Peer support coalition forming

Pennsylvania is forming a peer support coalition. The coalition will include all peer support workers (not just certified peer specialists, but anyone who has lived experience and does peer support work) in Pennsylvania. The coalition will have a steering committee, made up of peer support workers from various regions across the state. More information about the coalition, and how to get involved, will be coming.
You can go to PMHCA’s website for more information…. there is a board on the PMHCA forum dedicated to discussion of the coalition.

Peer employment training

I’m back from training!

Over the past three weeks I attended two trainings: one, to be a peer specialist supervisor; two, the certification training to become a certified peer specialist. (Yes, I sort of did them backwards.)

The certification training in particular was wonderful. Two weeks, back-to-back, Monday through Friday. Class was from 9 AM to 5 PM each day, and we had 2-3 hours of homework each night. It was grueling, but it was also wonderful. It gave me a better handle on the “tools” in my peer specialist toolbox; and I feel like I have a clearer understanding of how to articulate what my role in our agency, as a peer specialist, is all about.

We had some incredible moments during the training: spending an entire day listening to each other tell our stories, for one. To hear 20+ people stand up and state what they’ve been through, how they’ve survived and thrived, and where they are now plus their dreams for the future… wow. Every mental health worker in the country ought to experience a day like that. And the talent and gifts we all have! Art, music, writing, humor, speaking, helping others…

I saw incredible perseverance–people struggling with the intensity of the course, who came back day after day to make it to graduation, refusing to give up. Indescribable strength. As each day passed, it became more and more obvious that recovery DOES happen, that people can survive and thrive through anything, that we have incredible strength to draw from, and that it’s imperative that the system start recognizing all of this.

Reinvigorated

I’ve been working as a peer specialist for several months now–without actually being certified.

This month, I am finally getting the certification training.

I was already excited about that–finally getting the training–but this afternoon, that excitement just ratcheted up a notch. Because this afternoon, I found this: Mental Health Recovery.

It is module 2 of the peer specialist training curriculum by Recovery Innovations (formerly META).

Recovery Innovations was only recently approved to be an official training vendor for peer specialists in Pennsylvania. There are now two approved vendors: Mental Health Association of Southeastern PA (MHAPA), and Recovery Innovations. And to be honest… I was feeling slightly sorry for myself, that I wouldn’t be going through MHAPA’s training. After all, everyone else I know who’s been through the training went to an MHAPA training. And all those people LOVED it, thought it was great, learned so much, had a wonderful time… et cetera, et cetera.

So now, a training comes along–one I’m at last able to get into–and… it’s not MHAPA. It’s Recovery Innovations.

Hmph.

It felt anticlimactic.

There was this little tiny piece of my brain saying, “This better be good.”

How judgmental. Really.

So then today, I was Googling terms like “peer support marketing” and “peer specialist tools” and so on. And I stumbled across that article linked above–Mental Health Recovery–which is not an article, but a piece of Recovery Innovations’ training manual. And I was blown away.

It’s good. Really, really good.

So now I’m excited (even more so), and the little judgmental voice in my head has shut its trap.

Go read it if you haven’t already. Really. It’s long (16 pages), but it is GOOD. And it was exactly what I needed to hear today, too… exactly the reminder I needed about what peer support work really is.

Cutting

Can someone explain to me where the stigma around cutting comes from?

Obviously I am not promoting cutting. It’s not healthy. And if someone’s cutting themselves because they feel like they deserve to be mutilated, well… that’s a different ball game. But I’ve met people who cut as a coping mechanism for stress. Several of them have said the same thing: that it clears their mind, allows their thoughts to stop racing, allows a kind of quiet and stillness. That sounds awfully similar to what I get out of meditating. (And yes, I’d recommend meditation and would NOT recommend cutting.)

But all that said… I’m wondering… smoking is a pretty darn unhealthy coping mechanism, too. Why do we react to someone saying they cut to deal with stress as if they were the most hopeless of cases–as if they are doing something shameful–and as if that must mean they want to commit suicide–when we don’t react to smokers that way? Both involve self-harm. But if I say I smoke to deal with stress, very rarely does  anyone suggest I’m subconsciously wanting to kill myself. It’s just acknowledged as a habit–an unhealthy habit, sure, but a habit to help me deal with stress.

Isn’t it possible that cutting, for some people, is similar?

I’ve never cut. So I am really asking. Is there a difference? Is cutting always a sign of self-loathing, or can it ever just be a(n unhealthy) way to deal with stress? Anyone who cuts (or used to cut), any psychologists, anyone want to answer this?

And where does all the stigma around cutting come from?

Just… talk

I am 28 years old.

It took me 28 years to figure something out. Something rather simple.

That simple thing is this: to have a conversation with someone, I just have to open my mouth and say whatever I’m thinking.

Sounds ludicrous that it took me so long to figure out that, doesn’t it? And yet it’s true.

That truth hit me like a spiritual revelation this summer. I was walking on my lunchbreak, with a coworker, to the corner pizza shop, and noticed myself thinking about the appearance of the fountain on the square. And without thinking about it, I opened my mouth and said what I was contemplating.

And my coworker responded with a comment.

And we had a conversation.

And that was it.

Alright, maybe someone out there is laughing. Go ahead, because yeah, it’s rather absurd that this was a revelation.

But it’s true–for the previous 28 years, I had thought that the way to have a conversation with a casual acquaintance was to think up something to say. It was very freeing to realize I didn’t have to put all that work into chatty conversations, after all.

Why did it take 28 years to discover this? Probably many reasons, but I think there are two main ones:

 (1) I’m introverted. Talking–especially polite, casual conversation–has never come easily to me.

(2) For 28 years, most of what I was thinking was socially unacceptable to talk about. Really, you can’t say to a brand-new coworker, your best friend’s new boyfriend, a dinner party acquaintance, or another daycare mom, “Do you ever think about death? What do you think, did Camus really allow himself to die out of suicidal tendencies, or was it all truly an accident?” Nor could I say (as were often my thoughts in casual social situations), “Um, are you judging me right now? Do I look okay? Is my hair funny? Are you staring at me?”

So, yeah, in a sense I actually did need to think up topics for conversation for those 28 years. In a sense I really couldn’t let any current thoughts spew out of my mouth–not without freaking out my conversation partner, anyway.

But now? Now that death and suicide and depression and negativity and social anxiety and low self-esteem don’t occupy 75% of my thoughts? Now it’s quite possible for me to just open my mouth and talk–without thinking much about it–to practically anyone.

 It’s freeing.

What’s the point in writing this? I don’t know. I guess I figure that, if casual conversation was something I struggled with for years… if it was a revelation to me that you don’t always have to think up conversation topics… then maybe someone else has struggled with this, too. Maybe someone else needs to know that it’s okay to just talk about what’s on your mind.

Maybe this will come as a revelation to some other introvert.

Medical model vs. recovery model

A lot of people ask me what the difference is between a medical model of treatment for mental illness and a recovery model.

You want to know what that difference is, in a nutshell?

The medical model treats me like a disease; the recovery model treats me like a person.

Intake appointments

I dislike intake appointments. They make me feel worse when they’re over than I did beforehand.

The last intake appointment I had was with my new psychiatrist. She was very kind, professional, validating, and not at all shaming. She is a lovely psychiatrist.

But she’s not perfect.

And the intake form she used was not perfect, either.

Here’s the problem with these intake forms: they focus on disease and dysfunction. And they are made with preconceived ideas of (a) what is relevant in mental health treatment, and (b) a bias about what “mental illness” really is. Also? There’s just not much room for the client to talk about what THEY perceive to be the problem. Seems to me that’s an important piece of information, if you’re trying to determine how to help someone.

Anyway, at my last intake with my psychiatrist, we spent an hour talking about how messed up I am. I mean really, that’s what it felt like. I wanted to scream, “But do you understand I’m doing pretty well right now?” We reviewed my history–but by “history,” I mean: me at my worst.

Spending an hour talking about all your sexual indiscretions, your speeding tickets, the loss of your child, your suicide attempts, your failed jobs, your worst depressions, blah blah blah… it makes you feel, um, sick. It makes you feel MAJORLY sick.

There were exactly two–I counted, two–questions about how I cope and what helps me stay well. Two. Out of how many?

There is more to me than an illness.

But on intake questionnaires? In intake appointments? It sure doesn’t feel like it.

What is mental illness?

Is it a collection of symptoms? Is it environmental? It is biological? Is it cultural? Is it spiritual? All of the above?

Is there actually a specific set of chemicals in someone’s body, a “root cause,” for each mental illness? And if so, how do we know that all the people labeled “bipolar” actually have that “root cause” for bipolar, when we diagnose people based on symptoms? What if someone exhibits all the symptoms of bipolar, but does not actually have the “root cause”? Is that person still bipolar? If we are ever able to find that out, will we relabel them something else?

Am I bipolar? Borderline? Both? What’s the difference? What if the “root cause” of borderline and bipolar are the same thing? What if there IS a specific set of chemicals, or ratio of chemicals in the body, that causes mental illness… but the same set of chemicals/ratio of chemicals results in very different symptoms in various people?  What if what we now call “schizophrenia” has the same biological basis as what we now call “borderline personality disorder”?

And what if there is no “root cause?” What if all people with, say, schizophrenia have very different chemical makeups despite exhibiting similar symptoms?

What is mental illness? 

Right now in psychiatry, doctors diagnose a particular mental illness based on behavioral symptoms and feelings. That is not the most scientifically accurate construct. Can you imagine if physical doctors did this? What if you went to your doctor for severe stomach pain that wouldn’t go away? That stomach pain could be the result of numerous biological causes–a cancerous tumor; an ulcer; a burst appendix. Can you imagine if your doctor just looked at your symptoms, asked you to describe your experience of the pain, diagnosed you simply based on those things, and then treated you?

If you’ve got lasting, continuous stomach pain, and it’s clearly not the flu or some other mild-and-ordinary occurrence, any good doctor is going to going to run tests to find out what is actually the problem.  A good doctor would not just assume he knows what the issue is without running an ultrasound, some scans… some kind of physical tests!

Think about the HIV virus and AIDS. AIDS is the disease, but it is caused by the HIV virus. You can’t have AIDS if you don’t have the HIV virus. Even if you’re exhibiting symptoms of AIDS–lesions, the inability to recover from pneumonia or a common cold, etc–no doctor (not a single one!) would diagnose you with having AIDS if you didn’t have the HIV virus.

Yet in the mental health world, that’s what happens. People are regularly diagnosed with an “illness” based on their symptoms, and their symptoms alone. And often, those symptoms aren’t even followed long-term: the psychiatrist gets a snapshot of the symptoms in a one-hour intake appointment, and often, that’s considered sufficient to make a diagnosis. Oh, maybe if, for example, the psychiatrist thinks it’s depression, he’ll thrust the Beck Depression Inventory under your nose and have you answer some multiple choice items; and then he’ll add up your answers; and he’ll check your score; and if you score a certain number of points, he’ll say it’s depression. But the thing about those tests are… they are cyclical. They are designed according to the same construct as the DSM (Diagnostic and Statistical Manual)–so those tests are only searching for the symptoms that the DSM has already laid out as indicating depression. Psychological assessments and the DSM–what psychiatrists and psychologists use to diagnose us–are self-referential.

See how far behind psychiatry is, as a science?

We really don’t know crap about psychiatry. Heck, we don’t even know what “psychiatry” refers to, because we really don’t know the causes of mental “illness.”  Oncology? Refers to cancer. Cardiology? The heart. Psychiatry? Ummm… the mind? What the heck is “the mind,” anyway?

___________

I am not the first person to ponder these questions, and I won’t be the last. In fact, I think a lot of us with “mental illness” wonder these things, multiple times, throughout our lives.

Still… knowing I’m not alone in these questions, knowing I’m not the only one who questions… still, it doesn’t help with frustration of not knowing the answers to the questions.

In a sense, it doesn’t matter–not to me. Whatever I “have,” I’ve found a way to manage. Regardless of what my diagnosis is, and regardless of whether it’s an actual illness or just a heuristic, all I can do–all I need to do–is stay “well”: and I do that in many different ways.

But man, sometimes I wish we knew these answers. Maybe then we’d better know how to help people recover. Maybe there’d be more effective treatments (whether biological or otherwise) we could develop. Right now, treatment is trial-and-error… we try something and see if it works, and if it doesn’t, we move on to something else. I know some of that goes on in the medical field, too, but here’s the thing–the medical field is able to narrow the range of treatment options much more effectively, it seems to me, than the psychiatry field.

And maybe, if we knew what exactly mental illness is, if we knew what exactly to do to treat it, maybe then I wouldn’t worry so much  about my daughter… wondering if she too will be stricken with whatever this “mental illness” is, and wondering if there will be an effective way to treat it, if she is stricken.

Maybe I wouldn’t be experiencing the “cycles” of “bipolar” right now.

Maybe my husband wouldn’t have to ignore voices he alone is hearing because of his “schizophrenia.”

I don’t know. I don’t know what the answers are… and here’s the thing: psychiatry doesn’t know, either. And I write that to say: if you’re taking meds and they’re not working? If you are trying hard in therapy and it’s not helping? Just remember–this whole world of mental health is so much more complicated than most people would like to believe. It’s much more complicated than your psychiatrist may let on.

So if the meds aren’t working, if the therapies aren’t helping… don’t give up. You can feel better. But don’t depend on doctors to do it. It’s up to you to make yourself feel better. If meds help you, use them. But if they don’t? Don’t despair. It’s not evidence that you’re incurable… it’s just evidence that really, psychiatry doesn’t know much of anything yet. And not knowing much of anything includes not knowing much about you and your prognosis.

So don’t listen to anyone who says you can’t have a happy and fulfilling life. There’s no medical basis for that belief. You can have a good life… if you make it happen for yourself.

Does that mean you won’t have ups and downs? Heck no. Does it mean your “illness” will ever be completely cured? Maybe not–in a lot of cases, probably not. But it does mean that you can keep going, despite the ups and downs. That you can claw a whole heap of enjoyment and experience and fulfillment out of life, despite whatever your “illness” happens to be.

The Survivor Psalm

Survivor Psalm

I have been victimized.
I was in a fight that was
not a fair fight.
I did not ask for the fight.
I lost.
There is no shame in losing
such fights.
I have reached the stage of
survivor and am no longer a
slave of victim status.
I look back with sadness
rather than hate.
I look forward with hope
rather than despair.
I may never forget, but I need
not constantly remember.
I was a victim.
I am a survivor.

© Frank Ochberg, MD & Gift From Within

My wellness tools

Every person’s recovery journey is unique, and beyond some basic principles (hope, choices, empowerment, self-determination, respect, and so on), what helps each person recover is unique.

However, I think there is value in people sharing what helps them recover. Sometimes I learn a new technique for staying well that I’d never thought of before when a peer shares one of their recovery strategies. So here is my list of what helps me stay well. Some of these I need to do daily (like eating regular meals, showering, getting sunlight), some regularly (nearly daily, or weekly–like writing), and some occasionally (like drawing or painting). Above all, I’ve found that I need balance in my life. Bipolar takes me to extremes–maintaining a balance of activities helps moderate those extremes.

I’m sure this list isn’t comprehensive, but here’s what I can think of right now. In no particular order:

• Getting lots of sunlight
• Eating regular meals
• Eating veggies at least once a day
• Showering
• Taking my medications
• Sleeping appropriately
• Spending time with my husband and daughter every day
• Getting some physical activity (not necessarily regular, formal exercise, but at least having a pillow fight, playing ball, or walking to the park with my daughter; swimming; walking; and so on)
• Cleaning my home (usually in small doses: the bathroom one day, the kitchen the next, dishes every day or every other day…)
• Organizing my work space
• Going to work
• Keeping an appointment calendar
• Talking to other adults
• Writing
• Meditating
• Self-checking (observing my symptoms, thought processes, and emotions)
• Day dreaming about a long-term goal and taking steps to achieve that goal (such as selling my house, advancing in my career, going back to school)
• Drawing or painting
• Reading
• Going to therapy
• Spending within my budget (not using credit cards or overdrawing my account)
• Dressing appropriately (for the season and for the occasion)
• Taking my contacts out regularly
• Keeping appointments (psychiatric, physical, and dental)
• Getting my hair cut
• Drinking some water every day
• Getting out of my regular environment (taking a day trip to an art museum, zoo, state or national park)
• Staying warm
• Using my sun lamp
• Guided imagery
• Activism, in moderation and with wisdom (too much focus on changing the world can leave me frustrated–sometimes I need a break–and for me personally, I have to be careful to not use it escape my daily reality)
• Moderating my computer time (not spending hours on the computer, isolating myself)
• Cuddling my daughter
• Talking to my mom
• Apologizing when appropriate
• Forgiving–including myself
• Breathing deeply
• Stretching
• Petting my cats
• Listening to the news or music when appropriate (Sometimes the news depresses me, and I have to take a break from it; sometimes songs make me emotional, and I need a break. For me, a balance between music and NPR each day, during my drives to and from work, is what works best.)

There are so many things that help me stay healthy–and while medication is a part of my health, it’s certainly not enough on its own. I could take medication faithfully, religiously, every day and still be extremely sick, if, for example, I never cleaned up my house (a dirty environment depresses me and makes me anxious), never created (creativity is a huge part of me), and ate nothing but chocolate and salt (irritates my bowel, and when my physical health is poor, my mental health declines).

There is no magic pill, for me. While my medication certainly helps, and makes it easier for me to keep up with my other wellness activities, it doesn’t solve the problems of my life, eliminate stress, or make everything (including me) miraculously better. Pills are a part of my recovery, not the sum total. I have to take some responsibility for getting and staying well, too.

My recovery is up to me. Fortunately, the more self-awareness I develop, the more wellness tools I discover to aid me in staying healthy.