance based on mutuality and reciprocity. Refusing offers of reciprocity — whether it is an offer of a cup of coffee, a small gift, or knitting lessons — may be as rejecting as outright stating to the person “You have nothing of value to offer this relationship.” And, as our authors  observe, such condescending behavior “….is downright unfriendly.”

It is interesting to note that actions refusing reciprocity can stay with one for a long time. Here are two examples: Both helpers were excellent psychiatrists and good doctors for me. Both provided me with therapy as well as assessment and medication management.

The first helper happened to retire just as I was beginning to experience recovery. This psychiatrist had been through moderate to severe depressions with me, many drug trials, hospitalizations, and had “seen” my children grow up. He was very helpful to me and I admired and trusted him. Today I think of him fondly and with respect. He got me on the right road to treatment and a progressive, wholesome doctor-patient relationship.

The problem in short is that he didn’t accept a small gift from me of two tickets to a University of Wisconsin Choral Union concert. I was performing in the Choral Union and this doctor had been a backer of my quitting smoking and learning to use my voice, once again, to sing. It was a milestone for me to sing in the University’s acclaimed choir under the well-known and highly regarded Choral Director Robert Fountain. My doctor thanked me for the tickets but mailed them back to me with an apologetic note. Even though our professional relationship had ended, he felt accepting these tickets in any form would violate the professional-patient code of conduct.

I understood, but I cried.

Recently another psychiatrist retired. I had been with this person a long while as well. Through my blossoming periods of experimenting with recovery and hard times as well. Through my periods of NAMI activism and Family to Family service role. Through the empty nest syndrome. There was also a period when Jim became clinically depressed, followed by a period of great doubt and casting about from which, with Mutual Learning, Reciprocity, and Respect, we have since grown and recovered.

This psychiatrist accepted my gifts, which were two. At our last appointment, I bought a picnic lunch, complete with tablecloth and picnic basket filled with delicious finger food. We enjoyed the food and each other’s company. We talked about her future and my own.

I also gave her a book, One Hundred Names for Love, a true story of genuine love in which the author, Diane Ackerman, recounts the challenges and victories she and her husband lived through following his stroke.

The book was appreciated and accepted as a gift. The lunch was relished.

I will always remember that last appointment. It was delightful, reciprocal in nature … and empowering.

The Strengths Model’s Focus on Meaningful Relationships

gail louise Beyond Recovery to Healing, Chronic/SeriousMental_Illness ,

In my last post, I wrote about the Strengths Model – a progressive attitude about mental health thinking, care and services put forward by Charles Rapp and Richard Goscha in their book The Strengths Model: A Recovery-Oriented Approach to Mental Health Services, Third Edition, 2012.

The first proposition of their Strengths Model is: “The quality of niches people inhabit determines their achievement, quality of life and success in living”.

Here I address an equally important principle underlying the Strengths Model: “People who are successful in living [with mental illness] have a meaningful relationship with at least one other person.”

As a person living with mental illness, I have been fortunate. I’ve had two relationships especially meaningful and empowering to me at most times throughout my adult life. One meaningful relationship was with my husband, Jim. We had the great good fortune of always being able to talk over the hard issues of mental illness. He was, and is, my sounding board and advocate, too. Important also to me was the relationships I’ve had with a succession of strong women mentors. Sometimes that second person was a colleague; sometimes that person was one of my psychiatrists, but a second meaningful relationship was nearly always there.

Why was that second meaningful relationship so important? At times I was unsure just how objective my husband could be. “Of course,” I might (and sometimes did) think, “my husband will encourage and believe in me; he is my husband.” Jim would “have” to be on my side. In the face of negative thinking, a second meaningful relationship was very helpful.

These Meaningful Relationships are characterized by a partnership which is Reciprocal, Empowering, Genuine, Trusting, and Purposeful. Partnerships that intentionally strive to avoid Spirit-Breaking words and actions and focus on Hope-Inducing Behaviors.

It’s also a partnership characterized by continuity in the face of struggle.

For little did I know then how many persons with mental illness lose the support, understanding, respect and love of those with whom they had meaningful relationships, as they progress through life.

I will continue to write about these special partnerships and their characteristics. For these are relationships that can ignite and fuel successful living with mental illness.