Thoughts / empathy
I was eavesdropping whilst I was drinking coffee in a café the other day. I do this a lot FYI. Both, eavesdrop and drink coffee.
A man is telling a woman a story. A woman he knows was in a devastating car accident. Her life was shattered in an instant. According to the man, she now lives in a state of chronic pain. She can’t use her legs.
He reports that she had been “a mess” before the accident, but the tragedy has resulted in some positive changes in her life. That – according to him – as a result of this devastation, she is living a “wonderful life”.
And then he utters the words. The words that I really, really, really hate to hear. Words that can be responsible for emotional and spiritual and psychological violence.
‘Everything happens for a reason’.
Bullshit. Words that can destroy lives. And words that are so very untrue.
These words are pretty much my least favourite thing for anyone to say. To anyone. I reckon its both bad thinking and bad advice. Yet I am certain that I’ve said them at more than one time in the past.
Because I think it’s the thing we say to someone when we don’t know what else to say. Or worse, when we have difficulty sitting with the discomfort of a loved one. Whether our loved one be experiencing a relationship break up. Or the death or a child. Or the diagnosis of a debilitating medical condition. By uttering this phrase it forces us to turn a blind eye to that fact that life is unfair. That it involves suffering. These words try to cover up or push aside very real pain. This phrase makes us feel more comfortable.
But we can’t get to feeling more comfortable or to becoming more helping, generous and brave without navigating through tough emotions like desperation, shame and panic.
When I’ve been in the midst of desperation, shame and panic, I have had people to say to me ‘Everything happens for a reason’. I’ve wanted to kick them in the face. Luckily, I was usually way too depressed. What I thought was “You have no idea what I’m feeling you goose. I can tell because you’re saying all of these things that have nothing to do with what I am going through right now. Many, many things happen for no reason at all. Even if there is a reason this has happened to me, I’m not ready to think about it. I just need to be sad right now. I wish you could just let me”.
And the whole time the goose is smiling at me. To help me feel better. Goose.
At the time I didn’t want to be fixed. And I couldn’t be fixed.
The harsh reality is that some things in life cannot be fixed. As Adversity Strategist Tim Lawrence puts it, some things can only be "carried".
For some of us we may be able to go through painful experiences and experience growth. For others, devastation may destroy lives. And when we replace grieving with advice and platitudes we run into trouble. Because we become absent from our loved ones. We stop connecting. We stop carrying.
The platitude and fixes and ‘everything happens for a reason’s can be so very dangerous to those we claim to love. We deny them the right to grieve. Or be in pain. And in doing so, we can be denying them the right to be human.
The most powerful thing we can do for each other when we are in pain is to acknowledge and remain. We can literally say the words – I acknowledge your pain. I am here with you.
There is no greater act than acknowledgment. And it requires no training or special skills or expertise.
Being there is the harder part. Not leaving when we feel uncomfortable. Or when we feel we are not doing anything. Because it is in these places where the beginnings of healing are usually found. And every bit of healing needs human connection.
Not bullshit advice.
This is our first post from Hope Street Cards guest blogger - Kristen Malake. Welcome Kristen and we can't wait for more contributions from you!
I have a long history with mental illness. It began in middle school in the form of an eating disorder. One day a ‘friend’ taught me how to make myself throw up. I purged, tried to hide food, threw food away and exercised in the middle of the night. One night I was going to head out with a friend. We had spaghetti for dinner and even though I ran the shower my mother could hear me throwing up. I remember a loved one saying, “if you can’t control what goes in and out of your body then you can’t go out”. But really, at that point in my life, those felt like the only 2 things I could control. That’s what eating disorders are all about anyway, right? Well, my weight loss landed me in in my first impatient hospitalization. I was there for almost 3 weeks, which is almost unheard of these days.
Following this we went to family counseling, which I did not find to be helpful at the time. The therapist asked me where I would like to start and when I spoke my thoughts, she belittled me. The silence and tears began. I said to my mom: “you talk too much”, and to my dad: “you don’t talk enough”. Looking back, I would like to think the therapist was inexperienced because her response to me totally made me shut down. At this time, I was 16 and began my never-ending journey with medication. I am now 43 and am still taking medication. In the times that I have tried to go without, I have ended up in crisis, having suicidal situations. I have come to understand that my brain is wired in such a way that it needs certain chemicals that only medication can provide.
During this time, I was diagnosed with Major Depressive Disorder and Social Anxiety Disorder. Those diagnoses never changed until only a few short years ago. The therapist I had been seeing for about 5 years was certain that I had Bipolar Disorder. Over time, it has become apparent to me that this is a true diagnosis for me, as well as the Social Anxiety Disorder.
I think society has been taught to believe that Bipolar means the same thing for everyone. The “ups” meaning feelings of exuberant joy; 2 am cleanings of the house, top to bottom; extravagant shopping sprees; losing thousands of dollars gambling, and; having multiple sexual partners in short periods of time. The “downs” meaning not being able to get out of bed; going for days without showering; missing multiple days of work; crying constantly; self-harm, and; avoidance of people. However, this is not the case for me and probably not for a lot of people. My symptoms are more subtle, to the point when I don’t always know when I am becoming manic or depressed. I usually have to check in with my husband and he is typically right. When I feel manic, I talk frequently and rapidly. Often people find me difficult to follow. I may shop more than usual, but I always keep in mind that we do live on a budget. I become more anxious and have difficulty sitting still or just relaxing. I have to be doing something to feel okay. I generally feel like the world is full of mostly good people and that I am one of those people. It is easier for me to tell when I am becoming depressed. My need or want for sleep increases and I eat more without really tasting the food. I become agitated and irritable with my loved ones. I feel hopeless and helpless and yes, sometimes still suicidal. I feel like I should have a better job at this point in my life, that I’m not a good mother and that I don’t deserve the patience my husband has provided. I cry out of the blue. Sometimes I just want to be done, to be gone. By that I mean that I don’t necessarily want to die, but to just disappear.
When my diagnosis changed from Major Depressive Disorder to Bipolar, I was prescribed mood stabilizers. I don’t know that I have noticed much difference. I have had a few psychiatrists, one for many years and have been on multiple medications. I have heard several times, “well, it looks like you have tried about everything” and “have you looked at Electroconvulsive Therapy (ECT) as an option”. This is not what a person who is already feeling hopeless needs to hear.
To fully understand me, you must also know that I am an alcoholic. I have been in recovery since April 16th of 2009. My drinking and smoking cigarettes began around the age of 18 and the use of many illegal drugs soon followed. It started with wine coolers and throwing up in bed and not being able to move to clean myself up. My parents eventually nailed my bedroom screen window on to prevent me from sneaking out to drink. In college I would wake up on door steps and in apartments where I didn’t know the people and didn’t remember how I got there. In my early adult years, I somehow managed to earn an Undergraduate and Graduate degree in Social Work. However, I continued drinking. Vodka and lots of it. In the beginning I had it every night after work. Never mixed, just shots. I kept one bottle outside and one inside, as well as airplane size bottles in my purse. I would put water in the bottle to make it look like I hadn’t drank as much. When I hit bottom I was drinking ¾ bottle a day. I began between 7:00 and 7:30 in the morning, drinking straight from the bottle that I kept in the freezer. I drank until noon and then stopped to “sober up” by 4:30 when I had to work. During the day I stayed home with our young children, ages 1 and 3. When my husband came home, I would go to work, assisting adults with mental illness interestingly enough. I hit rock bottom as many do and it was very, very low. In short, I was given the choice to sober up or lose my husband and children. I chose to sober up. Thanks be to God and supportive family and friends, I am still sober to this day.
What I want those who love a person with mental illness to know, above all…..this is NOT about you. It isn’t your fault and it isn’t your job to “make things ok”. If you had the power to do that, I’m sure you would. But you can’t. This is not your doing and this is not your battle.
That doesn’t mean that you are helpless to watch your loved one suffer. I love hearing “what can I do for you” and “how can I help”. These phrases allow me to say what I think you could try that might help me feel more loved. It’s about support and helping me to feel that even though I’m ill, I’m still me. At the heart of me, I am still the person you fell in love with or have come to enjoy the company of. I don’t mean to be hurtful with my words. I don’t want you to feel responsible to make me happy. Only I have that power.
Intermittently as my illness has allowed, I have been an advocate for persons with mental illness in both a personal and a professional capacity. It remains clear that society still does not have a clear understanding of mental illness. If they did, mental illness would be equivalent to a physical illness in terms of stigma or lack thereof. People fling around words like crazy, say I think she missed her meds, or take a chill pill. At Halloween there are haunted houses where the goal is to escape the “psych ward”. I used to be ashamed of my condition. I used to try to hide it, but it was hard to hold a job without an eventual breakdown. I feel ashamed no longer. This is a part of who I am, only a piece of my whole puzzle. I didn’t create this problem. I was born into it through a combination of family history and brain chemistry. Those who know me and love me will continue to.
My biggest supporter is no longer. She committed suicide four years ago. We were friends for 34 years. She took the easy way out. Often times I wish that I could do the same. I will never place blame on her, but I will never get over her loss, how it occurred and the reason why.
My sister has been a constant my entire life. She has dropped everything to come to me when I have needed her. She is and forever will be my best friend. My parents were always quick to get me professional help when I needed it and have supported me consistently. A friend literally let me lay in her room until I could keep myself safe. A coworker held me when I felt like I was falling apart. My husband has stuck with me through it all. We met as social workers assisting adults with mental illness. He has continued the same work for over 20 years. Perhaps out of not knowing any other way, it is difficult for him to provide me support that differs from the kind that he provides his clients. I can’t imagine how difficult my illness has been for him to cope with. There are times when I wonder how he can even stand me because often, I can’t even stand myself. I know that my emotional instability is difficult to live with. He could have left a million times, for a million different reasons, but he didn’t. He’s still here.
When I am unwell, I may reach out and I may not. It depends upon the severity of the symptoms. Often at work, I pretend to be even better than I usually am. I say that I’m fantastic, wonderful, peachy. Fake it until you make it as they say. But that can be what turns out to be helpful. I pretend to be someone that I’m not. Because people like happy people. Let’s face it. They enjoy being with those who laugh and smile.
One of the most unhelpful things I hear is “smile”. Really? Why? So that you can feel better. So that you can go about your merry way without having to worry about me. The other thing I don’t like to hear is “everything happens for a reason”. I don’t believe that to be true. Sometimes things just happen. People die. Children are abducted. Families lose their home. What reason justifies these things? And would having or understanding the reason make the situation any better? I don’t think so. People say what they feel like will placate the situation, so that they can walk away feeling like they have done something. That’s not to say that there are not people who genuinely care because there are. There are very kind people who have heard me and held me through some of my darkest hours.
I don’t need or want expensive gifts to make me feel better. The things I love the best are notes that I find on my car after work that simply say, “I’m thinking of you”. Or a bag of my favourite chocolate hanging on my doorknob when I get home. It says that I am important enough for you to take the time out of your day to think of me. Cards in the mail are always appreciated. They are a surprise and who doesn’t like a card right?!?
Please do not try to fix my situation. Do not give me options of what to do when I just want you to hear me. Just listen to me. Sit with me. Don’t tell me what you think will or will not work. When I am in the middle of my pain, I’m not thinking about solutions. I’m thinking about breathing, calming my shaking body….that’s all I can think about. I’m certainly not in the mindset to problem solve.
So really, what it really comes down to is the support of those that we love and trust. It’s knowing that there are a select few who will never leave, not even in my darkest hour. When my mascara runs black down my face, dripping snot on their shoulder, barely able to breathe through the wretching sobs. If I am lucky enough to have even one of those people, I am lucky enough.
We made another card! It’s a card for anxiety disorders and this is what it looks like:
This card wasn’t born out of any clever psychological theory or any observed societal need. It was born out of the honest truth that when someone is experiencing a mental illness it can be really, really frustrating, sad and scary at times. And I’m not referring to the person who has the illness. I’m talking about everyone around them. This card was written for the card givers. (In the hope they’d still give them away to others).
Finding out that someone close to you has a mental illness can lead to any number of feelings and these feelings can have a serious emotional impact on you. Some loved ones might struggle to find a reason for the illness and wonder if they are in some way responsible, leading to strong feelings of guilt. People might feel angry and frustrated that this is happening, that the illness has become a dominant focus of life and disrupted the normality of the family or friendship group. It can be normal to feel confused as to what the hell is going on and what in the heavens this means. A lot of people report feeling a significant sense of loss and grief. It can be possible to begin grieving the loss of the relationship as it was and the life you had, the opportunities and plans that have now changed and to feel overwhelming sadness as to how much the person that they really, really love has been changed by their illness. Mental illness is still a stigmatised condition and for some people they might feel embarrassed or ashamed about what others might think of themselves and their loved one. And it’s scary. Loved ones are particularly likely to worry about what might happen to a person with a mental illness and if they will ever get better.
This exhaustive list of emotions is shit. But all of these, or a combination of a few, is a pretty common and normal experience for loved ones to go through when someone close to them has been diagnosed with a mental health condition.
As a supporter of someone with a mental illness, it’s really, really, really important that you acknowledge and talk about these feelings. Whether that’s with your own friends and family, a mental health professional or a support group. Acknowledging these feelings is the first step towards resolving them. It is important to understand that neither you nor the person with the mental illness are to blame for any of these events or feelings. They just are.
And with this in mind, I wrote this card. The aim was for the supporter to be able to say “OMG, this is just so shit. I am feeling awful and I know you are probably feeling worse and I just wish by magic it could all go away and we could go back to how it was”. But in a way that wasn’t going to make the person with the mental illness feel more guilty/alone/afraid/insert awful consequence of anxiety here. (Obviously I tried to keep it a bit upbeat/empathic/loving).
Because if you, as the supporter, can acknowledge and move past these common, yet horrendously awful and possibly destructive feelings and develop a more positive attitude, you’ll be able to be such a wonderful support for your friend or family member with a mental illness.
And really, really nice feelings can come from supporting someone too. So many people reflect on how their love for their friend or partner or relative deepens and a closer bond develops as they venture through experiences such as this. The new relationship you form with your loved-one can bring growth, deeper connections and learning for you both.
You can find the card here.
Feedback from the ground (that’s you guys!) is that, buying a card for someone who is experiencing a mental illness is one thing. That perhaps is the easy bit. But writing and sending a card for someone experiencing a mental illness is a whole other story. This perhaps is the not so easy part.
Totally agree my friends. I still get a bit nervous or worried when someone I really like in my life is unwell. What can I say? Will I say the wrong thing? Will I be unhelpful? All valid points, thank you critical voice in my head. But do you know what’s probably worse? Knowing someone is unwell and not doing anything at all. Just pretending it’s not there and ignoring it all together.
Whilst everyone is unique and ultimately you know your loved one much better than me, here is a list of my general tips to fill in the blank spaces of your cards with compassion, empathy and hope.
- Try and use statements that show you recognize that your loved one is unwell. This is called validation. Validating someone’s feelings and their illness rather than shaming, questioning or trying to analyse it can make a difference. Statements such as “That must be very hard for you”, or “You are important to me. You matter to me and so do your feelings”, can be very comforting for the person experiencing a mental illness and has the potential to relieve them from some of the shame they may be experiencing regarding their experience.
- Often when people are experiencing a mental illness their brain is being a total bitch. In a nutshell it can really attack the person from the inside, skewing their perception of themselves and the world around them. This is an excellent opportunity to bring them back to reality. Or try anyway. Pay your loved one some compliments. Remind them why you really, really like them. For example, “Please don’t forget that I think you are a kind/ generous/beautiful/insert-nice-adjective-here person to be around.” If you’re loved one is very unwell they might not believe it 100%, but it’s never harmful to hear these things.
- Let your loved one know that you’re not going anywhere. And then don’t go anywhere. Everyone fears abandonment on some level, but often the experience of mental illness can be particularly isolating and lonely. As someone who has had a mental illness, or three, the fear that people are not going to stay around for much longer as a result of being so unwell was a real and significant fear. Who would want to hang around someone who hasn’t been able to wear anything but tracksuits and leave the house in a week? If you can say “I am here for you and I’ll be hanging around too”, this might just bring a massive sense of relief to your loved one.
- Ask your loved one what you can do to help. The key word here is ‘ask’. This is important because it shows your loved one that you’re ready to assist them in their way. When they’re ready.
- Remind your loved one that what they’re going through is really tough and they are doing an excellent job. Something along the lines of “Be kind and gentle with yourself. You are doing the best you can”, is realistic and factual, but probably the kind of feedback that your loved one is not giving them self right now.
- Provide some statements of hope. Unfortunately mental illness often comes with other friends attached. Friends like hopelessness and helplessness. If you can provide some realistic words of encouragement and hope it might slightly lessen the impact these friends are having. Statements like “You can get through this experience. I believe in you”, can let your loved one know that you are hopeful for them, even if they are unable to be right at this minute.
- Write about a ridiculously silly and incredibly funny story. Sometimes when people are experiencing psychological pain they need something to laugh about. And just because they have a mental illness does not mean they have lost their sense of humour. When I was in hospital my sister used to send me ridiculous photos, texts, emails and updates about her day. Like how many biscuits she’d eaten. The sheer ridiculous of these frequent daily updates (and the phenomenal number of biscuits she could consume in a work day) eventually bought me to belly laughs.
- Tell them you love them. Do this repeatedly. This is probably the simplest, best and most important thing you can do.
These things can all be hard to say – or write – but if you can find something that comes from love, acceptance and empathy I think you’ll be right. Remember, they’re still just that person you really, really like. And if they’re experiencing a mental illness they’d probably really love to hear that from you.
I had the most beautiful conversation today.
It came from the pleasure of lunching with two of my favourite human beings. Whilst this is a reasonably regular occurrence, special shit went down today.
These two friends have been having some difficult times of late. One is experiencing symptoms of a mental illness and undertakes outpatient therapy and has begun taking prescribed psychiatric medication. The other has started seeing a psychologist for support with managing the effects of someone close to her experiencing a mental illness.
Now there’s nothing beautiful about the situations my friends are in. Both of their experiences have been difficult to watch. It’s so incredibly hard to see your loved ones in distress. And unfortunately neither of these situations is uncommon. Nor are these things are easily fixed. It’s a continual adventure of gains and setbacks.
But at lunch today, I took a moment just to observe what was happening. And it was divine.
We were all discussing aspects of our emotional health with vulnerability and honesty and openness. And there didn’t appear to be any shame involved. We didn’t feel the need to lower the volume of our voices, in order to hide our experiences from those around us. We offered each other advice and support with compassion, empathy and love. We felt safe. We discussed our own experiences of therapy and referred to each other’s therapists by first name. We came up with hypothetical conceptualisations and formulations of our own and other people’s behaviour. And my non-mental-health-professional friends used psychological terms fluently, sporadically AND correctly. Terms like “co-rumination” and “validation”. As I mentioned – divine.
There’s so many things that are special about this. Firstly, and most importantly, these two loved ones have acknowledged that they value their mental health and have been brave and courageous in asking for help and professional support. And my hypothesis on this, is that with time, they’ll reap the rewards. Secondly, I didn’t feel one little bit guilty. Guilty about burdening others with my emotional issues. Thirdly, it was so very, very easy to talk about these things. We switched between the achievements of potty training to our mental health to illegal internet browsing at work without any hesitation at all. And I think it was easy because we came from a place of love. We were open and honest and discussing these things in a place of no judgment.
Even though I reasonably regularly have conversations about my mental health with my loved ones, the frequency of these conversations is still rare. I’m so glad I took that moment to observe this experience in all its beauty, because otherwise it might have just passed us by. We’ve probably had other lunches just like this and I've probably had other conversations on par with this, but just not noticed how special it was at all.
So my dream is that all – okay, I’ll go with most – conversations about mental health are like this. Filled with honesty, love and empathy. Devoid of shame, judgment and fear. My dream is that conversations like this don’t just occur between three really close friends. But occur between friends, colleagues, acquaintances even.
Imagine if you could run into a distant relative down the street and when they asked how you were, you could explain that actually you’ve been experiencing some panic attacks and they’ve been quite horrific and you’re really struggling, but you’re seeking some assistance from a professional. And you’re not scared or ashamed to do that. Because the basic human reaction that you’re expecting is compassion and love and support.
Wouldn’t that be divine? I hope it happens in my lifetime. I’m so glad the conversation I had today did.
For some weird reason most human beings prioritise their physical health over their psychological health. Take for example our teeth. There are so many things most of us do, to ensure good dental hygiene. We brush our teeth. And not just every single day, twice a day. We eat appropriate foods. We might use mouth wash. My Dad even flosses! And we’ll have regular check-ups at the Dentist and if something feels wrong in our mouth, we’ll make an emergency appointment with the Dentist. We do this, despite going to the dentist being one of the most despised activities on the planet.
Compare this to our psychological health. We all experience emotional injuries or pain ALL the time. Things like failure and rejection and sadness. And often they get worse if we don’t look after them or go off and get them treated. And mostly we don’t go and get them treated. Research shows that only 35% of people who experience significant mental illnesses seek treatment. And this is so very weird, because psychological treatment is not like going to the dentist. Seeing a counsellor/psychiatrist/psychologist or therapist is awesome!
There are so many wonderful things about therapy. Here is my first, of hopefully many, lists of why getting some counselling is purely fantastic.
1. You get a solid chunk of time, whether that be half an hour or an hour, to focus completely on yourself. Therapy is like an education course where you are the subject matter. Could anything be more interesting? You can explore yourself, go deeper into your current thoughts and feelings, or just sit and ‘be’ for a while (a pretty vital practice that often gets ignored).
2. You get to enhance your vocabulary. You can learn all these new convoluted and sophisticated terms to describe relatively simple behavioural phenomena. I don’t know where I’d be now, without being able to use the terms ‘dissociation’, ‘transference’ and ‘priming’ throughout the course of my day.
3. Therapy can be a dress rehearsal for life. You get to practice all the things that just seem way too hard in the real world. That’s right friends, I’m talking role plays and experiments, which means when you have to go out into the bright lights of work, social and family settings new patterns and behaviours don’t seem as terrifying.
4. You never, ever get told to stop crying. Or feeling whatever you’re feeling. On the contrary, you might be asked to explore the feeling or try and work with it. For so many people this is quite a different approach. Working through the shit feelings, the ones that usually get avoided and denied. Trust me, it’s really quite nice in the long run.
5. There is stack loads of research and scientific evidence behind talk-based therapies showing that it is effective for making painful experiences more tolerable. It’s a proven method for changing harmful thinking, relational and behavioural patterns. It’s also used to make good lives great. And I haven’t come across many people who don’t want to change anything about their life.
6. Your therapist can make you feel really, really normal. As an objective professional, they are really, really good at normalising base impulses and behaviours. Just the other day, when I was banging on about how difficult it would be for me to keep up a relatively new behavioural pattern forever, Dr M kindly reminded me that all humans have a fundamental issue with the concept of “forever”. Boom. Thanks Dr M. Correct, and weight lifted of my shoulders.
7. The therapeutic relationship is really one sided. And if you’re the patient/client/consumer, that’s in your favour. It’s a fascinating and intriguing experience being involved in such a relationship. A relationship where someone knows so, so, so, so much about you and you know nothing at all about them. To even up the balance, I like to invent things about Dr M. He’s a bird-watching hipster who is really a passionate geek at heart.
8. There’s someone who will hold all of your secrets. Without any judgement. Amazeballs.
9. It’s a really good opportunity for “aha” moments. If this was a cartoon, a light bulb would be in a thought bubble above your head. These moments are pretty awesome. When you come to a realisation of how everything has been fitting together and what might need to happen next. There is the potential here for transformation and enlightenment and just general life gets better stuff.
10. You get to be an explorer of one of the most complex and grandest things – the mind. And more importantly, your own mind.
At Hope Street Cards we’ve released a new card. This is what it looks like:
That’s right; this card is all about the neuroscience. That is, the science of the brain.
The world of understanding things doesn’t really seem to know exactly why and how mental illnesses exist and occur. Diagnosing a mental illness isn’t like diagnosing other conditions. There’s no blood test, no x-ray, no CT scan that can yield a diagnosis of anything mental health related. It’s much more difficult and it involves looking at a big conglomerate of complex factors that makes up an individual’s situation – the biology, the environment, the thinking, the culture, the relationships.
When it comes down to the relationship between mental illness and the brain it all gets pretty interesting. And even a little bit controversial.
The brain is AMAZING. It consists of billions of neurons or cells that must communicate with each other. The communication between neurons maintains all of our bodily functions, informs of us of pleasure and pain and lets us know when a bird has pooped on our head. The communication between neurons is controlled by the brain’s type and level of neurotransmitters. Neurotransmitters are the chemical substances that control and create signals in the brain both between and within neurons. Without neurotransmitters, there would be no communication between neurons. The heart wouldn’t get a signal to beat, our mouth wouldn’t know how to speak and our arms wouldn’t be able to react widely in an attempt to shake bird poop from our hair.
For quite some time it has been believed by numerous smart people that having a “chemical imbalance” or an imbalance of certain neurotransmitters within the brain was the main cause of psychiatric conditions.
Dopamine is one such neurotransmitter, which when found in the thinking areas of the brain can be considered the neurotransmitter of focus and attention. It is hypothesised that low levels of dopamine here can impair our ability to focus on our environment, stay on task or activities, or maintain conversations. Low levels of dopamine in these areas of the brain have been found to be prevalent in individuals experiencing Attention-Deficit Hyperactivity Disorder (ADHD). At the other end of the scale, extremely high levels of dopamine in the brain can cause us to lose our contact with reality. We can begin to develop unusual ideas about what is happening to us. We might experience delusions (false beliefs) and we might experience hallucinations of our senses. Not surprisingly then, medications that block the dopamine receptor work wonders in calming the psychotic symptoms of people with schizophrenia.
Serotonin is another neurotransmitter that has been identified in multiple psychiatric disorders. This neurotransmitter is a major regulator of things and is involved in a lot of bodily processes such as sleep, libido and body temperature. Most importantly it is commonly regarded as the chemical responsible for maintaining mood balance. Because of its’ role as a major regulator of things we often rely on serotonin a lot when we are stressed. Living in a high stress situation for a prolonged period of time, we use more serotonin than is normally replaced and prolonged exposure to high stress can gradually lower our serotonin levels. When serotonin levels are low, we experience difficulties with concentration and attention. Routine responsibilities can seem overwhelming. Sleep and appetite disturbances can occur and mood can reduce. Drug treatments, such as Selective Serotonin Reuptake Inhibitors (SSRI’s) a commonly used anti-depressant, have been found to have beneficial effects in people with major depressive disorder. These medications work by blocking serotonin-producing cells from reabsorbing a good portion of the neurotransmitter they secrete – as they normally would – leaving more of the chemical available for communication around the brain.
These drug discoveries resulted almost entirely from serendipitous accident though. And scientists went searching for the neurological roots of the medications workings after the fact. So we know that SSRI’s can work for treating depression in some people, but we still don’t know for sure that a shortage of serotonin is the cause of the depression.
And it appears that the research focus on neurotransmitters as the key cause of mental illness stopped producing any new findings long ago.
Despite not knowing the nature of the imbalance, the term ‘chemical imbalance’ has been argued to have made psychiatric disorders more palatable for patients and less stigmatising. If the cause of mental illness is our brain chemistry or our DNA, then it’s much more difficult for the person to be blamed for their symptoms. Advocates argue that stigma will diminish if we come to see mental health problems as biologically caused diseases, no different from diabetes or cancer.
Critics of the ‘chemical imbalance’ hypothesis claim that this hypothesis continues to be advanced only by pharmaceutical companies, with mammoth amounts of money going into possible pills that could bring their brain chemistry back into balance.
So does someone who has a mental illness actually have a “sick brain”? I don’t think we know for sure yet. We presume there is a ‘chemical imbalance’, but it’s uncertain as to what that imbalance actually is. We don’t know the exact biological nature of what is wrong when someone has a mental illness. And we don’t know for certain the exact mechanism by which medications or other treatments work.
I think we can say that someone’s brain is sick though to describe what we can’t scientifically explain. We know that something is not quite right in someone’s brain when he or she shows symptoms of bipolar disorder or schizophrenia or major depression. We know that certain chemicals might help to alleviate these symptoms. We also know that a mental health condition is probably caused by a range of things outside of the brain as well.
Like other body parts though, it’s entirely possible that the brain can also become a bit sick, or faulty, or imbalanced. Whilst it’s not the only factor contributing to the development of a mental illness, it’s an important one to note. If we acknowledge that there is a part of mental illness that is physically manifested, perhaps we will start to move from a narrative of blaming the person with a mental illness for being crazy or weak, to just being unwell. Because that’s what they are. And like all unwell people, they very much deserve to receive a card of support.
I really debated whether to write on this topic, mostly because by now probably every other person has said their piece. For better or worse. But in the aftermath of the events over the weekend and in the context of the horrors of what happens across the world on a regular basis, perhaps there is a couple of things we need to be mindful of.
From what I’ve read, the term ‘terrorism’ can be a difficult thing to concretely define. In the psychology world though, we often refer to terrorism through the concept of ‘psychological warfare’. The mechanism of action to terrorise the society may be a little different but the purpose remains the same. I’ll attempt to explain it. Terrorism is a form of political violence that is meant to send a message about a particular organisation or idea through violent victimisation or destruction. By design these acts induce terror and psychic fear (which is sometimes indiscriminate), but aids the activity of achieving maximum publicity and amplifying force (Marshall, 2005).
Terrorism and psychological warfare have been around for as long as anyone can remember. Throughout history, pretty much every military conflict has in one way or another involved some form of psychological warfare to disadvantage the opponent. But in today’s world, the rules of engagement in this type of mental battle have changed.
Because of the advances in technology, we have no idea what we might see, hear or learn when we turn on the television, pick up our phone or engage with our friends through social media. Unlike historical military battles, the effects of psychological warfare aren’t limited to the people involved or the countries and communities in which they took place. Nowadays we can all, in one way or another, become involved. Images of terror can trigger a visceral response no matter how close or far away from home the event happened. And the impact has the potential to be even greater too. To instil a sense of fear that is much greater than the actual threat itself.
Sometimes I like to think of each person having a psychological bubble around them. The bubble is made up of all their strengths, their range of coping skills, their beliefs and values and their past lived experiences and history. It’s a protective barrier that can help each person, in its own unique way, navigate through their experience of the world. And when things happen, the bubble reacts and transforms in different ways.
I spoke to a number of people over the weekend, who were feeling distressed about the news of what had happened in a foreign country half way around the world. And I felt it too. I felt sad and shocked and scared. And this is natural. As awful as it is, it’s natural to feel disturbed. And that’s because the majority of us are all beautiful human beings and in our bubbles we have the strength to feel empathy. Professor Haroun from the University of California says: “The human reaction is to put yourself in the situation, because most of us have good mental health and the capacity to empathise. We put ourselves in the shoes of the unfortunate.” So in essence, because we have the capacity for compassion for others, events such as these hurt.
Not only can it trouble the feelings in our bubble, witnessing an act of terror can also disrupt our belief system. There was a time when I was working closely with patients who were seeking asylum in Australia. It was not until then that I realised that how l had been so fiercely protected by the belief systems and values that were inside my bubble. I was fully aware that not everyone had the same values and social niceties as I did and I felt that as a result of my life experiences I had a reasonable grasp on reality, but when I heard the stories of extreme terror from these patients my bubble, my beliefs and values about the world I live in, became significantly challenged and violated. My bubble was significantly disrupted. And the result was an immense fear. Fearful in the sense that I was living in an uncaring and unsafe world because I was no longer ignorant to how low the bar of humanity was. And it took quite some time to learn to cope with that. To get my bubble back in balance.
The research suggests that the key to coping with psychological terror is to find a healthy balance. And most people do. Studies have shown that even in extreme disasters, the majority of people do not become incapable of functioning. While there may be initial shock and distress; people call on their personal strengths and those of their family and community. And for the most part, people recover and return to their normal activities.
We may not be able to prevent all attacks that occur, but there are some things we can do to protect ourselves and those we care about to find a healthy balance, protect our psychological bubble and ensure that we don’t become over-anxious about the possibility of terrorism. Because we are human, our decision-making skills can be impaired in times of extreme stress. So try and stay grounded in reality and seek out the reliable sources of news and information. And where possible don’t rush to make quick judgements on what might be incomplete or inaccurate information.
The Mental Health Association of NSW offers a number of practical suggestions to assist people living with the fear of terrorist attacks or other human-made disasters. These include:
- Find out where to get help in the event of an emergency
- Give and receive emotional support
- Keep in touch with the people you care about
- Offer help to others in the community
Additional suggestions can be found here. It is also possible that people with pre-existing mental health conditions may experience a worsening of symptoms in response to such events. Keep an eye out for any such loved ones and where possible try and provide additional support.
A strategy that has worked well for me in the past in ensuring my bubble remains strong and resilient is to seek out the hope. Hope is often the antithesis of fear. And so I find that by discovering (and sometimes it’s quite a search) the things that come from a devastating event that can add some hope back in to to my bubble helps to get my psychological health back in balance.
“When I was a boy and I would see scary things in the news, my mother would say to me, 'Look for the helpers. You will always find people who are helping." Fred Rogers.
So whilst our news feeds on social media, the opinion pieces on blogs and the background natter of the television continue to remind us of humanity’s atrocities, please look after yourself my friends. Try and keep your psychological bubble balanced, healthy and strong.
If you need to chat to someone:
Lifeline: 13 11 14
Beyond Blue: 1300 22 4636