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Should Mental Health Determine Pain Treatment Options?

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

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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?

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

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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

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

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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

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

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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

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

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

See credits below.


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 Amazon.com retails for around $25 and contains only 250 mg of CBD extract.

ADHD

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.

Anxiety

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).

Depression

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.

Sleep

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.

PTSD

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.

Schizophrenia

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.

References

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?

This post was imported from www.psychcentral.com

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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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