Monday, 30 September 2019

Is EEG Useful in Psychiatry?

Is it useful for psychiatrists to order EEGs on their patients? That’s a perennially controversial question, and one that’s worth revisiting from time to time. The basics of EEG First...

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Can You Recover from Dissociative Identity Disorder?

We used to refer to Dissociative Identity Disorder (DID) as multiple personalities or Multiple Personality Disorder (MPD). The creation of multiple identities occurs often in response to extreme abuse in childhood. Individuals who have developed different identities have described the experience as a way to escape the abuse.

Recently, an Australian judge made a landmark ruling allowing six of Jeni Haynes’s personalities to testify against her father for the horrific abuse she suffered as a child. In response to the extreme and persistent abuse, the woman created 2,500 different personalities to survive.¹ The ruling is a precedent where a person diagnosed with Multiple Personality Disorder (MPD) — or Dissociative Identity Disorder (DID) — testified in their other personalities. As a result of the testimony, the father was convicted and sentenced to 45 years in jail by a Sydney court.

In the words of Jeni Haynes, when asked about one of her personalities, a 4-year-old girl named Symphony, she explained, “he wasn’t abusing me, he was abusing Symphony.” Splitting into different people allows for an escape from a situation that cannot be escaped from.

While the ruling in Australia is modern, the phenomenon that we describe as Dissociative Identity Disorder is not new. In fact, it is already described in ancient Chinese medical literature.⁴

Is it possible to recover from Dissociative Identity Disorder?

The short answer is yes. But what does recovery from DID look like? The goal of treatment for DID is integrated function and fusion. A person with multiple identities may feel like several different people each who have their own distinct personalities complete with individual names, memories, likes, and dislikes. However, these separate selves are part of one whole adult person. The subjective experience of the person with DID is very real and the goal of treatment is to achieve fusion of each personality so the person can begin to function as an integrated whole. Fusion occurs when identities merge together and become a unified whole. It is important to understand integrated function as a process that occurs over time, and fusion as an event where two aspects of identities merge together.

Helping each identity become aware of the others and learn to negotiate conflicts is an important part of the therapeutic process.² Established guidelines for the treatment of DID state that each personality must be acknowledged and allowed to participate in the therapeutic process. Disruptive or unpleasant personalities should not be ignored or treated as undesirable. The goal of therapy is to integrate each unique identity into the whole self. Therefore is is unhelpful for the therapist to encourage “getting rid of” any of the unique identities that exist within the person rather, each must be acknowledged and accepted by the therapist.

What does recovery look like?

Successful treatment outcome results in an integration of each individual identity as part of the self. In addition to this, harmony among the alternate identities is desirable.³ When an individual achieves harmony among identities and ultimately merges each into one unified person, they can begin to feel whole and are no longer subjected to the feeling of being fractured within themselves.

Not all individuals who experience Dissociative Identity Disorder are able to achieve complete and final fusion of each identity due to the difficulty of confronting painful memories. However, treatment is still helpful in moving towards recovery as it allows the individual to receive support and work to resolve past trauma. Healing can be achieved even without complete fusion and resolution of all trauma.

Dissociative Identity Disorder is best treated with a practitioner who is experienced in complex trauma. Not all practitioners are aware of the relationship between DID and past trauma.⁵

References

Mao, F. (2019). Dissociative Identity Disorder: The woman who created 2500 personalities to survive. BBC News. Retrieved from https://www.bbc.com/news/world-australia-49589160
International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187.
Kluft, R. P. (1993). Clinical perspectives on multiple personality disorder. American Psychiatric Pub.
Fung, H. W. (2018). The phenomenon of pathological dissociation in the ancient Chinese medicine literature. Journal of Trauma & Dissociation, 19(1), 75-87.
Connors, K. J. (2018). Dissociative and complex trauma disorders in health and mental health contexts: Or why is the elephant not in the room?. Journal of Trauma & Dissociation, 19(1), 1-8.

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Even Typing This I Feel Like I’m Going Out on a Limb: I Feel Like What I’m About to Say Is Wrong and That I’ll Be Punished

But here it is.I must eat, I have to eat , I’m not fat i just feel like i must eat and i feel like it feeds my body and keeps me strong, i know i have special abilities, i mean i am special right ? I feel like even that was too much said but non the less I shall continue. I feel like or really know so that God has blessed me with power and great strength but it only comes out when it’s truly needed. But BUT thats not all …ok I’m not a bad guy but i have urges and sometimes i think about acting on them please I know it sounds bad but I feel like if I just act on my urges they’ll go away, Will they? I’ll go ahead and say it , I read the rules but idk if it counts as inappropriate to say but here it is I have cannibalistic urges more so thoughts , it’s not my fault, I just want them to stop , they’re not constant but I can’t help but think about how good the beautiful girl walking past me would be , or how lean her toned muscle would be , I don’t like to think like that it’s not me , it’s the evil, I was sent here to do great good things in and for this world , that’s why I am special. Recently though I’ve also had thoughts of hurting people and to kill them , I WONT i just thought I should include that.

I’m sorry if this is too much but I need an answer.

As said before I feel like something bad will happen since I told you this even though I know nothing bad will actually happen.

That’s all I could think about right now.
Please forgive any Typos.

Thoughts are not illegal. You can’t get into trouble for your thoughts. You can’t go to jail for how you think. No one will charge you with a crime for having fantasies. There is no such thing as the thought police. You’re free to think anything you want, about any topic.

However, you should never ignore the danger of homicidal fantasies. They happen for a reason—deep distress, pain and suffering, among other explanations. They always indicate that something is wrong.

Currently, there’s no definitive evidence that indicates that homicidal fantasies lead to homicidal actions. In fact, studies show that the majority of people in the population have thought about killing someone, at some point, in their lives. Despite that fact, most people never kill anyone. Relative to other crimes, murder is relatively rare.

Among individuals who commit homicide, particularly those who commit serial homicide, it is common for them to have had repetitive homicidal fantasies. That is always a red flag. Many serial offenders have described intense, strong urges and a compulsion to kill. These often occur in a stepwise escalation wherein the fantasy grows stronger and more difficult to resist over time. At some point, they feel compelled to act upon their urges.

The key in the aforementioned circumstance is that those offenders made a decision to act upon their fantasies. They chose to do what they did. Some have indicated that they could not control their urge, thus suggesting that their behavior was not their fault but that is far from the truth. They chose to give into those urges. They did it because they wanted to do it. They could’ve gotten help. They knew that their fantasies and urges had been escalating but they decided against seeking help and instead indulged their fantasies. They made a decision to hurt people to satisfy their urges. Make no mistake, it was a choice.

What leads an individual to commit murder is more than just fantasy. I am simply focusing on the role of fantasy for the purpose of this answer but what ultimately leads an individual to kill is not a simple matter.

In your case, you seem aware of the potential problems with your fantasies. By asking your question to us here at Psych Central, you are indicating an openness to treatment. That’s great news. I’m convinced that many of the people who ultimately have committed murder, especially serial perpetrators, had they received treatment, would’ve never have killed.

My recommendation is to consult a therapist. Therapy will help to both reduce your problematic fantasies and provide an opportunity to examine what underlies them. Without treatment, your risk them growing stronger and more intense. Should that happen, you might feel compelled to act on them and hurt people. You must do everything in your power to make sure that never happens. Getting help now is a way to prevent you from acting upon your fantasies.

At this point, you’ve done nothing wrong. A therapist would not be shocked by what you wrote in this letter. They are capable of treating these kinds of issues. Whenever you recognize that something is wrong, and that innocent people may be hurt, it’s incumbent upon you to take action. It would be a mistake to ignore this issue. Getting help is the right thing to do.

I hope that you will consider my advice. It’s important to understand why these thoughts are occurring but most importantly, to ensure that you never hurt people. Thank you for your question. Good luck and please take care.

Dr. Kristina Randle

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Put Yourself in Your Life’s Driver’s Seat

Why is it that people do everything they can to learn to drive a car but don’t do the same to drive their life? It really is the same process. I’m going to risk torturing a metaphor to make the point. Put yourself in life’s driver’s seat. Here’s how.

Want it: When you didn’t know how to drive, you wanted to. You really wanted to. You knew that not knowing how to drive kept you dependent on others to get anywhere. It prevented you from getting to places and people you wanted to see. It might even have kept you poor because you couldn’t get to a job reliably. At some point, you were sick of not being able to drive. You were so motivated, you pushed aside or got over whatever fears you had about being in the driver’s seat and took charge.

Becoming successful at driving your life follows a similar process. There are probably people who are quite willing to drive your life if you let them. Only you can decide that you don’t want to be out of control any more. Push aside or overcome your fears to get in your driver’s seat.

Take instruction: To learn to drive, you either took a driver’s ed class or got a parent or adult friend to take you on the road. You were willing to take instruction because you understood that there was more to learn than just how to turn the key. You accepted the expertise of someone who was older and experienced.

People who are successful in life do just that. You don’t have to pretend to know it all when you don’t. Find yourself a mentor or two or more. Listen carefully and watch how things are done.

Learn the Rules: While learning to drive, you learned the rules of the road. Staying safe and out of trouble meant obeying the law. If you didn’t like a law, you learned how change can happen. You learned, for example, that you couldn’t change an intersection by demanding your “right” to make a right turn from a left lane. But you also learned that you might change how that intersection is configured by going through a process.

There are rules in life as well. Every teacher, every boss, even every friend has expectations (rules) for how things should be done. Getting along means accepting reasonable rules. Do the “rules” seem unreasonable? As much as you might want to, you won’t be successful if you unilaterally start doing things differently. Instead, learn how to engage in a process of negotiation for making change.

Learn the Social Rules: There are also social rules that keep drivers in cooperation with each other. Letting someone else make the turn or giving a little wave when someone else does it for you aren’t required but they do make things friendlier. Most people do understand that road rage doesn’t help when another driver does something thoughtless or stupid. In fact, rage usually makes things far worse. You learned how to let some things go and what to do to report someone whose driving is dangerous. Yes. You know where I’m going …

There are social rules in life, too. General politeness as well as small and large acts of kindness do keep things friendlier. Regardless of how angry coworkers, friends, or family make you at times, expressing rage will only make things worse. Learn how to let some things go and how to effectively confront the situation when you can’t.

Practice the hard parts: While learning to drive, you practiced — a lot. Skills like parallel parking and Y turns are challenging, but you tried and tried again until you mastered them. Practice matters in life, too.

Let’s say you are socially anxious and interacting with others is really, really hard for you. You can’t be successful in life if you refuse to leave your house. Instead, you need to identify social skills that are challenging for you and be willing to practice — a lot.

Call for help if you need it: When there’s something wrong with the car and you don’t know how to fix it, you aren’t ashamed to take it to a knowledgeable friend or to a shop. Your friend or mechanic will diagnose the problem and offer solutions. Sometimes you’ll be able to implement their suggestions by yourself. Sometimes, you’ll need to take the car off the road for a time for a lengthier fix by mechanics. Sometimes it will require learning how to drive the car a little differently in order to improve its performance.

There will be times in life when you know there is something wrong with your body or mind that you can’t fix with an over-the-counter drug or by talking to a friend. There is no shame in seeing your doctor or a therapist for help. They will diagnose what’s wrong and will offer you guidance about what you can do yourself and what might take more regular tune ups (appointments) after an initial fix. You may need to learn how to live life differently to get well or just to grow.

Don’t give up: While learning to drive, you had to learn what to do if you were stuck or spinning your wheels or unsure about what to do next. You learned a variety of ways to get out of a rut.

It’s unlikely that getting where you want to go in life will always be a smooth ride. Learn to recognize when you are “spinning your wheels.” Slow down. Accept that you won’t get different results if you use the same tactics over and over. Learn how to get out of the “ruts” you know only too well.

Take care of the car: Take care of your car and it will take care of you. It needs gas. It needs maintenance. It needs to be regularly cleaned up. It may need some retooling to perform even better.

So, yes, here I go again: Take care of your body and it will take care of you. That means doing the basics of maintenance like getting enough sleep, eating right, and fitting exercise into your schedule. Looking your best by cleaning up and dressing up will help you do your best. If you want to up your horsepower, you need to do more than the minimum. You may need some retooling by getting more schooling or more experience.

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Podcast: Policing Language in Mental Health Communities

In the first full episode of Not Crazy, we learn a little more about the new co-host, Jackie, and her history with chronic illness and depression. Gabe rants about person-first language and how nitpicking verbiage is distracting from more pressing matters in the lives of those living with mental illness. Overall, we decide that “crazy” is not a dirty word and there are other, more time-sensitive, things we should be focusing on that can benefit the mental health community.

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About The Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.

Jackie Zimmerman has been in the patient advocacy game for over a decade and has established herself as an authority on chronic illness, patient-centric healthcare, and patient community building.

You can find her online at JackieZimmerman.co, Twitter, Facebook, and LinkedIn.

Computer Generated Transcript for ‘Policing Mental Health Language’ Episode

Editor’s Note: Please be mindful that this transcript has been computer-generated and therefore may contain inaccuracies and grammar errors. Thank you.

NC – Ep 1 Policing Language

Gabe: [00:00:00] Welcome and you’re listening to Not Crazy with Jackie Zimmerman. She is depressed and colostomy-ized.

Jackie: [00:00:07] I don’t know if I should introduce you yet because you already got it all wrong.

Gabe: [00:00:10] I mean, you’re not depressed at the moment, but.

Jackie: [00:00:12] No, but I also am not colostomy-ized. That’s wrong. This is Gabe Howard, he’s bipolar. He also has no idea what a colostomy is. And that I don’t have one.

Gabe: [00:00:22] But you have a J bag

Jackie: [00:00:24] I have a J pouch.

Gabe: [00:00:26] What’s the difference, isn’t a pouch and a bag like the same thing?

Jackie: [00:00:29] No. A J pouch is an internalized thing made out of your small intestine, an ostomy bag is an external device made out of not your intestine.

Gabe: [00:00:41] I really think there’s a missed opportunity here. They should reverse that. They should make the external one out of your intestine. Because think of the discussion that you could have like, oh my God, what’s that? Oh, it’s my small intestines strapped to the side.

Jackie: [00:00:55] Well, actually, if you want to if you want to get technical. Although I feel like it’s a bit off-topic, however, a stoma is made out of your small intestine and does sit on the outside of your abdomen. So when you do have an ostomy, you do get to see part of your intestine on the outside of your body.

Gabe: [00:01:11] You’re fun at parties.

Jackie: [00:01:13] So weird party trick. Yeah. Yeah.

Gabe: [00:01:15] I’m really excited. Our first episode ever. We’re just getting to know each other. This is the first recording, so it’s not like we did a whole bunch of practice and then recorded our first one, which now that I think about, it would have been like a really good idea.

Jackie: [00:01:27] Probably,

Gabe: [00:01:28] Yeah

Jackie: [00:01:28] Yeah

Gabe: [00:01:28] We could have started off a lot stronger. I feel like we need a Jackie joke in there.

Jackie: [00:01:33] I don’t have one.

Gabe: [00:01:34] Make up a joke.

Jackie: [00:01:36] I can’t be joking on the spot. I’m not funny on the spot.

Gabe: [00:01:39] So you’re only funny accidentally.

Jackie: [00:01:42] Yes. Yes. Yes. When I first met my husband, I told him that I’m the funniest person he will meet. And he said, Oh, tell me a joke. And I said, I don’t tell jokes. And I was like, I don’t understand. Like, I’m just really funny, but I don’t tell jokes. So it’s like no pressure.

Gabe: [00:01:55] My ex-wife thinks that she’s funny because people are constantly laughing at her. But yeah, it’s never on purpose.

Jackie: [00:02:03] Oh.

Gabe: [00:02:03] She is being very serious and I should point out that I am good friends with my ex-wife. I mean, she was still smart enough to divorce me. This is a mental health podcast, and the reason that we picked the great Jackie Zimmerman to be the co-host of Not Crazy is because you just have such an incredible wealth of physical health knowledge. And I have such a wealth of mental health knowledge. And what we found out sort of during our preproduction and getting to know each other and interview stage is that you ignored your mental health because you were so focused on your physical health. And I ignored my physical health because I was so focused on my mental health.

Jackie: [00:02:43] Together, we could have been one whole person.

Gabe: [00:02:45] One whole person. Would we have been like short with blue hair or tall with red hair, like what would our person have been?

Jackie: [00:02:53] We would’ve been a medium with purple hair.

Gabe: [00:02:56] I want that so badly.

Jackie: [00:02:59] That’s some color theory right there.

Gabe: [00:03:01] As you know, this is the offshoot of A Bipolar, a Schizophrenic, and a Podcast. That was the start of this whole idea that the idea that people with mental health issues, people living with mental illness, whether it be schizophrenia, bipolar depression or just, you know, grief or anxiety or OCD or just, shit, I had a bad day and I don’t know how to deal with it needed an outlet. They needed to hear about stuff that was important to them and not like in this nonsense self-help garbage. Oh, you’re a shitty person, but if you listen to my podcast and give me a hundred dollars, you’ll be less of a shitty person kind of way.

Jackie: [00:03:34] But if you do want to give us one hundred dollars, I wouldn’t be sad about it.

Gabe: [00:03:37] We will not turn down one hundred dollars. You can PayPal us at show@psychcentral.com. That’s not even a real PayPal address, like the money is going to go nowhere. So, so, so quick. What what’s our what’s our PayPal address, Jackie? No, just kidding. Don’t say it. Don’t say it

Jackie: [00:03:53] I think part of the will say inspiration behind this show and the direction that we’re taking is this idea that physical health and mental health are connected, but that the world doesn’t quite realize that. So there’s a lot of focus on physical health about how to keep yourself fit and great and all of this stuff. And they’re starting to become, I would say, a shift on mental health. But there still is a lack of understanding that mind-body connection. It is real. And as somebody like myself, like we mentioned, had a very rough go at physical health, not just like I wasn’t healthy and I was overweight and sad and lonely. Well, that’s not physical. But, you know, I mean, it was that like my body was eating itself and I was dying. It’s kind of this bizarre thing that you’re talking to a doctor. You still have to really push the mind-body connection. I have a medical team now that believes this, which was a huge shift from when I first was sick. And so I think the idea behind this podcast is to talk about mental health from people who obviously are mentally ill. I guess we’ll talk about that later, because I don’t really define as mentally ill, however, but not discounting the fact that a lot of people with physical disabilities, physical illness, also experience issues with their mental health and not discounting their experiences by saying, oh, well, it was just a temporary lapse of happiness in your life or it was just situational depression, like all of those are issues with mental health that are worthy of being addressed.

Gabe: [00:05:27] I love what you said, even though you have depression, even though you’ve been suicidal, even though you take medication for depression, you don’t define as mentally ill. So, for example, even though I am 42 years old, I don’t define it as 42 years old. I define as a millennial because everybody hates me. So it just seems like it fits better. And you’re probably thinking as a millennial, no gay, but you are not a millennial, just like I’m thinking. No, Jackie, you’re not mentally healthy.

Jackie: [00:05:59] Yeah, I think that’s a pretty fair assumption because I am 100 percent thinking that.

Gabe: [00:06:03] The way that we talk about mental health, mental illness, the word that we use, we see a lot of stuff on the Internet about everybody policing language. And it’s not just in mental illness. It’s not just in mental health. It’s it’s everywhere. Everybody is just fighting about, you know, person-first language. These words are offensive. I don’t identify that way. Don’t talk it this way. I’m not trying to throw that all out. Like these aren’t valid discussions because I think that there are valid discussions in there. But I think that sometimes people go too far. And speaking just in the mental health community, we have this idea that people who say things like I am bipolar are somehow being offensive

Jackie: [00:06:49] Yes.

Gabe: [00:06:49] Or people who say I’m not crazy or I am crazy or I feel crazy or I’m acting crazy like, no, no, no, we can’t say crazy.

Jackie: [00:06:57] Or even just using the word crazy like, oh, that’s crazy. You can’t say crazy. I am guilty of this. I say bananas. I don’t say crazy. Makes it feel icky. So I’ll be like, oh, that’s bananas. And it’s also because I picked up from a former co-worker who I really liked.

Gabe: [00:07:12] But here’s the problem that I have with this. We’re not doing shit to make life better for crazy people. We’re just changing what we call them. Isn’t that fantastic? We don’t have to do anything to make you well. But we’re going to give you a different name.

Jackie: [00:07:27] When we started being more p.c. and making things better for them because you can’t call them crazy. We gave them a better title, we’ll say. But then we took away all their help and support. So their lives got shittier

Gabe: [00:07:38] Do you think that people in those families feel like that’s a win? Do they really feel better that they can’t get the medical care that they or their family members need? Because after all, we’re speaking about them in a positive way. We’re not putting our money behind them in any positive way, but we’re speaking about them in a positive way.

Jackie: [00:07:58] So. No, I live in Michigan and I saw in the news the other day. We are rolling back resources for mental health. Michigan State wants to shut down funding for counselors to meet with patients via insurance. So basically in a time where Generation Z, we’re all crazy, all the little ones are running around with their lives on display and freaking out about it. That wasn’t very nice. But anyway,

Gabe: [00:08:24] You’re getting letters for that one.

Jackie: [00:08:26] I know. I’m sorry. I’m not sorry anyway.

Gabe: [00:08:28] I apologize. Wait, wait, hang on. It’s Generation Z?

Jackie: [00:08:32] Yeah.

Gabe: [00:08:32] You’re getting tweets for that one.

Jackie: [00:08:33] Yeah,

Gabe: [00:08:33] You’re getting insta pictures for that one.

Jackie: [00:08:36] They’re going to Snapchat me, but joke’s on them, I’m not Snapchat. But there’s this there’s this huge focus. I mean, all the psychologists and psychiatrist are saying we are about to have a mental health epidemic on our hands with this next generation. And meanwhile, our legislatures like cut the funding. We’re fine.

Gabe: [00:08:52] We’ll be right back after this message from our sponsor.

Jackie: [00:08:55] And we’re back talking about why crazy is not an offensive word.

Gabe: [00:08:59] I’m always going to say things, quote unquote, correct. You know, I’m going to say died by suicide rather than committed suicide. I understand how person first language works living with bipolar or living with schizophrenia. I understand all of these things because. Well, I’ve been educated. I’m right in the thick of things. You might not know this, but I have a podcast.

Jackie: [00:09:19] You have a couple podcasts.

Gabe: [00:09:21] I do, I do, and they’re fantastic, but I didn’t start out this way. And could you imagine if Gabe Howard from 20 years ago would have gotten the courage fuck. Could you imagine if Gabe Howard from 20 years ago would have gotten the balls to stand up and say, hey, something is wrong with me. I am crazy. I am screwed up. And the response to that would have been, “Gabe, but no. You’re a person who is living and currently experiencing a mental health issue. You’re saying it all wrong.” You know how much gumption and courage it takes to admit that you’re crazy. And instead of helping me with that, they corrected my language.

Jackie: [00:10:05] I can’t relate to that necessarily because my issues with depression and anxiety didn’t start until my mid 20s when I was an adult and supposed to be living my life and being great. And then I got sick in my life just like tanked really fast. I lost my job. I was dying all that jazz, you know, that fun stuff. But I didn’t even really have the opportunity to sort of declare that I was depressed. I just got there real fast and it got real bad, real fast. And there was no talking to people to get help. It was just this is a crisis immediately. We need to jump on this before there’s nothing left to jump on. So I remember one time I was really, really sick and I was really, really depressed. And I was definitely planning my suicide. And I went to my doctor for a regular checkup and my dad drove me because I wasn’t able to drive myself. And the doctor was like, we need to get you inpatient like right now. I was like, but I have this day planned with my dad. And he drove me here. And I really just want to spend the day with my dad. And she basically was like, well, if you’re going to stay with your dad, that’s fine. And in hindsight, I’m like, was that the right decision? I’m still here. So I guess it worked out fine. But the idea of I guess that was me asking for help or asking for definition or asking for someone to give me something. And she was like, here with your dad, it’s cool. Mind you, I was twenty five. It’s not like I was 16. But it was weird to me that she was willing to let somebody who just said, I am suicidal and very, very, very depressed because my life is getting worse with my sickness. Just go home. She was all right bye

Gabe: [00:11:43] There’s so much to discuss in that statement. You actually use the correct words. You said, I’m suicidal, I’m depressed and still you got sent home. So imagine what would have happened if you would have walked in and said, I’m crazy and I’m going to kill myself,

Jackie: [00:12:01] Yeah.

Gabe: [00:12:01] Especially as a woman. You know, listen, women and millennials at that are always labeled dramatic. So if you would have said, I hate my life, I want to kill myself, but I want to die. And they would’ve been like, oh, god, another woman with blue hair and tattoos screaming that she wants to die. It’s unfortunate, but the care that people with mental illness get is just so incredibly dependent on stereotypes. It’s so incredibly dependent on the amount of money that we have. They always say that the difference between crazy and eccentric is a million dollars.

Jackie: [00:12:36] Whoo! Good one.

Gabe: [00:12:38] But why? You realize that some of these famous artists throughout history that we look at, Andy Warhol is my favorite. This guy was fucking nuts. He literally boxed up his tissues and toilet paper and required them to be warehoused. But he was eccentric. He was unique.

Jackie: [00:13:00] Well, and I would also argue in the same same category of millionaire. He gave the world art so they can say, look at his beautiful art. Artists are eccentric versus me or you. I mean, technically, I have an art degree, but I don’t really do art. So his value was high because he was an artist. So his crazy didn’t matter because he was valuable.

Gabe: [00:13:21] And when does that shift? When does that shift over? Like, for example, if you start making art tomorrow. Jackie, I’m going to assume that you’re not going to become Andy Warhol. No offense. Just no offense.

Jackie: [00:13:33] None taken.

Gabe: [00:13:34] But you are creating art. So does this mean that we’re going to allow you to wipe your ass, put it in a box and store it in your garage and we’ll just call you eccentric? Or are the people listening to this thinking, that’s bat shit crazy. Saving that is disgusting and sick and that person needs help. But Andy Warhol not only did that. He paid people to do it for him. He just

Jackie: [00:13:58] Well, that’s where the money comes in.

Gabe: [00:13:59] He just putut the box. And now, all these years later, we open up these boxes and sort through them. And we’re finding fascinating things in there,

Jackie: [00:14:09] Like shit.

Gabe: [00:14:09] Like Polaroids of Marilyn Monroe, and shit.

Jackie: [00:14:13] Well, this is this is the perfect storm trifecta of the appropriate type of crazy. The I contributed to the world. I have a lot of money and I’m crazy. And if you are missing any of those pieces, I don’t think it works. I don’t think you get to be Andy Warhol. If you’re not rich or you’re not an artist.

Gabe: [00:14:33] So it means that we’re not policing the behavior anymore. And that’s my entire point. We’re not looking at the behavior. We’re looking at the person and then the behavior. This behavior is OK if you’re Andy Warhol. This behavior is not OK. If you’re Gabe Howard, but this behavior becomes OK again. If you’re homeless suffering from schizophrenia and we’re OK with letting you freeze to death under a bridge because after all, get a job, lazy ass.

Jackie: [00:15:00] Well, because now you’re doing the opposite. You’re not contributing. You’re doing the opposite, you’re hurting us. So we don’t need to help you.

Gabe: [00:15:06] Shame on you and your homelessness.

Jackie: [00:15:08] Right. This is your fault.

Gabe: [00:15:10] The discussion surrounding severe and persistent mental illness is almost non-existent until a crisis point happens. The discussion surrounding mental health and mental health crises are starting to to happen in a productive way. But we have all of these external forces that are trying to control the narrative by controlling the words. The example that I get all the time, as I say, my name is Gabe. I’m bipolar. And people immediately look at me and say, no, you’re not. You’re so much more than just bipolar, Gabe. You’re a person to which I respond. Yeah, I know that. Do you think so little of me that you think that? I think that I’m just bipolar. Also, why are you hearing the word just. I said I’m Gabe. I’m bipolar. And what you heard was, I’m Gabe. I’m just bipolar. Why did you feel like you needed to add that word? If I would have said I’m Gabe, I’m married. Would you have said, oh, my God, you’re so much more than just a husband? If I would have said, my name is Gabe, I’m a father. Oh, my God, you’re so much more than just a father. Come on. If you introduce yourself. Hi, I’m Jackie. I work with Gabe. Do you think anybody would say, oh, my God, Jackie, you do so much more than just work with Gabe. You are much more than that. And if they did say that, would you reply? Oh, my God. I didn’t realize that I had more worth than just my partnership. The bipolar dude I met on the internet. How effective is that? Isn’t that mansplaining? It’s like mental illness plaining.

Jackie: [00:16:37] It is, and it actually goes across condition areas, whether it’s mental illness, physical disability, chronic illness, this kind of thing is rampant everywhere. I’ve been doing a lot of research in the physical disability space research meaning, I follow a lot of people on Twitter who are talking about this and how people are working really hard to remove the term sort of. I am disabled from their vocabulary and the people these advocates in the disability space are saying why you are disabled like that. That is part of who you are. And by removing it. It’s adding the stigma that it’s bad to be disabled. So by saying I’m disabled, that means we all think it’s bad. So you identify that way. So we think you’re bad. So we don’t like you because you’re disabled. And I think that this goes across the board and mental illness or chronic illness. For example, I have multiple sclerosis. I don’t identify as disabled because of that, which is another weird. You know, what I identify as is becoming apparently clear that I don’t identify in any of the right ways, but I have multiple sclerosis. I’ve always said that the phrase I have multiple sclerosis, it doesn’t have me drives me fucking insane. I hate that shit because the thing is, I do have it. I will always have it. It’s not going to go away. Is it all that I am? No. Like you said, it’s not. I think the move to do this. The idea was to do the I am not just this. That was the idea behind person first phrasing was I’m not just to this one thing, but by changing it, we are actually removing the power by identifying this way. And I’m not gonna say I feel powerful when I say I have M.S. or I have ulcerative colitis or I have depression or I have anxiety, should I keep going? And all the things that I have, I’m not going to say.

Gabe: [00:18:22] We don’t have that kind of time.

Jackie: [00:18:23] I don’t feel more powerful when I say that it’s not a conscious decision, but it just seems silly to me to beat around the bush to say I’m a person with or I have been diagnosed with. No, I have it. End of story. It’s faster. It’s I guess it’s it’s a more compact way of saying it. And I’m all about getting shit done fast.

Gabe: [00:18:40] For me, it’s just about wanting to define my own life. That’s all I’ve ever wanted to do. I remember Gabe at Wales. I was a fat, little pimply faced, four eyed, braces having, redhead.

Jackie: [00:18:56] Face only a mother could love.

Gabe: [00:18:58] Oh, my God. I don’t even think my mother loved it, to be honest. She was just like, oh, my God. He’s adopted. I was. My parents just I don’t know. And I’ve long since lost the point of this entire story.

Jackie: [00:19:13] Let me reel it in for you. I got this. Ready. So the experiences of young Gabe led you to this point. You did not have a diagnosis to to, I guess, attribute some of your behaviors to. Now you do. And the lack of, let’s say, attention to that or treatment of that, develop some behaviors in you that took you into adulthood and took you into this space where you want to advocate for bipolar, which also puts you in a space to be a well-known advocate for bipolar, which I think means to some extent does make bipolar a huge part of who you are. And part of your identity. I feel the same way. Like as an advocate for M.S. and you see and I have been in this space for 14 years. When people say I have a message doesn’t have me or, you know, I’m more than just M.S., nope. This is a huge part of me. I make my career. I’m talking about having these things like if I didn’t have these things, I wouldn’t be here. I would be talking about it. It’s not the only part of my identity, but it is a huge part of who I am. I make money on it. It’s a massive part of who I am.

Gabe: [00:20:21] I thought you you’re gonna say you make massive money and I was about to hit you up for a loan.

Jackie: [00:20:24] No. No.

Gabe: [00:20:25] So, I’m sorry that.

Jackie: [00:20:26] I don’t. Let me correct that. I do not make massive money on this. I just make some money on this.

Gabe: [00:20:32] I’m not trying to get the whole world to use the correct language so that people can get help. I’d much rather focus on what people are actually saying. I read this fascinating article that said that if your child says they have a stomach ache all the time and by child, you know, like, you know, four, six, eight. But if your child is constantly saying, I have a stomach ache, they might not actually have stomach problems, they might have anxiety. But kids don’t have the words for anxiety. They don’t have the words for nerves. They don’t have the words for panic or paranoia. What they do have are the words to describe stomach ache. I feel that it would be much better to educate the parents and the adults that I have a stomach ache could mean these other things. That person first language really strikes me as no, no, no, no, no. We have to teach a 4 year old to say, Mama, Poppa, I’m having a serious anxiety problem or possibly panic or paranoia, and I must see my mental health specialist as quickly as possible. I think that people lie awake at night and think they’re going crazy. I think people lie awake at night and cry and wish they were dead. I don’t think that people lie awake at night and wonder about the state of their mental health. I don’t think that’s the way that our brains work. I don’t think those are the words in our internal monologue. I don’t think that’s the way that we talk to our friends and our family when we’re desperate and in those vulnerable, vulnerable moments. And if we wipe out all that talk, what’s left? These people are not going to be able to get help because we will not recognize their words or worse, we’ll spend our time correcting them rather than helping them. It stifles.

Jackie: [00:22:10] And on top of the issue with children. So, yes, children do not have these words. But let’s be real people who are not highly educated, affluent and have money for therapy and doctors may also not have these words.

Gabe: [00:22:22] Oh, yeah.

Jackie: [00:22:22] So we’re not just isolating small ones with tiny vocabularies. We’re isolating a large portion of the country we live in who does not have access to care, does not have a great education, does not have higher education. All of these things that give us the verbiage to say what you just said, it’s part of why we nameed the show “Not Crazy.” It’s part of why we did and probably will get more pushback on using the term crazy when talking about people with mental illness. It all comes down to words have weight. If we give them weight. So if you’re offended by crazy, use a different word. If you’re not offended by crazy. More power to you. Here’s the thing. I am a 34 year old suburban, white, straight hetero woman. I’ve got privilege coming out of my ears, which in today’s day and age means I am offended by everything. I’m offended for you. I’m offended by you. All these people I don’t even know. I take offense for them because it’s like my duty in the world we live in right now. I am not offended by the word crazy. And I think part of that is because that’s the word a lot of people know. It’s how they can explain what they’re feeling, what they’re thinking. And if people who don’t identify with mental illness use the term crazy in a way that does not talk about mental illness, it’s not even related to mental illness. Who cares? Right now, I feel like we have bigger issues in the world than whether or not the word crazy is offensive.

Gabe: [00:23:50] And one of those issues is that people with severe and persistent mental illness are literally freezing to death every winter. I don’t really think they care what you call them as long as they can get access to shelter, food and medical care. I’d really love to see us put our resources there rather than policing language.

Jackie: [00:24:10] Snaps. I agree.

Gabe: [00:24:12] But hey, I can’t wait for the day that we have so much money that everybody with a mental health issue gets the help that they need. Everybody fully understands and there’s literally nothing left but to argue about language. And that’s what the Internet was made for. We’re just ahead of our time. Jackie, this was fun. Did you have a good time hosting your first episode of Not Crazy?

Jackie: [00:24:36] I did. I look forward to talking about crazies, myself included. Maybe by the end of this whole thing I will identify as mentally ill. I don’t know, TBD.

Gabe: [00:24:46] We’ll see what we can do for you. All right, listen, everybody, this is our first episode of the Not Crazy podcast. We would love it if you would share us on social media. Post a message if you have any questions you’d like to ask us. You can hit up the same email address. The new Web site for the show is PsychCentral.com/NotCrazy. You can find us on every single podcast player. And as we say goodbye to A Bipolar, a Schizophrenic, and a Podcast, you now have a bipolar, a millennial and a podcast. Frankly, I think we were doing better with the schizophrenic. We’ll see everybody next week.

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This Supplement Prevents Alzheimer’s Disease (M)

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An Irritating Sign Of Vitamin B12 Deficiency

A symptom of vitamin B12 deficiency that can be irritating.

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Day #42 : Conditional Probability – 365 DoA

Up to now we've been dealing with single variable pdf and the corresponding CDF. We said that these probabilities relied on the fact that our variable of interest was independent. However, what if we knew some property that impacted our probability? Today we are talking conditional probability and that is the question we will be answering. It's going to be a long, long post so plan accordingly.

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Do I Have Anorexia?

From a teen in Finland: Hey! I’ve had thoughts about possibly having anorexia for a long time now. But I’m not sure if it’s possible. Mostly because I’m not underweight yet. I have lost over 10 kg but I’m a few kg away from being underweight. I restrict food from my life and often I only eat two meals or even one in a day because I am so afraid of being fat. A part of me knows that I am not actually really fat but I feel like I am and I just can’t stop until I can truly be happy about myself.

And maybe others would also accept me if I was more like them. I’ve never had a lot of friends and sometimes I have been bullied because of my weight, so it would mean everything to me if I could find a way to me perfect like everyone seems to be. Just not me.

These things have been with me for months now but it’s getting worse everyday. So my question is: “Could i possibly be suffering from anorexia?”

I’m so sorry you’ve been bullied. I’m so sorry you are so unhappy with yourself. But you are looking for solutions in the wrong places.

I don’t have enough information to know if you actually have anorexia. What I can say is that what you have in common with people who do is the belief that if you change your weight, it will change everything. It won’t. The reason? Because your problem isn’t your weight. Your problem is your shaky self-esteem and loneliness.

You’d like to think that losing weight is the magic that will solve those problems. Controlling your weight looks easier to you than taking on what seem to be things beyond your control. Sadly, developing an eating disorder will only add to the problems you already have.

You’re not at all alone in that kind of mistaken thinking. Eating disorders affect millions of adolescents around the world. According to some studies, over half of young people are over-concerned about how they look and want to lose weight in order to feel better about themselves. In America, where I live, over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors like restricting food or skipping meals or over exercising. The diet industry is a multi-billion dollar industry that counts on people’s insecurity about their looks and their belief that dieting will fix it to increase their profits.

I would need to know much more about you to be able to advise you about how to develop more self-confidence and how to find friends. For that reason, I’m urging you to make an appointment with a licensed counselor. In therapy, you will learn ways to deal directly with those issues. A therapist will give you practical advice and will be there with the support and encouragement you need to try out new ways to think and be.

Please do make that appointment. You deserve to be happy and to have friends, whether or not you are model thin.

I wish you well.

Dr. Marie

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People of color - getting quantitative about police-involved deaths

From Edwards et al.:

Significance

Police violence is a leading cause of death for young men in the United States. Over the life course, about 1 in every 1,000 black men can expect to be killed by police. Risk of being killed by police peaks between the ages of 20 y and 35 y for men and women and for all racial and ethnic groups. Black women and men and American Indian and Alaska Native women and men are significantly more likely than white women and men to be killed by police. Latino men are also more likely to be killed by police than are white men.

Abstract

We use data on police-involved deaths to estimate how the risk of being killed by police use of force in the United States varies across social groups. We estimate the lifetime and age-specific risks of being killed by police by race and sex. We also provide estimates of the proportion of all deaths accounted for by police use of force. We find that African American men and women, American Indian/Alaska Native men and women, and Latino men face higher lifetime risk of being killed by police than do their white peers. We find that Latina women and Asian/Pacific Islander men and women face lower risk of being killed by police than do their white peers. Risk is highest for black men, who (at current levels of risk) face about a 1 in 1,000 chance of being killed by police over the life course. The average lifetime odds of being killed by police are about 1 in 2,000 for men and about 1 in 33,000 for women. Risk peaks between the ages of 20 y and 35 y for all groups. For young men of color, police use of force is among the leading causes of death.

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Sunday, 29 September 2019

Quality Characteristics of ABA Services for Individuals with ASD

This article will review some of the recommendations for what helps autism services to be considered quality services particularly when the autism services are provided from the framework of applied...

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How to Overcome the Fear of Marriage

If you long for a soul mate, you’re not alone. It’s human nature to want a partner for life.

The longing is there. Yet so many unions don’t last these days. We may hope to say “I do” but fear being disappointed.

Actually, I was like this. I avoided commitment for such a long time that a friend at my wedding, 31 years ago, quipped, “It’s the end of an era.”

When I told my mother I was engaged, she said, “It’s a miracle.” She expected me to stay single. She didn’t want my heart to be broken like hers had been when she and my father divorced.

When she knew I was seeing someone, she’d ask, “Is he still nice?” meaning he’d sooner or later disappoint me. So I stopped telling her about men in my life. As far as she knew, I hadn’t had a date in ten years. “Get a dog,” she said. “Anything to cuddle with.” No wonder my news surprised her.

If I can do it, so can you! Below are four bits of advice for overcoming fears and creating a fulfilling, lasting marriage:

Develop realistic expectations.
Gain knowledge.
Know your reason for marrying.
Gain confidence that you can succeed.

Developing Realistic Expectations

When single, my friends and I talked about what was wrong with men, blithely unaware of our own imperfections. In real-life good marriages, not the fairytale kind, annoyances are normal. Spouses who are compatible and realistic treasure each other regardless.

The idea is not to simply marry someone who loves, loves, loves you. It’s to marry a person who’ll also stay the course even when you’re not being so lovable. And to marry someone whom you’ll still hold dear even when he or she slips up.

So do recognize your fine points, traits a good partner will value. But also note traits of yourself that are less than ideal, though not necessarily deal breakers. It’s fine to cut yourself some slack about your own shortcomings — as long as you’ll do the same for a good potential partner.

Knowledge Is Power

You can succeed in marriage, once you learn how. Many resources exist to guide you toward choosing a partner wisely, dating constructively, committing, and preparing for a lasting, fulfilling union. If you’re been avoiding commitment for a long time, perhaps by staying out of the dating pool or staying in a going-nowhere relationship, you may find therapy helpful for getting past a self-defeating pattern. You can also learn a lot about creating a good marriage from happily married people. They can serve as mentors and role models.

You may find some of the many good books for marriage-minded singles helpful. A number of them offer one-size fits all kinds of advice, so evaluate which recommendations or advice really fits for you and your situation.

I believe in marriage. Societal pressure to marry has decreased. Economic incentives are less relevant. So why marry?

Why Marry?

New, yet often unconscious, reasons exist for tying the knot. Most of us long for a lasting union that fulfills us emotionally and spiritually, as well as physically and materially. This book tells how to create such a marriage.

Not everyone who hopes to marry will say so, when cynics are claiming marriage is obsolete. Some people don’t speak about their desire because they fear being viewed as desperate.

A mother told me that her daughter, Emily, in her 40s, wasn’t interested in marriage. That’s what Emily told her. Then I met Emily, an attractive public relations executive with a bright smile. Privately, she looked me in the eye and said, “I want to get married. My friends do too.”

Susan, 26, with a 4-year-old daughter, said “My life is fine.” Yet in moments of vulnerability, she asks, “Why can’t I meet a great man who accepts me, really cares for me, and wants to be with me for life?”

Beth, 68, gave up on finding a partner after her second divorce 20 years ago. Recently, she confided, “I want to get married. But I’m afraid of the ‘meet market’ (or meat market, as some people think of it) and being rejected if I put myself out there. Can you help me?”

You Can Succeed in Marriage

As a clinical social worker, psychotherapist for over 35 years, and leader of Marry with Confidence workshops, I’ve seen people of all ages create great marriages. Many women in their 20s and early 30s are eager to wed and have children. Others want to establish their career first, another reason later marriages are more common. Plenty of women in their forties to seventies and beyond are marrying for the first time, or again.

Whether you want to marry and start a family or are seeking a partner later in life, you can gain a wonderful, lasting marriage. Marriage is here to stay.

My mother loved me. She warned me about whom not to marry. Doctors were too stuck up, lawyers argued too much, and of course, avoid drinkers and gamblers. (Good thing an accountant wasn’t on her list; I married one.) Yet her story has a happy ending. At a later age, my mother found love. She spent the last 8 years of her life married to a wonderful man who cherished her. Another miracle.

Every good marriage is a miracle. You too can create one.

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3 Steps to End the Year with Success

I know you don’t want to hear it; neither do I, but it’s true. It’s time to put our muck boots on, start hammering through our poo, walk through the muck, eat some crow, and all that jazz. It’s time to get uncomfortable.

There is an opportunity to ride out 2019 in a clambering smash. An opportunity to come out as winners, and to do that, we are going to choose to get uncomfortable with the areas of our life causing us lingering stress and discomfort, and/or areas where we want to do something but are afraid (and what not). It’s time to get-on-it.

It’s time to stop dodging, running, hiding, ignoring, and distracting from what needs to be done.

Why Not Just Face the Discomfort Directly?

There’s a lot of power in that question. Contemplate it. Chew on it. You don’t have to swallow it whole, much to say that you probably can’t or at least won’t be able to digest it. It’s a big question, just don’t spit it out.

“Don’t look away,” as Rumi would say.

It’s an interesting thing to consider when we realized how much time, effort, and energy we spend dodging the object of out discomfort instead of choosing to face it directly.

Discomfort Is the Key to Change

When I go to my meditation retreats, inevitably, there is someone sitting (in a meditation stance of some sort) and trying to get real comfortable — with more cushions, different cushions, a different chair, more blankets, different blankets, and such. And I understand, I’ve done it myself. You realize when you realize…

In essence, they are not meditating; they are trying to get comfortable. When they realize that getting comfortable is not why we have cleared our schedules to sit for 10+hours every day, they will then stop trying to get comfortable and start meditating.

There is a thing about alchemy — in that, there is some form of pressure needed for the transformation. No pressure, no transformation.

My meditation practice is Vipassana — known as insight meditation. No discomfort, no insight.

Embracing Discomfort

Face it. Name it. Soulutionize it; bring some heart soul to those solutions.

1. Face it. The real aim to close out 2019 is to gain more self-respect. Increased self-respect will lead to success. We win when we stand in the midst of our very own self-respect.

The saying, “To save face,” is to say that you are holding on to your self-respect; to save it, don’t lose it. In and of itself, to face the stress and discomfort directly will allow you to “save face.” To retain your self-respect is powerful in and of its own right. A win.

2. Name it: Is it money? Substances? Health? A relationship? Job stress? Distractions? Too much of x and not enough y? That to-do list?

Naming it calls it out; it’s the “I see you.” If you plan to win, you need to see clearly when you are aiming at. You need to see the target.

3. Soulutionize it. Get uncomfortable with it. Get jiggy with it. Get-on-it. You got this.

You are now face to face with the stress and discomfort (the target): I see you.

The solution has more to do with the arrow upon which we will aim; the arrow of self-respect. Ask yourself; what can I do about this situation that would give me a sense of self-respect?

We can’t always determine outcomes, we can’t guarantee results, so the real solution is to aim and shoot our self-respect at the target of stress and discomfort.

The Truth about Discomfort

Oh, the beauty and sneakiness of discomfort; it gets us no matter where we turn. The beauty of discomfort is a benevolent way for life to inform us that change is needed, and it gives us options. Discomfort is kind enough to give us a choice.

Which discomfort do you choose? The discomfort of continued suffering as we continue to avoid, hide, and run from what we need to face? Or the discomfort of facing it, and giving it a solution instead of keeping it a problem to dodge?

Awareness Practice: Observe the ways you run, hide, ignore, and distract from what needs to be done, and how much that madness adds to the stress of your life. Notice how much you add discomfort to an already uncomfortable situation.

Realization: It can be mind-blowing to realize how much we create our own stress, and/or add to what is not necessarily stress or a problem; it just something that needs a solution. Self-respect is a natural byproduct of facing our stress and discomforts directly. Self-respect is the win.

Reference:

Roth, G. (2011). Women, Food, and God: An unexpected path to almost everything. New York, NY: Scribner.

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A Fascinating Sign of ‘Normal’ Narcissism (M)

While narcissism is often considered a bad thing, not all aspects of the trait are negative.

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The Easiest Weight Loss Technique

People in the study lost 5 pounds more with this simple technique.

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Day #41 : Connecting the Concepts – 365 DoA

Maybe we shouldn't phrase it this way, since there is still quite a few days left of 365DoA, but you made it to the end! No, not THE end, but if you've been following along the past few posts we've introduced several seemingly disparate concepts and said, "don't worry they are related," without telling you how. Well today, like a magician showing you how to pull a rabbit from a hat, let's connect the dots and explain why we introduced all those concepts!

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My Girlfriend’s Mom Died in Front of Her When She Was a Child. I Need to Know How to Help Her as Best I Can

As a disclaimer, I’d like to say i know it’s not my place to “fix” my girlfriend. i just want to know what i can do for her to help her cope.

My girlfriends mother collapsed and died from liver cirrhosis when she was very young, and my girlfriend (we’ll call her L) was the only one there to witness her death and deal with the situation. this day forever haunts her, and she has a lot of problems processing this trauma as an adult. she’s told me, through tears “ i want to think about it. i want to think about her death or im afraid ill forget.” shes told me multiple times that she constantly thinks about it and its making her really depressed. id like to know what to do rather than just saying how sorry i am and im here for her. ive told her she should seek professional help but so far she has not. any help is greatly appreciated.

The problem you have described is very personal. It is something that she will have to deal with when she’s ready. It’s not clear why she is refusing professional help but you can certainly continue to encourage her to go. She may not be open to it now but she may be in the future. Hopefully, that is the case.

Many people have the wrong idea about mental health treatment. Some of the more common themes involve people feeling like a failure if they ask someone else for help with their personal problems; believing that only “weak” people need help; not wanting to reveal personal information to a stranger or to tell other people their business; believing that therapy doesn’t work; or believing they can’t afford it, among others.

Those aforementioned false ideas (and others) about seeking out professional help prevents many people from receiving help. The resultant effect is that many people suffer with curable psychological problems. They suffer simply because they believe in misinformation about the nature of psychological help.

With your girlfriend, it’s not clear why she is resistant to treatment. One potential theory is that she worries that the treatment would erase the positive memories of her mother and thus she is unwilling to even try. That, of course, is untrue because therapy does not work that way. Therapy does not involve changing memories. Like many others, she might be ill-informed about the nature of therapy.

If she’s unwilling to go to treatment, then, you’ll have a choice to make. Her problem is affecting the relationship and thus it’s affecting you. You’ll have to decide if you want to continue your relationship with someone who is refusing help, for a treatable problem. Will that be okay with you?

She is purposefully choosing not to resolve this problem. Her reason may be fear. You need more information about why she is refusing treatment. Knowing more about why she is reluctant to seek treatment might give you insight into what she’s going through and how you can best support her.

The bottom line is this: you can’t fix someone else’s problems. They have to do the work themselves. Hopefully she’ll take your advice and go to counseling. That would be the best outcome.

Your power in this situation is very limited and will mostly involve you continuing to be supportive. How long you will want to continue in that role, is something only you can decide. Thank you for your question. Good luck and please take care.

Dr. Kristina Randle

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Identifying Emotional Abuse in Relationships

Know how to define emotional abuse to prevent toxic relationships.

Emotional abuse is a form of domestic violence, there’s no doubt about that.

In fact, emotional abuse is the most harmful form of domestic violence that people report experiencing.

There are several risk factors that make emotional abuse so harmful. For one, many tend to rationalize or normalize emotional abuse because you can’t “see the bruise”.

However, there is a very real bruise.

The signs of emotional abuse and domestic violence are not always visible or physical. Chronic abuse is internalized by the victim as a negative sense of self-esteem, which lasts a lifetime unless treated.

Furthermore, many do not get treatment for emotional abuse because the scars are not visual or physical, so they do not know that they have been harmed or need help. A further risk factor is the fact that emotional abuse is often a precursor to physical abuse.

In my 20 years of clinical practice, the form of domestic abuse and violence that is most common and most often causes mental health issues is emotional abuse.

Many people do not understand this, because there is no adequate information and education regarding emotional abuse.

7 Things That Look Like Love (But Are Actually Emotional Abuse)

In fact, there are some facts about emotional abuse that will help you dispel myths or misconceptions:

Emotional abuse is perpetrated by men and women.
Emotional abuse is perpetrated in spousal relationships and in parent/child relationships.
Naturally empathic people or children are more likely to internalize emotional manipulation or abuse as inherently “their fault”.

Some people find it difficult to understand how emotional abuse is “violence”. The term “violence” refers to intentional harm done on another.

In physical violence, the harm is physical and visible. In emotional violence, the defining quality remains the intention to do harm to another, and the harm is not visible to the eye, but it is still real.

Emotional abuse signs are not always visible. So, a helpful means of distinguishing violence, abuse, and manipulation from the normal range of fighting or hurt feelings in any relationship is the presence or absence of empathy.

While people in healthy relationships will absolutely hurt one another’s feelings, disappoint one another, and even say things that are hurtful, emotional abuse is defined by the sustained inability to meaningfully consider how your actions have affected another.

Here is an example of how a conversation can go in an emotionally abusive relationship:

Mary: “John, I”m so angry, you came home late last night again, you’re always late, you just don’t care about me.”

John: “I”m sorry I was late again last night, but it’s an exaggeration to say I”m always late, you know I’ve made an effort and been home for dinner 3 times this week.”

Mary: “Right, sure, you’ve made an ‘effort’. Whatever. You obviously don’t care about anyone. I’m obviously not important to you. Just go on making your ‘efforts’, good luck with that, no one would ever be happy with this.”

Here Mary is using manipulative techniques including the induction of guilt to get the desired response. (“You’re always late! You don’t care about me.”)

She is also using sarcasm, which infers that John’s response is unworthy of her consideration and respect (using air quotes around ‘efforts’), and making a criticism of John that infers he, as a person, is not worthy of respect or love (no one would ever be happy with this), rather than critiquing John’s choices or behaviors while making clear that he as a person is worthy of respect.

There is also an implied threat in this statement. (“Good luck, no one would be happy with this subtle threat that I will leave you and you’ll be alone because you’re no good.”)

But, in a healthy relationship, the conversation might look like this:

Mary: “John, I’m so angry, you came home late again last night. When you’re late, it’s really hard for me to feel important to you.”

John: “I’m sorry I was late again, I understand how important it is for you that I’m here for dinner. This is why I made an extra effort to be home for dinner 3 other days this week. Is there anything I can do to remind you how important you are to me?”

Mary: “You’re right, you did make an effort, I appreciate that. I am really struggling still to feel important. I honestly don’t know what to ask for right now, but I’ll think about it.”

You can see how the lack of manipulative statements from Mary, from the get-go, opened up a different response from John. While John’s response wasn’t manipulative in the first example, he was feeling more defensive than supportive.

You can also see how Mary, in the healthy example, was able to talk about her feeling state and need and refrained from defining who John is as a person, insulting him, undermining his efforts, or inducing guilt.

When Mary was less manipulative, she got more of her needs met.

If Mary were to stay stuck in that manipulative manner of relating, then their relationship is not healthy for either of them.

Here’s an example of a more extreme case:

Ellen (to her boyfriend): “You wouldn’t believe what we did last night, we went out to the lake after the dance, and we all ended up skinny-dipping after dark! I’m not sure how I feel about that but it was such a warm night and everyone had such a good time, I just wanted to tell you, and let you know nothing unsafe or untoward happened. I wish you were there!”

Jake: “I can’t believe you did that. You would seriously do that to me? Only a slut would do that. You are so untrustworthy.”

Jake then ends the conversation and refuses to talk to Ellen for an entire day. Later he continues to blame her for the demise of the relationship.

In this example, Jake is insulting Ellen’s personhood. (“Only a slut would do that, you’re untrustworthy.”)

He is also inducing guilt, without any empathy or concern for Ellen.

Despite Ellen’s attempts to build trust through transparency, Jake is essentially gaslighting her by telling her that she is untrustworthy and has been willfully destructive to the relationship.

Gaslighting is defining the reality in a way that willfully ignores what one person is saying or doing in a way that suggests that Ellen should doubt her own perception of her own intentions. Over time, gaslighting is enormously destructive to the victim’s mental health.

6 Heartbreaking Ways Emotional Abuse Changes You

Jake is also stonewalling by refusing to talk further with Ellen. Stonewalling is a very toxic behavior that controls the relationship and the other person by means of withdrawing empathy, dialogue, consideration, and mental flexibility.

The healthy version of this conversation would look something like:

Jake: “Wow! Really? I don’t know what to think about that, I guess I need a minute. I guess I thought we would never, ever be naked in front of anyone but each other. I feel pretty confused right now. To be honest, I’m even having trouble believing that nothing else happened, but I know you’ve never lied to me before, so let’s try to work through that. We need to have a serious talk and make sure we’re on the same page about some things, can we make some time to do that?”

In this example, again, Jake is able to state his own feelings, fears, and needs. Emotional manipulation and abuse occur when a person lacks the ability or willingness to state their own needs and feelings.

This self-ownership and transparency replace the former attack and blame on his girlfriend. Jack has every right to feel confused, scared, even betrayed, but he is able to approach those feelings with a basic empathy for Ellen, and conveying respect for her, even if he strongly disagrees with her decision.

Knowing the difference between healthy critique, fighting fairly, and emotional manipulation or abuse is the key to avoiding toxic relationship patterns!

If you find yourself in an abusive situation and need help, the National Domestic Violence Hotline can be reached at 1-800-799-7233.

This guest article was originally published on YourTango.com: This Is What Emotional Abuse In A Relationship Looks Like.

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