On the Bus

     Manual override is something that I do in my mind. WRAP is different. It is a written plan for you, the people around you, and your healthcare professionals. The parts of WRAP are: The things to maintain your wellness on a daily basis, The primary indicators that you are about to have a problem, The things that you and others need to do when you become episodic, What to do when things really go bad, and What you think are the indicators that you are improving, able to handle the situation on your own, and what other people can do to help. In the best scenario, it is way to get better and maintain yourself. In the worst case, it gives you a voice when you cannot speak for yourself.

     Some of you may have an issue with the word recovery. Recovery is not recovered! Recovery is an ongoing process. I don’t think it ever ends. Maybe management is a better word, but it doesn’t make as nice an acronym!

     II. Make a list of the people you count on for support. Make another list of the people that you support what qualities do you like most in your supporters and what do you have to offer others.

     III. Who are your professional healthcare supporters? What do you like and dislike about them? Is there anything new you would like to try, and what do you think you need to do to accomplish that goal?

     IV. Write down your own medical history. Include you family members and any current conditions and treatments. Don’t be afraid to make a list of the questions you would like to ask your professionals.

     Important parts of the course are some exercises to help you to fill out the plan. Make a list of some positive things about yourself. Also, make a list of some of the negative thoughts. Examine them critically, look for evidence, to see if they are true. If in fact they are true, write down some things that you think you can do to change them.

     V. Make a list of things that commonly (or uncommonly) trigger you. Do you ever have preliminary symptoms that indicate the onset of an episode? Write those down as well.

     VI. Maybe your symptoms have become very severe, or they have gone on for longer than usual. How severe? What kind of behaviors will you be doing?

     How long is critical? How well have you done before. Do I want to see a doctor? Go to the ER? Write all that down.

     VII. Either you think that everything is Ok, the sky is falling, or you don’t think anything at all. What are some indicators, particularly to other people, that it is time for them to take over? What things need to be done? who do you want to do what? Who do I want to see and talk to/ don’t want to see or speak to? Is there a particular doctor or hospital you like/ Don’t like? I there a particular drug or therapy that you think would be effective/ not effective/ dislike intensely? It is important to plan out these last two stages when you are thinking clearly. Do not wait until you are having a problem! Remember, you can always change it!

     VIII. Lastly, what are some good indicators that you are doing better and ready to care of some/all of your responsibilities? Are you going to need some help? From who? And with what?

     Once you have completed writing out your plan, it is recommended that you review it regularly. Weekly is what is recommended, but I’m sure that monthly is equally good. It is after all a recovery/maintenance tool. You may change you mind, think of something new, or the mental health journaler’s lament, “I wrote that! I must have been crazy!” You are supposed to make copies and give them to friends, family members, and you physician. Some of this stuff may be very personal and you may not want it widely distributed. You ought to give a copy to at least one other person. Failing that, leave a copy somewhere that someone else can find it if needed.

     Learning, writing, and using this plan can work. it doesn’t matter whether you use WRAP or manual override. The key elements are motivation  to get better, a belief that you can get better, actually implementing the program, and persistantlyusing it, even at times when it doesn’t work so well (remember, you can change your plan!).

     This my stop. See you next month.

     Baco

All of us either have some form of mental illness, or know someone else who does. Are we crazy? Are we different from normal people?

Almost everybody knows someone with a mental illness. It is unfortunately all too common. Crazy and normal are really a poor choices of words. Healthy and ill are better choices. But even then they are variable terms. A person can have a broken leg and still be healthy. Likewise, a person can have diabetes or even cancer and still be considered healthy. Conversely, a person can have the common cold and be terribly ill!

The question that all of us have asked ourselves is, “Why me?” Why are we ill and others are healthy? Why do we have these thoughts that make us say and do the things we do?

Something happened to each of us, something not very good. Yet these same things happen to other people, and they do not become mentally ill. Or at least they do not let it affect their lives.

There is a body of evidence that abusive and dysfunctional homes are not the cause of mental illness. I have no idea how they came to that conclusion, but try explaining that to someone who has lived that experience! Yet some people do survive this kind of experience and go on the lead happy, healthy, and successful lives. They must represent a statistical majority, although I have met very few people that can say they are one of them!

There is obviously a biochemical component to mental illness. Adding certain chemicals and using other chemicals to impede or enhance our body’s own chemicals do make a difference in how we think, act, and feel. For some people, some of these chemicals work very well, for some, with varying degrees, and others, not at all!

There is considerable research into the genetic component of mental illness. In wild animals, where most of their behaviors are instinctive, almost all of these behaviors are genetically encoded. Many of these encoded behaviors lie dormant until environmental conditions predicate that they engage. We do not like to think of ourselves on the same level as the animal world, but we most certainly are. We also must certainly have genetically encoded instincts and behaviors that become triggered by environmental conditions. Many of the selective pressures under which our ancestors have evolved have diminished in importance to our survival. From a purely parochial scientific viewpoint, many people who would not have survived under the old pressures have survived to produce offspring. Much of this encoded information may have been intensified, altered, diminished, or out bred altogether!

All of us, as children, imprint upon our parents. We speak the same language and use the same inflections. We learn to act like them in many ways. Maybe for a child growing up with a mentally ill parent, mental illness may be a learned behavior!

But! But! But! Normal people have all these same things, what makes them different and why cant I be like them? Normal is a setting on the dryer or air conditioner. Considering that there is an estimated 40 million undiagnosed and untreated mentally ill in this country, and the World Health Organization believes that mental illness is the worlds number one public health problem, there may not be anything such as normal! Much like flu or the common cold, even the healthiest person can have a “touch” of mental illness, and then it goes away. It doesn’t have to be forever

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For those of you who have not heard my mantra before, here it is again; “mental illness can be treated, managed, and controlled. Mentally ill people can lead happy and successful lives.” Essentially, they can become normal. Maybe the “normies”, unlike us, do not have to go to a doctor or therapist to learn to do these things. They devise their own strategies for dealing with their symptoms. When something doesn’t work, they try something else. They never give up!

Maybe we aren’t so different after all!

See you on the bus!

Most of us who have suffered from, and have been treated for mental illness will empathize for the stories main character, Virginia Stewart Cunningham. Hopefully, the author, Mary Jane Ward, did some actual research on mental illness and it’s treatment before writing the book (1946), that was then made into a movie in 1948. We all can hope that things certainly were not actually that bad in mental hospitals of the time. But the film was so emotionally powerful that it change peoples attitude about the treatment of the mentally ill.

The Wards are numbered by the severity of the illness, lower numbers being the better patients, higher numbers being the more severe. At the time, she is housed in ward three. All of the patients are pretty disassociative, and even in ward one, are still fairly delusional. Patients within a ward are all together, even at night, and are not separated from one another. The facility itself is dark and dank. It has bare brick walls and is very prison like. The film is in black and white and this adds to the effect.

The first scene in the movie, Virginia is sitting on a park bench and hearing voices. She has actually been in the institution for five months and has no recollection of that time or the events that brought her there. Virginia is unsure of who and where she is, and is unable to have a coherent conversation with her doctor. He decides on electroshock therapy, of which Virginia gets several treatments. The break through comes when she realizes that she is ill and in an institution. She does however, slip back and forth between reality and delusion, and displays extreme anxiety over minor issues.

The doctor then tries a drug induced hypnotic regression. Oddly, this was the only time during the film that any medications were administered. (I can only assume, that in 1948, drug therapy for mental illness consisted of a sub-lethal dose of barbiturates!) During this regression, the doctor finds some Freudian issues dealing with her ability to have a relationship with her husband, treats her based on that premise.

Another issue dealt with in the film is the nursing staff. The nurses complain that they have too many patients to deal with. They have an “I am doing my job“ attitude, “behave and follow the rules!” they are generally uncompassionate toward the plight of the patients. In one case, the charge nurse schedule Virginia for another shock treatment even though the doctor has has not ordered it, having failed to even look at the patients chart! In another case, this attitude causes Virginia to have an extreme anxiety attack which the nurses responded to by putting her in a straight jacket and shipping her off to ward 33! The role models for Nurse Cratchet in “Cukoo’s Nest.”

In ward 33, Virginia has an epiphany. Surround by the extremely ill, she realizes that she is one of them, though not quite as delusional. She becomes the friend of one of these women, Hester, and tries to help her. Over time, the Freudian based therapy appears to work and her family would like to take her home. She goes to “Staff”, where the doctors examine her prior to release. She is not ready. During the course of the exam, one doctor badgers her about remembering facts about her life in an unsympathetic manner. He shakes his cigar holding finger in her face. This causes another very severe attack, and its back to the wards.

The therapy continues and Virginia begins to realize that the causes of her illness are things that she cannot control and that she does not have to let them ruin her life. She passes through “Staff”, and makes a breakthrough with her friend Hester.

It’s a powerful movie. It won an academy award and was nominated for eight others. I’m sure in 1948 it was shocking and thought provoking. After the movie’s release, 26 states changed their laws on how the mentally ill should be treated. In great Britain, the censors required and introduction that pronounced that mental Hospitals in Great Britain bear no resemblance to the institution portrayed in the film.

The film does accurately portray Virginia’s progression through her illness toward wellness; grief and denial, acceptance and coping, to management and even advocacy. What is portrayed inaccurately , are the patients. While I am sure there are people like that, I do not believe that they make up the majority of the mentally ill. I also fear that the portrayal of the mentally ill and their treatment may have contributed to the stigma associated with the mentally ill, and the fear of seeking treatment. I can only hope that administrators, doctors and nurses in institutions are more compassionate and knowledgeable about the suffering of their patients, than those in the movie.

While in this case, the Freudian based therapy was successful, my sources tell that it is now considered to be overly simplistic. It does raise the question; why do these traumas send some people over the edge, and others are able to go on living normal lives? See the movie and think about it.

Welcome bus riders!

People who suffer from mental illness’s and people with other handicaps are often the victims of stigmas. Personally, I did not know how bad it was to have mental illness, until I had it. The people who practice stigmatization probably aren’t bad, they just don’t know any better. It is up to us to educate them.

The very first thing you can and must do is be an advocate for yourself. Sometimes this may require “Coming Out“, and being open, honest, and public about your illness. But it can be as simple as doing those same things within the framework of your treatment professionals, and/or support groups. Say what you want! By that I don’t mean say anything, but stand up for yourself, and try to do it in a rational manner. If you are going to be critical, try to be specific and constructive. If your treatment isn’t working for you, ask what kind of changes can be made. Your doctor and support group may respond by asking you what changes you think you should make. You must also be prepared to take criticism.

OK! You’ve become a successful advocate for yourself. Congratulations! You have put yourself on the road to wellness and recovery. You may have noticed how other people have the same problems that you have dealt with, but are not doing so well at it. It’s time to be an advocate for others, and there are numerous ways of doing this.

Some people are very good at “Working the System”. They know what programs are available, where to go, and who to talk to. There is a large assortment of benefits available; low priced and free medication, low priced and free psychiatric care, housing, transportation, food, employment, general medical care, and even cash! Obviously, it can be very difficult to get well and manage your illness without some of these things.

Being supportive is both a talent and a skill. It comes naturally to some, but there are courses you can take that are very helpful. Saying the right thing at the right time to keep someone out of crisis, or pulling out someone who is in crisis, is invaluable to our community.

Knowing about medication can be a tricky subject. Everybody’s illness is different. Everybody’s brain chemistry is different. There may be co-occurring medical condition. What works for one person, may not work well for others. Be Careful! I know within the NAMI model, we are prohibited from suggesting medication. Too much like practicing medicine.

Take charge! “If you want something done right, do it yourself!” “If nobody else is going to do something, I will!” Assume a leadership role in your support group and community. Be politically active. Speak publicly. The general public needs to realize that the mentally ill need not be incompetent. Many of us are highly educated!

Being an advocate is good for you. I try to get people involved in our DBSA board. It’s not high stress, and it gives them a feeling of accomplishment. I took a peer facilitator course from NAMI. I’ve facilitated meetings for DBSA many times and it was easy for me. It was not so easy for others. I would tell them, “ The first time you realize that you have helped someone, you’ll think to yourself,’ I can do this!’”

I cannot let this subject go without a big thank you to Edwina and Kelly, who started and run this chat room. They have continued to expand and improve it. It has turned into a valuable, international resource for the mentally ill. What an accomplishment! All of us know them both, some better than others. Like the rest of us, they have their own problems. But they both serve as a shinning example of how you do not have to feel good all the time to be an advocate and help others. Hey, You can do it too!

We all come here to chat with one another. Each of us has our own reasons for coming here. And each of us has at one time or another, experienced some kind of behavior that we did not like.

There are some important things to remember. Everything that you post to the internet stays there. Forever! For anyone to read! I do not know what the copyright agreement is , whether our post belong to Edwina or Para chat and how protected they are. Also almost everyone who comes here to chat is mentally ill! Some more than others.

Trolls! If you are reading this, there may be hope for you. These may some of the most ill people that you encounter on the internet. They are just looking for attention, and are not particular what kind they get. In the mental health chat rooms they neither ask for, nor offer help. They do not even want to friends with people. Do not try to talk to them, argue with them, or even call them names. Operant conditioning! Ignore them. They “ignore” feature of this room helps. Click on the name to the left to highlight it, then click on the “ignore” button. Nuff said!

Troll-like behavior. These people too, may be seriously ill or episodic. They sometimes carry on a conversation with themselves, say irrational things, and fail to relate to others in the room by acknowledging their post. You might be able to start a conversation with one of these. Use your judgment. If it is someone you know, you may want to carry them. If not, you may want to direct them to this blog. Otherwise, ignore or sign off and come back later.

Then there is what I like to call, “The Lord of The Flies” effect. Simply put, it is mob rule. One person says something stupid, someone else jumps on their case, then everybody else has to jump in also. I’ve done it. It is easy to get caught up. Generally, the ensuing defecations and condemnations are even more stupid than the original remark! Try not to do this. The people that come to mental health chat rooms have an illness. JUST LIKE YOU! They ma be having an episode and/or not completely in control. The things said in these lynch mobs can be more than just offensive, they can end friendships, and do long term damage to someone elses wellness and recovery.

The dating game. Most of us live so far apart there is hardly any chance of actually meeting that other person, let alone getting “horizontal” together. They have been a few happy cases of people who have found each other. Very rare! Generally, the mentally ill have lousy relationships. You could hurt someone , or get hurt yourself. Once again, screwing yours or that other persons wellness and recovery. Those may the only things that get screwed. There is an old saying, “don’t sleep with anyone who’s problems are worse than your own!” In this case, “don’t sleep with anyone who’s taking more medication than you!”

Hyper sexuality. This is an unfortunate symptom of Bi-polarity. When manic, people may actually believe that they are attractive and alluring. A lot of the sexual banter and “I love you’s‘” are tongue-in-cheek and “for entertainment purposes only.” Please, no wagering! I get a kick out the cyber suave de bon aire’s who actually think that they are going to get in the pants of some gal (or guy) a thousand miles away! I used to be one! If they are such a hot product, how come they are some geek on the internet, instead of out on the town with some hot bod? You silver-fingered-devils!

Chronic cacaphonia. Samuel Johnson used to say, “profanity is the refuge of the illiterate.” I’m no prude. I use it. But at times it is ridiculous. I like to compare to the cub scout troop that has just learned all these new, forbidden words.

Remember, this is a mental health chat room. Some people may be prone, from time to time, to say and do things that they regret later. If you have never done anything like that, you probably do not belong here! Everyone expects compassion for the mistakes that they make. But it seems hard for the same people to give it to others. If it is something you would not say with your mother in the room, in mixed company, or face-to-face with that other person, you probably should not say it here! Try to avoid cutting to the quick and doing permanent damage. The mentally ill can be very sensitive.

A couple thousand years ago, a famous rabbi is attributed to have said, “taking back words that have been said, is like removing the salt from water in which it has been mixed,” yet another famous rabbi said, “what is distasteful to yourself, do not do to others.” Much later it was paraphrased by anther famous rabbi, “Do unto others, as you would have others do unto you!”

Newly Diagnosed?

In most cases, the introductory symptoms are eating disorders, too much or too little. You may be experiencing sleep problems, again, too much and too little. People with mental illness frequently have relationship problems, both personal and occupational. Then there are the delusions. These take many forms; “nobody understands me”, “everyone is looking at me”, and “everyone is talking about me”. Other Delusions can be more complicated, and of course more serious; “the CIA satellite is reading my mind”,” I’m getting messages from G-d on the TV and radio”, or people may believe that are responsible for events that they have no control over, and no connection what so ever. Of course alcohol and substance abuse are key indicators and very much a causative factor.

Personally, I was taking my father to a psychiatrist to get medication for his Alzheimer’s. I did this for over a year, each time the doctor would ask, “How are you doing Ron?” And I would respond, “I’m doing OK!” One day, I just said, “Not so good.” And almost cried right there in his office. Later, when I had my first appointment, he revealed to me that he knew I was having a problem the first time he met me! You cant hide from those guys! You will find that you cant hide from your fellow bus riders either!

Your doctor probably gave or prescribed some medication. Be sure to take it as directed. These medications do not always start to work right away. That is not unusual. And when they do, they may not have the same effect that you had hoped for. There is no magic pill that cures mental illness. Medications are like training wheels; they help you, but you still have to learn to ride! Sometimes, the medication work very well. You may feel so good that you want to stop taking them. DO NOT DO THIS!!! It is possible to forget one or two doses, but remember to get started again. Generally, not taking your medication is your ticket to the psychiatric emergency room, or in the worst case , to jail! Do not pass go. Do not collect $200!

What do I do now? Most everyone has a job, school, or household chores that need to be done every day. Do them! Get up, clean yourself up, get dressed , and have a life. That is absolutely the best therapy there is. I always suggest to people; have a goal to do something positive every day. That way when you go to bed at night, you will not have that feeling that you have wasted a day. Do that every day, and pretty soon, you’ve had a good constructive week. Then a month. Then a year. Eventually you will feel good about your life.

Do not isolate yourself. Sitting around and dwelling on your problems is the worst thing you can do. There are solutions to almost every problem. You are here in this chat room. I have to admit that there are times when this is not the healthiest place. There is almost always someone who will take you in and give you some support. Learn how to use the private message and ignore features. Support groups are terrific. I swear by them! The Depression& Bipolar support Alliance, and The National Association for The Mentally Ill , both operate support groups all over the country. There may be one near you. They have an advantage of being real people. A handshake or a hug, a human voice, and eye contact are things you cannot get in a chat room. Those things in themselves can be very therapeutic. Just about everyone at these groups has been through what you have been through, including being newly diagnosed!

Regular daily exercise is terrific. Not only can it generate endorphins that will make you feel better, but will improve your overall fitness. Start slow. Do easy exercises and try not to hurt yourself. It can be something as simple as a daily walk. This can also improve your sleeping. Leave the ipod at home. Learn to enjoy the world as it is.

Lastly, It is very important to learn to recognize your own symptoms. You may have to do some reading to do this. To learn what are the common symptoms of your illness. This will help you learn what causes these symptoms and devise strategies to control them. It will also help your doctor plan a course of treatment for you.

One of the most common and potentially disastrous symptoms of mental illness is suicidal or self destructive thoughts. This should be obvious. What is not always obvious is that they are a symptom of the illness. No one really wants to kill themselves. What everyone really wants is to have a happy and successful life. But sometimes the illness is so overwhelming, that we cannot think of the ways to accomplish that goal. Controlling your symptoms and figuring out those ways is the real object of treatment for mental illness.

Like I said when I began, you have already taken two giant steps. Attending a support group is kind of another giant step, and so is becoming and advocate (to be addressed later in another column), but for the most part, getting through recovery and on to wellness is a lot of baby steps. As much as we would like, there is no instant cure. You may find that some of things you need to do are very difficult. But its still better than being sick! As you meet more and more of your fellow bus riders, you will find that some people have made remarkable recoveries. And then you will meet people who have suffered for years and gotten nowhere. Try to learn from both of them. It is most important to remember, There is hope. People can and do get better.

See you in the room!

Ron