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What is the difference between an anxiety attack and a panic attack?

Having had both, I feel like I’m overqualified to write this article, but as I was discussing this issue with someone the other day, I realized something: As careful as I like to be in my language – particularly when discussing mental health and mental illness – I had goofed. There is a difference between the two, and an important one at that.

What is it? From what I can tell and what I’ve researched, it seems to me that panic attacks are the dramatically more painful experiences, the ones which make it feel like your chest is going to explode out of your body.

There are a ton of similarities, of course. Both come with painful physical symptoms, including chest pain, difficulty breathing, dizziness, upset stomach and other fun things. Both come with an overwhelming sense of fear.

However, anxiety attacks are more characterized by worry and distress. Panic attacks are the ones where you feel as if you have to escape from wherever you are, right now. They often come out of nowhere, whereas anxiety attacks are usually caused by some stress or worry.

It this a distinction without a difference? I’d say no. Panic attacks – if experienced repeatedly – can be beyond debilitating. They can safely be described as “intense and disruptive.” Anxiety attacks can as well, but I’d argue that they are less frightening, and perhaps less painful.

Why does this matter? Because words matter. There’s a reason that there have been so many efforts to watch how we discuss suicide. Phrasing things one way or the other can have implications. It can also affect treatment – anxiety and panic are two different things. Indeed, the notion of an anxiety attack isn’t even a diagnosable illness, but a panic disorder absolutely is.

I’d also add that we need to make sure we don’t confuse these two things because how we discuss them can alter how others respond to them. Panic implies immediate danger and something to be deeply worried about right now. Anxiety, at least to me, implies an ongoing and persistent fear and worry.

Does this make sense to you? Please let me know your thoughts, and if you think this is the right idea or not.

The Best Way To Help Veterans With Mental Illness

Today is Veterans Day, the day of the year in which we are supposed to remind ourselves about the importance of the veterans who have served all of us. It’s a solemn day…one which most people know better by the kind of sales they can get and if they get the day off or not.

As an elected official, I’ve certainly been to my share of Veterans Day events, and had three leading up to today. That being said, they are events which always leave me feeling inadequate. Why? I never served in the military, and while I don’t believe that is necessary to be a good public servant, I do always worry about talking to veterans and thinking that they must think I don’t understand what they have been through. That’s me projecting, to an extent, but of course, I don’t understand what they have been through, the things they have seen.

As a politician, I’ve always said that I want to be judged by my actions, not my words. And when it comes to taking care of our veterans, far too many of our actions come up short. This goes double when it comes to mental illness. A brief look at the facts reveals:

These numbers are unacceptable. Those who give so much for us should receive even more in return. That being said, for the vast majority of us, our options are limited. Let me pose this question, then, if you’d like to learn more about how to help our vets: What can you do to help veterans who are suffering from a mental illness?

Here are a few thoughts.

Understand what you don’t understand

One of the things I have realized in my time in government and the mental health universe is that you will not understand everything – and that’s okay. You don’t have to understand what it was like to serve. You don’t have to actually have experienced someone else’s pain to understand that it exists. Not being a veteran doesn’t disqualify you from this conversation, but it does require extra effort. Read up on the specific challenges which veterans face. Learn more about what they need and how you can help. This broader prospective will put you in a better position to help those who need it.

Support groups who support vets

While the need is great, the response has been as well. Numerous organizations do a fantastic job of taking care of our veterans. If you can afford to do so, please contribute to these organizations, because while the passion is there, the funding often is not.

Read up on veteran-specific mental health issues

Part of understanding veterans issues is learning more about them. PTSD and TBI (traumatic brain injury) are both tragically common for veterans. If this is something you want to learn more about, read up on these two devastating diseases, and learn more about how you can help.

Talk about it, and find others who know more

The best way to address and reduce stigma is to talk about it – but to do so in a way which is inclusive. Discussing mental illness is important, but talking about it from the perspective of a veteran even more so. Make sure to be inclusive when discussing mental illness and stigma, and make sure to rely on other voices (like veterans) who may have more experience than you.

I know I missed a lot here – as usual, I’d love your thoughts. Do I have a goo handle on this? What am I missing? Fill us in in in the comments section!

When To Take A Step Back

I’ve written a lot about the importance of trying to push through your mental illness. To clarify, I don’t mean “power through” or “man up” or any of those other absolutely ridiculous cliches. By that, I suppose I more mean “don’t surrender.” As someone who constantly feels like they are being chased by anxiety/depression – and that they will nip my heels and catch me one day – I think one of the hardest things is knowing when to stop moving.

What do I mean by that? Well, if you suffer from this stuff, you probably know. You’re exhausted – words aren’t making any sense anymore – and your brain is just fighting back against every productive impulse you have. All you want to do in the world is build a big old blanket fort, watch Netflix, eat all of the ice cream, and go to sleep.

But you can’t. Because you are so scared that, once you slow down and surrender…even if it’s just for one moment…it will catch up with you. And once it has you in its grips, you lose. It’s over.

Now, if you are someone who isn’t depressed or anxious…or at least, has a better handle on it than I clearly do…you are looking at me right now like I’m saying 2 + 2 = 5. Because non Type-A people, and people without a mental illness, don’t suffer like this. They can take their foot off the pedal without feeling guilt or fear.

I suppose, then, that this is an entry for those of you who know what I’m talking about. Because the truth is that there are moments where you simply must take your foot off the pedal and slow down.

When do you hit that point? I bet you know. I bet you know somewhere, in your heart of hearts, when it is time to back off.

When you hit that point – and the guilt or fear starts to set in – I have two points for you to consider.

First – stop. An hour playing video games doesn’t mean that you will lose your career. No human being, ever, has made it in this world without self care, be them type A, B, X, Y or Z. Every event is not vitally important. Every assignment does not have to be done RIGHT STAT NOW, because even if it is necessary for your career, a career which holds that must sway over you is not that important.

Second, let me flip it around. People like me – and maybe you – who are obsessed with productivity need to stop conflating working non-stop and productivity. Microsoft Japan just tried a four day work week and the result was…a 40% increase in productivity. It’s almost like working smarter is better than harder.

Also. Your demons will find you, or they won’t. But taking a break never killed anyone. But it probably will help kill your demons.

Alright. That’s it. I’m out. I need to eat me some ice cream.

How Politics Helps Keep Me Sane – And How It May For You, Too

 

So, I’ve written extensively about mental health, depression, my book, etc. But, if you’ve followed this blog for long enough, you’ve probably seen me allude to my full-time career. I want to talk about it for a second – and talk about why I think that getting involved politics and governance is actually really good for your mental health.

My full time job is to serve as a Pennsylvania State Representative, where I work for 65,000 people who live in the City of Allentown and South Whitehall Township. I’m a Democrat, and involved in a slew of issues, but mainly working in education and mental health.

One of the more common things I get when I discuss my long-time issues with anxiety & depression is, “IN YOUR LINE OF WORK!?!?!”

I mean, yeah. To quote Finley Peter Dunne, Politics Ain’t Beanbag. And there are times where the hard parts of this job – the negative mailers, the nasty comments – they get to you. They weigh on you. And when you combine the normal stresses of this abnormal job with a mental illness, it can be ugly. I should note something here: If I hadn’t had years of therapy, and medication, I’d never be able to cope with the stresses and requirements of this job. I’d have never been able to hold it, and I hope do well at it, as I hope I have.

That being said, I firmly believe that politics has been good for me and my mental health, and if you are similar at all to me, you may feel the same.

Why? A few reasons.

First and foremost, politics & government gives me a chance to make a difference. I firmly believe that, with my type of depression, I feel worst when I am hopeless, helpless, and out of control. That includes a variety of things in my life, including the health of my loved ones or the state of the planet around me. Being in government, I firmly believe, is one of the most noble and powerful callings that there is. It also gives you a modicum control over one of the most powerful entities in the country. As a result, this job let’s me have a say in the direction of resources and state authority towards what I believe to be just pursuits. That acknowledgement, alone, is often enough to help combat the helplessness I feel as a citizen of a country and planet for which that I am deeply worried.

Second, it gives my mental illness meaning. On those bad days – where I’m sitting with my hands in my head, plagued by some very silly demons – I can’t help but wonder, Why me? Yes, there’s that tendency to stew in your own sad juices if you have some sort of mental illness. Being in government and politics – helping people – is the perfect antidote for that self-indulgent question, because I know I’ve helped people by telling my own story.

To be clear, government isn’t required to find meaning. But I get to be someone who is part of a good story – how mental illness is being viewed by our society, and how those views are evolving. I’ll take that.

Third, I can speak with authority. One of the biggest challenges we have in government is people don’t believe us. Much of that we bring upon ourselves, so I get that. However, it’s hard for people to ignore you when you speak on an issue which personally affects you in a deeply personal way. As humans, we are built to better understand stories – personal stories – and when I tell mine, I think that people are inclined to listen. I can speak with authority on this issue. Honestly, that helps me sleep at night.

There’s more, of course, but I’d say those are the biggest reasons I’ve found government to be helpful to me when it comes to dealing with my own depression. This is just me – your mental illness may have helped motivate your career choice, and if that’s the case, I’d genuinely love to hear it.

Why We Need More Articles That Get Specific to YOU on Mental Illness

I’ve been relieved to see that more and more people are discussing mental illness lately. When done right, this is a good thing – people become more aware of the breadth and depth of the mental health crisis we have, and hopefully more likely to seek help themselves or encourage their loved ones to do the same.

As long as the topic is approached with sensitivity and empathy, there is no such thing as a “bad” mental health article. Some articles, however, can have more of an impact than others.

Which ones are those? The ones which focus on you or your loved ones.

Consider, for a moment, these articles which focus on specific professionals:

Or these articles, which concentrate on age groups:

Or these racially or location-focused articles:

If you reviewed all of these headlines and identified with any of them, you felt a moment of empathy. You probably felt a touch of happiness at being mentioned in a story like this. If you fell into any of the groups noted above, I bet you were a little more likely to click on the article and read more, and from there, maybe you found a useful piece of information. Maybe you found something that made you think of someone you loved. Maybe you filed a scrap of information away for later.

Either way, stigma and mental health campaigns work best when they are targeted at the person with someone that they recognize. Often times, in the work of mental health planning, you will hear conversations about the need for culturally competent campaigns – meaning campaigns where it’s people of varying ethnic and racial backgrounds.

I’ll take that one step further by point to the above. There’s no question that cultural competence in every area – including mental health conversations – is very important. However, it’s not the only one. We also need to have these conversations where the reader can look at someone and recognize them because of their job, their age group, their location, and that’s why these stories are so important.

Generalities aren’t enough. The more specific we can get – the more targeted we can be in our efforts to discus mental illness and stigma and suicide – the better our campaigns can be.

The American Public Gets It: Stigma Is Real, and We Need To Do More

CBS News ran this fascinating poll on mental illness. I’d argue that there aren’t many surprises in the poll, but I got two key takeaways.

First, to summarize the findings:

  • 51% of Americans say that people living with a mental illness face “a lot” of stigma and discrimination – 31% say “some.”
  • 38% of people say that mental illness stigma has gotten better, 22% say worse, and the rest say that it hasn’t changed.
  • 66% of people say that mental illness is a very serious public health problem – 28% say somewhat serious.
  • People do believe that mental illness is a real medical condition (79%). Roughly 2/3 of those polled also said that virtually anyone can get a mental illness and most people who are treated right can lead productive lives.
  • A mere 12% of people say that services for the mentally ill are adequate – but 49% said they are not.
  • A whopping 77% of people say that celebrities speaking about mental illness are doing a good thing – only 18% said no.
  • 73% of Americans know someone diagnosed with a mental health disorder (I guarantee that number is higher and people just hid their own mental illnesses), while 58% said that they had a family member who sought care for mental health (again, I’m sure that number is higher).

So, here’s what I got out of this. First, those support numbers are just overwhelming. 66% of people think mental illness is a “very serious” public health problem. 28% say it is at least “somewhat serious.” That’s 95% of the American public who think that mental illness is at least somewhat serious. That is not a small number! The key question is this: What does that translate to? Are people willing to dedicate more time and money to mental health care? Or is this simply a, “Gee, that sucks…moving right along” sort of things?

At the bare minimum, it is good to know that people understand just what a major problem mental illness is.

Second, the stigma questions got me thinking: What if the stigma is all self imposed? I mean, take a look again at that top finding. 51% of people think individuals with mental illness face “a lot” of stigma, while 35% say they face “some” stigma. That is not a small number. But if that many people think stigma is so real, what’s really the problem here? People who acknowledge stigma is real must also have stigma-inducing thoughts, right? Or, what if the stigma is just the fear of being stigmatized? Or self-stigma? I’ve always thought that self-stigma is a bigger problem then actual stigma.

The findings, in my mind, mean that we have to rethink our traditional definition of mental health stigma, because I don’t think that a traditional understanding of, “People with mental illness sure do face a lot of stigma” is enough.

But, as always, I ask: What do you think? What are your thoughts on this poll? Let us know in the comments!

The Business Case for Speaking Up About Mental Health

An interesting article from Forbes:

In a recent study of 1,000 employees, 62% of respondents said having someone in a leadership role speak openly about mental health would make them feel more comfortable talking about it themselves. The research also showed that only 26% felt any action was being taken to address mental health in the workplace…

This…this is important. For many reasons.

First, let’s take a quick look at the economy. Unemployment is low in most places, and that makes it clear that it’s an employees market. Companies have to work harder than ever to get the right kind of talent, and in many cases, a good salary and benefits package just isn’t enough. Many employees – such as millennials – want to know about a company’s values and culture. They want to make sure they are working at a place where they will feel happy, valued and safe.

And that is where mental health conversations come in.

If this information is accurate – and I have no doubt that it is – businesses can use mental health conversations and care in order to better recruit. Furthermore, not only can this help them get better employees, but it can help them reduce costs. Stigma is associated with a delay in getting care, and that leads to major lost dollars for companies. According to estimates, the direct and indirect costs of mental illness are north of $2.5 trillion dollars.

Even the slightest dent in these figures can save millions, if not billions, and can make a real impact on the bottom line of a company, and you don’t need to look at a study to know that, because you know it yourself. When you are down, when you are anxious, you just aren’t as good as when you are feeling better. This leads to worse work products for you, your team and your company.

All of this begs the question: What can a business do? I’d offer a few suggestions.

First – to the extent that members of a company’s leadership feel comfortable – they should talk about their own mental health struggles. An important way by which we can create a culture which kills mental health stigma is by having people at the top and bottom of an organizations hierarchy talk about their own struggles, how they overcame them, and how they cared for themselves.

Second – have mental-health friendly policies. Yes, this means explicitly stating that mental health days are real, that mental illness deserves to be treated, and that your company expects their employees to take care of themselves. And remember, if you are a manager or supervisor, you set the tone. Take those days yourself, and be honest with those you supervise when you do.

Third – a business must make sure that their insurance covers mental health, and covers it to the same extent that physical health is covered. While mental health is supposed to be covered at levels identical to physical healthcare, that isn’t always the case, sadly. It is on a business to ensure that the coverage which they offer is robust, fair and covers all the needs of their employees, including mental health care.

As always, I conclude by turning it over to you. What am I missing? What else should we discuss? Let us know in the comments!

 

 

 

How Gun Control Can Help Stop Suicides

When people who oppose gun control don’t want to say, “Hey, yeah, I think that we should allow ordinary citizens to own ballistic weapons without so much as a background check,” they don’t do that. Instead, they say, “We shouldn’t focus on gun control – we should focus on mental health.” It’s a lovely political pivot from a group of people who don’t want to actually focus on things which will stop gun deaths.

Related: They then do less than nothing to help people with mental illness.

I’ve attacked that argument before, but now I’d like to add to it: Gun control measures – and specifically Red Flag laws – can help stop suicides.

What is a “Red Flag Law”?

A “Red Flag Law” – also known as an Emergency Risk Protective Order – is a formal court proceeding. They vary from state to state but have the same characteristics: If a person is making threats or found to be a danger to themselves or others, someone (such as a family member or police officer) can petition the Court to have an individual’s guns temporarily removed from their possession. They’ve been promulgated as an effort to stop mass shootings, but the data thus far shows that they are more beneficial in the fight against suicide.

Limiting Access To Deadly Means Stops Suicide

Multiple studies and historical experience have proved it – if you limit someone’s access to the means of suicide, you can reduce suicides. And that is precisely why Red Flag laws are so important for reducing suicides. If crafted appropriately, a red flag law can result in the removal of a gun from someone who may hurt themselves with it.

So, yes. Here’s an area where we can help mental illness – but it’s via sane gun control measures.

Red flag laws are relatively new, so the research on them is somewhat limited. But, from what’s available, they work. For example, take a look at the experience of states like Indiana and Connecticut, which enacted red flag laws relatively recently:

“In Indiana, after the enactment of the law [in 2005], we saw a 7.5 percent decrease in firearms suicides in the 10 years that followed,” Kivisto said. “We didn’t see any notable increase or decrease in non-firearms suicide.”

“And so when we looked at it from 2007 and beyond [in Connecticut], [gun suicides] decreased by 13.7 percent,” Kivisto said.

This furthers the idea that access to deadly means can help control for suicide.

Suicide is a massive societal problem, one which belies simple solutions, involves multiple areas of public policy and will require significant investment to truly tackle. That being said, some small laws can make a big difference, and reducing access to suicidal means can do just that.

The Mental Health of our LGBTQ Friends

We celebrated National Coming Out Day last Friday, and it gave me a few things to think about. As we all know, this world is hard enough. The times we live in are more interconnected, more stressful and more difficult than they ever have been, and I do think that the current state of our world is adding to our rising rates of mental illness and suicide.

So, imagine being someone who so many in society say is wrong.

I’m a straight, white man. This comes with many societal advantages. And let me be clear, I cannot imagine how difficult it must be to be a sexual orientation that is different.

But numbers don’t lie: It’s a harder life. A quick look at the statistics:

  • 28% of all LGBTQ youth said they felt depressed most of the time (in the past 30 days), compared to 12% of non-LGBTQ youth.
  • When compared to non-LGBTQ youth, LGBTQ youth are:
    • Twice as likely to feel suicidal.
    • Four times as likely to attempt suicide.
  • Over the course of their lifetime, 30-60% of LGBTQ people deal with depression – 1.5 – 2.5 times as straight individuals.
  • These issues are largely impacted by perceived support and social stigma.

So, what can we do to help individuals who identify as LGBTQ? A few things. First, remember, all language counts. If you show bias towards one group, individuals are far more likely to perceive you as biased towards another. Don’t be that person who uses bias and then jumps in with, “But I have a gay friend!” Don’t show bias in your language. Don’t use derogatory terms to discuss anyone. Language counts. Language reinforces stigma and stereotypes. Use appropriate pronouns. Use language that is kind and respectful. And just…don’t be an ass.

Second: Show your support. You don’t know who is struggling or who is desperate for someone to talk to. One study which was bouncing its way around my Facebook feed showed that an LGBT individual who found a supportive adult could see their risk of suicide drop by 40%. Be that one person. And be so explicitly. Yeah, post something to your Facebook page about how you support LGBT people and you’re a safe person to come out to. Is it gonna get anyone to come out to you? Maybe. But, more importantly, someone who is LGBTQ will see it, and will appreciate it. They will know that you value them as a person. That you believe in their dignity and basic human rights.

Third: Support policies which humanize LGBTQ people. In most places in Pennsylvania, you can be fired or evicted for being gay. That’s madness, and laws matter: When gay marriage was equal in only some states, studies showed that LGBTQ people had better mental health and lower rates of addiction when they lived in states where gay marriage was legal. Again: PUBLIC POLICY MATTERS. It makes a difference! Support your LGBT friends by supporting candidates for office who support human dignity for all.

Others who are better versed in this subject have written about it, and I encourage you to read more about how to help millions of Americans feel loved and safe. I can’t imagine how hard it must be to be a minority in America – particularly today, given that the President is a racist, xenophobic monster who stirs up hatred at anyone he can find. That being said, I remain convinced – now more than ever – that this is the moment to show our friends – all of our friends – the love and respect they deserve. Be that person. Be one of the people who tells our friends that they are loved. You may save a life.

The Hope and Sadness: Out Of The Darkness Walk

With one exception, I’ve had the honor of speaking at every Out Of The Darkness walk which has occurred in the Lehigh Valley in the time I’ve been a State Representative. Since I began publicly discussing my struggles with depression, anxiety and suicidal ideation, my role has expanded, and I’ve MCed the event for the past few years. I came back from this year’s event a few minutes ago, and I wanted to discuss it.

First and foremost: Man. It’s really, really tough. People walk around with shirts and team shirts and mottos and anti-suicide tattoos and teams of people and you just feel their pain. There are sweet dogs everywhere.

I always have a tough time – particularly during the Honor Bead ceremony, where you introduce family members and attempt survivors – and that just breaks you. You read these stories out loud of people with life and love and potential, and they are gone. This year, I had the honor of reading the Honor Bead ceremony with Congresswoman Susan Wild, someone I’m proud to call a friend. As many of you likely read, Congresswoman Wild lost her long-term partner, Kerry, to suicide, and has lead a very public fight for suicide prevention and mental illness. I cannot imagine how hard it was for her.

And I’m not gonna lie, I feel terrible feeling emotional. I’ve struggled with depression, and I have been suicidal, but I’ve never attempted suicide. I’ve lost people I’ve known, but never a dear friend or someone I love. And you walk around this event – people come with shirts and signs of their loved ones – and you can’t even imagine their pain.

Please understand, I am not looking for comfort here. I get why it’s hard. I just don’t think my pain compares to those who walk for someone they love. And I don’t expect it to, either.

The one story I don’t think I’ll ever forget was this:

That…yeah. It was hard.

Here’s the dichotomy of the event though, and I suppose it’s more a reflection on the dichotomy of the human experience. It was still, for all the sadness and grief, a beautiful event.

First of all, they raised over $115,000. YAY!!! Oh, you can go here to donate. And you should.

Second of all. It’s not all sadness. It was stories of hope. People who survived and turned their life around. An army vet who survived addiction and multiple attempts to stand on that stage in honor of the 22 veterans who die by suicide every single day. People who walk to remember, and who find each other. I kept watching people talk to Congresswoman Wild and say thank you. But there was a real feeling of community there.

As I said in my brief remarks, everyone who attended and walked was brave. We all know what a prominent issue suicide is: 47,000 died in 2017, and more than 1.4 million attempts. And yet, still. Silence and stigma. Every step that was taken, every dollar raised – that’s a little crack in the darkness. I’ll take that.

So, despite the sadness and pain of an event like this, you have to find hope. It can be a struggle. It can be emotionally and physically draining. But it was such a beautiful event to participate in. People found hope, found each other. And found an awful lot of puppies. Seriously, that really helped. The puppies.

I won’t lie and say I’m fine – it was a hard event to run. Speaking personally, there’s a sense of burden there. You want to do the best job you can, and you want to let people know that those of us in power are listening. And that we share their pain and want to help alleviate it.

As always, thanks for reading. Please leave any thoughts below!