Treating Mental Illness: The Mind and Spirit Connection

There is a line in my favorite musical Next to Normal, which is about a woman with bipolar disorder, that says:

"What happens if the cut, the burn, the break was never in my brain,
or in my blood, but in my soul?"

This is from the song "The Break" which is about how she has tried medications and treatments but none really work for that long and she has relapses of her illness. She wonders if maybe all of the treatment is not working because the illness is really mainly in her soul.

I named my blog "Bipolar Spirit" because I feel the body and spirit (what some call soul) are intricately linked together. (I guess I would not be a minister if I didn't believe that.) While I know mental illness is a chemical imbalance, I also believe it is an imbalance in the spirit as well.

I have been trying to manage my mental illness for fourteen years (I have been sick since I was six but only started getting treatment when I was 19) with medicines and talk therapy, and I have never really gotten better. Through all of this, I have always known that my mental illness really comes from a crushed spirit. The psychiatric profession calls it a trigger event (or events), as in a traumatic event happens and it triggers the chemical imbalance in your brain. I think the trigger causes a break in your spirit that co-occurs with the chemical imbalance. If our treatments only focus on trying to fix the chemical imbalance and not also on taking care of your spirit at the same time, I am not sure anyone really becomes well. 

I would add: "Help Heal Yourself."

I believe truly managing mental illness means possibly taking medication, going to therapy, and also becoming in touch with your inner spirit and the Spirit of Life that is all around us. I have finally found a medical practice that takes an integrative approach to medicine which will help my logical and my spiritual sides combine in order to treat my illness. While some people may think this is not a legitimate way to treat mental illness, I know it is the right way for me. I see too many people with crushed spirits to think differently. That is why my faith is so important to me, because it speaks of salvation in this life, through knowing you are loved just as you are and discovering who you are and your place in the Universe so you can live out your purpose in life. When you are able to do that, you are healthy and whole and can bring love into the world to make it a better place. Essentially, if you are out of balance, you can't really care for those around you. 

Blessings,

Rev. Katie

What is Binge Eating Disorder?

Binge eating disorder (BED) is when you consume large amounts of food in a short period of time (two hours or less) two or more times a week, with a lack of control of how much you are eating, for a period of at least six months.

Those are characteristics of binge eating which can be found in the DSM-IV which includes the criteria above as well as such things as feeling ashamed about eating, being unable to stop eating, and eating much more rapidly than normal. BED is a mental illness which affects more people (3.5% of women and 2% of men) than Anorexia or Bulimia.

I sat in my car today parked in a local large supermarket parking lot eating fast food. One car pulled up in the spot next to me, then another on the other side. We were parked way out in the lot, away from most other cars near a garbage can. All three of us sat eating fast food in our cars. I don't know if the other two people have a binge eating disorder, but I do. Hiding in your car, eating as much food as you can, and throwing the wrappers away in a public garbage can so no one knows what you ate - that is a typical binge eater. 

Here is what binge eating disorder is like from my experience of it:

• You eat tons and tons of food and you can't stop eating even when you feel sick
• You hide the food you eat by eating in the car, bathroom, or other "safe" place
• You eat food out of the garbage can
• You eat quickly, like a pack of wild wolves ripping apart a carcass
• You may be thin or may be overweight- BED does not descriminate based on size
• You think about food all day and dream about food at night
• You plan out where you will get your next binge foods from and how you will hide them
• You know all the stores where you can buy food and their hours, especially the ones open after 1am. 
• You plan out your food buying so none of the cashiers ever get to know you very well and you will not get "caught" as having a problem
• You choose food over time with friends and family
• You may miss work or events because you have eaten so much it makes you
• You wish you could stop and just can't which causes extreme angst and the feeling that you are worthless 
• You gain 14 pounds in two weeks
• Your disorder ruins your life by making you physially and emotionally ill due to all the chemicals and calories you are eating

Gingerbread House. Photo by Jeff Norris

I have had BED since a very young age. I remember sneaking food from the pantry and running up into my room to eat it. Hiding the wrappers in my bookbag until I could find a safe place to throw them out. I have never really delt with my eating disorder though. Why? Because it is extremely embarassing. Actually, in my exerience, telling someone I am a binge eater has caused more ridicule and pain than telling them I have bipolar disorder. People just think you are fat, lazy, and don't have enough willpower. They find you disgusting, repulsive, and weak.

I dieted and kept the weight off for two years actually by eating unhealthy foods in small amounts. I was still a binge eater but it was just infrequent enough that I could excerise off the calories and stay at a decent weight that did not look too big. The problem was that all I focused on was loosing weight, not treating the underlying disorder of binge eating.

I am finally addressing the binge eating disorder because I have to take care of it so I can follow the eating plan needed to treat my bipolar and because I have gained 20 pounds in the last two months.

As I go through this process, I will let you all know how it goes and what might be helpful to other people with BED. I already have a few book reviews in the works.

Blessings,

Rev. Katie

Read more here:
Binge Eating Disorder
http://www.bedaonline.com/abouted/BED.html

It Matters Who Prescribes Your Medicine

I realize that I have never talked about what to do if you think you need treatment for a possible mental illness. There is really not enough information out there on how to find the help so I will be creating a few posts on the subject.

So today my first piece of advice on this topic is one I am adamant about:

NEVER LET YOUR PRIMARY CARE PHYSICIAN PRESCRIBE MEDICATION FOR A MENTAL ILLNESS!!!

While I love all you primary care physicians and I know you care about your patients, in my experience this has never worked out well. It has always led to larger problems.

You would not let your primary care physician treat you for cancer, heart disease, scoliosis, or anything that requires detailed knowledge of a condition. Mental illness is not different. First of all, you really need to be diagnosed by a psychiatrist to know if you have an actual mental illness. A primary care physician does not have the detailed knowledge of all different types of mental illness to diagnose you. Misdiagnosing you and giving you the wrong medication can be extremely dangerous, such as sending someone into a medication induced manic episode because they were misdiagnosed as depressed when they were really bipolar. "Studies show that 74% of people seeking help for depression will first go to their primary care physician. Of these cases, as many as 50% are misdiagnosed. Even of the cases that are correctly diagnosed, 80% are given too little medication for too short a time." Also, many primary care physicians do not know how to correctly take someone off a medication for mental illness which is dangerous as well.

Photo by Jeff Norris

Lastly, these medications are very tricky to handle and have many physical and psychological side effects. Your primary care physician needs to know the basics about many different medications in order to do their job. They do not have the time to know the detailed facts about specific medications for mental illness and the less common side effects they cause which are not listed in the drug information packet.

So, if you are in crisis and feel you need help right away, get admitted to a psychiatric ward. If not, then ask you primary care physician to refer you to a psychiatrist for prescriptions and a psychologist (or other licensed mental health therapy professional) for therapy. If you are on medication which you are worried about, do not just stop taking it. These medications need to be tapered down under a psychiatrists supervision.

There is an exception to my rule of never letting a primary care doctor prescribe for you, and that is if your insurance does not cover a psychiatrist and you can not afford one on your own. This happens to far too many people. My husband and I have accrued quite a bit of dept paying out of pocket for psychiatrists, psychologists, and other mental health treatments. For us, debt was better than death, but I am not recommending everyone make that decision. No matter what, get treatment though.  Fight for the best medical care you can get within the constraints you have.

Blessings,

Rev. Katie

For Some Additional Reading:
Antidepressants Over Prescribed in Primary Care
Should Family Doctors Treat Serious Mental Illness?

Speculation Around the Batman Shooting Increasing Stigma Against Mental Illness

There are many news stories speculating that James Holmes, the 24 year old that opened fire during the midnight showing of the new Batman: Dark Night Rises movie in Aurora, Colorado last Friday, has a mental illness. This is all speculation since no doctor of his has said he has a mental illness and he has not entered a plea stating that he has one. It has been all over my Facebook page of friends saying he has a mental illness and people commenting that he "looks crazy" in the photos from his initial court appearance today.

I am deeply saddened by the extreme violence in our society that keeps happening over and over again. I feel for the families of the 12 who died and the over 50 people wounded. I can't believe that this happens and it makes me scared that it seems like no place is safe anymore.

At the same time, I am also appalled by how almost every time a violent act is committed, particularly by a Caucasian, people start diagnosing mental illness. There are news reporters, Psychologists who report for the media that it likely someone has a mental illness even though they are not the person's doctor, and the random public who all say this. All over Facebook I see people claiming Mr. Holmes had a "psychotic break," he "must be schizophrenic," he just "looks crazy," and "people typically have their first episode of schizophrenia in their 20's and he is 24 so that's what he must have."

Every time our society blames violence on mental illness, we promote the hysteria, stigma, and fear of mental illness. I was shocked to find out that the National Alliance on Mental Illness was asked by the news media what the warning signs are for someone like Mr. Holmes. NAMI created a great response, stating that incidents of violent crimes are very low in people with mental illness and no one should be diagnosing Mr. Holmes unless they are his doctor. I wish they would have also challenged the public media to not slap the label of mental illness on people who do violent things as that perpetuates the stigma against people with mental illness.

I am also so tired of people claiming that these violent people "look crazy," meaning they have a mental illness. This is just offensive. Technically, by our society's standards, I am "crazy," and I don't really think I look like Mr. Holmes.  I even see this coming from people of my own faith tradition, Unitarian Universalism, a faith who has fought so hard to end stereotypes. No one in our faith would tolerate someone saying a person "looks gay" yet stating someone "looks crazy" goes largely unnoticed and is even encouraged.

I believe that our society jumps to the mental illness label because evil is scary for us. Most people are not quite sure what makes someone do evil things and they sure as heck want to make sure they personally cannot ever be seen as evil. So, they blame an illness, which they don't have, as a way to distance themselves from the situation. As if they are saying "only mentally ill people do evil things, so that means I can never do anything evil." Really though, as stated in the NAMI response, the "U.S. Surgeon General has reported that 'the overall contribution of mental disorders to the total level of violence in society is exceptionally small.'"

But can I ask the general public: "If you want to distance yourself from evil, how do you think it makes people with mental illness feel when you claim someone who committed a violent act must have mental illness?" You are perpetuating the myth that we are inherently evil. You are telling us we are bad and have the potential to do something evil just because we have an illness. Do you know how scary that is for us? Ever since I was a small child I knew of this stigma, and I always wondered if I was evil and didn't know it. That is a horrific, soul crushing, scary, and devastating thought to carry around with you. How do you think the current six year old with bipolar feels then they hear the shooter "must have had mental illness." How do you think the children of people with mental illness feel knowing that society shuns and fears their parent?

Whether or not it comes out that Mr. Holmes does have mental illness, we have not handled this well. We have vilified people of a certain group, and that is not acceptable. Even if he does have mental illness, that does not explain why he committed an evil act because there are thousands more like him who don't have a mental illness and do the same thing.

I would ask that the next time something like this happens, we do not jump to label someone as "other" so that we feel less threatened. We do this all the time, such as when we have labeled people who commit violent crimes as "terrorist" if they happen to be Muslim, or the assumptions that spread when the person is African American, Asian, or Latino/a. It's not alright to increase stigma and oppression for any group of people just so we can pretend like these events have nothing to do with our society as a whole, and instead we have some group to "make pay" or "blame" for the evil.

Blessings,

Rev. Katie

Bucket List: What Do You Really Want?

This Sunday at West Shore Unitarian Universalist Church, the lay leadership of Worship Associates and some church members presented a worship service called "Your Bucket List, Your Life, Your Legacy." Bucket Lists have become increasingly popular. They are lists of things you want to do before you die, or "kick the bucket" (which interestingly is a term that may have come from suicide where you kick the bucket out from under yourself in order to hang yourself.)

Anyway, the service looked at the purpose of bucket lists but also how they change over time and what legacy we leave based on what we did or did not accomplish from our list. The speakers ranged in age from 16 to 70's and they all had great reflections on goals, expectations, and legacy.

As I sat there listening to each person, I was in particular struck by the youth (who happens to be one of our babysitters) and how she said adults often tell her when she speaks of her list, "your are young, things will change" and how that kind of negates what she is saying. I can identify with the same thing happening to me when I was her age. Then there was a woman in her 30's who has a theater background like me and we had a lot of similarities. She spoke of how she needed to follow her heart and not get caught up in expectations others may put on her. The best way for her to leave a legacy is to bring her gifts into the world even if those gifts are different than the average person or family. I identified with what she was saying as well. These were two very powerful messages of the need to follow your own heart rather than let other people define who you are.

UU Lego Minister with bucket and chalice :-) Photo by Jeff Norris.

For me, I actually have accomplished the bucket list I had for myself ever since I was little that everyone told me was unrealistic, too much like a fairy tale, and not successful enough. It wasn't a long list, just a short one about marriage, family, and career.

I married a smart, kind, successful man who is a great husband and father who respects me and really is my prince. While I thought I would have six kids when I was little, I now have one, but mainly I wanted a loving family, and I have that with my wonderful son who is so smart and compassionate I just can't believe it sometimes. I also wanted to be successful in the arts. First I wanted to be a Disney animator and then changed that dream into being a star on Broadway. What I really wanted out of those jobs was to bring people a message that could help them in their lives and present it in a creative way that reached all the senses through music, art, and word. Now as a minister, that is what I do.

Looking back, I know I accomplished that list because I was fiercely protective of it even though other people thought it was wrong. Even when other people told me I made decisions too quickly, too young, or didn't focus on jobs that would make me more money or bring me more prestige. The times when I am most miserable in life and make the most mistakes are when I try to fit into what other people want from me.

Now when I think of what I would put on a Bucket List today, I can think of lots of things:

• Be a great Mom. 
• Be a great wife. 
• Write a book.
• Be a minister who helps people find their own path.
• Spread the good news of Unitarian Universalism that everyone is loved just as they are. 
• Raise awareness all over the world about the stigma against mental illness and dementia. 
• Go to Italy. 

But really, what I absolutely want, I can never have, and that makes me sad. If I could have anything I ever wanted before I die, I would want to not be sick anymore. I appreciate all I have learned from my illness and know it makes me who I am today, but after all these years, I would want it gone. Or maybe I just wanted it managed enough so that I can live a next to normal life.

Blessings,

Rev. Katie

Rosie: Getting a Psychiatric Service Dog

A while ago we came across information about Psychiatric Service Dogs (PSD's). You are probably most used to service dogs such as Seeing Eye Dogs, but over the years they have found that dogs can be trained to assist with all kinds of disabilities.

Psychiatric Service Dogs assist people with whatever disability comes with their particular mental illness. For instance, people with schizophrenia who hear voices can train their dog to check rooms for them or alert them if someone else is around them. If the dog does not see or hear something, then the person (the dog's handler), knows that what they heard or saw was not real. PSD's can ground someone who has Post Traumatic Stress Disorder when they have a dissassociative flashback or can awaken them during night terrors. PSD's can stop people who self mutilate by pawing at them until they stop the behavior. Often psychiatric medications make you forgetful and if you don't take your medication you can have severe side effects so your dog can be trained to bring you your medication. Your dog can be trained to awaken you when you can't awaken due to medication side effects or deep depression. A PSD can ground you and provide tasks that decrease anxiety enough so that a person can have a job and function every day. PSD's can even alert you to a panic attack or manic episode before they happen. These are just a few of the things Psychiatric Service Dogs can do but basically, they help you live your life with your disability.

Once we found out what PSD's could do we decided that getting one would be a good option for me, especially since I have such a hard time with medications.

Getting and training a PSD is not all that easy. Typically with many other types of service dogs, you can get a dog who has already been trained from an organization. There are places that train service dogs such as Seeing Eye Dogs, Autism Service Dogs, and there are even organizations that provide Veterans with Post Traumatic Stress Disorder (PTSD) with PSD's but other than that, most Psychiatric Service Dogs are trained by their handler with the assistance of a dog trainer and someone who specializes in training dogs to do PSD tasks.

From my experience and with the resources we have, here are the basic steps to getting started with a PSD:

1. Talk to you Psychiatrist and/or Psychologist. As with all types of service dogs, you must have a disability in order for you to have a service dog. If you have a disability, your doctor will wright a letter stating that you have a disability and are in need of a service dog. You will keep this in your files, but you do not need to carry your doctors order with you as it is illegal to ask for proof that you need a service dog.
2. Find a basic dog trainer who uses positive reinforcement training, most often Clicker Training. Do NOT use a trainer who uses yelling, shock collars, or other forms of negative reinforcement. This trainer will help train the basics, socialization, and the Canine Good Citizen Class. 
3. Find someone in your area who does PSD task training or find online resources for PSD task training that your regular trainer can help you with. Make sure your trainer knows how to train a dog for all the basic service dog requirements like potty on command, tucking their tail while inside, how to sit under a chair or table, etc...
4. Find a dog.  There are many ways you can find a dog appropriate for a PSD but the best thing to do is have a dog temperament tested by a vet behaviorist. I would suggest finding a rescue dog that has gone through a basic training program and has passed Canine Good Citizen so you know they are trainable and they will be a bit older, past the puppy phase, which is really hard to handle. Just because the dog took well to basic training though does not mean the dog will be a good service dog so you need your trainer to check the dog out. For instance, we have a dog already who was trained in a prison program. She is a fantastic dog who learns really quickly but I could not use her as a service dog not only because she is too old already, but because she was abused and is very anxious. Her anxiety makes her very scared in certain public situations, causes her a lot of stress in the car, and when I am manic, she hides from me, so she would not be able to help me when I needed her.
5. Start training, realizing it will probably take two years and if it does not work you have made a commitment to still keep your dog as a member of your family. 
6. Love your dog and create a great relationship with him or her.

Rosie, Psychiatric Service Dog in Training

Blessings,

Rev. Katie

Depression: When It All Falls Apart

There are no words adequate to describe depression. Unless you have gone through it, you never know what it is like. And there are different kinds for different reasons. Many of us will go through situational depressions in our life that may even last a few years from an illness or grief from loss of a loved one. The depression I am talking about is the one that is a mental illness which just lasts and lasts your whole life. Where you go out in public and you look at other people and wonder how they look so normal. How do they get through their day? Why are they smiling? Is life so excruciatingly painful and hard for them as it is for you? Do they live every moment of every day doing only what they have to do to keep their jobs and not look like a freak? Do they count down the seconds and hours until they can go back to bed and stay there until their next required task comes around? Do they wish they enjoyed time with family and friends? Do they have no motivation to wake up in the morning because they know every day will be agonizing and joyless? Soulless almost?

It is sad to have depression because you wish you enjoyed all the things you love, like family, friends, and work. But when you are depressed you want to spend no time with anyone, doing anything. It can also make you mad that you are required to fake a smile and pretend to be happy just so you don't make other people uncomfortable.

Photo by Jeff Norris

It's also annoying because you do the right things and are still sick. I took the medication, which seemed to be working but the side effects were so bad I had to dramatically decrease the dose and see if I can build up more slowly. Any time you change a dose of medication, it can make your symptoms much worse and so my depression now is extremely bad. Also, my Mom has gotten worse and is now in hospice care so I am sure that is adding to my poor mental state. The problem is that normal sad or scary life events are different for people with mental illness. These events may or may not set off your illness and make it much worse. It is not like you can avoid those situations, but you may have to realize you will have months or years of fallout after stressful life events. Even good events like job change or marriage. And right now I have changed medications, changed jobs, and Mom is dying so I should expect that I will get worse, it's just that every time it happens, you have never quite prepared for it.

You are never prepared for how your illness with rear it's ugly head. For me it's how the depression, mania, anxiety, and eating disorder combine to create depths of despair and hell I didn't think were possible.

So, now when all of those things happen in your life, what do you do about it? You have mental illness and can't just "change your mind," "shake it off," "act happy," or "be different." But that does not mean you are lost. Here are a few tips and I know they are not easy to do, but once you do one, it gets easier and easier to do more:

1.  Remember that it is not always like this. It is not always this bad, there are good moments.
2. Ask for help when you need it and will accept it.
3. If you have not exercised, slept, or eaten correctly in weeks, do one of those things right one day, then two the next. Make one good decision every day that makes you feel better, no matter how small it seems.
4. Tell your illness and whatever other factors contribute to it that they won't win. (I would probably use some more colorful language around that to really be firm about that point.)
5. Write about what is going on, that usually diffuses the situation and helps you see things more clearly.
6. Know that you are loved by God or the Universe, whatever you see as greater than yourself. Get in touch with that Spirit of Love through church, prayer, nature, art, animals, meditation, the beauty of science- anything that gives you the "awe factor" and lets you know you are not alone.

Remember that managing mental illness is a process where you will get better and worse. You just can't give up, and that is the hardest part. You are too precious and too important to this world to give up on and you always need to remember that no matter what your illness makes you think or what other people tell you.

Blessings,

Rev. Katie