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Is it Time for a Psych Inpatient Stay? Things to Consider

By Ashley L. Peterson / 2022-05-23
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Is it time for a psych inpatient stay? Factors to consider - graphics of a hospital and a head with a psi symbol

Sometimes, hospitalization for mental illness happens involuntarily and isn’t under our control. Other times, though, an inpatient stay is something we have to ponder and weigh the pros and cons of. So, what are some of the factors to consider in making that decision? This post will look at a few of them.

Suicidality

There are a few things to think about when it comes to suicidality. Do you have a specific plan? Do you have the means to follow through on that plan? Are you experiencing a high level of intent to act on the suicidal thoughts? Is it coming in intense, impulsive urges?

For me, I know that passive suicidal ideation (as in I’d rather be dead, but not thinking about doing anything in particular to make that happen) is something I can handle, and hospital isn’t something I need to contemplate. I also know from past experience that I’m not impulsive with suicidality, so based on knowing my own history, active suicidal ideation is something I know I can manage at home in the short term. It’s when I start looking up details of methods that I know something needs to change, whether that involves hospital or something else.

Basic self-care

If you don’t have much appetite and just can’t be bothered with the whole eating or grocery shopping nonsense, that’s a big ol’ red flag. It’s one thing to let the higher-level self-care lapse from time to time, but it’s probably not a good idea to let the bare minimum basics slide for too long.

I don’t consider showering to be one of the bare minimum basics; however, when it gets up to about a week between showers and I’m only dragging myself into the shower because my hair is so crusty that it hurts if it moves, that’s a sign that some sort of change/intervention is called for.

Access to treatment options

Certain treatment options are easier to access when you’re in hospital. Electroconvulsive therapy (ECT) is a whole lot easier to do as an inpatient than as an outpatient. If you need a major overhaul of your meds, that may be easier to do as an inpatient, depending on how complicated your medication regimen is. Certain medication starts, such as the antipsychotic clozapine, may be easier to do in hospital because of the level of monitoring required.

Past experiences

Negative past experiences can be a very strong deterrent to treatment-seeking. That’s certainly been the case for me. The potential to be committed under the Mental Health ACT as an involuntary patient definitely doesn’t help matters.

For my most recent hospitalization, I tried to negotiate a voluntary admission, but things quickly went south and I got committed and put in restraints. It certainly makes for a very strong reason not to ever bring myself to hospital ever again. The mouse infestation didn’t help either.

What’s in your chart

Past experiences will affect how you feel about the prospect of hospitalization, but what’s in your medical records (whether it’s accurate or not) also influences how treatment providers will respond when you show up. Some people may get slapped with labels like attention-seeking, which can make it much more likely that they’ll get dismissed the next time they show up to hospital.

For others with a history of suicide attempts that the clinicians documenting them considered to be serious, health professionals may be more inclined to overestimate the level of risk. In my case, I have a history of multiple suicide attempts and a couple of 2-month-long hospitalizations with a whole schwack of ECTs. With the history in my chart, I can be fairly sure that if things are bad enough that I feel the need to bring myself into hospital, the question isn’t will I be admitted, but rather will I be able to talk them into admitting me voluntarily rather than involuntarily.

Diagnosis can also make a difference; certain diagnoses (like borderline personality disorder) are likely to get a cooler reception than others (like schizophrenia).

At-home crisis team availability

Some places have mobile crisis teams that are able to see people at home to give them extra support and keep them out of hospital. (I used to work for one such team.) I don’t think I’d ever want that for myself, partly because I don’t want people invading my space, but mostly because I don’t typically find talking to people all that helpful. If things are really bad, I want ECT, and the talking part is mostly just the price I have to pay to get the ECT.

Community crisis home availability

This kind of thing may or may not exist where you are, but some communities have crisis facilities in a home-like setting with round-the-clock nursing staff. It can be a less intense, more comfortable kind of setting than hospital.


Anytime you’re faced with this choice, I encourage you to do what seems likely to be most helpful, even if it feels selfish. Don’t try to pick the option that works best or is easiest for other people in your life; go with what’s best for you.

Is this something you’ve ever needed to contemplate? What were some of the factors that you weighed in making your decision to seek or avoid inpatient care?

So you've just been diagnosed with... [ mental illness]

The So You’ve Just Been Diagnosed with… [a Mental Disorder] page brings together information, advice, and resources from people who’ve been there. New input is always welcome!

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Common Themes of Delusions in Psychosis

By Ashley L. Peterson / 2022-05-10
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List of some delusional themes in psychosis, e.g. persecutory, religious, grandiose, delusions of reference

Delusions are a type of abnormal thought content that involve false beliefs that are firmly held despite evidence to the contrary. They are idiosyncratic and can’t be accounted for by a person’s culture, religion, or level of education. They’re considered a type of psychotic symptom, which can occur in the context of various illnesses, including schizophrenia, schizoaffective disorder, delusional disorder, bipolar disorder, and major depressive disorder. While certain themes may be more common in certain disorders, simply knowing the content of someone’s delusional beliefs isn’t enough to determine what their diagnosis is.

We probably all believe things that are false, and we may be quite attached to those beliefs, but these are based in our understanding (however flawed) of reality, whereas delusions represent a greater disconnect from reality. “Normal” flawed ideas may come from believing information from unreliable outside sources, but psychosis is an inside-the-head process. While conspiracy theories, for example, tend to be shared by groups of people, shared delusional beliefs (as occurs in folie à deux) are quite rare. The journal article Understanding Delusions explores different theoretical perspectives on what constitutes a delusion.

Characterizing delusions

Delusions are loosely categorized as being bizarre (e.g. aliens sneaking into your house through the phone line and stealing your organs while you’re sleeping) or non-bizarre (things that are within the realm of possibility but not actually happening, like your neighbour setting up cameras inside your house). In the context of mood episodes, delusions may be categorized as mood-congruent or mood-incongruent.

People who experience hallucinations, which are perceptual disturbances in any of the five senses, may have delusional beliefs associated with those hallucinations, but not all people with delusions have hallucinations, and vice versa.

Sometimes, delusions are systematized, with delusional ideas built on top of one another to form a coherent, organized, and sometimes very elaborate belief system.

Common delusional themes

Persecutory

Persecutory delusions can involve the belief that one is being followed, spied upon, harassed, ridiculed, sabotaged, or poisoned, or that others are harming or attempting to harm the self in some other way. This is a common theme for delusions.

Religious

Religion is another common theme, and these kinds of delusions can occur whether people are or are not religious when they’re well. Delusional religiosity is a different creature than the view that some people have that religion in general is a delusion. Delusions deviate from beliefs and experiences that are framed as normal within one’s culture or faith system. Someone who’s experiencing religious delusions might believe that they are God, they are Jesus, they have special powers granted to them by God, or they have special knowledge that’s been imparted to them by God, angels, or other religious figures. These beliefs are not present when they’re well.

Katie R. Dale’s book But Deliver Me From Crazy is a good example of someone who has strong religious faith at baseline, but also experiences religious delusions in the context of manic psychosis, and these deviate from her normal beliefs.

An ex-boyfriend of mine had schizophrenia, and he had recurring religious delusions that involved belief about a special connection to Jesus and knowledge about things contained in the bible. When he was particularly unwell, he would write a lot about this (as in pages and pages for hours). Jesus as the lamb came up a lot, but overall, it didn’t make any sense, and I was never clear on exactly what it was that he believed. When he was doing well, he wasn’t religious.

Grandiose

While the phrase “delusions of grandeur” is sometimes used colloquially to describe people’s overestimation of their abilities, grandiose delusions are a marked departure from reality. This theme is common among people who experience psychosis as part of bipolar mania.

Grandiose delusions have a different flavour to them than narcissism. While excessive pride might mean someone consistently believes they’re such an amazing developer that they’re someone who can make the Metaverse really happen, delusions of grandeur could involve someone with no background in computing believing out of nowhere that they gave Mark Zuckerberg the idea for the Metaverse and have been a key technical advisor every step of the way.

Control

Delusions of control refer to beliefs about outside influences controlling one’s thoughts. These can involve thought insertion (the belief that thoughts are being put into one’s head), thought withdrawal (the belief that thoughts are being taken out of one’s head), or thought broadcasting (the belief that one’s thoughts are being broadcast to others). People may or may not have a sense of where this outside control seems to be coming from.

I experienced thought insertion at one point where it felt like rules were put in my head (not from an identifiable source) for things I had to do.

Delusions of reference

Delusions of reference involve things in the environment having special meanings or messages directed towards the self. Examples include believing that someone on tv is sending coded messages to you through what they’re saying, or believing that items you see when you’re out for a walk have been placed there especially for you.

I’ve had delusions of reference before, and it’s creepy.

Somatic

Somatic delusions involve things that are going on with the body. This can involve things that are happening inside the body or on the outside of the body. This is different from health anxiety, which involves anxious concerns about things that might be happening; rather, it’s a certainty that things are happening. There may be anxiety that arises from that certainty, but anxiety is not the core issue.

Delusional parasitosis is the term for beliefs about things like critters burrowing into the skin; this may be accompanied by tactile hallucinations.

Jealousy

Delusional jealousy is the idea that one’s partner is cheating kicked up to an extreme level.

Guilt

Like delusional jealousy, delusional guilt takes a normal experience to extremes. This delusional theme is common in psychotic depression.

I’ve apparently had this before, although I don’t remember it. It doesn’t surprise me, though, as guilt can get pretty intense when I’m not decntly medicated.

Erotomanic

Erotomanic delusions involve the belief that another person, often someone famous, is in love with oneself. Acting on them can produce stalker-ish behaviour.

Rarer delusional themes

Capgras delusions

These involve the belief that familiar people have been replaced by imposters.

Fregoli delusions

These involve the belief that unfamiliar people are actually familiar people in disguise.

Nihilistic delusions

These involve beliefs about the self or parts of the self not being real. People with Cotard delusions believe that they’re already dead.


Delusions usually aren’t fun (although occasionally people do have delusions they experience in a positive way), but I find them quite fascinating. The border between “normal” skewed reality and psychotic disconnect from reality can be a blurry one sometimes, but when people are really ill, it can be quite clear to observers that reality has left the building entirely. When I was a nurse, the patient population I most enjoyed working with was people experiencing psychosis, because I just find it so interesting how the psychotic mind works.

If you’ve experienced delusional thinking before, which of these themes have your delusions tended towards?

You may also be interested in theses posts:

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Book Review: Overcoming Anticipatory Anxiety

By Ashley L. Peterson / 2022-05-04
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Book cooer: Overcoming Anticipatory Anxiety by Sally M. Winston and Martin N. Seif

Overcoming Anticipatory Anxiety by Sally M. Winston and Martin N. Seif uses a cognitive behaviour therapy approach to help readers deal with chronic indecisiveness, avoidance, and catastrophic thinking.

The book begins by explaining what anticipatory anxiety is—the expectation of distress and the push towards avoidance that occurs before you encounter the situation you fear in real life. The authors refer to it as the “third layer” of fear—it’s being afraid of being afraid of being afraid. They explain that sometimes people will refer to this as “free-floating anxiety” when they’re not actually aware of what they’re anticipating.

The book describes how anticipatory anxiety shows up in anxiety disorders and OCD, as well as other conditions like PTSD, mood disorders, and substance use disorders. In generalized anxiety disorder, anticipatory anxiety is the initial what if, which is then followed by thoughts to try to make that anticipatory anxiety go away; however, those subsequent thoughts actually end up reinforcing the anxiety. In OCD, anticipatory anxiety drives the performance of compulsive behaviours. In anxiety disorders and OCD, anticipatory anxiety often sticks around the longest during people’s recovery journeys.

One of the topics covered is chronic indecisiveness, which is presented as a behaviour that can be changed rather than a personality trait. There’s a not-so-fun mental loop where people have anticipatory anxiety so they try to avoid making decisions (the book describes strategies like procrastination and convenient forgetting), but indecision increases anticipatory anxiety. The book explores several issues that can feed into indecisiveness, like FOMO, feeling the need to make the best/right choice, fear of regret, and perfectionism.

There’s a chapter devoted to how anxiety works in our minds and bodies. The authors explain how the amygdala works and why it sends out a lot of false alarms (way back in the day, that would have helped save you from getting eaten). There are also personality traits that people can be genetically predisposed to that make anxiety more of an issue. Because of the way the brain is set up, the feelings you get are basically the same when you’re actually in danger vs. when you’re anxious. I thought the authors did a really good job of explaining this in a way that validated why people feel the way they feel but at the same time giving a solid alternative way of evaluating those feelings.

The book also explores avoidance, pointing out that this removes the possibility of new learning to teach your brain that your catastrophizing isn’t accurate. Also, the more effort you put into trying to remove unwanted thoughts and feelings, the more they stick around.

“Surrender and commit” is presented as the antidote to avoidance. This includes “attending to what is instead of what if,” disentangling yourself from your thinking, and committing to proceeding with either action or choice. I quite liked this line: “problems related to too much thinking are not solved with more thinking.”

The book closes with a chapter on troubleshooting and a chapter that explores what recovery might look like (and what it won’t look like).

I liked this book. I thought the explanations were really effective at conveying why our minds work the way they do. Another thing I liked was that the authors seemed very realistic. There were no flowery promises about strategies that will have you feeling better lickety-split. CBT-based books sometimes annoy me by being overly certain, but this book didn’t have that feel to it. The focus on anticipatory anxiety isn’t something I’ve encountered in other books on anxiety that I’ve read. Overall, I thought it was quite well done.

Overcoming Anticipatory Anxiety 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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Book Review: Inside Of Me

By Ashley L. Peterson / 2022-04-28
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Inside Of Me by Wendy Shipman is a novella about dealing with depression. It’s a 2020 Christian Indie Award winner in the Personal Growth category. I recently reviewed Wendy’s more recent book, the memoir I Died So I Could Live.

In the book’s preface, Wendy shares that writing this book was an important part of releasing her own pain. She writes, “So many people suffer with depression like I do. This book is meant to inspire those that feel like you can’t survive… but you can! You can free yourself from the depths of despair by seeking therapy, support from family/friends, medication and/or counseling.”

The book opens with protagonist Judean at a church service, which sounded exactly like what my head imagines that a Black Southern Baptist church service would be like, with lots of hallelujahs and praise Gods. While it’s a book about depression, there’s plenty of humour in it, which the reader is introduced to early. Sista Patrice, who has the hots for the pastor, was “jumping up and down so much that her breasts were about to shout right out of her dress. It’s a wonder that Pastor can still concentrate on his sermon while Sista’s triple DDDs are catching the eyes of every Deacon on the side wall.”

After Judean leaves church, we learn that she’s been hiding problems with her mental health from her adult son. The scene then shifts to her son EJ coming to visit her at home because he was concerned about how she was doing. Through their conversation and memories that Judean recollects, it becomes clear that Judean has had a lot of difficult experiences and struggled for a long time.

The book addresses taboos in the African-American community around talking about mental health and getting help, as well as common myths about mental illness. Readers see how Judean gets different forms of treatment and makes progress with her recovery. I liked how the book conveyed that faith can play an important role in recovery, but other forms of treatment are also valid and often necessary. I thought Wendy presented that in a very balanced way.

Having read Wendy’s memoir first (which was published after this book), I definitely recognized elements of her story in Judean’s. I think that’s a really great approach to do semi-autobiographical fiction first and then a memoir.

I think this book does a lot to challenge stigma and normalize mental illness within the Black community. The book talks about challenges, but the recovery aspect and the humour keep it from feeling dark or heavy. Overall, it was really well done.

Inside of Me has also been made into a short film, and you can watch the trailer on Youtube.

Inside of Me is available on Amazon (affiliate link). You can Wendy on her blog.

You can find my other reviews on the MH@H book review index or on Goodreads.

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What’s New in the DSM-5-TR?

By Ashley L. Peterson / 2022-04-25
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What's new in the DSM-5-TR? - cover of the Diagnostic and Statistical Manual of Mental Disorders

In March of this year, the American Psychiatric Association came out with the DSM-5-TR, the text revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Text revisions have changes that are less significant than the changes between editions, and the DSM-IV was also followed by the DSM-IV-TR. So, what do the latest changes mean for those of us who are dealing with mental illnesses? I wasn’t sufficiently motivated to go to the library and look at the actual book, but the APA has quite a bit of info on its website Psychiatry.org and its Psychiatric News site, so I stuck with that.

New diagnosis: Prolonged grief disorder

Prolonged grief disorder has been added as a new diagnosis. It had been included in the DSM-5 as a “condition for further study.” The APA explicitly says that the intention is not to pathologize grief. The Psychiatric News says: “Individuals who meet the criteria for prolonged grief disorder experience something dramatically different from the grief normally experienced by anyone who loses a loved one. The grief is intractable and disabling in a way that typical grieving is not.” They say that the aim is to help get appropriate care for people who need it.

The “prolonged” time frame is greater than a year in adults and greater than 6 months in children. Like any mental illness diagnosis, symptoms must be present to the extent that they cause clinically significant distress or impairment in functioning. Symptoms include:

  • intense yearning or longing for the deceased
  • preoccupation with thoughts or memories of the deceased
  • identity disruption
  • avoidance of reminders that the person is dead
  • feelings/thoughts about the death including: marked sense of disbelief, intense emotional pain related to the death, feeling that life is meaningless, intense loneliness
  • difficulty reintegrating into one’s relationships and activities after the death
  • emotional numbness

Reactions to this new diagnosis

On March 18, the New York Times ran an article titled How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer. The article itself is more balanced than the title implies, and includes voices both for and against the new diagnosis.

I feel much the same way about this as I did about the removal of the bereavement exclusion criteria for major depressive disorder in the DSM-5. The majority of grief is “normal,” but it seems reasonable that in some people, it can go beyond that and lead to illness that causes clinically significant distress and impairment in social/occupational functioning. Given that health care systems are often set up such that you need to have a diagnosis to get access to or coverage for services, having a diagnosis might make it possible for some people to access help that would be more difficult to access if they didn’t have a diagnosis.

Neither prolonged grief disorder nor the axing of the bereavement exclusion mean that anyone and their pet cat who’s grieving should be slapped with a diagnosis. Is there the possibility of overdiagnosis? Sure. But should a diagnosis simply not exist because some clinicians suck? I don’t think so. I think the NYT headline is irresponsible, because it suggests anyone who’s been grieving longer than a year will automatically be diagnosed, which is absurd and not at all what the DSM-5-TR suggests. The committee that came up with the diagnostic criteria had been considering using a 6-month timeframe, but they stretched it to a year to reduce the risk of overdiagnosis. Misdiagnosis and overdiagnosis are serious issues that definitely require some sort of mechanism to address, but I think that needs to be dealt with at the level of the professionals making the diagnoses rather than at the level of the DSM.

Resurrected diagnosis: Unspecified mood disorder

The DSM-IV-TR had a diagnosis of mood disorder NOS. The DSM-5 did away with this, and then it was brought back in the DSM-5-TR but renamed unspecified mood disorder. It’s basically a placeholder diagnosis for when it’s not initially clear what the true diagnosis is. So if someone shows up in ER and it’s unclear whether they’ve got unipolar or bipolar depression, they might be admitted with a diagnosis of unspecified mood disorder, and then the diagnosis would be clarified once there’d been the opportunity for further assessment. To me, this makes more sense than having to pick unipolar or bipolar based on a single assessment in ER without much collateral or background information.

Autism criteria clarification

The DSM-5 criteria for autism spectrum disorder included “persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following:” and then listed deficits in social-emotional reciprocity, nonverbal communicative behaviours, and developing/understanding relationships.

The DSM-5-TR adds “all of,” so it’s now “as manifested by all of the following.” That was the intended meaning in the DSM-5 (after all, the word and means and, not or), so this addition clarifies rather than changes the criteria.

Reactions to this change

A post in the aspergirls subreddit expresses hope that some additional changes in the DSM-5-TR chapter on autism will actually make it easier to get diagnosed. I’m not going to include what she quoted because I can’t verify that it’s accurate (you can click on the link if you want to read it), but the poster did say that she actually viewed the DSM-5-TR itself. The quoted material notes that clinicians should recognize that some people on the spectrum develop compensatory strategies that make their autism less noticeable, but the effort this requires takes a toll on them and they struggle in novel situations.

There’s a petition on Change.org organized by the Center for Neurodivergence (a self-advocacy group) challenging what it sees as more restrictive diagnostic criteria in the DSM-5-TR that will make it more difficult for people to get diagnosed. The petition mentions a podcast with Michael B. First, the editor and co-chair of the DSM-5-TR, in which he was talking about autism getting overdiagnosed.

The podcast was The Modern Therapist’s Survival Guide, and a transcript is published on their website. I can see how the Center for Neurodivergence got that impression, but I don’t think that’s what Dr. First was actually trying to say. My impression is that he was trying to say that some clinicians had been interpreting [a, b, and c] as [a, b, or c], and this was leading to overdiagnosis. To address the issue, the APA was just making it clear that and did, in fact, mean and. I have no idea if diagnosis-happy pediatric psychiatrists have been blissfully overdiagnosing for the last few years, but given that adult diagnosis seems to be off of almost everyone’s radar, I doubt that population crossed Dr. First’s mind at all.

Diagnostic name-tweaking

The DSM-IV diagnosis of dysthymic disorder was changed to persistent depressive disorder (dysthymia) in the DSM-5. The DSM-5-TR got rid of the dysthymia bit altogether. There were a number of diagnostic specifiers for PDD in the DSM-5, but the DSM-5-TR got rid of most of them except with anxious distress and with atypical features. I don’t think that’s going to change anything in anyone’s life.

Similarly, the DSM-5 diagnosis of social anxiety disorder (social phobia) was updated to simply social anxiety disorder.

Codes for suicidal behaviour and nonsuicidal self-injury

The DSM-5-TR has adopted codes that are already in use in the World Health Organization’s International Classification of Diseases (ICD-10-CM) to indicate suicidal behaviour or self-harm without suicidal intent (nonsuicidal self-injury). These aren’t stand-alone disorder diagnoses, but rather a way of making note of behaviours.

Language around gender

In the chapter on gender dysphoria, there have been some updates in the terminology used to better reflect modern language:

  • “desired gender” has been changed to “experienced gender”
  • “cross-sex medical procedure” has been changed to “gender-affirming medical procedure,”
  • “natal male”/”natal female” has been changed to to “individual assigned male/female at birth”

“Post-transition” has also been added as a diagnostic specifier.

Other changes and thoughts on the DSM-5-TR

There have been some changes related to race. The term Caucasian has been axed, Latino/Latina has been changed to Latinx, and “race/racial” has been changed to “racialized.”

There have been a variety of other tweaks, including some wording changes in the criteria for bipolar I and II, but these are more about clarity than actually changing anything. In a number of cases, it looks like the APA decided that language changes they made with the DSM-5 actually made things murkier rather than clearer, so some of the DSM-5-TR language moves to something closer to what was in the DSM-IV-TR.

Aside from the new prolonged grief disorder, I don’t think the DSM-5-TR is likely to change much of anything for anyone. They’ve tidied a few things up, and now they’ll make some money off of it.

Now it’s over to you. Any thoughts on these changes?

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Mental Health Benefits of Blogging: Updated Survey Results

By Ashley L. Peterson / 2022-04-24
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the words mental health on laptop screen
Photo by Polina Zimmerman on Pexels.com

Thanks to everyone who filled out my survey on the therapeutic benefits of blogging. I initially published results last weekend, but then decided to extend the survey and do an update today. In the end, there were 45 responses, although not everyone answered every question. There weren’t any major changes compared to the preliminary results with 37 responses.

Some people answered the survey questions in the comments section of last weekend’s post because for whatever reason the Google Form wasn’t working for everyone (still haven’t figured out why that is). I haven’t included those in the stats because I’m just going with what Google Forms has generated for me, including these pie charts. I can’t figure out how to get the html to make them fancy and show you what each pie piece represents if you hover over it, so I’ve just captured them as screenshots.


The survey results

Blogger characteristics

<img loading="lazy" src="https://dnwmedia.s3.us-west-2.amazonaws.com/blog/wp-content/uploads/2022/04/24114121/Screen-Shot-2022-04-24-at-3.42.00-AM.png" alt="How long have you been blogging? 4+ years (54.5%), 1-3 years (29.5%),

How long have you been blogging?

  • < 1 year: 15.9%
  • 1-3 years: 29.5%
  • 4+ years: 54.5%

There were some differences in how people who’ve been blogging for different lengths of time answered certain questions.


Is your blog anonymous? 15.9% yes, 38.6% no, 45.5% semi-anonymous

Is your blog anonymous?

  • Yes: 15.9%
  • No: 38.6%
  • Semi-anonymous: 45.5%

I talked in the preliminary results post about anonymity involving two elements, discoverability and recognizability. When I started blogging, I was going by ashleyleia and using a picture with my face partially obscured by Cookie the guinea pig. I was very recognizable, but I wasn’t particularly discoverable, as my full name wasn’t on my blog anywhere. I think it’s generally a good idea to Google yourself regularly, and if you think you’re semi-anonymous, see if you can find yourself using search terms that people in your life might actually think of.


Benefits of blogging

Do you believe your mental health benefits from blogging? 99.9% yes, 2.3% no, 9.1% not sure

Do you believe your mental health benefits from blogging?

  • Yes: 88.8%
  • No: 2.3%
  • Not sure: 9.1%

No surprises here.


Is being anonymous important to access the MH benefits of blogging? 57.1% yes, 20% no, 22.9% not sure

If your blog is anonymous, do you believe that being able to be anonymous is important for you to access the mental health benefits of blogging?

  • Yes: 57.1%
  • No: 20%
  • Not sure: 22.9%

What are the top 3 most important mental health benefits to you?

  1. Writing is a way to work through thoughts and emotions
  2. Self-expression
  3. Connecting with others with similar experiences
  4. A 2-way time between: Catharsis | Reading others’ experiences gives you a new perspective on your own
  5. Social support from the blogging community
  6. Learning new things
  7. A form of mentally stimulating activity
  8. Getting feedback/suggestions based on what you write

These responses were all selected by >10% of people. There were ties for the top 3 answers in the preliminary results last week, but they’ve separated out a bit in these results. This is pretty similar to how I’d rank them for myself, although for me social support would be higher, largely because I don’t have much IRL social support.

These were some of the other benefits identified:

  • Exposure to new strategies for dealing with mental illness
  • Helps with staying positive while dealing with challenges
  • A way to harness emotions and use them for creative expression
  • It helps with imagining a future

I could figure out how to set up this question so Google Forms would only accept three answers, so the responses are a blend of top 3 and just benefits in general.


Stigma

Does blogging change how you react to stigma? 53.3% makes it easier, 15.6% no difference, 31.1% not sure

Do you believe that blogging changes how you react to stigma?

  • Yes, makes it easier: 53.3%
  • No difference: 15.6%
  • Not sure: 31.1%

People who’ve been blogging 1-3 years were the most likely to say yes, and people who’ve been blogging for ≤1 year were most likely to be unsure. I like that there’s so many yeses. I find that it’s helpful to be reminded that stigma isn’t something that happens to me, it’s part of the bigger picture as something that happens to us and that we can fight back against together.


IRL support network

Do you have a support network of people with mental illness IRL? 37.8% yes, 62.2% no

Do you have a social support network of other people with mental illness in real life?

  • Yes: 37.8%
  • No: 62.2%

This is something I lack.


Self-expression

Do you find self-expression easier in person or in writing? 60% in writing, 2.2% in person, 37.8% it varies

Do you find self-expression to be easier in person or in writing?

  • In person: 2.2%
  • In writing: 60%
  • It varies: 37.8%

I’m not surprised that the majority of people picked writing. Among people who’d been blogging for 4+ years, 3/4 picked writing. Depression makes me really bad at in-person, so I’m writing all the way.


Masking

Do you feel pressure to mask your mental illness IRL? 46.7% yes - often, 40% yes - sometimes, 13.3% yes- no

Do you feel pressure to mask your mental illness in real life?

  • Yes, often: 46.7%
  • Yes, sometimes: 40%
  • No: 13.3%

That’s a lot of people who feel pressured to mask at least some of the time. I can’t mask anymore; my symptoms are too physically overt to be able to try to hide. I used to care that I looked impaired, but I no longer have any fucks to give for that kind of thing.


Do you feel pressure to mask aspects of your mental illness on your blog? 8.9% yes, 40% sometimes, 51.1% no

Do you feel pressure to mask or minimize aspects of your mental illness on your blog?

  • Yes: 8.9%
  • No: 51.1%
  • Sometimes: 40%

I like that so few people said yes.

As I mentioned last week, my answer is sometimes. When I’m on a downward trajectory, I tend to start disliking blogging and disliking dealing with people. I don’t mask so much as I’m very deliberate about what I’m willing to disclose. If I’m feeling suicidal, I would never disclose it on the blog until after it had passed, because when I’m in that headspace, I don’t want people fussing over me.


Learning new strategies

Have you learned of new treatment options or coping strategies from other bloggers? 77.8% yes, 22.2% no

Have you learned of new treatment options or coping strategies from other bloggers?

  • Yes: 77.8%
  • No: 22.2%

The people who’ve been blogging for less than a year were more likely to say no than people who’ve been blogging longer.

I’ve learned a ton from other bloggers. That’s not always in terms of treatment options or coping strategies that would work for me personally, but there are a lot of things that I’ve heard other bloggers mention and then I research to do a what is… series post.


Self-advocacy

Has blogging affected your confidence advocating for yourself? 77.3% yes, 22.7% no

Has blogging affected your confidence advocating for yourself (in any context)?

  • Yes: 77.7%
  • No: 22.7%

The yeses are a bit higher this time. In the group of people who’ve been blogging for less than a year, only 2/3 said yes.

I love that so many people said yes. This is probably the result that excites me the most.


I think blogging is a wonderful thing, and clearly other people are happy with it too. What did you think of the results?

The post Mental Health Benefits of Blogging: Updated Survey Results appeared first on Mental Health @ Home.

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When There’s Inaccurate Information on Your Psych Medical Record

By Ashley L. Peterson / 2022-04-21
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What can you do when there's inaccurate info on your psych medical record - graphic of a medical chart

An unfortunate reality of having a mental illness is that it’s fairly likely that inaccurate information will make it into your medical record at some point along the way. That might take the form of a misdiagnosis, inaccurate descriptions of how you were presenting, or inaccurate accounts of things you said. You might only learn of these errors some time later when another mental health professional is reviewing your older records. So, when you learn of these kinds of errors, what can you do?

Having the inaccurate information removed entirely may not be an option. Health professionals aren’t supposed to go back and change old charting; if, for example, a professional dropped the ball with someone’s care, they can’t go back and try to cover it up. And if professional B discovers an error in professional A’s documentation, they can’t just make that inaccurate bit of info disappear.

The one time I was able to get some erroneous documentation changed was when I’d had a review panel to contest my committal under the Mental Health Act. There were several factual errors in the decision letter, and because the panel had been audio recorded, the panel chair was willing to make the appropriate connections.

There’s a misdiagnosis in my chart from my first hospitalization. I was diagnosed with borderline personality traits (a lesser degree than borderline personality disorder) because I was a difficult patient, and from the treatment team’s perspective, difficult=borderline (a common stigmatized belief among health professionals). Luckily, subsequent treatment providers were able to recognize that this was inaccurate.

The most recent instance of inaccurate info in my chart was at the beginning of my recent admission, when nursing notes from the psych ER described me as yelling, combative, and paranoid. This was despite me speaking so quietly that everyone has a hard time hearing me, and the supposed paranoia was just me repeating over and over that I was a voluntary patient and wanted to leave. The ER psychiatrist charted that he had a hard time hearing me, and I was speaking so slowly that I was even taking pauses mid-word.

I didn’t learn about this until a week and a half later. At that point, I was on an inpatient unit and had no access to the nursing staff who’d documented that. My doctor on the inpatient unit didn’t meet me until 3 days after the made-up charting from ER. While he realized that it was a very unlikely account of events, he wasn’t in the position to say with 100% certainty that it didn’t happen that way, so he couldn’t exactly add a note beside the nurses’ notes saying it was inaccurate. I’m sure he documented that we discussed it and what was documented in the ER wasn’t consistent with how I was presenting at that point in time, but the inaccurate description still lives in my chart. I think there’s a distinct possibility that it could get taken out of context should I be admitted in the future.

The wrong bits in my own chart are pretty small potatoes compared to some of the the blatantly wrong diagnoses some people are stuck with. Sure, my diagnosis of borderline traits was wrong, but people don’t generally get overly excited about a diagnosis of personality traits; when people get a mistaken personality disorder diagnosis, on the other hand, that’s likely to stick to them like a bad smell that they’ll never get rid of, because health care provider stigma comes in to play at that point.

I’m not sure what the answer is. There’s a good reason why people shouldn’t be able to go back and change their charting to cover their asses. At the same time, people shouldn’t be haunted forever by misinformation.

So now over to you – have you ever had inaccurate information make its way into your medical record? How did that impact you, and what (if anything) were you able to do about it?

The post When There’s Inaccurate Information on Your Psych Medical Record appeared first on Mental Health @ Home.

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Tips on Dealing with Depression in Relationships: Guest Post

By Ashley L. Peterson / 2022-04-20
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Man and woman holding hands looking at a lake on a cloudy day

This guest post on dealing with depression in relationships, either as the depressed or the non-depressed person, comes from Marimeia of Through Anxiety and Beyond. We’ve done a guest post tradesies, and you can read my post about how fabulous all of you are on her blog here.


I have recently been to visit a friend of mine, and I met his girlfriend for the first time. They have been together for about two months. They seemed happy. The next day my friend receives tons of messages from his girlfriend full of anger, hate, and he even received two audios in which she was screaming. He bursted into tears. She accused him for not being caring enough, around enough, supportive enough. And he is, trust me. I did not understand what was happening until he told me she has depression. So then I began to tell him what I know about relationships with someone who has depression, because I have been the one with it while being in a relationship. He understood many things. And I would like you to understand them too, to help you go through this situation if you are in one. By no means I wish to substitute the advice of a professional, rather I want to give you the perspective of someone who went through it.

I would like to make clear that this is not a post about how gentle you need to be with someone with depression. Rather, I want to tell you to be real with them, even if sometimes it sounds harsh. Depressed people tend to not be aware of how much distress they cause in other people, being their pain too deep. It is difficult to deal with this, so my advice is to speak up. If they say something that hurts you and does not feel right, tell them so. Not speaking up equals to let them in ignorance, and this is not going to help them as the situation will not change. Treating them as nothing happened after an outburst will only make things appear as everything is alright, so the depressed person might not understand that in reality they are just pushing other people away.

The second best thing you can do is to understand that it is nothing personal. That is tricky, and it is only natural to feel angry or sad after some harsh words. The truth is that a depressed person feels lonely, so they tend to blame other people to not do enough for them to avoid dealing with themselves, because making changes while depressed is extremely hard. I made an ex parter feel like my happiness depended on them. The result was that they grew extremely anxious and they left me because they could not take such responsibility. I do not blame him, he did the right thing, because from it I realised that happines comes from within oneself, and others can only enhance it.

Another important thing is to not counter attack. When accused, one’s natural reaction is to defend the self and attack the other. While dealing with someone who struggles with depression, it is fundamental to understand that depression comes with guilt. Depressed people feel guilty for being worthless, a burden, useless and all sorts of thoughts that harm their self esteem. An “attack” would only make it worse, validating these feelings. So, instead of saying “your are accusing me of something I do not do so that makes you a liar and incapable to see my efforts”, try to say “I am sorry you feel like this. I believe I am doing my best, but if there is something else I can do, please, tell me”. It is probable that the depressed person would not know what to tell you, because they do not need you to do more, instead, they need to get through that painful situation.

It is important that while dealing with a depressive person you take care of your own mental health. That means that if the situation is letting you down, there is nothing wrong in taking a break. Tell the person you need to recharge, mute them, and take a break. When you feel better you can go back. Tell them that you need some time off to relax. If they feel responsible for it, you can tell them that you are switching off to be more present later on. This also gives the depressive person some time to reflect on their own situation. A friend of mine once decided to get away from me for a while, because I was too much, but she told me that she would come back. She then asked me to not talk about certain topics with her becauseshe cared, otherwise she would have just cut me off.

Taking care of your mental health also means to recognise our limits. I want to tell you that there is nothing wrong in deciding not do deal with the person altogether. It is hard to stay and watch someone suffer, and everyone has a breaking point. If you feel like you have reached it, then you need to prioritise yourself. That is the case of a friend of mine who broke it off with his girlfriend because it was simply too much. She would not show any sign of change after years, so he decided to leave. I saw him changing from being miserable to going back to himself. He told me that now if he will go out with another person and they tell him to be affected by depression, he will be direct and say that he cannot do it because he suffered too much in his previous relationship. Another friend of mine cried in front of me telling me that she felt responsible for the other person. I told her that that was her breaking point and she needed to take action and talk to her boyfriend about her feelings. She had been putting them aside because he is the one with the real problem, she told me. This is wrong, because bottling up feelings leads to suffering. So she decided to speak up and tell him that he needs to change or she would leave. They are now working things out.

Finally, I would like to talk about how I am dealing with my current relatioship. I am aware of being affected by depression, and this has always come in the way. But this relationship is working because I am being completely honest and I try to be as self aware as possible. I still have my low points. Once I cried at least once every day while staying at my boyfriend’s. I knew it was horrible for him, but I just could not help it. So I let him be. Altough I wished he would stay up at night to shoote my pain, I let him sleep. I let him take breaks, and I told him to absolutely not feel guilty in doing so. He would just sit beside me while I was crying and read a book or watch a movie while holding my hand. And that is all I needed, really. Seeing him affected by my pain would have only made it worse. Recently I felt low again and I needed attention, and I told him that he does not care. Immediatly after that I apologised and I told him that I felt low, thus needy, but that did not mean that he was not giving me enough attention, it meant that I was going thorugh a rough patch. I only manage to acknoledge the effects that my illness has on others because I went through theraphy, through which I learnt how to live with depression and having relatioships in spite of it while waiting for it to go away.

And now I want to adress those adressed by depression. If you are with someone, or you are struggling with keeping your friendships, always think how you would feel if they would tell you those things that you tell them at your lowest point. You will find out that probably you would feel hurt too. Try to speak up about your feelings. You are not a burden, and the more you talk about how you feel the more the other understands. I did not speak up for years to not bother others. When I finally started to open up I was told by my friends and family that they were relieved because they finally understood some behaviours of mine. Being honest about my condition helped keeping my friends and family close, and helps keep my boyfriend around.

I hope I gave you some help. I know how difficult these situations are, and I believe that finding someone to relate with is quite helpful. Hang in there, it will eventually get better.


Thanks for the post swap, Maria!

You can visit her on her blog Through Anxiety and Beyond.

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An Update on My Mental Health

By Ashley L. Peterson / 2022-04-19
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illustra
chenspec on Pixabay

I thought I’d do a little update on how I’m doing.

I wrote before about something that happened a week and a half ago that had knocked me on my ass. It turns out that my friend did thing X without knowing that thing Y would happen as a result, and it was thing Y that set me off on the personalizing and catastrophizing cognitive distortion extravaganza. He was then pissed off at the [insert expletive here] who was responsible for thing Y happening. Finding that out definitely helped me feel better about the whole thing. I’m also feeling confident now that he and I are going to be okay, and that makes everything brighter.

My sleep has remained good since I got home from hospital, which is a huge positive, as lack of sleep is both a trigger and a warning sign for my depression. On high-emotion days it sometimes takes me a little longer to get to sleep, but the amount of sleep I’m getting is still good.

I’ve been feeling good in relation to the piggoos, which is also a positive, because that’s something that starts to decline when I’m really struggling. I’ve been having cuddles with them too, which I tend to stop doing when I’m quite unwell.

I spend about an hour colouring every day, which is a nice way to turn off my brain and just be. I’ve been journalling a ton, and even when my mind wanders into messy places, I’m mostly able to write myself out of it eventually, so that’s definitely a positive.

As I mentioned in the last weekend wrap-up, my appetite is still on the low side. I’m eating two small meals and a snack each day, which is fine for now, but it’s something I’m keep an eye on (it’s one of the many things I keep track of in my bullet journal).

My lithium tremor has been kind of annoying. I’ve been on lithium for years, and the tremor tends to worsen with any stress/emotionality. My lithium level is fine, though (or at least it was the last time I had bloodwork done in hospital). The beta-blocker propranolol has helped in the past, but the tremor isn’t sufficiently annoying at present that I feel the need to medicate it.

Reading has been a rather slow process, as my concentration isn’t very good, but I’ve still been able to keep up with reading blogs. I’ve been getting some writing done for the blog, plus I had some posts finished or in progress before I went into hospital, so I’ll be trotting those out over the next while. My anti-blogging feelings from pre-hospital are entirely gone, and it’s feeling like a really positive thing in my life again.

Complaining about the hospital mouse infestation remains on hold for the foreseeable future. I just don’t want to do something that could potentially end up being agitating. In general, I’m staying away from things that aren’t high priorities mental energy-wise.

While the initial impact of the knock-me-on-my-ass incident got me wondering if I might need more ECT or even more time in hospital, things have been improving rather than trending in a downward direction since then, which I’m relieved about. I’m also feeling generally more optimistic.

I’ve got my first appointment with my new psychiatrist at the community mental health team at the end of next week. I’m good with the meds I’m taking at the doses they’re currently at, but I’m going to ask to restart the stimulant Dexedrine to help with the psychomotor slowing. It’ll probably help a bit with my concentration, too. I didn’t bother asking to have it restarted in hospital because it’s pretty symptom-specific rather than affecting the illness process overall, and I wanted to get a clearer picture of how much the ECT was going to help with the slowness.

A couple years ago I was getting biweekly intramuscular injections of L-methylfolate and vitamin B12 from a naturopath, which helped with my concentration. L-methylfolate plays (a methylated form of folic acid) a role in the production of neurotransmitters, and there’s research showing it can help with depression. I tried taking it orally at one point, but I didn’t get the same effect as from the injection. I had stopped seeing the naturopath due to the cost, but I’m contemplating restarting that, at least for a few months.

So things are moving in the right direction. That’s pretty much it for now. Hope you have a good rest of your day, and thanks again for all your support!

guinea pig Butternut partly hidden by a towel in his cage

I’ve used towels to create basically canopy beds for the boys so they have their own little cozy areas in their cage. This is Butternut hanging out in his little bed area. Behind the pink towel and hollow log is the area that’s mostly Peanut’s, although Butternut sometimes hangs out there. Peanut never goes in Butternut’s bed area, though; Peanut is the submissive boy piggoo, and he would never intrude on his brother’s territory.

The So You’ve Just Been Diagnosed with… [a Mental Disorder] page brings together information, advice, and resources from people who’ve been there. New input is always welcome!

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Book Review: On Mental Illness

By Ashley L. Peterson / 2022-04-19
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Book cover: On Mental Illness from The School of Life

On Mental Illness comes from The School of Life, which, according to their website, is “an organisation built to help us find calm, self-understanding, resilience and connection – especially during troubled times.” The book’s introduction says it aims to be “a sanctuary, a walled garden filled with nourishing psychological vegetation, and with comfortable benches on which to sit and recover our strength, in an atmosphere of kindness and fellow-feeling.”

Chapters in the book include reasons to live, acceptance, medication, psychotherapy, self-compassion, and gratitude. There’s a chapter on self-regulation that touches on common issues like sleep, hygiene, and exercise, and also presents the concept of the window of tolerance.

When it comes to the causes of mental illness, I’m anti-reductionism, whether that goes in a biological or psychosocial direction. This book leans pretty hard into psychosocial reductionism in this paragraph, which felt rather reminiscent of Johann Hari’s book Lost Connections (which I ranted about here):

“We shouldn’t be surprised at the enormous levels of mental illness at large in society; we need only get clear how bad we collectively are at love, how poor we are at lending sympathy, at listening, at offering reassurance, at feeling compassion and at forgiving—and conversely how good we are at hating, shaming, and neglecting… Furthermore, we’ve opted to wash our hands of the issue of love and handed responsibility for healing wholesale to scientists, as though they could culture a complete solution to mental wellness through their medication. We ignore that the cure largely lies in the emotional realm: in getting better at appeasing each other’s fears, at being generous about our transgressions, at no longer tormenting and maltreating one another for our failures  and at sitting together through the darkness in a spirit of care and kindly forbearance.”

Authors, whoever you are, you really don’t want to see me unmedicated.

The chapter on psychotherapy included the decidedly odd section “What benefit is there in your illness?” The book acknowledges that asking this “could sound like the height of nastiness,” but it “can be raised from the kindest and most sincere motives.” One of the example scenarios that’s given is a father acting out of jealousy of “his son’s nascent sexual prowess.” Oh my, how very Freudian! In the same chapter, I found this line interesting: “Most therapists we come across are likely to be less than what they should be.” I don’t necessarily disagree, but “most” was an interesting choice of word.

The book is a quick read, with short chapters. I’m not entirely sure how to describe the writing style, which is quite different from what I usually read. It felt formal; not academic or scientific or using difficult concepts or vocabulary, but sort of reminiscent of what you might expect to read when visiting a museum or monastery. There is some use of the collective “we,” but that didn’t make it feel any less impersonal to me. From the book description, it seems like people with mental illness are the target audience, but I finished the book feeling rather unclear on who it was really trying to speak to. I think it might actually appeal more to outsiders who want a kind, gentle, pretty picture of mental illness than it would to seriously mentally ill folks like myself. Or maybe it’s just me; hard to say for sure.

On Mental Illness 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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