Showing posts with label shame. Show all posts
Showing posts with label shame. Show all posts

Why Get Diagnosed with ADHD - And Introducing Jesse Anderson

Am I the oldest new member of the ADHD club? At age sixty-nine, why bother with a diagnosis and treatment?

That was the attitude of my new and now former primary care provider. She said that the prefrontal cortex develops out of ADHD in adulthood, or that people learn workarounds for its difficulties.

She didn't ask about my prefrontal cortex, or whether I had found workarounds. She thought I should just not worry about what I can't do.

As I said, former care provider.

But back to that question - why bother?

Two reasons:

Treatment for ADHD works

Sure, over those many years I developed some workarounds, ways of coping with the challenges of my neurologically divergent (ND) brain.


But they weren't alway sufficient. There were key times in my life when I failed to reach my goals because I couldn't get started, because I couldn't keep going, because I couldn't maintain concentration, because I couldn't remember, because I couldn't turn down the emotional interference that I experienced as a consequence of all the other symptoms. SHAME! Loads of SHAME!

My workarounds got me a certificate in congregational development. But I am not the Rev. DOCTOR Willa Goodfellow, because - I couldn't.

And yet today, I still have more I want to do, big things for which my workarounds have not been sufficient in the past and are not now.

But that pill, that tiny pill, that fraction of a pill after I cut it with my pill splitter, because for me it never takes much. . .

It was like the window opened, the sky was clear, I sat down, like I am right this very minute. . .


And I worked.

That's all. I didn't speed. I didn't stay up late. I didn't go down to the schoolhouse to score some more tabs off a sixth grader.

I simply worked. My brain was clear and in gear. And I got the job done.

There are things I want to do, books I want to write and promote, podcasts on which I want to be a guest, deadlines I want to meet. And one little fraction of a pill has opened the window for me.

Treatment works.

Community for people with ADHD helps

That's the second reason to get diagnosed, community. Just like any other challenging condition, the people who have it can help each other. Breast cancer, kidney cancer, Parkinson's, depression, bipolar, alcoholism, arthritis, eating disorders - whatever you've got, hanging out with others who have it too is huge. Community offers support, reassurance, information, and resources.

Once I knew I had ADHD I no longer felt like I was keeping a shameful secret - my failure to do what everybody else on the planet could do and what I expected myself to do.

And then I discovered others.

Twitter is a godsend for all things diverse, including neurologically diverse. It's where you find the people like you. Because there are people like you.

So if you have or wonder if you have ADHD, head for the bird app. This link will take you to the posts that people have tagged with #ADHD. That's a start.

Jesse Anderson

And this link will take you to Jesse Anderson on Twitter.

Jesse has a newsletter filled with ideas and strategies to help people with ADHD manage our time, energy, and motivation - those workarounds that we all supposedly discover on our own by the time we are sixty-nine. We don't all have to reinvent the wheel by ourselves!

Jesse has a podcast called ADHD Nerds that's just getting started. Personally, I am glad that they come in at around thirty minutes. Because who has the attention span for those ninety minute podcasts? - Not somebody with ADHD! Four episodes so far. I hope he finds it interesting enough to keep it going, because I find it interesting enough to keep listening.

And he's writing a book, Refocus: A Practical Guide to Adult ADHD. Not out yet. When it is, I'll drop a review. But get this - he is inviting input about what should be included. So go to that website; see what's already in the table of contents; send him your own thoughts.

So yeah, folks, even if I am the oldest kid in class, I am glad to have gotten here. I really like the consequences - being able to get stuff done, stuff that matters to me.

And finding my peeps. You rock!

photo of old lady and last meme from memes.com

photo of window to the sky, taken in the Dingle_Peninsula,_Co._Kerry,_Ireland by Maoileann, used under creative commons license

photo of handshake by shark, used under GNU license

What Happened When Meghan Markle Asked for Help?


Ask for help. That is the suicide prevention message. When you are in trouble, ask for help.

And I am not going to suggest otherwise. That's about the only way you will get help. The pain that you are in, the scary thoughts that you are having, there is a way out that is a way through, that leaves you alive on the other side. The way begins when you tell somebody, when you ask for help.

That, alas, is not the end of the story. This week we watched as a princess, a celebrity, somebody who lived in a multimillion dollar house in a multibillionaire family told her story of what happened when she asked for help.

They told her, No.

Trauma, COVID-19, and Cutting Yourself Some Slack

Are you failing to build your abs while social distancing?
Or learn that new language?
Or clean out that closet (you know which one)?

Are you utterly exhausted while getting nothing done and beating yourself up for it?



STOP. Just stop.
And read on.

Silence Kills -- The Stigma of Mental Illness Redux

It's Mental Health Month again. Out comes the stigma word, the pleas for understanding, the heart-warming whatever.

I am so done with stigma. Frankly, I am insulted that NAMI et al still use the word. Is Black Lives Matter about stigma?  It's dangerous to be either in the US, and for the same reason. Prejudice, people. We are talking about prejudice.

The following was first posted in July 2013. Alas, we are still trying to get our heads out of our asses. The Affordable Care Act made some progress, a little, toward mental health parity. Insurers had to get creative to deny us coverage. But this congressional session, it's all up for grabs again, whether our illness will get covered at all. And the prejudice of doctors -- don't get me started.

So from July, 2013 --

                              *************************

I don't use the s-word. I hate this title. I use it only because people who need this post will use it when they google.

I don't use the s-word. But here it is.

First from Google:

Definition of STIGMA

Noun
  1. A mark of disgrace associated with a particular circumstance, quality, or person: <the stigma of mental disorder>.


How To Tame Your Mind -- Ruby Wax

It's like training a dragon, only harder.

Ruby Wax nails depression: when your personality leaves town, and suddenly you are filled with cement.

She nails the problem: our brains don't have the band width for the 21st century.  Nobody's brain does.  Yours doesn't, either.

And she nails the solution: learning how to apply the brakes.

Hey, Jesus - Happy Hanukkah!

I must be one of ten people with mental illness in the United States of America who does NOT have holiday trauma issues.  My personal desperate darkness starts each year in late July and breaks some time in late October, with mild depression fading out through November.

Thanksgiving to New Year's is pretty much my best time of year.

Nevertheless, this year I have been sad, not depressed really, just sad, as I read on Facebook the hostility that has come to be the litmus test of Christian fervor.  Evidently inspired by Fox News, Merry Christmas is no longer an expression of joy and good cheer, but a battle cry against the First Amendment and the great American experiment of freedom and tolerance of difference.

Irony abounds here.  One of my own ancestors came over on the Mayflower, as a matter of fact.  The Puritans wanted freedom to practice their religion, not anybody else's, just their own, including a prohibition against Christmas, which they outlawed in 1659.  They knew their religious history, that the holiday originated as a pagan festival, full of excess of every sort, with the thinnest wash of Christian appropriation added later to assure pagans they could still celebrate the Winter Solstice after they got baptized.

The Puritans had mellowed by 1712, when Cotton Mather, whose credentials are as Christian as you get, preached tolerance for other Christians who did want to celebrate the baby's birthday.  I do not now dispute whether People do well to Observe such an Uninstituted Festival at all, or no, he said.

He went on to encourage a Romans 14 attitude: Good Men may love one another, and may treat one another with a most Candid Charity, while he that Regardeth a Day, Regardeth it unto the Lord, and he that Regardeth not the Day, also shows his Regard unto the Lord, in his not Regarding of it...

According to Cotton Mather, he believed in "political correctness", because he found it in the Bible, in Paul. 

The Brain And Christmas, Or At Least Something, Anything

Christian, Jew, Zoroastrian, Wiccan, Druid, "spiritual but not religious," and plain old capitalists, as the days get shorter, our pineal glands go into overdrive, pumping out all that melatonin that makes us want to hibernate.  Our brains cry out for relief.  Push back the darkness!  Light a candle!  Light a bonfire!  Wait a minute -- just a log.  Nothing in the brain requires that anybody get burned at the stake.

Regular readers know that, while Prozac Monologues is not for the purposes of evangelism, I make no secret of my Christian faith, and even defend religion and the disciplines of church membership as resources for mental health.

But not any religion.  Not what passes for Christianity but looks suspiciously like, well -- fascism.  There, I have said the word.  When the cross gets wrapped in the flag, no matter whose flag, you know that the frontal cortex is offline, the lizard brain is in charge, and somebody is about to get crucified.

Which is so not what Jesus would want for his birthday present.

I mean, the first guests invited by heaven to his party were the scruffiest low lifes of the neighborhood, who had probably been passing the bottle to keep warm that night, and some foreign fire-worshipers, for crying out loud!

Theology Alert

He came as a baby.  He came vulnerable.  He came helpless.  In the core and mystery of what Christians call Incarnation, God-in-flesh, that very vulnerability is how God tells us how much God loves us, that the great Almighty would set almighty aside in order to pitch his tent among us.

That God desires to be with us, and will pay whatever price that requires, and would indeed require, is the core of the Gospel, all we need to know that we are beloved.  We are worthy.  Knowing that, then we can exercise the courage it takes to treat others as beloved and worthy.

We can even say, to show our rejoicing for the worth that God gives us and our rejoicing for the worth that God gives our neighbors, Happy Holidays!

These days are holy, they are graced by God's presence among us, whatever days you keep.  That is what I believe.  And I hope for you that these days are happy.

Research on Vulnerability

So here is where the deep truth about God-With-Us and mental health research come together: Brene Brown, research professor at the University of Houston Graduate College of Social Work on The Power of Vulnerability.




That baby who slept in the cold and all the babies who tonight sleep in the cold call us to look deep, deep into our hearts, the hearts of our neighbors, the heart of the world, the heart of God.

Happy holidays.

painting of Announcement to Shepherds by Gaddi Taddeo, c. 1327, in public domain
mezzotint portrait of Cotton Mather by Peter Pelham, 1700, in public domain
photo of Luminaria at Lake Washington from Seattle Municipal Archives, used under the Creative Commons license
painting of Madonna and Child with Cherries by Jan Gossaert, c. 1520, in public domain

OMGThat'sWhatTheySaid! -- Stigma

On November 26th, the New York Times published an article about the presidential policy not to write letters of condolence to the families of service men and women who commit suicide in a war zone.  These letters of condolence have gone out since Abraham Lincoln started writing them during the Civil War.  Given the upswing of suicides in the Armed Services lately and the attendant publicity, this policy of silence, which began in the Clinton era, is coming under scrutiny and challenge.
In response to this article, psychiatrist Dr. Paul Steinberg wrote an Op-Ed commentary titled "Obama's Condolence Problem," winning him this month's OMG Award for -- oh, it's hard to choose.  There are so many prize-worthy lines.  But let's call it for: Indeed, there is nothing wrong with stigmatizing suicide while doing everything possible to de-stigmatize the help soldiers need in dealing with post-traumatic stress and suicidal thoughts. I will deconstruct this sentence after putting it in context.

Dr. Steinberg is concerned that any recognition of suicide, even the reporting of it, glorifies it and makes the taking of one’s life a more viable option. If suicide appears to be a more reasonable way of handling life’s stresses than seeking help, then suicide rates increase.

Dr. Steinberg is clearly in the voluntarist camp, believing that people make a conscious, reasoned choice to kill themselves.  Suicide, in his view, is an option, a way of handling life's stresses.  He is in, if not good, then plentiful company, who believe that even while the thought processes of those who commit suicide are impaired, their will is not. They remain responsible for their choice.

Regular Prozac Monologues readers know that I am not in the same company.  Dr. David L. Conroy gave me the words.  From Out of the Nightmare: Recovery from Depression and Suicidal Pain, "Suicide is not chosen; it happens when pain exceeds resources for coping with pain."

Conroy describes the many ways that people who are suicidal attempt to reduce their pain and save their own lives.  Those who are suicidal sometimes use the language of choice and reason.  Conroy, who speaks from personal experience, says it is terrifying to have such little control over our own emotional state that it can shove us headlong over the abyss.  This lack of control is part of, and adds to suicidal pain.  To claim that we have considered the options and are making a reasoned decision is a grasping for the image of control; it is an effort to relieve pain.

Steinberg asserts that choosing suicide over treatment is deserving of shame.  Now that first-rate treatments for depression and post-traumatic stress have evolved and are readily available, and people with emotional problems do not have to suffer quietly, are we taking away the shame of suicide?  When he decribes depression treatments as first-rate, he parts company with the National Institute of Mental Health and many doing research in the field, who acknowledge the true state of treatment.  At least a third of those who seek treatment are not able to find a medication that is effective and tolerable.  Meanwhile, certain side effects of these first-rate treatments themselves increase the risk of suicide, doubling it in the case of insomnia, a frequent side effect of SSRI's and SNRI's.  Akathesia (called "inner restlessness" on prescribing information sheets) is one of the most under-reported side effects, due to euphemisms, and among the five top risk factors for suicide among hospitalized patients.  [Side note: when you read "inner restlessness" on your prescribing sheet, did you realize that "inner restlessness" could significantly raise your risk of suicide?]

Steinberg believes that letters of condolence to family members could be an inadvertent incentive to suicide.  In light of the condolence-letter controversy, the administration is appropriately reviewing the policy that has been in place for at least 17 years — and may indeed want to consider leaving it as it is. But as a country, let’s focus our energies on doing everything we can to diminish inadvertent incentives that might increase self-inflicted deaths.  And elsewhere: We need to find the right balance between concern for the spouses, children and parents left behind, and any efforts to prevent subsequent suicides in the military.

I feel downright silly answering this argument.  But here it is:

First, the shaming of suicide is indeed one of the resources that we possess against it.  But it is an even more significant reason why people do not acknowledge and seek help for thoughts of doing it.  Shame interferes with willingness to report symptoms.  And failure to report symptoms is a significant factor in failure to recover.  To think that we can shame suicide and prevent it at the same time is fanciful. There is no balance to be found here.

Second, it is well known that surviving family members are themselves at greater risk of suicide.  Shame increases their pain, including their suicidal pain.  It is a barrier that prevents them from seeking support and prevents friends from offering it.  A letter from the President could go some distance in reducing the shame of family members and providing comfort in the midst of their pain.  If prevention of suicide is the goal, here is the most direct intervention the President could make.

Now back to the beginning.  Indeed, there is nothing wrong with stigmatizing suicide while doing everything possible to de-stigmatize the help soldiers need in dealing with post-traumatic stress and suicidal thoughts.  Putting to one side the impossibility of de-stigmatizing the second while stigmatizing the first, let's take a closer look at what Dr. Steinberg wants to de-stigmatize -- the help soldiers need.  What help would that be?  Psychiatry, leading the mental health professionals.

Steinberg wants to stigmatize suicide and de-stigmatize himself.  That's natural enough.  Nobody likes to be the object of stigma.  People who experience suicidal pain can identify with him in his desire. But I took a fanciful direction upon reading this op-ed piece.  I imagined Dr. Steinberg as a chaplain taking a course in Clinical Pastoral Education.  Are my clergy readers following me here?  Think back to your CPE experience.  Imagine the conversation in group after Dr. Steinberg says Indeed, there is nothing wrong with stigmatizing suicide while doing everything possible to de-stigmatize the help soldiers need in dealing with post-traumatic stress and suicidal thoughts.  Somebody from my CPE group would surely have asked, "How does it feel to be the object of stigma?"  And if he returned the question with a quizzical look, "How do you feel to know that people would rather commit suicide than come to you for help?  What does that mean to you personally?"

To my psychiatrist readers (do I have any?), do you have any training like CPE, where you are asked to examine your personal feelings and consider how they affect your judgments and your treatment of patients?  Does it include your judgments about suicide?  How do you feel about yourself when one of your patients commits suicide?   How do you feel about that patient, and the next patient with suicidal ideation?  Can you acknowledge those feelings?  Is shame part of your own experience?  Where have you put your shame?  Your feelings are just that, feelings.  Can you use them to inform your understanding of your patients?

I posted a facebook status last week with a link to Dr. Steinberg's article, asking, "Do patients with any other disease face such disrespect from their doctors?"  I am going out on a limb here.  But I wonder if many psychiatrists have not yet dealt with their feelings about their patients' dying.  When oncologists did, the treatment of cancer patients changed.  Now, who even remembers that cancer once was shamed?

Out of the Nightmare: Recovery from Depression and Suicidal Pain

Suicide is not chosen; it happens when pain exceeds resources for coping with pain. 

David L. Conroy had me at the opening sentence.  I read it first at Metanoia.org and knew it came from somebody who had been there.  I recommend the website for help and insight from the insider's perspectiveIf you are thinking about suicide, read this first. 

Depression and the Shackles of Shame


There is no blood test for depression, no x-ray nor sonagram.  Depression is the label that is given to a constellation of symptoms.  There are theories about the cause of the symptoms.  But the diagnosis is more like tea leaves. 


Depression Diagnostic Criteria 

· Lasting sad, anxious, or empty mood
· Loss of interest or pleasure in activities once enjoyed, including sex

· Feelings of hopelessness or pessimism
· Feelings of guilt, worthlessness, or helplessness
· Decreased energy, a feeling of fatigue or of being “slowed down”
· Difficulty concentrating, remembering, making decisions
· Restlessness or irritability
· Sleeping too much, or can’t sleep
· Change in appetite and/or unintended weight loss or gain
· Chronic pain or other persistent bodily symptoms without physical cause
· Thoughts of death or suicide, or suicide attempts
.


If you have five of the above, including one of the first two, for more than two weeks, and without appropriate reason (like, your mother died) then that's depression. You've got the Grim at the bottom of your teacup. 

Guilt

I have done enough intake interviews that I recognize the differential diagnostic tree when it's coming at me. I used to get nervous when they asked about guilt. No, I don't actually feel guilt, except appropriate guilt for recent misbehavior, not the horrible self-judgment for imagined offenses. I don't feel guilty for my depression. I am not the offender but the offended.

Shame

No, what I feel about my depression, and events that are related, is shame.  And what I really feel shame about is feeling shame.

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