Wednesday, October 13, 2010

What Makes Mental Illness Bad?



So why is it that some people have a psychiatric disorder and they bounce back and it's not a big deal, while others struggle terribly? For the unlucky ones, mental illness defines them.

Here are some factors that affect how much impact psychiatric illness has in a person's life:
(Note to Roy: did I get the effect/affect thing right here?)

1) The severity of the symptoms.
Any way you dice it, mild-to-moderate anxiety can often be hidden and isn't as disruptive as an episode of psychosis with hallucinations and paranoid delusions.
Just to give an example.

2) The duration of the episodes.
So a chronic depression or severe obsessive compulsive disorder may be more disabling than a brief episode of psychosis.

3) The form of the symptoms.
Some symptoms are intrinsically more public than others, or more difficult to bounce back from. In terms of "Can I be a doctor if I have bipolar disorder?," one episode of walking around the hospital naked may be all it takes to get sent home.

Form and severity of symptoms, and the duration of the episodes, are likely to be intrinsic to the disease and not something the individual controls.

4) How responsive the illness is to treatments.
Some people have very severe symptoms that are very responsive to treatment.

5) External support systems: access to good care, chicken soup, and TLC. Job flexibility may enable some people to quietly take time off when the going gets rough. Understanding friends & family-- these are all good things.

6) Individual personality features that support good coping. This is vague and I just made it up, but it's the best I can do--- maybe 'resilience' is another term for it.

7) Individual special features which help a person compensate. So being extremely intelligent, or extremely efficient and diligent, or very charming and charismatic, may make everything else a bit easier.

8) Stress load. This is hard to say for all people--- many people really struggle when things go wrong, and not all people with psychiatric illnesses relapse under severe stress, but all things being equal, it's probably better to not have a lot of loss and stress in life if one is trying to cope well with mental illness.

9) Co-morbid substance abuse. People with psychiatric disorders and drug or alcohol addictions just don't do as well. Often, it's a toxic combination.

10) Co-morbid medical disorders.

11) A willingness to devote time, energy, money and resources to a healthy lifestyle.
(It can't hurt)

What'd I miss?

28 comments:

HappyOrganist said...

So you're asking why is it bad for some and not as much for others? I think you hit on everything I could come up with. Resilience and stress come to my mind immediately.
You got affect right, btw ;)

Can't wait to see what other people come up with.. =)

simetrias said...

Why, the best pyschiatrist in the world, of course!

simetrias said...

By which I mean, having a psychiatrist whom one considers the best is a means of support like no other.

Sunny CA said...

Great article hitting just about everything I can think of except what "simetrias" added, a great shrink. For me it also required a supportive shrink who thought the neds I had been put on were unnecessary. I did not "bounce back" until I had my short-term memory back and could function in a manner that was not like a zombie, which was not the case when I was drugged up.

The list is great. I especially endorse #11. I think that having a healthy lifestyle with proper food, enough sleep, and exercise, plus the company of friends, not too much stress, and some entertainment can't be over-estimated.

Retriever said...

Other things that help:
Spend money on experiences not things (ie: a trip rather than a sofa)

Build in comforting rituals and structure to your life that will keep you going on autopilot and reassure you if your emotions are overwhelming.

Pets

Time outdoors in the sun, and exercise

Commitment to some cause greater than oneself ( patriotism or some issue, anything that energizes one to help others)
Having children: forces one to grow up and become less selfish, but also surprises us by how much we adore them and by how much joy they bring to life. If one can't exert oneself for one's own sake, one can usualy do so for the sake of beloved children.

It's never too late to develop a creative talent: writing, photography, knitting, painting, whatever. Winston Churchill used to paint (and he had terrible problems with depression--had he drunk less, it might have been easier for him)

Structure regular commitments that you will have to keep but that it will not be fatal if you are too ill to make. For example, a volunteer commitment at church, where people will be looking forward to seeing you, like adorable naughty Sunday school kids who will miss you if you skip class. But nobody will die if you are too depressed to go. You will end up going even if you feel down, and you will rise to the occasion, and teach them better than you thought possible.

Sometimes making a radical commitment to eating only healthy food (without trying to lose weight) can boost morale. Those things like fish oil and salads and better whole grains, etc. really will make you feel better, and when you treat yourself better (by not buying junk) you feel better.

Sign up for some group activity unrelated to mental illness and you will find that plenty of other people grapple with similar issues, they may just not have recognized them yet. Or they may have come out the other side.

Maggie said...

Yes, you did get that correct. Effect is a noun, affect is a verb. (Unless of course it's a noun, but then it's really a totally different word that just happens to be spelled the same. Of course. :-) )

Maybe this is covered under the rest of what you said, but it occurred to me that what you missed could be expectations-- both those of the sufferer and of their support system. When someone decides that you're hopelessly ill and won't be able to accomplish anything, that's hard to overcome, especially when that someone is telling you that your own perceptions aren't reliable and you should be depending on what they think. Few people succeed at anything without first believing that they can.

Sarebear said...

Maggie is talking about a sense of efficacy.

Efficacy is a HUGE problem for me, and something that we've talked about in therapy quite often since day one.

The shrink rappers, having gotten email me from me in the past, with my real name attached, may see some irony in part of my name given this issue . . . . the first time someone made a joke to me about the name, was after several failed inductions of labor that totaled 38 hours, and I was coming in for the final time for the last induction at 2 weeks overdue, and they made a comment. That was the only time I minded, really; I was about ready to punch that nurse in the face. "Maybe this time you'll pass!" Ha ha.

Not.

YOU try being poked and prodded endlessly for the last two weeks of your pregnancy and then someone makes a joke based on YOUR last name.

Speaking of efficacy, I can't even progress in labor, with all that modern medicine had to give. That's an example of how extreme my lack of a sense of efficacy can tank, sometimes, even though realistically there's some things that are just not my fault, after a lifetime of failures, you still try to beat yourself up for 'em, and have a hard time believing you have any sense of efficacy at all. Makes me kind of a hard case, sometimes, as I sometimes think of myself, and I wonder why my psychologist doesn't just throw up his hands in exasperation . . .

Anonymous said...

Having friends or counselors who grasp the real nature of the condition and don't offer the same old ineffective advice or, even worse, proclaim you either don't have the condition, or the condition doesn't exist.

Talking with two darling friends the other night and my ADHD came into the discussion, and before I knew it I was the focus of a kindly advice-fest, advising that I needed to find motivation and I could do this myself by cleverly finding the right techniques.

Oh, and they also advised me that since I am retired, I should just forget ambition and relax and enjoy life.

Plus, for bonus points, they told me that if I had really wanted to achieve X I would have achieved it, but because I haven't done so, this is proof I don't really want X.

These nuggets of advice were not therapeutic.

Retriever said...

Sarebear, off topic, and please forgive me if this sounds presumptuous but it is demeaning to any woman to tell her that she is not progressing in labor. I know it is a technical term, but it carries judgmental baggage, much as when a clumsy new resident in July comes into the ER waiting room to tell the scared family that "We tried everything but he just didn't respond" (ie: the patient died, but the blame is put on him).

You know, and every woman who has had a baby knows that bodies are mysterious and have their own maddening schedules. Sometimes linked to our hopes and fears, sometimes just to things guesstimated, or processes that cannot be predicted, quantified or perfectly orchestrated to suit a shift or a delivery suite trying to keep people moving.

How exhausting and frustrating that must have been for you, and painful too. The drugs used to induce and augment labor can be a !@#$#.

Then there is also one view of it all that holds that maybe that baby is just not ready to be born and is being stubborn...:)

You don't have to be a model of "efficacy". Every mother is a miracle of God's, bringing new life and hope to this hurting world. However she does it, the world is better for her labors.

Sorry to rant, but sometimes labor and delivery nurses are tired and get into their schedules and forget the point of it.

snoring solutions said...

The cartoon is very good,this cartoon give a good message.I like this post.

moviedoc said...

Mental illness IS stressful.

Sarebear said...

Retriever . . . that's the first time anyone has ever told me that.

She WAS one stubborn lil thing, even via C-section, they had to vacuum her, even. The final induction didn't work either.

But I've always just accepted what I was told as a medical fact. You didn't progress in labor, you're stuck, you're not even at a 1, barely. I just thought it was all, well, ME. Because that's what they told me. I never even thought that there could be a different perspective on it . . . .
I patiently endured things like a pair of nurses that took over an hour trying to start an IV line, fishing the damn thing in and out before the head nurse was called, all because, well, I was the one who was being a pain and a bother. You know how much it hurts to have them fishing that thing in and out of your veins for an hour, or trying to? I felt like where was the interrogator in this scenario . .

You've given me something to think about.

THANK YOU. (and sorry for the side trip on the thread, shrink rappers).

Anonymous said...

That covers it.

Personally, I think the two that matter the most are severity of symptoms an responsiveness to treatment. People with psychosis are much worse off than people with anxiety/moderate depression. People who respond well to treatments are better off than people who do not, or who have intolerable s/e from drugs (fatigue, apathy, memory loss).

HOWEVER... When it comes to non-psychotic, non-serious mental issues, I think resilience is the most important factor. Some people are whimps and bitch about their depression and take off work for long periods, and run to the doctor for every little blip of depression spell, pop xanax under the slightest anxious feelings.

Other people soldier on and weather it out and retreat to private to handle the burden of their cruel brain. I've had quite brutal depressions that left me unable to dress or shower, body feeling like lead and pretty much crying in my room all day for long periods, while still getting up and going to work. I've had depression like that, which is cruel beyond description and in hindsight I can barely believe how bad it was. When going through it, it is there all the time, it is with you all day every day and all you can do is distract yourself for short periods (and when the distraction evaporates the pain and brutality of your mind is so much worse). Trying to function in that state is hell. But it's all you can do because you know it is just your brain malfunctioning and you know it is temporary because you've been through it before.

Sometimes I think I have PTSD from depression. I fear it, and I am constantly vigilant for signs of it. IT is cruel and it is abusive, my mind is like an abusive partner and I cannot leave. I am not depressed now touch wood but I think back to those times, the pain and hopelessness and desperation and the suicidal thinking, physical pain, mental pain, heaviness of body and aches and slowness and dullness of mind. You just want it to end and you want help but all you can do is hold on. Depression is absolutely fucking horrible, basically.

And though I do remember the pain and crying and desperation, I think about how i was still able to get my ass into work. Sit at a desk and fight the urge to cry or ask my coworkers/superiors for some kind of help or release.

And then I see other people going through clearly much more mild depression as they are still engaging in lots of recreational activities, but they are far less functional. Sometimes, some people with depression, it's only their responsibilities and relationships that are suffering... IMO when people let their responsibilities slack first in depression, when relationships with others are being strained by the other party taking care of YOUR shit... that means crappy coping skills are a major problem. As someone with a long history of depression, everyone knows the first thing to go is recreational activity. You stop doing things you enjoy , because you stop enjoying them. All energy in your feeble broken body and mind go into maintaining functionality and not fucking up your life. Getting your corpse out of bed into work. This how a responsible adult handles depression. They carry it on their back like a cross and fucking march up that hill and do so until the brain is kind again. They go to work and make their bed.

But a lot of these people with depression have shit coping and they drink and do destructive things to escape and think nothing of indulging whims to not go to work and to drink and take pills / drugs instead. They totally royally fuck up their lives because they make no effort into being stable and being functional. They are NOT resilient. They are children. They are self indulgent children who can't cope well at all, they make no effort to keep going and stay center. Those coping behaviors are personality driven, depression doesn't make you do it. I have depression and do not do those things, I try very very very very hard to be a functional person , a responsible person, a productive person.

Anonymous said...

Personally, I think the two that matter the most are severity of symptoms an responsiveness to treatment. People with psychosis are much worse off than people with anxiety/moderate depression. People who respond well to treatments are better off than people who do not, or who have intolerable s/e from drugs (fatigue, apathy, memory loss).

HOWEVER... When it comes to non-psychotic/nonserious mental issues, I think resilience is the most important factor. Some people are wimps and bitch about their depression and take off work for long periods, and run to the doctor for every little blip of depression spell, pop xanax, drink, drug under the slightest anxious feelings.

Other people soldier on and weather it out and retreat to private to handle the burden of their cruel brain. I've had quite brutal depressions that left me unable to dress or shower, body feeling like lead and pretty much crying in my room all day for long periods, while still getting up and going to work. I've had depression like that, which is cruel beyond description and in hindsight I can barely believe how bad it was. When going through it, it is there all the time, it is with you all day every day and all you can do is distract yourself for short periods (and when the distraction evaporates the pain and brutality of your mind is so much worse). Trying to function in that state is hell. But it's all you can do because you know it is just your brain malfunctioning and you know it is temporary because you've been through it before.

SOmetimes I think I have PTSD from depression. I fear it, and I am constantly vigilant for signs of it. IT is cruel and it is abusive, my mind is like an abusive partner and I cannot leave. I am not depressed now touch wood but I think back to those times, the pain and hopelessness and desperation and the suicidal thinking, physical pain, mental pain, heaviness of body and aches and slowness and dullness of mind. You just want it to end and you want help but all you can do is hold on. Depression is absolutely fucking horrible, basically.

Though I do remember the pain and desperation, I think about how i was still able to get my ass into work, sit at a desk and fight the urge to cry or ask my coworkers/superiors for some kind of help or release.

Anonymous said...

(cont)
Then I see other people going through clearly much more mild depression as they are still engaging in lots of recreational activities, but they are far less functional. Sometimes, some people with depression, it's only their responsibilities and relationships that are suffering... IMO when people let their responsibilities slack first in depression, when relationships with others are being strained by the other party taking care of YOUR shit... that means crappy coping skills are a major problem. As someone with a long history of depression, everyone knows the first thing to go is recreational activity. You stop doing things you enjoy , because you stop enjoying them. All energy in your feeble broken body and mind go into maintaining functionality and not fucking up your life. Getting your corpse out of bed into work. This how a responsible adult handles depression. They carry it on their back like a cross and fucking march up that hill and do so until the brain is kind again. They go to work and make their bed.

But a lot of these people with depression have shit coping and they drink and do destructive things to escape and think nothing of indulging whims to not go to work and to drink and take pills / drugs instead. They totally royally fuck up their lives because they make no effort into being stable and being functional. They are NOT resilient. They are children. They are self indulgent children who can't cope well at all, they make no effort to keep going and stay center. Those coping behaviors are personality driven, depression doesn't make you do it. I have depression and do not do those things, I try very very very very hard to be a functional person , a responsible person, a productive person.

From the moment I realized I had a mood disorder and a fucked up brain (in my mid teens, around 16) I wanted nothing more in the world than to not be a burden anymore, to be able to be self sufficient and to not hurt anyone. I wanted to be productive and I wanted to stop being a waste of space. Is uppose my depression informed this drive as well (guilt is a big sign for me)... and it was a long time until I was well and healthy enough to be able to realize that.

I guard my productivity like pride, it is my honor, I feel deep shame and sadness about the prospect if not being self sufficient and productive. I have spent years learning how to be self sufficient and productive.

I hold disdain for those people with depression who act like children drinking and drugging and putting strain on their caretakers, threatening suicide all the time and demanding attention. I find it disgusting. Be an adult. Handle your pain.

I am thankful I am resilient.

jessa said...

Something I find helpful is realism. I don't want people making me promises about my future that they cannot keep. I don't want to delude myself into thinking that "I am perfect just the way I am." I don't want to be told "this will work." I want to be told "this might work, it has worked for some people and not worked for others, but it can't work if you don't try."

Another helpful thing: validation. That's pretty self-explanatory.

Also: not being abused by the people meant to help. Not really a thing that helps, but more avoiding a thing that worsens. It made me think I was sicker than I really was, it made me sicker than I started out, and it made things take much longer than they probably would have otherwise. Oh god oh god oh god, because being abused by those meant to help is exactly the opposite of helpful and makes the experience of mental illness so so much worse.

Anonymous said...

Pretty comprehensive list but I have to ask whether the same list could not have appeared under the title: what makes physical illness bad? Why line drawn between the two.I feel I can ask that question, having diagnoses in both categories if we really need to keep them apart.
And to anon who said psychosis is worse than anxiety: it depends. I have had my butt land in hospital for being in a psychotic state but given the amount of time over my life spent in psychosis as opposed to the severe anxiety I deal with almost all the time, I honestly have to say if someone could make the anxiety disappear I would take that in exchange for the time I spent locked up.

zozzyl said...

I've been discussing this topic -- or at least one closely tangential to it -- with several people as if it was a new discovery.

My contention is that a person with some of the mental illness labels can also be mentally healthy about those conditions.

Take MDD for example. After a few years I could detect the signs of onset and upswing -- now I know that when a down cycle begins, all I need do is practice patience (along with some other skills that I've learned, thanks to DBT) and that the inevitable change will, eventually, come. This does NOT mean I've become a patient person.

With practice, I've learned to be mentally healthy about most of the other diagnoses my brain care team came up with. Not always successful, mind you, but at least I've gained a sense of who I now am.

And yes, stress is perhaps the largest of the triggers in my life. So much so that I don't watch the news, limit the amount of suspense I permit myself in reading, and keep other things that stimulate the ANS to a low level. That approach has returned to me a fairly large slice of the more pleasant side of life.

Oracle at D said...

Great post! With a fine finish from simetrias and Retriever. It could only have been better if I had thought of it myself. :)

Anonymous said...

As part of the external support systems, I think a huge factor (at least for me) has been the opportunity to be open about my illness with my support system. The years that I hid my illness made its burden much heavier.

moomag said...

Perspective.
A psychiatrist once told me to look at my episodes of severe depression in terms of what I had learned from them, rather than what I had lost from them. Since I obviously had recovered, there were certain things that helped the recovery. What were they, and how can this help in recovering from my present episode. It was approximately twelve years ago he said this to me, and I believe it crosses my mind at least once a week still.

Dr. Psychobabble said...

Doggies: http://www.psychdog.org/

:)

Sarebear said...

When you have no support system, your resilience tends to waver alot sometimes, depending on how used up you feel.

I have my husband, but he gets overwhelmed with all this.

My DAMN in-laws (I include my siblings and their stupid spouses in that) haven't had even 5 minutes to spare for me this year to even give me a friggin' phone call, with all the hell I've been through with my two surgeries and recovery, and aside from the MIL being at the hospital the day of the first surgery, and picking up the daughter from school the day of the second, there's been little to nothing in the way of any kind of support for this physical and mental struggle I've been going through that has been hell, and I'm not even talking the usual mental illness crap, although certainly the mental illnesses have been interwoven throughout the whole surgical and recovery processes . . . . .

NOT. EVEN. FIVE. SIMPLE. STUPID. BLOODY. MINUTES.

They talk about family being there for each other, but when the chips are down? Well, I know, now, for sure.

They couldn't support as much as one of Dolly Parton's worn'out over used shot- to hell support undergarments, if they tried.

Oh, unless it was the mother, or the one sibling of the four who is female, the "princess" of the family.

Us, we live in Timbuktu, I guess, 20 minutes away. The Mormon "culture" is supposed to be all about supporting "the family".

My parents drove up almost every day from an hour and 15 minutes away, after each surgery, to help take care of me, for about 2 and a half weeks. And yet my mother-in-law thinks 20 minutes is too far, and she's not near as old as my 74 year old father.

Okay, can you tell I'm just a LITTLE hurt and ANGRY?

I've spent many a therapy hour on it. Well, sort of. Maybe that's the problem . . .

Anyway, I try to tell myself that, well, if you don't have a support system you just have to be strong yourself, but sometimes you just get used up and have no strength left, so then where does that leave you? It kind of leaves me where I am right now, which is is on the brink of alot of potentially risky manic behavior, potentially life-changing behavior, dangerous things that I am drawn towards to make the bad stuff I'm feeling go away (at least temporarily). You try and be strong . . . . you try . . . and feel very, very, very alone.

katie said...

resilience, for sure. (can it be learned or is it inbred, there's a question....)

support system and job flexibility are pretty key for getting your life back together post-episode.

i'd agree with response to treatment, and i'd agree with a good psychiatrist, but i'd tie the two together, as well: you won't have a good response to an inappropriate treatment (wrong meds, no meds, placebo meds, etc).

tracy said...

Wow. Sarebear i feel like i totally understand what you are going through. And i am so sorry you are there too. :(

Anonymous said...

Interesting list. I think you missed timing of symptoms and geographical location though. If you have onset in college its worse then high school or after collage cause it has more impact on future career prospects. If your vision blacks out in orgo lab for example its more dangerous then in an office or at home. If you live in NY city and need anti-depressants getting around without driving is easy. In rural Oklahoma taking medicine may greatly curtail your activities.

So people with the same disease and symptoms and resilience may do very different based on the timing and life circumstances.

-M

Sarebear said...

Thanks, Tracy.

Carolyn Thomas said...

Excellent article! I'm a heart attack survivor who is also a 'graduate' of the WomenHeart Science & Leadership Symposium for Women With Heart Disease at Mayo Clinic.

Mayo cardiologist told us that post-heart attack depression strikes up to 65% of survivors, yet only about 10% are appropriately treated. This is significant, because we now know that depression can mean poorer longterm outcomess for survivors.

And a large UK study last summer published in the 'British Journal of Health Psychology' confirms that heart attack survivors may have a disturbing incidence of undiagnosed PTSD. Her research team found that 16% of survivors studied met clinical criteria for acute PTSD, and a further 18% reported moderate to severe symptoms.

More on the subject of depression and heart disease in: "Welcome to The New Country Called Heart Disease" at

http://www.myheartsisters.org/2010/10/09/new-country/