Like Him

Full Disclosure: I struggled with the decision to write about this topic. This is probably the most personal blog post about my life that I will ever write. Trigger warning: This blog post contains details related to domestic violence.

I'm pretty sure I've mentioned in previous blog posts that my mom also lives with a clinically diagnosed anxiety disorder. I'm pretty sure that I've also mentioned that she does a great job at managing and living with her anxiety disorder. What I haven't mentioned before is that my other parent lived with bipolar disorder for which he refused to follow through on any kind of treatment plan. In addition to the untreated bipolar disorder, he also had pretty extreme issues with power and control that made him an abusive person. The fact that he self-medicated for the bipolar disorder with alcohol only exacerbated the power and control issues and worsened his bipolar-related impulse control issues. 

Growing up with my father in the house for the short time before the end of the relationship, I mostly remember fear. I remember his anger, the yelling, and the times when he would become violent. I remember other times, too, when he was downright cruel in very calculated ways that had nothing to do with impulsive, violent outbursts. I remember the multiple suicide attempts when my mother would try to get him to leave to end the abuse. I also remember the multiple times he had to go into in-patient treatment to get his medications and the rest of his treatment plan sorted out, but then he'd always go back to the same hurtful pattern as soon as he was released. 

His family and sometimes mine would make excuses for his behavior. He had bipolar disorder, and they blamed the anger issues and even the abuse on the bipolar disorder. For some reason, nobody ever really pointed out that it was his responsibility to treat and manage the combination of his bipolar disorder, his power and control issues, and his drinking in order to not be the abusive person that he was. 

As you can imagine, with the way people linked his violent behavior with his mental illness, I also made that same link in my young brain, and it stuck there for years. In medical appointments, I often heard doctors talk about my genetic predisposition for mental illness (which doctors made seem like an inevitable thing) because of my father's bipolar disorder. As a result of that kind of input, I was terrified of developing any mental illness, because in my mind, mental illness could make me more like the man that had caused so much fear and hurt in my family.

I spent a lot of time as a teen monitoring myself to make sure I wasn't LIKE HIM. I monitored my anger very closely. I monitored myself for signs of depression. When the intrusive thoughts made their appearance, one of my thoughts besides thinking I was possessed was, "Is this going to make me LIKE HIM?" This fear of being LIKE HIM may have played a small part in why I refused to acknowledge the fact that something was wrong and I why I didn't seek treatment. It definitely played a part in my earlier refusal to accept my mental illness as a thing with which I could co-exist peacefully.

The thing that I didn't realize until much later than I should have was that I was never going to be like him, even if I developed a mental illness, even if I developed the same mental illness. Although his mental illness was often used as an excuse, it wasn't what truly made him the person that hurt our family. (Because, as we all know, living with bipolar disorder doesn't just make someone uncontrollably violent.) His choices made him that person. He actively made the choice to continually behave in ways that were violent, abusive, and cruel. He actively made the choice not to go to therapy and not to take his prescribed mood stabilizing medications. He actively made the choice to self-medicate with alcohol even though he knew it wasn't healthy. Since he actively chose to be the way he was, I realized that I could actively choose to be different from him, even with a mental illness. I was already actively choosing not to be like him before the mental illness became an issue, and I could continue making choices that were different from him as I learned to live with my mental illness.

I'll end with this: Having an abusive, mentally ill parent, especially when we actually hear people linking the abuse with the mental illness, can make us afraid of confronting, dealing with, and accepting a genetic predisposition to develop a mental illness because we may worry about becoming LIKE THEM with mental illness. But...just because we're genetically predisposed to develop mental illness because of genes we share with a terrible person doesn't mean that we will become a carbon copy of that terrible person if or when that mental illness appears. Our mental illness, even if we developed it because of the genetic bits we share with an abusive parent, will not be the dreaded, terrible, terrifying thing that makes us LIKE THEM. It's the choices that we make, whether we make the same harmful choices they made or whether we actively choose to make different choices, that make us LIKE THEM. 

Poor Mental Health vs. Mental Illness

Sometimes, I see and hear people use mental health and mental illness interchangeably. I especially see it when people equate poor mental health with mental illness. I can see why a lot of people often think poor mental health and mental illness are the same thing based on the broad definitions we find online, but poor mental health is not the same as mental illness. 

According to the CDC, mental health is simply defined as "our emotional, psychological, and social well-being." Everyone has mental health that varies from great to poor from time to time, just like everyone has physical health that varies in the same ways from time to time. Also, just like with physical health we need to do certain things to make sure we're doing everything we can to maintain good mental health like getting adequate sleep, taking time to rest and de-stress, getting appropriate exercise, having meaningful social interaction and connection, making sure we have time for fun in our lives, and making sure we have healthy coping strategies for the ups and downs that come with life. 

Just like everyone experiences periods of poor physical health, everyone will also likely experience periods of poor mental health. Too much stress can contribute to poor mental health. Not enough time to rest and relax can contribute to poor mental health. Spending too much time or not enough time having meaningful interactions with other humans, depending on whether you're an introvert or an extrovert, can contribute to poor mental health. Being in a career or working at a job that doesn't give you enjoyment and fulfillment can contribute to poor mental health. Not having adequate coping skills to deal with things like the death of a loved one, a relationship breakup, prolonged conflict and stress within a family unit, having to live or behave in a way that feels contrary to who we are, or any other negative life experience can contribute to poor mental health. Basically, any prolonged period in life in which your social, emotional, and psychological needs aren't being met can lead to poor mental health, just like not meeting your body's physical needs leads to poor physical health.

When someone has poor mental health that does not mean that they have a mental illness. Poor mental health is not always a clinical condition, unless a person has a stress-related or exhaustion-related breakdown of some kind that requires hospitalization. (Although, seeing a therapist to help sort out the things related to your poor mental health is GREAT. Grief counseling...stress management...family therapy...all are good options to help you find ways to meet your specific needs.) Poor mental health can be improved by regularly checking in with yourself to make sure you're doing everything you can to meet your body's needs as well as your social, emotional, and psychological needs. Sometimes, to "cure" a period of poor mental health you may only need to slightly adjust the pieces of your life so that you're able to put more energy into different pieces.

Mental illness is a different thing altogether from poor mental health. Mental health is a fluid state of being. A mental illness is a clinically diagnosed condition that has a specific set of symptoms that severely and negatively affect a person's life. Mental illness, unlike poor mental health, can't be "fixed" or cured. It can only be treated and managed, most often with a combination of therapy and medication. Living with mental illness isn't just about making sure you're meeting your social, emotional, and psychological needs; it's about actually correcting issues with how your brain works, like issues related to the chemicals that the brain produces, reactions in certain areas of the brain, and actual pathways that have formed in the brain.

The causes of poor mental health and mental illness are also different. Poor mental health can often be caused by major life events, things in a person's environment, and/or the way they're living their life at the time their mental health becomes poor. Mental illness, on the other hand, has an internal cause related to how the brain actually functions and may have a genetic component that predisposes a person to develop a certain mental illness. A person with a mental illness may not have even had poor mental health prior to the onset of the symptoms of their mental illness. 

I'll end with this: Mental health is a state of being, like physical health, that can and does change from time to time depending on how well our needs are being met and how well we're coping with our life experiences. Mental illness is a clinically diagnosed condition that has a specific set of symptoms that severely and negatively affect a person's life and is usually treated in a specific way with therapy and medication. Being in a state of poor mental health and having a mental illness are not the same thing. A state of being can be changed and remedied, but a mental illness can only be treated and managed for the rest of someone's life. 

Some is Better Than None

Many of us that live with a mental health condition have probably been told by our mental healthcare team that we needed to make some lifestyle changes as well as taking medication and going to therapy in order to help our unwell brains become healthier. We've probably been told that exercising would help improve our mental health along with getting more sunshine. If your therapist is anything like mine, they may have also suggested taking up a meditation practice, doing yoga, and even diet changes to help manage the day-to-day symptoms of our mental health conditions.

Being asked to make all those lifestyle changes at once can feel like we're being asked to do a complete lifestyle overhaul, and that can be daunting, to say the least. The knee-jerk reaction for many of us is to say, "I'm never going to be able to make these big changes like they've asked. I'm not even going to try so I don't have to fail at it." It's not that we don't want to do it a lot of the time, really. Sure, resistance to the therapeutic process might be a piece of the puzzle, but the other pieces of the puzzle are all real world based. Those big changes can be hard to make because of budget, time, energy, and actual physical limitations that we have to work with.

When I first began my meditation practice, I would constantly take this issue to my therapist. I knew from research that twenty minutes of daily meditation is the amount of time recommended by scientific studies to be the most beneficial for helping manage the symptoms of mental illness. I felt like I was failing at meditation because I just couldn't make it to the recommended twenty minutes. I could comfortably do ten minutes before I started to feel stiff and fidgety and before I got antsy for it to be over. There were also times that I couldn't even find the time in my day to do the ten minutes. 

My therapist would always remind me of the same thing. She would say, "Just remember that some is better than none. Just because the science says that twenty minutes of meditation a day is the MOST beneficial for our brains doesn't mean that less time isn't beneficial, too. Any time you spend in meditation, whether it's ten minutes in a quiet room, a couple of minutes in the car, or even a minute in line at the grocery store, is better than spending no minutes in meditation."

She had the same approach to exercise and diet. Some smaller healthy changes that build to a bigger change are better than making no healthy changes in diet and exercise at all. If you can't do a complete diet overhaul, swap one unhealthy snack for a healthy one each day, like swap carrots, olives, or an apple for your usual potato chips or swap water for one of the sodas or sugary juice drinks each day. If you can't do a full work out because of time constraints with work or school or because of physical limitations, find some stretches to do at your desk or find some targeted exercises that work with your physical limitations that you can do so you're doing some exercise. 

The point is that we're trying to make the changes that will help our unwell brains. Instead of getting hung up on how big and daunting the changes feel before you start, and instead of remaining locked into the same patterns that are unhealthy because you have no idea where or how to start, just remember: some is better than none. Some of a good change in whatever area you need to work on is better than no good change in that area. You can always build on the "some" and the small changes as you go along and figure out what you have to work with in your life until you reach your goal.

I'll end with this: Being asked to make lifestyle changes in order to help our unwell brains can feel like we're being asked to overhaul our whole lives, which seems impossible to manage for a lot of us with budget, time, energy and/or physical limitations. But...we don't have to do the whole overhaul at once if it doesn't fit in the confines of the resources that we have. It's okay if you can only make smaller lifestyle changes, and you shouldn't feel like you're failing or that those smaller changes won't be beneficial for you. Remember you're doing your best with what you have to work with, and also remember that some healthy lifestyle changes are better than no healthy lifestyle changes. You can build on the "some" whenever you have the ability to do so, but you can't build on anything if you don't start it.

Who Am I to Tell You?

 I recently saw a series of tweets by Allison Raskin, a mental health advocate that I respect and admire, and I've been thinking about her tweets ever since. In these tweets, she talks about how she used to "gate-keep" OCD diagnoses. She said that she used to be someone who didn't want people to say they had OCD unless that person had been diagnosed by a mental health professional. She went on to say that she felt differently now because she realized that, basically, she didn't have the right to say whether another person had "OCD tendencies or enough symptoms for it to significantly impact their life."

I hadn't realized it until I read the words of Allison Raskin that I'm also guilty of gatekeeping mental health diagnoses, especially OCD diagnoses. I've had a few people in the past earnestly tell me that they believed they had OCD. A dear friend once told me that he believed he had "a touch of OCD" after I disclosed my diagnosis to him. My response was usually to tell the person something like, "Well, unless you see a mental health professional and get a diagnosis, you can't really just go around saying that." After my dear friend said he thought he had a touch of OCD, I remember telling him, "You can't have a touch of OCD, really. You either just have it or you don't, and you need to see a professional to find out for sure." I have to admit that I was also a bit offended when people would say they had OCD if they hadn't been clinically diagnosed. 

My reasons for gatekeeping are similar to the reasons Allison Raskin laid out in her tweets. Like her, I also felt like people self-diagnosing OCD (or any mental health condition, really) would minimize the condition and the struggle of living with it. My other reason for gatekeeping was well-intentioned, but it was still gatekeeping. I didn't want people to self-diagnose mental illness because they might be wrong. I was worried they would self-diagnose a mental health condition and get the condition wrong and then apply the wrong at-home treatment approach or that what they thought was a mental health condition could actually be a neurological condition or some other physical health problem that needed timely medical intervention.

Thinking about it now, of course, Allison Raskin is absolutely right. Who am I to say whether or not someone has a mental health condition? I don't live in their body with their brain. I don't live their life with them every day. Who am I to say whether or not and to what degree something impacts somebody else's life? I don't have the right to tell them that they can't say or think they live with a certain mental health condition because they haven't been given a clinical diagnosis from a mental health professional. Not everyone has access to a mental health professional to even get the clinical diagnosis. 

My job isn't to police whether or not someone has a mental health condition based on whether or not they have seen a mental health professional to tell them they have the condition. My job isn't even to observe them to see if they actually have symptoms of the mental health condition so I can disprove or approve their self-diagnosis. My only job is to ask, "How can I help?" and then listen to them when they tell me what they need from me, whether that's helping them find information about the disorder they're concerned about, helping them navigate finding mental health services, sharing what I've learned in therapy, just listening to them as they think out loud about it, or just checking on them every so often.

I'll end with this: Recently, thanks to Allison Raskin, I realized I had been gatekeeping mental health diagnoses and that I shouldn't have been. I don't have the right or the knowledge and insight to tell someone whether or not they have a mental health condition or to what degree it affects their daily life. I don't live in someone else's body to experience the way they think and feel, and I'm not a mental health professional qualified to observe and diagnose them. In situations in which someone believes they have a mental health condition, my only job is ask how I can help and then actually listen to what they need from me.

My OCD Didn't Make Me a Better Person

I get varied reactions when I mention that I live with a subtype of OCD called primarily obsessional OCD and that my obsessions tend to be religiously and morally based. Some people are confused but curious because they never knew OCD could be more than the stereotypical contamination or checking type of OCD. Some people think I'm joking when I tell them that I can't lie. Some people are dismissive because the particular type of OCD I live with doesn't seem like a "real" mental illness. Then some people say things like, "Well, at least your mental illness makes you a better person."

I know, or at least I hope, the person is saying that statement from a place of kindness. I try to remind myself that the person is probably trying to find the silver lining in a situation that they don't really understand. However, statements like the above really hit a nerve with me. 

On the surface, the statement feels dismissive of my mental health struggle. On a deeper level, it feels uncomfortably close to the "transformed by suffering" trope we see over and over again in movies and books in which something tragic happens to a person who consistently lives in a moral shade of gray, and then they suddenly realize they need to be a better person after the tragic thing happens to them. It feels, to me, like the person is softly implying that my OCD is the tragic thing that turned me into a better person, which isn't really how OCD works.

The thing about OCD, according to my therapist, is that it tends to attach to the areas of a person's life that are most important to them, and then it tortures them with it. For people with morally based OCD, sometimes called Scrupulosity, those people are already morally upstanding people that are doing their best to be honest, kind, and helpful, but OCD makes them doubt that and then tortures them with intrusive thoughts related to falling short of their version of moral perfection. For people with religiously based OCD, they're already walking in a path of faith and doing their best to live their lives according to that faith, but the OCD torments them with thoughts related to their sins, their higher power's anger at them for falling short of perfection in their religious practice, and terrifying blasphemous thoughts. This aspect of life that the OCD is attached to is so important that the person often feels a crushing amount of guilt and shame. With OCD there is no such thing as "good enough"; it has to be complete perfection or we're complete garbage. 

I was already doing my best to be a good person. I was already doing my best to walk thoughtfully down my faith path. My OCD didn't make me a better person or a more devout Christian. All it actually did was give me an unhealthy dose of moral perfectionism, and it made me hate myself so much that I thought it would be a blessing if I didn't exist anymore. I didn't need all the mental anguish that comes with living with a mental illness to grow as a person or to push me to strive to be the best version of myself. What I needed was to be able to love myself while allowing myself to be as human as possible so that I could learn from my mistakes and grow as a mentally healthy person without the rigid black and white thinking and self-loathing that comes with OCD. 

I'll end with this: Some people think that certain mental illnesses like morally themed OCD and religiously themed OCD make the people that live with them better people. On the surface, sure, it might look like that because the person is really honest and kind or really devout. But...that's not actually how OCD works. OCD actually attaches to an area that is really important to someone and then basically tortures them with it. Since that area was already super important, the person was actually already trying their best to be morally upstanding or trying their best to walk thoughtfully down their faith path. They didn't need to be made into an even better or more devout person by irrational fear, mental anguish, and self-loathing. 

The Balance of Moments

     A lot of the time, living with a mental illness can feel like living with a bully inside our heads. It can feel like OCD and other anxiety disorders hoard our worst fears or our most embarrassing and most shameful memories to use against us when we start to feel the least bit secure or confident. Another way that our mental illness can be a bit of a bully, too, is by making us feel like we're difficult to deal with or a burden to our family and friends. 
    Life with anxiety comes with its fair share of panic attacks and stress crying. Sometimes, I end up catastrophizing in a situation, and all I can see are bad, worse, and end-of-the-world types of outcomes, which, of course leads to panic, hopelessness, and crying. Then loved ones have to deal with me after the crying or sometimes even during the crying. I'm frustrated that I've catastrophized myself into a panicked meltdown when I can logically see that I have catastrophized AGAIN, but I can't stop it once that ball starts rolling. They're frustrated because they may not even know why I'm crying or how to talk me down from that panicked ledge that looks right down at the end of the world.
    After it's all over, I'm left feeling, at best, like I was difficult in a situation that didn't even need to be made difficult by me or, at worst, like I'm a burden that my loved ones probably wish they didn't have to deal with at all. After every panicked meltdown I have that my mother has to witness, I'm so sure she's just going to be so tired of having to deal with me that she kicks me out of the house. In reality, she would never do that, but my anxiety often is not based in reality. My anxiety makes me feel like I'm such a difficult person, that I'm so hard to live with most of the time, that the only logical option is that people must not want to have to deal with me at all. I mean, some days I don't want to deal with myself either, so I get it.
    When I talked to my therapist about these feelings, she told me that just because we have moments that are difficult doesn't mean that we, as people, are difficult or a burden. She asked me if I had a friend who was experiencing something and catastrophizing until they cried if I would think they were difficult or a burden. Of course, I wouldn't. So, she asked me, "What makes you different from your friend? What makes you feel like you're more difficult and that people don't want to deal with you?" I didn't have a logical answer that didn't have to do with my mental illness. 
    My therapist also asked me to think about the balance of the moments. Sure, there are difficult moments. Sure, there are moments when I'm a difficult person to deal with and people get frustrated with me. However, there are also good moments in my relationships with people...moments in which I'm funny, moments in which I'm caring, moments in which I'm the one listening to loved ones and offering helpful advice, and moments in which I make people's lives a little bit better because I'm part of their lives. She also reminded me that it's likely that the difficult moments don't actually outnumber the good moments and that the difficult moments don't take away from the good moments. 
    It's also important to remember that all humans have moments when they're difficult to deal with, whether or not they live with a mental health condition. Nobody is pleasant and agreeable all the time because we all have changing moods, unpleasant thoughts, and days that feel like they're terrible for lots of internal and external reasons. What's important is to view the bad days in the whole balance of good and bad moments and to try to remember not to believe everything you think.
    I'll end with this: Life with mental illness comes with its fair share of moments that are difficult for us and of moments in which we're difficult to deal with. The moments in which we feel like we're being difficult or making a situation difficult can often lead us to feel like we're too difficult so that our loved ones wish they didn't have to put up with us or like we're a burden. Instead of letting that feeling take hold it's important to take the time to view the difficult moments in the whole balance of moments in our lives. Sure, you were difficult in that one moment, but that doesn't mean there weren't moments before and won't be moments after the difficult moment in which you did or can improve the lives of your loved ones by being yourself and being the kind, understanding, funny, and/or helpful person that you usually are.

Therapy Doesn't Work?

    Sometimes when I bring up therapy, people tell me that it doesn't work. I hear this from people who have never tried therapy at all, sure. However, I also hear this from people who have gone to therapy for a mental health condition who feel like therapy didn't help them, or worst-case scenario, that therapy made their mental illness and/or trauma worse than it was before. 
    I get it. I've been there. Through no fault of her own, my first therapist felt like she made my OCD and panic disorder worse. While I was in therapy with her, I probably would have been a person that was extremely hesitant to recommend therapy to other people because, at the time, I felt like therapy didn't work. Then I met my current therapist, and I finally started to manage my mental health conditions well enough to truly improve and begin a real wellness journey with the things she was teaching me.
    A lot of people think that just starting therapy sessions with any licensed mental health professional is the most important thing about therapy. It isn't actually. The most important part of starting therapy is actually finding the right therapist for you. This means finding a therapist that matches you in certain areas like their area(s) of expertise, the therapeutic techniques they use to treat clients, their treatment plan for you as a client, their ability and willingness to be available when you need them for regular sessions as well as emergencies, and their goals for your treatment. If you don't match with your therapist on these key elements, then, of course, you're not going to get what you need to improve from that therapist, and you're going to have the idea that therapy doesn't work because you're not improving. 
    My first therapist, although I was attached to her because she was the first professional that ever told me there was a name for the thing that made me hate myself and that it was a treatable condition, was not the right therapist for me. I needed more frequent sessions that she was able to offer me. She also didn't have the experience she needed to be able to adequately treat my subtype of OCD. So, of course, if I wasn't getting the treatment I needed from her, my mental health was going to continue to get worse. 
    It also seems like a lot of people expect therapy to work faster than it possibly can, and then they start to think therapy doesn't work because they aren't getting "better" fast enough. Therapy is a slow process. It's literally rewiring your brain and forming new neural pathways to make your brain healthier. You can't go to a month's worth, or even three months' worth, of therapy sessions and expect your mental health condition to magically disappear. If that's your expectation, of course it's going to seem like therapy doesn't work, and you'll be more likely to stop going to therapy before it has the chance to truly work. (Medication can generally help chemically rewire a brain faster than therapy alone for some conditions, but that's an option that people need to discuss with their treatment team.)
    I should also point out that some mental health conditions can be medication-resistant in some people. This naturally means that treating mental health conditions in those clients will be more difficult and will take longer. This doesn't mean that therapy doesn't work for them. It just means that it doesn't work as quickly as it does for clients that have medication as part of their treatment plan. 
    I remember when I first started therapy with my current therapist. I cried every week in my sessions for at least the first two months, and I cried more at home as I was learning to process and manage my anxiety and my other emotions in healthier ways. Even after I stopped crying in my sessions, it took a few more months to notice myself feeling, thinking about, and interacting with my OCD and panic disorder in a healthier way. I had to learn to let go of my expectations about how quickly I would get better and actually give the things I was working on in therapy time to change my brain. That's when I was able to let therapy do its job without judgment and impatience, and that's when I was sure therapy was working for me. But, before I saw that progress, man, did I want to give up a few times. (I'm really glad I didn't.)
    I'll end with this: Some people think that therapy doesn't work. They're not completely wrong, but they're not completely right in thinking that either. Therapy with the wrong therapist, the wrong treatment plan, the wrong treatment goals or expectations, and/or the wrong medication(s) will be therapy that doesn't work. When one of those things isn't right for someone, it can be discouraging, and it can make anyone want to give up on therapy altogether. It can even make us feel like it's our fault that therapy isn't working for us even though we desperately want it to work. However, therapy DOES actually work when you find the right therapist for you, and you actually give the therapy the time it needs to start working on your brain. If therapy hasn't worked for you before, or it currently isn't working, it may not be that therapy doesn't work at all; it could mean that one of the key elements doesn't match for you and something needs to be changed in order for you to get the help you need.