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(Mental Health) My Comorbidity

Myth 150One of the reasons it can be difficult to talk about mental illness is the simple fact that so many diagnoses feel poorly defined, or that just when our understanding of terms starts to stick in the public consciousness experts change the game on us, or that those of us with mental illnesses seem to collect diagnoses like Pokemon. Staying on top of the proper terms for mental illnesses or the latest consensus on what those illnesses even are can be frustrating and exhausting, and I get that. It’s even more difficult for us who are having to deal with it.

I’ve said this again and again, but one more time for the folks in the back: the brain is a tremendously complicated organ and our understanding of it is limited for a number of reasons. It can be really hard to know exactly what’s going on in there in real-time, or to concretely map activity in one area of the brain to a specific function. Even when an area of the brain or a neurotransmitter is isolated and understood, the interaction with other areas of the brain shade those known functions to a degree that it gets…murky knowing how one part of the brain influences another. Our ability to gather information about the brain directly is restricted — and rightfully so — by our ability to poke around within it and get feedback from the volunteer. And with something as subjective as personal experience, how can we assign a concrete, scientific measurement to self-reported data?

These are huge challenges that don’t have an easy solution, but scientists work hard to find every scrap of information they can. Through that work, we’ve come to understand a lot more about how the brain works and that’s resulted in a radical shift within the psychiatric disciplines. Filthy, poorly-run sanitariums are a thing of the past, and we now know mental illness affects large segments of the population who nonetheless manage their symptoms to lead productive lives. We have a range of treatments, from medication to talk therapy, that we can lean on to learn how.

Over the past several entries, I’ve talked about my personal experience with Major Depressive Disorder, Generalized Anxiety Disorder, and Attention Deficit Hyperactivity Disorder. Each one of these disorders affects my life in distinct ways, but together they interact with one another in ways that make it much easier to fall into a destructive loop. Comorbidity, in psychology, is the term we use for the presence of multiple disorders in one individual — but it’s also a term that points to the lack of concrete understanding for the underlying causes of many disorders.

Comorbidity frequently occurs because the cause of one disorder can also affect other aspects of the way our brain functions. For example, increased amygdala activity has been noted in individuals with both depression and anxiety disorders; it’s possible that what started out as an anxiety disorder became depression due to an individual’s experience struggling with one issue, or a lack of help, or the effects of anxiety disorder such as isolation, sleeplessness, poor diet and exercise.

Because of the way we classify mental illnesses, and the fact that it can often take a long time before a proper diagnosis is made AND proper treatment begins to take effect, it’s a fairly common thing for comorbidity to occur in those of us with mental health issues. Major Depressive Disorder, for example, is often the first diagnosis and subsequent ones are found through the course of treating it. I learned about my Generalized Anxiety Disorder and ADHD through talk therapy for my depression, when I spoke about my fear about stepping into a new position at my day job, my certainty that I would screw it up somehow.

I’ve thought a lot about the nature of my mental illness, why it’s happened to me. I’ve mentioned that my biological mother was diagnosed with paranoid schizophrenia when I was very young, and I only found out about it as a teenager. For years I was terrified that I would become schizophrenic too, that I would slowly and steadily lose my grip on reality over time. Living through the effects of that myself, and seeing how similar ailments like Alzheimer’s Disease and dementia affect a patient’s loved ones, that kind of progressive and incurable deterioration is still something that keeps me awake at night. The idea of losing myself to a disease that could make me hostile and cruel to the people I love the most is the scariest thing I could imagine for myself.

So I’ve done a lot of digging. I know now that the children of schizophrenics are genetically predisposed to other mental illnesses and yes, do have a higher chance of being schizophrenic themselves. It’s why I’m comfortable saying that my mental illnesses are largely biological; my brain is simply wired differently and that’s something I can’t help. But it’s not the only part of the story. Your environment and experience plays a tremendous role in whether or not these issues develop.

One of the big theories that I find really compelling is the idea of mental resilience — that the mind has variable success with bouncing back from traumatic experiences. If, like me, there’s a predisposition towards depression or anxiety, then these kinds of experiences make it much more likely for that to happen. Someone who is more neurotypical might be able to absorb that kind of trauma better and recover more quickly — again, that’s not guaranteed, but some might be better psychologically equipped to deal with really stressful times.

This is why it’s such a dick move to tell someone to “just get over it” if they’re struggling to recover from a bad experience. For some of us, it might be psychologically impossible to do that without help or a significant amount of time and effort. We might have the ability to absorb some stressors better than others as well, or we might have been marinating in a stew of stress for some time, barely keeping above it before something causes us to sink.

I know that in addition to my genetic predisposition, I’ve had a number of experiences that have knocked me flat. I was bullied almost constantly from elementary school to high school; my relationship with my mother was almost perfunctory; my sister ran away several times; my adoptive parents were divorced and my dad went missing five years later; I learned about my mother’s diagnosis; I was outed before I was ready and disowned by my mom; one of my first real relationships ended incredibly badly; I’ve been sexually molested multiple times; I lost my sister to an overdose. I’ve survived quite a lot, but it hasn’t been without significant consequences that I’m still dealing with to this day.

Despite that, I consider myself incredibly lucky. I’m in a community of wonderful, creative people who support me. I’m in a stable long-term relationship with an amazing man. I have health care that covers mental health services and makes prescriptions for medication affordable. I’m able to build an environment for myself that minimizes stress and allows me the space to find the best coping strategies that work for me.

So many family members, neighbors and friends from back home don’t have this. They’re still stuck in an environment that leaves them up to their necks in stress without the support network, mental health services, or cultural understanding they need to deal with that. Illnesses that could be resolved through therapy and lifestyle adjustments are left to progress, and they’re forced to do the best they can with little to no understanding. There’s no wonder to me that so many of my brothers and sisters turn to reckless behavior, drugs and alcohol, or even antisocial behavior to deal with everything that’s going on.

Mental health is a complicated subject that science is challenged by even under the best of circumstances. When you put the messiness of life on top of that, and the terrible sociopolitical situation we find ourselves in on top of THAT, it becomes clear that this is a big problem that will only get better if we make a concerted effort to address the things that block us from looking after ourselves. Mental illness is almost never just one thing. Sometimes it’s everything, at once, beyond our capacity to cope.

This is part of a month-long series about mental health for Mental Health Awareness Month. I’ve previously talked about my personal experience with depression, anxiety and ADHD; next week, I’d like to talk about ways those of us dealing with mental illness can help ourselves and how our friends and allies can help us in our efforts. If you’d like to know more about mental illness and what could be done to help the nearly 44 million Americans who are coping with them in any given year, visit the National Alliance on Mental Illness, the National Institute on Mental Health, and the American Foundation of Suicide Prevention. And finally, if you appreciate what I’m doing here feel free to buy me a Ko-Fi to keep writing.

 
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Posted by on May 16, 2018 in mental-health, Self-Reflection

 

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(Mental Health) My Executive Function

Myth 150Attention Deficit Hyperactivity Disorder is a bit of a misnomer; I think the name is a big reason why ADHD is so poorly understood and controversial as a mental illness. Those of us with the disorder aren’t necessarily hyperactive, and it isn’t always characterized by a deficit in attention. We aren’t bouncing off the walls from one thing to another, never able to finish a project because we have so much energy to burn off and no way to actually direct it. I mean, it’s partially true — but never in the way that people unfamiliar with the disease or its critics imagine it to be. ADHD is, like almost all other mental illnesses, a fairly complex disorder that can have a variety of expressions.

Also like so many other mental illnesses, the exact cause and nature of ADHD is poorly understood. However, there’s been a lot of research for it possibly because it’s such a controversial subject, with a number of scientists spearheading research to better classify it. We do know that ADHD expresses itself differently in children than it does in adults, primarily because undiagnosed children develop internalization mechanisms in order to “hide” symptoms, cope with them in increasingly complex social or professional environments, and attempt to deal with the lack of support or understanding for their difficulties.

We do know that ADHD is primarily a dysfunction of the parts of the brain that govern executive function, which leads to problems sustaining attention, being organized, and procrastinating. It affects planning, prioritization, time management, impulse control, decision making and mood regulation. In children, this can look like they’re incredibly hyperactive and impulsive, with a tendency to lash out and ignore instruction. In adults, this often looks like someone who is a ‘space cadet’ — lazy and unfocused with no capability of remembering the things they need to.

In any case, it’s generally accepted that the frontal lobes in the brain handle executive functioning. While there may be differences in the structure or volume of brain matter in this region, there might also be really hyperactive dopamine and norepinephrine reuptake mechanisms there. Since those neurotransmitters are very important for brain function in these regions, this can result in the neurons in that part of the brain working “sluggishly” because there simply aren’t enough chemicals within the synapses needed to promote enough electrical activity. This is why, paradoxically, stimulants like Adderall and Ritalin work so well. They increase the level of dopamine and adrenaline (epinephrine) in the brain. It’s also why folks with ADHD tend to seek out constant stimulation; it’s the brain trying hard to get its fix.

People with ADHD tend to have other mental illnesses, either as the direct result of the physical/chemical issues within the brain or due to the struggle to understand and cope with the illness. Depression and other mood disorders, anxiety disorder, low self-esteem and other issues all tend to pop up; I know for the longest time, before my diagnosis, I thought I was simply broken. I couldn’t make my brain do the things I know it needed to, and my focus would just slide off a task that I knew would require sustained, intense effort. This has been the case ever since I entered high school, to be honest — it was then that I realized I couldn’t simply coast through lessons, but I had never learned how to actually work for the consistently high grades I had gotten before. It was a pretty hard crash, and I never managed to recover from it.

For me, ADHD expresses itself in the form of intense procrastination on projects that I know will be difficult and require sustained focus, detailed effort and a lot of moving pieces. The kinds of stories I like to write are the worst for this, and I genuinely wish I could adopt a style closer to, say, Vonnegut or Douglas Adams or Charlie Jane Adams. But stories with tightly-written plots and thoughtful, nuanced takes on difficult themes often require great care, and I so badly want to make sure that I’m treating these subjects with the mindfulness they require. It’s been a great struggle to fight through a brain that simply doesn’t have the equipment to be as organized and detail-oriented as it needs to be.

It took me a long while to come to grips with the possibility that I had ADHD, mostly because of the stigma and controversy that exists in the media. There’s a steady diet of hot takes out there suggesting it’s a made-up disease, or that it’s especially overdiagnosed in children who are just being regular kids, or that drugs like Adderall and Ritalin are abused by people who are looking to stay up all night and crush that exam or work project.

There’s also a heavy stigma around the use of Adderall. Do you remember that (likely doctored) Calvin and Hobbes comic where Calvin is prescribed medication and it forces him to ignore Hobbes? I’m not going to lie, that scared the shit out of me — the thought that my ability to daydream, to be creative, would have to be sacrificed in order to be productive haunted me for a long time.

calvinhobbes

Seriously, this is nightmare fuel.

But now, of course, I know that’s a false dichotomy. ADHD actually hinders your ability to be creative; if you’re like me, you get hyperfocused on one aspect of the story and (because of my anxiety disorder) fall into a loop where you feel you need to rewrite again and again and again before you’re allowed to move on to the next aspect. Then, you get burned out or distracted and end up with three paragraphs that have been polished to within an inch of their lives.

Medication is absolutely a viable option for treating ADHD, especially in adults, but it’s only one avenue of treatment. Cognitive behavioral therapy (CBT) and other techniques are needed in order to unlearn all the bad habits that our own stumbling about to deal with our brains might have introduced. It can also give us a greater understanding of our individual challenges with ADHD and offer ways to cope with them.

Now that I know that my executive function is impaired and that makes it really difficult for me to stay on task, resist distractions, stay organized and deal with my impulses in a healthy manner, I’ve taken steps to address those. Developing routines that teach you how to consciously do what many others can do in their own heads has been a lifesaver; it’s how I make sure I take my medication, meditate, feed and water my rabbit; it’s how I make sure I’ve broken down projects into bite-sized chunks that I can actually handle one at a time; it’s how I make sure I write down just about everything I need to remember and keep on top of my to-do list. It’s still a struggle to get things done, but I’m no longer wondering why things are so hard or what’s wrong with me. There’s nothing “wrong” with me; my brain works differently from most and while that offers certain challenges it also opens up a lot of benefits too.

Hyper-focus, for example, is a tremendous tool. I know that if I’m emotionally invested in something or fascinated on a certain level it’s a lot easier for me to enter a state of flow where that’s all there is in the world. If I can find a way to access that feeling for a certain project, it’s much easier for me to devote a significant chunk of time to it. Learning how to be organized and mindful is also a strange fringe benefit, but it’s served me well. My Bullet Journal and I are super-best-friends, and the organization, mindfulness and productivity it has brought me feels so much sweeter because it’s been so hard won.

It’s also enabled me to recognize problems with executive function in other people. If someone can never seem to be on time, or forget things if they don’t write them down, or constantly misplace things, it doesn’t bother me nearly as much as it used to. Understanding myself and how I work allows me to be more compassionate towards the difficulties that other people face. It’s so very hard to be an adult, where it feels like you’re juggling balls and spinning plates all the time, and people only notice the kind of job you’re doing when something goes crashing to the ground. All of us are trying to keep too many things in our heads at once; it’s kind of a blessing to know how impossible this is and stop trying.

Symptoms and issues of ADHD can happen to anyone, but that doesn’t mean that ADHD isn’t a “real” illness. Multiple symptoms have to be present for a long time in order to be diagnosed, and medication can also have a weird ‘calming’ effect. For example, meditation and Adderall enables me to focus much more easily than I would be able to otherwise and I’m much more resilient against distractions.

If you think you might have ADHD — or even just an issue with your executive function — it’s best to learn more about how executive function works, what it looks like when that region of the brain isn’t working as expected, and schedule an appointment with your doctor to discuss the possibility. Even if it turns out you don’t have that diagnosis, there might be other issues or more information that might help you improve your focus, organization, and memory. Regardless of whether you’re neuro-typical or coping with a mental illness, proper nutrition, regular exercise and enough sleep are foundations for better mental health.

This post is a part of Mental Health Awareness Month; all month long I’m writing posts about my personal experience with mental illness, the stigma that prevents conversation and treatment, and bits of fiction that highlight these issues. If there’s a subject or aspect that I haven’t covered, please leave a comment!

 
 

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(Writing) A Writer’s May

Self Improvement 150The month of April was…not great for me as a writer. I didn’t make much progress on anything of note, though I *did* resume a long-dormant Pathfinder game that I’ll take as my big win. I could attribute the lack of writing to my day job, or family stress, or the general pressures of being an adult with obligations and such…but to be honest, the biggest reasons are fear and a lack of discipline. I didn’t write because writing has become this internal battle between my willpower and anxiety, and I’m just not mentally equipped to win that battle consistently.

It’s possible that I’m simply trying to do too much. In addition to an ultimate goal of three missives a week on this here Writing Desk, I’m trying to find a way to write consistently for my Patreon project, the Jackalope Serial Company; I’m working on a Pathfinder game that, at this point, is firmly mid-level and I’d like to take to level 20; I’m starting another Pathfinder game that aims to be more of a loose pick-up style campaign; I’m trying to write short stories for two anthologies that I’d love to be included in; I’ve been asked to contribute to other fandom projects and while I’ve said yes I have yet to take any concrete steps to do so. Then there’s the Udemy courses that aim to teach me more about blogging and tech, the Rosetta Stone course for French I’d like to get back to, SO MANY comics, books and short stories I want to read, the clarinet I want to practice, the cleaning and paring down of all my stuff I’d like to get to, the TV and movies I’d like to watch (and maybe review)…

I’m not sure that ADHD/anxiety is a big reason why I commit to so much and achieve so little, but it really can’t help. Because our executive function is compromised, it’s really difficult to set proper priorities and stick with them when we’ve been interrupted; splitting our attention just can’t happen, because we need to be rooted in one thing or else we go flying all over the place. That’s why off-loading your executive function to things like to-do lists and routines is so important; we have to find a way to make an instinctive internal process external and conscious.

I live and die by my Bullet Journal, though that has to be supplemented by other things like Todoist and Google Calendar to make sure I have an eye on deadlines. If I don’t make sure I have some place to put specific information, it’s pretty much gone — but even then, I can write down, say, a submission deadline for an anthology, but unless I take the time to break down the steps I need to take to actually GET to that submission AND make time for it in my schedule it’ll just sneak up on me and then I’m scrambling to meet a deadline. That kind of surprise triggers my anxiety disorder, which makes it more likely for me to just freeze up and watch the deadline go by.

Good project management practice can help with that, but building a project schedule can only do so much when you’re trying to juggle multiple projects at once. When it’s time to put pen to paper (or paws to keyboard in this case), it’s really hard to make productive use of my time. I know that my time with this project is limited, and my goal is…to just get it done. Not to have fun with it, not to engage with what I’m doing — if I’m being honest, most of the time I already have one eye out on the next thing I need to do. That ain’t no way to write.

So this month I’ll have to pull things back a bit and focus on fewer things that I can root myself well in. I have four big goals for this month — write for The Writing Desk consistently; resume regular updates for the Jackalope Serial Company; finish short stories for “The Rabbit Dies First” anthology as well as one other anthology.

Here at The Writing Desk, I’ll be focusing on Mental Health Awareness Month with posts about depression, anxiety and ADHD from my personal experience as well as the things that have helped me deal with them, or the things that I still need to work out. For the Jackalope Serial Company, I’ll be writing four “first issues” of various possible serials to see what folks take to, then continue on the most popular serial through June. With the short stories, I’ll devote as much time as I can to both of them once I’ve made sure the blog and Patreon are squared away.

I’ll also be working through my sky-high book stack as much as possible this month. I’ve got quite a lot of time off this month and I’ll be doing some international travel, so I’m fairly sure there’s a lot that I can knock out. Hopefully I’ll finish “Bluebird, Bluebird” by Attica Locke; “Steppenwolf” by Hermann Hesse; “Radical Acceptance” by Tara Brach; and “The Upward Spiral” by Alex Korb. If I can manage that, there should be a few good bits of reflection out of them.

So what’s your plan for May, writers? What’re you hoping to have finished by the time June rolls around?

 

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Rabbit-Hearted Guy

Myth 150No Shame Day was last week and I completely missed it, so I thought I would take a bit of time to open up further about my mental health issues. I believe that the more we discuss these things openly, the more people understand the nature of mental illness and the more we destigmatize those suffering from them.

I manage chronic depression, and I’m pretty sure I’ve had it all my life. Depressive episodes have been really bad a few times, and it was only recently (when I moved to California) that I finally got the help I needed. Now, I cope with a mixture of medication, cognitive behavioral therapy, and Zen meditation. For the most part this does the trick — my thoughts don’t run away from me nearly as often because I can recognize when something is being driven by depression and have tools to engage that.

However, things aren’t perfect. One of the reasons I identify with rabbit so strongly is because it’s a creature whose life is ruled by wariness. They’re constantly on guard for potential threats, and so much of their communication is about worry and the lack of it. The less they worry, the more their personality comes through; it can be hard to “get to know” a rabbit, but it’s a delight when you do.

I’m a high-strung person; most of my effort goes towards the managing and alleviating of stress — in myself and others. At work, I sweat the small stuff as much as I can, though it gets exhausting to do so and I end up dropping a lot of the details because I just don’t have the capacity to deal with them. THAT can stress me out, knowing that I’m inconsistent with my attention to detail or the ability to get things done. And since I’m stressing about that, I have a reduced capacity for new stressors in my life.

The cycle completes when I get overwhelmed. It becomes impossible to concentrate on the things I need to do. The more I try, the more my brain just seems to slide off the task and I look for anything that can provide a distraction. Sometimes I’ll end up just clicking on the same three websites over and over for distraction’s sake, not taking in anything, just doing something so I don’t have to think.

But that’s no way to live your life, much less spend your career. I’m trying to move into a position of more responsibility at work, but it’s difficult when you struggle to manage the responsibilities you have. This obviously isn’t something I can talk about my superiors with; I’m not a bad worker, I just have trouble dealing with certain aspects of my work. Still, something had to be done.

So I went to a psychologist to see if I had ADHD; the lack of concentration and focus, the excitability, the tension all seemed to point to that. After a test and a consultation, she determined that yes, that was a likely possibility as well as Generalized Anxiety Disorder. GAD is characterized by excessive worrying about various aspects of daily life (in my case, writing and work) with physical symptoms that include fatigue (yes), muscle tension (yes), twitching (yes), difficulty concentrating (yes), irritability (also yes).

So now I’m embarking on a new front for my treatment: group therapy classes for GAD and ADHD, with a round of medication possibly starting up today. I’m hoping that the coping mechanisms learned in these group therapy classes can help me cope with anxiety, and the medication at least puts me on an even keel for long enough to make those mechanisms habit. We’ll see how the rest of the year goes, but I’m optimistic that it’ll at least help me deal with my reactions to stress.

I know that mental health issues are difficult to speak about. You have celebrities and various seminars and self-improvement courses trying to tell you that it’s “all in your mind” and medication is never a good idea. You have the media promoting the idea that when something terrible happens (like say, Dylan Roof) it’s because the perpetrator was mentally ill. Well-meaning friends and associates tell you to suck it up or get over it without properly understanding just how difficult (and sometimes impossible) that is — like people who suffer haven’t tried that already.

But mental illness is a real thing with real causes; sometimes those causes need medication to be resolved, and sometimes developing a mindfulness program is enough. Sometimes the condition is transient, brought out by extraordinary stimuli. Sometimes it’s chronic, without any cause but chemical, and you’ll have to work to manage it for the rest of your life.

All of this is OK. We each have our own burdens, and sometimes we need the help and wisdom of people better equipped to deal with them. It takes a while to find a therapist we feel understood by; it takes a while to find the medication that makes us feel even without feeling emotionally restricted. Learning just how to handle mental illness is a journey that can be long, lonely and frustrating. But like getting to know a rabbit, the end result is very much worth it.

It’s important to me that people know mental illness is a real affliction, and that it can be managed. People who have them can live productive and meaningful lives. And most importantly, that there’s help out there. If you feel there’s an issue that you can’t manage on your own and need help, mentalhealth.gov is a good place to start. Reach out to friends and/or family you trust; a support network can be tremendously helpful. And know that you’re not alone. There are those of us who are fighting the fight with you, all the time, every day. We see you, we understand you, we love you.

 

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