Posted in advocacy, Community, Late Night Thoughts, Peer Support

Your Role In The mental Health System

This is to all my fellow psychology majors, graduates, and future students. What do you believe your role in the industry is?

To all my fellow mental health consumers, what do you believe your role is?

These are the two simple questions I have. I’ll share mine, and I ask for you to share yours in the comments below!

I am both a major and a mental health consumer, but both roles have shifted dramatically. I thought my role as a worker was to help people. I thought my role as a mental health consumer didn’t exist; I knew I struggled with anxiety, but I believed it was just another hurdle to get over, and I’d gotten over many hurdles before.

I learned my role in the industry as a worker wasn’t to help people, and that people are mostly capable of helping themselves. My role was one of support and guidance so that they may discover what they are capable of. My role has also shifted recently in this aspect. My schooling has shifted from the goal of counseling psychology to the goal of research and clinical education. I know I want to be one to bring science and empirical data to the forefront of the industry. All this glorious information is sitting there wasted because clinicians don’t take the time to read it, and because the system is built in such a way that paying for training and education is ridiculously expensive for clinicians. Research is becoming more biased and doctored and that’s obviously a problem too. I want peer support integrated. I want evidence-based treatment properly understood.

My role in the industry as a consumer has changed as well. It’s bounced back and forth between dependent and utterly independent. It’s bounced between needing professionals and shunning professionals. It’s bounced between feeling hopeless and feeling as if I’m finally healing. I also have learned that my role includes reaching out to others, accepting their help, while also letting others reach out to me.

I look forward to reading your thoughts below.

Or, catch up with me on:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you liked this post, please share and follow The Philosophical Psychotic. I appreciated every reader and commentator. You give me more reason to encourage critical thinking about mental health.

Posted in psychology, science

Mental Health Month: Personality Disorders

Hey everyone. Welcome to this hour of Mental Health Month. Upon checking my notes, I realized I’ve completely skipped the week of the 18th, where we cover Somatic disorders, eating disorders, and depressive disorders, and went straight into the last week which covers Gender Dysphoria, Neurodevelopmental disorders, and personality disorders. So, I’m switching things around a little.

Yesterday we talked about Gender Dysphoria, the meaning of tolerance, and the realities of biological humans–that is, a brain can indeed develop specifically toward a different sex than the sex of the body. Today, we’re going to talk about Personality Disorders. Tomorrow we will cover Substance-Related and addictive Disorders. The following week will be Somatic disorders, eating disorders, and depressive disorders. We will include Neurodevelopmental disorders on the last day of the month so no one feels left out.

If you want to share an experience you’ve had with any of the above conditions, or even ones we’ve already talked about, feel free to contact me here or on my social media (profiles below).

Now, we come to my favorite section of the DSM-5, with one of the only disorders that has been characteristically diagnosed unreliably–that is, psychologists often come to same conclusions on other disorders but can never quite agree who has this one– and with little to no genetic influence detected. I’m, of course, talking about Borderline Personality Disorder. We’ll get to that shortly. 761

Because personality disorders widely controversial, the DSM constructs this section completely differently. First they describe personality disorders, clinically, as a discrepancy between a persons inner experience/behavior and the expectations of their culture. This is stable over time and generates impairment.

Then, they mention because of the “complexity” of the review process (this is a fancy way of saying because research that correlates these labels with “disordered brains” are inconclusive and scarce), they have split the personality disorder section into two. The second section updates what was in the DSM-4-TR, and the third section has a “proposed research model” for diagnosis and conceptualization.

Personality disorders are separated into clusters still. Cluster “A” disorders are:

Paranoid Personality Disorder: this includes someone with a “pervasive distrust” of others. People’s motives are perceived as malevolent and the individual has a preoccupation with doubts about people’s loyalty, and trustworthiness. There is a constant level of perceiving personal attacks where attacks are not intended and believe that others are exploiting them. This cannot occur during schizophrenia or any other psychotic disorder, including Bipolar mania. They may, however, experience brief psychotic episodes that last minutes or hours. I’ve always thought of this disorder as a miniature schizophrenia.

Schizoid Personality Disorder: This one is actually less harmful in terms of relationships because the person does not form close relationships and has no desire to do so. Not quite sure why that’s a problem. But, they have restricted range of expressed emotions and chooses solitary activities. They may be indifferent to praise or criticism and has a flattened affect. I’ve always thought of this disorder as the negative symptoms of schizophrenia, plus one.

Schizotypal Personality Disorder: This includes issues with close relationships as well but includes cognitive distortions, ideas of references but NOT delusions of reference, odd beliefs, bodily illusions and odd thinking. Paranoid ideation and constricted affect are also included. This cannot occur during the course of other psychotic disorders either, and is probably more of a mini schizophrenia than Paranoid Personality. People often seek treatment for the anxiety and depression rather than their thoughts or behaviors and they may experience psychotic episodes that last minutes to hours.

Cluster “B” Personality Disorders are the ones everyone wants to get their hands on.

And by hands on I mean “grasp an understanding of.”

And when I say Cluster B personality disorders, I really mean just the first two. The others no one seems to mention very often.

Antisocial Personality Disorder: This is not sociopathy. Sociopath isn’t even the correct word. Psychopath is. But that’s not who these people really are. We’ll talk about The Dark Triad next month. It’ll be great fun.

Those diagnosed with Antisocial PD do share some things with clinical psychopaths though, and that is their unyielding disregard for other’s natural rights. This includes breaking the law remorselessly, lying, conning, and being otherwise deceitful for fun or personal gain. It also includes impulsivity, aggressiveness, disregard for other’s safety, and irresponsibility. People must be 18 years old before this diagnosis is concluded and must have evidence of a conduct disorder before 15 years of age. None of these criteria can occur during schizophrenia episodes or bipolar episodes.

Borderline Personality DIsorder: This is the controversial one. It’s described as instability of relationships, self-image, and affects, with a sprinkle of impulsivity and efforts to avoid real/imagined abandonment. Individuals may also be impulsive with self-damaging activities, like reckless driving or spending, binge eating, substance abuse. There may be reoccurring self-mutilation and emotional instability around irritability and anxiety that lists a few hours and rarely more than a few days. Feels of emptiness, intense anger, and severe dissociative symptoms may also occur.

The dissociative symptoms should give a clue to what is one of the number one correlations with this disorder.

75% of diagnoses are female. And with every clinician learning that statistic, more females are likely to be diagnosed with it than actually have it. Across cultures as well, according to the DSM, it is often misdiagnosed.

Histrionic Personality Disorder: Not a commonly heard one, but in reading the description you might think you know someone with this personality type.

These individuals are attention seeking excessively, and very emotional. They need to be the center of attention and are often seductive. They have rapidly shifting expressions of emotions and their speech lacks detail. Everything is a theatrical display.

Narcissistic Personality Disorder: The second of the Dark Triad, which we will talk about next month. This is a pattern of serious grandiosity, fantastical or in behavior, and a need for admiration. There is a severe lack of empathy and these individuals generally want to be recognized as superior without reason. They are obsessed with fantasies of unlimited power, love, beauty, and success. An individual may believe they are inherently “special” and are insanely entitled. They are arrogant and envious.

50-75% are male. Again, these numbers also make it more likely they will be diagnosed with this.

Cluster C Personality Disorders are on the softer end of the spectrum. Softer not in intensity, but in personality. These are the people certain Cluster B types would take advantage of easily.

Avoidant Personality Disorder: This is someone who feels inadequate and hypersensitive to criticism, so much so that they avoid anything that may make them feel inadequate. This includes social gatherings, work, and any other interpersonal situations.

Dependent Personality Disorder: These individuals have a pervasive need to be taken care of. This may lead to serious submissiveness and clinging behavior. They fear making others feel bad, and so they will not disagree with people. Initiating projects on their own is hard, and seeks another relationship as comfort when another relationship ends.

Obsessive-Compulsive Personality Disorder: This is kind of like the umbrella diagnosis of OCD, but more inclined toward only orderliness, perfectionism, interpersonal control, and lists. They really like lists, rules, and organization. Money will be hoarded in case of catastrophe and they may be inflexible about morality, ethics, and values.

There are other personality disorders that may be due to medical conditions or are unspecified/otherwise specified.

What’s Up With Borderline Personality Disorder?

Well, what isn’t up with Borderline Personality?

It’s been the hot button in clinical psychology because of the intensity of emotions these individuals feel. It often results in some psychologists refusing to treat people diagnosed with these conditions. Two out of my six therapists have told me some version of a “horror story” of an anonymous someone diagnosed with BPD who stormed out of an appointment or blew up in anger and then stormed out of an appointment.

I feel this attaches a very negative connotation to this set of experiences. Everyone expects the outbursts, the sudden changes, the unruly emotions, and so when they happen it’s just more affirmation that the individual is out of control. Self-expectations and other’s expectations can play a huge role in behavior, even in those with this condition.

The problem is, psychologists actually really struggle in diagnosing this. Back in my research course I learned that studies showed psychologists are quite confident when they make the diagnosis, but when other psychologists evaluate the same patient, they often don’t come to the same conclusion. This is in comparison to someone with narcissistic personality disorder, where most psychologists came to the conclusion that that diagnosis was fit for that person. This could be for many reasons: the background of the psychologist, the presentation of the person, the interpretations of the psychologist. It could also be, though, that this condition presents varying experiences and that makes it harder to recognize patterns.

Borderline Personality usually comes with a decent set of childhood trauma. This article from 2017 talks about how childhood trauma can affect biological systems that are then connected to the development of borderline personality. This article from 2014 talks about Complex PTSD (which is not a DSM diagnosis) and Borderline personality. CPTSD overlaps a lot with Borderline, and so these researchers question the scientific integrity of CPTSD and the role of trauma in BPD.

It could be that we’ve had it wrong this whole time, that BPD is not in fact a personality “disorder”, but instead a trauma response condition. This switch would require absolute links between BPD and trauma, the likes of which would match with PTSD, and right now we have no absolute links for any mental health anything. So let’s not hold our breaths.

The point is, the experience of BPD are very real. The label and possible cause mean nothing when someone’s life is turned upside down, when relationships are constantly crumbling, when someone blames themselves constantly for “not being normal.”

Let me re-frame: the possible cause is important in the sense that it could change how treatment is approached. But it is not more important than affirming people’s experiences. Right now treatment for BPD includes therapies in which the individual learns to recognize, label, and acknowledge when their emotions are exaggerated, and medications normally meant for other conditions. There are no medications registered solely for the treatment of BPD.

People often see this as a hopeless diagnosis. Because of this, I encourage people to read personal stories from people diagnosed with this condition so you can see that many of these individuals are creative, vibrant, determined, beautiful people in many ways. There’s one personal story and one more here to get you started.

What’s the Difference Between Antisocial Personality and Psychopathy?

Well, one’s in the DSM-5 and the other is a checklist, for starters.

Psychopaths often lead pretty normal lives. The likelihood that you will see them in a therapists office or in the cell of a jail getting diagnosed with something is very, very slim. They are charming people, do very well in life, and no, they are NOT only serial killers. That’s romanticized Hollywood bullshit. They will manipulate, remain remorseless, and often create an abundance of wealth for themselves. C.E.O’s can score quite high on the psychopath checklist.

People with Antisocial Personality have trouble leading normal lives and can find themselves in trouble. They may be erratic and rage-prone, which can catch quite a lot of attention.

Criminals, like gang-members, are not necessarily psychopaths or antisocial. The DSM mentions that Antisocial may be misdiagnosed if someone is fighting for what they believe to be is their survival. Often gangs are comprised of people who feel close to the other members and consider them family, people who believe they are fighting for “the principle of the matter”, for honor, for integrity, for power. They know their lifestyle inflicts violence and fear, but believes there is no other way to live. They are willing to die for their street family.

That is the opposite of antisocial. It is criminal, but not abnormal given the circumstance.

Some people with antisocial personality are also psychopaths. Some people who are psychopaths are serial killers. Both overlaps are rare.

You are safe.

If anyone watches SBSK on Youtube with Chris, they did an interesting interview with someone diagnosed as Antisocial. You can watch it here. Again, sociopath is a clinically incorrect term.

Please. Stop using it.

If you want to share your story this month, here are my social media links:

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 encouraging critical thinking about psychology.

Posted in psychology, science

Mental Health Month: Dissociation

As promised, here is last weekend’s OTHER Mental Health Month post. Tonight we’re talking about Dissociative Disorders.

You all know how this works: we talk about what the manual classifies as disorders, then we talk about the experiences. If you would like your mental health story (substance use and LGBTQ+ also!) shared on this site for Mental Health Month, contact me here, or reach me on my social media (linked below). People have seem to like reaching out through Instagram, and I enjoy talking with people. Feel free to contact me just to chat–that’s what’s been happening most recently.

Let’s dive into it.

Like Bipolar, this section is concise in the DSM-5 and tied deeply to studies in cognitive psychology, especially when it comes to the controversy of repressed memories. You’ll recognize the first diagnosis:

Dissociative Identity Disorder: This is not a light diagnosis to come by, although it has a wild history of it’s introduction into mainstream mental health. Formally known as “Multiple Personality Disorder,” DID is characterized with identity crisis. This means someone’s personality states are split into two or more, and can affect memory, behavior, perception, cognition, and other senses. This can be reported by others, or noticed by the individual themselves. Gaps in memory of trauma or everyday events may be obvious. This, obviously, must cause severe distress. We’ll talk more about this below.

Dissociative Amnesia: This is also related to trauma. The individual will be unable to recall autobiographical information related to a trauma or stressor. This is not the same as being stressed out and forgetting your keys. The forgetting must be above and beyond that of ordinary memory decay. This can be with or without dissociative fugue.

Depersonalization/Derealization Disorder: Depersonalization is feeling detached, or outside of your body observing your thoughts, feeling, and bodily sensations. Things feel unreal, your self is absent, and your sense of time is distorted. Derealization is a detachment with respect to what is around you: objects, people, feel unreal, wrong, or are distorted. You do not leave reality but this does cause distress and impairment in everyday life.

Other Specified Dissociative Disorder: Mixed symptoms of the above types.

Unspecified Dissociative Disorder: People experience characteristics of the above, but none of it meets the full criteria. Again, your normal is disordered.

Is Dissociative Identity Disorder Real?

This is the big question everyone asks.

I don’t refute people’s experiences. If someone tells me they have 25 different personalities, I’m not going to sit there and tell them they don’t; I’m not inside their body or their brain, and I haven’t lived their life. And it seems in the science community that experiences aren’t being question either, but rather the onset of symptoms comes into question. So, let’s talk about what we DO know.

  1. People are distressed by these experiences. Some lose control of their lives, bounce between hospitals, treatment centers, group homes. People are reliving traumas in their body and their mind. This is not a joke.
  2. Repressed memories, since their conceptual birth within Freudian times and psychodynamics, have never had any real conclusive studies. Behaviors can be studied of course; biological responses can be studied, of course, but whether or not someone’s memory is correct cannot be studied. If you ever take a cognitive neuroscience or psychology class, you will learn that memories are reconstructive. That is, our brains put memories together as we remember them. They are not snapshots of the past. We retain central ideas and key themes, but we will not remember incidents or scenes as they are. Flashbulb memories, those that are caused by sudden trauma, have been shown just as unreliable as our regular memories. Researchers have actually seen this process; new neurons branch and stimulate growth as we remember something–they are not pulling from neurons that are already there. Memory is not as simple as it seems and research on repressed memories is inconclusive.
  3. DID has a bad wrap. It got a bad wrap from people across the country back in the day opening treatment centers, holding people who are struggled with some sort of mental distress in their lives, tying them down, and telling them they have different people living inside of them. These centers were eventually disbanded for fraudulent billing (they got a lot of money for this breakthrough treatment) and got ousted as a cult. They kept people from their families, told them their families were the ones who had abused them, and ruined a lot of lives. It took years for those people to get real trauma therapy and realize their identity was intact. There’s a documentary on one of these centers that I watched in my Research course least year. If I find it, Ill post the link. The concert today, though, is whether this kind of literal brain washing is still happening.
  4. Planted memories are a little more solid than repressed memories. Again, our memories are reconstructed upon remembering, so it’s been shown that people are inclined to fill-in-the-blanks sometimes, remember something that was there that wasn’t.

So, in the spirit of respecting those who know this to be their experience, and also respecting cognitive science which shows it may be possible to create these personalities in therapy, I looked up an article that compared the two causes of DID: Trauma Or Fantasy? I can’t link the study because I downloaded it from my school’s database, but if you’re interested in reading it, contact me.

Researchers compared four different groups: Genuine DID diagnosed individuals, DID simulating individuals (people acting), people with PTSD, and a healthy control group (“healthy” meaning unaffected by a condition). Long story short, results showed that those in the Genuine DID group were not more prone to suggestive memories nor were they more likely to generate false memories. There are some limitations with this study, one being that it was a small group of people and that their malingering results came back inconclusive; I didn’t see them list any reasons for this. They used reliable and valid testing measures, but didn’t experiment, which is a big problem if they’re really trying to challenge the fantasy model of DID.

The point of all this scientific arguing? People’s experiences are people’s experiences. I honestly don’t care if a therapist put it in your head or if you actually went through a horrific trauma. The point is you’re distressed, you’re suffering, and no one needs that in their life. As far as experience is concerned, DID is as real as any other condition.

Does Your Trauma Need To Be Severe?

This is a hard question. When it comes to DID, it’s highly unlikely those series experiences are going to come after something like your verbally abusive dad. I’m not saying it can’t, we don’t know everything there is to know about the brain or how it processes things that harm us, but it is unlikely. However, derealization and depersonalization are common in people with anxiety and PTSD.

My second depersonalization episode happened when I was 15. I remember (and there’s a chance I’m remembering incorrectly, remember?) sitting in the passenger seat of my mom’s car as she drove me to school. I usually rode my bike or walked, but it was raining particularly hard that day. I felt myself floating, my spirit, and I was leaving my body. The inside of the car didn’t feel real, my arms didn’t feel real, and the experience of life wasn’t real. I told my mom, I said, “see, there it is again, none of this feels real. The car doesn’t feel real. It’s weird.”

I don’t remember if she said anything. But from that point on, dissociation became synonymous with living for me. I walked across four lanes of traffic and the three miles home with friends shouting at me, shaking me, calling my name, and I was lost in a void. I don’t remember them shouting at me. I don’t remember them touching me or that I’d narrowly escaped death. What I do remember is blackness. Becuase that’s all I saw.

It wasn’t painful.

It felt ethereal almost. I’d shed my physicality. I’d shed my ego, my anxiety, my worry, my fear. I’d shed my anger, and I had a lot of it back then. I’d shed my need for escape. I’d shed my uncomfortable reality. And, as strange as this sounds, it felt damp and warm, the blackness did. I couldn’t feel it how we feel, say, water on our skin, but I felt it in a purely infinite, internal sense. I felt spread across eons and for the first time I felt complete.

In our world, we diagnose this as dissociation, but I have not been convinced. This felt like I experienced raw life, real life, what we are outside of these meat sacks. But that’s a whole other conversation.

I remember walking through the door of my apartment and my dad asking me how school was. That, and the void.

I was never sexually abused or physically beaten to the point of hospitalization. I’ve never been in a car accident or a house fire. By big trauma event standards, I’m pretty low on the scale. I have endured repeated emotional and verbal abuse, some physical violence, homelessness, schooling terrors, and an alcoholic/drug addict parent while growing up. There are painful memories and a lot has stuck with me. So, the answer to the above question is, no. If something hurts you, your body and mind respond in the best protective coping mechanisms it can. Sometimes it needs to yank you out of the physical world and remind you who you are.

Does Excessive Day-Dreaming Count?

By DSM standards, no.

But, if your day-dreaming becomes so distracting that you find yourself struggling day to day, it’s worth talking about.

Thank you all for coming down this road with me. Mental health isn’t just my job or my personal affliction, it’s also my passion to share my experiences and knowledge, and to be apart of this kind of writing community. I am terrified of speaking and haven’t yet climbed over that hurdle, so writing is the next best way for me to be active in mental health advocacy. Thank you for being there with me.

This Thursday, Friday, and Saturday, we will continue with Gender Dysphoria, Neurodevelopmental Disorders, and Personality Disorders. If you have a story you’d like to share with me, here are my social media handles. *Feel free to just chat with me, it’s been great getting to know all of you* My email info is linked above as well.

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 promoting critical thinking for all.

Posted in psychology, science

Mental Health Month: Bipolar

I have been bouncing back and forth between what is healthy for my future and my present. They are often in conflict. We experience time linearly, but our choices can take us in spontaneous, curved, spiked, and winding direction. All of that contemplation has only landed me here. So, as promised, here is last weekend’s Mental Health Month post. We will continue with Dissociative disorders tomorrow evening. On Thursday, Friday, and Saturday we will talk about Gender Dysphoria, Neurodevelopmental disorders, and Personality disorders.

You know how it goes: we list the different diagnoses, what the manual thinks, and then we dive into the experiences. Today we’re talking about the Bipolar spectrum. If you have experience with Bipolar or any other altered state, including substance use, contact me here, or on my social media (below) to get featured.

Compared to the exhaustive lists of other diagnoses, this section is relatively concise. Most people are familiar with all of the terms listed below:

Bipolar 1, which is characterized by it’s key diagnostic criteria: a manic episode. This includes abnormal levels of euphoria and agitation. It will usually be obvious when someone is not themselves. they may be talking extremely fast, floating enough ideas to make your head spin, and getting a lot of things done–at least until things start not getting done. It’s stated that if you experience this while receiving any type of antidepressant treatment (including ECT) and this state persists, you can be diagnosed Bipolar 1. I’d personally like to see the studies that proved these states weren’t caused by the treatment being received, but of course that will never be possible. Take it with a grain of salt, people. Mania can elevate paranoia and distrust, and present confused, racing thoughts. It takes some time to be able to distinguish this state from an acute psychosis state related to schizophrenia.

After this extreme state, Hypomania (a lesser form characterized by an elevated mood, increased energy, inflated self-esteem and the likes, lasting for most of the day, most days of the week) may or may not occur. Depressive states may occur as well, in which a person cannot function, drowns in hopelessness, and lacks energy. In the same way that people who hear voices can miss their voices if a treatment “takes them away”, those with mania may experience a feeling a loss when stuck in a depressive state, particularly when it’s related to medication treatment.

Bipolar II is the next diagnosis. So, imagine constant, and sometimes severe depression, with a sprinkle of hypomania. You need to meet the criteria for hypomania at least once to be considered Bipolar II. Even if you never experience Hypomania again, or someone misdiagnoses your happiness amid all your darkness, you will have the brand of Bipolar II. Often the Hypomania does not impair the individual.

Cyclothymic Disorder may not be too familiar of a term, unless you’ve been diagnosed with it. This is when your Hypomania doesn’t match the criteria for hypomania, and your depressive symptoms don’t meet the criteria for a major depressive episode, for at least two years. Basically, if you’re more happy than usual, but not too happy, or more sluggish than usually, but not entirely hopeless, you’re also disordered. These symptoms must be present at least half the time, and for that 50% of those two years, if you don’t experience being a little too happy and a little too sluggish for more than two months, you’re just normal I guess.

I do not say with this condescension. I have no idea if Cyclothymic disorder throws people out of their normal routine or how it affects their life; I don’t have this. But if you read the wording in the DSM-5, it’s what I said above, without words like “basically.” It SOUNDS very much like they’re labeling normal states as disordered, particularly when they say “well, if you don’t meet the criteria for any symptoms, you’re still sick.”

While looking up some studies about Cyclothymic, I found that Schizothymia is also a thing–not a diagnosis, but a thing. It essentially embodies the “temperament” required to resemble that of someone with schizophrenia, without actually meeting the diagnostic criteria. So, again, normal but still disordered. Schizothymia has yet to make it in the DSM. It’s only a matter of time.

We can guess what Substance/Medication-induced Bipolar and Related disorder is. What’s highly interesting is that if your “bipolar” is activated by Alcohol, Phencyclidine, other hallucinogens, stimulants, cocaine, or sedatives, then you fall in this category. If it’s caused by an antidepressant or E.C.T., treatment that makes money, you don’t. I don’t suggest taking cocaine in place of your antidepressant, but I also recognize there are overlapping neurochemicals involved when we compare street drugs to legal drugs.

You can also have Bipolar and Related Disorder Due to Another Medical Condition, and Other Specified and Unspecified Bipolar and Related Disorder.

If you feel I’ve been tough on this particular category, I have. Wording matters. Wording is what gets people proper and improper support. Wording is how we start to internalize the views of ourselves. Wording is how others see us. Wording is everything. If you’re a studious kind of person, or already in the world of academia, I’d recommend taking a DSM critique course. They rip this manual apart. If not, give the document a read for yourself; it’s in PDF form across the internet and there are available copies in bookstores. If you are unable to separate your own experiences from the diagnoses though (that is, you can’t read one without going OMG I HAVE THAT), maybe just read some articles on critiques.

To get you started, This article is about how much influence pharmaceutical companies have in the revision and editing process. It’s scary. Again–you have substance-induced Bipolar ONLY if your drug of choice is illegal.

What Does Mania/Hypomania Feel Like?

I remember being manic. It’s been categorized as an acute mania, but I remember getting at least a few hours of sleep each night and my functioning wasn’t so impaired, so I’m more inclined to believe I attract the Hypomanic bug. I honestly don’t care, I just know I was managing a 4.0 average across semesters, taking Chemistry, Physics, Calculus, Psychology and Philosophy. I was happy. Very happy. I tackled five classes a semester, spent a lot of time out in the middle of the night, in my car with friends or my boyfriend, and I knew that I was special–beyond special. All of my ideas in science, in philosophy, had never been thought of before and every night I knew the next day brought fame.

My senior year of high school, and my first couple years of college–before I started working at Second Story–I tumbled through a lot of these mood shifts. A lot of my suicidal thoughts and actions, and self-harm, came as a result of these shifts, and so the Mania or Hypomania may not always cause the most damage. Sometimes it’s the aftermath, the picking up the pieces, the coming to a realization that something isn’t going right, that can impede wellness. I did not take care of myself, physically, mentally, every way, nor did I know what that was. I went through medications and doctors and therapy and sometime after one of my more serious depressions, the voices became more prominent and–well, the rest is history.

My experience in many ways pales in comparison to what some people go through. If you haven’t read the book “Mental: Lithium, Love, and Losing My Mind” by Jamie Lowe, I suggest giving it a read. She chronicles her journey fluently, and you get a sense of just how intense and fundamentally altering mania can be.

Many people get a sense of when a manic episode may be near, and this is just one story.

Is Bipolar a Throw-Away Diagnosis?

I believe a lot of descriptions of experiences should be thrown away, but Bipolar is not one of them. Mania can slam the breaks on people’s lives. Hospitalizations become traumatizing. People lose their career, their happiness, their stability, their wealth, their trust in themselves, their families, their possessions, their freedom, their understanding of what life is. All of it can be gained back, one way or another, but the act of starting over sometimes feels like an insurmountable obstacle.

Believe it or not, Bipolar 1 and 2 are quite over diagnosed, and ironically the over diagnosis causes stereotypes and expectations in a clinical setting which, in turn, fuels more incorrect diagnoses. For example, the night I was transferred to the psychiatric hospital over the hill, as soon as they learned I hadn’t been sleeping well–I hadn’t been up for days, I just had trouble sleeping more than a few hours, due to anxiety, panic, voices, and the feeling of being hunted–they diagnosed me Bipolar 1.

When I was released to the hands of the county here, I was interrogated with questions I can barely remember answering. I was still kinda gone, pretty sedated, and confused. The social worker acted more like a detective, or a doctor trying to figure out if I was actually in pain or just wanted opiates. Well, what do doctor’s usually assume? That you’re just trying to pop a pill. What did this social worker assume? That my diagnosis has been bogus because “they always throw that diagnosis at people, it’s a throw away diagnosis”.

That’s what he told me. He said I didn’t need any help and through his line of interrogation concluded my state was a result of marijuana. I had told him I’d smoked two weeks prior, but it had been over a year. As I said, I was gone, had no sense of time, and again slipped through the cracks. I also hadn’t been in contact with many people, my parents were still unsure of what was going on, and my boyfriend who came with me wasn’t allowed to say anything. It felt like I had to make a case in front of a judge without a seasoned lawyer, while hoping for my conviction.

In short, Bipolar is not a throw away diagnosis. People’s experiences are real, they are intense, scary, and incapacitating.

Why Are Manic Episodes confused with Psychosis?

Because they present similarly, and the wording to diagnosis either of these states is vague compared to the amount of variety in symptoms. For a proper separation of diagnoses, the key is to wait. Watch how the state presents itself, how it reacts to what medications, what kind of services, and how is the person after they are more lucid. Are the paranoia and hallucinations persistent without the lack of sleep? What level of insight does the person have to their experiences?

Although not much is known about psychiatric medication, I cannot deny the fact that there are people who are helped a great deal by it, including myself at one point. Sometimes we have data on medications that work better with some diagnoses compared to others. Mood stabilizers may not affect someone with persistent psychosis, and that can help rule out Bipolar 1.

This process is similar to when someone is on a substance, like amphetamines. Once the drugs are out of the person’s system, you observe their behavior and see if the temperament and experiences persist.

What is Helpful?

Two things are very important if you deal with any kind of mood fluctuations, but particularly if you have a bipolar-type condition: sleep and routine.

One thing that made doctors notice I had a mood issue was the fact that I wasn’t consistent in anything that I did, especially taking medication. I’d go on it for a few months, feel well, balanced, and annoyed by the medication side effects, and I’d stop cold turkey. I’d feel okay for a couple days, and then spiral, usually into a depression or severe agitation.

Having a routine includes being consistent with medication: this is true even if you decide to stay off of medication. Forcing your body through the process of adapting to medication, juggling brain chemicals, and then having to re-adapt when you stop isn’t good for your mind or your biological systems. If you choose to stay off medication, what are your limits? It may sound crazy, but mine is hospitalization; if I get hospitalized or feel myself moving toward the idea of voluntarily committing myself, I need to get back on medication. Neither has happened yet. If you choose to stay on medication, what are your limits? Do you believe you will have to stay on them forever or are you open to the idea of working toward getting off of them?

Having a bedtime and morning routine can help develop that stability. Having a set time to sleep and wake up, having rituals even (shower, teeth, pjs, a good book) can aide in that process. It’s important to note that this is not to make you feel “normal”. This is part of self-care. It’s not about being like everyone else, or wanting to feel like a “normal person”, it’s about being healthy and learning what you need to stay well.

And that takes us to sleep.

Get it. It’s important.

Medication is helpful for this in many respects. One thing I miss being on medication is how I got 8 hours of sleep every night, to the second. My body just instinctively took on this role of: wow, my brain has slowed down, I don’t have as many distractions and the sun is going down, you should probably start winding down. Melatonin and chamomile tea can help accentuate this if your normal medication doesn’t quite do the trick. Be wary of sleeping aides like Ambien.

Staying active and nutritious will also help your body get back into the natural sleep-wake cycle. No one will kill you if you have one of those chocolate pies or a doughnut, but if your diet is perpetuated with processed sugars, heavy carbs, and un-nutritious fats, sleep will be hard to come by. Exercise stimulates many different hormones and chemicals in our body, the same ones some psychiatric medications attempt to promote, so adding in a routine if you don’t already have one can dramatically affect how you feel in yourself and about yourself.

These are important for everyone, diagnosis or not, but especially important with a diagnosis. Wellness does not come from one branch on a tree. Wellness is the tree, and its branches are things like exercise, nutrition, attitude, outlook, worldview, medication, physical health, productivity, e.t.c. The more branches, the bigger the tree.

Thank you all for the Instagram messages and for reading this blog. I’ve been so incredibly happy to see that so many viewers are enjoying this content. Tomorrow we will talk about Dissociative Disorders. If you have a story to share with me, or you want to put it on this blog, please reach out to me via my contact page ( linked above) or my social media:

Instagram: @written_in_the_photo

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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 Uncategorized

Mental Health Month: Update

I really tried all I could to finish up my articles for this weekend but it looks like Bipolar and Dissociative Disorders will have to be pushed back to Monday evening and Tuesday evening, assuming I don’t work late on Monday.

If you’re wondering, I am still a student and have a couple finals and a paper to finish. I was at work yesterday too to help hire some people, and I needed some extra self care these last two days.

We will still cover those two diagnoses and continue on the regular schedule next week.

Thank you everyone who has been reading, following, and reaching out to me on social media. If you are interested in sharing your story for any part of Mental Health Month, I welcome all experiences. Please contact me on my social media:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

OR reach out to me on here via my contact me page.

Thanks everyone! Enjoy your weekend.

Posted in psychology, science, Voices

Mental Health Month: Schizophrenia

*This is a post dedicated to my Mental Health Month series, where each week we talk about different diagnoses, share stories, and ways toward wellness. Tomorrow we will cover Bipolar Disorder. If you have some experience to share for any of the topics we cover (or have covered), contact me here or on my social media handles and we will get you featured.*

Today we’re talking about schizophrenia and related diagnoses, one of which I have. I’ll share some of the things I’ve experienced and ways that I’ve dealt with certain aspects.

The reason Schizophrenia is now considered a spectrum is the wide ranges of experiences people have, and the level of distress resulting from those experiences. Our last DSM separated Schizophrenia into subtypes like “paranoid, residual, undifferentiated, disorganized, and catatonic.” I think it was a big sigh of relief when these boxes were removed. The DSM 5 now reads with these diagnoses:

  1. Delusional Disorder: This basically means someone is consumed with different types of delusions (like grandiose or jealous type) for at least one month or longer. If people do experience hallucinations, they are related to the delusions. Usually functioning isn’t as impaired at the same level of someone in an acute psychotic episode.
  2. Brief Psychotic Disorder: This is more like what someone would picture an acute episode: hallucinations, delusions, and some version of disorganization.
  3. Schizophreniform Disorder: I honestly thought they’d removed this a long time ago, but this is like a short-term schizophrenia; episodes are usually between one and six months long. This includes hallucinations, delusions, disorganization, and negative symptoms (apathy, lack of response, e.t.c).
  4. Schizophrenia.
  5. Schizoaffective Disorder: this includes elements of schizophrenia, like hallucinations, delusions, and disorganized speech and combines it with elements of a mood disorder, like depression or mania. The mood symptoms must be present concurrently with the top criteria of schizophrenia.
  6. Substance/medication induced psychotic disorder
  7. Psychotic disorder due to another medical condition.
  8. Cataonic conditions.
  9. Other specified Schizophrenia spectrum and other psychotic disorder.
  10. And of course unspecified.

Are Psychotic People Dangerous?

The thing that gets misconstrued often about psychosis is the level of danger someone experiencing an episode poses. Of course there are cases of those lost in delusion acting aggressively. There are many more cases of abuse and violence against those in psychosis.

The thing that isn’t understood is that when we are in this fragile state, everything is terrifying. Your smile is terrifying–a sign you’ve been conspiring against us. Your tone of voice, your pitch of voice, your very existence in our world means you are, in one way or another, against us. Every person, television, web camera, corporation, government institution, is a hunter and we are the prey, frightened only because we’ve just realized this whole time people have been plotting to harm us. And suddenly every bad thing that happens, or has happened, every innocent mistake we witness, every abnormal movement becomes apart of that plot.

Not everyone is vocal and so obviously outlandish. I, for example, spent a lot of my time in my room with a blanket over my head playing Minecraft in the dark. I spent five or six days a week doing this. Meanwhile, one of my coworkers controlled mby body, blocked the thoughts she hated, inserted new ones, forced me to eat a bowl of cereal, hounded me until I did it. I couldn’t walk properly and I’d lost awareness of my body because it wasn’t really mine anymore.

I spent weeks playing Grand Theft Auto in a room piled so full of trash and clothes my door couldn’t open properly and I couldn’t touch my carpet. The sheriff managed to shove my door open, though. That was when the voices were keeping me up all night with screams and mocking banter and whispers. I sat rigid and silent, only answered their questions with “yes” or “no” even if they asked an open ended question.

My diagnosis is Schizoaffective, first diagnosed as Bipolar 1 and several other things.

What pains me is when I hear about people deep in their experience who trigger the fear in officers that they’re trained to have to protect their lives. One man, over 8 years ago, came at an officer with a boom. This officer knew of the man’s psychosis and still opened fire with 7 shots.

Another man, silent, mute, like me, but naked, walked along a highway in the middle of the night. A trucker stopped him, called police when the man, also diagnosed schizoaffective, crawled up on the roof of his semi. The cops, assuming he was on drugs, gave him a pair of shorts or something, called the paramedics who took his vitals. The Sargent then drove the man to a closed gas station and dropped him off. That man then wandered back to the same highway and was killed by a car that didn’t see him.

The Sargent’s defense was that he’d dropped the man off in a safe place.

Are psychotic people dangerous? Not usually. What’s dangerous is the situations made volatile by people who don’t understand.

What does Research Say?

I’ve written on this before (big surprise) and if you’re curious, you can read the post, “Is Schizophrenia a Brain Disease?” You may be surprised by the answer. If you frequently keep up with psychology research, not the pop psychology agenda, you probably won’t be.

Can People Live Normally With Psychosis?

Yes.

For some people that means taking medication or living in a group home where social skills and independence are prioritized. For others, this means getting off of medication or moving out a toxic living environment. For all of us, though, who choose some version of wellness, it usually means keeping a routine, engaging in consistent self-care, and learning to manage our experiences to the best of our abilities.

Not everyone hears voices 24/7. Not everyone’s voices are external. Not everyone’s voices are negative. Not everyone has visual hallucinations. Not everyone is hospitalized constantly, or for insanely long periods of time.

So what happens to those who don’t reach a stable wellness? A lot of people give up on those who don’t seem to present a lot of insight, as if it’s someone else’s responsibility to make them develop insight. I don’t want to say that stability isn’t achievable for some. What I will say is that the level of insight depends on many things: support, past trauma, current trauma (hospitals, police, doctors), self-esteem, general worldview. All of this gets distorted in psychosis, yes, but the foundation is the same. If someone has spent a lifetime in child abuse where intimidation, violent threats/attacks, and coercion dominates their perception, assuming even bizarre things like aliens probing their thoughts is routed in a feeling of lack of privacy, feeling intruded upon, and invaded. If those underlying feelings are never addressed, if only obvious positive symptoms (like hallucinations) are dulled, and that is called the ultimate progress, then that persons self-esteem, drive, and hope will suffer.

Much of the mental health system stifles the cultivation of wellness for those with psychosis in many ways.

Living normally can mean many things. It could mean working. But it could also mean just steady self-care. It could mean being satisfied. It could mean getting on social security disability and getting back into hobbies and cultivating contentment. It doesn’t have to mean what society wants it to mean.

What Are The Experiences Like?

This varies in intensity and frequency across the spectrum of Schizophrenia. Common experiences are auditory and visual hallucinations, olfactory (smell) hallucinations, tactile (touch) hallucinations, thoughts and feelings of being hunted, attacked, hated, and the reasons for these feelings are what become delusions–for example, if someone feels they are being watched, the delusion isn’t just the action of being watched, but why; the government has tracked their IP address, put bugs in their phones, turned their family against them. They hear the agents outside their window, conspiring.

Other experiences may include a severe drop in drive, motivation, and emotional expression. They may have an affect that is inappropriate, that doesn’t match what they say or the atmosphere of the room. This is the reason one of the top Google questions about Schizophrenia is “why do schizophrenics laugh randomly?” They’re hinting at affect, but also possibly voices. Sometimes they say funny things and we laugh. That’s a normal reaction to something hilarious, but on the outside it seems scary, weird, and bizarre. There is no scientific consensus to whether medication is the cause of these “negative symptoms.” If we get some studies that aren’t done by researchers with severe conflicts of interest (e.g grants from pharmaceutical companies) we may get a definite answer.

When I was on medication, I was more focused and aware of my surroundings, but I was tired and had trouble caring about things. Apathy can come after a psychotic break, especially a first psychotic break, and again, there is no scientific consensus on whether this is result of the medication blockading certain synapses, damaging them, or just a result of the brain restructuring itself after the break.

For me, my voices are often but not constant, internal and external, random, mocking, encouraging, and repetitive. I also hear familiar voices, such as friends or coworkers, particularly when I’m around them. When I worked at the local library at the beginning of 2019 (yes, I tackled two jobs) I often heard the boss and the branch manager discussing me. One afternoon in particular, I was shelving some books. I heard them giggle and the boss (my supervisor) said my name, followed by words I can’t remember and the branch manager said “well, what are you going to do about her?” very loudly, and when I whipped my head around, they were talking, smiling, laughing, and I couldn’t hear them at all. They were across the library.

I took my cart to a different part of the library, felt my heart racing, and tried to look at the event objectively. They were far away, I couldn’t hear them, and maybe they weren’t taking about me. But they’d said my name. Maybe it was something good. Or maybe they hadn’t said anything at all. Every day in that place was me psychically defending my honor. I quit abruptly four months into the job.

I also hear unfamiliar voices, strangers walking down the street. One afternoon, before I was hospitalized this last time I think, my boyfriend and I were on the wharf walking back toward the street. We walked past a couple, and the man growled “you better watch your back”.

This was when I knew there were people placed on the street to intimidate and berate me. I knew some were possessed by the same entities that wanted me dead. I spun around and I asked my boyfriend, “didn’t you hear that?” Of course he didn’t, and I stopped in the middle of the walkway, blocked it really, watching the couple, and spoke loudly; “that guy just told me to watch my back. He thinks I don’t know what’s going on, but I fucking do. They don’t know who they’re messing with.”

I don’t know if my boyfriend remembers this, he may not, but I remember the fear, the anger, and the uncertainty.

Some people see creatures, demons, devils, regular people, spiders. Some people feel things crawling under their skin or in their organs, or smell strange scents. I remember smelling a lot of weird, noxious fumes not of earth and fire smoke. I always feel like someones touching me, grabbing me, trying to pull me in a different world. I feel things crawling on me frequently(not in me thankfully) and I misinterpret a lot of my body’s signals.

All of these things together can be incapacitating, terrifying, and unreal in real way. I still think back on some things and don’t believe that any of it happened, that I made it up, and that belief often has my voices calling me a liar, that I’m some kind of malingerer and my therapist knows it, my coworkers know it, and it’s going to cost me my job and my therapist is going to put me in jail.

How ironic, right?

How Should I Respond?

If your friend, child, parent, or any other relative is experiencing an episode or is home, on medication, and still in the midst of psychosis frequently, panic is probably the most incorrect way to respond. The second most incorrect way to respond is feeding or attacking delusional, disorganized, or otherwise different behavior. Do not agree that the government watches your son, but don’t dismiss it either. Sometimes the underlying feelings of being watched are fear, mistrust, or anger. Address those.

Studies show that the involvement of trusted family members during someone’s hospitalization can enhance and support the person’s recovery. Show up, visit, learn what you can. My mom feared driving over the hill to the hospital I was at and so my boyfriend brought me clothes and visited. It would have been nice to have either one or both of my parents though, so they could not only see the extent of my fear and mental frailty, but also so they could get involved and be a source of comfort. It’s so hard to get them to be a source of comfort sometimes.

Most of all, respond with compassion, patience. Step outside of your world and into ours.

This post is so late (it’s 11:46 pm for me on May 14th) because I have loads of classwork and have been working full-time for the first time in my life. Adjusting to that is taking some time. And so tomorrow, later as well probably, we will cover Bipolar. If you have a story on any diagnosis and you’ like to share it here, CONTACT ME or reach me on:

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 Late Night Thoughts

Happiness

I’ve been thinking a lot about what it means to be happy. Here are some of my thoughts.

I’ve done what all good, sheep-like psychologist eventually do: create categories for something that is probably far too complex for such an explanation.

But, hear me out.

I’ve reasoned there’s organic happiness and there’s constructed, or synthesized, happiness. An organic happiness would be someone’s baseline: how you are when you wake up in the morning, how you respond to the corresponding events of the day. This is the happiness we often feel we need to correct.

A synthesized happiness, then, comes in peaks and waves from an outside source. It eventually decreases gradually or exponentially. It may be uncertain, untrustworthy, or fleeting.

These thoughts came into my head not only because of our humanly need to correct all feelings we feel don’t line well with other’s feelings, but because there is such a stark difference between the happiness I feel organically, the one that sprouts naturally in my consciousness, a simple product of biological existence, versus the happiness I feel after I’ve accomplished something I had doubts about, after spending a day with the people I love, or after I take a pain pill for my back.

I think I’ve made this distinction because I notice I’m often disappointed in my organic happiness, in my baseline of existence.

There are tons of speculated biological and evolutionary reasons why certain chemicals peak at certain times in our brains–to keep us focused, to associate good feelings with good friends so that we build connections which were at one point most essential for survival, to simply bring us enjoyment. But now, there are so many things in life that can trigger intense rushes of endorphins, like substances and fame, that what we experience in the day to day just can’t compete. I am happier and friendlier when traveling. I am happier and friendlier when on pain medication. I am happier and friendlier to strangers when I am also among people I care for and love.

And so I find now, when I have a moment to rest and reflect, I remind myself that everything is enough.

I’ve had three of my six past therapists tell me I need to tell myself that I am enough, and I’ve tried that, but I think this stretches deeper. I think that realizing that life is enough, that how I feel is enough–negative or positive–is what paves the way for accepting myself. If I can truly believe that every negative feeling exists as a moment ripe with the potential for growth, and that every positive feeling exists as a moment ripe with the potential for contentment (as opposed to: oh no, I’m happy, let’s see how long this lasts), then I think that may be the key to actually existing.

But believing something doesn’t mean I create a mantra and repeat it to myself until I drop dead. That doesn’t foster belief and studies show that reiterating positive mantras to yourself can actually make you feel worse. I measure how much I believe in something by the rate and construction of my reactions. Let me give an example.

Last night while watching television, I felt the same disappointment I discussed earlier: I felt sad that I couldn’t spend every day feeling the fuzzy, determined, focused happiness that pain medication brings. I felt sad that I felt sad about that. I felt sad that my own level of being just didn’t seem to be enough; I enjoy my personality, I admire my intelligence, I accept my flaws, but the feeling of existing, the feeling of being human, limited, temporary, often enrages me. Being just isn’t enough.

And in this moment of realization, my mind reacted with a simple thought: let’s be okay with this.

Now sometimes I have voices responding to my thoughts, or voice-like thoughts responding to my thoughts, but this was all me, it was a reaction that I haven’t programmed. I haven’t spent the last two years off medication waking up every morning spewing “learn to love yourself” and “you are enough” quotes until I repeat them robotic, on demand. I’ve spent my time entrenching myself in the madness, the chaos, the pain. I spent time locked in my room staring at the wall, if that was what my pain was. I spent time walking off waves of panic, if that was what my pain was. I spent time being unhappy, if that was what my pain was. I resisted the urges for bail outs–a psychiatrist would have bailed me out, numbed me to my anxiety, tainted the voices and the paranoia, evened the mood swings and depression. And I would have learned nothing.

This is not to be said in a way where everyone taking medication should be offended. For me, medication was another avoidance technique that I’d perfected through years of trauma. For others, medication is the stability key that allows them the time and focus to come to the same types of realizations I have. We all reach wellness in different ways.

I’ve noticed in depression, I am no longer overwhelmed with sadness because I allow the sadness to spread. I choke sometimes with the paranoia, fight it, try and reason with myself and that often cycles me further. I am still growing. I choke with the anxiety as well, get lost in the sensations of my body, and the doom my mind screams. I am still growing. But the depression, which has been with me since I was eleven years old, has become a close friend. I am 24 years old. It’s taken 13 years to cultivate this friendship.

And so happiness for me does not mean contentment or joy or the absence of sadness. Happiness for me means experiencing being without judgement.

I figured I’d share some of these thoughts with everyone as we plunge through Mental Health Month as well as the Covid Pandemic.

This week we are covering Schizophrenia, Bipolar, and Dissociative disorders, starting tomorrow. The post will be later in the evening (PST) as I have some self-care and some things that need to get done at work. If you have a blog post on those topics that you’ve written and would like to share, or if you’d like to submit your own story, contact me here or on my social media handles below.

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 Community, psychology, science

mental health month: trauma

Welcome back! Let’s talk about Truama and Stressor related disorders. Read more for a great book recommendation for emotional trauma and CPTSD.

What is Trauma?

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.

What Are Trauma Disorders?

I had a similar question. The DSM-5 has somewhat of an answer. Here are the diagnoses they list:

  1. Reactive attachment disorder: This is in early childhood or infancy where the child does not look toward their caregiver for “comfort, support, protection, and nurturance.” If you’re anything like me, psychopathy might pop into your head. There isn’t a lot of research supporting Reactive attachment disorder as a precursor to psychopathy. But if you’re interested, here’s a random presentation I found on the subject.
  2. Disinhibited Social Engagement Disorder: This is basically the opposite of the above disorder. These children will approach strangers and act overly familiar with them, also breaking cultural boundaries. Often they have experienced some kind of pattern of severe neglect from their caregivers. They must be at least 9 months of age to receive this diagnosis. Don’t ask me how that works.
  3. Posttraumatic Stress Disorder: This has some of the longest criteria to meet and is often diagnosed very quickly. Major symptoms can be obvious. However, for those of us who have struggled with emotional abuse, it takes a keen eye to recognize the signs. PTSD is an emotional response to one or more traumatic events. This includes “fear-based re-experiencing, emotional and behavioral symptoms. Experiences range from explosive “reactive-externalizing”, to dissociation.
  4. Acute Stress Disorder: This would be caused by a gun to your head, or anything else that threatens death, serious injury, or sexual violation. This also applies if you witness one of these events, such as someone being shot in the head, threatened to be shot in the head, someone being raped or beaten. If you had a conscience and were the person filming Ahmaud Arbery‘s death, you may develop this disorder. Evidently that person has not. This can happen to police officers or detectives, or any emergency responders who are repeatedly exposed to violent/disturbing/fatal cases. Keep our COVID front-line medical staff in mind.
  5. Adjustment disorders: This is marked by emotional or behavioral symptoms that appear within three months of a stressor. For example, the changes a person may experience after the death of a loved one or sudden death of a close friend.
  6. Other-specified Trauma and Stressor-Related Disorder and Unspecified Trauma and Stressor Related Disorder: These both carry criteria of a person exhibiting trauma like responses that cause significant distress but don’t fit in the categories of the other disorders.

How do People Manage?

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.

Today, we are greatful to hear from Caz again, over at mentalhealthfromtheotherside.com. Read about her experiences with childhood sexual abuse here.

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:

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, psychology, science

Mental Health Month: OCD and Related conditions

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.

What is Obsession?

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

2.Hoarding Disorders

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).

Is Hoarding Like That T.V Show?

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.

Is Body Dysmorphic Disorder Real?

Yes.

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.

What Kind of Treatment is Available?

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.

What can we do?

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:

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, 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.