Tag: schizophrenia

Posted in psychology, science, Therapy, Voices

Is Psychology A Science? Part 1.

Posted on by alidware

That question won’t be answered in this post.

This will be a multi-part series I think. There is a lot to say here, a lot to absorb, and it’s not really a matter of opinion. That tends to turn people away, because they want their opinion heard and other’s heard. Your opinion can be heard, just know its validity lies in facts and not how much you (or anyone else for that matter) believes in it.

We hear a lot today that disorders are on the rise, specifically ADHD, Autism, and Bipolar (in children). We hear that there are all these new holistic approaches. We hear about EMDR, we hear about Mindfulness, we hear that long-term medication is the only reasonable approach for certain experiences. We hear supplements will one day replace these medications. We hear psychiatry kills. We hear psychiatry saves. We hear a mix of the two–not sure how you can both kill and save someone, but psychiatry seems to be pretty good at it.

So, how do we make decisions on what is accurate and what is not? Most of the time it’s a matter of opinion. You read something good on the internet, an article that cites specific sources and looks very professional and so you trust it. You do the same with your doctor. You hear things from friends and somehow generalize their great experience to all the population of mental health consumers and suddenly you’re an advocate for acupuncture exercising demons from the tips of your fingers and you’re not quite sure how you got there, but now you’re there and you really believe it.

The thing we don’t ask for is research. The things doctors don’t read is research.

There are about 40,000 psychological research papers published each year. The majority of clinical psychologists read 1 of those research papers a month. That’s about .03% of all psychological research papers.

So let’s talk about what’s going on. There are two main issues:

  1. Practitioners rely more heavily on their intuition than repeated, peer-reviewed research (which they haven’t read).
  2. The actual science of psychology is basically the quantum physics of social sciences.

We’ll start with number 1.

We talked in the last post about the differences between a Ph.D and Psy.D (both psychologists), MFT’s and LCSW’s. We talked about how the technique the clinician uses dictates the effect on the client more than the supposed higher or lower degree/education level of the clinician. What we didn’t talk much about is why a lot of repeatedly proven therapeutic techniques are being replaced with new fad-like “holistic” and “client-centered” approaches. There are a couple reasons and one of those reasons has to do with practitioner intuition.

They have gone through years of school. Residency for some. Internships. Hours upon hours of supervised practice (3000 for those who want licensing in my home state of California, 1000 most everywhere else). They’ve made sacrifices for this, thrown themselves into debt, worked shitty jobs, lived in cramped situations. They gave up a lot for their passion and now they can be called an expert. That means they’re, well, the expert.

It’s very difficult to read a paper that says your technique has been proven multiple times to present no significant effect on the wellness of most people (we’ll talk about this idea of “most people equating to the general population later, that’s related to my second point) and be forced to change your method of practice that you’ve grown comfortable with. It’s hard when you have to admit you may very well be wrong. It’s much easier to come up with reasons why the research may be wrong–you’ve seen the progress in your clients (confirmation bias; you want to see that, so you will see that), your colleagues are using the same techniques with great success (they may be biased in the same way, and may have not read the research), and you’ve read articles which said this technique is effective; in fact, you went to a specialized school for that technique. And so you ignore the shoddy research–there’s probably no control groups, a poor sample size/selection, not evidence of peer review, and a lot of pseudo-science talk telling you that this new discovery they’re providing you with is being “stifled” and “shunned” by the medical community.

It boils down to practitioners struggling to admit they may be wrong. Ironic considering the work they’re in.

The issue with this isn’t their pride. The issue is that by not considering the possibility that they don’t know everything, they don’t have the chance to learn something that could indeed improve their practice and the well-being of their clients.

Now, the effectiveness of clients (as much as I despise that word, it’s appropriate for what I’m talking about) is measured by behavior noted by neutral observers. To properly do this, behavior is measured before and after “treatment”.

From this scientific approach, we’ve learned that ECT has been “effective” (when effective is defined as a positive change in behavior, and “positive change” is defined as the patient’s depression lessening). But, the effects have been found to be temporary, we don’t know why it temporarily works, and it causes a myriad of health issues, most severely memory loss.

We’ve learned that CBT treats panic disorder better than no treatment, better than a placebo, and better than Alprazolam (A version of Xanax). 87% of participants reported they were free of symptoms 15 weeks into CBT. 50% reported freedom after 15 weeks of Xanax. 36% with the placebo, and 33% with no treatment–they were told they were put on a waiting list (Klosko, 1990). Now what this shows us is a couple things.

  1. CBT works pretty damn well for those struggling with panic disorder.
  2. With the simple passing of time, people get better. That’s very important to consider in this field with certain experiences.

The scary thing is a lot of people who struggle with panic don’t get CBT treatment. I didn’t, not for many years.

Now, I have two examples of practitioners believing more in their expertise than research. One is a wide-spread example, and the other is a personal experience from 10:30am this morning.

I’ll start tomorrow’s post with the wide-spread example, because there is a little background needed.

This personal experience of mine sent me in a tail spin. My thoughts today have been taken over with good and evil (not the separation of them, but the unification of it) and the spirits, the voices, have essentially been trying to thwart my success and I’m struggling with whether they’re doing it to save me or to torment me for both. They played a particular song to mock me in the store today, and there was a woman following me around, going where I went, picking products next to me just to let me know that they’re here with me again, the spirits. And so this is an example of why clinicians need to pay attention to how they speak with people.

I literally just did a panel presentation on this shit to some local mental health workers yesterday, and then this asshole comes along.

He wasn’t trying to be an asshole, I know this. He is a young psychiatrist, very kind, and struggled to find the right words to dominate me with. I made an appointment with him because the person who’d been recommended to me had appointments months out and I couldn’t wait; I’m looking for a PRN for my panic as my current techniques (CBT, and processing my emotions) haven’t been working as well lately. I want it for short-term use so I can get back on track. I am on no other medications right now.

Problem is, I was prescribed Percocet and Valium for my back two weeks ago. And he saw this.

He didn’t ask me much about myself. Which was strange; usually psychiatrists go very in-depth at the first appointment. He asked what my diagnoses had been. I told him one psychiatrist couldn’t decide between Psychosis NOS or Schizoaffective. I told him my current therapist believes Bipolar 1 with Psychotic Features (mainly because she believes schizoaffective means your psychosis is only in your depressive episodes; we’re discussing this).

In ten minutes, he says he thinks I’m Bipolar 2.

This is after I tell him about my voices. This is after I tell him I was hospitalized after the Vegas shooting as it perpetuated a delusion of mine. He didn’t ask me about the voices really, or the delusion.

The problem with his diagnosis is that psychosis doesn’t happen in Bipolar 2. That would automatically make it bipolar 1. I also haven’t been depressed in over a year, and Bipolar 2 is mainly depression and hypomania. He believes my manic episode in the beginning of college was not mania because I’d get at least two hours of sleep every day. I understand that reasoning. But it’s not a reason to conclude bipolar 2 in ten minutes.

So he didn’t believe the voices. Why? I’m not sure. He didn’t ask if they were external or internal. He asked me what they said and I gave him a couple examples. He asked me if I’d heard them within the last week. I said yes, and within the last month. I told him it’s not a constant roll of voices all the time, every day. When i’m doing well, it’s less frequent. When i’m not doing well, it’s constant.

He didn’t want to prescribe a PRN because of the Oxycodone prescribed to me. I told him I’m not using the Percocet for back pain; I have 16 out of the 20 pills left. I don’t need them. He seemed intent of giving me more Valium. I said I didn’t want Valium; it has a half life of three days and I don’t want a slight risk of physical dependence.

He suggested Gabapentin (the nerve pain and anti-convulsant that keeps being prescribed in psychiatry even though it shouldn’t be, like many other drugs)or Busbar. Both are taken daily. I said no. I told him three times SSRI medication did not work well for me, and he respected that. But he still tried to squeeze it in there, advertising it as a safer drug than Valium.

What this ended with is me with a 30 day supply of Klonopin (which I’ll use maybe once every two months??? I don’t need it all the damn time) and a lot of anger. A lot. I felt invalidated. Ignored. He was young, confused maybe, thinking I was lying, manipulative, and the voices told me that’s what he thought and I believe them. He thinks I was there for drugs and he didn’t believe my psychosis.

Who lies about psychosis?

This sprung a lot of thoughts. The store I stopped to shop in was malevolent. Class was difficult. My thoughts are not nice, they’re disorganized right now, and I’m disheveled.

But it’s an amazing example for today’s post: if you’re a clinician or a psychiatrist and you rely heavily on your intuition, you’re invalidating the tiny scientific standing psychiatry has in the medical community.

Take a day off and read some research.

To Be Continued . . .

Posted in Freedom

To Be A Mental Health Consumer

Posted on by alidware

Yesterday I said today’s post would be about whether or not psychology is a science and how certain types of philosophy play into the ideals psychologists and M.D’s are trained with, but right now I don’t have access to the notes I made in regard to that topic. So today will be kind of an introduction.

We’ll talk about the importance of education and its scary insignificance.

If you’ve ever taken an introductory psychology course, you have most likely heard the story of “Little Albert”. In using classical conditioning, John Watson and Rosalie Rayner conditioned Albert to have a fear of a white rat. They did this, according to my recollection, by making loud, sudden, scary noises when presenting the white rat.

Now, if you’ve taken a recent introductory psychology course which covered this case, and you are not in California, there is a slim chance you were not told what I was told. I’m betting you were, though.

I took General Psychology 5 years ago and was informed that the experimenters discovered this infamous baby known as Little Albert had also been conditioned to fear white things in general. Fluffy, white, harmless things like a puffy rabbit or a dust bunny. My class was then told this fear persisted throughout this child’s life, and that fears could be unconditioned as well. This example is used as evidence to prove that classical conditioning in humans perpetuates specific phobias.

The study was referenced in a few other courses as well, all with similar conclusions. The textbooks were no different.

So, imagine my surprise when my research course revealed Little Albert had been fearful for ten days. After that, his reactions subsided. When they attempted to recondition the fears, his responses were lessened than the first time and the fears did not stick. My research professor said he had never learned this until he actually read the paper Watson and Rayner published.

And so this brings up many serious issues, one of which I’ll talk about tomorrow.

But for today, we can just focus on one main issue: if we can’t trust our education, how can we trust our practical training? Are they following research or intuition? Are they creating programs and trainings that are based in research topics but finalized by idealism?

This doesn’t mean we flush our meds down the toilet and spit at our therapists. Maybe it means that for some people but for me it means self-research is probably one of the most important things I can do for myself as a mental health consumer. I don’t like to say “question everything” because that implies a lack of trust and in order for people to trust you, you also must sacrifice some vulnerability and offer trust. What I say instead is “research everything.”

Get a new diagnosis? Great! It matters to you, it explains what you feel and how you think and you really identify with it. Learn about it, if that’s something that matters to you. And that doesn’t mean googling “schizophrenia” and reading about how your negative symptoms will take over your life after medication quiets the positive symptoms and how medication is the recommended long-term treatment and how some people can still live meaningful lives (after the author spent six pages ripping your self-esteem to shreds).

Learn about negative symptoms if you want. Learn about positive symptoms. Learn about different medications, different therapies (usually CBT) used to help people cope with confused thoughts. Learn about why the dopamine hypothesis is only a hypothesis. Learn about how medications work and how they don’t work. Learn about support groups. Learn about alternative treatments. Learn about how they work and how they don’t work. Learn about hearing voices (if applicable) and learn about the Hearing Voices Network, and affiliated organizations/movements. And most importantly, be objective.

Don’t just swallow the information you’re provided and internalize it. Not even the information in this post: research it for yourself.

This is hard to do when you’re in a crisis. That’s when we’re at our most vulnerable. That’s when we put up defenses and refuse help that may be useful. Or that’s when we’re so outside of ourselves that we have no defenses and so we absorb any help, and sometimes that means forceful and hurtful help.

It took me years of mental growth supported (sometimes unknowingly) by the connections I’ve made at the Peer Respite house I work for, and my own inner revelations, my own retraction from society and sanity, to really learn things which I would have never known had I not had a few questions and some hours of research.

And so the second lesson here is patience. While you go through the horror and the terror and wallow in darkness, look around. Touch the walls you’re trapped in. Smell the air that’s tainted and stale. Feel the ache in your heart. Hear your own screams. Explore the desolation because there is nothing more all-encompassing. And when something is all-encompassing, there is no escaping. So don’t run. Melt into it.

Let me give an example.

I was part of a cultural competency training/story telling event for the company which helps run and fund the respite house. There were other providers from within the company who attended, nurses and clinicians from other mental health and housing programs. (For some background, the company runs 100+ other programs and the Respite is the only fully peer program).

I was one of three who was scheduled to tell my mental health story and how I interacted with providers during the worst of my crisis. This was to provide them a view from the other side.

However, public speaking isn’t usually my thing. I used to faint in elementary school when I had to stand up in front of people, and this fear continued through high school and college until about a year ago. It still makes me intensely nervous, but I’ve gotten just a smidgen better at controlling my body and my thoughts during my presentations.

And so my anxiety sky rocketed the moment I stepped into the building. What this usually means is I go sit somewhere quietly and ignore the room and put some music in my ears and try not to listen to my own self-criticism or voices.

What it meant this time was understanding my limits and using my crutch to further develop my own skills. I took some valium I’d been prescribed for my back. This doesn’t last very long in my body with my metabolism, but it lasted just enough to calm my body. I wear a Google Wear smartwatch that tracks my heart rate religiously and I use it as a biofeedback because biofeedback was what helped me see how my mind exaggerates my feelings.

When the medication kicked in, my heart rate went from 109 to 68. And in this period I felt it. I felt my body and my hands and how cold they were. I felt my eyes moving in their sockets and my tongue brushing across my lips. All the while my mind panicked.

And so I focused my awareness on that disconnect. I spoke with my brain and my body and I told my brain: do you see how the body feels right now? It’s okay. This situation is okay. Feel how grounded we are right now? Feel how I’m leaning on the counter top? See, you made that person laugh. You’re having conversations. Do you feel how loose the body is?

And so I didn’t run. I dove into the discomfort and identified the disconnect that perpetuated my fears. I will and do talk quite a lot of shit about medication. It’s understudied and should not be cleared for long-term use in any one human being or animal. It is studied for short-term usage, all of it (meaning 4 weeks to 3 months) and the only medication I am comfortable with my body enduring is as-needed medication for panic. And the only way I will take one is if I recognize I won’t learn anything from the panic if I can’t get out of my body and into my mind. I have to reconnect the two, and one needs to be isolated (calm) in order for me to show the other one everything is okay.

I quite enjoyed my talk. I’m sure there are many things I could have done better, things I could have said better maybe. But it was the first time I spoke to a room of people without pouring sweat, stumbling over words, or fainting. By the time the talk started, the Valium had left my system.

The key notes to take from this post?

  1. Be Objective.
  2. Have Patience
  3. Don’t Run

Posted in psychology, Therapy

Let’s Talk About Therapy

Posted on by alidware

For those of you unfamiliar with the mental health system or are unsure about therapy or whether or not a psychiatrist is a good idea, this post is for you.

For the rest of us, it’s also a good post for you. It’s a good post for everyone.

Anyone (with a degree and some version of licensing of course) can be a therapist. That could be a LCSW (Licensed Clinical Social Worker), a MFT (Marriage & Family Therapist/Master’s of Family Therapy), a clinical psychologist (Ph.D) or Psy.D (Doctorate of Psychology). A psychiatrist (MD) could as well, but many of them have zero background in psychology other than your average level of undergraduate study.

An LCSW and MFT will indeed make less than a Clinical Psychologist or Psy.D. Those two will generally make less than any Psychiatrist depending on where you live and what clinics each individual works. If you feel that someone with a Ph.D will be much more knowledgeable and better trained than an LCSW, you would be terribly, terribly wrong. In fact, the main difference between them is the amount of money they make.

Studies (and the lecture in my research course) have shown that credentials have no effect on success rate; that is, just because you have a Ph.D doesn’t mean your “clients” do better than an LCSW’s clients. That includes the M.D’s.

This might seem obvious: it depends on the clinician, right?

Wrong.

It depends on the techniques. If a clinical psychologist with a Ph.D is certified as an International Board of Repression Therapist (a non-scientific therapy) and their colleague in the office next to them is an MFT certified in Cognitive Behavioral Therapy (a scientific therapy) and one client experiences IBRT and the other experiences CBT, chances are CBT will provide a hefty affect over the IBRT. Yes, there are other factors which play into this, some important ones being what the client is seeking support with and their drive level. Connection to the provider plays a role as well. However, speaking from a technical point, there is no solid (well-done) research supporting IBRT, and plenty of well-done research supporting CBT.

That doesn’t mean IBRT is useless. One day perhaps someone will come up with some verifiable, testable, and reliable data. But until then, I won’t be seeing anyone specializing in IBRT. The Inner Child exploration therapy is another “non-scientific therapy” and I’ll have a post on that later, as I have experienced it and have mixed reviews.

There are three basic differences between a Psy.D and a Ph.D.

  1. Scientific training.
  2. Clinical training.
  3. Cost

Colleges which offer Psy.D programs are by far much easier to get into and much less regulated. They also cost thousands of dollars more (unless you’re trying to get Ivy league training in which case good luck paying out of pocket for your Ph.D from Yale. I suspect school type also doesn’t correlate with client success rate) compared to your average Ph.D training.

There is a school which I had planned on attending back when I was ready to transfer for a Psy.D until I realized their training isn’t really based in any science. And psychology is supposed to be a science of the mind, right? (More on THIS in tomorrow’s post). The success rate was large, in the 80 percent or so, the school was still working on its accreditation, and the classes they required were scant. In fact, they didn’t really require anything other than a couple of psychology classes. They claimed integrated, client-centered approaches, which is great. And I’m sure once we have more actual data on the effectiveness of their techniques, that school will be booming.

I believe they got accreditation some months after I learned they weren’t yet accredited.

I have seen MFT’s, LCSW’s, Psy.D’s, M.D’s, and now my first Ph.D therapist.

And so how do you pick?There’s all these choices, all this research you have no access to, all these articles online pulling you this way and that and are probably based more in opinion than actuality.

I used to choose my therapists by their profile picture and their degree level. If they looked friendly and had a high degree from a reputable school, I’d try them. And every time I left them.

This time I tried a different approach. I searched for therapists in town at all degree levels. If they didn’t have a website explaining their practice methods, mission, and specialties, I did not consider them. If their picture seemed unfriendly or strict, I also did not consider them (and that’s a totally unscientific, personal preference). If they did have a website but didn’t meet my specialty requirements, I crossed them off too. If their website wasn’t fully developed or seemed unprofessionally dull or full of metaphysical intuitive opinions about nature and life, I also crossed them off.

I love philosophy and enjoy metaphysics. But I’m also aware that people with that mindset are more inclined to tell me “if you believe it, you can achieve it” and I don’t need cliche sayings. Believing the demons will go away will not make them go away. I need to learn how to work with them, not shove them off a metaphorical cliff that I created in my mind and watch as they tumble helplessly into the locked drawer which I also created in my mind. Not my type of therapy.

Now, if someone had a decent, updated website that laid out their specialties which coincided with my needs, what insurance they accepted (if any), their location, phone number, and a blurb about their practice and themselves, I’d investigate further.

I eventually came down to three people: two women and one man.

I eventually crossed off the man because he had been in practice for many years, thirty or forty, and while that’s not a bad thing there is also no notable effect between years of experience and better rate of client success. I’ll explain why in tomorrow’s post as well. The reason the years influenced my decision is because many still maintain old views of specific “disorders” and treatment methods. I refuse to see a psychiatrist who graduated in 1979 and below.

The two women: one was a LSCW and the other a Ph.D. Both had well defined websites and structure to their treatment methods. I went for the LSCW because the Ph.D had listed their G.P.A and grades and I considered that rather conceited.

The LCSW was on vacation and when she got back she called me to let me know she wasn’t accepting new patients.

As disappointing as that was, my last choice was the Ph.D. I was nervous because of her degree and her listing of her G.P.As. I predicted she’d have an arrogance about her and see me as less than. I was indeed very wrong. This will be relevant in tomorrow’s post as well, how intuition can lead us far astray.

This particular therapist and I connected immediately. I have only connected in such a way with two other people in my life, one girl when I was in first grade and a guy when I was 14 in high school.

She is attentive and didn’t seem to mind that I hadn’t mentioned on our phone consultation that I hear voices and have experienced psychosis. She did believe that voices went away with medication (which isn’t the case for most of us, and I filled her in on my experience) and that schizoaffective can only be diagnosed under the condition that psychosis appears alongside depression (I didn’t correct that because I felt awkward doing so; it’s in the DSM-5, she can check it out if she wants. I have a DSM-5 PDF copy if she needs it) but overall she validates my feelings but also challenges me when something doesn’t seem quite right.

She will help me see alternatives and consider alternatives. She is full of humor, and gets my humor, and I’ve never laughed as much with a psychologist as I have this woman. I don’t feel judged usually, and have felt free talking about my voices with her. I have not talked in depth with anyone else about my voices, and I certainly haven’t told anyone else that I hear both internal and external.

Why did she work out? Because I didn’t follow my intuition, I followed a set of criteria I set for myself that weeded out those who were specializing in what I needed support with versus what I didn’t. And her listing her G.P.A has nothing to do with that.

And so what it comes down to is:

  1. Test the waters. See what kind of people you like. Don’t get disappointed if some don’t work out. You don’t make friends with every person you meet, do you?
  2. Don’t choose solely on degree level: you’re disgracing science and ignoring data.
  3. Take your time. You might not pick the right person on the first try, but you want to get as close as you can so you don’t have to go through 20 different people. That can happy very easily.
  4. Do your research. See what others say, but also recognize people can be picky about things you might not care about.
  5. Come up with your own criteria for the qualities that would be helpful for you. Make your stance clear at your first appointment.
  6. Get ready to work and be open to opinions that don’t match yours. Don’t assume CBT will work just because it’s a proven technique. Put some effort into it. Cry. Feel things. Process things. Think about things. Get frustrated and angry and annoyed. That’s literally the whole point.
  7. Don’t rely on your intuition solely.

And most importantly? Remember you have a say in your treatment. Make the therapy and partnership and it could become one of the better relationships you’ll establish in your life.

Posted in Peer Support, psychology

Own Your Care

Posted on by alidware

Today’s post is a little late because I’ve just come back from Urgent Care to get my back checked out. I overextended in the gym and have torn some lower back muscles. The pain is pretty severe, the doctor is thinking it’s very deep tissue, and let me know what I need to do to continue recovery.

But the events leading up to Urgent Care inspired this post on how important it is to own your care, both physical and mental.

The thing is, you’re going into the office of a person who (usually) doesn’t know you very well other then the check ups or issues you come in for on a haphazard basis, and even if they do know you well they don’t know you so well that they are aware of your body more than you are. The same goes for psychiatrists.

An important thing I’ve learned to remember in both my physical and mental health care is that no one, regardless of Ivy League education or multiple specialties/degrees, knows my body better than me. No one.

For example, I’m considering getting a PRN (as needed) medication for my anxiety, as my panic has been off the Richter scale lately. It would be something I took maybe once a month, or even less, as I tend to work very hard on balancing my panic when it comes on. (I’m careful not to say I “control” my panic, because I’m not going to run around in circles and play Panic’s power-struggle game).

Since I’ve got to find a new psychiatrist for this, I filled out an intake form which asked me what my primary concerns were and if I had any other information about medication or suicidal tendencies. I wrote something along the lines of: “SSRI’s and SNRI’s do not work for anxiety for me; I do not want them. I don’t need anymore antipsychotics, they make me dead. I am coming in for a PRN for anxiety, and nothing more. I have been happily off medication for a year and three months.”

I stated that twice.

The reason being when the psychiatrist sees my history of psychosis and mood swings and depression and says “weeeeeeeell, how would you feel if we also try a little–”

I can then say “Weeeeeeeeell, why don’t we try reading my intake form where I state exactly what I’m here for?”

Because the fact of the matter is that yes, I still struggle, often daily. But I know myself. I know my limits. And I know that getting back on meds would wreck more havoc on my body. No psychiatrist can know that. All they know is what they read in a textbook.

Conversely, if you are content with taking poorly-researched medications, and you feel they improve your well-being, it doesn’t cause any side effects and hasn’t yet ruined your physical health and a doctor tries to tell you “this med isn’t very good, I’d like to try another,” your response should be something along the lines of “well this doctor isn’t very good, I’d like to try another.”

Not to be a smart ass. Not to insert your dominance. But to make sure you’re being heard and that you’re in control of your health. A lot of people like to say “doctor’s work for you”, but I don’t use that phrase because that initiates yet another power-dynamic with you on top. That’s not the goal here. The goal is fair collaboration.

Having an advocate accompany you to your psychiatrist appointments can be helpful as well, preferably someone who is very clear on what your concerns and wants are, and someone who has been through similar situations. Not only will you walk in the office with confidence, but if you’re someone like me who wasn’t always present or aware of what was going on and so assertiveness took a backseat, you have someone to fall back on who you know will do you justice. Doctor’s can be intimidating with their degrees and “factual” knowledge and they’ll blurt things at you that make you feel lesser, not always out of intention but just because that’s how they show you they “know what they’re talking about”.

This doesn’t mean be afraid of new things or ideas. If something isn’t working for you, speak about what’s not working specifically. Don’t say “I just don’t like it,” because that gives them more of a reason to convince you you’re just not giving it enough chance. If you feel coming off medication is something you’d like to try, find the doctor that will support your decisions. Don’t let anyone tell you that you can’t, because you’ll start believing it. Yes, you can come off medication, even with severe psychosis. If you’ve been on them for years, 10+ as many are, you’ll be needing to come down 50x slower. Even as small as .025mg at a time. Doctor’s words, not mine. Also, researcher’s words, not mine.

In the world of psychiatry, we must be wary of manipulative words. Whether they mean to be manipulative or not. When our brains are fragile we are at our most vulnerable.

And so take this post with you to your next psychiatrist appointment if you’d like, if you feel you haven’t been heard or respected and you’d like some strong words from an internet stranger to back you up. Hell, have your advocate read it and them snap their fingers in the “Z” formation afterward. Your doctor’s response will tell you all you need to know about that doctor.

Posted in Peer Support, psychology

Pros and Cons of Working at a Peer Respite House

Posted on by alidware

Did you enjoy the totally unrelated photo I took of the Hollywood sign some years ago?

This August celebrated my third year anniversary at my job. I may have mentioned briefly in passing on one other post that I work in peer support, or maybe I didn’t. I think maybe I didn’t, because I talked so much about it on my old blog. I’ve only posted a few times there this year. Ultimately, it’s abandoned.

So I figured I’d talk a bit about it today. Not the job itself really, but the pros and cons I’ve come across with working with other people with lived experience at a respite house. There are ten times more pros than there are cons, but I think anyone would say that if they work a job they actually care about.

Pros

  • People understand you.
    • I’d say this is really what separates a retail job or even another professional career from peer support. There’s no need to hide who you are or how you think and there’s encouragement to express your feelings. It’s difficult to do that in other jobs because most other jobs aren’t centered on your feelings or your comfort. When you are struggling, you’re free to say so and good chances are you’ll receive support from not only your coworkers but the people who are receiving the peer services. When was the last time a customer gave a shit about why you were in a bad mood? (Not saying it doesn’t happen, there are some nice customers out there, but most people just get offended by your shitty mood and therefore act more shitty toward you because how dare you ruin their good mood).
  • You can take literal mental health days (and get paid).
    • The way it works for us, people either use their sick time or vacation time, or a mix of both, depending on if they work full time (which is four 8 hour shifts a week, or a mix of overnights and day shifts) or part time (which is what I do). There is no limit on the amount of sick days or vacation days you can use in a given year, as far as I’m aware. I accumulated weeks worth of sick days and used them all at once (for that hospitalization period) and a couple weeks later I used some more. It may be different at different peer places, but for us that’s how it works, and I’m sure other places have a similar sense of leniency.
  • Transformations are amazing.
    • Even if you don’t jive with a particular person coming in for services, chances are they’ll connect really well with at least one other person, be it another person receiving services or a peer worker, and you get to see people come out of their shells or make revelations about themselves. You see their perspectives shift. Some people become less helpless as they realize they really can do things (like cook for themselves, navigate bus lines, search for housing, create a resume, e.t.c). Some people express their feelings for the first time (like me) and other people learn how to pull back on their sharing and give other people the space to share.
  • Uncomfortable situations are uncomfortable and kind of cool.
    • Sometimes you’re presented with abrupt shit. It can catch you off guard, especially at 2 in the morning. The cool thing is that you learn how to work with the uncomfortable-ness instead of against it, and you learn more of how to do that everyday. Eventually all this shit you learn rolls over into everyday life and you’ll find yourself learning a stranger’s life story when all they’d said was hi to you, and you said hi back and asked how they were and they shrugged and rather than walk away you just had to comment: “that seems as if you’re not satisfied with today” and there you go, you’ve opened Pandora’s box full of reflections and open ended questions. Just roll with it. You’ve become your ultimate self.
  • You’re apart of a community, not just a workplace.
    • And not only are you apart of it, you get to help build and maintain the atmosphere and contribute to people’s lives and they contribute to your life and it’s never just “coming to work”. You go places with people mentally and physically (we take people on outings to the beach and such). The more you get to know certain people, the more they trust you and the more you trust them and it’s not some weird hierarchical “I’m the worker, you’re the guest (we call people guests, not clients or whatever), do what I say”. Or, “This is what worked for me so it’s going to work for you, you just need to listen to me”. Or “You’re not complying with my orders and that makes me insecure and therefore you’re a problem guest”.

Cons

  • There are A LOT of different personalities. You won’t jive with them all.
    • No one jives with all of their coworkers at any kind of job, or the people they interact with. But at most jobs you just knuckle through it and the drama is kind of hovering in the background, the elephant in the room. You don’t go after a customer and say “you know, your kid didn’t put that toy back on the shelf and that hurts because my next hour I have to stock and there are so many toys misplaced that I can’t even get my actual stocking job done and I just feel it’s disrespectful to the store and to us workers when people throw things around. How do you feel about that?” No. You do your job, you go home, you gossip on social media or whatever. At this job the drama can blow up fairly quickly and some of it is a bit under the rug but most of it is in the open. This isn’t really a con. But it can become extremely stressful, which is why I put it on this list. Everyone deals with separate mental health stuff, so some people’s anxiety can really up your anxiety. Other’s paranoia can really, really up your paranoia, I’ve noticed personally.
  • You don’t always make enough to live on.
    • At least, not where I live. With two overnight shifts and one day shift, I bring in an average of $1500 a month before taxes (+ or – $500). Now, if I lived in Cheyboygan, Michigan, that would be a lot. Here, it’s not even enough for one month’s rent for a studio half the time. And if you find a studio less than that, don’t expect to eat or have electricity or soap to wash your ass. The addition of one night shift (10 hrs) was enough to push me 100 dollars over the Medi-Cal welfare limit and so my insurance was ripped away and all the Health services I received. Some people purposefully keep their hours low so they don’t lose insurance and social security and subsidized housing. You get trapped in this web of “I want to work, and I can work, but I can’t work enough to make a living because I still get overwhelmed and the government doesn’t want me to work but they do want me to work so what the fuck?”
  • It’s easy to get burnt out.
    • If I worked more than I do, especially right now, I would (majorly) break down at least twice a year. There’s a lot of emotions to deal with. There’s a lot of stuff you might accidentally bring home with you.

There are a lot more positives and probably some more negatives too, but I’m not trying to go on into infinity. Overall, this is the most comfortable and rewarding job I’ve had. They hired me a month before my 21st birthday and I’m still the youngest worker there by one year. I always joke they’re not allowed to hire anyone younger than me because I’ve always been the baby they’ve had to cradle; I feel like I was raised there and it’s only been three years. That should say something about growth. I think maybe I was mentally raised there.

There are a bunch of different types of peer services out there. Walk-in/Drop-in centers, Warmlines (which are phone lines manned by peers. Some are better than others. We offer a Warmline at the house.) NAMI is a version of family and peer services; some people find them useful and rewarding. There are more respite houses popping up across the U.S. There may be 40 or so now. There was 30-something when I first got hired. Sometimes there are peers working in the hospitals.

If you’re curious about a peer respite near you, check this directory This is the U.S list. There are peer services in other countries as well, it just takes a quick google search.

If you want to learn more about what a Peer Respite actually is, read this description here.

Posted in psychology

Objectively being Objective

Posted on by alidware

Do other bloggers/writers enjoy writer’s block as much as I do? I think it’s a time to explore what you want to say versus what you could say. Or maybe I’m one of those horrible people who see light in every darkness, and not in the cliche “there’s a positive in every negative” way.

Of course there’s a positive in every negative. It wouldn’t be negative if there wasn’t. Come on.

I was thinking about my previous post and about craziness in general, and about variation too, about how all of our experiences are different and yet they overlap. I wonder if they overlap because they are caused by similar “defects” (as the medical model persists) or if they overlap because we, again, enjoy organizing things into categories. Because it seems to me, in reading the research, that there are many different pathways that cause many different experiences, and no matter how much the media tells you serotonin is responsible for anxiety and dopamine is responsible for psychosis, no one actually knows.

Here’s a tip: if you hear a psychologist or researcher presenting information to the media, their work probably hasn’t been peer reviewed or replicated yet.

And so that makes me think about the spectrum of psychosis. I mean, there’s a wide range of experiences, and I touched on them last time just; this difference between internal versus external voices and how they were once regarded separate in their effect but now are regarded quite similar, the only difference being those with primarily internal voices have more awareness of their “origin”.

Some people have visual hallucinations, some people don’t. Some people have very few, like me. Some people believe people are coming to kill them. Some people believe spirits are coming to kill them. Some people think they’re God. Some people think you’re Lucifer. Some people sit silent, aloof, and stare at a wall (me). Others run down the street. A tiny fraction of people become violent out of nothing more than fear or confused anger.

So, what is it that varies all these experiences? It can’t all be chemicals. After all, delusions and hallucinations have a lot of fun playing off things/people/events happening around you.

There’s no point in arguing nature versus nurture, we’ll never be conclusive on that. People can have opinions, but the data will never be conclusive. What I think, then, is things like this should be considered with that ambiguity in mind.

It’s another fact that we’re human and humans hold bias. Researchers who want to be that one person to find conclusive evidence that a specific pathway with a specific chemical and electrical impulse in the brain is responsible for the cluster of experiences we call schizophrenia or bipolar or depression or anxiety will find that conclusive evidence. It might not be significant, it might not be real, and it will probably be correlational at best, but they’ll find it because they’re searching for it. They’ll find it because the companies they’re researching for toss out the evidence which doesn’t support the theory–that’s a big source of fraud in medical science these days.

It’s difficult to be objective in regular, everyday life. It’s ten times more difficult in research psychology, especially if you’re after fame or truly believe that your efforts will save millions of lives. Because if you don’t become famous and you don’t save everyone’s lives then you’ve just spend hundreds of thosuands of dollars on a degree in a job that may never pay off in the ways you imagined. And no one wants their fantasy squashed.

So I implore you in your daily lives, and especially those of you studying psychology or any science really, to remember nothing is certain. Remember a theory can never be proven; no matter how much “evidence” you think you find, we can never claim it as an absolute truth. Remember falsifying theories is more important; if we weed out the false ideas we can get closer to the truth, kind of how a limit never approaches zero but does that funny thing where it gets super close. Remember you’re the ass if you bend to the whim of money and fame and bribes.

Who wants to be so certain of everything, anyway? I enjoy waking up in the morning unsure of what the day will bring, and even more so now that I’ve stopped thinking “OH GOD OH GOD WHAT’S GOING TO HAPPEN TODAY” and started embracing “I wonder what could happen today? Well, I guess I’ll just find out.”

Certainty is so boring. That’s probably why the universe doesn’t care for it.

Posted in Voices

Soggy Boxes and The Variation of Us

Posted on by alidware

As a species we really adore concrete things. We like to have hard lines; we like our tables to have edges, our doors to have frames, and a lot of the time that’s practical and necessary. I’ve noticed we also like our thoughts to have the same uniform structure.

Our brains are there to make sense of everything and when something doesn’t make sense we must make it make sense and to do that we find a perfect little box and if we can’t find a perfect little box, we create the broken box; if something doesn’t fit the standard box, that something must be broken. The broken box is where mental health issues lie.

We often call ourselves broken, ill, sick, all these negative connotations because that’s the box we’ve been given, and we feel broken, ill, and sick.

Within the broken box, there are three more little soggy boxes in the rain: mild, moderate, and severe. They’ve been around for a couple decades now, could use some time out in the sun and duct tape on the sides. In the mild box, you won’t find much help or understanding. Maybe you get anxiety every once in a while, or in specific situations. Maybe someone’s poured an ounce of depresso in your coffee and you have that annoying “blah” feeling, but you never miss work, you never want to die, and you function well.

The moderate box is a little less full. Your anxiety is constant. You get two ounces of depresso each morning and miss work once in a blue moon because you just can’t take it anymore. You think about finding a therapist, but draw the line at psychiatry until someone convinces you otherwise.

The severe box is the smallest, but that’s supposed to be good. Your anxiety won’t let you leave your house–not for the last three years. Your depression fills your cups of coffee, all four of them, every morning, and you don’t leave your bed, let alone your house. You can’t think straight, you’re spouting words which don’t exist on earth and God’s been talking to you, really talking to you this time, and you’re the chosen one. You can’t work, you can’t shop for yourself, and help is forced, not chosen.

So, for those of us who don’t fit in the soggy boxes, where do we go? We float in the ether.

Sometime I’ll talk about the most broken areas of the mental health system, and that will include the closet they keep all these boxes. But in this post I wanted to talk about variation.

I’ve never considered myself mentally ill, or to have a mental disorder. That’s not because I’m in “denial”. It’s because I don’t see myself as ill. I was in therapy at 6 for not talking. All of school was trauma because I still didn’t talk, I didn’t make friends, anxiety made me cry every five minutes, I was homeless for a few years and then also hormones. I think puberty should be considered a trauma. In high school I got depressed, was deep in self harm already, got on medication and into therapy. Neither helped.

In college, I solved Ebola and cured anxiety with frequencies. It’s a long story. Then I questioned things. People didn’t seem to hear the same things I did, or notice patterns I did. For some reason this didn’t frighten me. It startled me, but it never frightened me. I only got frightened when I was dragged into hell, trapped by demons, and then caused the Las Vegas mass shooting.

Obviously I didn’t cause the Las Vegas shooting, but I thought it was because of me.

And the things I heard: it was strange. It wasn’t just people outside talking to me, or talking about me, they were in my head too. Like, really lodged in there.

When you read this post silently to yourself, you have that mini-you voice. They were not that. They were similar as I didn’t hear them outside of my head, but they were differently pitched than my mini-me voice. They said random things (my favorite is “Put that burrito on reservation”), commented on things, and overwhelmed me when I sat in class. I dropped a lot of classes during this awakening period.

It never felt appropriate calling these voices because I knew it’d be dismissed and so when assessed I said I heard externally ones occasionally and they didn’t always say a lot, I didn’t know them well, and one just screamed.

Again, I didn’t fit in any box. I had periods of grandiosity, of depression, but also of consistent, unbreakable, delusions, regardless of my mood (sometimes). I’d seen things others didn’t. All I was missing to really put the dot on their fucking I’s were consistent, mind-numbing external voices.

So I read some papers. It was thought just a little over a decade ago that internal voices weren’t a thing, and then when they were, they were considered less severe than external ones.

And then I found this 2016 gem.

And felt oddly validated. Strangely validated. Horrifyingly validated.

Because now I fit in a box. And that feeling has plagued me ever since.

I don’t want to fit in one of those soggy, disgusting, abandoned closet boxes. But if I don’t, my struggles will be invalidated and dismissed.

So, I created my own box. Not a sick, diseased, ill box, but one which harbors a variety of human experiences and calls them just that. It’s not really a box at all, it’s just a flat piece of cardboard on the floor with no ceiling, no walls, and you can stretch your arms and breathe fresh air. There’s no duct tape or shipping labels or clumsy shoving of your limbs.

In the abstract of the above article, the researchers say they found those with internal voices to be more aware of where the voices come from. And that makes things easier, I think, because when I do hear things externally, I usually believe it’s someone in the building or outside of the building commenting on me or hating on me or whatever, and that’s a lot harder to work through.

Maybe it’s the awareness that dilutes the fear. It doesn’t dilute the stress.

And their internal nature doesn’t mean I believe they’re coming from me. So, do with that information what you will.

My point? We are human. Humans have experiences. Humans have varied experiences. And to call an experience, even a terrifying one, even a disrupting one, even a repetitive, life shattering one an illness like cancer is an illness, an illness like high blood pressure is an illness, is some kind of twisted medical logical fallacy.

You want mental health to be treated like physical health?

It already is.

Posted in Freedom

On Mental Health And Freedom

Posted on by alidware

I don’t know about the rest of you, but one thing I struggled with a lot in the worst of my mental health was feeling free. Not just from myself and my own judgments, but from other people’s judgments and the judgments of life; I talked a bit in the previous post about how it feels life has a standard of living we should be striving toward.

Growing up with anxiety meant every little thing made me cry. I felt kinds words reprimanded me, I felt harsh words reprimanded me, and silence or confusion around my actions or word made me feel “stupid”. That’s been a big hurdle for me: feeling stupid. Let me give you a recent example.

I decided to quit a second job I had acquired about six months before. One anxiety I still battle is approaching people, and a series of events lead up to me ghosting the job (as I have every job I’ve quit for the last 7 years). Their incessant calling my phone, my mother’s phone, and my primary job sparked paranoia; I heard the workers talking about me, their voices, their thoughts, and had the first panic attack I’ve had in 2.5 years. At the end of it all, friends seemed to reflect that I’d felt bad for ghosting my employer. But that wasn’t the case.

The things I heard were them discussing how stupid I’d been to do this. I feared looking stupid in the eyes of people I’d probably never see again.

There’s no guarantee had I quit “properly” I wouldn’t have experienced the same things. I always thought they considered me stupid, and that is in relation to how little I speak. That’s traced back into a childhood of selective mutism and gut wrenching anxiety and people actually thinking I was slow.

So, freedom felt hard to come by. Unobtainable. Non-existent.

My first realization came some months back: I needed to give myself permission to speak. I had never been given the chance or the encouragement as a child; at home, I was bullied into stifling my voice, especially around “grown folks”, and at school I was reprimanded for never talking. My child brain didn’t know how to reason through that contradiction. And so my first step as an adult was to remind myself I’m allowed to speak.

My second revelation came as I thought about the meaning of freedom. Could I do whatever I wanted? Murder without a conscience? Disregard consequence? Revel in havoc and embrace chaos? I dabbled in heavy partying for a brief period, mixed medications and alcohol hoping to feel alive and free in debauchery and carelessness. I didn’t feel trapped anymore, but I didn’t feel free either. So chaos wasn’t freedom, it was just a localized, appealing version of pain.

If recklessness wasn’t freedom, than what was? I thought back to the days I berated myself and physically hurt myself out of confusion and some underlying need to be noticed. I didn’t consider myself a bad person, but I didn’t think I was very good either, and then I learned.

I learned I judged myself (and assumed other people’s judgments) were based on whether or not I saw myself, or they saw me, as a bad person, a stupid person, an awkward person. I wanted to be good with the assumption that good meant genius, perfect, social. Being smart wasn’t enough for me–I needed to be smarter than everyone or my intelligence was worth nothing. I needed to not have acne or be so tall or wear unflattering clothes. I needed to not isolate. I needed to not need isolation. I needed to meet people and have friends and be normal. Normal was good. By those standards, I was very, very bad.

I spent time cycling around town, hiking in mountains, and thinking. I learned bad was pretty good.

I don’t mean this in the cliche sense of “in every bad person, there’s a good heart”, nor do I mean “not being normal is also good.” I mean, quite literally, we wouldn’t understand this concept of “bad” without good, and visa versa. Both are within each other, and created from each other, and therefore to label myself one or other, I labeled myself both. And I don’t mean that in the sense of “yes, everyone has a good side and a bad side”. Again, I mean this quite literally, and in a concrete sense, separate from the outcome of actions or thoughts. I.e, starting a riot in the middle of the street is called bad and therefore also called good. One concept can’t exist without the other in every form of life.

It didn’t mean that because snorting coke was both good and bad I should indulge. It meant I could acknowledge the duality and weigh my choices based on the outcome I wanted. I don’t not do drugs because it’s “bad”. I don’t do drugs because it would serve no purpose in the way of freedom.

That brought a lot of comfort because I no longer logically needed to live up to an invisible standard.

Being content with and understanding the connective duality of life gave me freedom from myself. It allowed me to allow space for those voices in my head, including my own negative thoughts; we were all now equal in our non-equality. Their darkness, and my own, was now also light. There was freedom in not fighting, and by not fighting, I fought. It’s similar to breaking an enemies resistance without fighting, which I believe is a central theme in Doaism teachings.

None of this stopped the pain. But all of this let me understand pain, and what I understand, I don’t fear.

It’s refreshing to understand yourself.

Posted in Emotions

To Process Emotions

Posted on by alidware

When I stopped seriously blogging about two years ago, it was abrupt and painful. Painful because I missed the writing community of almost five years which had enjoyed stories and laughs and tears and memories and traumas alongside me. They were there when I got my first car. They were there when I quit each job I got. They were there when I became employed at a Peer Respite house. They were there in my largest transformations of self.

Also painful because I was cracking up. Breaking down. In the hospital, confused and somewhat oddly satisfied in my terror of life. I felt alive again in a twisted way. I felt targeted and special and immortal and genius and connected to something greater than myself.

I posted every once in a while, but lost my follower’s attention. I created a slough of new sites, but WordPress changed so much of their format that I got frustrated trying to adapt. So, I went dark.

I told myself I’d be back only when I felt secure in myself. I’d be back only when I knew I had something important to say. I have something important to say.

This journey through depression and delusion and anxiety has given me new insights on darkness. Its introduced me to the true duality of nature so described in daoism. It’s roughly coddled me into accepting not only myself but all of life.

At the beginning of the pain, before I even worked at the respite house, a voice kept telling me “dead man walking”. Considering I’m a woman, it kind of cracked me up and also simultaneously terrified me; someone, something, was coming to kill me I thought. But I don’t think he predicted my future. I think he commented on my present. I was dead. I enjoyed nothing. I faked smiles. I practiced expert avoidance. I ignored myself and my inner processes because they scared me and because of that fear those inner processes found a way to express themselves for the first time in both of our lives. That way was voices, beliefs, depressions, a mania, panic attacks, and the underlying feeling of being broken.

I could talk about childhood stuff here. I could talk about medication and homelessness and the trauma of school. But I spent years reiterating that on my previous blog. I’ve spent time reiterating it to friends and therapists. And now, I can sum it all up in one word: fear.

I feared everything, for many reasons. I feared life. I feared being sad. I feared being happy because sadness came after. I feared anxiety, I feared death, I feared fear.

I think many of us go into therapy or other treatments confused on what “processing emotions” means. I think some therapists and psychiatrists who have never really gone through that heavy process are also confused on what it means. So they blurt it because they’re supposed to, it’s part of the script.

Processing emotions for me meant more than just talking about them and feeling them. It meant not telling myself “tomorrow will be better” or “this is temporary” or “I’ll be happy some day”. It meant not telling myself “you need to get up”. It meant greeting darkness with a handshake and respecting the space it needed within me. The darkness is lonely, too.

It meant sharing my body and my mind with panic and voices and fear and setting boundaries with them; if we all have to live in here together, we need to communicate and I can’t hold the power. But neither can you.

It meant getting comfortable with uncertainty. There is no standard “life”. My experiences don’t make life worse than what life should be, they don’t make life better than what life should be because life doesn’t have a designated “should”. It doesn’t have a designated “have to”. It’s just there.

It meant veering from my psychology degree and studying philosophy, a bit of physics, and leafing through neuroscience articles. It meant studying research. It meant, for me, getting off medication, and really feeling ALL of myself.

I’m sure most people have heard of the double-slit experiment in physics. I remember hearing about it for the first time as I sat high as a kite in High School chemistry. You learn the conclusion is that photons (and other particles) behave as both a wave and a particle, given the observed interference pattern. What high school teachers don’t talk much about is that the reason we come to that conclusion and label it as a reasonable consensus is because, as of right now, we’ll never know if we’re wrong.

We can’t see a single photon pass through anything with the naked eye. And so when we don’t observe it with a camera, when we can’t see what’s happening, the photon behaves as a single photon. The camera we use to observe this particle has a tiny light. That tiny light is a confounding variable–it could be affecting the particle’s behavior. Or maybe it isn’t. But, because we can never see for ourselves with a naked eye, we’ll never know. That’s the paradox, and part of the foundation of the Uncertainty Principal.

We’ll never know. We’re limited in this life we have, and when we’re not okay with that, we run ourselves exhausted trying to fix what isn’t broken.

I’m not scared of darkness anymore. What is there to be scared of?