RealMental

People call me/I call myself A.

I see myself as a man in his late thirties seeking peace of minds in all things. I am once divorced and have experience in single and couples therapy, as well as Co-Dependents Anonymous. I’m a big fan of sharing my truth and communicating my truth on the road to peace of mind.

If you listened I would tell you my truth.

I am struggling with and succeeding at struggling with finding peace of mind.

I want people to know that peace of mind is possible.

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B. asks:  How does one go about helping someone recognize that they need help?My brother had a brain tumor removed in March.  He has made an astounding physical recovery, but has
now somehow slipped into a dark well of anger, possibly depression – who knows?  He’s not talking about what’s going on in his head.Granted, some of this may have physical/neurological roots and the doctors say it can take some time for those to improve, but the guys at work seem to think he’s acting just like before.  At home however, his behavior is destroying his marriage.

Thanks for any words of wisdom you can offer.

Dear B,

What I can offer are some ideas based on my training.  The real wisdom is more likely to come out of you. After seeking ideas here and elsewhere, take the ideas into your heart and compare them to what you know about your brother, the family, and the situation, and do what your heart tells you is right.  In the depths of your loving heart–that’s where the real wisdom is.

Helping another person realize something that they’re not seeing is tricky, because usually they are choosing not to see it.  They want to see life the way that they are seeing it, and usually for a good reason.  The truth is too scary or ugly or painful, and they’d really rather not go there.  Who would?  For that reason, a big part of a success is reducing the person’s fear and emotional pain as much as you can–while still getting the bitter pill down. 

I would recommend getting together your sister-in-law and any other family and friends that have witnessed your brother’s dysfunction, and who love him firmly.  Have dinner together.  Have someone (chosen for his/her influence with him) lead out by explaining that part of the reason for the dinner was to give everyone a chance to express their love to your brother.  One by one, go around the table and share your positive feelings to him–happy memories, admirable traits, your happiness that his surgery went well, etc.  After the last person speaks, the leader could invite your brother to say a few words.  The next part of the dinner is unscripted, with the lead person deciding how to proceed based on your brother’s comments.  Possibly your brother will express feelings of unworthiness because he has been so angry lately.  If he gives an opening like that, the lead person can acknowledge that s/he has noticed his change of demeanor; the others present can affirm this also.  The lead person can then say something about how it has been hard on him/her seeing your brother so unhappy, and that s/he would like to help him find greater happiness.  Others can echo the sentiment.  Someone should say at this point that they have read somewhere (like here) that in cases like this, both counseling and medicine are likely to be helpful.  Someone else should have the name/number of a counselor or counseling center handy (homework done beforehand).  Your brother may be taking medication already, and possibly part of what he is experiencing is a side effect of that medication, so a straight-up talk with the doc is in order to either change medications or add a new medication to help.  The point is that your brother feels that he has a lot of people who care about him and want to help him. 

If your brother gives a gracious ‘acceptance of love’ speech without giving an easy opportunity to slide into the next topic, the lead person gets to decide how to proceed.  S/he might decide that it is best just to finish dinner and take up the topic another time.  If things are going smoothly, the next step might be to have someone invite his wife to speak about what it has been like for her, with her husband’s recovery.  Then she can start into the part about noticing a change in his personality and how that’s been hard for her to see because she loves him and hates to see him so unhappy.  And then you’re on your way.

Here’s hoping things get better for your brother and for the family. 

Best wishes,

Mr. C.

After you’ve been taking, and alternating among, the different psychoactive drugs for a while, you forget which side effects go with which drugs– and they take you by surprise all over again, when you resume a prior course, abandoned for whatever side effect became intolerable for a time. I’ve been from lamictal to lamictal plus effexor to lithium and back to lamictal again, this time just pushing the lamictal dose and leaving out the SSRI adjuncts, I’ve gone through a hell of a cycle since May ’05, when I started this medication journey. After two months of titrating up on the lamictal, I am feeling more myself again than I ever did on the lithium. But I’d forgotten the horrible dry mouth, which receded on the lithium. And I’d forgotten the horrible headache I’d get, if I went more than twelve hours between doses. I rediscovered that yesterday, after forgetting my morning dose before leaving the house for day’s worth of activities outside. I’d forgotten the second-day-after-titration inability to form a sentence, or process others’ conversation, while retaining the ability to read, write, and email– but gone the third day, ephemeral as a puff of air.

But those bads are balanced against, outweighed by the goods. I’d forgotten how good the sleep is. I’d forgotten the calmness, the lack of anxiety, the energy to push through and get things done, the mental clarity and ability to concentrate. I’d forgotten contentment, creativity, and spontaneous joking and laughter. And suddenly, I’m remembering as all these things come back. It’s more than la recherche du temps perdus— a remembrance of mental health past– but a recollection, a resumption, a re-tasting of my mental health madeleine, melting on my tongue, filling my senses, not evanescent, but ever-present.  At least until the next round of side effects.

Tay asks:  “I was wondering if (you) had any insight on inpatient vs. outpatient care specifically with someone suffering from dissociative disorders.  what are the pros and cons and (do you) know of any inpatient places that deal with these disorders.”

Mr. C. says, Dissociative disorders often take a lengthy time to heal, making it difficult or impossible to get well on the eight outpatient visits that might be authorized on the average insurance plan.  The advantage to going inpatient is that you can often move more quickly through your healing.  Another advantage is that you don’t have to go home, be responsible, and function after intense therapy sessions.  If you are unable to function effectively in your daily activities (such as having a job, acting the part of parent or spouse, caring for personal hygiene, etc.) consider something more intensive than regular outpatient.  There are also levels of care that are in-between standard outpatient care and inpatient care, including intensive outpatient (usually treatment a few hours on most days) and day treatment (treatment all day and staying at night at a place of your choosing).  Of course, each of these comes with its own cost, which is a factor to consider also.  Inpatient is usually the most costly, as you might guess. 

Although I have worked in a state hospital where dissociative disorders were occasionally seen, I don’t have first hand knowledge of inpatient settings that actively focus on these disorders.  Even though I can’t recommend any particular program, here are a couple of websites that you might be interested in:

 http://bsd.clinicalsocialwork.com/treatmentcenters.html

http://www.networktherapy.com/directory/find_facility.asp

I recommend that you get as much information about a program as possible before signing on the dotted line.  Look at their webpages online, and contact someone as well via email or phone.  Tour the facility if possible.  Find out about their treatment philosophy and see if it sounds like something that would work for you.  Ask about their treatment team.  It would be important for them to have a psychiatrist on board.  Get information about their daily schedule–how much treatment does a person get in a day, and what kind of treatment is it?  Find out about cost and if they have scholarships or financial help (if you need it).   If you can find anyone that has been to the treatment center, ask them about their experience. 

I’m sorry for your suffering and hope that you will find the best treatment possible to relieve it.  Best wishes for good healing!

I go through phases.  Distractions.  Obsessions.  It occurs when I am depressed, and don’t want to face work, bills, life.  Sometimes it’s my same favorite books, reread over and over, every night, sometimes for months.  For a while, it was crossword puzzles.  Right now, it’s a few different TV series online, which is crazy, since normally I don’t even watch TV.  While these obsessions are ascendant, while my depression drives me to distract myself, everything else takes a back seat.  I can’t concentrate on work, which is bad.  I don’t pay bills, even worse.  I hardly talk to my friends, or my husband.  Instead, it’s the addictive call of whatever helps me block my biochemistry’s hold on me, if only for a few hours.  But like all addictions, it’s dangerous.  And the time’s come for cold turkey, though I hardly know (as I always do, which should give me strength) that I can do it.  It’s not alcohol, drugs, or gambling, but the inattention to what’s really important is still there.  That’s the scary part– that the distractions become all there is, because I’ve blown everything else.  Wish me luck.

I was reading M.F.K. Fisher’s Last House and was touched by her essay titled “My grown-up ears.” The story was about being receptive to things we once were not, and how it’s a relief. I had a number of thoughts about the essay, on the particular points that she was making, but I won’t recite them here, other than to say that the thrust of the article was not to be too hard on yourself, or guilty for not being ready for something; just be happy when you are, and relieved and attentive to the things you can now appreciate.

It made an impression on me– one that came to the surface when I was reading this post by She She about her relationship with her mother. She talked about that one moment, when something happens, literally momentarily, that changes everything. For her, it was a realization about her mom, that allowed her to relate to her in a different way. She was wondering– was this what it meant to be grown up? And I felt momentarily sorry for myself, because I’m not there yet in my relationships with some of the people in my life. But then I remembered how sanguine Fisher was about her “grown-up ears.” She didn’t
tell herself off for not being ready to hear some piece of music, appreciate some writer’s work, find the flow in a piece of prose or the melody in a bit of lyric. She just let go of the not getting it, and embraced looking forward to getting it, as it came.

Would that I could be so graceful, in letting go to resistance, or of recognizing resistance has disappeared, in time to embrace something, someone, with a grown-up heart. I know I would tell a friend that they can’t force themselves into feeling something. It just has to develop. I would tell a friend that knowing and accepting are different things, and that knowing won’t necessarily speed up the accepting– and that pushing it, or feeling guilty about the slowness of your heart’s adaptation might even hurt, causing your not-yet-ready hard to dig in a little, hold on a little more tightly to angers and resentments it’s not yet ready to relinquish.

While I might not have a heart that’s ready to give up all of its childish resentments, I can at least know and try to accept that someday I might be able to– and take solace in the fact that I have given up some. Instead of nagging myself into an acceptance I’m not yet feeling, I can just look forward to someday, feeling that moment, when I find my grown-up heart.

Belle (not her real name) asks:

Hi there,
I realize that this question will likely take research by me, but I thought I’d ask in case you knew off the top of your head — do you know if there are intensive outpatient programs (Partial Hospitalization programs) who take people who don’t have insurance. I recently got depressed enough that I needed to quit my job and move in with my dad, and I’m realizing that leaving my health insurance behind was likely counterintuitive.

I’m sorry that this difficult time has come to you. As you guessed, you will really end up having to research this yourself, because hospitals and their programs vary a great deal. I hope these general ideas give you someplace to start thinking and looking for information.

If you are unemployed and have no assets, you may be able to qualify for Medicaid, a government program that includes mental health benefits, including hospitalizations when needed. If your father is a supportive person, and if you are very depressed, consider asking his help to pursue this. It’s a process. You have to first deal with the Medicaid system (and its paperwork), and then the mental health system (and its paperwork) and get a counselor and start treatment. The counselor would be the one to help decide if you would qualify for hospitalization, based on your symptoms and functioning. That’s just a lot of steps to go through and I hate to ask a very depressed person to face all that without some good support. However, this is the most likely way for you to get hospital or supported living services without your own insurance.

If you are not significantly suicidal or homicidal, I would recommend that you start off with finding a good counselor and also a good psychiatrist. A combination of medications and counseling is likely to benefit you, and it will cost a lot less than a partial hospitalization. The mantra of the mental health world is to serve people in the least restrictive environment that is safely possible. Bottom line: if you’re not a danger to somebody, you’re not likely to be hospitalized anyway. I hope you will also reference the recent post, “Knowing is Half the Battle.”

I hope you will be able to find the help that you need to feel better and regain a happy life!

Best wishes,

Mr. C