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You Are Not Alone: The NAMI Guide to Navigating Mental Health by Ken Duckworth, NAMI’s medical director, is the first book released by the National Alliance on Mental Illness. The book includes excerpts from interviews with 130 people who either self-identify as having a mental illness or have a loved one who does, and the author writes, “Mental illness and recovery are human experiences, so I consider experience-based evidence an authoritative source for this book.”
The book opens with the author talking about his history with NAMI and his family’s experience with his father’s bipolar illness. Throughout the book, he comes across as talking with readers on the same level rather than being an expert talking at readers.
The book is divided into four parts. The first part looks at mental health conditions and mental health care, the second part focuses on people’s experiences with their recovery journeys, the third part focuses on family members, and the final part is devoted to traditional experts answering commonly asked questions.
The author acknowledges the flaws with the DSM diagnostic system, and he’s also realistic about the problems with the mental health care system, or lack thereof: “The mental health ‘system’ throughout the United States is chaotic and full of gaps. It has long been broken and fragmented, and if you try to wait for the system to be less confusing and frustrating, you will be waiting a very long time.” The book talks about medical model and recovery model strategies (focusing on symptoms and living a good life, respectively), and the author encourages a both/and rather than an either/or approach.
Topics covered in the book included peer support, cultural issues, becoming an advocate, and legal issues around things like involuntary treatment, privacy, and police and criminal justice system involvement. The final section included an FAQ chapter with various experts answering questions, as well as a chapter with clinicians and researchers addressing questions about care for depression, OCD, borderline personality disorder, trauma, co-occurring disorders, bipolar disorder, and psychosis. It felt like a lot of disparate things to cram into two chapters.
There was a chapter on making meaning of suicide loss, and there were a couple of comments I found quite interesting. An interviewee who had lost a brother to suicide said “The last engagement he had was with another person who was talking to a classmate about how to divide homework problems, and I found him twenty minutes later. If you’re struggling with suicidal ideation, you’re not talking about homework problems.” The author, whose brother died by suicide, wrote “My brother ordered a computer monitor the day he died, and it arrived the day of his funeral. People who are contemplating suicide don’t do that.” Except they do; if the action hasn’t happened yet, there is some degree of ambivalence, and tasks of living continue in that space of ambivalence.
While the goal was to be comprehensive, I found the book kind of unfocused, and I felt like that detracted from the overall usefulness. I’m all for sharing people’s stories, but the way excerpts from the interviews were pulled together (often a paragraph or two at a time) created a bit of a hodgepodge that made it hard to feel connected to the individuals. While I can see the potential value of interviewing 130 people and interspersing bits of their comments throughout the book, I think it does make it harder for readers to feel like they’re really getting a sense of who these people are.
As you might expect from a NAMI book, there is a NAMI promotional element. Although it wasn’t unexpected, I did think it was a little overdone. Another element that wasn’t unexpected was optimism about recovery and stories of people doing really well. There was plenty of acknowledgement that things have been hard in the past tense, but there wasn’t a lot of present tense struggling conveyed. As a present-tense-struggler myself, I found it a bit unbalanced, but I think probably a lot of the people who end up reading this book will like the recovery emphasis.
At over 400 pages, this book is a serious commitment. The length and the lack of focus and structure don’t make a great combination; it tends to promote skimming, which takes away from the power of some of the interviewees’ contributions.
I can see this book being useful for family members who are looking to learn as much as they can about what this whole mental illness thing is about, and that’s probably the main target audience that NAMI is aiming for. It’s probably going to be less useful for people who’ve been around the block a few times dealing with their own illness.
You Are Not Alone is available on Amazon (affiliate link).
I received a reviewer copy from the publisher through Netgalley.
You can find my other reviews on the MH@H book review index or on Goodreads.
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In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is thought-action fusion.
Thought-action fusion (TAF) happens when people believe there is an equivalence between thoughts and actions. It was first described by researchers in relation to OCD, although it’s not exclusive to OCD.
There are a couple of different kinds of TAF. Likelihood TAF involves the belief that thinking about something makes it more likely to happen, and moral TAF involves the belief that thinking about an action is the moral equivalent to that action being performed or that event occurring.
A related concept is magical thinking, which involves the belief that thoughts, actions, or symbols can influence external events when there’s no logical reason to expect there to be a causative relationship. Thinking that knocking on wood actually has an effect on outcomes would be an example of this.
Thought-action fusion can increase the perceived importance and threat of intrusive thoughts. Inflating the significance of thoughts can lead people to try to suppress those thoughts, which in turn can intensify the thoughts. Appraising intrusive thoughts as more significant can also feed into a sense of moral responsibility for one’s thoughts.
The Thought-Action Fusion Scale
The Thought-Action Fusion Scale is a psychometric test developed by Shafran and colleagues to measure TAF in OCD. It contains three subscales—one for moral equivalence, one for increased likelihood of outcomes for others, and one for increased likelihood of outcomes for the self. Examples of items from each subscale are:
- “Having violent thoughts is almost as unacceptable to me as violent acts.”
- “If I think of a relative/friend being in a car accident, this increases the risk that he/she will have a car accident.”
- “If I think of myself being injured in a fall, this increases the risk that I will have a fall and be injured.”
The average person tends to have higher levels of thought-action fusion with regards to an increased likelihood of thoughts affecting outcomes for the self compared to an increased likelihood of their thoughts affecting outcomes for others, as they recognize that their thoughts are more likely to affect their own behaviours. People with OCD, on the other hand, don’t tend to make that distinction, and they’re more likely to see their thoughts as influencing others’ behaviours.
Association with mental disorders
While thought-action fusion is common in OCD, not all people with OCD have TAF, nor can TAF on its own fully explain the symptoms of OCD. Some research has linked TAF with greater severity OCD, but findings have been inconsistent, and some studies have suggested that the TAF seen in some people with OCD actually has more to do with depression than the OCD itself.
TAF can skew an individual’s sense of personal responsibility, and they may feel that they need to take some sort of action to neutralize the perceived threat, which may fuel compulsive behaviours in OCD. One way of trying to do this is mental neutralizing, which involves trying to change one’s thoughts in order to reduce the likelihood of bad things happening. This sounds consistent with what’s sometimes referred to as pure-O OCD, where compulsions are mental rather than behavioural.
Likelihood TAF can be an issue for people with other anxiety-related disorders, but they tend to use avoidance rather than neutralization strategies. In particular, likelihood TAF has been linked to generalized anxiety disorder. This may relate to the belief that worry, a major element of GAD, can influence the likelihood of feared outcomes occurring.
Moral TAF has been associated with depression, and this may relate to the self-blame, personalization, and guilt that can go along with the illness.
A related concept, thought-shape fusion, has been described in relation to eating disorders and thoughts about food. This includes beliefs about the badness of thinking about forbidden foods and beliefs that thinking about food will affect body size and shape.
The role of religion
Culture and religion may influence baseline levels of thought-action fusion. A small study by Berman and colleagues compared the way that highly religious Protestant Christians and agnostics/atheists reacted to being instructed to think about particular harmful scenarios. The researchers found that the religious participants had more TAF, believing that it was morally wrong to think or write about negative effects and doing so increased the likelihood of those events happening. Other research has also linked Catholicism and Judaism with moral TAF.
I first stumbled across the term thought-action fusion quite recently when reading the book Everything You Need to Know About OCD. While moral TAF can be an issue for people with depression, I don’t think that’s the case for me. Does TAF sound like a pattern of thinking that you tend to have?
References
- Berle, D., & Starcevic, V. (2005). Thought–action fusion: Review of the literature and future directions. Clinical Psychology Review, 25(3), 263-284.
- Berman, N. C., Abramowitz, J. S., Pardue, C. M., & Wheaton, M. G. (2010). The relationship between religion and thought–action fusion: Use of an in vivo paradigm. Behaviour Research and Therapy, 48(7), 670-674.
- Shafran, R., Thordarson, D. S., & Rachman, S. (1996). Thought-action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders, 10(5), 379-391.
- Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Thought-action fusion across anxiety disorder diagnoses: Specificity and treatment effects. The Journal of Nervous and Mental Disease, 201(5), 407.
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
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People had a lot to say in response to my recent post Suicidality and Other People’s Perspective, so I thought it would be good to have another down and dirty chat about the reality of dealing with suicidal thinking (and sometimes attempts). In this post, we’ll talk about the tendency to be impulsive and engaging in drawn-out, detailed planning. I won’t talk about specific methods, but I will refer to attempts, so skip this post if you’d rather not go there.
I first experienced suicidal ideation and attempted suicide back in 2007, when I had my first major depressive episode. I’m a planner in general, so it’s not really surprising that I was a planner when it came to suicidality. Back then, though, the thoughts and feelings were new and unfamiliar to me, so I didn’t really know what to do with them. The closest I came to an impulsive attempt was at a point during that year when I was barely managing to hold it together, and a major part of my support system suddenly stepped out of the picture (which ended up only being temporary). The suicidal thinking had endured for several months at that point, but that particular decision to act was prompted fairly abruptly.
I got sick again in 2011, but I didn’t start having suicidal ideation until a few months into that episode. At that point, it no longer felt new and scary. Since then, any time I’ve felt suicidal, it’s been a steady buildup without many significant spurts of impulsive urges. When things get to the point where I’m considering taking action, that’s when the planning kicks in. A pattern I’ve noticed is that I set decision milestones, although I’m not sure if that’s the best way of putting it. I make a decision that I can keep going until date A or thing B happens. If, when date A or thing B comes along and I feel like I can keep going but just barely, I will set date C or event D to reevaluate. If life still feels really unlivable, I might take steps to obtain means and set date C or event D as the next point to make a decision as to whether I can keep going to another target point or if things need to end.
Back in 2012, I was working at a job where I had weekends and every other Friday off. I decided that a Thursday night before a long weekend would be the best time to act, as that would give me the longest amount of time before anyone would notice my absence. For a couple of months, each Thursday morning before my Friday off, I would make a decision about whether or not I thought I could hang on for another two weeks. Eventually, it got to a point where I felt like I couldn’t.
Because I’m such a planner, I’m predictable to myself. I know I can endure extended periods of steady passive suicidal ideation (i.e. feeling like I’d be better off dead, but not making plans). I know that I can handle a couple of weeks of daily active suicidal ideation (i.e. thinking about methods) before I start setting decision milestones. I know that if I set a decision milestone, I’m not going to act before I reach that next target. Other people may unwittingly have an influence by delaying when a target event happens.
While I don’t tend to be impulsive, others do get intense impulsive suicidal urges that can be really hard to resist, and there’s a whole wide range of thoughts and emotions in between being mostly impulsive and mostly a planner.
So that’s me and my weird rigidity. Where do you tend to fit in on the range of impulsive to planned?
The Straight Talk on Suicide page has crisis and safety planning resources, along with info on suicide-related topics from the perspective of someone who’s been there.
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The WordPress Reader can be a fascinating place to poke around and look at other people’s blog-ish habits. One of the things that interests (and puzzles) me is the like-for-like phenomenon. I think there are a fair number of people who do this, and there are some bloggers that I notice liking so many posts that I have strong doubts as to whether they’re actually reading (or even opening) all of those posts that they’re liking.
The like-for-like phenomenon becomes particularly obvious when you come across blogs with high engagement numbers but content that does not in any way warrant such numbers.
One example is a site that posts printer drivers. A post with drivers for the HP Envy Pro 6455 got 86 likes, because really, who wouldn’t want to read that, and who doesn’t have an HP Envy Pro 6455?
That pales in comparison, though, to the 252 likes for a font site’s post with download info for a font called Not Bad. Because again, who doesn’t want to include that in their day?
Or you’ve got the real estate company that does blog posts in Spanish and gets >200 likes per post from a lot of non-Spanish-sounding bloggers.
In turn, if you want to get a bunch of likes on your posts, you could probably look at the people who are liking posts on the printer driver and font sites and go and like their posts to climb aboard the like-for-like express.
Does anyone remember Sebastian? He was around last year and for a little while this year liking a whole bunch of posts, often within seconds of people publishing them. There were multiple reports about him on the WordPress.com support forum (including here, here, here, here, and here), and WP did take away his ability to like posts in the Reader, although it sounds like he kept creating new accounts and they had to do some chasing to keep up with him. And if you’re as fascinated by Sebastian as I am, Google “relatocorto” (the oh-so-creative name of his website, which translates to “short story”), and you’ll see that he’s managed to convince Google that he’s a legit place of business.
People do this kind of thing because it “works”, and people will keep doing it as long as there are people who will participate in like-for like. I remember Sebastian used to get a shit ton of likes on his posts (which probably resulted in him making money off the ads he had on his site). He has a Buy Me A Coffee page, and he’s had a lot of coffees bought for him, although I suspect that a chunk of that is him using other accounts to buy coffees for himself to make it look like he’s popular.
Like-for-like may be a pretty effective way to get a lot of (pretty meaningless) likes, but the artificiality of it really doesn’t do it for me. Is this something you’ve noticed or participated in?
The blogging toolbox series has tips to support you in your blogging journey. It includes these posts:
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Here’s what happened in my life over the past week:
- Fuuuuuck things were grim in my world for a while there. Finally this week I’ve been sleeping better and felt at least somewhat human again after going through my annual August/September depressive worsening.
- Earlier this week, the FDA released a warning about a TikTok challenge that involved cooking chicken with NyQuil. What the actual fuck is wrong with people? I know people did dumb shit before social media, but social media sure does highlight the stupidity.
- I was looking at the Wikipedia page for psychomotor retardation, which is a symptom of depression that I happen to have. Someone had decided that because they didn’t like the word retardation, it would be appropriate to change it to “psychomotor impairment”. Except that’s not what it’s called; psychomotor retardation is the medical term, because it is very literally thought-movement-slowing. People are free to be offended if they’re so inclined, but it all gets a bit ridiculous sometimes.
- I got my custom table of contents block (based on the code from the SimpleTOC plugin) working and was able to ditch the custom blocks plugin I’d been using before but was no longer happy with. I’ve also created a custom separator block working. I’ve got a couple of readers who are developers who might appreciate this – WordPress says you need to “learn how to use JavaScript to extend and enhance the block editor.” Little did I realize that using JS involves a whole hell of a lot more stuff than just learning some plain ol’ JS. Some things have changed since the HackerNoon article How It Feels to Learn JavaScript in 2016 was written, but it made me laugh because it’s very much how I felt.
- WordPress is planning on releasing an update in November, and they made the first beta version available this week. I’ve criticized WP before for not doing enough testing of regular everyday bloggish activities, so I decided to actually do some of that myself, and I found and reported a couple of bugs.
Peanut the guinea pig crossed the rainbow bridge a couple of days ago. He’d been sniffly for the last couple of weeks, but he’d been doing okay in the early part of this week. Then Thursday morning he was so weak that he couldn’t stand, which is typical of guinea pigs who are close to death. We had a couple hours of cuddles and then my little potato died very peacefully while warm and cozy on my chest.
How has your week been?
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I wanted to share with you a new podcast created by my friend Mike Edward called Living with Chronic Mental Illness. It’s about his own journey with chronic schizoaffective disorder. As the host says, “It’s the story of challenging moments, of failures, of successes, of love, of loss, and of hope. This is the story of how ignorance lost its bliss.”
It seems like sometimes people try to portray a sanitized picture of mental illness in an attempt to make it more socially acceptable.The downside of this is that there are a lot of us who don’t have a neat and tidy experience of mental illness, and I like that this podcast captures the reality that life with a chronic mental illness is hard. The host is honest and open about the challenges he’s faced and the fact that he continues to face challenges on an ongoing basis due to his illness.
I tend to have a hard time concentrating on auditory information, so I liked that the episodes are on the shorter side, each lasting about 5-10 minutes.
The podcast is embedded below, and you can get to it via Linktree. New episodes are posted weekly on Mondays at 12am. I encourage you to check it out!
Podcasting has certainly been growing in popularity. An article on Buzzsprout from earlier this month offers the following statistics pulled from various sources:
- In 2022, 62% of Americans age 12+ have listened to a podcast
- 38% of Americans age 12+ listen to podcasts at least monthly, and 26% listen weekly
- The number of podcast listeners in the US has grown from 46.1 million in 2017 to 82.7 million in 2021
Here are some Buzzsprout platform stats from August 2022:
- 118.8 million downloads
- 170.5K new episodes
- 114.3K active podcasts
Personally, I’ve never thought about doing a podcast or being a guest on one; I’m a writer, not a talker. Aside from podcasts created by friends, I’m not a podcast listener, either; the written word is a better medium for me than the spoken word. However, there are probably a lot of people for whom the written word is not an ideal medium, and venturing out into things like podcasting is a way to reach different audiences. And when it comes to getting the word out about the reality of mental illness, the more different audiences that can be reached the better.
Besides Living with Chronic Mental Illness, another podcast I would recommend is Perfectly Imperfect by my friend Johnzelle Anderson. It focuses on Black mental health and social justice issue. If there are any mental health-related podcasts you’d like to recommend, feel free to drop the links in the comments below.
Are you a regular podcast listener? Do you have any thoughts on whether the rise in popularity of podcasting will impact the popularity of blogging?
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I was all kinds of excited when I was browsing Netgalley and came across Quack Quack: The Threat of Pseudoscience by Dr. Joe Schwarcz, the director at McGill University’s Office for Science and Society. The book aims to convince people of the importance of separating sense from nonsense, and it’s packed with plenty of examples of the kind of quackery that people are promoting and making lots of money off of.
The book’s main focus is the nonsense of the present, but it begins with a look at some of the quackery of the past. For example, “In the late 1800s, the Battle Creek Sanitarium was unquestionably the place to be for people who needed to be cured of diseases they never had.”
You might recall that drinking one’s own urine was one of the bizarre ideas people came up with for supposedly curing COVID. There’s a chapter devoted to autourine therapy (i.e. drinking one’s own urine), and apparently, there was a World Conference on Urine Therapy.
Then there’s the woman who thought fermented cabbage juice could cure anything and everything, let you regrow missing limbs, and let you live 400 years. Regarding that, Dr. Joe says, “Never before have I heard such concentrated hogwash in such a short time.” He writes that her claims are “full of baloney. Or bunkum. Or balderdash. Take your choice. I have other words too.”
A fair bit of the book is devoted to debunking the weird and wacky claims that people make about water. For example, there’s alkaline water, and Dr. Joe points out that even if it did change the pH of the blood (which it doesn’t), “you would not have to worry about illness because you would be dead.” There’s also the notion of double helix water, as opposed to regular water, which is supposedly weakened by flowing through straight pipes. Then there’s raw water, which can actually harm you depending on what bacteria happen to be contaminating it (I can’t even begin to tell you how not fun it is to have a Giardia infection, quaintly known as “beaver fever“).
The author points out how companies that make these dodgy products will often string together a bunch of words that sound scientific but are actually meaningless. Regarding a device that’s claimed to energize water, he says, “In all my years of wading through swamps of claptrap I don’t think I have come across anything to match the stew of random, garbled, meaningless words cooked up on behalf of Alpha Spin.”
Dr. Joe explains that the most prevalent myth that he’s come across is that “natural” substances are somehow inherently superior to synthetic ones. He points out that chemicals are made out to be a bad thing, but all atoms are chemicals, so the notion of chemical-free doesn’t even make any sense. And if you thought homeopathic remedies were just another kind of herbal product, they’re not, Dr. Joe will explain to you just how wacky the idea behind homeopathy is (trust me, it’s really out there).
The book concludes with a chapter with tips on evaluating information/misinformation, like “nonsensical lingo can sound very scientific”, “nature is not benign”, and “education is not a vaccine against folly.”
This book is hilarious. The things the author is talking about are funny, but it’s the way he talks about them that is absolute gold. I love his word choices, including mountebank, “mind-numbing claptrap”, poppycock, “mindless twaddle”, “woo-isms”, mumbo jumbo, balderdash, malarkey, puffery, and gobbledygook. There were plenty of bits that had me laughing, such as this after being urged not to knock a product before trying it: “Well, I’m knocking. We do not live in a scientific vacuum. We do not concoct ways to trap the tooth fairy.” It was rather difficult to limit myself when it came to the number of quotes I included in this review, since there were just so many great lines.
I loved this book. I think anyone with a science background will find it highly amusing, and I hope that it will convince some people to keep their money to themselves rather than hand it over to hucksters trying to make them think that they need a magic carafe to make double-helix water. Our world is desperately in need of more sense, and hopefully Dr. Joe’s book will help to put a bit of a dent in the shortage thereof.
Quack Quack is available on Amazon (affiliate link).
I received a reviewer copy from the publisher through Netgalley.
You can find my other reviews on the MH@H book review index or on Goodreads.
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moreThis is a mystery I’ve been wondering about for a while now, and I’ve never been able to come up with an answer. A few years back, WordPress introduced a feature in the browser version of the Reader where if you hover the mouse over the “like” button, you’ll see who has already liked a post. I don’t like that feature, but that’s beside the point. The mystery is the order in which WP displays who has liked a post, because it’s not chronological (as opposed to the order in which you see your notifications under the little bell thing, which is chronological).
No matter whose post it is, if Paula, Suzette, and I have all liked a particular post, Paula’s name will always show up higher than my name in the little pop-up list of likers, and my name will always show up higher than Suzette’s. If we throw Maja of Lampelina into the mix, her name will always be higher than Paula’s, Suzette’s, and mine. Again, this order is consistent, no matter whose post it is that’s been liked. I’m assuming that the order I see is the same order that other people see when looking at the Reader, but I don’t actually know that for sure; it’s certainly possible that other people see an entirely different order.
If there is a consistent order, and it’s not chronological or alphabetical, what on earth is it? Any ideas?
Update: Mystery solved! The info about who likes a post comes from the WordPress REST API, which returns a list of who’s liked a post ordered by user ID number (yup, you’ve got one of those). That’s why Paula’s always above me and I’m always above Suzette. I have no idea if that ID number is based on something (like maybe when you first created a WordPress.com account), but the order of likers is based on that number.
The blogging toolbox series has tips to support you in your blogging journey. It includes these posts:
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