On Death Upon Death

By epower • 1 min read

cemeteryDo you know a lot of people? If you do, as I do, there will come some painful time of multiple deaths.

I went through this the first time in 1989, when 13 people died in one year, three in three days at one point. Martin, in a car wreck; Ed, from AIDS, and George committed suicide, unable to regain enough of his abilities after a stroke for his life to make sense. Then it was my mother, a cousin or two, several people in the plant where I was working, and I don’t even remember who else.

Humpty Dumpty tumbled off the wall. Grief upon grief, and all capacities overwhelmed. All the internal stitching together? Undone.  The model then was a “what’s wrong” model, a diagnosis (dissociation), and long hard work gluing the egg together.

I’ve learned a lot in the intervening years, and become more convinced than ever that caring for one’s self when the stuff hits the fan (and when it doesn’t!) is critical.

So, since the 7th of March, it’s been death upon death again. My cousin Steve, of a stroke after bypass surgery. The same day he was buried, my 101 year old Great Aunt Ruth, one of my early childhood heroes. A friend from my childhood church, Ed. A friend from CA reached out to let me know her husband of 30 years dropped dead at a business meeting in Utah. Saturday morning, the call came that my Uncle John had died. While I was receiving that call, another one came in that my friend Linda’s husband had died. And, another friend in my age bracket, Vickie, on Sunday.

Being trauma-responsive–recognizing the impact of multiple difficult, and at least momentarily overwhelming, experiences–means checking on Humpty Dumpty’s mended seams.

My question has long been”What would 99% of the people who are not hospitalized for a mental illness be doing in this situation?” Now I’ve changed it: “What would 99% of the people who I consider mentally and emotionally healthy being doing in this situation?”

Resting. Eating well. Walking lots. Being quiet. Avoiding any more distress. Remembering the good things about each of these. Weeping a little (OK, sometimes a lot for a little while). Tucking in with comfy pillows, a cool dark room, and early bedtimes. Shutting out negativity, conflict. Steadiness. Sturdiness.

What would you all do? How would you handle this much loss in such a short time?

“Trauma-responsive” means “Inclusive”

By epower • Less than a min read

Starry.NightToday I had another saddening conversation with someone who was convinced that “only abuse, neglect, and  maltreatment” are trauma–nothing else. I am saddened because that leaves so many of us out. And I  know my stuff was showing (for those who remember, it’s kind of like “having your slip show”) when I spoke with a woman in Georgia whose organization worked with combat vets who had PTSD and TBI.

What makes us so protective in this way? What prevents us from recognizing it’s not the name of the event,
it’s the impact that makes it traumatic? Part of me wanted to shriek that I was diagnosed with PTSD before
those folks were even thought of.  Then I was embarrassed for thinking that.

When did I sign up for the Olympiad in trauma?  I didn’t realize there was a competition for who had the worst or the most or the awfulest.

Trauma-responsivity means including–and I am talking to the mirror, too–those who seem to collect stars for each traumatic event, as if a gold cup were awarded to the one who suffered the most, who was wronged the worst.

It also means letting go of the need to compete for the titles you never  wanted to have.

Help me–What am I missing? Am I just out of touch here?


6 Ways to Support Someone With a Mental Illness Diagnosis

By epower • Less than a min read

Here’s how:

  1. Focus on their health.
  2. Realize that they have the same needs you do.
  3. Recognize the system may have trained them to act weird because it reinforces that they’re crazy or dangerous, which may be the only identity they know.
  4. Listen without being a fire hydrant.  Be clear about what you can/will tolerate.  Set limits on what you’ll take in and where they need to discuss/take the rest.
  5. Get over the idiotic ideas about what it means to be or have X, Y, Z.
  6. Recognize how much what you believe is influenced by people (like the mental health industry, like radicals like me) with vested interests in your beliefs.

And you want to know how to support someone who may benefit from, but hasn’t yet received mental health care? You guessed it: it’s those same six things. Wash, rinse, repeat.

To discuss mental illness and trauma informed care, please visit me on Facebook.

What I Wish I Knew Before I Was Diagnosed With Mental Illness

By epower • 3 min read

DissociateWell, we sent yesterday’s version of this post out with a much more gruesome photo than necessary – and missing a few edits that make it a little clearer. My editorial assistant and I sometimes have differences of opinion about what I want as visual portrayals (I don’t care for things that disturb me to the point of turning away even it might make for more readers!).  Believe me, he’s a good egg.  So the image with this repost is perhaps not so graphic?  And with a little more meat on its’ bones. Without further ado:

Continue reading… »

How To Make SAMSHA’s “Health Homes” Work for the Homeowners

By epower • 2 min read

Just the heart/doctorSAMHSA defines health homes as “a team-based clinical approach that includes the consumer, his or her providers, and family members, when appropriate.” Done right, they could provide a needed “home base” for people with chronic health conditions or impairing mental health conditions to coordinate care. This includes organizing multiple services from multiple providers. But as with any new major system, there are challenges.

Continue reading… »

Why We Control “Touched” People Instead of Asking “What’s Wrong?”

By epower • 3 min read

“One gent used to get a little tooted up on likker, steal a dumpy old private plane and bomb his ex-wife’s place with five pound bags of flour.”

When I grew up in Southern Appalachia, it seemed like everyone had a family member or knew someone who was a little strange — “quare” or “teched,” we said in deep accents.  So long as they didn’t behave in ways that were dangerous, these “teched” people were tolerated.  You could be a little (or maybe a lot) different, and as long as you knew your place, played nice, and didn’t cause too much trouble or embarrass people too badly, you could make do. It’s been said that if you put a fence around the South, you’d have an asylum. But in the days when there was more space between people and places, there was also more tolerance for the “local eccentrics” – they were just neighbors and family members.

Continue reading… »

The Effect of Stigma Against People Diagnosed with Mental Illness

By epower • 2 min read
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 • 1 min read

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 • 3 min read
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 • 4 min read

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


Subscribe to this Blog:

Or Get a Single, Daily Email (enter email address):

via FeedBurner

Recent Comments
  • epower: Thanks, Leckey–it’s easy for me to think I’m in a bubble (and that could still be true!).
  • Leckey: No, you aren’t out of touch. The person who thought they knew something, did not. Having researched...
  • epower: I am sorry society imposes this perspective about who men are “supposed” to be. I think fewer and...
  • Marc W: I think it was John Watkins who proposed the BASK theory.
  • Mark: I have a little OCD and depression/anxiety issues. People don’t think I am crazy, they think I am a...
Find a Therapist
Enter ZIP or postal code

Users Online: 12240
Join Us Now!