Cruel, disgusting, irresponsible: they all fit. But our guest writer prefers astonishing when it comes to how we treat our mentally ill. She’s been there, folks, and brings a powerful message.
Too many of the psych doctors I have experienced treat you like a number. Patient #567 with severe bipolar disorder…
Received an email from Ashley a week or so ago. Said she has a mental health blog in the works and wanted to know if I’d accept a guest post.
She sent me three, I chose one, and here we are. By the way, I love how she goes with “our mentally ill.”
Let’s get on it. The floor’s yours, Ashley…
Treatment of our mentally ill
What I have personally endured as a mental patient is nothing compared to what I have read of others. It is astonishing that the world we live in can still be so dark and cold – so misguided and tortured.
I can grasp that it is hard to understand the thoughts of one diagnosed with a mental illness. Why do we say what we say? Why do we react the way we do? Why is every case so different and unique?
I’m sure many of us who suffer with mental illness have asked these very questions ourselves. And for the most part, we don’t know.
All we know is the desperate need to feel better, to find a morsel of normalcy in a life scattered amongst the wind.
The mentally ill are mistreated and being misguided
Across America, the mentally ill are mistreated and being misguided.
Timothy Williams of the New York Times provides an example…
Mentally ill inmates in prisons and jails across the United States are subjected to routine physical abuse by guards, including being doused with chemical sprays, shocked with electronic stun guns and strapped for hours to chairs or beds.
How is this behavior acceptable? They don’t know how to handle the situation, so they resort to neglect and abuse.
My personal experience
I remember the countless doctors surrounding me, being the object of everyone’s attention. Yet, my voice went unheard.
They would murmur amongst themselves as to what they felt was “wrong” with me and what medication or therapy they were going to attempt next.
I felt like I was at a zoo – laid out, vulnerable, and unwanted – for all to see.
”Really, the only thing left for you is ECT.”
“If you slow down, open your mind and heart, and listen, you might just get to know me.”
A million times I told them what medications I already tried, but they insisted that I try them again. To no avail, of course.
And then this: “Really the only thing left for you is ECT.” That’s electroconvulsive therapy, in pretty terms.
I guess I agreed to it, but honestly the “therapy” wiped all memory of that. As well as god only knows what else.
All I know is the next few weeks, which are lost forever, were a total fog. Months went by and I still struggled to recall even the simplest of things.
I do remember a flash – getting rolled into a room, given medicine to fall asleep, then waking up scared in a room full of others in beds, all trying to remember why we were there.
Is ECT really a solution?
I personally think ECT is awful. There isn’t any proven evidence of why it sometimes works for patients. I think frying your brain until you can’t remember why you’re there isn’t the answer.
I find it appalling doctors are still doing this. It’s like they have given up and their last resort is to shock you until you feel better. Does that really sound like a solution?
I just don’t want anyone to lose who they truly are – what makes them human – in desperate attempts to find hope.
Overlooked and ignored
Too many of the psych doctors I have experienced treat you like a number. Patient #567 with severe bipolar disorder. depression, PTSD, blah, blah, blah.
I once read my medical chart when the doctor left the room. And it wasn’t pretty. Scary, in fact, to read. I wasn’t that person.
But to them nothing I said was real, which made it all the scarier for me. I was constantly overlooked and ignored like so many others.
There’s always hope for mental illness
There is always hope, the general public need to be educated more on mental illness. That would include our struggles and dangers, along with our triumphs and hard work, so we can be better not only for ourselves, but society.
Nothing will grow in darkness
Spread the word, and let’s get more help, better help, for our mentally ill. Let the world know your own personal experiences with mental health care.
Nothing will improve, nothing will grow in darkness.
We must push through to the light, carrying on for those who no longer can. We are people, and we deserve just as much respect and dignity as anyone else.
Knowledge is power. Speak up, stop the stigma.
That’s a wrap
No doubt, Ashley, astonishing is the right word. And thank you for writing such a powerful piece for us. My money says it’ll hit home for many Chipur readers.
Living with emotional/mental disease can be isolating and lonely business. But stigma is a take no prisoners brute. And the only way it goes down is if we challenge it together. Are you in?
As long as we’re together, let’s move beyond stigma and chat about identity and hope. How are you feeling these days?
Look at our group above. My guess is half of those stigma fighters are managing emotional/mental disease. And I’m thinking the other half have joined the just cause. As hurting and angry as any of them may be, they’re smiling. Yeah, they’re happy to be together – to be involved.
The truth about stigma
Perhaps like you, I live with disease that affects how I receive, interpret, and react to my world – myself. Instead of using the stigma-perpetuating term “mental illness,” I’ve come up with emotional/mental disease (EMD). And that’s no different than having, say, heart or kidney disease. After all, we have but one body, without above or below the neck distinction.
Time was, going public with EMD would just about end whatever hope we had of living a judgment-free and peaceful life. Others knowing our circumstances would only exacerbate the problems we were already trying to manage.
Fortunately, things are a little better here in the early 21st century; however, society still has a long way to go regarding its perception and treatment of those living with EMD.
As prevalent as EMD is, many enduring it don’t seek treatment. And that’s because of roadblocks such as lack of education and personal insight, inadequate or non-existent health insurance, and, of course, stigma.
Something is very wrong with this picture.
If you’re struggling with EMD, I encourage you to hold your head high. You have nothing about which to be ashamed or embarrassed. Indeed, your self-candor and courage are admirable.
Please join me in declaring it’s okay to have EMD. Because the only way society is going to completely embrace us is if we step forward together and demand to be counted – and respected.
As far as we’ve come, a shiny badge of disgrace continues to be pinned upon many living with EMD. As a result, we’re too often improperly scrutinized and unfairly treated at the workplace and school, regarding insurance, and in other essential arenas of life functioning. Yes, stigma is still alive and well.
This has to change.
I have emotional/mental disease. And my circumstances deserve the same respect, freedom from judgment, and treatment opportunities afforded other health situations.
Let’s challenge stigma together.
Identity and hope
“Man, I don’t know anything anymore.”
As long as we’re together, let’s move beyond stigma and chat about identity and hope.
How are you feeling these days? Not so hot? Or maybe things are so overwhelming you just don’t know.
Do any of these hit home? Desperate, hopeless, helpless, frustrated, lonely, out-of-control, crazy, stuck, lost, angry, numb, scared, worthless, disgusted, dead.
Life with EMD can be brutal, right?
Ya’ gotta’ know I didn’t come by any of the above from a textbook or by listening to war stories. I’ve experienced all of them…
Thought ’em…felt ‘em…got blue over ‘em…got manic over ‘em…cried over ‘em…laughed over ‘em…drank over ‘em…fretted over ‘em…raged over ‘em…guilted over ‘em…obsessed over ‘em…got compulsive over ‘em…panicked over ‘em…you name it over ‘em.
That’s right, having EMD most all of my life, I’ve been exactly where you are. Yep, I’ve been in the trenches and know what, and how, you’re feeling.
And I’m here to tell you a peaceful and fulfilling life is yours for the taking.
That may be tough to believe in the moment. But that’s okay, just keep an open mind.
Actually, all I want you to do right now is pause. Now, take a couple of relaxing breaths and bask in the warmth of hope, knowing that someone who’s suffered at least as much as you is living a productive and calm life. And he’s been doing it for many moons.
The same is waiting for you.
See, when you come to know others are experiencing the same pain, suffering, distorted thoughts, and distressing feelings as you, relief begins. I mean, it removes the mystery from what you’re experiencing and helps you realize you’re not some sort of hopeless, worthless psycho-freak.
Do you feel that way about yourself?
I did at one time. But always remember that when you come to know others have experienced your misery, hope begins to become a part of your life. And when it sinks in that others have conquered their misery, hope transitions to “So can I” thinking.
Identity and hope: a worthwhile chat, don’t you think?
We’re not alone
Stigma is a take no prisoners brute. It’s directly impacted me numerous times over the years. And I’ll bet it’s slapped you as well. Together, let’s challenge it and put it down.
As for our identity and hope chat, well, it means everything to anyone enduring emotional/mental disease.
And that’s because it tells us we’re not alone, and we can get better.
Any time is right to explore dual diagnosis, but it’s such a great fit for the holiday season. Lord knows the number of times I dosed my anxiety with alcohol all those years ago. Hey, you may be numbing-up now. So what say we toss some things on the wall and see what sticks. Good?
Sooo, if so many people are having a dual diagnosis experience; shouldn’t help, support, or treatment also have a dual diagnosis approach? And it does!
Our “resident” clinical psychologist Dr. Mae Casanova dropped me a line a week ago asking if she could contribute another post. Stating her mission, she wrote…
…focusing on how mental health symptoms or disorders can be the underlying factors in substance abuse…So much of the time people with substance abuse do not get the help they need with their underlying mental health issues. I wanted to shed some light on it…I was going for educational, stigma-breaking, and resourceful.
What can I say? I was – am – all in. So I’ll turn things over to the good doctor…
Exploring Dual Diagnosis
Dr. Mae Casanova
Mental health and substance abuse have found themselves in separate categories for quite some time in the public eye – though they were not put there by professionals.
Substance related and addictive disorders have been considered primary mental health disorders in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) since the third edition. They’re just the same as, say, the mood and anxiety disorders.
However, so much of the time in society’s eye, substance abuse and addiction aren’t recognized as mental health disorders, rather more of a lifestyle choice. While mental health disorders, such as mood and anxiety disorders, are still struggling to break the stigma associated with them, substance abuse is having an even more difficult time.
Bringing Disorder Categories Together
Substance related and addictive disorders do deserve their own category, given the combination of physiological and psychological effects, as well as the severity of the consequences of use. But what if they were connected? What if the use of a substance was to manage the symptoms of another mental health diagnosis?
No one starts using a substance with the intention of abusing or becoming physiologically (needing more of the substance to get the desired effect – tolerance) or psychologically (needing more of the substance to get the desired effect – reality detachment) addicted.
Initial substance use could be experimental or social. But the effects – the calm or alertness, the numbing or the attention, the pleasure or the dissociation – could be providing relief from mental health symptoms like mania, depression, anxiety, or even trauma.
Sooo, if so many people are having a dual diagnosis experience; shouldn’t help, support, or treatment also have a dual diagnosis approach? And it does! There are many different options to receive support and guidance through a dual diagnosis. More than you may be aware of!
12-Step + Therapy 12 step programs and abstinence-based programs have a strong support system of members for whom the program has worked – works. This abstinence-based approach (e.g. Alcoholics Anonymous, Narcotics Anonymous) has provided community and constant support systems through meetings and sponsors for people of all ages “in recovery” for decades.
Lots of success and sobriety have been found in these programs. But the question remains – how can they address other underlying mental health disorders or symptoms?
If AA or 12-step programs work for you, then it could be as simple as adding individual therapy weekly with a licensed mental health professional to help guide you. Therapy with a trained professional can help identify, treat, explore, and build a tool box to support and manage underlying mental health symptoms that will come to the surface after the substance use has stopped.
Non 12-Step + Therapy There are quite a few options out there for Non 12-Step approaches to substance use. Some have an emotional component built-in.
SMART Recovery is considered a self-empowering recovery program. The main focus is to help explore and resolve underlying issues and related problems, as well as substance abuse issues.
Refuge Recovery is a Buddhist-based recovery program that focuses on finding compassion for oneself and one’s experiences. The focus is on wisdom and kindness, enabling people to be more mindful of the mental and emotional process associated with their addiction. They see addiction as a suffering state for which one needs to have self-compassion.
Only you can decide the direction that will work best for you and your recovery. If you have not been successful using 12-step options it could be beneficial to look around, remembering to add therapy with a licensed mental health professional.
We are all unique human beings, with our own specific experiences. So our treatment and support options need to be just that – unique and specific.
It’s a Wrap
Thank you, Dr. Mae – always good hearing from you. We’ll look forward to the next time.
In closing, as you reflect upon the concept of dual diagnosis, do so within the context of having interactive diagnoses. Say you’ve been diagnosed with generalized anxiety disorder (GAD) and an alcohol use disorder. Though they’re separate on paper, consider them as one entity, constantly influencing each other. So what’s good for the treatment of one is good for the treatment of the other. Got it?
Hey, wishing you the best for the holidays – as you perceive and acknowledge them. Still, always remember, ’tis the season.
Anyone enduring an emotional or mental health disorder can share multiple examples of stigma cutting them to the bone. And it’s not just expressions of stigma, as the fear of bumping into it can be just as devastating. Molly brings us a personal guest post…
Patients who fear the stigma of disclosing to their doctor mental health concerns may unknowingly risk worsening symptoms…
Guest post requests hit my inbox daily, and 99% of them get trashed because the intent is marketing, not lending a hand. But every so often…
Molly Canfield is a seasoned mental health provider who works hard to manage her own depression and anxiety. She tells me she’s excited to share a portion of her story and play a role in educating and comforting others troubled by their emotional or mental health circumstances. Molly has just begun blogging at DEPRESSION2PERSPECTIVES. We’ll link-up at the end.
Now, I did some editing of her piece because of space constraints. You can catch the entire article, entitled “You Have Depression?!,” on her site.
All yours, Molly…
“You Have Depression?!”
I opened my appointment with my new pain management doctor by saying, “I’m going to take a big leap of faith and trust you with what I’m about to tell you.” I went on to tell her I was being treated for depression and anxiety and that both are at manageable levels. The doctor responded, “You?! Depressed?!”
Leap of Faith?Trust?Really?
“Why?,” you may ask, was it a leap of faith, a matter of trust, for me to bring up my mental health issues? Well, here’s what happens in my mind. If I tell my general practitioner about my diagnoses (major depressive and generalized anxiety disorders), will s/he continue to treat me with a consistent perspective? Or will my symptoms (and I) be seen through a mental health filter?
This is what I imagine may be going through the doctor’s mind after being made privy to my mental health issues: “She says she’s still having pain, but it might be the depression/anxiety/etc. talking.”
But it isn’t just me.
Sharing with the Doc? No Thanks.
The National Institute of Mental Health reported results of a phone survey with over 1,000 adults in California. The question was whether or not the participant would share their depression symptoms with their family doctor. All participants were asked to choose among eleven possible reasons for not sharing.
43% of the participants said they would not share the information during a “normal office visit.” The majority said they weren’t comfortable with receiving a prescription for an antidepressant. These participants endorsed an anti-medicine stance that depression was not something a general practitioner could address.
This is unsettling, as the general practitioner is the healthcare professional who most often takes note of a patient’s mental health status. This may well be the initial contact for the patient to share troubling mental health symptoms. The doctor should be able to recognize the symptoms that may prompt a referral to a psychiatrist, psychologist, or counselor.
The Stigma Barrier
Next on the list of reasons for not being forthcoming was stigma. Many people believe, and perhaps with a valid reason, their mental health information would become a permanent part of their medical record. Furthermore, they’re concerned that their employer might be able to see this information. Would it effect the employee’s position in the company? Would co-workers find out? Would it effect a possible promotion?
Patients who fear the stigma of disclosing to their doctor mental health concerns may unknowingly risk worsening symptoms due to a missed opportunity and a chance for early intervention. Many scientists have come to believe that, like other chronic conditions, the longer depression is left untreated, the more difficult it becomes to effectively intervene. So any hesitance in sharing possible emotional or mental health symptoms may cause significant problems later in life.
Final Thoughts from Molly
Perhaps it is telling that, for me, sharing my diagnoses with my pain management physician felt like a leap of faith. Thirty years after that initial clinical depression diagnosis I’ve encountered a range of physician perspectives; some biased, others more open-minded.
I’ll close with a story: When I was in grad school I started seeing a neurologist for what was diagnosed as migraines. It was my first appointment and I waited for what seemed like an eternity, as the migraine pounded and pulsed through the side of my head.
After a brief examination my newfound neurologist told me he didn’t prescribe pain medication. He went on to say, “Pain never killed anybody.” I was shocked, but being a relatively naive patient in my early-twenties, I didn’t challenge his “wisdom.”
Perhaps it was statements like that, and less than compassionate care by other physicians, that cause me to see doctors from a somewhat biased viewpoint. It may be that I will continue to have to make leaps of faith.
Self-harm and substance use disorders are brutal reality for millions, including loved ones and friends. I haven’t mentioned them much here on Chipur; however, that’s been remedied thanks to a wake-up email. Cool thing is, the sender provided the content…
In more cases than one might imagine, self-harm and substance use disorders go hand in hand. Many who self-harm turn to substances as a means of relief, and vice-versa.
So the email bug has bitten again. Received one some time ago from the blog producer at Harbor Village, Miami, a substance use disorder treatment facility.
Now, I frequently receive emails from treatment center reps scrounging for guest post opportunities, and I decline 99.9% of the time. I mean, it’s just too “markety.”
But I entertained JessiRae’s request because I knew I needed to feature some well-considered self-harm and substance use disorder content. Oh, and she pointed-out that one of Harbor Village’s missions is to stomp stigma and provide education and actionable advice to the struggling among us.
But you know what really closed the deal? JessiRae told me self-harm is her “personal demon.”
Boom! It was on.
So I’m going to get out of the way and let JessiRae takeover, with my thanks…
Self-Harm and Substance Use Disorders: Connections
If ever there were two things society does not want to talk about, self-harm and substance use disorders are definitely towards the top of the list – and it’s a grave injustice to the people struggling through both.
In fact, those engaging in self-harm and those enduring substance use disorders may share underlying causes. Both instances (or habits) of self-harm and substance abuse manifest as a desperate attempt to quell internalized conflict and outward strife.
In more cases than one might imagine, self-harm and substance use disorders go hand in hand. Many who self-harm turn to substances as a means of relief, and vice-versa.
Self-harm and substance use disorders are legitimate issues (sadly, have to emphasize) that often require extensive therapy. Those who no longer actively self-harm may immediately turn their thoughts to, say, cutting in times of stress, and are prone to relapse just like those with a history of a substance use disorder.
Self-harm typically includes cutting, biting, burning, head-bashing, skin-picking, incessant scratching, hitting oneself, and poisoning. And if you think about it, what is a substance use disorder if not a slow and sometimes willful poisoning of the body?
Don’t misunderstand, once instances of substance abuse turn into a substance use disorder, the poisoning of the body is no longer “willful.” Yes, substance use disorders are diseases.
Instances of self-harm and substance use disorder co-occurrence require specialized treatment to get to the bottom of each condition, which may take-on separate lives. It’s possible to treat one, but neglect the other.
Without proper treatment of both conditions, relapse of either is more likely if one considers self-harm as a precursor for substance abuse, or vice-versa.
Those who turn to cutting are often considered either suicidal or attention seeking. This is not the case. Cutting does not equate to suicidal behavior. Akin to taking addictive drugs, cutting (or other outlets of self-harm) helps those engaging in the behavior feel better and cope with their emotional turmoil.
This is one of the more difficult presentations of cutting to understand, as it is counter-intuitive and “perverses” our primal instincts for self-preservation.
Cutting serves as a release for emotions one is otherwise unable to express. Many engage in self-harm (or are more susceptible to it) because they are not effective communicators. This is also true for those with substance use disorders.
Simply, cutting is an attempt to cope with life’s traumas. Suicide is the attempt to end life’s traumas.
Those who assert self-harm is a cry for attention cause irreparable damage in many cases. This notion has created stigma surrounding those who self-harm – those who are ultimately unable to admit to their problems, obscured in the secrecy of clothing.
Because those who cut do not wish to be branded as “attention seeking,” it’s common for families, friends, and loved ones to have no idea what’s going on.
In fact, those who cut need to be heard, but are often unable to speak up for themselves or seek the help they need because the guilt of cutting is too great, and often leads to more mutilation. This thought pattern mirrors substance use disorders.
Many who cut feel the need to punish themselves, because they feel they are unworthy of love, merit, or consideration (yet another key facet of substance use disorders).
Self-mutilation and substance use disorders require careful treatment and empathy. Because both disorders are frowned upon publicly, many will go without treatment and continue their habits – until a slip of the knife too deep or an accidental overdose.
And There You Have It
Thank you, JessiRae. Your contribution is really appreciated.
No doubt, Chipur readers, self-harm and substance use disorders are brutal reality for millions, including loved ones and friends. And given their frequent association with the mood and anxiety disorders, Chipur needed JessiRae’s content.
I’m glad we finally started the conversation. And if you’d like it to continue, go ahead and comment…