Help Getting Help (for mental health)

On a regular basis, I have friends approach me in private and say something like “I don’t know what to do. My mental health is not good and I don’t know where to go or who to call.”

A few months ago when the world lost one of the greatest comedians of all time to suicide, my social media feeds lit up with admonitions to “get help” and “take mental health seriously” or to “call a suicide prevention hotline.” I agree with all of those and I also know that there is so much secrecy and shame around mental health struggles and treatment that many people don’t know how to get help. I think it is because of a rampant lie that tending to emotional and mental wellbeing is shameful or suggests a moral or spiritual failure. But that is what it is, a lie. The truth is, it takes extraordinary hope, faith, courage, strength, and patience to get help for mental health issues (click to tweet). Neglecting or denying problems does not work for an ear infection, and it doesn’t work for mental health problems.

I can relate to that moment when the only thing you can think to do is type “HELP” into Google. Do I call my doctor? A psychologist? A therapist? A psychiatrist? The national suicide prevention hotline? My mom? What’s this going to cost me? Will they treat me like a crazy person? Will it be as awkward as it is on TV?

A good first step is to take a deep breath.lifesaver

Then ask yourself what kind of help you want to pursue? There are three basic options: medication, talking to someone (therapy/counseling), or both. I will tell you a little about some options, in order from the most medical to the most relational.

Call 911 if you are unable to wait for help. Please.

Call your physician if you just want to try medication for something like anxiety or depression. You will likely get be able to get in and out fast. Keep in mind that the doctor is likely not going to take a lot of time to unearth the source of your problems or get to know all the contributing factors of your personality, experience and relationships. Not because they are bad, it’s just not a major part of their training. It’s like asking your dentist to look at your sore throat. This will cost what your doctor’s visits always costs which you probably already know because there isn’t a stigma attached to seeing a physician.

Call a psychiatrist if you want to try medication but you know your situation is a little more complicated that the average due to allergies, rare diagnosis, side effects to common medications, meds with high potential for abuse, etc. The drawback is it will probably take longer to get into see a psychiatrist, but they have at least a million years of school know a lot about mental health medications. You can expect short appointments (maybe 15 min) to check side effects and adjust dosages if needed. Keep in mind; psychiatrists are highly trained in psychopharmacology, not in creating a healing therapeutic connection. Beware that this avenue may require more patience and money. You can plan on waiting a month or two to get into a psychiatrist and an initial visit is going to cost around $350 without insurance. Insurance should cover it similar to a regular doctor visit.

Call a psychologist if you want a correct diagnosis, a thorough assessment and to talk about your symptoms and your life. Psychologists are typically more focused on the individual’s brain, behavior, and diagnosis and not relationships, strengths, and social influences. Psychologists cannot prescribe medications (nor can any others on this list from here down). Without insurance, this will probably cost around $200 per hour. With insurance, it will cost the same co-pay as your regular office visits.

Call a Licensed Therapist: such as: LPCC (Licensed Professional Clinical Counselor), LMHC (Licensed Mental Health Counselor), LADC (Licensed Alcohol and Drug Counselor), or LICSW (Licensed Independent Clinical Social worker) if you are interested in at least a master’s level professional counselor. As opposed to psychologists, master’s level therapists’ education was more focused on the actual practice of counseling and not research or assessment. They tend toward a strengths based philosophy and might see diagnoses as a necessary evil for insurance purposes. This is the person to go to if you need fresh perspectives, new coping strategies, chances to share your hurts and dreams, and pursue your version of a life worth living. Without insurance, many sliding fee scales go down to around $30 per hour and full price is usual between $100 and $175/per hour depending on specialty, experience, and education of the therapist. With insurance, you pay your regular co-pay or co-insurance.

I could lump Marriage and Family Therapists in with the previous group, but since this is my biased blog, I will give them their own category. Licensed Marriage and Family Therapists (LMFT) are trained in family systems. Simply put, people affect and are affected by others. MFT’s observe rules, roles, and patterns in relationships and help people make changes not just to the individual, but to the system. Yes, MFT’s see people individually, but they will likely view you in the context of your relationships. While an individual psychologist might diagnose depression, and look at the brain chemicals, an LMFT might focus more on the dynamics in the family origin, current relationships, and larger systems in play like the dynamics of power, gender or race. This is the best option if you want to bring family members, roommates or significant others into the therapy room because so much of their training is geared toward helping people heal their relationships.

After you decide what treatment approach(es) you want to pursue, call the number on the back of your insurance card and ask who is covered in your network.

If you can’t afford these options and your health insurance isn’t helpful, find a provider ask them about a sliding fee scale or pro-bono options. There might be a graduate intern or pre-licensed professional who is willing to work for free or a reduced rate to get the experience. Most therapists I know won’t turn you away for lack of funds. They will be willing to help you figure something out. In Minnesota if you have medical assistance insurance, your visits are usually 100% covered with an in-network provider.

There is a really good therapist finder on PsychologyToday.com where you can search by provider type, specialty, insurance network, zip code etc.

The American Association of Marriage and Family Therapy has a therapist locator as well. This is a great tool if you want to be sure to find an LMFT.

There are so many people who spent years learning and preparing to help you. I know that they would love nothing more than a chance to meet you and hear your story.

What you should know about Autism

This post is the 3rd in my series What you should know about mental illness. Read here about Narcolepsy and ADHD.

It was the end of a tiresome day at the center for Autism where I worked years ago. The little boy I was paired with that day had been staying with grandparents while his mother traveled. His mom returned and was excited to pick him up.

She spotted her son and hurried to scoop him up in an embrace. No emotion or recognition registered on his face. Instead, he fixed his attention on the logo on his mom’s shirt, and he uttered one of the very few words he knew how to say,

“Rainbow.”

The mom’s face fell. After a few moments of trying to catch his eye, she gave up and began to gather his backpack and coat.

Automatic. Automobile. Autopilot, Automate. Autism. These words all have the same root. I’m no linguist, but I’d say it’s something to do with operating independently.  People with autism do not readily interact, engage or relate to other people.

Despite that autism is relatively common; there is a lot of confusion about what it is in the general population.  The first time I heard someone say “Autistic” I thought she said “Artistic” with an accent. When I asked what it was, she said, “Someone who rocks back and forth in the corner.” And even after dozens of psychology and counseling classes, I still didn’t know much more than that.

My professional experience was with kids who were almost completely locked in their own minds, some devoid of functional language. However we’ve all heard about someone with Autism who graduated top of his class or wrote a bestseller. The differences between these examples beg the question; how could this be the same disorder?

The answer to this question is that Autism is a spectrum disorder.asd

When you hear people say “He’s on The Spectrum” they are likely referring to Autism. My purpose is to give you a better understanding of what it is so you can be sensitive and kind to those who are affected by it. I will try to be clearer than the first definition I heard, but vague enough that this won’t become a checklist for you to diagnose your friends (please leave that to the professionals.)

There are three categories of impairment:

  1. Social. Not interested in interacting socially, might not give eye contact, lacks emotional reciprocity, will not point something out to someone else to share enjoyment. This category is the hallmark of the disorder and generally understood.
  2. Stereotyped Behavior.  This is less understood. It includes self stimulating behavior (called “stimming” for short). It is simply doing something for the sake of the sensory input. It could be as normal as twirling hair, or it could be as odd as flapping hands, reciting the words to a movie, walking on tip toes, making repetitive sound, or of course, rocking back and forth in the corner. Stereotyped behavior also includes odd and rigid daily routines, playing non-functionally with objects (lining toys up instead of playing with them), echoing what they hear, and focusing on one part of a whole object (the wheels of a car or the logo on a shirt). Sometimes people with Autism become super interested in something and it might seem that it’s all they can think about.
  3. Communication. This category does not apply to those who are on the far right side of the spectrum (high functioning autism/Aspergers). Impairments include delayed, slowed, or absent language development.

Max Braverman (played by Max Burkholder), a character on NBC’s parenthood is a very accurate example of a kid on the high functioning end of the spectrum. The movie Rain Main (1988, with Dustin Hoffman) paints a fairly accurate portrait of an adult with Autism, however it gives the false impression that people with Autism are also savants, when in fact that is very rare.

Just like anything, once you know what Autism is, you will likely see it everywhere. Next time you see a kid at mall who doesn’t seem to be listening to his mom, or maybe he’s having a tantrum because he wanted to walk down aisle 12, withhold your remarks and judgmental glances. In that instance, a warm smile and an encouraging word to the mom could have the power to change the world.

As always, I welcome your questions, comments, and stories below.

What you should know about Attention Deficit Hyperactivity Disorder (ADHD)

This is part 2 of a series about mental illnesses. Read the intro here.

My junior high industrial tech class started the same way every day. A voice on the intercom would interrupt our post lunch chatter as we were taking our seats and digging around for our notebooks. “Is Jack Smith in class today?” Jack would look stunned, like “Who me?” The voice would proceed to tell Jack to report to the office to take his medication. The class would chime in with comments like “Jack! Are you serious? AGAIN? Come on, how stupid could you get?” He would mumble something like, “Oh, yeah…forgot” as he shuffled out the door towards the nurse’s office.

I would thank God in that instant that I took sustained release tablets for my ADHD so I didn’t have to take pills at school. While I’d like to think I could have remembered to go to the office each day after lunch, I know that is not likely. I know because every week I would forget my band lesson, or my music book, or if I had my book, I wouldn’t have my trumpet. I know because I would stay up all night working on a beautiful collage for art class and I would leave it on the coffee table 9 times out of 10. I know because I set a record at my orthodontist for number of lost retainers. Countless discussions about “responsibility” and “planning ahead” and “think about where you last saw it” had no effect on my ability to remember, stay organized, or be prepared. It’s not that I couldn’t focus; it’s that I couldn’t focus on the thing that I was supposed to focus on.

No one really talked to me about what it meant to have ADHD. The only things I knew about it at the time was that the kids who had it were always getting in trouble. Before I was diagnosed, the only other person I knew for sure had ADHD was a kid in my grade who burned down a gym. The rest of the group who took medication after lunch was mostly boys who didn’t have a reputation for being bright, responsible, upstanding classmates. I thought the doctor who diagnosed me was mistaken. Yeah, maybe I missed the bus because I was braiding the sleeves of my shirts together in my closet, or drawing pictures in the condensation on the bathroom mirror, but I surely wasn’t an arsonist.

Over the years of dealing with myself and my sometimes-scattered brain, I have come up with a few tips.

Tips for dealing ADHD:

1. Contrary to popular advice- calendars, alarms, phones, fancy folders systems and notepads don’t work. You won’t have them when you need them or they will be too complicated to sustain. Go low tech and make up a song or rhyme of things to remember and sing it on your way out the door as a checklist.

2. If you need to remember to take care of something put a laundry basket on your bed until you take care of it. It doesn’t have to be a laundry basket, just do something wherever you are standing when the thought hits you: Put your ring on the wrong finger, flip a chair upside down, or unplug your tv. Anything that you will see and think… “What the ?? Oh yeah- I gotta pack my lunch.”

3. You can’t give up when things don’t go well. Persevere!

4. Don’t apply to jobs that say, “Impeccable organization skills and attention to details required.” Play to your strengths.

Tips for teachers/parents/friends of someone with ADHD:
1.As frustrating as it can be to live with someone who struggles with this, punishing someone with ADHD for having ADHD is ineffective and can be damaging.  

2. Let natural consequences teach the lessons.

3. Sustained release tablets for kids… see above story
4. Remember that ADHD has nothing to do with IQ

5. Use physical activities to engage the brain

6. Keep in mind that many people with ADHD are creative, fun, thoughtful, active, spontaneous, big picture people.

Fast forward 15 years, I am at work meeting with a teen girl. She just got in trouble because her grades weren’t reflective of her ability because she had so many missing assignments. “Let me guess, you did all of the assignments, but you forgot them or lost them or forgot to put your name on them.”

“Oh. Did my mom call you?”

“Um, Something like that…”

What you should know about Narcolepsy

This is the first in a series about mental illnesses. Read the intro to the series here.

In A.P. Psychology we all watched in delight as Rusty, the narcoleptic dog, collapsed midstride into a deep slumber. One second he was bouncing through a meadow, and the next he was flat on the ground dreaming of steaks. And we laughed and laughed and laughed. And just like two year olds we said, “AGAIN!” each time the video clip was over.
sleep[1]
Someone close to me has narcolepsy. People love to tell me stories about him falling asleep at inopportune times. They think it is hilarious that someone would fall asleep at a baseball game, during calculus test, at the state fair, or at the dinner table. They promise me that they are not making it up, as if I would never believe it. They wonder at why he is so tired and hypothesize about the reason.

What they don’t realize is that he hates these stories. He hates feeling miserably tired every single day and hates having uncontrollable sleep attacks. He hates feeling the onset at a party and realizing that he doesn’t have much longer before it hits him. The image of someone falling asleep in their mac and cheese is maybe a little funny in a slap stick, 10 year old kind of way, but it is less funny to fall asleep during an important conversation or when you paid $40 to hear a band play and you miss the whole set. It’s less funny to fall asleep at a job interview, even less funny if you can’t wake up to the sound of your baby crying, and not funny at all if you fall asleep while you are driving. Right around the time when I was sitting in class laughing about Rusty, my friend (before he was diagnosed) was driving home from high school in rush hour traffic. He veered into the lane of oncoming traffic, and into someone’s yard just missing their front door. Thankfully the damage was confined to the car and a ceramic gnome.

I get irritated with people’s ignorance about narcolepsy, but I really can’t blame them. After all, I was just as amused by Rusty, the narcoleptic dog, as the next person. I learned about the condition, but I didn’t think very deeply about the implications. I understood and memorized all of the clinical facts about it (the brain skipping to REM sleep, the body going limp, the triggers, etc.) but I didn’t really consider what a real person with narcolepsy has to live with.
1 in 3000 Americans has Narcolepsy with Cataplexy so it is very likely that you know or will know someone affected by the condition. Here are 6 things you should know so that you can be understanding, rather than obnoxious.
1. Narcolepsy is a neurological disorder- NOT caused by psychological problems, emotional distress, personality type, bad habits, improper sleep training as a baby, nor anything else that someone did or didn’t do.

2. It is not the same as being tired a lot.

3. Playing tricks (i.e. drawing on their face, taking their picture, putting things in their mouth) on someone who accidently falls asleep is just not that cool.

4. Medicine and caffeine help a great deal in managing symptoms day to day, but there is no cure. It usually begins in adolescents and sticks around for the rest of life.

5. It is classified as a sleep disorder, but it is more of a “wake” disorder. People often confuse it with sleep apnea or insomnia but these are about not being able to sleep or not having high quality sleep, whereas narcolepsy is the opposite.

6. Though it may appear that people with narcolepsy are super laid back, lazy or stoned, this is not necessarily the case.

If you’ve been recently diagnosed with narcolepsy, I want you to know there is a bright side. Here are some benefits to having this disorder that your doctor won’t tell you:

1. Espresso at midnight? No problem. My friend says that at a certain point, using caffeine to stay awake is like using bicycle breaks to stop a train.
2. No tossing and turning, obsessing about the stupid comment you made earlier or counting sheep. Just lie down and start dreaming within seconds!

3. No trouble falling asleep camping, in an airplane or airport, in a bus, or on a cement slab.

4. Time travel through boring lectures or church services.

5. Wake up feeling refreshed no matter how long you slept.

6. The ability to take a 20 second nap right before a life insurance appointment causing your resting heart rate to resemble a world class athlete.

7. And finally, a practice my friend likes to call, “Swinging the Pendulum.” Slam an energy drink or take your prescribed medication followed immediately by a short nap. The caffeine takes affect while you are sleeping and you wake up super charged.

As with any disorder, narcolepsy is something that some people have to live with, but it does not define them. As a therapist, I think of myself as strength-based, meaning that I think what is right with people is much more worth focusing on than what is wrong. However, I think it is good to talk and learn about these things that make us all unique so we can understand each other and be better to each other.

Intro to series: What you should know about mental illness

dsm-dump[1]When I tell people what I do, I often get questions about mental illnesses. Like, what does someone have if they do XYZ? I don’t really like diagnosing hypothetical strangers based on an out-of-context list of symptoms, but even more so, I don’t like reducing wonderfully complex people to a mere label. It limits their view of themselves and my view of them. I prefer to focus on people’s strengths rather than their problems, and yet I think it is helpful to talk about disorders. Often, the silence on these topics leads to confusion, shame, stigmas and misunderstandings. Even though I am proud of the large amount of dust on my DSM (manual of mental disorders), I am going to write a series of posts on some of the most misunderstood mental disorders. My aim is not to help you understand them in clinical sense, but that you could better empathize and connect with real people that you know that are affected by these illnesses. I will try to address each of the disorders with the upmost respect in order that we could all be better to each other. Please comment below or send me a message if you have a “favorite” illness you’d like me to address in this series. First up: Narcolepsy.

Nesting and Insomnia

I’m not even sure how long I’ve been sitting in my living room in the dark trying to get comfortable/ turn off my brain/ get sleepy/ write this sentence. Before that I was in my bed for a few hours attempting the same (except for the writing part). Last night was similar and before that… I can’t quite remember. Today is my first day of the 3rd trimester and it seems Insomnia has found me again (a little earlier this time). As Dora would say, “That sneaky fox!”

On my short list of favorable pregnancy symptoms is a new found focus. I had the odd experience of finding a to do list in my coat pocket from a few days past and realizing that I had completed every single item on the list. I don’t know if that’s ever happened to me before.  I’m making appointments, putting them on the calendar, planning ahead, cleaning the bathroom, staying on top of documentation at work, filing taxes, organizing closets. It’s crazy! I’ve wondered several times if this is how normal people operate most of the time. Maybe these pregnancy hormones are kicking in to help me prepare for this new life and giving me a taste of what it’s like to be more organized.
The only part I don’t like about it is the feeling that there is always more to do. As soon as I complete one item, I am on to the next and feel a bit panicked that the list keeps getting longer. I feel like I can’t sleep because I’m… well I’m itchy, heavy, and can’t breathe very well… but also because there’s so much to do and my brain won’t stop obsessing about the next thing I could be doing. I almost did a workout last night at 2am but I stopped myself because I was realizing that it was time to rest and that I need to work on being content with what I can and can’t get done in a day.
I’m tyring to intentionally counteract the turbo-powered-nesting-instinct and just be present in each moment as they come. I’m trying not to be too focused on what’s happening in less than 3 months (although I am so, so excited) and not too focused on what I didn’t finish yesterday. I just want to be grateful for this moment in which can feel my contacts getting stale, and I can hear the trains rumbling by, the dog’s heavy breathing and the clock ticking. This moment in which my womb baby is flipping and my girl baby is probably nestled in one small corner of her crib… blanket kicked off and boppy (aka pacifier) near. This moment in which the heartburn I felt earlier is subsiding and the nausea that seems to always be with me may just be taking a little nap.
And for my next trick, I will be attempting to fall asleep. Again.

p.s. I remembered that I posted about insomnia during my last pregnancy 2 years ago, so I searched back in the archives and lo and behold… I posted in on this EXACT day 2 years ago. Must be something about February 10th and me being awake thinking about being awake!

How to Survive so-called “Morning Sickness”: 9 uncommon tips

If you, like me, think “Morning Sickness” should be called “The 9 Month Flu” you might benefit from reading this post. I’m not promising any cures or remedies. As someone who has tried just about everything to alleviate my nausea and vomiting during pregnancy (special diets, mint, lemons, ginger, Zofran, other drugs, acupuncture, chiropractic adjustments, small frequent meals, liquid chlorophyll, sea bands, protein, bland foods, Unisom, exercise, relaxation, Vitamin B, and many more) I don’t see the need for another post along those lines. These are some mindsets and practical tips that have helped me cope with feeling like a moody, sleep-deprived adolescent with the perpetual flu.  Don’t worry, I’m not going to tell you to put crackers by your bedside, we’ve all heard that joke too many times!

Disclaimer: I am not an expert; I am just speaking from my experience: one complete pregnancy with severe nausea and vomiting for the entire duration, one miscarriage with moderate nausea and vomiting, and one current pregnancy, 13.5 weeks along with ongoing constant nausea and occasional vomiting.
1.       Keep an empty ice cream bucket in your car. This one was my mom’s idea, and the more I think about it, the more I realize its perfection. Just yesterday a strong wave of nausea hit me while I was driving home from work. I was on the interstate and there was nowhere to pull over. I grabbed the first thing I could find to use as a receptacle; a paper bag. While it was better than nothing, it was not ideal. Yes it leaked out on my pants… yes my husband thought I wet myself… yes I was grateful I was coming home from work and not going to work. An ice cream bucket would have been so much better because you don’t have to hold it open (safer while driving), it doesn’t leak, AND you can put a lid on it. The only problem is we don’t really eat ice cream in this family so we don’t actually have one. I will buy someone ice cream if you give me the container! Anyone?
2.       Learn to interpret nausea as hunger. This is really difficult because it is unnatural to eat when you feel sick. During pregnancy I have not felt hungry. Instead I feel nauseous. Tricky little nausea is always trying to make food seem repulsive, but food is the only thing that calms the storm. There is a point of no return when the nausea is too strong and food will not stay down. Just try not to get to this point… I know it is hard.
3.       Choose the least of evils: During my first pregnancy I got my vomiting under control with drugs but I still felt miserably nauseous. I ate frequently to get my nausea under control and gained too much weight. The drugs gave me headaches and slowed my digestion way down if you know what I mean. During my second pregnancy I threw up too much and ended up losing the baby… though we’re not sure why. So based on what you can tolerate today you must choose: vomiting or drug side effects, nausea or weight gain, healthy foods or pickles and gummy bears, being a semi-functional human or spending the day in the bathroom.
4.       Don’t eat it if you are disgusted by it. I ate chicken the other day because I thought it would be a healthy choice. I turned off the lights because I was grossed out by the sight of it. I didn’t sleep for the first half of the night because I was so ill from it. When will I ever learn to listen to my aversions?
5.       Enjoy the 1-5 minutes after you finish throwing up. This is the best you’ll feel for months. If you can, fall asleep during this time so that you can avoid experiencing the resurgence.
6.       Take Gummy Prenatal Vitamins. Forget about choking down those horse pills. Mary Poppins was right a spoonful of sugar helping the medicine go down. My new gummy vitamins do contain sugar, and they do not have iron so they are easier on the tummy.
7.       Lie to yourself. Despite my track record, it was imperative that I believed I would feel better during the second trimester this time. It gave me hope, it gave me something to count down to. It made me feel better just knowing there was an end date. That date was over a week ago, so now I’m changing my nausea end date. It’s just a little game I play to keep myself sane… if you call this sanity.
8.       Keep your Eyes on the Prize: baby, baby, baby, baby, baby, baby, baby, baby, baby, baby, baby (it’s all worth it for you babe).
9.       Accept that you feel how you feel. One definition of suffering is pain plus the non-acceptance of that pain. My first pregnancy I felt upset because it wasn’t fair, it wasn’t right, it wasn’t what I read about in the books, it wasn’t what my friends described, it lasted much longer, and it felt much worse than I ever expected. Now I am coming to terms with my situation, and it is still hard, but a little tiny bit better. I still have hope that by some miracle, I will have some relief from my nausea before this is all over, but I am doing better at accepting that at this moment, I feel sick and it’s not helpful to protest that fact.
My guess is that if you are reading a post with this title you have had similar or worse experiences than mine, or you know me and are reading out of boredom, empathy, curiosity, obligation, confusion, amusement. If you fit into the former category, how have you coped? Which of these things have been helpful/unhelpful for you? I’d love to know, and I’m sure others will benefit from your wisdom. Comment below!