The Effect of Stigma Against People Diagnosed with Mental Illness

By epower
Swiss Miss ~ 5 of 5 photos

“Quirky” or “mentally ill”? Why should the fact of a diagnosis define how we are perceived?

There is nothing more horrifying than the shift in perception and trust that can happen when you reveal a mental health diagnosis – nothing worse than being friends with a family for six or seven years, spending time with their kids, being considered a valued family friend by people who assume you to be “normal” or perhaps “eccentric,” and then, when you reveal your diagnosis, hearing them say “we just don’t feel comfortable with you playing with our children.” From inside that diagnosis, it’s incomprehensible that a visit to the therapist’s couch converts you from a “trusted family friend” to a “dangerous person” after a long history of positive relationship!

Or perhaps it’s worse to be part of a faith community that proclaims its inclusivity and then, on learning your diagnosis, asserts that you’re “demon-possessed” – offering grace by saying that only after you complete THEIR deliverance program will you once again be welcome.

Or maybe the worst is the next faith community who thinks they know diagnoses and labels, who insists you have something you don’t.  Why? Someone in their family has it, and it’s the closest terrifying thing they can think of. At any given moment, you might lapse into mayhem.

Or the workplace that treats you well, gives you good evaluations, and sees you as a valuable team member…until you file a sexual harassment charge and suddenly they can’t look past the stamp of your diagnosis and “don’t know how to trust what you say.”

Maybe it’s your own family, trying to put the fun back in dysfunctional by pointing at you and saying, “How are your delusions?” They want to show they’re cool with your experience, but by laughing it away, they disregard the possibility that there might be some truth in what they’re labeling as delusions.

The stigma of mental illness lets people without (or who are unable to own) a diagnosis:

  • Take the diagnosed person seriously until they want a reason not to.
  • Believe that they are better than, healthier than, and more entitled to things than the diagnosed person.
  • Avoid looking at their own dysregulation and bad behavior.
  • Feel it is right to control the diagnosed person’s behavior to manage their (often irrational) fear.
  • Feel free to mock, mimic, and make fun of people with diagnoses in the media or in person (something abhorrent when pointed at other populations).
  • Treat people as if they have a contagious disease (the biological model) or are stupid (the learned model).
  • Assert that “people like that” should be “locked up”.

Remember how long it took for people of color to even begin to be taken seriously? Or people who were of different gender orientation and sexual identities, and people with visible disabilities?

So how does this make sense, that without knowledge of a diagnosis, others take you seriously, and consider you a peaceful person, and with knowledge of a diagnosis, others dismiss you and consider you a high risk for violence against others—in spite of all the evidence and facts?

I’d love to hear your ideas. Meanwhile, I’m building new relationships with people who appreciate me for all that I am, including quirky.

Please join me on Facebook to discuss this thing some people call “mental illness”.

Image: Mary Anne Enriquez via Compfight

Trauma, Spirituality & Faith: Webinar for All Organizations Dealing With Traumatized Refugee Populations

By epower

Is your organization equipped to deal with the aftermath of trauma in refugee populations?

In 2010 the U.S. State Department admitted 48,282 refugees to the United States. In 2013 the number was 69,926. Look around the world: from current conflicts and historical hot-spots, people are seeking shelter and safety. These people have experienced trauma and they are dealing with its aftermath. Increasingly, they are dealing with this aftermath here in the United States. Are we prepared to support refugees who have been traumatized in their home countries? Whether you believe the overall answer is yes or no, we could certainly be more prepared. That’s the goal of a webinar I’m facilitating this Wednesday the 19th for the Gulf Coast Jewish Family & Community Services in cooperation with the National Partnership for Community Training (1:00-2:00pm EST, register HERE).

The program will use the Sidran Institute’s Risking Connection model to describe how organizations can meet the needs of refugees, immigrants and those who have survived torture. While this webinar happens to be seated in the faith community, the lessons are universal — Trauma, Spirituality and Faith: An Overview of the Interplay as Survivors Risk Connection and Recovery will help you and your organization accomplish the following:

1. Effectively convey the importance of faith communities in health and recovery for refugees, immigrants, torture survivors, and others who have experienced trauma
2. Connect spiritual practices such as yoga, meditation, and ritual to healing and community-building
3. Equip providers with knowledge and tools useful in leveraging faith communities in the service of reaching out to torture survivors
4. Embed best and promising practices for working with survivors of torture in the context of connecting with faith communities

Recently I taught a Risking Connection in Faith Communities seminar for clergy in Baltimore and would love your participation as I work toward similar programming for the American Association of Pastoral Counselors. Together we can help congregations of all faiths move a little further towards the trauma-informed approach of dealing with “what happened” instead of “what’s wrong”.  Congregations in all of the Abrahamic traditions (Jewish, Christian, and Islamic) have a long way to go toward dropping the stigmatizing approach mental health care. I hope this webinar is a small step in that direction.

Image: gnuckx via Compfight



The Difference Between “Curing Mental Illness” and “Improving Mental Health”

By epower
There's a Park Nearby

On one side is the medical model of “mental illness” and on the other side is a strategy that promotes mental health.

Position One: Curing Mental Illness
If I have an “illness” I can seek a “cure.” If I seek a cure I am likely to—since pills cure so many things—look for the magic bullet of a pill.  If I am “sick” you can’t blame me or expect me to be responsible for my behavior.  I do what I do because I am “sick.”  And because I am sick, it means someone should take care of me, because that is what people do when someone is sick, right?

A “medical” model of mental illness inherently searches for a biological cause.  And there are certainly biological causes of mental illness like syphilitic lesions, UTIs, basal ganglia cell inflammation (for which little testing is done), meningitis, and certain parasites that cause symptoms of the things we call mental illness. Treating these biological illnesses requires less expensive diagnostics and allows care to follow the current medical paradigm.  Ask the woman who wrote Brain on Fire.  She’s a great example. Or the women who were chronically suicidal and later found to have a parasite found in cat feces transmitted by cleaning cat litter. For each of these, being a “patient” with a bona fide biologically based condition would be very comforting.  Get the body right, and the symptoms (should) disappear.

Even when the cause of a mental health diagnosis isn’t biological, but is behavior learned in the context of specific settings, naming the challenge as a disease may help the diagnosed person make sense of experience.  However, a “patient” can also become a scapegoat – everyone else is behaving badly, but I have a diagnosis, so they put the spotlight on the person with the diagnosis. Your behaviors are understood in the context of “It’s your illness…” or “Might this be because of your history?” or “Well you can’t trust what SHE says.” Seeing challenges behaviors as the inevitable result of an “illness” becomes a “Catch-22” that makes healing nearly impossible.  And over time with the insistence of how “sick” one is, it becomes easy to believe it.  The shame and judgment are easy to internalize, and it becomes easy to believe less of oneself.  Even if you believe more of yourself than others do, the scarlet letter is there, and the risks of having the knowledge of your “condition” used as a weapon in relationships, work, faith, communities and healthcare is present.

Are there patterns of connections in the brain that make thinking, feeling, and acting in ways that most others do difficult if not nearly impossible?  Of course.  Can medication help people feel better and have the room to think, feel, and act differently—can it help adjust those patterns?  Of course.  Does learning to transform challenge thoughts and behaviors require developing a sense of self, personal agency, learning to say no and deal with the flak that comes? Absolutely. And that is something at which we are less than proficient.

Position Two: Improving Mental Health
Everyone can improve mental health—think about personal and professional development, self-improvement, and the many programs and labels people apply to efforts to change their thoughts, feelings, and actions in ways that make it easier for them to fit in, relate, grow and succeed. And, truthfully, when you begin to think about how specific behavior is helpful (without copping an attitude about the other person’s behavior!) and consciously choose to believe people are doing the best they can… well, the world changes. Everyone has some degree of mental health that can be improved.

Strategies to improve mental health are available to everyone.  They require no diagnosis.  They only require identifying something one defines as “better,” or “healthier,” finding a model, and practicing different thoughts, feelings, actions.  Every athlete, musician, actor, physician—everyone—practices something to perfection.  Change the target, change the practice, change the outcome.

Unlike curing a disease, improving mental health is a stigma-free process.  It gives a person power in the process: instead of a patient or consumer, you’re the person who pays the caregiver’s salary, directly or indirectly.  You’re the person who has a right to health and who is paying the other person to help you develop it.  It’s a learning process instead of a curative process. Learning is the work of life.  Learning liberates the diagnosed person from the shame and stigma of disease in order to look at “what happened” and to create a different way of being.

Please join me on Facebook to discuss mental health and this thing some people call mental illness.

Image: RP Norris via Compfight

The Line Between “Spacing Out” and “Dissociation” is Only Degree and Distance

By epower

365 Days - Day 71 - Hippy Tree Huggers
When you’re driving down the road and you suddenly realize you missed your exit or maybe you’re not quite sure where it is because you developed the “white line trance” you’re dissociating.  Those times you get so sucked into a movie or game that someone has to lob a Nerf ball at you to get your attention?  Or maybe when you’re reading a great book and look up to realize it’s dark outside and the last time you checked was noon?  Or maybe you’re an athlete, and you get in the Zone sometimes where everything just flows. Those are all dissociative moments – non-pathological ones. Dissociation is fundamentally akin to trance states, as when people are lifted outside of themselves in spiritual experiences.  In fact, research in the 90s showed that people who were dissociative had more charismatic or spirit-filled experiences.  There are some big implications here in terms of religion, but I’m not going there. Yet.

The difference between these and “having another personality” is degree and distance.  People for whom dissociation is not a major issue usually continue to know who they are, where they are, and their internal arguing is self-contained. Another difference is the structure of experience.  Buddy Braun, a psychiatrist, came up with the BASK model of dissociation, pointing out that a person could “disconnect” from their behavior, affect, sensations, or knowledge (thus “BASK”)—or any combination of these.  I met Buddy at a conference for people working with folks who dissociate and I told him that I thought he’d left out an element: a W that stands for Will.

When you learn to not be present in some way when something happens, it’s usually because you don’t have the choice to distance yourself from the event in some other way.  No child would stay physically present for what they can’t endure, whether the cause is trauma with a little t or a big T.  If the child can’t leave, how special it is to be able to symbolically create someone else—a partial or full personality, another electrical pattern—to handle the intolerable situation! The challenge is that when this process develops in young children, their will (capacity to choose) is undeveloped, and sometimes their environment doesn’t support being present for difficult times (even those like death of a parent, natural disaster or other traumatic events that don’t depend on another person’s volition). The tool works, and as it does it begins to be reinforced, and a reconfigured self begins to develop that aids this child stuck in the time of the intolerable.

In this way, profound dissociation is a developmental disorder, one in which children who are stuck in “flight” but who can’t escape physically learn how to flee emotionally in order to cope.  And the parts that learn to cope develop at different points and in different ways.  So the mosaic has gaps – no one state has all the information or all the “development”.  Each has developmental gaps, learned as forms of state-dependent behavior. A state that might be exceptionally bright may have no physical sensation.  A state that is pure affect may have no awareness of behavior or knowledge.  Another may be unaware that choices can be made.

Language fails here—any self-respecting part of a person that has pride in survival longs for identity, just as any other “person” would.  Yet self, personality, alter, and state all imply ways of being that aren’t quite correct.  Pronouns for dissociative identities are awkward.  Responsibility is a peculiar crisis: who does what in one skin?  And the experience of being the “other” to one’s own “self” is odd in the extreme.  Sometimes awareness that an “other” has been in charge may come from a shifted visual field, unusual strength for tasks, changes in food preferences, even allergies.  Sometimes physical appearance shifts markedly or subtly.  Sometimes preferences of all sorts shift.  And how aware one is of these states and perceptions and ways of being varies – just as it does for anyone who is not so diagnosed – only the degree of change between states may be far more profound.

Think about every day.  You switch between Dotty Daredevil Driver, Suzie Superworker, Mad Mommy, and a host of others.  Hopefully you know this about yourself and you move among roles and expectations with some degree of fluidity, agreement, and awareness.

If you are profoundly dissociative, you may not be aware of these movements.  You may think some of the things that happen to you are the work of others, eliciting accusations of paranoia and fear. (Who changed my furniture? Where did those clothes come from?) Maybe you maintain sense of continuity in self, but change wardrobes radically, making others see you as eccentric (and you might not remember buying or wearing the clothes, let alone see the variations as off-putting!) Or you may “come to” hearing others berate you without any awareness of what happened to create their behavior. These jarring snaps in your reality teach you to dance realllly fast: lots of passing and covering.

An overview of DID by Martin Dorahy found that about 5 percent of psychiatric inpatients and about 1 percent of the overall population meets the diagnostic criteria for DID. Reasonably good research by psychiatrist Colin Ross in the 90s (before he went a little off the rails…), in the heyday of the exoticness of dissociation, indicated that as many as 1 in 1,000 college kids could be diagnosed as dissociative…if their lives weren’t working so well! Frank Putnam, another psychiatrist, documented the statistically significant differences among certain measurable aspects of physiology among people accurately diagnosed with DID and actors: the difference among roles an actor assumed were not as great as those among a person with DID moving among themselves.

But the media frenzy, the ways in which people with multiple personality disorder (as it was called then) were so unbelievable, the over-focus on horrific abuse as the cause of their difficulties, and the exoticness of the process pushed a lot of people who might otherwise have been diagnosed back into the closet. It is a closet where the gifts and the challenges of dissociation are often covered over with “eccentricities” or other diagnoses, many of which are considered more intractable and difficult than dissociation. Bipolar disorder, borderline personality disorder, anything beginning with “schizo” and substance abuse can all accommodate shifts in the self to other configurations.

Functional multiplicity is part of many people’s lives, many of whom have no diagnosis at all. The difference between the “spacing out” a lot of us do, and shifting into another totally separate state, is only one of degree and distance, and how functional our lives are on a general basis.


Please join me on Facebook to discuss cultural concerns in mental health diagnosis and care

Auntie P via Compfight

Breaking the Silence About Mental Health

By epower

Starry.NightI’m breaking the silence.  I’m talking about Mental Health.  Radical that I am, I talk about it every day.  Every. Day.  Not just on its named day.

I talk not about the horrors of untold demons, or weeks of unrelenting flashbacks, or being unable to summon the life to turn over in bed. We all know about that.  I don’t talk about biological brain disorders, because few (if any) can be definitively proven to be biological.  I don’t talk about a lot of things about the horrors of mental illness.  That just scares people, me included.

And I don’t talk about the things that overwhelm us to the point that we can’t cope.  Can’t make sense of them.  Can’t integrate the feelings.  Can’t understand what’s happening.  They cut across, or sometimes pick like flesh taken by crows, our spiritual lives, our pscyhes, emotions and certainly our bodies.  I know that list personally. That’s old news, inner baggage, slow-healing wounds. If you’re trying to get happier, why gaze into hell all the time?

I turn my gaze.  I turn it instead to things that focus on warmth.  Connection.  Growth. Restoration of relationship.  Remembering who cares for me, who gives me wise counsel towards life.  I turn towards being kind, being supportive, consciously choosing to believe that others are doing the best they can.  Wondering what happened instead of deciding what’s wrong.  Towards thinking about the things for which I am grateful.  Saying nice things.  Paying compliments.  Building up.  Thanking others. Thanking myself.  Loving the plants in my garden, my cats.  Being present for others, and for myself. Things that no one can silence me for.  Things that build life, health, and healing.

Yes, I’m breaking the silence.  I’m talking about Mental Health.  It’s recently been Mental Health Day of some sort, and I keep seeing these articles about the overwhelming needs of people with mental illness and  screenings for depression. Then there are the articles about the awful lives caught between coverage, disability and health. I read about the god-awful suicide rates, and now and then an article or two about recovery and people, usually diagnosed with schizophrenia.  Now and then.  When someone with a gun shots people in the work place, or at a school, or on a military installation, people really talk about it, as if gun violence and mentally illness were inexorably linked.  They’re not.

There’s something deceptive about the news.  No matter how hard they try, the newsfolks lean on the newsworthy: usually the disturbing stuff. I understand.  Readership.  And they mean well: reduce the stigma by talking about the success stories.  It doesn’t reduce the stigma. I promise you, not one person living in the community is reassured by the story of someone who has been diagnosed with schizophrenia does well—if they are, the reassurance is countered by the reputation of “those people” when they are off (and sometimes on) their medication.   It’s disturbing if someone goes off and gets violent (more so if they are known to have a mental illness—which makes the violence understandable).  It’s disturbing if someone who is not supposed to do well does so (expectations of failure are smashed—and uncertainty sets in).  Frankly, it’s disturbing any time a person is out of their “place”—we get a little anxious about what might happen.  That’s stigma.

And talking about the successes won’t reduce it. I remember when people painted hateful signs on the mosque nearest me.  Instead of empty conversations about tolerance and salvation, and the nice Muslims they knew, the Jews, the Christians, Muslims, non-believers and the unchurched secular humanists went together to help paint. I remember when a crowd acted as if they were all experiencing the same challenges that someone had taunted, and the bullies faded away: they didn’t know who to pick on.

That’s why I talk about Mental Health. Every. Day.  Because when we all own up to being a little mentally ill at some point in life, or for different lengths of time than others, there’s no one left to wrongly blame, exclude, not hire, keep out of life.  Then it’s about the kind support each of us needs.

Join me at Facebook to help break the silence.

A Trauma-Informed Perspective on Oscar Pistorius

By epower

PistoriusHow is it that Oscar Pistorius’ case of “shoot your girlfriend and get away with it” isn’t evoking universal outrage?  There is no doubt that bullets from the gun he fired killed his girlfriend.  There is no doubt that her parents and many others are enraged with grief and want someone to pay.  That’s the normal, predictable reaction.

Even the legal beagles of South Africa are adopting enraged positions. In a Tweet, James Grant, Wits University criminal law professor said, “Masipa doesn’t accept that accused intended to kill anyone. Huh? His defence was he didn’t intend to UNLAWFULLY kill.”  He Tweeted again, “How can you voluntarily fire four shots into a toilet cubicle & not foresee the possibility of killing whoever was in there.”

But this outrage hasn’t leaked into the public consciousness – family and law professors can and are shouting to the high heavens, but the public seems uncharacteristically accepting. Why?

Continue reading… »

Before You Medicate, Read This

By epower
Image: Flickr/NeilsHeidenrich cc license

Image: Flickr/NeilsHeidenrich cc license

Yesterday I wrote about the pros and cons of psychotropic medicines; basically, I’m all for drugs that make people feel better quickly. But the physical, mental, emotional and financial costs of these drugs as currently prescribed so often outweigh their benefit. Yesterday after I clicked “publish”, I started thinking about a couple things I wanted to say – you know, like coming up with the perfect comeback in the shower, six hours after you could’ve used it. Most of these short points center around the idea that learning to “feel better” without medicines is a difficult and lengthy process for people diagnosed with mental illness. And so for many of us the question become whether we try to feel better quickly with drugs in a process that may or may not have worthwhile results, or whether we do the painstaking work of learning to feel and act closer to the ways in which people without a diagnosed mental illness would feel and act, without drugs. Again, what is right for you or the person you love may vary. But here are a couple things I’ve been thinking about on my own long and winding road toward majority culture cognitive and emotional processes:

1. If feeling is something you are unaccustomed to, how can you learn to feel?

Feelings can be pretty scary things.  Trust me: after disconnecting from my emotions for a very long time, learning to live with (and love them along with the information they bring) was a terrifying journey.  It took lots of time, and lots of work, and I am pretty sure that as far as I have come, I have that far to go again.  But for me, the payoff is worth the price: the world of emotions is a rich, juicy, complex one worthy of a life of difficult learning.  No matter how many emotions we learn about—their names, where others feel them in their bodies, under what circumstance, and how those others manage these emotions, there are still more emotions – more names, more situations, more difficult and sometimes confusing management. If you wanted a quick “how-to” for learning to experience and manage emotions, I’m sorry to disappoint; but through hard work I’ve come a long ways and I know that I’m not that unique – sorry for the glib bow tied on this package, but if I can do it, you can too!

2. If exercise is the best intervention for depression, what keeps us from exercising more?

Think about this as a bigger question: if some sort of hard work is the best medicine for a diagnosed mental illness, why don’t we do it? Well, it terms of exercise and depression, sometimes it’s not having any company while doing so.  Sometimes exercise is inconvenient.  Sometimes it’s frightening to be outside, or inside, or anywhere.  Sometimes it goes back to #1: moving means feeling and feeling is terrifying. But eventually, every person I know wants to feel—it’s just that some want to feel differently. As terrified as we are to feel, depression is a feeling too and we’re stuck in it. The question is whether we’re more terrified (and immobilized or comfortable) in the mental health diagnosis or more terrified of the state of feeling that hard work could bring for us. The people I know who take big psychotropics don’t want to be “crazy,” and they don’t want to be shut down by their medications, either. In some cases, “hard work” interventions – like exercise for depression – might work. But darn does it take courage to find out the alternative…

3. If medication works for you, why not use it as a tool?

It’s a great premise: we know medication changes brain pathways so why not use it to grow the brain pathways that would make us feel better?  One of the most gifted clinicians I ever worked with asked a group I was in of childhood trauma survivors to go on very low-dose antidepressants for a year, while we also did work to learn how to feel happy (which many of us never had).  In that year, not only did we do expressive work, we also did somatic work, and cognitive restructuring.  Other than the fact that I was only able to tolerate the medication for six months, it was great.  I learned a lot.  I practiced hard.  I achieved an optimal level of happiness that served as a great baseline for the rest of my life – though I couldn’t always fly at that altitude, I always had something to shoot for and I knew it was there.  If you can use meds as tool while you learn, great.  If it becomes a long-term support, okay.  But when meds stand in the way of real development, and potentially a means of social control in which clinicians or others medicate away different, valid ways of being in favor of the great ugly blanket of “normalcy”, I get nervous.

So there you go. Those are the little addendums I wanted to add to yesterday’s post. The thing is, there are thousands more points to be made about this delicate balance of medicines versus difficult work in this crazy thing society calls mental health (pun intended). I would love to hear about your experiences. What are the factors you take into account when choosing for yourself, your loved ones, and the people in society with a diagnosed mental illness? With meds, there’s all there’s nothing and then there’s careful nuance. What’s your opinion of the best use of these medications?

– Please join me on Facebook to discuss personal and organizational trauma, healing, ethics, and innovation.

The Pros and Cons of Psychotropic Medications

By epower
Image: Flickr/Sam_Catch cc license

Image: Flickr/Sam_Catch cc license

Many people think I am anti-medication.  In some ways, I am—and in many others, absolutely not. It’s a tricky balance – one that takes into account wanting to feel better quickly, but one that also takes into account the risk and cost of medications and even the risk that comes with feeling too good, too fast. Here’s how I see it:

Here’s where I am “against medication”:

A lot of us are unwilling to “do the work” that is required to not need medication: we won’t lose weight to manage diabetes, arthritis, or heart disease because it’s easier to take a pill.  Even though the medications for each of these seemingly benign conditions carry effects no one wants, and some can have fatal consequences, it’s easier to take medications than, say, get up off the couch and walk.  Stop eating processed foods.  Start drinking more water and going to bed earlier.  We’re, ahem, lazy. Yes, that bothers me. And similar is true of medications prescribed to treat people diagnosed with mental illness. It may be much easier to believe the promise of a pill than it is to do the hard work that would allow you (and me…) to act like other people act without medication.

Some of us have such idiosyncratic reactions to medications that our options are much more limited.  We are required, by our hypersensitivities, to do things differently rather than medicating away our troubles.  Our bodies cannot tolerate many medications.  The effects are much worse than the benefits.  For us, many medications—for many things—don’t seem to be an option.  We are required by our bodies to work: to exercise, change foods, walk more.  This bothers me, too, even though being forced into hard work by the inability to take medication is probably healthier in the long run.

Here’s where I am “for” medication:

Am I against feeling better quickly?  Are you kidding me?  Seriously?  The answer is a flat NO.  I am all for feeling better—and quickly—because I know that when I feel better, I act better.  So does everyone else.  I don’t think anyone—anyone—wakes up thinking, “Wow!  I’d really like to try Zyprexa, or Seroquel, or lithium—yeah—and stay on it for twenty or forty years or maybe the rest of my life.”

“Feeling better” and “quickly” are the key phrases.

I believe in neuroplasticity (the brain’s ability to rewire itself to adapt to its surroundings), and I believe in similar behavioral plasticity due to epigenetic changes to DNA and RNA that occur as a result of historic trauma and other environmental influences, something about which we are just now learning.  For example, the Episcopal Church’s 1928 Book of Common Prayer writes about “the sins of the father visited upon the children” and epigenetics may be a mechanism to make it happen – how you were parented, what you experienced, how you took care of or neglected your body, and even how your parents cared for their bodies and brains before you were born all make epigenetic changes to the very makeup of how your DNA is expressed.  (For another example, do your own research and check out the recent discoveries about the impact of trauma showing up in the short tail of the RNA of a man’s sperm.)

However, these epigenetic changes don’t have to be expressed – your experience needn’t define your RNA, which needn’t define who you are.  Just as RNA was changed in our example by a father’s experience, it can be changed by a child’s experience.  The two million connections a child’s brain makes every single day in the first five years of life organize themselves according to the child’s experiences.  Those patterns are flexible—more so in childhood, still at least a bit so ‘till death.  “Feeling better” is a combination of neurochemicals, structural changes in the brain and change in behavior…which, of course, are then turned around and written into the brain.

How do we change these experiences that then become our brain’s new normal, which then in turn influences our future experiences? Well, medication can—and for many—does help, especially when it’s a medication that works without being dulling or causing more toxic side effects.  Creating this careful ecosystem of medication takes wise, careful, judicious work—often not the specialty of crowded, underfunded, overworked prescribers who would like to do more, be better, offer more effective help.

The word “Quickly”, the other key phrase, is just as critical as “feeling better”.  For people who are depressed in a big way, sometimes the trajectory of “feeling better” isn’t fast enough and trapped in this limbo of slow change, they feel well enough only to do what their depression has been begging them to do—namely, commit suicide. On the other hand, if you feel too better too quickly, the “mania” as it’s called can be dangerous.  Medication can help people “feel better” “quickly” and if they can tolerate feeling better, that’s a good thing. But this immediate sea change in function can be hard to handle – even change for the better if it’s too extreme too quickly can be a dangerous magic.

So am I “against medication” or am I “for” medication?  I am for conscious and careful medication that helps more of the people about whom I care live better lives, longer, with fewer effects that cause catastrophic health and life consequences.  I am also for increasing functioning, a combination of learning and if needed a little chemical help. I am against overmedications of chemical soups that people on limited incomes can’t afford to take or not to take – soups that can have unintended and heartbreaking effects if not carefully managed.


– Please join me on Facebook to discuss personal and organizational trauma, healing, ethics, and innovation.

Robin Williams and The Thing That Lurks For Us

By epower

Robin.Williams.picHow can I not jump on the wagon and talk about suicide?  Robin Williams’ death is a shocking loss to all of us, made even more poignant for me because a number of my colleagues met him, knew him, and admired him.  I did too.  I often pointed to him as an example, if such a thing could be named, of “functional multiplicity” especially when I saw him as the Genie in Aladdin.  He could shift among persona faster than anyone I knew and with more pizzazz to boot.

In my travels this week, I saw someone wearing a T-shirt that had “10 Reasons I am an Episcopalian” on the back—attributed to Robin Williams.  Only a few days later, I read of his death by suicide at 63—only two years older than I, and the same age as my sister.  I remember the people whose lives have been too unbearable for them to continue who were my cousins.  I remember my friends who could find no open door, many exceptionally creative, all tormented, all lost.

I remember the times I have considered suicide in my earlier years, and I rankle—no, rage—at Fox News’ reaction all but calling anyone who considers (let alone those who succeed) suicide “cowards.”  If they only knew the heroic efforts it takes for a severely depressed person to continue.  If they only knew.  Just like every comic who overcompensates to try and force love and humor into his or her own life when there is instead an empty cavern, these Fox News anchors seem to rely on their assumed positions for emotional safety.  The message is, “If only you were so fortunate to be like us: conservative, well-grounded in our beliefs and certain of our rightness, you wouldn’t crave the weakness of suicide.”

It is, sadly, a shell of a different color that can easily hide—for a time—the deep cavernous darkness of never feeling the satisfaction of applause for a job done well; the terrifying knowledge of self as unlovable; the internalized belief of being fundamentally flawed and defective; feeling like a thing made only for others’ use.  We are, those of us who know, as busy as three cats: one looking, one digging, and one covering up as we scratch desperately to make meaning in lives that underneath it all feel as if they have no meaning except to feed The Thing That Lurks For Us: emptiness, internal annihilation, self-oppression, depression, alienation from love we can feel unless… unless, perhaps we are dissociated, high, drunk, in the limelight, medicated.  We work incredibly hard, we face unhearable and unbearable stories, we wrestle with every fiber to quell The Thing That Lurks For Us.

Our brains are not on fire—though they may fire frequently, often, and with great light in our professions—they feel like little tiny peas that can’t even rattle because they mean so little.  And so we are angry, or sad, or withdrawn, or covering like those three cats, trying to pass.  It shows in our eyes, though, a deep sadness, a distance that Ajax used to call the “ten thousand mile stare” that afflicts those whose lives have overwhelmed them in some way.  Robin Williams was a great light, a good man, and a beloved fellow Episcopalian.  I beseech All That Is for his peace and ease, and for peace and comfort for his family.  He was, despite the flawed logic of a self-absorbed news channel, a generous, giving, and gracious hero.

Who among us is invulnerable to the despair of years of effort and unrelenting work to overcome our darkness?

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Whether Biology or Trauma, Mental Illness Requires Care not Cure

By epower
Image: Flickr/MariaMorri cc license

Image: Flickr/MariaMorri cc license

In a beautiful article for Nature, David Adams recently wrote, “Psychiatric research has yet to provide a single reliable biomarker to aid diagnosis and treatment. Self-reported symptoms and their subjective interpretations remain the basis for clinical diagnosis. Drug companies have walked away.”

For years I have taught and will continue to teach that the symptoms don’t care about the diagnosis. And working from the other side, people have wrestled with what diagnosis creates what symptoms. It’s a paradox that we are still working to unravel – does the “nature” of biomarkers we haven’t found yet create mental illness, or do experiences create symptoms that in turn lead to a diagnosis? Nature or nurture?

For example, biochemical markers exist for syphilitic lesions (a neurological problem whose symptoms are relegated to “mental illness”), and also for inflammation of the basal ganglia (another neurological problem whose symptoms are relegated to “mental illness”), and for the newly emergent science of the biome (the “second brain” as it is called, that wonderful universe of gut bacteria that can create symptoms related to, you guessed it, “mental illness”).  Oh, and we now know that there is a connection between some parasites and suicidality but, again, guess what–that gets relegated to mental illness as well, not parasitology.

So what the heck is mental illness anyway? Maybe some mishmash of these conditions that affect the brain with experiences that we carry with us and likewise adjust our thoughts and emotions?

More people get treated (often poorly) for “mental illness” than are assessed for these bug-based causes of brain challenges. In part, that’s because the germ-based theories underlying the medical model of mental illness don’t hold up, which is part of what has led to the abandonment by drug-makers.

There’s a challenge here: we want relief, the sooner the better, and the challenge is that if at least part of what we call mental illness is due to some form of overwhelming experience and not to a bad bug, the secret to relief isn’t in a pill but in managing emotions, creating and fostering connections, and feeling worthy of life.

And there’s another challenge in this dichotomy between what happens to us and what’s wrong with us – the symptoms and the diagnosis: the cause of mental illness influences the degree to which society “blames” those with a diagnosis. The parent of a mentally ill child leans hard on the biological explanation that gets him/her off the hook for parenting that could cause symptoms of mental illness, whereas the person with the diagnosis who fears being victimized because of their behaviors/symptoms leans on the diagnosis to engender understanding and compassion.

Cure is unlikely – it takes an act of sorcery to utterly rewire the brain to a totally neurotypical pattern. And frankly, we probably don’t want it.  We don’t want to eradicate the Albert Einsteins, Temple Grandins. John Nashes, Mary Lincolns, Ellyn Saks and many others of us who are bright (if not brilliant) and different to the point of diagnosis.

Care is a better term than cure. It means feeling as well as we can by the best means possible. It means committing to health as much as we commit to treating illness. It means we need to offer one another kind support.

To me, the process of being diagnosed and figuring out how to live well in spite of symptoms that were maddening to others has been such an education.  I came to the realization that – no matter nature or nurture, parasites or experiences – the most important task in front of me was to disregard diagnosis and figure out how to act more like the people whom I thought were “mentally healthy.” It required a lot of learning. And believe you me, I’m still learning every day.


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