Mental health and the holidays

Gobble gobble!

Now that the obligatory greeting is out of the way, here’s another: Happy Thanksgiving!  I hope that, for whatever struggles you are currently enduring, you are able to find a way to be grateful for all that you do have.

The holidays can be a stressful time, particularly for those who suffer from mental health issues.  This interesting article from Healthline notes two very accurate reasons for depression during this time period:

  • Social isolation, particularly during the holiday season, and particular if you actually don’t have the opportunity to spend time with friends and family.
  • Grieving.  The holidays can be very difficult for those who have lost someone, even more so if that death is a recent one.  After all, since the holidays are usually associated with spending time with people you love.  As such, the loss of those who you are close with can make the pain of the holidays feel virtually unbearable.

This story from a 2014 Huffington Post article adds some additional insight:

  • People tend to set unrealistic expectations for their social interaction and what they can accomplish during the Holidays (pro-tip: You aren’t Martha Stewart).
  • People try to do too much.
  • “Comparing your insides to someone else’s outsides,” particularly thanks to social media (YES this a thousand times!).

That being said, I may as well take this opportunity to dispel a suicide-related myth: Contrary to popular belief, suicides do not increase during the holidays.  In fact, they actually decrease.

On a personal level, I was always relatively okay during the holidaus, even at my most depressed points, though there were some rough patches.  Thanksgiving and Christmas were always nice, but, randomly, what always got me was the 4th of July.  It’s supposed to be a fun, relaxed holiday, but somehow, I always spent it alone, or frequently with people who I didn’t really like and made me feel alone.  There’s something about holidays that can just make you feel like a loser…like, you are supposed to be having fun and aren’t.  Isn’t that the worst?

So, how do you survive?  Some thoughts:

  • First and foremost, don’t even think about talking about Donald Trump.
  • Stay.  The.  Hell.  Off.  Of.  Facebook.  Seriously.  As I’ve discussed previously, social media can be really bad for your mental health, and this can be particularly true for moments when you are already vulnerable from a mental health perspective.  For your own sanity, limit your time on social media.  It will be way, way too easy to, as the note above says, “compare your insides to someone else’s outsides.”
  • It’s Thanksgiving.  Try to be as thankful as you can be.  That’s easier said, than done, of course.  But, to the extent that you are able, think about it.  If you are reading this blog, you have internet access, which is better than the more than three billion people who don’t have internet access. That likely means you live in the developed world, which means you have access to food, clean drinking water, modern sanitation systems and decent medical care.  It’s not much, but try to remember – odds are, you have it better than billions of people across the planet.  That has to count for something.  Challenge yourself to shift your perspective; yeah, you have the racist uncle sitting two seats down, and he’s had one to many Coors, but odds are still better you have it better than billions.
  • Remember – if you are able – actually relax!  The holidays were designed for unwinding.  Need a break?  Take it.  The damn turkey can wait.  You’re more important.
  • If you are someone (like me) who values routine, don’t let the holidays knock you off of it.  I’m still going to the gym.  I’m still gonna go to sleep and wake up at my usual times.  I’d recommend the same for anyone else.

This isn’t much – and it may be woefully inadequate for what you are facing, that I completely understand – but hopefully these little tips can help make your holiday a little better.

Happy holidays, readers!  I am thankful for many things in my life, and that certainly includes those of you who keep coming back to read what I have to say.  I hope you have a great holiday season, and a very happy Thanksgiving!

You probably need an escape

The more I think about it, the more convinced I’ve become of this idea: If I didn’t have an escape, I’d go absolutely, positively out of my mind.

As I’ve said before, I’m an elected official. It’s not a low-stress job.  No matter what anyone tells you, by and large, it’s a pretty grueling gig: Long hours, lots of stress, important decisions, and often a sense of helplessness that is not conducive to people with depression.  Now, just to be clear: I love it.  It gives me a change to change lives and advocate for the issues that I care about.  I knew what I was getting into when I got this job, and I am not complaining, because this job is absolutely amazing.

But, loving a job and having it drive you nuts at the same time can certainly occur at the same time, and my experiences operates as proof.

So, going back to the challenges of my job: I know I’m not alone.  No matter who you are, and no matter what you do, odds are decent that you get stressed out at work, life or with your family.  For people who are more likely to get depressed or anxious, this goes double, and we know that chronic stress can lead to depression.

And that, of course, is why you need an escape.

It doesn’t have to be a literal, physical escape.  For physical, emotional, job-related or financial reasons, a physical escape is often impossible.  Between my family, job and trying to pay off student loans, a regular vacation isn’t an option for me, and I suspect this is the case for the vast majority of you as well.

So, that brings me to my central question: What is your escape?  Where can you go to lose yourself, even if it’s only for a few hours?

Personally, I have two answers to that question.  The first is the one that sort of inspired me to create this blog in the first place: My writing.  I have found tremendous peace in my writing, and a sense of purpose as well.  As I’ve noted before, I have a Young Adult Dystopian thriller coming out, one which features a main character that also battles depression and anxiety.  At moments where my job feels fruitless, I can find solace and inspiration in the idea that this book can potentially do the same things I seek to do every day in public policy: Improve people’s lives.

Second, my not so guilty pleasure: Video games.  We just bought a Switch and I have been obsessed with Mario Odyssey.  I also just, finally, downloaded Civilization VI and am intrigued, to say the least.

Video games, of course, are easier than writing, which requires more work but a bigger payoff.

Anyway, my main point is this: You need an escape.  A mental place where you can go – a hobby where you can lose yourself and hit that perfect state of flow – if only to recharge.  Remember, an escape isn’t really an escape.  The word “reprieve” may make more sense here – or perhaps “recharge.”  Make sure you can find a place that you can go and get your bearings again.  It’s an invaluable part of self-care.

What anti-stigma really means

Call this one a brilliant thought that I had in the shower the other day.

There are plenty of anti-stigma campaigns related to mental health.  In many cases, the goal of these campaigns is simple, noble and necessary: to defeat “mental health challenges in the workplace and at home.”  This is vitally important work.

There’s good news related to that though.  In many areas, anti-stigma campaigns have already done their job.  For example, a poll taken in my home state of Pennsylvania (March 2017) shows high levels of comfort in terms of working with someone with a mental illness, a vast improvement over previous levels.  While there is still a long way to go, this poll shows significant movement in the area of mental illness.

I was thinking about this poll the other day, and it had me thinking: What does anti-stigma really mean?  Obviously we need to continue to work on critical areas like discrimination and access to healthcare, but I’d argue there’s more than that.

My argument is this: The most powerful sense of stigma is self-stigma.

Consider this 2012 article, which describes self-stigma as when “patients agree with and internalize social stereotypes,” resulting in:

•Patients often think that their illness is a sign of character weakness or incompetence.
•Patients develop feelings of low self-esteem and become less willing to seek or adhere to treatment.
• Patients anticipate that they will be discriminated against, and to protect themselves they limit their social interactions and fail to pursue work and housing opportunities.

As a result, patients find themselves less willing to seek treatment and social support, leading to lower rates of recovery.

This realization has had me rethinking how I approach the notion of anti-stigma campaigns.  Of course they should be focused on ensuring that all of society views people with mental illness not as sick freaks who are weak, but as real people suffering from real disorders that can be treated like any physical illness.  I want to push society to a place where all of us – those with mental illness and those without – view people who are suffering from a mental illness the same way that someone views a cancer patient.  No one who suffers from a mental illness should do so in fear, shame or silence.  They should talk about their therapy appointments the same way a cancer patient discusses chemo or someone with a broken leg discusses physical therapy.

I suppose, then, that what I am saying is this: Anti-stigma campaigns shouldn’t just address societal stigma.  They should address self-stigma as well.

As always, I welcome your thoughts – am I onto something here?  More importantly, have you found any anti-stigma campaigns that fulfill what I am describing?  Let me know what in the comments!

How to look at social media and not want to throw your phone out a window

As I’ve written before, social media can be really, really, really bad for your mental health.  This is for a variety of reasons, including:

  • It inspires unrealistic comparisons between yourself and others.
  • It creates unrealistic and unhealthy expectations of how someone should be living their life.
  • It can lead to increased feelings of isolation.
  • It can inspire jealousy.

All of this, and more, are why I am going to be paying particular attention to research and experiences as they pertain to social media and mental health.  I swear, it’s almost like we need a primer on how to teach people to use social media at this point.  I’m looking at my kids – they are 6 and almost 5 – and terrified of the day that I will have to relent, give them a phone, and allow them to be exposed to the world that isn’t real.

Let me go back to what I just said: A primer.  Seriously, we need that when we go on social media!  The world that appears in our newsfeed can be so fake, so overwhelming and so depressing, that I think it’s important that we keep a few things in mind when we use Facebook, Twitter, Instagram and more.  Some initial thoughts:

First, and most importantly: THIS.  IS.  NOT.  THE.  REAL.  WORLD.  Say it with me now: “Social media is not the real world.”  That happy, smiling family?  Probably upset as often as you.  That sweet looking couple?  They have struggles, too.  Social media allows for a very biased view of the world, where everyone looks shiny and happy and pretty.  It is so, so important to keep in mind that there is very little about social media that is real.  People choose to present a biased picture of themselves, one in which they seem perfect, even if they aren’t.  If you can keep that in mind while scrolling through your newsfeed, odds are good that you won’t be quite as miserable while you scroll.

Second, approach social media with a Dale Carnegie perspective.  I took a Dale Carnegie course about a decade ago and it changed my life.  One of the most important lessons I learned was this: No one wants to hear about you.  In the course of public discourse, instead of focusing obsessively on yourself, focus on other people and how you can make them feel good.  To that end, when you are on Facebook and Instagram, don’t scroll through your feed looking for likes and clicks on your own content.  Instead, approach social media from the prospective of how you can make someone else happy.  Like other people’s comments.  Try to be joyful and happy for their accomplishments.  Instead of comparing yourself to others, try to just be happy for other people.

And yes, I know that is easier said than done.

Third, stop comparing yourself.  Yes, this is directly related to item #1: If you use social media and think, “Why aren’t having as good a time as Jimmy is?” you are going to make yourself depressed.  If you use it and think “Well, good for them, they are having fun!” you’ll be fine.  Remember, in this instance, treat social media like the real world: Do you run around, comparing yourself to random people that you see on the street?  I hope not.

Anything else to add?  Let us know in the comments!

The importance of telling your story

This is a bit of a different entry: Partially standard, but also partially self-promotional.  Fair warning!

As I’ve discussed before, I made a very conscious decision, about three years ago, to tell my story about my experiences with anxiety and depression.  I made this decision because I thought it was important to put a face to these two largely misunderstood and under-discussed disorders, and because I realized that doing so would help fight the stigma that still surrounds both of these illnesses.  A good friend of mine also told me that going public would change my career in a very dramatic way – he was completely right, in ways that I totally failed to anticipate.

Three years later, this public conversation has evolved into something more.  I’ve always enjoyed writing, but had basically given up the art of writing fiction.  That changed around 2015, when, during one of my down periods, I decided to try it again, remembering the joy and therapeutic value I got from it.  Reading Fan Girl by Rainbow Rowell at around the same time certainly helped remind me!

That, in essence, was the start of Redemption, my fiction book that will be premiering in the first half of 2017.  I’ll have more to say as the book gets closer to release.  The basic plot is this: A group of young adults find themselves transported onto a spaceship, and they have to save the world. What makes this one a bit different is the main character, who suffers from anxiety and depression. Sounds familiar, right?

If you are interested, I discuss the book, my own battles and the importance of telling your story in this podcast with my friend Kim Plyler of Sahl Communications.

Obviously I wrote this book to tell a story, and I think it’s an important one: Depression and anxiety are real, they are treatable, but they don’t have to stop you from doing important things and living/enjoying your life.  I discuss all that and more in the podcast, and I hope it’s something you can listen to!

What recovery means

People who have recovered from addictions to alcohol and drugs are often very, very cautious with how they describe their recovery, and that’s for good reason: Relapses are, tragically, all too frequent.

It didn’t dawn on me until much, much later in my life that the same applies for people living with depression.

First, a look at some broad facts: According to one study, ” at least 50% of those who recover from a first episode of depression having one or more additional episodes in their lifetime, and approximately 80% of those with a history of two episodes having another recurrence.”

In other words, sadly, the more depressive episodes you have, the more likely you are to have another one in the future.

Making this personal: The worst depressive episode I’ve had in my life, and the most extended, was my freshman year of college.  Therapy and medication helped me learn to live again, but I had a pretty hard-core relapse my senior year, and then another one a little after grad school.  Periodic ups and downs followed, but I’d say those were the three worst “episodes” of my life, with the most dehabilitating consequences.  As I got older, the intensity of these episodes began to wane, as I became better at recognizing depression for what it was, coping with it’s symptoms and seeking additional help as appropriate.

That’s not to say they went away.  They didn’t.

I’m bringing this up to make a point: Recovery is not an end state.  It’s not a destination.  For most, it’s a journey.  For some, they’re lucky: One episode of mental illness, one bout with addiction, and they are done.  You lucky, lucky sons of…sigh, anyway….

For most who have ever suffered – depression, anxiety, addiction, whatever – a relapse could always be just around the corner.  This means that you can never let your guard down, because you’re never really, truly “done” with mental illness.

Is this a bad thing?  Well, I’d be a heck of a lot happier if I never had to worry about this again.  But the specific reason I am bringing this up is to remind people who suffer that recover is not the end state – it’s a perpetual one – and that relapses are okay.  They are part of the disease with which you suffer and not endemic of any internal weakness.  Recurrences shouldn’t be dealt with via self-flagellation and scolding – they should be treated as a natural flare up of a disorder that can be dehabilitating without treatment.  Don’t yell at yourself.  Don’t hate yourself.  And don’t think that your any recovery must be permanent or you are failing.

Recovery is a journey.  Not a destination.

Going meta: Observations and topics for the future

So the this blog is now a few months old and I wanted to take a second to note my experiences in writing it so far.  This is not the first blog I’ve ever run – it’s the third, I think – and there are, as you can imagine, a few things that make it stand out.

First, some comments about the audience for this blog, and this came as a surprise.  There aren’t quite as many people reading it as I had hoped.  That’s disappointing.  But, what is surprising is the level of engagement.  My posts here get more likes and comments than they ever did on any previous blog.  That’s surprising and interesting.  It tells me that the people who are interested in mental health are passionate about the topic and want to engage with it.

Second, a realization about the topics.  The most popular entries for this blog are, in order:

  1. What you should know if you love someone with depression
  2. A shameful disparity: Minorities and mental illness
  3. 4 ways to stop an anxiety attack
  4. Depression is more than feeling sad

What connects these entries?  Well…not a lot, actually.  Not that connections all four of them, anyway.  Numbers 1, 3 and 4 all provide some unique insight on mental illness.  #1 was far and away my most popular entry, and I think that’s because it’s something with which people can sympathize.  The lesson, for me, is that people seem to really be interested in entries that provide some level of up close examination for mental illness, and that is what I will continue to try to focus on.

With a few exceptions, the entries where I focus on more public policy aspects of mental illness are not as well read.

So, going forward, here are my plans for this blog:

  • Provide that unique insight: Without sounding too much like a self-aggrandizing schmuck, people – particularly those with some sort of mental illness – seem to truly appreciate this discussion – and I don’t just mean the blog.  I think others like hearing that there are people out there, like me, who are in recovery.  I will continue to blog about that topic, and try to make sure that people know there is hope, regardless of what sort of mental health disorder you suffer from.
  • Serve as a resource for families & friends: The most popular blog entry – one which discussed what family should know if they love someone with a mental illness – was an interesting lesson for me.  We constantly talk about people who suffer from a variety of diseases, but we don’t focus enough on the caregivers.  That’s something I’d like to explore more as the blog goes forward.
  • Explore the interaction between technology and mental illness:  I’m scared – really scared – about our over dependence on technology and social media.  I worry about how this may affect mental health.  I’ve written a little about the topic in the past, but I really think this is one that is going to blow up over time.
  • Discuss public policy and mental illness: I know, I know – I said above that those entries aren’t as popular.  That being said, they are still read and I think they serve a useful purpose.  Like it or not, mental illness is largely affected by public policy, a topic I am all too familiar with in my real job.  For both my readers – and for me – it’s something I am going to continue to focus on.
  • Promote my book: If you’ve made it this far, you get a secret – in the first half of 2018, I’ll have a fiction book published.  I’m not going to reveal too much of the details yet – don’t worry, I will! – but know that it is a young adult, sci-fi adventure – one that deals with mental health and living with depression and anxiety.  You can expect to hear more about this one later.

Now, all of that being said, a blog isn’t a blog without readers.  So, let me ask you, my friends – what can I answer for you?  What questions would you like to see this blog explore?  What topics are you interested in?

Let me know in the comments below – and thanks so much for reading!

 

Shhhhhhhh and listen

I have always found that, when depressed, one of the most difficult things for me to do is to shut up and actually listen to others.  This makes sense, of course: When you get depressed, you have a hard time escaping your own head.  After all, depression and rumination are linked; that is to say that when you are depressed, you are more likely to think about yourself.  Your problems.  Your issues.  Your concerns.  Doing so makes you more self-absorbed, which, in the case of many people (me for sure!), can make you feel incredibly guilty and like a burden to your loved ones.

I also want to tie this back to the current political environment in which we find ourselves.  Last week, I went on this FB rant:

tl;dr – I listened and learned something.

I find that there is a big connection with how self-centered I feel and how depressed I am, and that the more I focus on the needs of others, the better shape I’ll be in.  I suspect this feeling is universal – indeed, there is evidence to show that is the case.

On an intuitive level, this makes all the sense in the world.  Thinking of other people makes you more likely to get out of your own head, less likely to ruminate, and more likely to break the cycle of destructive thoughts that are bouncing around in your own brain.  It can be hard.  Really, really hard.  I remember my therapist once telling me that avoiding people and allowing yourself to retreat in to a corner is the absolute worst thing you can do when you are depressed.

He was right, as far as I am concerned.  I think trying to think of others and actively engage with other people when you are down can be next to impossible, given the mood of a depressed person.  That also makes it all the more important that you try and break through and change your focus…get out of your own head.

Now, this is all well and good, but it doesn’t answer the question…how you gonna do it?  How can you break that cycle and start engaging with other people well all you want to do is grab your iPad and dive into a blanket fort?

A few thoughts on that:

  • Most social interaction is casual and almost thoughtless – that is, it lacks conscious effort.  When you are down, you have to actively make yourself talk to someone else.  Get up.  Get out of the chair.  Go find the spouse you’ve been ignoring because you are trapped in your own head.  The kid you were letting watch too much TV.  Talk to them.  As them how they are doing.  Try to start a conversation and hook yourself in.  Make a conscious effort to do something real.
  • Can’t leave the house, or don’t want to?  Pick up the phone.  Don’t text!  No texting!  And don’t send a FB message!  Call someone…you know, like phones used to be used.  Start talking with a real voice.  Engage in that human connection that I think far too many of us have delegated to texting and messages.
  • Read a book.  Alright, this one is slightly different than the first two.  But, staring at your phone, mindlessly scrolling your way through your Facebook newsfeed, isn’t going to help yourself.  Instead, try to break the cycle by getting lost in someone else’s life.  See if you feel better on the other side.

There is more – so much more – but I want to hear from you.  How do you get out of your own head when you are depressed?  Let us know in the comments!

When depressed is caused by nothing at all

I have an interesting question for those of you out there who suffer from depression: What do you do when your depression is caused by nothing at all?

There are times – and I suspect that this is for everyone, not just folks who have depression problems – where I get depressed for no reason.  At least, none that I can think of.  I remember my therapist once telling me that there was always something lurking around in the back of my mind somewhere.  That depression is almost never caused by “nothing.”  I suspect that he is right, and that makes it even more frustrating.

I’d argue that this can often be worse than feeling miserable for reasons that you can identify.  Obviously, that depends on the reason you are down, but if there is a reason behind a depression or sadness issue…well, then you can actually deal with it.  When there’s no reason, it’s harder to grasp.  In instances like these, fighting depression is like pushing smoke.  It just can’t be done.

On instances like this, I come back to a conversation I had in a psychology class when I was in college:

glass-half-full.jpg

Ahh, yes, the glass half full.  But, this one comes with a different spin.

I once had a Muhlenberg professor describe mental illness as a combination of genetics and environmental factors.  This is a vast oversimplification, of course, but hear me out.  Let’s say that the water already in the glass is your genetic predisposition to depression.  Additional water gets poured in as a result of environmental factors and other stressors, and when the glass overflows, bam, you are depressed.

In this metaphor, people who aren’t predisposed to depression are less likely to be depressed, but that’s because they have less water in the glass to begin with.  Those people can still get depression, but it’s gonna take a heck of a lot more water (life stressors) to get them there.  For others who have a history of depression or a genetic predisposition, it only takes a little bit of water to get the glass overflowing.

I agree with my psychologist – it’s never really nothing.  It’s always something – maybe something you don’t want it to be, maybe something you are ashamed or embarrassed by, but there is usually something bouncing around in your head which is going to push you over the edge into a depressive funk.

So, here’s my advice: When it’s nothing at all – when you are depressed, but have no idea why, try to ask yourself what’s truly on your mind.  Work?  Family?  School?  As best you can, within your own head, ask yourself those questions.  Create a judgement free zone and allow your heart and your head to tell you what’s really up.  I hope this doesn’t come across as new-agey mumbo-jumbo, but as helpful advice.  Sometimes, the best way to get yourself feeling better is to ask yourself the right question – even if you don’t really want to know the answer.

I hope this is helpful, and as always, I’d love to hear your thoughts – for this one more than most!

An in-depth look at suicide statistics in the United States

Before you can truly solve a problem, you have to have a better idea of what that problem is.

In my policy-making career, I’ve taken a long look at suicide reduction.  I’ve come to the conclusion that there is no one-size fits all approach; different demographics require different solutions.  We know there are certain groups more likely to commit suicide, and those groups require different interventions.

First, here’s a look at what the American Foundation for Suicide Prevention has found.  The basic statistics are tragic:

  • Suicide is the 10th leading cause of death in the United States.
  • 44,193 Americans die by suicide.  That’s an increase of 25% since 1999.
  • For every completed suicide, there are 25 attempts (Note: Terminology matters – “committed” or “successful” suicide have negative connotations, and “completed” suicide is a much more appropriate term).

Now, this is a broad overview.  Let’s take a closer look at these numbers in-depth.

Gender

According to the CDC:

Males take their own lives at nearly four times the rate of females and represent 77.9% of all suicides.

One of the reasons for this: Men are more likely to attempt suicide via a firearm, which is much less survivable than other suicide methods.  This is also despite the fact that women attempt suicide three times as often as men.

Race

In most mental health related fields, it is members of the minority community who are on the wrong end of the statistics.  That being said, for race, the reverse is true: Whites have the highest suicide rates of any ethnicity, followed by American Indians.  African Americans, Hispanics and Asians are well behind.

More research certainly needs to be done in this realm, but at least one researcher suggests that, “White older men, however, may be less psychologically equipped to deal with the normal challenges of aging, likely because of their privilege up until late adulthood.”

Age

While suicides have been increasing across all age groups, those of middle age (45-64) have the highest rates of suicide, followed by those 85 or older.

What is particularly striking and tragic is where suicide falls in terms of leading causes of death.  It is the 3rd highest cause of death for those 10-14 and 2nd for those between the ages of 15-24 and 25-34.

Method – and gun ownership

49.8% of all completed suicides result from firearms, with suffocation (26.8%) and poisoning (18.4%) as the next most used method.  It is important to note that there is a strong link between gun ownership and suicides.  Suicide rates are higher in states where there are high levels of gun ownership, and lower where there are low rates of gun ownership:

The lesson? Many lives would likely be saved if people disposed of their firearms, kept them locked away, or stored them outside the home. Says HSPH Professor of Health Policy David Hemenway, the ICRC’s director: “Studies show that most attempters act on impulse, in moments of panic or despair. Once the acute feelings ease, 90 percent do not go on to die by suicide.”

But few can survive a gun blast. That’s why the ICRC’s Catherine Barber has launched Means Matter, a campaign that asks the public to help prevent suicide deaths by adopting practices and policies that keep guns out of the hands of vulnerable adults and children. For details, visit www.meansmatter.org.

As I hope this entry has demonstrated, “suicide” should not be viewed as a monolithic disease or condition.  It varies from person to person, group to group.  We have to treat is as such, and ensure that any treatment effort addresses the many various demographics that suffer from suicidal idealization or attempts.