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(Mental Health) How to Help Others

Myth 150When I look back on the person I was in college — during the worst period of my depression — I am honestly amazed that I still have so many friends who knew me back then. I spent most of my time in the computer lab talking to folks online, and barely had enough energy to eat, sleep or bathe. Everything I talked about centered around how awful life was, how insurmountable my problems were, how much of a failure I had been. When folks were kind enough to apologize when they offended my hypersensitive emotions, they were treated to small passive-aggressive jabs instead of gratitude. It was awful. I was awful. And it makes me so grateful that there were people who stuck with me through all of it.

I try to take that knowledge with me whenever I’m dealing with someone in the throes of depression or anxiety, because I know how much it helped to have people who never gave up on me even when I wasn’t capable of showing my appreciation at the time. They made one of the worst times of my life a little more bearable, and I know now that it was at considerable expense on their part. The energy and patience required to deal with me when I was in my worst depressions are more than I could ever expect from anyone, even close friends. But those people who spent it on me are people I would do anything for now.

There is no shortage of people in geek spaces suffering from depression, anxiety, or another mental illness; supporting us can be very difficult, especially if you can only do so online. It can feel so inadequate to put encouraging words on a screen when someone tells you that they just want to die, and it’s really hard to be sure you understand what they’re going through when they bring up a problem. And, quite honestly, it’s a rough deal to spend so much time and energy consoling someone when you’re online to gain some measure of relief from the world yourself — especially if it feels like all of that time and energy is being sucked into an emotional void with no measurable improvement. Still, most of us are good people who don’t want to see our friends and fellow fans suffer, so we do what we can to ease the misery where we can.

With that in mind, what can we do to make sure we’re helping friends who are having a hard time coping with mental illness? There are a few things I can recommend from my personal experience on either side of that conversation, combined with suggestions from professionals and mental health advocates. I can’t guarantee that your friend will be cured if you follow this advice, of course, or that it will even result in a marked improvement. I do think that they will help you understand what your friend might be going through and offer the best assistance you can.

Listen actively. It takes work to be a good listener. Most of us only practice what I call “surface listening”, where we pick up the generalities of what’s being said while planning the next thing we’re going to say. Deep listening, the kind where you not only hear what’s being said but work to understand the intent behind what’s being said, is both more rare and more difficult. However, for those of us stuck in a bad headspace, it can mean a lot for someone to understand what we don’t have the vocabulary or insight to say.

When I’m in a bad depression, it’s hard to open up about what I really feel. Sometimes I don’t even know what that is, so I end up talking around the problem or trying to get to the precise feeling from different angles. It can be frustrating to have this strong emotion roiling inside of you without the means to express it, only to have a conversation that leads you further away from it with someone else.

I know this sounds like depressed people might expect you to be a mind-reader, which isn’t fair. But you don’t have to be — sometimes, all it takes is really listening to what someone is saying to understand what they mean. Active listening is difficult, and like any skill it takes practice to get good at it, but it reaps dividends not just for helping a depressed friend but for pretty much any other conversation you could have.

Offer support, not solutions. This is a bad habit of mine that I’m constantly trying to curb, but when someone comes to me with a problem my brain immediately kicks over into “solution mode” where I try to attack the problem with the person who brought it to my attention. This often just causes that person to be frustrated and frequently dismiss my suggestions for one reason or another. This frustrates me because I’m too deep into “solution mode” to get what’s happening there. If this person didn’t want my help solving their problem, why did they even come to me in the first place?

The kicker here is that I’ve been on the other side of this conversation, and I know how frustrating it is to bring a problem to someone only to have them immediately go into a list of solution suggestions. It’s so strange to me that it’s so easy to be disappointed in someone for doing the same thing I do all the time when the roles are reversed; if nothing else, it’s proof that we’re just not the rational creatures we think we are.

This might not be true all the time, but for a significant portion of the cases I bring a problem to someone I’m just looking for a safe space to vent — especially in the grips of a depression. It’s comforting to have someone else offer support and understanding, to acknowledge a problem you’re having as difficult to deal with. Sometimes, it helps to know that someone cares about you and that they’re on your side.

Know your boundaries. Having a friend with a mental illness lean on you heavily for emotional support can be exhausting. It’s all right to acknowledge that. Sometimes, we just don’t have it within us to be the outlet for someone going through a tough time — while that can be a difficult realization if you feel partially responsible for someone’s well-being, it’s also important to recognize when you’re getting burned out and unable to cope with the workload.

Having a firm handle on what you can and can’t handle is important for your own emotional well-being, and when you’re getting close to your limit you have to step back to preserve your own peace of mind. It’s noble to want to be right there in the thick of things with your friend, but compromising your own emotional health for the sake of someone else doesn’t solve their problem; it only creates more to be dealt with. If you need to take some time to recharge, tell your friend as kindly and compassionately as possible, and let them know that you’ll be available some time later.

If possible, it might help to find a support group online or in person to join. This can help you learn how to cope with caring for someone better, and that you’re not alone. There might be other resources you can share with your friend or a common support network, as well.

Encourage treatment. Most of us with friends who are dealing with a mental illness aren’t equipped to handle helping them on our own. Part of knowing our own boundaries is knowing when we’re in over our heads and professional help is needed; we wouldn’t offer a diagnosis or treatment for someone with a mysterious pain in their chest, so we shouldn’t do that for mental illness either.

Recommending a visit to the psychiatrist can be a tricky subject. Even if someone has health insurance, there’s no guarantee that mental health services are easily available. Besides the resistance to seeking treatment to begin with, there might be legitimate social, logistical or financial barriers to getting the care they need. Those of us in a bad spiral might see going to a therapist as a defeat, or be reluctant about sharing intimate and painful details of our lives with a stranger. Sometimes, though, it’s the best option we have for getting help.

If you feel your friend needs to see a mental health specialist, see if there’s a low-cost or no-cost resource available and what (if anything) would need to be done in order to take advantage of it. If they’re in a position where they can see a specialist with relative ease, talk with them about their reluctance to do so and see if that can be worked through. While treatment for a mental illness can be a long process that requires patience and trust, it’s worth sticking with. Helping a friend seek the help they need might be the best thing we can do to support them.

Discourage abuse. One big hazard of being emotional support for someone is the very real possibility of being subjected to abusive or manipulative behavior. I’ve known a number of people who feel that their mental illness is a valid excuse for treating the people around them poorly, and far too often the people in their support network enable that behavior by letting it slide. It breaks my heart to see this. No one deserves to be verbally or emotionally abused, and mental illness is no excuse for being an asshole. Letting this go unaddressed hurts everyone involved.

If a friend is engaging in inappropriate or manipulative behavior, it’s our duty as their support to let them know they’re crossing a line — especially if it’s with us. It can be very difficult to do so in a compassionate way, and it may take some delicate handling to do so, but it’s worth it every time. It helps to make sure the behavior is addressed as separate from the individual (“you did a bad thing,” not “you’re being a bad person” for example) so the person doesn’t internalize the action to the point that it’s a part of their identity. And it might help to remember that the behavior needs to be addressed in order to truly help your friend; keeping the goal of the conversation in mind might work to keep it from derailing.

Most importantly, it makes sure that you maintain your equanimity as that friend’s support. Some of us have a tendency to make other people see the world in the same skewed ways we do when we’re depressed. Sometimes we’re driven to these actions by the irrational fear that controlling someone else’s behavior or lowering their self-esteem is the only way we can keep them associating with us. Making sure it’s known that behavior won’t be tolerated AND that the relationship is one built on positive shared values (and not fear or control) provides a clear counter-narrative to that internal monologue, and might help that friend come around a bit sooner than they would otherwise.

Even then, if the abusive behavior continues or a line is crossed that makes the relationship untenable, it’s important to establish your boundary and make it clear there are consequences for those actions. If that means ending the relationship, as difficult as that is, then the relationship must end. Supporting someone else should not come at the cost of your own emotional health. Only give what you’re willing to part with, and make sure your loving relationship with yourself remains intact.

I hope these suggestions help, and offer some small insight into the difficulties of emotional support. I’d also like to take this time to thank all the people who’ve helped me through the worst times of my life, from the bottom of my heart. I wouldn’t be where I am without your continued faith and support, even when I really didn’t deserve it. Thank you Ryan, Kyle, Odis, Brian, Matt, Mat, Cy, Sherri, Crystal, Virginia, Joe, Kaycee, and so, so many others. I think about all of you all the time, and I appreciate all you’ve done.

 
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Posted by on May 23, 2018 in Buddhism, mental-health, Self-Reflection

 

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(Mental Health) How to Help Yourself

Myth 150If I could have readers leave the Desk at the end of the month with only one new piece of information, it’s that mental illnesses are actual, physical ailments in the brain. While the way we think and perceive has something to do with how the illnesses are expressed, the fact remains that most conditions come down to processes in the brain working in ways that cause significant suffering. For folks like me, these ailments are going to stick around for a while; that means one of the best things we can do for ourselves is develop coping mechanisms and routines that help us have as few bad days as possible. Now that I’ve talked at length about the conditions I have, I’d like to talk about a few of the things I’ve learned to do that help me most.

Before that, though, I do want to make a few disclaimers. First of all I’m not a licensed professional and none of the advice you find here should be taken as gospel; feel free to discard any or all of this if your psychiatrist or psychologist tells you different. Second, this shouldn’t be viewed as the equivalent of professional help. If you have (or think you have) a mental illness, the best course of action is seeking professional treatment if at all possible. Finally, taking these steps won’t guarantee that you’ll never have issues with your mental illness. I still have bad days and I still fall into depressive episodes myself. Hopefully, though, these can help shallow out the emotional valleys and make it easier to recover from them.

THE BORING STUFF

Sleep. Sleep has been the most important thing for me to get under control for my mental health. Back in college during my worst periods I had functionally no schedule for sleep; I would instead spend as much time as possible in my dorm’s computer labs seeking out some kind of human connection to make myself feel better. But the lack of consistent sleep made it so hard to regulate my emotions, pay attention in class, or absorb the day-to-day stresses that come with a full courseload.

While the exact function of sleep is not entirely understood, we do know that a number of important “brain maintenance” processes happen during rest. For those of us who have problems with brain function, a consistent sleep schedule is one of the easiest ways we can help our brain manage what it can. Our internal clocks are different, and for those of us working jobs with variable schedules or have some other function that doesn’t let us adopt a stable routine, it might not be possible to set a consistent bedtime for, say 10 PM – 6 AM. Do what you can, but do something; seven or eight hours of sleep a night are a must before just about anything else.

Diet. Again, I know that this is some loaded advice. There are so many folks who are simply unable to eat well because they can’t afford or find fresh produce, don’t have the time or will to cook for themselves, or have other legitimate reasons preventing them from making big changes to their diet. I get it; I’m not going to ask you to go vegan or only buy organic. But small changes to your diet that recenter focus on nutrients that help your body function better can be made. A good rule of thumb is the classic quote from food writer Michael Pollan: “Eat real food, not too much, mostly plants.”

At minimum, I’d recommend eating less salt, sugar and processed foods; drinking fewer sodas and juices (even diet and sugar-free versions); eating more lean meats and whole grains; drinking more water and tea. Most carb-heavy processed foods tend to convert into sugars within our bodies (at least, to my understandings) and the simpler or more processed the carb, the faster that process tends to be. In the United States we’re all about our processed carbs, and breaking away from them can feel like swimming upstream. It’s hard, I know. But if you can have fruits, vegetables and lean meats — have as much of them as possible.

Exercise. Exerting ourselves can often trigger the body into releasing dopamine, endocannibanoids and other chemicals that lift our mood, and the best part about exercise is that there’s a near-limitless variety of things we can do to work ourselves out. There’s weight training, sure; but there’s also running, sports like basketball or soccer, yoga or tai chi, cleaning the house, or walking along a favorite trail. In addition to the benefits of regular exercise, getting outdoors also helps our bodies to make Vitamin D (which helps build our bones and protects against cancer) as well as serotonin (one of those neurotransmitters I’ve been talking about).

Personally, I love running, but the spirit might move you to try something different. I understand how hard it can be to make time for regular exercise — I still struggle with it myself. But taking even ten minutes a day to walk around the block during the day can help lift your mood and give yourself more energy.

Getting more sleep, eating better food, and developing a regular exercise routine are all suggestions that any of us who’ve gotten professional help for our mental illnesses have heard time and time and time again — but there’s a reason for that. Taking care of our most basic needs is incredibly important. Not only does it help our body develop the tools it needs to manage the imbalances in our brain, but it also encourages us to change our relationship with ourselves. I’ve found that making sure I eat, sleep and move well helps me to think of myself as someone worth caring for and also helps to make me more sensitive to those needs. I have a better gauge for when I’m hungry, or really need sleep.

LESS BORING STUFF

Meditation. There are a lot of misconceptions about what meditation is, and that might be because everyone who practices it has a slightly different concept of what it is. In popular culture, meditation is the emptying of mind and communion with everything around you in the present moment; it’s an act of peaceful enlightenment that you have to do perfectly the first time you do it or you just can’t.

I’m here to tell you that meditation is messy and disorganized. I’ve meditated (almost) every day for seven years or so now, and most days are still a struggle against “monkey mind”. Meditation is not the mechanism we use to force ourselves into mindfulness and peace; it’s the mechanism we use to watch and accept our own thoughts as they arise.

When I sit on the meditation bench, I replay past arguments I’ve had with people; I think about the many mistakes I’ve made; depressed and obsessive thoughts pop up all the time. That’s completely fine — that’s what I’m on the bench for. However, so many of us believe that the thoughts or feelings we have are inherently bad and meditation is the way we rid ourselves of these thoughts. That’s not the case: these thoughts and feelings are natural, and it’s OK to accept that we have them. Acceptance of these difficult emotions and the thoughts they’re associated with is the first step we need to take in order to make peace with them.

Meditation as a daily practice allows us to gain better insights into the deeper layers within our thought process. We might notice, for example, that the same kinds of situations trigger a specific memory or regret; or we might notice that there’s a common thread in the things that make us angry or sad. If we accept this, we can then explore these insights with a gentle and compassionate curiosity. Perhaps, in time, we can even resolve the things that cause us suffering.

That definitely takes work, persistence, and faith in the process. But it’s been worth it to me. Due to my meditation practice, I have a much better understanding of when I’m in a depression or particularly rough bit of anxiety; that allows me to handle myself better when I’m in those spaces so I’m not as likely to do something that I’d later regret. That alone makes the depressions easier to deal with.

Making a care packet. One of the things that I like to do for myself when I’m feeling fairly well is making a “care package” for a future version of myself struggling through a bad depression or anxiety day. This can include one package of my favorite candy, a story or novel that I love, a playlist that lets me “lean in” to that feeling of sadness and turn it into a cathartic experience, or a Snuggie, or a really sweet letter or gift from a friend. Your mileage may vary with this, of course, but now that I can somewhat anticipate when I’m hitting a downward spiral I can look into the small things I’ve left myself to feel better and use them.

Of course, the things in your care packet don’t have to be physical objects: it could be permission to cancel a social engagement without feeling guilty, or a day to binge-watch a show in your pajamas. The main idea is to accept that there will be moments where despite your best efforts you hit a rough patch, and to do little things in advance that will help your future self ride out those times. In addition to giving yourself presents, it also helps retrain your brain to treat yourself a bit more kindly and to recognize that these “flare-ups” aren’t your fault. Sometimes they happen, and it’s important to be kind to yourself when they do.

Engage and learn. For most of us with mental illnesses, it can feel like we’re the only people who have this messed up thing where our brains lie to us about how the world works every once in a while. The terrible thoughts, the embarrassing emotions, the situations that are surprisingly common for those of us with deep depressive episodes — all of these can make us feel alienated and broken beyond the possibility of repair. The stigma that surrounds these illnesses can make it hard to open up about them, to share experiences even with other people we know going through the same thing.

That’s why learning as much as we can about our conditions and engaging with others who are also coping with them can be so important. The messed up things we do or think at our worst might be a fairly common experience; or we might, through the course of consoling a fellow sufferer, learn how to be gentler with ourselves dealing with a similar problem. There are a large number of online resources for depression, anxiety, and ADHD — even grouped by location, background, or lifestyle. The Internet is a wonderful gift here, in that it’s given us the capability to share our struggles in ways we’ve never been able to before. It might help knowing more about what you’re going through, and that you’re not the only one going through it.

These are some of the things that have helped me build better coping strategies and resilience against my mental illness. I sincerely hope they help a few of you out there, as well.

 

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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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(Mental Health) My Anxiety

Myth 150When I was a little kid our family had an ancient brown Chrysler my mom called “Nellie”. I wasn’t sure if it was actually brown, or if the car was covered in that much rust, but Nellie was a formidable vehicle, a 20-foot land yacht with leather seats that gave you frostbite in the winter and third-degree burns in the summer. The space on the floor in front of the seats was so wide we actually sat there during long drives sometimes, watching the sky speed by through the windows. There are a lot of things about that car I miss, but I did not miss the joy-buzzer sound of its alarm system.

Nellie bleated about everything whether it was a problem or not: the oil gauge would light up even when she was half-full, and so did the gas. The temperature gauge was lit no matter what, so we just learned to ignore it. But the bane of my existence was the “door ajar” alarm, which would sound sometimes even when you just bumped the door with your elbow. Sometimes, during long trips, it would just buzz until we stopped and shut it again — and that wasn’t something a seven-year-old bookworm could do easily. Mom would turn up her Motown tape to try to drown out the noise, but really it just made it worse. Even today, “Ain’t Too Proud to Beg” just doesn’t sound right without that buzzy whine.

As ancient as she was, Nellie was a good car — even if her gauge system was completely shot. I think fondly of her these days because I identify with her so much; like her hypersensitive open door sensor, my anxiety trigger will go off for like, no reason.

I am one of about seven million Americans with Generalized Anxiety Disorder, a mental illness that is often found in people with Major Depressive Disorder. People who cope with GAD are natural-born worriers, with anxiety flaring up over just about anything. The anxiety is excessive for the given situation and many of us feel like we can’t control how much we worry. Symptoms often include a feeling of restlessness or edginess, difficulty with concentration or your mind going blank, muscle tension, difficulty with sleep, and/or being easily fatigued. That worry and accompanying symptoms have to be present for at least six months before diagnosis.

GAD is one of those disorders that develops gradually, so the typical age of diagnosis is right around 31. It affects women more often than men, though it’s not entirely clear why. In fact, not much is known about how GAD develops in general; the best guess is that combination of biological factors, family background, and life experiences — especially stressful ones.

In general, GAD is treated with cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), mindfulness training and/or medications like SSRIs (selective serotonin reuptake inhibitors, which prevent your brain from cleaning up free-floating serotonin in your synapses). Cognitive behavioral therapy helped me understand my anxiety disorder much more clearly, and gave me a good framework to deal with it.

I find it helpful to think of my emotions like the gauges and alerts on a car’s dashboard; when they light up, it’s my mind telling me that I need to pay attention to something. Happiness is basically Cruise Control; everything’s good, just keep doing what you’re doing and you’ll be fine. The temperature gauge warns me when I’m getting too hot and need to cool down; the gas gauge warns me when I’m hungry and so on. When the sensors are working properly, emotions are a useful way to bring mindful attention to a situation that might need to be changed. For those of us with mood disorders like depression or GAD, however, the sensors are over-sensitive and tend to light up when they really don’t need to.

Those of us with anxiety disorders tend to have trouble with uncertainty; what’s unknown is dangerous, and our minds tend to jump right into hypothetical catastrophes. So we try to plan or control as much as possible, getting out ahead of any situation that might arise. This can be put to good use in a lot of different ways when the anxiety is mild or even moderate; but when it tips into severe anxiety things get a lot harder.

My biggest stressors are failing at something I really want to be good at, forgetting to do something I’m supposed to, and disappointing someone. For the longest time I refused to move into a position that required more expertise at my day job because I knew in my heart I wouldn’t be able to do it — I’m not detail-oriented enough and the consequences of failure can be pretty high. I didn’t want to be the one person who couldn’t keep up and forced other members of my team to drop what they were doing to bail me out.

Deadlines are a nut I have never been able to crack, especially with writing. I stress about everything when working on a story, and all too often I get caught in a loop where I’ll get stuck on a single aspect of the process, revising again and again and again until I’m exhausted. As the deadline grows closer, that anxiety grows until it feels like I’m physically unable to concentrate on what I need to do: my monkey-brain leaps all over the place, or my mind simply goes blank and I can’t hold on to a thought. Almost always, I’ll freeze in the face of the deadline and watch the opportunity pass me by. Having never tried is almost a relief compared to the imagined hell of really going for it and failing completely.

While this kind of performance anxiety is fairly common, it’s not the reason GAD is so troublesome for me. Like Nellie’s constant open door buzzer, my worry is ever-present and all-consuming. I am in a near-constant state of fight or flight, ready to box any perceived threat or run screaming from it. Right now, as I type this, I’m worried about the following things: the possibility of marijuana addiction; the spectre of a progressively worse anxiety disorder that blossoms into a full blown obsessive-compulsive disorder; all of the people I haven’t spoken to in a while and what they think of me; the last work project I need to turn in; my Patreon; my Pathfinder game; countless other projects I’ve committed to and should be working on; my mother; my brother-in-law; my bank account; my new job; the possibility of dementia at an old age; Trump; Iran developing nuclear weapons; my rabbit; how this post will be received; how much I still need to do before bed; whether or not I’ll sleep well; how much I can get done tomorrow; my upcoming trip to Europe; the possibility of nuclear war or a terrorist attack; my weight; my libido; the length of this paragraph.

My mind gnaws over these worries all the time, from my first thoughts in the morning to those last troubled, fuzzy ones that pop up when I’m lying in bed. I’m constantly thinking about the things that could go wrong, the things that have gone wrong, what’s my fault and how bad it will be when the consequences are due. I’m not going to lie, it’s exhausting; whenever I find something that makes me more relaxed, it’s like discovering Narnia. People who can just wing it, or not care about what happens, are straight-up aliens to me.

But simply knowing that my brain has this hypersensitivity to stress helps me deal with that. It means that building a less stressful life is not just an idle dream; it’s a necessary component of self-care. I’m a bit more watchful for the symptoms of high anxiety, like unfocused near-panic just waiting for something to latch onto or the tendency to take a small annoyance and make it exhibit A for a major problem that we’re screwed if we don’t solve. And when I catch myself feeling overwhelmed, I know that I need to take a breath and a step back, then force myself to take things one step at a time.

Still, it’s a struggle. Knowing that my amygdala is intensely hyper-active doesn’t necessarily make the effects any easier to deal with, especially when they prevent you from doing so much. Anxiety frequently overwhelms the techniques learned through CBT because there’s no one thing that causes it; it really is an omni-present entity, a background static that makes it really easy to be thrown into a state of high anxiety and all that comes with it.

While I’ve been dealing with depression for long enough that I feel comfortable with the coping mechanisms I’ve developed for it, Generalized Anxiety Disorder has proven to be much more difficult to deal with. It prevents me from trying new things readily, or producing stories that I would want to show people. It makes it harder to be relaxed or confident; it affects my ability to be social. I wish it weren’t so, and I wish I had a better way of managing it, but that’s the way it is.

Over 40 million Americans — roughly 18% of the population — has some kind of anxiety disorder, whether it’s GAD, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, or a Specific Phobia. We are a very anxious country, and it shows. I think one of the best things we can do for ourselves and our neighbors, coworkers and fellow citizens suffering silently under this epidemic is foster an environment of safety and acceptance wherever we can, however we can. Making sure those of us who are anxious have concrete feedback that the consequences aren’t as bad as we fear for failure sure helps, but it also helps to ease the ‘background anxiety’ in our culture. That might be the most important thing we can do: removing fear from our lives and our communities as best we can.

This post is part of Mental Health Awareness Month; I’m writing to share my personal experience with my mental health and hopefully ease the stigma around the very real illnesses I and millions of other people cope with on a daily basis. If you’re interested in helping with this work, here are a few things you can do: support the National Alliance for Mental Illness; visit The Siwe Project, which aims to reduce the stigma of therapy and mental illness in the African diaspora; visit and support The Black Emotional and Mental Health Collective (BEAM); and, if you like, chip in a dollar or two through Ko-fi for the blog. I appreciate your support, no matter what form it takes.

 
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Posted by on May 9, 2018 in mental-health, Self-Reflection

 

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(Mental Health) My Depression

Myth 150Back when I was 14 or 15, my sister ran away from home for a month and it straight-up wrecked me. We had no idea where she was or if I would ever see her again, and it was the first time we had been apart for that length of time. Growing up, we were pretty close; she protected me from the neighborhood bullies because she was a little spitfire and I told her stories and made our meals when Mom was occupied. We had often made a game of running away together, planning our escape route and the best time to steal away; but this time, she left without me and I had never seen it coming. She was one of the only people I felt I could rely on.

During that month I was in a haze. I remember being even more quiet than usual, and it felt like I was moving and thinking through cotton — slow, muffled, distant. When I got home from school, I didn’t know what to do or what I had the energy for, so I would sit on the floor and stare at the back of the couch until it was time to go to bed. Looking back through decades of experience, I can say that was the first time I ever had an episode of major depression.

Major Depressive Disorder is a mental illness that affects over 200 million people worldwide; it can strike anyone at any time, but it tends to affect women more than men and first diagnosis frequently happens between 20 – 35 years old. Common symptoms include a persistent, inescapble low mood; anhedonia, or an inability to experience pleasure — even with things that you used to love; feelings of guilt and worthlessness; insomnia; fatigue; loss of appetite. There are a number of depression disorders, besides. Atypical Depression, for example, tends to manifest earlier and sufferers will respond to good news with an increased mood, but also eat more with low moods and tend to sleep more during episodes. People with atypical depression also have a very high sensitivity to social rejection.

There’s Persistent Depressive Disorder or dysthmia, a less-severe but chronic state of depression lasting for over two years. There’s Bipolar Disorder, where a depressive state “swings” into a normal mood or manic state. There’s Post-Partum Depression, in which a woman experiences a disabling episode of low mood after giving birth. There’s Seasonal Affective Disorder, where bouts of depression happen during a particular season. All of these conditions can cause real difficulties in the lives of people who are coping with them. They affect our ability to be consistent with our work, attentive in our relationships, resilient with our setbacks, content with our lives. These mood disorders make it hard for us to maintain an even perspective about ourselves and the world around us, even with treatment.

That’s because depression is a disease that affects the brain, the one organ we rely on to interpret all the stimuli we get everywhere else. Because the brain is so complicated we’re not entirely sure how depression is caused, but we do know there are several areas of the brain that tend to be affected. Neurotransmitters — the chemicals that stimulate brain activity and give us the ability to think, feel, and make connections — tend to have a harder time working in depressed people, and some areas of the brain are different. The hippocampus, the part of the brain responsible for long-term memory and recollection, tends to be smaller in depressed people; the amygdala, a group of structures associated with base emotions like fear, sadness, and arousal, tends to be more active as well. This combination, especially in depressed people, could explain why it’s easier for us to remember past events that are associated with intensely negative emotions while we tend to forget the things that counteract the internal narrative that preserves our low self-esteem.

Because depression can be caused by either having too few neurotransmitters, or having receptors that are too sensitive or not sensitive enough to them, or an overly-aggressive reuptake system that sweeps them our of our synapses, it’s difficult to say with any clarity which treatment works best; every one of us who deals with depression has a distinct mix of physical, neurological, genetic and environmental factors. Some of us that respond well to medication might have a lot of trouble with talk therapy, while some of us who can manage quite well with lifestyle changes and behavioral therapy might suffer intense side effects with medication. For most of us, some combination of therapy and medication often does the trick — though it can be a process finding the right therapist and/or medication. No one treatment is better than any other; the best treatment for your depression is the one that makes it more manageable for you.

Depression can manifest differently depending on your age, gender, environment and cultural background, but there are no hard and fast rules. Men tend to be more irritable or have trouble controlling anger; women might become more withdrawn; young people might become more reckless or less able to concentrate. It can be really difficult for Black Americans with depression to receive proper treatment for a host of reasons — we are often expected to “fight through” emotional pain, and the cultural stigma about mental illness is still fairly strong. There is a distrust of doctors, especially psychiatrists, and there is too little value placed on openly discussing our feelings. Beyond that, the dominant culture often misreads the expression of a mental illness and either misdiagnoses it or misses the diagnosis completely. While the field is just starting to take a culturally competent approach to mental health care, it still has a long way to go.

It can be easy to dismiss depression as an “imaginary” disease simply because the factors that determine its causes, diagnosis, and treatment are so complicated and can often feel subjective. I understand how it can look from the outside that those of us within the mental health space are just stumbling around in the dark, guessing at definitions and such. But just because something isn’t well-understood doesn’t mean it isn’t real; just because our understanding about something is fuzzy doesn’t mean that thing can’t be pinpointed exactly.

I’ve been dealing with depression for my entire life, and I’ve only recently been fortunate enough to have the ability for treatment. I’ve attempted suicide twice due to my depression, and I still fight through it every day in order to live the best life I can. I know that I’m more likely to have depression because I’m the child of a schizophrenic, and the hereditary link between that mental illness and offspring is well-established. I’ve seen every one of my siblings suffer with their own issues; I know one of my nephews will need to learn how to cope with it. These are facts.
My personal experience with depression has taught me a few things about how to relate to it. All the stuff they tell you about sleep, diet and exercise? Absolutely true, with perhaps sleep being the most important. Being active really does help, especially if it gets you outdoors and in the sun for some time. I can often feel when an ’emotional trough’ is coming on, because it becomes harder to concentrate and I find myself unable to be interested in things; when this happens, I can ‘prepare’ for what’s coming by making sure I focus more on self-care than productivity. It doesn’t stop it from happening, but it becomes easier to ride out.

Depression, for me, is intensely associated with self-worth. I become paralyzed by the idea that I have nothing worthwhile to say or that I can’t say anything in a way that engages or affects other people. I feel stupid and boring and permanently, unfixably broken. It becomes too much effort to do more and more basic things, and my world shrinks steadily because so much becomes unreachable. Cooking something to eat feels like an ordeal; talking to someone to explain how you feel is impossible; doing something for the joy of it feels pointless, and doing something productive feels inconceivable.

My worst spells have all heavily featured unchecked emotional eating (candy and salty chips in alternating waves), being unable to leave my bed or couch, and an overwhelming desire to just sleep forever. Being active, sticking to my routine, finding something to stimulate different parts of my brain — that’s something other people can do. I can’t. Sometimes, even breathing feels painful and exhausting. I need some kind of stimulation, like a TV show or music, but the stimulation doesn’t bring pleasure — just a reprieve from my own thoughts.

Thankfully, I haven’t had a really bad spell in about ten years thanks to Prozac and cognitive behavioral therapy. But I know that it’s unlikely I’ll be off medication at any point in the future, and I’ll need to constantly work on myself to develop better habits and coping strategies. For many others, depression can be a more-intense but less-chronic condition. Some of us have very long cycles that enable us to be fine for years before something knocks us back into that headspace. Some of us will have to wander in the wilderness for a very long time before we find a treatment that works for us.

No matter what, it’s important to remember that depression is a real illness and those of us who cope with it must do so with significant complications. We might not be able to put energy into practices and routines that would help our brain chemistry. We might not be able to afford proper treatment or medication. We might not have a support network to rely on for the things we need. We might have cultural barriers that prevent us from seeking the help we need or getting the proper treatment. It’s a hard enough illness on its own; combined with social, economic and environmental factors it can be that much harder to deal with.

So please, if you can, be easy with the people who are dealing with depression. Recognition and encouragement are vital to shift not only our perspectives, but the perspectives of those around us as well. People with depression aren’t hopeless or crazy; more likely, we’ve just never been given the chance to get the knowledge and help we need.

This is part of a series of post for Mental Health Awareness Month. For more information about what you can do to help build awareness for this often-neglected aspect of our personal health, go to this website: http://www.mentalhealthamerica.net/may.

 
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Posted by on May 7, 2018 in mental-health, Self-Reflection

 

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