Common Signs of Someone Who May Be Suicidal

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About 70 percent of people who commit suicide give some sort of verbal or nonverbal clue about their intention to end their life. That means you could be in a position to guide someone to get help before they commit the one action that can never be taken back.

While 30,000 Americans die each year due to suicide, more than 800,000 Americans attempt suicide. Although women attempt suicide three times as often as men, men are four times more likely to be successful in their attempt.

Warning signs of suicide are not difficult to spot, but professionals differentiate between someone who simply has a passing thought of suicide or ending his or her own life, and someone who has persistent thoughts and has a definite plan. However you don’t have to know how serious a person is in order to help them.

Possible Suicide Warning Signs

Have you ever heard someone say two or more of the following?

  • Life isn’t worth living.
  • My family (or friends or girlfriend/boyfriend) would be better off without me.
  • Next time I’ll take enough pills to do the job right.
  • Take my prized collection or valuables — I don’t need this stuff anymore.
  • Don’t worry, I won’t be around to deal with that.
  • You’ll be sorry when I’m gone.
  • I won’t be in your way much longer.
  • I just can’t deal with everything — life’s too hard.
  • Soon I won’t be a burden anymore.
  • Nobody understands me — nobody feels the way I do.
  • There’s nothing I can do to make it better.
  • I’d be better off dead.
  • I feel like there is no way out.
  • You’d be better off without me.

Have you noticed them doing one or more of the following activities?

  • Getting their affairs in order (paying off debts, changing a will)
  • Giving away their personal possessions
  • Signs of planning a suicide, such as obtaining a weapon or writing a suicide note

Friends and family who are close to an individual are in the best position to spot warning signs. Often times people feel helpless in dealing with someone who is depressed or suicidal. Usually it is helpful to encourage the person to seek professional help from a therapist, psychiatrist, school counselor, or even telling their family doctor about their feelings. The National Suicide Prevention Lifeline (1-800-273-8255) offers free and confidential support for people in distress as well as prevention and crisis resources for you and your loved ones.

Remember, depression is a treatable mental disorder, it’s not something you can “catch” or a sign of personal weakness. Your friend or loved one needs to know you’re there for them, that you care and you will support them no matter what.

Suicide is one of the most serious symptoms of someone who is suffering from severe depression. Common signs of depression include:

  • Depressed or sad mood (e.g., feeling “blue” or “down in the dumps”)
  • A change in the person’s sleeping patterns (e.g., sleeping too much or too little, or having difficulty sleeping the night through)
  • A significant change in the person’s weight or appetite
  • Speaking and/or moving with unusual speed or slowness
  • Loss of interest or pleasure in usual activities (e.g., hobbies, outdoor activities, hanging around with friends)
  • Withdrawal from family and friends
  • Fatigue or loss of energy
  • Diminished ability to think or concentrate, slowed thinking or indecisiveness
  • Feelings of worthlessness, self-reproach, or guilt
  • Thoughts of death, suicide, or wishes to be dead

Sometimes someone who is trying to cope with depression on their own might turn to substances like alcohol or drugs to help ward away the depressive feelings. Others might eat more, watch television for hours on end, and not want to leave their home or even their bed. Sometimes a person who is depressed may stop caring about their physical appearance on a regular basis, or whether they shower or brush their teeth.

It’s important to realize that people who suffer from serious, clinical depression feel depressed for weeks or months on end. Someone who’s just having a particularly rough or stressful week (because of school or work demands, relationship problems, money issues, etc.) may not be suffering from clinical depression.

Common Signs of Someone Who May Be Suicidal

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When Your Anxiety Doesn’t Have a Trigger

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It’s very common for Kristin Bianchi’s clients to tell her that they’re feeling anxious, but they’re not sure why. They say they recently haven’t experienced anything particularly stressful or anxiety provoking, so it doesn’t make much sense.

Consequently, “they frequently become worried about the meaning behind these seemingly random feelings of anxiety,” said Bianchi, a licensed clinical psychologist who specializes in treating OCD, anxiety disorders, PTSD, and depression at the Center for Anxiety & Behavioral Change in Rockville, M.d.

In other words, she noted, “they become worried about worrying, or frightened of fear.”

When many of Regine Galanti’s clients initially start working with her, they, too, describe their anxiety as just happening. Galanti is a licensed psychologist and director of Long Island Behavioral Psychology, where she specializes in using evidence-based treatments for anxiety and related disorders in children, teens, and adults.

Many of us believe our anxiety comes out of the blue. It just feels so random and sudden—startling us like the siren of a smoke alarm, or a squirrel jumping out of the bushes.

But this is rarely the case. Rather, we simply don’t notice our triggers. What we do notice is our anxiety, because it tends to be blaringly, glaringly loud. “When we feel something strongly, we often zero in on it and discount all the information leading up to and surrounding it,” Galanti said.

And the information that leads up to your blaringly, glaringly loud anxiety might be a thought, feeling, or behavior. Galanti noted that anxiety, and really all emotions, consist of those three parts. For instance, you might feel horribly anxious the morning after going to sleep past midnight, she said. You might become anxious as you notice your heart beating faster, she said.

Bianchi noted that it’s very common not to recognize that our thoughts are a significant trigger. “Thinking happens so quickly and automatically that we often don’t realize that we’re having stressful dialogues or creating catastrophic narratives in our own heads.”

For instance, she said, you might not even realize that you’re revisiting a recent conversation that caused you some stress. Maybe you’re replaying how your coworker was gossiping about your boss, which made you very uncomfortable. Maybe earlier this morning you and your spouse fought over your monthly budget (or lack thereof). Maybe your mind drifted to the sarcastic remarks your date was making (and how annoying they were).

The catastrophic narratives your head is spinning might include: “wondering whether or not you turned off certain household appliances, then imagining your house burning down if you forgot to do so; worrying that something bad will happen to a loved one, then imagining your reaction if that type of personal tragedy were to occur; creating ‘worst-case scenarios’ involving academic, career, or financial ruin when thinking about a recent disappointment or setback in any of those domains,” according to Bianchi.

Panic attacks also are a prime example. They seem sudden, but there are usually specific triggers, Galanti said. It might be a thought, “I can’t easily escape this situation,” or a physical sensation, such as your heart rate speeding up, she said.

And then there’s our digital culture. “We reflexively hop from tab to tab, app to app, and website to website, generally giving very little thought to the process,” Bianchi said. But while we might not notice that we’re doing all this hopping and scrolling, we’re still responding emotionally to what we’re consuming, she said.

That means that we are responding emotionally to sensationalist news headlines, flawless Instagram images, and emails from colleagues and clients, all of which can trigger anxiety. However, we’re too hyper-focused on these stimuli to notice what’s brewing inside our bodies.

“Even low-level anxiety reflects that we’re experiencing a fight-or-fight response,” Bianchi said. “When we finally notice it, it can come as a surprise to us, as we hadn’t been paying attention to it up until that point.”

So what can you do? What are your options when your anxiety seems to arise out of the blue?

Below, you’ll find a few tips on identifying your triggers—even the subtle ones—and reducing anxiety when it starts. It’s especially helpful to practice the relaxation strategies when you’re not anxious. This way you’re familiar with them, and maybe even created a habit.

  • Act like a scientist. Galanti tells clients that the goal is to help them treat their anxiety like a scientist: to “take an outsider perspective on their insides.” To do this, she suggested readers use a journal or the notes section on your phone to record your anxiety. That is, whenever you feel anxiety coming on, she said, ask yourself, “What just happened?” “literally, what happened immediately before and then try and pinpoint [your] thoughts, physical feelings, and what [you] do.” Maybe you downed a huge cup of coffee. Maybe you thought about your to-do list. Maybe your thoughts shifted to your child’s first big presentation. Maybe you read an email from your boss. Maybe you said yes to an invitation (that you really, really didn’t want to accept). Maybe you started sweating because it’s so hot. Tracking what triggers your anxiety helps you to spot patterns, and “those patterns can help people come up with solutions,” Galanti added.
  • Slow down your breathing. Bianchi suggested “breathing in slowly through your nose to a count of 4 to 6 seconds, holding your in-breath for 1 to 2 seconds, then slowly breathing out through your mouth to a count of 4 to 6 seconds.” When you’re breathing out, it helps to “imagine that you’re blowing fuzz off a dandelion or blowing a stream of bubbles,” she said.
  • Practice this grounding technique. According to Bianchi, find five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. “This shifts our focus away from the anxiety and helps us to reconnect to the present moment using our five senses.”
  • Practice progressive muscle relaxation. This involves scanning your body for muscle tension, and then “unclenching” tight muscles to release that tension, Bianchi said. “When doing this, it’s important to remember to relax your jaw, open your mouth slightly, and make sure that your tongue is positioned at the bottom of your mouth (versus flexed against the roof of your mouth).” You also can use an app that offers a guided practice, such as Headspace; Stop, Breathe, and Think; and Pacifica, Bianchi said.
  • Face your fears. Avoidance only amplifies and strengthens our anxiety. Facing your fears, a skill known as “exposure” in cognitive behavioral therapy (CBT), is incredibly effective in reducing anxiety. Galanti suggested devising a list of small steps to help you face your triggers. For instance, she said, if caffeine triggers your anxiety, you might “start drinking a little bit of coffee a day, and see what happens. Even if you do feel anxious, maybe you can handle it better than you think you can.” Another option is to work with a therapist who specializes in treating anxiety with CBT or other successful treatments. Bianchi suggested starting your search at a professional organization, such as https://adaa.org, and http://www.abct.org.

Anxiety can sometimes feel like it has zero rhyme or reason, which can be exceptionally frustrating. It can feel like you’re going about your business, and BAM! an object falls from the sky and smacks you on your head.

But when you delve deeper, you realize that there’s a thought, feeling, or behavior that sparked that bam! And that’s valuable information. Because now you can focus on the root of the issue and try to resolve it, whether that’s a conflict with a loved one, difficulty saying no, the fear of fear, not enough sleep, or something else altogether.

When Your Anxiety Doesn’t Have a Trigger

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Small Things I Do Every Day to Manage My Depression

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Some days you feel well, and other days, darkness envelopes you. You feel achingly sad, or you feel absolutely nothing. You’re exhausted, and every task feels too big to start. You feel weighed down, as though there are sandbags attached to your shoulders.

Managing the symptoms of depression can be hard. But even the smallest steps taken every day (or on most days) can make a significant difference.

Below, you’ll learn how five different women live with depression on a daily basis, and the small, yet pivotal actions they take.

Having a daily routine. “Having a daily routine helps me push through the days when I’m not feeling my best,” said Denita Stevens, a writer and author of the recently released poetry collection Invisible Veils, which delves into her experiences with depression, anxiety, and post-traumatic stress disorder (PTSD).

Stevens’s routine starts at night with two morning alarms: one alarm is optional, the second one, which rings around 7 a.m., is not. “I take a moment to gauge how I’m feeling before deciding which one I wake up to.  Sometimes I don’t always have a good night’s sleep and an extra hour of rest helps.”

When she’s up, she drinks coffee and reads. Then she focuses on work. The evenings are dedicated to personal time. This “gives me motivation to accomplish what I need to do during the workday in a timely manner and allows me to end the day investing my time in myself,” Stevens said. This me-time might mean socializing, exercising, relaxing, or working on a writing project—right now she’s working on a memoir about what it was like to live with undiagnosed PTSD and how she recovered.

On weekends, Stevens doesn’t have a schedule. “A balance between scheduled and unscheduled time every week seems to work best for me,” she said.

Setting boundaries. “Setting boundaries is extremely important to my mental and emotional well-being,” said T-Kea Blackman, a mental health advocate who hosts a weekly podcast called Fireflies Unite With Kea.

For instance, Blackman has set her phone to go into “Do Not Disturb” mode every night at 9 p.m., because she wakes up at 4:45 a.m. to exercise. “Working out has been beneficial as it helps to improve my mood and I sleep much better.” Going to bed around the same time and waking up around the same time helps her get consistent rest. “When I am not well rested, I am unable to function throughout the day.”

Exercising. “I make myself exercise even if I don’t feel like it,” said Mary Cregan, author of the memoir The Scar: A Personal History of Depression and Recovery. “If my mind is troubling me, I’ll try using my body instead.”

If Cregan’s energy is really low, she goes for a walk. And these walks have a powerful benefit: She gets to see other people—“little kids in playgrounds, old people walking with their shopping bags, teenage girls all dressed alike. People can be interesting or amusing, and help me get out of my own head.”

Cregan, who lives in New York City, also likes to walk along the Hudson or around the reservoir in Central Park, and admire the water. She likes to look at the plants and trees, too. “If the sun is out, I’ll sit on a bench with the sun on my face.”

Tidying up. Cregan also regularly makes her bed and cleans up the kitchen. This way, she said, “things don’t feel messy or ugly, because that would be depressing in itself.” Sometimes, she buys flowers for her home, since looking at them cheers her up.

Having downtime. Blackman prioritizes downtime to help her unplug and recharge. Sometimes, this looks like listening to water sounds—waves crashing onto the shore, water hitting the rocks—and putting on her essential oil diffuser as she listens to a podcast or reads a book. Other times, it looks like lying in bed and letting her mind wander, as she listens to the water sounds and breathes in the essential oils.

Wearing comfortable clothes. Fiona Thomas, author of the book Depression in a Digital Age: The Highs and Lows of Perfectionism, regularly tunes into her inner dialogue. When she notices the chatter is negative—“you’re so lazy”—she decides to actively challenge the voice and be kind to herself instead.

“One small way that I’m kind to myself every day is by wearing clothes that I feel comfortable in as opposed to what I think people expect me to wear. If I want to wear leggings and a baggy jumper to the supermarket, then I do it.”

Creating small moments of self-care. Another way that Thomas is kind to herself is by going out for coffee, or taking several minutes to stand by a canal and watch the ducks go by.

Practicing self-compassion. In addition to depression, Leah Beth Carrier, a mental health advocate working on her master’s in public health, also has obsessive-compulsive disorder and PTSD. When her brain tells her that she isn’t worthy, doesn’t deserve to take up space, and won’t ever amount to anything, she gives herself grace. “This grace I give myself allows me to be able to hear these old tapes, acknowledge that they are fear based and my fear has a purpose, and then continue to go about my day.”

Taking a shower. “I try my hardest to take a shower every day even though I find this really difficult with depression,” Thomas said. “Even if [showering is the] last thing [I do] at night, I know it helps me feel healthier in the long run.”

Looking in the mirror. “I have also found that the simple act of looking at myself in the mirror, eye to eye, each morning and making a point to say hello to myself—as silly as it sounds—keeps me grounded,” Carrier said. “It is also a little reminder that my existence here on earth is allowed and OK, maybe even something to be celebrated.”

Of course, the specific small actions you take will depend on the severity of your depression, and how you’re feeling that day. The above actions are examples that speak to the power of small. Of course, it’s also vital to get treatment, which might include working with a therapist and/or taking medication.

Ultimately, it’s important to remember that the pain isn’t permanent, even though it absolutely feels permanent in the moment. You won’t feel this way forever. “Having lived with depression since I was a teenager, I’ve discovered that even at my lowest points, I can still survive and it will get better,” Stevens said. “It always gets better. May not seem like it at the moment, but those feelings are only temporary.”

“I never believed it when people told me it would get better when I was in my darkest days and attempted suicide, but I remained committed to my recovery…,” Blackman said. She’s made various changes, and has seen a huge improvement in her mental health.

Don’t discount the power of small daily acts and steps. After all, before you know it, those small steps have helped you walk several miles—a lot more than had you been standing still. And if you do stand still on some days, remember that this is OK, too. Try to treat yourself gently on those days, to sit down, and extend yourself some compassion.

Small Things I Do Every Day to Manage My Depression

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I Believe It’s Possible to Fully Recover from an Eating Disorder

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When I first started struggling with food and body image at eight years old, I was convinced it would be a lifelong struggle. My days were spent getting on and off a scale more times than anyone could imagine and counting out my cornflakes before I’d even think of eating them. I felt that I was destined to be bound by my eating disorder forever.

However, at 22 years old, I am fully recovered from anorexia. There is some controversy in the mental health world about whether full recovery from an eating disorder is possible, and I wholeheartedly believe it is (in fact, I’m living proof). Eating disorder expert Carolyn Costin says,

Being recovered to me is when the person can accept his or her natural body size and shape and no longer has a self-destructive or unnatural relationship with food or exercise. When you are recovered, food and weight take a proper perspective in your life and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size or reach a certain number on a scale. When recovered, you do not use eating disorder behaviors to deal with, distract from, or cope with other problems.

My eating disorder truly is a thing of the past. While I still struggle with major depressive disorder, generalized anxiety disorder, and PTSD, and my battle with anorexia has certainly informed the woman I’ve become, I no longer experience eating disorder thoughts or even the slightest urge to use eating disorder behavior. I’ve learned that my life will never be perfect, and I’ve gained the ability to cope effectively, even in extremely difficult circumstances.

Mental health advocacy has been one of the biggest catalysts in my recovery. Through discovering mental health advocacy, I’ve had the opportunity to be a part of something so much bigger than myself. I’ve found an immense sense of purpose, and I’ve connected with countless individuals who have also found true full recovery from their eating disorders. My commitment to this advocacy, coupled with my dedication to my professional treatment and my determination to find a life beyond my eating disorder truly led me to full recovery.

Long gone are the days of 10-year-old Colleen measuring her Rice Krispies, 16-year-old Colleen compulsively exercising after hours of dance rehearsals, and 19-year-old Colleen relapsing after seeing the number on the scale change. Now my days are filled with truly experiencing all emotions, appreciating my body regardless of any numbers, eating the foods my body, mind, and taste buds want, and pursuing my dream of becoming an eating disorder therapist.

While I can’t promise you will find full recovery, I can tell you that it is possible. I encourage you to seek professional treatment and start your own advocacy journey, whether it be through volunteering for organizations like Project HEAL, Mental Health America, and NEDA, or through getting more vulnerable about your struggles on social media—it might just change your life

Mental Health America

This post courtesy of Mental Health America.

I Believe It’s Possible to Fully Recover from an Eating Disorder

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What I Want Someone Who’s Overwhelmed with Their Mood Disorder to Know

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You have depression, or bipolar disorder. And on some days, you feel like you’re treading water—at best. You’re tired of struggling. You’re tired of regularly feeling tired. You’re angry that your to-do list just keeps getting longer and longer. You’re angry that you have to deal with so much darkness day in and day out.

Some days are just hard. Some days you feel so overwhelmed.

It is on these days that you probably feel like the only person on the planet who’s struggling with persistent symptoms.

Thankfully, you’re not. And thankfully, it will get better.

We asked individuals who live with depression or bipolar disorder to share what they’d like others who are feeling overwhelmed with these same conditions to know. Most of the individuals are speakers from This Is My Brave, a fantastic nonprofit organization that hosts live events and aims to “end the stigma surrounding mental illness through storytelling.”

Get treatment. T-Kea Blackman, a mental health advocate and speaker who lives with depression and anxiety, stressed the importance of seeing a therapist who can help you identify triggers, learn healthy coping tools, and set boundaries, along with a psychiatrist if you need to take medication. (For bipolar disorder, both medication and therapy are vital.)

Blackman emphasized not getting discouraged if the first or third medication you try doesn’t work, or the first or third therapist you see isn’t a good fit. “It can take time to find the right dosage and medication, and therapist for you.” This can be frustrating, but it’s common—and you will find the right help.

Focus on small victories. Sivaquoi Laughlin, a writer, blogger, and mental health advocate with bipolar II disorder, has good days, bad days, and sometimes great days. She underscored the importance of realizing that it’s OK not to be OK, and acknowledging small victories, which are actually “huge.”

Some days, those small victories might be getting out of bed and taking a shower, she said. Other days, they might be excelling at work and going to dinner with friends. Either way, it’s all important and worthwhile.

Forgive yourself. Fiona Thomas, a writer who has depression and anxiety, stressed the importance of not beating yourself up when you don’t do everything on your list, or when you have bad days. One of her friends always says: “Remember that your best changes when you’re not feeling well.”

Thomas, author of the book Depression in a Digital Age: The Highs and Lows of Perfectionism, suggested not comparing today’s output to your output from last year or last week. “It all depends on how you’re feeling mentally, and if you’re not 100 percent, then just do what you can—the rest will come later.”

Thomas also suggested doing one small thing every day that makes you feel better. This might be anything from drinking a few glasses of water to walking around the block to talking to a friend, she said. “There are so many ways to boost your mood little by little, and over time, they become habits and make you feel better without even really having to try.”

Do one enjoyable thing every day. Similarly, Laughlin encouraged readers to find one thing that brings you happiness, and try to incorporate that into your daily routine.

For Laughlin, it’s many “one things.” That is, she loves being with her grandson and her dogs, meditating, hiking, reading, and writing. “Start small and build upon it. Forgive yourself if you miss a day or days.”

Remember you are not broken. Suzanne Garverich is a public health advocate who is passionate about fighting mental health stigma through her work on suicide prevention as well as telling her story of living with bipolar II disorder. She wants readers to know that you “are not damaged, but [instead] so courageous and strong to live through and fight through this illness.”

Document your OK days. This way, “when you are having an off day or month or series of months, you can go back and remind yourself that you have felt differently,” said Leah Beth Carrier, a mental health advocate working on her master’s in public health, who has depression, obsessive-compulsive disorder, and PTSD. “You are capable of experiencing emotions other than the numb, black hole you reside in at the moment. There is hope.”

Surround yourself with support. “Surround yourself with people who can support you and find an online community who can relate to you, such as the Buddy Project or my community, Fireflies Unite,” Blackman said. She also noted that the National Alliance on Mental Illness offers free support groups.

Other online supports include: Psych Central’s forums, and Project Hope & Beyond and Group Beyond Blue–both of which were started by one of our associate editors, Therese Borchard.

Teresa Boardman, who has treatment-resistant bipolar disorder, attends weekly therapy sessions, but sometimes, she said, she needs more. “It’s OK to talk frankly with someone. I like to use the crisis text line because I do not have to break my cone of silence. Expressing yourself truly makes you feel less alone.”

Living with a mental illness can be hard. Acknowledge this. Acknowledge your overwhelmed, exasperated, angry feelings. Remind yourself that you’re not alone. And remind yourself that you are doing an incredible job, even on the days it doesn’t feel like it.

What I Want Someone Who’s Overwhelmed with Their Mood Disorder to Know

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Mental Illness Deniers Are as Dangerous as Climate Change Deniers

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Back in the mid-80’s, I was one of a few, fortunate psychiatrists in Massachusetts in charge of administering the just-released atypical antipsychotic medication clozapine. In our clinic, its use was still limited to a small number of carefully-selected patients with schizophrenia who had not responded to any of the conventional antipsychotic agents.

Harry was one of my first clozapine patients. He had been an inpatient for much of his adult life, and was widely thought to be a “lost cause.” For many years, Harry had been tormented by threatening “voices” urging him to harm either himself or others. He had become a shrunken wreck of a man, pacing the halls with a haunted look on his face, and confined to the inpatient unit with little hope of a normal life.

Clozapine changed all that for Harry. After a few months of treatment, the voices quieted down, and we were able to discharge Harry from the hospital and arrange for placement in a neighborhood residence. As I described in an earlier essay, Harry actually went on to earn his driver’s license.1

But, in the world of mental illness deniers, I was the deluded one. There is no such thing as schizophrenia, these critics claim. Mental illness itself is a “myth”, as famously (or infamously) argued by the late psychiatrist, Thomas Szasz. (Disclosure: Dr. Szasz was one of my teachers during residency). At most, the deniers claim, what psychiatrists call “mental illness” is nothing more than a socially-constructed label, or a misguided metaphor. According to mental illness deniers, the term “schizophrenia” does not identify a “real disease”, like cancer or coronary artery disease; rather, it is a term grounded in a mistaken theory of disease, based on an agenda of social control and coercion. Szasz argued, to his dying day, that only bodily disease is “real”. For him, a “diseased mind” was a contradiction in terms. Szasz argued that classifying thoughts, feelings, and behaviors as diseases was a category mistake, like classifying the whale as a fish.2

Szasz was a genial man, and a brilliant polemicist who still has many admirers among antipsychiatry groups and bloggers. But Szasz was flat out wrong regarding what should count as “disease.”3 When someone is suffering and incapacitated by a condition that destroys the ability to separate delusion from reality, that is real disease. When this person winds up lying dirty and disheveled in an alley way, hearing the Devil’s voice saying, “You don’t deserve to live,” that is real disease. When someone’s thoughts are tangled up in knots; when their emotions are blunted; when they think constantly of suicide, this is not the result of a metaphor or a myth. This is the reality of serious psychiatric illness, like schizophrenia.

To be sure, not all critics of psychiatry are “antipsychiatry.” Some are prominent psychiatrists themselves who rightly point to specific problems within the profession, such as over-prescription of some medications in certain settings, or the use of imprecise diagnostic criteria. In contrast, dyed-in-the wool antipsychiatry groups dismiss psychiatry as a fraud. They write off psychiatric diagnosis as nothing more than pathologizing “disapproved of behaviors” or “problems in living.” (Try telling that to someone like Harry, or to his anxious and beleaguered family). In a sense, mental illness deniers represent the flip-side of mental illness alarmists — people who, for example, see mass shootings, gun violence, and other violent acts as the product of mental illness, despite the fact that when psychiatric illness is adequately treated, it is very rarely associated with violence. Left untreated, however, serious psychiatric illness can increase the risk of violence; and, unfortunately, many people with untreated psychiatric illness wind up in the largest “mental health system” in the U.S. — our jails and prisons.

Both the deniers and the alarmists misconstrue the nature of psychiatric illness, and both do harm to people like Harry. The mental illness deniers erect barriers to the effective treatment of serious diseases like schizophrenia and bipolar disorder, and make it harder to persuade Congress to provide adequate funding for psychiatric research — after all, why should we fund research on a “myth”? The mental illness alarmists fuel social prejudice and job discrimination against those, like Harry, who suffer from severe psychiatric impairments. In my view, the mental illness deniers pose as much risk to the health of this country as climate change deniers.

To be sure, some people who post angry comments on antipsychiatry websites have had bad experiences with their own psychiatric care. Whether their accounts are entirely accurate or not, these people are understandably aggrieved by perceived mistreatment. Having worked in a variety of psychiatric settings over several decades — hospitals, nursing homes, outpatient clinics, and private practice — I have seen both excellent and poor psychiatric care, and everything in between. Certainly, there are legitimate reasons to confront psychiatry on its shortcomings. But this is a far cry from the outright denial of the reality of mental illness, and the blanket condemnation of psychiatry as a medical specialty. Like climate change deniers, mental illness deniers are doing a grave disservice to the health and wellbeing of their fellow citizens.

I have seen hundreds of people like Harry, suffering with psychiatric diseases as real as lung cancer or heart disease. And, with proper care and treatment, I have seen many of them recover their sanity, their lives, and their dignity.

Acknowledgment: Thanks to Dr. John Grohol for commenting on an earlier draft of this essay

For further Reading:

Insane Consequences: How the Mental Health Industry Fails the Mentally Ill by DJ Jaffe (Author), E. Fuller Torrey MD (Foreword)

Mental Illness Deniers Are as Dangerous as Climate Change Deniers

Footnotes:

  1. Pies, R. (2009, May 4). A Guy, a Car: Beyond Schizophrenia. The New York Times. Retrieved from: https://www.nytimes.com/2009/05/05/health/05case.html []
  2. Szasz, T.S. (1998). “Thomas Szasz’s Summary Statement and Manifesto.” Retrieved from: https://selfdefinition.org/psychology/articles/thomas-szasz-summary-statement-and-manifesto.htm []
  3. Earley, P. (2018). Psychology Today Article Debunks Claims By Antipsychiatrists: “Easily refuted by scientific evidence.” Retrieved from http://www.peteearley.com/2018/09/07/psychology-today-article-debunks-claims-by-antipsychiatrists-easily-refuted-by-scientific-evidence/ []

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Small Things I Do Every Day to Manage My Bipolar Disorder

This is an interesting article I found on: www.psychcentral.com

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Living with bipolar disorder can feel overwhelming. Maybe you’re tired of the ups and downs of different episodes—the soaring energy, the debilitating fatigue, the racing I-need-to-do-everything-and-I-need-to-do-it-now thoughts, and the dark, decelerated, bleak thoughts.

Maybe you’re exhausted from struggling with an especially stubborn and deep depression, which makes it tough to concentrate on anything, and feels like you’re walking through a river of waist-high molasses in a fog.

Managing bipolar disorder can feel overwhelming, too. What can make it much easier is getting effective treatment. Bipolar disorder is highly treatable—but a lot of people with the illness don’t get professional help.

Author Charita Cole Brown pointed out that “Of the estimated 5.7 million Americans living with the disorder, over 50 percent won’t seek treatment.” She wrote the memoir Defying the Verdict: My Bipolar Life “to reduce the stigma surrounding mental illness in general and bipolar disorder in particular. People need to understand how important it is to seek appropriate treatment.”

“My recovery is no anomaly,” Brown said. “By sharing my story, I want people to understand that mental illness is physical illness, therefore we must seek treatment as we would for diabetes or a broken arm.”

In addition to seeking treatment, there are small things you can do every day. Below, alumni from This Is My Brave share the small and significant ways they manage their bipolar disorder. This Is My Brave is an international nonprofit organization that hosts live events and publishes essays on their website written by people who are living with mental illness and living well.

Checking in. Amy Gamble is a speaker, executive director of NAMI Greater Wheeling, and a former Olympian. Every day and throughout the day, Gamble checks in with how she’s doing: “’Are my thoughts racing a little or do I just have a lot of creativity going right now?’ If I find I’m a little charged up or anxious, maybe even hypomanic, I take extra precautions not to make a lot of decisions.”

Gamble monitors her behavior, too. “I think about what is typical for me when I’m balanced. I am a very deep thinker and don’t typically make impulsive decisions. If I start acting on impulse, I reel myself back in. I don’t always notice a change in my behavior right away, but I monitor with hypervigilance.”

Suzanne Garverich also carves out time to pause and do a “self-inventory.” “I assess quickly how I am doing emotionally, physically, mentally, and spiritually,” said Garverich, a public health advocate who is passionate about fighting mental health stigma through her work on suicide prevention as well as telling her story. This helps her identify her needs—“before I go too far down the rabbit hole”—and meet them.

For instance, if Garverich determines that she’s feeling emotionally low and having dark thoughts, she figures out what she needs to do to “help me not go deeper into the dark thinking and depressive feelings.” She might call a friend or take a 10 to 15-minute walk. “It could be as simple as walking to the water fountain and drinking some water—just moving a muscle to change a thought. It could also be that I need to do some redirection of my thinking using my CBT and DBT skills…”

Having an effective bedtime routine. “The major thing I do is to make sure I get 8 hours of sleep a night,” Garverich said. “This really helps in keeping me balanced—sleep has a huge effect on my bipolar.”

To help herself get restful sleep, Garverich maintains a routine. Two to 3 hours before her bedtime, she stops doing anything work-related. She usually watches 30 minutes to an hour of TV. Then about an hour before her bedtime, she takes her nighttime medication, and gets into bed to read. Some nights she also takes a shower or bath.

“I also spend time before I go to bed breathing on my back and reviewing my day—seeing what I have done well, what I would like to improve, and if there is anything I need to share with anyone.”

She sets her alarm for the same time every morning. After she wakes up, she meditates in bed for 30 minutes. (More on meditation below.)

Practicing mindfulness and meditation. Gamble, also author of the book Bipolar Disorder, My Biggest Competitor: An Olympian’s Journey with Mental Illness, practices meditation, deep breathing, and mindfulness. “Staying in the present moment keeps me from getting down about how my illness has limited me.” (She also reminds herself that “everyone has something they are dealing with.”)

Every day Gamble listens to a playlist of her favorite meditation songs. “I put on my headphones and attempt to quiet my thoughts. I focus on slowing my mind down and paying attention to my breathing.”

Garverich also finds it helpful to practice deep breathing throughout the day, especially if she’s overwhelmed. For instance, at work, she usually takes a break and goes to the bathroom to take deep, slow breaths.

Connecting with others. “For me what is really important to achieve daily, to manage my illness and nourish my well-being, is feeling connected and not alone in my thoughts,” said Susie Burklew, who shared her story at the 2018 This Is My Brave show in Arlington, and co-produced the fall 2018 show. Eight years ago, for the first time, Burklew told her therapist that she thought she had a problem with alcohol. Her therapist suggested Alcoholics Anonymous (AA).

“I went to my first meeting that evening and I haven’t had a drink since. For the first time in my life I felt like I wasn’t alone. I connected and was inspired by people who had been through the same struggles and were living a happy life in recovery. I formed a strong network of people in AA and became comfortable opening up about my addiction to alcohol.”

For the past 6 years, Burklew has worked as a behavior specialist and counselor at a government residential rehab that specializes in co-occurring disorders.

Today, reaching out to someone on a regular basis—such as someone from her recovery network—helps her to stay in the moment, instead of getting “caught up in the stress of something that’s happened in the past or the fear of what’s ahead.”

Garverich connects with at least one person in her support system every single day. She might talk to this person over the phone, or they might simply text. Either way, this helps her know she’s not alone—something her illness wants her to feel, she said.

Sivaquoi Laughlin, a writer, blogger, and mental health advocate with bipolar II disorder, makes sure she spends time with her grandson and her dogs every day. “The energy from both provide me with a level of joy that I’m constantly yearning for.”

At the end of the day, Laughlin also sits down with her “16-year-old daughter and [we] discuss our day and name something good/great that happened. Even if it’s been a hard day or we haven’t had time to really connect, I make sure she knows that every day has a highlight.”

Engaging in art projects. “I undertake artistic projects daily. I am no good at it, but I can feel like I can breathe,” said Teresa Boardman, who has treatment-resistant bipolar I disorder with PTSD, OCD, suicidal ideation, and hypersomnia. Her latest project is a birdbath. “It is quite discombobulated that I decided to go with a steampunk theme. Now it is beautiful because I changed how I see it.”

Reducing the to-do list. Every morning, Laughlin lets her dogs out, and immediately makes a cup of tea. Next, she looks at the day ahead and jots down three things she’d like to accomplish. “They could be simple, such as returning a library book or dropping off dry-cleaning to bigger projects like organizing my closet or mowing the lawn. I’ve found that by committing to only three things, it keeps me from being overwhelmed and being triggered by ‘voices’ telling me I can’t do something.”

Boardman makes notes on her bathroom mirror of things she needs to do. For instance, she might list her exercise routine (e.g., 20 minutes of cardio, 20 minutes of yoga), and that she needs to take her morning medication and her evening medication. Boardman noted that she tries to work with her illness and its varying moods. After having over 20 electroconvulsive treatments (ECT), she realized she needed to take a different approach and embrace her illness.

It’s understandable that living with bipolar disorder can feel overwhelming and frustrating. But remember that there are 5.7 million Americans struggling alongside you. Remember that this illness, though difficult, is also highly treatable.

“Don’t give up hope,” Gamble said. “Things will get better, and you can learn how to manage the symptoms. They might not go away completely, but you can learn how it affects you. You can learn how to beat bipolar disorder.”

Small Things I Do Every Day to Manage My Bipolar Disorder

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Evidence-Based Addiction Treatment Explained

This is an interesting article I found on: www.psychcentral.com

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12-step programs are an incomplete approach and do not meet the requirements for evidence-based treatment because they lack biomedical and psychological components, and they use a one-size-fits-all approach.

When looking for treatment for addiction, there is a lot of information out there and countless opinions. Friends, family, doctors, researchers, and people in recovery all have their own beliefs about what you need to do to get well.

Unlike in other areas of healthcare, addiction treatment is often deemed “effective” based on anecdotal reports. In fact, most people who seek or are forced into treatment do not receive health care that is aligned with evidence-based practice.

A frequently-cited definition comes from a 1996 article in the BMJ Medical Journal: evidence-based “means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Other definitions also include the patient’s individual circumstances, preferences, expectations, and values.

These variables are not necessarily constant, and there is no one-size-fits-all solution; any list of evidence-based treatments is going to include a wide variety of approaches.

What Is Addiction?

In the United States, addiction is still treated more as a crime than as a chronic illness or disorder. Until that perspective changes, treatments will not meet their full potential and will not be as effective as they could be. Addiction, or substance use disorder (SUD), is a chronic medical condition that has remissions, relapses, and genetic components.

Are Relapses Normal?

A relapse is not a failure but a symptom. The brain of a person with SUD has gone through neurobiological changes that increase the risk of relapse because the damaged reward pathways stick around much longer than the substances stay in the body. Stressful events and other painful life experiences can trigger that maladaptive coping mechanism and cause a relapse.

For other chronic illnesses we would consider a relapse to be an unfortunate symptom of the disease, and we might call it a recurrence instead of a relapse. When successfully managed, the condition is considered to be in remission. Remission is a term that is relatively new in addition treatment; substance use disorder was not always believed to be a disease but rather a moral failing and a problem of willpower. We now understand that addiction is a chronic medical condition and that remission is the goal of treatment. Remission, as defined by the American Society of Addiction Medicine, is “a state of wellness where there is an abatement of signs and symptoms that characterize active addiction.”

What Is Successful Addiction Treatment?

Let’s take a look at what it means to have an effective treatment outcome in terms of addiction. The primary goal is usually abstinence or at least a “clinically meaningful reduction in substance use.” To measure effectiveness, we must look at how and if treatment improves the quality of life for the patient. Improving quality of life is the aim when treating all chronic conditions that have no cure.

Evidence-based therapies do not support the notion of “hitting bottom.” As with any chronic disease, early intervention is going to provide the best outcomes.

Even more effective than early intervention is prevention because SUDs are both preventable and treatable…

Find out more about evidence-based treatment — including different therapies, holistic care, and whether 12-step programs are evidence based — in the original article What Is Evidence-Based Addiction Treatment? at The Fix.

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How Writers Write About Heartbreaking Things and Care for Themselves in the Process

This is an interesting article I found on: www.psychcentral.com

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For more than 20 years, Mary Cregan wanted to write her recently published memoir The Scar: A Personal History of Depression and Recovery, but she felt that she couldn’t. It’s primarily because she wasn’t ready to face the exposure required to be so honest about such a devastating, difficult part of her life.

Because that’s the thing about writing: We let readers into our innermost thoughts and feelings, into our souls, and that can be scary.

We tackle topics we’d never bring up with a close friend, let alone a stranger, and yet that’s exactly what we do. We share our stories with thousands of strangers.

Writing about heartbreaking things and publishing that work makes the private very, very public, a process that we, of course, can’t reverse. This is especially difficult if you were taught to keep your stories to yourself, behind closed doors. As Cregan writes in The Scar, “In my large Irish Catholic family, the tacit understanding was that it was best not to draw attention to oneself.”

Nita Sweeney thought she was writing a memoir about running, but after many, many drafts realized that she was writing a memoir about how running saved her life—from depression, bipolar disorder, panic attacks, agoraphobia, and alcoholism.

“The fact that I’d gone from a woman who could barely walk around the block into a marathoner was important, but the real story was that I’d gone from a woman who wanted to kill herself into one who wants to live,” said Sweeney, whose forthcoming memoir Depression Hates a Moving Target: How Running with My Dog Brought Me Back from the Brink will be published mid May.

Mental health advocate and writer Hannah Blum regularly writes about her experiences living with bipolar disorder on her blog “I’m Bipolar Too” and her website Halfway2Hannah.com. While there are many parts of her story she’s not ready to share, writing about difficult things actually isn’t that difficult for her.

“Turning my pain into art gives power to any of the challenges I have faced throughout my life.”

“It’s when I am writing about the people I have met along my journey who were not given a chance because of their mental illness that I struggle to write about the most,” Blum said.

Author, mental health advocate, and Psych Central editor Therese Borchard has been writing online about her experiences with mental illness for many years (and before that she shared her story in her print column). But that doesn’t make sharing any easier.

“It’s extremely difficult to share the more personal posts. My index finger hovers over the publish button sometimes for an hour before I have the courage to press it,” Borchard said.

Why Write About Such Hard Things?

When a friend asked Cregan why on earth she’d want to revisit the worst days of her life—the death of her infant daughter, and her descent into a deep, unrelenting, suicidal depression—Cregan realized that it was because she’d spent decades trying to conceal that time. “…I wanted to turn to the past and face it squarely,” she writes in her memoir.

Cregan also wrote her story as a way to reject the stigma and shame surrounding mental illness. She wrote it for her younger self, and for the young women in her family who, too, live with depression.

“It is also for the countless people who find themselves struggling to cope with internal forces that feel overwhelming but—as I try to show in these pages—are survivable,” she writes.

She writes at the end of her book: “Most importantly, I want to encourage people in the depths of hopelessness to believe that they can come through, and to find help from a compassionate, responsible professional who will care for them until they do. People in the grip of severe depression might take as their mantra a line from Rilke so relevant to all kinds of human trouble that it has become an Internet meme: ‘Just keep going. No feeling is final.’”

Sometimes after publishing a vulnerable post, Borchard feels like she’s “walking around naked,” and wonders if it’s really worth it. “However, then I will get an email or comment from a reader who tells me she feels less alone because I shared it, and it makes it worth it.”

Blum, too, is propelled by the people who read her work, along with the mental health community in general. “Knowing that I may help someone not feel so alone or encourage them to accept themselves is a gift to me. Relating to people emotionally through words inspires me every day to write.”

For Borchard, writing about the more challenging parts of her recovery helps her in another powerful way, as well: “I get to recognize the voice within me that doesn’t necessarily come out in casual conversation with friends or even in therapy. There is something about writing about your experience that clarifies it…”

Self-Care During the Writing (and Publishing) Process

After Borchard pens a difficult piece, she’ll often walk in the woods or over to the creek by her house. This is when she processes what she’s written—and tells “myself that should I get scathing responses, it doesn’t detract from my truth—that I am a good person who speaks from the heart, even if that truth isn’t received well.”

Blum finds it helpful to sit with her thoughts, and journal what she feels. She also reads books by Hemingway along with pieces from modern-day poets, such as April Green, Lang Leav, and JM Storm.

For Cregan, when the writing became especially difficult, self-care looked like refocusing her attention toward researching or writing less personal sections of her book. On the days it felt unbearable, she’d schedule several sessions with her psychiatrist.

She also found it helpful to “change the channel” in her mind, something she still does today when she’s getting depressed. “I read or watch a movie or see a friend—anything, really, to get my mind out of the track it’s stuck in.”

Exercise is equally critical for Cregan’s well-being, which she does regularly, whether it’s indoor cycling or yoga.

For Sweeney, self-care while writing includes: hugging her husband, cuddling her dog, running, spending time with a supportive community, meditating, taking medication, going to therapy, not drinking, and calling her sister.

Because Sweeney writes regularly, the actual process isn’t so difficult (more on that below). But the after is.

“My mindfulness meditation practice helps with the aftermath, the ‘post-writing’ emotional hangover…During the time I’ve allotted for this practice, the huge rock in the pit of my stomach or the noose tightening around my neck becomes the object on which I focus. Awareness and a non-judgmental attitude transform these unpleasant sensations into something more neutral. It might sound like hocus pocus, but it’s quite intensely practical and for me, effective.”

And sometimes, Sweeney said, she needs a good “scream-cry.” “I do my best to experience heaving chest, stinging tears, and howling, with awareness and equanimity. If I find myself judging any of this, that becomes the object of meditation.”

The Power of a Regular Writing Practice

Sweeney also has developed a consistent, strong writing practice. Thanks to studying with Natalie Goldberg, she’s learned to “shut up and write,” and “go for the jugular.”

“Following [Goldberg’s] suggestion, I’ve spent years, no, decades, pushing my pen or pounding keys into painful and unpleasant memories. Hours reading aloud to small groups of people then listening to others who are also sharing their difficult situations by reading aloud, developed my spine.”

Plus, Sweeney has participated in National Novel Writing Month every year for a decade, writing or revising nonfiction. “Producing 1667 words a day during the 30 days of November, trained me to write on a regular schedule the rest of the year.”

Because she’s always writing, nearly every day since 1994, she doesn’t think about it. “It’s just what I do. If I thought about it too much, I’d never do it.”

Borchard views writing from the heart as “just another way of living sincerely, or with integrity.”

“It’s not for everyone, but I’ve found that the more transparent I can be in my life, the more I create opportunities to bond with readers and others on their journey. You are like a travel guide of sorts. So it’s also a privilege and one I take seriously.”

How Writers Write About Heartbreaking Things and Care for Themselves in the Process

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Should Mental Health Determine Pain Treatment Options?

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Patients with a mental health condition might have a hard time accessing opioids for pain relief, while patients with unexplained pain are often referred to psychiatric care, which does little to alleviate their symptoms. Finding treatment can be frustrating and humiliating.

Four years ago, Dez Nelson’s pain management clinic demanded that she complete a visit with a psychologist. Nelson was surprised, since she had no history of mental illness, but she didn’t feel that she could push back on the request.

“Of course I said okay — I didn’t want to lose my treatment,” Nelson told The Fix. “I was not happy about it, but I did it.”

Nelson, 38, went to the appointment and had a mixed experience with the psychologist. She hasn’t been back since and the pain clinic hasn’t asked her to visit a psychologist again. Still, Nelson said that the experience highlighted — yet again — the discrimination pain patients face.

“It was a condition of my continued care,” she said. “It seemed like they’re bringing it up in a beneficial light, as part of a multi-pronged approach to pain care. But I don’t think [mental health treatment] should be forced on a patient who doesn’t think they need it.”

Chronic pain and mental illness are among the most stigmatized conditions in modern medicine. The conditions frequently intersect and change the way that patients are cared for and treated. Patients who have a mental illness might have a hard time accessing opioids for pain relief, while patients with unexplained pain are often referred to psychiatric care, which does little to alleviate their physical symptoms. At the same time, research suggests there is a strong connection between mental health and pain: depression can cause painful physical symptoms, while living with chronic pain can cause people to become depressed.

All of this makes treating chronic pain and mental illness complex and frustrating for doctors and patients alike.

A Mental Health Diagnosis Affects the Way Your Doctor Treats You

Elizabeth* is a professor in her mid-thirties who had undiagnosed Lyme disease for eight years. Her Lyme contributed to the development of an autoimmune disease that has led to widespread inflammatory and nerve pain throughout her body. Elizabeth also has bipolar disorder. Despite the fact that she has been stable on medication for a decade, her mental health diagnosis complicates her pain treatment.

“Doctors’ demeanor changes when I tell them my medications. When I say I have bipolar disorder, it’s a whole different ballpark. To them that’s clearly a risk factor and red flag for drug abuse,” Elizabeth said.

Opioids are one of the few treatments Elizabeth has found that works to alleviate her pain. But she also takes benzodiazepines on an as-needed basis to control her anxiety (usually once a week). Even though Elizabeth is well aware of the risk of combining the two medications and knows better than to take the two pills together, doctors refuse to prescribe both. They don’t seem to trust her not to abuse them.

“I could tell them that I wouldn’t take them together. But that’s not a valid choice,” Elizabeth said.

While doctors were extremely cautious about this drug interaction, they didn’t focus on another drug-related risk: medications that are used to treat nerve pain can cause adverse reactions in patients with bipolar disorder. No one warned Elizabeth of this danger, and she ended up being hospitalized for psychosis after a long stretch of stability.

“The doctors didn’t talk about it because it’s just a side effect, not a liability concern,” she said.

On the flip-side, Elizabeth has experienced psychiatric providers who were skeptical of her pain diagnosis.

“They wrote in my chart that I had a delusion that I had Lyme disease,” she said…

Find out more about the complications of treating pain in patients with mental illness, the dangers of confusing one’s body with one’s psyche, and the “time bomb” of untreated pain in the original article Should Your Mental Health Determine How Your Pain Is Treated? at The Fix.

Should Mental Health Determine Pain Treatment Options?

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