En-JOY is an Action Verb: Mental Health Means Enjoying a Life Worth Living

May 12

 

The term mental health has become quite a buzz word (and well it should), but as a concept, it is very broad. What does mental health really mean? At its core, it means not merely the absence of illness; mental health means thriving and enjoying a life worth living.

Mental Health Awareness Month is in full swing, and how wonderful it is.  To have an entire month dedicated to increasing awareness about mental health and wellbeing is in itself something to celebrate. It means that we as humans want to be well, to not only exist but to live and to thrive, and we want to raise awareness so that this wellness can be achieved by all.

Truly, mental health and a life worth living can indeed be achieved by everyone. Happily, these concepts don’t discriminate. Each and every human being on this planet can create his/her own life worth living. Positive psychology is a field dedicated to helping people transcend challenges and problems and make meaning in their own lives.

To transcend problems is not necessarily to completely get rid of them. That’s not always so realistic. We, as human beings, face myriad challenges in our lives, including (and certainly not limited to) various physical and mental illnesses. Do these health challenges mean that a life worth living is out of reach? Is it possible to thrive and have wellness while simultaneously living with a physical or mental illness?

The answer is simple, and admittedly it’s not necessarily easy: a resounding and confident yes. Really? Is it really possible for someone living with depression or anxiety, for example, to thrive? (Yes.) Does he/she need to wait for the depression or anxiety to be gone in order to live a life worth living? (No.)

Here's how enjoy is an action verb and how we can use it to create mental health and a life worth living.Creating a life worth living is a grand adventure, a majestic quest that begins with a mere step and continues one small step at a time. At the heart of it is finding joy, day by day and moment by moment. Mental health means thriving and enjoying a life worth living.

Enjoying a life worth living. En-JOY is an action verb. A question to explore over and over again is how can I create joy in this moment (or this hour or during this event, etc.)? This isn’t a superficial joy or putting on a superficial—and artificial—happy face. This is about paying attention to who you are, where you are, and what you are doing and creating joy in that moment.

As someone who once experienced a significant amount of social anxiety, I used to live in fear of being judged wherever I went. While I was able to make myself go out and about in the world, I did so with anxiety and dread. One time, I vented to a mentor that I didn’t want to attend a certain event because I knew I would do something stupid and make everyone look down on me more than they already did. My mentor merely grunted and said, “What do you care what people think? Does it matter? Just go have fun and enjoy the experience.”

Perhaps you’re thinking what I initially did, that he completely trivialized my anxiety and clearly didn’t understand. Thanks to my superhuman ability to ruminate, I mulled over his comment repeatedly, for days. And nights. And more days. Eventually, his remarks began to blend with what I already knew about positive psychology, counseling, and wellness. It spilled over into other areas of my personal life and experiences as well as into my experiences in working with others. Things began to click.

No matter our challenges, we can all take an active role in owning our own lives. We can create joy, even little joys, in our lives. Feeling that life isn’t worth living? Find things that you are grateful for, that you like and that you enjoy, and focus more on them. Perhaps it’s fresh air but the thought of going out of the house makes you want to hide in bed and never get out. How about opening a window and enjoying the feel of the air? Then later what about opening the door? Then maybe enjoy a step or two outside. Concentrate on how good these things feel rather than how hard they are or what might happen. Little by little, you are en-JOYing your life.

Once I understood that “enjoy” is an action verb and that I could thus act to make joy in my life, to make my life worth living, I found myself transcending my anxiety. I didn’t need it to go away before I could have a life worth living. Waiting doesn’t work. Instead, I took charge of enjoying my life and making it worth living. It was then that I found that true happiness (not a problem-free happiness but a core satisfaction with life and all of its ups and downs and twists and turns) means actively making joy rather than passively waiting for it to appear.

My Life in a Nutshell: A Novel is the story of two people who don’t quite know how to live in the world—the man, Brian, because of debilitating anxiety; the girl, Abigail, because of instability and abuse.  Neither one of them feels they have a life worth living until they slowly begin to create joy. One time, Abigail says enthusiastically, “Come on, Brian. Let’s go play in the rain!” That, right there, is the embodiment of enjoyment. Play in your rain!

 

 

I’m Good because I Own my Mental Illness

May 14

 

I’m proud to join the I’m Good campaign hosted by P.E.E.R.S. (Peers Envisioning and Engaging in Recovery Services). This proactive, pro-mental health organization has created this campaign to raise awareness of mental illness — and mental health — issues during Mental Health Awareness Month. Join in and and share how YOU are good!

I'm Good badge

 

Like many of the millions of people living with mental illness, I haven’t always been good. My most “ungood” period involved five stays in a behavioral health hospital over the course of a couple years. I was admitted for the first time because of a plummeting ability to function in daily life. It was a result of a traumatic brain injury sustained in a car accident, or so I believed. Early on, I was diagnosed with bipolar 1 disorder, generalized anxiety disorder, and social anxiety disorder. But that was wrong, I said. I had a brain injury, not mental illness.

I grew increasingly “ungood” throughout the revolving-door treatment. I was “ungood” when my employer politely let me go when it was discovered that I was hospitalized, not in a regular hospital for brain injury stuff, but in a behavioral health hospital for mental illness. I was “ungood” when friendships ended.

I’m happy to say that I didn’t stay “ungood.” People are resilient, and I began to remember that I was a person, too (I didn’t always believe that), and as such I possessed the strength to bounce back. I started to become good when I started to take charge of my life and gain control.

At first, though, becoming good through taking charge didn’t quite work because I was doing it wrong. I was trying to take charge of my life by ignoring and outright denying that I had bipolar disorder. It. Was. The. Head. Injury. Period. Turns out, it wasn’t. Looking back over my life, it is very obvious that I have lived with bipolar 1 disorder since young adulthood and perhaps even adolescence. It intensified and grew entirely unmanageable and undeniable after the brain injury, but the brain injury was neither the cause nor the explanation. Just the catalyst that led to diagnosis.

Yet for a couple years after the diagnosis, I continued to live in denial. I went off my medication once I felt stable because of course I didn’t need it. I needed it. Symptoms returned with a vengeance. That’s when I finally stopped denying it. And when I stopped denying it, it stopped controlling me, and I finally became good.

In owning the fact that I do, indeed, have a mental illness, I have taken charge of my life. I willingly take medication because it keeps me good. And I stopped beating myself up for losing a job because of psychiatric hospitalization. I realized that I didn’t want that job anyway, and I became free to take control and choose what I wanted to do in life. That was a good feeling.

I gave myself permission to follow my passion. I gave myself permission to use my experience with mental illness to help the world develop empathy for those who live with it. The novels I write feature characters living with mental illness. I hope to show what mental illness is really like. I do what I love to help increase understanding of and empathy for real-life people who live with mental illness. I have taken charge of my life, and I am good.

I am good because I have owned and taken control over bipolar 1 disorder and anxiety disorders. I have incorporated them into my life to help others be good. Hopefully, I can help others say, “I am good,” so I can say, “We are good.”

A Life Worth Living is in Reach of Everyone

May 5

 

Make a Life Worth Living A life worth living. It’s an important concept and is found in various therapeutic approaches to help people achieve well-being. It sounds appealing—a life worth living means that you’ve got really good things in your life that you want to be around for.

It sounds appealing because it is appealing. It feels great to know that your life is a good one and that you have reasons to get up and keep moving. I think that for me the feeling is especially strong because I haven’t always felt that I had such a life.

I’ve always been an optimist, even in my darkest times. That glass? It’s always been half-full, not half-empty because I truly was (and am) someone who focuses on what is there rather than what is lacking. Yet there was a period of time during which I could think positive thoughts, but I just didn’t feel them deep within. It was a time of dealing with a brain injury, a diagnosis of mental illness, hospitalizations in a behavioral health hospital, and stress within my family.

There were times that it was difficult to function, and life seemed pretty miserable—definitely not “a life worth living.” That time most definitely didn’t last forever. I took charge of my well-being, embraced the fact that I did, indeed, want to have mental health (as I discussed in the last post, it is possible to have mental health even though you live with mental illness because they’re not either-or states of being). Since that decision, I’ve actively sought a life worth living.

Mental health and well-being are within everyone’s reach. Mental health isn’t reserved for a select few who have money or health or great jobs or fast cars. It’s for everyone.

Everyone deserves, and can achieve, a life worth living. It’s not always easy, but it’s possible. Having a life worth living doesn’t have prerequisites. You don’t have to have certain things in order to achieve it. It is in reach no matter what you’re dealing with or how bad things are in your life or what mental health struggles you face.

Ways to Make a Life Worth Living

Below is a list of five of my favorite things on the journey to mental health and a life worth living. I have more, but these are some of the most effective things I do on an ongoing basis for my own well-being.

  • Visualize what “a life worth living” looks like to you (and don’t worry about what it “should” look like based on other people’s ideas).
  • Think about what part of that you already have, and focus on those aspects.
  • Decide what changes you want to make, and start making them little by little.
  • While it’s healthy to have a goal you’re working for, don’t forget to notice all of the good things in and around you right now. Let your mind and heart be present in the good parts of the here and now.
  • Keep a gratitude journal (or app on your phone such as Happy Tappers). Writing down 3-5 things every day that you’re grateful for or happy about will help you see that you do have a life worth living.

Part of mental health truly does involve feeling like you love (or at least really like) your life. Not always feeling it is part of being human. Fortunately, part of  being human is the ability to, step by small step, achieve a life worth living and the well-being that accompanies it.

 

Mental Health is not the Opposite of Mental Illness

May 1

mental health awareness month

Every May in the United States, people acknowledge mental health and its importance to a life of wellness. It’s a great thing, because mental health is truly in reach of everyone once people are aware of it and how to enhance it.

MENTAL HEALTH EXISTS INSPITE OF DIFFICULTIES

Mental health is vital and goes hand-in-hand with well-being. Mental Health Awareness Month is a time to focus on our sense of life satisfaction, resilience, inner strength, core happiness, stress relief, and the like. Part of this celebration is that these things are in reach of every single one of us. They don’t exist instead of difficulties; they exist in spite of them.

Very recently, I had a conversation with a group of people at a NAMI (National Alliance on Mental Illness) office. The mood was one of frustration. The frustration at hand was the idea of choice in life. Can people truly choose how their life goes? Certainly, no one chooses mental illness. Did I choose to have bipolar 1 disorder? No, I did not. (I will say, though, that it hasn’t been all bad and has helped make me the person I am today, strengths and faults alike.)

It’s clear that mental illness is not, in fact, a choice. It is something that a person has to live with and contend with. Functioning (not intelligence) is often impaired, all areas of life are interfered with, there’s medication and side effects and therapy and missed work or unemployment and impacted relationships and financial hardships and facing stigma and a sense of shame. No wonder no one would choose this!

EVEN WITH MENTAL ILLNESS, WE HAVE CHOICES

However—and there always seems to be a however—does this mean that having a mental illness means that we have no choices in our lives, no power, no control? That mental illness means someone can’t have mental health?

The answer to that is a resounding NO. It does not mean that at all. We all have choices. Despite the way it sounds, mental illness is not at all the opposite of mental health. Mental health is possible for everyone.

I’ll use myself as an example. I didn’t choose to have bipolar disorder. I certainly didn’t chose to do or to live with some of the things that I did as part of bipolar disorder. (That was another component of the discussion I had. Sometimes mental illness makes people act in ways they wouldn’t if the illness weren’t “acting up.” While true, I would argue that people still do have choices after the fact.) Those things can’t be undone. They’re in the past. They don’t, though, affect my choices going forward. I can choose to do things to enhance my mental health and well-being.

One of the most important components of mental health is the idea that we can make choices in our lives, choices in thought, emotion, and behavior. Even in the face of hardship or despair, we can choose little things to, step by step, increase our well-being.

“Choose your attitude” is a common adage. It exists because it’s possible. We can choose. Everyone has a choice and thus can achieve mental health. I’m not naïve. It’s much more complex than just adopting an attitude. But we can adopt an attitude and we can take steps toward well-being. Mental illness is not at all the opposite of mental health.

Mental Illness and Well-being are not Either-Or Conditions

May 29

According to the World Health Organization, health is not merely the absence of disease.

Similarly, mental health is not just the absence of mental illness. “Mental health” encompasses a great deal of concepts pertaining to the human experience.  The term doesn’t really refer to a single state of being, but rather to a continuum of conditions ranging from mental wellness on one end of the spectrum all the way to mental illness on the other end.

Yes, mental wellness and mental illness are two ends of a spectrum.  Does this mean, though, that well-being is an all-or-nothing idea?  That if someone experiences mental illness to any degree of severity, he or she does not nor cannot experience wellness?  Absolutely not!

Well-being is attainable by all, no matter where we fall on the spectrum of mental wellness and mental illness.

Well-being is not the opposite of “ill-being.”  It’s not the opposite of anything.  Well-being stands alone in that it isn’t the presence or lack of any condition.  Well-being also stands with everything else because it can exist alongside anything.

What, exactly, IS well-being?  Psychologists have been studying the concept for a long time, and they will continue to do so indefinitely.  It’s at the center of a movement known as positive psychology.  It has been the focus of spiritual gurus of various traditions and cultures for millennia.  This is a really good thing for humanity, and I hope the quest continues.  Thankfully, though, we don’t have to wait for the final results to be in in order to fully experience well-being.

Well-being involves little things, so it's never out of anyone's reach.

Well-being involves little things, so it’s never out of anyone’s reach.

Simply, and literally, put, well-being is the state of being well.  That is rather vague, and this vagueness is the beauty of the term.  Following the concept set forth by the World Health Organization, being well is more than the absence of illness.  We can struggle, we can suffer, and we can still experience well-being.  I wrestle with anxiety, and I deal with bipolar I disorder.  These things can be miserable, yet through it all I can honestly claim to experience well-being.

This is possible because we are in charge of our own state of well-being.  There are numerous things that constitute well-being:  gratitude, happiness, outlook, interests, actions, use of our strengths.  This, of course, is but a partial list of attributes that contribute to wellness.  What is fantastic is that these are things that originate from within each of us.  None of these things is dependent upon external circumstances or on having perfect mental health.

Consider happiness as an example.  It is a state of contentment that is within everyone’s reach because it has little to do with external things and everything to do with our inner attitudes and belief systems.  Study after study indicates that external things don’t bring us lasting happiness.  As long as our basic needs are met, an abundance of material things just doesn’t increase lasting inner happiness.  How we think about things is what brings contentment.  Fair enough.

But what about someone who has a mental illness?  Can he or she be happy?  Absolutely yes.  Hey, doesn’t happiness come from within?  And what if someone’s “within” is ill?  How does it work?  It works because wellness is not merely the absence of illness.  We all have the ability to be happy.  We can all choose what we focus on and we can choose what our priorities are.  Attending to our own values and priorities is a big part of feeling happiness and contentment.

I’ll use a personal example to illustrate.  As I mentioned, I have bipolar I disorder.  Simplified (over-simplified, really), this involves states of mania alternating with states of depression.  By its nature, the mania definitely contributes to a feeling of euphoria.  Depression, though, is not famous for its feeling of happiness. One would think that anyone experiencing depression, whether as a part of bipolar disorder or on its own, would not feel happy.  To be sure, as I know firsthand, it’s hard to feel cheery and bubbly during depression.  Often, things feel downright terrible.  Yet, it is entirely possible to find things that make us happy.  Sometimes it absolutely can’t be something huge, a big-picture thing that miraculously cures depression.  It just doesn’t work that way.  However, when I’m depressed, I look for little things each day that either bring happiness or remind me of times that I am happy, and doing this helps.  So, while I experience happiness differently during times of depression, I still can find the ability within myself to bring a degree of contentment.

Further, well-being doesn’t just mean “happiness.”  It involves many different things that contribute to our health and our lives in a positive way.  Well-being is a way of being in life and within ourselves.  It’s for everyone, with or without mental illness.  It’s an inherent power possessed by every human being, and we need to trust our own ability—and the ability of others—to experience wellness in any circumstances.

What does well-being mean to you? What little steps can you take every day to achieve and maintain it?

 

 

Four Ways to Reduce the Stigma Around Mental Illness

May 20
I participated in the Portland NAMI Walk on May 19, 2013. My daughter and I walked with our local team to help raise awareness for mental illness.

I participated in the Portland NAMI Walk on May 19, 2013.

On the third Sunday of May, the third Sunday of National Mental Health Awareness month two very different things occurred that reinforced for me the importance of increasing understanding of what mental illness really is.  Early in the afternoon, my daughter and I participated in the Portland NAMI Walk.  It was a very large crowd that walked the five kilometer route to illustrate how many people are impacted by mental illness.

Late in the day, the season finale of The Simpsons aired on Fox.  It was the only episode of the entire season that I watched, and I’m glad I tuned in to this one because of one single line.  At one point in the episode, a character named Reverend Lovejoy received a text message from his wife.  The text irritated him, and as he dismissed it, he grumbled about her and referred to her as “The Bipolar Express.”

That there are negative judgments surrounding mental illness is well-known.  Earlier this month, I wrote a post equating stigma to bullying.  Stigma is so damaging that there is a growing movement in mental health circles to reduce it, and the reduction of stigma is one of the many focuses of mental health awareness month.

The good news is that it’s possible to reduce the power that stigma holds over us all.  It is indeed helpful that national organizations such as the National Alliance on Mental Illness (NAMI) and Bring Change 2 Mind have huge campaigns to raise awareness in the United States.  It’s beneficial too that many other countries have organizations working toward this common goal.  Groups such as the Canadian Mental Health Association and Time to Change (UK) are making great strides to increase awareness of mental health issues and to end stigma. We do need their efforts.  Their efforts, though, won’t work at all if the individuals in our societies don’t join in.

I don’t believe for a second that most people want stigma to continue.  I do think, though, that confronting stigma and doing things to bring it to an end can be tricky.  Most individuals don’t have the resources to organize large-scale walks or make videos, billboards or thousands of t-shirts.  Thankfully, this isn’t necessary at all.  These things are being done already.  So what can we “little guys” do?  Surprisingly, there’s plenty that you and I can do to help make this a kinder, gentler world.

We can all do things to increase understanding and reduce the stigma surrounding mental illness.

We can all do things to increase understanding and reduce the stigma surrounding mental illness.

1.   Notice things that cause misunderstandings and perpetuate stigma.

  • Watch/read the news and pay attention to how mental illness is discussed and portrayed
  • Watch for stereotypes and negative references on TV and in the movies.

2.   Pay attention to language.  Avoid using words like

  • Psychotic
  • Psycho
  • Schizo
  • Crazy
  • Nut job
  • Insane
  • Looney bin
  • Schizophrenic (often used as a derogatory adjective to describe erratic behavior)
  • Bipolar (again, often used as a derogatory adjective)

This is important in other ways, too.  Think of how often words like “retard,” “retarded,” and “gay” are used in very negative ways.

 

3.   Watch for events, such as NAMI Walks, in your area.

  • Take part if you can.  Or…
  • Talk about the event with people you know.
  • If you know someone who’s participating, support them with encouraging words.

 

 4.  Have conversations!

  • When you notice stereotypes and stigma perpetuated on TV, in the news, etc. talk about it with people you know.
  • Avoid use of derogatory words in your casual, everyday language.
  • When you hear negative stereotypes or language, take the opportunity to nonchalantly begin a discussion about the inaccuracy and impact of such stereotypes.

 

We as individuals are as powerful as large organizations.  Think of the good that will happen if everyone were to do even one or two things to increase understanding and empathy!

When you hear derogatory comments like "The bipolar express," use them as opportunities for discussion.

When you hear derogatory comments like “The bipolar express,” use them as opportunities for discussion.

 

 

 

 

 

 

 

Mental Health Tip: Pay Attention to What You Pay Attention To

May 14

Have you ever been innocently going about your business, doing whatever it is that you’re doing, and happen to glance at one of your fingers only to discover a paper cut or other such invasion of your skin?  You had absolutely no idea it was there, but suddenly there it is.  And now it hurts.  It didn’t hurt before.  You only felt the pain when you noticed the cut.  (I hope this has happened to you.  Well, I don’t hope that you’ve felt this pain, of course.  I just hope that I’m not the only one who experiences this phenomenon.)

The reason for this strange occurrence is simple.  Our minds register what we pay attention to.  Once something is on our mind’s radar, we continue to attend to it.  We think about it.  We can go so far as to ruminate over it.  What we pay attention to shapes our thoughts, and our thoughts affect our emotions.  Both of our thoughts and emotions impact our behavior.  (This principle is part of a number of different therapeutic approaches, including the popular-because-it’s-effective Cognitive-Behavioral Therapy (CBT).

I encountered a fantastic example of this the other morning at breakfast before my kids went off to school.  As usual, my son flipped on the television.  SpongeBob SquarePants was on.  (Nickelodeon.com has information about this show if you don’t know about this cartoon character.)  If you are familiar with the show, you may know that SpongeBob is a blissfully happy, completely optimistic creature.  In this particular episode, he was standing in the kitchen of the Krusty Krab (where he works as a fry cook) when Squidward, SpongeBob’s polar opposite, handed him an order slip.  It read, “2 Krabby Patties  P.S. SpongeBob, you’re an idiot, love Squidward.”

SpongeBob’s reaction was both amusing and entirely inspirational.  He did indeed read the “you’re an idiot” part, but when he had read the whole note, he exclaimed with sheer joy that he loved Squidward, too.  He was ecstatic.  He was jubilant that Squidward signed the note that way because clearly it meant that he liked him.

This is beautiful.  I liked it so much that I wrote it down on an index card and taped it to my desk.  I’m not a pessimist, but I do tend to interpret social cues negatively.  If I had received that note, I would have obsessed for days over the “you’re an idiot” part.  I would be able to compose volumes on why it is absolutely true that I’m an idiot.  I’d feel the need to apologize for all of the idiotic things I’ve ever said and done, and then I would have wanted to hide in shame.

I’m guessing that I’m not alone in this.  What if, rather than focusing on the “you’re an idiot” part we focused instead on the “love Squidward” part?  What if.  Imagine the possibilities.  Instead of that note causing pain, it could cause pleasant thoughts and emotions.

In the paper cut example, we don’t notice the pain until we notice the cut.  Then we have two choices:  to continue to focus on the pain or to go back to what we were doing thus making the sensation of pain retreat again?  In the example of the note, we could see the “idiot” part and feel the pain, or we could see it, acknowledge it (it’s neither realistic nor advisable to completely ignore what’s happening in our world), then let it recede into the background by attending to other things—the “love Squidward” things.  One person says or does something hurtful.  That doesn’t mean that this person always says or does things like this, or that every person says or does hurtful things.

We get paper cuts sometimes.  We get negative messages sometimes.  But they’re only powerful when we give them our full attention.  It’s Mental Health Awareness Month and a perfect time to be aware of what we pay attention to and its effect on our well-being.

“P.S.  SpongeBob, you’re an idiot.  Love, Squidward.”  Love Squidward!!  Oh Squidward, thanks!

spongebob

Better for Mental Health: Cleaning or Kayaking?

May 11
Stop and smell the flowers. Or go inside and wash the floors. Whatever helps your mental health and well-being in the moment.

Stop and smell the flowers. Or go inside and wash the floors. Whatever helps your mental health and well-being in the moment.

It’s an absolutely gorgeous Saturday where I live.  The rhododendrons are in full bloom, and the sun’s rays make the flowers that much more vibrant.  The outdoor world is exploding in shades of magenta, salmon, butter, goldenrod, blush, cherry.  With azure sky as a backdrop, nature looks brilliant today.  The air is fragrant with the smells of freshly-mowed grass and blooming trees and flowers.  With only a slight breeze to stir the scents, all bodies of water are calm.  It is an ideal day for kayaking, one of my favorite activities.  Blissfully, I am not cutting across the water today.  I’m inside.  Cleaning.  (And writing.)

Why?  Because it’s important for people to attend to their well-being.

That probably doesn’t make a whole lot of sense.  As my family and I were planning the day this morning (son:  baseball practice then play practice; dad: assisting at baseball practice and household-supply shopping; daughter:  friends and a dance competition), I stated that I wanted to clean.  My husband sweetly suggested that I take advantage of weather and opportunity to kayak.

Of course I appreciated his thoughtful suggestion, but it instantly created dissonance and anxiety within the dark recesses of my soul and the more illuminated surface of my brain.  Tension took over, and I obsessed over what I “should” do.  I quickly thought of dozens of reasons why I shouldn’t waste the day by cleaning and dozens of reasons why I shouldn’t waste time by kayaking.

I am fully aware of the fact that it is essential for mental well-being to take care of ourselves.  Life is stressful, and it essential to find enjoyable leisure activities to counter that stress.  Finding healthy, pleasurable activities makes the daily grind of life bearable and helps us feel good emotionally and physically.  I’ve studied positive psychology, cognitive behavioral therapy, and many other fields of psychology and counseling.  I’ve helped others find passions and learn how to pursue them.  I’ve also had doctors and therapists help me do this during those times when I’m not in a place to apply what I know.  So I get it.  We do need to do things to decompress and maintain emotional well-being.

So this very principle was one of the many things (as in racing thoughts) that went through my head as I was anxiously debating what to do.  After near-paralysis, I had an epiphany:

There is no “right” or “wrong” way to attend to emotional well-being (as long as the activity isn’t harmful to you or others).  Leisure activities such as kayaking are a fantastic idea and are very good to do.  But they don’t have to be done just for the sake of doing them.  If you do something just because you “should” (living by “shoulds” can be very problematic, by the way), it tends to defeat the purpose of why you’re doing it in the first place.

Yes, I love to kayak.  Normally it is very relaxing.  Today, though, I want to scrub the floors.  I’m starting to see increasing evidence of poorly-wiped up spills and spots of dirt that has been tracked in from outside.  It doesn’t feel like a chore today, either.  It’s something I want to do because it will feel highly satisfying.  And I love listening to music.  I can listen to peppy music to make the process energetic and fun, and I can make the floors shine.  When I’m done, the inside of the house will look as bright as the outside with its rhododendrons.  It will smell just as crisp and fragrant as the outside, too.  When the house is clean and clutter-free, I feel relaxed and good.  And isn’t that what mental health and well-being are all about?

What, specifically, you choose to do to attend to your emotional well-being isn’t what’s important.  The key is simply to do something that makes you feel relaxed and well.  Other than safety, there are no rules.  No shoulds.  There will be many other gorgeous days, and I’m really looking forward to kayaking during some of them.  Today, though, the thought of that creates tension and anxiety.  I’m going to go clean.  It will make me feel satisfied and relaxed.  May you find something that helps your well-being, too.

 

Stigma is Bullying

May 10

There’s a scene in the novel Leave of Absence in which Penelope and Oliver, patients in a behavioral health hospital, are waiting for a group session to start.  Because of her schizophrenia, Penelope feels as though she doesn’t even fit in in a behavioral health center:

“When they entered the room, some participants stared and others blatantly averted their gaze.  As usual, Oliver and Penelope sat in the back of the room.  Other people came in, but not a single person sat next to them, and the chairs on either side of them remained empty.  Penelope leaned toward Oliver and whispered, “I wonder if people just hate me or if they’re afraid they might catch what I have.  It’s been like this for almost two years.  Do you see why I can’t do this to William?  I don’t want him to be shunned by the world because of me.  It feels really awful, and I can’t do that to him.”  She looked down at her hands and picked at her nails.”

This shunning that devastates her is known as stigma.  Stigma’s impact is hurtful; in a poll, a high percentage of people indicated that they would rather not associate in various ways with someone who has a mental illness.  The numbers are shocking.  What, though, do they actually mean for someone experiencing mental illness?

It’s very easy to hear the word stigma and understand that it implies negative judgment against a group of people (in this particular case, it’s against people with mental illness).  But it’s not always easy to verbalize the implications of stigma.  What happens to someone who faces stigma?

With stigma, someone is judged negatively.  No one ever likes to be judged negatively, of course.  Who among us hopes for a really harsh performance evaluation at work?  Stigma, though goes deeper than this.  A bad review at work is based on things someone does.  Stigma is based on a personal trait.  Stigma, then, is based on who someone is.

Stigma is judging someone for who they are, and it leads to shame.

Stigma is judging someone for who they are, and it leads to shame.

This type of judgement actually perpetuates the stigma and stereotypes against people experiencing mental illness.  This type of judgment is a form of prejudice (of pre-judging).  It’s looking at only one aspect of a person rather than at the whole picture.  It’s seeing mental illness rather than the whole person who’s experiencing it. This is what a person facing stigma “hears” (if not through direct words, through actions like when no one would sit by Penelope in the above scene):  You are different. You are strange. You aren’t good enough to hire. You aren’t good enough to hang out with.  You are worthless.  You. Are. Mental Illness.

You are mental illness. See how this idea intensifies stigma and prejudice?  You are “schizophrenic.”  “You are bipolar.”  You. Are. Crazy.

You are the flu?  No.  You have the flu.  You are asthma?  No.  You have asthma.  You are depression?  No.  You have depression.  (Or even better, you are experiencing depression.  Wording it this way further removes it from one’s identity and reinforces that any mental illness is, like asthma, something a person has to deal with rather than who someone is.)

When someone is criticized for something he/she did, he/she might feel embarrassed.  When someone is criticized for who he/she is, he/she feels shame.  Shame is a feeling of worthlessness. Shame is painful.  Stigma leads to shame and can create isolation, loneliness, and self-loathing.

bullying

Think back, for a moment, to middle school (or, depending on your age, to junior high; for me it was junior high).  For most of us, being different meant the risk of ostracism, and committing a social faux pas (which involved even the slightest deviation from “normal” behavior) resulted in at best a bit of ridicule and a worst downright bullying.  It’s an awful experience.  I have never heard anyone say that if, given a chance, they’d go back and do middle school all over again.  Most people I’ve talked to (yes, I have conversations like this) say emphatically that noting would be worth experiencing the nightmare of middle school ever again.  The reason for this is not because of the rigorous academic coursework.  It’s not because of the cafeteria food (although I’m sure that the lunches aren’t really missed).  It’s because of the judgment of the other students.  Middle school is a time when kids feel scrutinized constantly for every little thing and bullied for any deviation from the norm.

Luckily, many people no longer experience the stress and fear of harassment that happens in middle school.  Those human beings, though, who experience mental illness and face the stigma associated with it, perpetually live in middle school.

 

 

Schizophrenia’s Negative Symptoms Don’t Mean Bad

May 8
Schizophrenia can involve positive, negative, and cognitive symptoms.

Schizophrenia can involve positive, negative, and cognitive symptoms.

Schizophrenia is a mental illness with both positive and negative symptoms. The terms can be misleading. They sound like judgments, but they’re not. Positive symptoms are things added to the person (such as hallucinations, delusions, and disorganization), negative symptoms are things taken away from the person, and cognitive symptoms are problems in thought processing. Schizophrenia isn’t crazy or violent.  Schizophrenia is very individualized and the symptoms show up differently for different people; further, schizophrenia ranges in severity from mild to severe.

The negative symptoms of schizophrenia aren’t bad. Again, they are things that are removed from the person. Negative symptoms can be categorized with “A” words:  affective flattening, alogia, avolition, and possibly anhedonia.

One of the most noticeable, especially when someone has known a person for quite a while before his/her diagnosis, is a restricted range of emotional reactions.  This is also known as having a flat affect or affective flattening.  Someone with schizophrenia often displays a diminished range of emotion.  Many times his/her face is nearly expressionless.  Someone might not always maintain eye contact.

Something that’s important to realize is that this flat affect is how someone with schizophrenia might appear; however, this is not indicative of how they feel.  People I know or have worked with who deal with schizophrenia very much experience a range of human emotions.  A young man I knew had desires and hopes and dreams.  He sometimes became frustrated when he couldn’t express himself and felt that he was misunderstood.  (Who doesn’t become frustrated upon feeling unheard?)  Many times he was sad because of what he was experiencing.  He also had a sense of humor.  None of this was apparent by looking at him, but it became very obvious when interacting with him as the true, authentic person he is.

The second “A” word is alogia.  Alogia a reduced productivity of thought and/or speech, which means that someone might speak slowly or haltingly or might take longer than others to formulate a response during a conversation.

The third “A” word that can be among the negative symptomology is avolition.  This involves a reduction in goal-directed behavior.  It might be challenging for a person to start a task or participate in a task.  This can affect someone’s work or social life.  In extreme cases it can make it difficult for someone to do the tasks necessary for their own daily care.

The last of the “A” words above is anhedonia.  This is a lack of pleasure.  Sometimes someone with schizophrenia might have a hard time taking pleasure in something.  This one, though, is a tricky one to pinpoint.  A person experiencing anhedonia, whether or not they have schizophrenia, might actually be dealing with depression.  Or it could possibly be a side effect of medication rather than a feature of schizophrenia itself.  Another caveat when considering anhedonia is that schizophrenia can involve a flat affect which can make it falsely appear that someone doesn’t feel the full range of emotions.  It’s good to be aware that anhedonia can be a possibility with schizophrenia, but it’s important to avoid giving this too much power.

Schizophrenia also has cognitive effects. These aren’t part of the criteria used for diagnosis as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the tome published by the American Psychiatric Association and used heavily by mental health professional. Cognitive symptoms, though, are present with schizophrenia.

Someone with schizophrenia can sometimes have issues with memory/working memory, attention, problem-solving, or processing speed.  This does not mean that someone with schizophrenia can’t think and reason and learn!  This does not equate with lower intelligence.  It can be conceptualized as difficulty with the way a person thinks and processes information rather than as an inability to think and process information.

In the novel Leave of Absence, Penelope, who has been diagnosed with schizophrenia, has a flat affect.  The content of what she expresses, though, belies this outward appearance.  It is clear to her friend Oliver and her fiancée William that she very much experiences the gamut of emotions.  Also, she experiences alogia. Until her medication begins to work, her speech is deliberate and halting.  She wrestles with anhedonia, but this is part of her depression.  As is the case with everyone with schizophrenia, Penelope doesn’t experience every single negative symptom.

This concept is important.  The positive symptoms are delineated in a group of four (hallucinations, delusions, disorganized speech, and disorganized/catatonic behavior), and the negative symptoms are lumped together as a single concept (descriptively called “negative symptoms”).  To be diagnosed with schizophrenia, one must experience at least two from this list of five items.

The positive and negative symptoms of schizophrenia can be classified as psychotic symptoms. "Psychotic" just means things that are related to impaired or distorted reality. It doesn't actually mean "unstable" even though it's used that way sometimes in slang terms.

The positive and negative symptoms of schizophrenia can be classified as psychotic symptoms. “Psychotic” just means things that are related to impaired or distorted reality. It doesn’t actually mean “unstable” even though it’s used that way sometimes in slang terms.

There are a lot of ways to experience schizophrenia, and the symptoms differ. Each individual who has schizophrenia is unique.  Each human being on the planet is unique, after all, so why would it be any different for those human beings who happen to deal with schizophrenia?