Mental disorders today are believed by many researchers to result when a biological predisposition is triggered by the environment. There are many types of environmental stimuli that are thought to have the ability to trigger mental disorders.

Early childhood experiences may be one such trigger. Many adults who grew up in families with less-than-ideal parents wonder if their troubles coping with life’s difficulties could have something to do with their early childhood experiences.

Some idea about whether or not early childhood experiences influence the development of mental disorders might be found in research on Attachment Style. Attachment Style in adulthood has been studied for the past 25 years.  Recent research combined all the results from all the studies to find out how early childhood experience with attachment might influence adult mental health (Bakermans-Kranenburg, & van IJzendoorn, 2009). this research involved over 10,000 people and over 200 studies.

What is Attachment Style

We find many people in life to love, but we form attachments to only a few people. Attachment is deeper than love. The attachment relationship is reserved for our parents, significant others, and children.

Attachment style is generally  handed down from one generation to the next. You are likely to have the same attachment style that your mother had, and your children are likely to have the same attachment style as you do.  Attachment style can be upgraded in situations where one has a very caring spouse. It can also be downgraded by situations of loss—for example, having a child with a handicap.

What is Your Attachment Style

Adults have three basic attachment styles:

• Secure-Autonomous Attachment

Securely- attached adults value relationships.  They describe their relationship to their caregivers as “important” to their personality formation. They are able to talk about their early childhood experience with their caregiver, whether those experiences were positive or negative, in a straight-forward and coherent manner.

• Insecure-Preoccupied Attachment

Adults with Preoccupied Attachment tend to ruminate their early childhood experience. They believe their relationship with their caregivers was critically important to their personality formation—perhaps impairing them in some way.  They tend to be passive or angry when they describe their relationship with their caregivers.

• Insecure-Dismissive Attachment

Adults with dismissive attachment tend to minimize the impact of their early attachment experiences.  Alternatively, adults with dismissive attachment will idealize their attachment to their caregivers but not be able to provide concrete evidence to support their claims.

Evidence that Attachment with Caregivers Has an Influence on Mental Disorder

The result of combining all the research samples studying adult attachment styles suggested that an insecure style of attachment, whether it is Preoccupied or Dismissive, appears to increase the likelihood that a person will have a mental disorder.

Here is how persons who with no know mental disorders  compared with persons with a known mental disorder:

• No known mental disorder:   Secure Attachment: 58 %; Insecure Attachment 42%

• Known mental disorder:  Secure Attachment  27%; Insecure Attachment 73%

There is not enough evidence to definitively say that insecure attachment predisposes one to mental disorders.  The people with no known mental disorder had never sought treatment, while the persons with a known mental disorder had sought treatment. The groups that had not sought treatment had also not been screened for a mental disorder. The researchers were able to identify that many of the group that had not sought treatment had unresolved attachment issues (18%).

The most we can get from this study is that there appears to be a relationship between early childhood attachment experiences. People who have been diagnosed with mental disorders are more likely to have insecure attachment to their caregivers.  People who do not have a diagnosed mental disorder are more likely to have secure attachment. How that relationship comes about will need further study.

Finding out what causes mental disorders is important because it will lead to treatments that are even more effective than what we currently have.

References

Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2009, May). The first 10,000 Adult Attachment Interviews: distributions of adult attachment representations in clinical and non-clinical groups. Attachment and Human Development, 11(3), 223-263.

But your adolescent can have a better experience.  Your adolescent’s summer can be the time the two of you focus on building a foundation for their successful life.  Plan on taking some time with your adolescent to talk about what they want for their lives and how to get it.

Researchers who have studied the process needed for adolescents to build successful lives have summarized their findings with the words “selection, optimization, and commitment” or SOC for short (Gestsdottir & Lerner, 2008).

• Selection: The adolescent selects goals that are appropriate and achievable.
• Optimization: The adolescent makes a “how-to” plan by thinking through resources available and resources needed.
• Commitment: The adolescent is able to keep on going for the goal when the planned strategy does not work.

Successful Life Strategies Require Selecting Goals

The mother in the picture above is using the opportunity of her daughter’s web search to talk about what her adolescent wants in life.  As she passed her daughter in the living room, she noticed that her daughter had her “Pinterest” account open, showing a shiny, blue Hyundai Elantra.

Mother: “Oh, my, Jesse, you have great taste in cars!”

Jessica: “Hi, Mom!  Yes, this is the car I want to buy when I get my license next month.”

Mother: “Oh, so you are planning on buying a car?  Have you thought about how to do that?”

Successful Life Strategies Require a “How-To” Plan

Jessica originally had thought that her parents might buy her the car for her birthday.  She was a little disappointed to hear that mom and dad had no plans for such an expensive, elaborate gift. Further, if she wants to drive, she will have to have car insurance–which must be paid monthly. This seems pretty overwhelming, but Jessica is a girl who is willing to work for what she wants.

Jessica: “So, mom, how much would it cost to buy this kind of car?”

Mother: “I was wondering the same thing. And of course, you would have to consider more than just the cost of the car.  There would be an initial fee for the license plate and property taxes. There would also be a monthly bill for auto insurance. And fuel for the car–you would need to be able to pay for the gas to take that car wherever you want to take it. ”

Jessica: “It sounds like I would need a job.  But I also need to keep up my grades at school. How can I do both?”

Mother: “I like how you are thinking.  Have you thought about the information you might need to figure that out?”

Jesse: “I need a lot of information. First, I need an idea about how much it will cost each month to have the car.  Then I will have to figure out how many hours I would need to work each month to make that kind of money.”

Mother: “You are right on target!  And most important, you might look at whether you would be able to spend that amount of time working and still make good grades and spend some time with your friends.”

Successful Life Strategies Require Commitment

Jessica figured out that she would have to work about 15 hours a week to afford a two-year old version of her dream car.  She would need to pay $1,000 down–and she only had $300 in her savings account.  She also did not have a job. She could see that it was possible to get that car and fill her obligations at a job and school–but it might not leave enough time to have fun with her friends. Still, if she had a car, she could drive herself to school. It would also signal important people in her life that she was growing up and becoming independent. This would be especially true if she had a part-time job.

Jessica:  “Mom, if I got the car, I might not have the time I need to hang out with friends. I would be working all the time that I am not studying or going to school.  But I still want to get my own car and have a job.  So maybe I need a less expensive car. How do I go about making this happen?”

Mother:  “Jesse, you are showing good problem-solving skills.  But I need to admit, I certainly don’t know much about buying cars at an affordable price.  Do you know anyone who might have some ideas. . .”

The Positive Outcomes

Jessica, of course, was very happy when she drove a used car home from the auction lot (which was a plan she made after consulting with her dad). She enjoyed showing her car off to her friends. She even enjoyed working 8 hours a week at a local burger joint.

But best of all–she had learned that she is a “get-it-done” kind of girl.  She can organize her behaviors to get what she wants in life and to be the kind of person she wants to be. She enjoyed holding the mature-looking car keys in her hand.  But she also had the kind of keys to turn her behaviors toward creating the kind of life and lifestyle of her choosing.  She like those keys best of all.

References

Gestsdottir, S., & Lerner, R. M. (2008). Positive development in adolescence: The development and role of intentional self-regulation. Human Development, 51, 202-224. doi: 10.1159/000135757

Summertime offers parents an opportunity to increase children’s competence by focusing on skill development.  Skill development requires concentration, which instantly improves mental health and reduces complaints of being “bored”. Here is Moxie Mental Health’s list of Summertime Learning Opportunities for Children.  Adults who love to learn may themselves be captivated by these sites.

Art Instruction

Www.artistshelpingchildren.org/howtodraw.html . Artists Helping Children contains learn-to draw lessons and how to make crafts from paper and recyclables.

Www.drawinghowtodraw.com/drawing-lessons/improve-drawing/drawing-for-beginners.html  How to Draw contains links several learn-to-draw sites which are appropriate for children as well as adults.  One of them is entitled “How to See and Draw the Shape of Things and Figures”.

Www.kidsfront.com/how-to-draw-pictures.htm  Kids Front How to Draw Pictures contains step by step drawing of cartoon figures and other images.

Computer Programming

Marshallbrain.com/kids-programming.htm  Marshall Brain provides parents with ideas and sources to engage their children in computer instruction through games that teach problem solving to the web sites that teach coding and programming languages.

 Www.squidoo.com/teach-computer-programming   Teach-Computer-Programming gives parents a graded sequence of programming languages children can learn and apply from ages 7 on. It also includes where to find the instruction for the languages.  Languages include logo (for youngest kids) up through Java and Python (for older kids).

Math

Www.childandme.com/how-teach-your-child-math-glenn-domans-dot-method/

Child and Me has instructions on (would you believe it?) how to teach math to babies.  It is an article from Science Daily describing games researchers have found work at teaching children math.

Www.aplusmath.com   Aplus math teaches math to children from primary through middle school. The site uses a multimedia approach including games, flashcards, worksheets, and tutorials. The site also gives parents tips on teaching children math.

Www.enchantedlearning.com  A comprehensive site with activities for children that teach math, science, English, Spanish.  The resource-intense site has an annual fee of $20.00 annually.

Www.khanacademy.com  site that helps parents diagnose and remediate math  and skills.  Includes over 3,000 videos on math (and many other subjects), as well as instructional materials . A google interface enables children to do the work, and parents to get reports based on their child’s work.

Reading

Clicknkids.com.  This is a great site for parents who want to teach their children how to read. Price is a one time $58.95. Additional children can be added on to the program for $19.95 each.

Science

Www.sciencenewsforkids.org/mysnk/for-kids  Science news for kids includes pictures and information for kids on chemistry, geology, biology, and health.

Www.sciencekids.co.nz/geology.html colorful page from New Zealand has links for geology games, facts, and projects for kids

Www.kids.gov/6_8/6_8_science_geology.shtml This site from the U.S. government has links to sites that teach geology to children from kindergarten to grade 8.

Www.rockhoundkids.com Rock hound kids has links to many websites with information about how to find rocks and build a collection.

Library.thinkquest.org/J001539  Think Quest has instruction on basic chemistry for kids for kids. The site includes glossary.

Faculty.washington.edu/chudler/introb.html  This is a large site with links about neuroscience for kids.  This site has great illustrations about how the body’s nervous systems work.

Sciencespot.net/Pages/kdzbio.html  This is the biology section of sciencespot.net, and is designed for children and teachers of middle-school aged.

Writing Instruction and Contests

Www.nwp.org/cs/public/print/doc/resources/help_write.csp  The National Writing Project site has ideas for parents to encourage good writing .

Owl.english.purdue.edu/owl/resource/680/1/  The Owl site contains a plethora of guides for parents who want to encourage good writing in their children.

Www.time4writing.com/  Time4writing offers eight weeks of online writing instruction for k-12 students with an instructor.  Price: $99.00 for eight weeks.

Www.noodletools.com/debbie/literacies/basic/yngwrite.html  Noodle Tools has about 30 writing  contests for young writers, third graders through high school.

Alcohol Poisoning and the Adolescent Body

Alcohol is a deadly toxin. It depresses nerves that control involuntary actions such as breathing, heartbeat, and the gag reflex. Adolescents can die from alcohol when their drinking depresses their involuntary actions too much or they become unconscious and cannot take corrective action for the feedback their body is giving them that help is needed.

• Alcohol irritates the stomach, frequently causing vomiting. If the vomiting occurs while the adolescent is unconscious, the adolescent can “drown” in their own vomit.
• Breathing can become so shallow it eventually stops and the adolescent dies of respiratory arrest.
•  The heart can stop beating.
• Vomiting can cause severe dehydration, leading to seizures and permanent brain damage.
• Glucose (sugar) levels in the blood can become dangerously low, leading to seizures and coma.
• The body loses its ability to regulate temperature. Body temperature can go down too far, causing hypothermia.

The alternative to dying is to get to an ER in time to pump the alcohol out of the system. Adolescents who are aware of the danger can make sure that happens.

Adolescents who are aware of the signs of alcohol poisoning, however, have the power and knowledge to save their life or the life of one of their peers. Make sure that your teenager knows the signs of alcohol poisoning and what to do if he or she encounters it.

Why the “Wait and See” Approach Can Be Fatal for Teenagers Using Alcohol

The most important thing and adolescent needs to know to deal with alcohol poisoning is to get help as soon as they suspect the alcohol might be poisoning someone.

The “wait and see” approach can be fatal when it comes to alcohol. The reason?  Alcohol levels continue to go up after the person has stopped drinking. Alcohol levels will jump up when the alcohol reaches the small intestine–and it takes some time for the alcohol to transit from the mouth to the small intestine.  That teenager who is passed out over there is not drinking right now–but his or her alcohol levels are still going up.

Symptoms of Alcohol Poisoning

Adolescents should know to “get help” as soon as they notice any of these symptoms:

• Vomiting
• Person can’t be roused after they have passed out
• Slow breath–breathing 8 times a minute or less
• Pale, bluish skin (a sign of hypothermia)
• Irregular breath (more than 10 seconds between breaths)
• Mental Confusion
• Seizures

What Adolescents Should Do When They Notice Symptoms of Alcohol Poisoning

The most important thing that needs to happen if an adolescent has alcohol poisoning is to get immediate medical help.  In the USA, dialing “911″ will usually get medical help fast.

The second most important thing to remember is: Never, Never, Never “wait and see” when a person has symptoms of alcohol poisoning.  It could be too late. Its better to have a false alarm than a dead friend.

Adolescents are very concerned about getting in trouble with their parents, and often fail to deal effectively with an alcohol crisis out of fear of getting into trouble. Parents should talk to adolescents about how staying alive, and keeping one’s peers alive trumps getting in trouble.

Do this Today

If you have an adolescent, whether or not you are aware they are drinking–have an adult conversation today about the dangers of alcohol poisoning , how to recognize it, and how to address it. Make sure your adolescent knows to do this:

1.  Call for help–even if they are afraid someone will get in trouble.

2. Be vigilant about their own and peer’s state of body and mind if they are drinking.

3. Never, never, never “wait and see” if there are symptoms of alcohol poisoning.

Katrina Miller, PhD

The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the Veterans of earlier wars were treated and appreciated by their nation. (George Washington)

Have you been to war, or sent a loved one to war?  You may remember the constant worry about whether or not you or your loved one was going to face death from enemy fire.

While soldiers, airmen, marines, and sailors face the possibility of death on the battlefield, they face an even greater risk of death once they come home.

Risk of Suicide in Veterans is Triple

Veterans are more likely to die as a suicide victim then as a war casualty. Both male and female veterans commit suicide at two to three times the rate of their civilian counterparts. Veterans commit 20% of all suicides in the United States.

How You Can Help Yourself or Your Veteran

Is your veteran at risk?  Be aware of these conditions associated with increased risk:

• Post Traumatic Stress Disorder. Veterans with PTSD continue to reexperience the trauma through nightmares, flashbacks, or daytime preoccupation. The inability to forget what happened impairs the veteran’s ability to function in the home, at school or work, or in the social environment.
• Substance Abuse.  While moderate drinking is common, binge drinking or persistant over-drinking is a hazard.  Substance abuse occurs when someone uses substances in a hazardous way. About a third of veterans do substance abuse. One study showed that 77% of the veterans who completed suicide both did substance abuse and had a mental disorder.
• Mental Disorders. The conditions of wartime killing and substance abuse make veterans more vulnerable to mental disorder than their civilian counterparts.
• Traumatic Brain Injury (TBI).  A traumatic brain injury is the “signature” injury of the Iraq and Afghanistan conflicts.  Any veteran who has been in an explosion probably sustained a mild-severe TBI. A TBI tears and bruises brain tissue.

The rate of suicide completion and attempt is considerably lower if the veteran is receiving treatment.

Any veteran with one of these conditions should have access to treatment. This is currently a problem. Currently, only 6 million of the nations 22 million veterans are enrolled in Veterans health services.Up to last week, the Veteran’s Administration was hiding the fact that it takes about 50 days for about half of veterans to get their initial appointment for veteran’s care.  The planned remedy is for the Veteran’s Administration to hire about 1600 more clinicians to help veterans. Contact your regional Veteran’s Administration hospital today to get the process started.

Veterans who are in care need to stay in treatment for the full recommended length of time.  Currently only half of veterans with mental health problems are staying in treatment as long as has been recommended.

If medication is prescribed for the veteran, it is important that it be taken as prescribed. Most of the suicide completions involved the veteran not taking the medication as prescribed.

The Basics

If you or your veteran is at risk for suicide, here is your checklist:

1. Enroll today at a Veteran’s Center for Care.
2. If there is a wait time longer than 1 week, talk to your primary care physician and follow his or her recommendations for care. This may include seeing a therapist or psychiatrist in the meantime.
3. Stay the full course of recommended treatment.
4. Take your medication as prescribed.

Veterans Crisis Line: 800-273- 8255

If you or  your veteran are having thoughts about suicide and need someone to talk to immediately, please call the crisis line. You can print out decals with the crisis line phone to attach to your phone  or put in your wallet by clicking this link.

Katrina H. Miller, PhD

What about My “Self”

Psychology and religion often use the word “ego” when they talk about the “self.” Ego, in Greek, means “I.”.

In psychology, the “ego” or “I” of is that part of us that balances out the inner conflict between the pleasure we want and the good people we want to be. A healthy “I” or “ego” has some virtues combined with some vices. The goal is to keep virtues and vices balanced.

Religions stress the importance of not letting the “ego” or “self” bulldoze over the desires and needs of others. “Self” is used as the starting point in managing behavior toward others. “Do into others as you would have them do unto you,” known by Christians as “the Golden Rule,” has a corollary in nearly every major religion.

The combined wisdom of psychology and religion looks something like this:

•  Our “self” has virtues and vices  (None of us are perfect and that is the reality of life. Period.)
• Each of us needs to keep the perspective that others’ needs and our own  are equally important.

What About Other “Selves”

There are many personal qualities starting with “self” that we would like others to have: “Self-control,” “Self-efficacy,” and “Self-awareness.”

There are other “self” qualities that we want others to not have: Being “selfish,” “self-absorbed,” or “self-righteous.” We want them to have ample room for us.

We also want others to care for their selves. We expect: “Self-esteem,” “self-efficacy,” and “self-sufficiency.” That way, others won’t become a burden.  They will also enjoy richer lives.

Our emphasis on the vocabulary of self informs us that the behavior of others is extremely important to us. That is why is so tempting to try to manage the behavior of others.

So before trying to manage others, we might want to manage our own perspective about our self and the other self:

• We, ourselves, are not perfect and neither is the other person. We both have the right to be imperfect—because that is the only variety humans come in.
• We and the other both have many virtues
• We both have needs, which are equally important

Ideally, these facts about self and others would be mutually understood—but that usually isn’t the case. Somebody, during a discussion about unwanted behaviors, is likely to let go of self-control. They automatically and mindlessly start running their mouths without engaging their brain.

We cannot stop the other person from losing self-control; but we can assure that our attitudes and behaviors remain true to our intention to value and accept others.

If the other person lets go of their steering wheel, and begins acting like a zombie (a mythical creature that moves but is dead and mindless), we can nudge them back to the living by using our own self-control.

Just for fun, let’s call a discussion where one participant goes mindlessly into the attack mode  “an attack by a conversation zombie.”

One “conversation zombie”, spouting off the negative thoughts and feelings that come from being emotionally swamped,  had a very different experience when her husband made an important decision. . .

The Attack by a Conversation Zombie

Rick:  “So, Peg, talk to me about what happened at dinner .”

Peg: “There you go, Rick, accusing me of being a ‘bad mother.’”

Rick:  “You’re concerned that I might not support you as a mother.”

Peg: “I know you won’t support me.  You never have!  You only care about the kids.”

Rick: “Maybe you’re concerned that I don’t notice how much effort you put into making sure our children have a mother who makes sure that they do well in school.”

Peg: “Not only that they do well in school, but—wait! You know–you’re right!  I saw that look in your eye when I told Ben to leave the table! You think I’m a **!## (short for ‘conversation zombie).’”

Rick: “I care about your feelings—I know that you care about how I feel about you. You are my sweetheart!”

Peg: “Well, I’m really concerned that Ben always has an excuse for not bringing homework home. . .”

This tidbit of after-dinner talk started out very badly. Peg is not so good at reading Rick’s mind. Secretly, she worries about being grumpy, and would like Rick to put more effort into guiding Ben. When she feels discouraged, she feels she cannot do anything right. She often feels unlovable. And at night, after she is exhausted from a difficult day job, she often tells herself that it is all Rick’s fault.

Rick did not appreciate the continued attacks. He knew that it was just “Pegspeak- after- a- long-day,” but he sometimes got tired of it.

They had a discussion like this last week, and he decided that next time he was not going to allow it to deteriorate into an argument about whether Rick or Peg was the “bad guy.”

Rick is not a therapist, and he has never had a class in communication. In fact, he works with numbers, rather than people (he is an accountant).

Rick simply did three things differently than what is ordinarily done when under attack by a conversation zombie.

• He refused to get defensive and take the bait when Peg tried to make the conversation about him
• He acknowledged her feelings without agreeing (or disagreeing) with her
• He consistently made comments that focused on her virtues

So, who won in this disagreement that did not happen? 

Rick’s good self-control and acknowledgement of Peg’s feelings successfully dislodged her from the attack mode. As a result, she got out of her rut and talked about her real concern.

Rick was more energized as well. He had won at poker before—but this is a much sweeter victory–not a victory over Peg, but a victory over his own impulses. He hoped that getting it “right” once would help him get it right again and again.

As for Ben?  When his dad told him that he would not be playing computer games until after the homework was done—Ben found his homework and got it done. Ben saw the boundary his father set for him as evidence of his love.

If the conversation would have turned in the direction of Peg’s attacks, the homework thing would have been left unresolved. But tonight, nobody went to bed empty.

What are Your Chances of Having a Child with Autism

Have you ever thought autism was something that happened to somebody else?  Think again.  Here are the rates reported around the world:

• United States, 1 in 88 children  (1 in 54 males; 1 in 252 females)
• Europe, 1 in 100 children
• Asia, 1 in 100 children
• South Korea, 1 in 45 children

What is Autism

Autism and Autism Spectrum Disorder are general terms for complex disorders of brain development. There are several types of autistic disorders that we are aware of:

• Autistic Disorder  (classic autism)
• Asperger’s Syndrome (like autism, but with normal language development)
• Pervasive Developmental Disorder  (a catch-all term for autistic behaviors that don’t fit any of the other patterns)
• Childhood Disintegrative Disorder  (a rare condition where the child learns skills, but loses them by age 10)
• Rett Syndrome (a genetic illness that occurs only in females)

The disability ranges from mild to severe. The impairment in brain functioning is demonstrated in three areas:

• Social interaction
• Verbal and non-verbal communication
• Repetitive behaviors

According to Autism Speaks, the leading advocacy organization, most persons with autism are verbal (75%) and many people with autism are average or above average in intelligence (40%). About one in ten autistic persons have extraordinary brilliance in areas such as music, math, or the arts.

In most cases (60%), autism is associated with retardation (having an IQ of less than 70) . Most autistic adults have significant disability and require the supervision of others.

Autistic children require a great deal more supervision than most children without autism.  Parents and siblings of autistic children are usually under a great deal of emotional strain as the supervision of the autistic child requires extraordinary patience and every spare moment of time.

Autism is a Puzzle

The major epidemiology research  (studying the rates of disease) in the United States is done by the Center for Disease Control. In conjunction with John Hopkins University, they have established the Autism and Developmental Disabilities Monitoring Network (ADDM), which monitors the rates of autistic disorders in eight-year-old children each year in the United States.   Here is some data from the report released by the ADDM in March, 2012:

• The rate of autistic disorders in the United States is on the rise.  It has increased by 78% in the past 10 years.
• Though the same criteria were used for identifying autism in each region, the rates vary greatly. Utah has the highest rate, with 1 in 47 children born in 2000 were diagnosed with a form of autism. Alabama has the lowest rates, with 1 in 244 children born in 2000 diagnosed with autism. You can find a report about the rate of autism in your state here.
• Boys are five times more likely to have autistic disorders than girls

Autism is visually represented as a set of red, green, blue, and yellow puzzle pieces.  The multiple colors represent the diversity of forms of autism. The puzzle pieces reflect the urgent need for answers to the unanswered questions that would enable us to get a grasp on improving the quality of life for persons with autism and their families—and perhaps someday find cures.

Early Intervention Leads to a Better Outcome

The earlier parents and doctors identify that a child has Autistic Spectrum Disorder, the more likely that specialized help can make a difference for the child. The Centers for Disease Control and Prevention (CDC) believe that children with Autistic Spectrum Disorder have the best change if they are diagnosed by age 3.

How to Identify Autism Before Age 4

Here are some indicators that a young child might have an autistic disorder:

• no babbling or pointing by age 1
• no single words by 16 months or two-word phrases by age 2
• no response to name
• loss of language or social skills
• poor eye contact
• excessive lining up of toys or objects
• no smiling or social responsiveness.

Parents can ensure that their child is diagnosed in a timely manner by observing whether or not their child is meeting developmental milestones.  A developmental milestone is a specific behavior that is expected to emerge by a certain age.  You can act early in detecting autistic spectrum disorder and other developmental problems by reviewing  developmental milestones of each age.  There is well-defined information on the site  to help parents identify which concerns should be discussed with doctors.

There is usually funding through the school district and other sources available to help children with autistic disorders.  You can find sources of help in your state by clicking this link.

How You Can Help

Now you know a little more about how to identify autism and what to do about it—maybe you can help someone who needs to know today.  With so many victims of autism—there is likely to be someone in your family or neighborhood who could benefit from what you know. Mostly, they could benefit from knowing you care. Please reach out to them.

Could life so end, half told; its school so fail?
Soul, soul, there is a sequel to thy tale!
~Robert Mowry Bell

In an earlier life, I was a religious person.   My crash into the wall of religious disappointment maimed me more than if I had hit a real wall going at freeway speeds.  My foundation of faith was ripped away from my feet, and I was left to wonder if my other beliefs about life might be nothing but water vapor.  But I continue to hold on to one very dear belief. . .

The belief  that there is life after death and that we will, after death, continue to enjoy the comfort of friends and family. I’m no expert on the afterlife, but I believe that death is similar to moving.  We change houses, but go on living.

My friend Michael, on the other hand, is certain that “when you’re dead, you’re dead!”

Many people in the world believe, like Michael, that death is final.  If, in the end, Michael proves to be right—there won’t be anything left of me to feel disappointment.  And though life is wonderful sometimes, it is often accompanied by physical and emotional pain that can seem unbearable.

What Do You Belief About Death

The question¸”Is there life after death?”  has been around a long time.  The Egyptians, Greeks, and Romans believed in an afterlife.  The belief of life after death has been taught by many other cultures, including Polynesia, Australian Aborigines, and Aztecs.

Religion, culture, and even science have tried to provide answers to that important question about life after death.  Ultimately, each of us will ask the question of ourselves, as we try to piece the meaning of life back together after death separates us from someone we love.

How Have You Experienced Death

Though we all expect to experience the death of loved ones, it usually leaves us feeling shocked and numb for quite some time.  That is probably why we don’t talk much about it openly. It makes us cry. Like I am doing right now.

My closest experience with death occurred one week after Easter, 16 years ago.  My habit was to bring my younger brother, Chad, over to our house for Sunday dinner. I went to pick him up from his apartment.  His partner opened the door slightly to talk to me.

“I’m afraid I have some bad news for you,” he said.  “Your brother died Friday night.”

From the opening in the door, I could see my brother lying on the couch with a towel over his face.  So I laughed and told the partner I did not appreciate bad jokes.

The partner took me over to my brother, and removed the towel. Blood had drooled out of both eyes and was dried to my brother’s cheeks. I picked up Chad’s leg, but it was hard and heavy.  His flesh was cold.  All I could think to do was to scream, “ I love you, I love you” over and over, hoping by some chance, Chad would hear me and know the most important truth about our relationship.

Chad, age 32 at the time, had Bipolar Disorder  and Polysubstance  Abuse.  He also was HIV positive at a time we had no way of prolonging life with AIDS. He died of mixed poisoning (heroin and alcohol).

Why I Believe in Life After Death

Michael (my friend, the skeptic) would say that I believe in life after death because I cannot face losing Chad.  I need to believe I will be with him again in order to cope with the profound sadness and emptiness brought on by the death of a loved one.

My belief comes from a combination of religious training, reading stacks of books on philosophy, and having some “shared death experiences.” ((A shared death experience is an encounter that a living person has with the afterlife that is shared with a person who is dead or dying.  For more information, see  Moody and Perry (2010 )).

For You Who Seek Comfort

Many readers of Moxie Mental Health have, like myself, carry some grief and loss over a loved one’s death.  It is Easter, and everyone is talking about the Resurrection and Life After Death. Perhaps you would like some reassurance?

Here are two resources from men I consider have some objectivity about the subject of life after death. I believe that watching these resources can bring you much comfort.

The first resource is from Carl Jung, an imminent psychoanalyst . It is a Youtube video interview where Dr. Jung discusses his observations leading to the conclusion that there is life after death (Listen to Dr. Jung)

The second resource is an MP3 recorded from a speed by Dr. Raymond Moody made in Salt Lake City on June 11, 2011. Dr. Moody is a psychiatrist and a professor at the University of Las Vegas.  He is also a personal associate of mine, and I have enjoyed the privilege of dinnertime conversation with him.  He wrote the first edition of his book, Life After Life, in 1975, initiating a public interest in “near death experiences”.  Dr. Moody’s observations about life after death come from thousands of interviews with people who have had near death experiences and shared death experiences (Listen to Dr. Moody).

I find Easter to be an opportunity to renew my hope that there is life after death and that I can be with Chad again.  This belief gives me joy and energy.  Though I don’t attend church, I remember well the hymns of my youth.

This Easter morning, I will sing one of them.  As I have each of the 15 Easter mornings since Chad’s death,   I will sing the best news I have ever heard: He is Risen!  (Listen to Mormon Tabernacle Choir sing ” He is Risen“)

He is risen, He is risen

Tell it out with joyful voice

He has burst his three-day prison

Let the whole wide world rejoice!

Death is conquered, man is free!

Christ has won the victory.

Works Cited

Alexander, Cecil Frances. He is Risen. In  Hymns of the Church of Jesus Christ of Latter-Day-Saints, #199. Salt Lake City: Church of Jesus Christ of Latter Day Saints.

Moody, Raymond. (2001).  Life After Life: the investigation of a phenomenon – survival of bodily death, San Francisco, CA: Harper San Francisco.

Moody, Raymond and Perry, Paul. (2010). Glimpses of Eternity: Sharing a loved one’s passage from this life to the next, New York, NY: Guideposts.

Human beings are necessarily dependent on each other.  But often, we do not understand the needs that other people have.

Throughout the ages and throughout the world, human kind has had wise teachers who have taught us to care about others with the same consideration we show for ourselves.

We should also give ourselves the same kindness we show others.

The Golden Rule in Eight Religious Traditions

I found this list of Golden Rule Teachings at http://www.teachingvalues.com/goldenrule.html. It represents the teachings of eight different religions regarding our duty to care for each other.

Drug Industry is Over-Involved in Writing DSM-5

For the past 20 plus years, the foundation of diagnosis, medication and treatment for mental disorders has been the diagnostic categories found in the psychiatry’s diagnostic manuals:

• Diagnostic and Statistical Manual of Mental Disorders-IV (DSM IV) (American Psychiatric Association, 1994)
• International Statistical Classification of Diseases and Related Health Problems -10 (ICD 10) (World Health Organization, 1992)

Generally, the DSM IV is the manual used by American Psychiatry; while the ICD 10 is used internationally. The diagnoses and codes in both manuals are roughly equivalent.

The problems.  Two major issues with how diagnoses and categories have been put together have tainted the process of diagnosis.

• The diagnoses and categories were not shaped scientifically. No new psychiatric knowledge was used. There was not statistical investigation of how well the symptoms fit into the diagnostic categories
• Political processes governed the selection process.  Representatives from industries standing to gain financially from diagnoses have comprised more than half of the DSM task forces in the past (Mayes & Horwitz, 2011)

Current status. A revolution in psychiatry is occurring right now, spurred by the opportunity afforded by the need to rewrite the diagnostic manuals. The DSM-5 is expected to be published in May, 2013, and the ICD-11 is expected to be published in 2015.

The problems will not be fixed by the DSM -5. In fact, the problems have been made more visable to the public by the process. Here is what happened:

The current DSM-5 taskforce consists of 70% representatives who stand to gain financially from the decisions made (Cosgrove and Bursztajn, 2009). That is 14% more than the representation industry has had at any other time in the past.

Knowing that the public would understand how this was a problem, the American Psychiatric Association tried to cover up by having the participants sign “nondisclosure” statements (Carey, 2008). The secrecy was not tolerated when the public found out, and the task force has since revealed their conflicts of interest.

The outrage is most welcome, as it provides an opportunity for public dialog about what has gone wrong in psychiatry, and how to fix it.

The major complaint about this heavy representation by pharmaceutical representatives is that the DSM provides the industry with a long list of illnesses for which they can develop profit-making drugs.  It is an understatement to say that the DSM makes the pharmacy industry a lot of money, and the industry maximizes the opportunity to make money with the DSM with their participation in the task force.

Future Diagnosis Will Be More Scientific

The problems with too many pharmaceutical industry representatives and not enough scientific validation remain in the DSM 5.  However, there is a plan by the National Institute of Mental Health, the agency controlling federal grants for research in mental health, to make mental health diagnoses more scientific. They have a plan to only fund research that uses science (rather than political process) to define what will be the subject of research.

This approach makes sense, given the explosion of information about the relationship between mental disorders and the brain in the past 20 years. This explosion has been made possible by imaging studies allowing more direct observation of the brain in process. The new information from imaging studies and increased neuroscience research has further clarified the need for a more medically based and scientific approach to mental disorders.

How it works.  The first step in NIMH agenda is to reclassify mental disorders so they are less of a label (for example “bipolar disorder”, “schizophrenia) and more a description of the basic deficit in functioning (for example “working memory” or “fear” or “social dominance.”). This approach is formally known as “Research Domain Criteria” or RDoC. The NIMH has invited researchers to help identify what the descriptions of functioning deficits should be.

It is possible that identifying the real substance of mental disorders will reduce much of the social judgments and stigma that clouds objectivity and logical thinking in the public understanding of mental disorders. When we all understand that a mental disorder is a “medical problem” and not a “social disgrace”, there will be more funding and support from individual donors. Research funded by people who are affected by mental disorders and are interested in finding a cure,  rather than people who are mostly interested in making money off of mental disorders,  may be exactly what is needed to uncover the mysteries about what causes of mental illness and how to effectively reduce or cure the symptoms. .

Works Cited

Carey, B. (2008) Psychiatrists revise the book of human troubles.  http://www.nytimes.com/2008/12/18/health/18psych.html?_r=1&pagewanted=all

Cosgrove, L. and Bursztajn, H.  (2009).  Toward credible conflict of interest policies in clinical psychiatry. http://www.psychiatrictimes.com/dsm-5/content/article/10168/1364672

Mayes, R. & Horwitz, A. (2011).  DSM III and the revolution in the classification of mental illness.  DOI 10.1002 /jhbs.20103

Diane Sawyer interviewed a Harvard scientist regarding how effective he understood antidepressant medication to be.  The scientist, Dr. Irving Kirsch, has been writing for 30 years regarding his views on antidepressant medication.  Here is what he said:

“People get better when they take the drug (the antidepressant), but it is not the chemical ingredients of the drug that is making them better.  It is the placebo effect.”

The “placebo effect” is a healing response that is thought to occur because of the patient’s expectations, rather than the medication or procedure used. In the United States, every medication that is approved by the Food and Drug Administration must demonstrate that it outperforms a placebo (usually a sugar pill) in at least two clinical trials before it is approved for sale in the marketplace.

Do Antidepressants Work?

Dr. Kirsch believes that antidepressants are effective.  However, he also believes placebos are as effective as antidepressants.

His interview on Sixty Minutes provoked much response from critical colleagues, fearful that people might say to themselves, “Well, if antidepressants don’t work any better than sugar pills, than why take them?” As a result, people who really need antidepressants might stop using them, and serious effects from the depression, such as suicide, might result.

The Background of the Controversy

Dr. Kirsch is a reputable researcher who obviously has the courage to say what he means, even if it ruffles the feathers of others.  His research interest is in how peoples’ expectations influence their medical outcome.

Dr. Kirsch calls his idea about how people will experience medical treatment the “Response Expectancy Theory”.  The idea is that how people experience medical treatment is at least partly due to what they expected from the treatment in the first place. The expectation of getting better from taking medication, according to Dr. Kirsch, is as powerful of a healing agent as the molecules in the medication. His response expectancy theory has been used to explain how hypnosis works.  In addition to using the theory to explain depression, the theory has been used to explain how people experience pain, asthma, addictions, and anxiety.

Dr. Kirsch studies research, rather than people. His way of doing research is to accumulate a lot of studies and then combine all the data from the studies to see what it says about the power of peoples’ beliefs and expectations.

 What Do Other Experts Think About Antidepressants?

Dr. Kirsch’s assertion that what people expect from their treatment influences the effect the treatment will have is generally accepted by experts.  That is why the FDA requires that the medication they approve must be more effective than what expectancy alone can produce.

 Most of the medication that goes through the clinical trials does not get approved.  If the clinical trial cannot show the medication is more effective than a placebo (or the person’s expectancy), then it does not pass muster.  There are also other reasons medications may not be approved.

Most experts believe that medication for depression saves lives. They also believe that medication is important because it helps people who have depression continue to function as employees, students, parents, or whatever their role is in life.

Most experts agree that medication is needed when a person has severe depression. Depression is considered severe when the person is at risk for harming themselves or other persons or cannot function in their roles.   Medication has been shown repeatedly to speed the recovery process and reduce the damage that severe depression can do to people.

Only about one-third of people who start antidepressants feel relief from the first attempt of the doctor to find a medication that works for the person.  However, about two-thirds of persons find that medication works after the second visit.

If a person’s depression is not at the point where they have difficulty functioning or think about harming themselves or others, medication may not be as effective as it is in severe depression. It is important to remember, however, that for some people with moderate depression, medication is still the best option.

Whether or not your doctor recommends medication, there are other interventions that will help you feel better.  The research shows that medication and therapy, used together, is the most efficient and effective way of recovering from depression.

 What Kirsch’s Research Adds

Kirsch’s suggestion that your beliefs and expectations are as powerful healing factors as medication highlights the wisdom of using your inner resources to help you heal.  Do you have inner strengths that can lift you above the fog and negativity of depression? Are you loving, courageous, insightful, or have other strengths that you can leverage to help you get better?  Do you have a lot of faith?  Kirsch’s research brings good news—your inner resources may be more powerful than you ever imagined.

Mental Disorder is another word for “Mental Illness”. If you have been diagnosed with a “mental disorder” or “mental illness”—what does that mean about you in relation to people who do not have a diagnosis?

The truth is that the diagnosis is only a tool to help you understand what you need help with.. A diagnosis can open the door to help you get insurance reimbursement for treatment.  It also can help identify which treatments might be most effective for your situation—based on research done with people who have a similar cluster of symptoms.

Did you know you can have a mental disorder and good mental health at the same time? Diagnosis is about your condition. Mental Health is about how you will cope. The diagnosis identifies something about your mental disorder, but tells us nothing about your mental health.

Diagnosis Can Help You Get Better. Stigma Can Help You Stay Sick.

Sometimes, the only difference between someone who has a diagnosis of a mental disorder and someone who does not is whether or not they have seen a doctor or therapist.

Even the mentally healthiest of persons will have hard times when they will experience one or more symptoms of mental disorder.  Perhaps they will be irritable, or have difficulty with concentration or attention.  At what point do we say there are enough symptoms to constitute a “mental disorder” ?

The current classification system, found in the Diagnostic and Statistical Manual IV-TR, uses number of symptoms as well as whether or not those symptoms have created significant impairment in one’s functioning or social relationships as the criteria.

In other words, a diagnosis is always somewhat arbitrary and subjective. It focuses on “what is wrong with you”, rather than “what is right with you”.

A diagnosis is a very good thing if you use it as a tool to practice good mental health. It can be a bad thing if you accept the stigma that a mental disorder is “not normal” and maybe even “bad”.

What to Expect If Stigma Keeps You From Getting Help. . .

Too frequently, people who could benefit from the help of psychiatry and/or therapy avoid getting it because they are afraid of finding out they have a diagnosis. They are afraid because our culture has unfairly given mental disorders a stigma—A stigma that has made a fairly normal situation (that of having a mental disorder) seem like a character defect.

You can choose to understand the stigma for the silliness it is; or allow the stigma to rob you from having the mental health and well-being you deserve.

Let’s think about this by comparing Janet with Jill:

Janet and Jill both have difficulty sleeping at night. They both feel sad and joyless most of the time. Both have wondered quite often, lately, whether or not life is worth living. They get upset so easily that they are having difficulty at work and in their relationships.

But how they approach their struggles is different.

• Janet does not go to the doctor because she does not want a diagnosis. She believes only weak people get psychiatric medications and/or therapy. She blames the people in her life for making her miserable.
• Jill knows that she is not acting and feeling like herself. She makes an appointment with a psychiatrist.  The psychiatrist tells Jill she has Major Depression and refers her to Cognitive Behavioral Therapy, where Jill learns to identify and correct thoughts that had been keeping her awake at night. She has also started taking medication that helps her sleep better at night, so she feels more refreshed during the day.

Nine months go by—Jill is no longer thinking life is not worth living. However, she still does not feel much joy, and continues to be irritable around others.

Jill, in contrast, was symptom-free after three months of treatment. She now enjoys being with her family and colleagues, and has no problem sleeping at night.

Jill practices better mental health than Janet. Jill used her personal strength to accept that she had a mental disorder and do something about it. She feels supported by family, friends, and her providers.

Janet was too afraid of social stigma. She wishes people cared more about her—maybe she would feel better if people would just care—and stop being so stupid!

What are You Doing About Stigma and Mental Health?

The comparison of Janet and Jill sheds light on the healthiest approach to social stigma.

Ask yourself, who has better mental health—People who see physicians and therapists about mental disorders, or people who do not? It depends. . .

But it is pretty evident that people who use social stigma to make their decision about how they will act and think about mental health need a little adjustment.

If you have an explosive family member, you have probably spent countless hours lying awake at night, wondering what you can do to keep the family functioning in spite of frequent and nasty conflicts. You many have made hundreds of plans, most or all of which have failed when your loved one blows up again.

When other family members blow up—we usually cope by trying to change their response. After all—they are “wrong”. What gives them the right to make everyone miserable with their bad temper? It simply has to stop!

The problem is, nothing we do to make them stop seems to work.

Have You Tried Logic and Reasoning?

People who blow up easily have had a lot of practice stopping the efforts of people who would try to change them. Your attempts to explain to your family member that he or she is making everyone else miserable may give your mouth and jaw some exercise—but little else. Exploders know what to do when other people reason with them. They scream, shout, become illogical, or whatever else it takes to punish you for criticizing them.

In the end, the pushback from the angry family member makes you look like the bad guy. It may seem like the angry person feeds on flesh, like a vulture; and trying to reason with them is like holding out your arm and inviting them to take a big bite.

How About Setting Limits?

You tried talking to your family member about the anger, and it backfired. So the next plan is to let them know that you are done!  You just are not going to take the abuse any more.

The next time your angry family member blows up—you blow up, too.  You tell them you are sick of being treated like crap, etc., etc.

What happens is predictable.  Your angry family member plays this game especially well.  The event has now become a contest, and the exploder in the family ramps up his or her nastiness to overcome any chance that you might win. No matter what you say or do, your angry family member will do one better—leaving you feeling even more abused in the end.

How Did it Get to Be This Way?

While your angry family member may act like a monster, he or she is not a monster. He or she is your loved one—any there any many things of your loved one that you love.

The habit of exploding is how the exploder has learned to cope with situations that are difficult for him or her. In most cases, the explosions come when the person feels overwhelmed or fearful.

In many cases, the explosiveness of your family member may be a symptom of a mental illness. Mental illness is an outcome of brain functioning (neurology) and development (the influence of the environment as one’s brain develops throughout the lifetime).

During an explosion, the areas of the brain that deal with reason and logic are not active. Reason and logic give people some control over their behaviors and moods—so the exploder is out-of-control with thoughts, behaviors, and emotions. His or her brain is impaired for the moment.

So Is the Explosion “Their Fault”?

There is little reward in being an angry, explosive person—so it is unlikely that someone would consciously choose that way of life. For non-exploders, blaming the person who is exploding is normal, but it tends to make the situation worse rather than better. And, it is easy to argue that the “anger” is a neurological symptom—in the same category as a “seizure”. It is also easy to argue that hair-trigger anger is the result of the environment in which the person’s brain developed.

Concern about who is to blame for an explosion is a little like kicking a dead horse.  It cannot get the angry person to stop exploding.

Taking Away Blame for Anger Does Not Take Away Responsibility

While there are causes for becoming an exploder that are likely outside the person’s control; the responsibility for the exploder to learn ways of maintaining control of their thoughts, behaviors, and emotions cannot be overstated.

If exploders want to be in relationships with other people—they simply must learn to control their thoughts, behaviors, and emotions.

So, What Can Be Done?

Talk to the exploder about the need to learn control over thoughts, emotions, and behaviors—but do it when their brain is working! The goal is to facilitate the exploder’s motivation to create a better life for self and others.

Ask, “have you ever wondered how your life would be different if your anger wasn’t triggered so easily?”

Or, “would that behavior have happened if you weren’t so angry?”

Or, “what were you thinking when you blew up?”

From questions such as these, it is possible to find out what the exploder thinks about their own behaviors, and how ready they are to change. If they are ready to change, you can go a little deeper:

“Have you thought about what might help you get better control?”

So what if the exploder is not ready to change?

This would be evident if the exploder becomes more defensive, tries to blame someone else (like you), ignores your question, responds with “yes, buts”, etc.

If this happens, tell yourself the exploder is not ready to change –don’t tell yourself that the exploder will never change.  Keeping your mind open to the possibility that your loved one can change will keep your eyes open to the opportunities to make a difference for your loved one.

Katrina

Do You Have Difficulty Sleeping?

One out of every three Americans currently report problems falling asleep or staying asleep. Because insomnia is such a common experience, it is easy to pass insomnia off as “no big deal”. Insomnia, however, often foretells that physical or emotional illness is either present now or is lurking nearby.

Why Insomnia Causes Physical and Emotional Illness

The underlying body issue behind insomnia is that insomniacs cannot turn the volume down in their body’s alarm system. Their bodies tend to remain in nearly chronic alarm, day and night. They just can’t relax, even when it is time for bed.

Insomniacs can be exhausted at bed time, but their bodies just can’t get comfortable when they get between the sheets.  They twist and turn. Their minds, also, cannot relax.  Bed-time is Rumination-time. Unwanted thoughts about worries and frustrations start making a circuit through their minds and they are unable to turn the thoughts off. If they are able to fall asleep, the worries and frustrations become unpleasant dreams, often nightmares. Their sleep cycles are disturbed and they are unable to get sleep that restores them. The number of hours of sleep that an insomniac is able to get is of little consequence—the sleep is not restorative.

The chronic alarm experienced by insomniacs is the result of the volume being turned up in two systems in the body:

1. The Sympathetic Nervous System–the neurons of the sympathetic nervous system become excited and keep firing throughout the night. The Sympathetic Nervous System prepares the person’s internal organs to deal with stress. Which organ functions are active and which are not so active when the Sympathetic Nervous System kicks in is dependent on whether or not the organ function would be helpful in meeting a severe threat—say a mastodon charging toward you. Digestion is not needed, so it shuts down. Oxygenated blood is needed, so the heart speeds up.
2. The Hypothalamic-Pituitary-Adrenal Axis (HPA) the HPA axis is made up mostly of glands that secrete hormones that hype the body up to deal with stress.

Insomniacs beware! The supercharged Sympathetic Nervous System and Hypothalamic-Pituitary-Adrenal Axis will take a bite out of you! It affects one’s medical as well as mental health.

What Health Problems are Associated with Stress and Chronic Insomnia

Persons with chronic insomnia are much more likely to:

•  Commit suicide
• Become Alcohol Dependent
• Develop Depression, Bipolar or Anxiety Disorders
• Develop Cardiovascular Disease and/or metabolic disorders

What If I Have a Psychiatric Disorder and Insomnia?

Most psychiatric patients have difficulty sleeping. Depression and Bipolar Disorder have the perhaps the highest rates of Insomniacs (60%-90%).

If you have Depression, it is important to remember that many of the antidepressants can cause difficulty sleeping.  It is important to talk to your doctor to see if this might be an issue for you.  You might also want to hear your pharmacist’s opinion.

If you have Bipolar, you may spend most of your time in the depressed phase.  You also might want to see if the medication you are taking may be contributing.

An additional concern for persons with Bipolar is that sleeplessness can trigger a manic or even a psychotic episode. Missing a night of sleep might not be a big deal—but if you miss two nights sleep, you could be heading for a psychiatric emergency.  It is important that both you and your psychiatrist are aware of your sleep patterns and have a plan on how you will manage sleep. You need to know at what point it is important to take what kinds of actions to minimize the possibility that you will end up with a crisis.

Are there Behavioral Changes that Can Help People Sleep Better?

Changes in lifestyle and behavior that help people relax more are effective in helping chronic insomniacs sleep better at night. Here are some of the changes people have found helpful:

• Eliminate or reduce caffeine, nicotine, and alcohol from your life.
• Engage in regular aerobic exercise
• Practice strategies that can help you sleep better, such as a bath before bed, an hour of “wind-down” time before sleep, staying up until you are really tired, etc.
• Get some Zen in your life! Try meditation, deep breathing, and relaxation exercises.
• Get some Cognitive Behavioral Therapy for Insomnia (CBT-I). You can get an inexpensive self-help course online for CBT-I or find a therapist locally who does CBT-I training.

Do You Want to Know More?

Here are some recommended links for further study:

The American Sleep Association

Can Lack of Sleep Cause Psychiatric Disorders?

Sleep and Mental Health

Sleep Disorders in Psychiatric Practice

Katrina

Katrina Holgate Miller, PhD writes about the strengths and skills people use to face their mental health issues with empowerment (moxie) rather than victimization. She has turned her 30+ years of clinical experience with thousands of clients into stories and tips about how her clients were able to recover from mental illness and addiction and return to the roles they enjoyed during times of wellness. She is author of the website www.moxiementalhealth.com.  Her email is katrina@moxiementalhealth.com

***Readers may freely reprint articles, with the condition that credit is given to Katrina Holgate Miller and this resource box is included in the reprint.

pic courtesy: whatthehealthmag.com

Let’s pretend your mind is a bag, and has been accumulating lots of stuff you thought you needed to keep.  But, much like the bag you hang from your shoulder or the wallet you stuff in your back pocket—it is bulging at the seams and you can’t find a single thought. So, turn it upside down and shake it out and let all the stuff fall onto the table, where you can sort it out and reorganize.

Of course, you can’t really dump things out of your mind; nor can you lay out its contents on a table so you can clearly see what is there. But if you let yourself play with the idea—you might become aware of the inner experience you are having now. Perhaps this experience could be an introduction to “mindfulness.”

So What is “Mindfulness”?

Mindfulness means paying attention in a particular way; on purpose, in the present moment, and not judgmentally.  . . .Jon Kabat Zinn

Mindfulness is a strategy that has been used for centuries to help people power-up on mental health.  It is a way of awakening awareness and using that awareness to overcome misery and build greater strength within. Mindfulness is a critical part of meditation. Only recently has it been recognized as a powerful tool in mental health.

Mindfulness is generally practiced sitting down, though how one positions the body is not important–as long as there is relaxation.  The strategy in mindfulness is to be aware of the contents of one’s mental experience without getting stuck on it.

Two major barriers in mindfulness include “mental chatter” and “judgment”.  Chatter occurs when we are unable to release ourselves from preoccupation with a relentless set of thoughts. Chatter keeps people up at nights–it is a major problem promoting insomnia. Those thoughts are like a noise in our head that won’t turn off. The other barrier, “judgment” is the human tendency to evaluate our thoughts as “good” or “bad”. For instance, we may observe thoughts of good experiences we have had with our family–and label that “good”; but if our thoughts turn to sexuality, that is “bad”.   The problem with both chatter and judgment is that they use a lot of mental resource without taking us anywhere productive–like marching in place. Chatter and judgment hook the basic insecurity that is a part of the human condition–taking us to a place where we feel fearful or as though we are not enough. Such thoughts can rob of of our creativity and self efficacy.

So Let’s Play it again—Mindfully

So, let’s begin at the point where our mental contents are open to our observation–which I have compared metaphorically to dumping the bag on the table. We may find ourself sitting silently in a room, early in the morning, just observing whatever mental activity presents itself. In order to make our meditation mindful–we need to pay attention in a particular way (with acceptance, rather than judgment) and not allow our mind to engage in recycling our worries and obsessions.  This is done by using an an “anchor”—something that will bring us back, so that we don’t find ourselves wandering aimlessly in the forest of chatter or judgment.

Your anchor could be a mantra—like a favorite word or phrase or even sound.  You noticed you had loving thoughts—perhaps you can just repeat to yourself a word associated with love.  “Love”, “Forgiveness”, “Mercy”—some word that can keep you focused.  Alternately, you can anchor yourself with your breath—or even with allowing yourself to keep coming back to an image that brings your peace–like a beach, or your child’s face.  The important thing of having an anchor during mindfulness is that it keeps you organized and on task—rather than churned up, confused, and going nowhere.

And what happens if during your session, you are unable to separate your mind from chatter and judgment?  You can’t stop thinking about your mortgage that is two weeks late, or the thoughts of someone’s foolishness keep pelting your mental space over and over and over.  This situation happens often during mindfulness.  The trick is to apply the principles of mindfulness to the situation.  In other words, you “let it be,” rather than preoccupy yourself with not being able to have a good mindfulness session. One of the good things that can be achieved from mindfulness is to get away from the mental fallacy of believing in failure.  Do what you can to let your anchor bring you back to mindfulness, and if you just can’t do it, try again later. Now that would be, shall we say, “moxie”?  Yes.

What Will I Experience in Mindfulness

Mindfulness is to witness the activity of the mind without the chatter or judgment. You may witness images, sensory messages (such as sounds or smells), thoughts, impulses, creative ideas, or even your state of mind. You may notice if you feel confused, clear, relaxed, or agitated. And, as you become more adept at the process, you can learn to expand your mind (I won’t discuss how to do this today).

Remember:  The mind is the host. The images, senses, thoughts, feelings, etc. are the guests.  They are temporary. When you find yourself evaluating the guests or becoming absorbed with one or more of them—use your anchor to bring you back to mindfulness.

How can mindfulness make our lives better?  That could be the source of many posts. A better question is, “How do I want my life to be better?”  Mindfulness can help you with that one.

Katrina

Katrina Holgate Miller, PhD writes about the strengths and skills people use to face their mental health issues with empowerment (moxie) rather than victimization. She has turned her 30+ years of clinical experience with thousands of clients into stories and tips about how her clients were able to recover from mental illness and addiction and return to the roles they enjoyed during times of wellness.  She is author of the website www.moxiementalhealth.com.  Her email is katrina@moxiementalhealth.com

***Readers may freely reprint articles, with the condition that credit is given to Katrina Holgate Miller and this resource box is included in the reprint.

Have you tried any of these approaches?

1. Tell them that their behavior makes you miserable.
2. Give them advice on how to change.
3. Talk to other people about how bad things are.

Research on the treatment of alcohol and/or drug addiction suggests that any of the approaches listed above are likely to prolong, rather than relieve your misery. People react strongly when they feel their freedom is threatened. Human beings crave freedom from judgment, especially judgment from people they expect to love and accept them. People are more likely to make long-term change when they feel that they are understood and felt by the people who are most important to them.

This observation has led to the development of an approach to facilitating change in others without tripping or offending their sense of dignity.  The approach focuses on building motivation, or desire to change—and letting the individual change themselves. Here are some of the ingredients needed for a motivational approach.

1. There is no moral judgment of the behavior. Labels, diagnoses, inferences of “badness” make change conversations “threatening” and are best left out of a motivational setting for change.
2. Expect and roll with the resistance you will surely get. Whenever other people perceive they are being judged, they will resist. You can tell you are being “resisted” when your conversation partner ignores, interrupts, argues, or denies in response to your advice.  After all, human beings want to be heard and taken seriously.
3. The person who is responsible to change the behavior is the person who has the behavior. This means that unless you are the person who needs to change, you should not be prescribing how to change.  Rather, that is the job of the person making the change.
4. Acknowledging the other person’s feelings, identifying mixed or ambivalent feelings, and encouraging exploration of the other’s thoughts about change are effective door openers to change talk.

Finding a Role that Works in Change Conversations

Ron wanted his wife, Katy to stop using more pain pills than the doctor prescribed. She had injured her lower back and neck in a motor vehicle accident a few years back.  For a long time, Katy’s primary care physician would prescribe opiate pain medication such as Oxycontin or Percoset.  However, Katy would run out after the first week.  She started ordering the pain medications from a internet pharmacy that did not ask for a prescription. Ron and Katy had a family friend, Pam, who had unexpectedly died recently, and the autopsy had found Pam had lungs had stopped working (this is how opiates kill people); and she had high levels of opiate medication in her blood. Ron lived in terror that the same outcome could happen to Katy.

An Attempt that Did Not Work

Shortly after Pam’s death, Ron decided to confront Katy about his fears.

Ron (using moral judgment): “Katy, I just looked at the bank statement and saw that you had made another order from Ping Ping Pharmacy. It makes me so mad that you take chances on your life by taking pain medication without a physician’s supervision.  And besides, you don’t know what is in that stuff. You need to be more responsible.”

Katy (resisting by arguing): “So who are you, Mr. Perfect? Why should I be interested in even having a life, if I have to live every minute in unbearable pain? I need the medication so I can handle the children and household.”

Ron (using moral judgment): “If you keep taking that medication, you won’t have to worry about the children or household. You will leave them motherless.”

Katy (resisting by arguing): “Look, I’m not going to talk about this with you. Just leave me alone.  I’m already in enough pain without having to have this conversation.”

Katy left the room (resisting by ignoring). As Ron sat there trying to figure out what happened, he heard her start the dryer.  He realized he had this conversation a hundred times with her, and it also had the same outcome.  It was like it was “scripted”—different day, same argument. He heard her rummaging around the cupboards for a cup.  He went into the kitchen and sat down at the bar.

An Attempt that Opened a Door

Ron (acknowledging he had judged her): “You know, Katy—I think I just put myself above you.  I came on to you as if it was my job to be your father.  But I’m not your father—I’m your companion and your lover.  Please forgive me.”

Katy: “I’m impressed. You should know that I don’t like having to take the medication—I’m scared, too.  But I just feel so miserable physically and emotionally when I don’t have the medication.  And when I feel miserable, I can’t pay attention to what the kids need. Then I feel like an awful mother.”

Ron (acknowledging her pain): “it sounds like you take the medication to relieve your physical and emotional distress, and then you are able to take care of the kids’ needs. But taking the medication creates more distress—you start to worry if the same thing will happen to you that happened to Pam (the deceased friend).”

Katy: “Well, yes. Every day—that’s all I think about. First, what will happen if I don’t take the medication—and that what will happen if I do take the medication.”

Ron (identifying her mixed feelings): “Oh, Katy, that must really be terrifying. So which one of those two conditions is most distressing—the physical and emotional pain from not taking the medication, or the worry about unexpected death?”

Katy: “Well, the physical and emotional pain from not taking the medication is a sure thing—I know I will have it if I don’t take the medication.  But the worry about dying from using the medication is about something that I don’t think will ever happen.  But then it did happen to Pam. But maybe it won’t happen to me. So I’d have to say—I can tolerate the worry better than I can tolerate the physical and emotional pain.”

Ron (encouraging exploration of change): “Have you ever let yourself wonder if there are ways that you could still take the medication and do what you need to do to relieve the fear of the pain in a way that will feel safer and not cause so much worry?”

Katy: “Oh yes, I think about that all the time. . .”

Ron’s second attempt to talk about the opiate medication was much different than his first attempt.  He was able to establish a collaborative, problem solving atmosphere. He acknowledged Katy’s worry and emotional and physical pain.  He even acknowledged her concerns that she was being judged. His new approach transformed his role in the opiate problem He now became a resource, rather than another source of pain for Katy. She started coming to him for support when she felt physical and emotional pain, and even started to cut back a little on the medication.  She got some outside help from a pain management doctor, who was able to give her a shot of cortisone at the pain sites. She started physical therapy, and an exercise regimen to help strengthen the core muscles in her back and neck. In a couple of months, she stopped ordering from Ping Ping Pharmacy and let her pain medication doctor supervise her efforts at pain relief.

For more information on how to use this strategy for change conversations, read up on the subject of “motivational interviewing”.

Katrina

Katrina Holgate Miller, PhD writes about the strengths and skills people use to face their mental health issues with empowerment (moxie) rather than victimization. She has turned her 30+ years of clinical experience with thousands of clients into stories and tips about how her clients were able to recover from mental illness and addiction and return to the roles they enjoyed during times of wellness.  She is author of the website www.moxiementalhealth.com.  Her email is katrina@moxiementalhealth.com

***Readers may freely reprint articles, with the condition that credit is given to Katrina Holgate Miller and this resource box is included in the reprint.

If you could use science to help your child earn better grades, would you?

What if, at the same time, you could help your child discover that learning is a blast!

The good news is—a strategy has been developed at Stanford University that makes this magic work. It has been has tested on hundreds of students to validate the results.  This strategy appears to turn kids on to the joy of learning and make better grades at school. The strategy is so simple; it can be done at home.

But here’s the catch: You may have to change how you think about things. You have to be willing to believe these two things.

• Failure is part of the learning process. It’s okay to make mistakes—they don’t define us.
• Skill comes from trying new things that will help you learn more.

Mindset Makes All the Difference

The power to ignite the love of learning in children comes from understanding how to influence their “mindset”. A “mindset” is a personal theory—in this case, the person’s theory about how success in life is achieved. Dr. Dweck identified two contrasting “mindsets” from which people approach success.

• A “fixed mindset” is the belief that success is a “gift” or a natural endowment of talent.  Children who have a fixed mindset about success are afraid of failure, as it may indicate that they (the child) just don’t have what it takes to succeed.
• A “growth mindset” is the belief that people can develop success through practice and hard work.  Children with a growth mindset accept failure as feedback to try harder next time.

Praise Children’s “Effort” Rather than “Being Smart”

To test her ideas about mindset, Dr. Dweck and her colleagues divided hundreds of junior high students into two groups and followed their progress for two years.  Initially, they gave both groups of students a fairly difficult set of ten questions from a nonverbal IQ test. The experimenters then created the two mindsets by the feedback they gave the students.

• The “fixed mindset” was created by praising one of the groups for “being smart.”
• The “growth mindset” was created by praising the other group for “working really hard.”

Though before the praise, the groups were the same; the differences began appearing immediately after the praise. The students were then given their choice of tasks, both easy and challenging.

• The group praised for “being smart” started rejecting choosing new tasks that they could learn from. They didn’t want to do anything that would call into question their talent.
• Ninety percent of the group that were praised for “working hard” choose a more challenging task that they could learn from.

Then Dweck’s researchers gave both groups of children some harder questions that they didn’t do so well on.

• The group praised for being smart thought that the reason they did not do well on the new questions was because they were not so smart after all. They didn’t think the problems were so fun.
• The group praised for making good effort thought the difficulty meant that they should “apply more effort.” Many of them thought the harder problems were more fun the easier problems.

Dweck’s researchers then gave both groups some more easy questions.

• The group originally praised for being smart plummeted in their performance on the easy questions.
• The group originally praised for working hard showed improved performance.

During the two years the groups were studied, the “growth mindset” group that was consistently praised for working hard was eager learners and their grades improved. As success built upon success, they did not need prompting to do their homework.The “fixed mindset” group who were praised for being smart became more self-conscious, more shy, lacked the enthusiastic learning style of the other group, and had lower grades.

How can you encourage your children to have “growth mindsets?”  Read the next post on Moxie Mental Health.

Katrina

Works Cited
Dweck, Carol. Mindset: The New Psychology of Success. New York: Ballantine Books, 2007.

Katrina Holgate Miller, PhD writes about the strengths and skills people use to face their mental health issues with empowerment (moxie) rather than victimization. She has turned her 30+ years of clinical experience with thousands of clients into stories and tips about how her clients were able to recover from mental illness and addiction and return to the roles they enjoyed during times of wellness.  She is author of the website www.moxiementalhealth.com.  Her email is katrina@moxiementalhealth.com

***Readers may freely reprint articles, with the condition that credit is given to Katrina Holgate Miller and this resource box is included in the reprint.

Which of these survival strategies works the best for you?

1. Try to intimidate them so they’ll leave you alone.
2. Try to defend yourself.
3. Take the moral high ground and insist you are right and the explosive person is wrong.

If you tend to do any of these behaviors when another person is exploding emotionally, you are likely to make a bad situation very bad.  A person who is exploding emotionally is impaired.  The judgment and control center of their brain is not in full operation. The stuff coming out of their mouth is undigested thought. Do not expect anything you try to put into their mind with your words to be understood—in fact, it is more likely to be misunderstood.

The dilemma is that the little man or woman inside of you wants to hurry up and fix the problem. It wants to be understood, to be treated fairly and kindly, and to receive social approval. So it may be screaming back, “You can’t say that!” or “You don’t understand!” But if the words in your head come out of your mouth—than there are two problems—not just one. And things could get unsafe.

First Goal: Keep Yourself Calm

Emotionally explosive people, during their fits, are on zombie-mode, not fully conscious. If you go into zombie-mode also, it will be like two people throwing garbage at each other.  You will have a better outcome by staying calm and focusing on de-escalating the explosion.

It is true that you deserve respect. Your feelings are as important as the feelings of the emotionally explosive person. It is important that you stand up for yourself—but do it at a time when the emotionally explosive person’s world is not narrowed down to a dot of distress.

If you can’t stay calm when the person you are interacting with is exploding, buy some time or bring in reinforcements. Say something like, “I want to hear what is upsetting you, and I want to give you my full attention.  Hold that thought while I get a drink (or get a support person).  If you need to, remove yourself totally from the situation so the exploder can have some time to calm down before expressing his or her distress.

Second Goal: Deescalate the Situation

The goal of the emotionally explosive person is ultimately to have someone understand their distress. Their mindset, however, may limit their ability to put the distress into words. They may be one big ball of exploding fur—and may need to start the process by communicating intensity rather than ideas.

Intensity is often expressed by hurling insults at whoever is there. The mouth may say something shocking and hurtful, like “you are an #^@&!”  The words may fall into the category of verbal abuse—an issue to be dealt with—but later.  For now, the translation is “My feelings are so intense I don’t know where to start.”

You will most likely successfully de-escalate the explosion by showing empathy. Do reflective listening that attends not only to the content of the explosive person’s words, but also to their feelings.

An Example

So, say you are dealing with an exploder and they accuse you of being a control freak.

Here are some examples of good responses:

• “So, what do control freaks do that really get under your skin?”
• “You feel really stuck.  Tell me about it.”
• “You are having such powerful feelings that blood wants to come out of your mouth.”

Here are some examples of responses that are not so good.

• “Me, a control freak?  Look who’s talking!”
• “You are just a big bully.”
• “Calm Down! You are out of control!”

Another Example

Your exploder says, “You’ve never cared about me.”

Good responses:

• “Sometimes, it feels to you like no one understands your pain.”
• “You would like me to understand where you care coming from.”
• “You feel unappreciated.”

Not so good responses:

• “Now, that’s not fair at all. You know that’s not true. You’re just trying to hurt me—and you’re doing a good job.”
• “Oh come on, you’re just being a big baby.”
• “Shut up and stop playing ‘poor-me’.”

It usually does not take a lot of empathic listening to finally get to the real issues. Your exploder may be angry at himself or herself. They may feel unlovable, or fearful, or lonely. They may be feeling unbearable stress.  At the point they let their real feelings surface, you can begin to have a meaningful conversation. Your skillfulness will have saved the day and strengthened a relationship.  Now, that is moxie mental health!

Katrina

Do you want some good reads about how to deal with emotionally explosive people?  You are sure to love these two books.

1. Behary, Wendy. Disarming the Narcissist: Surviving and Thriving With the Self-Absorbed. Oakland: New Harbinger, 2008.
2. Bernstein, Albert. How to Deal with Emotionally Explosive People. New York: McGraw-Hill, 2002.

Katrina Holgate Miller, PhD writes about the strengths and skills people use to face their mental health issues with empowerment (moxie) rather than victimization. She has turned her 30+ years of clinical experience with thousands of clients into stories and tips about how her clients were able to recover from mental illness and addiction and return to the roles they enjoyed during times of wellness.  She is author of the website www.moxiementalhealth.com.  Her email is katrina@moxiementalhealth.com

***Readers may freely reprint articles, with the condition that credit is given to Katrina Holgate Miller and this resource box is included in the reprint.

Because humans need approval and recognition as much as we need food, it is rather easy to wound a soul.  There are times, in all of our lives, when others have withheld their approval, expressed their disapproval, or been seething mad at us.  Psychologists call experiences that wound our fragile sense of self “invalidation”.

What Do You Do When You Are Invalidated?

Invalidation tends to trip some switch in our souls that lead us to reach into our bag of nastiness. Have you ever blamed, cursed, cried, shouted, or did something that you understood would create pain for the person who has invalidated you? Just as skunks are equipped to inflict their predators with spray, humans are equipped to inflict emotional predators with rage. We all came to life equipped with rage. Rage, however, begets rage between individuals, families, institutions, and countries. In rage, we offer the silent treatment, hire lawyers, build bombs, or even blow up the world.

Equally nasty is avoidance—which causes us to erect barriers to others loving us and withhold our love for them.  Avoidance occurs when we choose to freeze, run away, or build a wall to keep us isolated and safe.  Avoidance can be a silent, slow suicide or homicide, chopping years off of longevity in both the avoided and avoider.

Rage and avoidance are avoidance behaviors that can keep conflicts alive for generations.  Who of us has not developed ways of defending ourselves from the potential negative reactions in the process of coming together as humans? Being hurt and giving hurt becomes a circular process forcing us to rotate between the role of victim and victimizer.

How to Relieve Suffering

George Hegel (2009) proposed that mankind learns effective solutions by bouncing off of seemingly impossible contradictions (a paraphrase of his “thesis-antithesis-synthesis” idea).  Generations of human beings who have bounced off the dilemma of giving and getting hurt in the process of desiring to be loved have come up with a solution that is surprisingly similar: Acceptance can put an end to interpersonal suffering.

In our generation, the solution has come from pioneer psychologists, starting with Marsha Linehan’s (1993) recognition that Hegel’s observations could be used as an intervention to help patients with serious mental illness.  She recognized that these patients had excessive experiences as recipients of invalidation. She recognized that the initial response to invalidation is to resist and push against the invalidating event.  She labeled the natural push back “willfulness”.  She taught her patients, that instead of pushing back, they should accept the invalidation “willingly” and move on with life.

A decade later, Tara Brach (2004) popularized the term “radical acceptance” to describe the cure for emotional suffering. She noted that that the power of radical acceptance has been understood for more than millennia, and in fact, was practiced by the Buddha. The first truth of Buddhism is accepting suffering, as it is inevitable.

But wait—the Christ taught it, when he told his disciples to respond to the hurt inflicted by others by turning “the other cheek”. The Jewish mystics taught the Kaballah—which literally means “acceptance”.  Gandhi used the principle to earn sovereignity for India. Nelson Mandela led his nation to accept the injustice of Apartheid by having people on both sides of the controversy come together, acknowledge their pain, and move on. In nearly every faith and philosophy throughout earth’s history, there has been articulation of the wisdom of accepting rather than retaliating against hurt.

The strategy of acceptance is as effective for today’s interpersonal pain  as it has been throughout the millennia. The victim and the victimizer; the spitter and the spat upon—we will all take our turn giving and getting pain.  Will we choose to accept it, and move on with living?

I like it best the way the Beetles sang it:

And when the broken hearted people living in the world agree,
There will be an answer, let it be.
For though they may be parted there is still a chance that they will see,
There will be an answer: Let it be.

Let it be, let it be, let it be, let it be.
Whisper words of wisdom, let it be.

Stay tuned. Our next post will review some specific strategies that psychologist teach to facilitate the practice of accepting pain.

Katrina

Works Cited

Brach, Tarra. Radical Acceptance: Embracing Your Life with the Heart of a Buddha. New York: Bantam, 2004.

Hegel, George. Science of Logic (Digital Edition). Cyraria, LLC, February 2009.

Linehan, Marsha. Skills Training Manual for Treatment of Borderline Personality Disorder. New York: Guilford Press, 1993.

Katrina Holgate Miller, PhD writes about the strengths and skills people use to face their mental health issues with empowerment (moxie) rather than victimization. She has turned her 30+ years of clinical experience with thousands of clients into stories and tips about how her clients were able to recover from mental illness and addiction and return to the roles they enjoyed during times of wellness.  She is author of the website www.moxiementalhealth.com.  Her email is katrina@moxiementalhealth.com

***Readers may freely reprint articles, with the condition that credit is given to Katrina Holgate Miller and this resource box is included in the reprint.

Have you ever awakened in a terror, only to realize that the horrifying fate you had just witnessed was only a nightmare?  How would life be different if nightmares were real?  Perhaps there would be no more tomorrows, where you could continue to live with those you love and continue to do what you love doing.  Zap—you awaken, and life and its beauty come back to you.

Mental illness is like a nightmare.  Recovering from mental illness is like wakening to find ourselves once again fulfilling our roles in life successfully.  Recovery does not change the fact that an illness occurred, and that symptoms of the illness may even be present.  However, recovery frees us from believing we don’t count because we are crazy and irrational.  It puts our repertoire of “can’ts” in the background,  and reminds us of the many options for the good life that are available to us. Recovery allows us to shed the sick role and use sound thinking to guide our future.

How Do I Start the Recovery Process?

Doctors and therapists encourage but do not create recovery.  That is the job of the individual patient.  Recovery begins with hope—the insight that things can get better.  The Center for Mental Health Services (2004), a division of the Substance Abuse and Mental Health Services Administration (SAMHSA), summarized how to begin recovery in their consensus statement:

“Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible.”

Natasha spent most of her adolescence in acute and residential treatment facilities. Her Bipolar illness interrupted her ability to function at home and school.  Her intense emotionality and quick anger made it uncomfortable for others to be around her, and people sometimes felt threatened by her.  She was miserable—and often wondered if life had any meaning. One day, she had an insight that life could get better—and she started to work to make that happen.  This started her recovery process.  She enrolled in college and got a degree in fine arts. She fell in love, got married (later divorced) and had a son.  She got an administrative position at a prestigious college.  Her peers at work recognized her brilliance.  She was the life of the office and kept everyone in good spirits.  She had an eye for detail, and if anything was missing from a plan of action, Natasha knew how to fix it fast.

Her son, Randy, however, was her most precious endeavor in life.  She made sure he went to the best schools, and that he had the tools to master his academic subjects. He was always on the honor roll—until his sophomore year in high school.  That was the year that Randy became very ill with Bipolar Disorder.  The hardest part of Randy’s illness was the experience of psychosis: Hallucinations, delusions, not caring for any of his responsibilities—even his own grooming.

At first, it was relatively easy to stabilize Randy on medications.  But by his senior year at high school, it became harder and harder to stabilize Randy when he would become psychotic.

The best psychiatric hospital for adolescents was three hours away from Natasha’s home.  She would accompany Randy to the hospital, and stay in the Ronald McDonald House.  She was unable to keep her job and spend so much time away from work, so she retired. In fact, she gave up almost everything that had kept her going in life to “be there” for Randy.

Several months into the last hospitalization, Natasha told me she was starting to “lose it”.  She felt the old feelings of anger and despair surfacing daily.  She felt like she might end up in the hospital herself.

One day, I shared an observation with Natasha.  “You know, Natasha, you are one of the most emotionally expressive and powerful women I have ever met.  Have you ever written any poetry?”

In fact, Natasha had written many poems about her experiences over the years.  She kept them in a journal at home. She sent me an email with a couple of her poems. They were much better than any of the published poems I had read—another observation I shared with Natasha.

The realization of her value as a poet enabled Natasha once again turn to recovery. Natasha made arrangements for Randy to have the care needed until he was stabilized, and she returned home. She used the despair and anger and loneliness that troubled her to write “confessional poetry”. She started attending “open-mike” night at her community’s poet organization, and recited her poetry on stage.  Her blatantly honest descriptions of her feelings drew readers into her experience. They found the feelings she described “intriguing” rather than “sick”–in fact, many of them had felt the same way—but never admitted it.  Natasha’s description dignified their feelings.  Before long, she was a local celebrity. But most important, she had transformed her self-definition to “poet” and “friend” instead of “bipolar” and “lonely”.

How Do I Stay in Recovery?

Natasha’s story informs us that recovery involves redefining life in ways that empower us as valuable players in life.  As summarized by the consensus statement of the Center for Mental Health Services (2004):

”Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals.”

Can you believe in possibilities? Then you can find the road of recovery. Do you know and practice coping skills that work for you? Can you work a little each day on sharing your capabilities and talents? Then you can stay “in recovery”, and find it again if you ever get stuck.

Katrina

Works Cited:
Center for Mental Health Services. “SAMHSAs National Mental Health Information Center.” mentalhealth.samhsa.gov. December 16-17, 2004. mentalhealth.samhsa.gov/publications/allpubs/sma05-4129/ (accessed September 7, 2010).

Katrina Holgate Miller, PhD writes about the strengths and skills people use to face their mental health issues with empowerment (moxie) rather than victimization. She has turned her 30+ years of clinical experience with thousands of clients into stories and tips about how her clients were able to recover from mental illness and addiction and return to the roles they enjoyed during times of wellness.  She is author of the website www.moxiementalhealth.com.  Her email is katrina@moxiementalhealth.com

***Readers may freely reprint articles, with the condition that credit is given to Katrina Holgate Miller and this resource box is included in the reprint.