It's a Mental Healthcare Issue, Too

*Warning: This post will be political as well as personal. Discussion of Roe v Wade. 

Mentally ill people are considered a vulnerable population. People with mental health conditions are more likely than people without mental health conditions to be victims of crime, including domestic violence and sexual crimes. In addition to that, many people with mental illness live in poverty because their mental health condition prevents them from getting and keeping a steady job. Many people with mental illness are on disability for their mental illness, and they can barely survive on that small monthly check when they have to pay rent, food, and utilities costs. Never mind about paying for medications that aren't covered by insurance if they even have insurance, a car with car insurance, or a cellphone. Many mentally ill people are so unwell that they can barely take care of themselves, let alone another human being.

I am a mentally ill person. For the rest of my life, I will be a mentally ill person. Now, I may have reached a point in my treatment that I can live alongside my mental illness without fighting it every day of my life, but I do still have some periods in which my mental illness severely affects my ability to function at my usual level. Keeping my mental health in a place where I have more good days than bad days is like a full-time job for me, and it's the kind of full-time job that I can't really slack off of or take a vacation from. 

I am also a person that does not want children...at all...ever...even under "ideal" circumstances for a lot of reasons that I won't go into detail about in this post. I did not make that decision lightly. I did not make that decision because I'm irresponsible, immature, selfish, lying to myself, too feminist, or any other stereotype that seems to be tossed at people who choose not to have children. I made the decision because being childfree is the best choice for me, my life, and my mental health.

Not only would having children be bad for my mental health because I would be trying to make myself fill a role that I felt I wasn't meant for, but I also already live with two clinically diagnosed mental health conditions. Treating, managing, and living healthily with those conditions takes a significant chunk of my internal resources. Parenting a child properly takes practically all of a person's internal (and in many cases all of a person's external) resources as well. So, when I consider the resources that I have and my mental health in thinking about whether I could adequately parent a child without my mental health or the child suffering, my answer is: NO, I COULD NOT DO IT. Yet, I could end up being forced to since I live in state with very strict abortion laws.

I know my story isn't unique. Plenty of people list mental illness as a reason that they have for choosing not to have children. Many people recognize that they don't have the internal and/or external resources to properly care for a child AND themselves. Many people don't want a child to suffer through growing up with a parent that has a mental illness that would interfere with parenting and/or don't want to subject a child to a genetic predisposition to a mental illness that would make life more difficult for them. In addition, many psychotropic medications (the medications used to treat mental health conditions) can cause birth defects, which can make babies unable to survive outside the womb or, if they do survive, they may be a child that needs expensive care or surgeries that someone who lives in poverty because of their mental illness wouldn't be able to afford. 

Since Roe v Wade was overturned by the Supreme Court, many states, including the state that I live in, have laws that will go into effect banning abortions in almost all cases. There are no exceptions for rape or incest in my state's ban. There are also no exceptions for birth defects in the fetus in my state. There IS an exception for the health of the mother, but it only applies if the mother's life is in danger or if a major bodily function would be irreversibly damaged. As you can guess, mental health is not included under the exception for the health of the mother. 

States like the one where I live already don't think of abortion as healthcare unless the person who is pregnant is teetering on the edge of death. So, of course, they completely ignore that abortion is a part of mental healthcare as well. For me, it doesn't seem that farfetched to be concerned that many people with mental health conditions will be forced to stop taking the psychotropic medications that literally save their lives once it's medically confirmed that they are pregnant because the fetus is already considered more important than the person carrying it, according to the coming law in my state.

With laws like these, we'll likely see an increase in suicide among mentally ill people who find themselves pregnant and can't access abortion and can no longer take their medications because they don't want to cause damage to the child they'll now have to raise. We'll see more children neglected and some actively harmed because they live with a parent who can't care for them because of a mental illness. We'll see more children who had the misfortune to be born with a genetic predisposition to mental illness left in foster care until they age out of the system because people don't want to adopt children with "red flags" like a family history of mental illness or possible birth defects. Those "unadoptable" children will grow up to be traumatized adults who will also need access to mental health services because the foster care system isn't actually the kid-friendly system people think it is. 

Forcing more children to be born to people who don't have the ability or the resources to care for them isn't saving children. It's creating more children that will end up suffering. (And no, having a child more than likely won't be the thing that saves a mentally ill person from their illness. It doesn't work like that.) It'll actually create yet another crisis in mental health and even more of a strain for agencies like the Department of Human Services and Child Protective Services.

I'll end with this: Safe, legal and easy access to abortion isn't just healthcare, for many people it's also mental healthcare. If people with mental health conditions are barely surviving to care for themselves, expecting them to care for another human being that is completely dependent on them for survival is only going to be a stress that can exacerbate their mental illness. In fact, forcing anyone to live a life that they feel they can't sustain and be healthy, or that they feel isn't true to who they are, is going to have mental health consequences for them and the child they're going to be forced to care for.

What's the Point?

Currently, no cure for mental illness exists, but mental illness is treatable and manageable. This means that once a mental illness shows up in a person's life, they'll likely be dealing with the symptoms of that mental illness for the rest of their life, even if they go to therapy, take their medications, and do everything they're supposed to do to manage it. This reality of mental illness can lead a lot of people to think, "If it's not even curable, and I'm going to continue to experience symptoms with treatment, then what's the point of getting treatment at all?"

I know, it's really hard to hear that an unpleasant condition is now going to be a thing that you have to make room for in your life instead of a thing that you can get rid of completely. I know it's discouraging to hear that you can do everything "right" and still experience symptoms that interfere with your life. I've been there, and I've felt all the emotions that go along with that realization. I will still tell you that treating and managing your mental illness is worth it, even though it won't be cured. 

Calling life with a mental illness, particularly an undiagnosed and/or untreated mental illness, unpleasant is an understatement. Life with an undiagnosed and/or untreated mental illness is a miserable existence for most of us, and the longer a mental illness goes untreated the worse it tends to get until we reach a point at which we're no longer actually living; we're just...here, drowning in an invisible ocean of misery and barely surviving hour by hour. 

So, what's the point of treating and managing your mental illness if it can't be cured? The point is simple: you deserve it. You deserve to live a life that is made up of more than drowning in the invisible ocean of misery that your mental illness has created. You deserve to live as fully, as healthily, and as happily as you possibly can alongside your mental illness. You deserve the healing that happens as you learn to manage your mental illness and live peacefully with it. You deserve the treatment to be able to get to that place. 

Yes, the mental illness and its unpleasant symptoms will still be there, but your relationship to it and the amount it affects your life will change over time with proper treatment. The treatment and the management techniques make the mental illness less difficult to carry so that you're aware of it but it's not a thing that you're drowning in ALL THE TIME anymore. Bad days will probably still happen, but with treatment and mental health management, the bad days can become more spaced out and a little easier to recover from when they do happen. Treating and learning to manage your mental illness makes life a little easier to live, even with the bad days. 

 

I'll end with this: The reality of mental illness is that it can't be cured. It can only be treated and managed, which means symptoms are going to come and go, even when someone does everything "right" to treat and manage the illness. This reality often leads people to wonder, "Well, what's the point of treatment if I'm just going to keep having symptoms anyway?" The point is that life with an untreated mental illness is miserable, and you deserve to live a life that is filled with more than the misery created by your mental illness. You deserve to heal and to live as fully, healthily, and happily as you can with your mental illness, and treatment and management can help you along that path.

Trending: Mental Health Stigma

Recently, I've noticed people on social media, especially Twitter, saying something that seems to be a sort of slang that goes a little too far, especially when I think about the fact that we're still dealing with a heavy layer of mental health stigma as a society. Lately, I've been seeing people mention a personality trait, habit, or behavior and then say, "that's mental illness" as a way to emphasize that they don't like whatever the trait, habit, or behavior is. Not only are statements like those judgmental and unkind, but they also keep the mental health stigma alive and well. 

The knee-jerk reaction to my assertion about the mental health stigma related to the above-mentioned statements might be to think that I'm just nit-picking. People might roll their eyes and think, "Oh, come on. It's just the newest trend in harmless Internet speak. It'll pass soon enough." You might be right that the trend will pass relatively quickly, but it probably won't pass before somebody in your friend group or family who quietly lives with a mental illness is negatively affected by it.

Statements like the ones I mentioned above turn neutral terms like "mental illness" and "mentally ill" into an insult. When terms like "mental illness" and "mentally ill" are used to convey a dislike of annoying habits or even some problematic behaviors, then being annoying or a "problematic person" can become another generalization about or even another stereotype of mental illness. Once a generalization like that becomes thought of as common knowledge and a stereotype like that makes its way through society, then all people with a mental health condition start being thought of as an annoying and/or problematic person just because they have a mental illness, which can make things like entering into and maintaining a relationship or even finding employment even more difficult when or if they disclose the mental health condition. This extra layer of difficulty can lead even more people to refuse to get a diagnosis and treatment because they don't want to have to deal with the negative assumptions that society will make about them.

Using terms like "mental illness" and "mentally ill" as an insult is hurtful on a deeper level as well. Calling something like a habit or a behavior a mental illness just because you don't like or agree with it trivializes the struggle and pain of living with an actual mental illness. When words like "mental illness" and "mentally ill" start getting thrown around to mean or describe anything less than the actual, diagnosable conditions that take people's lives, the whole concept of mental illness can be seen as less serious than it should be. The mental health stigma already tells society that mental health conditions aren't real health conditions; we don't need slang on the Internet to play up that idea and make it even harder to fight that piece of the stigma.

I'll end with this: I know trends and slang change quickly, especially on the Internet. However, just because things like that come and go relatively quickly doesn't mean that they don't hurt people even after the words and their "updated" meanings have changed or faded from use. The words we use and the way we speak to and about other people matter. Calling something a mental illness that you don't like or agree with isn't only judgmental and unkind; it also helps the mental health stigma maintain its hold in society and makes life that much more difficult for people with actual mental illness.

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.