Posted in advocacy, Community, psychology, science

Mental Health Month: Anxiety Disorders

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.

What Is Anxiety?

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.

What Is An Anxiety Disorder?

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)

6. Agoraphobia

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.

Selective Mutism

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.

Social Anxiety Disorder

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.

So What Causes Anxiety Disorders?

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.

Anxiety Disorder Treatments

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.

Where Can I Get Help?

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:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

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.

Posted in advocacy, Community, Peer Support, Supporting Friends/Family, Voices

The Line Up for Sharing Your Story this Mental Health Month.

Hello friends!

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.

For submitting your story:

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.

Social Media:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

Let’s empower each other and remind the world why we matter.

Posted in advocacy, Community, Peer Support, Voices

Share Your Story

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:

Instagram: @written_in_the_photo

Twitter: @thephilopsychotic

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.

Posted in advocacy, Late Night Thoughts

Psychoanalysis, The Locked Ward, and Entropy

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.

For updates on posts, research, and conversations, follow me:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue this joyous hobby.

Posted in advocacy, Community, psychology

Friends, Let’s read

Hello friends, it has been some time.

Writing has been difficult. I hope everyone is staying healthy, safe, and inside their homes.

For those of us with mental health issues, all the panic, the uncertain information and unpredictable future can exacerbate our mind-states. If you are feeling effects from the global death, the misinformation and poor leadership (in some places), know that you are not alone. Many of us are feeling this. We are experiencing a collective trauma. Think of this as beautiful: we are stuck getting through this together as the economy flip-flops, healthcare becomes a war zone, and our sick family members and friends fight for their lives.

It’s obvious we lack some scientific understanding, as I mentioned in my last post, and that becomes scarily evident with the orange, diseased walrus in office (here in the U.S) barking empty threats to pull U.S funding from the WHO, lying about the amount of PPE and testing kits available, and tossing around ideas of re-opening public spaces against medical advice.

In the mean time, though, I browse mental health support pages on Instagram because they are recommended in my feed or I find them through other mental health connections I have on the app. It still baffles me that those of us who advocate for each other aren’t educated in the science of the brain. It’s great that we are experts in our own experience. It’s great that we leave space for others to be experts in their own, and don’t push drugs or not-drugs as an agenda. But how can we do that if we aren’t pulling from both sides?

Science and personal experience are how we exist in the world: our brains react to biology and environment, and both influence each other. Genes play an almost negligible role when it comes to the deciding factors of someone developing mental health symptoms, and yet we still push this idea that things like schizophrenia are inherited. They are not: schizophrenia in particular has a high level of heritability, meaning it swims around in the general population’s gene pool, and you are more likely to develop symptoms as a result of genetic chance than you are receiving it from your parents.

Now, before you say “well, I know that my mom. . .” or “well, my friend’s dad had schizophrenia and he does too . . .”, remember that your personal experience, or your friends’, are not common enough to generalize. Please stop.

As for environment, genes turn on and off in reaction to what the body experiences in this physical world. Brain structure changes. Trauma reroutes cells, wilts some, builds some in different, non-beneficial places. At the end of this pandemic, we will see noticeable changes in society and in the people living in areas hit the hardest. In the United States, New York healthcare works in particular may not be the same. In Italy, those who have been quarantined with the dead bodies of their relatives will not be the same. Trauma will change how they see the world, politics, life, friendship, and in their healing process they will learn new things, understand new things. Some will be okay. Others will not. And this variety of reaction is a testament to the way environment shapes us.

When we, as advocates, focus on spreading this disingenuous positivity, this overly positive positivity, as I call it, and we forfeit spreading facts, we are only harming our own cause. So, in light of that, I’ve been reading some research. Sleep is one thing I struggle with, and in my three-am database search for an interesting read, I came across this article here.

I had had access to a full text version, but right now can only link the abstract. If you have access to pubmed, or found it somewhere else, let me know.

But this article states they’ve found a consistent decrease in melatonin across those diagnosed with schizophrenia. Their participants had already been diagnosed and were not on antipsychotic medication (YES that is a possibility for some). Antipsychotics did not increase melatonin levels when introduced.

Nine people is a poor amount, and not very indicative of the population of us, but I assume a bulk of participants were just not available: how many do you know diagnosed with schizophrenia have the ability to take on their journey without meds? Not many.

This study however, has implications for how sleeplessness could be treated in patients with schizophrenia. What this also reveals is that the sleep you get from your antipsychotics (and I remember mine fondly, because I got LOTS of sleep, and I hadn’t had much in a very long time) is not restful. It’s more like a heroin knock-out, and less of your body’s choice.

Assessing those who were not on antipsychotics allowed these researchers to see a natural reduction in melatonin, not linked to the psych-drug usage, and although we could never say for certain that schizophrenia is the cause, the implication is there. What could be other reasons for the melatonin decrease? Perhaps large doses of antipsychotics when hospitalized had rerouted these patient’s melatonin years before, although unlikely considering doses of these antipsychotics int he experiment did not decrease levels of melatonin further. Perhaps their bodies adapted over the years as they got less and less restful sleep because of their symptoms. Perhaps their pineal glands had always secreted a low level of melatonin and THAT contributed to the development of their symptoms. We could hypothesize for years. We have been.

If you have something on the spectrum of schizophrenia, how would you rate your sleep? I rate mine poorly, particularly in times of stress. It takes me longer to fall asleep and it’s harder to wake up. I also attribute some of this to screens and my incessant need to play video games.

That study was from 1997: there may be updated research on this, or conflicting research. If you’re feeling lazy during quarantine, sad, anxious, scared, whatever your emotion, maybe some good old boring, informational research on schizophrenia could pull you out of your funk. It’d help your advocacy, too.

Also, welcome to the load of new followers I’ve received over the last few weeks. I promise I am much more consistent with my writing than I have been these last two months. Feel free to browse the blog for great past posts like this one about positive thinking and this one about supporting your loved one.

Be healthy, be safe, be mindful.

For updates on posts, research, and conversations, follow me:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue this joyous hobby.

Posted in advocacy, Peer Support, Supporting Friends/Family

About Mental Illness

I recently learned in a personality psychology course that the effect size in regard to how much words make a difference to people is very small. I’m currently trying to find studies which either argue for or against this, but in the meantime I decided I’d write a short blurb about it.

I’ve found nothing becoming about the term “mental illness”. It feels defaming and self-deprecating. I don’t really consider myself disordered and I’ve been ambivalent about the term schizophrenia and schizoaffective. And if I find these studies accurate, verifiable, and reliable, than I suppose none of this really matters.

I’ve been hung up on it since I was 14. In the CCMD, one of volumes, I remember reading schizophrenia was labeled as “Integration disorder” or something similar. I read a lot of books describing mental struggles as strengths, describing medication as poison, describing this idea of “illness” as bad. I agreed, and to some degree I still do.

But I’m learning to drop the words, really. It’s not about what you want to call it. Call it Schizophrenia, call it Integration disorder, call it Mental Illness, Disorder, Disease (even though there’s not enough actual scientific evidence to prove the disease part), call it whatever you want to call it because regardless we’re all talking about the same experiences. We’re all talking about the same pain, the same beauty, the same horror, the same frustration. The issue comes when people internalize the concept of illness.

The issue comes when someone loses sight of the rest of their future because they’re being told they need to take medication for the rest of their life and they can’t work, they won’t be normal, and everything has to change now–for the worst.

This is a problem because us humans are infamous for letting go of alternative possibilities when we’re provided an answer. This happens to be scientifically proven.

What I mean is, if our answer is: “take meds for the rest of your life”, our brains don’t automatically respond with “I need to find some stable ground, heal myself, and maybe find a way to not take so much medication/taper off. Or maybe I won’t. I need to explore all my options”.

When the answer is: “you’ll have this for the rest of your life”, our brains don’t automatically respond with “I may have this for the rest of my life, I also may not. What are other options?”

No, we say, shit, I have to take these meds. If I don’t, I’ll be unwell again. This is my life line.

We say, shit, I’m doomed. This has ruined my life. There’s nothing I can do.

Sometimes life experiences and therapy and friends and support forces help us see that our life isn’t ruined. Sometimes we can get off medication, and sometimes we can’t. What’s hard for me to swallow is that a lot of us don’t ever get to the point where we can consider either point of view. What’s hard for me to swallow is that when we try and advocate for each other, we do so from the perspective of “illness” instead of “wellness”.

We glamorize this idea that “I live with a mental illness and I’m doing well.” We have that weird AA group mentality of powerlessness. Studies show AA is actually quite ineffective and having been in both AA groups and Al-anon, I find them very cult-ish. I’ve also met countless people who have been saved by AA, NA, and other support groups based in “higher-power” thinking.

But essentially, if all our power comes from us being powerless, then we’re not actually powerful. We’re not anything really, but a pawn. A puppet, maybe. We let ourselves be pulled by the strings of our “disease” or disorder and we find no other avenues of compromise because we are powerless. Sometimes we feel because we made a choice to be powerless, we are empowered. Other times we argue against this adamantly, that we “manage” our illness, and “we don’t let it control us”. But the thing that all these black and white views have in common is fear. The fear, and knowledge, that we can’t control anything.

Why do we need to? That’s the question I ask everyone who presents me with this argument. Why is control even an aspect here? When you are in a healthy relationship or friendship with someone, and you have a disagreement, do you let them decide everything for you, your thoughts and feelings, because you’re powerless against them? Do you shout back and yell and scream and punch them? Hopefully not! Hopefully you don’t engage in either activity. Hopefully you engage in compromise.

When you’re in an unhealthy relationship, if someone is abusive, the partner often submits, terrified, hopeless in an uncontrollable situation. I am guilty of trying to force my thoughts and my mind into submission: I abused myself. My mind is guilty of trying to trap me in madness; my mind abused me.

But if we can engage with compromise with others, if we can strive for balance, if each person can have equal say and equal pull, if I can influence my mind and feel safe allowing my mind to influence me, then the issue of power and control is eliminated. We are free.

Is the healthy opposite of not being able to control anything absolute submission? Is the healthy opposite of powerlessness absolute power?

And so I don’t subscribe to the concept of being mentally ill. I accept that I experience moods and delusions and hallucinations indicative of what we’ve categorized as schizoaffective. But I am not a pawn. To be submissive, to feel I either need all of the control or I shouldn’t have any control, is ill to me. And so I don’t consider myself ill.

I’ve tried very hard to avoid the term “mentally ill” because of this. But hearing about these studies and their small effect size has got me wondering if any of it really matters. It’s got me wondering if the actual concept of mental illness can be looked at differently now.

It’s got me wondering if we will ever get away from this “sick not weak” hashtag.

It’s got me wondering if we will ever see ourselves as having potential for balance, for real vitality again, for health and wealth, without also having to mention the name of our disorder.

I honestly don’t care if you’re a writer with schizophrenia. I just care that you’re a writer, and a damn good one. I care about what you write. I care that you’re living well and are happy. If you have schizophrenia, great! If you don’t, great!

Let’s empower each other’s wellness, not our illness.

PS: I never said this was a site of popular opinions, or popular science.

I stray from popular for a reason. Popularity usually invalidates authenticity.

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Posted in advocacy, science, Supporting Friends/Family, Voices

Hearing Voices: Internal versus External

Something people who don’t hear voices misunderstand about hearing voices is that it’s not like sitting next to a party of five in a restaurant where you can generally tune out all the giggles and unrelated conversation and focus on the person in front of you. It’s more like that party of five arranged their chairs around you and take turns commenting on your posture, your date’s violent sexual thoughts, your wants you didn’t know you had, while also occasionally blurting a sentence that doesn’t make any sense, like “put that burrito on reservation.”

My point here is that ignoring it isn’t always the easiest or most necessary option. And to understand why this is a fact, we need to understand a little more about this.

Some people are really obvious about their inner experiences. They’ll be talking out loud or gesturing to no one. They might be laughing or crying or whispering. This is what scares people, both people, and what can make getting acquainted with our voices such a daunting experience; we’re aware (some of us) how we appear and that judgement is enough to warrant withdrawal. This tends to make things worse.

But let’s be clear: screaming at yourself at 3am probably isn’t the best way for your roommates to get to know you, nor is it a good way to get to know your voices.

It’s kind of a novel idea, to promote the “getting to know” process of things that don’t exist. But they do exist; they speak, they can have names, we can even have images to describe their non-existent physical features. They may not exist for your little brother or your mom or dad, but they exist for you and that’s still valid.

Psychiatrists and therapists aren’t trained in helping you with this process because school will tell them not to entertain delusions and to teach their clients how to cope with voices by ignoring them. This may be helpful for the clinician so they have a reason not to feel guilty when their client doesn’t remarkably improve, but it’s not always helpful for the client.

Ignoring needs to happen sometimes. But as a primary coping mechanism it sucks.

And so there’s something called “dialoging”, which I didn’t know about until attending a hearing voices workshop put on by the Hearing Voices Network. This is essentially someone on the outside speaking with your voices, getting to know them, their motives, their personality, and validating their existence. It’s for the voice hearer as well, so they can participate in a conversation instead of a shouting match. Because, again, what happens when you shout at someone? They shout back.

It’s also a common misconception, especially in clinical practice, that everyone who hears voices hears them externally.

I read a report of an experiment which examined this. They say that external voices have always been thought to represent more “severe” psychopathology, and to be more common, but that “empirical evidence has been equivocal”, meaning ambivalent. You can read for yourself at this link.

To summarize their study:

  • Some people experience only internal (coming from inside the head) voices
  • Some people experience only external( perceived as outside the head) voices .
  • Some people experience both.
  • In 1996 it was thought external voices were more severe. This project suggests, from observations, that internal ones can be more “disturbing, negative, persistent, involving, and commanding”.
  • Voices commenting and conversing observed (reported as) more internal.
  • “…no differences have been identified between internal vs. external hallucinators in other symptoms or levels of overall psychopathology.”
  • Another study, (cited Stephane et. al 2010) “found that schizophrenia patients with only internal hallucinations performed more poorly than those with only external hallucinations on an internal ‘say/think’ source memory task, suggesting that internal hallucinators may be less able to discriminate between internal versus externalized stimuli…”
  • Those with internal voices were observed to have more insight into the self-generated nature of their voices.

Why is any of this important? Well, it’s important for clinicians to read these kinds of findings and realize that experiences vary, and that one-shot generalized treatment WILL NOT work.

But it’s also important for those of us who do hear internal voices. First of all, it’s validation. Maybe you’ve been disregarded in the mental health system because your experience is perceived as “lesser”. Remember when we talked about the Soggy Boxes and the hierarchy of the mental health system? If you don’t, take a quick read at an older post of mine entitled The Soggy Boxes and The Variation of Us.

I’ve personally been reluctant to ever tell anyone about the internal half of me, because I knew the standard the system held. I also didn’t know they were voices. I did, but I didn’t.

So all this really does is remind us how different and similar we can be with each other. It also proves that the stale mental health system needs to readjust its understanding of life, of humanity, and experience in order to catch up with where we are. They’re behind US. It’s not the other way around.

If you are struggling with this currently, I’d encourage you to reach out to someone you can trust. If you trust no one, find the person you can trust the most. If you know someone who has been through similar things, reaching out to them may be the most helpful. If your options are limited, feel free to email me (info here). People seem to like connecting on Instagram better lately, so you can also reach me via my social media handles (info below).

People are fearful because they don’t understand. The nice thing is that there are many people who will make an effort to understand if you can have the patience to teach.

If you are a voice hearer and are comfortable with sharing your experience, pop it down in the comments below. If it’s a long story and you’d like a guest blog post spot, contact me! I’d love to feature your story on here.

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Posted in advocacy, science

How Important Are Your Psychiatric Medications?

This question is for all of us, including myself, without much judgement. There are those who quit their medication and are fine, those who quit and are not fine, those who want off but are worried about withdrawal (which can trigger an upswing of serious symptoms again), and there are those who want off but their doctors disagree.

For those with any diagnosis related to psychosis, one thing you’re told especially is to stay on your meds. The reasons for why are a little less clear. This is what research says.

The Papers:

I found two articles on this topic, both Meta-Analysis (they’ve collected a group of studies and used statistics to quantify the average results of all the studies)

They both discuss studies assessing whether long term antipsychotic treatment maintains sufficient and healthy remission for individuals experiencing first-episode psychosis. There are two conclusions you will often find when searching databases for this kind of research: 1) long term medication works and 2) long term medications interferes with progress. One of these analyses kinds of lands in the middle, and the other is 100% supportive of medication.

We’ll discuss possible reasons why both valid analyses come to such different conclusions, and what this means for us.

1. Maintenance Antipsychotic Treatment Versus Discontinuation Strategies Following Remission From First Episode Psychosis: Systematic Review.

This analysis follows studies which look to understand the risks of maintenance (Long-Term usage) compared to risks of discontinuing medication AFTER remission in first episode psychosis. Seven studies were included.

Now, they looked for specific things, particularly comparing hospital relapse rates and hospital admission rates of those First Episode Psychosis individuals who maintained antipsychotic medication to those who were discontinuing their medication. For the studies which used an intermittent treatment approach, the participants medication was discontinued by 50% every two weeks. For those exhibiting prodromal symptoms, medication was reintroduced. In the crisis-based approached, medication was only reintroduced upon a full-blown episode.

Ultimately, higher relapse rates and hospitalization rates were seen in those discontinuing medication.

Two of the studies provided information on psychosocial outcomes like employment status or quality of life measurement.

I encourage you to read the analysis for yourself. I found it shocking that things like an individual’s place in society, their level of function in their community, their sense of purpose, the amount of support available, was not included. Yes, medication discontinuation seems to increase the likelyhood of relapse according to this analysis, but what could be the reason for this? Only medication? Or what about lack of support? What about the fact that tapering off medication with 50% of the dosage broken down every two weeks is indeed quite fast? Perhaps the speed effected the results of that one study.

Another rather glaring fact which makes me worry for the integrity of the analysis is the possible bias of the authors. One of them recieved support from Janssen-Cilag (think Haldol) and Otsuka Pharmaceuticals (think Abilify). This author also was an investigator on trials funded by AstraZeneca (think Seroquel) and Janssesn-Cilag. He holds a Pfitzer (think Prozac) Neurosciences Research grant.

Another author received sponsorship from Otsuka to attend a conference, and has shares in GlaxoSmithKline (think Paxil) and AstraZeneca. The last author attended meetings supported by Sunovion Pharmaceuticals (think Lunesta).

The only inherent problem with this is conflict of interest. There are times many researchers have been caught falsifying data or misreporting data with the agreement that they would get paid extra by the pharmaceutical companies funding their research. This is also common in the world of regular medical science and was particularly a catalyst for the Opiate Epidemic. Think Purdue Pharma.

This is the largest issue medical science faces today.

2.Improving Outcomes of First-Episode Psychosis: an Overview

This overview looks at possible prevention of psychosis, which is curious in itself. You can read in the paper all the different steps and stages they present which could, with further study, advance the way psychosis is treated and/or identified in an individual. They acknowledge that despite all the preventative strategies currently in place, often people will fall back into old symptoms following their first episode.

They updated a 3-trial meta-analysis to 12 trials and found that relapse rates while undergoing preventative care strategies were, on average, lower than relapse rates of those undergoing standard treatment. However, they found that there was no substantial meta-analysis support that showed integrative preventative strategies significantly improved anyone’s potential rate of relapse in comparison to a standard level of care.

They also found that the hypothesis that each new psychotic episode “damages” the brain or is “neurotoxic” to the brain and therefore “progresses the disease” has no significant empirical evidence to support it. This hypothesis is known as the “neurotoxic hypothesis of psychosis” and I’ve heard people cite it quite often.

The overview goes on to discuss future studies and cannot conclude that any one way is the correct way. They advise against using certain medical strategies that observe and study physical illness to observe, study, and treat mental health conditions; the brain varies more so than the body in more ways than one, and to assume that both can be treated equally is pretty far fetched.

There is a lot of theory in this overview and I’m not sure how much of it could be put into practice. They discuss some ways in the article, if you’re interested, including areas of support. Accordingly, their authors were not previously supported by any pharmaceutical companies.

And so where does this leave us? We have empirical evidence that medication can halt a crisis, but it is unclear, according to the second study, if we’re simply prolonging the inevitable or helping cease the progression of something. In the case of prolonging the inevitable, it would seem more humane to let people ride through the torture and support them in other ways. In the case of ceasing the progression of something–well, it seems like we’d have more reliable and verifiable data if that were the reality.

I stopped medication because I don’t like uncertainty. And the truth of medication is uncertain. I stopped medication because I don’t like being lied to. And much of medication research and marketing is based in lies, even small ones.

This may not be the path for you. What makes your medication important to you? What makes it torturous for you? Do the risks outweigh the benefits? Would you like to discontinue them some day?

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Posted in advocacy, Community, Emotions, Voices

The Power Of Un-Positive Thinking

I profess that I am not the type to belt out cheesy posts. I don’t put cheesy one-liners on Twitter, and I don’t post mushy paragraphs on Instagram. I don’t spend a lot of posts talking about the bad things about schizoaffective, or what kind of medications I’ve taken. It seems that a lot of people think that’s what advocacy is about, though: cheesy posts about staying positive, the struggles of living with a mental health condition, and stressing the importance of medication.

It gets boring.

And so I’d like to challenge everyone in the mental health community. I’d like to challenge this belief that in order to lift each other up, we must constantly mull on our struggles so that others can reach out and spurt lines of hope we won’t believe in. I’d like to challenge those advocates who don’t have any experience with having a mental health condition but still insist on belting out “you can do this” posts every five minutes.

The thing about negative thoughts is that pelting positive thoughts at them won’t change the negative thoughts’ status. They will still be louder, they will still be heavier, and they will still be more constant. It’s kind of like trying to tear down a brick wall by chucking oranges at it. It would take millions of years to make a dip.

Sometimes it’s just not enough to wake up in the morning and tell yourself the day will be good. Sometimes it’s not enough to remind yourself that life is grand, even when you feel the opposite. Sometimes it’s not about thoughts as much as it is action.

And so I wonder how many of us have given negative thoughts a chance? Have we tried observing the pain when we wake up in the morning and not placing judgement on the thoughts (or voices) that tell us we’re worthless or useless? When the pain runs deep, have we tried breathing it in?

The way to take power from negative thoughts isn’t to replace them with positive thoughts. It’s to show them that you are not submissive. That doesn’t mean arguing or fighting with yourself all day. Save some of that energy. It means accepting their negativity, accepting the struggle, and moving through it not with the intention of “reaching the other side”, just with the intention of braving the moment.

All we really have are moments. They’re brief, seconds long, maybe nanoseconds long, or maybe it’s physically impossible to quantify them. But they are all we really have. And so the pain in that single moment is very real, but beyond that there is nothing else. Before that, there was nothing else. We experience time in a linear fashion, which means existing second by second, moment by moment, feeling by feeling, and so although it seems like pain strings along for years, that’s really just an accumulation of painful moments.

We observe time passing like bullet points in an essay. The only difference is the document is read-only, and there’s nothing we can edit. And so we read each bullet point and we get a feeling from it, we experience that one bullet point, and we move on to the next one.

But in life we get caught up in one bullet point and suddenly every bullet point reads like that first one. We can’t edit, so we feel helpless, and we can’t stop reading because life doesn’t stop moving. We can’t change how we feel about the pain and we can’t change the nature of the pain. The only thing we can change is our reaction.

And so I encourage all of us to be compassionate to these passing moments. They’re stuck to you as much as you are stuck to them. The more time we spend hating these moments, or running from these moments, or arguing with these moments, is just more time not spent living the way we’d like.

There’s no easy answer for living with a mental health condition. There’s no magical pill, there’s no magical therapy, and there’s no magical, positive quote on Twitter that will cure you. Life has pain, life endures pain, and pain isn’t a disease you can cure. So that one account you follow with 30 thousand followers that spouts out ropes of sticky, cheesy, positive one-liners is disillusioned. It fills people with this false sense of hope that if they just think positively long enough, something will change.

That’s just not how life works. I suppose the internet is quite infamous for distorting reality.

We shouldn’t run from pain. We shouldn’t fight it or disregard it or try and shove it away in a corner to rot because it will never rot. It’s non-perishable. When we speak about our experiences, let us talk about the negative and positive equally. Let us share things in a way that inspires hope not because our story concludes with general well-being, but because we’ve learned something from it, because we’ve discovered this balance in life that’s required to exist. Let us inspire people through our bravery in embracing pain and not just through our ability to share what’s happened to us. Let us empower each other through our confidence in living life as everyone else, not just through our living life while diagnosed.

Many of us write about mental health. I encourage all of us to scrutinize how we present our material, who we follow, who we re-tweet, or re-post. I encourage us to evaluate what our goal is in our advocacy work.

There is no right or wrong way to share your life or to lift people up. But some ways are productive and some get dull after a thousand re-tweets.

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Posted in advocacy, Freedom, Peer Support

When We Can’t Stop Thinking

People say secrets keep us sick.

I’d like to relate this to mental health, but in order to do so, we must read this post with the understanding that I don’t consider our experiences a product of illness or an expression of a sickness. We also must assume this only has to do with secrets in-part. So I suppose it has nothing at all to do with that saying.

What I’m getting at is that there are things we do for ourselves that exacerbate or substantially perpetuate our experiences, and there are things we do for ourselves that foster alleviation. Identifying these things is one of the best ways to care for yourself.

For example, diet plays a huge role in my mental wellness. In one of my most upsetting states, I was eating over 200 grams of sugar a day, an unknown amount of fat, and at least 200-300 grams of carbs. Alongside antipsychotic medication, my weight ballooned. After getting off the medication, radically changing my diet, and implementing a structured exercise routine, my depression lifted for the first time in my life, my anxiety lessened, and heavy psychotic experiences were less frequent.

If I skip meals and eat foods rich in sugar or carbs, my experiences worsen again.

Some of us don’t realize what we put in our body effects our mental state. Some of us know, but struggle in the transition. Some of us just don’t want to transition. None of those ways are right or wrong. But they have different consequences.

Some people have learned to take care of themselves through other peers, others with lived mental health experience. I mention this specifically because it’s what I attribute a lot of my own learning to, and also because it’s part of awareness and advocacy; we’ve been on that kick for a couple days now on this site.

What I’ve noticed is that telling your story can be both freeing and suffocating. There are some people who are able to write a blog about themselves, or speak about themselves, or start a small non-profit advocacy program and live a healthy life. There are others who do the same, but are engrossed on the internet and social media, who tell their story so much that their entire life is dedicated to mental health.

I don’t think that’s a bad thing, either. But what I notice is that it doesn’t seem healthy for everyone. I think it becomes detrimental when all you talk about is your bad days, or your good days, your experiences, what makes life difficult, and all these things that only serve to remind you how different and/or limited you are. The more that mindset is fed, the less life is lived.

What I mean by that is when you separate yourself from the whole of society, in a good way or a bad way, you start forgetting you’re apart of that society.

I remember being so engrossed in my depression and anxiety, before I experienced any altered states. And it wasn’t just the experience taking up all my time, because depression and anxiety are both all-encompassing, but it was the fact that I spent all my time thinking about both. I’d think about it in a positive light too. I’d blog my experience and talk to others about it; we’d relate and it was a positive moment in a lot of darkness. But it kept my thoughts trapped in this bubble.

People also like to say in mental health that “We are not our illness”. Again, assume that for this post, and for any post on this site, I do not adhere to the terminology “illness”, “disorder” or “sickness”, but the fact is if you spend all of your time talking about your experiences, in a positive or negative light, you are basically your “illness”.

NOT being your “illness” would entail you living life. It would entail you understanding that yes, sometimes things are hard, but that doesn’t make you special.

That’s another thing about certain advocates. Everything is about mental health–everything. Why focus so much on the hardships? Why not focus on the things you’ve been able to do because you’ve gotten support and found a healthy path? Why not show people what they could potentially do were they to also find their path? That would encourage me, at least. What doesn’t encourage me is people saying #depresssionfeelslike.

I gained a lot of freedom from getting involved in other things besides mental health and from hanging around friends without mental health struggles. Every once in a while I’ll talk about things, express views, but I do it at appropriate times and if people are willing to hear.

Sometimes people think I don’t blurt my diagnosis or experiences because I’m ashamed. Really it’s because I’m not a sum of any diagnosis or any experience. I don’t need to say, “yes I graduated with schizoaffective”. I just graduated. And that’s the whole of it.

Travel. Show yourself you can do something unrelated to the terror in your mind. Volunteer. Find a passion. Reignite a passion. Meet people. If people are too much, maybe a hobby. I’ve had to push myself away from reading fiction books with mental health characters because I want to remind myself I’m still in the world, even when I feel like I’m not.

I want to remind myself there is so much more out there than what’s just in my head.

I think we often forget that.

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