Relapse is Part of Recovery, TEDx talk is out!

“Relapses are opportunities for growth, not something to be ashamed.”

“We all need to be supportive of the people who relapse, because we all relapse.”

“STIGMA SMASH!”

Just some quotes from my new TEDx talk, which is about how the lowest points in our lives bring us insight and are NOT something to be ashamed of. I talked about my mental health history but expand challenges to apply to anyone and everyone – we are all in the same boat, which means we ALL need to support each other. Check it out!

Please share, like, comment!

 

Announcement!

Hi everyone! Hope that you are well! I have some great news…I will be giving a TEDx talk in New Jersey on April 7, 2018! My talk is called “Relapse is Part of Recovery.” I’m interviewing 100 people to really flesh out my talk, and here is a summary:

“Relapse is part of recovery” is a term frequently used in the addiction world to encourage people to continue if they lose their sobriety. But relapses (which I define as “rock bottoms”) happen outside of addiction and mental illness: there are relapses in careers, relationships, societies, identities, etc.

When people relapse, they are often faced with shame, disappointment, and see it as a failure. But what I’m finding is that frequently, as a result of a relapse, we gain some sort of insight that changes our lives for the better.

My talk argues that we need to rethink our views of relapse and how we handle relapses. We need to recognize that they are frequently an opportunity for growth. When someone relapses, we need to be supportive, encouraging, and hopeful. And that, my friends, will lead to “A Better Future” (the theme of the TEDx I am part of).

I am documenting my whole journey of building this TEDx talk on instagram: @hufsathegreat. I can’t tell you how many people are coming together to help me with this talk: allowing me to interview them, sending me pictures…I even have local actors who are going to help me film a scene for my talk. Wow!

Stay tuned! I’ll be posting about some of the stories I have been hearing!

Will Framing Mental Illnesses as Brain Disorders Reduce Stigma, or Make Things Worse?

I posted on Facebook about the director of the National Institute of Mental Health, Thomas Insel, pushing towards society referring to mental health disorders (also referred to as behavioral disorders) as “brain disorders” (you can see the video here: http://www.ted.com/talks/thomas_insel_toward_a_new_understanding_of_mental_illness). The question I posed after posting the video was, how do you think referring to mental illnesses as “brain disorders” will impact the stigma towards these conditions?

Thankfully, I found an answer. Patrick Corrigan, the king of stigma research, has already researched this topic and produced a paper, “At Issue: Stop the Stigma: Call Mental Illness a Brain Disease” (http://schizophreniabulletin.oxfordjournals.org/content/30/3/477.full.pdf). In the paper, he writes that explaining that mental illness is biological and genetic does reduce the public’s view that mental health conditions are the fault of the individuals with the condition. However, it has a reverse reaction as well: it causes people to believe that individuals with MI are then different than others, provokes a negative attitude towards these individuals, and reinforces stereotypes like the belief that people with mental illness are dangerous since the illness is “ingrained” in them and they are not able to control it.

Corrigan writes that psychosocial explanations for mental illness have decreased stigma, as it frames mental health conditions as “understandable reactions to life events,” such as child abuse, difficult life transitions, drug use, and trauma. However, we cannot just refer to mental illnesses as psychosocial, because not everyone who experiences a traumatic or life-changing event will develop a mental health condition—which could increase self-stigma, as one who develops mental illness might think they are weaker because they developed the illness when someone in similar circumstances did not.

The last issue is that while people can learn that mental health disorders are biological, genetic, and a reaction to life events, there is a lack of understanding that recovery is possible. To address this, Corrigan has shown that education about recovery, and even more powerful, contact with a person with mental illness, provides a balance to the public’s understanding: mental illness has biological and psychosocial components, recovery is possible, and there are numerous individuals with mental illness living successfully in recovery.

So what is the solution? Do we refer to mental illnesses as brain disorders?

Brain disorders will certainly be on my list of “words that mean mental illness that I can use so I don’t say mental illness 50 times in one post.” However, I don’t think we can switch over the term without teaching the public that recovery is possible and without more individuals in recovery coming out about their mental health challenges.

The debate on what term to use other than mental illness – mental health issue, mental health challenge, mental health disorder, behavioral health disorder, and more – shall continue. There will always be debate (and if anything, I’m happy there’s a variety of terms to choose from in my posts!), but what is most certain is that we need individuals with lived experience with mental health at the forefront of making that decision – and in collaboration with those who do not. 

“Nothing about us without us!”

Why Saying Donald Trump Has Narcissistic Personality Disorder (NPD) is Unnecessary, Unethical, and Harmful to People with Mental Health Conditions

All over the Internet, you see articles along the lines of “Therapists agree that Donald Trump has Narcissistic Personality Disorder (NPD),” or “A Neuroscientist Explains…” or therapists saying they will be using clips of Donald Trump in their classes.

This needs to stop!

First, I need to preface this by saying this is not an argument whether Trump has NPD or not. It is an argument that we should not even be discussing his diagnosis, because:

1. Donald Trump should not be President because of his words, actions, and views. That is absolutely enough reason to be against him. We do not need to diagnose him with something to create a new reason why we should not vote for him. (There is undoubtedly enough solid evidence already!)

(Really, you could stop reading here. That’s my biggest point, and it doesn’t need any further explanation. But if you’re interested, there are a few other reasons.)

2. Associating Donald Trump with NPD means that people with NPD will be associated with Donald Trump. (I certainly wouldn’t wish that upon anyone.) It is increasing the stigma of not just NPD, but also other mental health conditions. And why should one stop at NPD? I fear that this argument would be extended to other mental health conditions and other important positions. For example:
“We can’t elect Senator Patrick Kennedy to be a President because he has bipolar disorder, and his mood swings would destroy our international relations.”

3. Diagnosing someone who is not your patient and sharing their diagnosis without their consent is unethical, as stated in the code of ethics for psychiatrists, psychologists, and therapists. In order to diagnose, you must be trained on and fully knowledgeable of the DSM. Psychiatrists, psychologists, and therapists typically take AT LEAST one full hour to assess a new patient’s mental health history in order to properly diagnose them.

The American Psychiatric Association states “When a personal examination has not been performed and when a psychiatrist is asked for a professional opinion about a person in light of public attention, a general discussion of relevant psychiatric topics — rather than offering opinions about that specific person — is the best means of facilitating public education” (https://www.psychiatry.org/psychiatrists/practice/ethics). The American Association for Marriage and Family Therapists warn against the impact of public statements (https://www.aamft.org/iMIS15/AAMFT/Content/legal_ethics/code_of_ethics.aspx), and the American Psychological Association states “psychologists provide opinions of the psychological characteristics of individuals only after they have conducted an examination of the individuals adequate to support their statements or conclusions” (Section 9.01, http://www.apa.org/ethics/code/index.aspx).

4. This is something often forgotten by nearly all, including numerous clinicians: people diagnosed with personality disorders are, first and foremost, people—people who have treatable illnesses. Not everyone with a PD or mental illness is the same and not everyone with NPD is a “horrible person.”
Burnt out or old school clinicians and medical professionals have told me that people with PDs are “too hard to deal with.” Some have even gone so far to say that they are “untreatable.” But there is hope. I’ve seen people with PDs move on to graduate from the clinics where I worked, gain meaningful roles and activities, and have strong relationships.

5. Yes, I have in fact worked very closely with many people with NPD and other PDs as a case manager at an intensive outpatient mental health clinic and other jobs in mental health. It can be very hard, but they are not evil people. Just because someone has a diagnosis does not mean they are a bad person!

Note: There is typically a distinction between mental illness and personality disorders. However, I’m considering both them under the umbrella of “mental health conditions,” because the general public does not know the difference, as well as similarity of symptoms, comorbidity, and the need to be knowledgeable of both to make a diagnosis.

So please, world, start saying that Donald Trump should not be President because of who and what he is—and then stop before bringing mental health into this. You have more than enough evidence already.

9 Ways to Help Your Loved One See They Have Mental Illness

I’ve spoken to patients, family members, police officers, students, nurses, providers – mostly the former two groups. Of the family members, the most frequently asked questions are:

How do I get my loved one to accept they have a mental illness?
How do I get my loved one to take their medication?

I call them the Golden Questions, because I never know what to say.

Until now.

The two go hand-in-hand, but I’ll answer the first question as best I can, because I have helped people accept they have a mental illness in the program I work for. I’m not going to address the second question separately.

So, this is how I helped individuals with mental illness (we refer to them as “members” in this program) accept that they have a mental health condition – and that IT’S OKAY TO HAVE ONE. In the field, this is called “building insight (into one’s mental illness).”

I must note this is specific to my program – which is voluntary – that rehabilitates individuals with co-occurring mental health and substance abuse disorders coming from jail and prison. I use all of these at once.

1. Housing
In my program, all members MUST be housed, typically in a sober living home or board and care. This is to provide a stability that is required to advance in one’s recovery.

2. Injectable medications
Members are required to take medication if they want to participate in our program. They can decline medication, but then they can no longer be in our program.

Injectable medications are shots that are given typically 1-2 times per month. They take the place of daily pills, which has advantages in several ways. First, it reduces the issue of people forgetting to take their medication (or just plain not taking them). Second, it also reduces the stigma associated with taking medications every day – frequently a reminder of having a mental illness, which numerous people shun.

Third, it provides a more uniform dosage of medication into the body – thus, enhanced stability. (I can explain the difference between injectables and pills in another post.) This is frequently used for individuals experiencing psychosis. The medication will help reduce or eliminate their symptoms, which allows people to focus on other aspects of their recovery. A simplistic (but not unrealistic) example is that the injectable medication may eliminate voices saying, “Don’t take your medication.” Without that distraction, members can start to believe they have a mental illness or start working on things like therapy and coping skills.

3. Education
I lead a Symptom Management group which focuses on teaching members about the various mental illnesses. If I have a member who has poor insight, I add them to this group.

In this group, members are educated on all the symptoms that members of that group experience, e.g. depression, anxiety, hypomania, mania, and psychosis. The power of education is that it shows that mental illness is separate from one’s identity. It is an illness that someone has and can successfully maintain, just like diabetes. It teaches members to identify the symptoms within themselves, empowering them to self-monitor.

The member must be given educational materials as well. You can easily get them from the NAMI (National Alliance on Mental Illness) website or DBSA (Depression and Bipolar Support Alliance). This further emphasizes that mental health is something physical, tangible, and real.

4. Peer Support, Support Groups, and Sharing Experiences
It is crucial for the member to be around other individuals with mental illness, preferably the same or related mental illness. They need to know that they are not alone. I know hundreds of people with mental illness, and one thing I see constantly is that people with mental illness think they are the only ones going through their symptoms…which is certainly not a shock, because our society does not talk about it!

Whether it is in a support group setting, or just among members hanging out, the member needs to hear similar experiences to reduce the stigma they feel because of having mental illness. The mental illness must be normalized.

In my groups, I specifically talk about stigma and self-stigma. Actually calling it out helps members to discuss it, see it within themselves – and learn how to counter it.

5. Therapy
Members must have a professional to help them process how they are feeling about having a mental illness. They need someone to listen to them, to guide them to acceptance.

6. Someone by their Side
This is the role I always take on. I am there to help members vent, to remind them they are not alone, to help them separate their mental illness from their identities, and to share my experiences. Show them that their condition is not who they are. Inspire them.

7. Serious Stigma Smashing
Something that always reaches people are stories of recovery – especially from famous individuals with mental illness. People always flip when I say that Abraham Lincoln had depression (I like to say, “See, Abraham Lincoln freed slaves when he was depressed. You can still accomplish great things with a mental illness!”) and the countless other people who have mental illness.

8. Time
Members need time alone, too, to process what’s happening to them. For many, having and accepting mental illness is a paradigm shift, full of conflicting emotions and confusion. It took me six years to accept that I have a mental health condition – and that it’s okay to have one.

Also, whereas I tend to do all of these things in close proximity to each other time-wise, it may benefit your loved one to take a more step-wise approach to this. That is up to your discretion, though.

9. Hope, Encouragement, and Praise

Hope. I’m not just talking about the loved one having hope – I’m talking about you having hope, too. Both of you need to believe that the future will be better, that what they are going through is temporary, that they have the potential to be someone with a more meaningful life. If you don’t believe that your loved one will get better, how can they?
Encouragement is also important, including praising your loved one for all accomplishments, no matter how little, and especially noting changes and differences. Things like, “You struggled to get out of bed before, but you did it all by yourself today, and that shows you’re getting stronger.” “I’m really proud of you for doing __.” “You’re doing a really good job and I know things are going to get better.” “I know things are rough right now, but they won’t always be this way.” (Etc.)

I know this is a lot. This is the full package that I know has worked for members in my program, specifically, though I believe this can help many others, too. I hope that if you have loved ones who do not understand or deny their mental illness, any of these components will help them find recovery.

Anything I’ve forgot? Leave a comment and let’s talk about it!

An anecdote on Schizophrenia from Ajahn Brahm, a Buddhist monk

I told the above story at a conference on mental health a few years ago. One of the department heads at a prestigious mental health facility was very impressed. He invited me to “bless” his building.

“What form of mental illness are you involved in?” I asked.

“Schizophrenia,” he replied.

“And how do you treat the schizophrenia?” I enquired.

“Just like you explained in your presentation,” he responded. “I don’t treat the schizophrenia. I treat the other parts of the patients.”

I raised my hands up in the Buddhist gesture of respect to him. He had understood.

“What are the results?” I asked, even though I knew what the answer would be.

“Brilliant! Much better than any other treatment,” he answered.

When you call people schizophrenic, they are likely to live up to your label. You have stigmatized them. When you regard them as people who suffer episodes of schizophrenia, that they are more than their illness, then you give the healthy part a chance to grow.

What do I do if I think a friend or family member has mental illness?

I’ve had many people ask me: What should I do if I think my friend or family member has mental illness?

Mental illness is a touchy subject. There is a lot of stigma surrounding mental health conditions, as well as a great deal of misunderstanding. I think we are all afraid of bringing up something, in case we might anger or offend the person. But if you really are concerned, here is my suggestion for how to proceed.

Step 1: Know and Recognize the Signs
Drawing from the American Psychiatric Association, Everyday Health, and Mental Health America, here are common warning signs of mental illness in adults as concisely as I can put it:

•    Thoughts of suicide and death, or attempts (IMMEDIATE RED FLAG)**
•    Delusions or hallucinations
•    Differences in usual behavior or decline in functioning
•    Prolonged sadness, irritability
•    Excessive fears, worries and anxiety
•    Rapid or dramatic shifts in feelings or “mood swings.”
•    Increase in risky behavior, which is unusual for the person, such as spending extravagant amounts of money or becoming hypersexual
•    Substance abuse
•    Dramatic changes in sleeping, eating, and self-maintenance

Additional signs are (quoting the above sources directly):
•    Confused thinking
•    Feelings of extreme highs and lows
•    Social withdrawal
•    Strong feelings of anger
•    Growing inability to cope with daily problems and activities
•    Denial of obvious problems
•    Numerous unexplained physical ailments
•    Recent social withdrawal and loss of interest in others.
•    An unusual drop in functioning, especially at school or work, such as quitting sports, failing in school, or difficulty  performing familiar tasks
•    Problems with concentration, memory, or logical thought and speech that are hard to explain
•    Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations
•    Loss of initiative or desire to participate in any activity; apathy
•    A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality.
•    Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or “magical” thinking typical of childhood in an adult.
•    Fear or suspiciousness of others or a strong nervous feeling.
•    Uncharacteristic, peculiar behavior.
•    Dramatic sleep and appetite changes or deterioration in personal hygiene.

Step 2: Look at the circumstances
•    Does mental illness run in the person’s family?
•    Does/Did this person abuse substances?
•    Did this person undergo any major life changes, such as going to college, starting a new job, experiencing the death of a loved one, or divorce?
•    Did this person undergo any traumatic event recently or in the past?
(Partially drawn from WebMD)

Step 3: Decide whether to bring it up to the person directly, or tell someone close to that person
First, don’t throw in the mental health card right away. I also encourage you to avoid the word “illness” during the conversation because it is so stigmatized. Talk to the person and bring up the signs you’ve noticed gently and gradually. Try to understand why they are behaving, thinking, or feeling the way they are.

Express that you are concerned and you want to help. Listen to them empathetically.

For example:

“Hi Hufsa. Are you alright? … I just wanted to let you know that I’m concerned about you because of a few things I’ve noticed. Is it alright if I point them out to you? … Well, I noticed that you haven’t been going to class lately and just stay in your room. This worries me because you don’t normally do that. I’ve also heard you cry in your room at night. Have you noticed these things?”

Step 4: Address the stigma and bring up the mental health issue
It’s a fact that people don’t understand mental illness and that mental health is as real as physical health. Bring up that you care about the person, and also relate it to a physical illness like the diabetes. Again, I don’t recommend saying the word “illness” because that is charged and stigmatized (at this time).

“Hufsa, I care about you, and I’m only telling you this because I want you to be better. If I noticed that you were eating a lot of sugar, getting dizzy, and having blurry vision, I would let you know that I think you have diabetes and encourage you to seek help. I’m doing the same thing right now by telling you I think you’re not well mentally and physically.”

Step 5: Let the person know they’re not alone and offer your help
It is important that the person knows that they are not alone. I cannot stress this enough. Let them know that there is help available and that you will (or have someone else) go with them to their first appointment. Help them make a call to their local NAMI for information and resources and where to seek help.  Give them information from the NAMI website on mental illness to educate them and normalize what they are going through.

“I know this might be a lot to take in. But I want you to know that you are not alone. I will be there to help you through this process of getting help if that’s what you want to do…here is information I found about mental health and there’s an organization called NAMI that can help you too. I can call them with you…”

Step 6: Follow up and help the person build a support system
Be sure to check in with the person after. Taking in the concept of having a mental health condition can be frightening, confusing, and overwhelming. It is frequently a long process and the person needs people by their side.

Again, these are just suggestions for what to do. I have consulted with several individuals with mental illness about how they would like to be approached by someone else about their illness, and this is what I’ve come up. By all means, if you have something to add, please do so in the comments!

** IF SOMEONE HAS VOICED SUICIDAL THOUGHTS, call 1 (800) 273-8255 with the person, the Suicide Lifeline IMMEDIATELY.**

Michelle Obama’s Speech on Mental Health

“At the root of this dilemma is the way we view mental health in this country. Whether an illness affects your heart, your leg or your brain, it’s still an illness, and there should be no distinction.”

This video was SO SPOT ON. SO, ABSOLUTELY, SPOT ON. I couldn’t say some things better myself. Using the power of parallels to physical health, she has hit the issue of the stigma of mental health on its mark.

Obama is making strides in the realm of mental health. The Affordable Care Act includes mental health treatment in it, and does not allow turning down someone who has a mental illness. I’ll post more about this soon!