How to explain mental illness to your kids

Like the vast majority of parents, my children are the light of my lives.  My son, Auron, is six; my daughter, Ayla is four, turning five in November.  I won’t sit here and wax on and on about how much I love them – I don’t have that kind of time, and you probably don’t have that level of interest.  But, for the sake of this blog entry, please understand that they are one of my main reasons for living, my biggest source of joy and a constant fountain of entertainment, surprise and hilariousness.

So, I suspect many parents can sympathize: Having children when you have depression can add innumerable guilt and sadness to an already debilitating disorder.

When I think about depression in relation to my kids, I think of it from two angles.  First is how it will likely one day affect them.  There is no question that mental illness has a strong genetic component.  Also, as much as it pains me to admit it and as hard as I try to make it otherwise, I suspect that both of my kids will learn some of my behavior and internalize it. Even more unfortunate is that a major source of childhood trauma is having a parent with a mental health disorder, and an expanding body of research has shown that these Adverse Childhood Experiences, or ACEs, can have significant and detrimental effects on the life of a child.

One of the symptoms of depression is guilt, and lemme tell you, this entry is not helping.

Second is how my disorder affects their lives.  As much as I hate to admit it, depression and anxiety have affected my parenting skills.  There’s no doubt that there have been times where it has affected my mood, made me snappier or less willing to do things.  Kids can tell when you are worried or down.  They are like little sponges.  They just know when things are off, and they are far, far more intuitive than most people realize.

So, all of this leads me to the critical question of today’s blog entry: How do you talk to your kids about depression?

Obviously, the answer to this question depends on the age of your child.  The first time it ever came up for me was when my son was about four and happened to walk into the bathroom when I was taking my medication:

“Dad, what are you doing?”

“Taking my pills, buddy.”

“Oh.”  Pause.  “Are you sick?”

Me, internally: Crap.  

Followed by: “Well, Auron, you know how people sometimes get really sad?  Or really scared?”

“Yeah.”

“Well, Daddy sometimes gets really scared or sad for no reason.  These pills help make sure I don’t get too scared or too sad, and they make it easier for me to have a good day.”

“Oh.  I’m gonna go watch Bubble Guppies.”

At that age, I think that was a pretty good way to describe it: Simply, and by relating it to something they already understood.  As my kids have gotten older, I’ve expanded that conversation to talking about it to a stigma perspective.  Whenever we are trying to illustrate something that we think is silly (All boys are better than girls at sports by default, for example), we scream “THAT’S NONSENSE!”  I’ve used that frame to describe how some people don’t think it’s okay to get sad, or get scared, and to try to tell the kids that anyone who is sad or scared should see a Doctor, just like if they had a broken arm.  Do they understand it?  I think so.  I hope so, anyway!

As they get older, it is my hope that the way I have dealt with my mental illness – openly and honestly – will help them recognize the symptoms of it within themselves.  I never want my kids to think that whatever circumstances they may be born with are completely out of their control – I want them to know that they do have the ability to deal with whatever challenges they may face.

I cannot control the mental illness that I have anymore than I can control the weather.  But, just like dealing with a rainy day, I can bring an umbrella.  I can take care of myself by ensuring that I see my therapist when necessary, that I take my daily medication, that I recognize my mistakes and try to learn from them, and by practicing good coping skills.  In that way, I hope I can teach my kids a very critical lesson: You cannot always control the hand that you are dealt, but you can control how to react to it.

As always, I welcome your comments.  How have you dealt with your own mental illness when it comes to your kids?  What have you said – and what have you left unsaid?  Let us know below!

4 ways to stop an anxiety attack

I’ve had a particularly interesting internal debate – well, interesting to me, anyway – about which is worse, depression or anxiety.  I’ve repeatedly come to the conclusion that, at least with the way I have both, I’d rather have depression than anxiety.  Don’t get me wrong – both suck something fierce.  That being said, with depression, if it isn’t too severe, you can still function.  Anxiety, and particularly anxiety attacks makes doing basic tasks next to impossible.

College was the worst for me in that regards.  I would have periodic anxiety attacks, usually brought on by a particular situation.  I developed fears of set events – travelling in buses or planes, for example – that caused me to avoid travelling in general.  Therapy and medication helped get me through, but I still remember how traumatic those events were.  I remember not being able to travel on a bus with my coworkers because I was so, so scared of having an anxiety attack.  Or having a major one while traveling for work that almost caused me to run off of a plane.

Learning how to control my anxiety is what got me through those dark times, and learning how to stop an anxiety attack before it started – or at least how to stop one once it was underway – was immeasurably helpful.  Learning these skills gave me the confidence that I needed to believe that I could survive the worst anxiety attack, and that taught me how to live again.

With that, here’s a few techniques that I’ve successfully used in order to try and head off an anxiety attack before it started, and cool one down when it began.

Oh, and standard disclaimer: I’m not a Doctor or professional. I’m a guy with a blog.  Don’t let my random thoughts stop you from seeking professional, medical advice!

1) Pick a number.  Count to seven.  And keep going.  One of the things I found when I was at my worst was that the brain desperately needed a distraction.  I believe it was a therapist who first made this suggestion to me: Pick a task and run with it.  Pick a random number – 136.  Add 7.  And keep going.  This will, hopefully, distract your brain enough to stop the anxiety attack in its tracks.

2) Breathing Exercises.  There are a ton of variations on this, and there is also ample evidence that anxiety and depression can be ameliorated in the long run with proper breathing techniques.  When I was younger, I found this to be particularly effective, particularly when I first started suffering from anxiety attacks.  I would literally sit there in 8th grade homeroom and say to myself, “There is nothing else but your breath.  Take a deep breath.  Fill your chest as much as possible.  In through your nose and out through your mouth.”

For a more formal exercise, click here.

3) Pick an object.  Any object.  This is related to the first technique.  Getting yourself out of an anxiety attack often means changing the way that you are thinking in order to stop yourself from cycling through panic.  To that end, find an object.  It can be simple or complex.  Stare at that object.  Get lost in it’s texture and colors.  How does it look?  What does it do?  Is it moving?  What are it’s colors?  Rough or smooth? Ask yourself simple questions, and then allow those questions to become more complex.  Remember, the goal here is to get your mind to concentrate on anything other than the panic.

For me, when I was at my worst, the challenge with this was trying to get myself to concentrate on an object, because starting too long at something could make me feel worse.  If that’s the case for you, no problem!  If one object doesn’t work, try picking a different one.  Or, allow yourself to look away for a moment before coming back to the object in question, and starting the cycle over.

4) Call someone.  I found that conversations with others – people I trusted, who wouldn’t judge – could be helpful.  If you allow yourself to get lost in your own mind, you can get yourself into trouble.  To that end, talk to someone you trust and love.  Talk about the anxiety attack.  Talk about the weather.  Do whatever works for you, but just make sure that you can get out of your own head.

As always, these are just suggestions, just my thoughts.  Have better ones?  Let us know in the comments!

4 Video Games that portray mental illness

As I’ve discussed before, I’m a video game nerd.  Hardcore.  And, as someone who is a bit obsessed with eradicating stigma that is related to mental illness, I remain fascinated by public portrayal of depression, anxiety and addiction.

Video games, I believe, are art.  I define art as the ability to make a profound emotional impact on a person.  As such, the portrayal of mental illness in video games – and indeed, humanity – continue to fascinate me, and make me think.  The good news is this: Video games can often describe the human condition in a more thoughtful and complete than many movies and television shows.  That line of thinking inspired this blog entry: How does video games portray mental illness?  How accurate is that portrayal?

Oh, and spoilers below.

Life is Strange: Before the Storm

LifeIsStrange

This one is the prequel to Life is Strange, one of my favorite games, made by Square Enix.  It is a walking simulator  in which you follow Chloe, the main character, as she battles her way through high school and falls in love with Rachel, the previously unseen character who plays a pivotal role in Life is Strange.  

I firmly believe that Chloe is suffering through some major depression symptoms.  Her father has died a few years before and her mother is dating a man who she openly despises and fights with; both of these experiences can lead to depression.  She drinks and does drugs often enough to have a regular dealer to whom she owes money. Her best friend is gone, and not communicating with her at all.  She comes across as angsty, but it’s more than that.  Her quotes, thoughts and actions are often self-destructive and reflect a young woman in pain.

To me, this is more than just a teen being a teen.  She’s miserable, she fights with her mom and her mom’s boyfriend, her family has financial issues, and she is clearly discovering her sexuality.  These are all symptoms that lead my to believe that Chloe is suffering from depression.

What makes the game more relatable is the game’s treatment of Chloe.  In the start of episode one, she is petulant and miserable – not the greatest portrayal.  However, as the game evolves, she becomes a more sympathetic character, and a multi-layered one at that.  You see her hopes, dreams and ability to connect with others.  And, by hearing her thoughts, you can hear all of the truly heartbreaking things she is thinking and saying to herself, about herself.

You intrinsically want Chloe to be better, to have healthier thought patterns and make better decisions.  And, in that sense, I hope that the game can give people a better idea of what it is like to live a life under duress, as Chloe clearly does.

A Night In The Woods

NightInTheWoods

Disclosure: I’m only part way through this one

A Night In The Woods is a platformer. You play as Mae, who has just dropped out of college and returned home.  I’m not very far along this one, but where I’ve gotten to, strange things are happening in her hometown after she reunites with her friends.

The college drop-out part is interesting.  Again, I’m not far in, but thus far, Mae has refused to talk about what happened to her in college, aside from saying that college “didn’t work out” or some variation of that phrase.  She reconnects with old friends, who all have their own battles:

Mae, the protagonist, experiences depression and anxiety, which sometimes create dissociative states during which she becomes completely disconnected from reality. It is implied, though never directly stated, that Gregg has bipolar disorder. His poor impulse control gets him into bad situations, and at times these factors impact his feelings of self worth. Bea and Angus both struggle with the consequences of abusive pasts and their relationships with their families.

As has been noted by Kotaku, the game’s creator’s have both discussed their own battles with mental illness:

The game’s creators have spoken candidly in the past about their own mental health struggles. Scott Benson, who animated and illustrated the game, has type two bipolar disorder. Programmer Alec Holowka runs the Everybody’s Fucked Up podcast, which aims to break through stigma around mental illnesses by interviewing people who have experienced them. (Bethany Hockenberry, the writer of the game, was unable to meet with Kotaku for an interview.)

This game is different than the standard platformer in a few ways, but chief among them is that it allows users to make dialogue choices that affect the game.  This puts you in the driver seat and gives you the perspective of Mae, thus ensuring that you get a first-hand look at what it is like to live a life with depression.

As I said, I’m only a little way into this one, but I’m very curious to learn more.

Please Knock On My Door

Disclosure: I haven’t played this one.

PleaseKnock

This is the portion of the blog entry where the games start getting a touch more obvious.  In Please Knock On My Door:

Please Knock on My Door is a simple game about a person living with depression. The protagonist, a blocky, inky-black character, lives a fairly standard life: Wake up, go to work, come home, repeat. The days are punctuated with mundane tasks like making a sandwich or showering, but each one carries extra weight as it drains — or bolsters — the main character’s mental fortitude.

The game’s art style is simple and stripped down, forcing players to experience the emotions of the game, not be overwhelmed by its graphics, and the focus on simple decisions and how draining they can be gives players the experience of depression, and the added knowledge that each decision made can weigh on a normal human being.  In that sense, it seems to concentrate on giving players the sense of just what a burden living with depression can be.

Depression Quest

Depression Quest

Disclosure: I haven’t played this one either.

Gee, I wonder what this game is about?  From the website:

Depression Quest is an interactive fiction game where you play as someone living with depression. You are given a series of everyday life events and have to attempt to manage your illness, relationships, job, and possible treatment. This game aims to show other sufferers of depression that they are not alone in their feelings, and to illustrate to people who may not understand the illness the depths of what it can do to people.

The game was designed by Zoe Quinn, who faced a slew of death threats for her efforts.  Charming.

As for the game itself: You live the life of someone with depression, making what are relatively mundane decisions about living life.  That being said, in the game, happier decisions are often grayed out, forcing the player to experience life as through someone with depression.  The game is told through a series of text decisions.  In that sense, again, it tries to get the user to experience depression from a first-person perspective.

These are just four, and there are certainly many more.  Any other games you’d like to share?  Let us know in the comments below!

Your smartphone may be making you depressed

I remember catching this story ages ago: A study found that the more time you spend on your iPhone, the more likely you are to be depressed.

Then, yesterday, a friend was kind enough to send me this article about how the University of Berkeley was offering students “counseling” in response to a conservative speaker coming onto campus.  I totally agreed with the article’s premise: That it is absurd to offer counseling for an optional speaker who some students may disagree with, and that such an offer does real harm to the mental health world be further stigmatizing and cheapening the need to get help.  However, there was a passage in the article which really caught my eye:

Researchers have, however, identified reasons to be concerned about the psychological health of teenagers and young adults. In her new book, “iGen,” social psychologist Jean Twenge argues that we may be on the brink of a major mental-health crisis among the generation born between 1995 and 2012, a crisis she links to smartphones and social media.

This made me wonder: Just how true is this statement?  As always, standard disclaimer: I’m not a scientist, just an observer with a real interest in mental health.  That being said, it certainly appears that the answer may be yes.

First, there’s this powerful Atlantic piece, written by Jean Twenge, which makes the case that iPhones are, without a doubt, leading to a “mental health crisis.”  It also argues that smartphones are causing problems at rates previously unheard of in past generational changes:

Psychologically, however, they are more vulnerable than Millennials were: Rates of teen depression and suicide have skyrocketed since 2011. It’s not an exaggeration to describe iGen as being on the brink of the worst mental-health crisis in decades. Much of this deterioration can be traced to their phones.

The articles conclusions are stark and tie directly to smartphones.  It makes the case that teens are going out less, spending less time with friends, showing less independence, dating less, having less sex and driving less than cohorts from previous generations.

So what are they doing with all that time? They are on their phone, in their room, alone and often distressed.

The case here is clear: Screen time makes teens less happy, and more likely to screen for depression.  Seriously, there’s a ton in this article, so if this is an area of interest to you, I highly suggest you read it.  It made me want to set my phone on fire.

Anyway….

Other articles have confirmed the link between smartphones, depression and anxiety.  What is most interesting to me is the nature of this relationship.  Anyone who has ever taken Psych 101 knows that correlation does not equal causation, meaning that just because two things are connected does not mean that one (smartphone use) causes the other (depression or anxiety).  That may be the case, but it may be that depression and/or anxiety actually cause an uptick in smartphone use; personally, I can vouch for this – when I get anxious, I frequently turn to my phone as a crutch or escape from reality.  It also may be a third item, like lack of self-confidence, simultaneously causes both depression and an uptick in smartphone use.

That being said, the Atlantic article I discussed above makes the case that the relationship is linked, and that smartphone use is causing depression.  That conclusion, however, is not uniform, per this meta-analysis:

…the studies examined were correlational, meaning that it is not clear if smartphone use causes symptoms of mental illnesses or if symptoms of mental illness cause greater smartphone use.

As I said above, I’m not a doctor or a scientist, but I do know that smartphones can have a deleterious effect on mental health and social development.  I suspect this is an area that will be the subject of increasing research as time goes on, and I certainly hope that is the case.

Now, go outside!

Fangirl: The book that reminded me that Writing = Therapy

As I’ve said before, one of the things that has helped me cope with my anxiety/depression issues.  There’s a few reasons for this, and I’ll get into that shortly, but I wanted to write what basically amounts to a thank you note to Rainbow Rowell, author of Fangirl, and talk a little bit about how I found a wonderful creative outlet…and, maybe, how you can too.

First, my personal history.  Ever since 8th grade, I’ve loved to write.  Like most young, male teenage authors, the first thing I ever wrote was…uhh, Star Wars fan fiction.  It was terrible, but that’s completely besides the point.  At the time, it made me extremely happy, and why not?  It gave me the opportunity to create, and feel like I was part of a franchise that I adored.  During my teenage years, writing continued – I wrote two full-length novels (unpublished, of course, probably because they were pretty bad).  In college, as the anxiety and stress continued, I tried my hand at poetry.  Again, it gave me…something.  The chance to express what I was feeling, and in putting it on paper, leave a piece of it behind.

What I remember the most about these novels, even more than their plot, is that they helped me cope.  Novel number one was about my family history, the loneliness that came with it and just being a teenager in general.  Number two was working through some of the challenges I had in my family at the time.

Both novels gave me hope.  They gave me a sense of control.  And in my worst, most loneliest moments, they gave me something to hold onto.  Not for nothing, but novel #2 never made it through revisions.  Once I came to peace with what was happening in my life, I more or less stopped writing it.

This was all in high school.  Fast forward fifteen years: I’m married, two wonderful kids and a State Representative.  To my surprise, I managed to achieve a dream and become a published author, but a non-fiction book: Tweets and Consequences.  

It was around the first half of 2015 that I hit a rough patch with my depression, arguably one of the rougher ones I had hit in years, maybe even since college, when my depression and anxiety really first began/exploded onto the scene.  At the time, I remember feeling misreable and just so helpless, searching desperately for a way out that I just couldn’t find.

What wound up pushing me to a better place was writing.  And what helped get me there was Fangirl by Rainbow Rowell.  From the book:

In Rainbow Rowell’s Fangirl, Cath is a Simon Snow fan. Okay, the whole world is a Simon Snow fan, but for Cath, being a fan is her life-and she’s really good at it. She and her twin sister, Wren, ensconced themselves in the Simon Snow series when they were just kids; it’s what got them through their mother leaving.

Reading. Rereading. Hanging out in Simon Snow forums, writing Simon Snow fan fiction, dressing up like the characters for every movie premiere.

Cath’s sister has mostly grown away from fandom, but Cath can’t let go. She doesn’t want to.

Now that they’re going to college, Wren has told Cath she doesn’t want to be roommates. Cath is on her own, completely outside of her comfort zone. She’s got a surly roommate with a charming, always-around boyfriend, a fiction-writing professor who thinks fan fiction is the end of the civilized world, a handsome classmate who only wants to talk about words . . . And she can’t stop worrying about her dad, who’s loving and fragile and has never really been alone.

For Cath, the question is: Can she do this? Can she make it without Wren holding her hand? Is she ready to start living her own life? And does she even want to move on if it means leaving Simon Snow behind?

The book resonated with me because the main character, Cath, is clearly having major adjustment issues to college (as I had) and discovering who she is.  She uses her writing to cope and get her to a better place, and the book details her struggle in terms of finding a voice that is authentic and truly belongs to her.  Cath is clearly a talented writer, and the book explores her writing journey, meshing with her adjustment to college, family separation, romantic experiences, academic struggles and more.  I’d also argue – and many others have also made this comment – that Cath is clearly suffering from some form of depression.

And that is exactly where the book hits a chord for me.  I remember there being one scene where Cath is in an advanced writing class with older students, and the professor – a big time author, if memory serves – is asking the class why they write.  One student answered “therapy.”  And that’s a note that just rang so, so true to me.

For me, writing was always a therapy for a variety of reasons:

  • It allowed an escape.  An idealized world where every situation could be reasonably thought through, all alternatives explored, and all potential problems dealt with accordingly.
  • It allowed me the chance to work through problems, to put myself in someone else’s shoes.  In a sense, I think writing allows you to sort the various parts of your head and put them somewhere better.
  • It allows you to mark the moment.  And I don’t mean remember.  I mean something stronger.  To carve it into your consciousness and make sure that the emotional core of an event – everything you are trying to deal with – are always remembered.  Every feeling, every sensation.
  • You can play God.  Play the hero, play the villain, whatever you want.
  • Ideally, you can work through your past, and channel it into something good.  I think that’s an important theme of my overall mental health journey: Once I realized I could go public, and help other people in the course of doing so, I became a better public official and a better person.

To those of you who write, in any form, for mental health purposes – I feel you.  And to those of you who don’t – maybe give it a go.

 

More about me: The Liebster Award

So, My Anxiety Matters was kind enough to nominate me for the Liebster Award, travels from blogger to blogger as a way to promote great content.  Thanks so much!

I really like this!  It’s nice to see bloggers recognize others.  There are a few really interesting parts of this award, including that you have to answer a series of questions.  Those are below:

1. What’s the best thing about where you live?

The sense of community.  People in Allentown – and the Lehigh Valley – generally care about each other.  The pay attention.  They are informed.  We have great corporate citizens, caring residents and wonderful non-profits.  It makes me proud to represent them.

2. Who’s your idol?

This is a really, really hard one, because there’s a few.  I don’t know if “idol” is possible for me to answer, but closest thing I can come up with is Abraham Lincoln.  Not only for what he accomplished, but for what he accomplished in the face of incredible depression.

3. Favourite inspirational quote?

Easy:  “Here on Earth, God’s work must truly be our own.” – John F. Kennedy.  It encompasses my view on religion, politics and society perfectly.  Prayers in not enough.  The only thing that is enough – or close to it – is action.

4. The scariest thing you’ve ever done?

This is really difficult.  Arguably pushing forward in the face of some of my anxiety attacks.  Bizarrely, writing the article where I first “came out” as clinically anxious/depressed wasn’t scary, though it impacted my career – and my life – in ways that I could never have dreamt.

Thinking about it logically, this speech, given on the floor of the Pennsylvania House of Representatives:

I remember being more nervous for that one than any other speech I have ever given.

5. Your inspiration for writing?

Depends on what you mean.  In terms of blog writing: A desire to “spread the gospel,” so to speak, on mental health, and bring an issue out of the darkness that has been kept there for far, far too long.  I’ll confess that there’s a self-promotional aspect to it as well; as I’ve mentioned on a few other mediums, I have a Young Adult book coming out in the first half of 2018, and the book deals with mental health and mental illness.

6. What do you do to relax your mind?

Hahaha.

Okay, okay.  That’s not fair.  I do relax, as best I can.

  • Writing/working on the sequel to my novel.
  • Just took up meditating.  Am a big fan so far!
  • Playing with my kids.
  • Video games.  I love video games, and I don’t care what anyone has to say about it!

7. Favourite feel-good song?

So hard, but here is what I went with.  LOVE Haim.

8. Your happy place?

Rehobath Beach, Delaware.  Outside of the Ice Cream Store.  Kids JAMMING ice cream in their faces.  Me with a Red Velvet Sundae.  Yum.

9. Bravest thing you’ve ever done?

That one is easy.

10. Your favourite book?

Again, a difficult one to answer.  I am a pretty avid reader.  Obviously Harry Potter, but I think that goes without saying.  But favorite individual book?  The one coming to mind right now is The Dome by Stephen King.  A book about monsters inside and out.

11. Your advice for someone struggling with their mental health?

I suppose two-fold:

  1. You’re not alone.  You’re never alone.  1 in 5 adults suffer from mental illness every year, and there are thousands of people – if not millions – that will drop everything to help you find peace.  Don’t give up, because there are millions of us out there – including me – that are living proof that you can live a good and happy life, despite what you are suffering from.
  2. Seek the help that you deserve, and don’t feel an ounce of shame.

There’s a pay it forward component to this, and I’m going to have to find some others to nominate, so let’s just take a rain-check on that one.  And again, thanks so much to My Anxiety Matters for the nomination! I highly recommend you go and check out the blog to see a very personal view of anxiety.

Physician shortages: The biggest challenge facing mental health in America

I often write about stigma and the devastating role it can play in terms of keeping people out of treatment.  I think a big part of the reason I discuss it so frequently is that it’s the one area that people can actually get involved in and feel like they are making a difference.

That being said, I need to be clear about this one: Stigma reduction, though important, is not the most critical issue facing mental health.  That, I would argue, is a lack of capacity, largely in terms of mental health practitioners.

The facts on our ongoing physician shortage crisis are staggering:

  • According to a report by the Association of American Medical Colleges, over the next eight years, the United States will experience a doctor shortage of between 61,700 – 94,700.
  • That problem is much more acute in the area of mental health.  According to one report, in order to meet demand, the United States needs to add 70,000 providers over the next eight years if we are going to meet a growing demand.  The problem is even worse for people who live in rural areas; 60% of all people in rural areas live in a mental health professional shortage area.  In general, according to NAMI, only 41% of all people with mental illness are treated, while that number increases to 63% of all people with a serious mental illness.
  • The shortage doesn’t just affect personnel, but facilities.  It can be extremely difficult for the mentally ill who need inpatient care to have access to it, with some surveys estimating that the United States needs a whopping 123,000 psychiatric beds.

How did we get here?
As you can imagine, there are a variety of culprits, including:

  • Incredibly high standards to get into medical school and a long length of time for training.
  • Crushing medical student loan debt (averaging $207,000).
  • A shortage of residency slots for hospitals.  These slots are almost entirely funded by Medicaid, and that funding has not increased since 1997.
  • High cost of malpractice insurance.
  • Varying reimbursement rates for different specialties (more on this later).

Why is this problem so much worse in mental health?
This problem is even more acute in the mental health universe, where amount of psychiatrists declined 10% from 2003-2013.  The shortage gets even more severe as you go into mental health specialties, such as pediatric and geriatric care.

Again, there are many reasons that this issue is so problematic for mental health.  For one thing, hospitals and insurance companies pay doctors more if they are involved in specialties that turn a profit, like orthopedic surgery and urology…not psychology or psychiatry.  Additional public cuts to human services and mental health further exacerbate the problem. As a result, there is less staff in this area, regardless of it’s importance.

Physician burnout is also a problem, with one study noting that “86 percent reporting high exhaustion and 90 percent reporting high cynicism.”

Another problematic area is physician training, where there are concerns that training models have not evolved enough to introduce more medical students to mental health areas.

There’s more – much more than a simple blog entry can handle.  For a more in-depth look, I highly recommend that you review this report by the National Council for Behavioral Health.

What can we do about it?

  • Increasingly utilize technology and telehealth, which some studies have shown to be promising in the area of mental health.  With additional capacity, telehealth can help overcome geographic shortfalls that occur.  Other systems, such as bed and doctor registries, can help patients in need of treatment find appropriate resources.
  • Expanded number of residency slots.
  • Adjustment to reimbursement rates to ensure that mental health services achieve parity with other areas.
  • Adjustment to licensure laws in order to allow for other certified professionals – with appropriate training – to treat patients.

It is important to not lose sight of this simple truth: The mental health practitioner shortage can devastate the quality of life of the mentally ill.  It can kill people, frankly.  In my government job, my office regularly fields calls from constituents who need help but can’t find it.  Mental health is an issue that society is only truly starting to understand and deal with.  We must ensure that the mentally ill have the access to the resources that they need.

Anxiety is like living in a box

If you are used to reading this blog, you’ve seen me discuss it before: 1 in 5 Americans suffer from some form of mental illness during a twelve month period.  That number is extraordinarily high, and it means that over sixty million Americans suffer from mental illness’ grasp during any given year.  This is shockingly high and exceptionally tragic.

That being said, here’s a different way of looking at this statistic, one that can be a little but of a head trip for advocates like me who can sometimes drown in the mental health universe: 4 in 5 Americans don’t suffer from mental illness over a one year period. While the world health organization says that 1 in 4 people will suffer from mental illness over the course of their lifetime, that still leaves an exceptionally high number of people who don’t know what it’s like, thank goodness.

Many people understand what mental illness is like.  When I first started talking about my own struggles, I was blown away by how many people said, “Me, too,” or confided that a beloved family member or friend knew exactly what this pain was like.  Even so, describing mental illness can sometimes be a challenge, so allow me to try.

As my life has gone on, I’ve often suffered from some combination of a generalized anxiety disorder, periodic anxiety attacks and a major depressive disorder.  I’d actually make the argument that the anxiety is more dehabilitating than the depression.  That’s because of this simply metaphor: Living with anxiety is like living in a box.  A box that slowly closes.

Allow me to explain.  The kicker about anxiety attacks is that they are often unexpected. While some triggers can make them occur, or can spike a general sense of unease and anxiety, many anxiety attacks occur out of nowhere, for no real reason.  For many – and this was certainly the case for me – there is only one place they don’t occur (without a very good reason): Home.  Home is the safe place.  It’s the place where nothing can go wrong.

So, you’re out at the mall, and bam, anxiety attack.  Or you are out with friends at a party.  Someone gives some backhanded insult, and there you go, down the rabbit hole of anxiety, with no end in sight.  Suddenly, you are miserable.  Stomach churning.  Palms sweating.  Heart rate accelerating.  Breathing difficult.  Hoping no one notices, you retreat to the bathroom, thinking, I need to get out of here.  And you do.  You make up some lame excuse – you’re tired, you have an upset stomach – and out you go.  You’re home.

And then the next time you get invited to a party, you remember.  Remember the pain, the anxiety, and like any normal human, you want to avoid it.  So you don’t go.

So take that situation.  Multiply it by every variable you can think of: The grocery store.  The mall.  School.  Work.  And that’s how anxiety traps you in a box.  It cuts off your life by making sure you engage in avoidance behavior, slowly chopping away joy and vital connections from your world.

Unfortunately, this is all to common among people with anxiety.  They become socially withdrawn, and at it’s most severe, it can lead to agoraphobia, which is when you avoid public situations altogether.

The best way to stop this?  It’s also the hardest: Face your fear and break out of the box. This is different for everyone, and often best done with the help of a therapist.  For me, when I was at my worst, I almost had to retrain myself to engage in social situations – go places by myself, where I was free of judgement, and just relax.  It worked, eventually, but largely because I followed a pretty regimented approach that was set up by my therapist.

As always, I’d love to hear your thoughts below.  Did I get the metaphor right?  Any better, more accurate one that you’d like to share? Let us know in the comments!

ISO: Great blogs

Morning, everyone, and hope you are having a weekend!

As I continue to build this blog, I’m looking to build other resources with similarly-minded blogs.  I’ve found some great ones, and if you have one to add – including your own – please let me know!  I’m looking to build a nice Blogroll, and would love to trade links with those of you who are interested!

Any good blogs for me to link to?  Please leave your thoughts below.

Have a good one!

Is Donald Trump bad for your mental health? And what can you do about it?

 

Alright, let me start by admitting that I really debated writing this one.  I’m a politician, and a pretty progressive/Democratic one at that, so as you can imagine, I am pretty much diametrically opposed to…err, everything Donald Trump stands for.  As a result, the last thing I want to do is to be accused of “bringing politics” into a mental health discussion, something that I legitimately think happens too often.  I’m going to do my best to stick with legitimate, reputable sources as I discuss this issue, and try to approach it from the most objective angle possible.

The short answer to this question is yes, the President of the United States can be damaging your mental health.  That, of course, depends on a variety of factors.

Let’s start in my favorite place, Twitter:

Well, that was stressful.  And yes, there are plenty more.  I will say that, in my personal life, I’ve repeatedly joked that this election turned me from an elected official into a therapist: I can’t tell you how many people I’ve spoken with who are suffering from Trump-related anxiety.

In the immediate aftermath of the election, 24/7 crisis lines found themselves overwhelmed with calls from frightened individuals.  Then there is this Daily Dot article, which led with the subtitle, “If you’re a liberal with a history of depression or trauma, this presidency could be more damaging than you thought.”

Well, crap.

From the perspective of a therapist, there’s no doubt:

Several patients with histories of sexual abuse and self-image concerns told me that they experienced significant increases in anxiety. One reported that the constant news coverage triggered memories of her past sexual abuse, and another suffered frequent crying spells and difficulty sleeping.

Quoting multiple therapists and psychiatrists, the article notes that many clinical professionals have had patients tell them that they are experiencing additional anxiety, worry and depression as a direct impact of Trump’s rise to the Presidency.  This effect is particularly pronounced for members of threatened classes, such as people of color, the LGBT community or other religious minorities, many of whom are already more likely to suffer from mental illness.

Then there is this survey, conducted by the website CareDash.  The data below is copied directly from the survey:

  • More than half (59%) of Americans are at least somewhat anxious because of the November election results. The national survey findings mirror an online poll of CareDash newsletter subscribers which found that 55% of respondents are at least somewhat anxious because of the November election results.
  • Nearly three-fourths (71%) of people 18-44 are at least somewhat anxious because of the November election results.
  • Half (50%) of Americans are looking for ways to cope with the negative political environment.
  • Over one-third (39%) of Americans are avoiding social media to reduce their anxiety around the political comments.

Another survey, conducted by the American Psychological Association, found that 52% of Americans believed the 2016 elections were a very or somewhat significant source of stress in their lives.

It seems pretty clear: Yes, Donald Trump has had a negative effect on the nation’s mental health.

So, all of this begs the question: What can you do if you are suffering from Trump Anxiety?

This Lifehacker article and this article from Psychology Today lay it out pretty nicely: Don’t just worry.  Channel that worry into something real and tangible.

  • Ask yourself some key questions about what you can and cannot do.
  • Get active in politics or other social causes – ones that you care about – that will help you reestablish a sense of control in your life.
  • Stop reading the news all the time.  There is a difference between being informed and being obsessed.
  • Connect with others; family, friends and people who, like you, are under serious stress.
  • Exercise!
  • Write down your anxiety.  Don’t just let it be free-floating – write what is troubling you, and use the information you gain from that writing to fight back.

The elections, and the aftermath, have been extremely stressful to some.  If you are one of those people, know you aren’t alone.  If you aren’t, I hope this entry gave you some perspective: There are real people who are truly suffering as a direct result of the election and its aftermath.

As always, I’d love your thoughts in the comments below!