How an Innovative Therapy Technique Made Me Feel like a Superhero When I Was at My Worst

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“Take another deep breath, hold it, and let yourself feel like you’re drifting and floating.”

The voice overtook me as I felt my body slip into that weightless feeling between consciousness and sleep. It was as if someone wrapped my body in memory foam and filled every corner of my mind with white noise.

“My jaw is slack.”

“My shoulders are relaxed.”

“My neck is loose.”

These were some of the phrases that I was told to repeat to myself in a recording made by my therapist and given to me during our first session together. Each one focused on a different body part, meant to make me feel warm, heavy, and unconstrained. This was the beginning of my biofeedback training.

Just Relax

I chose my therapist because he’s an expert in biofeedback, a psychology technique where a patient learns to control their body’s functions, like heart rate or palm sweating. Biofeedback was first introduced in 1969 as the crossroads of traditional whitecoat psychologists and those interested in a higher consciousness.

Before I could reach a higher consciousness though, I had to master just being relaxed.

A few weeks prior to my first appointment with him, I was trapped in a horror movie in my own mind. I couldn’t shake this one single thought that replayed itself incessantly for a week straight: that of the top knuckle on my right ring finger snapping backwards and breaking.

It’s a disturbing thought on its own to anyone who prefers their fingers in tact, but imagine it popping into your mind over and over — and over and over — until you want to check yourself into a psych ward. I was consumed. I could barely talk or sleep or work without wanting to slam my head against a wall. I was desperate for any advice, so when my dad recommended biofeedback, I made an appointment immediately.

The technique he employed in the recording is called autogenic relaxation. Through the self-induced relaxation akin to hypnosis, my doctor coaches his patients to cure themselves of ailments like depression, migraines, irritable bowel syndrome, high blood pressure and anxiety — my personal woe. Learning to relax your body was just the first part, though.

Anxiety by the Numbers

At my next appointment with my therapist, he hooked me up to a slew of sensors as I reclined in his plush leather chair. Three cold metal circles stuck to my forehead measured my muscle tension in millivolts, a small wire taped to my pointer finger took my skin temperature, and two more sensors on other fingers measured my sweat production. Once I was connected, the doctor quizzed me.

“Alright, count backwards from 1,000 by 3s. If you mess up, you have to start over. If you don’t get to 940 in 30 seconds, you have to start over. Ready, go.”

I’m sure my measurements immediately spiked. I’m terrible at math and to add a time pressure to them was beyond stressful. But I got through it. He did it again, but with higher stakes.

“Okay, now you’re going to count backwards from 1,000 by 6s and you have to get to 860 in 30 seconds. Ready, go.”

To prepare for my biofeedback training, my therapist was simulating an anxiety-inducing situation to see what my normal and stressful levels were.

During the following appointment, he again hooked me up to the muscle tension sensors, but this time instead of stressing me out, he walked me through the autogenic relaxation phrases from the recording. But this time, the machine I was hooked up to was now emitting a pulsing sound that correlated with my muscle tension level. The more tense I was, the faster the pulses.

As his voice coached me through the phrases, and then in the next appointments as I walked myself through them, I learned to listen to the pulsing and to my body to see what slowed the tempo. My muscle tension level started at around 4.0 millivolts and he told me some of his patients start out at as high as 10 millivolts. Each appointment, he set the threshold lower and lower on the scale and once I reached it, the pulsing turned off. Each appointment, I was learning to bring myself to a more relaxed state than the time before.

By focusing on the pulsing, I experimented with what autogenic relaxation phrases worked best for me, what my ideal relaxed breath is like, and even how to position my head and arms for optimal relaxation.

Put to the Test

I’ve struggled with anxiety for as long as I can remember.

As I walked into the doctor’s office during my fourth session, I laid eyes on someone from my past who brings me a great amount of anxiety. My heart rate spiked and my chest tightened. Suddenly, breathing became a difficult task. I immediately turned on my heels and hid in my car until the person left, but the anxiety followed me into my appointment. My newfound relaxation technique was about to be tested.

As I cleared my mind during the biofeedback training, I was able to turn the pulsing off, meaning I brought my muscle tension down to the threshold set by the doctor, but the second the stressful person popped back into my mind, the pulsing turned back on. Over and over I emptied my mind and filled it with the autogenic relaxation phrases and turned the pulsing off, but, again, it’d spike back up once I thought of the person.

Running into my past turned out to be a blessing in disguise; I was learning to control the stressful thoughts and ensuing physiological response with just my mind. It was hard work, but I knew it would be a skill I could turn to my whole life. If I could control my heart racing, maybe it’d be easier to quiet my disturbing thoughts.

In the sessions that followed, I learned to relax myself instantaneously and in any situation without the autogenic phrases, getting my muscle tension level from the original 4.0 down to just 1.7. I’m now able to take a deep breath, let it out, hold it, and find that perfect state of relaxation — like magic.

Biofeedback empowered me during a time when I felt shaken down to my core. I walked away from each appointment feeling like I have a superpower and for the first time in years, I feel like I can finally control the anxiety that seems to rule my life.

How an Innovative Therapy Technique Made Me Feel like a Superhero When I Was at My Worst

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Evidence-Based Addiction Treatment Explained

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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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What Is Mandated Treatment and When Does It Apply?

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When mental health conditions contribute to violent or dangerous behavior, affect the way a person treats their children, or increase the risk of recidivism, a court may order treatment. A court may also compel treatment if a person is deemed a risk to themselves or others. State laws governing court-mandated treatment vary, as do the programs a person might complete as part of court-ordered treatment.

Research on the value of court-ordered treatment is mixed. Mandated treatment offers access to mental health care that a person might not otherwise have. Some studies suggest that people pursuing court-ordered treatment may be less motivated in treatment or less likely to be honest with clinicians. Because treatment is mandatory, however, court-mandated treatments improve treatment completion rates.

The benefits and risks of court-ordered treatment depend on the type of treatment, the client’s commitment to treatment, the skill of the treating clinician, and numerous other factors.

The benefits and risks of court-ordered treatment depend on the type of treatment, the client’s commitment to treatment, the skill of the treating clinician, and numerous other factors.

What Is Mandated Treatment?

Mandated treatment is treatment ordered by a court. A person might have to undergo treatment for a set period of time, receive an evaluation from an approved mental health expert, pursue treatment at a specific facility, or agree to treatment as a condition of probation or parole. A person might also have to receive treatment before receiving visitation with or custody of their child.

Some examples of mandated treatment include:

Emergency mental health holds

When a person is a danger to themselves or to others, a therapist, doctor, or other clinician may pursue an emergency hold. These emergency holds require a person to seek evaluation at a mental health facility—usually a psychiatric hospital. In most cases, the hold lasts 72 hours. After the initial hold period, state laws vary. States generally have some form of judicial oversight, which means that a judge must approve the hold after a set period of time. A person can also fight a mental health hold, usually by filing an emergency petition with the assistance of a lawyer. A person cannot be indefinitely held against their will without a court order.

Treatment in lieu of incarceration

In some states, a person who is found not guilty by reason of mental disease or defect may be ordered to stay in a psychiatric hospital. In this scenario, the person cannot leave until they have either stayed for a period predetermined by the court or the facility has determined the person may be released.

Drug and mental health courts

Many states now offer diversion programs through drug and mental health courts. These programs require a person to complete treatment and other requirements. Those who finish the program can avoid jail or prison time. In many of these programs, jail time is used as a way to induce treatment compliance. For example, a drug court participant who doesn’t show up for a treatment session or who is accused of drinking might be forced to spend a weekend in jail before continuing the program.

Mental health treatment as a condition of some other benefit

Courts often make mental health treatment a precondition to receiving some other benefit. For example, a person being released early from prison via parole may have to seek treatment to avoid being re-incarcerated. Likewise, probation agreements that keep people out of prison sometimes require specific treatment. In these scenarios, a person typically meets with a probation or parole officer on a regular basis to show they are meeting court-ordered treatment requirements.

A person might also have to seek treatment to gain custody of their children. For example, if child protective services removes a child from a parent’s home because of the parent’s addiction, the parent may have to seek treatment and remain sober for a set period of time before regaining custody.

Legal principles of informed consent and informed refusal mean that a person cannot be forced into treatment without a court order. Some states offer a brief exception for 72 hour evaluation holds. In this scenario, however, a mental health professional must believe the person is a threat to themselves or others.

A therapist cannot force a client to stay in therapy or demand that a client undergo certain treatment. Even when a person receives court-mandated treatment, they retain basic rights such as the right to be free of physical abuse. People who have been ordered to undergo treatment may want to consult a lawyer. A lawyer can offer advice about your state’s laws as well as your specific rights.

History of Mandated Treatment for Mental Health

Mandated treatment allows clinicians, judicial systems, and treatment facilities significant control over a client’s life. Historically, mandated treatment was rife with abuse. People sent to mental health facilities might spend years in those facilities, receiving a wide range of unsupported and potentially traumatic treatments. Patients might be forced to undergo electroconvulsive therapy, be restrained for hours or days, or be subjected to violent abuse.

State licensing boards now regulate mental health facilities and prosecute abuse. Abuse can and does still happen. In 2009, a report detailed numerous abuses at Kings County Hospital Center’s psychiatric unit. New stories often feature tales of abuse in prison psychiatric facilities.

People undergoing mandated treatment should review all of their options, especially if they are permitted to choose among several therapists or facilities. When court-mandated treatment requires a person to seek treatment from a specific person or organization, advocates such as lawyers and family members can be key. Loved ones and paid advocates should educate themselves about the reputation of the treatment facility and remain in communication with the person undergoing treatment.

Common Reasons for Court-Ordered Therapy

Some of the most common reasons a court might order treatment include:

  • The person has been convicted of a sex crime. Some states’ sex offender registries require participation in sex offender treatment.
  • The person has lost custody of their child because of abuse, neglect, or addiction.
  • The person is involved in a child custody dispute, and the court thinks one or both parents need either a psychiatric evaluation or mental health treatment.
  • The person has a mental health condition or addiction and the court offers treatment as an alternative to jail or prison time.
  • The person is incarcerated, and the parole board offers treatment as a condition of early release.
  • The person is a threat to themselves or others. A person with intense suicidal ideation may be ordered to get a psychiatric evaluation or be held in a mental health facility for a set period of time. People with homicidal or violent thoughts may also undergo coerced treatment.

Does Court-Mandated Treatment Work?

Like any other treatment, the effectiveness of court-mandated treatment depends on several factors, including the skill of the clinician and the willingness of the client to actively engage in the treatment process. Court-mandated treatment can and does work.

Drug courts, for example, may lower recidivism. One study found that, over 2 years, drug court participation was correlated with a drop in recidivism from 40% to 12%.

Court-mandated treatment may also offer indirect mental health benefits. Researchers have repeatedly documented the harmful effects of incarceration on mental health. When court-mandated treatment helps a person avoid jail or prison time, it may prevent their mental health from deteriorating.

Mandated programs also have some shortcomings. When clients sign confidentiality waivers, they may be less likely to share openly with their providers. When a provider has the power to incarcerate a client by reporting noncompliance to the court, this can compromise the integrity of the therapeutic alliance.

Mandated treatment can feel scary and intimidating, especially if you have never sought mental health treatment before. Mental health workers offering court-mandated treatment are licensed professionals just like any other mental health worker. They have a duty to protect their clients and to offer compassionate care.

In many cases, a person compelled to undergo mental health treatment can still choose their own clinician. Click here for help finding the right mental health professional and here to find a treatment center near you.

References:

  1. Coviello, D. M., Zanis, D. A., Wesnoski, S. A., Palman, N., Gur, A., Lynch, K. G., & Mckay, J. R. (2013). Does mandating offenders to treatment improve completion rates? Journal of Substance Abuse Treatment, 44(4), 417-425. doi: 10.1016/j.jsat.2012.10.003
  2. Do drug courts work? Findings from drug court research. (2018, May 1). Retrieved from https://www.nij.gov/topics/courts/drug-courts/pages/work.aspx
  3. Hartocollis, A. (2009, February 06). Abuse is found at a psychiatric unit run by the city. The New York Times. Retrieved from https://www.nytimes.com/2009/02/06/nyregion/06kings.html
  4. Hedman, L. C., Petrila, J., Fisher, W. H., Swanson, J. W., Dingman, D. A., & Burris, S. (2016). State laws on emergency holds for mental health stabilization. Psychiatric Services, 67(5), 529-535. Retrieved from https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201500205
  5. Yasgur, B. (2018, May 29). Court-mandated substance abuse treatment: Exploring the ethics and efficacy. Retrieved from https://www.psychiatryadvisor.com/home/topics/addiction/court-mandated-substance-abuse-treatment-exploring-the-ethics-and-efficacy

© Copyright 2019 GoodTherapy.org. All rights reserved.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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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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Emotional Numbness and Depression: Will It Go Away?

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Even as we don’t like pain, it is a reminder that we are alive and have a steady pulse. Worse than heartbreak or rage can be the sensation of numbness, when you lose access to your feelings and can’t feel the sadness of an important loss or the aggravations that used to make you scream. Emotional numbness is a common, yet not talked about, symptom of depression.

In an informational video, Will This Numbness Go Away?, J. Raymond DePaulo, Jr., M.D., co-director of the Johns Hopkins Mood Disorders Center, describes emotional numbness and helps people to distinguish between the numbness caused by depression and that from medication side-effects. He also assures anyone experiencing it, that it WILL go away.

I don’t feel anything.

“Numbness is not the most talked about experience or the most prominent experience of a depressed patient,” DePaulo says, “but there is a small group of patients for whom their first concern is that they don’t feel anything.”

Writer Phil Eli could be included in that group. He wasn’t prepared for the way his depression stole his sex drive and attention span. Nor was he ready for the overwhelming fatigue that made it difficult for him to stay on task. However, he was most surprised by his inability to feel anything. In his piece “Sometimes Depression Means Not Feeling Anything at All” he writes:

Nothing about hearing the word “depression” prepared me for having a moment of eye contact with my two-year-old niece that I knew ought to melt my heart—but didn’t. Or for sitting at a funeral for a friend, surrounded by sobs and sniffles, and wondering, with a mix of guilt and alarm, why I wasn’t feeling more.

During my recent depression spell, I experienced this kind of numbness for weeks. Political news that would have previously enraged me left me cold. Music had little effect beyond stirring memories of how it used to make me feel. Jokes were unfunny. Books were uninteresting. Food was unappetizing. I felt, as Phillip Lopate wrote in his uncannily accurate poem “Numbness,” “precisely nothing.”

Is it my medication?

To further confuse matters, numbness can also be a side-effect of certain medications.

“It is true that there are medications and a particular group of antidepressants that can cause a very similar numbness,” explains DePaulo. “It’s important to distinguish that and know if it’s a side effect of medication. The Selective Serotonin Reuptake Inhibitors at higher doses can cause this.”

A 2015 study published in the journal Sociology found that emotional numbness was among the dominating experiences of antidepressant use among young adults, and a 2014 study published in the journal Elsevier cited that 60 percent of the participants who had taken antidepressants within the past five years experienced some emotional numbness.

That said, it can be tempting for people to assign blame on the medication when it is due to the depression, itself, especially in the initial weeks and months of treatment.

Will it go away?

Regardless of the cause, people want to know if and when numbness will go away. DePaulo asserts, “If the treatment is sufficiently helpful, it will go away.” However, he explains that it may not be the first thing to improve. The progression of recovery usually starts with a person looking better to other people and talking more and being response. “They may still feel awful on the inside,” he explains, “but usually those feelings go away later in the course of treatment.”

And if the numbing is caused by a medication? “We have to figure that out,” says DePaulo. “We may try reducing the dose of medication — if the medication seems to be otherwise working — or may attempt to change medications.”

Either way, though, DePaulo says, it should go away. “That is our job.”

The good-bad news is that ALL your feelings will return.

Emotional Numbness and Depression: Will It Go Away?

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Pregnancy and Addiction: Overlooked and Undertreated

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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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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 BipolarMomLife.com, 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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Podcast: Support Groups for Mental Illness – What are They?

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

See credits below.




Most people understand how doctors and therapists work, but many people can’t quite wrap their minds around support groups – especially peer-led ones. In this episode, our hosts dissect different types of support groups to make them better understood and more accessible. Listen Now!

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“[Mental Illness] Support groups are like a buffet — take what you want and leave the rest.”
– Gabe Howard

Highlights From ‘Mental Illness Support Groups’ Episode

[1:00] Lets talk about support groups.

[3:00] Fountain House in NYC is awesome!

[6:00] Why it’s great to be around like-minded people.

[8:00] Support groups in hospitals.

[12:00] Peer-run support groups, hints and tips.

[18:00] Gabe became a support group facilitator — what does that mean?

[25:00] Sometimes people come to support groups just to listen.

[26:00] Gabe and Michelle recommend support groups to listen and share.

[28:00] Don’t like your support group? You can find another!

Computer Generated Transcript for ‘Support Groups for Mental Illness – What are They?’ Show

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

Narrator: [00:00:09] For reasons that utterly escapes Everyone involved. You’re listening to A Bipolar, A Schizophrenic and A Podcast. Here are your hosts, Gabe Howard and Michelle Hammer. Thank you for tuning into A Bipolar, A Schizophrenic and A Podcast.

Gabe: [00:00:22] I’m Gabe, I have bipolar.

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

Gabe: [00:00:26] And today we’re going to try to give some helpful information and maybe demystify things like support groups peer support groups support groups read by medical staff like social workers or doctors kind of talk about our experiences we’ve heard from others and just try to tie it up at a nice little bow. For those of you who are sitting there thinking Should I go to a group support group and what’s it going to be like and huh.

Michelle: [00:00:57] You’ve been to a a lot of support groups right Gabe?

Gabe: [00:00:59] I personally love support groups. I’ve been to all forms I’ve been to the ones led by a psychologist. I’ve been to ones led by social workers. I’ve been to ones led by peer supporters. Yeah, I am a I’m a big big believer and I go to a drop-in center which is run by people with mental illness and addiction for people with mental illness and addiction to drop in. So, it’s not exactly a support group but it’s still a group setting for people with mental illness and or addiction to kind of chill.

Michelle: [00:01:34] Yeah I do that too when I go to Fountain House in New York City. It’s kind of just like a clubhouse for people with mental illness and it’s not necessarily group therapy but you’re around like-minded people and you can have really good conversations and there’s really just no judgment there.

Michelle: [00:01:49] And it’s a really nice place to be around.

Gabe: [00:01:53] You sort of feel comfortable there because it’s set up for people like you and me.

Michelle: [00:01:59] It’s more like you’re not being judged. You feel no judgment in a support group. Everybody’s likeminded. Nobody’s thinking bad things about anything you say. You just have just a normal conversation and maybe you think somebody said something weird but then you’re like you know what I’m at this support group to what may maybe something I say somebody else thinks is weird but it’s okay cause we’re all talking to each other openly.

Gabe: [00:02:25] Let’s take this in sections so the section number one we’re going to talk about consumer operated services or peer run organizations drop in centers clubhouses like Fountain House where you go in New York City the Peer Center where I go in Columbus, Ohio and there’s there’s hundreds and hundreds of these models across the United States.

Gabe: [00:02:43] So let’s do that first. You go to probably one of the most famous drop in centers in the country. You’re really super lucky to live in New York City because fountain House has all kinds of services don’t you like a rooftop garden.

Michelle: [00:03:01] There might be a rooftop garden I don’t know if I’d been there but I am in the horticulture unit where they do all the planting and all that kind of stuff and sometimes I do help with the planting but a lot of times I just go there with my computer and I do my work there because I like to be surrounded by people that I can talk to as I’m doing my work. It’s just friendly. It’s nice it’s calming. I mean I could go to a Starbucks but that’s boring. Why not go to Fountain House chit chat with a bunch of fun people while I do my work.

Gabe: [00:03:32] You know the Peer Center where I go doesn’t have a garden. I mean we don’t we don’t have a garden and to call it a horticultural unit. That that that seriously really bad ass. But let’s talk about that for a moment because you know some people hearing this, they’re like wait a minute what does a garden have to do with mental health. And I’ll tell you this is probably my favorite thing to explain to people because at the Peer Center people come in and like oh you have mental illness and you have addiction issues and you’re playing cards. How does playing cards help? How does gardening help?

Gabe: [00:04:09] And here’s what I say. Are you ready for this?

Michelle: [00:04:11] I’m ready.

Gabe: [00:04:12] When you sit down with a group of likeminded people to play cards you talk and this whole game of spades or Uno or whatever game you choose to play that’s just kind of the distraction. Well you’re actually doing is talking about the things that are bothering you just like everybody else who plays cards you talk about your week. You talk about your grandkids you talk about your grandparents if you’re young you just you’re playing cards against humanity you feel bad. But in the best of ways. But these are very social activities. So, while you’re doing these social things you’re talking about the things that are that are eating you inside or you’re bragging about the things that you’re proud of to other likeminded people. Now nobody leaves a Fountain House or the Peer Center or any drop-in center and says Hey I said that I was 35 days sober and I was really proud of myself and everybody said they were proud of me too. No, they say I played cards but we know that you can play cards anywhere you went for that reassurance from. From people who are like you and understand. And that’s really the magic of these places.

Michelle: [00:05:18] It is the magic of these places. People find it interesting that I have friends that are so much older than me. I go to Fountain House. One of my best friends there she’s 56. Like people your friends a 56-year-old woman. No, she’s a really awesome person. She has great things to say. I love speaking to her. Why is it judgment. Is it stigma that she’s 56? What’s the big deal that she’s 56? We have likeminded mental capacity with mental illness and we just talk about regular things. Age doesn’t even make a difference there.

Gabe: [00:05:52] It is hard to find people. Probably because of the stigma that understand what we’re going through. You know I live with bipolar disorder and as you know people with bipolar disorder except for like my people we aren’t wearing shirts that say bipolar so people with schizophrenia people with depression we tend not to advertise it. So, it’s really easy to feel alone. But when you go to a drop-in center you go to a place like this you can sit around other people who also admit to living with mental illness and you can have real conversations about it. Listen Michelle and I we didn’t meet in a drop-in center but we could have you and I could have met in a drop-in center.

Michelle: [00:06:28] Oh definitely.

Gabe: [00:06:29] Yeah. We could’ve just been sitting there like Hey I take meds and it causes sexual side effects and my mouth is dry and you would’ve been like Oh my God.

Gabe: [00:06:36] Me too. And we could have just had this great conversation about how sometimes our medication pisses us off and when we left, we would’ve felt better because I would’ve been like oh my god I thought I was the only one. And you would have been like wow at least I’m not pitiful like that guy.

Gabe: [00:06:50] And the whole thing just drives forward that’s the magic of having a place where we belong and everybody has this. You want to play basketball you go to a gym. If you’re fat you join a gym.

Michelle: [00:07:03] Or you eat a bunch of Oreos.

Gabe: [00:07:05] I love Oreos.

Gabe: [00:07:07] All I’m saying is.

Michelle: [00:07:08] It’s a place of acceptance.

Gabe: [00:07:10] It is a place of acceptance and everybody has this in society. Everybody has this. There are all kinds of clubs and social events. There’s a whole website called meetup.

Gabe: [00:07:21] We’re likeminded people can.

Michelle: [00:07:22] Meetup. That’s how I found Mike post collegiate lacrosse team was meetup.com.

Gabe: [00:07:27] There you go. So, we like to be around people who understand us. We like to feel understood and that that’s not a mental illness thing. That’s not an addiction thing. That’s a human thing. And that’s why drop in centers consumer operated services peer run organizations the clubhouse model. That’s why all of these things are fantastic. But that sort of leads us into support groups because support groups are, they’re not the clubhouse model because you know clubhouse drop in centers et cetera.

Gabe: [00:07:54] They’re open like for periods of time you know they’re open for like you know morning to night etc. whereas a support group especially a Community Support Group is usually like an hour to an hour and a half maybe once or twice a week. So very different vibe.

Michelle: [00:08:10] I would agree with that. Yes.

Gabe: [00:08:12] And there’s two types of those groups. Well there’s probably more than two types but two types that we’re going to talk about here. There’s pure run support group which means a person with mental illness running a support group for other people with mental illness or in the case of like Alcoholics Anonymous recovered alcoholics running a support group for people who are trying to recover or in recovery from alcoholism. So that’s the peer run model.

Gabe: [00:08:35] And then there’s the more you know medical model it’s run by a social worker or psychologist or you know somebody with some sort of training and they both have their pluses and minuses. One is not better than the other. They both have their pluses minuses now Michelle you went to more than a few if I’m not mistaken.

Michelle: [00:08:53] A support group?

Gabe: [00:08:54] Yes support group that was led by a doctor or a social worker.

Michelle: [00:08:59] Well the first kind of support group I’ve really went to was when I was in a psych ward and it was just kind of run by a nurse and we would just go around talking and something that I got out of it that I didn’t even really follow was. Do you journal you should keep a journal and measure your mood in that way? And I was like Oh OK. Sure. The most reason why I even went to those little support groups that were having in the psych ward was because I was so bored. I just wanted to talk to people. But that actually was really helpful and it was nice talking to people. And of course, that wasn’t my last time in the psych ward because the next one I went to we didn’t do any of that. And I realized this is the worst hospital ever, because that other hospital was so much more helpful because they had a support group for us to all talk but this other hospital didn’t do anything for us. So, I realized that a support group in a hospital is actually very beneficial. It made me feel better. We were talking to everybody else that was in in the psych ward then and they were talking about things that got them there and things in the past learning about them. And it was very interesting to get everyone’s story.

Michelle: [00:10:13] And then when I was in the other hospital nobody really shared stories. And there was no support group. Everyone was just kind of talking to each other a little bit but nothing was really organized and it made me feel lonelier because I didn’t know why anyone else was in there.

Gabe: [00:10:33] I think it’s interesting that you were in this other hospital and you were like Oh my God I’m so bored I’m gonna go to this thing and please correct me if I’m wrong but you thought you’re gonna hate it. You thought it was stupid and dumb and you didn’t want to go. You were just so bored you were like oh I’m going to do this even this crap.

Michelle: [00:10:47] Yeah.

Gabe: [00:10:48] And then you missed it like you got so much out of it you wanted to do it again.

Michelle: [00:10:53] Yes.

Gabe: [00:10:54] I can see why you believed this.

Gabe: [00:10:56] I don’t I don’t judge you at all when somebody said hey I want you to sit in a room full of strangers and talk about your eating disorder or your bipolar disorder or your depression or suicidality I was like No. Why. Why do I want to know? No this is dumb. This is stupid. I felt the exact same way I got so much out of it. I first started like you with the you know the more I don’t wanna say traditional but the kind of everybody thinks about with the nurse or the doctor or the social worker sitting up front and the fun is organized in a specific way medically. You know they ask questions everybody shares that kind of thing. But then as that evolved it when I got back out in the community you know those were expensive and I didn’t have a lot of money. But what was free or very low costs like you know throw a couple dollars in a hat kind of thing we’re peer run support groups. And that was the same kind of idea.

Michelle: [00:11:50] Yeah.

Gabe: [00:11:50] People sharing stories etc. except the facilitator or moderator is another person living with mental illness. Again, the most famous peer run support group of all time is Alcoholics Anonymous. It’s exactly like that except for mental illness or depression or bipolar or you know just depending on how it’s structured. I loved these groups the one that I joined very first. Are you ready?

Michelle: [00:12:11] Yes.

Gabe: [00:12:12] Bipolar bears.

Michelle: [00:12:13] Bipolar bears. That sounds good because you are as big as a bear.

Gabe: [00:12:17] Oh man that’s so mean.

Michelle: [00:12:19] I want to see a fight between you and a bear and see who wins.

Gabe: [00:12:22] The bipolar bear.

Gabe: [00:12:24] I picked the support group though because I was scared and the name was so adorable.

Gabe: [00:12:30] No that’s kind of a messed up thing to say but I just I thought How can I be scared go into a group of bi polar bears. honestly that that’s just what I thought. Like how can I be scared?

Michelle: [00:12:41] Was there a stuffed animal bear that you had a hold every time you were speaking?

Gabe: [00:12:45] No but that would be a really good idea. I was very nervous to go and here some hints and tips for some people who are nervous to go. Go with a friend. Even if that friend doesn’t go into the room with you even if the friend has drops you off and waits in the hall. 1 – That’s a really good friend and 2 – you know sometimes that’s all it takes. You know somebody to like pick you up go to dinner first then go. I had somebody help me go to the group because I was scared she didn’t go in with me but she dropped me off and waited and I thought that was really super cool of her because I was scared to go but then you know I got to know people I made friends with the moderator facilitator you know just I became more comfortable just as we’re all you know as humans do.

Gabe: [00:13:30] And then I just became a person who went to this support group for a long time and then after a while I felt that I wasn’t getting anything out of it anymore like I had shared all of my stories I had heard a lot of stories and there’s a lot of power in that too. There’s a lot of power in hearing other people’s stories.

Michelle: [00:13:47] There really is there really is because you might think that you’ve done horrible things in your life and then you hear somebody else and you’re like oh we’re equal or you might hear somebody else Oh that’s way worse than what I did.

Gabe: [00:13:58] And it’s not about judgment. It’s about sort of sharing the burden.

Michelle: [00:14:02] It’s about understanding what your illness is and what could happen what could not happen and what you’ve done in your life and how you can accept it. Really.

Gabe: [00:14:13] Yeah. And when somebody tells you something that they did when they unload on you know they just. I didn’t mow the lawn and I was supposed to mow the lawn. And then you say to them you’re like look I didn’t mow the lawn either. There’s that connection. There’s that understanding. And that person feels better. And then you’re like Wait. Now I feel better because I helped you. And there’s just there’s a lot of power in that more so than people think and listen. Replace lawn with anything you want. Obviously when I walked into these groups for the first time, I thought I was the only person that never mowed the lawn. And then I learned that it was just so common. And then after I was there for a while new people walked in and they thought they were the only people that never mow the lawn. And I got to tell them that I mow the lawn. And I’m also thinking wow of all the analogies and examples to use. Why did I pick lawn mowing?

Michelle: [00:15:01] I don’t really know because I haven’t ever mowed on either.

Gabe: [00:15:05] Oh it’s OK though.

Gabe: [00:15:06] Neither have I.

Michelle: [00:15:07] The only as a peer support group if I ever went to. I went with my bipolar friend who took me to the bipolar support group at Columbia University where it’s just donation to get in.

Gabe: [00:15:17] Yeah.

Michelle: [00:15:18] And so I went there and I was talking I couldn’t relate fully to what everybody was saying but it was very interesting because this one guy was saying that his hyper sexuality was so big and he’s gay and he had you know unprotected sex and he got HIV.

Michelle: [00:15:36] So you know I’m schizophrenic and a bipolar group and people are talking about you know hyper sexuality and look what happened to this guy I’m a schizophrenic I go through all these troubles I do all these things but wow look what can happen. You know you would learn people’s stories and you know you kind of just understand that things could be so much worse even though you don’t think that your life is amazing.

Gabe: [00:16:02] We should probably touch for a moment because I don’t want people to get the idea that it’s like the suffering Olympics which we’ve talked about on this show before in a matter of somebody’s story being you know better worse. But at the same time, it is. I know exactly what you’re saying because sometimes I think Oh man, I thought that I hit rock bottom but I could have gone further and then other people they hear my story and they’re like oh wow this guy is way worse than me. It’s not about the judgment. It’s about the understanding the gravity of the situation and the breadth of the situation and just how just how bad it can get.

Michelle: [00:16:39] Yeah.

Gabe: [00:16:40] And then it’s also about finding those people and lifting them up and carrying them up and helping them and making it so that they’re rock bottom is way far below them because my rock bottom was way down there today. But you know when I sort of go into these support groups I was standing on rock bottom.

Michelle: [00:17:00] Hold up. We support from our sponsors. We’ll be right back.

Narrator: [00:17:04] This episode is sponsored by betterhelp.com 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 betterhelp.com/PsychCentral and experience seven days of free therapy to see if online counselling is right for you. Betterhelp.com/PsychCentral.

Gabe: [00:17:35] We’re back talking about different types of support groups.

Michelle: [00:17:37] The support groups that you and you were so helpful for you that you became a facilitator. What was that like for you?

Gabe: [00:17:44] So one day I realized that I wasn’t getting anything out of the support groups anymore so I stopped going and that’s a great decision to make. Some people believe that you have to go to support groups for the rest of your life or you’re turning your back on people. That’s not true. You just keep going until you no longer get use out of it and then you step aside and let the next people sort of rise into their places. But I missed it and an organization that I was volunteering for put out a call for peer support facilitators for these groups you had to go through training.

Gabe: [00:18:15] I had to go through a three day training eight hours a day for three days. I had to learn a whole bunch of stuff I had to pass a test I had they had to make sure that I was good at it I guess. We learned things about like hot potatoes like what to do if somebody mess in certain words how to get people help how to have a resources how to structure the group how to you know the rules of engagement as it were how to de-escalate and on and on and on.

Gabe: [00:18:36] And I got through that. And then here here’s me and another person we get our own support group. Yeah. Like Gabe and Jane we’ll call her Jane because I want to protect her or her anonymity. Gabe and Jane now have the support group and people started coming and it’s different when you’re the facilitator. The biggest thing that you have to remember when you’re the facilitator is it’s not about you. It’s not about me at all. Like there’s no part of it that it’s about me. The only thing that I’m there to do is make sure that people are obeying the rules and keeping people safe and making sure that people have the resources that they need. That’s it. You know in a perfect world I wouldn’t speak at all.

Michelle: [00:19:22] Really?

Gabe: [00:19:23] Yeah I would come in. I would start the meeting. I would have everybody read the principles of support I would have everybody read the group guidelines. I would ask everybody by show of hands if they understood. I would ask who would like to go first. And then if everybody takes their turn one at a time and nobody gets upset or triggered and everybody shares information and has a nice reasonable conversation the next thing that I would need to say is all right well we have about five minutes left so we want to go ahead and wind down or they’re there anything that I can answer because we always like to end on time is very important we don’t want groups to go on and on and on and on and on. That would be perfect and you know believe it or not it worked that way a lot. Usually the most I had to do it would say something like. All right who wants to go next or. Hang on hang on hang on Jim. Michelle has been waiting to talk Michelle. You know stuff like that just like little things.

Michelle: [00:20:13] That’s funny because it has such an opposite experience that I had in the in that group that I went to maybe because I’m in New York City and people just can’t stop talking all the time. But it was just one after and another after another after another. A lot of people were talking about you know burning bridges self-sabotage all kinds of things like that with their partners that are cheating on their partners all the time is the hyper sexuality. Things like that. And at one point I had mentioned something about me being in the group but I’m schizophrenic and a girl goes, “Oh you don’t even know what people say to me. They said they say oh thank god you’re bipolar and not schizophrenic” and I’m like yeah I’m feeling this stigma in this group.

Gabe: [00:20:56] Well but wait though you even in your own description though you said that everybody talked one at a time.

Michelle: [00:21:02] Yeah but he was just flowing flowing flowing. It was never who wants to talk next everybody was chatting. Everybody just went on and on and on.

Gabe: [00:21:11] But it sounds like you had a really good facilitator because nobody talked over each other.

Gabe: [00:21:18] There were no side conversations and if there were did the facilitator shut it down.

Michelle: [00:21:22] It wasn’t the facilitator at the end was like this really went very well I also didn’t really have to moderate. You guys talk really great then.

Gabe: [00:21:34] And that’s what I mean by. If you if you do a good job, you’re just kind of like the cop sitting on the side of the road. You don’t have to do anything. People see you and they slow down if you’re a good facilitator you just kind of establish the rules and you enforce them. But you know you don’t have to enforce them unless people are breaking them. And for the most part groups went fine they went fine people learn from each other they share it. People talked and you know support groups are like a buffet take what you want and leave the rest just because something is put out there in a support group doesn’t mean that you have to take it accept it or agree with it. You are more than welcome to leave it right there. And I would encourage people to do this week after week after week and it went fine.

Michelle: [00:22:18] Were there ever any problems?

Gabe: [00:22:20] From time to time there would be a problem. I really want to stress that 90 percent of the time it was fantastic nothing more than you know just reminding people not to cross talk you know cause sometimes there’d be like a little cross talking where somebody is having a private conversation I remind them that you know they need to leave the room if they want to do that that kind of thing or you know I would notice that maybe a shyer person just wasn’t getting wasn’t jumping in.

Gabe: [00:22:43] So I’d quiet everybody down so that you know Michelle would have a chance to talk as she was maybe being a little shy.

Gabe: [00:22:49] You know stuff like that but. But every now and again of a fight would break out and be like No no. And that’s really poor wording on a podcast an argument a disagreement. Tensions would rise people would ramp up backs would be raised and I had de-escalation techniques that I use. I’d say all right stop everybody calms down please let’s all take a deep breath. Michelle, I understand that you’re upset that somebody said that lacrosse isn’t a real sport OK and Gabe. I understand that you think that lacrosse is not a real sport but that is that is not kind you. You should really apologize to Michelle for saying that and then the person usually apologizes and I would say and Michelle when somebody says something you disagree with yelling at them is not the best way.

Gabe: [00:23:42] So would you mind apologizing for yelling and then you would say I’m sorry I yelled at you and I say OK now let’s talk about what we were talking about before and I’d remember like what started the fight and get us back on that and almost I would say all but I honestly I think this worked 100 percent of the time I just really don’t like to say 100 percent of the time the two people they got in the argument would become like BFF’s. They almost always would because they would talk it out you know I would say look I didn’t mean it wasn’t a real sport I was just nervous and I don’t understand lacrosse and you would you would say Yeah look I you know I didn’t invent lacrosse. I don’t know why I got so mad and I’d be like but you’re a sports fan and you’d be like Yeah, I really like hockey. I like hockey and then the next thing you know we’re having a podcast.

Michelle: [00:24:25] How many people are you’re in these groups of you?

Gabe: [00:24:28] Anywhere from the smallest groups I ever had were probably six or seven the largest groups that I ever had were 15 to 16.

Michelle: [00:24:35] That’s huge.

Gabe: [00:24:36] Yeah. We weren’t allowed to have more than 15 people. Yeah, every now and again we would let the 16th person sneak in before we started turning people away but at 15 what was our maximum limit which is why I’m saying 15 or 16 because we really weren’t supposed to go over 15 because you’re right. That’s a huge group. And there were two of us. There were two facilitators and we would sit in a circle and we’d sit on either one and we’d make little notes at each other and we’d look at each other and we would just keep people on the right path.

Michelle: [00:25:04] I knew one person in the group that I went to. She was just there to listen. She just wanted to sit there and listen to people. She didn’t want to participate. Her method was just listening and I know that it was interesting there was a guy next to me. He said he was actually a preacher and he doesn’t really like to talk that much he likes to listen. But he was saying he’s a preacher and nobody that he works with knows that he’s bipolar because he’s a preacher and he asked to keep that that kind of like you know that he has strong you know successful man and he can’t tell anyone. You know in the church that he has bipolar because that would make him look bad. But he comes to these meetings and he listens. He doesn’t speak that much but it just helps him by being there.

Gabe: [00:25:50] By in the room. By being in the presence of other people. That’s enough for some people not me I’m a talker.

Michelle: [00:25:57] Yeah yeah.

Gabe: [00:25:58] I like to do a lot of talking a lot of sharing. I like to offer support but I also needed to remember when to listen and when to shut up and sometimes when I was a group member the facilitators would have to put their hand up and remind me to stop talking.

Gabe: [00:26:13] And that’s a good the thing for a facilitator to do.

Gabe: [00:26:17] And if the facilitator doesn’t write you’re not embarrassed you’re not a shame you’re understanding that they’re making space for everybody. I really like support groups and I encourage people to go to them if they are available in your community. Please go. Oftentimes they’re free. Maybe you got to throw a couple bucks in a hat. But even if you just sit there and listen you’ll learn so much and you’ll be in the presence of other people that have similar experiences.

Michelle: [00:26:43] It’s very it’s very helpful to note that you’re not alone.

Gabe: [00:26:47] Exactly. And some of those people listen. Some of those people will annoy you. There’s personality types that you will not get along.

Michelle: [00:26:54] Oh trust me yes.

Gabe: [00:26:55] And that’s okay too because it shows you that even people who are annoying have mental illness. That’s okay.

Gabe: [00:27:05] My mother annoys me. I still love her. Your mother annoys you Michelle.

Michelle: [00:27:11] Just the little.

Gabe: [00:27:12] Just a little.

Gabe: [00:27:14] And.

Michelle: [00:27:15] I still love her.

Gabe: [00:27:16] Yes.

Gabe: [00:27:17] So the people in a support group you will find that common ground and you don’t have to be best friends. In fact, I discourage going to a support group to make friends should go to a support group to get support. It doesn’t mean that a friendship won’t come out of it but that should not be your goal your goal should be to attentively listen. And your goal should be to truthfully share and if you do that, I think that you’ll get a lot out of it. So, if you are afraid to go find a buddy and go even if the body just sits outside or just go on your own. Talk to the facilitator let him know you’re scared show up early so that you’re there before the big group gets there and tell the facilitator that you’re nervous.

Michelle: [00:27:51] You can always change your name too.

Gabe: [00:27:53] There is most all the groups that I did. Everybody went by their first name and you’re right. We didn’t I didn’t I didn’t card anybody. So maybe everybody’s name was wrong.

Gabe: [00:28:02] I don’t know.

Michelle: [00:28:03] I mean you can change your name you cannot say what your job is.

Gabe: [00:28:07] Yes.

Michelle: [00:28:08] Just share only what you want to share. There’s one issue you want to talk about. You can only talk if you would make us only talk about that issue. That’s what you want to speak about you’re forced to say anything you don’t want to say.

Gabe: [00:28:19] Exactly. You can share as much as you want or as little as you want. All that’s required is honesty. It’s not full disclosure. And I think that people miss that sometimes they think that it’s some sort of an interrogation. It’s not. It’s participation at your speed at your rate. And if the support group isn’t working out for you don’t go back. There’s nothing wrong with that. If I am very lucky as are you Michelle because we live in big cities there’s dozens of support groups. So when I didn’t like one I just joined another one. If that’s the case for you know support group shop. If you only have the one you might have to work a little harder to make it work. But I really encourage support groups and finally the last thing that we want to say is PsychCentral.com has a ton on of online support groups. I like the in person one’s certainly better. The advantage of the online ones is they’re open 24 hours a day. They’re available when you need them. It’s kind of like a drop in center for online. So visit sites PsychCentral.com. Join the support groups and just have a blast. Those groups are really awesome and they don’t pelt you with advertising or ask you for a bunch of stuff either. So we really love Psych Central here at A Bipolar, A Schizophrenic And A Podcast.

Gabe: [00:29:31] Michelle Are we out?

Michelle: [00:29:33] I think we’re out.

Gabe: [00:29:34] Thank you everybody for tuning in. Remember you can head over to store.PsychCentral.com and pick up a Define Normal shirt when they’re gone their gone unless of course we order more or you can run over to PsychCentral.com. Join a support group read great articles everything over there is free and they are a very generous supporter.

Gabe: [00:29:51] Of this podcast. We’ll see everybody next week.

Narrator: [00:29:56] 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 GabeHoward.com. To work with Michelle go to Schizophrenic.NYC. For free mental health resources and online support groups. Head over to PsychCentral.com Show’s official Web site PsychCentrald.com/bsp 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 gabehoward.com.MICHELLE 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: Support Groups for Mental Illness – What are They?

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Does Calling Depression an Illness Worsen Stigma?

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

See credits below.


I plead guilty to expounding on the biochemical vulnerabilities and abnormalities in neural wiring of depression to make the case that it is a legitimate illness alongside lupus, breast cancer, or psoriatic arthritis. I thought I was doing a good thing by quoting experts like Peter Kramer, M.D, who believes that because depression can be associated with the loss of volume in parts of the brain, it is the “most devastating disease known to mankind.”

My intention, like so many other mental health advocates I know, was to use science as a tool to lessen stigma. But is that really effective?

Proof of the Madness

I am relieved by clinical reports that explain why my efforts at cognitive-behavioral therapy aren’t enough to correct certain behaviors or thoughts — that brain imaging reveals the breakdown in normal patterns of processing that impedes the ability of depressed people to suppress negative emotional states and that high levels of activity in the amygdala part of the brain (the fear center) persist despite efforts to retrain thoughts. I would rather know that depression involves a problem in the wiring pattern of my brain than to know I simply wasn’t trying hard enough.

I get excited about the progress of finding genomic biomarkers for different types of mood disorders and about twin studies that show if one twin developed depression, the other twin also suffered from depression in 46 percent of identical twins. I am delighted that experts have found a common genetic mutation associated with a person developing clinical depression when faced with traumatic events in his or her life because it means that I’m not making this stuff up, that genetic variations exist that increase a person’s vulnerability to depression and other mood disorders.

No illness, please.

But apparently, people want their distance from those with illnesses or defined diseases. According to some research, concentrating on the biological nature of mood disorders can actually worsen stigma.

In his article, “Hyping biological nature of mental illness worsens stigma,” Patrick Hahn cites several studies that have shown public attitudes toward those who suffer from mental illness have worsened with the promotion of bio-genetic theories. One was a German study that found that between 1990 and 2001, the number of respondents who attributed schizophrenia to hereditary factors increased from 41 to 60 percent. In the same report, an increased number of respondents said they didn’t want to share a building, job, or neighborhood with a schizophrenic.

In the U.S. the General Social Surveys of 1996 and 2006 say pretty much the same. As the neurobiological explanation of mental illness gained approval, there was an increase in the number of people who didn’t want to be closely associated with someone with a mental illness, not as a co-worker, neighbor, friend, or in-law.

Extreme versus Sick

Hahn explains the two ways of looking at mental illnesses:

We could regard them as more extreme versions of the despondency, fear, wrath, or confusion that we all experience, as perfectly understandable reactions to overwhelming abuse and trauma. Or we could regard them as brain diseases, probably genetic in origin, requiring the sufferer to take powerful mind-altering drugs, quite likely for the rest of her life.

One approach emphasizes our common humanity, and the other seems to regard the sufferer as a mere biological specimen. One approach invites us the consider the societal and economic factors that lead individuals to feel despondent, fearful, wrathful, or confused, and to think about ways of changing them, while the other seems to regard society as basically sound, but unfortunately plagued by those individuals with faulty genes or guilty brains who can’t fit in.

I see room for both perspectives. While I regard some of my symptoms as exaggerations of the human condition — allowing me to explore the societal and psychological causes — I also recognize when my despair falls into the category of illness, an assessment that offers me a kind of relief — to know that my brain scans look different than the average Joe’s, and that there is a reason therapy and meditation and all my other efforts can’t fix it.

Embracing All Illness

Mood disorders are thorny and different from other biological illnesses in that some of their symptoms can be experienced by persons who are not diagnosed with them and their symptoms can overlap with a variety of conditions. For example, a person without major depressive disorder can feel lethargic, sad, and irritable.

But I’m not going to let the complicated nature of depression stop me from promoting research about biomarkers or genetic studies. I firmly believe that depression and all mood disorders need to be understood in their biological context. In my perspective, if the stigma increases with the acceptance of the bio-genetic model, then we need to work harder at embracing everyone who is ill, whether they have cancer, lupus, or depression.

Does Calling Depression an Illness Worsen Stigma?

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8 Reasons Why Your Depression May Not Be Getting Better

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

See credits below.


You’ve been to four psychiatrists and tried over a dozen medication combinations. You still wake up with that dreadful knot in your stomach and wonder if you will ever feel better.

Some people enjoy a straight path to remission. They get diagnosed. They get a prescription. They feel better. Others’ road to recovery isn’t so linear. It’s full of winding bends and dead-ends. Sometimes it’s entirely blocked. By what? Here are a few impediments to treatment to consider if your symptoms aren’t improving.

1. The Wrong Care

Take it from the Goldilocks of mental health. I worked with six physicians and tried 23 medication combinations before I found the right psychiatrist who has kept me (relatively) well for the last 13 years. If you have a complex disorder like I do, you can’t afford to work with the wrong doctor. I would highly recommend that you schedule a consultation with a mood disorders center at a teaching hospital near you. The National Network of Depression Centers lists 22 Centers of Excellence located across the country. Start there.

2. The Wrong Diagnosis

According to the Johns Hopkins Depression & Anxiety Bulletin, the average patient with bipolar disorder takes approximately 10 years to receive the proper diagnosis. TEN YEARS. About 56 percent are first diagnosed incorrectly with major depressive disorder, leading to treatment with antidepressants alone, which can sometimes trigger mania.

In a study published in the Archives of General Psychiatry, only 40 percent of participants were receiving appropriate medication. It’s pretty simple: if you’re not diagnosed correctly, you won’t get the proper treatment.

3. Non-adherence to Medication

According to Kay Redfield Jamison, Ph.D., Professor of Psychiatry at Johns Hopkins University and author of An Unquiet Mind, “The major clinical problem in treating bipolar illness is not that we lack effective medications. It is that bipolar patients do not take these medications.” Approximately 40 to 45 percent of bipolar patients do not take their medications as prescribed. I’m guessing the numbers for other mood disorders are about that high. The primary reasons for non-adherence are living alone and substance abuse.

Before you make any major changes in your treatment plan, ask yourself if you are taking your meds as prescribed.

4. Underlying Medical Conditions

The physical and emotional toll of chronic illness can muddy the progress of treatment from a mood disorder. Some conditions like Parkinson’s disease or a stroke alter brain chemistry. Others like arthritis or diabetes impact sleep, appetite, and functionality. Certain conditions like hypothyroidism, low blood sugar, vitamin D deficiency, and dehydration feel like depression. To further complicate matters, some medications to treat chronic conditions interfere with psych meds.

Sometimes you need to work with an internist or primary care physician to address the underlying condition in tandem with a mental health professional.

5. Substance Abuse and Addiction

According to the National Institute on Drug Abuse (NIDA), people who are addicted to drugs are approximately twice as likely to have mood and anxiety disorders and vice versa. About 20 percent of Americans with an anxiety or mood disorder, such as depression, also have a substance abuse disorder, and about 20 percent of those with a substance abuse problem also have an anxiety or mood disorder.

The depression-addiction link is both strong and detrimental because one condition often complicates and worsens the other. Some drugs and substances interfere with the absorption of psych meds, preventing proper treatment.

6. Lack of Sleep

In a Johns Hopkins survey, 80 percent of people experiencing symptoms of depression also suffered from sleeplessness. The more severe the depression, the more likely the person will have sleep problems. The reverse is also true. Chronic insomnia creates a risk for developing depression and other mood disorders, including anxiety, and interferes with treatment. In persons with bipolar disorder, inadequate sleep can trigger a manic episode and mood cycling.

Sleep is critical to healing. When we rest, the brain forms new pathways that promote emotional resilience.

7. Unresolved Trauma

One theory of depression suggests that any major disruption early in life, like trauma, abuse, or neglect, may contribute to permanent changes in the brain. According to psychiatric geneticist James Potash, M.D., stress can trigger a cascade of steroid hormones that likely alters the hippocampus and leads to depression.

Trauma partly explains why one-third of people with depression don’t respond to antidepressants. In a study recently published in Scientific Reports, researchers uncovered three subtypes of depression. Patients with increased functional connectivity between different brain regions who had also experienced childhood trauma were categorized with a subtype of depression that was unresponsive to selective serotonin reuptake inhibitors like Zoloft and Prozac. Sometimes, then, intensive psychotherapy needs to happen alongside medical treatment in order to reach remission.

8. Lack of Support

A review of studies published in General Hospital Psychiatry assessed the link between peer support and depression and found that peer support helped reduce symptoms of depression. In another study published by Preventive Medicine, teens who had social support were significantly less likely to become depressed after experiencing work or financial stress in early adulthood than those without support. Depression was identified among conditions affected by loneliness in a paper published in the American Journal of Public Health. Persons without a support network may not heal as quickly or as completely as those with one.

8 Reasons Why Your Depression May Not Be Getting Better

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