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

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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 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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Podcast: The Warning Signs of Bipolar and Schizophrenia

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In general, people with mental illness aren’t perfectly fine one day and suddenly symptomatic the next. It often feels that way to people with bipolar, depression, and schizophrenia, but many of us in recovery realize that the warning signs were there all along.


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“If you think there might be something wrong – that is a red flag.”
– Gabe Howard

Highlights From ‘Warning Bipolar Schizophrenia’’ Episode

[1:00] March 30th is World Bipolar Day!

[2:30] What are some of the warning signs of mental illness?

[5:00] Will supplements and exercise fix everything?

[7:45] Michelle’s huge red flag that she had schizophrenia.

[12:15] The red flags that Gabe has bipolar disorder.

[14:00] Why our hosts didn’t get any help when they were younger.

[18:30] The obvious warning signs of schizophrenia that Michelle’s college roommates noticed.

[22:00] Common symptoms of bipolar and schizophrenia.

[24:00] Everybody goes to therapy.

Computer Generated Transcript for ‘ The Warning Signs of Bipolar and Schizophrenia ‘ Show

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: [00:00:07] For reasons that utterly escape everyone involved, you’re listening to A Bipolar, A Schizophrenic, and A Podcast. Here are your hosts, Gabe Howard and Michelle Hammer.

Gabe: [00:00:09] You’re listening to a bipolar schizophrenic podcast. My name is Gabe Howard and I have bipolar.

Michelle: [00:00:24] Hi, I’m Michelle. I’m schizophrenic.

Gabe: [00:00:27] And we’re going to talk about red flags. Basically-

Michelle: [00:00:30] Gabe, you forgot to say what this is.

Gabe: [00:00:32] This is a podcast. I said that.

Michelle: [00:00:34] When? You did?

Gabe: [00:00:35] I did. I said, “It’s A Bipolar, A schizophrenic, and a Podcast.”

Michelle: [00:00:37] I missed that.

Gabe: [00:00:39] But you know what I did forget to say? So I am glad that you brought it up? On March 30th, it is World Bipolar Day.

Michelle: [00:00:47] It is?

Gabe: [00:00:47] It is.

Michelle: [00:00:48] What a happy day. Or sad day. Or, I don’t know.

Gabe: [00:00:53] I kind of look at it as a both day. Like I wake up sad, but I go to bed happier, and kind of vacillate back and forth throughout the day.

Michelle: [00:01:00] Yeah. I know there must be so many people that are happy, or sad, or in the middle, or going up and down about how to feel on such a day.

Gabe: [00:01:07] So, World Bipolar Day. It takes place on Van Gogh’s birthday. And it really is kind of weird to think about, but it’s supposed to be like a celebration, or an acknowledgement of bipolar disorder and the contributions of people who live with bipolar disorder. It’s a day of awareness. It’s a day of acknowledgment. It’s a day of celebration. It can kind of be anything that you want. And it’s really caught on in the last few years.

Michelle: [00:01:28] Do you set off fireworks?

Gabe: [00:01:30] Not intentionally.

Michelle: [00:01:33] [Laughter]

Gabe: [00:01:34] It’s a really cool day, and I don’t know if our listeners are familiar with it. But you can find information on it by googling “world bipolar day.” You can also find more information on That’s the International Bipolar Foundation. They sort of spearheaded this, but it’s been going on for a number of years. Michelle, is there a world schizophrenia day?

Michelle: [00:01:51] That’s a good question. I don’t really know.

Gabe: [00:01:54] If there’s not, like, I’m getting an idea.

Michelle: [00:01:56] You’re getting an idea?

Gabe: [00:01:57] We should spearhead world schizophrenia day.

Michelle: [00:02:01] OK, let’s do it.

Gabe: [00:02:01] We’re just gonna do it? Just do it?

Michelle: [00:02:03] Just right now.

Gabe: [00:02:03] Just right now?

Michelle: [00:02:04] How about today?

Gabe: [00:02:05] Let’s just cancel the podcast and just start our own holidays. It worked for Hallmark.

Michelle: [00:02:08] Let’s just make like different holidays every day. And then we never have to do anything, because it’s always a holiday.

Gabe: [00:02:15] This is genius.

Michelle: [00:02:17] Yeah. Holiday all day every day.

Gabe: [00:02:19] Holiday all day every day?

Michelle: [00:02:21] Yeah.

Gabe: [00:02:21] Excellent.

Michelle: [00:02:21] Excellent.

Gabe: [00:02:22] It sounds a little bit like our lives, though. If you think about.

Michelle: [00:02:25] A little.

Gabe: [00:02:25] Michelle, when we were going over the idea for the show, you said we should really talk about red flags of mental illness that we saw in ourselves before we were diagnosed. And we came up with really good ones that we’re gonna discuss. But, I think that we should maybe open it up a little later on in the show to talk about warning signs that we have personally seen in others. So, we’ve sort of got, like, the personal experience, the lived experience. But you know, maybe we should cover, like, some just straight up warning signs? Like, for example, if you are running naked down the street screaming that you’re being followed by Osama bin Laden, you might be schizophrenic.

Michelle: [00:03:04] Yeah. I would say there is something really big going on there. Or you could be doing a lot of drugs, honestly. If you’re really yelling that down the street.

Gabe: [00:03:11] It is interesting that you bring up the drug thing. Because we know many people who were diagnosed with bipolar disorder or schizophrenia because they were abusing drugs and alcohol, and when they got clean, they realized that they didn’t have a mental illness at all. But they were having the hallucinatory. . . “Hallucinatory?” Is that a word for real?

Michelle: [00:03:29] Sure, yeah.

Gabe: [00:03:30] Of the drugs. So it is kind of a messed up thing, isn’t it?

Michelle: [00:03:34] Drugs or schizophrenia? Let’s see. I guess so, sure.

Gabe: [00:03:38] And what if you genuinely have schizophrenia, but you are self medicating with drugs?

Michelle: [00:03:43] Well, that sounds like fun.

Gabe: [00:03:45] Does it?

Michelle: [00:03:46] No.

Gabe: [00:03:46] I mean we should probably put a little asterisk there. That Gabe and Michelle are not advocating treating schizophrenia with drugs.

Michelle: [00:03:55] I would not advocate that. I wouldn’t say to treat schizophrenia with drugs. Not a good idea. A guy on Instagram just told me that I should try CBD oils with exercise to help. And I said, “Well, you know, any kind of supplement or anything with exercise is always good. So thanks for the unsolicited advice asshole.”

Gabe: [00:04:15] Well now wait a minute. Come on, we can’t call our fans assholes.

Michelle: [00:04:18] No, I’m not saying he’s an asshole but I just don’t need like advice like oh how to schizophrenia. Have you tried CBD along with exercise? Okay, first of all exercise is always really a healthy thing to do. CBD? Sure, like all the other supplements could be beneficial or could do nothing. So, I don’t need somebody on Instagram telling me what to do to help my schizophrenia.

Gabe: [00:04:43] But isn’t this why social media was created? So that we could stalk other people and tell them they were wrong?

Michelle: [00:04:48] Sure. But listen, if I want your advice on Instagram I’ll ask for it.

Gabe: [00:04:55] I remember my father when I was growing up, he’s like, “If I want your opinion, I’ll give it to you.” That was his motto.

Michelle: [00:05:01] What do you need? Some CBD and an awesome exercise, Gabe?

Gabe: [00:05:04] Maybe I need some CBD oil?

Michelle: [00:05:05] Yeah, just take some CBD and do some exercise, you’ll feel so much better. I heard it on Instagram today.

Gabe: [00:05:11] It is interesting, and I want to talk about something for the younger generation while we’re on this vein. I’m over 40, but I remember the exercise craze of the 90s. The early 90s, and there was all these supplements that came out. All of these pills that you could buy at the gas station, exactly like CBD oil. It’s going to change your life, they’re better, they’re amazing, and if you take the pills exactly like they order you to do so, you will lose weight. That was the big thing, they were weight loss supplements. And I always laughed, because they would say things like, “OK, you have to take four pills a day. Morning, noon, evening, and night. You have to take it each with a gallon of water.” So you’re gonna drink four gallons of water a day.

Michelle: [00:05:52] That’s not healthy.

Gabe: [00:05:53] And yet, maybe it wasn’t a gallon, maybe it was half a gallon, but it was an extreme amount of water. You’re supposed to take it with a lot of water. You were supposed to take the pills in supplement of dinner. So you weren’t supposed to eat dinner at all. And they put on the package that the pills worked best if you took a brisk 15 minute walk after each dosage.

Michelle: [00:06:13] Take a pill. Don’t eat. Drink lots of water, and take a walk.

Gabe: [00:06:17] Yeah.

Michelle: [00:06:17] And you will lose weight.

Gabe: [00:06:18] Yeah, and it’s the pills. It’s the magic pills.

Michelle: [00:06:20] Oh my goodness! That’s… that’s…. God that’s wow. Wow. So, I personally love the pills at the gas station that say that you get a huge boner.

Gabe: [00:06:30] Yeah. Yeah. It does remind me of the boner pills.

Michelle: [00:06:33] Yeah. The boner pills. I love those. OK. Gabe we are like on a tangent right now. What were we talking about? Red flags.

Gabe: [00:06:38] It is a good tangent, because, I think that there are many people who live with mental illness, that think that they can take a magic pill that they bought at the gas station and they will live well. It’s really odd to me because, you know, “Big Pharma,” pills are bad unless you buy it at the gas station.

Michelle: [00:06:54] Just go take some St. John’s Wort.

Gabe: [00:06:55] Well you know, at least St. John’s Wort has some study behind it to show some efficacy for low grade depression. We, me and you, we do not have low grade anything.

Michelle: [00:07:04] I took St. John’s Wort. It did nothing for me. I’m not against St. John’s Wort. It’s just that personally, it was probably as helpful as CBD and exercise.

Gabe: [00:07:12] To tie this back together into something good, though. It is a red flag if you are constantly looking for sources outside of yourself to feel better.

Michelle: [00:07:20] Yes.

Gabe: [00:07:20] If your depression is so bad that you’re willing to try something that you bought on the Internet, or advice that you got on Instagram, or something at the gas station. If you are desperately looking for a cure, it is a pretty good indication that you’re acknowledging that you’re suffering from something. Because people who are healthy and happy don’t just buy random products and ingest them for no reason.

Michelle: [00:07:41] That’s a very good point.

Gabe: [00:07:42] I’m good at that. I do that.

Michelle: [00:07:43] You do that a lot, Gabe?

Gabe: [00:07:45] Michelle, what were some red flags that people saw in you before you noticed that anything was wrong?

Michelle: [00:07:50] Well, the huge red flag was that I was constantly talking to myself and I didn’t even realize I was talking myself or just laughing at myself. I remember my mother speaking to like high school teachers and/or middle school teachers, and she said your teachers are saying that you’re laughing at them. They’re saying that you’re laughing in class. And I’m like, I’m not laughing in class. I was going into delusions and hilariously laughing at my delusions and just laughing in class. Which had nothing to do with the class or anything I was learning about. I was just often off in like another land laughing hysterically. But I didn’t realize I was doing it, and I didn’t know what it was, and I didn’t know why. I didn’t have memories of myself laughing during class to even try to defend myself. And I would say, I wasn’t laughing during class. But there you go. Right there was a huge red flag. The only time I remember specifically doing that was like, 11th grade physics. I’m sitting in the back of class and I guess I was just laughing so hysterically over and over again and not noticing that a girl who is two seats ahead of me turned around and goes, “Hey, are you OK?” And that’s when I realized. I started to go, “Oh! Oh, sorry. I… I was just laughing at something.” She goes, “What were you laughing at.” I’m like, “Oh, I think I was just thinking of something funny. I don’t know.” And that’s like the first time I noticed that I actually was just completely bursting into laughter at nothing around me. Only what was in my head.

Gabe: [00:09:11] Well, it’s interesting that you brought up that you were laughing at things that were in your head. You weren’t aware of anything that was happening around you, and the teachers and fellow students thought that you were, like, mocking them.

Michelle: [00:09:22] Yeah.

Gabe: [00:09:22] So now you’ve got two problems. You’ve obviously got the delusions, the laughter, and the lack of self-awareness. And you’ve managed to piss off people that you weren’t even aware were in the room.

Michelle: [00:09:33] Yeah.

Gabe: [00:09:33] And this is one of the things that makes it really, really difficult to get treatment. Because nobody thought that you needed treatment, but they did think you needed punishment.

Michelle: [00:09:41] Right. Actually, this just reminds me of college. I would, for example, I had my computer with me, and I would sit in the back of the class on my computer. And in the room it would often be dark, but the computer lights up my face. And I guess I would laugh a lot while I was, you know, also being delusional in class. I would just look at my computer, I would laugh, I would kind of take notes. But one time I went up to the teacher after class, and I said something to him, and he goes, “Oh, by the way, I see you laughing a lot during class. Are you laughing at, like, what you’re looking at on the computer? Or, like, at what I’m saying?” And I go, “Oh, no. No, no, no. I just do that a lot.” So there I was doing it again in college. Just bursting into laughter, being delusional at nothing. My whole life, I’ve been doing it and I still didn’t know I had schizophrenia.

Gabe: [00:10:25] This is interesting because I think that people need to understand that the worst case scenario is that people think you’re a jerk, because you’re laughing at them. But what if the thing that you were doing was yelling and screaming? What if you were like posturing and like a defensive thing? And like raising your fist? You know you’re a tiny little girl, Michelle, you know? But I’m a 300 pound, six foot three, man. Imagine if I was completely unaware that I was in a room, and I would stand up and I would start yelling, “Get off me!” That’s the kind of thing that can get you tackled, hurt, beat up, shot, arrested. Because it’s scary. It’s scary, you know? You’re kind of telling the story like hey, it’s a big red flag, because you were laughing in class. But you know, nobody’s gonna tackle and have you arrested because you’re laughing. Worst case scenario is they’re going to ask you to leave. But, you know, a lot of people in our community, their delusions don’t revolve around things that make them laugh. Their delusions revolve around things that make them defensive, or appear angry, or scary. And I understand why it would be scary if I stood up and started screaming at you. I wouldn’t want you to wonder whether or not I’m having a delusion. I would want you to run. So I’m telling you that if I’m sick, run. But that means you’re not helping me. But you really can’t risk it. I’m one hundred and fifty pounds bigger than you.

Michelle: [00:11:38] One second, we’re going to commercial.

Announcer: [00:11:40]This episode is sponsored by secure convenient and affordable online counselling. All counselors are licensed accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to and experience seven days of free therapy to see if online counselling is right for you.

Michelle: [00:12:10] And we’re back, talking about red flags. Did you have any huge red flags?

Gabe: [00:12:16] Oh man, I had so many red flags! The biggest one that I’ve talked about on this show before, is that I thought about suicide every day as far back as I can remember. I didn’t think it was odd at all.

Michelle: [00:12:27] Like how far back?

Gabe: [00:12:28] Like when I was 4? 3? I don’t know. I never remember not thinking about it, and I think that kind of blows people’s minds, too. Remember on another episode, that you said that you didn’t tell anybody that you were paranoid? Because, after all, you were paranoid.

Michelle: [00:12:39] Right.

Gabe: [00:12:40] And it’s the way that you always felt, and it felt normal to you. The paranoia seemed very protective, so you weren’t doing anything to try to fix it. You were steering right in to that curve of paranoia.

Michelle: [00:12:50] Right. I believed it. I thought it was right. Therefore, I didn’t tell anybody, because I didn’t want to go against it. Because I didn’t want it to get worse.

Gabe: [00:12:58] Yeah.

Michelle: [00:12:58] If you, like, don’t listen to your paranoia, it’s only going to get worse. Because you’re going to get more paranoid. Right?

Gabe: [00:13:05] And the reason that you believed it is because it was just always with you?

Michelle: [00:13:07] Right.

Gabe: [00:13:07] Right. That’s how suicidal thoughts were to me. They were just always with me, and I just assumed that everybody else was thinking about suicide as well. I’m not saying that I thought that everybody was going to die by suicide, because that would be nuts. I thought that everybody was considering it. Just like I know that everybody can eat pizza. I just do. I just do because, you know, pizza is something that’s readily available. It’s relatively inexpensive. So when I see people not eating pizza, I assume to myself that the reason they’re not eating pizza isn’t because it’s unavailable to them, but it’s because they don’t want it. So when I see people not committing suicide, not dying by suicide,, or not self harming themselves, I just assumed it was because they didn’t want to. Not because they weren’t thinking about it, or not because they were emotionally healthy. I just thought they were making a choice, that was different from mine. But I sure as hell thought they were contemplating it. I did. I thought my parents would go to bed at night and think, “Wonder if we should kill ourselves tonight? No, we’ll stick it out with the kids.” That’s just what I thought.

Michelle: [00:14:11] I get that. When I when I was in high school, and I knew I had those behavioral issues, every time I was brought to any kind of, like, guidance counselor, or any kind of therapist or anything, and they’d say, “You know, everything is between you and me. Unless you’re thinking of hurting yourself or somebody else.” So right at that moment, I wouldn’t say anything because I was thinking of hurting myself. I was suicidal, so therefore I never got any help, because I never opened my mouth. But yet I didn’t think of that as a red flag. Because it was that big a deal that they were going to tell my mom that I was thinking of hurting myself. That should have been like, “Oh, it’s such a big deal that they would tell my mom!” That is such a big red flag right there. I was thinking, “Oh no, don’t say a word. They’ll tell my mom! I should just be quiet because I don’t want her to know.” When really, that’s something she should have known about because that’s really important to get fixed.

Gabe: [00:15:02] Along that same line, it never occurred to me that anything was wrong with this because there was no mental health training. My parents, if my parents would have sat me down one day, and I hear this is kind of a messed up thing to say. But if they would have sat me down one day, and said, “Gabe, thinking about suicide is abnormal.” I would be like, “Really? That’s – really?” But they didn’t. We never had those conversations because my parents didn’t see any value in it. Which is, I love my mom and dad. I want to make that very, very clear. My mom and dad are not bad people. It never occurred to them that their child was thinking about killing himself, because if it would have occurred to them, they would have done something. We just believed all the bullshit about mental illness that most people believe. My parents were like, “You know, he’s smart. He gets average grades. He’s funny. He’s a good kid, and he comes from a good family, and we’re all good people. So clearly suicide isn’t an issue. He’s not mentally ill.” But my mother to this very day says that she always described me as her “Dr. Jekyll and Mr. Hyde kid.” And I always point out when she says that you’re describing bipolar disorder. So my mother recognized that I had this. That I had the symptoms of bipolar disorder as a teenager, but she never was able to put it together any further. And that scares me, because that’s a giant red flag that everybody I knew missed. Even though they were all sitting around talking about it.

Michelle: [00:16:28] I don’t know. For a while I was trying to tell everybody that I couldn’t sleep at night. I can’t sleep at night. I can’t sleep at night. And I was just told, “You’re not getting sleeping pills! Stop trying to get sleeping pills!” I don’t want sleeping pills. “What do you want?” I want to sleep at night.

Gabe: [00:16:45] That’s interesting, because I too had trouble sleeping, and my parents had a billion reasons that it was my fault. You drink too much Mountain Dew. You’re too hyper. You’re watching too much television. You don’t get enough exercise. Or my personal favorite one, try harder.

Michelle: [00:17:02] Right.

Gabe: [00:17:02] Yeah. I can’t sleep. Try harder.

Michelle: [00:17:04] And sleeping was, like, the hardest thing. Because going to try to fall asleep was when the paranoia was almost at its worst. Because it would go through my entire day and everything I did that day and it would tell me how everything I did that day was the most horrible thing I could have done. And then, I would get delusional and believe that things happened that day that never happened, making it even worse. So then it was then things that I didn’t believe are true happened and then paranoia. It was just all this crazy. Kind of, who knows, is making up all this nonsense in my head. And I would cry myself to sleep every night, and the only thing I would say was I just want to sleep. Please I just want to sleep. “You’re not getting sleeping pills!”

Gabe: [00:17:43] You know when I said that I couldn’t sleep, nobody told me that I couldn’t have sleeping pills. The advantage I guess of being 14 years older than you, is that apparently sleeping pills just weren’t a thing in my generation.

Michelle: [00:17:52] It’s not that I wanted sleeping pills.

Gabe: [00:17:53] I know that it’s not. But nobody even thought that when I said I couldn’t sleep. Nobody thought that I was trying to get sleeping pills.

Michelle: [00:17:59] Oh yeah. Everyone was like, “Yeah, you just want your drugs.” They thought I was drug seeking.

Gabe: [00:18:01] Yeah, that’s bizarre. Nobody ever accused me of drug seeking by saying that I couldn’t sleep, but they didn’t think it was a problem either. And everybody thought it was my own fault. You know, frankly, they blamed it on caffeine, or my poor eating habits, or I needed more exercise. There was always some reason that these things were my fault. We’ve talked a lot about being kids. We’ve talked a lot about, like, our teenage years, when we were under our parents’ control. And maybe you were diagnosed sooner than me. What were some warning signs for you as an adult? Like what was with adult Michelle? The warning signs?

Michelle: [00:18:35] Like adult Michelle? Is that considering college as well?

Gabe: [00:18:37] Yeah. I mean, I mean, well, when you were a grown ass woman.

Michelle: [00:18:41] Well, there would be times I’d be in my room in college. Then I would just hear my other roommate, Kate, just yelling, “Who are you talking to? Who are you talking to?” And I’d be like, “Why? What are you talking about?” She goes, “I hear you speaking to somebody.” I’m like, “Oh, I was just working something out of my head. I’m just working stuff out.” But then other times that happened I would actually be on the phone, and she’d yell. I yell back, “Give me a break! I’m on the phone okay. Leave me alone.” But this happened so often. And then other times, my other friends, would be like, “You’re schizophrenic.” And I’d be like, “No, I’m not schizophrenic. That’s voices outside your head, not inside your head.” And they’re like, “Are you sure about that?” And I’d be like, “Yeah, I’m definitely not schizophrenic, guys. Don’t worry about it. Don’t worry about it, I’m not schizophrenic.” So that’s why when I told them I was, they were like, “Yeah, no shit. We told you that.”

Gabe: [00:19:32] Yeah.

Michelle: [00:19:33] That’s why they knew. They knew way before me. So when I told them, it was like telling them that I have brown hair. They were like, “We know. We know. We already knew this about you. What? What are you even trying to tell us? Like, you’re telling us nothing.”

Gabe: [00:19:46] That’s always a fascinating part of your story to me. You know, every time it comes up, or we discuss it, this idea that a lot of people around you knew that something was wrong, yet they weren’t actively seeking help for you. They were telling you, which is a step in the right direction. And you were ignoring them. And the reason that you were ignoring was not like people think. You weren’t ignoring them because you were schizophrenic. You were ignoring them because you didn’t understand. You didn’t agree with them. You didn’t. You didn’t see it yourself. You had no self-awareness, which I suppose people can argue was because of schizophrenia, but I think it’s a mixture. I’m sure that being schizophrenic probably played a role, but I think having no understanding of how mental illness works, its symptoms, its causes, or what to do about it, made it easy for you to skip.

Michelle: [00:20:32] Yeah I think so. I mean, I was diagnosed as bipolar. So I thought I was just bipolar. But then, I was, I kind of knew that those symptoms didn’t fit. When I googled the symptoms, it was like, I really don’t have this. But I might have something worse. But I don’t want to look it up, whatever is worse. And I don’t want to believe other people, so I’m just gonna say that I’m bipolar and leave it at that.

Gabe: [00:20:54] It’s fascinating to me. You’ve said this before, and I never know, like, how to respond to it. Because you’re like –

Michelle: [00:20:59] Because it’s like is one really worse?

Gabe: [00:21:00] Well, yeah. You’re, like, just bipolar. It’s kind of a bit like saying, “Well, I just have testicular cancer. I mean, I don’t have lung cancer. Just testicular cancer.”

Michelle: [00:21:13] I know. I was like this. I just stigmatize myself in that. That was like-

Gabe: [00:21:18] No, it was me. Just a lot of that is that just I’m very sad that you would do this to me.

Michelle: [00:21:23] Oh, yeah.

Gabe: [00:21:24] Just, wow. Just –

Michelle: [00:21:25] Wow.

Gabe: [00:21:25] Make sure you use person first language the next time you stigmatize me. That will make it all go away.

Michelle: [00:21:31] Oh really? Oh really?

Gabe: [00:21:33] Michelle, you and I, we had a lot of signs. And anybody listening to this show should know that the warning signs for both Michelle and I were like spotlights. And nobody really picked up on them. Our parents didn’t do nothing, and they made attempts to get us help, here and there. But it wasn’t the concentrated effort that it needed to be, because they didn’t know what to do. Outside of the symptoms that we have and that we’ve kind of discussed on the show, let’s talk about some other really big symptoms that we’ve heard about other people having. Common ones that people hear about. Like, for example, not being able to go to work for several days in a row, but not being physically ill, and not understanding why you can’t get out of bed. That’s kind of happened to us in a way, but –

Michelle: [00:22:15] Just not being able to get out of bed because you’re so depressed?

Gabe: [00:22:18] Yeah, yeah.

Michelle: [00:22:19] Yeah.

Gabe: [00:22:20] We’ve certainly been there, but kind of gone back and forth and back and forth. But I think by the time we were there, we probably knew we were mentally ill. So, it’s not necessarily a red flag before diagnosis, but rather an ongoing problem that that we suffered from. But losing interest in things that you used to have interest in is a big red flag. You know, giving away prized possessions is a big red flag. Pulling away from friends and relatives that you were close to is a big red flag. And while some of those things happened us, and some of those things didn’t, any of those things alone are cause for concern. And you know, maybe you should get a mental health checkup. Whether you go to your general practitioner, whether you go to a social worker, or a psychologist, or whether you go straight for a psychiatrist. I’m really always bummed when people say, “You know, I thought maybe there was something wrong, but it didn’t seem serious enough.” You know, we live in a country that goes to the doctor for the sniffles, and I’m OK with that. Like, I don’t think that’s a bad thing. So if you think that you might have a mental health problem, why not go get it checked out?

Michelle: [00:23:24] I have a friend that I hadn’t seen in a while, and I saw her, like, last weekend. And I’m talking to her and she’s struggling and things. And she’s going, “I think maybe, I think I’m going to go get some therapy. I think it. I think I’ll get therapy.” And I just said to her, “You know you’re saying that like not everybody goes to therapy? Everyone goes to therapy. It is incredibly common to go to therapy.” And I’m trying to explain to her that her thinking that therapy is like, so taboo, and that she’s going to go. Because she’s, like, kind of, almost seemed ashamed of it. That she could possibly be going to therapy and it’s such a bad thing that she thinks she needs it. And I’m just telling her, everybody goes to therapy. Everybody does it. There’s no shame. You ask a bunch of or maybe 10 people and ask them who’s been to therapy, at least half the people are going to raise their hand. There’s no shame in going to therapy. If you think you have to go to therapy, don’t think and make a huge deal about it. Just go.

Gabe: [00:24:20] It’s fascinating to see how therapy has sort of evolved from the generations. Like, my grandfather is 88 years old. He’s like, “Therapy is bullshit. Nobody should go. Be a man.” You know my dad’s in his 60s, and he went to therapy. But he wouldn’t tell anybody. My mom knew, and none of us kids could know, and he’s gonna hear this episode and he’s gonna be like, “What? Why? Why are you telling people that?” And then there’s my generation. You know, I’m in my 40s. I’ll go and I’ll tell my friends and family, but that’s it. And then there’s all the 20 year-olds that are like live streaming therapy on Facebook. Checking in with their therapist, they’re just like, “What do you mean, you don’t have a therapist?” But that is good. That is good to see the evolution of it, because it’s a valuable thing. It matters in our society. And if you want to know the biggest red flag, that everybody should respond to, is if you think there might be something wrong, that’s a red flag. If your friends are coming to you and telling you there might be something wrong, that’s a red flag. Don’t look for the giant ones. Pay attention to the small ones. Because like all other illnesses, early treatment is key.

Gabe: [00:25:24] Thanks again for spending this week with A Bipolar, A Schizophrenic, and a Podcast. Remember to share, like, and subscribe. Make Michelle and I famous. And if you get a chance, hop over to and buy my book, Mental Illness Is an Asshole. And of course, I have to be fair, so head over to schizophrenic.NYC and buy a shirt. You can also go to and buy the Define Normal shirt. They are almost out of stock, and I’m not sure we’re gonna be ordering more. We will see everybody next week.

Michelle: [00:25:53] Red flag.

Announcer: [00:25:57] You’ve been listening to a bipolar a schizophrenic kind of podcast. If you love this episode don’t keep it to yourself head over to iTunes or your preferred podcast app to subscribe rate and review to work with Gabe go to To work with Michelle go to Schizophrenic.NYC. For free mental health resources and online support groups. Head over to Show’s official Web site you can e-mail us at [email protected]. Thank you for listening and share widely.

Meet Your Bipolar and Schizophrenic Hosts

GABE HOWARD was formally diagnosed with bipolar and anxiety disorders after being committed to a psychiatric hospital in 2003. Now in recovery, Gabe is a prominent mental health activist and host of the award-winning Psych Central Show podcast. He is also an award-winning writer and speaker, traveling nationally to share the humorous, yet educational, story of his bipolar life. To work with Gabe, visit HAMMER was officially diagnosed with schizophrenia at age 22, but incorrectly diagnosed with bipolar disorder at 18. Michelle is an award-winning mental health advocate who has been featured in press all over the world. In May 2015, Michelle founded the company Schizophrenic.NYC, a mental health clothing line, with the mission of reducing stigma by starting conversations about mental health. She is a firm believer that confidence can get you anywhere. To work with Michelle, visit Schizophrenic.NYC.Podcast: The Warning Signs of Bipolar and Schizophrenia

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Pregnancy and Addiction: Overlooked and Undertreated

This is an interesting article I found on:

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If one needs proof that addiction is a disease and not a moral failing, look into the eyes of a woman who knows her behavior is harming her baby but still can’t stop.

With one in three individuals with opioid use disorder passing through the criminal justice system annually, court dockets across the country are overflowing with cases of illegal behavior fueled by addiction. Though such cases wrangle with the complexities of punishing individuals afflicted with what is increasingly seen as a disease that erodes free will, they are the bread and butter of the legal system.

However, the recent Pennsylvania Supreme Court case known as In the Interest of L.J.B. adds another level of intricacy to the court’s decision-making process. The question asked in the case—Does drug use during pregnancy constitute child abuse?—is unpleasant to contemplate, but it is one of absolute importance.

The defendant in the case, a woman referred to as A.A.R., tested positive for illicit opioids, benzodiazepines, and marijuana when she gave birth to her infant, L.J.B., in January 2017. L.J.B. then required 19 days of inpatient treatment for drug withdrawal and was placed in the custody of Children and Youth Services, which alleged that her mother’s drug use during pregnancy was child abuse. On December 28, in a 5-2 decision, Pennsylvania’s Supreme Court ruled in favor of L.J.B.’s mother, stating that Pennsylvania’s child abuse law clearly excludes fetuses in its definition of a child. While the issue may be settled in Pennsylvania, there is little doubt that similar cases will be heard across the country amidst the opioid epidemic.

Pregnant Women with Opioid Addiction—Overlooked and Undertreated

The case of L.J.B. and her mother has drawn national attention to women who simultaneously carry a child and the burden of an addiction—a group that has often been overlooked or ignored in the national discussions about the opioid epidemic. Few individuals in our society bear such a stigma as these women. As an addiction psychiatrist, I’ve heard harsher judgment passed on these patients—even from fellow healthcare workers—than on any others. This stigma permeates our medical and legal systems, creating dire consequences not only for these women, but also for their unborn children.

Pregnancy is unparalleled in its ability to motivate women towards healthier behavior, but approximately four percent of pregnant women still use addictive drugs. When I’m asked to evaluate a woman who is pregnant, I know her disease is severe before I’ve even laid eyes on her. If one needs proof that addiction is a disease and not a moral failing, look into the eyes of a woman who knows her behavior is harming her baby but still can’t stop. There is no better example of the ability of a chemical to overpower the deepest-rooted human instincts.

A recent report released by the CDC revealed that opioid addiction among women in labor quadrupled from 1999 to 2014, signifying the need for immediate action. Opioid addiction during pregnancy can create many problems for mother and child, including preterm labor, neonatal abstinence syndrome, and even fetal death. Tragically, pregnant women with addictions are less likely to receive prenatal care.

Aware of society’s disdain, many don’t want to be stigmatized at the doctor’s office. Some mothers-to-be can’t even find a physician willing to treat them, and others are afraid of being reported to authorities due to laws that have arisen out of prejudice and misinformation…

Find out more about what Dr. Barnett has to say about how harsh laws can harm the mother and child, how we can help pregnant women with their addictions, and more in the original article Pregnant and Scared to Get Treatment: When Conception Meets Addiction at The Fix.

Pregnancy and Addiction: Overlooked and Undertreated

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Psychology Around the Net: March 23, 2019

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Ever wonder how food affects your mental health? Do you think social media addiction should be formally classified (and should the companies behind them be taxed for help)? What’s your stance on Amy Schumer’s discussion of her husband’s autism spectrum disorder diagnosis?

Let’s discuss it all and more in this week’s Psychology Around the Net!

Nutritional Psychiatry: Can You Eat Yourself Happier? We’re not talking about eating your feelings but eating foods that actually affect your feelings. After struggling with anxiety and depression throughout most of her life, Felice Jacka, the head of the Food and Mood Centre at Deakin University in Australia and president of the International Society for Nutritional Psychiatry, found that her diet, exercise, and sleep had a major affect on her mental health. Before you scoff (duh, don’t we already know this?), her findings initially weren’t received with open arms. Now, a ton of research, studies, and and peer-reviewed papers under her belt, it’s obvious what we eat affects our mental health.

Fluctuation of Depressive Symptoms May Help Predict Suicide: According to a recent study published in JAMA Psychiatry, the severity and fluctuation of depressive symptoms are better at predicting suicide in at-risk young adults than psychiatric diagnoses alone. Says the study’s senior author Dr. Nadine Melhem, “Our findings suggest that when treating patients, clinicians must pay particular attention to the severity of current and past depressive symptoms and try to reduce their severity and fluctuations to decrease suicide risk.”

Social Media Addiction Is a Real Disease, U.K. Lawmakers Say—And Facebook and Google Must Be Taxed for It: The negative effects social media can have on mental health — especially teen’s and young adult’s mental health — is no news. We’ve been talking about it for years. Now, U.K. lawmakers aren’t just saying that social media addiction should be formally classified as a disease, but they’re also kicking it up a notch and claiming the companies behind social media platforms should have to pay a 0.5% tax on their profits to help solve the problem.

7 Things to Stop Doing to Yourself When Life Doesn’t Go as Planned: Frankly, my life isn’t going quite as planned right now. This was helpful, and so I’m passing it along.

New Study: Performance-Based Pay Linked to Employee Mental Health Problems: Pay-for-performance compensation systems such as bonuses, commissions, piece rates, profit sharing, and individual and team goal achievements — which are prevalent in approximately seven out of 10 companies in the U.S. alone — are meant to act as incentives; however, according to this big-data study that combined objective medical and compensation records with demographics, these systems are actually taking a negative toll on employee mental health.

Amy Schumer Tells Why She Revealed Her Husband’s Autism Spectrum Diagnosis: Since her latest Netflix special, Growing, began streaming last Tuesday, fans and non-fans alike have talked more about how Amy Schumer discusses her husband Chris Fischer’s diagnosis than anything else in the show. Some are offended, claiming she had no right to talk about his health; others are fine, stating we shouldn’t jump the gun because, you know, Chris is her husband and therefore probably knew — nay, probably was consulted — about it long beforehand. Well, according to Amy during her appearance on NBC’s Late Night with Seth Meyers, “We both wanted to talk about it because it’s [the diagnosis] been totally positive.” She then goes on to talk about the tools and resources they were given, how they’ve managed life and marriage, and how they both want to encourage people not to be afraid of the stigma. So, yeah. It sounds like Chris wasn’t a pawn in his wife’s comedy routine, nor was he ignorant to what she was going to say. Watch the interview clip.

Psychology Around the Net: March 23, 2019

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What It Means to Be a Mental Health Advocate—And How to Become One

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Over the years, the stigma surrounding mental illness has significantly decreased. One of the biggest reasons?

Mental health advocates.

These are the individuals who tirelessly share their stories in all sorts of ways. They remind us that we’re not alone in our struggles—and there is real, tangible hope and healing. They shatter stereotypes and myths about mental illness, helping the public see that people with mental illness are just people.

As Jennifer Marshall said, “By showing the world that we’re your neighbor, your family members, your friends, and we are not only surviving with these conditions, but thriving, we’re educating the world and changing the world for the better.”

If you’re thinking about becoming a mental health advocate, you might be wondering what advocates actually do, and how to get started. We asked advocates who are doing all kinds of incredible work to share their insights.

What It Means to Be a Mental Health Advocate

Therese Borchard defines a mental health advocate as “anyone who is a voice for those suffering from depression, anxiety, or any other disorder—who hopes to disseminate a message of hope and support.”

Similarly, Marshall said it’s “someone who learns how to take the best care of their mental health and shares openly about their story to help others.”

According to T-Kea Blackman, an advocate is “a change agent,” “someone who educates his [or] her community on mental health, reduces the stigma and fights for change in the behavioral system.”

Sally Spencer-Thomas, PsyD, thinks of advocacy as a “spectrum of engagement” from allies to activists. An ally is someone who feels connected to challenging the discrimination and prejudice related to mental illness, but might not act on their feelings. An advocate uses their voice to encourage change. An activist “engages in intentional action to move change along—getting people organized, moving legislation, changing policy.”

What Mental Health Advocacy Looks Like

There’s no one way to advocate. It really depends on what’s important and inspiring to you—and what you feel comfortable with.

Borchard mostly writes and has created two online depression support communities: Project Hope & Beyond, and Group Beyond Blue, on Facebook. She also serves on the advisory board of the National Network of Depression Centers, speaks to different groups, and helps depression organizations spread their message.

Blackman hosts a weekly podcast called Fireflies Unite With Kea, where she gives “individuals who live with mental illness the opportunity to share their stories.” She hosts mental health events and speaks at workshops and conferences. She also works as a peer recovery coach for a pilot program, helping others with their personal and professional goals.

Years ago, Marshall started a blog at, after being hospitalized for mania four times in 5 years. Today, she’s the founder of an international nonprofit organization called This Is My Brave. They share stories of individuals who have mental illness and live full, successful lives through poetry, essays, and original music. This Is My Brave hosts live events, and has a YouTube Channel.

Spencer-Thomas is a clinical psychologist, and one of the founders of United Suicide Survivors International, “pulling together a global community of people with lived experience, lifting up their voices and leveraging their expertise for suicide prevention and suicide grief support.” She also advocates for workplaces to become involved in mental health promotion and suicide prevention; for providers to learn evidence-based clinical practices; and for innovation in men’s mental health through campaigns such as Man Therapy.

Gabe Howard, who believes that “advocacy must start with open and honest dialogue,” primarily does public speaking, and hosts two podcasts: The Psych Central Show, and A Bipolar, a Schizophrenic, and a Podcast. He’s also testified in front of legislators, served on boards and advisory councils, and volunteered for various initiatives.

Chris Love has shared his story of recovery from substance abuse all over North Carolina. He works as a counselor at a substance abuse treatment center, and with the nonprofit organization The Emerald School of Excellence, which is North Carolina’s first recovery high school for teens struggling with substance use.

Lauren Kennedy is an advocate who speaks to all kinds of audiences, including police officers, high school and college students, and healthcare professionals. She also has a YouTube channel called “Living Well with Schizophrenia,” where she talks about mental health and her own experiences with schizoaffective disorder.

The “Why” Behind Advocacy

“Being an advocate is important to me because I believe the only way we’re going to eliminate the stigma, judgment and discrimination surrounding mental illness and addiction is by putting our names and faces on our stories,” Marshall said. “This Is My Brave does this one person and one story at a time.”

For Kennedy, being an advocate is important because “people living with mental health problems are just that, people; and deserve to be treated with the same respect and compassion as anyone else.”

Similarly, Blackman’s mission is to “show that mental illness does not have a look,” and to “show those in the African American community that it is OK to attend therapy, take medication (if needed) and pray.”

“We do not have to choose our faith over our mental health, or vice versa. Every human deserves the right to have access to mental health treatment. Therapy is not a white or rich people issue; this is a myth that must be dismantled in my community.”

Spencer-Thomas views her advocacy work as her life’s mission after her brother died by suicide. “Every day I get up to prevent what happened to Carson from happening to other people. I feel that he walks alongside me, encouraging me to be courageous and bold. My fire in the belly is fueled by the process of making meaning out of my loss. I would do anything to have him back, but he’s not coming back, so my work is part of his legacy.”

Howard noted that as someone with bipolar disorder, he’s been unfairly judged and discriminated against. He’s had difficulty accessing care—and seen others experience difficulty, as well, because of their finances, where they live, and other circumstances.

“I just couldn’t sit by and do nothing. It seemed wrong to me. I tried to ‘hide in plain sight,’ so I could avoid the negative reactions—but it felt so fake to me.”

During Borchard’s lowest points, reaching out to others relieved some of her pain. “In those times when nothing, absolutely nothing worked, becoming an advocate for those who suffer from depression and anxiety, gave me a purpose to strive for, to get out of bed. Today, I continue to feel the benefits of service. It connects the random dots of life.”

How to Become An Advocate

Becoming a mental health advocate can include big and small actions—it all matters!

  • Advocate for yourself. As Blackman said, you can’t be an advocate for others if you don’t first advocate for yourself. For instance, she recently talked to her therapist and psychiatrist about discontinuing her medication. They collaborated on a specific plan, which includes continuing to attend weekly therapy sessions and calling her doctor and returning to medication if she notices any negative changes. According to Blackman, advocating for yourself means getting educated, understanding your triggers, developing coping skills and stating your needs.
  • Share your story. Start with family and friends, which also will reveal whether you’re ready for a wider audience, Borchard said. Love said if you’re comfortable, consider sharing your story on social media. “The beginning of ending stigma is being able to put it out there and talk about it.”
  • Educate your immediate circle. “There is a tremendous amount of power in reflecting on how you think and talk about mental health, and how you can help others in your life to take a more positive and accepting stance on mental health and mental illness,” Kennedy said. For instance, you can correct misinformation, such as using person-first language (“person with schizophrenia”), instead of “schizophrenic,” she said. Blackman also noted that you can text family, friends, and colleagues articles about mental health. In fact, she started by sharing articles and videos with loved ones to help them understand what she was going through.
  • Volunteer. Many of the advocates suggested joining local mental health organizations and assisting with their programs and events.
  • Get a mentor. “Like most things, getting the right mentor is about building relationships,” Spencer-Thomas said. She suggested noticing people you’d like to be like, reading their posts, leaving comments, and asking questions. “Volunteer for events or at meetings where [this person] is present…Ask them directly about being a mentor and set realistic expectations.”
  • Get trained in legislative advocacy. Spencer-Thomas noted that one way to do that is to become a field ambassador for the American Foundation for Suicide Prevention.
  • Find your niche. “[F]ind the thing that you are better at than most and that inspires you,” Howard said. This might be anything from public speaking to writing to fundraising to managing volunteers, he said.

Advocates who’ve been there also remind us that even though we can’t see past our pain right now that doesn’t mean this will be our future. As Blackman said, “…I am amazed at how I went from not wanting to live [and] attempting suicide [to] using my experience with mental illness to educate and reduce stigma.”

What It Means to Be a Mental Health Advocate—And How to Become One

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Psychology Around the Net: March 16, 2019

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Hello, lovers of all things psychology, psychiatry, and mental health related!

Today we’re going to take a look at how vitamins and other supplements don’t ward off depression, why it’s important not to get swept up in “boutique” wellness trends (and what to do instead), the ways in which you can manipulate your brain to completely forget something (really?), and more.


Study: Diet Supplements Don’t Ward Off Depression: New research involving more than 1,000 overweight or obese participants located in Spain, Germany, the Netherlands, and the United Kingdom who were at risk for depression — but not currently depressed — showed that taking vitamins and other supplements won’t prevent depression; however, better eating habits might help.

Are Eyes the Window to Our Mistakes? Researchers from the University of Arizona report that because the size of our pupils change when we make certain types of mistakes, we might have a glimpse into what’s going on in our brains when we make, err, crappy decisions.

When It Comes to Mental Health Forget the Wellness Trends and Just Keep Moving to Feel Your Best: Boutique wellness centers have become so much of a thing that many people — especially those who are just starting out with exercise — are either a) getting too stressed from this “ideal way” incorporating itself into every area of their everyday lives to continue, b) getting too burnt out to continue, or c) becoming too intimidated to even start. Pip Black, founder of Frame, says when this is the case, ditch the trends and just focus on moving, getting some outdoor time, and always reminding yourself tomorrow is a new day.

Stop Using the Words ‘At Least’ to Comfort: Says Lifehacker’s Meghan Moravcik Walbert, “Most people who use ‘At least…’ to try to comfort are well-meaning. They think they’re being helpful by pointing out the ‘bright side.’ But people in pain do not want to see the bright side; they want to feel heard and understood.”

Yes, It’s Possible to Intentionally Forget Something—Here’s How: Ah, that sounds lovely, but be warned: you’re probably going to have to spend a lot of time remembering it before you can actually forget it.

ACLU Says Schools Need More Mental Health Professionals, Not Police: According to a recently released report by the American Civil Liberties Union (ACLU), nearly one-third of public school students (that’s more than 14 million kids) attend schools that have police officers but not nurses, psychologists, counselors, or social workers.

Psychology Around the Net: March 16, 2019

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Feeling Completely and Utterly Alone Because You Have a Mental Illness? This Can Help

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You have a mental illness, and you feel incredibly alone. Intellectually, you know that you are one of millions of people who also have a mental illness—people who also have depression or an anxiety disorder or bipolar disorder or schizophrenia.

You know that you’re not the only person on this planet to be in pain.

But it doesn’t matter. Because it looks like everyone around you is just fine. You’re the only one who has a hard time getting out of bed, who feels overwhelmed by everything, no matter how small. You’re the only one who feels like an impostor and a fraud. You’re the only one who feels irritable and on edge for no reason. You’re the only one who can’t seem to get through the day. You’re the only one who has strange, sad, uncomfortable and cruel thoughts.

But you’re not. You’re really not.

Sheva Rajaee, MFT, is the founder of the Center for Anxiety and OCD in Irvine, Calif. She’s lost count of the number of times a client has started a session by saying: “I know you hear things every day, but this one is really weird.” When the client shares their “gruesome or socially unacceptable thought,” Rajaee’s face barely registers surprise.


“…[B]ecause I’ve had the experience of seeing thousands of clients, which means thousands of thoughts. I’ve come to understand that if the brain can think it, the brain can obsess about it, and that everyone experiences dark thoughts and scary feelings,” Rajaee said.

Kevin Chapman, Ph.D, is a clinical psychologist who specializes in treating anxiety disorders in Louisville, Kentucky. His clients regularly tell him that they’re the only ones who feel afraid to go into a carwash, they’re the only ones who freak out at Target, they’re the only ones who feel like they’re dying, and they’re the only ones who are dwelling inside a bubble while everyone else is actually living their lives.

Rosy Saenz-Sierzega, Ph.D, is a counseling psychologist who works with individuals, couples and families in Chandler, Ariz. Her clients have told her: “I know everyone knows what it’s like to be sad, but being depressed is much worse…it’s like the darkest shade of black…it’s like a 100-foot pit that I have fallen into and there is no way out. I’m in there, alone, and I know I can’t get out.” “I can’t even describe what I feel to my friends because they just think I’m exaggerating.” “Being around people is just too difficult, but being alone means it’s only me and my dark thoughts.” “I feel like I have an emptiness I can never fill; I can’t ever deeply connect with anyone because they will never know what it’s like to be me…in my head.”

According to Chris Kingman, LCSW, a therapist who specializes in individual and couples therapy in New York City, “thoughts like ‘I’m the only one….’ or ‘I’m alone in this…’ are cognitive distortions. They are irrational.”

We tend to automatically generate these kinds of thoughts when we’re feeling vulnerable and are in an unsupportive environment,” he said. Sadly, while it’s getting much better, as a whole, our society isn’t very supportive of people with mental illness. That’s “because most people have not had sufficient education about mental health and illness; and [they] feel uncomfortable when faced with others’ mental health struggles.”

Cognitive distortions also are part and parcel of illnesses like depression and anxiety. For instance, Saenz-Sierzega noted that “depression creates a severely negative view of the self, the world and of one’s future—which frequently includes feeling as though no one can possibly understand what you are going through, how you feel, and how to help. [And this makes] it that much harder to seek help.”

While seeking support is certainly challenging, it’s not impossible. And it’s the very thing that will make a huge difference in how you feel and in how you see yourself. So if you’re feeling alone and like a massive outcast, these suggestions can help.

Validate your feelings. Acknowledge, and accept how you’re feeling, without judging yourself. Honor it. “The experience of having a mental health disorder of any kind can be emotionally and physically draining, and even with all the help in the world there will be days when you feel down and alone. This is normal,” Rajaee said.

Revise your self-talk. Kingman stressed the importance of not telling ourselves that we’re alone (or inferior or broken or wrong), because “feelings aren’t facts.” As he said, you might feel alone, and inferior and broken and wrong—and that’s a valid experience, as any emotion is—but these emotions don’t reveal some end-all, be-all truth.

“The issue is that you feel vulnerable and insecure, and you need support but you’re afraid of judgment and rejection.”

Kingman encouraged readers to record your thoughts in a journal. Specifically, observe how you talk to yourself, “catch” yourself when your thoughts are critical or demeaning, and replace these thoughts with constructive, compassionate, supportive self-talk, he said.

Seek therapy. If you’re not seeing a therapist already, it’s vital to find one you trust, Saenz-Sierzega said. A therapist will not only normalize your feelings and help you better understand how your mental illness manifests and functions, but they’ll also help you build a healthier self-image and learn effective coping tools and strategies.

“The gift of mental illness is that if navigated well, you come out a survivor,” Rajaee said. “The same tools and coping strategies you have had to learn through treatment give you a resilience that makes other challenges in life more doable.”

You can start your search for a therapist here.

Reach out. This is a powerful way to “get outside of your own head,” Saenz-Sierzega said. “Surround yourself with person(s) who love you, know your worth, and appreciate you for who you are.” Talk to them about how you’re feeling.

Join an in-person or online support group. For instance, Kingman suggested participating in 12-step recovery groups. They “are free and there are many groups in every city for so many human issues, like alcohol, drugs, gambling, sex, relationships, emotions, over-spending, and more. Lots of acceptance, support and solidarity in these groups for human suffering, diagnoses [and] struggles.”

Also, check out the online depression communities Project Hope & Beyond and Group Beyond Blue.

Rajaee suggested finding online forums with people who’ve been through what you’re experiencing. Psych Central features a variety of forums.

Another option is a therapy group, “where the experience of being human and the struggle of having a mental health disorder is normalized and where you are celebrated for your strength and resilience,” Rajaee said.

Finally, Saenz-Sierzega suggested texting “home” to 741741.

Listen to sound mental health information and relatable stories. “[I]f you’re not ready for [therapy, or want to expand your knowledge], start with a podcast on mental illness to get familiar with how to even talk about it and to learn what helps others,” said Saenz-Sierzega.

She recommended Savvy Psychologist and the Mental Illness Happy Hour. Psych Central also has two excellent podcasts called A Bipolar, a Schizophrenic and a Podcast, and The Psych Central Show.

Read inspiring stories. “To alleviate human suffering, we need solidarity with others who are suffering and working on their own process,” Kingman said. He recommended reading the book Feel the Fear and Do It Anyway by Susan Jeffers. Psychologist David Susman has a blog series called “Stories of Hope,” where individuals share their mental health challenges and the lessons they’ve learned.

Psych Central also features numerous blogs written by individuals who live with mental illness.

Create a list of comforting things. Your list might include activities, movies, songs or photos that make you laugh or spark a fond memory, Saenz-Sierzega said. Turn to something on your list when you’re having a hard time. Let it “remind you of who you are and who you are fighting for.”

Mental illness is common. If you just look at anxiety disorders, the stats are staggering. They affect about 40 million individuals per year, Chapman said. Forty million. Maybe this is reassuring to you. Maybe it’s not. Because your soul feels alone.

This is when reaching out is critical. This is when talking to someone face to face or in an online forum is critical. Because this is when your soul actually hears the truth: You are not alone. You are absolutely not alone.

Feeling Completely and Utterly Alone Because You Have a Mental Illness? This Can Help

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CBD Oil for Depression, Schizophrenia, ADHD, PTSD, Anxiety, Bipolar & More

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You can extract over 70 different components from a marijuana plant, technically known as cannabis sativa. Two of the most common constituents are delta-9-tetrahydrocannabinol (known colloquially as THC) and cannabidiol (CBD).

Because CBD is not as regulated as THC (though may be technically illegal under federal laws), nor does it provide any accompanying “high” as THC does, it has become increasingly marketed as a cure-all for virtually any ailment. You can now find CBD oil products online to treat everything from back pain and sleep problems, to anxiety and mental health concerns.

How effective is CBD oil in the treatment of mental disorder symptoms?

Unlike it’s sister THC, CBD doesn’t have any of the associated negative side effects of tolerance or withdrawal (Loflin et al., 2017). CBD is derived from the cannabis plant, and shouldn’t be confused with synthetic cannabinoid receptor agonists like K2 or spice.

Because of its relatively benign nature and more lax legal status, CBD has been more widely studied by researchers in both animals and humans. As researchers Campos et al. (2016) noted, “The investigation of the possible positive impact of CBD in neuropsychiatric disorders began in the 1970s. After a slow progress, this subject has been showing an exponential growth in the last decade.”

Research has shown that CBD oil may be effective as a treatment for a variety of conditions and health concerns. Scientific studies demonstrate effectiveness of CBD to help relieve some of the symptoms associated with: glaucoma, epilepsy, pain, inflammation, multiple sclerosis (MS), Parkinson’s disease, Huntington’s disease, and Alzheimer’s. It appears to help some people with gut diseases, such as gastric ulcers, Crohn’s disease, and irritable bowel syndrome as well (Maurya & Velmurugan, 2018).

You can find low-end and high-end CBD oil products. The most popular CBD oil product on retails for around $25 and contains only 250 mg of CBD extract.


In a pilot randomized placebo-controlled study of adults with attention deficit hyperactivity disorder (ADHD), a positive effect was only found on the measurements of hyperactivity and impulsivity, but not on the measurement of attention and cognitive performance (Poleg et al., 2019). The treatment used was a 1:1 ratio of THC:CBD, one of the common CBD treatments being studied along with CBD oil on its own. This finding suggests more research is needed before using CBD oil for help with ADHD symptoms.


There are a number of studies that have found that CBD reduces self-reported anxiety and sympathetic arousal in non-clinical populations (those without a mental disorder). Research also suggests it may reduce anxiety that was artificially induced in an experiment with patients with social phobia, according to Loflin et al. (2017).


A review of the literature published in 2017 (Loflin et al.) could find no study that examined CBD as a treatment for depression specifically. A mouse study the researchers examined found that mice treated with CBD acted in a way similar to the way they acted after receiving an antidepressant medication. Therefore, there is virtually little to no research support for the use of CBD oil as a treatment for depression.


Loflin et al. (2017) only found a single CBD study conducted on sleep quality:

Specifically, 40, 80, and 160 mg CBD capsules were administered to 15 individuals with insomnia. Results suggested that 160 mg CBD was associated with an overall improvement in self-reported sleep quality.


There are currently two human trials currently underway that are examining the impact of both THC and CBD on posttraumatic stress disorder (PTSD) symptoms. One is entitled Study of Four Different Potencies of Smoked Marijuana in 76 Veterans With PTSD and the second is entitled Evaluating Safety and Efficacy of Cannabis in Participants With Chronic Posttraumatic Stress Disorder. The first study is expected to be completed this month, while the second should be completed by year’s end. It can take up to a year (or more) after a study has been completed before its results are published in a journal.

Bipolar Disorder & Mania

The depressive episode of bipolar disorder has already been covered in the depression section (above). What about CBD oil’s impact on bipolar disorder’s manic or hypomanic episodes?

Sadly, this has not yet been studied. What has been studies is cannabis use on the effect of bipolar disorder symptoms. More than 70 percent of people with bipolar disorder have reported trying cannabis, and around 30 percent use it regularly. However, such regular use is associated with earlier onset of bipolar disorder, poorer outcomes, and fluctuations in a person’s cycling patterns and severity of manic or hypomanic episodes (Bally et al., 2014).

More research is needed to see whether supplementing CBD oil might help alleviate some of the negative impact of cannabis use. And additional research is needed to examine whether CBD oil on its own might provide some benefits to people with bipolar disorder.


Compared to the general population, individuals with schizophrenia are twice as likely to use cannabis. This tends to result in a worsening in psychotic symptoms in most people. It can also increase relapse and result in poorer treatment outcomes (Osborne et al., 2017). CBD has been shown to help alleviate the worse symptoms produced by THC in some research.

In a review of CBD research to date on its impact on schizophrenia, Osborne and associates (2017) found:

In conclusion, the studies presented in the current review demonstrate that CBD has the potential to limit delta-9-THC-induced cognitive impairment and improve cognitive function in various pathological conditions.

Human studies suggest that CBD may have a protective role in delta-9-THC-induced cognitive impairments; however, there is limited human evidence for CBD treatment effects in pathological states (e.g. schizophrenia).

In short, they found that CBD may help alleviate the negative impact of a person with schizophrenia from taking cannabis, both in the psychotic and cognitive symptoms associated with schizophrenia. They did not find, however, any positive use of CBD alone in the treatment of schizophrenia symptoms.

Improved Thinking & Memory

There is little to no scientific evidence that CBD oil has any beneficial impact on cognitive function or memory in healthy people:

“Importantly, studies generally show no impact of CBD on cognitive function in a ‘healthy’ model, that is, outside drug-induced or pathological states (Osborne et al., 2017).”

If you’re taking CBD oil to help you study or for some other cognitive reason, chances are you’re experiencing a placebo effect.

CBD Summary

As you can see, CBD research is still in its early stages for many mental health concerns. There is limited support for the use of CBD oil for some mental disorders. Some disorders, like autism or anorexia, have had little research done to see whether CBD might help with its symptoms.

One of the interesting findings from research to-date is that the dosing found to have some possible beneficial effects in research tends to be much higher than what is found in products typically sold to consumers today. For instance, most over-the-counter CBD oils and supplements are in bottles that contain a total of 250 to 1000 mg.

But the science suggests that an effective daily treatment dose might be anywhere from 30 to 160 mg, depending on the symptoms a person is seeking to alleviate.

This suggests that the way most people are using CBD oil today is not likely to be clinically effective. Instead, at doses of just 2 to 10 mg per day, people are likely mostly benefiting from a placebo effect of these oils and supplements.

Before starting or trying any type of supplement — including CBD oil or other CBD products — please first consult your prescribing physician or psychiatrist. CBD may interact with psychiatric medications in a way that is unintended and could cause negative side effects or health problems.

We also do not really understand the long-term effects and impact of CBD oil use on a daily basis over the course of years, as such longitudinal research simply hasn’t yet been done. There have been some reported negative side effects experienced in the use of cannabis, but it’s hard to generalize such research findings to CBD alone.

In short, CBD shows promise in helping to alleviate some symptoms of some mental disorders. Much of the human-based research is still in its infancy, however, but early signs are promising.

For further information

Reason Magazine: Is CBD a Miracle Cure or a Marketing Scam? (Both.)

Thanks to Elsevier’s ScienceDirect service in providing access to the primary research necessary to write this article.


Bally, N., Zullino, D, Aubry, JM. (2014). Cannabis use and first manic episode. Journal of Affective Disorders, 165, 103-108.

Campos, AC., Fogaça, M.V., Sonego, A.B., & Guimarães, F.S. (2016). Cannabidiol, neuroprotection and neuropsychiatric disorders. Pharmacological Research, 112, 119-127.

Loflin, MJE, Babson, K.A., & Bonn-Miller, M.O. (2017). Cannabinoids as therapeutic for PTSD
Current Opinion in Psychology, 14, 78-83.

Maurya, N. & Velmurugan, B.K. (2018). Therapeutic applications of cannabinoids. Chemico-Biological Interactions, 293, 77-88.

Osborne, A.L., Solowij, N., & Weston-Green, K. (2017). A systematic review of the effect of cannabidiol on cognitive function: Relevance to schizophrenia. Neuroscience & Biobehavioral Reviews, 72, 310-324.

Poleg, S., Golubchik, P., Offen, D., & Weizman, A. (2019). Cannabidiol as a suggested candidate for treatment of autism spectrum disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 90-96.

CBD Oil for Depression, Schizophrenia, ADHD, PTSD, Anxiety, Bipolar & More

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Which Should We Treat First: Mental Illness or Addiction?

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Substance use can alter behaviors, moods, and personalities so severely for people with addiction that without specialized knowledge and experience, it’s difficult to determine underlying causes such as mental illness or trauma.

I credit psychological intervention for pushing me into recovery from alcoholism.

Addiction is a mental illness, but is it one that needs to be treated before anything else? Or should we be stopping people from hitting their addiction bottom and helping them recover from their comorbid conditions concurrently?

What Is Addiction?

Before we can discuss treatment, we need to understand what addiction is and how it is defined. The two major guidelines for diagnosing mental health conditions around the world are the DSM and the ICD. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the standard diagnostic tool for mental health conditions in the United States and often used in North America. The ICD (International Classification of Diseases) is endorsed by the World Health Organization and often used in Europe.

In the DSM-5, substance abuse and substance dependence are combined under the same name of substance use disorder, which is diagnosed on a continuum. Each substance has its own sub-category, but behavioral addiction is also in the DSM-5, with gambling disorder listed as a diagnosable condition. Other similar entries, such as internet gaming disorder, are listed as needing further research before being formally added as a diagnosis. In the ICD-11 there is a subset of mood disorders called “substance-induced mood disorders,” which are conditions caused by substance use. To qualify for this category, one must not have experienced the mood disorder symptoms prior to substance use.

Hypothetically, a person who has alcohol-induced mood disorder might find health with abstinence alone, but substance use disorders do not occur in a vacuum and no one can go through the experience of addiction without it altering their mind and body, sometimes irreversibly. With enough time, substance-induced disorders change the function of the brain and alter emotion regulation. That doesn’t mean that addiction will cause another mental disorder; addiction is a mental disorder.

Not everyone with an addiction is concurrently experiencing another mental disorder. Substance use can alter behaviors, moods, and personalities so severely for people who are addicted that without specialized knowledge and experience, it’s difficult to determine what, if any, underlying cause is responsible for the changes. Drugs, even those that are prescribed and used as directed, can have side effects that seem to mimic the symptoms of other diagnosable conditions. These effects can also appear if a person is in withdrawal. Because of this inability to isolate co-occurring conditions, there was a time when it was popular for doctors and clinicians to first treat substance use disorders before exploring the possibility of other mental illnesses.

That is no longer considered the best approach to care…

So, what is considered the best approach then? Keep reading for more information about therapy to recognize addiction, integrated treatment, the consequences of discriminating against people with substance abuse disorder, and more over at the original article Addiction or Mental Illness: Which Should You Treat First? at The Fix.

Which Should We Treat First: Mental Illness or Addiction?

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