Category Archives: Stigma

Guest post: Bipolar 2- Wading through depression and loss of motivation by Jessica Flores

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This article is about Bipolar 2 disorder, a mood disorder where sufferers can cycle between high and low moods. Jessica writes about her experiences: 

If you have been diagnosed with Bipolar II, you know that it differs from Bipolar I disorder in that you still cycle between high and low, but you never experience complete mania (high mood), which is good. Instead, you get hypomania (a lesser form). Yet, more often than not, you are trying to cope with long periods of substantial depression; which can be more severe and long lasting . Roughly six million people in the United States  and millions around the world, suffer from some form of bipolar disorder, so you aren’t alone.

When I am hypomanic, I find myself excited to go out and have conversations and stay up all night. I want to make friends and craft furniture and redecorate. I end up buying things online for some new life I plan to begin living. It’s why half of my living room has been filled with boxes of mid-century housewares for the last two years. However, I spend most of my time being depressed.

My life often feels like it is happening underwater. Every action I attempt to take exhausts me. Showering daily is impossible. I sleep for half the day and sit in front of the computer to do my job without the energy to move forward or the cognitive wherewithal to make sentences. I don’t have urges to harm myself, but I wonder why I need to keep feeling this way every day. I lose hope for the future- it can be very difficult.

Lately, I have begun to wonder if I am depressed or if I am simply losing motivation.  I feel sluggish. I don’t feel motivated. My house is a wreck. I can’t remember the last time I cleaned the kitchen floor. I thought about getting a maid service last week, but I didn’t want anyone to see my apartment.  Sometimes I have negative self talk and think I am lazy, not depressed.

As it turns out, I am not alone in my thoughts about this. Many people with clinical depression reach a point where they attach negative descriptors to themselves. If people hear they are lazy often enough during depressive episodes, it’s not unusual for them to question whether or not it’s true.

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A depressed person isn’t simply dealing with a lack of motivation, they deal with changes in their sleep patterns, hopelessness, loss of pleasure in things they used to enjoy, changes in weight and/or appetite, and so much more. All of these are potential symptoms of bipolar depression and they can be treated. There are a number of medications that have proven effective in treating Bipolar II and many forms of therapy that are a critical element of a complete treatment plan.

Regardless, that’s a lot to handle all on your own. And what makes it especially difficult is the fact that it’s all being caused in your own mind.

Which is why it’s time to stop thinking of yourself as unmotivated or lazy, and it’s time to stop listening to anyone around you who does. You have a diagnosed medical condition. You are managing as well as you can in the given circumstances. I know it’s hard, but you’re going to need to learn to tell yourself that that’s all there is and you shouldn’t put yourself down for the resulting actions that you choose to take because of your condition. Instead of feeling ashamed, you need to make sure you are getting all of the treatment that you can and learning skills to help you control what you are able to.

Eleanor Roosevelt once said that nobody can make you feel inferior without your consent. This is your battle. To make sure that you yourself don’t make yourself feel bad for how you spend most of your days. By being proud of who you are and accepting your condition, you close yourself off from any hurtful comments any uninformed person could ever tell you. And it’s important for you to be able to do that. Because you’re not any of the negative things you just said. You’re amazing, capable, and strong. Remember that.

 

Jessica Flores is a wife, mother, writer, and woman diagnosed with bipolar II. She knows that her disorder affects her entire family and she works to lessen the impact as best she can. However, she also gives herself permission to experience changes in mood. Her drastic experience motivates her to blog about it and help others who are experiencing trying times.

The Anxiety Wheel: Lifes Voyage

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It has been a while- about a month since I have written about everything going on. This is because between the moments where I feel full of health and happy, I have been experiencing morning panic attacks at times again and I just didn’t have the energy to process it and write about it.

I have had morning anxiety for a long time, where I wake feeling overwhelmed and fearful about the day and I have had lots of therapy to try and help combat it. The only thing that seems to work for me a the moment is resilience and picking myself back up- but its not easy. After the adrenaline stops, I often feel embarrassed that I couldnt do a desired activity and I don’t want to let others down also. Its a catch 22.

I am doing a bit better this week but last week was tough. When I have breakthroughs, moments where I can socialise or go to work- then its excellent because it gives me confidence to continue.

Here is a diary entry I wrote in Starbucks the other day to make sense of the ups and downs of what I term the ‘Anxiety Wheel’:

In the past week and a half, I have been experiencing an increase in my levels of anxiety. It reminds me of a metaphor- that of running around a hamster wheel. Let me explain.

Sometimes it feels like I’m treading, treading, treading, trying to keep the wheel of life turning. Trying with all my might to function at a ‘normal’ pace. There are days when I can enjoy the running and everything feels enjoyable and exciting. There are days when I can take my feet off the hamster wheel and rest.

Yet, sometimes in my rest times, I can be overwhelmed by the anxious thoughts of lifes spinning wheel. It all feels too much and then I freeze, I hide, I go into fight or flight. I metaphorically hide and sleep in my safe cage, before I pick up the courage to turn lifes wheel again.

Today I am taking back control of my life and spinning the wheel slowly and cautiously before I get back into the full groove again. Picking myself up after panic attacks is not at all easy,. However, with support, resilience and inner strength, I can do this. I will feel safe and comfortable.’

Shame and Psychosis article for Time to Change

My latest article for Time to Change, a campaign in the UK aiming to end mental health discrimination. (name has been changed)

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Three years ago last month, my mind lost touch with reality in a very rapid turn of events that culminated in an acute manic episode of bipolar affective disorder. Having been diagnosed with bipolar in 2004, I had not experienced any mania or hypomania (a lesser manic state) in ten years, although I had fallen into a suicidal depression just six months earlier. So when my brain fell into full blown psychosis – with delusions and grandiose thoughts, fearful thoughts about loved ones and being in danger and a complete change in rational perception – it ripped apart the fabric of my life and all I knew. I am writing this to explain what psychosis is really like.

I was just 25 and although I had experienced a mixed state which left me hospitalised at 16 (and had experienced some psychosis then), this was by far the most challenging, lengthy and painful bout of mania and psychosis that I had experienced. I began to believe that my step father was behind why I was in hospital and wouldn‘t let him see me, I thought that the doctors and nurses were a gang holding me hostage. I was fearful of everything, talking and singing to myself, unable to sit still and became quite agitated at times with the staff and patients, which is completely out of character for me. I simply didn’t know what was real or unreal and I was so frightened of the staff and others while my brain was in this state. Eventually, I recovered after about two months of being given anti-psychotic medication and tranquilisers to help me rest (often I was pacing around due to agitation/ mania), in combination with individual and group therapies. I left hospital after three months.

I rarely talk about my psychotic state, which led me to be sectioned under the Mental Health Act. This is due to shame: I was ashamed of myself even though it wasn’t my fault – rather down to faulty brain chemistry and my medication that had stopped working. There is still a huge amount of stigma about psychosis and anything that makes you lose your sanity. My psychosis is part of my bipolar illness and happened completely out of the blue. My mood stabiliser hadn’t been holding me for some time but no one could have predicted quite how rapid my descent into psychosis and illness could have been (it took only a number of days and escalated at a weekend, leaving me to be admitted via A&E, which proved traumatising).

The shame of losing your mind is great and also acting out of character shatters your self-esteem. When I left hospital, I sunk into a depression due to the shame of how I acted in hospital and how my brain and its chemistry could go so catastrophically wrong. Kindness goes a long way when you are feeling ashamed. If you have a friend or family member struggling with this – be calm, show kindness, and show up for them. They need your support at what is an incredibly painful time. Let the person with feelings of shame about their illness know that they are human, that they are an important friend to you, and stand by them.

What truly helped me in those dark days was the attitude of my psychiatrist in hospital and in the day recovery unit I attended after. Despite being psychotic and unwell in hospital and quite agitated at times, my doctor persevered to get me on the right medication and put up with my changing moods. She knew that if I took anti-psychotics and then agreed to go on lithium carbonate (the main mood stabilising medication for bipolar disorder) that I would recover – even if it took me months to get there. It was a slow recovery but I got there in time. Her patience, perseverance and kindness saved me from a very acute episode of illness. Similarly, the psychiatrist and all the staff at the Day Recovery Unit helped me in my down days starting on lithium and having regular blood tests, recovering from being very unwell and they treated me like a human being, when I had felt so ashamed.

If it wasn’t for the Doctors, nurses, occupational therapists and other staff who looked after me  and helped build me back up, I wouldn’t be here today.

There is no need to feel ashamed, although you may do.

Although I still find it hard to talk about my descent into a psychotic state – I am so grateful to the NHS for all the help I was given and have been well for some time. I hope this article helps others in a similar position – you are not alone and don’t let anyone make you feel ashamed.

https://www.time-to-change.org.uk/blog/there-should-be-no-shame-experiencing-psychosis

Mental Health, Social Media and Relationships: Reality vs the Edit

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This post has been inspired by a few experiences that have happened to me in my life- regarding relationships with others- be they a friend or otherwise and social media.

I am a self confessed social media lover and addict. I love its ease, I use it as a way to store memories to look back on- photos, places I have been. A kind of virtual diary. I use it to keep in touch with friends, acquaintances who I would never normally see as they are in different countries or regions- and to keep in touch with friends I see regularly. I am always on Facebook, Instagram and Twitter (though not Snapchat- showing my age) and I truly love being online. Most of the time.

The difficult part about having bipolar disorder and anxiety disorder/ social anxiety is that it is not easily visible. Equally, on social media we always tend to present an edited version of ourselves- the good side. The positive side. The places we’ve been and the friends we’ve seen, those close to us. My Facebook profile, when I can achieve things, shows me smiling and being out and about. However, this has the potential to upset people if I have had to cancel arrangements due to anxiety.

The main refrain is often ‘But you were able to do it then- so why can’t you do it now?’.   How come the next day you could go out for dinner (I saw it on your Facebook)?

I understand this reaction. I do post a lot to celebrate achievements to myself and keep memories- happy memories for when I do become unwell again (which I hope won’t be for a long time). Social anxiety means that I want to look back on and remember the good times, the happy times.

The tough part is that relationships can become strained if one overly posts on social media. So its a complete dichotomy.

Do I post my life and enjoy the times I am able to socialise and go out without anxiety? Or do I edit what I upload so as not to hurt feelings of people I have had to cancel due to anxiety attacks? Ultimately- do I take my memories offline and into a private journal or on Instagram rather than Facebook?

All of this has been going through my head. Mental illness is not as straight forward to others as a broken leg. I don’t wear a sign saying I am bipolar or a bandage round my head.

I may look like I am having the time of my life…. but one may not see that:

Yesterday I could have had a panic attack which meant I couldn’t leave the house as I felt overwhelmed and embarrassed, and totally drained from the adrenaline. I got out to socialise now because a family member drove me somewhere as a form of exposure therapy to lessen my anxiety.

OR this scenario…..

My anxiety took over and I felt so frightened I was hyperventilating, crying and beating myself up emotionally, for not being able to see a friend. Because yes, we don’t want to have this and we care deeply about our friends feelings.

OR this scenario….

I have heard you talking negatively about me to someone else because I had to cancel an arrangement. Yet, I have anxiety about travel and socialising and sometimes feel overwhelmed. You know this, yet will still be upset- which I have to take into account.

So no, I am not really having the time of my life all the time. Friends are my priority but equally optimum health and managing day by day is to me hugely important.

I will try my very best not to let you down. If I hurt you through my social anxiety, it is never intentional.

I have learnt the hard way the pitfalls of social media with mental health issues. The large part is that we don’t want to talk about how depressed or anxious or panicked we are on Facebook. So it gets hidden and misunderstandings happen.

I hope one day it comes into the light, through my blog and when I can be more open.

Guest post by Karen: Being a Mental Health Professional with Anxiety, my Recovery

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Working in an outpatients’ mental health service in the NHS I was well-placed to recognise the signs and symptoms of a mental health problem. I have seen most ends of the spectrum from working in a secure men’s forensic unit, treating people experiencing psychosis in a clinic and in their homes, to treating outpatients with mild to moderate depression and anxiety. Yet none of this prepared me for my own mental health crisis that crept up on me suddenly and unexpectedly last year.

I have experienced anxiety in my life on many occasions before. I developed a fear of panicking and losing control going on the tube and was starting to avoid taking tubes and trains and places I felt I could not escape from easily. Later on I realised this was panic and agoraphobia and since I was considering dropping out of my Masters degree because it involved travelling long routes by tube, I knew I had to get some help. I had a course of CBT privately using graded exposure therapy which I had to get on board with and be committed to, and was incredibly effective for me. My CBT therapist was a real lifeline for me and we had an effective rapport which really helped.

I have since moved out of London and abroad. In September last year I started a number of new part-time teaching roles (not in mental health) in my relatively new European city. I was really worried about my ability to speak the language and to be able to communicate if there was a problem. In fact, I had pretty much spent my entire summer holiday dreading, worrying and catastrophising about all the things that could go wrong, and didn’t really tell anyone exactly how I was feeling.

I started in one of my jobs and it seemed to be going just fine the first week. I did experience a lot of worry after each class and before the next one. I was really concerned about how other people would perceive and judge me, particularly as I was not yet fluent in the language and could not understand 100%. I continued to be anxious about how other people thought I was doing my job for the next few days and had consistently negative thoughts that would not go away which were concerning as they seemed to upset me more and more. I remember that on the last day of that first week, I had been introduced to my new colleague, a really lovely lady who seemed really helpful. She was really experienced and obviously had a lot of knowledge and I started to feel inadequate in that moment. That was the moment everything spiralled out of control.

I went home and over the weekend I experienced constant racing thoughts of things going wrong and worst case scenarios. My husband and I were watching TV in the evening and I just could not focus on anything as my mind was racing so much. What surprised me the most was how physically I felt the anxiety this time and how different it was to any anxiety I had before this. I felt hot and cold every few minutes, had the sweats and could not sleep for days. I could not seem to regulate my emotions and rationalise them. I retreated to bed to warm up and calm down and called my mum for moral support. I lost my appetite and could physically not put anything in my mouth apart from forcing some sugar down me.

This pattern continued the closer it came to Monday. I found it really hard to get out of bed – I was heavy, anxious and tired due to lack of sleep. It was hard to sit up straight and I forced myself to have breakfast. I have never felt before the way I felt that day. I was inconsolably crying, paralysed with terror, and curled up on the sofa. I called in sick to work and spent the best part of the entire day on the phone to my parents who flew out the next day to be with me. All of this was entirely alien to my husband. He knew I worked in mental health but I guess I never realised that he totally didn’t understand what I did and what mental health looks like. He had no idea what was going on with me and had to learn how to support me.

I am really lucky to have found a supportive and really competent GP when it comes to managing mental health. I wanted to be put on a course of medication as I know that medication is a key part of the treatment equation and the SSRIs I am on have helped tremendously. My GP also gave me a temporary course of benzodiazepine very closely monitored by her to help me with the initial stage of going to work, coping with the anxiety and helping me sleep initially.

All in all, this was a really acute depressive/anxious episode and I did go back to work the following week with a LOT of positive self-talk, support from husband and family, and a chill pill. My recovery was gradual and I guess I realised that we are all vulnerable at one time or another. My parents have both experienced anxiety and depression over their lives and I know that having a depressive episode makes it more likely that we will experience further episodes.

Recovery means making your mind your priority and this is what I’ve tried to do. I have regular follow-ups with the GP every few weeks as I’m still taking medication. I am concerned about how coming off the medication might affect me but I have a good relationship with my doctor and trust that she will manage that process with me in the next few months. When I’m feeling anxious and restless I know I need to up my exercise to channel my adrenaline elsewhere. I try to facetime friends and family more often and say what I’m feeling more. My friends have been so supportive and didn’t judge or change their behaviour towards me when I told them- I found it really hard to tell them though. Having a good night’s sleep helps too- going to bed and waking up at regular times. I have also found Acceptance and Commitment Therapy (ACT) self- help reading to be extremely helpful too and highly recommend “The Happiness Trap” by Russ Harris- a refreshingly easy way of managing difficult emotions and learning to live with them.

The biggest piece of advice I can give anyone who is struggling with negative thoughts, depression, anxiety, stress, is to tell the people closest to you what helps you. Sometimes it’s the fact that our family’s, partners, friends don’t know what helps or what to say which causes more stress or potential conflict. Tell them what you would like them to do or say to you when you are feeling a certain way. I told my husband that every time I start to feel anxious, inadequate and catastrophising about my work, to remind me of how much enjoyment I have had at work and the positive things I say when I get home from work.

I don’t believe that a cardiologist should have experienced a heart attack to make them more capable of treating a patient effectively, but as a Mental Health Professional, I do have that bit more compassion and understanding of the vulnerability that we all have, no matter which chair you are sitting in.

 

 

Guest Post: The Efficacy of Online Cognitive Behavioural Therapy- CBT by Dr Stacey Leibowitz- Levy

We are delighted to have Dr Stacey Leibowitz-Levy, psychologist writing about Cognitive Behavioural Therapy for us. As with any therapeutic practice, it is very much individual as to whether it will work for you and CBT will not work for everyone- but has been proven to work for many. Here Dr Leibowitz-Levy explains how it can work online.                        

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Online counselling is a growing field with more and more people turning to the internet to seek out counselling help. Counselling services offered online incorporate the range of therapeutic approaches that have been developed within the field of psychology. Approaches to understanding mental ill health and treatment include therapeutic approaches such as logo therapy, psychodynamic therapy, systemic therapy, psychodynamic therapy and Cognitive Behavioral Therapy (CBT). How do these therapeutic modalities translate to the online environment? This article will address the compatibility of CBT in particular as an online counselling approach.

CBT is a widely-utilised mode of therapy that focuses on an awareness of the relationship between thoughts, feelings and behaviour. The aim of CBT is to address difficulties through modifying distorted thoughts, unhelpful behaviour and unpleasant emotions. In order to achieve this end, the client works collaboratively with the therapist in building awareness and understanding of his/her condition, and an accompanying skill set for evaluating and changing distorted beliefs (as well as modifying dysfunctional behavior). The therapist develops clear objectives and a treatment plan that requires active participation from the client during sessions, and follows through on homework assignments between sessions.

This form of therapy is characterized by a structured, time limited and outcome focused approach to managing mental health challenges. Often CBT is focused on a specific issue such as anxiety or managing depressive thoughts and, as such, many CBT interventions are available in a protocol format. CBT offers a delineated and clearly defined intervention that is largely directed by a clearly defined process and structure. This is in contrast to many other therapeutic approaches that have less defined parameters and take their cue on a session to session basis from the client.

The format and approach of CBT lends itself to an online format in that the structure and process are not only defined and constrained by the relationship between therapist and client but are also defined by a clearly delineated therapeutic procedure. This procedure offers a framework within which to deliver support which can easily be translated to an online process. CBT follows a set format. It is driven by the imperative of building an understanding of the issues the client is experiencing and imparting a certain skill set to assist the client in managing his/her mental health issues. CBT is thus based on specific content and has a strong psychoeducational aspect, which means that delivery online can be located in tangible and clear cut content and outcomes for the client.

This also allows for versatility in the delivery of CBT online. While face to face time with a therapist may be desirable for some clients, the option of online delivery of psychoeducational as well as skills based elements in other formats also works well. For instance, the psychoeducational aspect could be communicated very effectively through a video delivery. CBT lends itself to the format of online courses where clients are guided through a process of identifying and understanding their particular issues and developing the skills to manage them. Interspersing this with face to face time or the opportunity to clarify or ask questions in a chat or e-mail format makes for a very effective online intervention.

While many of the issues addressed in CBT are personal to the client, the possibility of locating these issues within a more general format is very much part of the CBT approach. There is a set way of getting information from, and accessing and understanding the client’s experience, with the client having to act on this information between sessions. This more “scientific” process also makes for an approach that lends itself to an online format.

The efficacy of CBT as an online intervention is borne out by the number of sites specifically offering online CBT in a variety of formats (for some examples, see here and here). The online availability of this well researched and well-verified approach to managing mental health problems offers increased affordability, accessibility and greater choice for mental health consumers.

Dr. Stacey Leibowitz-Levy is a highly-experienced psychologist with a Master’s Degree in Clinical Psychology and a PhD in the area of stress and its relation to goals and emotion. Dr. Stacey has wide ranging skills and expertise in the areas of trauma, complex trauma, anxiety, stress and adjustment issues. Stacey enjoys spending time with her husband and children, being outdoors and doing yoga.

Living with Uncertainty- Life and Journeys with Mental Illness

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*Trigger warning- talks about severe depression. Please be careful when reading*

There is so much I want to write on here that I havn’t yet written. Some topics  are too deep or painful for me to address- particularly surrounding certain aspects of previous hospitalisations. I hope one day I can share these with you. However, as a writer, I often get into the flow and just want to spill whats in my heart. So, this blog is about what living with mental illness can mean- its uncertainty and coming to terms with my own brain.

As most of you know, I was diagnosed with bipolar affective disorder, a mood disorder, as a teenager. I was poorly with depression and a mixed state in hospital when diagnosed and I don’t think fully came to terms with what the diagnosis meant until a few years later.

Being diagnosed so young instilled a lot of fear in me and a lot of avoidance. I decided not to drink alcohol or try drugs- as I didn’t know their effect on my brain and I was already  pretty anti drugs for many reasons. I knew my illness meant that the chemistry in my brain wasnt the same as everyone else without it- I had either too little seretonin causing depression, or too much causing hypomania and manic episodes. I felt often that despite taking mood stabilising medication and anti depressants and tablets to help PMS- that everything was uncertain. I had no idea when the next episode would strike- or if I would  be well enough recognise it.

I am lucky. My illness is very severe when it happens. Yet, I went 10 years without a manic episode or hospitalisation, though I suffered from acute depression that got truly so bad I didn’t want to be here anymore- which is quite a common side effect of being depressed. I was able to be supported at home and with my psychiatrist. I knew it was my depressed thoughts and not me- but this uncertainty  was incredibly stressful to myself and my family. I spent years being depressed and anxious and trying (and failing at times) to function- because my medication wasn’t holding me and my brain correctly.

Despite the uncertainty of so many things- dating, the effect of stressors in my life, work, etc- I am doing well at the moment. However, the uncertainty of the illness makes you worry that you could suddenly get ill again.

I practise a lot of self care- try to get to bed early, eat well, take my medication, tell my family or friends if feeling low etc. However, I always live with the knowledge that my Bipolar may pop up at different times in my life- and important times.

Due to having had this for 13 years- I am used to living with the chronic nature of my mental health condition. It can still be frightening and distressing and down right annoying. Yet, with the right support network and medical team, I know I can stay well for as long as my brain allows me- and I can get well and recover.

Recovery makes you stronger, Living through the pain makes you stronger, Surviving an episode makes you stronger.

You are not alone.