PHYSICAL PAIN AND MENTAL ILLNESS

THE MIND-BODY CONNECTION I chose to write about the mind-body connection today, because it has been a big part of my own life. The mind-body connection describes how mental illness increases the risk of physical pain, and physical pain increases the risk of developing a mental illness, especially chronic pain. Mental pain and physical pain are interlinked. I live with both chronic migraines and major depressive disorder. I don’t know if my depression caused my migraines or vice versa. I could see them both making each other worse. But it’s interesting to look at the effects they have on each other and on our lives. For some people, it may be obvious that one caused the other. It makes sense to me that living with chronic pain could lead to the development of a mental illness. Pain is painful. It can severely worsen one’s quality of life and cut out a lot of activities. It’s understandable that this stress and pain, coupled with the “right” biology, could bring on a mental illness, like depression or something else. I believe my depression worsened on account of my chronic migraines. The summer before my senior year of high school, I had my first migraine. I remember sitting at lunch at a restaurant with my parents with this headache that just got worse and worse. I couldn’t focus on anything but the pain- I couldn’t think. That’s what a migraine is like for me. It starts with a pressure in my face. I feel like I can’t relax the muscles in my forehead or eyebrows. Then the pain gets worse and spreads to the top and sides of my head. Then there is sharp pain in my temples and eyes. I become extremely sensitive to noise and sound. Having a light on in the room is an absolute no. Noise also becomes intolerable- I remember I used to know a migraine was coming on when the sound of someone putting dishes away in the cupboard felt like pain instead of noise. My point is that the pain is bad. I saw a neurologist that October. He was young. He put me on a medication that didn’t work. He just kept increasing the dosage. Meanwhile, I was having migraines 5 to 6 days a week and painkillers didn’t work. Furthermore, the medication had side effects- it made my hands and feet really hurt and caused weight loss. This kept on for a year until I switched doctors the next August. Now, I have migraines only 3-4 times a month by taking daily meds and getting Botox. Long story short, that pain and disruption of my life caused isolation and cut out most activities. I became very depressed and this developed into major depressive disorder (officially diagnosed two years later). But I think my situation illustrates how chronic pain could be the stressor that, when combined with the “right” genetics, develops into a mental illness. As an aside, one other point I want to make very clear is that physical pain, even if caused by mental illness, is real pain. The brain processes pain, so even if there is no physical cause of the physical pain, the physical pain is still experienced the same- pain is pain no matter what the cause of it. Even though I have migraines and they might be related to my depression, my pain isn’t just “all in my head.” It is real. But, it’s less obvious to me why physical pain is often a symptom of mental illness. I’ve learned that it is because your thoughts and feelings affect your body. Mental illness affects your physical body. Some everyday examples: if you are anxious about an upcoming presentation at work, you might experience an upset stomach. If you are stressed out, you might get a headache. In my case, my depression which resulted in severe stress, eating unhealthy, irregular sleeping patterns etc… made my migraines more frequent and more severe. All of those things are triggers for my migraines: stress, changes in sleep, skipping meals—other triggers: heat, changes in weather, and sometimes there isn’t a trigger. To repeat myself one last time: there is a mind-body connection. Mental illnesses can cause real physical pain. If you have physical pain and don’t know why- consider mental illness as a possible cause. If you live with chronic pain, watch out for symptoms of mental illnesses that may develop. Be aware of the connection. Your mind and body are both important parts of you. Take care of them...

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Eating Disorders

In the US, approximately “1 in 20 people will suffer from a clinically significant eating disorder at some time in their life.” Eating disorders have the highest fatality rate of any mental illness.   Many people nowadays have trouble maintaining healthy exercise and eating patterns. Many people diet or avoid certain foods or don’t eat enough vegetables or eat too much fast food or exercise too much or too little etc… but these people do not have eating disorders. Eating disorders are serious, complex mental disorders. Unfortunately, lack of understanding and the presence of a negative stigma would have you believe that people with eating disorders are vain and just too obsessed with their looks and dieting to eat enough (anorexia, bulimia) —-or perhaps….just too weak willed to stop eating and too lazy to exercise (bulimia, binge eating). My hope is to help quell those beliefs. EATING DISORDERS ARE NOT ACTUALLY ABOUT FOOD. Eating disorders are behavior disorders that develop because of other underlying problems. Examples of these underlying problems include: gaining control over one’s life, coping with intense emotions resulting from depression and anxiety disorders, dealing with previous trauma or abuse, and others (often the underlying problem is a the existence of or symptom of another mental illness—-eating disorders  often appear with at least one other mental illness as well). Let me say it again: the secret that society does not understand is that eating disorders are really not about food or appearance. Don’t get me wrong, appearance can have a role. For example, society values thinness, so restricting food intake might seem like a good way to feel in control of one’s life and less anxious. On the other hand, binging on food might seem like a great way to calm anxiety or boost one’s mood (which food does do- it increases serotonin in the brain)— but society’s value of thinness may make a person think purging to rid themselves of excess calories is the next step. On the other hand, a person may solely engage in binging behavior without purging. In this case, society’s praise of thinness does not influence the eating behavior the person does to cope with life. A person with an eating disorder attaches a lot of thoughts and feelings to food, which are distorted and irrational. For example, a person might think that they only have worth if they are losing weight. They might think they will only be loved if they don’t eat that day. A person may only feel like they are safe if they binge. A person may think the only way to feel calm or not anxious is if they binge, but then feel the need to purge. A person with an eating disorder actually believes these thoughts and that’s why they engage in behaviors like restricting, binging, purging etc… Soon these thoughts and behaviors take over your life and consume all your energy. It’s all you think about. Then, the eating behavior (whether restriction and/or purging and/or binging) because of its positive effect/reward (calm, elevated mood etc…) makes that behavior more likely to be repeated. This pathway in the brain becomes strengthened and the behavior can soon become compulsive and akin to an addiction. In this case, the addiction is to a behavior rather than a substance but the resulting obsession, dependence, and urges are rather similar. Developing this distorted thinking isn’t someone’s fault. The right biology in combination with the right environmental trigger (just like any other mental illness) is what causes a disorder to develop.  And eating disorders are strong. They are real. They will fight to stay with you and control you. They will ruin your life. And reaching recovery will be very difficult- difficult but possible. It is important to not blame yourself, and to keep up hope for recovery. What I learned after spending the last 8 months in treatment for my own eating disorder: Eating disorders are not really about food (as mention several times previously!). I was using my food behaviors as a coping strategy for dealing with my anxiety and depression. So, part of my eating disorder treatment included therapy for my anxiety and depression. The urges for symptom use—which may occur hourly, daily, weekly, be constant—- take a very long time, possibly years, to go away. The urges may never completely go away but will lessen in frequency and intensity over time. Even after 8 months of treatment, I still have urges to use symptoms almost every day. This is very frustrating- recovery is taking a lot longer than I had hoped for, but it will be worth it. It is SO hard to...

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Dual Diagnosis

Dual Diagnosis/ Co-occurring Disorder: A mental illness and substance use disorder occurring simultaneously. Substance abuse does not directly cause mental illness to occur (except in the case of drug-induced psychosis). Genetics and the environment work together to cause mental illnesses to develop. However, substance abuse can lead to certain situations and environments that make the development of a mental illness more likely. For example, drug and alcohol abuse increases the chances of becoming a victim of sexual assault or rape, which increase the risk for mental health issues such as PTSD and depression. On the other hand, mental illness can lead to substance abuse in a more direct way. A person may abuse substances in order to cope with their mental illness. For example, a person living with social anxiety may drink to feel more comfortable or a person living with depression may use cocaine to get more energy to do things. This ‘self medicating’ alleviates symptoms in the short term but, even though substances initially are an effective means of relief, they only make the symptoms of mental illnesses worse in the long term. Unfortunately, this has led to about 33% of all people living with a mental illness and 50% of people living with severe mental illnesses to also develop a substance use disorder.  Notably, within the population of people living with mental illnesses, men are more likely to develop this kind of dual diagnosis as are people with a lower socioeconomic status.     From where I stand, there is even more stigma surrounding substance use disorders than most mental illnesses. There’s the idea that substance abuse is a person’s own fault; they chose to try a substance in the first place, so they deserve their addiction. They could stop if they really wanted to. Substance abuse is a moral flaw or a weakness of will-power. All of these beliefs are what sustain the unrelenting, vicious stigma that surrounds substance abuse. And sadly, in my experience, while the stigma surrounding mental illness is slowly –very slowly- decreasing, the stigma surrounding substance abuse is not. What people don’t realize is that substance abuse is a real disorder, not a choice. Take alcohol, for example: many people drink alcohol; many people binge drink, yet only some people develop an addiction to it. No person would choose to be among the few who develop an addiction. And no one knows who, out of the population of substance users, will be the unfortunate ones to develop an addiction. Some people who choose to drink alcohol are lucky enough not to develop an addiction, but that does not give them any right to judge those who do. Part of the reason for the judgment around substance abuse probably stems from the fact that many addictions are to illegal drugs or improper use of prescription medications. However, when drug use is present with mental illness, I do not feel the criticism is fair. When drugs, or alcohol, are used as ‘self-medication’ they are used out of desperation. They are not taken with the intent of becoming addicted, they are taken to get away from the horrible unbearable pain which is their reality of living with a mental illness. There are other addictions that go along with mental illness which do not get the same bad rap, such as cutting or throwing up your food. Those are addictions, yet they are not substances, so they get more empathy and understanding from the general public. By promoting empathy and understanding of those living with a dual diagnosis, I do not mean to imply that substance use is a good coping strategy. Part of breaking free from a substance use disorder — that is co-morbid with a mental illness – will be to develop healthy coping strategies. But, people need nonjudgmental support, not anger and judgment. Breaking an addiction which has physically changed the chemistry and processing of the brain takes time and hard work. It is unbelievably hard to get over an addiction, especially when in conjunction with the challenges of living with a mental illness, and a little compassion may go a long way. Resources: The Connection Between Mental Illness and Substance Abuse http://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis...

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Self-harm

Self-harm is when a person intentionally and repeatedly harms themselves in a non-lethal way. Self-harm includes all types of harming oneself physically, but the most common include: skin cutting, head banging, and burning. Adolescents are at a great risk for self-harm (15%), college students even more so (17-35%), and as much as 4% of the entire American population engages in some form of self-harm. Self-harm is not well understood by the general population, because it’s not a natural instinct to intentionally harm oneself. So, why does anyone do it? There are a few reasons individuals may engage in self-harm. Most often, it is to seek relief from intense negative thoughts or emotions. It can also be to bring about positive emotion or to gain some control over one’s life. Although self-harm is not a substance, the urge to self-harm is experienced similarly to addiction. The need to self-harm can be compulsive, and this lack of control can bring about feelings of shame. It can also feel shameful to self-harm since it is generally judged by others as strange, unnatural, and destructive. So, understandably, those who engage in self-harm often attempt to hide it from others. Unfortunately so, as this can delay the onset of getting treatment. Self-harm is often co-morbid with eating disorders. To me, this makes sense since eating disorders are also often about asserting control over one’s life and include compulsive behaviors.  However, people living with other mental illnesses also engage in self-harm, including: borderline personality disorder, bipolar disorder, major depressive disorder, anxiety disorders, OCD, and others… It is important not to assume you know why a person is engaging in self-harm. Assumption leads to judgment and misunderstanding. I’ve found that some common assumptions include: -Self harming means you are suicidal. In fact, individuals who self-harm most often do not intend for the injuries to be fatal. The risk is more that an injury may cause more damage than intended, which may then unintentionally result in a fatality. The intent of the injury is to bring about relief from emotional pain, not suicide. -Self-harm is done to get attention. In fact, this is most often not the case. People who engage in self-harm usually try to hide it from others. Reactions that I personally have received from family and friends in response to cutting are extreme concern and fear and also disgust. It’s a worse reaction than any of my other symptoms have received. My guess as to why, is that I don’t think cutting is really something people can fully understand unless they experience it themselves. I’m sure when people see scars, they think “how could anyone do that to themselves?” It does not make sense to them, because to them it is not a coping strategy; it doesn’t relieve emotional distress; it’s just pain. Scars really stand out as an obvious, visual representation of how much distress someone is in. It makes others uncomfortable. And my own self-harm is unfortunately very noticeable, having cuts up the side of my arm. I don’t know why it still surprises me when people notice the marks. But it does. It’s uncomfortable for me as well when someone mentions it. I just don’t have much to say about it to other people except “I’m working on it.” I could explain that I do it for the momentary relief it brings from the intense negative emotions that hit me. I could say that sometimes the intensity is just too much to handle, and now that I know that cutting will make the emotion stop for a while, it’s hard not to cut; it’s harder than people realize I think. But I don’t tell people when I am experiencing such horrible emotions that make me want to cut, because it’s embarrassing, and because of the reaction I get. I have found a few things that help me refrain from self-harm, however,  including rubbing an ice cube on my arm where I’d want to cut. It’s important to find other coping strategies, besides self-harm, to deal with emotions that your mental illnesses may cause. Seeking treatment for self-harm is hard to do, especially with the stigma surrounding it, but it is vitally important. Treatment, per usual, includes psychotherapy and medication. Hopefully this post will bring some understanding to the why of self harm, and by doing so lessen some of the judgment and disgust. Resources: http://www.mentalhealthamerica.net/self-injury...

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Domestic Violence & Mental Health

In honor of Domestic Violence Awareness month this October, I decided to write about how domestic violence and mental health are related. And they are -very- related. [Domestic violence, including physical, emotional, sexual, verbal, and financial abuse]. Having a mental illness puts a person at greater risk of becoming a victim of domestic violence. They are more vulnerable. But, it goes both ways; being a victim of domestic violence also increases the risk of developing a mental illness. On average, over 50% of women who use mental health services are or have been victims of domestic violence. Experiencing a trauma such as domestic violence leads to an increased risk of developing several different mental illnesses including: PTSD, depression, substance abuse, and others- even schizophrenia. Of course, not everyone who experiences a trauma will develop a mental illness. But the fact that it greatly increases the risk is still worth mentioning. Mental illnesses are life altering disorders and can be very serious. —————————————————————————————————————————————————————- When I personally think of domestic violence and mental health, I think back to when I worked at a domestic violence shelter in Minnesota. So many of the women, and few men, who called were looking for counseling and support groups. Because of this great need, the shelter did run several support groups. Of course, the individuals who walked in and called also needed things like a place in the shelter and legal advice. But I was actually surprised by the number of people who did call simply looking for people to talk to about what they’d been through. I heard a lot of anger, blame, pain, and sadness in their stories. Some individuals were dealing with the immediate aftereffects of their traumas. But others were calling years later. The trauma they had been through did not leave them. It continued to haunt them. And, to me, it makes sense.  For most mental illnesses that occur, you cannot point to a singular event which caused its development. You cannot blame a singular person for it. However, with domestic violence, in a way, you can. All mental illnesses are a product of both biology and the environment, but, in the case of domestic violence, the environment is blatantly obvious; it’s one (or more) distinct event(s). Domestic violence is very serious. Mental illnesses are very serious. Understanding their relationship is very important and will hopefully lead to less judgment and more compassion.   Learn more at: http://www.joyfulheartfoundation.org/learn/domestic-violence/effects-domestic-violence...

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Sharing Your Story

Sharing your personal story, your journey with mental illness, is an absurdly difficult thing to do. The first time I considered it, I had extremely intense anxiety; I had to just blurt it out like ripping off a Band-Aid. I told only very trusted people at first, but gradually I became more comfortable telling others as well. Luckily, it does get easier and easier the more you do it. It might seem like nobody’s business. Why would you ever need to tell anyone if you have a mental illness? But why wouldn’t you when you share the rest of yourself with others? If you keep it to yourself, there’s a reason why, even if you don’t admit it. Fear of judgment, embarrassment, denial… it could be any number of things. But there should be no shame in having a mental illness! It does not make you any less of a person. It is not something you choose, or something you deserve. It is an illness, a disorder. It is not as visible or understood as physical illnesses, but it occurs just the same way: the product of the perfect storm between environment and genetics. There is unfortunately a tremendous amount of stigma surrounding mental illness, so much so that it can actually feel embarrassing or shameful to tell someone that you are living with a mental illness. But that is only because society makes it so. Mental illnesses are not understood well enough by the general public, and so misconceptions and assumptions, mostly negative ones, surround mental illness and cloud it with a huge, dark, stigma. But if you admit that you are living with a mental illness. If you proclaim it to the world and tell people casually, acting like it is not shameful (which it is not….), then others may respond to that. Often, I have had the experience, when I tell someone about my mental illnesses in a nonchalant way, of them also responding like it’s not a shameful thing. They’ll say: “sorry, that sucks.” But, they won’t respond with fear or disgust. But sharing such a personal part of yourself without fear of judgment is crazy difficult. It’s important, but it’s not easy. I’ve feared telling my parents about my mental illnesses, especially certain behaviors and symptoms associated with them which they don’t approve of, such as cutting or drinking. I’ve feared judgment from people I go on dates with. Will they think I’m not worth dating because of my mental illnesses? But I’ve finally arrived at the mindset that, if someone is put off by the fact that I am living with mental illnesses, then they are not worth building a relationship with. You are not your mental illness. Living with a mental illness does not mean you do not have a unique identity and personality. You are still you. You still have worth and value as an individual. There is nothing lesser about you for having an illness. And that is why I share my story with anyone who wants to hear it, and I do so with pride. I have been through a lot, but I have...

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Committing a loved one to the hospital.

In my short time working here at NAMI Nebraska, I have had several phone calls from concerned family members wondering what in the world they can do to help their loved one who seems to be in dire need of mental health care, but doesn’t want to go get any treatment. These calls have been extremely difficult, and are always the ones that affect me most emotionally. The law in Nebraska states that a person over the age of 18 cannot be forcibly committed unless they are a danger to themselves or a danger to someone else (http://www.treatmentadvocacycenter.org/browse-by-state/nebraska). So, family members need to prove that their loved one is dangerous, which they are almost always very reluctant to do. It feels like an act of betrayal. I’ve heard several times, “We don’t blame them! We love them, they are a good person! They just are acting this way because of the mental illness!” or, “We’re not doing this because we don’t like them. We don’t know what else to do,” or, “That’s what I thought I needed to do, I knew they needed to be committed to the hospital, I just needed to hear it from someone else.” I try to explain that committing a person to the hospital is never meant to harm someone, as an act of revenge, or punishment. Emergency hospitalization for a psychiatric evaluation is meant to help. It is a way to deal with a crisis situation and keep everyone safe. It can provide explanation and diagnosis. It can provide emergency treatment, to help a person through a psychiatric crisis, whether psychosis or other. It is not harmful to the patient and will only last as long as necessary. The guilt that one feels when committing a loved one, well understandable, is not necessary. Everyone has the right to feel safe: You do, and your loved one living with a mental illness. I also make sure they know that, if they do not feel comfortable bringing their loved one to the hospital themselves, they can call the police to do so for them or at least perform a wellness check to see if hospitalization is appropriate. However, if anyone feels like they or another or their loved one living with the mental illness is in immediate danger, they can call the police and ask for the CIT (Crisis Intervention Team), who are trained to deal with mental health crises. —————————————————————————————- However, not everyone who needs treatment is necessarily an immediate danger to themselves or others. What should people do then? They can’t forcibly commit the person, over 18, if they refuse. This is often heartbreaking, because there is nothing really to do. The law protects the autonomy of a mentally ill person to make their own medical decisions. In theory, this is a very good thing. A person should not be able to be treated against their will, simply because they have a mental illness. That is unjust. On the other hand, a person living with a mental illness might be refusing treatment because their illness prevents them from seeing or thinking clearly. Or they may simply not want treatment even if they might benefit from it. Then, what is a parents/friend/family member to do? This is why it is so complicated. It’s a balance between giving a person living with mental illness autonomy and the right to make their own decisions… and making sure people who need help get help and the community remains safe. Unfortunately, this leads to some heartbreaking situations. A man once called whose wife was living with bipolar disorder and desperately needed help. However, as he explained it, she “convinced the hospital staff that she was fine and wasn’t any danger to herself or others.” I felt helpless in this situation. There was really no advice I could offer. Considering committing a loved one to the hospital for a psychiatric stay is a daunting task to embark upon. But, it is often necessary and can help things dramatically. Unfortunately the stigma surrounding it is huge, but hopefully this post brings a little more understanding and perspective. Or at least to the limited way in which I have encountered...

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