mental illness – Inspiring Change LLC

When Severe Mental Illness Strikes a Loved One

Book Review: “I Am Not Sick, I Don’t Need Help” by Xavier Amador, PhD. (Vida Press, 2012)

For the last 20 or so years, brain research has helped doctors and therapists understand that the serious mental illnesses of schizophrenia and bipolar disorder are diseases of brain function. During the century before the “Decade of the Brain (the 1990’s)”, these rare and frightening mental diseases were blamed on bad or inadequate mothering (the “schizophrenogenic mother”), thanks to the early theories of Freud and subsequent generations of psychology, puzzling over the cause and treatments of such life-altering and permanent mental illnesses.

In his wonderfully personal and helpful book “I Am Not Sick,” Dr. Amador explains that the primary feature of these severe mental illnesses is the core belief that the sufferer is “not sick.” In medical terms, this disbelief in their illness is called “anosognosia” (ã-nõ’sog-nõ’sê-ã). Sufferers may be homeless, talking to voices in their head, unable to sleep or put together a clear sentence, believing that aliens have made inroads to their cells, but to these ill brains, the beliefs and thoughts are as real as sunlight and gravity.

If you have ever been in a relationship with a loved one who has become mentally ill and whose illness has this feature of anosognosia, you know that trying to convince them to get to the hospital for treatment or to take their medication is a futile, frustrating, and relationship damaging exercise. But this is how almost everyone attempts to get their loved one’s the help they need to be safe and recover.

In his best-selling book, Amador explains the model of engagement that he has developed over 30 years of living with his older brother, who was a schizophrenic, and working as a professional forensic psychologist and therapist. He walks the reader through this counter-intuitive but effective model that listens, understands and collaborates with the sufferer, who, in the end, must participate in their care in order to get better.

He calls this program “LEAP,” which stands for Listen, Empathize, Agree and Partner. Utilizing the tools familiar to therapists of Client-Centered/Active Listening, Cognitive-Behavioral, and Motivational Interviewing models, Dr. Amador provides tools, examples, and scripts as examples of learning to use this strategy with loved ones who need help.

I read this book as a way to help one of my clients, whose loved one is beginning to demonstrate marked personality changes, delusions and strange behaviors. As we talked about how to be helpful short of calling 911, this book has become a welcome addition to my library and therapeutic models. If you have someone in your life you are seriously worried about and wonder how to help. I urge you to get this book or log onto his website, LeapInstitute.org.

13 Reasons Why NOT

13 Reasons Why is a video series available on Netflix. If you’ve been told you NEED to watch this drama in order to understand teens now, I want to argue the opposite. I don’t believe that watching this series is necessary in order to understand teen cultures. Many viewers make this series sound as if it is presented as a documentary; it is not. It is a sensationalized, emotionally wrought fictional presentation of hours and hours of teen suffering and feels voyeuristic in its brutal and graphic portrayal of suicide. I managed to watch about 15 seconds of that scene and was so repulsed I turned it off.

Fictional, video streaming accounts of high school are not the way that our youth their own experience their lives. Parts of it, yes. Intense, highly edited with a powerful sound track? No. What this series does, I’m afraid, is double down on the visual trauma our youth are exposed to regularly. And we wonder why they are anxious, depressed, afraid and suicidal in greater and greater numbers?

If parents or counselors are curious, then watch a half hour or so. You won’t need any more exposure than that. I suggest it is completely unsuited for anyone, never mind teens. Watchers of any age are participating in reinforcing trauma. As a pastoral counselor and family therapist, I see the effects of too much trauma exposure daily. It’s very difficult to heal.

Healing Traumatic Memory

If only life was one long, beautiful, inspirational journey. But it’s not. Some of us know that life can include experiences of such fear, helplessness and pain that we wonder how we survived. Over time, and with support, most of us get back to what we would call our normal. Yet others of us discover no matter what, we just can’t.

We call these experiences psychological trauma, the kind of experiences that steal our mental equilibrium. Many traumas have their origin in childhood; our bodies and minds are dependent, small, developing and vulnerable. The younger we are when they occur, the more impact they may have on the way we learn to relate, think, feel and trust the world around us.

Traumatic memories happen within the brain when we survive a life-threatening event and experience overwhelming shock, loss, fear, horror and helplessness. The words we have for what we experienced are just not enough to explain it to others. Motor vehicle accidents, physical, sexual and emotional abuse, parental neglect and addiction, domestic violence, plane crashes, witnessing homicide, military combat, escaping house fires: these are among the experiences that can overwhelm our emotions and capacity to bear what we have seen and known. The memory of the experience is stored in a kind of jumble in the brain, never blending into what we would call our normal sense of self, our everyday explicit memory.

Neurologists, psychologists and other researchers have made wonderful strides in the last 30 years in understanding how trauma effects the brain. And as the science of trauma becomes clearer, so has the clinical work of seeking effective treatments: treatments for the post-trauma effects that are expressed in our bodies in the form of chronic pain, sudden panic attacks, visual and auditory flashbacks, depression, anxiety, relationship and work problems, addictions and patterns of emotional dissociation.

First generation psychological care for traumatic memory was talk therapy; some relief was attained by patients helped to fully describe their experience in a private, compassionate therapeutic environment. Second generation care added strong prescription medications to calm the nervous system, limit emotional affectivity or target psychotic symptoms. What the most recent research has shown is that both methods are insufficient; talking uses the cognitive portions of the brain without adequately engaging the emotional and survival systems, systems that were in charge during a trauma, and dulling trauma memories or disengaging them temporarily with psychotropic drugs won’t heal the damaged and chronically misfiring memory patterns.

What does work is helping the sufferer to carefully, artfully, and in a controlled and focused way to re-experience the memories, feel the experience again in the body while expressing the energy, body movements, sounds, sights and postures that were suppressed at the moments of helplessness, dissociation and physical restriction. To think the thoughts that seem too terrible to think, and to help the mind link up the original memory to the fuller, day to day explicit or narrative memory that we live and work in every day.

This is what the work of Francine Shapiro’s EMDR (Eye Movement Desensitization and Reprocessing), Peter Levine’s Somatic Experiencing (SE), Albert Pesso’s Psychomotor Therapy and Pat Ogden’s Sensorimotor Approach all seek in their similar models: to have the sufferer become integrated with their physical bodies, those same bodies that have experienced the trauma, to feel, tolerate, express, observe and rewrite their story in the present sense of the self.

All this is to say: there has never been a time in human history where more can be done to help the trauma sufferer than now. If you are besieged by physical and mental echoes of a terrible event in your past, please seek out care from a psychotherapist trained in the newer trauma resolution techniques. Many of us have found peace where there was no peace, and wish the same health and healing for you.

Mass Murder & Mental Illness

As the roar of reaction begins to quiet following the horror in Newtown, many media comments I have read express a demand for better “access to mental health services.”

I’m not sure what that means in this case.

The biggest gap in mental health care in our country, as I have come to know it, is in in-patient hospital care. After Congress passed laws in the 1980’s that down-sized state hospitals, hundreds of people were released from care. States and communities were expected to provide needed services, but in many places, such care never materialized. The numbers of homeless, mentally ill and/or addicted persons swelled, and state and federal dollars for the seriously and/or persistently mentally ill dwindled and has stayed low.

We have now have a chronic shortage of psychiatric hospital beds, and an even more critical shortage of child and adolescent psychiatrists. The cost of in-patient care is close to $1000 a day in some cities like Minneapolis. We have a shortage of psychiatrists because our medical system is controlled by the third party payer system of insurance companies, and they don’t pay psychiatrists commensurate to their 10 year + post-college medical training. Fewer medical students want a job with longer training and lower pay.

If the shooter in Connecticut wanted mental health care, there are plenty of master and doctorate level out-patient counselor/therapists in Fairfield County. Family physicians are often the first level of care for mental health, and would have been able to offer referrals for counselors and medication if needed. If anyone feared for his life or someone else, state laws around the country commonly allow for persons to be held in a locked hospital ward for up to 72 hours for evaluation.

But that is all for those whose mental health is clearly disturbed and dangerous. We’d like to believe that we can see the most dangerous among us coming from a mile away. The plain truth is that we often can’t.

Contemporary research into the minds of mass killers in America has shown that the majority are men who have had difficult lives and blame their pain on everyone else. They don’t have a sense of their own responsibility for their lives, and when pressed even harder by some large stressor like the loss of a job or an important relationship, plan a sweet revenge upon their oppressors. These are usually men with personality disorders, people whose characters have little concern for the well-being of others. These folks make up about 10% of the population and don’t seek mental health care. Or when they do, can fake their way through and get released without any improvement.

Stalin. Hitler. Mussolini. Pol Pot. Idi Amin. These men are mass murderers too. Do you think more mental health care would have solved the problem of human evil in them? No. We will always need to build a world that takes human sin seriously. That does what it can to control for access to weapons that kill quickly. That knows that evil doesn’t come at us through normal channels. That remembers that evil seeks power, and that power can overtake governments, too.

We weep with those whose lives have been shattered by evil in the form of a silent 20 year old killer. For their young lives lost. But also for all who, throughout human history, have died at the hands of evil persons. Evil does exist, and it exists not outside of us, in some kind of satanic underworld of the devil. Every evil I know of is born of a bent human mind, and the continuous will to wreck vengeance, power and control of others.

We can’t medicate, hospitalize, or counsel our way around human evil. Looking for relief from the mental health system is looking in the wrong direction.

Major Mental Illness (MMI) and the Family

For all the research that has been done in the last twenty years attempting to understand the brain, the organ at the top of our spine retains its essential mystery. We know more now than ever how the brain works, how it has developed over the centuries to do the miraculous things it does, and what is happening to it when it gets injured. Doctors, parents, coaches and professional athletes are more alert to the dangers of brain concussion. Neurologists study to become adept at repairing the brain with surgery, cellular transplant, or electrical stimulus. Every one of us has a stake in the health of our minds.

But no one has now, or may ever, understand what to do when a brain loses its essential emotion balance. Major mental illnesses (MMI) like bipolar disorder, major depression, schizophrenia, schizoaffective disorders, and severe personality disorders are currently treated with hospitalization, a variety of medicines, and several kinds of therapies including group, art, music, physical, occupational and individual, couple and family therapy. All of this effort does help a person suffering acute episodes create some safety from self-harm and violence to others. But we currently have no cure for the worse of brain diseases and dysfunction. Those afflicted with the most severe mental illness bear this burden without much hope of recovering their former, pre-illness selves. It’s a terrible, life-changing diagnosis.

Many of those who suffer also try to help themselves with illegal drugs and alcohol. It’s estimated that nearly half of those with MMI also may be drug addicted. It’s quite easy to see that a chronic emotional disorder, topped with occasional medications from a hospital stay, plus a chemical dependency, legal or otherwise, is a simple recipe for chaos. And that’s exactly what can happen. These are the majority of those we call the Homeless: adults whose illness and addiction make any kind of stable life impossible. Whose schools, work places, doctors, community programs, churches, friends and family in an uncoordinated effort tried to help but ran out of options, money, beds, time or energy.

If you have a family member with chronic mental illness, it certainly has affected your life as well. If you are like most of us human beings, the early months or years were a mix of denial, sorrow, anger, and accommodation as you tried to learn how to manage life with someone who couldn’t stay in the lanes of the average emotional highway. You may have had more than your share of blinding rage at promises broken and soaring optimism as your parent or sibling found a new doctor, a new medicine, a new religion, a new apartment. And then the up and down cycles of recovery and illness, of stabilization and hospitalization, continued. It feels insane. And in fact, it is. It’s easy to see how many people give up on the most mentally sick.

In the grand scheme of life, it’s to your emotional and spiritual benefit not to lose touch with your family member who struggles to stay mentally balanced. You may be their only connection to a person who remembers them when they were well, who has the same family features, who reminds them of their place in the human family. You may be the only person they know with a shared childhood memory. As exhausting as it can be to stay in their lives, I urge you to try.

To keep your own life in balance, to have good relationships, keep your job, and sleep well at night, you will need a simple but unyielding strategy when it comes to dealing with your loved one. Here’re my suggestions:

1. Education: Get informed about your loved one’s diagnosis. Have a basic understanding of the medications they are on. Attend family meetings held by hospital or other care providers. Learn about the long-term physical and mental outlook of the disorder. Speak to an attorney if financial support, inheritance, property, arrest or civil commitment issues arise.

2. Support: Seek out the understanding, company and expertise of others who struggle with mental illness in the family. Support groups such as NAMI (National Alliance on Mental Illness) and those run by your county or local hospitals or churches are excellent places to find on-going information, support and referrals to local mental health resources. It’s here where you can grieve the person your loved one may never become, and figure out to live with the person as they are.

3. Clear personal boundaries: You will need to figure out how to care about your family member while leading your own life. Your job, your marriage and your children will all suffer if you can’t say no to requests you can’t fill, to demands on your time that can’t be met, to assumptions about money you can’t meet. You may need professional help (i.e., a good therapist) to help you manage, grieve, and maintain your limits, especially if you are connected to your family member in any helpful way.

MMI is a devastating brain dysfunction that can destroy every good relationship in its wake. One day, we may have more than a bucket load of powerful drugs to help manage and even heal diseases like schizophrenia. But until then, if you have MMI in your family, do everything you can to manage its effects and continue to lead the life you want. You’ll need help to do it; it’s a long journey.

Violence and Mental Illness, Again

Yes, most mentally ill people are not violent. Thanks to the USPRA for such a wonderful professional reflection on the violent attack in Arizona.

USPRA Issues Statement on Tucson Shooting January 13, 2011

The US Psychiatric Rehabilitation Association released the following statement in reaction to Saturday’s Tucson shooting in Arizona:

In wake of Tucson’s tragic shooting that shook America over the past weekend, we wish Congresswoman Giffords and the 13 other wounded individuals a speedy recovery, and our thoughts and prayers go out to all of those whose lives were impacted by this act of horrific violence.

With such senseless acts, we often search for someone or something to blame. The assassination attempt on Congresswoman Giffords has generated considerable speculation around the mental condition of the suspected shooter, which has heightened the stigma associated with mental illness. We must remember that there is a weak link between mental illness and violence. According to SAHMSA, nearly five percent of the US population suffers from a mental illness resulting in serious functional impairment, but only a very small group of individuals with mental health issues shows any violent behavior. Most people with mental illnesses are not violent, and most people who are violent are not mentally ill.

While we have no way of knowing whether or not our nation’s mental health system failed this individual, the Tucson tragedy should spotlight mental health policy & the provision of mental health services as a national priority. The best strategy to providing individuals with mental illnesses the assistance they need is to have an accessible system of care that is easy to use. However, because the majority of mental health services are delivered through public systems, these are usually the first programs to be cut in a state budget when money runs short. More socially accepted diseases like diabetes, heart disease, high blood pressure and other physical illnesses don’t experience the same inconsistencies, yet funding for mental health programs seems to fall to the cutting room floor year after year.

In light of the Tucson shooting, we must also increase awareness of the need for mental health services within schools and colleges. The Mental Health on Campus Improvement Act attempted to increase accessibility to a range of mental and behavioral health services for students—including a focus on prevention, identification and treatment of students in college and university settings—but failed to gain any traction in the last two Congresses. We must realize that only by providing resources for prevention and outreach programs, can we ensure that students can obtain the support they need in order to recover and re-establish themselves in the community.

USPRA hopes that this tragic event brings the essential mental health system reforms that we so need in our nation and we will continue our responsibility to urge legislators to effectively address the needs of individuals with mental illness.

Resource: (Friedman, R.A. (2006). Violence and mental illness—How strong is the link? New England Journal of Medicine, 355(20), 2064-2066. )

Violence and Mental Illness

Today I pray, along with so many others for the victims of the Arizona shooting yesterday: six dead, at least 12 others injured, including Congresswoman Rep. Gabrielle Giffords. The man in custody for this violence is now being held on multiple counts of murder, and his background searched for clues to his destructiveness. The county sheriff says the young man has mental issues. I say No Kidding.

Most of us who suffer from issues of behavior, emotion and thinking have what are called mental disorders. In other words, we as individuals have problems. Problems we know as something a part of ourselves but distinct from ourselves as a people. Those who suffer mental illness are people whose disorders have them. Major mental illness (MMI) like schizophrenia or psychosis so distorts the mind, mood, perception and behavior that we have commonly called these people “out of their mind.” They behave as if they don’t have two normal thoughts to rub together. Often, they don’t.

American courts have long recognized this distinction, with what most of us know as the insanity defense. Someone may be considered guilty of an action but not punishable, not sent to prison, because they were “out of their mind” when committing a crime. Instead, they are committed to a psychiatric hospital in a locked ward. Prison for the insane. Most never get out, because it’s pretty hard to get your mind back once you’re out of it.

Our current cultural political and religious speech, so out of control with hatred, divisiveness and extremism, is like gasoline to MMI’s fire. Words do have that kind of power, to inflame emotions and create sides where there needs to be common cause. Shame on those who, like former Alaskan governor Sarah Palin, have used their political power to incite violence with website images of a gun’s cross-hairs on an picture of a political opponent. Her ignorance of how her words can hurt people is mind boggling.

Internet technology gives hate speech a world-wide audience. When politicians stir up hate in the name of partisanship, it is no wonder those whose minds are disturbed and distorted by illness take their rhetoric for truth. And occasionally act on it.

Mental illness is the next great medical frontier. Just as MRIs, blood tests, CT scans and Xrays have given us astonishingly detailed windows into our bodies, I pray for increasingly clear windows of understanding into the most mysterious of all our organs, our brains. One day we may be more able to anticipate and treat MMI before individuals become violent to themselves or to others. It won’t save us from our stupidity and ignorance, though. So far, there’s no cure for that, save education, humility and self control. Something, at least right now, is in dangerously short supply amongst many in politics, media and self promotion.

Pastors are a Bridge

When I first began my private mental health practice, I knew one thing was certain: I needed to meet as many area clergy as I could. Today I had the pleasure of having coffee with an another local parish pastor. Thanks, C!

So many people still experience embarrassment, resistance and fear when it comes to seeking therapy for relationships, emotions, or behaviors, they stall when it comes to getting help. They may talk to their friend or family member. They may occasionally tell their physician about how they feel. But as they get ready to reach for help, they may also talk to their pastor.

Most pastors are great at emotional triage. Trained in basic listening skills, taught how to manage themselves in emergencies, experienced at handling emotions at funerals, parish clergy are the go-to folks in many people’s lives when it comes to figuring out what to do when the going gets rough. I am honored so many people trusted their lives to me over my years in the parish. I learned early on to have a small group of trusted counselors I knew and to whom I could refer my parishioners who needed more help than I could give. I tried to think of myself as a link between suffering and help, and I kept in touch with those counselors on a regular basis.

Now, I strive to be one of those counselors that the pastors, ministers and priests around me trust. Someone they have met, looked in the eye, and gathered a personal sense of me for themselves. As I reflect on clients who have recovered well, who make the most progress in their personal goals, the ones who feel that therapy was a success: most have come to therapy via their pastors.

Thank you, Pastor, for being on the front lines in people’s personal lives. You are under appreciated in our secular culture, and over-worked inside the special world of the congregation. You may not feel it often enough, but you are loved, respected and trusted by your members, and a lot of neighbors and strangers, too. Helping people navigate the details of mental health care is a compassionate gift you give. Thank you for trusting people you care to me, and to other therapists you know and trust.

Oh, and one more thing: you are often neglectful of your own mental health. Don’t forget to reach out for help yourself. Some of us know exactly what your life is like, and can be trusted as a confidential guide to increasing YOUR emotional health. God’s grace surround you!