WillSpirit!


∞ Where Mental Skills Heal Mental Ills ∞

A former physician writes about mental health and recovery using insights from life, science, and spiritual practice.








  • Red_Exclamation_DotDisclaimer
    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.


Closing the Window on Past and Future

In a meeting last week with my Acceptance and Commitment Therapy (ACT) practitioner, I remarked that worries about the distant future and regrets about the remote past no longer trouble me. For instance, I don’t lie awake nights fearing old age and isolation. I don’t visualize myself slumped in a wheelchair in some nursing home, alone and forgotten. Nor do the choices that led to my lack of children and career haunt me like they once did. It feels wonderful to be freed from mental content that used to terrify and demoralize me.

On the other hand, prior to the past few days, more immediate events remained profoundly disrupting. For some reason, the window seemed to be about six months in either direction. For instance, I felt intensely frustrated by a doctor who has been treating me since January, because he views me through the lens of stereotypes bequeathed by my psychiatric record. I regret placing my orthopedic care in his hands. And part of the reason for my recent psychiatric collapse was my fear of aimlessness in the aftermath of my closing the acupuncture practice. I have no idea what to work on next, but rather than giving myself time to reorganize, I recoiled against my current lack of direction.

But why, I’ve been wondering ever since my ACT session last week, should a six-month envelope keep me captive? If I can release fears about what might happen in two decades and regrets about choices I made a dozen years ago, why not let go of next summer and last winter?

It should be easy to further narrow the window of relevance. If images of loneliness and isolation in old age no longer trouble me, when they once sparked panic attacks, why should I worry about a few months of extra free time? If the decision to move away from San Francisco and take up suburban life no longer seems disastrous, why complain about my poor choice for a new doctor?

The future and the past don’t reside in the brain. There is only the present moment, colored by traces of years past and imaginings of coming events. Both the traces and the imaginings can be consciously reshaped to serve our better purposes. For that matter, they can be left in the hidden matrix of latent neural patterns rather than pulled into current awareness.

I’ve enjoyed a new feeling of spaciousness over the past couple of days as a result of this realization. It seems to me that the difficult work of letting go of deep past and distant future makes this shift in attitude toward more immediate events rather easy. It only requires that I exercise my ability to determine what gets pulled into awareness and how my thoughts frame reality.

As often happens, a serious (though brief) psychiatric crisis forced me to reassess my mental life and update my strategies. This is the value of pain, I believe: it stimulates growth. Our task is to quit fighting and start learning.

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Closing the Window on Past and Future was published on May 14th, 2012 . 4 comments






Forgiving Self and Others

The last post bemoaned my failure to love my father properly despite his faults. In fairness to myself, I must emphasize that he did not make love easy. But although that’s a reasonable excuse, with increased spiritual grounding I can no longer fall back on it. At the same time, there’s no point in wallowing forever in remorse.

Soon after writing that piece, I prayed under the stars for an hour, begging forgiveness for everything I’ve done that’s hurt anyone, ever. I understand God as something that arises from within, not without. So with genuine remorse, praying may not be necessary. But it can’t hurt. Gazing at the stars shining out of the clear mountain night, I tried to recall as many missteps as I could. In addition to the times I hurt loved ones, I also feel terrible about the patients who were injured by my mistakes. Errors were especially common during medical training, but also cropped up occasionally in later practice. My list of sins was painful to behold, but the ritual helped me feel freer. With that release I hope to quit beating myself up about what happened with my dad or any past error. I did the best I could. It wasn’t that great a performance, but it was all I could muster at the time. I believe it’s OK to move on.

The next morning I received an email from a reader, Trabel, who offered an interesting take on the book my dad gave me at that last visit, a text about corruption within the medical establishment. Her analysis makes sense to me; I share an excerpt with her permission:

There could be another possible interpretation of this last encounter with your father. Taking into consideration the title of the book he offered to you, it may be implied that he wanted to give you a warning about the deadly abyss of the medical system to which you were heading right in …

He had an empirical, realistic way of thinking, I can imagine; he also witnessed how your mother lost herself in the “health care” system (he saw not only her, maybe) – and by giving this book to you, he may have wanted to tell you “Do not let yourself get lost in this system! Don’t rely on them – find your way all by yourself!”

My father was indeed worried about the psychiatric drugs and their negative effects on my weight and clarity of thought. He did not like the way I was taking on the illness role and shrinking from engagement. And he did feel anger toward the psychiatrists who contributed to my mother’s decline and death. So it makes sense the book may have been meant as a warning.

Since I would have been resistant to his opinion stated outright, giving a book might have felt like his best option. A few years later I donated his present to our local library thrift shop without having read it—the book caused me pain just sitting on the shelf. I regret that decision and plan to track down the text and read it now, to honor my father and his last gift to me.

My dad made mistakes that caused lifelong problems for his children. The root problem was alcoholism. He knew he was an alcoholic, but he refused to seek treatment. He openly acknowledged that he drank to escape life’s pain; he could not imagine facing his demons sober. His fatalism in the face of his addiction may have been the most tragic fact of his life.

As I forgive myself for my shortcomings, I continue to work on forgiving my father. My recent writings have forced me to realize the scars remain more tender than I knew. Healing the past is an ongoing process, as perhaps it will always be…

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Forgiving Self and Others was published on April 20th, 2012 . 6 comments






Some Problems with Psychiatric Diagnosis

rose_mosaic

One of the sites I’m fond of is Hopeworks Community. A number of things can appeal to me about a site. Some are heartfelt. Some are lyrical. Some provide pragmatic advice. Some take political stances. In fact, most do all these things. Hopeworks provides reasoned analysis of issues relevant to people affected by mental illness (but see Hopeworks and what I write below for some discussion of the ‘illness’ concept). Any time I get engaged in a topic, my fingers go nuts and before long my text has morphed from an intended sentence or two into a mini-essay. That happened yesterday on Hopeworks, when I wrote a comment discussing two posts: ‘What diagnosis depends on‘, and ‘On the words we use‘. The subjects were diagnosis and semantics in mental illness. Important subjects. Since I was happy with my little response, and since I won’t have much time to write today, I am posting my discussion below.

I promised to write about the relationship between ‘who we are’ and ‘what goes on in our brain’. That topic is so vast that covering it in a blog post is presumptuous to the point of grandiosity. But I do have some ideas that can be squeezed into one of my longish essays. The interrelationship between mind and body (especially, of course, brain) fascinates me, as it has philosophers for ages. I want to do it justice. I have touched on it before, and no doubt I will come back to the subject over and over until the day I die (hopefully a long time from now, for those who monitor me for suicide risk). So the much-anticipated essay will be produced soon. But not today.

Instead, here is my 2¢ about diagnostics and the labels that result.

[Comment to Hopeworks with regard to psychiatric diagnosis:] Having had medical training, and even one-time aspirations to become a psychiatrist, I started out with faith in the DSM. The more time I spend as a patient, and reading blogs, and thinking about how I’m going to get to a better place, I see the fallacy in labeling people as mentally ill. My latest thinking is that our brains are as different as our mugs. Maybe I even brought this up on your blog before. You can categorize faces: male, female, European, African, Asian, old, young, attractive, ugly. And you can separate facial expressions: happy, sad, angry, etc. But just saying someone (like me) is a male, of European descent, middle-aged and with a look of concentration at this moment does not mean that is all I am or will ever be. It is not enough information for you to recognize me on the street, or to know what would work to make me more comfortable with being alive.

Psychiatric diagnoses have that level of precision. Some people have fluctuating moods. Some are chronically sad. Some worry all the time about everything. Some hear voices and have ‘odd’ ideas. Each of these persons can be diagnosed with a DSM label, and so by that definition they are mentally ill.

It’s a bit like saying only a particular race or gender is capable of running things. Only a certain emotional make-up is healthy; deviate far from that norm and you have a disease. Maybe you should be locked up and sterilized. You certainly can’t be in a position of leadership or responsibility (is anyone else old enough to remember Thomas Eagleton?).

Like you say, what matters is what works. And what works is what makes life a more satisfying experience. Dulling emotional responses, or squelching internal voices may help accomplish that for some people. But not for all. Some would be happier to be left with their minds in their native condition. Some can get a lot more happiness out of life by accepting their quirky brains than they ever can by acquiescing to long-term psychiatric drugs.

As someone who once bought the mental disease model intellectually and emotionally, I am astounded to find myself about to write that I am not sure that mental illness is a valid construct. I took all my meds diligently for years (I was a very ‘compliant’ patient). But I still felt rotten. Now I feel better even though I am on a milder chemical cocktail (hopefully soon to be none at all). So was I really sick? Or just confused?

I spend time on the local psychiatric unit, counseling patients about their legal rights when they face involuntary confinement. Some of these people are quite out-of-control, and would have trouble being safe on the streets. I can’t say what the answer is in those cases. Maybe when things go that far there really is a sickness going on. But that does not mean that the person has a mind that can never be trusted again. That they now should carry a lifetime diagnosis of, say, bipolar I. That they will require drugs forever, and can never learn to live safely and well without medication. Maybe it is the all-too-frequent permanence of mental illness diagnoses that is their biggest problem.

We are all different. ‘Some of us are more different than others.’ The problem with the ‘illness’ label, is that it automatically means there is something defective. Maybe all that is wrong is that our eyes are open. That we see and feel more pain, or are more in touch with imaginative influences in our minds. Or we are more conscientious and want everything to be just right. Or impulsive. Or scared. These are not illnesses, they are responses to life. Maybe they are exaggerated and do not serve us well. Maybe medications can help us live fuller lives. But I object to being told my brain is abnormal, and that the person who never soars into ecstasy or crashes into sadness is healthier and (by implication) better.

It cannot be overstated: what matters is what works. If having a diagnosis in hand makes one feel vindicated, so now they can show people they aren’t just lazy or selfishly pessimistic, then it is a good thing. If it helps select a medication to get someone balanced enough that they can go home and work on better solutions, then maybe a diagnosis is useful. The same if being given a name of their ‘lllness’ leads a person to the most helpful shelf in the bookstore. But if it means I can never get long-term care insurance (I can’t), or be trusted to practice medicine (a psychiatry program I applied to reported me to the medical board), or that I will always need to take medications that wreck my body and undermine my self-image, then they are most definitely not OK. thornsThat kind of thing happens so often, that it is easy to understand why people with mental/ emotional/ behavioral/ brain/ psychiatric – illnesses/ conditions/ disorders/ diseases/ abnormalities/ challenges/ dysfunction/ gifts object to the psychiatric model. When diagnostics work they help a little. But when they are overused, misinterpreted, or otherwise go awry, they do an incredible amount of harm.

(I slightly modified this post on 2009 August 17, c. 08:30 PDT.)

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Some Problems with Psychiatric Diagnosis was published on August 16th, 2009 . 19 comments






The Vitality of Risk vs The Safety of Caution

Mountain Lion Picture comes from National Park Service via Wikimedia

Yesterday my post took too much time to tell a story too far off-topic; the main subject is meant to be behavioral health. Even though life-history, spirituality, and psychology overlap, I plan to keep mental health the central stream. Yesterday’s final paragraph said what the entire memory/story had been driving toward: remember how excited we were as youths? Wouldn’t it be nice to regain some of that passion? Even if it also meant making some silly mistakes? Or taking some risks?

Not long ago I concluded that to a large extent, for me, fulfilment depends on passion. Life begins to look dull and pointless when everything feels lukewarm. There needs to be an occasional volcano, or some lightning storms, or comets racing across the sky. Maybe feeling a lava flow’s heat scorch my face, or listening to the roar of a tornado from across an abandoned field would do me good. Over the past decade, my mental health clinicians inculcated me with a sense of fragility. Last year at this time friends were going on a trip to experience three-day ‘vision quests’ alone in the high desert. My therapist and psychiatrist convinced me that doing so might make me depressed. Wouldn’t want that.

But what if I had taken the challenge, and then became depressed? Couldn’t I have learned from that, just like my ‘manic-psychosis’ in 2000 brought me ecstatic spiritual enlightenment? The time has come to quit handling my psyche like a wounded dove, and let it step forth as a muscular mountain lion (we have those around here), alert and voracious.

Today’s post extends the theme a little further. It is not as short as I’d hoped, but it completes the diptych. Having made the point that hazards are the price we pay for feeling the thrill of life, I now walk myself back to when I stood in the currents of danger, and gazed at death’s face. Yesterday’s post laid the groundwork for this closing anecdote. Here is the stage setting:

With a recently met friend, a sixteen-year-old kid (me) starts a hike of the 211-mile John Muir Trail in California. (Check out this JMT link for photos of what the scenery looks like in the High Sierras). The first day they make the steady climb from Yosemite Valley (elevation 3966 ft/1208 m), past two waterfalls, to an area called Little Yosemite Valley (elev. 6100 ft/1860 m). In this region, the river that feeds the waterfalls runs through smooth channels carved in granite by nature’s forces. The icy snow-melt water moves swiftly, but the granite sluices are so smooth-walled that the liquid travels without gurgles or waves or white water. Pure and fresh, it does not carry debris or obvious life forms. The stream looks perfectly transparent, and only the shifting reflections and refractions of sunlight hint at the deep and powerful currents.


Now for the story: After we reached this area above the falls, I noticed many people were camped on one side of the river, and none on the other. It seemed sensible to me to cross the flow, and set up our site away from the masses. I looked for a place to traverse, and settled on a spot where the stream widened to forty or fifty feet (12-15 m), but was only about four to six inches (10-15 cm) deep. At this location the water was sliding down the face of a hillside of solid granite. The expanse of ash-colored rock looked as big as a hockey rink, and formed a steep grade as it leaned against the mountain. Its surface dipped slightly in the middle, forming a shallow depression where the river spread out to became a flat, flowing sheet. Broad and smooth, the channel introduced no frothing or white water. All I saw was a layer of perfectly transparent water, moving quite fast, but only as deep as a full sauce pan. It looked like wading across would be no problem; the spot seemed like the perfect ford.

I led Paul to the place I’d found, and started to step in. Without explaining why, my hiking companion hung back and just watched. With no hesitation, I waded with confidence toward the other side. Not paying much attention, I made it ten feet (3 m) or so into the flow before realizing the hazards of my action. First, the granite surface felt almost as smooth and slippery as ice. My feet seemed ready to slide right out from beneath me. Second, the water carried far more force than I expected. Although the stream was only inches deep, my standing in the middle of the flow created an obstacle that brought forth the water’s hidden power. By blocking the current, my body caught the river like a sail catching gale-forced wind. A wave of boiling turbulence climbed my leg to mid-thigh, and I had to lean hard into this wall of water to keep it from knocking me over. It felt like a linebacker was slamming into my lower body. Finally, I looked downstream, and saw that this broad sluice ended at a jumble of angular boulders the size of compact cars. Huge flags of water sailed into the air where the river smashed into the rocks, and the roar sounded just like the waterfalls we’d passed coming up the trail. After crashing over the granite blocks, the water gushed into what looked like a small, deep lake. The surface of this icy body of water bubbled in whirlpools and eddies that spread away from the inlet. That I had not noticed the chaos and danger where the granite channel poured into the pool below shows how little I had thought through my plan.

rapids

With a sudden flash of clarity, I realized the danger of my situation. For the first time in my life, death stared at me with its frozen eyes. Almost like watching a movie, I could imagine my feet slipping out from under me, and could almost feel my hands claw at the glassy granite surface as I slid down its face at shocking speed. I felt the shove of the water driving me toward the boulders, and imagined my bones cracking hard against them. My head jerks against my neck like a doberman on a chain, my legs snap like dry sticks, and I fly into the water as if I were a bumblebee in the jet of a garden hose. I land face down, then writhe against my clothing and the icy water, trying to turn over. I am sinking and freezing at the same time. My arms don’t work right, and my jeans feel like lead blankets wrapped around my legs. I put every ounce of my waning strength into holding my breath, but my lungs are already screaming. After just a few more clock-ticks, I can’t hold it one more second, and against all my willpower my chest bursts, forcing me to blow out air, and suck in water. Ice-cold liquid floods my mouth then slams against my throat. My larynx clamps tight in a gagging spasm, and my chest heaves, both choking against the liquid, and wrenching in gasps for oxygen. Every muscle in my body cramps like twisted rope as my lungs fill with a column of cold, cold water. Then a kind of peace descends. In an oddly calm way I think, “So this is what it’s like to drown.” The screen fades, and then turns black.

As this imaginary scene flickered in my mind, I kept my body motionless, as if paralyzed. By leaning into the massive wave breaking against my lower body, and not shifting my feet by even an fraction of an inch, I was holding my footing. But how could I possibly get back to dry rock? I was no more than a quarter of the way across the river, so heading forward was not an option. I turned cautiously, looking to see if Paul had suggestions. He sat an a flat rock far away from me, looking in my direction but talking to a pair of young women who had their backs to me. I noticed some strangers watching my predicament, and moving toward me as they recognized my danger. But no one could help. Even if they’d had suggestions, I could not have heard them over the thunder of water blasting against rocks.

I had no choice but to back up. With barely perceptible shuffles, I crept my feet backward bit by bit. Time seemed to stop. My body ached with the tension of resisting the pitiless column of water shoving against me, at the same time as moving my feet and legs with surgical precision. I could not make the slightest misstep, or my hiking boots would lose their tenuous connection to the slick granite, and I would die. I knew this one fact with absolute certainty. At no time in my life have I been more aware of every muscle in my body. At the precipice of extinction, my mind had more connection to physical reality than ever before. Daydreams, distractions, future plans, regrets, and every other extraneous mental action left me. All was focused on moving just the right way to survive. For someone who has contemplated suicide with clock-like regularity, at that moment I was fighting for my life with every cell and particle of my being.

Have you guessed that I inched my way out of that situation without catastrophe? Maybe my predicament was not as dire as I thought. I have not been back to that area since, so perhaps the granite was not as steep as I picture it, the water not as fast, the boulders not as big. It does not matter. On that day I saw my death with the same clarity as I see the computer screen right now. At age sixteen, this was when I first met mortality. As should be clear from the story I told yesterday about chasing the bear, which happened that very night after my aborted river crossing, the need for caution did not sink in right away. In fact, I continued to make wild and risky decisions for a few more years. But the way was now prepared for me to some day ‘settle down’.

I am quite settled. Domestic and cautious, I try to make careful decisions, and not wreck things by acting rashly. I made poor choices in the run-up to my breakdowns ten years ago, and that further cemented my anxiousness to avoid mistakes. Not that I don’t do stupid things. I can’t help it. But I do not take risks that I can forsee.

So the binary story of today and yesterday is now complete, and they arrive at more or less the same conclusion: I have learned to play it safe at the expense of simple play. I don’t let loose and just see what happens. I don’t ‘throw caution to the winds’, as exciting as that phrase always sounds to me. Dulling the knife-edge of passionate impulse may be necessary, but it is also sad.

Of course, there are those who refuse to get in line. They hang-glide at 15,000 feet. Or scuba dive deep into labyrinthine underwater caves. Or fly over rough dirt on motorcycles, hurling off jumps without looking first to see where they might land. Thrill-seeking probably brings that exact sense of death’s nearness that I experienced back at age sixteen, in the middle of a freezing river. That so many pursue such adventure shows the value of it. For my part, I am so cautious that violent accidental death is unlikely. More probably I’ll succumb to boredom. If I don’t change.

I don’t plan to take up rock climbing. The most dangerous thing I’m likely to do is hike around our house in the mountains near (is it just a coincidence?) Yosemite. Doesn’t sound too scary, except for the mountain lions. The cats have many deer to eat in this region, and being well-fed are not likely to attack adult humans. Still, I have to admit, it feels just a little thrilling to take the miniscule chance of getting eaten by a carnivorous wild animal. Perhaps that would be better than dying in a nursing home in thirty years. As I intimated in the story of the river, my first brush with death was also, in a strange way, my first contact with life. Just as you can’t see a white object unless you have a dark background, you cannot feel truly alive until you shake the hand of the reaper.

Death and life. Yin and Yang. They depend on each other, define one another. Death would have no meaning if nothing were alive. And life feels less significant when we lose touch with what makes this moment in history special. This instant, this second is ours, and there are only a finite number. If we lose sight of our ultimate fate, we risk devaluing our brief afternoon on this planet. How sad to spend a short life wanting to die, for instance. Death is not far, and obsessing about suicide makes no sense to me anymore. At age fifty, I finally ‘get it’ that my time is limited; until recently I had forgotten what those seething, frozen waters taught me at age sixteen. Suicide is a way of escaping life, but in a way, so is excessive caution. Right now, for me, risking more is a way of dying less.

This turned out longer than I planned. I also fear it sounds trite and obvious. I lay no claim to clairvoyance or unparalleled insight. All I know is that recovering my youthful zest for life seems vital to me right now. After ten years of fearfulness, introspection and self-pity, I want to recover bravery, a forward view, and self-confidence. The time has come to crack open the chrysalis, and emerge into the next stage of my adulthood. That requires stepping out of my protective shell, and into the heated embrace of fate.

(I modified this post on 2009 August 9, c. 06:40 PDT.)

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The Vitality of Risk vs The Safety of Caution was published on August 8th, 2009 . 5 comments






What A Lifetime of Therapy and Self-Help Hasn’t Taught Me

AACA Cartoon

What does it take to transfer understanding in the rational part of the brain to the emotional part? The number of years I’ve spent in therapy, or support groups, is vast. Here’s a partial list of the therapy:

  • 15 sessions with a court-ordered counselor when I was sixteen.
  • 12 sessions with a PhD psychologist in college, after a suicidal gesture atop the campus bell tower.
  • 180 sessions with another PhD psychologist, who called himself a behaviorlist.
  • 20 sessions with a counselor in medical school, as I went through a divorce.
  • 24 sessions with a Jungian analyst.
  • 150 sessions with a psychiatrist during residency, who mostly had me talk about family-of-origin dynamics.
  • 250 sessions with a psychiatric nurse who specialized in recovery from child abuse
  • 20 sessions with a counselor who practiced sand tray therapy, among other things.
  • 2 psychiatric hospitalizations, of 12 days and 8 days.
  • 300 sessions with a psychiatrist who took me (again) through family-of-origin dynaymics
  • 100 days or so in intensive outpatient treatment.
  • 20 sessions or so with a social worker specializing in Cognitive Behavioral Therapy) CBT and mindfulness.
  • 12 sessions with a social worker specializing in Acceptance and Commitment Therapy (ACT)–ongoing.
  • Recent sessions with a social worker to deal with history of sexual abuse, and how damage from medication brings that up. (long story to be dealt with in another blog)

And here’s a partial list of the support groups:

  • Support group of medical students weekly for 18 months in medical school, then occasionally for 2 years.
  • Alcoholics Anonymous since 1987. Countless meetings.
  • Alanon since 1988. Countless meetings.
  • Adult Child of Alcoholics meetings weekly for one year while living in Manhattan. (These groups were often hard to take)
  • Adult Survivor of Child Abuse meetings weekly for two years.
  • An eighteen month intensive group therapy for child abuse survivors.
  • Numerous meetings, sporadically attended, of other 12-step programs (e.g., debtors anonymous, sex and love addicts anonymous, etc.)
  • Weekly meetings of a dual recovery group for 2 years ’06 to ’08.
  • Weekly meetings for people with a history of problems with prescription drugs, ’06-’08.

Now, you would think that after all that I would not spin out because my blog-stats dropped. But I did. So how do I take all the knowledge that I really do have about codependence, abandonment issues, self-esteem, acceptance, etc, and make myself well? How come it is so easy to know something with my mind but remain completely clueless in my heart? Is there anyway to transfer the knowledge? Can I build some kind of high-speed data connection between the two parts of my brain that deal with these things? (Aside: Don’t you just hate brain/computer comparisons?)

The only solution I can find is looking for improvement (‘progress, not perfection’ is what they say in AA). Yes, I did crash and burn about the web statistics, but I pulled myself out of it pretty quickly. I was even able to see the humor in my response. That is much better than ever before. What’s more, I opened up about what was going on with me, reached out for help, and was rewarded by many kind messages from those who’ve been reading my posts. (And this was true even though I’ve only been doing this with any regularity for 3-4 weeks; a real testament to the kindness of those who read mental health blogs.)

Thus, I look for signs that my emotional skills today are more honed than yesterday. But I am still puzzled about why I’m so dense. Therapy ‘should’ help the emotions. The unconscious ‘ought’ to learn, but mine obviously did not. Or maybe it sometimes learns, but other times forgets. One way or the other, I find my theoretical understanding far surpasses my practical application of what I know about how to be healthy. Hence, I find it easier to give advice than to live in a state of emotional balance and spiritual connection. It would be easy to blog about all the stuff I’ve been told, and never mention that it only works for me half the time. But that would not be honest, or fair, or helpful to others or to me. So here I am, admitting that the simplest things still trip me up, even though I was fortunate enough to have good insurance, the resources to pay for what insurance would not, and to live in an area with a surfeit of recovery and therapy groups.

I’ll end by asking if anyone knows some tricks for taking cognitive understanding, and turning it into emotional maturity. I am anxious to grow out of this phase and into something more enduringly healthy.

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What A Lifetime of Therapy and Self-Help Hasn’t Taught Me was published on July 28th, 2009 . 13 comments






Recovery Model, Mindfulness, and the Value of Spirit

stonehenge

Today’s post is in response to the comment left by Lex Douvasa of the MHCD Research and Evaluation Team about my most recent post. In short, that essay talked about my (experientially if not actually) transcendent adventures as a mental health patient, about how my spiritual views have evolved since the resolution of my psychosis, and how spirituality and meditation help with mental health issues. Lex brings the Recovery Model into the conversation.

As I explore the internet communities interested in mental health, I am surprised at the intensity of the discord. The various factions differ so widely in their viewpoints that it is hard to see how any consensus could ever develop, at least not in the near term. That makes me wonder if I am being smart in diving into this controversy, especially since my attitudes are not yet fully formed, and I dislike extreme views and dogma. Then I think: maybe that will be my role, to comment without developing a strong allegiance to any side.

Even from that position, however, it is easy to embrace the Recovery paradigm in mental health. I have spent years in substance abuse recovery using the 12-step model. So I know that the approach can be effective. Anything that encourages people to be find deep sources of strength, to never stop pursuing improvement, and which provides hope of a better life, must be considered a good thing.

The spiritual dimension of the 12-steps can also be beneficial, though obviously it does not appeal to all. It appears that in the mental health context the spiritual aspect is not emphasized to the same extent as in, for instance, Alcoholics Anonymous. That is probably good, since people who run out the door won’t be helped.

I am glad there are people working to bring this way of seeking peace into the realm of mental wellness. Of course, even though the Recovery paradigm seems like it should be fairly harmless, and  has a vast potential, it is not immune to criticism. The Wikipedia discussion helped me see some points of contention that were new to me. Although probably written from a pro-Recovery viewpoint, it still gives a balanced perspective. Most of the criticisms seem to revolve around fear that abandoning the traditional structure might leave people stranded or feeling bad about themselves. It comes across as paternalism, a if people with mental conditions can’t tolerate being told they have the ability to help themselves. Despite the few voices of dissent, my impression is that the Recovery approach is headed toward the center stream. It already looks pretty well accepted as a valuable option in the arsenal of approaches to psychiatric ‘distress’ (here you could insert ‘illness’, ‘condition’, ‘abnormality’, ‘giftedness’, ‘diagnoses’, or whatever your preferred term is for the kind of entity the mental health system addresses). I applaud you for working to advance and document its effectiveness. Do you agree that it is gaining wide support? Or are you facing more resistance than I understand?

Since you inquired, my own treatment began as a rigidly traditional approach (I am using my hospitalization as my starting point here, though my first interactions with the ‘system’ started in childhood and adolescence). My psychiatrist (between 2000 and 2006) treated me with a powerful mix of medications that left my mind fuzzy, like a permanent hangover. In that state, it became easy to buy into her assessment that I should give up hope of ever again being productive. Since before then I had been an aggressive high achiever, this prognosis hit me very hard, and no doubt prolonged my severe depression.

Eventually, I made the intelligent decision (despite my chemically impaired cognition) to switch to a different system of care, which I found within the Kaiser HMO. In that setting they did not follow a Recovery Model explicitly, but did promote a sense of optimism and hope for improvement. They embraced a mind-body philosophy, for instance by teaching how important exercise can be.

(As for brain derived neurotrophic factor (BDNF) I listened to a good podcast on Dr. Ginger Campbell’s ‘The Brain Science Podcast‘ not long ago about exercise, the brain, and BDNF.)

Kaiser staff also introduced me to DBT (Dialectical Behavior Therapy), which you mention. I participated in part of the DBT series and benefitted from it, though the protocol struck me as unnecessarily complicated. Despite that reservation, DBT’s underpinnings of savoring bodily experience, not running away from feelings, and remaining in the present moment all make a big difference for me, when I abide by them.

In short, I believe that by turning to Kaiser I found a more modern model for my mental health care I entered a pretty enlightened system; it encouraged me to seek progress, rather than accept a static place of disability. (As a disclosure, I was a Kaiser physician before my neck degeneration ended my surgical career. I now have no connection–financial or otherwise–with Kaiser, except as a patient.)

In my opinion, a lot of mental illness results from feelings that spiritual traditions have historically tried to alleviate: hopelessness, futility, meaninglessness, loneliness, guilt, resentment, etc. That does not mean everyone with mental illness should be religious, or even do anything that harkens to a (possibly nonexistent) spiritual realm. But it is probably a good idea to encourage people to explore what they value in life, why they think it matters whether they treat people well or poorly, what helps give them a sense of purpose or meaning, and what they think makes a good person. That will give them some benchmarks for measuring their progress, milestones separate from society’s focus on material success and social popularity. It might also help them look more realistically at their failings, and recognize that they have the same human frailties as the remaining 7 billion people on the planet. If they take it a step further, and develop a sense of divine presence, or connection with a transcendent realm, then so much the better (and although I personally object to religions that are judgmental and fundamentalist, each person needs to choose their best path to wellness).

As I have emphasized in this nascent blog several times already, there is no one prescription that will work for everyone. Nevertheless, the Recovery Model in mental health, if it works anything like AA has in the addiction community, should have broad appeal and effectiveness. The mutual support, spirit of ongoing action, and belief in even seemingly hopeless cases can all be adapted from the addiction world to the benefit of those of us with psychiatric issues. Adding in encouragement for growth in the direction of finding meaning and purpose in life, or even exploring feelings of transcendent spirituality, would also be helpful to many people.

Thank you for bringing this paradigm to the forefront of my attention. I have read a little about it before, but it helped me to explore the topic further. Whether or not anyone reads all the way through this (typically for me) overlong post, the exercise helped me expand my understanding of available approaches to psychiatric conflicts.

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Recovery Model, Mindfulness, and the Value of Spirit was published on July 21st, 2009 . 2 comments






Engaging vs. Escaping the Mental Health System

psychhypnosisMarian (Different Thoughts) pointed me to her interesting commentary on the practice of clients (aka users or consumers or patients) becoming practitioners in the mental health field. I was aware of figures like Dan Fisher, MD, PhD. I believed myself in a position to follow a similar path, though I did not count on becoming much of a public persona. Marian’s blog set me thinking more about the implications of my failure to get accepted by psychiatry residencies, and helped reaffirm my current path. At first, getting rejected felt just like that terrible word I used in the last sentence: failure. As someone who used to be a high achiever but then suffered a string of nasty losses over the first ten years of this third millenium, that perceived failure and humiliation hurt. And of course, it’s a short journey from hurt to anger.

Since I already carried a burden of hostility toward the system for how medications damaged my life and my body, the rejection propelled me into a belief that I should be an activist from without, rather than a clinician on the inside trying to do a better job. Problem is, I’ve never been an activist before, having mostly done safe (though long and tedious things) like go to medical school and become a surgeon. But at least I like to write, and apparently one can accomplish a lot just by putting ideas on paper. ‘Activism’ doesn’t only mean I have to get out and hit the streets.

What is happening, however, is that I am being pushed into a more extreme position than that from which I started. I’d like to think medications are not all bad. I do believe they have a role in acute situations. It’s just that as chronic treatments, they suck. Side effects and destruction to health build up, and efficacy diminishes. In the end one gets stuck in my position, having a really hard time getting off the drugs because my brain has gotten habituated (read: addicted) to them. Yet, the more I read, the more I wonder how much the benefits outweigh the hazards. While some small number of acutely psychotic people will perhaps always need some medication, most likely the majority of  ’patients’ could be treated better with kindness, cognitive techniques, and comprehensive attention to their spiritual and physical health. This is the kind of approach I believe Tom Wootton’s Bipolar Advantage is advocating. Maybe we have enough medications for now. Maybe the whole endeavor (and highly profitable industry) of looking for and marketing new drugs needs to be shelved. These are questions that I can’t answer right now. Not for myself and certainly not for others. But I do see my attitudes becoming more and more opposed to the medical model and psychiatric drugs. This wouldn’t be occurring if I was on my way to becoming a psychiatrist.

My biggest question is: would I have been able to make more difference as a clinician? Would helping dozens, or hundreds, of patients get (what I consider) appropriate treatment be more valuable than writing? The point is mostly moot, of course, since I don’t have a door into the field. On the other hand, I could reapply (to programs that don’t already know me) without being so revealing about my psychiatric history. Yet, all I’ve read since I entered the (badly named) blogosphere convinces me I’m better off not going into the field. Marian makes a persuasive argument about the compromises that one inevitably makes in the course of entering any kind of organization. Plus, if I could bring myself to get my whole story out (I’m still hesitant to reveal the worst of it), it might attract some attention and really increase awareness. It would require a lot of work, and that much effort might be beyond me (not to mention the requisite compelling writing style). It is an idea for the future. For now I am just exploring options, writing my blog, and commenting on the blogs of others.

I never wanted any of this. Although I once had dreams of glory, more recently my ambition has just been to settle down as a happy worker bee, productive and comfortable. Unfortunately for those modest dreams, however, my past has caught up with me. My only choice seems to be to tell my stories and comment on the messed-up systems of psychiatric care. That puts me out in public view, where the way to be successful is to try to be as visible as possible. So now the question becomes, once again, how successful do I want to be? Especially knowing that the price of success is exiting my comfort zone and losing my anonymity?

Which brings up the whole question of obligation. Having learned medicine formally, a lot of psychiatry informally, and possessing a pretty good understanding of cellular neurophysiology, I certainly can speak with an authoritative voice about the medical implications of modern mental health care. Add to that how I’ve suffered really horrible side effects and lost a decade of my life  to mental illness-related disability (which might not have happened if I’d not been given so many medications), can I justifiably stand by and not speak out? Can I actually, in good conscience, let this go on without trying to make a difference? Painful questions for someone who just wanted life to get easy.

Forgive me for using this website as a chalkboard for sketching out a future strategy and a guiding philosophy. I am learning a lot from your blogs and your comments, and look forward to a lively and productive conversation.

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Engaging vs. Escaping the Mental Health System was published on July 10th, 2009 . 4 comments






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