I aced the quiz! Part One: Know thy enemy.

Disclaimer: The information contained in this post is not intended to diagnose or treat any condition. I am a licensed therapist, but I am not your therapist. 

I ACEd the quiz! Tongue firmly in cheek, of course. There is no quiz, but today I would like to touch on trauma and its physical effects–hence the reference to ACES, or the Adverse Childhood Experiences Scale.

As any even casual reader of the blog knows, trauma is kind of My Jam. I love working with clients who are struggling with the same core issues I struggled with the first 20+ years of my life. I knew that was going to be bailiwick from the time I started therapy myself, at 18, but I didn’t really do much with it until I entered grad school and suddenly had to write a thousand different papers (that were not centered around arguing whether the box of money in Faulkner’s The Sound and the Fury is actually a box of shit. Look it up. It’ll change your life).

When I got my very first assignment, my brain went “PING!” and told me trauma was the area to hit. It’s a touchy area, for sure. Go too fast, and you risk re-traumatizing your client and damaging rapport. Go too slowly, and your client will stagnate. It’s like a dance.

The ACES study began in an obesity clinic in 1985, believe it or not. Physicians were interested in figuring out why people kept dropping out of their weight loss program; long story short, they developed the Adverse Childhood Experiences Scale and administered it to their patients. The results were unprecedented: they uncovered a link between childhood trauma and struggles with controlling their weight later in life. 

I’d love to wax poetic about the biology of chronic stress and implications for adulthood, but that needs its own post.

On to the significance of ACEs. The instrument itself is simple–ten self-report items, scored either “0” or “1.” I’ve re-typed it here for the sake of your eyes, but you can see the original and lots of great info on acestoohigh.com.

To avoid inadvertently triggering readers, I’m going to put the actual scale underneath this spoiler tag, as the questions do involve all forms of child abuse.

On Vulnerability

There are so many words in the English language relating to innocence and vulnerability, and most of them can bring me way down if I’m not careful. They provoke some ancient anxiety that I’ve come to realize, with the help of my excellent therapist, are linked to what she calls my “wounded younger self.” (I was incredibly skeptical of inner child work at first, but it is incredibly effective and incredibly healing.)

“Little” is an adjective that, when paired with certain words that also remind me of innocence, usually messes me up emotionally. That’s the word that got under my skin tonight.

I’ve been feeling kind of “off” the last few days. I recently blocked my mother completely on my phone–including the second number I thought she’d deleted until she used it to contact me after I blocked the first number–and was treated to some really unsettling dreams on Monday and Tuesday night.

Monday’s main feature involved me skipping my grandmother’s birthday party because my mother was going to be there and I knew she’d be drunk. Tuesday’s late-night horror show involved a healthy helping of guilt because I was hiding from her (in a Target, of all places) while she wailed and lamented that she “couldn’t believe [I] didn’t want to talk to her.”

Naturally, this put me in a pretty weird headspace today. Wednesdays are my big clinical days and I do group as well as individual client work. As such, I generally store my feelings away to deal with later and do a pretty good job of not thinking about them at all during the day because I’m 100% focused on my clients. (Side note: I adore them, and I’m bummed that I’m leaving my practicum site in a few weeks!)

On the drive home from class this evening, though, those neglected feelings reared their ugly collective heads and roared.

The anxiety and guilt were so powerful that I considered just going to bed early and sleeping it off.

Instead, I took a shower.

I focused hard on those thoughts and attempted to get a good, cathartic cry in. Nothing happened.

I turned the focus to that wounded younger self I mentioned and took the opportunity to literally hug myself while I waited for the conditioner to work its magic on my decidedly unruly hair. I decided to speak aloud because I’m home alone most days during the week and hey, I knew the cat wouldn’t judge me. (Audibly, anyway.)

I told my younger self that it’s okay. I told her I love her and that I’m sorry she felt like no one could keep her safe. I told her that I’m going to do it. This changed into me speaking to whatever hypothetical future child I’ll end up having. I promised that child to take the best care of it I can and to make sure it never feels afraid or lonely.

And I cried. Instead of stifling it or trying to be tough, I gave myself over to it completely–ugly, wracking sobs. After a while, those sobs turned into relieved laughter that I’m sure sounded like I’d finally gone completely ’round the bend.

I think there’s something to be said for having a good cry.

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On Monday, I spoke to my clients in group about the concept of “ghosts”–they had all shared some intense and profound stories about their deepest wounds, their secret shames, their most painful memories. I told them that while they can haunt you, they can’t physically hurt you. You can start to let go of them.

I led them in one of my new favorite exercises, which is “HA!” breathing. Basically, you take a deep breath and push that breath out while making a “HA!” sound. I opened the group with the exercise and invited them to imagine themselves yelling at someone or letting frustration out. I demonstrated (because I am not afraid to look silly anymore), and they loved it. After the big, intense sharing session, I led them in the exercise again, this time instructing them to imagine the “HA!” on the exhale as them blowing out part of their ghosts.

I’m glad it was a hit, and I encourage you all to try it, readers. Howling into the void or, as I called it, “therapeutic yelling,” is incredibly cathartic.

 

News Day Tuesday: Ohio State Mental Health Triage

Good afternoon, readers! Today, we’re tackling the concept of mental health triage for university students. Ohio State University has reported a 43% jump in the last five years in the number of students seeking mental health care. Needless to say, that’s huge.

The question of how much academic demands contribute to anxiety levels among the student body is a complicated one. Parenting styles have definitely changed over the last decade or so–I’m 27 and when I was young, “helicopter parenting” really wasn’t a thing. My peers and I were allowed to walk alone to and from school and play outside unsupervised, often late into the after-dark hours. My family placed relatively few restrictions on how I spent my free time; reading and viewing choices were left up to my own discretion, with the assumption that I would make good choices for myself. As a result, I didn’t have much trouble adapting to the freedom that comes with college life, though I did live at home for the first two years of my undergraduate program.

As a non-parent, I can’t speak personally to what parenting styles are in vogue these days. However, it seems that (for very valid reasons) parents have become much more cautious and protective. This naturally leads to students feeling anxiety over the unprecedented freedom that comes with college and living away from home for the first time. Tuition and student loans are also enormously stressful–I know I’m not the only one who had a bit of a freak-out upon receiving that first scary bill after the post-graduation grace period ended. The overall “climate” of university life, combined with the myriad of complicated developmental changes adolescents and young adults have to navigate, creates a perfect storm for the emergence of mental health issues.

This brings us back to the subject at hand: mental health triage. It’s an intriguing concept and one that’s particularly timely; with so many patients in need being turned away from psychiatric wards due to lack of beds, it’s clear that we need to figure out a way to prioritize who needs what kind of help, and how urgently they need it.

Ohio State’s triage consists of determining whether students require more intensive one-on-one therapy or more general group-based therapy and seminars. The university offers a workshop called “Beating Anxiety,” which is something that I’d love to see implemented at more schools, particularly as part of the standard first-year curriculum. During my first year of undergrad, I saw many of my peers struggle with taking full responsibility for every aspect of their lives. It can be overwhelming to navigate roommates and coursework as well as meeting daily needs for the first time. Add to that a work-study job or two to supplement financial aid, and it’s not hard to see why so many students are stressed.

Another aspect of Ohio State’s program that I love is the “Recess” event:

On a grassy lawn, there are tents where students can make balloon animals, blow bubbles and play with therapy dogs and a large colorful parachute. The event is designed to help students relieve stress and to introduce students to counseling center services and staff in a fun way.

– Students Flood College Mental Health Centers, The Wall Street Journal

You can read more about the impressive range of resources offered to students at Ohio State here.

Readers who have a college background, what kinds of programs do you think are most valuable? What was/is available to you?

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News Day Tuesday: Bipolar Awareness Day!

Happy Tuesday, readers! Today (October 4th) is Bipolar Awareness Day, so I wanted to share an article with you that outlines the basic symptoms (for the uninitiated, as I know there are some new readers here) as well as what’s on the horizon in terms of treatment.

First of all, let’s hear about what bipolar disorder actually is. I’m referencing bt.com for the purposes of this tidbit, as the article I found gives a really great Reader’s Digest condensed version of the illness.

National charity Bipolar UK characterise the condition as “a severe mental health illness characterised by significant mood swings, including manic highs and depressive lows”, and note that, “the majority of individuals with bipolar experience alternating episodes of mania and depression”.

According to this article, it takes 10.5 years on average (in the UK) for people with bipolar disorder to be properly diagnosed. The National Depressive and Manic Depressive Association (NDMD) paints a similarly grim picture: it can take ten years or more for a diagnosis to be reached, and 69% of cases are misdiagnosed.

What are the symptoms?

There are two sides to bipolar: mania and depression.

During a bout of depression, it is possible to feel: grumpy, without hope, guilty, self-doubting, suicidal, pessimistic, worthless, lacking curiosity and concentration.

And with mania: elation, full of energy, ideas and plans, easily distracted, feeling invincible, risky behaviour including spending huge amounts of money.

Both can feature: lack of appetite, insomnia and delusions.

-bt.com

My experience began very early. I remember fits of agitation and depression as early as eight years old, which at the time was chalked up to the incredibly rough hand I was dealt–a broken home, a mother who struggled with bipolar disorder herself as well as alcoholism, extreme bullying, and persistent nightmares (which were later diagnosed as a feature of PTSD). NAMI states that rapid-cycling bipolar disorder, the most severe form of the illness, seems to be more common in individuals who begin exhibiting symptoms early in life.

From NAMI.org:

Early Warning Signs of Bipolar Disorder In Children and Teens

Children may experience severe temper tantrums when told “no.” Tantrums can last for hours while the child continues to become more violent. They may also show odd displays of happy or silly moods and behaviors. A new diagnosis, Disruptive Mood Dysregulation Disorder (DMDD), was added to the DSM-5 in 2014.

– See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder/Overview#sthash.l0XKtkSy.dpuf

When I was eighteen, I decided to see a therapist and psychiatrist for the intense mood swings that had plagued me for most of my life. I was initially told that my deep depressions were the result of PTSD. I was prescribed fluoxetine (brand name Prozac), which only made the agitation worse. And I was still depressed.

At 22, I relocated to Wisconsin and began the search for something, anything, that would finally help me feel “normal.” The misdiagnoses continued: major depressive disorder, for which I was prescribed Abilify and trazodone. I felt amazing on Abilify for about two weeks, and then I crashed. Trazodone made me a zombie. (Note: It is not atypical for antipsychotics to be prescribed to treat both MDD and bipolar disorder.)

Bipolar disorder is most often misdiagnosed in its early stages, which is frequently during the teenage years. When it is diagnosed as something else, symptoms of bipolar disorder can get worse. This usually occurs because the wrong treatment is provided. Other factors of a misdiagnosis are inconsistency in the timeline of episodes and behavior.

-healthline.com

When I was 24 and in my first “adult job” with health insurance, I found a wonderful psychiatrist who, over the course of several sessions, examined my family history and asked very specific questions to find the root of my illness. At first, I didn’t even think to mention my “up” periods, because even with the agitation and sleeplessness, I actually felt good–and no one goes to the doctor when they’re feeling well. But upon deeper probing, he came to a conclusion: first bipolar II, then, after further investigation and a few weeks of mood tracking in a journal, rapid-cycling bipolar I.

That first year was rough. I cycled so frequently that the days were exhausting. One day, I bounced between depression and mixed episodes several times in a single 24-hour period. Slowly but surely, the medications my doctor had prescribed (venlafaxine/Effexor, lamotrigine, and lithium) began to take effect. I began to stabilize. There were no more florid creative periods, but I was also able to sleep for more than an hour a night for the first time in weeks. My misery began to ebb, and though it didn’t disappear completely (a dysfunctional marriage contributed, among other things), I began to feel like a person again instead of a defective thing that needed to be turned off and fixed.

Aside from pharmaceuticals, NAMI’s website mentions cognitive-behavioral therapy, psychotherapy that focuses on self-care and stress management, and, in rare cases, electro-convulsive therapy (ECT). Learning to recognize the triggers for each type of episode is key; one suggestion offered by the numerous therapists I’ve seen over the years is mood tracking/journaling.

However, I had to stop at one point because, in the heyday of my illness, I began to obsess over the cycles, sometimes tracking up to ten or eleven times a day. Instead of the journaling soothing my mind, I began to worry that I was untreatable. I found my mood journal during a recent move and it was difficult reading, to say the least. But it was also a reminder of how far I’ve come and how much my quality of life has improved since receiving a proper diagnosis.

These days, I’m doing much better. My medications have been adjusted slightly to accommodate the deep depressive episodes I’m prone to during the fall and winter months, but I am proud of myself for being able to recognize that the winter storm was a-comin’. Three years ago, I would not have been able to see the symptoms for what they are: a warning sign and a signal that I need to not only keep up with my medications, but to practice good self-care. In the past, I saw fall and winter as something awful that I had to endure. Now, I realize that I can still enjoy life even when the days begin to get longer and darker. The seasons are no longer a metaphor for the overall “climate” in my head.

How long did it take for you to receive a proper diagnosis, readers? Are you taking care of yourselves as winter approaches? I hope you’re all doing well and staying healthy and safe. And spread the word–this illness is massively misunderstood, even by mental health professionals, so it’s our job to reach out and counter-strike against the misinformation and discrimination.

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News Day Tuesday: Local Mental Health Resources

Good afternoon, readers! This time, let’s talk local resources for mental health care.

I saw a wonderful counselor through the Johns Hopkins Student Assistance Program (which I’m eligible for because my significant other is currently a student). I’ll share more of the personal details in a post later this week, but the counselor I met with gave me some information about local resources I had no idea existed, and I’d like to pass those on to you. I feel they’ll be particularly useful to anyone in the Baltimore area, but I’m sure there are similar programs throughout the country.

First is Sheppard Pratt. Being new to the area, I was unfamiliar with this hospital, but they have a program specifically designed to help people dealing with all sorts of trauma.

The Trauma Disorders program at Sheppard Pratt specializes in dissociative disorders and CPTSD, which is exciting because I had no idea these types of programs existed anywhere. They certainly weren’t a thing in the Midwest, where I’m from. It’s an inpatient program, which isn’t a good fit for me for a number of reasons, but I plan to reach out to see if they know of any good outpatient therapists who are well-versed in these issues.

It’s comforting to know that there are facilities that offer support specifically tailored to complex post-traumatic stress disorder, which can present challenges to many therapists. I found one therapist during my time in Madison who seemed to know quite a bit about PTSD, including my dissociative symptoms, but she went on maternity leave shortly after I began seeing her. My subsequent searches for therapists was largely unsuccessful, which is not a negative reflection on any particular counselor–as I said, it can be a tricky affliction to effectively treat. I’ve been told that because of the depth of my dissociative symptoms, I’m not a great candidate for EMDR, which eliminates one of the most widely-used techniques for treating PTSD.

The second resource I learned about last Friday is the Baltimore County Crisis Response, which offers not only crisis intervention (as the name suggests), but also a 24-hour hotline and–this is the most exciting part–one-time psychologist and psychiatrist consults, which are particularly useful for people who are in a transitional period and looking for providers in the area but need refills of medication or therapy. That’s right, readers; there’s actually a place you can go for those all-important refills you can’t get anywhere else, which means no more rationing of medication to make it through.

The counselor at JHSAP was also kind enough to email me a long list of references for therapists in the area. Admittedly, I’ve been procrastinating a bit and haven’t gotten around to checking them out, but it’s on the list for this week.

Are you aware of resources and programs in your area, readers? Are they easy to locate, or do they require a bit of digging?

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News Day Tuesday: Digital mental health care

This week, I’d like to touch briefly on digital mental health care, which has become increasingly popular. I recently applied to work as a volunteer with Crisis Text Line, which is an awesome resource that allows people in crisis to communicate with trained volunteers via text message.

I’m still waiting for one more letter of recommendation, but if I’m approved, I’ll get to counsel others via text–how cool is that? It’s a four-hour-a-week commitment that lasts for one year, and I’d definitely encourage anyone with an interest or background in mental health to consider applying.

From Crisis Text Line’s website:

1. We fight for the texter. Our first priority is helping people move from a hot moment to a cool calm, guiding you to create a plan to stay safe and healthy. YOU = our priority.
2. We believe data science and technology make us faster and more accurate. See our Founder’s TED talk for more scoop on how we’re using this stuff. While we love data science and technology, we don’t think robots make great Crisis Counselors. Instead, we use this stuff to make us faster and more accurate–but every text is viewed by a human.
3. We believe in open collaboration. We share our learnings in newsletters, at conferences and on social media. And, we’ve opened our data to help fuel other people’s work.

This article from Scientific American examines digital mental health care and its pros and cons. I’m a huge fan of anything that allows people to get the help they need, and many people simply don’t have the means to physically attend therapy due to income, transportation, disability/illness, or other factors.

The article also raises very valid concerns about “impression management,” or the tendency clients have to only share information that is likely to make the therapist think positively of them. On the one hand, many people find it easier to express themselves through writing; because there are barriers between the writer and the reader, people may share more freely than they would in person.

On the other, it’s hard to overstate the importance of face-to-face interaction, particularly in a therapeutic environment. Being able to see the client allows the therapist to assess the client’s nonverbal cues, such as body language and facial expressions. This, in turn, can help the therapist direct the session in ways that make the experience as comfortable and productive as possible.

What do you think, readers? Would you be more likely to “talk” to a counselor via text, or do you prefer old school face-to-face therapy? Personally, I’m all for attacking issues from every possible angle, though I haven’t tried digital counseling myself (yet). If anyone has personal experience with digital mental health care and would like to share their story, please do! I’d love to hear from you.

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My very first column – “Depression: Cancer of the Mind,” published October 15, 2008.

This marks the beginning of a new mini-feature on the blog: Throwback Thursdays. See below for more!

When I was nineteen (and probably manic), I submitted a column proposal to my hometown’s newspaper. Shockingly, they decided to pick it up. It wasn’t a huge reader base—my hometown’s population is somewhre in the 60,000 range—but I was surprised and elated to have the opportunity to share my experiences and put a face to mental illness, which was a big deal in a small city in Iowa.

I had to abandon the project seven months later, when taking a full course load and working two part-time jobs plus an internship became too much; however, I was approached the following summer by two women in my hometown to write a series of articles regarding the transition from high school or college to the “real world.” The series caught the attention of Mental Health America (the Iowa branch) and I was honored with an award and some cash (which, as a poor twenty-year-old college student, was greatly appreciated). 

I’ve kept all of the articles and letters in a box for years. I still pull them out sometimes when I start to feel like a hack or minimize the impact of the things I’ve done. Ultimately, it’s not about recognition or awards (although I must admit that my writerly ego really enjoys being stroked from time to time). It’s about having tangible proof that I was here, that I was able to accomplish something despite having been dealt what most would agree is a fairly difficult hand in life. 

As an existential nihilist, it’s difficult for me to see any inherent meaning in the universe, which I view as absurd and often confusing. But it’s actually a very hopeful philosophy/worldview to have, because it means that each of us has the opportunity to create meaning for ourselves and share it with others. I am slowly beginning to learn that “hope” is a four-letter word, but it’s not necessarily a bad one.

Over the next few weeks, I’d like to share my articles, some memorable stories about my time as a columnist, and perhaps a few of the more poignant letters and emails I received in response to my columns. I’m somewhat mortified by how young my voice is, but I’m reminding myself that it’s an interesting and valuable snapshot of who I was at 19: a girl who wasn’t afraid to put herself out there, who believed she could make a difference in her own small way and was maybe a bit idealistic.

In some ways, I think I am still that girl.

“Depression, cancer of the mind” was originally published on October 15, 2008. My editor had titled the first article, which I’m assuming was because I was too disorganized/cycling too hard to do it myself. I can’t remember who came up with the titles after that; it was probably a mixture. The column appeared every other Wednesday.

Note 1: The features editor decided to give my series a title—Depression: Cancer of the Mind—and a little banner at the bottom, which I thought was the coolest thing ever.

Note 2: At this point in time, I was still diagnosed with and being treated for mild-to-moderate PTSD and general depression. It wasn’t until September 2012 that I was re-evaluated and diagnosed with major depressive disorder, and it was an even longer wait (July 2013) until my correct diagnosis—rapid-cycling bipolar disorder, type I, and C-PTSD with dissociative features—was confirmed and I was able to begin treatment.

Depression, cancer of the mind   Published October 15, 2008

Sometimes people ask me, “How did you do it? How did you make it through 11 years of severe depression without ever once asking for help?”

I guess I can understand their disbelief: I have been through the mental equivalent of hell and come out the other side. I have climbed over Satan’s frozen back, much like Dante traveling through Hell in The Inferno. The only difference is that in this case, “Satan” is the despair trapped inside my mind, causing it to decay slowly from the inside out.

Some say that schizophrenia is the cancer of mental illness, but to an extent, I disagree. It’s true that schizophrenia does kill the mind and allow the sufferer to descend into madness. But just as there are many types of cancer, there are infinite varieties of mental illness that could be considered cancerous.

Depression is one of them.

When you are depressed, most people assume that you will “snap out of it,” even though the stereotypical person living with depression does not leave his or her bed for days, sometimes weeks, at a time. It is every bit as destructive as cancer or diabetes, though even now few people realize it.

I suppose this is because people traditionally fear the unknown, and mental illness, aside from death, is one of the biggest unknowns of all. It can strike anyone at any time. Even those of us living with depression who have found ways to cope and make it through the ending and exhausting days look just like everyone else. Unless you are having a particularly bad bout of depression and feel the urge to run from the room crying (which society views as unacceptable), depression usually goes unnoticed.

It is my hope that by sharing my struggles against the silent suffering associated with depression, others will know that they will be OK, that mental illness is nothing to be ashamed of, and will share this knowledge with others. The more that people know about mental illness, the better; educating the public is the first and most effective step in fighting to tear down the stereotypes.

Something that I would like anyone who has lost hope to know is that you are not crazy, only extremely sensitive to the world around you. You are very brave, but you do not need to suffer alone. There is always help available, and accepting it is not admitting defeat.