*A featured personal story for this MENTAL HEALTH MONTH series*
I’d been in counselling following the breakdown of my relationship with my sons’ dad. It had become excruciatingly painful, revisiting places and feelings I’d long-forgotten so, about eighteen months in, I leftwithout telling my counsellor. I stayed away, despite her letters asking me to return.
However, things were coming back to haunt me. It was like I had this video in my head, fast-forwarding, re-winding over and over, sometimes so fast, it made me feel physically sick. The accompanying thoughts were disturbing and taunting me but, as I had nowhere to turn, these thoughts just amassed and I felt like a volcano, ready to erupt at any moment.
In desperation, I wrote to Linda (my Counsellor) to ask if I could go back to counselling and thankfully, she agreed. At my first appointment back, she said she hoped and thought I would return. I got the feeling she knew there was more than the breakdown of my relationship going on.
However, because I’d kept my dirty secret, together with these revolting thoughts and stomach-turning feelings, inside for so long — It took many months before it all came tumbling out — but I just couldn’t say the words.
I tip-toed around the topic but Linda was good at making me stay on track, patiently asking endless open-ended questions like “and then what happened?” or “and how did that make you feel?” How f*cking stupid was she? I felt angry, so f*cking angry. Right at that moment, I hated the world and everyone in It! And I felt full of rage towards Linda – for making me do this! I hated how she was digging into the filthy pit of my stomach, scraping out the misery, disgust, hatred and fear, one dirty lump after another. Then she turns. She asks, almost sweetly, “Hannah, can you tell me what is making you so angry?”
“Okay, Okay! I was f*cking abused. Is that it? Is that what you want to hear?” I screamed, and “I. was. sexually. Abused! You happy now? Or do you want to hear how he told me touch him, and I did. Okay. I did! And I don’t know why……,”
Zapped of all energy, my screeching gave way to sobbing and whispered apologies to Linda.
Months in and towards the end of one of our sessions, Linda held up a book and I burst into tears. It was the first time I’d ever seen anything in print about what had happened to me. I felt sick, I couldn’t breathe, and I was sobbing uncontrollably. I think I was in shock, I felt shaken and I had a panic attack.
However, once I’d recovered from the panic, I think I felt slightly relieved. It hadn’t happened to just me. Not that I wanted it to happen to anyone else, but others had been through it, come out the other side, and had written a book to help people like me.
That afternoon, I took the book home and was sitting on my bed, feeling slightly dazed and afraid to open it, when my brother walked in. Puzzled at my silence, he sat with me and saw the title of the book. He put his arm around my shoulders, opened the book, and as we read the Preface, we shed silent tears together. I will always remember this moment and I’ll be eternally grateful to my brother.
I continued with the counselling, trying to unravel this mess – this living nightmare of childhood sexual abuse. processing my thoughts and emotions, slowly. For a long time, I hated myself. I hated that it had happened, that I let it happen, that it went on for so long.
I’d known all this stuff for years but refused to confront it. I wasn’t able to push all that stuff to the back of my mind anymore. I’d always hoped that was it; in the past — gone. But it never goes. It does get easier in time.
Catch Caz at: https://mentalhealthfromtheotherside.com
Her twitter: @hannahsmiley
Pinterest board: http://www.pinterest.co.uk/pin/800444533760600123/
If you would like to submit your personal story to be featured this mental health month, contact me here or on Instagram @written_in_the_photo or on Twitter @philopsychotic. We will be covering Schizophrenia, Bipolar, and Dissociation next. If you have anxiety or trauma related stories you’d like to share, message me anyway. We’ll get you featured.
Welcome back! Let’s talk about Truama and Stressor related disorders. Read more for a great book recommendation for emotional trauma and CPTSD.
This can be any event or events which leave lasting psychological distress. This ranges from emotional abuse influencing your world view to the vicious physical flashbacks veterans face after war. A car crash can be a trauma that makes you anxious or avoidant about cars. Divorce is a trauma. Children of alcoholics, such as yours truly, have a specific set of common trauma responses. Sexual abuse, the death of a loved one, a gun to your head are all specific traumas that can cause specific perspectives and responses from people.
Sometimes trauma can cause a person to lash out suddenly, aggressively, or present the opposite characteristics; some will shut down, avoid, and become stagnant or submissive. There’s research supporting the hypothesis that traumatic events can heavily influence the wiring in our brain. This has a lot of implications in all mental health conditions, not just Post Traumatic Stress Disorder. But for the sake of honoring Trauma today, we will talk about that only in the context of trauma.
I had a similar question. The DSM-5 has somewhat of an answer. Here are the diagnoses they list:
Writing this hasn’t been easy. My chest is tight, my hands are shaking, and I keep having to remind myself to breath. My senses are become more sensitive by the minute and I’ve had to change my music to something softer and easy to ignore. My stomach is in knots. I’m not thinking about any incident in particular, but the body has an amazing memory. It encodes emotions, sensations, feelings. That’s why dissociation is such a common respond to trauma: escape your body and the feelings are void. It’s a mistake to think only the mind holds the capacity for feeling.
Therapy is a common go-to for trauma. EMDR has stormed popular psychology but according to my research professor last year, it’s unclear whether the lights/wands used in EMDR are causing an effect or if it’s the CBT you’re doing during the session. After all, CBT is the leading therapeutic treatment for trauma. There are no studies with participants using CBT, EMDR (that includes CBT), EMDR without CBT (which would basically be flickering lights or waving wands with you sitting there awkwardly staring at them) and no treatment which would put you on a “waiting list”, you unknowingly part of the control group.
Much of my own trauma is rooted in emotional events. Being threatened, bad mouthed (an eleven year old being called a bold little motherfucker for expressing distress about something is kind of how that went constantly), and intimated taught me to be suspicious, distrusting, and defensively aggressive. Being homeless created a lot of insecurity, confusion, and depression; the first day I wanted to kill myself I was eleven, sitting outside of the house we stayed in where the owner drank a bottle of Jack Daniels each night followed by a plate of Xanax. Her daughter had sex orgies loud enough to permeate the street and the other went to work and school. I have many more stories about many wild people I’ve encountered. Maybe I’ll tell it sometime.
But the alcoholism and drugs in my own house, coupled with our 3 year homelessness, and my terror of school I’d experienced since I was five in day care, made me closed, submissive, and withdrawn. When I hear certain words today–for example, in a team meeting at work, if I hear the word “activity”, my body flashes cold, my heart races more than it already was, my hands shake, my muscles twitch. This is an example of an encoded emotion from my days in school. There are studies going into this.
I didn’t ever talk. I fainted if I was asked in front of the class, and was so nervous to raise my hand that I often peed on myself in elementary; I couldn’t ask to use the bathroom. By middle school I’d developed a ritualistic routine to avoid asking for anything in class: use the bathroom before school, five minutes before the bell ended break, five minutes before the bell ended lunch. That’s continued through college; I’ve never got up and walked out of a class before the class ended. By high school, my dissociation got so severe I experienced fugue states (only lasting at most a day), one that caused me to walk into four lanes of traffic against the light, with my friends apparently screaming. They eventually caught up to me but I only remember walking through my door at home. I don’t remember the rest of the day or what made me so terribly distressed that I left my body.
There are some medications offered, usually SSRIs but sometimes heavier medications like Seroquel for a knock-out sleep. Sleeping can be hard with trauma. Your body is constantly in high alert.
Meditation helps some. This can be any activity that helps you focus on your breath and rooting your thoughts in your body. We get so used to ignoring, avoiding, or giving in completely to the distress our body and mind feels that we lose sight of reconnecting our system, which is so essential to wellness.
Support groups and other outlets to express the physical and emotional experiences are key. Just typing my physical experiences above helped relieve a lot of the tension; it’s important to acknowledge what your body feels, and get specific about it–write it down, call a friend or support force, schedule a therapy appointment. Resort to emergency medication if the experience doesn’t abate after trying everything, including sitting with yourself. I’ve had panic attacks related to body-trauma flashbacks push through Seroquel, Ativan, Klonopin, Valium.
Drugs aren’t always what you need. Sometimes it’s just your body screaming for you to offer understanding, consolation, and acknowledgment of its distress; it’s been through the same things you have, on a cellular level.
Complex PTSD: From Surviving to Thriving has been on my read list for a while. It covers “Complex-PTSD” which is not a DSM diagnosis no matter how many psychologists push for it, but references the emotional markers left over from childhood trauma.
Thank you to everyone who has been messaging me on Instagram. Sharing your story is difficult and I appreciate those of you just reaching out with words of encouragement, thankfulness, and those of you asking about my own experience with psychosis. We will continue with Mental Health Month NEXT WEEK.
Thursday May 14th: Schizophrenia
Friday May 15h: Bipolar
Saturday May 16th: Dissociative disorders.
These posts may be a little later than usual as I am on a hiring panel at my job on Thursday and Friday. Finals are also coming up. I will keep everyone updated. If you would like to submit a paragraph, quote, or personal story with any of those listed experiences, please reach out through my CONTACT PAGE, or message me on:
If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue reporting poorly executed science.
We’re in day two of our Mental Health Month series where we discuss different DSM-5 diagnoses and the research behind them. Today we’re talking about Obsessive Compulsive and Related Disorders, including Body Dsymorphic Disorder.
Let’s distinguish the difference between being obsessed with something and obsession ruling your life.
If you have an obsession with Michael Kors, you probably don’t have a condition.
If you have an obsession with, like, that one show that, like, you stream on Netflix, you probably don’t have a condition.
If you had to touch all of the buttons, one by one, on the television, the remotes, the kitchen appliances, the computer, before you leave the house to prevent a house fire, and this becomes so disruptive you leave the house only twice a week for essentials (even when NOT in a pandemic), then you might think about searching for some support.
But OCD (obsessive-compulsive disorder) is not the only condition that exists under this category. There is also:
1.Body Dysmorphic Disorder
3.Trichotillomania (hair pulling)
4. Excoriation (skin-picking)
5. Substance/medication-induced obsessive compulsive and related
6.Obsessive-compulsive and related disorder due to another medical condition.
7. unspecified obsessive-compulsive and related disorder (like obsessional jealousy).
Hoarding gained a lot of popularity after A&E came out with their show HOARDERS, which follows the lives of extreme hoarders, often living in squalor beneath their belongings. The people featured are often reluctant to get rid of their material items because of an obsessive emotional attachment to them. This doesn’t just extend into beautiful or valuable items, like a porcelain doll or an antique speaker; most people will be hard-pressed to give away something that has some semblance of importance or function. For the people on hoarders, even garbage or blankets covered in rat droppings and urine are part of their livelihood, either because of memories or because of the simple fact that that item, along with all the other items in the house, fills a void.
Indeed, those with Hoarding Disorder have “persistent difficulty discarding or parting with possessions, regardless of their actual value”, per the criteria of the diagnosis. That difficulty leads to an “accumulation of possessions that congest and clutter active living areas”, much like what you see on Hoarders. This causes “distress or impairment” in all areas of functioning.
We also see a variety of personalities on Hoarders. Some people have what the DSM calls “good or fair insight”. They recognize their hoarding has been causing problems, but feel both trapped and safe among their things. Some people have “poor insight”, in that the clutter isn’t viewed as problematic. As we see in the television show, some people with this level of insight will accept help but fight against losing too much stuff. Some revert back into their old ways after the trauma of losing things all over again. Those with “absent insight/delusional beliefs”, are absolutely convinced nothing is wrong–yes, to the extent of delusion. These are the people you see who halt the process in the show, and the house or yard is cleaned only in a hundred square feet or so.
These behaviors may be related to the temperament of the person, indecisiveness being a leading trait, and also related to some traumatic or stressful event that exacerbates the behavior. Let me give a personal example.
When I was 11, we lived in a two story, two bedroom apartment next to a registered sex offender and across from a drunken, drug-addled manager. My dad, a musician, also spent most of his free time drinking or working on cars, and it was only a matter of time before him and the manager got into an irreparable fight. The problem is, she was the manager and we were the tenants; her words against ours to property management meant nothing. We were evicted.
My parents’ credit was in the tank, and we were not rich, so no other apartments in town would take us and we bounced around from hotels, to a tent, to rooms in houses of family friends—that doesn’t sound terrible, but three years of much more drugs, alcohol, and uncertainty (in every place we stayed) isn’t all that fun.
A two-story, two bedroom apartment can hold a lot of stuff. Everything in my room except important papers and one hand-me-down banana republic plastic shelf went in the dump–bed included. We didn’t have enough space for all my stuff and my parent’s stuff in the small storage locker we rented, so we sacrificed most of our belongings.
I noticed I started clinging to things later when we finally got another apartment. I picked up stuff from the street I didn’t need–like broken street signs, discarded car review mirrors, desks, and even a bent reflector. I kept that bent reflector for ten years. In fact, I kept all of it for ten years. My closet is still full of junk I picked up from the street or things I thought were valuable from the dump. My room itself is cluttered, disorganized, and it took three years of picking through invaluable things with perceived value to keep at least two feet of walk space from my bed to the door. I still haven’t learned how to organize.
This example doesn’t mean I have Hoarding Disorder. I only share this to show that obsessions with material items don’t make people vain or stupid or rude. Loss and grief of any kind can make us cling to whatever solid, certain, undying thing we can find.
I don’t know how much of A&E’s Hoarders is dramatized for television. Sometimes it seems the film is edited to make the people look disgusting and defeated, and then a sob story told to make us feel pity. At the end we’re supposed to feel amazed the house is clean or disappointed in the person if it’s not, without recognizing the uniqueness of each individual’s process. All in all, the people are real. I don’t know about the show, though.
In fact, it’s the first disorder listed in the category. People struggling with this perceive a defect or flaw in their appearance that seems slight to every one else but causes severe preoccupation for the sufferer. This could cause people to go to drastic measures to fix this flaw–which may include several cosmetic plastic surgery interventions, or cause them to remain indoors, trapped behind the fear that everyone will see, ridicule, and be disgusted by their flaw. This is not the same as being preoccupied with ones weight, and it cannot be Body Dysmorphia if the symptoms of an eating disorder are present.
This is linked to people who have relatives with OCD, and has been seen correlated with high rates of childhood neglect and abuse. Females are more likely to have a co-morbid (occuring at the same time) eating disorder and males are more likely to be preoccupied with their genital region. What does all of this mean?
It means life is a living hell. Being in the view of others causes such distress there are people who hide behind their curtains, in their house, for years. And this is, again, not a vain “omg nobody look at me”. This is such a level of heightened anxiety that an entire life is disrupted. I feel that many obsessive conditions get looked at as people being selfish: the person living with OCD can’t take care of their child because the compulsions take up most of the day–that means they don’t care about their kid enough. Or the people with Trichotillomania has pulled a bald spot on their head, but then complains about being nervous of others seeing the bald spot–they need to just stop pulling their hair. And things just aren’t that simple. None of this is vanity or selfishness, it’s anxiety, it’s stress, it’s trauma response.
Here is a great Ted Talk by Meredith Leston that highlights how body image is spread in the world and how troublesome views can lead to great distress and disruptive conditions for some people. Let’s remember: our environment plays a huge role in dictating which genes turn on and off. Everyone has the potential to develop a mental condition at some pointing their life. Why it happens to some and doesn’t to others not only depends on environment, but social factors and genetic make up too. Not so much brain chemistry.
If anyone watched Barcroft on Youtube, you might like this clip on Body Dysmorphia and OCD. I tend not to watch them too often, but sometimes they have okay material. Let me know how real or not real this is.
For some of these conditions, like Trichotillomania, there are no drugs that reduce symptoms. Even in cases of severe OCD, psychotropic medications fail miserable. This is a testament to how much we still don’t know and why some researchers are putting more weight on alternative treatments and Cognitive Behavioral Therapy, the only psychotherapy which has been tested (with high reliability AND validity) and proven to change the course of people’s thoughts.
This Double-blind, placebo controlled, Cross-over study examined the possibility for Milk Thistle as a treatment for Trichotillomania. They concluded their sample size too small to yield any confident results, and that their evidence only weakly supported the use for Milk Thistle.
This placebo study with Trichotillomania only further showed that 1) change is possible depending on expectations of the participant and 2) easy access, simple treatments for this condition remain elusive and the condition reminds misunderstood on a clinical level.
I will say that OCD itself gets a lot of research while these other disorders fall short of people interested in finding treatments. For OCD there is a long list of possible SSRI treatment, ECT treatment (if you don’t mind losing your memory), different therapies, stimulants, and even EMDR. This is why I speak on the disorders we don’t hear much about. Because for the rest of these unknown, quiet, hidden disorders, sloppy therapy and hopeful medication are thrown at patients. Many suffer in silence.
For a condition like Body Dysmorphic Disorder, other alternatives are being studied too. This experiment examines whether an intranasal dose of Oxytocin could cue a helpful response for BDD. This too failed. It increased self-blame and “other-directed blame”, and the researchers “advise against the use of Oxytocin in BDD patients”. Glad science kept us from THAT mistake.
But, for those diagnosed with BDD and Social Anxiety disorder, this study found that Cognitive Behavioral Therapy and attention retaining significantly improved the Body Dysmorphic aspect of the participants life.
There is some progress.
If someone comes to you and tells you they have been struggling with one of these conditions, withhold whatever your initial reaction is. Remind yourself that many who struggle with these types of conditions blame themselves enough. Even those who don’t blame themselves may still feel guilty for the disruption it causes their lives. I feel guilty sometimes for the disruptions my anxiety and Schizoaffective-ness has caused in my life and others lives.
Remember that they are not disgusting or vain or weird. Remember that there may be a whole list of trauma you’ve never learned about. Remember that even clinicians don’t understand this, probably because they’re trying to understand it on a biological level too much–some things need a different perspective in life.
So, this Mental Health Month, let’s keep in mind that there is a lot of suffering going on right now. Let’s not compare our pain to others, but instead use that energy to remind each other we’re not as alone as we feel. If you are suffering in silence, may this space give you the extreme–almost inhumane it feels sometimes– courage it takes to send a text, or call to someone you can trust. You can comment on this blog even, or contact me on my home page; eventually the burden of silence will hurt your back. It’s damn near broke mine before.
I write these posts in this format because I’m tired of articles listing symptoms, bland, over-used, understudied treatments, and urging people to talk to their doctor. It’s a good idea sometimes to seek professional help, but to do so uneducated and so desperate for relief that you’re unable to look at things critically will only trap you in the quantum loop that is the mental health system, especially if you’re in America. Mental Health Month is about education and reducing stigma. We can’t do that if we don’t preach from the side of lived experience AND scientific research.
Tomorrow we cover: Trauma and Stressor related DIsorders.
Next week, we cover: Schizophrenia, Bipolar, and Dissociative disorders. If you’d like to submit your story for any of these, please contact me HERE, or on my social media handles below:
If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue reporting poorly executed science.
*A featured personal story for this MENTAL HEALTH MONTH series.
Some months after my relationship with the boys’ dad ended, I had what can only be described as a ‘break down‘. And that’s exactly what it felt like because, both physically and mentally, I was broken.
I started to get these odd sensations; I could feel my heart thumping out of my chest and could hear it pounding in my ears. Lots of jumbled and disturbing thoughts races around in my head and I felt scared all the time, so I was constantly jittery. I was anxious about being anxious again and much of the time I felt like I was on the world’s longest and biggest rollercoaster.
Sometimes, there was so much adrenaline buzzing through my body, my nerves were jangling, and I couldn’t sit still, so I’d pace around my home. At other times, I felt exhausted or gripped vice-like with sheer terror so I couldn’t move.
I was having what I now know to be panic attacks – throughout the day and particularly at night keeping me awake until it was time to get the boys ready for school. It felt like how people explained having a heart-attack. My fingers and toes were tingling, and I could feel the colour drain from my face. I was finding it hard to catch a breath it felt like I was drowning in quicksand, so I’d lie rigid until it passed, knowing it would be followed by another, and another.
It was torturous, twenty-four-seven, week on week and with no end in sight, I wished I was dead. Although close friends and family were aware of the break-up, I couldn’t tell anyone what was going through my head, scared they’d think I was mad and that I should be locked away. This was to continue for around eighteen months.
I’ll be eternally grateful that our GP eventually noticed and taking me aside, he urged “Tell me, what’s the problem? You’ve lost so much weight and though you smile, I think you are very sad.” Once I’d explained and told him that I was devastated by the break-up, he was able to get me to immediate counselling. He actually drove me to our local hospital where he knew the Psychiatric Team.
Fortunately, although I had suicidal thoughts, the psychiatrist and his team were confident that I had no intention of killing myself. I’d told them I knew I couldn’t do that to my sons. I couldn’t possibly leave them with that legacy. Three years of painful weekly counselling followed.
I was on the road to recovery when I realised I wanted to study but I wasn’t sure I was clever enough and I wasn’t sure what to study. I thought I’d test the water and start small, so I took evening and weekend courses in Shiatsu. This was quickly followed by Swedish Massage, Seated Massage, Aromatherapy and finally, Indian Head Massage, where I was trained by the blind guy who invented it (Narendra Mehta). I loved it and so too did my family and friends who I practised on.
I had the massage table, the massage chair, lots of fluffy white towels and a full kit of aromatherapy oils. However, despite passing my exams with distinction in all the above types of massage, I just couldn’t charge anyone. I didn’t like asking for money so all I asked in return was a fluffy towel or an aromatherapy oil.
In February 1997 I learned I was about to be made redundant again, which was fantastic as I’d seen a large advert in the Evening Standard looking for General Nurses to study at my local University and Hospital. This didn’t so much interest me but, right at the bottom of the ad, there was a few lines about becoming a Mental Health Nurse. It felt right, and I believed that my own experience of mental illness would help to make me a good mental health nurse.
So, during my recovery from, what I learnt was, a lengthy psychotic depression, anxiety, panic attacks, and anorexia, I applied to train as a Mental Health Nurse. After three long years of study, I worked successfully as a Mental Health Nurse in various settings before becoming a Ward Manager. I had the honour of meeting thousands of people who shared their chaotic and difficult life stories with me, possibly for the first time ever. I always felt humbled by their often-fraught experiences and journeys through mental illness.
I remain extremely passionate about raising mental health awareness, I’m a determined advocate of mental illness and continue to fight the stigma, the social exclusion and discrimination that come with it.
“As one person I cannot change the world, but I can change the world of one person.” – Paul Shane Spear
“Think of the enormous impact if just ONE PERSON improved the world of just ONE PERSON. That alone might change the world. And everyone in the world would be part of the change.” – Samuel Rozenhider
A big THANK YOU to Caz for her willingness to share her story about moving through anxiety. Catch her at THESES LINKS:
For tips on anxiety and panic attacks, you can use my link, here: https://mentalhealthfromtheotherside.com/2020/01/17/10-quick-and-easy-coping-techniques-for-anxiety-and-panic-attacks/
Or use my home page, here: https://mentalhealthfromtheotherside.com/
My twitter feed, here: https://twitter.com/hannahsmiley
Pinterest boards, here: https://www.pinterest.co.uk/pin/800444533760600123/
Today we start our Mental Health Month series. As a short recap: every Thursday, Friday, and Saturday this month we will be covering different DSM-5 diagnoses, recent research, and featuring personal stories from YOU. This week we’re covering Anxiety disorders, OCD and Related Disorders, and Trauma and Stressor Related Disorders. If you want the FULL LINE UP, click HERE. If you want to submit your story, CONTACT ME, or find my social media handles below.
Now that that’s over, let’s get into today’s topic: ANXIETY DISORDERS.
We all know feeling anxious isn’t uncommon. It’s simply our body’s natural response to stress. If you look at the state of the world right now, it’s not surprising pharmacies were running out of anxiety medications.
So far, we believe this stress response prompts waves of catecholamines (neurotransmitters like dopamine and epinephrine) which give rise to our flight-or-fight response. From an evolutionary standpoint, this may come in handy if you’re scrounging for food in tiger territory. From a modern standpoint, our sympathetic nervous system is constantly bombarded with new information and new things to worry about. From an epigenetic standpoint, your resulting anxiety from this overstimulation influences the on-off switch in the genes of your child, creating a world of ever-more-anxious, alert, frightened children.
There’s no definitive proof for any of these hypotheses. There is evidence suggesting all sides, and more, but studying humans is hard and concluding one idea over the other might not be practical. Please do not take this ambiguity lightly. Most people want to agree with one of the three hypotheses listed above because it just makes sense to them. This is a trap of confirmation bias.
I find that anxiety becomes a fear of the future, a fear that the present could not possibly (or will exactly) lead to the future, and a fear that the past has ruined the future; anxiety, today, is a summation of fears.
Let’s talk about what happens when this becomes debilitating.
Let’s first consult the DSM-5:
It states, “Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances.”
Not vague at all, right? You’ll learn much of the DSM is vague and simple in a convoluted way that makes diagnosis tricky: much of it is based on the subjective interpretation of the clinician.
There are 11 total anxiety diagnoses in the DSM-5:
1. Separation Anxiety Disorder
2. Selective Mutism
3. Specific Phobia
4. Social Anxiety Disorder
5. Panic Disorder (with panic attack specifier)
7. Generalized Anxiety Disorder
8. Substance/medication-induced anxiety disorder
9. Anxiety disorder due to another medical condition.
10. Other specified anxiety disorder
11. Unspecified Anxiety disorder
For the sake of the attention span of the average person (including me), we’re going to list the criteria of two of these diagnoses in depth so that you may see how they are broken down.
Let’s run through criteria, and then we’ll talk “causes” and treatment.
For this diagnosis, you must have the following (criteria summarized for all of our sake):
A) Consistent failure to speak in situations where there is expectation to do so, like at school.
B) Interferes with education, occupational, social achievement and communication
C) Lasts at least one month.
D) Not attributed to a lack of knowledge or comfort with the spoken language.
E) Not better explained by a communication disorder and does not occur during the course of autism, Schizophrenia, or another psychotic disorder.
These kids will speak in their homes with their immediate family but not with close friends or second-degree relatives—like grandparents. They “refuse” to speak at school, so says the DSM, although I’d argue it’s much more like an anxious reflex, this coming from someone who had this diagnosis; the anxiety is so severe the only option is for the child to shut down.
This also can include “excessive shyness, fear of social embarrassment, social isolation, and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or mild oppositional behavior.” It is a “relatively rare disorder”, usually appears before 5 years old, but it may not be obvious until the child enters school. The long-term of this disorder is unknown, and “clinical reports suggest that individuals may ‘outgrow’ selective mutism.”
This next line is what happened to me: “In some cases, particularly in individuals with social anxiety disorder, selective mutism may disappear, but symptoms of social anxiety disorder remain.”
Temperamental factors are not well identified. Environmental factors, such as parents modeling social reticence, can contribute to the development of selective mutism. This may include controlling parents or overprotective parents.
Genetic factors: nothing identified.
For this diagnosis, it’s exactly what you think and some of what you may not have thought of. These criteria have a longer list, so I will summarize in a paragraph:
There must be obvious anxiety about social situations when the person is exposed to possible scrutiny of others, like meeting with unfamiliar people. In children this must be observed with peers and not just adults. The person fears showing anxiety symptoms which could be judged negatively. Social situations always provoke fear. In children, this maybe seen as crying, freezing, tantrums. These situations are avoided or endured terribly—very terribly.
Of course the fear must be deemed out of proportion to the actual threat of the social situation. This lasts for six months or more (like my entire life) and influences impairment in social, occupational, and other areas of life. It’s not attributed to substance use or other medical conditions, and can’t be explained with another disorder.
Apparently, “the duration of the disturbance is typically 6 months” and so I would like a refund please—24 years and counting.
It’s seen that individuals with this disorder might be poorly assertive or excessively submissive or even highly controlling of the conversation. They might not use a lot of eye contact—so parents, don’t worry, your anxious child probably does NOT have autism. They may be withdrawn, and disclose very little about themselves, or speak with an overly soft voice.
They may live at home longer.
Self-medication is common.
The median age of onset is 13 years old. If that average were taken with kids also diagnosed with Selective Mutism, the median age, I’m speculating, would be much lower.
Temperament: The trait of behavioral inhibition (shrinking away from unfamiliar situations) has been linked to the development of this disorder.
Environmental: No increased rates of childhood maltreatment in the development of this disorder, BUT maltreatment is a risk factor.
Genetic: Traits, like behavioral inhibition, are genetically influenced. Social anxiety is heritable (NOT inherited). No specific genetic factors have been identified.
What’s the first thing that comes to your mind? Trauma? For those of us who have been ingrained in the mental health system for a while, you might think “chemical imbalance”. Not even the DSM endorses that as absolute. You will find that genetic factors are no where near being identified, much less a chemical imbalance.
When tackling this, we must remember that your genes, your body, your cells, your thoughts, are incredibly malleable. When we talk about “predisposition” in relation to genes, we’re talking about the propensity for them to switch on and off. For example, it seems that some genes are more likely to, in response to a traumatic event, turn on.
Every cell in your body is influenced by your environment. This makes it extremely difficult to confirm what is solid at birth—were you doomed to live with anxiety?—and what is developed after birth. In fact, we may never know.
If you Google “what causes anxiety”, you will be lead to proper links citing similar things as the DSM: personality traits with an unknown genetic basis has a large influence.
If you Google “what causes anxiety disorders”, you will be fed a mix of “chemical imbalance like diabetes” and “stress”.
If Anxiety, or any mental health condition, was a chemical imbalance like diabetes, we’d have a psychotropic equivalent to insulin.
If you search for a similar phrase in psychology databases, you won’t find what you’re looking for.
I managed to find an article entitled “Biological markers for anxiety disorders, OCD, and PTSD: a consensus statement. Part 2: Neurochemistry, Neurophysiolgy,, and neurocognition”. If you are interested in it, I only have access through a database, so I can email you the full text.
This paper from the World Journal of Biological Psychiatry summarizes all the current biomarkers (as of 2017) for anxiety disorders, OCD, and PTSD. They state “none of the putative biomarkers is sufficient and specific as a diagnostic tool, [but] an abundance of high quality research has accumulated that should improve our understanding of the neurobiological causes of anxiety disorders, OCD, and PTSD.” It cites Serotonin precursors, GABA, Dopamine, Neuropeptides, and even Oxytocin the love neurotransmitter.
My criticism for this starts with their PTSD makers. It states: “Compared with control subjects, PTSD patients showed significantly elevated platelet-poor plasma NE (norepinephrine) levels and significantly higher mean 24 hour urinary excretion of all three catecholamines (NE, Dopamine, HVA).” It cites another study as the source for this, which I can’t find yet. What could other factors be for this rise in stress neurotransmitters? My point: you couldn’t possibly pinpoint this particular rise in catecholamines to PTSD alone because we can’t isolate the PTSD from the rest of the body/brain. Take everything with a grain of salt.
Biomarkers are real. We ARE biological beings, and to ignore that would be, well, ignorant. However, the lack of understanding for how our biology transforms through life means attributing brain states to only chemical differences without connecting the body’s experience of physical life is just as ignorant.
So, we ask, are anxiety disorders a chemical imbalance? The answers is: we don’t know. And we may never know.
Medication has been a go-to for years. Benzodiazepines, dangerously addictive and physiologically dependent in a short amount of time (2-4 weeks) do well at cutting panic attacks down for size. Valium, Ativan, and Klonopin have saved me more than once. SSRI’s and SNRI’s, researched for depression and sold for everything else without care, can sometimes help calm anxiety. Lexapro, Effexor, Zoloft, and Trintellix—honestly I couldn’t tell if they did anything at all to my anxiety. But for some people, they work.
Some antipsychotics like Abilify (some, again, sold against the label) are added on to antidepressants with the purpose of easing depression, but can also inadvertently help anxiety and there’s no rhyme or reason for it. It can probably be dedicated to the sedating effect.
Certain therapies, however, have been proven time and time again to be more potent than medication for SOME disorders, and many experiments show a combination of therapy and medication is better than mediation alone or therapy alone. These studies must be scrutinized with care however: some of them have no control group or comparison treatment.
For example, Cognitive Behavioral Therapy has been shown to significantly reduce distress in Panic Disorder and PTSD when compared to medication and no treatment. What will work depends on your willingness to throw yourself into the process. I’ve done much CBT and found that it only started working after I stopped putting off the homework. There are also personalities and onset of the condition that affect this, which you can read about here.
Other treatments are being studied too. We talked about Freespira here, the medication free treatment that is entirely invalid.
There is study going into Chamomile treatment for Generalized Anxiety Disorder. This study concludes there was non-significant reduction in GAD relapse but significantly better GAD symptoms and improved psychological well-being. Part of their funding came from the Nations institutes of health and a cancer center, and the authors have no conflicts of interest. It was a randomized clinical trial. Read it here.
Naturopathic care, including certain vitamins, need more research, but has some success in this article. My criticism is that if the participants were aware that anxiety was being studied, the placebo effect could be huge. I didn’t read through the entire study, admittedly, but if YOU find whether participants were aware or if they were deceived as they should have been, let us know.
If you feel you are struggling with anxiety, please reach out. If you don’t have close friends or family, message me.
If you want to speak with someone anonymously, I recommend Peer Support warmlines. These are not hotlines for crisis, but for meaningful conversation with someone who has been there. There is a list at this link. Those are for California, but anyone can call from anywhere. I’ve spoken to people from England before. You can search for some in your own state or region as well.
If you don’t trust any of those, give us a call at 831-688-0967. We are also a peer warm line service where I work, and have gotten calls from people throughout the country. We are open right now, 24/7. We try and keep conversations to twenty minutes, but I’ve been known to stay on longer if nothing else is going on in the house and the person is really needing support. *I will say I won’t necessarily be the person to pick up. We have other staff members.* If something comes up in the house, our current guests are a priority and we may need to get off the phone.
If you choose Therapy, online or otherwise, is another option. I recommend Psychology Today to find a therapist near you, or your health insurance website.
Your general practitioner may also have suggestions. If you choose the medication route, I suggest researching a good psychiatrist, reading your OWN research, and not allowing your general practitioner to run your psychotropic medication case. They are not trained for that.
Our Mental Health Month Featured story is at THIS LINK: Read about Caz and her journey through anxiety and into a mental health nurse career.
For updates, support, or to submit your story, follow me:
If you enjoyed this post, please share, like, and follow ThePhilosophicalpsychotic. I appreciate every reader and commentator. You give me more reason to continue reporting poorly executed science.
I have some time before work to put out the writing schedule of this months posts, all dedicated to learning more about DSM diagnoses and the research that backs them up (or doesn’t). I’m also asking for people’s experiences so that we may add a personal aspect to all of the clinical madness.
If you want to submit your story (200 words or more), you can find my contact information on my HOME page (click here) or you can reach me on my social media handles (below).
Each post will go live on Thursday, Friday, and Saturday each week of May. The Line Up is as follows:
Week of May 4th: Anxiety Disorders, Obsessive/compulsive and related disorders, and Trauma and Stressor related disorders.
Week of May 11th: Schizophrenia, Bipolar, and Dissociative disorders.
Week of May 18th: Somatic disorders, Eating disorders, and Depressive disorders.
Week of May 25: Gender Dysphoria, Neurodevelopmental disorders, and Personality Disorders.
On Monday, May 31st, we will give a quick summary, explore feelings that may come up, and find ways we can celebrate and inform people about mental health every day, not just one month out of the year.
If you would like to present something 200 words or more, your story will be posted separately from the main article, but on the SAME DAY as your topic. For example, if you want to submit your story about anxiety, it will be posted within an hour of the main post this Thursday.
If you would like to provide a quote or small paragraph (less than 200 words) it will be included in the main post at relevant points.
For both types of submissions, I can link your blog, social media, name, or anything else that you’d like. For longer stories, if you want to write a bio, I will put it at the end of your post.
Please share this information with friends, family, and anyone you feel would want to participate. If you yourself wants to participate, please contact me.
Let’s empower each other and remind the world why we matter.
In honor of May being Mental Heath Month, I’ve decided to do something consistent, informative, and fun on this blog.
During the course of May, starting this week, every Thursday, Friday, and Saturday I will be doing one or two posts dedicated to a diagnostic category. This means we will be covering stuff like anxiety disorders, schizophrenia spectrum disorders, ADHD, Autism, and more.
I notice when people give information about disorders, they limit what they share to symptoms, medications, and the everlasting advice of self-care. This will be covered as well, my sources being my DSM-5 copy. But we will expand on this, address the most recent research articles I can find (and gain access to), and talk about supportive options that vary beyond just medication and doctors. We will address mental health as whole-person health.
I would also like to include personal experiences or quotes from those of you willing to share. This could be a direct quote or small paragraph from YOU that expresses what it feels like to experience living with mental health conditions, or it could be as simple as a list of words describing your experience.
If you would like to do a longer piece (anything above 200 words), I will post that separately, the same day as the other article, and link the two to each other. For example, if your story is about your experience with anxiety, I will link that up with the article talking about anxiety disorders.
You can reach me from my contact page (listed on the home screen of my blog) or you can reach me at my social media accounts listed below. I will also be including some of my own experiences if there aren’t enough people who feel comfortable sharing.
Please share this with someone who you feel might want to participate, or with someone who you feel would like to follow this series throughout this month. We will be learning a lot and challenging the current perspective of mental health.
The goal of this little project is to show the world that we are capable, determined, literate, and worthy human beings, just as everyone else. This is also a way to empower each other and remind ourselves that we are so much more than we give ourselves credit for sometimes. Especially during these times, its important to remember the good about ourselves, about others, and sharing our stories can support us in that.
If you’d like to participate, you can reach me at my social media handles here:
Or click at this link to be taken to my contact page.
Give me an idea of what you’d like to contribute and we can work together in getting your voice out there. Feel free to also contact me if you have a particular category you’d like this series to focus on this coming Thursday, Friday, Or Saturday.
I will also include your blog, social media handle, and/or name (if you’d like) at the end of each article. All articles will be promoted on my twitter handle and Instagram handle.
Thank you everyone. Please share this so we can have multiple voices. Mental Health month is about togetherness, erasing stigma, and uniting as a positive force in the word. Stay healthy, be well, and I’ll see you all on Thursday.
Briefly last week, I considered getting back on medication. My panic attacks have been relentless, my voices have been annoying, my thoughts have been in and out of this world. I went as far as going online to a pain center my previous psychiatrist worked at. She is long gone, but there are other great doctors there, and I have nothing bad to say about this particular institution of health professionals. They were informative, kind, and their offices are quiet, clean, bright, and overlook trees even though they’re one hundred feet from a freeway entrance.
While browsing their website to see if they conducted Telehealth appointments, I found a tab specified for panic disorder and within that tab they listed a new, medication-free treatment for anxiety. Curious, I investigated.
Firstly, Freespira is a breathing trainer. You receive a special Freespira tablet and medical censor that tracks your breathing rate and your Carbon Dioxide output. The hypothesis here is that those of us who panic have irregular breathing patterns even when we aren’t panicking. When we do get anxious, our breathing rate becomes even more so arrhythmic and we aren’t outputting as much carbon dioxide as is healthy. This physiological response cannot be addressed by therapy or drugs, and this is the response Freespira targets. The device teaches you how to regulate your breathing so that you exhale the proper amount of carbon dioxide. Their website says “by training panic suffers to permanently change their breathing patterns, panic attacks are dramatically reduced and, in many instances, completely eliminated.”
This takes a set amount of sessions over the course of a few weeks.
As a desperate panic sufferer, I know all too well of the tingling in the limbs, the racing heart, the feeling that death is imminent. I lost count how many times I’ve went into the ER because my hyperventilation threatened my consciousness. I won’t spend breathless paragraphs reiterating the doctors who accused me of drug use, who almost refused me treatment, who took my blood without consent to test for meth. The idea of an anxiety treatment that doesn’t including putting poorly tested chemicals in my body daily, or risking “as needed” medication becoming “need” medication and eventually, if not severe physiological dependence, than addiction, almost made me cry.
The statistics are promising. Their website states clinical results are as followed:
Protocol Adherence (meaning participants followed instructions correctly): 83%
Panic-Free immediately post treatment: 85%
Panic-Free 12 months post treatment: 81%
Reduction in panic symptoms 12 months post treatment: 94%
A Stanford trial in 2008 showed “positive changes in respiratory physiology, and strong evidence for safety and tolerability”. 68% of participants were panic free, 93% had a reduction in symptoms after 12 months.
Another trial showed similar results, with protocol adherence and freedom from panic ranging from 71% to 88%.
The last study they cite has no verifiable link on google.
These results are pale in comparison to those reflected by drug therapies and every other talk therapy except Cognitive Behavioral Therapy for panic disorders. It is easy, quick, self-administered, and finally puts to use all those breathing techniques you learned that felt useless. Suddenly, they’re not so useless because you have a tablet and sensor telling you they’re not.
I hope you don’t feel as let down as I did.
In my excitement, I didn’t fall blind to the fraudulent world of psychology research. And so, I researched. My first hint that something was off came from the website healthnewsreview.org, a website dedicated to “improving your critical thinking about health care”.
Some of the noteworthy things they mentioned, briefly summarized because I love you guys, are:
1: The cost treatment is not discussed. In 2015, a news story reported the monthly cost as $500.*
2: No absolute numbers are released, just overall percentages states on the website.
3: No mention of what the harms could be, if any, and there were no links to the studies mentioned on the website. We’ll come back to this.
4: one of the most IMPORTANT: Freespira website DOES NOT discuss or post who funded these studies. We’ll come back to this too.
5: No alternatives discussed. I mentioned CBT earlier in this article, as it is one of the leading and most proven methods for treating panic disorder. A comparison is no where mentioned.
*link to the ‘news story’ on healthreview.org
By this point, I’d lost hope.
And so, I’ve done the nice, hard work of finding the studies Freespira reports as their evidence. They did indeed provide citations eventually of their sources, but I could only find them when I switched from desktop view to mobile view. I have linked them above.
Let’s remember How to Read a Research Paper before continuing. I don’t know if this was actually conducted at Stanford, but Freespira lists this citation as the Stanford study they mentioned.
Not Freespira specific, but tested for the effectiveness of capnometry-assisted breathing therapy, the type of device freespira is purporting to be.
Methods and participants: 37 participants, 31 with panic disorder and agoraphobia, 6 with panic disorder and NO agoraphobia. 20 were randomly assigned to the treatment, 17 were wait-listed as a control group. Recruiting happened with community advertisements. You can read the study for more in depth description of the participants.
Treatment: educating patients on breathing, showing them problematic respiratory patterns, having them perform breathing maneuvers with feedback, teaching ways to control carbon dioxide levels, and having them practice breathing exercises daily. Twice daily, 17 minutes, at home. Read for more in depth description.
Results: Low attrition (drop out rate). 40% experienced no more panic attacks during the four weeks. 2 month follow up, 62% had experienced no further attacks, and 68% were panic free at 12 months. This shows brief capnometry breathing therapy can be therapeutic. Improvements were seen in the treated but not untreated participants and success improved as time passed. Non-respiratory mechanisms, such as treatment rationale (meaning they told the participants the point of the study) let the patients develop cognitive components needed to avoid catagstrophic thinking and gave patients a sense of control–one thing we lose in panic attacks. The breathing exercises triggered sensations similar to those we experience in panic attacks, and desensitization may have occurred to the bodily clues rather than respiratory changes being the sole drive. Need future studies testing viability (success of the treatment).
Limitations: The first thing you learn in an introductory research course is that when you are studying treatments for mental health disorders, you can’t simply pair the treatment with an untreated population. In order to test for something like viability, you need to compare your treatment to other treatments. This study did not do that, and lists it in their limitations section.
This study was supported by the NIMH.
Methods and Participants: Primary diagnosis of Panic Disorder, 18-65, moderately ill or greater based on the Clinician Global Impression Scale, and were off medication or had been stable on medication for 3 months. Conducted at multiple non-academic clinical sites with different clinicians at different levels of expertise.
Procedure/Treatment: 4 weeks. Breathing sessions 17 minutes long with baseline stage (sitting quietly with eyes closed for 2 minutes), a pacing stage (monitoring of Carbon dioxide levels with breathing at a specific rate for ten minutes), and a transition stage (patient maintains breathing pattern with feedback for 5 minutes).
Results/discussion: 20% dropped out. Significant decrease in panic disorder severity over four weeks, early identical results to the previous study. Patient compliance was high as well as patient satisfaction. This treatment can be made largely available at a low cost. Side effects were rare, like mild dizziness or lightheadedness in the beginning training sessions.
Limitations: Again, no control group, not even a wait list. The study itself says “these results cannot be considered a definitive documentation of efficacy”, but instead “extends [the previous studies’] findings to document feasibility and utility in more naturalistic treatment settings.” It discusses no alternative reasons for why they may have seen significant results and a decrease in panic symptoms.
This study was funded by Palo Alto Health Sciences, the developers of Freespira.
Several of the doctors on this so-called study have received research grants and/or consulting fees from PAHS and Merck. This is listed as the Conflicts of interest. For obvious reasons.
Results show the need for many, many more studies, but no real evidence of efficacy.
Try at your own risk. Especially if it means you’re paying out of pocket.
If you go in thinking it will work, it will probably work. if you go in remembering this evidence, it probably won’t.
If you have tried Freespira and it worked for you, leave your experience below or message me and let’s write about it! The same applies for if you have tried Freespira and it hasn’t worked for you.
Also, notice the degree of ethical practice reduces when the study is funded by the developer of the treatment. Keep that in mind for when we discuss the studies of psychotropic medications.
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It’s another day in global crisis, my friends, and this has afforded many of us with much more time on our hands than we’re used to. For some of us with mental health problems, the loss of our routine and the possibility of even more financial hardship means certain destabilization.
While reading the Tao Te Ching today, I came across a beautiful quote I wanted to share with my internet community.
In olden times, the ones who were considered worthy to be called masters were subtle, spiritual, profound, wise. Their thoughts could not be easily understood. Since they were hard to understand, I will try to make them clear. They were cautious like men wading a river in winter. They were reluctant like men who feared their neighbors. They were reserved like guests in the presence of their host. They were elusive like ice at the point of melting. They were like unseasoned wood. They were like a valley between high mountains. They were obscure like troubled waters. . . we can clarify troubled waters by slowly quieting them. We can bring the unconscious to life by slowly moving them. But he who has the secret of the Tao does not desire for more. Being content, he is able to mature without desire to be newly fashioned.”Tao Te Ching, Lao Tzu
We are in the middle of raging rapids. Waves crash, destroy, but they also whisper. We are bound by this eternal gravitation between the Earth, the moon, and the rate of our spin. We can hold water behind a dam, we can melt ice and let sea levels rise, we can trap it in a pool, we can let it evaporate, but inevitably it falls back to earth. We can manipulate its form, but never erase it.
Let’s think of distress in a similar fashion.
I don’t know how you’ve been during this pandemic. I don’t know how your anxiety is, your depression, your voices, your self-esteem, your confidence, your happiness, your family, your pets. (I’d love to know though, leave comments below if you’d like to share, or meet me on Instagram). I know that I personally have braved waves of panic attacks, nights of voices telling me I’m dying and that I don’t exist, trying to trick me into separating from the panic of today. I’ve faced a sense of hopelessness, financial burden, and fear for my parents, one of which has several serious physical underlying health conditions. There’s been days I switch between so many states of emotion that I didn’t have the strength to walk four feet to the bathroom.
Whether you’ve experienced similar things or you haven’t, I urge you to practice yielding judgement of this moment, this very second, as you read this. Let’s not avoid the anxiety, the stress, or the pain we may be in. Let’s not fill ourselves with meaningless distraction. Lets not cling too desperately to the sparks of happiness or joy as if we’ll never experience them again, or as if we’re uncertain when we will experience them again. Let’s instead acknowledge the importance of all states, unified, and accept this moment for what it is.
In this moment, I feel the pain of my back injury radiating down my right thigh. I feel my head resting against the soggy cushion of this couch. I feel the stress of bills tightening my shoulders, where I hold a lot of my tension. Anxiety is cold in my feet. There is also contentment and acceptance. With all these things, I let them be. I don’t seek ways to eradicate the physical pain. I don’t fluff the couch cushions, I don’t scramble to straighten out finances. I’m not warming my feet. I’m not questioning my contentment or acceptance.
It’s not irresponsible to breathe in the moment and accept horribleness for its unique horribleness, or euphoria for its lack of insight. This is not a time to tear yourself apart. This is a time to remind your mind and body that they are a stronger force together than separate.
This moment is one among trillions. Celebrate that. There will never be another like it.
Be well, friends. Practice good information hygiene, and take advantage of as many resources as you can. Volunteer what you can, donate what you can. You’re only as healthy as your sickest community member.
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Some more thoughts to share, friends. Let’s talk psychoanalysis, the locked ward, and entropy.
No, we will not spend countless paragraphs discrediting psychodynamics and psychoanalysis. The facts are there: Freud’s systematic hypotheses were circular, full of confirmation bias, and untestable. This makes his ideas of Psychoanalysis quite useless, inherently flawed, and simply unscientific. However, modern psychodynamics has come a long way, and if you’ve ever read The Center Cannot Hold, by Elyn Saks (if you haven’t, READ IT!) you know that one of therapists which helped her through her cognitive dysfunction pre-hospitalization was indeed a psychoanalyst. Her therapist often took Elyn’s discombobulated words and reflected them, unbiased, nonjudgmental, back to Elyn. This doesn’t happen often anymore, especially not in hospitals, and we lose this understanding that psychosis is not necessarily meaningless. This idea that it may have meaning is derived from psychoanalysis itself, which is rooted in Psychic Determinism: every thought, action, personality quirk, is there for a reason; nothing is ever accidental.
Anyone who says it’s impossible to communicate with someone in psychosis hasn’t really tried. There was a time I did a regular outreach group at the local psychiatric hospital, in which i’d been as a patient before, and there were often people in my group who were by clinical definition incomprehensible. Sometimes people would wander from the group or I’d end early and someone would want to keep talking. To the average person, and I’m sure many of the workers there, the babble was pointless, but there was one particular man who sought me out every time he saw me. And when he said something like “There isn’t anyway to know the ticking and I don’t know where my home is but I know there’s some fact in that”, I’d say something like “it’s hard when we feel lost and can’t find home” or “there’s a lot we can know in the world, and not know”.
This wasn’t easy. I stumbled a lot over my words, trying to keep up with his thoughts, and maybe nothing I said ever resonated as clearly as these words are registering to you as a reader. I wouldn’t know, I’ve never had someone approach me in this way during my worst moments. But it did something. Sometimes the group was just us, and we’d talk like that, back and forth, for fifty minutes. He’d always shake my hand before I left, and this was one of the people the staff “warned” me about, said he could get unruly, loud, disruptive, and although I can never confirm the way I spoke with him as a clear reason why he never appeared aggressive with me, I can say that our conversations were always even tempered, relaxed, human.
I do not advocate for this as the ONLY form of treatment. Acute episodes are terrifying, traumatic, confusing, they require many things. But staff shouting, tackling people, and being argumentative doesn’t reduce the terror, the trauma, or the confusion. I CAN say that.
So, there are positive things to come out of the idea and possibly the practice of modern psychoanalysis and psychodynamics. Let’s be clear though: Freud was wildly inept as a scientist. All of his hypotheses were derived from case studies and never tested with experiments or even standardized self-report data.
Scrolling along some text in my personality book, some reading for classes during COVID, this author caught my attention when he compared the natural course of entropy in the universe to the entropy of our thoughts. Essentially, entropy focuses on how ordered systems, over long periods of time and inevitably, tend toward disorder. Freud had a similar sense about the mind, says this author, and insisted that we attempt to order our thoughts and lives for the sake of our own creativity and growth. Entropy dooms these efforts.
Freud describes his philosophical understanding of his own hypotheses in terms of libido (NOT just sex drive, but a life energy) and thanatos, (not Thanos as I had read, but a drive toward “death”). Libido described one part of the brain designating energy for a process, and in that time such energy could not be used anywhere else in the brain. We know this not to the be the entire story now. Thanatos was not a wish for death, or a fear of it, but was this very recognizable, a very EASTERN idea that everything contains its opposite.
This is essentially a less developed, disorganized form of YinYang. It’s presented in the textbook as quite a novel idea. But Eastern cultures and indigenous cultures across the globe, have held this collective understanding for centuries. Reading philosophy on the duality of life is what helped me come to terms with my psychosis. Freud didn’t do it first, I promise. If anything, he was super late to the party.
He called his version of YinYang the “doctrine of opposites”. While I refrained from rolling my eyes at this, his “doctrine” maintains that everything requires and implies its opposite. That is, life needs death, sadness needs happiness, and one cannot exist without the other. If you’re curious how this really lines up with YinYang, I’d recommend getting in touch with someone who knows this philosophy well, or reading the basics in this post here.
Why is any of this relevant?
I think what I learned, and am still learning, is that pain is not as simple as we want it to be. There cannot be pain without no pain, and there cannot be no pain without pain. You can’t fix your thoughts with medication, therapy, electric shocks, substance abuse. You can’t be broken without also being together. Unifying the good and the bad, not separating them, not fighting with one over the other, has been the key to many of our successes.
You cannot be ill without also being well. That is the message here. If you identify with mental illness, then you identify, also, with mental wellness; there is harmony in the illness, and disharmony in the wellness. We see this often: there are advantages to being anxious sometimes. For me, I know my anxiety makes me more prepared during stressful events. Because i’m panicking all the time, I don’t panic when others do. I’m often a voice of reason. There are disadvantages to being happy: for me, I get wary of this gentle contentment I’ve come to over the years, because of the imminent threat of not being happy again.
A lot of people view that latter statement as a struggle particularly of clinical depression or bipolar. I don’t see it that way anymore. I recognize that is the duality of things: there is inherent unhappiness in happiness. That’s the nature of things.
Labeling the thoughts as defective is the result of the depression, and part of the struggle. Accepting the truth in pain and the dissatisfaction in wellness is recovery.
What do you think?
Curious about research, news, and a community dedicated to “Eliminating Barriers to the Treatment of Mental Illness”? Check out TreatmentAdvocacyCenter.org for more information, as well as support for COVID-19. This post isn’t sponsored by them, I just stumbled across their site and found it highly useful.
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