Lessons of the Roller Rink

Blue disco quad roller skates (Photo credit: Wikipedia)

When I was in middle school, one of the few entertainment options for people my age was going to THE local roller rink. (Yes, there was only one.)

I will spare you the details of the boy I always hoped would Pick ME for the Couples Only skates (he's mostly foggy in my mind anyway) and move to my main point:

We almost always skated widdershins (counter-clockwise). It makes sense, in order to avoid carnage on the floor (which there would have been) that there was ONE official direction in which to skate. Most people are right-handed; beginner skaters could then clutch the safety bar along the wall with their right hands.

Most of us were also on rental skates, owned by the rink, since most parents didn't want to pony up for skates used perhaps a dozen times before their kids grew out of them.

However, several times a night they would turn on the light for all skaters to reverse direction.  So now we were going clockwise, instead of counter-clockwise.

It felt weird. It felt unnatural. Our bodies were accustomed to doing our cross-overs of right foot over left at the turns (mine were, anyway). Our vision wasn't used to watching out for out-of-control skaters coming at us from different directions.

More than that, the skates themselves were used to going in a different direction. The wheels bore a subtle wear pattern that made us want to circle left, like NASCAR, rather than circle right.

There were a lot more spills and accidents when everybody was going clockwise - more, even, than there were when the setting was for backwards skating only.

(If you're curious, I did, eventually, master learn to mostly stay upright when backwards skating. Nothing like these peeps, though. Though I did entertain fantasies of skating this well, which I would easily accomplish while in the company of the sweaty-handed boy from the grade above me.)

Any excuse to show Patrick Swayze performing is a good one, IMO.

Anyway, my point (and I do have one) is that when a pattern/habit is being changed, maybe there's more than one component. There's the mind, of course, with its patterns, and then perhaps one is having to work against an actual physical component that inclines a person to naturally lean left, as it were.   I remember sometimes having to really work against the skates that wanted me to go in that direction (which was directly into the wall). My mind would feel like it was totally in the groove, but my skates were saying, "Bitch, we don't care how and where you want to turn."

Sometimes I managed it. Sometimes I faceplanted.

I think, for those struggling with mental illness, or even long-ingrained habit, maybe we should cut ourselves a little slack when we fail, not get into blaming ourselves.  (Not that we should stop trying to end a bad habit, or start a new one.)

But maybe it's not ALL our mind or lack of willpower or negative attitude that causes us to fail.  Maybe sometimes it's a pair of funky skates.

Your thoughts?

A-Z: Xcess - That Invisible Dividing Line from Quirky to Crazy

How do we tell when somebody has crossed the line from quirky to crazy? That's part of the problem, because many symptoms of mental illness actually look quite admirable - in smaller doses.

The key is Xcess and Xtreme. (Getting a bit creative with the spelling here, so what.) Take someone who is bipolar. During a more low key manic cycle, she may be animated, creative, fun to be around. Then perhaps a little down and sad. During an extreme cycle, she may want the entire family to join her in painting the kitchen - at 2:00 a.m. Or be unable to drag herself out of bed for days at a time.

Cleanliness, admirable. Sterilizing kitchens and bathrooms like a hazmat team, not so much.

Being an ardent recycler and repurposer, great. Having an endless collection of boxes, pen lids, and food containers... hoarder.

From  My Mother In law is Still Siting Between Us... Randomness (7/29/10). All pictures used by permission.

Pen lids

Hundreds and hundreds of crosswords, cut out, dated (aren't they already?), and meticulously labeled. She had a note on each, about whether or not she had checked the answers, and a list of the numbers (6 across, 17 down) which she hadn't yet checked. Some of these date back to '89.

Crossword puzzles

 

Empty See's candy boxes - apparently, one can never have too many.

Burned out light bulbs, with notes as to the date each burned out, and the fixture.

What's so bad about keeping some useless junk? Nothing, if it stops at a small stash of empty boxes or burned out light bulbs.  But too often, it crosses the line to this:

The Kitchen

Inside the fridge

Yeah. Horrifying, isn't it? The tragic thing, for adult children of hoarders, is that even when their parents "maintain" a home in conditions like this (or worse), there are legally no options to force them to get the help they so clearly need. It's a matter of having to wait until they die, and then...cleaning the Augean Stables. Only there's usually not a handy river nearby.

Other areas where a line gets crossed:

Having a close personal relationship with God/Jesus/Allah, perhaps even believing that He speaks to you... harmless, perhaps even helpful. Hearing the Voice of God/Jesus/Allah telling you to kill your children/congresspeople... dangerous.

With OCPD, in moderation, there are many wonderful qualities. They're usually very tidy and timely, give great attention to detail, and truly care very deeply about people they love.  There's a great blog written by an OCPD'r I know on the subject, The Gift of OCPD.

We would have many fewer inventions and modern conveniences that we take for granted, were it not for people with Aspergers, OCPD, and many other mental illnesses. Peter Roget (Roget's Thesaurus) probably had OCPD. Steve Jobs may have had it. When OCPD symptoms become extreme, however, they are devastating to both those who have the condition, and those who live with and love them.

The line is where the "quirks" become either harmful or dangerous, to oneself or others. Unfortunately, it is almost impossible for the person with the mental illness, or someone who has lived with him/her for a long time and perhaps become desensitized to odd behavior, to determine when the line has been crossed. Or what to do if it has.

My A-Z theme is Issues related to Mental Health or Mental Illness.

Have you ever had quirks that went to extremes?

If so, how did you recognize it, and what did you do?

Have you ever lived with someone who seemed to go "too far"?

A-Z: Therapy Is Not A Dirty Word

IMO, more people are afraid of a bad therapist than a bad marriage. Generally those who've experienced a disastrous love relationship will be willing to try again with a new partner, but if they've had a bad therapy experience...!

Besides which, there's a huge stigma factor.

When we hear that someone has been "in therapy" for an extended period of time, our initial reaction is not, "Oh, what a brave and courageous person. Kudos to her/him for facing her/his issues head on and getting the help s/he needs." It's more along the lines of, "Wow, that person must be really f---ed up."Am I right?

I am ashamed to admit, I tend to think that way - and I know better! I've had long term counseling myself, and I'd do it again tomorrow.

Sometimes people get stuck in a rut, whether that rut is grief, PTSD, or choosing bad relationships. If our car is stuck in a rut, would we feel ashamed or embarrassed to need a little push getting out of the ditch? (Okay, maybe a little embarrassed, depending on how we got into that ditch.)

But if we'd been in a car accident, and needed physical therapy to recover the use of, say, an arm, wouldn't we commit to it for as long as it took to get the maximum use of our arm back?

Yes, there are personality clashes, and sometimes, despite any number of impressive degrees, we may have hit on a "bad" therapist, but mostly, therapy fails because:

• We aren't seeing the right kind of therapist.
• We aren't getting the right kind of therapy.
• We aren't committed to the very hard emotional homework of being honest with our therapist, and working on the exercises or changes s/he suggests.

Here's the different types of therapists:

• Psychotherapist
• Psychologist
• School Psychologist
• Psychiatrist
• Mental Health Counselor
• Marriage & Family
• Social Worker
• Psychiatric Nurse
• Pastoral Counselor

The amount of education and training required for each varies, from none to a substantial amount. A psychiatrist is actually an M.D. and can write prescriptions for medications (in a few states, so can a psychologist), but generally a psychiatrist will refer any ongoing therapy work to a psychologist.

Because someone is "lower on the food chain," does not necessarily mean he or she will be an ineffective therapist. For some problems and disorders, medication is not indicated.  For others it may be helpful on a short-term basis in conjunction with CBT or other brain retraining exercises; and for some people, long-term medication may be necessary. In yet others inpatient care may be required. A nutritionist may add needed support.

A good therapist will recognize when a client needs more help than s/he can provide, and be eager to steer her/his client to the right kinds of additional help.

Different types of therapy include:

• Psychoanalysis
• Cognitive Behavior Therapy (CBT)
• Dialectic Behavior Therapy (DBT)
• Antipsychotic and/or antidepressant medications, and/or mood stabilizers

A treatment once promoted, which fell into some disrepute, and now gaining some proponents is ECT (Electroshock Therapy) as a treatment for bipolar disorder and depression. Diet modification, music therapy, group therapy, yoga and mindfulness exercises; all can form an integral part of helping a person become as whole and mentally healthy as possible.

The most important factor in therapy success is being committed to it. If we are not willing to embrace the process and say, "Yes, this area of my life is causing me and my loved ones too much pain. I will do whatever it takes to make it better for everyone I love - including me," then no matter how experienced and skilled the therapist, no matter how effective the treatment, it's not going to work.

Changing lifelong behaviors and thinking patterns is hard, hard work. In an earlier post, I compared it to shifting the course of the river - the river tries to flow along the same channels it always has. This is where medication in partnership with therapy often works well, interrupting the old patterns long enough for new ones to form (they say about 90+ days is the minimum time frame to quit an old habit or form a new one).


I know people who are diagnosed as mentally ill who religiously follow their medication, exercise, diet, and therapy regimes. I know others diagnosed as mentally ill who are willing to try certain therapies but not others. I know some who refuse to see any kind of counselor, under any circumstances, even if it means being fired from a job or losing a spouse or partner, using the excuse of, "I saw a therapist once, and it didn't help." They believe all it takes is willpower and determination to not be disordered.

Guess which group is most successful at managing their condition?

My A-Z theme is Issues related to Mental Health or Mental Illness.

Have you ever had good or bad therapy?

Would you be willing to try it again?

Why or why not?

Related articles

• Cognitive Behavior Therapy and Cognitive Distortions (carlarenee45.wordpress.com)
• Why We Still Need Psychiatrists! (madinamerica.com)
• Learning to Be Present With Yourself (psychologytoday.com)
• PTSD Scientifically Speaking (writeintothelight.org)
• C is for Cognitive Behavior Therapy (CBT) (motherwifestudentworker.wordpress.com)
• Religion and the Psychotherapy Process (serentalasman.wordpress.com)
• How To Tell If Your Shrink Sucks (And Then Fire Them) (xojane.com)
• Employees Able To Return To Work Sooner Following Work-Focused Psychotherapy (medicalnewstoday.com)

A-Z: Question - What Causes Mental Illness, Anyway?

PET scan of a human brain with Alzheimer's disease (Photo credit: Wikipedia)What causes mental illness? Genetics? Environment? Trauma?

We have many more questions about mental illness than we have answers. But we are beginning to put some of the pieces together.

As we are learning to scan brains in various ways, and see parts of it that are over- or under-active, enlarged or shrunken, it becomes ever more evident that when they say mental illness is "all in your head," that's literally true.

Many mental illnesses look very much like what happens when we know someone has suffered a brain injury; a bad fall, a war injury, or a stroke.

After Brain Injury: The Dark Side of Personality Change (Part 1)

The author here describes building a new relationship with her husband after his massive heart attack and cardiac arrest caused a severe anoxic brain injury.

Most of the time, Alan displayed his engaging pre-injury personality marked by kindness, love, curiosity, and humor. However, post-injury personality changes also meant that we dealt with bouts of intense anger, confusion, and unpredictable behavior. Sometimes his moods shifted so suddenly that I called it "Jekyll and Hyde syndrome." It was as if two versions of Alan resided within him. One was rational and easy-going, but the other was frightening and even dangerous at times.

Why brain injury affects emotions

First, some background. Brain injury sometimes causes subtle or pronounced changes in personality. Damage to specific areas of the brain, including the frontal and temporal lobes, amygdala, and hippocampus might leave the survivor vulnerable to agitation, volatile emotions, memory impairment, verbal attacks, physical aggression, and impaired impulse control.

Psychiatric issues after brain injury

Brain injury can also contribute to psychiatric issues including depression, severe anxiety, substance abuse, or obsessive compulsive disorder. Some survivors experience post-traumatic stress disorder (PTSD) as a consequence of the circumstances and medical events that caused the brain injury. In addition to damage to specific areas of the brain, Alan's brain injury disrupted the production and function of neurotransmitters that influence mood and thought regulation.

We quickly learned that anxiety or depression made Alan more susceptible to angry outbursts or threatening behavior. He often responded well to the judicious use of medications to modulate depression, anxiety, and agitation for years after the injury. We never used medications in place of attention, communication, behavioral strategies and keeping environmental stimulation within his comfort zone. However, I came to appreciate their value.

from Caregiver.org:

Emotional Lability
In some cases, neurological damage after a head injury may cause emotional volatility (intense mood swings or extreme reactions to everyday situations). Such overreactions could be sudden tears, angry outbursts, or laughter. It is important to understand that the person has lost some degree of control over emotional responses. The key to handling lability is recognizing that the behavior is unintentional. Caregivers should model calm behavior and try not to provoke further stress by being overly critical. Help the person recognize when his/her emotional responses are under control and support/reinforce techniques that work.

Self-Centered Attitude
The person who has survived a head injury may lack empathy. That is, some head injury survivors have difficulty seeing things through someone else's eyes. The result can be thoughtless or hurtful remarks or unreasonable, demanding requests. This behavior stems from a lack of abstract thinking.

Help cue the person to recognize thoughtlessness. Remind him/her to practice polite behavior. Realize that awareness of other people's feelings may have to be relearned.

We're finding out that people with a certain genetic component might be more vulnerable to Alzheimer's disease. As our living environments become ever more compromised with pollutants, we know that children growing up in certain areas become more prone to certain types of cancer and other birth defects. But not all children growing up next to the Love Canal developed cancer. Certain physical problems seem to require both a genetic and an environmental component.



from WebMD:

What Biological Factors Are Involved in Mental Illness?
Some mental illnesses have been linked to an abnormal balance of special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or are not working properly, messages may not make it through the brain correctly, leading to symptoms of mental illness. In addition, defects in or injury to certain areas of the brain have also been linked to some mental conditions.

Other biological factors that may be involved in the development of mental illness include:

Genetics (heredity) : Many mental illnesses run in families, suggesting that people who have a family member with a mental illness are more likely to develop one themselves. Susceptibility is passed on in families through genes. Experts believe many mental illnesses are linked to abnormalities in many genes -- not just one. That is why a person inherits a susceptibility to a mental illness and doesn't necessarily develop the illness. Mental illness itself occurs from the interaction of multiple genes and other factors --such as stress, abuse, or a traumatic event -- which can influence, or trigger, an illness in a person who has an inherited susceptibility to it.

Infections: Certain infections have been linked to brain damage and the development of mental illness or the worsening of its symptoms. For example, a condition known as pediatric autoimmune neuropsychiatric disorder (PANDA) associated with the Streptococcus bacteria has been linked to the development of obsessive-compulsive disorder and other mental illnesses in children.

Brain defects or injury: Defects in or injury to certain areas of the brain have also been linked to some mental illnesses.

Prenatal damage: Some evidence suggests that a disruption of early fetal brain development or trauma that occurs at the time of birth -- for example, loss of oxygen to the brain -- may be a factor in the development of certain conditions, such as autism.

Substance abuse: Long-term substance abuse, in particular, has been linked to anxiety, depression, and paranoia.

Other factors: Poor nutrition and exposure to toxins, such as lead, may play a role in the development of mental illnesses.

Personally, I suspect that for many with substance abuse problems, it's more a vicious circle. A person with undiagnosed symptoms of mental illness began self-medicating with alcohol, or cocaine, or crystal meth, and as the addiction grew, any relief continued to shrink. While meanwhile, the person's drug of choice was wreaking havoc on his/her body.

Back to the brain trauma issue; it's entirely possible to have clots, growths, and mini-strokes inside the brain, large enough to affect the personality; but entirely unrecognized. I know a young woman recently diagnosed with epilepsy. She had previously been diagnosed with bipolar disorder, but taking a closer look, her doctors said that her brain appeared to be having periodic "lightning storms" inside it, which affected her behavior, even though she did not exhibit what most people think of as epileptic symptoms.

There's probably an emotional component to mental illness as well. Living in a home where emotional, physical, or sexual abuse sends fight-or-flight hormones flooding the body might send a child who already had a tendency towards mental illness, firmly over the edge. Even if the child is not the target, being a regular witness to his mother or her father being abused, must leave lasting damage.

But I think it's time and then some to stop blaming all mental illness on "bad childhoods/bad mothers." Clearly, many people endure them, and somehow, become neither mentally ill, nor abusive, themselves.

In another few decades, I suspect there will be fingertip blood tests for certain neurotransmitter levels linked to mental illness symptoms, as there are now for diabetics and their blood sugar levels. Wouldn't it be wonderful if those with certain mental disorders could take smaller doses of mood-regulating meds only when they needed them?

We all have brains, and we all have bodies, and pretty much every human being has Issues. Nearsighted. Allergic to cats. Digestive problems. A tendency to ingrown toenails.

Perhaps instead of taking pride in the fact that "at least I'm not crazy," we should count our blessings.  Realize, just because we fall in that category today, things could change for us, or someone we love, tomorrow.

My A-Z theme is Issues related to Mental Health or Mental Illness.

Have you ever known anyone who experienced 
 a traumatic brain injury?

Have you ever participated in a study on mental illness?

Why or why not?

Related articles

• After Brain Injury: The Dark Side of Personality Change Part I (psychologytoday.com)
•  After Brain Injury: The Dark Side of Personality Change Part 2 (psychologytoday.com)
• Researchers Use Brain Injury Data to Map Intelligence In The Brain (news.illinois.edu)
•  My Brain is Not Always My Buddy (steponacrack.wordpress.com)
• Children and Mental Illness (moorestorms.wordpress.com)
• I Hate Having Bipolar Disorder (galaxybounce02rabbithole.wordpress.com)

A-Z: NAMI - Four Letters of Goodness

Who woulda thunk that talking about race, politics, and religion would be the easy conversations?

Well, as far as race goes - whatever race (or combination of races) you are, that's what you are. Not gonna change. Politics and religion - whatever yours are, now, that's by your own choice, and you can choose to stay what you are now, or make a change at any time of your choosing. There's a kind of security in that.

Not so with mental illness. At any moment, mental illness can hijack you and make you sound... like a winner.

Charlie Sheen, via Wikimedia

Most of us find that concept more than a little scary. We want to deny it could ever happen to us. Yet some of the most creative, smart, and funny people in the history of humankind have been mentally ill. Take a look at this very incomplete list:


I kind of feel sad I do not (yet) qualify to be included. (But maybe my time will come.)

If mental illness does strike, either you or someone in your family, you can't call Ghostbusters.

You can call NAMI (And I bet they'll help hook you up with your local resources if you live outside of the USA.)

About NAMI

NAMI, the National Alliance on Mental Illness, is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raising awareness and building a community of hope for all of those in need.

From its inception in 1979, NAMI has been dedicated to improving the lives of individuals and families affected by mental illness. Financial contributions allow NAMI to offer an array of programs, initiatives and activities in support of the NAMI mission.

 NAMI provides support for local centers that offer programs such as: 

• Family-to-Family
• Peer-to-Peer
• Missing Persons Support
• Veterans Resources
• Information, training and support for parents, teachers, and professionals dealing with mentally ill children and adolescents.

They're not all about pushing drugs, but helping to educate families to make choices that work for them.

One of the problems we face in the US (and pretty much, every country all over the world), is when economic times are tough, programs that help the mentally ill and their families are usually among the first to be slashed. It's understandable; it is also penny-wise, pound-foolish. Supporting someone with a manageable mental illness to stay on his/her meds, in counseling and employed, is way cheaper than locking him or her in jail, where a number of mentally ill people end up.

But there's still the perception that if mentally ill people "just tried harder," they could think/will themselves out of their depression or mania or auditory hallucinations. (Dare I say that people who think that are, well, crazy?)

How can you help? Pick any/all of the below:

• Join NAMI as a member.  (Dues are currently $35 a year. Hell, I spend more than that just on chocolate.)
• Follow NAMI on FaceBook.
• Follow NAMI on Twitter.
• Donate, when funds permit.
• Vote for candidates and measures that support mental health.
• Speak out when people with mental illness or disabilities are bullied or become a Stigmabuster.

We can't cure mental illness by willing or wishing it away, but we can work together towards finding its causes, and support those families who deal with this burden. It may be "them, over there," today, but it could be us, tomorrow.

My A-Z theme is Issues related to Mental Health or Mental Illness.

Have you had a personal experience with NAMI?

Ever supported their walks, or donated?

Has mental illness touched your life?

Related articles

• What can I do for my depressed friend/relative? (slacktivist.typepad.com)
• Adult ADHD | A post on health care reform from NAMI (adultadhdhelp.net)

A-Z: Mental Health - Don't Know What You've Got Till It's Gone

Mental Health Awareness Ribbon
(Photo credit: Wikipedia)

Did you wake up today and ponder, "Should I be totally sane, a little bit wild and wacky, or full-on Crazy McCrazypants?" just like you would decide whether to wear a green shirt or a blue one?

Me neither.

If we are (as far as we know) mentally healthy, we tend to take that for granted. Perhaps we smugly assume it is due to "good genes" or some superior behavior on our part. (I've never taken drugs/abused alcohol; I eat a healthy diet and exercise regularly.)

Yes, all those things are important for building or maintaining a healthy body and mind. But even if we do all the right things, even if (as far as we know) nobody in our families has ever been mentally ill, someday we still might become mentally ill. Or face it in a loved one who never "did anything wrong." (Post-partum depression or Alzheimer's, anyone?)

In the United States and Canada about one in four adults suffer from a diagnosable mental disorder in a given year. (Mind you, just because someone could be diagnosed, doesn't mean s/he actually is diagnosed.) Many, many people struggle alone, trying to combat their disorder through willpower and denial, because they don't want the stigma of seeking help for a mental disorder. Or because they do not realize they are actually ill, not simply sad or moody.

We are beginning to learn that many cases of alcohol and/or drug abuse are actually people self-medicating for untreated mental illness or to relieve the pain of traumatic events, like childhood sexual abuse. (Clue: it only works for a little while.)

Janet's fun clip here has absolutely nothing to do with mental illness, 

but 'Til It's Gone inspired my title and thoughts for this post.

Rather than be judgmental and harsh with ourselves and others, we need to offer real support and encouragement. That means money - for treatment, for research, for medication, and living facilities for the most severely affected. We need insurance policies (or single payer plans) that don't impose a lifetime cap of "50 visits to a therapist, and you're on your own."

We don't expect people to "will away" their nearsightedness or broken arms (except for Christian Scientists). We don't tell people to just not let their kidney stones hurt them so much.

Why do we expect people with an ailing brain - whether it's OCPD, bi-polar disorder, or depression, to simply make up their minds to be well?

From Adventures in Depression at Hyperbole and a Half:

When I couldn't will myself to not be sad, I became frustrated and angry. In a final, desperate attempt to regain power over myself, I turned to shame as a sort of motivational tool.

But, since I was depressed, this tactic was less inspirational and more just a way to oppress myself with hatred.  <snip>

The self-loathing and shame had ceased to be even slightly productive, but it was too late to go back at that point, so I just kept going. I followed myself around like a bully, narrating my thoughts and actions with a constant stream of abuse. <snip>

I spent months shut in my house, surfing the internet on top of a pile of my own dirty laundry which I set on the couch for "just a second" because I experienced a sudden moment of apathy on my way to the washer and couldn't continue. And then, two weeks later, I still hadn't completed that journey. But who cares - it wasn't like I had been showering regularly and sitting on a pile of clothes isn't necessarily uncomfortable. But even if it was, I couldn't feel anything through the self hatred anyway, so it didn't matter. JUST LIKE EVERYTHING ELSE.

Please go to Hyperbole and a Half and read the entire post. (Partial reposting with attribution, as I have done here, is permissible according to the author on her FAQ's.) It's a brilliant example of what Depression really is - not just feeling a little sad, go outside and take a walk or blow some bubbles and you'll feel better.  (Btw, it's not helpful to tell someone who has Depression with a capital D that you know how they feel, because your cat died and you were depressed for weeks.)

Sometimes episodes: of depression, of mania, of anxiety, of paranoia - end on their own. Other times they do not.

There is nothing wrong with seeking help when you or a family member is mentally ill - or even if you suspect you, he or she might be. If you had an infected tooth, wouldn't you seek treatment? (Then again, for some people, the answer is hells no.)

When our cars are making a weird sound, we generally hurry in to the mechanic. We can't afford to let our cars break down. What would society be like if we did the same thing for physical and mental health - got regular "tune-ups," and went for help whenever we suspected "something's not quite right," without worrying what the neighbors would think? (Or without worrying as to whether the bills might send us into bankruptcy?)

Right now, we don't do much as a society for mental illness until someone pulls out a gun and starts shooting people. Or dies in a fire in their hoarded home, or commits suicide. We can't afford to allocate the monetary resources, people say. But how much does ignoring the problems until they become tragedy, cost us?

My A-Z theme is Issues related to Mental Health or Mental Illness.

Have you or someone you have known self-treated 

for stress, mental illness or emotional trauma?

What was the factor holding you/them back? 
Lack of money/insurance coverage?

Afraid of the stigma that would attach to the treated person?

Related articles

• Help is Available When Mental Illness Prevents Working (psychcentral.com)
• Does Anybody Want to Pay for Depression Treatment? (thehealthcareblog.com)
• Common Mental Disorders may Not Elicit Much Support (psychcentral.com
• There is no 'us and them' (twim-blog.org)

A-Z: Borderline - Not Just a Tune You Can Dance To

People think "borderline" means part of this, part of that.  Perhaps the concept of borderline as being on the edge may be helpful in understanding Borderline Personality Disorder.

My A-Z theme is Issues related to Mental Health or Mental Illness.

Unfortunately, the real Borderline Personality Disorder doesn't come with choreography and cute hats.  It also goes beyond "being a little moody" or having PMS.

From NCBI, US National Library of Medicine:

People with BPD are often uncertain about their identity. As a result, their interests and values may change rapidly.

People with BPD also tend to see things in terms of extremes, such as either all good or all bad. Their views of other people may change quickly. A person who is looked up to one day may be looked down on the next day. These suddenly shifting feelings often lead to intense and unstable relationships.

Other symptoms of BPD include:

• Fear of being abandoned
• Feelings of emptiness and boredom
• Frequent displays of inappropriate anger
• Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting
• Intolerance of being alone
• Repeated crises and acts of self-injury, such as wrist cutting or overdosing

Borderline Personality Disorder Awareness (Photo credit: Gemma.E.Taylor)

While they offer support and resources to people dealing with all Personality Disorders, the excellent site Out of the Fog was initially created by partners of those suspected or diagnosed with Borderline PD.  (Note: the DSM-V, currently under review and due "out" in 2013, may be renaming this disorder as Emotional Regulation Disorder (ERD) or Emotional Dysregulation Disorder (EDD).)

Suggested treatment includes DBT, Dialectical Behavior Therapy.

As with any mental disorder, your mileage may vary.  For anyone in a relationship with a disordered person, getting help for yourself and keeping the lifeline open to family, friends, and other support is vital.

My A-Z theme is Issues related to Mental Health or Mental Illness.

Do you know someone with Borderline Personality Disorder?

Do you have any good tips for managing a relationship 
with such a person?  Your thoughts?

Related articles

• There IS Hope: Effective Treatment For Borderline Personality Disorder (peterhbrown.wordpress.com)
• Reading about Borderline Personality Disorder (fiercelinguist.wordpress.com)
• You: Dialectical Behavior Therapy for Borderline Personality Disorder (natashatracy.com)
• Treating Borderline Personality Disorder: The Dialectical Approach Reviews (untreatableonline.com)
• Diagnostic Interview for Borderlines (neumannpsychology.wordpress.com)

Anyone Get the License Plate Number of that Truck?

via Rhys Asplundh at Flickr

I never saw it coming.

One of the things that happens when a person in a relationship with an OCPD'r begins telling stories to outsiders about the worst moments, is people look at you like you're insane.  Like either you're a liar and making stuff up, because the person who is so nice in public couldn't behave like that at home.  Or because you'd have to be a blithering idiot to sign up for that kind of abuse.

Well, we didn't sign up for it.  Most of us dated a person who seemed (relatively) normal, if a little quirky.  But don't we all have quirks?

Theirs seemed harmless enough, perhaps even an improvement over our own habits.  If he was excessively careful about his personal appearance, this seemed like a nice change from guys who were content to go out in public in a ratty T-shirt.  Maybe she seemed a little hung up on cleaning and arranging everything, but aren't women "supposed" to be like that?

They loved us and we loved them and we had excellent chemistry together.  They were smart and funny and seemed to be more organized and "together" than a lot of other people we'd been involved with.

And then the relationship moved to the next level, and like the frog in the pot of cold water, the heat gradually increased.  Or some "event" happened - marriage, moving in together, a new baby - and like a werewolf during a full moon, they transformed into an OCPD raging monster.

Everybody is on their best behavior while courting, anyway.  That initial stage of being "in love" that lasts anywhere from 4-6 months to up to two years.  During that time, the dopamine (feel-good/reward hormone) and oxytocin (promotes attachment) levels go way up.  So the anxiety and fear which seems to be at the root of OCPD controlling behaviors (if I do everything perfectly, and anticipate every possible catastrophe, bad things won't happen) is not simply masked, but overwhelmed.

But "the good guy hormones" will eventually take a break.  And now, because we have been added to the list of things the OCPD'r feels s/he must manage and control, lest disaster ensue, their anxiety level shoots way up.

Image via WikipediaIt may be sweet at first, being fussed over, "Let's get those boots off you; I hope you didn't get your feet wet." "Make sure to wear your warm coat," but in a severely OCPD person, it becomes panic when you're driving.  (I blogged earlier about Mrs. Potatohead.) And "don't you realize if you leave the toaster plugged in it could burn the house down!"  Bring on the Crazy Rules!

It wasn't that they were being deceptive or putting on a deliberately false front; things were wonderful between us, and then (from the POV of an OCPD'r) we changed.  We started doing things that were annoying, slovenly, or downright dangerous.  We made mistakes, and mistakes are not permitted in OCPD, aka Perfectionism on steroids (except on a theoretical level).  Mistakes could lead to disaster.

If we only cared as much as they did, we wouldn't make mistakes.  At the very least, we would obsess over them as much as they did.

What?  They make mistakes, too?  Not possible.

Because OCPD is a mental disorder, those who have it are subject to distorted thinking.  They pride themselves on logic, therefore, even if they made a mistake, they get locked into loops where their reasoning in making a mistake - they were misled by circumstances, and so it really isn't their fault after all - is defended to the death.

Early on, we may get suckered in to trying to persuade an OCPD'r to see our point of view (aka JADEing).


What keeps us in the relationship, beyond the initial bonding is the difference between OCPD and say, a Narcissist or sociopath.  They don't torture their loved ones for the sheer sadistic pleasure of it, like a deranged child pulling the wings off flies to see them struggle. At the root of some horrifically abusive behaviors is genuine worry, genuine caring.  No matter how bad things get, we know and sense they deeply care.  There are moments when they have flashes of insight, or seem to revert to the fun, caring person we fell in love with.  We think, we hope, this time, the insights are going to stick.

And then the fog rolls in.  Sometimes it rolls out again, and everything we hope for happens - the OCPD'r gets hit by the cosmic two-by-four, realizes the problem isn't with everybody else, but in fact, within his/her own head.  S/he gets serious about changing her life, for herself, and with professional help, begins working to untwist OCPD-think and long-formed habits.  These people are true heroes.

More often, the fog doesn't roll out, the behaviors worsen, and we reach a point where we can no longer stay in the situation, living on thin hope that our partner will see the light and be willing to put in the very hard work to change.  S/he may be in denial or anosognosia; may have made moderate changes but our tolerance threshold has been exceeded.  We realize we can't stay and remain sane.

The one thing we need to do, the one thing we can do, is examine our own co-dependent behaviors.  Do we see ourselves as a Rescuer? Do we think our partner will crumble into a thousand bits if we leave him?  (I believed mine would; saw him a few weeks ago, he is just fine.  Well, he is not "fine," he is still dysfunctional, but no more dysfunctional than when I broke up with him.)

Do we pride ourselves on being kind and understanding (I certainly did) even while our "kindness" is helping neither us nor our partners?  In many ways, I think my ex is relieved I am gone.  In retrospect, I don't believe, for all my good intentions, I budged him one micrometer towards mental health, despite all the agony and heart-rending pain I went through.

I'm not saying it's right for you to go.  We all must make the decision to go, stay, or stay for now, according to what seems right for us.  It takes different kinds of strength to make each decision.

If you have made the decision to leave (or ask to leave) a disordered partner, I applaud you.  If you have made the decision to stay and work with him/her, because s/he is truly trying, I applaud you.  If you have made the decision to stay for now - until the kids are in college, the MasterCard is paid off, whatever - I applaud you.  If you have already left, I applaud you.  If you are getting professional counseling for yourself, I stand and applaud you.

Those of us who've been in that situation, know it's not black-and-white.  We didn't deliberately pick out a monster and choose to live with him or her, because we thought getting berated and criticized every day would be loads of fun.  More like, we checked carefully before entering the crosswalk, and got hit by a truck anyway.

And for those behind the wheel of the truck, with OCPD, who feel like they're in that defective Toyota, trying frantically to make the brakes work, turn the engine off - you know I love and respect you, as well.  My hope is that someday, we can find out how to turn the brakes back on, so you can drive and brake just like everybody else.

How Can I Deny Thee, OCPD? Let Me Count The Ways

Catherine Zeta-Jones
via Wikimedia Commons

One of the most pernicious aspects of Obsessive-Compulsive Personality Disorder is the fact that those who have it are usually convinced there is nothing wrong with them. With those around them, sure.  They are surrounded by fools and incompetents!  

It's hard for any of us to admit that we might be mentally ill.  There's a big stigma (perhaps it should be called a Stinkma) about having any kind of mental disorder - except for perhaps the "cool" ones, like bi-polar disorder or anorexia.

Note: I am NOT saying it is "cool" to be bi-polar or have an eating disorder.  I know full well, the very deep pain and intense suffering that those with those diseases experience.  Still, the perception in the general public is that there are glamorous models, actors and actresses who have eating disorders, or who are receiving treatment for bi-polar disorder, or substance abuse.  So if these talented, beautiful people have a problem just like ours, it becomes a little easier to admit we suffer from it, too.

There are no "beautiful people" stepping forward and saying, "I have OCPD."  Many people have never even heard of OCPD.  Often, it's confused with OCD, or Asperger's, or autism, and what is true is that some people with OCPD also have some OCD or Asperger characteristics.  They may share a sensory overload with light, sounds, or odors, for example.  They may exhibit similar emotional "meltdowns" when something occurs they did not expect.

Many of the qualities of OCPD are extremely admirable, in small doses.  When cooking, we might not realize that we've added too much salt, but we sure know it when we taste it.  Way too much salt can make food not only unpleasant but inedible.

Here's an example: many women (and some men) with OCPD obsess over a clean house.  They are constantly cleaning, disinfecting, and bleaching things.  This might not seem so bad, until you hear stories about a woman who put so much bleach into her husband's laundry that he had to be medically treated for chemical burns in his crotch.  Twice.  Sometimes an OCPD woman (or man) is so wrapped up in obsessive cleaning 14 hours a day, 7 days a week, that there is no time to socialize with friends, play with the children, or go out to dinner with the spouse.

When partners, co-workers or children first hear about OCPD, there is a thrill of recognition, relief and hope.  This is what the problem is, I'm not going crazy after all, and now my partner/father/co-worker can get treated and things will be better.

Sometimes it works that way, but more often, the person with OCPD will deeply resent getting an amateur diagnosis from his loved one.  S/he will insist the partner is the one with the problem; will look up the condition online and point out triumphantly that s/he doesn't hoard, or obsess about being on time, so you see, s/he couldn't possibly have OCPD.  (Disregarding the other items that are spot-on.)

S/he may agree to go for counseling, and then:

• Storm out because s/he doesn't like the things the counselor says.
• Refuse to listen because s/he doesn't think the credentials of the counselor are impressive enough.
• Listen but only hear part of what the counselor has to say.
• Out and out reject a professional diagnosis of OCPD and a recommended course of behavior therapy.

The counselor, in turn, may not even use the term OCPD.  Because so many who have it react negatively to "labels," s/he may pussyfoot around, refer to "obsessive-compulsive tendencies" or "overwhelming anxiety."  So in some cases, denial may occur in part because the term OCPD was never officially used in the first place.  We can understand why a counselor might make that choice, because if a patient is willing to accept some therapy, sans label, it would seem better for their well-being than forcing a diagnosis on someone who will then abandon therapy altogether.

Here's some true stories (some details have been changed): 

I finally got my wife to read the book Too Perfect, and when she did she said wow and agreed that OCPD was her all the way. So much so that she actually made an appointment and has been going to a therapist. However,..... when I mention OCPD she gets upset and says not to label her. This coming from a woman who openly admitted that she could identify with the entire book.

My boyfriend knows he's OCPD but hates "labels" and denies having OCPD. When our therapist first brought it up and read the symptoms, I had my mouth hanging open and he had the BIGGEST smile on his face. He was proud!!   Now, he denies it (it's like talking to a crazy person!) and he gets upset whenever i bring it up.

My OCPD wife went to joint counseling last year on threat of separation. When she was diagnosed with OCPD, she didn't accept it and we came to an impasse.

My husband actually found out about OCPD on his own 2 years ago, then made an appointment with a psychiatrist who officially diagnosed him. At the time I thought it was encouraging that he could admit and realize he had OCPD, but now he is in absolute denial and says he has it under control. That the problems all come from our "bad communication" skills.

My wife was diagnosed first by a neuro-psychiatrist after extensive testing with OCD. It was only after I did extensive research that I could bring OCPD to their attention, and now she is being treated for OCPD with medication and therapy.

Recently, the counselor brought up the concept of OCPD.  I later found out from the counselor that my husband wouldn't accept the diagnosis of OCPD, so the counselor took the "symptom approach," i.e. explaining to him how he was obsessive and compulsive. These he accepted. However, now that my husband has convinced himself that he doesn't have OCPD, he is very angry at me for having "imprisoned" him with this diagnosis of my own making for years. Not to mention, as far as I can tell, he's not working very hard on his "symptoms."

My girlfriend had a brain scan done and it was opposite of normal. The guy looked at her and said "how do you sleep at night?" She didn't. She knew something was up but she had no real interest in seeking a fix, something that might even help her feel better. Even her mom suggested getting help. Eventually she did go to therapy and it was about blaming everyone else. As soon as the therapist started scratching the surface she became too busy with work to go any more!!

Five years into the marriage, my husband was diagnosed with OCPD.  Constant conflict between wanting special concessions because "that is the way I am" and the continual denial that anything was wrong with him. This went on for another ten years, until I just could not stay in a war state of mind, all of the time.

Now after all this gloom and doom, is there any hope?  Yes, there is.  This is also a true story: 

I was formally diagnosed 10 years ago, and managed to completely dismiss and ignore it for many years.  My symptoms started to really get worse, to the point where I was making lists to organize my lists! I hated how I felt, was interested in feeling better, and came to learn techniques that addressed the OCPD without ever acknowledging the OCPD. It all comes down to acknowledging and taking responsibility for the chaos in your life, regardless of what the origin of that chaos is.

Having the official label of OCPD can help the partner to understand this is a mental disorder - that it is not us.  It may or may not be helpful to the person who has it.  If they would prefer to call themselves excessively perfectionistic, or "a little bit obsessive about some things," what matters is not whether they accept the label, but if they are willing to do the very hard work of battling the disorder.  



Photo via OIPA



As their loved ones, we need to understand our own boundaries, our own co-dependent tendencies to save the wounded birds.  It is entirely possible, once we stop enabling that they will feel the pain enough to take action about it.

One thing's for sure, nagging, reminding, and "helping," doesn't.

Got an experience with diagnosis and counseling you'd be willing to share?