On when life gets in the way of recovery

Recovery is not where you go, but how you get there. It is as much a process as a product. But sometimes life gets in the way.

A major part of recovery (certainly not the only part) is how we get along with other people. We are “hard-wired” to connect with other people and there is ample evidence to suggest that when that part of our life goes well other areas also go well. Personal renewal is a core of recovery, but if you are going to walk the walk and not just talk the talk, there will also be a renewal of how you connect with other people.

But relationships are sometimes inconvenient and we often let other things take precedence. Simple busyness has a way of destroying our focus on what is important in life. Urgency replaces importance. Life becomes a “to do” list and the anxiety about what we havent done captures our attention and daily focus. We dont even have time to listen to each other. Rather than listen with an intent to understand we listen with an intent to reply. People become one more thing to get done.

All of us have things that we use to enlarge ourselves: money, status, power, things, feeling good. I have known some people who desperately want to improve their lives “as long as…..” As long as it does not require them to risk the “stuff” of their life. We try to find ways to “be different” without “doing different” and not so strangely find it hard to do.

Recovery is first about priorities. It is about becoming an expert on your life and your issues and applying that expertise in pursuit of the life you desire and were meant to live. As much as it is a getting it is a giving up. The pursuit of some things, some people, and some values for some folks simply get in the way. And the decision to move in a different direction is something that is never done, but must be renewed each day. A friend of mine once told me his recovery was a “miracle…” But it was he said “a miracle that must be redone each day.”

Life can get in the way of recovery, even for the most sincere people. Take a look and ask if this is an issue for you.

On holding hope

She was new to the group. The last words she said as she left stuck with me. “I am so glad I came….I need someone to hold my hope for a little while. I have come so close to losing it and I am so scared I wont know where to look to find it again.”

I have thought a lot in the last few days about the idea of “holding hope” for other people. One thing I have realized is how often, particularly in the last couple of years, other people have “held hope” for me when it seemed like I would lose it. Sometimes it has been in their stories, their testimony. Sometimes it has just been in doing nothing but being there. There is even something hopeful about having someone listen to you, even when you are able to say little.

This lady talked about the losses in her life. They were too many to even begin to go into in this space. Yet she was strong and courageous. With every reason to quit she hadnt and didnt want to. She had a wisdom about her. She told one person in the group, “In your possibility I see my own….Hearing how it has worked for you makes me think it can for me…” I liked her a lot.

I am reading a book right now that talks about how we are hard wired to connect with each other. It talks about a new field called social neuroscience and explains about mirror neurons and many other things. Basically it means that on a brain level what other people feel is important to us and indeed that what they feel changes our brain to “feel” the same way. Empathy it seems is built into our hardware. It is not just a nice thing to do or a productive way to act. It is part of who we are.

I dont understand all of it by any stretch of the imagination, but part of what it means is that the best antidepressant may be other people. It means that in sharing our hope with others it can literally change them on a brain level. It means that caring counts.

There are so many people who have held hope for me when I didnt know where to turn. I hope I have held hope for some of them. I hope we can help this lady to hold hope. I think we can. Without even knowing it she has strengthened my hope. It was a good night.

Something to think about. When it is bad who hold hope for you? Whose hope do you hold?

Peace.

What do you think? Advice to a newcomer

I have just met a man who has just been diagnosed with bipolar disorder. He has had years of serious problems, but right now is really scared about what this “bipolar stuff” means for him and his life. He has a wife and a teenaged daughter who have seen him in the worst of times. They love him, but are also really scared. What would be your advice? Many people seem to find “the system” as scary as the bipolar. What would you tell him?

ON what to do in a crisis

The following is from SAMSHA. It describes their idea of the framework to deal with crisis situations. It is well worth reading and thinking about. I look forward to your feedback.

Responding To A Mental Health Crisis Ten Essential Values

Ten Essential Values Are Inherent In An Appropriate Crisis Response, Regardless Of The Nature Of The Crisis, The Situations Where Assistance Is Offered Or The Individuals Providing Assistance:

1. Avoiding harm. Sometimes mental health crises place the safety of the person, the crisis responders or others in jeopardy. An appropriate response establishes physical safety, but it also establishes the individual’s psychological safety. For instance, restraints are sometimes used in situations where there is an immediate risk of physical harm, yet this intervention has inherent physical and psychological risks that can cause injury and even death. Precipitous responses to individuals in mental health crises—often initiated with the intention of establishing physical safety—sometimes result in harm to the individual. An appropriate response to mental health crises considers the risks and benefits attendant to interventions and whenever possible employs alternative approaches, such as controlling danger sufficiently to allow a period of “watchful waiting.” In circumstances where there is an urgent need to establish physical safety and few viable alternatives to address an immediate risk of significant harm to the individual or others, an appropriate crisis response incorporates measures to minimize the duration and negative impact of interventions used.

2. Intervening In Person-Centered Ways. Mental health crises may be routine in some settings and, perhaps, have even come to be routine for some people with serious mental health or emotional problems. Nevertheless, appropriate crisis assistance avoids rote interventions based on diagnostic labels, presenting complaint or practices customary to a particular setting. Appropriate interventions seek to understand the individual, his or her unique circumstances and how that individual’s personal preferences and goals can be maximally incorporated in the crisis response.

3. Shared Responsibility. An acute sense of losing control over events or feelings is a hallmark of mental health crises. In fact, research has shown “feeling out of control” to be the most common reason consumers cite for being brought in for psychiatric emergency care.12 An intervention that is done to the individual— rather than with the individual—can reinforce these feelings of helplessness. One of the principal rationales for person-centered plans is that shared responsibility promotes engagement and better outcomes. While crisis situations may present challenges to implementing shared, person-centered plans, ultimately an intervention that considers and, to the extent possible, honors an individual’s role in crisis resolution may hold long-term benefits. An appropriate crisis response seeks to assist the individual in regaining control by considering the individual an active partner in—rather than a passive recipient of—services.

4. Addressing Trauma. Crises, themselves, are intrinsically traumatic and certain crisis interventions may have the effect of imposing further trauma—both physical and emotional. In addition, people with serious mental illness have a high probability of having been victims of abuse or neglect. It is essential that once physical safety has been established, harm resulting from the crisis or crisis response is evaluated and addressed without delay by individuals qualified to diagnose and initiate needed treatment. There is also a dual responsibility relating to the individual’s relevant trauma history and vulnerabilities associated with particular interventions; crisis responders should appropriately seek out and incorporate this information in their approaches, and individuals should take personal responsibility for making this crucial information available (for instance, by executing advance directives).

5. Establishing Feelings Of Personal Safety. An individual may experience a mental health crisis as a catastrophic event and, accordingly, may have an urgent need to feel safe. What is regarded as agitated behavior may reflect an individual’s attempts at self-protection, though perhaps to an unwarranted threat. Assisting the individual in attaining the subjective goal of personal safety requires an understanding of what is needed for that person to experience a sense of security (perhaps contained in a crisis plan or personal safety plan previously formulated by the individual) and what interventions increase feelings of vulnerability (for instance, confinement in a room alone). Providing such assistance also requires that staff be afforded time to gain an understanding of the individual’s needs and latitude to address these needs creatively.

6. Based On Strengths. Sharing responsibility for crisis resolution means understanding that an individual, even while in crisis, can marshal personal strengths and assist in the resolution of the emergency. Individuals often understand the factors that precipitated a crisis as well as factors that can help ameliorate their impact. An appropriate crisis response seeks to identify and reinforce the resources on which an individual can draw, not only to recover from the crisis event, but to also help protect against further occurrences.

7. The Whole Person. For individuals who have a mental illness, the psychiatric label itself may shape—even dominate—decisions about which crisis interventions are offered and how they are made available. An individual with a serious mental illness who is in crisis is a whole person, whose established psychiatric disability may be relevant but may—or may not—be immediately paramount. That the individual may have multiple needs and an adequate understanding of the crisis means not being limited by services that are compartmentalized according to healthcare specialty. An individual’s emergency may reflect the interplay of psychiatric issues with other health factors.And while the individual is experiencing a crisis that tends to be addressed as a clinical phenomenon, there may also be a host of seemingly mundane, real-world concerns that significantly affect an individual’s response: the whereabouts of the person’s children, the welfare of pets, whether the house is locked, absence from work, and so on.

8. The Person As Credible Source. Assertions or complaints made by individuals who have been diagnosed with a serious mental illness tend to be viewed skeptically by others. Particularly within the charged context of mental health crises, there may be a presumption that statements made by these individuals are manifestations of delusional thinking. Consequently, there is a risk that legitimate complaints relating to such matters as medical illness, pain, abuse or victimization will go unheeded. Even when an individual’s assertions are not well grounded in reality and represent obviously delusional thoughts, the “telling of one’s story” may represent an important step toward crisis resolution.13 For these reasons, an appropriate response to an individual in mental health crisis is not dismissive of the person as a credible source of information—factual or emotional—that is important to understanding the person’s strengths and needs.

9. Recovery, Resilience And Natural Supports. Certain settings, such as hospital emergency departments, may see individuals only transiently, at a point when they are in acute crisis and in a decidedly high-stress environment. Even when not occurring within hospitals, mental health emergency interventions are often provided in settings that are alien to the individual and the natural supports that may be important parts of his or her daily life. It is important not to lose sight of the fact that an emergency episode may be a temporary relapse and not definitional of the person or that individual’s broader life course. An appropriate crisis response contributes to the individual’s larger journey toward recovery and resilience and incorporates these values. Accordingly, interventions should preserve dignity, foster a sense of hope, and promote engagement with formal systems and informal resources.

10. Prevention. Too often, individuals with serious mental illnesses have only temporary respite between crises.An appropriate crisis response works to ensure that crises will not be recurrent by evaluating and considering factors that contributed to the current episode and that will prevent future relapse. Hence, an adequate crisis response requires measures that address the person’s unmet needs, both through individualized planning and by promoting systemic improvements.

————–

You dont have to know the answers to all of life’s answers just…..

I often dont know what to do. I hear from many people with all kinds of problems. Many times I dont understand the problem. Sometimes I misunderstand the problem. Sometimes I just dont know enough. But I do know one thing care matters. Love matters. Sometimes solutions are more important than answers.

I believe in stories. In the stories of others I find direction for my own. Sometimes the stories are in word, sometimes they are written, sometimes they are in music. The video below is a story that speaks to me. I hope you like it.

Second look: On the narrow edge of suicide

Hope matters.  Prayer matters.  The post below was originally written 4 or 5 months ago.  The lady I speak about is doing well in life.  She has made it through many crisis.  She is beginning to realize that, even for her, happiness is possible. 

 

I have a close friend who almost died.

 

She used to describe for me what a day was like when you were suicidal.  She said it was like a prison, but she could never leave.  Everywhere she went it came too.  It was like a thousand voices telling you to do something you really didn’t want to do and when you looked to see who was talking to you all the voices were yours.  She didn’t live just in depression or discouragement.  She lived in terror.

 

She told me about how many times in a day she would think about slitting her throat or walking in front of a car.  The desperation in her voice come through clear with every word.  She felt like death was the best answer for her—but she didn’t want it to be.   In the end I think the only thing stronger than her passion for death was her passion for life.  She held strong and ferociously to the idea that what was happening was not her, but something that was happening to her. 

 

She has searched diligently for the right medication and so far hasn’t really found it.  She seems to be a walking side effect.  Most of her meds have serious side effects and she always seems to have the most serious of the side effects.   She often wonders if the cure stops the disease what will cure the cure.  She has gained a lot of weight  and with that has come a lot of health worries.  On a good day she feels bad.  She has had significant dental problems from years of anticonvulsants.  Many of the everyday stresses that she deals with are described in the medication packages where it starts with “side effects include.”

 

She has been in the hospital before and may well have other visits ahead for her.  She hated it, because she felt like her dignity as a human being was disregarded there, but it was a safe place in an unsafe time and may well serve that function again.

 

She is a prayerful person.  She turns daily to Him and in her weakness has found His strength.  She is grateful for the many blessings she has gotten and told me once that even this overwhelming depression that seemed cloak everything she said or did was at bottom an opportunity to get closer to Him.  Even when the worst of things seem to occupy every inch, every breath, every beat of her life she tries to rejoice in the opportunities ahead.

 

She is in many ways a miracle.  In her illness she has tried to find a path to what she can be instead of a complaint about what she can’t be.

Sometimes she is very much afraid.  She knows terror well.  But hers is a terror ultimately of herself and the edge to which her strange brain chemistry drives her.  She loves life and loves God with all her heart, but knows the terror of that which tries to entice her, to browbeat her and threaten her until she finally gives up on what she loves and buys their counterfeit truth.

 

She has won no wars, but fights many battles.  Some days are better some days are not.  One day she may die.  The illness will not go away and constantly demands more of her life.  I asked her once what she had learned and what she could tell other people and I liked what she said.

 

“I have learned what it is like to live in a prison of one.  I have learned to keep other people close so that the walls don’t rise.  I have learned that there is wisdom sometimes in fear and to always be open to it.  I have learned that no matter how much I feel like doing something I don’t have to do it.  I have learned I am not my illness.  I have learned that I do not prosper in the denial of my illness, but in knowing that my freedom, as much as I have it, is in deciding what of its demands I listen to.  I have learned I can decide not to die, but I must decide so every day.  I have learned that God is with me and I matter to him.  And I have learned when the demons come upon me and their chorus grows louder and louder, I can say with His help, “No.  No, not this time.”

 

She remains each day in my prayers.  I hope now she will be in yours.

On managing your feelings

Feelings do many things.  Sometimes they enlighten us.  Sometimes they seduce us.  Sometimes they command us to act.  Sometimes they give us excuse not to act.  Sometimes they are the result of how we see.  Sometimes they are the lens through which we see.

Feelings are like hungry appetites.  They all want to be fed to grow stronger.  All try to convince us to do things that make them larger and mor powerful.  All try to convince us that feeling like things are so makes them so and feeling like doing something is the same as deciding to do it.

Feelings can give vital information to make decisions by.  They are poor decision makers.   Most of the stupidities in our life “felt like” a good idea.

The more demand quality a feeling has-  the more it shouts “do this” or “see this”- the more it has us, instead of being something we have.  A large part of managing our feelings consists of one simple task- learning we have a choice.  Feelings tend to shed a light down one path and if we are not careful we find ourselves assuming there is no where else to look. 

You begin to manage your feelings not when you try to deny them or push them away.  You manage your feelings when you know they are so, but that they are not all that is so.  You manage your feelings when you know they are a tool to understand and enjoy life and not a hole dug that you must jump into.

There is a line in “A Beautiful Mind” where John Nash says in regard to his hallucinations, “I choose not to feed those desires….”  How we respond to our feelings has more to do with the size, shape , and power of our feelings than the feelings themselves many times.  You can bring them closer, but with practice, can let them go. 

Feelings are great and bring intensity to life.  Just remember not to confuse them with that life.

On the gift of fear

I have a friend who has made probably 13 or 14 suicide attempts in the last 2 or 3 years.  But she has made none in the last 6-8 months.  I asked her what happened.

“More than anything else I have learned to be afraid of me…. I get into spaces where death doesnt frighten me anymore…. I actually begin to think it makes sense….”

She explained further as she went on.  She was really terrified of herself.  She was afraid of what she might decide to do… afraid of what would make sense to her.  She wanted so bad not to be afraid, that she tried to not pay attention to it.  When she would start getting desperate, when she would start thinking about hurting herself,  when she would start feeling like she had no where to turn…..she would try to turn it off and not pay attention.  And quickly the situation would get out of control and things would get very dangerous.

She said things had changed recently.  One thing in particular….  She realized now that fear was not a threat.   She had begun to realize that it was a gift.  That it was her fear of herself that had kept her alive and that it was important that her eyes stayed open and that she listened to what her fear told her. 

Before fear had fed her desperation and now she says it had begun to fuel her hope.  As long as she listened and acted she could deal with the stresses of her life and with the stresses of her.  Life has gotten better.  She still gets afraid, but it no longer seizes her and runs away with her mind.  She can know desperation, but decide to not join in.  She has learned that to feel desperate is not the same as to be desperate.  Death is no longer her friend and no longer what seems sensible to her.  Fear has been a gift for her, and has taught her that life is equally a gift and to be treasured everyday.

Second look: There is a line

There is a line in the Bible that says simply, “Jesus saw….” He saw us past the labels, the names, the possessions…..the anything “about us” to us. Nobody was too important or unimportant, rich or poor, sick or well, old or young. He cared about people.

We spend endless time and endless energy fighting and fussing about things “about us.” Too this….Too that….not enough this…..not enough that. Wrong color shoes, wrong color hair, wrong color skin. Thinks this…thinks that…

We lose the people. We lose each other. We lose ourselves. In an endless stream of labels, words, and stuff that we consider more valuable than gold and the true measure of who we are as a person.

My goal today is to see more than I saw yesterday. My prayer is that you do the same.

The video attached below lasts for 4 minutes and 39 seconds I believe. I hope you listen. It will be time well spent.

On a prescription for pessimism

Pessimism is our greatest natural antidote to hope.   It is one of the most surefire ways to short-circuit any movement in recovery and convince you that continuing to try is fruitless and foolhardy.  It is something many of us struggle with (I know I do) and a struggle that most of us just accept as a reflection of the things really are.

In his book, “”Learned Optimism” Martin Seligman gives the best prescription for pessimism I have heard.

1. Take everything personal.  It is not enough for things to go poorly or be hard.  It is so much worse and so much more overwhelming if all the hard things or things that go poorly are an attack on you.  I am reminded of the last time my tire went flat and I had a long conversation with my tire asking it why it was trying to mess me over.
2. Assume everything bad thing is going to last for a long time.  If you want to really feel bad convince yourself that this is going to be the way it is going to be forever.  It makes it seem real stupid to even try to make things better.  Part of the key to pessimism is not just seeing the bad things but convincing yourself that there are only bad things and making things last forever is a good way to do that.
3. Assume that any bad thing is going to mess everything up.  Catastrophizing is a welcome addition to anybodies efforts to be pessimistic.  How many times have you went to be at night thinking you would wake up dead and wake up to find out that things are not that bad.  I know I have.

The combination of these 3 skills are almost guarenteed to enable anybody to wrap themselves in the warmest blanket of pessimism possible.  I know none of these skills are a stranger to me and I have been in periods where I can testify to how well they work.  I bet you have too.

Being optimistic doesnt mean you dont believe in bad things.  It means that you dont believe that bad things are all there is.

Just because there is a prescription for pessimism doesnt mean you have to fill it.

What do you think? Responsible for what?

There is a major trial going on in my area.  When the defendant was found guilty of rape and murder one of the things he pointed to was that he had bipolar disorder.

Do you buy that?  Does bipolar relieve you of any personal responsibility?  If so what?  Bipolar seems to be the first excuse for so much public misbehavior.  Is that an accurate expression of reality?  Is it true or is it an excuse or is it something else?  What is your reaction when there is a public scandal or crime of some kind and the person guilty says, “bipolar made me do it.”

What do you think? What is the consequence of reducing life to a medical diagosis

There is seeming no human experience, regardless of how good or how bad, that does not seem to be someones target for a new diagnosis.  Life in a real way seems to be reduced to a disease state.    It seems no longer a question of “what you have”, but “how many things you have.”  What do you think has been the result of this for our culture, our communities, our families, and ourselves?  How has it affected who we are, how we treat each other and how we live?

On the theft of joy

Fear steals our joy.

One of the most common questions I hear from folks in our support groups is “am I ever going to get to  the point where I really enjoy life?”  They are not just concerned with managing symptoms.  Many of them are relatively stable, but still wonder if life is anywhere close to all it can be for them.  One lady told me one night, “I dont feel like happiness is real anymore.  Too much is in the way.   It feels like a lie.”

Another lady told me the only constant thing she could count on was fear.  She explained, “Life it seems to me is just one bad thing after another… just one more dissapointment.  I am always on-guard for what is going to happen next.  I dont feel like I can ever afford to let my guard down, because everytime I do the roof caves in… I cant sleep sometimes…. Nothing seems to be much fun anymore…”

I wasnt sure exactly what to say.  I quietly asked her, “Did you think maybe you pay so much attention to what is going to happen that maybe sometimes you miss some things that are happening…?”  We talked about a lot of things she liked and a lot of things she was thankful for, but for her they just didnt seem as real or as big as what she was worried about.

I told her part of the truth as it seemed for me.  Sometimes I get real occupied with what might go wrong.  And for  a simple reason- so much has gone wrong…  I discovered though I had the problem wrong.  The problem was not what I saw.  The problem was where I looked. 

When I practiced looking different places it became easier to see different things.  Hope was making the scary things go away.  But hope, I have begun to realize, is in knowing that scary things are not all there is.   I had gotten looking to one place and forgotten there were other places.  Life can be hard– but that does not mean it is all there is.

I found hope and courage in 3 places:

• What I knew-  it has often been said that knowledge is necessity.  And knowing the path of the road sure made it possible to drive more safely.  It also made it possible to find a new road.
• What I remembered-  I kept the memories I treasured at ready reference.  And I learned a neat phrase.  “This is like that…”  It was the beginning of faith.  I begin to see reoccuring patterns of  the good things of life and I began to see even if I couldnt see them coming if I just paid attention they tended to happen again.  “This is like that.”
• Who I cared for and who cared for me-  It is scariest alone and another set of eyes can see things you are too busy to see.

Everyone needs something to look forward to each and every day.  A major part of the joy of life is the anticipation of good things.  Fear is not just a feeling or a behavior.  It is a set of lenses we look through.  Sometimes the only answer is to get a new prescription.

Second look: on the downhill model of relapse prevention

I have a friend with bipolar disorder who described his theory of relapse prevention.  I thought it made a lot of sense so I want to share it with you.

I call it the downhill model of relapse prevention.

Relapse is a process of “going downhill.”  In traveling downhill there are certain things you need to think about:

1. Don’t ride in the mountains unless you are okay with going down some hills.
2. When possible pick your hills.  Steer away from those that are going to be too steep for you to get safely down.
3. Know when a hill is coming.  Slow down before you get there.  Prepare for danger.
4. Take your foot off the gas.  It is bad enough as it is.  Do not make a bad situation worse.
5. Stay calm and accept the situation.  Look for level ground, but open your eyes and realize that you are on a hill right now.
6. Find some good music.  Do what you can to keep those who are with you calm and okay.
7. Don’t slam on the brakes.  It is an easy way to lose control.  Stopping the car is not the same as reaching level ground.  Wanting it to be over doesn’t make it over.
8. Look for emergency pull-offs in case you lose your brakes.
9. Give others plenty of room.  Other people are on the same hill.  Respect them.  Don’t crash.
10. Remember every hill has a bottom.  Level ground is on the way.
11. Be grateful for the bottom.  Congratulate all on a job well done.  Don’t forget there will still be more hills.  Be ready.

Give it some thought and I believe you will find a lot of wisdom in this small theory.  I know I do.

A second look: On isolation

A woman came recently to one of our support groups for the first time.  She had never been to one before.

More than anything she talked about isolation.  In the midst of family and “friends” she had never- not once- opened up and talked about the issues she was struggling with.  She talked about the fight to get out of bed.  She talked about the pain of being alone in a crowd.  She talked about the pool at her apartments and how she watched people go and wished she could go to.  And she talked about how often she wanted to die.

She was alive because she thought her death might inconvenience other people.  She talked about trying to find a month when no one had a birthday or there wasnt a holiday or a special event.  She didnt want to make something good into something bad.  She was thoughtful to the max, but didnt think she was worth a thought.

She talked.  Then she cried.  Then she talked some more.  I think she really suprised herself with how much she had to talk about.  It is hard to have faith in yourself if no one around you has.  It is hard to treat yourself as important if no one else does.  Isolation isnt always about how many people are around.  Sometimes its about how you are around people.

We told her how she deserved more and how she was worth more and how much courage she had.  She is not used to good news and although I think she liked what she heard I think it made her uncomfortable.  She is sadly comfortable in the theater and feels awkward at the thought of being part of the movie.

I hope she comes back.  I think she might.  She at least said so.  Mental illness for her has meant being alone.  Always.  She was married for a long time, but even then was alone.  She talked about her husband for a while.  “You know,” she said, “we were together for years.  I never even knew how much he made…” 

Chronic isolation is a form of death before dying.  For too many with mental health issues it is a death too easily found.  Remember God gave us hands for reaching out to others.  Say “hello” to someone today.