A case for family treatment

We cannot escape family. Their presence or absence will always impact us on some level because family is interconnected in a way that nothing else is. It’s foundational to who we are. A family can be composed in many ways – with blood being only one possible tie – and we will all have different “families” throughout our lifetimes. Sometimes we may be more alone than others, but we all started in a family and that is paramount to the people we become.

There’s an analogy that compares a family to a mobile or a wind chime. There are independent units, but you can’t move one without moving the others. Everything we do impacts our families – and everything they do impacts us. For instance, if a child graduates high school and moves out to go to college, the family has to readjust to the environment without that person. This can mean practical changes, such as redistributing chores, or emotional ones, like when the sibling closest to the one who moved feels left out and has to form new bonds with the remaining family.

  

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There’s a concept in psychology called the “identified patient” (IP). The IP is the family member who has a “problem.” This could be an alcoholic parent, a child failing out of school or someone struggling with physical or mental illness. Everyone else in the family can convince themselves that they are okay because they are not the IP. In this way, all the problems of the entire family get shifted on to one person. 

This isn’t done with bad intentions. Often, the family has benevolent or fond feelings for the IP. A wife will make excuses for her partner’s absences due to a drug problem in order to save face or get him off the hook. A parent gives a child lots of attention because she’s acting out at school. A teenager is happy to have an ill brother because he distracts the parents so she can rebel. This isn’t the family being mean. It’s the family adjusting.

These adjustments that are made for the IP do, however, have consequences. The wife is saving the husband from the repercussions of his drug problem, enabling him to continue to use. The siblings of the “problem child” feel like their parents don’t care about them. The sister gets in trouble because the parents were busy caring for the sick brother. Trying to cover up the problem is just creating more problems, but because they aren’t the IP, the other family members eschew their own troubles in favor of those of the IP.

Remember that mobile? One person “moves” by having a problem and everyone else shifts their problems somewhere else. 

This brings up the question of where the real problem lies. Is the identified patient of concern, or is it the family as a whole? What starts out as an obstacle for one family member can set off a chain reaction wherein everyone becomes involved.

So what happens when the IP gets better? First of all, the family often stands in the way of the IP improving. If her problems are resolved, then theirs become real again. While the family wants what’s best for the IP, they also want to retain the balance they have established. They might even fear becoming the next IP because the family doesn’t know how to function without one. 

This is why family treatment is so important. It allows all the cards to be put on the table, making it easier to notice connections between family members and their various problems. Sometimes, having a mental health professional take a look at your family unit as a whole can help all of the family better understand what is going on and how to make the family healthier. Everyone’s problems get a chance to be addressed, not just the IP. A good therapist will know not to blame the IP for everything.

   

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Family treatment can cause upset, though. It’s a time of change as new habits and coping skills need to be put in place. It will bring out all sorts of things that no one knew were there and things might even feel worse for a while. But having the family unit heal both individually and as a whole is worth it. There is no price for having stronger, healthier bonds and better problem management. 

When each family member learns to see what he contributes to the problem, he can learn valuable information about how he relates to others, which will be useful in any type of relationship. As she examines her real issues and how she displaces them, she can learn to take more responsibility and thereby have more control over her life. None of us exist in isolation and none of us can heal that way.
                                                                                                                   Individual and common concerns are intricately
                                                                                                                   interwoven.

Even if all the family members aren’t struggling, consider getting treatment together anyway. If nothing else, the love and support shown by joining the treatment is irreplaceable. There is work that simply cannot be done in individual therapy. Besides, by learning healthier patterns, you can improve the lives of the generations to come by having and teaching the skills necessary to have a healthy and happy family.

Have you had any experiences with family treatment? Post your experience in the comments.

Annals of Idiocy: Discouraging Students who Need Help

Getting right to the point, it is highly irresponsible for anyone to discourage others who need help, especially adolescents and young adults.  It is tough enough for them to deal with fear, stigma, and the labyrinth of mental health care systems.  For them to break through such barriers only to have someone discourage them should outrage all of us.

In recent months there have been at least two cases of this irresponsibility.  In one, a journalist covering the issue of withdrawals from campus due to mental health issues, an admittedly complex process, allowed the following title to be used in a Huffington Post article: "Using College Mental Health Services Can Lead To Students Getting Removed From Campus".  In another an attorney allowed the following title in a Chronicle of Higher Education piece concerning the alleged mismanagement of therapy records in a rape case: "Raped on Campus? Don’t Trust Your College to Do the Right Thing", and then added further damage by stating "Students: Don’t go to your college counseling center to seek therapy."

It is not that the authors had no point to make.  I do not take issue with advocates calling attention to allegations that there may be problems in the application of procedures on some campuses.  But making sweeping condemnations of an entire field in a large country goes well beyond that.  The number of cases mentioned in articles or blog posts like these is typically very small, as it was in these articles.  This, friends, is what you call over-generalization.  There are over 1,000 college counseling centers in the United States providing millions of therapy sessions annually and they, I dare say, do so competently and with good results.  OK, so the ethics of blogging may be loose indeed, fine.  But these authors are advising potentially millions of our youth to avoid the most convenient, least costly, most specialized services for the college student population.  Doing so is patently absurd, hurtful, and wrong.

Sometimes, actual college counselors are quoted in the articles, but generally very few.  Even rarer are articles written by someone who actually does the work.  Say what you will about attorneys and journalists, but the fact is they do not know, and cannot know, the work from the inside.  They are not managing extremely challenging circumstances while being intimately knowledgeable about and adhering to our specific professional codes of ethics.

Students, listen to those who do the work.  Use your campus counseling service.

Healthy Relationships in College

On this Valentine's Day, let's take a brief look at the ingredients of a good, healthy relationship. While the focus of this blog is on college students, what follows can certainly apply to anyone, at any age. College students have many opportunities to meet new friends and develop enriching relationships on campus. Such relationships can make the difference between a positive and negative college experience. It is important to know the difference between healthy and unhealthy relationships, and to know how to make choices to preserve the former and improve the latter. Here are a few hallmarks of a healthy relationship:

• Mutual respect and civility
• A sense of reciprocity, or "give and take"
• Feeling supported and supporting the other
• A significant degree of trust and honesty
• Fairness and equality as adults
• Comfort with emotional intimacy or closeness
• Comfort with distance and "separateness", or being able to have your own life apart from the other
• Open, direct communication without fear of reprisal, hidden agendas, or manipulation
• Good "boundaries", or being able to set personal limits with self and others

While no relationship is perfect and we all have bad days, students should be able to evaluate their relationships and feel, on the whole, that they are positive and healthy. If they are less than healthy, steps should be taken to improve them. Such steps involve both assertiveness and listening. If you have concerns about the state of your relationships with family members, friends, roommates, faculty, co-workers or others, contact your campus counseling service for assistance.

About beating the stigma's on mental illness at the workplace

Last week I read a tweet about a BBC article on prosthetic Hollywood masks being used to educate trainee mental health nurses. The writer of the article seemed enthusiastic about the idea and so were the people in the attached video. 

What surprised me most was that they seemed to be unaware of the stigma attached to using those masks. To me they seemed to portray people with mental illness as weird Hollywood movie characters.  They didn't look at all like the people I have been supporting in my 25 years of mental health nursing. 

This article shows again that there is still a lot of stigma's to beat within the profession. Besides: what about non-verbal communication, the most important thing to learn about because most people put their 'mask' on pretending they are fine. As very often, do we all. But maybe more when we are anxious or paranoid and don't feel safe enough to express ourselves. 

"I am fine" is the most commonly told lie. When you use masks you can't see the look in someone's eyes or their facial expressions. 

This idea isn't helping trainee mental health nurses and as a result of that its not helping the people who have mental health problems. Its  counter-productive. A much better idea would the use of trained actors as we had when I was at nursing school. 

We all stigmatise and probably much more than we think.  The stigma attached to mental illness is a major obstacle to our patients and to better care. Lives will be improved if we keep ourselves and each other aware of that.

The stigma within the profession leads to a lot of unwanted and serious effects. A few examples: 

It makes people feel unwanted; 

I'm not understood and;

I'm uncared for. 

Apart from that it's a great danger to their physical health because it leads to not being taken seriously when having a physical health problem. I have seen people die from stigma, from not being believed, from assuming it was "psychosomatic"or "attention-seeking" It's that serious. 

I once supported a patient to ER after she suddenly lost the sight in one eye. She talked very slowly, a reason for the triage nurse to think that it was psychosomatic and if I had not been there to urge her to contact an ophthalmologist that patient would have been blind now. 

The stigma within the profession discourages our patients to dare to take chances in life, to improve their future. It prevents family members from being important team members. It leads to people feeling labelled instead of being a person with many strengths and skills, someone who is more than just a diagnosis. It prevents us from really listening to someone. 

I have a patient who was put in an isolation room for throwing a glass on the floor because a voice told her so. She wasn't hurting anyone. Later she said : "if only someone had asked me why I did that they would have known I had voices. And I would have cleaned it up and paid for a new glass if they had asked me ".

I used to get annoyed about stigma's but nowadays I find beating them a challenge instead of a problem. The stigma on mental illness is an important reason why people don't understand and why those who with  mental health problems often don't dare to seek help in time.
I hope this mask issue will lead to better awareness of the stigma within ourselves and our colleagues.And to improved support of people with mental illness so they feel listened to ,accepted and cared for.

5 dating tips for those with a mental illness

  

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Last week, we talked about dating someone with a mental illness. Today, we’re taking a look from the other side. Dating can be overwhelming and confusing, and having a mental illness just adds to that. But it is possible to have a successful, happy and healthy relationship even if you are struggling with your mental health. It took me quite a while, but finding that balance is possible. Here are my suggestions to speed up your process.

1. Don’t expect her to read your mind.

This is a good tip in general, but especially important when mental illness is involved. Other people don’t know what you’re thinking or feeling if you don’t tell them. For instance, you can’t expect someone to cheer you up if he doesn’t even know you’re feeling depressed. Assert your needs. Be as open about what you’re experiencing as you are comfortable with (and as is appropriate at your stage of the relationship). This will help your partner get a better picture of what you’re dealing with, which makes it easier for both of you.

2. Take responsibility.

Mental illness pushes us to do things we would not otherwise do. There are times when we legitimately can’t help it, but you can’t blame everything on your illness. It is not a crutch and it is not an excuse. You have choices, no matter how much you feel the odds are stacked against you. When you really, truly tried your best and your illness got in the way, say that and explain what happened. But you still need to own up to your faults because you are not possessed. You made a decision. You are still you and we all
                                                                             make mistakes sometimes.

3. Respect his needs.

It can be easy to get caught up in our own needs when we are struggling with our mental health. It feels like too much is going on and a lot of energy goes to managing our symptoms. But your partner has needs, too. Respect that she can’t always answer your call at three in the morning. Be okay with him taking the night off to see his buddies. See how you can be helpful as well. Even if you can’t do everything you’d like to, you can make an effort to show that you respect and value her.

4. Work on your recovery.

Your biggest gift to your partner is yourself. That is one motivation to work on improving. You want to be fully present and available, which can be hard when you are struggling with yourself. Dating someone with a mental illness can be stressful, so the improvements you make help it be more manageable for your partner. A healthy you is more able to meet his needs as well. Just be careful that your partner doesn’t become your only motivation.

5. Love yourself.

Have you ever heard someone complain about herself and thought, “I don’t see that at all”? No matter how unlovable you think you are, there are reasons others like and care about you. Pushing away this love to wallow in self-pity not only is unhealthy for you, but can be hurtful to your partner. Self-image is a huge part of mental health. Focus on what you do appreciate about yourself. You should be doing something to show that you care for yourself every single day. Besides, the more you healthily love yourself, the more you can healthily love others.

What has your experience been with dating while struggling with a mental illness? Talk about it in the comments.

Anti-Epilepsy Medication May Reduce The Effects of Stroke

Currently, new research suggests that the anticonvulsant medication, retigabine, could dramatically reduce the effects of stroke.  Researchers have already recognized the potential of this medication in treating neurologic conditions, such as migraine, tinnitus and neuropathic pain.

By observing mice models, researchers discovered that merely a single dose of retigabine prevented loss of balance and motor coordination following a stroke.  Balance and coordination was tested by using a balance beam.  The mice that were not treated with retigabine following a stroke displayed more slips and falls whereas the treated mice easily manoeuvred along the beam.  Researchers even remarked that it had appeared as though the treated mice had not even experienced a stroke.

In addition, brain tissue showed significantly less damage following a stroke when mice were treated with retigabine.  Interestingly, the medication also protected brain tissue for up to 5 days post-stroke.

The team studied ischemic stroke, the most common occurring type, where oxygen and nutrients are blocked due to a clot in a blood vessel.  After only 6 hours, cells deprived of oxygen and nutrients that are dying can be affected in such a way that they are unlikely to be repaired.  “Moreover, when cells die, they release factors that trigger many types of responses including an inflammatory response, leading to more cell death in the areas around the blood clot.”

“Retigabine and similar agents open specific proteins called potassium ion channels, whose action stops the electrical activity of nerve cells in the brain.”  Therefore, researchers theorize that electrical activity can be stopped before causing more damage and conserved until blood supply is restored.

According to researchers, “future studies will assess how long brain function can be protected after a stroke, and whether injury-related seizures can be prevented.

At this time, embolic or thrombotic strokes are treated with tissue plasminogen activator (tPA) drugs, which dissolve clots and restore blood flow. However, tPA works by thinning the blood therefore, cannot be used in many circumstances, such as patients with high blood pressure or weak blood vessels.  Additionally, it must be used within a few short hours following a stroke as later treatment with this drug may actually cause more damage.

According to the World Health Organization, 15 million people suffer a stroke each year.  Of these, 5 million die and another 5 million are permanently disabled.  Stroke is the third leading cause of death in the United States and every seven minutes, a Canadian dies of heart disease or stroke.  Now is the time to continue research and improve these figures.

Anti-epilepsy drug preserves brain function after stroke, research suggests
Stroke Statistics

© www.mentalhealthblog.com

5 tips for dating someone with a mental illness

  

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It’s February, so romance is on everyone’s minds. Love is such an important emotion. It can change lives in a way that nothing else can. We all need love, and that includes those of us with mental health issues. Here are some suggestions to help you if you are dating someone with a mental illness.

1. Ask appropriate questions.

You need to be reasonably respectful of your partner’s privacy, but don’t be afraid to ask questions. Preface them with, “You don’t have to answer this, but I’d like to know…” so that he doesn’t feel like he is being pressured. Focus on what pertains to you. “What do you want me to know about your condition and how it makes you feel?” “How can I be helpful?” “What are signs that your symptoms are worsening and what do you need when that happens?” It matters a lot when someone takes the time to find out how she can be supportive.

2. Give him space – or don’t.

At a time when your partner is doing reasonably well, talk about how much space she needs and when she needs it. Also talk about when he should not be alone. For instance, someone with PTSD might not want to be touched while experiencing flashbacks. Discuss those boundaries. Alternately, depressed people tend to shy away from others, but it isn’t always healthy. Asking in advance, is it okay to take initiative when these times come? If serious suicidal thoughts are an issue, make sure that your partner has someone to be around at all times. Support and space are equally important and it’s helpful to know when each is needed.

3. Focus on her strengths.

Mental illness can make you feel vulnerable, inferior – even useless. Some people feel like they aren’t contributing enough to the relationship or that they are being a burden. This is why it’s very important to make note of when he does something positive. Notice specific actions and comment on them. Things as simple as “Thank you for making me dinner,” “You look nice today,” and “I appreciate that you spent time with me today,” can boost self-confidence and foster positive emotions. A lot of people with mental illness need reassurance, so knowing they did something right can bring peace of mind.

4. Be accommodating and flexible.

Part of the challenge of mental illness is that it’s unpredictable. Sometimes there’s a reason that symptoms flare up, such as stress or failure, but other times random little things can set off an episode. Work with what you have at any given time. If you had a dinner and movie date planned, but your partner is too anxious to leave the house, order takeout and watch something on Netflix. If physical intimacy is difficult, go slowly and let him take the lead. If she has a hard time being around strangers, don’t drag her to big social events. 

5. Set your own boundaries.

Having a partner with a mental illness can be stressful. At times, you might find yourself in a caretaker role and it can be draining. This is why it’s important that you set boundaries. For instance, make sure you have enough time to take care of yourself. You might need to state that when he starts yelling at you, you will leave until he has calmed down. It might be helpful to make clear that there are some things she can’t blame on her illness (and what they are). It’s important to be understanding, but if you are struggling, you need to have the space to take a break and gather your strength. You can’t be as helpful if you aren’t doing well yourself.

Mental illness is hard on both partners, but it isn’t an impossible barrier to a happy relationship. While your partner might have some challenges, he also has gifts to offer. Living with a mental illness can make you empathetic, brave, considerate, grateful, persistent, thoughtful, strong and any other number of positive qualities. It encourages deep feelings and that includes love. In the end, both of you are just people. You have frustrating qualities as well. But love is beautiful in that it can make everything else disappear, if only for a moment at a time. Love is worth whatever it takes.

Check back on Tuesday to hear about dating from the other side.

What have you found helpful in dating someone with a mental illness? Tell us in the comments.