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?

724

gail louise On Suicide ,

I’d like to give you a feel for the burden of suicide in Wisconsin: A joint report released in 2014 (the most current data I have) says that, on average, 724 valued and treasured individuals in Wisconsin take their own life each year.

What do we know about these individuals as a group?

Four out of five persons who died by suicide were male.

For every person who died by suicide there were eleven hospitalizations or emergency visits for self-inflicted injury.  And approximately three out of five patients hospitalized for self-inflicted injury were female.

Taken together, one estimates 8,000 people attempt suicide every year in Wisconsin.  724 die.

Firearms were the most frequent means of suicide.  And Means Matter:  Men use firearms more often than women, and attempts with guns are more likely to result in death than those in which other means are utilized.

Death from a suicide attempt was highest among individuals aged 45-54.

Veterans accounted for one out of five suicides in Wisconsin.

Teens and young adults are more likely to be seen or hospitalized for self-inflicted injuries than any other age group.

Among suicides with known circumstances, fifty percent had a current mental health problem and approximately forty-five percent were currently receiving mental health treatment. Where toxicology testing was performed, 37% tested positive for alcohol and 20% tested positive for opiates.  Of the known life stressors, intimate partner problems, physical health and job problems were most often reported. Significantly, 35% disclosed their intent to die by suicide to at least one person.

724 deaths by suicide in Wisconsin.  Each year.

And yet, as the Harvard School of Public Health reports, 90% who survive their attempted suicide do not go on to die by suicide later.  This is a terribly important fact.  Help is possible.  Those who attempt suicide, much more often than not, do not go on to die by suicide later.

How can we offer help to someone contemplating suicide?

The good news: Everyone can play a role in protecting their friends, family members and colleagues from suicide. However, as a national poll found, 50% of American respondents found obstacles and barriers that stopped them from trying to help someone at risk for suicide. Two barriers were commonly raised: Many feared that something they would say or do would make things worse rather than better. And many, understandably, simply did not know how to find help for a person feeling suicidal.

  • Most suicidal individuals want to live; they are just unable to see alternatives to their deep struggles and setbacks.
  • Most individuals give definite warnings of the suicidal intentions.
  • Talking about suicide does not cause someone to be suicidal.
  • Surviving family members not only suffer the trauma of losing a loves one to suicide, they may themselves be at higher risk for suicide and emotional problems.

Let’s look at what we as individuals can do to help.

  1. BE AWARE OF THE WARNING SIGNS
  • Hopelessness
  • Rage, uncontrolled anger, seeking revenge
  • Acting reckless or engaging in risky activities, seemingly without thinking
  • Feeling trapped-like there’s no way out
  • Increased alcohol or drug use
  • Withdrawing from friends, family and society
  • Anxiety, agitation, unable to sleep or sleeping all the time
  • Dramatic mood changes
  • No reason for living, no sense of purpose in life
  1. WAYS TO BE HELPFUL
  • Be available. Show the person interest and support.
  • Ask if he/she is thinking about suicide.
  • It’s ok to be direct: Talk openly and freely about suicide.
  • Be willing to listen. Allow for the expression of feelings, and accept them.
  • Be non-judgmental. Don’t debate whether suicide is right or wrong, or if one’s feelings are good or bad. Don’t lecture on the value of life.
  • Don’t dare him/her to do it.
  • Don’t ask ‘why’. This encourages defensiveness.
  • Offer empathy, not sympathy.
  • Don’t act shocked. This creates distance.
  • Don’t be sworn to secrecy. Seek support.
  • Offer hope that alternatives are available, do not offer glib reassurance; it only proves you don’t understand.
  • Take action: Remove means!
  • Get help from individuals or agencies specializing in crisis intervention and suicide prevention. The National Suicide Prevention Lifeline (phone:   text:) is a good place to start.

I was very fortunate when I was suicidal long ago. My husband enacted a good many of these helpful responses to me. He and we talked openly and freely about suicide. I did express some of my feelings about being suicidal and he accepted those feelings. Also important, I was offered empathy and most of all, I was offered hope. Hope offered when I had no hope. What a gift!

Lies your depression tells you when you are suicidal

gail louise MajorDepression, On Suicide, Shame

He was middle aged and in the prime of life when he killed himself. He had family and children. A prestigious appointment at a respected University – and he had received several awards for his research. Wholesome looking and in good shape, he seemed to have had everything to live for. Do you know what? That’s right; he did have many things to live for, including a promising future.

Yet he went out of town for the weekend, quietly rented a motel room and died there by his own hand.

We all ask why. It seemed like the man had the world by a string. Why does anyone commit suicide?

It doesn’t make sense, does it? No it doesn’t and yet people take their lives every day. WHY?

Nearly always there is an intractable depression pushing the person into despair. Depression lies, and its false thoughts and lies are utterly convincing. Yet to the depressed person these thoughts feel completely real and desperately true. In my experience they are intense, persistent, and severely painful.  The person becomes overwhelmed by their depression’s lies.

I’d like to share insights from Amanda Redhead, Mother, Nurse, Writer, and Warrior from her Huffington Post blog entry of Sept 9, 2016:  Five Lies Your Depression Tells You When You Are Suicidal.

Here are five lies that depression imbeds in the head of a sufferer:

  • YOUR LIFE IS ALREADY OVER. YOU HAVE SCREWED UP BEYOND REPAIR!
  • YOUR LOVED ONES ARE BETTER OFF WITHOUT YOU.
  • THE PAIN WILL NEVER END, NEVER END.
  • YOU ARE NOT WORTHY OF LOVE OR LIFE.
  • … THEREFORE, YOU MUST KEEP YOUR THOUGHTS ABOUT HARMING
    YOURSELF QUIET!

One: Your life is already over. You have screwed up beyond repair.

Wonderfully, there is no such thing as a life ‘beyond repair.’  Amanda writes “You may have messed up so royally that you believe that no one will ever forgive you. But there is life beyond this pain and there is life beyond whatever mistakes you have made.”

Two: Your loved ones are better off without you.

This empty lie is probably the biggest of them all.  Far from removing their pain, suicide only creates an emptiness in your loved one’s hearts. That hole remains. Your loved ones find only sadness and the pain of losing you. “You may be feeling like a failure right now but I cannot imagine a greater mistake than having your last act on earth be one that causes intense pain for each and every person you love.”

Three: The pain will never end.

It feels like a pain that will never end.  I remember looking for just a brief reprieve.  Silently I bargained for relief in minute increments. The pain of depression felt very catastrophic and chaotic to me. I couldn’t believe that the rest of the world would or could go on functioning with my pain in it.  A moment in this pain feels like a year.

But there IS an end to the pain, unlikely as it seems now. As Amanda said, “I cannot tell you when that end will happen, but I can tell you that the end is somewhere.” You may have to work for it, your may have to get help or take medication or reach out when you want to stay silent, but the end of the pain is out there on the  horizon.

Four: You are not worthy of life or love.

Another big lie. This lie and others like it are invasive and seem so accurate. Everyone is worthy of love, no matter the mistakes they have committed. Everyone is worth living! You are only seeing the negative things about yourself right now. Remember depression colors your thoughts. You are a valuable human being and deserve to be alive and loved.

Five:   …You must keep your thoughts about harming yourself quiet.

#5 is the ultimate lie: Yes, your depression wants you to stay silent. Depression wants you to take your life. There is great shame around depression, anxiety and suicidality.  When we talk about the depression, we erase some of that shame and stigma.

Please believe me: There is no need to suffer in silence.

Pick up the phone and call one person and tell them what you’re struggling with. This may be the hardest thing you will ever do, but it gives life – your life – another chance.

Here I must add a word of hope:

Yes, depression distorts the depressed person’s thoughts. And depression’s thoughts can be deadly.  The five lies illustrate various cognitive distortions.  And forms of cognitive therapy can assist depression suffers to learn to recognize and combat false and irrational thought patterns – depression’s lies. Today recognizing and analyzing distorted thoughts that feed depression is called cognitive behavior therapy (CBT). There is a promise of hope for recovery.

Psychiatrist Dr Aaron T. Beck laid the groundwork for the study of these distortions. His student, David D Burns, MD, continued research on the topic. Dr Burns’ book, Feeling Good: The New Mood Therapy, was first given to me in the mid-eighties by my psychiatrist. I glanced at it and rejected it, thinking that my doctor was telling me I should learn ‘positive thinking.’ I knew depression was a disease more serious than superficially thinking right. But in the 1990’s I was able to accept the book and its premises. Soon I underwent a group therapy session during which some of the basics of CBT were taught. I was able to learn those basic principles and asked for a therapist to do CBT regularly with me.  The short of the story is that I did find a therapist, who had a PhD in psychology and had done significant graduate work specifically with CBT. He was willing to take me on weekly for several months.  Cognitive Behavioral Therapy became one of the essential pillars undergirding my recovery from suicidal depression.

Depression now sometimes gets a grip on me. But with medication that works for me, with the practice of cognitive behavioral therapy, with a supportive family, and with a doctor’s ongoing psychiatric care I no longer develop full-blown depressions. Depression occasionally gets a start, but CBT’s corrective is powerful, and negative thinking doesn’t get a hold on me for long.

Thanks for reading,
Gail Louise

Suicide is frightening to talk about… Part 1

gail louise On Suicide, On Support

What might we experience as a Suicide Survivor? _________________________________

(This, the first in a series of postings on suicide issues, is based on a very real need for me and my family to know how to support people experiencing the death of a loved one by suicide.

The people left behind when suicide has occurred face not only grief, but a complicated grief, full of many questions and challenges.  We who are left behind are often referred to as suicide survivors…..)

Most of us have experienced the death of a loved one. And we can appreciate that the grief that follows is always difficult, even though it is an instinctual and helpful reaction. Suicide survivors too, are left with grief and feelings of loss, sadness, and loneliness after the death of a loved one. Yet these are often magnified by feelings of guilt, confusion, rejection, shame, anger, and the effects of social stigma and personal trauma.

As suicide survivors we are plagued by the need to make sense of the death and to understand why suicide appeared to our loved one as their only option. We may overestimate our responsibility, as well as guilt for not being able to prevent the tragic outcome. Survivors may replay events up to the last moments of their loved ones’ lives, looking for clues and warnings that they blame themselves for not noticing or taking seriously.

We might recall past disagreements or arguments, plans not fulfilled, calls not returned, words not said, and ruminate how if only we had done or said something differently, perhaps the outcome would have been different. If it is easy for we who are suicide survivors to get caught up in self-blame, it may help to understand that many (most) people who complete suicide were struggling against mental illness when they died.

Suicide survivors sometimes feel rejected or abandoned by the death. Survivors may see the deceased as choosing to give up and leaving their loved ones behind.   Also survivors can feel bewildered, wondering why the relationship they had with the person was not enough to keep them alive.

Anger is a common response: Directed at the person who died, or at themselves, or perhaps at other family members, at professionals, at God or the world in general. “Why did my loved one not seek help or feel our love and concern?”

Suicide is stigmatized. The bereaved may find it difficult to talk to others about their loss because others often feel uncomfortable discussing a death by suicide. This can leave the family/friends feeling isolated. For all of us, talking about a loved one’s death is vital for our recovery. Stigma concerning suicide poses an unwelcome barrier to the healing process.

Finally, survivors of suicide find themselves at a higher risk for suicidal thoughts and behavior than are other bereaved individuals (Dialogues in Clinical Neuroscience, Vol 14, No. 2, 2012).

Suicide is frightening to talk about… Part 2

gail louise On Suicide, On Support

What can we do to help support suicide survivors? ___________________________________

Individual counseling and suicide support groups can be particularly helpful. While there are many grief support groups, grief support focused specifically on suicide appears to be much more valuable for suicide survivors.

As Dialogues in Clinical Neuroscience, Vol 14, No. 2, 2012 reports, “For many friends and family of a suicide victim, participation in support groups is felt to be their only access to people whom they feel can understand them, or the only place where their feelings are acceptable.”

As the support group talks together, we who are suicide survivors may obtain assurance that we are not alone in our feelings. Others, we find, have faced similar experiences and have survived not only intact but often able to better bear their grief. The bonds that form among participants can be very strong as they offer each other mutual support. Also there is practical advice for such real-life obligations as dealing with legal issues, talking to others (including one’s children), developing fitting memorials for the deceased, coping with holidays and special events, and setting realistic goals including care for one’s self.

Successful suicide support groups share the characteristics of other successful groups:  They provide accurate information, give permission to grieve, help normalize emotional and behavioral episodes that are out of keeping from one’s usual personality and deportment.  Most importantly, successful groups convey to survivors that they are not alone.

Please note, a support group may be especially effective for children who have lost a parent or family member by suicide.

Support groups can be found on Web sites of such groups as the American Foundation for Suicide Prevention (AFSP) and the American Association of Suicidology (AAS) which host directories for hundreds of suicide support groups in the United States.

Suicide is frightening to talk about… Part 3

gail louise On Suicide, On Support

Here are some tips for supporting a grieving suicide Survivor

LISTEN WITH COMPASSION

*Accept and acknowledge all feelings

(Let the grieving person know that it is ok to get angry; to break down. It is ok to cry.  Grief is emotion, so we suicide survivors need to feel free to express our feelings without fear of judgment, criticism or argument.)

*Be willing to sit in silence.

(It is a true comfort to a survivor to simply be in your company. Offer eye contact, a squeeze of the hand or a reassuring hug.)

*Let the bereaved talk about how their loved one died.

(Those grieving may need to tell their story over and over, sometimes in painful detail. Repeating the story is a way of processing and acceptance. Pain lessens with each retelling.)

*Offer comfort without minimizing the loss.

(Again, the emphasis is on listening and asking the other to tell you how they’re feeling. Avoid hollow reassurance.)

OFFER PRACTICAL ASSISTANCE TO A SUICIDE SURVIVOR

Just as we might in the aftermath of any death, we may offer to –

  • Shop for groceries or run errands
  • Drop off a casserole or other food
  • Stay to take phone calls or receive guests
  • Help with insurance forms or bills
  • Help with housework like cleaning or laundry
  • Watch their children or pick them up from school
  • Drive them wherever he or she needs to go
  • Go with them to a support group meeting
  • Accompany them on a walk, lunch, or movie

PROVIDE ONGOING SUPPORT

* Our ongoing support may be more important at this time than ever.

(Stay in touch with the grieving person, periodically checking in, dropping by, or sending letters or cards.)

(Don’t make assumptions based on outward appearance; some may be struggling on the inside.)

*Avoid saying things like “You are so strong” or “You look so well”.  Also avoid comments like “He/She is in a better place now.” Or “This is behind you now; it’s time to get on with your life.”

(These comments are well intended, but put pressure on the survivor to keep up appearances and to hide true feelings.)

*The pain of this loss may never fully heal.

(Life may never be or feel the same. You don’t get over the death of a loved one. The suicide survivor may learn to accept the loss. Pain may lessen but sadness may never completely go away.)

*Offer extra support on special days.

(Holidays, family milestones, birthdays and anniversaries often reawaken grief. Be sensitive on these occasions. Let the person know you are there for whatever they need.)

WATCH FOR WARNING SIGNS OF DEPRESSION

*It is common for a suicide survivor to feel depressed.  Or to feel confused and disconnected from others, or that they are going crazy.

(If the bereaved symptoms don’t gradually fade —or they get worse with time- this may be a sign that the grief has become a more serious problem, such as clinical depression.)

*Encourage suicide survivor’s to seek professional help if any of the following warning signs are observed after the initial grieving period:

  • Difficultly functioning in daily life
  • Extreme focus on the death
  • Excessive bitterness, anger or guilt
  • Neglecting personal hygiene
  • Alcohol or drug abuse
  • Inability to enjoy life
  • Hallucinations
  • Withdrawing from others
  • Constant feelings of hopelessness
  • Talking about dying or suicide

FINALLY, STAY CLOSE

*Families often feel stigmatized and cut off after a suicide.

*From the Harvard Women’s Health Watch, July 2009, Left Behind After Suicide:

“If you avoid contact because you don’t know what to say or do, family members may feel blamed and isolated. Ignore your doubts and make contact. Survivors learn to forgive awkward behaviors or clumsy statements, as long as your support and compassion are evident.”

Grief works at its own pace.

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.