Mental Self-Defence

Out of all the topics covered in this series, this is the one I have the most formal education in. While my experience isn’t enough for me to claim to be an “expert,” it does provide me with insight on the topic of mental health. What I can say for certain is that in the area of mental health there is often a lot of “noise;” there are good studies and there are bad studies, and then there is everything in between.

One thing I learned early in the Psychology field is that, what is considered acceptable in a study isn’t necessarily appropriate to apply directly to the general population or to inform understandings across multiple cultures. I also learned that there are massive divides running through the world of psychology, as various schools of thought and areas of focus often do not get a long.

“…[T]here are also deep uncertainties in the field itself. Psychiatrists have no blood tests or brain scans to diagnose mental disorders. They have to make judgments, based on interviews and checklists of symptoms.” (Benedict Carey, “What’s Wrong With a Child? Psychiatrists Often Disagree,” The Washington Post, Nov. 11, 2006)

Ultimately, Psychology, while it is considered the science of the mind and behaviour, is not an exact science. The often referenced checklists of symptoms are typically based on the information provided in the much debated Diagnostic and Statistical Manual of Mental Disorders (DSM)

More often than not, these complications make finding good advice for mental health difficult, especially if you are in the “thick brown soup” (so called by Safi Bahcall on the Tim Ferris Show) that can be a mental health episode.

So let’s forget any formal training or education I’ve have had, but rather focus on the fact that I have personally dealt with mental health issues; in the form of Clinical Depression, from both nature (family genetics) and nurture (learned behaviors and crappy adolescence) components. Of which I feel I have mostly cured myself, with little help or support from the few close people I had in my life (which makes it even harder). So trust me when I say I understand, even if you get the impression that I am insensitive to your mental health plight.

Throughout my life I have also had friends and acquaintances who have experienced various states of a variety of mental health issues, such as Severe Anxiety, Bipolar Disorder, Manic and Clinical Depression, PTSD, and much more. I have been exposed to such individuals simply by virtue of not living a sheltered life, and by recognizing that, perhaps, the saying “birds of a feather flock together” has some truth to it. For those who had both decent genetics and stable upbringings with good role models, in my experience, these people often struggle to deal with those who have mental health issues; often due to prevalent social stigma causing those with mental health issues to perhaps be naturally drawn (pushed?) to each other. This, of course, results in a history of rather interesting, albeit difficult, personal relations.

Merely two paragraphs ago I mentioned that I often come off as insensitive to those who have mental health issues, but, really it’s about my understanding of a simple fact:

If you, with all of the mental burdens you are feeling, want to get better, there is only one person who can truly help you get better…

You!

It’s a harsh reality to accept, especially if you are struggling. Medication (which I took for a few years and it did help me) or counselling (which I also dabbled with) will do nothing for you if you don’t do the work to change how you think and how you live your life. (Outside intervention may even be re-enforcing the way you think and feel.)

Much like addicts, the story we like to tell ourselves is that no one understands. Even when we meet other people with similar problems, if not identical, we still like to say things like; “But you don’t really understand,” “My situation is worse,” “You can change, I can’t.” A topic by the way recently discussed by Doctor Drew on the Podcast The Fighter and the Kid, so don’t just take it from me, take it from an addictions expert.

While, yes, there are extreme cases, most of the time you are no different than that other person experiencing the same thing. The cause or specifics may be different, but the feeling is the same. There is a reason after all, those people experiencing the same mental health problems often have very similar brain scans. Because, fundamentally, in your brain it’s the same problem.

This means that once you can get over yourself, and realize you want to get better, you are likely already halfway down the path to a happier life. The next step is getting off the couch and doing something about it.

Medication

I figured starting here is a good place since its probably one of the more controversial topics. Generally I operate on the “bell curve” model for most things. Some people who have mental health issues serious enough to need help may need to be on medication indefinitely, lets say 5-10%, some people may never need medication, lets also say 5-10% and then everyone else falls into some kind of spectrum (dependent on many factors).

Let’s start with something very important first. For most people, the first thing you do in a mental health episode/crisis is to contact a doctor, whether they be a General Practitioner (GP) or a walk-in clinic. Therefore, it is likely that the first person you will interact with only understands mental health in a general sense. Furthermore, they may not be able to consider the larger context of your life or specifics of your particular situation.

In general most GP’s and the like only have one tool: Medication. In my opinion, pills are often over-prescribed and should rarely be the first course of action. It is, however, the easy route, even though it is really not the best place to start. A reminder though; some people do require medication, even if its only for a short time. But, in general, long term use is not advised in most cases (again, in my opinion).

The reason I say this is a simple one: Sometimes the factors causing a mental illness or episode are very much environmental factors, such as a horrible job, terrible home life, a death in the family, or lack of social skills. Doctors rarely have the time to truly dive into your life to figure out if it’s a non-biological factor that is causing your distress. You may not even know! People like to lie to themselves about the situation they are in, and it can take weeks or months for people to open up and be honest.

Questions you should ask yourself are; “Can a find a different job,” “am I able to change my living conditions,” or “is there a family history of this issue” (even an undiagnosed one). This should always be the place to start.

Often this means deep and difficult discussions with yourself, which may result in requiring serious, and also difficult, life changes. This is why medication is often the route people take. Because it’s easier.

For the record, I was on Selective Serotonin Reuptake Inhibitors (SSRIs) for about two years, and for me it was a great help because I finally started to understand what people were talking about when they said “just be happy.” My mind literally had no frame of reference, internally, for this notion, and I simply couldn’t understand. This is why, in my case, where there is clearly a family history, it was hard for me. Being on medication really helped me gain the basic framework from which to start building the internal/external skills to cope and change how my mind worked. But I knew being on SSRIs long term wasn’t great, as they do have drawbacks; I was lucky they only made me feel fatigued and robotic. Weirdly enough, the latter helped me socially, as I was “more likable” because I was less emotional or reactive. People liked the toned down version, but for me it really wasn’t a long term option, so I slowly weened myself off SSRIs after about 2 years (which was it’s own struggle).

Anyway, it can’t be overstated that a doctor whose first response is to give medication, without proper follow ups and a significant look into your life and context, in my opinion, should not be a doctor anymore; they are just being lazy and dishonest. For me, the decision to go on medication was only after I had done everything else (from therapy to moving to another country). Even then, it was only after a serious manic depressive episode that it occur to me that there was actually something seriously wrong.

So, should you go on medication? Which type should you go on if you do? For how long? Should you go on something meant for short term relief or a long term regime?

These are all good questions that really need to be deeply considered, with yourself, your doctor, and any consulting mental health professionals you have access to.

I generally believe that if you have not done anything to improve your situation, then you should try other strategies first. If after several life adjustments things still haven’t changed, then medication, even for a short time to get you moving, may simply be what your brain needed to rest and heal.

A word of warning: To my knowledge they don’t really have a good way of knowing which medication and at what dose to give to start people on. It’s often guesswork based on feedback from the patient. The thing is most people give very dishonest feed back, for whatever reason. I remember going on one type of SSRI at 5mg, nothing changed. Then 10. Nothing changed. My doctor said “let’s do 20mg and if it doesn’t work we will try a different type.” I casually asked the pharmacist how to know if it works. They said “If it’s working you will know.” The pharmacist was correct! For me, that particular brand, at 20mg, was like a ray of sunshine in the darkness. It immediately kicked in. Later, when I was going off the meds, I was only on 10mg, and eventually none. If you are honest, you will know if it is working or not. Do not just say it is if there is no real change.

Therapy

This may be a better place to start once you have identified that there is an issue. Here’s the thing, therapy, if not covered by medical insurance, can be very expensive indeed. One thing that drives me nuts is when mental health professionals try to tell a person who is broke and already struggling that they can find a way to afford counselling sessions, at $100 dollars an hour, at least once a week, because “it’s worth it.” While it may very well be, it might also be more of a financial burden than the individual can handle.

The other thing is, just like doctors or any other professional, there is a reason there is always a “best in the field.” Many therapists, whether they are a psychiatrist, private therapist, or public therapist, will be better at their job than others. This means that the chances of finding someone who is effective, who you connect with, and who you can afford, is very difficult.

However, especially if you don’t have a support network, someone is better than no one. What I will say is, don’t just stick with the first person who could see you. If you don’t click, you don’t click.

I would also caution that, in most cases, if you have to see them for more than 6 months or a year, other than maintenance checkups, they may just be taking your money. A decent therapist can often give you want you need in far less sessions than you think. That is, of course, if they are decent and they are not trying to take advantage of you.

For some, several sessions may be required at regular intervals at the beginning to assess and build a framework, others may only need one. It really depends.

I would like to stand up for therapists, though, and say that, often the reason things haven’t gotten better for a person regularly seeing a therapist is that the person is using the therapist as a crutch and hasn’t actually done anything to improve their life outside of therapy.

Remember, the responsibility for getting better is on you, not the therapist. They can only guide and advise, they are not supposed to tell you what to do. Which means that if they keep saying the same thing to you for years, the fault is on you. I know, people don’t like to take responsibility, even in normal times let alone mental health situations, but, sorry, it’s the truth

There is a reason, after all, that Cognitive Behavioral Therapy (CBT), still tends to be the most effective type of therapy for treating a variety of mental health issues. As the onus is on you to do the work, on a consistent, daily basis, and re-shape how you think about the world and yourself.

So, pick your therapist wisely, and remember that you need to want to get better, no matter who you talk to.

Support Network

They say having a strong support network helps. That is, if you have one. Some people are lucky enough to have a strong group of supportive friends they built from high-school, or have strong family support on all levels. Though to be honest, if you have severe mental health problems there’s a good chance you did not have a very strong support network from the start. If you do, than that’s awesome, you have a leg up and I am very happy for you.

In my case though, I had few, very consistent, people in my life who did offer support. The reality is for me, they did not have the skills, knowledge, or time to really help me in a more meaningful way. I suspect that for many this is a familiar experience. This is why, no matter how hard it seems, it may be on you, and you alone, to get help and get better. (Notice a theme?)

The reason it can be difficult to have a strong support network is because those in your life who have their shit together more than you often are too busy with their own lives. Or they don’t have the energy to deal with what, to them, seems like a difficult friend.

I can say that for me, someone who has always struggled to have strong connections with other people (partially due to mental illness, but also the fact I am a strong-willed person at the best of times), the majority of the people I thought were my friends essentially bailed on me because I was too difficult to deal with. You can look at this a few ways:

1. You are just too much – This may not be a popular thing to say, but dealing with people suffering from mental illness is tough. Unless those around you really have their shit together and have the right temperament, you may actually be just too much for them to deal with at that time. It’s very unfortunate, but it’s an all too common scenario. It’s not that they don’t care, they just can’t make you a priority in their life. It’s okay, everyone has their own lives. These are the people you should forgive, as it is more an indication of their life than yours.
2. They were not very good friends in the first place – To be honest, though I admit I am a difficult person, I would say that this is the category into which the majority of the “friends” I had before my major episode fall. I say this because the vast majority of people didn’t even try. They just saw I was being difficult and bailed on me outright. If this is the case, then be happy that they are out of your life. They clearly didn’t care enough to ask if everything was alright when the signs are clear as day that it is not. Don’t feel bad, just know that when things get better you will find new friends and you will be happier for it.
3. It really is your fault because you aren’t even trying to get better – This applies to those people who have an active support network who are always trying to help, yet years later nothing is better. There is a point, whether you realize it or not, that eventually people will give up on you. I am sorry, but you may be just too much, in general, and you aren’t taking responsibility. Either you may need to seek different professional help, or realize that, if you don’t change, everyone in your life who matters will be gone. If you don’t want to change so that you can be happier, then there is nothing anyone else can do for you. It is ultimately on you. They tried, you didn’t. After a long enough timeline, don’t be surprised when people walk away.

The trick is to know which category you fall into. If you have an amazing support network from the past, or a new one you have discovered, whether it be a new friend, a support group for your mental illness, or a therapist, then that is awesome. But, if not, do you fall into one of the three scenarios mentioned above, or is there another one? The truth is you probably won’t actually know until later, when your mind has calmed down and you can think clearly. It may even be years later that you finally it out. But know, though, it is easier with a support network. So make building or finding one a priority in your first steps. You can get better without one if you really want to, yes, it is a lot harder, but it can be done.

In a country like Canada there is little reason why you should not be able to find something, as there are many government funded resources and groups you can access. Even if they are not for you, they can often start you on a path to healing, one way or another.

Conclusion