Not "Damaged" Enough

     I started going to therapy because I couldn't go a day without having a panic attack. My anxiety had gotten to the point that it interfered with my ability to function on a daily basis, and so my primary care nurse practitioner suggested that I try mental health counseling. Fast forward to today, and I'm in a much different place. My anxiety no longer interferes with my ability to function, and I haven't had a panic attack in (possibly) close to a year. In other words, I no longer seem "damaged enough" to need weekly (or bi-weekly) therapy anymore, but I still go to my appointments.
     My mom recently met someone at work who's story feels similar to mine. This person deals with anxiety on a daily basis and has often-occurring panic attacks to the point that the person's primary care doctor put them on anti-anxiety medication. (They were actively having a panic attack at work when my mom met them. It's actually WHY she met them. She wanted to help.) When my mom asked them about therapy, they told her they had tried to get therapy, but the provider told them they were "not damaged enough for therapy". So, they never tried to seek therapy again, despite the anxiety and panic attacks that still continue to interrupt their life.
     There is this idea of what people need to be like before they're "allowed" to justifiably seek mental health counseling. You know, they need to be suicidal or they need to be literally unable to function in their day-to-day life. Or, they needed to have had a really traumatic event happen to them, like surviving a war, domestic and/or sexual violence, or some other terrible thing that really "damaged" them. Society needs to be able to objectively see that someone is  unarguably "damaged" before therapy is necessary. In other words, society tells us that therapy is only meant to be used as a last resort to help someone survive instead of a resource to help someone thrive.
     That's completely the wrong idea to have about therapy. Therapy isn't meant to be a last resort. Therapy is actually meant to be a resource to help everyone thrive. I honestly believe that a yearly mental health check-up should be a common part of the usual yearly check-up list. Nothing has to be "wrong" with anyone for them to go get a yearly physical or to go get their eyes checked every year. So, nothing has to be wrong for someone to make an appointment with a therapist every year or every six months for a brain check-up.
     Thriving instead of just surviving is so important. The first minute that you start to notice something feels "off" or that your thinking has shifted to a place that you don't like, go ahead and call a therapist. Nobody else has to tell you that you're "damaged" or that you need help before you're allowed to go and get it. You can do that as soon as you feel like you need it because you know yourself better than anyone else. You don't have to wait until you're barely functioning to go talk to someone. Again, therapy is a resource, not a last resort.
     Therapy can also help with stress management. (Even happy changes and events can be stressful, friends.) Therapy can help you be a more effective communicator or a more effective boss for your employees. You can also go to therapy to learn about and understand yourself as part of an adventure in  personal growth.
     I'll end with this: Society tells us that therapy should only be used as a last resort to help us survive, that we must be "damaged enough" and at our breaking point before we seek help. That is the wrong way to think about it. Therapy is a resource that is meant to help us thrive as well as survive. Therapy is a great way to start a journey of introspection and personal growth as well as a treatment for mental health conditions.

Maintaining Mental Health in Isolation

     Things feel weird, to say the least, right now. To some of us, myself included, things may even feel terrifying because of all the uncertainty. On top of the threat of illness, we're being told to self-quarantine or self-isolate, and businesses are being told to change the way they operate as the world deals with the spread of this illness. People are likening this global event to dystopian novels, and people in my area of the US are even likening it to the biblical "end times".

     If you're like me, a peron who thrives on routine and planning and certainty, these changes to the normal patterns of our lives are enough to heighten anxiety or possibly cause panic. (Never mind the fact that my OCD mainly focuses on religious obsessions, and that feeling alone and isolating can actually make it easier for my anxiety to spiral.)

     In times like these, with all the panic, the unpleasant parts of humanity on full display, and the constant worry of contracting physical illness, it's super easy to let our mental health end up on the back burner. That's exactly the opposite of what needs to happen, though. In times like these, our mental health efforts need to be ramped up, and we need to check in with ourselves more often as we navigate through the uncertainty. 

     I know a lot of non-essential health services are currently suspending office hours. That may mean your therapist (if you have one) isn't in the office. Or maybe, you're afraid to go out to go to the appointment with your therapist, which is completely understandable. That doesn't mean you have to cancel your appointment, though. Right now, my therapist has switched to phone or FaceTime sessions, and it's worth a shot to ask your therapist if you can do the same if you're too afraid to go to the office. Also, don't be afraid to call your therapist between appointments if you feel like you need extra help.

     If you don't have access to a therapist, I encourage you to look into the apps you can download on your phone to help manage anxiety as well as other mental health conditions. You can also text or call crisis centers and hotlines, and someone there will be able to talk to you.

     If you're like me and you need to exercise to help keep your mental health condition under control, you don't have to miss the exercise because you can't go to the gym. I find that walking for at least twenty minutes really helps my anxiety stay at a manageable level. If you don't have a treadmill, walking around your bedroom or around your house works. (I do this.) Body weight exercises are also a good option if you can't go to the gym and don't have equipment at home (think push-ups, lunges, squats. Yoga, Pilates, or Barr exercises are also a good way to get anxious energy out that you can do at home.).

     Self-care is so important for our physical and mental health right now. It's okay to take it a little easier on yourself  and to add more soothing activities if you need them while we're self-isolating. Take the bubble bath. Watch your favorite movie. Eat the comfort food. Take a nap. Meditate. Spend more time talking on the phone or chatting online with your friends and family. Ignore or mute the illness updates on your phone and social media if you have to in order to avoid a spiral or a panic attack. Try not to be angry with yourself for being extra anxious or struggling more with your depression symptoms right now.

     I'll end with this: It's easy during an event like this one to let mental health take a back seat to physical health, but we have to remember that mental health is just as important in helping us maintain overall wellness as physical health. Keep your appointments with your therapist as much as possble, keep up your exercises to manage daily symptoms if that's a coping strategy, ramp up your self-care plans. Reach out to people through phone calls, texts, or online chats if you're feeling alone. Also, practice the techniques you learned to help you keep from getting lost in an anxiety or depression spiral during the overload of negative or frightening information.

Children and Mental Health

     I saw a post going around on my Facebook over the weekend, and I haven't stopped thinking about it. In this post, a man says he saw a reporter ask a school principal (on the news or something like that), "What are we missing? What do kids need?" The principal tried to mention mental health and other relevant issues for children. The person that posted about this obviously didn't like what the principal said because the person sort of went on a rant about it. The person on Facebook said things like, "None of that mumbo jumbo makes a lick of sense. Here is what children need..." Then the person on Facebook went on to list that kids just need parents, other family members like grandparents and cousins, a bicycle, time to play outside, coloring books, and church. Basically children need, "faith, family, and good ole fashioned fun," the person states.
     While I agree that children need a support system, love, and time to just be children, I don't like that this person on Facebook completely discounted any discussion of mental health in relation to children. And, friends, this post was being spread around on Facebook like wildfire, which says something that concerns me. To me, that post being shared a lot say that a lot of people might have the idea that children, unless they had an extremely traumatic childhood, don't experience clinical mental health conditions.
     Any child, even those that come from ideally functional, loving families, can have a mental health condition. As someone who dealt with childhood anxiety and, what I didn't recognize at the time, as panic attacks that started when I was somewhere between 7 and 9 years old, I can tell you that children can have mental health conditions that need to be treated. (My doctor wanted to put me on medication.) I know someone who experienced depression so severe they wanted to die at age 8, and she will tell you that she wishes her parents would have gotten her treatment. Family time, church, and some "good ole fashioned fun" weren't going to solve any of our problems. Treatment was the only thing that was going to help.
     Mental illness does not discriminate based on age, gender, family structure, or socioeconomic status. Children's brains can become unwell, and they will need actual treatment, with a therapist to become well again. (Why do you think schools have school/guidance counselors? It's not just for teaching young children to share and helping older students pick out classes...)
     So, the "mumbo jumbo" that principal was talking about actually does make sense. (Some) parents are missing the signs that their child is in need of mental health treatment. The fact that children can have clinical mental health conditions before they even get anywhere near high school, where it's more likely to be addressed, is what we, as a society, are missing. Kids, even the young ones, need to know that if they feel sad a lot, or afraid all the time, or angry all the time, or any other kind of "funny"/"weird" / "not right" feelings they can talk to their parents about it and that their parents will ACTUALLY listen and possibly consult a professional.
     I'll end with this: Children, even really young children, can have a mental health condition. Mental illness does not discriminate based on age, family structure, or socioeconomic status. I know it's hard, but everyone needs to talk to their children about mental health so that they know their parents will actually listen and try to help them if they experience symptoms. And please, don't write it off or ignore it if you notice changes in your children or if they come to you and say something feels wrong just because you think your child "shouldn't have a mental health condition".

Mindfulness Meditation

     I talked about Mindfulness as a way to deal with emotions that I don't like to feel in a previous blog post, but I haven't mentioned Mindfulness Meditation before. I find this particular type of meditation to be helpful in managing my intrusive thoughts and my overall anxiety. It's one tool that always seems to be effective for me no matter how much I use it. 

     When I talk with different people about Mindfulness Meditation, I always here a few common misconceptions about this particular practice. Every time I even mention the word "meditation", the person usually says, "I can't meditate. I can never clear my mind." Or, "I'm not good at meditating. I can't concentrate well enough." Or, "I can't meditate. I just can't relax." Or, "I can't meditate. I can't sit still that long." People tend to think of meditation as the stereotypical scene in a serene and silent room, with some incense, and hours spent still as a statue, almost in an altered state of consciousness, striving for spiritual enlightenment.

     People tend to be surprised when I tell them that Mindfulness Meditation isn't quite that kind of meditation practice. The point isn't to get to spiritual enlightenment (but you can strive for that if you want to). The point isn't to clear your mind. The point isn't to rigidly force yourself to concentrate on something for a certain amount of time. The point isn't even to relax, really. The point of Mindfulness Meditation is to learn to exist with your mind in whatever state you find it in that day and to learn to separate yourself from your thoughts. (Meditation does increase the gray matter in your brain over time which MAY result in a calmer brain, though.)

     Mindfulness Meditation is simple to do, or, at least it's simple the way my therapist taught me to meditate. I just find a quiet spot, and I find a comfortable place to sit. I like to take a couple of deep breaths just to get my brain into "ready to chill" mode. Then I close my eyes, rest my hands on my knees, and I focus on my breathing. I follow my breath into and out of my body. If other thoughts creep in, (and other thoughts always creep in), I just think, "Thinking has just occurred. Now back to breathing." Then I return my focus back to following my breath. I don't judge the thoughts or argue with them. I just acknowledge that thinking happens and refocus. I try to do ten minutes every time I meditate. I started with five minutes first and worked my way up to twenty, but ten minutes seems to be my best amount of time, so I do that. (I read that twenty minutes of meditation a day would be helpful in treating symptoms of anxiety and depression, but I can't remember the name of the article.)

     My brain also tends to take me somewhere else while I'm meditating for whatever reason. I don't know if that's just a "me" thing or if that happens to other people. I usually end up in a forest or in a room with a floor-to-ceiling window looking out at a forest while my intrusive thoughts are separated from me by another glass behind my chair. (That sounds weird, I know. It's fine if nobody else does that.)

     My therapist assures me that I don't HAVE to have a strict amount of meditation time, but I like routine. She tells me that meditating for the two minutes I steep my tea or while I'm in line at the grocery store would be helpful for my brain, too. She tells me that any time spent mindfully meditating is better for your brain than no time spent meditating at all. You just have to pick the best amount of time that works for you, or do it in increments if you want.

     I'll end with this: A lot of people only think about meditation as a thing that only monks, nuns, and "New Age" enthusiasts practice, but really, Mindfulness Meditation is a different sort of practice from the stereotypical meditation we see in movies. The point of Mindfulness Meditation is to learn to live with your mind whether its going haywire, chilling out, and doing everything in between. It may take a bit of time with daily meditation, but it honestly helped me manage my anxiety. It's still a tool that I use regularly.

The Magical Answer

     I know someone who struggles with OCD and is in therapy like me. We talk about everything from our intrusive thoughts to the things we learn about in our therapy sessions. My friend was diagnosed and entered into treatment long before me. We're at different places in our journey to healing and wellness, and that's perfectly okay. My friend's favorite question to ask me seems to be, "How do you cope with it?" My friend asks in a way that makes me feel like they think I have the magical answer that will suddenly make things all better. It makes me feel like I have a duty to save them because I'm further along in my journey of healing.
     I don't mind questions about things that worked for me. I'm glad to engage on any mental health topic. It's just that their question makes me...uncomfortable. Maybe it's just the way my friend asks that makes me uncomfortable. I want desperately to be helpful and to be able to give them whatever answer they're looking for, but I don't have the answer that fixes everything. Honestly, half the time I'm amazed at my own progress, and I find myself asking gratefully, "How and when did I get here? I didn't think this was even possible!"
     I know how I got here, really. I worked on it. I used the things that my therapist taught me, and I worked hard. I'm still working hard to manage my anxiety. I take life with my OCD one day at time, and deal with whatever it tries to throw at me the best I can. I can't say that to my friend without sounding a little bit like an asshole or like I'm bragging, at the very least. I know that isn't the answer my friend wants to hear.
     Another reason their question, or maybe the way they ask it, makes me a little bit uncomfortable is because I have no idea if any of the strategies I use will help them. I know how my brain works, and I know how OCD works in general. I still don't know which coping strategy will be helpful to me from one day to the next, and which ones will stop working altogether (because that happens over time). Finding things that work is a lot like finding medication and/or a therapist that works for you. It's a trial and error process, and you just have to hang in there through it and change things as needed. I still have to go through this process all the time. So, how can I save someone else when I'm still in the process of saving myself all the time?
     I'll end with this: The reality is that I can't save anyone else. I don't have the magical answer that fixes everything. I can only offer information that MIGHT be helpful and then hope and pray that something I said actually helps. And then I can hope they find the type of help they need so they can save themselves. When it comes to mental health, we can't expect to have all the answers for everyone or even ourselves. Therapists don't even have ALL the answers, and they've studied mental health extensively. We can only take it one day at a time and try our best.

Finding a Therapist

     As all of you have probably realized at this point, I'm all for mental health counseling. I love therapy. I think everyone should go at least once in their lives, even if they think nothing is wrong with them. (Nothing has to be "wrong with you" to go see a therapist, by the way.) As you also probably know, I'm quick to suggest that people go see a therapist, but then that's usually the end of the conversation. I usually don't think to mention how they can find a therapist or where they can go to actually talk to a therapist unless they ask.
     I was thinking about that this weekend, and something occurred to me. A lot of people, in fact, I'd say most people, have no idea how to find a therapist. People know what they see on TV. You know how it goes: someone asks, "Have you thought about talking to someone about this?" or "I really think you should see someone about this." Or, worse, they see someone in a hospital after an "incident" or they see someone involuntarily committed. Then, suddenly, the scene changes, and the person is sitting calmly in a chair or lying on a couch talking to a therapist. It's like someone says a person needs therapy, and then a therapist just appears Mary Poppins-style with a bag of tricks and tools. Nobody even needs to say the words "therapist", "counselor", "psychologist" or even "doctor", it just...happens, and we understand that those words are implied.
     In reality, we all know that isn't how finding any kind of medical treatment works. Finding mental health treatment is no different. It's the same process, but it can appear more daunting because mental health treatment is still shrouded in mystery with a lingering layer of taboo that varies in severity based on the area in which you live and your cultural background. I completely understand how people might not know if their area even has any mental health counseling options. So, let's get rid of the mystery and break finding a therapist down into manageable steps.
    Step 1: You literally just ask. You can ask any friends or family if they know anyone who has gone to therapy or if they know of any therapists they could recommend. You can also talk to your school counselor if you're in high school or middle school. You can talk to your campus counselors if you're in college or university. You can call your family doctor and make an appointment to discuss mental health treatment options in your area. You can also call your insurance company and ask about in-network mental health services, if you have insurance. You can also just Google "MENTAL HEALTH SERVICES NEAR ME", and that should give you a list of names and numbers along with an interactive Google map of every publicly-listed mental health professional within about a 30-mile radius of where you live.
     Step 2: Research. I like to look up the therapists. I like to read reviews and look at their websites. That way if you've been diagnosed with a condition like an eating disorder, anxiety disorder, depression, or PTSD, you can possibly narrow down the list of names based on whether or not that therapist or agency is able to treat your condition.
     Step 3: You make some phone calls. You have your list of potential therapists or mental health agencies, and you call them. If it's a community mental health organization, you just schedule an intake appointment, and they put you with a therapist that would be most helpful. If you can't travel, you can also ask if the agency or private therapist does Skype or tele-sessions (done on a TV monitor), or phone sessions. If they're a private therapist, it's also a good idea to ask if they're licensed and what kind of degree they have.
     As you're doing your research, you'll see a lot of initials after the person's name, which can be confusing, especially if you've never sought mental health treatment before. Your therapist or counselor absolutely needs to be licensed, and they should have a Masters degree or higher. One degree or license isn't "better" than the other. So, let's break down some of the most common degrees and licenses you might see, too, while you're looking for a therapist.
     1. Ph.D. and Psy.D.: Both of these are doctoral degrees in Psychology and/or Mental Health       Counseling. Both provide mental health counseling. (My current therapist is a Psy.D.)
     2. DSW: This is a Doctor of Social Work. This person can also provide mental health counseling if they are a Clinical Social Worker.
     3. LCSW: This is a Licensed Clinical Social Worker. They have a Masters degree in Clinical Social Work. This is a social worker that has specialized in mental health. They provide mental health counseling. (My first therapist was a LCSW.)
     4. LPC: This is a Licensed Professional Counselor. They have a Masters degree in Mental and/or Behavioral Therapy. They provide mental health counseling.
     5. LMHC: This is a Licensed Mental Health Counselor. They have a Masters degree in Mental Health Counseling. They provide mental health counseling.
     6. MFT: This is a Licensed Marriage and Family Therapist. They have a Masters Degree in Mental Health Counseling with a focus on Marriage and Family Therapy or a degree in Marriage and Family Therapy. They provide counseling to family units, not individuals unless they have another qualification listed along with the MFT.
     I'll end with this: Finding a therapist still seems like a mysterious, taboo process, but it's just like looking for any other kind of service we might need. Please, don't be afraid to ask any questions you have about finding a therapist, the kinds of therapists that are out there, or the cost of therapy. The information is out there, and there are people that can help you find it. I'm happy to help if anyone wants to ask. Also, if you're going to suggest someone see a therapist, it wouldn't hurt to offer names of private therapists or community agencies with the suggestion, or just to offer to help someone gather information.

Identify It and Flag It

     Some days I don't notice my intrusive thoughts at all. Other days, it feels like my mind stereo is on full volume, and my intrusive thoughts are all I can hear. I've even found myself physically recoiling and flinching away from my intrusive thoughts like they're a physical entity. (I know they're not, but they just feel SO REAL and SO TRUE some days, and that just HURTS...) It's still hard work to manage my OCD on those particularly loud days, but I've found that one method of dealing with my intrusive thoughts has worked well since I started (trying to) use it a few years ago, after my therapist kept saying that I should stop arguing with my intrusive thoughts and trying to prove them wrong.

     I mentioned the Identify and Flag Method in last week's blog post as part of the list of ways I manage my OCD. It's simple, but it feels difficult until it becomes a habit. Here's how I do it: An intrusive thought comes, and I say to myself, "That was an OCD thought." Then I imagine myself placing a giant checkmark over the thought as if to say, "Yeah, I see you, and I've dealt with you." Then I let it go. That's it. That's the whole interaction with my intrusive thoughts. I do that over and over for every intrusive thought until they all have a checkmark on them. I don't fight it. I don't engage with it. I don't argue. I don't analyze it. I don't reassure myself that I didn't mean it. I call it what it is, flag it, and get back to whatever I was doing. 

     Here's why that works (for me): By recognizing the terrifying thought as an OCD intrusive thought, and then calling it an OCD thought, I've reassigned the responsibility for that thought. I've made myself aware that I'm not responsible for the terrible and terrifying thought. My disorder is responsible for the terrible and terrifying thought. The Identify and Flag Method helps me (finally) let go of the responsibility I thought I had to control my brain and all the thoughts. (No one can control EVERY thought that passes through. Our brains generate a lot of nonsense and garbage thoughts all the time, but people with OCD have a harder time filtering out the garbage thoughts.)

     As soon as I've labeled the thoughts, my anxiety drops. If I'm not responsible for the thought, then I don't need to feel worried that I'll act on it, I don't need to feel guilty or ashamed of it, and I don't need to "undo" it. I've taken away the intrusive thought's power because I've recognized it as a thing that is separate from who I am. That means I haven't had the extreme emotional reaction to the intrusive thought, which stops the feedback loop of thought-->anxiety-->compulsion.

     I'll end with this: We are not who our disorders try to make us believe we are. We're not responsible for every single thought we think. Everyone's brain generates nonsense and garbage thoughts, and the Identify and Flag Method has helped me learn to separate myself from the garbage intrusive thoughts my OCD likes to toss out at me. It's hard to get used to doing something that seems counter-intuitive, like not trying to stop the thoughts from coming, but it gets easier with practice.