Mental Health Awareness: Wanted Compassion and Understanding

By: Elise Ronan | Ops & Blogs | The Times of Israel

Impressions we make are essential to how we view each other. Social awareness, some call it mindfulness, of the unsaid signals we emit are part and parcel of human interactions. But what happens when a person doesn’t understand the nuances and the secret handshake of unwritten social rules? What happens when these people become so overwhelmed by their environment that they exhibit actions, such as a meltdown, inappropriate yelling – laughing, or experience a panic attack complete with hysterics and uncontrollable crying?

It’s one thing if the helpless person involved is a child. Most of society has all sorts of qualifiers for a child that has issues and mental health concerns. But, as a person ages, society’s tolerance for such actions not only becomes mute, but in most part disappears altogether. Mental illness becomes an unspoken burden in part because it is sadly ignored,  swept away by families due to societal derision. As a person ages the stigma associated with mental illness becomes as much of a weight as the illness itself.

Society lacks basic knowledge about mental health issues. And in many ways tabloid journalism is to blame. The issues are sensationalized, especially when a violent individual commits some unspeakable crimes. (Ignoring the fact that most heinous crimes are actually committed by person considered sane.)The news will drone on and on about a subject that they know nothing about, simply making life unbearable for those already viewed to live on the fringes of society. The uneducated make conjectures, elicit ignorant opinions and promote fear instead of trying to enunciate understanding of what mental illness is and what it is not.

-Mental illness covers a wide range of illnesses. HERE Everything from ADD to autism to panic attacks to PTSD to the more severe forms of schizophrenia.

-The overwhelmingly vast majority of persons with mental illness are NOT violent. In fact they are more likely to be the victim of a violent crime than the perpetrator. HERE

-With help recovery is possible. HERE

It is important to remember that those with mental health illnesses are trying their best. What they need is understanding and acceptance. We can talk about accommodations and we can talk about civil rights until we are  “blue in the face,” but in truth, if someone is uncomfortable around a person with a mental illness, there will never be friends, employment and a successful navigation of society. Can comfort be taught? Can compassion become part and parcel of society?

First, what society needs to understand is that meltdowns, panic attacks, “episodes” are personal to the person. It is how the effected individual is feeling at that one given moment in time. Their being overwhelmed is about how they are processing the sensory information before them. They are in that space and they cannot necessarily remove themselves from that tornado that is their mind. (And as I have said before this inability to see beyond themselves-mindblindness- becomes more problematic as a person ages. A meltdown by a 10-year-old is taken alot differently than a meltdown by a 200 pound, 6 foot tall, grown-adult-male.) HERE, HERE, HERE, HERE

Second, yes, once their “episode” is over, they are capable of understanding what has happened. They realize, once they feel better, if they have been mean, cross or had been inappropriate. “I’m sorry,” is something heartfelt. Apologies abound. They truly feel embarrassed when they have digressed in the presence of their peers and they truly feel shame.

But unfortunately if their actions have frightened someone, scared off a potential friend, or have lost them a job, sometimes there really is no going back. What is lost is lost. The question becomes how do you teach them to understand their feelings in the moment and to control themselves? How do you teach them that impressions are real and that they have consequences before these consequences are life effecting?

Lastly, so what is a parent or caregiver to do? It is trying to teach the idea  that it is the little things that become important when talking about perception. It is the little things that become important when preparing someone for the future.

Walking out of a room, class or environment when they start to feel overwhelmed is a typical self-help method. (Making sure that they leave the room before they exhibit any negative actions is important also, and part of a long process of education.) Trying to get them to understand that their “tone” in a conversation is essential to how their emotional state is perceived is important for social interactions at both school and work. Teaching them the appropriate way to horse-around (even though it seems that in a school setting typical male bonding is seen as anathema in the first place in today’s world) and what to say as a “joke” in public is a good place to start, when teaching about community acceptance. Getting them to understand the necessity of therapy and medication to their own well-being. Promoting a healthy attitude towards exercise, food and self-care can also help in their navigation of the world.

But in the end we do need to accept the fact that there is also just so much anyone person can do to accommodate the world-at-large as well. We also need to understand that no matter how hard those with mental health issues do try, there is always going to be that one person who is just totally unaccepting towards them. This person will, no matter what, never forgive the ill for who they are. They will never see beyond the disability or mental health issue. Honestly, its better to teach the effected individual how to identify these antagonistic people and to just stay away from them. You can’t please everyone and honestly it’s not even worth trying.

As I have always taught my children this primary life lesson…wherever you go in life there is always going to be one “shmendrick.” The trick in life is to NOT be the “shmendrick.” That is basically impressions in a nutshell. That is the basic goal of those with challenges.

In the meantime, May is Mental Health Awareness Month. Maybe one day there will be more give and take with society. Maybe one day the partnership will actually be 50-50. But until that time we work, we teach and we hope that the stigma of mental illness will be lifted and those that are forced onto the fringes of society will be accepted, understood and welcomed into the world inwhich they live.

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Bipolar Disorder: Just Another Manic Monday? How to Tell if You or A Loved One Has Mania

By Tracy Latz

Is There Such a Thing as ‘Manic Season’?

Many of my patients who have been diagnosed in the past with Bipolar Disorder have heard me ask them during their visits with me in the early spring season: “How has your mood been? You know we are now in ‘Manic Season’.”

Mania can actually occur any time of the year if one is given the “perfect storm” of situational stress or sleep deprivation. However, just as depression can often be more prevalent in the darker months of late fall and winter, mania too is often associated with the season of spring with the rapidly increasing length of daylight hours. The decrease in exposure to daylight in the fall/winter months can lead to a decrease in the production of neurotransmitters serotonin and/or dopamine for many sensitive people which can in turn be experienced as depression or anxiety- also known as Seasonal Affective Disorder (see our post on SAD).

The increase in exposure to sunlight in the spring (from about March 1st until about the end of May) can lead to an increase in the production of serotonin and/or dopamine in some sensitive individuals to create feelings of euphoria. This can lead to what many people sense as a slight boost in energy and elevation in mood known as ‘spring fever‘ or it can cause some people to have a more marked increase in mood and energy level known as ‘hypomania‘ that can eventually lead to full-blown ‘mania‘ where a person can then become quite angry or irritable – or even violent. A person in a full manic episode may begin to feel so out of control due to their thoughts or behaviors that they may begin to feel trapped and that suicide is the only way out.

What Are the Symptoms of Mania?

• Experiencing for most of the day (nearly every day) for a period of at least a week of abnormally and persistently elevated/expansive (excessive happiness/joyfulness out of the realm of norm for the circumstances), euphoric  or sudden irritable/angry/hostile mood

• During the period of mood disturbance at least 3 of the following symptoms (4 if the mood is only irritable) have been present to a significant degree:

1. Inflated sense of self or grandiose thinking
2. Decreased need for sleep (feels rested after just 2 to 4 hours of sleep)
3. More talkative than usual or has an internal pressure to keep talking (rapid speech that is difficult to interrupt)
4. Flight of ideas (jumps from one thought to another in an unrelated manner) or a subjective report of the person that their thoughts are racing from one to another
5. Distractibility (attention easily shifted to unimportant or irrelevant external stimuli)
6. Marked boost in energy level/activity (social, work, school or sexual) or significant agitation
7. Excessive involvement in pleasurable activities or risky behaviors that have a high potential for painful consequences (spending money on buying sprees that cannot afford, gambling, high sex drive, sexual indiscretions, or foolish business investments)

• Symptoms have been severe enough to cause marked impairment in ability to function at work or school, in usual social activities, or in relationships with others; or severe enough to be hospitalized to prevent harm to self or others

• Severely manic people can become psychotic (seeing things/hearing things others cannot see, experiencing increasing paranoia, preoccupation with political or religious ideation to the exclusion of usual activities, having an inability to connect thoughts to form intelligible sentences, or believing they have “special powers”)

• Symptoms are NOT initiated and maintained by a known organic cause such as illicit or prescription drugs causing a mood disturbance

Hypomania is a much milder form of mania where there is only mild disturbance in ability to function and there is no psychosis involved.  In hypomania the fast ideas, increased creative bursts of activity, feelings of elevated confidence, boosted sensuality, and euphoria is exciting and the tendency is to want to continue to experience that state of mood.However, it is nearly impossible to “ride the crest of the hypomanic wave” without crashing into either full-blown mania or depression. Many historically well-known artists, musicians and performers have had some of their most creative work manifest during periods of hypomania.

What If I (or my Loved One) Has Bipolar Disorder: What are the Early Warning Signs of Mania?

1. The first thing that I tell my patients or family members of patients to look out for is a decreased need for sleep. It is time to take action (call the treating provider or take something other than alcohol or illicit drugs to assist with sleep) if a person with a known diagnosis of Bipolar Disorder is sleeping 4 hours or less for 3 nights in a row.
2. Stress may trigger mood disturbances – become aware of and monitor for mood changes during periods of time with increased stress. NOTE: Stress may be good (weddings, births, celebrations, holidays, promotions, positive moves, etc) OR stress may be bad (death, loss of job or relationship, divorce, physical illness, surgery, etc).
3. Increased energy or increased talkativeness
4. Increasingly impulsive behaviors

What Can I Do To Help Stabilize My (Or My Loved One’s) Mood?

1. Consider evaluation by a trained mental health professional to discuss the risks and benefits of use of mood stabilizing medication, psychotherapy, or other treatments as well as to assess for suicidal or homicidal thoughts and psychosis.
2. Good, well-balanced nutritional intake with avoidance of highly processed, high sugar or caffeine-containing foods or beverages. A diet with good hydration and a balance of daily essential vitamins, protein, reasonable amount of carbohydrates and omega-3 fatty acids can assist with stabilizing mood.
3. Avoid alcohol or opiates/pain pills (while it may initially cause sedation or drowsiness, it tends to eventually fuel either mania or a crash into depression)
4. Avoid psychoactive substances or hallucinogens- while this may seem obvious at first, I have seen many people who will intentionally use cannabis (pot, marijuana) to attempt to “relax” yet the effect in bipolar disorder actually worsens paranoia or psychosis. I also have seen many bipolar patients who will intentionally us pot, hallucinogens, or speed/cocaine to attempt to get into a hypomanic state in an attempt “feel that good again”.
5. Avoid stress – develop a daily centering practice such as meditation, qigong, yoga or time spent walking calmly in nature. We live in a busy, hectic world and it is important for all of us to become quiet and go within in a mindful, centering manner to restore our inner peace daily.
6. Regular exercise – this helps us burn off excess energy during the day and feel tired at our regular bedtime at night. It can assist with resetting our natural internal biorhythms, including our sleep-wake cycles.

Is Mania the same thing as a Mixed Manic Episode?

No, during a manic episode, the symptoms include only the ones listed in the above “Symptoms of Mania”. During a Mixed Manic Episode, a person experiences symptoms of BOTH depression and mania- which can be confusing to both family members, the person with the symptoms and to primary care physicians who may not have been trained to look for this condition. Often the patient will complain or feeling depressed, yet the family members and the treatment provider who spend an hour with the person will begin to see signs of mania such as irritability, mood lability (rapid shifting from sadness to anger to inappropriate laughter or silly behavior). If asked in an interview, the person will begin to let you know of decreased sleep (4 hours or less per 24 hour period) and other signs or symptoms of mania in addition to depressive symptoms. If the manic side is missed and the person is only treated with an antidepressant, they are at high risk for becoming fully manic and possibly paranoid or psychotic.

Is Bipolar Disorder the same thing as Cyclothymia or Borderline Personality Disorder?

No. Cyclothymia is often considered a milder form of Bipolar Disorder. The hallmark is that for a period of at least 2 years there is a presence of numerous hypomanic episodes and numerous periods with depressed mood or loss if interest or pleasure in usual activities that do not meet criteria for a major depressive episode. The repetitive mood disturbances typically last for only a few days and are not solely attributable to reaction to stress or external stimuli or substances.

Borderline Personality Disorder is not the same as Bipolar Disorder either. Bipolar Disorder is considered a major mental illness while Borderline Personality Disorder is considered to be a “characterological” or personality disorder. I have never liked the term “personality disorder” as it seems to denote an idea that someone has a defective personality. What it really is referring to is a pattern of maladaptive coping strategies and ways of thinking about one’s self and the environment that can cause dysfunction at work, school, in the family, social or intimate relationships. I have seen many people with Borderline Personality Disorder who were misdiagnosed with Bipolar Disorder. You can see mood swings with both conditions; however, the mood swings in Borderline Personality Disorder are short-lived (only lasting usually a few hours and rarely more than a few days) and tend to be due to emotional reactivity to an environmental or relationship stressor.

Hope this is helpful! These are the questions family members and patients most often ask me about Mania, Bipolar Disorder & Borderline Personality Disorder.

Happy (and a Balanced Healthy) Spring to you all!

Tracy Latz, M.D., M.S. (a.k.a. one of “The Shift Doctors”)

- To learn more about “The Shift Doctors”, their books, videos & meditation CD’s visit www.shiftyourlife.com   **The Shift Doctors (Tracy Latz, M.D. & Marion Ross, Ph.D.) are available for keynote talks, classes, events or for seminars (1/2 day or up to 2 day) on personal transformation, team-building, motivation, anger management, intuitive development, or collaboration for private groups, conferences, corporations or corporate events. Contact them at info@shiftyourlife.com or find out more about them at www.shiftyourlife.com .

Source: Shift Your Life

Bipolar Disorder: What Is It?

Most Important Risk is Suicide

Bipolar disorder, which used to be called manic depressive illness or manic depression, is a mental disorder characterized by wide mood swings from high (manic) to low (depressed).

Periods of high or irritable moods are called "manic" episodes. The person becomes very active, but in a scattered and unproductive way, sometimes with painful or embarrassing consequences. Examples are spending more money than is wise or getting involved in sexual adventures that are regretted later. A person in a manic state is full of energy or very irritable, may sleep far less than normal, and may dream up grand plans that could never be carried out. The person may develop thinking that is out of step with reality — psychotic symptoms — such as false beliefs (delusions) or false perceptions (hallucinations). During manic periods, a person may run into trouble with the law. If a person has milder symptoms of mania and does not have psychotic symptoms, it is called a "hypomanic" episode.

Bipolar disorder is now divided into two subtypes (bipolar I and bipolar II). Bipolar I disorder is the classic form where a person has had at least one manic episode. In bipolar II disorder, the person has never had a manic episode, but has had at least one hypomanic episode and at least one period of severe depression. Bipolar II disorder may be more common than bipolar I. A third disorder, closely related to bipolar disorder, is cyclothymia — people with this disorder fluctuate between hypomania and mild or moderate depression.

The vast majority of people who have manic episodes also experience periods of depression. If manic and depressive symptoms overlap for a period, it is called a "mixed" episode. In some people, moods alternate rapidly or it is difficult to tell which mood — depression or mania — is more prominent.

People who have one manic episode most likely will have others if they do not seek treatment. The illness tends to run in families. Unlike depression, in which women are more frequently diagnosed, bipolar disorder happens nearly equally in men and women. Bipolar I and II disorders occur in up to 4% of the population.

The most important risk of this illness is the risk of suicide. People who have bipolar disorder are also more likely to abuse alcohol or other substances.

Source:  Everyday Health

Bipolar Disorder Basics

Bipolar Disorder: What Is It?

Bipolar disorder, also known as manic depression or manic depressive disorder, is a condition characterized by wide mood swings, from high (manic) to low (depressed). There are two main subtypes of bipolar disorder: People with bipolar I have experienced at least one manic episode, while people with bipolar II experience hypomanic episodes — which are milder — along with depression. Bipolar disorder is often misunderstood, but help is available with the right diagnosis and treatment.

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