On Support

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.

The Unseen Disruptions of Living with a Mental Illness

gail louise Giving and Receiving Support

It’s early April as I write this – the evening of April 3rd, 2016, to be exact. Now the temperature has fallen back to around 42 degrees F. But it was a balmy 65 degrees when we were out walking the Aldo Leopold Wetland Management Area in Columbia Co. We were stretching our legs and taking in big healthy breaths of good Wisconsin fresh air. Relaxing, being contemplative, and Intent on the low key beauty of the marsh.

The many varieties of ducks we saw were not surprising and neither were the geese, but the eagle! The eagle was a special gift and unexpected. It soared far above us in the clear air and we delighted in its flight. Then returning it descended quite close so that I had a good view of the raptor‘s majesty. It was wondrous.

A little while later, outwardly unrelated to this day’s explorations, a feeling of impending doom cast its spell on me. I was experiencing my first panic attack in recent years. Once again it was as if an octopus had released its fluid, so dark and inky and totally encompassing was the sense of foreboding ruin. Danger lurked everywhere; there was no safe niche for me or for us. Not If I believed my false mind. Not being able to depend on one’s own mind, to know its emotions are reliable, is one of the most difficult aspects of having a mental illness. Certainly there was no danger. I was even in touch with my husband – holding his hand – yet I was struck by a chilling miasma.

 

Luckily, I have experience now. I recognized and knew this episode was a panic attack (please note *) . That meant my feelings weren’t accurate and I had to hold on to myself firmly enough to wait it out. Wait out the fear and wait out the panic. A cool 20 minutes, while awash in waves of alarm and high alert.  Today’s attack was pretty smooth because there was just Jim and I walking in this vicinity. When I was a younger woman, our children would have been outdoors with us, exploring for the first signs of spring. Things were awkward then for all of us.

Panic attacks can happen any time or anywhere. From my NAMI Family to Family Education Program curriculum (2013): “You might be shopping, sleeping, or in the middle of a meeting. Suddenly, your heart begins to race, your face flushes and you have trouble breathing. You feel dizzy, nauseated, out-of-control —- maybe even like you’re going to die.”

What to do?

What did I do? I kept on walking……walking at the same steady pace. Today I do not run; I do not desperately seek to hide, to retreat. And we did not begin bright cherry talk in an attempt to break free of the imploding fear. Instead, I informed Jim as to what was going on. I asked for and received a quiet squeeze and we pursued our goal, a simple late afternoon walk.

As I have found from my experience, and as psychiatric treatment and research has shown, learning about and accepting a panic attack for what it is can help lessen its effect. A panic attack is often a reaction to fear, and some of the strange physical reactions experienced during an attack are the result of the body reacting to this fear. One may become mentally anxious over a past, traumatic event and the body responds as if it will happen right away. Or a person may not only picture themselves experiencing a traumatic event, but perhaps also fear losing control and not being able to handle the current situation.  Your body goes on alert and automatic bodily reactions ensue. Your mind remains stuck on fearful thoughts.

Giving this array of physical feelings and scary thoughts a name, i.e., panic attack, cuts the phenomenon back to a human scale. I have found that the more I understand my fears, the better I am able to control them. Here are some practices I have found helpful:

  • Simple breathing and relaxation techniques.
  • Walking and light aerobic exercise.
  • Confronting your fears.
    Try writing in a journal about your panic attacks. Read the description when you’re feeling better. This technique is helpful for two reasons: you’ll learn what to expect and two, you can look for patterns to find similarities between attacks. From this practice one gains some mastery which can help counter the overwhelming flood of helplessness that fear and doom brings.

It was also helpful for me to remember that panic attacks were relatively brief and not real in the sense that the doom wasn’t real.

For those whose loved one experiences panic attacks, my husband passes on this message:

“…..Simply and gently ask the person experiencing a panic attack what would make them more comfortable. In years past we tried to help by focusing on a bright sunny sky, for example, but Gail’s panic worsened and she felt rejected. Best was a calm acceptance and a safe presence while panic flooded her person. Try reminders to do deep breathing. Again, give gentle reassurance that the frightening experience will pass. Allow some time afterwards for a breather for everyone to recover before you attempt to get back to things as they were.”

 

(*) I’m speaking here of the experience typically termed a “panic attack.” They may be infrequent or never occur again, but if you have recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, you may have a condition called panic disorder.  Please seek help.
(Return to your reading)

Communities in Action to Prevent Suicide, part IV

gail louise Communities Preventing Suicide, Learning to Hope, On Support, Shame , , , ,

Dr. Whiteside, concluding her keynote address to the Communities in Action to Prevent Suicide conference, April 2015, asked us to visit the websites below for a look at what suicide attempt survivors have to say for themselves.  Their words offer important insights.

www.livethroughthis.org is a wonderful and compelling collection of portraits each linked to a suicide attempt survivor story, as told by those survivors. LiveThroughThis shows through these remarkable stories that everyone is susceptible to depression and suicidal thoughts. It does this simply by showing portraits and stories of attempt survivors — profoundly sharing that they are people no different than you or I.

As the website’s author Dese’Rae L. Stage writes, “…these feelings could affect your mom, your partner, or your brother, and the fear of talking about it can be a killer.”

The second website attemptsurvivors.com  is a now-completed project of the American Association of Suicidology. This site also features attempt survivors who have spoken up and told their stories. This website’s editor taught me a valuable lesson also. She wrote that people continually ask survivors about suicidal thoughts and actions, saying “Why would you want to do that to yourself?” As she noted, this question represents a shocking and a fundamental misunderstanding. You see, as when inquiring about any potentially fatal health issue the question needs only be, “Why is this happening to people we love?”

Do you see the stark difference between these two questions? The first, intentionally or not, is accusatory and focuses on blaming the suicidal person. The second question reflects concern for the person and asks why it is that this has happened to this individual, without seeing the act as a personal fault — and in truth, suicide is usually the result of a mental illness process.

Thank you for reading and for hearing and listening to them.

Communities in Action to Prevent Suicide, part III

gail louise Communities Preventing Suicide, MajorDepression, On Suicide, On Support , , ,

A core value, again taken from The Way Forward, that Ursula Whiteside highlighted during her keynote:

Preserve dignity and counter negative stereotypes, shame, and discrimination

“The negative perceptions of behavioral health issues and subsequent discrimination pose major barriers to help-seeking.” …. “Stigma, negative stereotypes, and discrimination (covert or subtle) are particularly damaging when we already suffer from depression, hopelessness, damaged self-image, trauma, self-doubt, and shame – thoughts and feelings common during a suicidal crisis. In contrast, when we are treated with dignity and compassion, it reaffirms our sense of worth and value.”

My second psychiatrist (and each of those who followed) treated me with the dignity and compassion I needed to progress. It made a HUGE difference. One appointment I’ll never forget is the day I thanked him for NOT telling me ‘my difficulties’ were that I was ‘too sensitive’ (as I had been told by my first psychiatrist) . My doctor got very still, sat up straight, looked me in the eye, and said, “Gail, it’s not that you are too sensitive. You have major depression. It is an illness for which we will pursue and persist in finding the right treatment combination for you.”

He treated me with full dignity by clearing up any chance that I would misunderstand ‘sensitivity’ for major depression. Or think that ‘my difficulties’ were only that, ‘difficulties,’ and that they were something I caused. I felt affirmed and clear about the real lesson I was learning.

I particularly like this core value because it is so active…….counter stigma.

You can see from the photographs that Dr. Whiteside – Ursula – is younger than I. Her experience and youth were very helpful as I gained insight on how to reach to a younger public than I am used to addressing. She does social media very well; I need to go there too. The mid-part of her keynote presented her vision developing www.NowMattersNow.org into an online public resource focusing on strategies for managing suicidal thoughts and intense emotions. Ursula introduced us to her colleagues: Team Now Matters Now. I smiled with pleasure as one of the team members mentioned was Marsha Linehan, PhD, clinical psychologist. Nothing more was said about team member Marsha … But it’s worth noting that Dr. Linehan is the creator of Dialectical Behavior Therapy, the psychotherapy that has helped so many people with borderline personality disorder. She is well known and admired for her work.

DrUrsulaWhiteside    DrMarshaLinehan

Ursula summarized what she and Team Now Matters Now had learned from suicidal people working through a crisis. Here are some of these points (underline emphasis is Ms. Whiteside’s):
• Be fully present with me
• Help me hold my pain ( so I feel less alone in my pain)
• I feel helpless, broken and scared
• Discuss with me my diagnosis, as it is in the charts and go thru the DSM criteria with me
• When including family and friends, tell me and let me decide who and how
• Help me empower myself
• Gently examine my paranoid thoughts with me
• First I need empathy, a witness (rather than fixing)
• Know that I am telling you about my suicide ideation/plans because I want to live, I want help and I want to work together

Communities in Action to Prevent Suicide, part II

gail louise Communities Preventing Suicide, Depression during Pregnancy, Learning to Hope, On Suicide, On Support , , , , , ,

Spring in Wisconsin has brought us needed and gently persistent rainfall. Nourishing rain on fertile ground; good food for our thoughts together.

Ursula’s keynote message, “…Zero Suicide and the Engagement of Those with Lived Experience” was a blend of her experiences working with others, and of new directions advocated in “The Way Forward: Pathways to Hope, Recovery, and Wellness with Insights from the Lived Experience, 2014”.

The Way Forward is the most readable, engaging, no-nonsense document that I have ever read. In fact, it is so good and there is so much to learn from it, that I read deeply through the report twice! It is a unique and creative look at suicide prevention. Prepared by the Suicide Attempt Survivors Task Force of the National Action Alliance for Suicide Prevention, the report’s recommendations are based on and prepared by people who have previously attempted to take their own life, and are now helping others in a crisis situation. Over the next days, I will highlight core values and recommendations from the report as presented in Ursula’s keynote. The first core value is:

Foster hope and help people find meaning and purpose in life

Pervasive hopelessness is a major risk factor for suicidal thinking and behavior. Studies have found that hope and optimism can help guard against suicide. From The Way Forward: “Hope is also linked to self-esteem and self-efficacy, as well as improved problem-solving. The pursuit of meaning can help a person cope with pain and suffering. Similarly, research on reasons for living has demonstrated that meaning and purpose are keys to recovery in many different groups of people who have lived through a suicidal crisis.”

I know this well. In my own suicidal crisis, I was saved by my husband who knew, somehow, that he had to teach me how to hope. (Please see Oh So Real: Pregnancy and Suicidal Depression) I had no hope for me or our unborn child, but I did have hope in our beautiful daughter who was about to turn 5 and start kindergarten in the fall…….when the baby was due. So Jim taught me to focus on specific events or achievements or activities of our daughter. One hope at a time, sometimes very small, got me through those difficult days and hope for her life certainly gave me a reason for living that had meaning and purpose. While the psychic pain of feeling suicidal is or can be overwhelming, meaning and purpose dull the pain…….take pain from the driver’s seat to the back seat.

It is possible to fuel a very small hope.

About Partnerships … thinking about enhancing care and support within them

gail louise Beyond Recovery to Healing, Learning to Hope, MajorDepression, On Support, Real Life; Real Challenges , , , , , , , , , , , , , , , ,

46 years. That’s how long my husband and I have been married.  And it was 50 years ago when we first dated, a sweet memory today.  Jim has always been the very kindest, most fun and interesting man I know.  Our kindness toward one another is a key to our relationship, especially when the water wasn’t so smooth due to effects of mental illness on my thoughts, feelings and behaviors.

My partnership is our marriage.   It is the most supportive aspect of our lives together.  It is, it turns out, quite a bit stronger than mental illness.  Yours may be another partnership – marriage is not the required word, but supportive is.  How do we support our partner without being overwhelmed?  How can we be supported without having to feel we’re a burden?  I don’t have all the answers, but we do have some suggestions here based on our experience.

Resources on Suicide – and the way forward

gail louise Learning to Hope, More First Things, On Suicide, On Support, Shame , , , , ,

I’ve written a resource page on Suicide – Look on the menu bar, click Suicide and then Resources on Suicide.  There are links there for anyone who may be at risk for suicide or is a survivor of a suicide attempt.  I hope they can be of help for you.

Especially I want to draw attention to the link for the report The Way Forward: Pathways to hope, recovery and wellness with insights from lived experience (2014 pdf), by the National Action Alliance for Suicide Prevention’s Suicide Attempt Survivors Task force.   The report is unique in its breath and scope, and unique in that its co-leads were one, a survivor of suicide attempts and mental health advocate, and the other, a psychologist with years of experience working with people in suicidal crisis.

“For far too many years suicide prevention has not engaged the perspectives of those who have lived through suicidal experiences. Because of social stigma and fear, as well as personal shame, a culture of silence prevailed. The Way Forward represents a seminal moment in this field’s history; it is an opportunity to benefit from the lived experience of suicide attempt survivors. Many of its recommendations are derived from evidence-based practices, and several are aspirational. All are grounded in the evidence of recovery and resiliency that is clear in the lives of our Task Force members.”
– from the report.

What to do, “When Mental Illness Enters the Family”

gail louise Chronic/SeriousMental_Illness, Learning to Hope, Loyd Sederer, MD, On Support, These Illnesses , , , , ,

What do we do now, now that mental illness has entered our family?  Dr. Lloyd Sederer’s video “When Mental Illness Enters the Family”  is a Godsend. In this short, 15-minute video, Dr. Sederer addresses family members of people with mental illnesses and gives them clear and doable tips on how to live harmoniously (mostly) and wisely (usually) with the ill family member. His four main steps to cope with the effects of mental illness are right on target.  I can write this because of the lived experience I have had with two members of my family of origin. One person is still living, a sibling,  and  I work to understand better how to provide this person true support and health needs in an integrated manner without sacrificing my health in the process. The recommendations in “When mental illness enters the family” are a good beginning for people starting out on that road – Helping to care for someone with mental illness – as well as a good review for experienced family members.

Dr Sederer is a psychiatrist who is the medical director of the New York State Office of Mental Health –, i.e., Chief psychiatrist for the nation’s largest state mental health organization. He was the  medical director and executive vice president of Harvard-affiliated McLean Hospital in Massachusetts. He is also the mental health editor and columnist for The Huffington Post.

I also heartily recommend readers who have a mental health condition and family members of people with a mental health problem explore NAMI’s (National Alliance on Mental Illness) website for all the valuable resources and information that are gathered there.

As I worked and volunteered for NAMI on the state and local level for many years (20) here in Wisconsin, I will post a resource article with thoughts about the NAMI website and programs soon.

Real Depression; Real Men: “Because you have to deal with it. It doesn’t just go away.”

gail louise MajorDepression, On Suicide, On Support, Real Life; Real Challenges, These Illnesses , , , , , , ,

This post’s title is taken from a video clip “Real Men, Real Depression” featuring Patrick McCathern, 1st Sergeant, US Air Force, Retired, and available here on The National Institute of Mental Health’s website.

Depression in Men often manifests itself differently. What ails men may not be recognized by them or their family or friends as depression. It may be mistaken as a sleeping problem or a digestive problem … or a character flaw. When a man has depression he has trouble with everyday life and loses interest in anything for weeks at a time.) He may be irritable, feel very tired, and lose interest in his work, family, or hobbies.

The tricky part of depression in men: They may not want to recognize, talk about, or acknowledge “it” or how they are feeling. (Please see my entry on Male Depression under These Illnesses in the menu section of my website for life experiences with my father’s depression.)

The quiet truth about depression is that it is very, very painful, and unending. And although women with depression more often attempt suicide, men are more likely to die by suicide.

HOW CAN I HELP A MAN WHO IS DEPRESSED? (Recommendations from The National Institute of Mental Health):

  • Offer him support, understanding and encouragement. Be patient.
  • Talk to him, but be sure to listen carefully.
  • Never ignore comments about suicide, and report them to his therapist or doctor.
  • Invite him out for walks, outings and other activities. If he says no, keep trying, but don’t push.
  • Encourage him to report any concerns about medications to his health care provider.
  • Ensure that he get to his doctor’s appointments.
  • Remind him that with time and treatment, the depression will lift.

MEN WITH DEPRESSION ARE AT RISK FOR SUICIDE. IF YOU, OR SOMEONE YOU KNOW IS IN CRISIS GET HELP QUICKLY.

Call your doctor or 911 for emergency services.

Call the toll-free, 24-hour lifeline, National Suicide Prevention Lifeline

1-800-273-TALK (1-800-273-8255)                  TTY: 1-800-799-4TTY (1-800-799-4889

On Healing and the Caring Community

gail louise Beyond Recovery to Healing, Chronic/SeriousMental_Illness, homelessness, On Support, Rev Craig Rennebohm , , , , , , , , , , ,

Recently I have been re-searching the book, Souls in the Hands of a Tender God: Stories of the Search for Home and Healing on the Streets for more wisdom.

The book’s author is Rev. Craig Rennebohm, founder of the Mental Health Chaplaincy  in Seattle, WA. This UCC minister speaks of the illness experience and how healing can occur even with serious illness. He places the experience of illness in perspective with many other factors in life. He writes,”…. Our illness self, may predominate at any given moment, but is not absolute and does not determine finally who we are. An illness, no matter how grave, is but a part of our larger identity; our wholeness as persons encompass the moment of illness and far more.”

I first heard him speak at the 2013 NAMI (National Alliance on Mental Illness) annual convention held in Seattle that year. I learned although there is no cure for mental illness but there is recovery for many, that I am experiencing healing “…within a larger frame of personal growth and caring community” as the next stage in my recovery.  Continue Reading more on his profound message.