Socialization and Family Archives - Page 2 of 2

Social Therapies

In the USA in the 1960s, the era of the Civil Rights Movement, the rise of Feminism, and President Kennedy’s Community Care policy, psychoanalysis became a country-wide fad. Much of Woody Allen’s humor was based on poking fun at psychoanalysis. More significantly, a personal analysis was an essential requirement for a chairperson of a Department of Psychiatry. Over the next several decades the pendulum swung away from psychoanalysis towards biological explanations for psychiatric disorders, partly as a result of technological advances in brain imaging and genetics, but also due to the campaigning of the large and powerful pharmaceutical companies. Today psychoanalysis is almost extinct in the USA. The emphasis on an exclusively biological basis for schizophrenia generated a mind-set inimical to the notion of recovery.

There was never such a wholesale commitment to psychoanalysis in the UK, where the number of analysts has not exceeded several hundred for a population of 55 million. Furthermore the majority of analysts live in the major cities, and there is only a handful in the north of England. The dominant ideology in mental health has been a social approach, the pioneers of which were active from the 1930s, establishing community services before the advent of psychotropic medication. The founding of the National Health Service in 1948 provided a basis for social therapies such as rehabilitation, with an emphasis on recovery from psychiatric illnesses including schizophrenia. From the 1950s onwards, successive governments of both the Right and the Left supported a policy of deinstitutionalization, which has been effective in reducing the number of psychiatric hospitals in England and Wales (Scotland has its own Department of Health) from 130 to less than a dozen. The discharged long-stay patients are living in much improved conditions with greater freedom, and there has been almost no homelessness, or victimization.

The emphasis on a social approach in the UK has led to important advances in the non-pharmacological treatment of schizophrenia. These include professionals working co-operatively with family careers and patients, with a reduction in relapse for the most vulnerable patients from 50% over 9 months to 10 %. British psychologists have adapted cognitive behavior therapy, developed in the US for depression, for the treatment of schizophrenia, with a reduction in delusions and the distress due to auditory hallucinations. Recently a computer-assisted therapy has been developed for the treatment of auditory hallucinations resistant to medication, which has been effective in reducing the frequency, volume and malevolence of the voices in many patients. A minority even ceased to hear the voices altogether. These social therapies do not abolish the need for antipsychotic medication, but are free of side effects and produce improvements in the symptoms that enable patients to re-establish productive and satisfying lives.
Julian Leff

“What We Siblings Have in Common, Besides our Sibs”

We brothers and sisters of people with special needs, whether we are young, old, or somewhere in between, have much in common. Of course we are all individuals and as unique as everyone else on the planet, but there are some general traits and aptitudes that we tend to share. I would sure love to hear back from some of you after reading this blog to learn what you find to be true, how your experiences are different, and what your thoughts are as you read. Are you surprised? Are you validated? Do you get a feeling of “Oh, it’s not just me?”, or are you thinking “Hmmm, I am a sib and this doesn’t describe me at all”. Maybe you see another one of your sibs in some of the phrases. Please feel free to share.

There are three very typical behaviors taken on by children who grow up with a special needs’ sibling. We’ll call them “The Overachiever”, “The Invisible One” and the “Pick Me! Pick Me!”.

The Overachiever: Some sibs (it often happens to be the eldest, though not always) seem to try to overcompensate for the special needs’ siblings by working extra hard in school, being overly helpful in the house, behaving exceptionally well. They see that it is sometimes difficult for their parents to care for their sib, and so they do their part to make things easier. This sounds wonderful, and in many ways is, but hopefully these kids are having fun too, and not growing up too fast. One upshot of being The Overachiever is the good grades which may afford them scholarships and invitations to good colleges and universities. Another is possibly a lower risk lifestyle and safer adolescence with less chance of experimental drug or alcohol use, or young onset of sexual activity. The bad news is the self-induced pressure and high standards which might be difficult to maintain, and depressing when they can’t be lived up to. This is still a child we are talking about, after all.

The “Invisible One”: For the same reasons as The Overachiever, The Invisible One just figures if they fly below the radar it will make their parents’ lives easier. They may, unfortunately, be feeling an absence of attention from their parents since much of their focus is on the special needs’ sib, and so they feel a bit invisible, and then simply behave in a way that lives up to that persona. They’re not getting into lots of trouble, or failing in school, yet they’re not stand-outs either! They simply go along, hardly recognized, and are sometimes referred to as “easy” children. The good news, again, is possibly lower risk behavior, getting into very little trouble at home and in school. The bad news is maybe these children are not living up to their fullest potentials, or as happy and fulfilled as they could be. Maybe they want more out of life, or from their parents, but do not seek it because this would certainly make them visible.

The “Pick Me! Pick me!”: Oh boy, this can be a fun child. Often described as precocious, incorrigible, one who stands out from the rest of the family, or simply – trouble, this child wants to be noticed and plain refuses to be ignored! They may at times realize their parents’ attention is being directed to where it needs to be, and simultaneously feel badly or guilty for interrupting that, however, they also feel a compulsion to be noticed; to want to be “picked”. The good news is that they are strong-willed, which is a quality helpful in later life in terms of assertiveness and getting their needs met. It may, in fact, gain them the attention from their parents that they need. It gets them noticed alright! The downside is that they sometimes don’t mind if it entails breaking the law, doing badly in school, acting out at home. They simply WILL be noticed.

Of course all kids, regardless of whether or not they have a sibling who has special needs, may fit into one of those three types, or another type. In addition, so many other factors in a person’s life affect their coping styles, including whether or not they are from a two-parent household, examples set for them, birth order, etc. The point is there are surely some general commonalities, and I point them out because it can be enlightening for a sib to know this, and to determine or gain some insight as to why they behave the way they do or became the way they are. I was a “Pick Me” kid and I did not end up in jail. I did, however, give my parents a run for their money. I think, and sure hope, that now they would be proud of the way I’ve turned out. I mention this to point out that it is not always a negative thing. Kids learn to cope in various ways. It just is what it is.

Special needs’ sibs learn and experience their family life in ways that most kids don’t. Empathy is often a lovely outcome. Most sibs are not only compassionate, but are also quite open-minded and tolerant of people who aren’t “typical” in myriad of ways. They don’t tolerate bullying. A high percentage of sibs grow up to find themselves in the helping professions (nurses, teachers, therapists, physicians, etc). I think sibs are special and make the world a better place. It is my hope that you will communicate with each other, meet each other, find support and understanding in each other, thereby creating a better understanding within yourself, and feel less alone in the world. In my next blog I will discuss the current available supports to encourage this. Please stay tuned and consider reaching out.

Lisa Croce, RN, BSN

www.rockymountainsibshops.com

Sticks, stones and stigma

“Sticks and stones may break my bones but words will never hurt me. This poem is wrong. I have never broken a bone in my life, but words have cut, trampled, and drilled through my heart. All the pain inflicted on one person can tear them apart. I should know. I have been in pieces since preschool.”

This was written by my grand daughter when she was eleven and writing about how it is to be living with a brain disorder and ostracized as being weird by her peers. Fortunately, she is doing very well now at fourteen, has lots of friends and is a star goal keeper for her high school soccer team. Still, it was a long haul and I have kept this piece she wrote to help remind me how important it is to work continuously to fight name calling and the stigma of mental illness. As a retired mental health professional, I have found the National Alliance on Mental Illness to be a great way for me to continue being an advocate on our Colorado Public Policy Committee. We need all the help we can get so please consider becoming active in NAMI.

NAMI Colorado is dedicated to building better lives for the 250,000 plus Coloradoans and their families who are affected by any number of mental illnesses – schizophrenia, bipolar disorder, depression, PTSD, obsessive-compulsive disorder, borderline personality disorder, panic disorder and others.
We do this by providing:

— free educational classes about mental illness to the community;
— providing support groups for those with mental illness and their families;
— through political advocacy for all concerned;
— and through our volunteer support and donations.
NAMI’s national website is www.nami.org

NAMI Colorado’s website is www.namicolorado.org

Phoebe Norton

“What About Those Siblings?”

An often overlooked demographic, siblings of people affected by mental illness, are typically the longest living relatives, and potential caregivers or pillars of support for people with serious mental illness, as well as other disabilities. Despite this fact, and due to varying factors, this population is the least likely to receive support, education, assistance, or even a forum to openly discuss their concerns, worries, questions. Change is occurring, but all too slowly.

Many years ago, even parents were not provided adequate support for their children’s diagnoses. That has certainly evolved. There are many parents’ groups now and educational resources in print as well as online. It is immediately recognized these days that when a child is diagnosed with any type of disability, it involves the family, and providers march into action to address concerns with the parents. The siblings, however? Very seldom, even now in 2013, are the siblings’ needs thought of, mentioned, addressed. This is changing. Slowly. Very slowly.

As a person who was a sibling to a brother with a significant disability, I always knew something was missing in terms of support. I worried. I wondered. I worried and wondered silently. My parents did the best they knew how to do, and actually did it quite well. Most of their time was, of course, spent caring for my brother. Rightly so, and I wouldn’t have had it any other way. We sisters knew to not add to their distress by asking too many questions, adding to their tensions by letting them know of our concerns. There were times I was too embarrassed to have friends to my house after school because his behavior was odd. I did not understand. I felt tremendous guilt for feeling that way. I said nothing about any of it. There was absolutely no one who I could talk to. Who would’ve understood? As I look back I realize there were probably friends at school who had siblings with a disability, and maybe I could have spoken with them, but how would I have known who those students were? It sure would have been nice to connect with them – with someone.

One of the reasons that siblings have not been well included in the conversations over the years is simply that parents were/are trying to protect the sibs. They often feel it is their burden and do not want to share that with the sibs. Parents are intrinsically assigned to protect their children, after all. The intention is truly good. Another factor is that they just do not know how much to say, exactly what to say and not say, and are often thrown off by various ages of the kids and who should be told what!

The good news: A huge percentage of siblings of people with special needs grow up to be amazingly empathetic people themselves, are less likely to bully or tolerate bullying, and often mature into contributing via their careers in the helping professions. It is good to remember that there are joys as well as concerns that result from being a sib.

I plan to write blogs pertaining to the following specific topics: current available supports, one on nothing but the joys, one about shared concerns regarding who is to help out after the parents die, typical traits and common concerns of the sibs, one on statistics, one for the parents on best ways to communicate with the sibs, and so forth. With opens ears and arms I welcome your suggestions. SIBLINGS – what do you want to talk about?

In closing this initial sib-focused blog, I just want to say that as a mental health nurse working with people dealing with all sorts of illness and disability for my entire career, the siblings and I have always resonated, and my brother’s biggest gift to me was the compassion, empathy, and connection that was instilled in me to share with you. You are not alone. I hope you find the solace and sense of understanding, even belonging, that is here for you.

Lisa Croce, RN, BSN

www.rockymountainsibshops.com

To post a response to this blog please visit The Recovery Trust.

The Recovery Trust, a Colorado-based nonprofit, has added a new resource for families in need of education and support. It is a free, secure, online forum through which family members can join with others in the same situation.

The forum is moderated by a team of mental health professionals, psychiatrists, family members and people who have experienced mental illness, all of whom have received extensive training in their role as facilitators. Users of the forum can access a large database of information about these illnesses, FAQs and links to other resources.

Words matter: How should we talk about mental illness?

“So, I am thinking about how to talk about my….well….my, you know, my mental illness. I mean, my brain disorder. Well, I don’t know how to describe what it is.”

Words do matter and how we talk about what we experience is important. It may be that through the years a person’s symptoms have led to a diagnosis, one that is listed in the DSM-IV. When that becomes clearer, or clear enough, there are ways for these symptoms to be treated, usually by a combination of medications and programs. The major “s” listed by the National Alliance on Mental Illness are schizoaffective disorder, autism spectrum disorders, obsessive-compulsive disorder, panic and anxiety disorders, and borderline personality disorder.

One of the lively conversations today is around how to talk about these illnesses. “Mental Illness is an illness like any other” is a phrase we have heard. However, that does underestimate the way that most illnesses can be determined. Diabetes or cancer or heart disease are measurable, based on biological data. “Mental” illnesses are not yet in that category. We go on symptoms, as mentioned above, and we don’t have a brain scan at this time to indicate why these symptoms occur. While treatable, the causes of mental illnesses are not completely known.

Still, there are many who say that mental illnesses are physical disabilities. They are biologically based and arise in some way from the brain. Therefore, we use the medical model of treatment. “Here are the medications to try in order to alleviate the ‘illness.’” This understanding has at least one enormous benefit. It may reduce the stigma that is present around “mental illness.” What has been known as “mental” illnesses can now be called “brain disorders.” It sounds less stigmatizing, removes the burdens of blame for what causes these symptoms, and can empower those who are living with the shadow of self-recrimination to speak and act more openly in society. Living into that reality, however, still leaves more work to be done. Some people think the word “disorder” is too clinical and medical.

For instance, when I mentioned that I had been using the words “brain disorder” to describe my son’s mental illness, bipolar disorder, it was very clear to him that this is was not the way that he wanted me to talk about this part of his condition. He said just use “bipolar.” I sincerely apologized because I had not asked him before, and I felt that I had used words that were inappropriate. He is an adult who is fully alive, filled with honed wisdom, has a creative wit, and I deeply love him. He was direct in pointing out that I had erred in his case.

Language can be tricky. It can elucidate things or muddy things. So what can we do? Keep on keeping on working on language seeking to describe how things are. It will not be perfect since someone will always come up with an “on the other hand” perspective on what you are seeking to make general and universal. Now I have come to understand even better from my son that perhaps the best thing is to talk with the person who is affected by a “mental illness” or a “brain disorder” or “depression” or “bipolar” or whatever to see how they see it themselves. This is all about relationships anyway. Connecting with someone who is affected by mental illness/brain disorder/etc. may reveal something new and fresh in our own understanding and therefore lessen our perplexity and confusion about our use of language.

Alan Johnson,

Interfaith Network on Mental Illness and Caring Clergy Project

To post a response to this blog please visit The Recovery Trust.

The Stigma Inside Us

We grow up surrounded by a cultural myth – the stereotype of the person with mental illness. Our news media and daytime TV shows portray people with mental illness as violent criminals or, at best, figures of fun. Not so long ago, I saw a realtor’s ad in a local newspaper headed “Driven Crazy by Your Housing?” that illustrated the message with a snarling face with bulging eyes, wild hair and distorted features. Community surveys reveal that people think of people with mental illness as always being unable to make any rational decisions, incapable, unpredictable and worthless. A 1960s American survey concludes that they are viewed by the public with “fear, distrust and dislike.” In short, “all things bad.” Since then, there hasn’t been much, if any, improvement.

This stereotype leads on to all kinds of misconceptions about mental illness. Half the people answering a public survey in Britain in the 1990s thought that setting fire to public buildings was a “very likely” consequence of mental illness. American surveys of the same period found that the majority of the public blamed mental illness on “lack of discipline,” and believed that people with mental illness were more responsible for their condition than were people with AIDS or the obese or any other stigmatized group. Worse still, people with mental illness themselves, and their family members share these misconceptions. When I was involved in a global anti-stigma project a few years ago, we conducted a survey of family members in Madrid. It showed that more than half felt that people with schizophrenia should not be allowed to study, drive a car or have children.

So, growing up in a world where everyone accepts this myth and shares these misconceptions, what would your reaction be if someone were to tell you that you suffer from mental illness? If you have an ounce of dignity, it would be, “No, not me. I’m nothing like that.” And, of course, you would be right. No-one is like that. But it may take you a lot of time and effort to get past the stereotype, see the illness for what it is, an illness, and see yourself again for the responsible and capable person you are. Your first impulse would be to say it can’t be true.

I was lucky enough to hear Pete Earley talk in Boulder recently. He is the author of Crazy, an account of what he learned about the US mental health treatment system after his son, Mike, developed a serious mental illness. In a recent blog, he writes about trying to understand why his son didn’t want to take medication for his mental illness. One day, he asked Mike to explain to him, in writing, why this was such a struggle. Mike writes:

Denial was a strong factor in my understanding and even when evidence of my own madness would be presented, my mind would find a way to weave out of the circumstance and an obtuse reasoning would somehow form that would keep my own pride intact. Always two steps ahead of the truth, my brain would tap dance its way into a room where I was not at fault, where it was everybody else versus me, where I was some sort of prophet or special medium who was undergoing visions, not hallucinations, and I was important, not a victim.

It is very hard to understand that one’s own credibility is broken. There is a lot of personal shame one undergoes when they realize that they are no longer in line with society’s understanding of sane. It makes one doubt one’s own instincts and second guess the movements and decisions that one makes. Suddenly, the veil of confidence and ability has been lifted and one is a wreck, struggling to piece together the remnants of what are left of one’s self image.

I learn a lot from my son, Pete Earley concludes. One lesson he has taught me is that taking anti-psychotic medication is much more complicated than being told by your doctor that you have high cholesterol.

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

You can read his entire blog here: Why Won’t You Take Your Mediation

Denial is a major consequence of the stigma of mental illness that we all carry within us, but when denial gives way to acceptance and shame, there’s a lot more trouble in store.

People who accept the label of mental illness take on a burden. They can see themselves as incapable and worthless. Out of a sense of shame they may withdraw socially from their friends, give up on their careers, academic or marriage plans and, viewing themselves as hopeless cases, become dependent on their treatment providers and others in their lives.

Consequently, the person with “insight” into his illness may do less well than expected while those who reject the label of mental illness are more likely to hold on to their ambitions and try to forge ahead with their lives.

We conducted a study a few years ago in Boulder, Colorado, that showed this to be true – that people who accept the label of mental illness and hold stigmatizing beliefs about it tend to feel dis-empowered and worthless and don’t do as well as they might.

There are several other studies now that point to the same problem. Insight coupled with a sense of shame about the diagnosis leads to hopelessness, avoiding social contacts and poor self-esteem. Internalized stigma, it seems, undermines the possibility that insight will lead to recovery.

Mental health professionals have long been trained to help their clients develop insight and to accept their illnesses. It seems, however, that there are two other elements that are vital to recovery that are much less likely to be emphasized in training – empowerment and reducing internalized stigma.

On the road to recovery, people with mental illness need to find the information that will help them shake off the stigma, stereotypes and misconceptions that come with the label of mental illness and to access advocacy to combat discrimination. They need to be treated with the respect that will allow them to retain a sense of dignity and to be provided with opportunities for advancement that will show them that they are masters of their own destiny.

Mental Illness: The Last Stigma

When I entered medical school over 40 years ago we were taught never to say the word “cancer” in front of a patient. The stigma was so great that patients were often allowed to die not knowing what their diagnosis was. The obituary never named the illness.

The same was true of “schizophrenia.” You just didn’t mention it.

Since those days we have shaken off the stigma that cancer carried. People talk about their illness and its treatment openly and get support and information from all sides. We learn about the illness daily from the media.

The same thing has not happened with schizophrenia and other psychotic illness. The stigma of serious mental illness still permeates the fabric of our society.

Most of us know someone close to us, a relative or a friend, who has experienced a psychotic disorder, though, of course, we may not have been told about the problem at the time it was occurring out of a sense of shame or not wanting to hurt the feelings of the person with the illness. But few of us know much about the nature of these illnesses – the causes, the symptoms of the various disorders, the possible outcomes and how to respond to the person with the illness.

It’s not that people don’t want to know. For some years, when I worked at the public mental health center in Boulder we would regularly teach about mental illness in the community. We would talk to the police and judges, who often meet people with mental illness during their working day, and get to answer their many detailed questions. We would go into high schools with some of our clients who had experienced psychotic illness and have them tell their stories. The students would be on the edge of their seats, filled with obvious interest and empathy.

In the debate on gun control, there is an emerging consensus on one point. The senate and the president agree that we should educate teachers about mental illness. Good idea! But why just teachers? What about their students – the next generation of adult citizens? Many of them are living with someone with a mental illness. Some will develop a mental illness. More will become parents of someone with a mental illness.

We don’t teach about these conditions in school on a regular basis. It is not reliably part of the psychology curriculum. The health curriculum in my local school district is a wonderful program for teaching citizenship skills and how to lead a full and productive life, but it contains nothing about serious mental illness.

The result of this lack of education is that our citizens grow up not being able to recognize the onset of disabling mental disorders in their own children, not knowing what treatments are possible and what benefits they can bring. Often families find out what they needed to know years after the problems develop, and even then, they may not be able to access the information that could help them. The National Alliance on Mental Illness (NAMI) and its many chapters across the US has proven to be a wonderful resource for families in this situation. Their Family to Family program, through which trained family members teach courses for other families on what they need to know about recognizing and managing these illnesses, has been shown to be effective in improving outcome for people with schizophrenia and similar disorders and has become a model for the world.

The Recovery Trust, a Colorado-based nonprofit, has added a new resource for these families in need of education and support. It is a free, secure, online forum through which family members can join with others in the same situation.

The forum provides a vital new opportunity for support and education for families and friends of people with mental illness who live in outlying areas of the state where there may be few other resources. We expect that it will be helpful for people who can’t get to support groups because of distance, work or other factors.

To enroll as a user of the forum visit here.You can preserve your anonymity.

The forum is a resource for a people who urgently need information about mental illness. But we must move beyond this and look at how we can educate our young citizens so that this important knowledge is disseminated throughout our society like other vital health information. Including some information in high school health curricula would be an excellent place to start.