Thoughts / mental illness

How does it all start?

I have been getting my life in order of late. In extremely exciting and very adult news, I have paid off my HECS debt! I now actually own my two degrees. I have consolidated my fifteen superannuation accounts. This week I got my car serviced and after a very assertive talking to from the mechanic, I have two brand new tyres. And I am going through the process of having a ‘proper’ General Practitioner. Like, a GP who actually knows me. Not just the one who is available when I've got myself an ear infection from washing my hair too frequently in the bath.

I haven’t had a regular GP since I was a very young person. So new GP – let’s call him Dr Nick, because that is his name – had a bit to catch up on. And we’ve spent time together looking over and listening to different parts of my body. And I’ve attempted to succinctly summarise my mental health history for him. This has not been as easy as I’d hoped. Turns out I’m not the eloquent historian I envisioned. And also, answering personal psychological questions short and sharp, is tough. It’s not like sitting on the couch with psychiatrist Dr Matt and being able to babble on for a forever until you think you might just nearly maybe have it sort of figured out.

Take this, question for example. Dr Nick asks – ‘Have your episodes been triggered by anything?’ (Except he didn’t ask it like this. Because he is a doctor. And sometimes doctors prefer to use really complicated language to remind us that they’re really smart. Technically he asked – ‘Have your episodes of mental illness had an etiological cause or event?’)

It’s a warranted question to ask. There is immense scientific literature on this topic. People who have a severe depressive episode are most likely to have experienced a stressful life event within the past year (like divorce, moving, job loss, death of a loved one, medical illness etc.) compared to people without mental illnesses.

But I found it a tricky question to answer. In a short GP consult.

Probably, my episodes were brought about by a complex interaction of biological, cognitive, social and psychological factors all conspiring together in wonderful ways.

What I reckon probably happens to me is that there may be a build-up of life events (yes, we could call these social factors, or environmental causes or triggers), and when these events are of a particular kind that holds an inherent threat to my sense of who I am (the psychological part) then my mood is more likely to shift. Probably downwards.

So, there’s been times in my life where there has been a lot of life events or stressors and because of the nature of these events, they’ve affected me in a particular way. There’s been periods where I have been working full time, feeling a bit anxious, but keeping my head above water, to quite a different state of mind. When I am there I feel quite different. I don’t only feel sad, I feel physically ‘changed’; heavy of limb, tired, unable to sleep yet also very agitated and restless. I ruminate about things that at other times I would be able to cope with easily and I can be full of fear and panic. When I look in the mirror I am quite sure I can see it in my eyes. There are times when my fear can shift into obsessive and paranoid thoughts and feelings of wanting to end my life. It’s terrifying and yet oddly familiar at the same time.

And there’s other times where there’s been life events or stressors that have occurred, but an episode of mental illness hasn’t followed. Why? Probably because these stressors didn’t play into my vulnerability so much. They didn’t attack my sense of self or my psychological state in the same way. Or my psychological state was stronger or more resilient at the time.

I reckon the most toxic kind of life event that can trigger depression is one that resonates with a particular aspect of the person’s underlying vulnerability. Life almost seems to conspire to match the event to the person. Eventually anyway.  

And as I’ve mentioned before that vulnerability for me is the big Ps. Please. Perform. Perfect. The belief that if I do things perfectly I can minimise or avoid the pain of blame, judgment and shame. This comes with the nasty and debilitating belief ‘I am what I accomplish and how well I accomplish it’. So when events or stressors come along that target this belief system (which happen reasonably regularly), I become more susceptible to depression and anxiety.

So why do I experience depression when others experience far worse life events then me, yet don’t become diagnosed with mental illnesses? The only way I can explain why only some of us seem to become depressed in response to life events is by drawing on the concept of vulnerability. A combination of genetic factors, early life experiences and life stresses can cumulatively add to our vulnerability. Such that, when a torrent of life events come along, those of us who have the greatest vulnerability and lowest threshold for becoming depressed, can get washed away by the waves while those who are fortunately more resilient seem to remain standing.

So, how did I respond to Dr Nick. Unfortunately not with a neat and succinct hypothesis regarding predisposing factors, psychological vulnerabilities and precicipating events. Instead I said something along the lines of “Yeah, sort of.”

Because that’s maybe nearly about right.

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Kristen's story

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.

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Power and Recovery

Dr M said a while ago – “People who have gone through recovery are very powerful”. And I would have to totally agree. It got me thinking though, where is it that that power comes from?

I think/hope it’s reasonably well known by now that there is no quick fix or stand alone cure for mental illness. Instead what we aim for - for ourselves and for our loved ones - is ‘recovery’.

This in itself can be a bit confusing. When we are physically unwell we do all we need to do in order to recover. We go to the doctor, we take the medicine, we get the physiotherapy or the surgery or the rest or the whatever it is we need. We can see and feel the results when we are recovering and they are obvious to others as well. From my understanding, in the medical world, recovery generally means cure or no current symptoms.

To add to general life complexities, in the psychiatric world the concept of recovery is not about being restored to your previous health. Indeed, it could be argued that nobody returns unchanged to a prior state after an event. We are changed, if not in the objective sense, certainly in the experiential sense and how we see the world. As such, mental health recovery does not always refer to the process of complete recovery from a psychiatric condition in the way that one might recover from a physical health problem.

For many people, the concept of recovery is about staying in control of their life despite experiencing a mental health problem. Recovery can be described as a process of change through which people improve their health and wellness, live a self-directed life, and strive to reach their full potential (SAMSHA, 2011).

Recovery is "a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness" – William Anthony, 1993.

So, just because the illness isn’t there anymore doesn’t mean the battle is over. I remember very clearly when Dr M and I were discussing my current state and experience well over a year ago and he cheerily said “Well, you’re not clinically depressed anymore.” I nearly cried. I was bordering on devastation. There was no celebratory dance for no longer meeting DSM-V criteria for a current psychiatric condition. No, I was upset because whilst I was not technically “unwell”, I knew I still had a really, really long way to go. I was in recovery again. And I knew what I was in for.

This wonderful picture explains recovery from a mental illness perfectly to me:

(Source: Anna Borges, Buzzfeed)

Recovery is messy. Really, really messy. And hard. Really, really hard. And time-consuming. And a bit shit. For me, the process has felt like trying to walk up a really steep hill on really unsteady legs during a cyclone.

And why wouldn’t it? I was in the process of building a meaningful and satisfying life, with the threat of recurring symptoms or mental health problems. The evidence suggests, the key themes of recovery are:

  • Agency: Gaining a sense of control over one’s life and one’s illness. Finding personal meaning, an identity which incorporates illness, but retains a positive sense of self.
  • Opportunity: Building a life beyond illness. Using non-mental health agencies, informal supports and natural social networks to achieve integration and social inclusion.
  • Hope: Believing that one can still pursue one’s own hopes and dreams even with the continuing presence of illness.

So what does recovery look like in action? I think this is what we’ve got so far. Diagnosis is helpful, but just because a person no longer is identified as a ‘patient’, doesn’t mean there’s not still work to be done. The development of resilience might still be required to meet the challenges of life. Also, based on the definition there is more than one road to recovery and treatment is just one route amongst many. Sure there are a lot of well researched pharmacological, psychological and social interventions widely available, but there are a lot of ways forward here. And possibly most importantly, the best judge of recovery is the person directly affected. How could anyone else possibly comment or judge on whether another individual is living the life they want to lead? It’s impossible.

Personally, the thing that I have been most surprised about is that recovery is not all bad. I knew back when I was beginning recovery that I would probably not get my previous life back – because, really no one can go backwards – but I didn’t expect to have such a mixed reaction to it all. I would never, ever in my wildest dreams wish the experience of a mental illness recovery on my worst enemy, yet I also wouldn’t ever want to wish my own experience of mental illness recovery away. My recovery has helped to create a more meaningful life than I have ever had. It feels pretty powerful. And I’d never, ever wish that away.

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Hope Street Cards Book Club - January

Welcome to the ‘Last Wednesday Book Club’! It’s our very first meeting and this gathering probably would have started better had I properly invited you along or given you full notice in advance. But we will continue.

Here’s the down low. ‘Last Wednesday Book Club’ is new to Hope Street Cards for 2016 and what it will involve each month is me posting a blog reviewing a book which in some way discusses issues related to mental health or mental illness. It might be a self-help book (not to be scoffed at – some are actually helpful), a memoir or autobiography (we will NOT be reading anything related to Ben Cousins), it might even be a textbook of sorts. Each month I’ll let you know the book we will be reading for the month and if you wish, you can join in. And due to the powers of the Internet you can join in in the most wonderful ways. You can submit your own review by commenting on the blog, you might choose to leave your thoughts on our Facebook page (Hope Street Cards) or you might like to tag really lovely photos of you reading the book to our Instagram account (@hopestreetcards) or with the hashtag #lwbc. Again – how wonderful is the Internet?

So, I will know channel my inner Jennifer Byrne and kick it off. This Month I read Sane New World: Taming the Mind by Ruby Wax.

For those who haven’t come across her, Ruby Wax is/was a British comedian who apparently used to interview a lot of celebrities on the tele. As she discloses in the book, at one point she was involved in a television series where she interviewed people in their homes who were experiencing mental illnesses like OCD, depression and PTSD. Interestingly at this time she was also an inpatient at a (very nice) private psychiatric facility and would return to the hospital post-interview to receive treatment for her own depression. Following this, Wax began studying psychotherapy before going on to Oxford University and completing a Masters in mindfulness-based cognitive therapy in an attempt to understand the neuroscience behind her own experience of mental illness.

The book is split into four parts. The first part is a subjective look at depression and Wax’s formulation for why we are all “mad”. She moves on to make a compelling case for how certain “normal” human thought processes and behaviours were incredibly useful to the average hunter-gatherer – and how they’re not so well suited to the ins and outs of everyday modern life. The third section looks at the ways in which the brain controls and balances our emotional lives. There’s information about the structure and the function of different parts of the brain, and an outline of some of the better known neurochemicals. And in part four of the book she explores mindfulness – the practice of focusing one’s attention and becoming aware of one’s experience – and its use in self-regulating thoughts and emotions as a means of dealing with mental health problems. Replete with exercises that aim to put in practice the art of mindfulness, the book encourages readers to reconsider the way they deal with and think about their emotions and thoughts and ultimately the ways we can retrain our brains to improve our health and happiness.

I don’t really know how to write a book review. I was in a book club once before but it seemed as if our main priority in that club was reviewing the food available. So, I’m going to do this review motivational interviewing style, because that I know how to do.

The good things about this book:
• This book is really quite funny. Despite a lot of banging on about how most of society is really gloomy, Wax makes you laugh out loud. Whether it’s describing her Nazi-escaping parents (“child rearing was not their specialty”) or explaining the complex issues surrounding the evolution of human brains: “Millions of years of natural selection, and this is what we’ve come to. We want to be the most famous, the richest, the thinnest and the busiest. Darwin would shit himself in his pants”, you can't help but chuckle.
• The part of the book where she talks about the brain – the development, the structure, the way it works, the important neurotransmitters – is brilliant. Really well researched and informative. And because she brings in her humour, there’s a chance you’ll actually remember some of it. I really wish I had have been able to use this book to study for my second year undergrad neuroscience subject at Uni. The text I tried to rote learn was dull in comparison. Can’t remember a single thing. The diagrams in this book were also very good.
• In terms of celebrity memoir (of which there is quite a bit) it’s not too over the top or narcissistic or irrelevant here. That seems to happen with celebrity memoirs. A lot.
• Because of her inherent sarcasm and almost cynicism about the world around her, that Wax has faith in mindfulness practice adds further to her argument for neuroplasticity and mindfulness practice. For example, she scorns books that give 200 pages of advice “that boil down to ‘Think happy thoughts and your dreams will come true, just like Tinker Bell promised’”, yet she’s ultimately providing us with a 'self-help' book of sorts. And she puts in a lot of evidence-based research to support her theories.
• For a ‘self-help’ book it’s pretty brutal and honest. When outlining the predicament of the minds of all of western civilisation in part one there’s not much sympathy. In a nutshell, Wax sees us all as pretty stupid. And that was quite refreshing for a book of this genre.
• The overall message is one of hope. And this message is supported by the science. That we can change the way we think and improve our responses to things like depression and panic and feeling crap. Or as Wax puts it, “the brain is like a pliable 3lb piece of Play-doh, you can resculpt it by breaking old mental habits and creating new, more flexible ways of thinking”.

The less good things about this book:
• I can’t really figure out who this book is for. I think she thinks it’s for everyone, however it would be very difficult to read if you were experiencing a mental illness or in early recovery. The first part in particular is very heavy on the doom and gloom. If it’s for people who are functioning, however haunted by the “nag-nag” voices then it might be worthwhile. But then the parts regarding Wax’s own experiences with depression might make it feel less relevant. Still stumped on this one.
• It’s really quite a tiring read. And I don’t think it was the content, with all the brain information , research etc., that made me tired. It was all the quick sentences and punch lines and exclamation marks. It’s written in a very similar way to how she speaks on a comedy tour. And I found it a little relentless and exhausting. It was hard to read before going to bed. The irony of it all is that she’s writing at such a frenetic pace, yet telling us all we should all slow down.
• It might be funny (for some people), but I don’t think there’s anything to be gained by using terms like “mad” and “crazy” and “inmates” to describe oneself or other people. Nothing at all. We have so many other words at our disposal, yet Wax almost incessantly sticks to stigmatising mental illness language. I think it’s unhelpful. I’m not going to bang on about why it’s unhelpful. Now, anyways. (You can find one of my rants about it here though).

So, that’s my review. Overall I think it’s pretty good. And my take home message was if we don’t start paying attention to what’s happening in the present, we’ll miss it all. And that will suck.

If you’ve read it and have opinions get involved and let me know them. If you haven’t read it, but have opinions on my opinions get involved and let me know.

Next month I’ll review The Anti Cool Girl by Rosie Waterland. Last Wednesday of February. Happy mental health reading!

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Sending empathy, love and hope

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.

  1. 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.
  2. 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. 
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.

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Chatting and dreamin'

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.

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The joys of therapy

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.

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The sick brain?

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.

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Don't call me 'mental' .... please.

I highly doubt this will be the only time I write on this subject, given the number of times I have banged on (and on and on) about it, time and time again. Language matters. Big time.

Language shapes how we see the world. This is true for everyone. And for everything. Our perceptions and expectations are shaped by the words we hear and use. They are part of the underpinning framework of our lives. The words we choose and the meaning we attach to them influence so much. Our feelings. Our attitudes. Our beliefs. Words can makes us feel happy, beautiful, ecstatic. Words can also make us feel miserable, angry, guilty.

“If thought corrupts language, language can also corrupt thought”  George Orwell.

But the great thing is that we have a choice over our words. We have full control over the language we use to describe ourselves, others and the world around us.

Historically, the world around us appears to have found mental health conditions and experiences difficult to confront, treat and talk about. It wasn’t that long ago that people who experienced mental illness were abused, removed entirely from society, subjected to un-anesthetised electric shock treatments and had parts of their brains removed through lobotomy procedures. And with these treatments and the complex issues regarding explanations of mental conditions came a range of language to describe such people: ‘lunatic’, ‘psycho’, ‘neurotic’, ‘maniac’ etc. Luckily with the progresses of psychology and psychiatry in both better understanding and treating mental illness, the language has changed over time, with the words used expressing the prevailing views of society.

“Language is the road map of a culture. It tells you where its people come from and where they are going”.  Rita Mae Brown.

But I think we’ve still got a way to go. Unfortunately the use of particular labels to describe people and their behaviours is still hanging around. The problem is that the use of a label often implies a separation of ‘us’ from ‘them’. And this separation can quite easily lead to the belief that ‘they’ are fundamentally different from ‘us’ and that ‘they’ even are the thing they are labelled. ‘They’ can become so different from those who do not share a negative label, so that ‘they’ can appear to be a completely different sort of people. Our use of language is revealing regarding the use of labels to distinguish ‘us’ from ‘them’.

Like I mentioned, I think this is improving, however for a long time it has been commonplace to label someone a “schizophrenic” instead of saying he or she is a person with schizophrenia. For physical illnesses things are handled differently and people will usually say, a person has cancer. The person with cancer remains one of ‘us’ and has an attribute, while the ‘schizophrenic’ becomes one of ‘them’ and is completely defined by the label we affix to the person. In this way, language can be a powerful source and sign of stigmatisation.

It intrigues me how people use labels to describe their experiences of mental illness. When I was working as a psychologist, it was something I would challenge clients on and the relationship between their choice of words and recovery was fascinating. When I was a patient in a psychiatric hospital, it was one of the things I most commonly ranted about to other patients in groups as to how I thought they should speak about their own mental illness.

From my experience, the three most commonly asked questions (with common answers) that are asked between inpatients in a mental health facility appear to be:

  1. What’s your name?
    1. My name is Sam/Andrew/La-ah
  2. Where are you from?
    1. I’m from Brisbane/Lismore/Timbuktu
  3. What are you here for?
    1. I’m depressed/anxious/bipolar/psychotic/crazy etc.

More often than not, patients described themselves in terms of their illness. So not only does the wider community place these labels on ‘us’, but sometimes it comes from the individual themselfl. But mental illnesses are not adjectives. And they are not ‘us’. I am not defined entirely by a disorder. Just as no one would ever say “I’m cancerous” or “I’m urinary tract infection”.

So what’s the best thing to do when talking about someone else’s mental illness? Be respectful. Taking the time and making the effort to show respect for people who may have different backgrounds, life experiences and cultures from our own can really improve our ability to communicate. Maybe spend some time becoming aware of your own beliefs, stereotypes and biases about people who have a mental health condition. Be aware that certain words and labels can hurt.

Remember that all people are people first and foremost. Rather than describe the person as their illness, describe them as a person experiencing a certain something. E.g. Sam is experiencing a mental health episode. Remember that a lot of mental illnesses are treatable and manageable and as such may pass. Probably best then not to stick a label on someone  for a condition that may not even hang around.

And why not ask your loved one how they’d like the mental illness to be referred to? That too can work.

“The limits of my language means the limits of my world” Ludwig Wittgenstein.

 

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Why the 'hope' in Hope Street Cards?

I’m going to be entirely honest here. It wasn’t brilliant genius that led me to the name of this little card business. It was a bike ride home on a miserably cold Canberra evening. The idea for Hope Street Cards had been with me for some time, however I had been struggling with finding a name that wasn’t naff, lame or tacky. I mean, my sister’s hipster reputation was at stake here! I remember having a very negative internal dialogue with myself that evening regarding the state of the weather and catching myself attempting to disrupt these thought patterns as I cycled into my street. Thinking ‘Oh well, at least I get to live on a street called ‘Hope Street’’. Full disclosure. I got the name from my address at the time.

The more I thought about it though, the more totally appropriate it was. Because there really is not much more important a thing than hope.

I find it really difficult to concretely define or describe hope with the poetic justice that I feel it deserves. The dictionary says that ‘hope is an optimistic attitude of mind based on an expectation of positive outcomes related to events and circumstances in one’s life or the world at large’. Thanks dictionary. The psychologist Charles Snyder associated hope to the existence of a goal, combined with a determined plan for reaching that goal. Thus an essential ingredient for future planning, motivation and change. But it just feels like so much more than that.

Viktor Frankl, Austrian neurologist and psychologist, chronicled his experiences as a concentration camp inmate in his book ‘Man’s Search for Meaning’ (1963). Frankl’s observations and writings led him to discover the importance of finding meaning in all forms of existence, even in Auschwitz, which create a reason to continue living. He stated “It’s a peculiarity of man that he can only live by looking to the future” (p. 115). He warned that “the sudden loss of hope and courage can have a deadly effect” (p. 120) and observed that “the prisoner who had lost his faith in the future – his future – was doomed” (p. 117). Prisoners who Frankl observed as having lost hope reportedly died within a short time. That’s pretty massive.

And more recent, empirically-validated research backs the importance of hope up. Hopeful individuals have been found to make healthier lifestyle choices in areas such as exercise, eating and drinking (Peterson, 1988). They recover from illness and injury more effectively (Snyder, Rand & Sigmon, 2005) and have increased life expectancies (Maruta, Colligan, Malinchoc, Offord, 2000). They manifest less depression and anxiety symptoms (Cheavens, Feldman, Gum, Michael & Snyder, 2006) and experience increased positive mental health, personal adjustment, life satisfaction (Gilman, Dooley & Florell, 2006; Kwon, 2002) and sense of meaning in life (Feldman & Snyder, 2005). Obviously the benefits of possessing a hopeful approach to life are numerous and noteworthy.

During my first year of clinical psychology training, the importance of ‘instilling a sense of hope’ in conjunction with the client was taught as one of the key ingredients for providing successful psychotherapy. Some consider hope as one of the four most significant common factors in good therapy outcome (Hubble, Duncan & Miller, 1999). Irvin Yalom a guru in the world of psychotherapy teachings identified the instillation of hope as the first curative factor in effective group psychotherapy. Esso Lette observed: “Hope is crucial to recovery, for our despair disables us more than our disease ever could”.

During my very early training this knowledge made me feel slightly relieved. Being overwhelmed by anxiety at providing psychological treatment whilst feeling entirely inadequate, underprepared and paranoid I would end up ruining someone’s life, I thought, ‘well at the very least I think I can help someone feel hopeful’. And for the most part I could. There was one time though, when that sense of hope was so incredibly difficult to cultivate. Where the empathic response I had to a client’s traumatic past and current internal experiences left me feeling devoid of hope. I too felt hopeless. And it was gut-wrenching. And terrifying. And so incredibly sad.

That experience really affected me, because the guiding principle of recovery from a mental illness is hope – the belief that it is possible for someone to regain a meaningful life despite a serious mental health condition. And that recovery is not a linear process. Or an end result. It’s a process, ongoing adventure, one step at a time, that sometimes looks and feels like one big mess and is completely different for everyone. And it’s really, really, really hard work. Because there’s so many things you have to do that you often just don’t want to do (e.g., get adequate sleep, exercise, challenge unhelpful thinking patterns). And you have to do these things with no absolute certainty that doing these things will make you feel better. You need courage and commitment and a bucketload of hope.

But for someone who is experiencing a mental health condition there can be an overwhelming sense of hopelessness, so where can that foundation for recovery come from? At the launch of Hope Street Cards, Clinical Psychologist Jo beautifully described the benefits of having someone else “hold on” to that hope for you, when you yourself can’t. And I totally agree. At my darkest times my therapist – let’s call him Dr M – has held the hope for me. I’m not even sure he knows he’s doing it. But he will refuse to engage with me in any particularly ridiculous notions of my self-worth I might have. He does this very subtly and tenderly, but it is a gentle reminder that he doesn’t believe in such thoughts, he believes in me. And at times this has been enough.

At other times it’s been my family and my friends who have carried that hope for me. Just by being there they provided the gift of faith that I might be able to live well again. And what does that gift feel like? I think Emily Dickenson may have described hope best: “Hope is the thing with feathers”. And those feathers tickle your heart a little.

 

Smart things I quoted:

Frankl, V. E. (1963). Man’s search for meaning. New York: Pocket Books.

Yalom, I. (1985). The theory and practice of group psychotherapy. New York: Basic Books, Inc.

Peterson, C. (1988). Explanatory style as a risk factor for illness. Cognitive Therapy and Research, 12, 117-130.

Snyder, C. R., Rand, K. L., & Sigmon,D. R. (2005). Hope theory: A member of the positive psychology family. In Snyder, C. R. and Lopez, S. J. (Eds.). Handbok of positive psychology. (pp. 257 -267). New York: Oxford University Press.

Maruta, T., Colligan, R. C., Malinchoc, M., & Offord, K. P. (2000). Optimists vs. pessimists: Survival rate among medical patients over a 30-year period. Mayo Clinic Proceedings, 75, 140-143.

Cheavens, J. S., Feldman, D. B., Gum, A., Michael, S. T., & Snyder, C. R. (2006). Hope therapy in a community sample: A pilot investigation. Social Indicators Research, 77, 61-78.

Gilman, R., Dooley, J., & Florell, D. (2006). Relative levels of hope and their relationship with academic and psychological indicators among adolescents. Journal of Social and Clinical Psychology, 25, 166-178.

Feldman, D. B. & Snyder, C. R. (2005). Hope and the meaningful life. Theoretical and empirical associations between goal directed thinking and life meaning. Journal of Social and Clinical Psychology, 24, 401-421.

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