Thoughts on therapy.

     I would imagine a lot of people are afraid of the idea of therapists.  The idea of allowing yourself to be so vulnerable to a complete stranger is very alien.  I have only had two therapists for any extensive amount of time; and both experiences are completely different.  During my first session with my therapist in the United States, she completed a rather comprehensive sort of evaluation that allowed her to recommend a diagnosis to the psychiatrist.  After that she dove right into problems I was currently having.

     Here in Canada, a much more basic evaluation was given, more as a general psychiatric and psychological history than anything else.  The next few sessions were a getting to know each other period where I didn’t talk much and answered her questions directly.  There was a great period of time in both instances where I needed to become comfortable with talking to them about my issues.  In both cases, there was very little talk about my past and instead a focus on how to deal with my current problems.

     I have been undergoing a form of therapy known as cognitive behavioural therapy (CBT), which has less of a focus on past trauma and instead focuses on the present and changing your thought-feeling interaction.  It is especially useful for people with anxiety or other issues dealing with irrational thoughts affecting moods.  My current therapist does most of the talking during our sessions.  Given my various issues this is not necessarily a bad thing.  It does, however, go to show that the pressure is not on you to talk if you don’t want to.  It can be beneficial to “interview” your therapist to see what types of therapy they offer, credentials, and other things important to you in a potential therapeutic partner.

     I am in a position where I cannot “shop” for a therapist, though it is recommended that you do so that you can find one that is right for you.  Generally therapy is not cheap, but keep in mind that there are usually options for those who cannot afford regular therapy costs, such as sliding scales, government-assisted payment, and non-profit organizations that help people with mental health conditions.  I am fortunate enough to be in a position where I do not have to pay for the therapy I receive; the trade-off is that I am limited to a very small circle of therapists I can see.  Even in my position, I still have the right to seek another therapist if this one does not meet my needs.

     Seeing some sort of therapist does not make a person any weaker.  Therapists are often nothing more than a sounding board or tool to get alternative ideas that you ordinarily would not have thought of on your own.  Often my therapist gives my thoughts validity and gives me the courage to actually do what I know needs to be done.  A therapist is just another, as mine would say, tool in your toolbox of mental health.

     What are your thoughts on therapy?  Do you see a therapist, do they work for you?  How long did it take for you to find one you liked?  What sorts of questions would be helpful while “interviewing” a new therapist?

--JJM

Bullying and its effects.

     Bullying can have profound effects on a person’s health; and there are many types of bullying.  What I mostly want to talk about are bullies who are also adults.  Though when most people think of bullies they think of children, this is false.  Adults can be bullies to each other, and though it may come as a surprise, some adults can be bullies to their own children.  Bullying can lead to depression, social anxiety, general anxiety, nightmares, and it perpetuates the cycle of bullying.  Bullying is based on an imbalance of power, both real and imagined.  If one person wields more power than the other, or if one person perceives the other as more powerful, then there is the potential for bullying. 

     Not all relationships with a power imbalance lead to bullying.  This is what makes it particularly difficult to imagine a parent bullying their child.  There are different types of bullies; some do not care at all about the feelings of others and seek only to cause pain; some may not even mean to bully; some may use language to bully others; and others may resort to physical means to bully others.  Some examples in the real world would include a boss who makes a sarcastic remark about the speed or skill at which a task is being done.  This is bullying, even if unintentional, and words hurt more than people realize.

     How many times have we been told “sticks and stones may break our bones, but words can never hurt us?”  Those of us who have been at the end of a verbal bully know that this isn’t true.  Words can leave a mark just as deep, if not deeper, than physical wounds.  We carry those words with us for our entire lives, and if it is a parent doing the verbal abusing the damage can be especially wounding.  I am not trying to discount the experiences of physical bullying and abuse, which is heinous in and of itself.  Those that are unfortunate enough to have undergone physical bullying know that it rarely travels alone and is accompanied by other types of bullying.

     Physical bullying by an adult can be administered to a child as a form of “discipline.”  It is often said there is a fine line between spanking and child abuse.  Studies have shown, over and over, the negative effects of spanking on a child.  Also, hitting a child with a belt, paddle, or switch is without a doubt child abuse, as is a hit or slap to the face/head.  It is especially damaging to young children when they do not associate the spanking with the action they were doing.  This is not a matter of opinion: http://www.legal-info-legale.nb.ca/en/spanking_disciplining_children.  The intent of the discipline doesn’t matter, physical discipline is often bullying.  The child is helpless, and this type of bullying leads to a distrust of adults and a view that adults want to hurt them.

     It is sad to report that unfortunately there is very little a person can do about an adult bully.  They are often set in their ways and have their behaviour so ingrained that there is no desire to change.  They also have very little desire in “talking it out.”

     I have been bullied many times, many ways, for many years.  These events have crushed my self-esteem, and made it difficult to form loving attachments.  That is not to say that I wasn’t, at times, a bully myself.  To those people, I would like to deeply apologize for my actions; it is only upon being an adult and fully being able to understand the ramifications of my actions that I can see how much damage I have caused.  We are often told to ignore bullies and they will go away seeking more “fun” prey, and what they do is predation, but by then the damage has, more often than not, been done.

     What recourse is there for those who have been bullied?  Report the bullying, and people need to take it seriously.  It is a very serious event with long term, and deep running, effects.  As an individual undergoing bullying, stand tall and look them in the eye and tell them to stop.  This may or may not work, however, and especially if a child is being bullied by an adult may make matters far worse than originally suffered.

     Have you ever been bullied?  Are you currently being bullied?  How did/do you deal with bullies?

--JJM

Ending discrimination against mental illness.

     We are conditioned to fear those with a mental illness.  I remember, even in a group of other people who live with such conditions, the fear associated with a young man who laughed and talked to himself.  There was no reason for anyone to be afraid of him, yet many in the community did.  They feared he was “crazy” or at least “crazier” than they were.  They thought he was going to snap at any moment.  He was, as I remember him, gentle and very friendly.

     Why are we so prejudiced against those with a mental health condition?  I’ve mentioned before, but it needs repeating, the media is largely to blame.  Not just news media, but also film and literature as well.  We are bombarded with images of violent people who are mentally ill.  Perhaps a so called “psycho-killer” or some other stereotype that has existed for so terribly long; perhaps some person popping their medications to make the bad things go away.  When a violent crime is committed, the news media is very quick to find a sort of mental illness to blame away the violent behaviour.  Something near 25% of the adult population suffers from some sort of mental health condition.  It certainly stands to reason that a portion of violent criminals may indeed be seeking treatment for an illness, but is that really pertinent to why the crime was committed?  Is it important to mention if the shooter were diabetic or on blood pressure medications?

     Why does the news focus on such a singular aspect?  I wonder if it makes it more palatable; being able to turn the event into “us versus them,” the sane, versus the insane.  The simple truth of the matter is when undergoing proper treatment those with a mental health issue are not any more likely to commit a crime than any other person.  Likewise, today’s society is biased against those with such an illness and tends to turn them into victims themselves.  Over simplifications, stereotypes, and false information lead to the vilification of those with a mental health condition.

     It is precisely these stereotypes that cause shame and fear in openly discussing mental health concerns.  Those that suffer are afraid to speak up, and those who do not know better are afraid to ask at the risk of incurring wrath and ire.  As someone with a mental health condition, I understand the importance of being patient and kind in my dealings with those who simply do not understand, but equal consideration must be given.  That is, do not be shocked if the answer you get is not the one you expected.  Be patient with the person’s response.  They simply may not be ready to talk about it.  However, both parties must be willing to discuss these matters.

     It is a problem world over that an employer would hold in higher importance the mental health of a person over their physical health.  In the United States, at least, there is a provision that reasonable accommodations may be requested by the employee in doing their job.  What is often the case is that they mean accommodations for physical limitations may be requested, but mental limitations are met with skepticism because they are “in the person’s head.”  The only thing that should matter is “can this person, with reasonable help, do this job?”

     What can we do about it?  As a whole we can stand up for those too timid to stand up themselves.  Contact news stations to ask what purpose did mentioning mental health serve in an article.  Don’t watch films that portray the mentally ill in a negative and exaggerated light.  Do not go to these Halloween haunted asylum attractions, and write in protest of them.  Those with mental health issues can strive to be shining examples whenever and however they can.  They can be open to questions, and try hard not to be offended by ignorance.  Remember that they are just trying to understand.  Those in entertainment can stand up and refuse to allow such stereotypes to be perpetuated.  Make a stand and have mental illness cast in a realistic light for a change.  Together we can end the discrimination against those with mental health conditions.

--JJM

Reflections on having social anxiety disorder.

     On top of bipolar I also have social anxiety disorder.  I would like to think that my case is much more mild than most, however it still greatly affects my life.  Social anxiety disorder is also known as social phobia and it can strike anyone.  People like to think of those sufferers as just being shy or introverted, but the reality of it is far worse than that.  Many, including myself, worry about everything we say or have said.  Often those who live with this type of anxiety practice what we are going to say or do many times before actually doing it.

     I know I try to “predict” how a conversation is going to go.  I often guess at what someone is going to say before they say it so I can work on how I would respond.  I am often wrong and it leaves me in an awkward situation where I have no idea how I am supposed to respond.  This leads to one of two things, either I don’t say anything, or I say what I perceive as the “wrong thing.”  Both of these are problematic.  If I don’t say anything I assume people with think I am smug or that I am uninteresting.  These feed into issues of self-worth and confidence.  If I say the so-called wrong thing, I call myself stupid for saying it.

     If I am not trying to predict the conversation then I simply trip over my words.  My mouth works faster than my brain can edit and something strange comes out, if anything at all.  Again, these are my perceptions of how I sound and feed into a sort of depressive mood where I “beat myself up.”  It is often the case that social anxiety and depression occur within the same person.

      My other problem is, perhaps, smug.  I simply don’t care what someone else is actually saying.  I don’t mean if they are saying something important or interesting, I mean when a stranger on the bus starts talking about the weather.  I don’t care.  I don’t understand so-called small talk.  It confuses me beyond belief.  People rarely say what they mean, they rarely say anything important, but in order to fit in with society you have to play the social game.

     I have often asked others, many in mental health professions, what the purpose of small talk is and they have no answer except that it leads to other conversations.  I don’t understand why people can’t just start with real conversation, or at least enjoy the silence.  If you jump right to the “meat” of a conversation before it is appropriate you are considered to have committed a faux pas.

     Another problem that I know I have is not answering questions correctly.  I don’t mean factually correct, I mean adhering to the letter of a question not the spirit of it.  For instance if you ask me how my day went there is a huge chance you will get the answer “fine,” and that’s it.  I have been informed that the spirit of that particular question is actually a series of implied questions such as “did anything interesting happen?”  “How are you feeling after your day?  (How is your mood today?)”  “What happened in general during your day?”  “Why did your day go the way it did?”

     I rarely answer my phone, even if it is my therapist confirming my appointment, and just wait and check my messages.  This is similar to how I deal with knocks at my door.  I tend to not answer, or oddly enough, I feel obligated to answer and listen to what the solicitor has to say to the fullest and then feel guilty about saying no.

     Facets of social anxiety make it hard for me to say no.  I feel that if I say no, or voice a contrary opinion I won’t be liked.  Being liked is very important; even though I like to say that I don’t care what people think about me, if I know they don’t like me it does hurt.

     I used to be far worse than I am now.  Since moving to Toronto I have been seeing a CBT (Cognitive Behavioural Therapy) therapist.  There I have started to learn to live in the moment and try not to predict how a conversation is going to go.  I am also learning to be more assertive and to stand up for myself.  I’ve learned about separating thoughts from feelings, and many other useful tools.

     While CBT may not be for everyone, it has certainly helped me.

     You are more than welcome to share your thoughts and/or experiences on social anxiety disorder in the comments below.

--JJM

My experiences with shame and stigma.

     Many, if not all, of us have experienced some sort of stigma at a point in our lives.  Before getting into the stigma I have faced let me say that I know exactly how privileged I am.  All in all, I’ve had a pretty good life.  That being said I am going to talk about my experience with stigma as it pertains to mental health issues.

      What is stigma?  For those that don’t have a good idea about what stigma actually is, it is a negative stereotype.  It often trivializes those that it stereotypes, belittling them.  It also usually offends them, and patronizes them.  If it does any of those things, chances are it is an example of stigma.  I would say that stigma comes from assumptions.  When we make assumptions we run the risk of stigmatizing people.

     Growing up there was nothing specific I can remember being said against those with mental health issues.  There was certainly something in the air in general though.  The media is steeped with stereotypes against those that suffer with mental health issues.  Perhaps that is where I learned that there was something wrong with something being wrong.  At any rate, I learned two things: getting help is not something a man does, and medication is only for when there is something you can’t fix on your own.

     As my life progressed and I needed help I didn’t even know how to ask for it.  It was offered, but I couldn’t accept it.  When I was in the hospital for the first time my own assumptions about what those with mental health issues crept into the open and didn’t allow me to get the help I desperately needed.  I thought to myself “these people are crazy, I don’t belong here, I’m normal.”  After getting out of the hospital I was given tremendously bad advice by those who didn’t understand, didn’t want to understand, or had a skewed perspective on what was going on with me.

     I think they were honestly trying to help, but were of a generation that had less of a grasp on mental health than I did.  I think the biggest issue was everyone simply not talking about what was going on.  There was something wrong with me; others claimed it was just weakness.  There was shame, shame in disappointing others, shame in not being able to look others in the eye with confidence.  I remember feeling so broken.

     I didn’t know how to talk about what was going on with me.  This caused me to run.  I tried to run as far and as fast from everyone I knew, and when my issues flared up my first instinct was to run.  This caused many failed relationships.  Not just romantic, but friendships and familial relationships were ruined.  I was so afraid of being judged harshly and part of me felt it wasn’t their business.  I could handle my own affairs solely.  This always ultimately led to isolation.  If I was alone, I couldn’t be judged.  That seemed like the best course of action.

     It wasn’t until I entered the work force that I fully understood what type of discrimination I could face for having bipolar and being hospitalized.  I remember the shame I felt immediately after my latest (and hopefully last) suicide attempt.  There was nothing but shame in my eyes.  I feared that I would lose my job.  I learned shortly thereafter that another employee was demoted for being on antidepressants that were supposedly causing her to make mistakes.  I worked in retail, which in and of itself is not forgiving of any missed time, and every time I needed to call off I was so afraid I was going to lose my job that I desperately needed.

     I was ashamed and told white lies to coworkers so that they would not know what had happened regarding my hospitalization and my continued instability.  I was afraid that they would treat me differently.  I was afraid of the discrimination I would face.

     One particular instance I remember was talking with my therapist about doing work that I found fulfilling, and I had said that when I worked the customer service desk I felt more as though I were doing something that mattered because I made people happy.  My therapist had suggested that I get a note from my psychiatrist stating that I could only work the desk.  When I turned it in I was met with overwhelming opposition.  The request was seen as unreasonable in that it was more stressful and harder work therefore it made no sense that I should have such a request.

     I was so careful about what I said to anyone about why I was only behind the desk and of course made it a point to hide anything going on with me.  I couldn’t always hide, of course.

     Eventually a local relocation forced me to leave that particular store and part of me really wonders if the reason I had such a hard time finding work (I didn’t), while I was still in the state, had to do with receiving a negative review by my previous place of employment.  For some reason I was even denied a transfer to a local store that was within walking distance.

     It was not until recently that I have fully embraced what is going on and realizing that there is discrimination against those with mental health issues and that the only way for that to end is for people to stand up and publicly state what is going on with them.  That being said, I am trying very hard to correct people when they make a discriminatory statement and be more open about my own issues.

    So, how about you?  What are your experiences with stigma?  Have any stories or anecdotes about discrimination?  Share them in the comments below if you feel comfortable.  Let’s get a dialog going on this, shall we?

--JJM