What’s the worst that could happen? And who will you still be regardless of the outcome? In today’s podcast, Gabe talks with author Shira Gura about her newest method CLEAR, a tool we can all use to prepare for an upcoming event or situation that is causing anxiety. 

Worried about an upcoming exam, a date, or a party where you won’t know anyone? Join us to learn a great method to help CLEAR your head before you go.

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A third of all people will be a caregiver at some point in their lives. Caregiving for people with schizophrenia presents challenges that many people are ill-prepared for.

Host Rachel Star breaks down the principles of caregiving and creative ways to navigate schizophrenia.

Dr. Sarah Kopelovich joins to share schizophrenia caregiver specific training.

About our Guest

Sarah Kopelovich, PhD is a forensically-trained licensed clinical psychologist in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. Dr. Kopelovich is an Assistant Professor in the department and holds the Professorship in Cognitive Behavioral Therapy for psychosis. Her current research is specifically oriented toward implementation and dissemination strategies for psychotherapeutic and psychosocial interventions for Schizophrenia Spectrum Disorders. She regularly conducts workshops, seminars, and professional consultation across the country for an array of mental health professionals and trainees in CBT for psychosis; Recovery-Oriented Cognitive Therapy; Individual Resiliency Training for First Episode Psychosis; Assertive Community Treatment; and diagnostic, suicide, and violence risk assessment.

www.PsychosisREACH.org

Back to Life, Back to Normality: Volume 2 -outlines many of the cognitive-behavioral techniques used in the Psychosis REACH training.

(https://www.amazon.com/Back-Life-Normality-Relatives-Schizophrenia/dp/1107564832)

Computer Generated Transcript of “Caregiving for Schizophrenia” Episode

Editor’s Note: Please be mindful that this transcript has been computer-generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.

Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference?  There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.

Rachel Star Withers: Welcome to Inside Schizophrenia. I’m your host, Rachel Star, here with my wonderful co-host, Gabe Howard. Gabe, now it sounds at first like we have a very squishy, lovey-dovey topic. Caregiving, right. I could feel like just the title of it. It sounds like a nice Hallmark movie kind of thing going on. But we’re going to get into some kind of, I don’t want to say deep, but intense stuff with it. We’ve talked before, Gabe, we feel strongly about that word being used towards people with mental health problems.

Gabe Howard: Caregiving is universally thought of only in the positive, but as folks are going to learn, even very positive things can have a flip side.

Rachel Star Withers: And right off the bat, I don’t like the term caregiver because it automatically puts that person kind of over the other one. So if my mom is my caregiver, then obviously she has to take care of me for whatever reason. I’m not able to. I’m sick. I’m inferior. You know, there’s a problem somewhere, which is true in it, but it does, it just kind of that mentally puts it out there. And, you know, Gabe, I gush all the time about my parents. They’re absolutely wonderful. And I cannot live on my own. It’s hard for me to have to accept that on some level that they are my caregivers, because that means I’m a burden to them. And I know they would never describe it that way. But it makes me feel bad as a 35 year old grown woman that I do have to depend on somebody else.

Gabe Howard: So here’s sort of the issue with caregiver, right? It becomes all encompassing. Let’s say that tomorrow you get in, we’re going to use car accident and for the purposes of this analogy, you’re going to recover. But in the car accident, you break both arms and both legs. Now, that’s like pretty high level caregiving. Nobody would argue that you need care and that the person doing it is your caregiver. But in that analogy, remember I said you’re going to make a full recovery. Eventually you start getting use of your body parts back. First your hands work and then your arms work and your family or your caregiver starts doing less and less and less and less and less. And in physical health, people acknowledge that. People acknowledge that you’re needing less assistance and less help. Over on mental health, it doesn’t matter if you are the worst of the worst, the sickest of the sick, or if you are Rachel Star and all you’re really doing is just living in your parents’ basement, hanging out. It’s talked about in exactly the same way, and I think therein lies the problem. Right? Because now when people say, oh, Rachel, your parents are your caregiver, they immediately assume that you are the worst of the worst and have no partnership, no control, no faculties. And you are not assisting in your own care.

Rachel Star Withers: And I also think whoever they’re talking to, like this third party, they automatically feel sympathy, like you poor thing, you have to deal with this, you poor thing. And I don’t want to say, like as the person who has the issue, like, I get jealous, but it’s also like, OK, well, they’re not the ones who are hallucinating.

Gabe Howard: We have more sympathy for the people next to the person with schizophrenia than we do for the actual person suffering from schizophrenia. And could you imagine if somebody said, oh, you know, Rachel has cancer, but the real people suffering are her family, like everybody would just be up in arms

Rachel Star Withers: Oh, yeah.

Gabe Howard: And not tolerate that. But if you say, well, you know, Rachel has schizophrenia, but the real people suffering are her family people immediately they’re like, well, but I mean, they’ve gone through a lot. It can’t be worse for them than it is for you, Rachel,

Rachel Star Withers: Yeah, to make it clear for everybody, when we were saying caregiver today, we’re not talking about the doctors, nurses, that kind of thing, we’re talking about the kind of normal day to day stuff. So a caregiver, they could be paid but most caregivers are unpaid members that are related or in the social circle of the person who is needing care. Usually our caregivers don’t have any professional training. We have a wonderful guest today who’s actually going to talk to us more about caregiver training. The majority of caregivers are women. I think with a lot of women, you already have that kind of motherly role and they’ll usually be the first to step up to be the caregivers. Typical duties, this is all little things, OK? Daily activity stuff is what caregivers do. They manage medications, making sure that you’re taking your medications, you’re taking them correctly. They may talk to the doctor or nurse or whoever on your behalf.

Rachel Star Withers: With schizophrenia, what we need might change. So caregivers, when it comes to schizophrenia, may or may not have to help with like cleanliness, that kind of thing, making meals, making sure that the person is eating healthy, not just eating Pop tarts nonstop. So right now, there’s around 50 million family caregivers nationwide in America. Fifty million people. That’s so many. And if you were to pay them, in theory, it would be around three hundred and six billion dollars. So these family care like you are worth a lot of money. To my people that are out there listening, it is a thankless, usually moneyless job. And a third of us, a third of all people will have to be a caregiver at some point in their lives. But you also have to take into account the person and you need to make sure that they are still feeling respect and dignity. No one wants someone telling them what they can eat, what they can’t eat. OK, this is what you’re going to do today. Like nobody wants their whole life controlled by somebody else.

Gabe Howard: And nobody wants to be seen as less than. Oftentimes, people experiencing schizophrenia don’t have that level of respect to balance out the burden. We just have the burden. That’s a lot to overcome, to be seen by society as hurting our families in addition to managing schizophrenia. That’s, that’s big. That’s, that’s mighty big. We don’t want to hurt our family. We love our families. And we are incredibly thankful for everything that they’re doing for us. We just want to make sure that we’re not lost in that discussion.

Rachel Star Withers: If you are a caregiver for someone who, like you said earlier, has a broken bone, if you’re a caregiver for someone who is elderly, you kind of know what to expect. But with schizophrenia, it’s not that predictable. The caregiver of someone who has schizophrenia, you have to be on the lookout for other things. One of the biggest is going to be medications and side effects. If the person that you are helping also has depression, you really need to kind of watch out for suicidal tendencies, kind of signs that this person might not need to be alone. This person might need to have their medication changed up. And the side effects I know, Gabe, and you’ve seen me do my little dance here, but I have tardive dyskinesia where I shake and there’s just a lot of side effects that can affect people with schizophrenia differently, it’s not predictable. With those medications, and we had a previous episode about this, it opens you up to being vulnerable for more diseases. So, for instance, diabetes is a huge risk if you have schizophrenia. If you’ve ever been on any antipsychotics, you do tend to put on weight very frustratingly quickly. So caregivers need to kind of watch that. And I’ll be honest, Gabe, I don’t like the idea of someone telling me what I can and can’t eat.

Gabe Howard: Well, right, because you’re an adult and you need to make your own decisions and let’s take this at a base level like a human dignity level, if you are not choosing your own meals, your own food, if somebody else is making that basic decision for you, how much wellness do you actually have if you don’t even have the autonomy to choose what you put in your own mouth, what you eat for sustenance and meals?

Rachel Star Withers: Another thing that changes with schizophrenia versus other types of disorders, diseases, et cetera, is the cognitive ability, disorganized thoughts. Sometimes, and it’s so hard to explain when people ask me about this, but sometimes, like, I’ll forget something very simple, like, how to zip up my jacket? It’s just like the piece is gone and you can have a full conversation with me, I’m fine. But then I’ll go to do something. And I’m like, oh, no, how do I do this random thing? And I’ll get confused. That’s what caregivers have to watch out for with schizophrenia. Like, I don’t need anyone to help me dress. I don’t need anyone to come over and pick my clothes out for me. But then some days I get confused and I can’t remember how to do something. And just throwing this out there, my way around that is that I lay out my clothing ahead of time and I always have a backup set with no fun things like zippers and things. Schizophrenia isn’t predictable. Gabe, a few weeks ago, I had a really bad psychotic episode and I haven’t had one this bad in way over a year, 99% of the time, I don’t need help.

Rachel Star Withers: I hallucinate and I have little delusions and things, but I’m able to manage it myself. I usually don’t even tell anyone. But this was different. And when it happened, I became very scared. I knew I did not have a grasp on reality. I couldn’t get my phone to work. I was trying to text my mom who was upstairs, and I couldn’t seem to text. I couldn’t remember how to text. I was like fighting my phone. I don’t know if I was texting the right person couldn’t put words together and somehow I got in the kitchen. Eventually, my mom, she did get some of the text messages. She came out, got me and stayed with me the rest of the night. That was very scary. And I’m very lucky that she was there to step in. Again, this is once a year that she had to do that. But we don’t know when that once is. She may have had to, like, be up early for work or something the next morning. So taking care with schizophrenia, it’s very unpredictable. And it’s kind of like you’re on call, like you’re ready to help if the person needs help in this way. But most of the time they might be OK.

Gabe Howard: And obviously, that can be frustrating for all involved, I mean, who wants to be on call? You’re going about your day, you’re doing what you’re supposed to do and then boom, right in the middle of it, this thing happens that you have to be 100% for your loved one and that you want to be 100% for your loved one. And hopefully your loved one realizes what you’re doing and they need help. And that’s why I think that it is extraordinarily important to make a plan when you’re well. You know, one of the things that that Rachel does well and that we’ve talked about in this whole podcast series is she doesn’t just talk about schizophrenia with her family when she’s in crisis or when she’s hallucinating, when she’s having a problem. This is a continuous conversation that they have even when she’s completely well. The analogy that I like to use is it’s like having a fire drill when the house is on fire. But the best time to install smoke detectors and the best time to have a fire drill is when your house is not on fire. It’s very much the same in schizophrenia. And I think a lot of caregivers miss this. And in fairness, a lot of people living with schizophrenia, they miss it, too. We want to believe when everything is fine that it’s going to stay fine. And we just want to focus on the here and now and not make a plan for what happens in the event that things go a different way.

Rachel Star Withers: So many of these caregiver relationships, like my own, is parent, adult child and mothers out there, a lot of you just kind of don’t step in to caregiving. You just step into mothering, just taking over like you did when they were five. And that’s where a lot of the tension comes from. ‘Cause I’ve talked to so many mothers who are just overwhelmed with trying to help their adult child and don’t know what to do. And part of it is you’re trying to do too much. You need to acknowledge what the person with schizophrenia can and can’t do. Like, I would much rather just bring someone food and be like, eat it, then say, OK, well, let’s work out the plan. You’re going to cook this, not, you know, I get it. That’s like more work. It’s totally easier to just dominate over someone and make all the decisions. But you can’t. Gabe, so I have a friend around in his 30s, but he has schizophrenia and he lives with his parents and he’s on disability and they’re constantly fighting because his parents take all of his disability money and he doesn’t like that. He’s like, that’s my money. And I was like, well, if you were out on your own, you would still have to pay for rent, groceries, utilities, etc. So I do believe that they are entitled to some of that because you’re using those things. I don’t think they should take all of it. But when they do give him money, he immediately spends it on alcohol, gets drunk. I don’t know, Gabe. What are your suggestions? Because I know so many people that get caught in like, what do we do? We’re stuck in this circle and don’t know how to get out of it.

Gabe Howard: In this scenario that you’re given, both sides are right, the family needs the money for the expenses that the person living with schizophrenia is generating. We can’t ignore that. But we also can’t ignore that the disability check is this person’s. It’s in their name and they feel like they’re not being given a choice. They feel like their money is being stolen. But then again, let’s go back to the other side. They feel like, well, when I give that person the money, they make dangerous choices. You know, buy alcohol, and especially in the case of, you know, the family dynamic, if this person uses alcohol, it interferes with the meds. They have a crisis. This crisis affects the whole family. So when taking a look at everything, these are very difficult things to resolve because the reality is, is both sides are right and both sides are wrong. This is where it’s really important to understand that. I call it negotiating in good faith. If you have this idea in your head that the other side is wrong and you’re right, you’re not negotiating in good faith. And I’m speaking both to the caregiver side and the side of people living with schizophrenia.

Gabe Howard: And that also points to a larger problem, which those two sides are often at odds. They’re often looking at each other as heroes versus villains when in actuality you’re neither of those things. That’s very important. These things get resolved in any number of ways, whether it be by compromise, whether it be by walking a mile in the other person’s shoes, whether it’s understanding. So often, caregivers don’t think that they’re the ones that need to seek mental health help. They don’t think that family therapy is needed because after all, they’re this big, strong caregiver. It’s only the person living with schizophrenia that needs help. It’s vital that you understand that if something is contributing to the mental health decline of the household, it means that the entire household needs mental health help. And so often people think, oh, well, I’m not as sick as my loved one with schizophrenia, therefore I don’t need any help. Don’t think of it that way at all.

Rachel Star Withers: And you have to know what you can and can’t do. Most people have to work full time. OK, so we get this. This is almost like a second job or maybe a third job for many on top of your life. And it becomes intense. Family members are awesome because they’re usually the main support system. Whenever you’re making that decision of should the person with schizophrenia live with you, there’s actually I like this. It’s a little chart, Gabe, I have here, but it says

Gabe Howard: I love charts as well.

Rachel Star Withers: I know, but it says, living with your family and you have schizophrenia works best if you are high functioning and you can still maintain friendships and activities outside of the home, meaning I’m still able to go to a part time job, volunteer work. I still have friends I talk to. It’s not just me and my parents and that’s it. Another is that the relationship around the family is relaxed. You know, if you always have a lot of tension with a certain family member, it’s going to be a lot worse when you add in schizophrenia and then living together. You want to make sure that there are other support systems. Again, you can’t do it all yourself. We’ve talked about NAMI and different things, support groups, at the doctor asking them. Make sure as the caregiver that you’re not all the person with schizophrenia has and make sure this last one here that the living situation is not negatively impacted, if there’s young children in the home, by the person with schizophrenia, children come first. Always make sure they’re protected and everything. I’d say for the most part, my family has, they fit all of those.

Gabe Howard: Ok, Rachel, but along that same vein, what things are immediate disqualifiers? Like living with the family is not advised if what happens?

Rachel Star Withers: Well, one, if the caregiver is single, ill or elderly, that’s going to be really hard. You know, someone in their 80s is going to have a very hard time helping out with someone with schizophrenia. That’s just the truth of it. If the schizophrenic is very low functioning, if they pretty much they need more help than you can give them. So when I say high functioning, low functioning, what I mean is I’m usually considered a high functioning schizophrenic, meaning that for the most part I’m good for, let’s say, two weeks I could live alone. But after that I get weird and I have, like, little spurts of times when I’m going to need a lot more help. But I’m high functioning. Low functioning would mean I need a lot more help, more supervision. I need someone kind of stepping in my life, helping me make important decisions, helping me with my money, etc.

Gabe Howard: Makes sense. Understood.

Rachel Star Withers: You shouldn’t be a caregiver for the person in your family if it’s causing stress on your marriage, if your life is in shambles, you can’t help anybody else. I can’t stress that enough. And you’re going to hate that person you’re trying to help because you’re like, oh, well, I’ve lost my marriage. I’ve lost my job because of this person. It’s going to impact you both negatively. You just have to accept that you cannot do everything.

Gabe Howard: And I think that’s really the key. What we want to point out is that doing something about it doesn’t necessarily mean that you personally do it. It could be a matter of getting the person to the right care. For example, we’ll go back to the car crash scenario that I gave. I am not an EMT. I am not a trauma surgeon. I don’t know how to set a bone. So if that happens to my friend Rachel, the best thing that I can do for her, of course, is call 911 and get her the help. In mental health, we have this tendency to do just the opposite, to say, oh, I’m going to pick you up, Rachel, and we move her from the car accident, we start doing all kinds of damage because we’re unaware. Sincerely, ask other family members to pitch in, call friends, call the local charity, schedule an appointment with a therapist, find out what you can do. And honestly, by listening to this podcast, you’re already starting that process. You’re looking for hints and tips of how you can be better. Again, I really feel the need to be clear. Me calling 911 one for Rachel in the car accident analogy is me doing a hundred percent of what I can do and ensuring that Rachel has the best possible outcome. We need to start thinking that way in mental health rather than thinking, OK, well, I have to fix 100% of this because after all, I love my child, friend, family member, etc.

Rachel Star Withers: So, Gabe, we’ve really been a downer up until this point,

Gabe Howard: And we don’t mean to be

Rachel Star Withers: We don’t mean to, but we have all these problems we discussed. How do we fix them? One of the best things you can do is set out rules or make it very clear as the caregiver what is expected of you and as the person receiving care, what is expected of them so that, you know, if you’re overstepping your bounds. Make sure that the person receiving care has to give something too. All right? It’s not just like take, take, take. Now, it could be little things. It could be. You know what, hey, if you’re able to vacuum, if you’re able to handle the groceries, but make it clear that this is a partnership, it’s not just one person completely depending on the other. You know, what you can and can’t do might change over time. For the most part in my family, I buy a lot of like the groceries and things like that. I like that I’m able to provide food, make food and things because it makes me feel that, hey, I am contributing to the household. It’s not just me living in the basement, creepily skulking around the house, taking everything and not giving back.

Gabe Howard: I really like what you said about little things really matter, you know, I have a, I have a pseudo kid in my life. I have a granddaughter and they’re a young family. They’re in their early 20s. They have a two year old. They don’t have a lot of money. They’re just starting out in life. They just bought a house. Long story short, whenever we go anywhere, I pay 100% of the time. I buy dinner, I buy the putt-putt tickets, I put gas in the car because I can afford to do so. The other day, my daughter in law bought me a Diet Coke. She showed up at the house. She was running errands. She had to drop something off. And when she pulled in, she handed me a Diet Coke from my favorite place. Straw and all, exactly how I like it with the light ice. It cost her a dollar. That meant a lot to me, an incredible amount, and it meant a lot to her because she got to give back in some small way. And, you know, there was hugging. You have to understand that those things are very, very powerful, breaking that analogy into the caregiver relationship with somebody living with schizophrenia.

Gabe Howard: Find out what that is. Because it empowers the person and it gives you that hope and positivity to move forward as the caregiver. So often we’d rather just sit and think, well, I pay for everything. Well, I do everything? Well, they don’t help at all. Find those, I’m going to call them little Diet Coke moments. If you have this idea that you’re always going to be the caregiver and that they’re always going to need help and that they’re never going to contribute, you create a self-fulfilling prophecy.

Rachel Star Withers: And so many times when someone does have to move back home or need care, they’re recovering. They’re recovering from a very bad psychotic episode, or maybe they’ve just fully been diagnosed as having schizophrenia and they’re going through that. So make sure that you have goals of where do I want to be in a year? If your goal is to live on your own, and right now you can’t. If the caregiver is too overprotective and just taking over my life, I will never get to that point because I won’t know how to stand up on my own. You did it all for me. So make sure as you find objectives to help with that, as a caregiver, you know when to step back. As the caregiver, you need to watch out for some things in your own life. There’s actually something called caregiver syndrome, and that is when you’ve just kind of you’re burnt out. And you can get burned out on a job, lots of things in life, but you’re burnt out of caring for a person. And that manifests in exhaustion, anger, rage, depression, anxiety and even physical things. High blood pressure, diabetes. This is all stuff we talked about earlier. Gabe, this is like, you’re trying to help someone else with these exact same problems and now you have the problems.

Gabe Howard: Yeah, you can’t pour from an empty cup. I know that it’s a cliche, but if you are not well, what support are you providing? Sincerely, Rachel, would you want help from a person who was sleepless, scattershot, angry, frustrated, confused, annoyed? Is that the person that you want to show up to provide you what, in some cases, could be life-saving care?

Rachel Star Withers: I do not, Gabe. The stress there. Can you imagine now if I’m living with that person and it just never ends? You’re going to have to learn as a caregiver to step back, take a vacation, even if it’s just like little mini vacations during the day. Really cool. I actually was talking with this family and they had a young teenage son. He was diagnosed with childhood schizophrenia. And so he had been on antipsychotics for quite a while. And they’d definitely affected his weight. And the parents were just pretty much, they were at their wits end. You know, they’re doing so much trying to help their child. And now on top of that, they’re worrying about his weight gain.

Rachel Star Withers: So what happened? The uncle stepped in. The uncle decided that he was going to start working out with the young man. And it was kind of cool. You know, you got the cool uncle. The pressure wasn’t there. They would go out, he’d pick them up, they’d go and they would do some physical activity every single week. For one, that gave the parents a chance to take a little break from having to worry about the son, but also gave the son a social outing. And it made him feel like this isn’t something I have to do. I’m getting to spend time with my fun, cool uncle. And I love that. And that’s something like if you’re able to incorporate that, look around. If there’s other family members, be like, listen, I’m already doing this, this and this. Is there any way that you could help with one of these things? If one of your family members likes to cook? Yo, like, maybe you could make a little more. Maybe you could come over and show, like, find ways to give yourself a break as a caregiver. You can also look into assisted living situations like that. You know, don’t think that you have to do everything. Get help when you need it.

Gabe Howard: I think a lot of people are experiencing stress in the time of corona, so it’s very important to understand that no matter how hard your family dynamic tries, external factors out of your control can change things. And the whole point of this is this is why it has to be an ongoing conversation and an ongoing partnership between all the parties. Otherwise, you’re not going to be nimble enough to survive when things happen. Now, obviously, I don’t think anybody saw a worldwide pandemic coming, but nevertheless, people with schizophrenia are also managing a worldwide pandemic, as are the people who love them.

Rachel Star Withers: And we’ll be right back after a message from our sponsor.

Sponsor: It can sometimes feel like another schizophrenia episode is just around the corner. In fact, a study found that patients had an average of nine episodes in less than six years. However, there is a treatment plan option that can help delay another episode: a once monthly injection for adults with schizophrenia. If delaying another episode sounds like it could make a difference for you or your loved one, learn more about treating schizophrenia with once monthly injections at OnceMonthlyDifference.com. That’s OnceMonthlyDifference.com.

Rachel Star Withers: And we’re back discussing schizophrenia and caregiving.

Gabe Howard: Rachel, you got to spend time with Dr. Sarah Kopelovich, who is an assistant professor, and has done a lot of research on caregivers. She taught us things like compassion fatigue, and it was very, very cool. I loved hearing your interview. So let’s go ahead and play that now.

Rachel Star Withers: We’re here speaking today with Dr. Sarah Kopelovich, who is a licensed clinical psychologist, and she’s also an assistant professor who has been doing a lot of very interesting research into schizophrenia spectrum disorders. And today we have been talking about caretakers and the role that they play in helping different people with schizophrenia. Doctor, tell us about your research and how it deals with caregiver training.

Sarah Kopelovich, Ph.D.: Sure. So my primary area of expertise is in psychotherapeutic interventions for people with schizophrenia spectrum disorders and other forms of serious mental illness. I do a lot of work trying to increase access to these evidence based psychotherapies. And the kind of frontline intervention in that realm is cognitive behavioral therapy. In trying to increase access to cognitive behavioral therapy for psychosis, how do we leverage other members of the treatment team and the natural support team so that we can really take an all hands on deck approach to helping people get access to good quality skills that can help them cope better with the symptoms of psychosis? There is a model called Psychosis REACH, which was developed by Dr. Douglas Turkington, who also happens to be one of the co developers of Cognitive Behavioral Therapy for Psychosis that teaches family members cognitive behavioral therapy concepts and skills so that they can have more therapeutic interactions with their loved ones. We have now piloted an eight hour training in May of 2019 and it was a huge success. So we found that just through a one day training, we were able to improve the well-being, so in other words, depression and anxiety, scores of the family members who attended that one day training and there was no other intervention involved. It was just that one day in person training, correcting myths and misconceptions about psychosis, providing background, and how can cognitive behavioral therapy help improve your life and well-being and depression and anxiety? And then how can you use these skills and concepts to improve relationships with your loved ones? So we’re really excited about these preliminary findings and we’re continuing to provide this training to family members in the coming years. Now, virtually, of course.

Rachel Star Withers: That’s really amazing. So it’s just a one day training as of right now?

Sarah Kopelovich, Ph.D.: This is a one day training and it is outside of any mental health clinic. We know that our national schizophrenia treatment guidelines recommend that the care team is providing family intervention for psychosis, but unfortunately, that’s just not playing out in practice. Only about two percent of families in the United States who have a loved one with serious mental illness are receiving any kind of family intervention for psychosis. So our goal was to take this out of the clinic. And I was able to do that because I was very, very fortunate to receive philanthropic support. So we offered this training to anyone. We provided financial support for travel and lodging. We brought them all together in a beautiful space, catered and just really communicated to families you’re valued. We care about you and we want you to learn. We know you’re doing as well as you can. We want to help you do even better.

Rachel Star Withers: So why is caregiver training important?

Sarah Kopelovich, Ph.D.: Well, we know that for a long time now, families have been in the shadow of the mental health system in our country. I talked about how 98% of the time families are not brought into their loved one’s mental health treatment, and this is contrary to the overwhelming evidence. Research shows that if we can support families appropriately, we can save money, we can save relationships and we can save lives. We spend three hundred billion dollars annually on costs associated with serious mental illness. And much of that comes from hospitalization costs. Which it just so happens that family interventions like caregiver training, one of the strongest outcomes that we see for this intervention is reduced hospitalization rates and reduced number of days in the hospital. In terms of saving relationships, there’s this really interesting study about 10 years ago out of Delaware. They just asked people living in the community with a schizophrenia spectrum disorder, do you feel alone? And 90% of the people that returned a survey said yes. And yet it’s also true that 90% of individuals with psychosis are in close contact with at least one family member. Psychosis can be a terribly isolating experience. So you can be surrounded by people, and by very well intentioned people, and feel so utterly alone. And we can change that. We can help get the relationship back on track. We can improve quality of life. And then, of course, that brings me to that last point, which is that family interventions like caregiver training can save lives. So one third of people with schizophrenia will attempt suicide and one in 10 will die from suicide. When you ask about why caregiver training is important, it’s about saving families and saving lives. It’s about giving family members a very different message than they’re likely receiving, which is that they should expect recovery. That’s what the data supports, is that most people who experience a psychotic episode will experience wellness, will experience recovery, and families need to hear that.

Rachel Star Withers: Very nice, I agree on that. When I know most people hear caregiver, we tend to think of someone taking care of like an older family member. When my grandfather and my grandmother both had Alzheimer’s, I remember we kind of had to do a little caregiver training, but it really had nothing to do with the mental. How is your type of caregiver training different than, let’s say, dealing with someone who’s in their 90s like we were?

Sarah Kopelovich, Ph.D.: Yeah, well, so first I want to clarify that I’m using the term caregiver quite broadly to refer to anyone who identifies as a support person. So that could be a biological family member, a significant other, a friend. And in terms of how it differs from other kinds of caregiver training, I think the domains in terms of what it’s trying to accomplish are actually more similar than they are different. If you are the loved one or the support person of somebody who’s experiencing an episodic or potentially episodic condition, then there are some basics that we need to help you to do. One is to have accurate information about the diagnosis and to be realistic and also hopeful. And with schizophrenia and other forms of psychosis, there’s a lot to be hopeful about. Despite all the doom and gloom you might confront on the Internet or in even peer reviewed journal articles, there’s a lot of progress that is being made in the realm of psychosis, recovery and treatment. Family members need to hear that. Otherwise, they’re going to go do a Google search or they’re going to talk to a family member that has their own anecdotal experience, and it might not be positive. Right? But there’s a lot to be positive or hopeful about. Family members want and need connection with their professional care team, but also that connection with other caregivers.

Sarah Kopelovich, Ph.D.: And that’s across conditions. And then finally, I think they want resources and skills training. How do I, how do I help? What helps? And what makes things worse? They want to know what can I manage at home and what will the professionals be doing to help my loved ones recover? And then on the flipside, what in the home environment might be counterproductive to my loved one’s recovery? And what kinds of treatments might be unhelpful? There are more similarities than there are differences. But when we get a little bit more granular, a little bit more detailed, that’s where we start to see differences within the Psychosis REACH training and other kinds of family interventions. We’re going to be giving psycho education, obviously, about psychosis. We’re going to be really defining some boundaries for a training so that when we teach you these skills, our goal is not for you to do psychotherapy with your loved one. Right? That is not indicated, nor is that within your skill set. It’s really about helping you to apply some of these skills to yourself in your own life so that you could be more effective with your loved one.

Rachel Star Withers: When you’re doing these different trainings or you’re speaking with loved ones, support givers and whatnot, what are some of the common problems that they bring up to you?

Sarah Kopelovich, Ph.D.: My colleague, Maria Monroe-DeVita, conducted focus groups before we started the Psychosis REACH training and these focus groups were across the state of Washington with families who had had a loved one hospitalized for a psychotic episode. And what these families disclosed can really be boiled down to two things. They wanted skills to manage their loved one’s illness. And they said that they wished that they had had someone, and they were referring to another family member, appear to tell them, this was my experience. This is what you can expect. Here’s what worked for us. There’s something incredibly powerful about connecting with other people who have walked that path before. And then they also wanted to know things like how do I respond when my loved one is experiencing a delusion? How do I help them when the voices get really intense or really degrading? They’re referring to things like coping skills, problem solving skills, communication skills. So that’s exactly what Psychosis REACH teaches them. How do you help? What do you do in those situations? And then also how do you know when to back up? Because we also need to make sure that we are meeting people where they’re at and kind of know when to tactfully withdraw from the situation.

Rachel Star Withers: How can your loved ones know when they need to tactfully withdraw or maybe kind of step back from a situation?

Sarah Kopelovich, Ph.D.: So it’s really important to know that we cannot progress from a place of conflict. Sometimes things can escalate quite quickly or unpredictably, and you find yourself in a situation where now people are yelling. And so that’s not a therapeutic interaction, right? That’s a situation where we need to actually withdraw. You know, this is a bad time. Let’s come back to this another time. Or shift topics, right? Hey, I’m wondering if you caught the game last night. I missed it. Can you fill me in? Falling back on the relationship, going to neutral topics, getting back on the same page with your loved one. Hey, I know it’s really important to both of us that you stay out of the hospital and I can see you’re feeling really unsafe right now. What can we do to help you feel safe in this moment?

Rachel Star Withers: So many times, including my own situation, you have a support person or caregiver that’s a parent, and the person that they’re supporting is their own child, an adult child with a serious mental disorder. Not only do you have the stress of the parent child, but with that added schizophrenia and psychosis. Can you speak on that?

Sarah Kopelovich, Ph.D.: Sure, it can be a really tricky balance, right? You have a parent who wants their child to be well and can feel quite helpless and might be concerned for their well-being, for their safety, for what’s happening with their school. Are they going to get so off track that they’re going to have implications for their future? And then you have a young adult who is appropriately going through this process of separating from the parent and individuating, really becoming their own person, independent of their parent’s aspirations, their parent’s thoughts and ideas. It can feel quite stifling for the young adult to now have a parent who is taking care of them, who’s asking them about their medications. Who’s asking them about whether they’ve gone to their therapy appointment. That’s part of what we try to do with the Psychosis REACH training is to create a different dynamic. How do we change that dynamic that has started to unfold with the diagnosis or with the onset of the disclosure of the symptoms so that we don’t have so much stress and tension in the home? And this is really coming from a key finding in the psychotherapy literature where we see that that therapeutic relationship is the key to positive outcomes in therapy. So we work with the family members to identify shared goals. What’s important to you and what’s important to your child? And the way to get to those goals might be different. And usually it is, right? Usually they can both be on the same page about the fact that they want to be healthy and to kind of get back to the things that matter to them.

Sarah Kopelovich, Ph.D.: But the parent thinks that the way to do that is to take this set of medications and to throw themselves back into life as usual. And the child thinks, well, when I smoke marijuana, that’s what helps me, right? It’s not these other medications. But the goal is the same. How do we take that goal and work from there? How do we help them activate positive emotions by thinking about positive memories, by having other things that they connect about outside of just the illness. And so when we can redevelop that healthy relationship, then we can progress to other kinds of skills, like inquiring curiously. So asking and not assuming, asking good quality, curious, open ended questions about your child’s experience, about their perspective, about what they want. We can teach parents to not fear their child’s experience. A lot of that concern and that tension that’s happening is coming from a place of fear. If we can tell parents actually voice hearing is a really common experience. And there are a lot of voice hearers all over the world. And here’s what we know about what leads to distress in some and not in others. Then they feel a little bit calmer. They feel a little bit less anxious about what their child is going through. And then we can help them work on the higher level skills as well, like trying out different skills together and getting feedback.

Rachel Star Withers: Very interesting. A large part of our audience is caregivers and the support people, family that are all around different people with schizophrenia. What do you have to say to all of those people?

Sarah Kopelovich, Ph.D.: What I want to say is it’s not your fault. That if you feel like you’re not doing enough or you feel like your child or your loved one isn’t getting enough, that it’s not your fault. And psychosis is nobody’s fault. That needs to be the first message right out of the gate. Psychosis is nobody’s fault. We have a lot of wishes for behavioral health system transformation, and we know that the system isn’t doing as well as it could be to help meet their needs. So I have training in dialectical behavior therapy as well. And one of the principles of dialectical behavior therapy is this assumption that we’re doing the best we can and at the same time we can do better. That’s the message I tell myself every day. That’s the message that as a policy advocate, as a mental health professional, I communicate to mental health providers and administrators. And that’s what I share with family members as well. You’re doing the best you can. And when we know better, we can do better.

Rachel Star Withers: It’s very interesting that you said that one of the main important things is that it’s not your fault. That was just kind of really struck me because in my own situation with my parents being my main support system, I do think it comes up a lot. And I would say that for other people with schizophrenia and their support system, that our family. Yeah, that’s a big thing is did I cause this? Did I give this to my child? Did something happen under my watch to my child to cause this? And I hear that a lot. As far as like, did something traumatic happen? This is very interesting. That’s one of your main points, you’ve got to accept right away that it’s not your fault. That just when you said that, it really struck me that was very powerful.

Sarah Kopelovich, Ph.D.: Absolutely, the more we know about psychosis, the more complicated that picture becomes, because it’s really not this simplistic model of how you’ve got this set of genes, then you’re going to develop schizophrenia. There are a lot of contributors to psychosis. We used to see psychosis as this really uncommon, abnormal state. Psychosis is far more common than we used to know. And across cultures. There are the schizophrenia spectrum disorders are one kind of set of causes for psychotic experiences. But there are a lot of people who have psychotic or psychotic like experiences who don’t have a mental health diagnosis. There is not a clear formula for this, but what we do know is that it’s not any one thing.

Rachel Star Withers: It’s a very powerful point that. Definitely helps a lot of different support people out there who are listening to hear that. So how can caregivers find training?

Sarah Kopelovich, Ph.D.: In my mind, the place to start is the National Alliance on Mental Illness, NAMI is the largest mental health organization for families, been around since 1979, and it’s really become a leading voice on mental health. What NAMI provides is both a way to connect with other families and also they provide their own set of education and resources to family and caregivers. And because they are such a large organization, there’s a good chance that you’re going to have a local NAMI chapter in your region. I find their trainings are a really nice base for families who are just beginning their journey supporting a loved one with psychosis. A lot of their educational programs will teach you about some of the common terminology. They’ll talk about different treatment options for different disorders. And then a lot of families will find that they’ll benefit from more specialized training. For loved ones who struggle with a family member who doesn’t agree with their diagnosis, which sometimes gets referred to as poor diagnostic insight or something called anosognosia, for those families they might find a specialized training program is helpful. And the LEAP Foundation, which is directed by Dr. Xavier Amador, can be really informative and helpful. They have a number of offerings, a number of different trainings that they’re now offering virtually.

Sarah Kopelovich, Ph.D.: It’s kind of the silver lining to the dark COVID cloud is that so many of these trainings are now being offered via distance learning. The LEAP program uses principles and techniques from motivational enhancement therapy or motivational interviewing to really target communication patterns and to improve relationships for family members who are looking to learn concrete coping and problem solving skills and to dive deeper into their understanding of psychosis. They can sign up for the Psychosis REACH training. We had our first training back in May 2019. We got a little off track because of COVID, but we are offering now our second training. It’ll be our first virtual Psychosis REACH training. We’re really excited because of the philanthropic support that we’ve received for this training, I’ve been able to get the leading expert on CBT for psychosis, a psychiatrist named Dr. Douglas Turkington, who co developed CBT for Psychosis and Psychosis REACH, and he’ll be leading the training. And then in May 2021, we have another training that will also be virtual that folks can pre register for. They can go to www.PsychosisREACH.org to learn more and to preregister.

Rachel Star Withers: Sarah, and I understand you have some different books that you can recommend.

Sarah Kopelovich, Ph.D.: Sure, Dr. Turkington and Dr. Spencer have written a book called Back to Life, Back to Normality: Volume 2, and this outlines many of the cognitive behavioral techniques that we’re teaching to families in the Psychosis REACH training. So I highly recommend that one. That’s been a big asset to the families who’ve gone through our Psychosis REACH training in Washington. And then I have a book chapter coming out next year in 2021. It’ll be in a book published by the American Psychiatric Association called Decoding Delusions Advanced Psychotherapy Practices for the Clinician. And I’ll have a chapter in there called Supporting Families Caring for Someone with a Delusion. I will also go through the Psychosis REACH training key points.

Rachel Star Withers: Well, thank you so much for sharing all of that with us today. I know that you have definitely helped a lot of our listeners who are support family and caregivers. I know my mom, I’m definitely going to have her listen to this and check out the books and the REACH program that you spoke about. Thank you so much for joining us today on our show, Sarah.

Sarah Kopelovich, Ph.D.: Thank you so much for having me. It was so nice to be here.

Gabe Howard: Rachel, a great interview, as always. What was your main takeaway?

Rachel Star Withers: It really kind of threw me during our interview when she said it’s not your fault. I don’t know, like why that struck a chord with me, but it just kind of maybe like, I guess, peacefulness almost. You know, caregivers, a lot of times it’s a family situation. You need to know that stuff going on, a lot of it’s out of your control. You didn’t cause it. And the same thing for people like me who have schizophrenia, you didn’t pick this. This is just something you got that you have to learn to deal with. But you didn’t do anything bad. You didn’t do anything wrong. And that’s not something that we tell ourselves very much, Gabe. I think it’s easier to blame yourself for everything, whether you’re on the caregiver or the receiver end of that.  It’s easy to be like, well, you know, this is all happening because I can’t work anymore. This is all happening because this person’s lazy. But you know what? A lot of this stuff, it’s no one’s fault. We just got to figure out how to deal with it. That gave me peace.

Gabe Howard: I can certainly understand why. When you start blaming people, you expect those people to fix it. If I say this is Rachel’s fault, well, then I can just sit back and do nothing except be angry that Rachel is not fixing it. And the reality is, is if it’s nobody’s fault, then that gives Gabe and Rachel an opportunity to work together to assess the situation, find the problem and fix it. And the fixing it is what we want. I’m angry because I’ve blamed Rachel and she’s not fixing it. That manifests itself as me being angry at Rachel, but in reality, I’m mad at the problem that’s not being fixed. And I’m placing the blame not on the problem, but on an individual. That spoke to me a lot.

Rachel Star Withers: Absolutely right, Gabe, and a lot of this keeps coming back to one thing, communication. Make sure that whatever the situation is between the caregiver, the care receiver, talk, make a plan, define the roles, what is expected of each person and reexamine them depending on if I’m doing better, if I’m doing worse. If I don’t need you to help me get dressed, don’t do that. All right. However, I could be sick one day and I haven’t showered in a few days, and you might have to help me. So be up front, reexamine the roles, know what’s required of each person. That way you don’t have to, like, step on toes. And to my fellow schizophrenics, check in, let people know how you’re doing. I’m really bad at this, OK? I won’t tell people I’m having a hard time until it’s really, really bad. And I don’t need to do that. I need to speak up. But it’s awkward sometimes. Just to be like, oh, hey, just so you know, I’ve been hallucinating a lot. I don’t know, I’m bad about that. But we need to step up, you know, let the other people know when you need help or especially if there’s signs that you notice that you’re going into a psychotic episode. Give them a heads up. Hey, by the way, this has been happening a lot. If you could just kind of watch me a little bit closer. We all need caregiving in some way during our lives, you know, we need to take care of each other, whether you are a family member or a close friend or even a neighbor or let’s say you signed up for a program and this is a stranger and you’re stepping up. That’s awesome. But know that you’re appreciated and make sure to treat each other with dignity and respect. I’m Rachel Star. Thank you so much for listening to today’s episode. Like, share, subscribe, pass it around to all of your friends and we will see you next time here on Inside Schizophrenia.

Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail talkback@PsychCentral.com. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.

The post Caregiving for Schizophrenia first appeared on World of Psychology.

For example, what’s the problem when patients are told they need to be med-compliant at all costs? Should you be open at work about your illness? Join us to hear Gabe’s experiences and learn from his rookie mistakes (which actually ended up working out in the end anyway).

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About The Not Crazy podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.

Lisa is the producer of the Psych Central podcast, Not Crazy. She is the recipient of The National Alliance on Mental Illness’s “Above and Beyond” award, has worked extensively with the Ohio Peer Supporter Certification program, and is a workplace suicide prevention trainer. Lisa has battled depression her entire life and has worked alongside Gabe in mental health advocacy for over a decade. She lives in Columbus, Ohio, with her husband; enjoys international travel; and orders 12 pairs of shoes online, picks the best one, and sends the other 11 back.

Computer Generated Transcript for “Newly Diagnosed” Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Lisa: You’re listening to Not Crazy, a Psych Central podcast hosted by my ex-husband, who has bipolar disorder. Together, we created the mental health podcast for people who hate mental health podcasts.

Gabe: Hey, all, my name is Gabe Howard and I am the host of the Not Crazy podcast, which you are listening to right now. And as always, I am here with Lisa Kiner.

Lisa: Thank you, Gabe, and today’s quote, the two most powerful warriors are patience and time, and that is from War and Peace by Leo Tolstoy.

Gabe: What happened to the pregnant quote? I kind of dug that one better.

Lisa: Really? That was just for you, I didn’t mean that one for the show.

Gabe: Well, what was it? I really do think that it illustrated an excellent point.

Lisa: Ok, so Warren Buffett said no matter how great the talent or efforts, some things just take time. You can’t produce a baby in one month by getting nine women pregnant.

Gabe: I like that one because I do think that it is a good analogy, and I, I get it, Leo Tolstoy versus Warren Buffett. I’d like to point out that they’re both old white men, so.

Lisa: But it’s a slightly different feel, one you’ve got patience and time, not just time, and also it’s about the warring aspect of it and this is your strongest tool in the fight.

Gabe: I think the point, though, is, is no matter how hard you try, how efficient you are, how much you want it, how hard you work, baby takes nine months.

Lisa: No amount of extra effort gets it to be less than nine months.

Gabe: Right, and in terms of mental illness recovery, no matter how hard you want it or how hard your family and friends want it for you, it takes as long as it takes. And I think this is often missed when people are diagnosed with severe and persistent mental illness. Which leads us to our show topic. 

Lisa: Yes, the topic today being things I wish I had known when I was diagnosed, the chief among them being just the sheer amount of time everything would take.

Gabe: Wasn’t that like a shocker to you?

Lisa: Yes, very much so.

Gabe: It was a huge shock to me. I sincerely believed that I was going to leave the psychiatric hospital one hundred percent in recovery and perfectly well, I had no idea it was going to take four years.

Lisa: Well, certainly, I didn’t think it was going to take four years, but really, you honestly thought it was going to take zero?

Gabe: Of course.

Lisa: Like the next day would be done?

Gabe: Well, yeah. Consider this, every other time I had ever had a medical problem, I went to the doctor, they diagnosed me, they gave me the treatment, and within a few weeks, I was fine.

Lisa: But that just goes to show how good your health had been up until that point.

Gabe: Yeah, you asked me things that I wish I knew when I was diagnosed, that’s one of the major things that I wished I knew when I was diagnosed. And I got to tell you, the average age of diagnosis of a severe and persistent mental illness is 16 to 24. For the average group of people to have excellent physical health are people who are the ages of 16 to 24. That’s why they’re all the athletes, Lisa. It’s no surprise that all the athletes are young. It’s not

Lisa: Well, but I’m just 

Gabe: A bunch of old people

Lisa: I’m just, I’m trying,

Gabe: Except now Mike is fighting and he’s like really old.

Lisa: I’m trying to show

Gabe: You know what I mean?

Lisa: You

Gabe: Like like like old people

Lisa: You are such an ass

Gabe: Are getting out there more, but still the best are the young people.

Lisa: What I’m trying to say is that this isn’t unique to mental illness. This is true with all illnesses because we all watch too many medical dramas on TV. We all just expect that as soon as someone leaves the hospital, it’s over, it’s done. They don’t need long term care. Their problems are completely resolved. I had surgery yesterday, but today I’m ready to go back to normal life. In real life, healing just takes a really long time and that is not represented in media.

Gabe: You’re right, young people, we believe that we’re invincible. I thought I was invincible. I thought that any problem that befell me could be resolved with, you know, drops or pills or, you know, an outpatient stay. 

Lisa: Well, because you only had acute problems, you never had a chronic problem, that was one going to take long term management or even that just takes a long time.

Gabe: Right,

Lisa: The kind of things that you’re

Gabe: Yes.

Lisa: Talking about are things like a sprain or needing stitches

Gabe: Right.

Lisa: Or something like that.

Gabe: Yeah, that was my only understanding of medicine, but let’s move that back for just a little slight, tiny moment, even though that was my experience, you recognize that if I would have gone to the hospital for three days and had been diagnosed with breaking both of my legs, I would have recognized that that was long term. So when you say, well, everybody thinks this. Yeah, everybody thinks this about things that they understand. I didn’t understand mental illness. I didn’t understand it was going to take this long. Nobody taught me anything about it. Or perhaps, just perhaps, I would have been diagnosed before the age of 25, considering I had symptoms of this insidious disease at 15. 

Lisa: Well, and as we all heard of the last episode, though, it wouldn’t have been appropriate to diagnose you at 15.

Gabe: It would have been at 20.

Lisa: Yeah, it would have been. Yeah, you were definitely symptomatic by then. Yeah. Like I said, I didn’t recognize my own mental illness until I was in my 20s. And that was a long, long time of symptoms.

Gabe: I like the point that you’re making, Lisa, where you say, look, one of the reasons that that we have such a hard time understanding and managing mental illness is because we’re young and we just we just don’t understand the process of our bodies and minds failing us. But I don’t like what you’re implying that, yeah, we’re stupid about everything and mental illness is just exactly the same. I do think there’s another level.

Lisa: I do think there’s another level.

Gabe: I did, in fact, have symptoms that nobody recognized. I do believe that my family would have recognized symptoms of other illnesses. The example that I always use is my mother took me to a dermatologist from the time that I was very young because she understood that her red head, translucent son burnt easy and had a lot of skin problems. Well, how did she learn that? My mom was not a doctor. Enough people came up and told her and said, hey, your son is a redhead and very fair skinned. You’re going to want to put a lot of sunblock on him and get him a dermatologist, like on call. Why did nobody teach them this about mental health just as a precautionary measure?

Lisa: Well, but there’s got to be somewhere in the middle. The number one thing, when people tell me that they have a new diagnosis or a friend or family member has a new diagnosis, that I want to impress upon them is the amount of time this is going to take. And I had absolutely no concept of that. And I think things would have been a lot better, a lot different if I had, although I’m not sure I would have listened. If one of your doctors had sat us down and said, look, this is going to take four years. I don’t think we would have believed it. We would have thought that, oh, no, that’s ridiculous. We can knock this out in six months, tops.

Gabe: Yeah, I mean, it’s going to take nine months to have a baby, but that’s ridiculous, we can knock this out in three months, tops.

Lisa: All right, good point.

Gabe: The reason that we know how stupid that sounds is because we openly talk about pregnancy. We’ve met people who were pregnant. We’ve seen people who were pregnant. We’re willing to discuss and learn about pregnancy and not for nothing. I recognize that nothing in pop culture is displayed accurately, but pregnancy is displayed fairly accurately. Never once have I seen a show where they said, oh, I will only be pregnant for one month and I won’t gain any weight and I’ll have a baby. No, they always show the baby bump. They always imply that it’s been nine months. The baby ages fast. ou know, the woman has way too much energy in most cases. I

Lisa: Never gains any weight.

Gabe: No, no, she does gain weight, but it’s that perfect little baby bump.

Lisa: Yeah, her face is exactly the same.

Gabe: Face exactly the same, arms exactly the same, and of course, she’s still walking around in high heels like it’s not a problem, I recognize that it’s not a perfect analogy, but never once have I watched a show where they said, hey, this woman is pregnant on Monday. She’s going to work really, really hard and be really, really efficient and give birth on Friday because everybody’d turn it off and call that stupid. Just go back to my personal experience and the personal experience of a lot of people. They don’t realize how long it takes. And that leads me into my next thing that I genuinely and honestly wish that I knew on the day that I was diagnosed. I wish I knew that the term be med compliant was bullshit.

Lisa: Well, I don’t know that you can say that it’s bullshit, but I would say that I wish I had known that medication wasn’t the end of the story.

Gabe: The reason that be med compliant is bullshit is because it’s not complete. First off, being med compliant doesn’t do anything. For example, let’s say that all you had to be was med compliant. Well, then every psychiatrist should just prescribe every single mental health patient, M&M’s, and say, listen, wake up and eat a bag of M&M’s and go to bed and eat a bag of M&M’s. And as long as that person does that, they will in fact, be med compliant. But we all know that that’s not going to help them with their mental illness. That’s complete nonsense. I don’t understand why the term isn’t being med compliant on the correct medications. I feel that it’s be med compliant only because that puts all of the pressure and responsibility on the patient while giving none of the pressure or responsibility to the doctor. The minute you add be med compliant on the correct medication, well, now you’ve got a combo deal. Now the doctor has to be right and the patient has to be right. I think that it is this little insidious thing that puts all of the pressure on the patient, because after all, if it’s not working, it’s because you weren’t med compliant. It’s not because the medicines didn’t work or were wrong or you were prescribed incorrectly or diagnosed wrong. No, no, no, no, no. It’s you weren’t med compliant. That’s why I hate that so much. And that’s why I say it’s bullshit.

Lisa: That is a good point, I did not have a good understanding of how long it would take to find the right medication.

Gabe: I remember, Lisa, when I was first diagnosed, you did a really good job of saying to me, listen, people with bipolar disorder, they have this habit. You understood this very well because, well, you had done it. You had done it with depression. You told me that under no circumstances was I to stop taking my medication, that I must be 100 percent med compliant. I needed to be perfect, you said. And that as long as I took my medicines as prescribed, you would stick with me, you would help me. I am so thankful that you gave me this message because I do believe it was a good one. But I would like to point out that even though I was perfect on my medication, it took four years.

Lisa: Yeah, you were always perfect.

Gabe: And this was a big shock to my system, because all I could think was, is I’m doing what I’m told, I’m listening. This hurt me a lot because I started to believe things like, oh, I must have treatment resistant bipolar. I must have such a severe case that it can’t be cured. And you’re thinking, why did you believe that, Gabe? Well, I did everything the doctors told me to do. I did everything that Lisa told me to do. I was obeying all the rules and I wasn’t getting better. And since I did not have any understanding that it could possibly be the doctor or the treatments’ fault, that only left me, it must be my fault. I must be bad. I must be wrong. That’s a lot to deal with on top of, of course, managing a chronic illness.

Lisa: So what are you saying you wish you had known?

Gabe: I wish that I would have had a better understanding that this needs to be a relationship between me and my doctor and that we need to work together to find the right treatment for me. I did not understand that. I thought that this was 100 percent on Gabe and that any failure was only my fault.

Lisa: I do have to give you a lot of credit for that, you were in fact, 100 percent perfect. You were always compliant, unlike almost every other person diagnosed with bipolar disorder we’ve ever met. That’s just a common thing. Lots of people go on and off their meds. And you never did to the point where every once in a while, a doctor would doubt that you were actually taking it. They would say things like, well, are you sure you’re taking it? Well, but are you taking it every day? Are you taking all the pills? So it’s yeah, even doctors have this very condescending attitude sometimes about, well, it can’t possibly be the treatment. It must be you. 

Gabe: I know we’re going to talk about stigma later in the show, but this is one of those like hidden forms of stigma, right? It’s like systemic stigma.

Lisa: Yeah.

Gabe: I feel like there’s only two choices for people with mental illness. Either we are unwell and therefore failing, or we got our shit together.

Lisa: Right, there’s no in between.

Gabe: It’s always our fault. If the treatment works, oh, thank God for the treatment. Yeah, yeah, it worked. If the treatment fails, you must not be taking your meds. You’re not be going to therapy. You’re not using your coping skills. You don’t want it bad enough. You need to try harder. There’s not really a space for you beat it. You’re a survivor. You’re amazing. The two choices are you are sick or you got your shit together and you’re normal.

Lisa: Yes, there is. There’s totally a space for that cheerleading, you did it, it’s over, you did it. Yay! What there’s not space for is the in-between time of treatment. And cancer doesn’t have this problem with cancer being our favorite disease analogy. You either don’t have cancer and you’re fine or alternatively, you’ve recovered from cancer, you’re in remission, but you can also be undergoing treatment. You can be in treatment. You can be getting chemotherapy right now. You can be getting radiation right now. We don’t have that. Either you don’t have mental illness or you’re successfully treated. You’re in recovery. Well, what about that in-between time where OK, I’ve been diagnosed, but I haven’t really found what’s working for me yet so that I can be in recovery and have that life that I’m looking for. What about that period? There’s no in treatment, not all the way there yet, period.

Gabe: It just really seems like there’s only two levels for people with severe and persistent mental illness, either sick or well. And when we’re well, the credit is not given to us for being well.

Lisa: You’re right. I think we’re making two separate but intertwined points where you’re saying that there’s no victory at the end

Gabe: Exactly, that is what I am saying.

Lisa: And I’m saying there’s only the two steady states.

Gabe: There are only two options and you’re either well, in which case everybody gets the credit but you, it seems. You know, your mom worked so hard for you. The doctors got all the right medicines. Research is so great or you’re sick and then it’s your fault for not wanting to be better. It reminds me of all my photographer friends. If they take a bad picture, it’s because they suck as a photographer. But if they take a good picture, it’s because they have an amazing camera. Oh,

Lisa: Yeah,

Gabe: You must have an amazing camera

Lisa: Yeah, and that’s why no one’s willing to pay the money that it takes for good photography.

Gabe: Exactly. I think that’s very difficult because I want my moment in the sun, I feel that this, just I thought I would get it. I sincerely believed

Lisa: You did?

Gabe: That if I. Yeah, I thought that if I worked hard that I would be praised for beating bipolar disorder, for achieving recovery, that people would be like, that is amazing. Wow. You know, most people his age don’t have to deal with that. And Gabe did it.

Lisa: Wow.

Gabe: But when I got there, everybody’s like, what? You’re finally behaving, buddy.

Lisa: This actually makes a lot more sense on some of your behavior during that time, leading us to another thing you wish you had known when you were diagnosed, the role that stigma was going to play.

Gabe: But you know what? I can’t count this as one of the things that I wish I knew because I did know because you told me. You told me a hundred percent about

Lisa: Yeah.

Gabe: All of the stigma, the discrimination. And you pleaded with me to change my behavior. And I

Lisa: Yep,

Gabe: Thought you were wrong. So,

Lisa: Yep.

Gabe: Yeah, things I wish I knew now. This would go under the show, advice I wished I would have taken.

Lisa: So the thing that you wish you knew was that Lisa was right.

Gabe: Yeah, I just.

Lisa: Which maintains a lesson you could use today.

Gabe: You specifically described it about the stigma that I would experience at work, and you said to me, look, Gabe, if you tell people that you have bipolar disorder, that you have mental illness, they will treat you differently, they will behave erratically and it will hurt you and your career. I had known these people. I had worked at this place for, what, four years? I did not believe that based on an illness, coworkers who held me in high esteem and who I held in high esteem would immediately turn on me. But I got a death threat, I.

Lisa: You wouldn’t shut up about it as soon as you were diagnosed, you put it on the Internet,

Gabe: I did.

Lisa: Because you were off for a couple of weeks after being the hospital. OK, where were you? Oh, well, I was at the mental hospital and now I’m back. And I had pleaded with you not to do that because, yeah, I knew that was going to turn out badly. I knew it was. I knew this would hurt you at work. And we desperately needed you to continue working. But to be fair, I did not anticipate how bad it would get and how deep the stigma in our society really ran.

Gabe: I want to defend my reason for not listening to you. It’s just.

Lisa: There’s never a reason for not listening to me.

Gabe: I can think of many. It’s you told me that people that I respected were going to turn on me. Why would anybody believe this? I just obviously I want to be right. I want to be clear. I love winning arguments with Lisa. In fact, that’s pretty much my only hobby in the new COVID world, but.

Lisa: That’s too bad you suck at it.

Gabe: I mean, I think I’m holding my own,

Lisa: I could do this all day.

Gabe: I but, you know, Lisa, if I told you, hey, your parents are going to stab you in the back, you need to not do something. You wouldn’t believe me, right? You’d be like, no, my mom and dad aren’t going to do that now. Now, obviously, that’s your mom and dad. People are like, well, yeah, that’s her parents. I recognize that I should not have had this level of faith in my coworkers. But as you know, Lisa, I was a rock star there. I was the youngest person who was ever hired. I was well respected. I was on a management track. If I never got sick, I would probably still be there.

Lisa: Yeah, doing quite well.

Gabe: I was doing quite well when I hired and they only wanted to give me more. Why on earth would I think that that would suddenly change based on a diagnosis that was given to me by a doctor? Obviously, you were right. I know you were right. I give you full props, but I’m still struggling with why? How? This is absurd that you were right. It’s absurd.

Lisa: At a certain point, dealing with the stigma and the reactions of other people for you actually did become more difficult than dealing with the illness itself. Yeah, it was terrible. I just. How did you not know this? How could you not have known that this was in our culture ahead of time? I mean, what was your own reaction to people with mental illness? Were you nothing but progressive and understood and had nothing but sympathy and compassion?

Gabe: I did not really know anybody with mental illness, so I never had an opportunity to try this out, so.

Lisa: There wasn’t anybody in your family who just couldn’t get their shit together?

Gabe: Well, yeah, that’s not mental illness, that’s couldn’t get their shit together. My family didn’t recognize mental illness in me and I didn’t recognize mental illness in me. So I was that person. I couldn’t get my shit together. And we sure as hell didn’t think it was mental illness. Once it was diagnosed with mental illness. Let’s flip it and pretend that I’m the perfectly sane one and a family member is diagnosed with mental illness. I would not have threatened them or been mean to them or dismissive of them. But I am fairly confident that I probably would have done nothing. And silence implies consent. In my workplace, not every single member of my workplace attacked me. That’s nonsense. Only three or four people did the horrible stigmatizing things that I’m talking about. The other 30 just sat there and watched and did nothing.

Lisa: Like management.

Gabe: Like management, for example, so, yes, so you’re asking me, Gabe, do you live in the real world? I don’t think I would have ever been mean to somebody with mental illness, and I would have thought that doing nothing was neutral or helpful. But in actuality, doing nothing was very painful to me because the people who I thought were my friends and allies turned out not to be in this case. But yes, I would have accidentally stigmatized my mentally ill friends, family or coworkers. I would never, ever have threatened to kill them. I want to be very clear.

Lisa: And I want to point out, you’re not kidding on the death threat thing, that is not an exaggeration. It sounds like it. Very few people believe you when you tell them. But, yeah, that actually happened.

Gabe: It happened in writing, 

Lisa: Yeah,

Gabe: In writing.

Lisa: In e-mails. Yeah, we had the emails, printed them out, took them to management, took them to H.R. and still nothing was done to stop this behavior. 

Gabe: No, no. Something was done to stop.

Lisa: Well that’s true. That’s true. You were fired.

Gabe: Yes.

Lisa: That definitely did stop that problem.

Gabe: I was let go, they did handle it, they said that I was inviting the conflict, that

Lisa: Yeah,

Gabe: That was the solution.

Lisa: Yeah, it is unbelievable, if I had not been there, I probably would not believe you. It was so extreme.

Gabe: And that’s another thing that I wish I would have known, it does fit into stigma. I wish I knew that people would stop believing things that I said. Look how we’ve structured this conversation. We’ve made sure that I have brought proof that somebody threatened to kill me because they got angry with me at work and that I was the one let go. I’ve got Lisa here vouching for me. Why isn’t my word enough? And I’m constantly with my friends, my family members and even on panels where I say that things happened and people are like, well, did they? Are you sure? And this is particularly traumatizing for people with mental illness when they report abuse or misunderstandings from doctors, therapists, orderlies, hospital staff, because we say, hey, X happened and the other side says, no, it didn’t. And they’re like, well, you know, yeah, it didn’t. I mean, you’re the crazy one. So we don’t have to believe you. We’re not even going to investigate. I didn’t know that before I was diagnosed with bipolar disorder, Lisa. I commanded so much respect and people saw me as somebody with so much integrity that if I said it happened, that was the end of it. After I was diagnosed, I better bring along the smoking gun, proof and, you know, something notarized from God. It was, it was very, the contrast was incredibly stark for me.

Lisa: You know, I’ve been stable for so long that that really doesn’t come up for me very much anymore, but every once in a while I’ll mention maybe offhand that, yeah, I take antidepressants, I’ve taken them for a long time, and someone will suddenly, after years of knowing me, start acting differently or say something or be like, huh? Really? 

Gabe: We’ll be back in a minute after these messages.

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Lisa: And we’re back, talking about things we wish we knew when we were diagnosed with mental illness.

Gabe: Another thing that I wish I knew when I was diagnosed is that living publicly with bipolar disorder has this exceptionally high cost. I just thought that being who I was enough. Like that was enough. Like Gabe, why are you telling people you have bipolar disorder? Because I do. 

Lisa: Well, I think that you knew something was wrong, something was clearly wrong, you had this underlying wrongness. And so when you finally had a name to put to it, you were just so relieved. You felt that it justified a lot of your behavior and you were just so relieved to finally have an answer, to have a word, to have a way to express what was happening, that you wouldn’t shut up about it. You told everybody, which I advised against.

Gabe: I didn’t expect telling people that I had bipolar disorder to absolve me of the responsibility. I thought that it provided a clear explanation of my behavior, which would lead to forgiveness or understanding or mending the relationships and.

Lisa: Right, or a chance to explain further.

Gabe: And in some cases, it did. My relationship with my parents got a lot better once they understood that, OK, Gabe isn’t a jackass, he’s sick and he’s working on it. It gave us a starting point to mend fences. They now understood why my behavior was erratic in a way that they did not before. And I understood why my behavior was erratic in a way that I didn’t understand before. That’s what I was excited about. That’s why I told everybody. I guess I don’t want people to think that it only had bad consequences. If I could do it over again, I would only tell my family and friends and I would not tell anybody at work.

Lisa: That would also be what I would wish for you. This just gave you so much insight and understanding into yourself that you wanted to share it with others. You wanted them to also have this insight and understanding into you. It became an important thing to you that you wanted to tell other people about. We talk about that a lot about should you be open at work? Eh, good for the cause. Might not turn out so well for you. There’s a definite cost to that. And you paid it.

Gabe: Ultimately, I’m happy with my decision, I get to be me.

Lisa: But you would have liked to have done that on your own terms, I would say that you are not, in fact, happy with that particular decision. If you had it to do over again, you would not have told your work back then.

Gabe: I would not have.

Lisa: You might still have ended up in the same place or thought to yourself, hey, the very fact that I can’t tell these people means I need to go become a mental health advocate. But yeah, you would not do that over again. It was not worth it.

Gabe: This is of course, one of those interesting lemonade out of lemons things. The reality is, is I do regret it. I regret it a lot. And at times I regretted it more than others. But in many ways, it sort of reminds me of the guy who applied to be the piano player at the brothel.

Lisa: Ok, I’m not familiar with that story.

Gabe: Oh, it’s it’s. 

Lisa: Oh, good a chance for you to share an anecdote.

Gabe: You know, I love anecdotes, so this guy comes to town and he needs a job, so he walks into a brothel and he says, hey, are you hiring for anything? And they said, well, we’re hiring for a piano player. Can you play the piano? And he says, no, no, I can’t play the piano. And they said, well, that’s the only job we have. So he goes out and he tries to find a job and instead he starts a business. And 20 years later, he’s a multimillionaire. He’s on the world stage and everybody loves him. And he’s just really famous and he’s really rich. And his mother says to him, you know, don’t you wish that you would have taken piano lessons? Imagine what you could have been. And he thinks about it for a minute and he says, Huh, I guess I’d be a piano player in a brothel. The point is, is that you never know how things are going to interconnect or work out or go together. And in this case, him ignoring his mother’s wishes to play the piano made him a multimillionaire. But it can turn out many different ways. In my situation, if I hadn’t told anybody, yeah, I’d still be in that job. Maybe I’d be making lots

Lisa: Maybe.

Gabe: Of money. Maybe I wouldn’t. I don’t know. I am fairly certain that if all of these bad things hadn’t happened to me. I never would have become a mental health advocate because I became a mental health advocate so that nobody else had to go through this misery. I guess the misery, it was training to be an advocate. I’m just so sad that this misery exists. And that I had to go through it.

Lisa: But you don’t know how it would have turned out, maybe on your way to that job, you would have gotten hit by a bus.

Gabe: Yeah, you always say 

Lisa: It totally could have gone another way,

Gabe: You always say stuff like that.

Lisa: Because you always go with the best-case scenario. That’s not necessarily what could have happened. Anything could have happened. You might have ended up in the exact same place.

Gabe: Yeah, we all get that. My only point is that I would not have become a mental health advocate if bad things didn’t happen to me, the only reason I was an advocate is because bad things happened hard stop. I went through hell and I saw other people going through hell and I became a mental health advocate to stop them from going through hell. Some people would argue that’s worth it. I don’t know that that’s worth it. I’m just saying that’s where I ended up. This is one of those things that people will debate until they’re blue in the face. Oh, well, if you’re happy now, it all turned out the way it was supposed to. I don’t know that I’m leading my best life, my worst life or just a life. The bottom line, though, is, is had I made different decisions, I’d end up in a different place. And people seem to like this show. So I guess the job that fired me for getting a death threat did all of our listeners a solid.

Lisa: You’re welcome. Going back to the theme of the show, you do wish that you had known that this would happen, you wish that you had known how deep the stigma went so that you could have prepared for it differently.

Gabe: Yeah, and then I never would have done it. Never would have done it. Never would have told them at work. 

Lisa: If you wanted to tell people at work now after so many years of stability or recovery, that’s a whole different thing than right at the beginning when it’s still new to you and you’re still adjusting and you’re still coming to terms with it.

Gabe: And I wish I knew that conversations like this had to take place where I would be sitting at home with my wife and saying, OK, somebody asked me why I was out for six weeks. Now when Jenny was out for six weeks, she said it’s because she had a baby. And when Jimmy was out for six weeks, he said it’s because he broke his hip in a jet ski accident. Now, I was out for six weeks being treated by a doctor in a hospital. But you’re saying that I should lie. Like that’s, that feels bad to me. You know, Jimmy and Jenny, they got casseroles and cards and letters and there was a potluck when they came back, they decorated their desk. When I came back, there was nothing. There was nothing.

Lisa: No casseroles, not a casserole illness.

Gabe: Nothing, nothing.

Lisa: And at the next job, we told absolutely no one.

Gabe: Yeah, and it did turn out better in terms of none of the stigma, none of the discrimination, but I had a very difficult time making meaningful connections with my coworkers because I felt like I was always on guard and always hiding. And that juxtaposition, the openness was bad. The being closed was bad, made me pick the lesser of two evils, which I decided to go ahead and be open, knowing full well that I was inviting stigma, discrimination and chaos into my life. It was a very difficult decision and frankly, it sucked that I had to make one. I do wish that I would have understood that. And you know what else? I wish I would have understood the seething anger that accompanied this discrimination and this diagnosis and the way that it impacted my, my. Lisa, I was I was angry.

Lisa: You know what I’m going to say, this is what white male privilege is, because you’d never had this experience before,

Gabe: That is true.

Lisa: Because there’s been plenty of times that something has happened to me and I think to myself, is this because I’m a woman? Is he not taking me seriously because I’m female? I’m not sure. Maybe he’s just a jerk who doesn’t take people seriously. But I wonder. You never had to wonder these things.

Gabe: I never did.

Lisa: That’s what privilege is. Never wondering about it. So now you started thinking to yourself, huh? Is my boss giving me this problem because he knows that I’m going to be out for a psychiatric reason? Or is he just not a very good boss? You never had to think about how you were portrayed to other people. You could just relax and be yourself. You didn’t have to constantly be on guard. That was very difficult for you. You just didn’t have any experience with it.

Gabe: None, none whatsoever. I could just be who I was, and if I didn’t get the job, it’s because I didn’t get the job. I didn’t have to wonder if I didn’t get the job because I had bipolar disorder. This has been explained to me in so many different ways and so many times. And it’s fascinating to me because you’re right, this set me up higher to fall further. And in that way it’s a negative. But on the other hand, cry me a river. You had all of this free birth right stuff because of your race and gender. I struggle with this a lot because I don’t want to come off as arrogant. But that was difficult for me.

Lisa: It was. It was surprisingly difficult for you.

Gabe: I didn’t have any training or experience at this, you know, my father is a white male, too. He didn’t teach me any of this, probably because he didn’t know it existed. Nobody prepared me for this. And it made it harder suddenly wondering if people liked me based on something I couldn’t control.

Lisa: This lack of confidence was very difficult for you. It was surprising to me at how difficult that was for you.

Gabe: And this manifested as rage, just literally rage, I was angry all the time, and to try to get ahead of this, I would just explain to people why I was pissed off and why I had been wronged and how the universe had screwed me. And remember what you said there, little Kiner?

Lisa: Yeah. I said to you, yeah, God f**ked you and nobody cares, you can’t pay the bills with your sad story.

Gabe: I would like to point out you were wrong

Lisa: Yeah, yeah, yeah.

Gabe: About the second part.

Lisa: Now you’re paying the bills with the story, yes, yes, yes, anyway.

Gabe: But you were right. No, I was only alienating the few people that I had left, but I didn’t realize at the time. And truthfully, I don’t think you realized at the time either how much of this anger was symptomatic. 

Lisa: Yeah, all the time.

Gabe: I think that we saw bipolar disorder as the depression and the mania and the grandiose thinking. I don’t think that we considered that anger was part of bipolar disorder. And I say that because in the early years, we never reported that level of hostility or anger to my therapist or my doctor. It wasn’t a symptom that we were on the lookout for, which is one of the reasons that it makes the list of things that I wished I knew when I was diagnosed, because I wish that I could have told my therapist, my doctors how much anger I was actually having.

Lisa: And gotten some help.

Gabe: Yeah, I could have gotten some help for it. Once we understood it, remember? I went to anger management. We started talking to my therapist about anger. And you were the start of that because I realized that I had to do something about anger. And when I started talking about it openly, that’s when I found out that there was this intersectionality or connection or symptom. And I was like, well, all stuff that would have been good to know yesterday. 

Lisa: I feel that a little bit with my own diagnosis, with depression, when I first started getting treatment for depression, in my mind, depression was sadness. So the doctor said, how are you doing? Well, I’m not sad. There you go. It didn’t occur to me that there were other symptoms, the fatigue or the lack of motivation. I didn’t associate these things with depression. So when it came time to tell a medical practitioner how I was doing, I was leaving out huge swaths of the story, which no doubt led to me getting worse care than I would have otherwise. To add to the things you wish you knew the day you were diagnosed, just more about bipolar disorder, more about the symptoms, the symptomology, what was going to happen in the course of the illness. It would have been nice to just know more.

Gabe: And that leads me to another thing that I wish that somebody would have told me when I was diagnosed, that support groups are not bullshit.

Lisa: Yeah.

Gabe: They just they sounded so I had seen 12 step programs portrayed on TV with everybody in the basement and all of the who’s going to share. And I just I mocked them. 

Lisa: Me too

Gabe: Just listen to me.

Lisa: I was shocked.

Gabe: I made fun of support groups and then we got so desperate, Lisa, you made me go because we had just run out of options.

Lisa: Yeah, there was just nothing else to do.

Gabe: We had zero, zero hope that this would be effective and it turned out to be one of the most influential things in my recovery.

Lisa: It made a big deal at the time, for me too.

Gabe: And to go from openly mocking something and saying that it was stupid and wouldn’t work and it was dumb and only weak people go, that’s the other thing. I mocked the participants. I just, I feel so incredibly guilty for being such an asshole. People were doing something that was providing value to their life. And I was mocking them like, how arrogant is that? When you made me go, Lisa, as you know, we live in a big city and I was able to find a lot of support groups. And the one that I went to was called Bipolar Bears because I was scared to go. And frankly, that name, that name sounded

Lisa: Comforting.

Gabe: Comforting to me. I went to the very first one, and this didn’t happen immediately. I was in there

Lisa: Yeah, you had to go to for a few before you started feeling there was value.

Gabe: Yeah, I was in there with a few people and I didn’t kind of know what I thought about it, but we had agreed that I would try to, I forget how many I would agree to? I Would go to a few.

Lisa: It was like three or four.

Gabe: Yeah, then the magical moment for me was when I was sitting in that room and a woman was just talking about her day. That’s it. There was nothing mind blowing or mind shattering. And she said something about cleaning the house and working with her husband and getting the kids ready. And I just looked at her and she looked so normal. She was a wife and a mother and a homeowner. Now, I have no idea this woman’s name. I know nothing about her. I would not recognize her if I passed her on the street to this day. But I immediately realized that she was a woman living with bipolar disorder, leading the kind of life that I wanted, which meant that I could do it. It’s doable. It’s so much easier to do something after you see somebody else do it first. That was probably the biggest moment in support groups. I’m a huge fan of them. As you know, Lisa, I went on to become a support group facilitator. That’s how much I believe in these. I was a volunteer for years. I meet a lot of people, especially men, especially men, that the minute you bring up support group, they roll their eyes and they think all the same things that I did the day that I was diagnosed. I wish someone would have gotten through to me and said, you’re an idiot. Go. They are amazing. There’s lots of different types. There’s lots of different options. There’s, there’s 12 steps. There’s discussion. There’s I’m not even naming them all. They’re led by peers. They’re led by therapists. There’s, there is one that will work for you where you are if you put a little elbow grease and Googling into finding them.

Lisa: That’s the thing to emphasize, that there are so many options, especially for us in a large city, if one of them isn’t working for you, the structure, the folks, whatever, there are other choices out there. You aren’t constrained by just this one model.

Gabe: And you age out, you know, I don’t go to the Bipolar Bears anymore, I went for a long time and then I stopped. I went to the Depression Bipolar Support Alliance for a while. I went to the Connections group for a while. There was a 12-step program, Emotions Anonymous, I went to for a while. And you’re thinking, well, if they’re all good, why did you switch around? Because I was in different points in my recovery. Also, you know, sometimes just groups’ dynamics change. You know, you might like a group for a while and then decide, well, you know, I’m not digging this group anymore, go away for a year and then come back. Well, there’s probably going to be all different people. That’s OK. I didn’t understand any of this and I can only imagine how helpful it would have been if I would have gone immediately after diagnosis rather than waiting, what, a year? 18 months?  I guess what I wish I would have known, Lisa, is to keep an open mind.

Lisa: Well, you know, the silver lining of COVID is that a lot of support groups are online now.

Gabe: Yes.

Lisa: If you are in a rural area, you don’t have a lot of options where you live, there’s a lot of options online.

Gabe: Very, very true. Google it and check it out.

Lisa: I went to one of the family support groups, and you’re saying that the thing that did it for you was seeing what a vision of the future could look like, that this was a possibility. The thing that did it for me was seeing that I wasn’t alone. It was actually the very first meeting when some gentleman was talking about his girlfriend and it could have been you. And I was just amazed that even though these people, you know, they were different ages, they had different jobs, different genders, but they were having such similar problems. That was very powerful. That I wasn’t alone on this out on my own. This wasn’t completely unique, that no one else had ever dealt with before. That was very valuable to me. And luckily, that support group was free because another thing I wish I had known on the day that you were diagnosed is just more information about health care and how the health care system works and how health insurance works. That was just a whole other problem. You’re not just dealing with the illness. You’re dealing with how to access care for the illness.

Gabe: There were two fascinating things that happened for me in regards to the mental health care system, one, it was just how messed up it really was. And I had money. I had health insurance. I had a support group and resources and lived in a big city. And two, your reaction to it, because you had been battling insurance companies for a physical health problem for a long-time and.

Lisa: You were frankly lucky to have me.

Gabe: I was very lucky to have you.

Lisa: Because I had a lot more experience than the average.

Gabe: Yes, the thing that you kept saying is, oh, my God, I thought that physical health care was messed up. This is so much worse. And I just, I thought that you got sick. You used your insurance to get help. That’s how I understood it. You were smarter than that. But you thought you jump through all the hoops and you got care. But there were so many extra hoops.

Lisa: Yeah, I was shocked and I didn’t expect it to be a good system or to be easy. I thought it was going to be complicated. It was so much more than I thought. And the part where everything is separated that there’s this divide between mental and physical health just creates its own problems.

Gabe: I have this, this really good memory of you saying, OK, Gabe, we’ve got you approved to see the doctor for three visits. And I said, well, what if I’m not better in three visits? And you said, I don’t know. They said that you have to be better in three visits. And I said, is this typical? And you said, no, no, it doesn’t work this way in any other illness. You get cancer. They’re not like, OK, well, you can see an oncologist three times and hopefully you’re cured. But in mental health, they’re like, oh, we’ve approved three visits. We’ve approved six visits. The insurance company is like, what? Magic eight ball? Bipolar disorder will be cured for Gabe in oh, looks like three visits. Where are they getting this number? And listen, I had health insurance. This was the Mercedes plan. 

Lisa: You did, you had amazing insurance.

Gabe: Don’t even get me started if you have Medicaid or Medicare or crappy health insurance. Like I said, I was cruising along in the Mercedes and I thought it was shit. Oh, some people, they don’t even have a car. It’s so bad.

Lisa: Well, not to mention the shortages and the wait times, every place you called would be like, oh, five months, six months. It was like, really? Really?

Gabe: I’m sick now, I’m sick right now.

Lisa: Apparently, America needs a lot more psychiatric practitioners. I just couldn’t understand why the market wasn’t satisfying this. If there’s so much demand for psychiatrists and people are willing to pay for it, why aren’t there more psychiatrists?

Gabe: Because people can’t afford to pay for it, it’s one of the lowest paying specialties in all of the medical field.

Lisa: Ok, fair enough.

Gabe: You need just as much training and it costs just as much money to be a psychiatrist as it does any other specialty. Yet here you are not only making less money, but every single psychiatrist that I’ve ever talked to is like we’re just looked at like we’re evil. You know, Lisa, we did that anti-psychiatry episode. And remember, they’re the target of this. Not only do they have to spend hundreds of thousands of dollars to get this job, they are also paid less and they have an entire movement of people calling them murderers. I’m surprised we have any. We don’t have enough doctors. I don’t know how we’re going to get more.

Lisa: Gabe, out of curiosity, is that something you wish you’d known when you were diagnosed?

Gabe: Oh.

Lisa: Would that have helped?

Gabe: Oh, that’s I, you know, I’ve never really thought about it before, I just on one hand saying, no, I’m glad I didn’t know that. I’m glad that I thought the world was fair and that everybody loved me. Seems

Lisa: Yeah.

Gabe: Like I’m burying my head in the sand. Right. But that would have just been so overwhelming. Could you imagine if the day that I was diagnosed, somebody would have told me all of this, all the stuff that I’ve learned. I think it’s better that I did not know. But you recognize that a lot of people who are newly diagnosed know this is a problem because it’s preventing them from getting care. I’m saying that I think for my care, it’s better that I didn’t know, fully recognizing that the people who know the day they’re diagnosed are the most vulnerable people there are. 

Lisa: I’ve been thinking about this as we’re talking about this, I do wish I had known these things on the day I was diagnosed or the day you were diagnosed, but I don’t think I would have been super receptive to some of them. I think if someone had tried to tell me any of these things, I would have dismissed it or not believed it or thought it didn’t matter. 

Gabe: So, wait, you mean to tell me that if somebody would have warned you about this system, that you wouldn’t have believed them? Kind of like how when somebody warned me about stigma, I didn’t believe them? So you’re saying that you would have made a Gabe type decision because it just sounds so incredulous? Interesting.

Lisa: I don’t think that’s interesting at all.

Gabe: But just for the record, I agree with you, I don’t know that I would have understood this concept, I.

Lisa: I don’t know how you would even begin to explain it.

Gabe: Yeah.

Lisa: What are you going to put some of this in a pamphlet? Although I do feel like the medical practitioners around us had some non-zero responsibility, because that’s what informed consent is, to tell us some of this stuff, especially the big one for me is the time aspect of it. I had no understanding of it just wouldn’t be a linear process, there wouldn’t be a clear path forward, and how long it was going to take for you to get better. I had no concept of that. And the people around us knew. Your doctors knew. They all knew. They had to know that our expectations were completely unreasonable and no one ever said, hey, that’s completely unreasonable. I don’t know that I would have believed them, but I feel like they had an obligation to let us know that. And then we could have done what we wanted with the information. Chosen to believe it or not.

Gabe: Obviously from this vantage point, we now know all of the things that we wish we knew when we were diagnosed. But I’m very interested in that thing that you said where somebody should have told you, because it’s their responsibility to tell you. But as we’ve just illustrated, somebody did tell me one of these things and you admitted that if somebody had told you, you wouldn’t have believed them. How do we wrap our arms around this idea that simply telling people isn’t enough? We’ve both admitted on this show that either we didn’t use the information, Gabe, or that we wouldn’t have believed the information even if we had it. Lisa. How do we get this information to people when the two people on this podcast having this discussion have admitted that we wouldn’t have accepted the information and/or didn’t accept the information?

Lisa: Wow, that is a really good question, I, I don’t even know how to react to that. I don’t know. I’m not sure. But I am angry. I am upset that nobody told me this, especially your doctors, your therapists, et cetera. You’re not unique, this process of how long it takes and the fits and starts and the frustrations, that is not unique. That is pretty much universal. So they knew. They knew that this was the path before you and it wasn’t even hinted at. I don’t think that’s right. I think that information should be shared with us. But, yeah, I don’t know what I would have done with it. So I don’t have a good answer to this problem.

Gabe: I’m still hung up on this idea, Lisa, that you believe that doctors should tell us, I don’t think we would have listened to doctors. I didn’t listen to you. You already admitted that if somebody had explained to you that this is the way that it worked, you wouldn’t have believed them because it’s just so utterly ridiculous. Your brain would have rejected it outright. And there’s a shortage of doctors. Do you really think that doctors should sit down and try to explain all of this to us? 

Lisa: They could put it in a pamphlet.

Gabe: Could they? Could they put it in a pamphlet? And if it was that easy, why has nobody done it? But actually, it’s on the Internet. You know that it’s on the Internet, right? Hell, it’s in this podcast. Is the problem solved? Clearly, we are not reaching the people. Why are we not reaching the people with this information? That’s my question to you. The information is out there. Why do people not either A, consume it or B, believe it?

Lisa: Because they don’t want to.

Gabe: Now, that seems like a cop out.

Lisa: Because it’s sad and you don’t want to believe it.

Gabe: It is sad.

Lisa: The same reason everyone who gets a cancer diagnosis decides that they’re going to be in the percentage that makes it.

Gabe: But that’s, that’s a life or death thing that’s, that’s

Lisa: And this isn’t?

Gabe: I know, I mean, like I understand what you’re saying and I’m, but you’re confusing the issue in a way that I don’t think is serving this discussion. What I’m saying is, is I trusted you. You know that I trusted you. I did 99% of the things that you told me to do. And I followed you blindly. But you told me not to tell the people at work, to keep this on the down low or that discrimination would follow. And I did not believe you. Clearly, there’s nothing more that you could have done. If I didn’t believe you, I certainly wouldn’t believe a pamphlet. I certainly wouldn’t have believed a doctor. And as you just illustrated, if somebody had explained this to you, you wouldn’t have believed them. If somebody would have told you this is how the mental health system works. You, Lisa Kiner, would not have believed it. So no, no, it’s not because people don’t want to or because they’re stupid. And if they are, why didn’t we believe it? Because Gabe and Lisa are stupid and it’s sad and we don’t want to? Because we didn’t do it. So whatever reason you come up with as to why people don’t understand this applies to Gabe and Lisa. So be very careful with your next words because you’re describing us.

Lisa: I have no words, I’m going to have to think about this, I don’t know.

Gabe: It’s stunningly, surprisingly complicated.

Lisa: It is surprisingly complicated, yeah, it seemed much more straightforward when we started.

Gabe: I love that I was able to stump you.

Lisa: Eh, I wouldn’t say stump, just consider more deeply.

Gabe: You had unlimited time to answer this question and you couldn’t, and we’ve been mental health advocates for a decade, and if we knew the answer to this question, we’d do it. 

Lisa: Does anybody have the answer?

Gabe: I don’t think people have the answer. I think that people have some answers. Peer support, support groups sharing information. This podcast, I think that does get the information out there. But does it get it out there in a meaningful way for people who are unaware that they need it? What are the odds that somebody is going to get diagnosed on Monday and find our podcast on Tuesday? And more specifically,

Lisa: Believe it.

Gabe: Believe it or connect? You know, maybe if they find a middle-aged guy who gets diagnosed with bipolar disorder and he’s like, hey, I talk a lot, too. And I hang out with my ex-wife and I’m from Ohio. You know, I trust this guy. But it’s also possible the person listening to this podcast is of a different race or socioeconomic status or gender or lives in California and thinks these two are idiots. Our information is correct. But how do we get people to connect with it, to relate to it, to understand it, and most importantly, remember it when they need it the most?

Lisa: Is this something we can outsource to the comment section?

Gabe: Listen, if you have the answer hit up show@PsychCentral.com and tell us about it. We would love to hear from you. Wherever you download this podcast, please, please, please subscribe. And as I tell you every week, I am the author of Mental Illness Is an Asshole, which you can absolutely get on Amazon. But if you want to be one of the lucky people to get Not Crazy podcast stickers, go to gabehoward.com, buy it there. I’ll sign the book, and I’ll send you those stickers absolutely free.

Lisa: And we’ll see you all back next Tuesday.

Announcer: You’ve been listening to the Not Crazy Podcast from Psych Central. For free mental health resources and online support groups, visit PsychCentral.com. Not Crazy’s official website is PsychCentral.com/NotCrazy. To work with Gabe, go to gabehoward.com. Want to see Gabe and me in person?  Not Crazy travels well. Have us record an episode live at your next event. E-mail show@psychcentral.com for details. 

The post Dear Newly Diagnosed: What We Wish We Knew first appeared on World of Psychology.

Join us for a great discussion on how the parent-child dynamic can go wrong when undiagnosed mental illness is involved.

(Transcript Available Below)

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About The Not Crazy podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from Gabe Howard. To learn more, please visit his website, gabehoward.com.

Lisa is the producer of the Psych Central podcast, Not Crazy. She is the recipient of The National Alliance on Mental Illness’s “Above and Beyond” award, has worked extensively with the Ohio Peer Supporter Certification program, and is a workplace suicide prevention trainer. Lisa has battled depression her entire life and has worked alongside Gabe in mental health advocacy for over a decade. She lives in Columbus, Ohio, with her husband; enjoys international travel; and orders 12 pairs of shoes online, picks the best one, and sends the other 11 back.

Computer Generated Transcript for “Dysfunctional Childhood” Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Lisa: You’re listening to Not Crazy, a Psych Central podcast hosted by my ex-husband, who has bipolar disorder. Together, we created the mental health podcast for people who hate mental health podcasts.

Gabe: Hey, everyone, and welcome to this episode of the Not Crazy podcast, I’m your host Gabe Howard. And with me, as always, is the sparkling Lisa Kiner.

Lisa: Thank you, Gabe. Hey, all, today’s quote is by C.S. Lewis, you can’t go back and change the beginning, but you can start where you are and change the ending.

Gabe: But is that true?

Lisa: Yeah, of course that’s true, it’s never too late until you’re dead.

Gabe: That goes along with my quote, It’s never too late to have a happy childhood.

Lisa: No, that’s not similar at all.

Gabe: Are you sure? Because I think that memory is one of those weird things. The way that we remember things changes dramatically as additional information pops into our brain and now it should be no surprise that we’re going to be talking about Gabe’s childhood, specifically how toxic my parents were.

Lisa: Ok, but, yes, your memories are constantly being re-evaluated by your brain, but the actual truth of what happened is not. If you had a video camera that wouldn’t change, you could just go back and watch the video. What actually happened is the same. It’s just how you interpret it or feel about it has changed.

Gabe: But that’s a very esoteric concept and have you ever watched.

Lisa: You don’t use the word esoteric correctly. No, it’s not an esoteric concept. You mean to say nebulous,

Gabe: Fine, it’s a nebulous concept, I

Lisa: Ok?

Gabe: Think it’s esoteric, you think it’s nebulous, let’s call the whole thing off. The

Lisa: No, the words have actual meaning.

Gabe: Do they?

Lisa: Yes, that is the purpose of words.

Gabe: Do they?

Lisa: Oh, for God’s sakes. Ok.

Gabe: The point that I’m making is, is that the way that we see things change as additional information becomes available, for example, the whole world, literally, the whole world believes that there is a line in the movie Casablanca that says, play it again, Sam, that

Lisa: Yeah.

Gabe: Line doesn’t exist. And we all remember it. We all believe that it’s true. Now applying this to our own lives, I very much remember my childhood in a certain way, but it evolves as I put myself in the shoes of my parents. For example, when I was 15, my parents were idiot morons that were just trying to keep me from living my best life. And when I was 25, they were horrible abusers that were trying to kill me. And now that I’m 43, they’re boring and they just bicker a lot. But I’m remembering the same.

Lisa: We need to go back to that twenty-five-year-old thing, oh, my God, really?

Gabe: Well, I knew you at twenty-five, that’s.

Lisa: And that convinced you that your parents had been trying to kill you?

Gabe: Somebody had to be trying to kill me. It was either that. 

Lisa: What?

Gabe: Or made up stuff. If it wasn’t them, who was it?

Lisa: Whoa, whoa, whoa, whoa, whoa, back up. You thought your parents were trying to kill you when you were 25?

Gabe: So.

Lisa: Like, wait, wait, wait. Were they trying to kill you when you were 25? Or looking back on it, you thought to yourself, gee, they were trying to kill me 10 years ago?

Gabe: I, probably all of it. Remember back then, I thought that demons were hiding under my bed, I was paranoid. I thought that something was trying to kill me and I very much blamed them for all of my problems because I had to blame somebody and my world was very small. In fairness, I also blamed my ex-wife, society and probably several celebrities. It was a hectic time. But remember, those who are closest to you take the brunt of the blame. It’s no surprise that when you and I got married, it transitioned over to you.

Lisa: There is so much there.

Gabe: There is. There’s an incredible amount there.

Lisa: And all of this is coming up because we received an email with a question and the question is, Gabe, how old were you when your bipolar symptoms appeared and when were you diagnosed? Did you have a relationship with your immediate family members then? And how did they help or hurt your recovery?

Gabe: Obviously, we’re going to discuss this a lot more because, you know, we need to fill a longer show, but the speed round answers were the symptoms were kind of always with me. Nobody just recognized them. Right? I thought about suicide as far back as I can remember. Like literally from birth. Yeah. It was just always part of me. I showed symptoms of bipolar disorder in my teen years. Yeah, it was always there. I was 25 when I was finally diagnosed and my relationship with my immediate family was strained when I was diagnosed, I.

Lisa: Before the diagnosis or because of the diagnosis?

Gabe: Oh, no, before. It was strained because of the

Lisa: So at the time of diagnosis, your relationship was strained?

Gabe: Yeah, it was strained, it was, it was problematic, I don’t want to say bad because we were still in touch. I consider bad like I haven’t talked to my mom for five years. Like, that’s bad or like extreme abuse. Like your family is stealing from you or,

Lisa: Ok.

Gabe: You know, I don’t know that.

Lisa: So, it wasn’t as good as it is now. So, strained.

Gabe: Oh, no, no, no, now, now it’s fine.

Lisa: Now, do you think that was strained because of your behavior and your symptoms?

Gabe: Oh, yes, yes, without a doubt, my behavior was very problematic, both in the way that I treated them and in the way that I perceived they treated me, that’s like the real bitch about bipolar disorder, right? It sort of warps what you see. And that’s very hard to get over. Even after treatment, it took years to reflect back and realize, oh, what a weird reason to be angry.

Lisa: You say that you had symptoms of bipolar disorder in your teens. What types of symptoms are we talking about?

Gabe: When I was diagnosed with bipolar disorder, my mother said to me, after she learned what bipolar disorder was, she said, oh my God, I always described you as my Dr. Jekyll and Mr. Hyde child. And I said, Mom, that’s literally what bipolar disorder is. How did you not think that something was wrong? And she was like, well, I just I thought it was hormones. I thought it was boys will be boys. I thought it was the teenage years. I. In my parents’ defense, I’m the oldest. This was their first teenager. They didn’t know what the hell was going on. And teenage boys are ridiculous. We’re. Watch any coming of age movie, and I don’t know that my behavior was all that atypical. If you get your mental health education from pop culture, they just thought that I just needed direction.

Lisa: I’ve often thought that, especially about parents of teenagers, you know, like if you have a kid who’s crippled by anxiety. Well, the point of a parent is to say, no, no, no, you can do it. Go out there, try the thing. Well, at a certain point, they can’t. Your parents specifically, like you said, you’re the oldest. Teenagers are moody. You were moody. Teenagers are dramatic. You were dramatic.

Gabe: See, here’s where I think it’s a good idea to talk about the hidden symptom of bipolar disorder, and I’m trying to be like, really dramatic, like dun dun dunn. See, everybody thinks of bipolar disorder as the two poles, right? Suicidal depression and God-like mania. And those are absolutely symptoms of bipolar disorder. But what people get wrong is that it’s a spectrum illness, meaning suicidal depression is the lowest you can hit and God-like mania is the highest that you can hit. But you’re going back and forth on this spectrum. That’s what gets me to my quote unquote, hidden symptom. It is reasonable and probable and likely and possible that through doing nothing, you will end up in the middle. You will end up quote unquote, normal, just fine. And in my teenage years, that’s when I would excel in my after-school activities. That’s when I would excel in school. That’s when I would be the charismatic, intelligent, charming Gabe that my parents were trying to raise. And when that middle ground fell in the vicinity of a punishment, we now know that that was just luck. That was just random. But at the time, my parents were like, well, Gabe acted up. We grounded him. And now look. Now look, he’s doing great. He joined a club. Look at all his friends. He’s mowing the lawn like we asked. That was just luck. I was just asymptomatic, but I wasn’t actually asymptomatic. I was just in the middle of that spectrum.

Lisa: That is asymptomatic.

Gabe: Well, sure, but this further drove home to my parents that what they were doing was working, but it was actually just the disease process randomly linking up in the vicinity of my parents’ discipline.

Lisa: I’m confused. You keep calling it a hidden symptom, but that’s not a symptom, that’s a period of normality. You’re saying that at times you had a normal mood state because you were in between the two extremes. That’s actually the lack of symptoms. That’s not a hidden symptom. That is a period of normal mood state. That’s not a symptom.

Gabe: I understand what you’re saying, and I don’t mean to be confusing, but the reason that I call it a hidden symptom is because it still has negative consequences. So, you’re describing it as being symptom free, but you’re still on the bipolar spectrum. It’s not like because I am asymptomatic, I am not having symptoms.

Lisa: Yes, actually, that’s what the word asymptomatic means.

Gabe: Ok, you’re right. Let me, let me, let me clarify further, I’m trying to spin an analogy, and it’s clearly not working well. Let’s take an example. So, I get suspended from school because I’m dancing in the front of the room and I’m being the class clown because that’s what mania looks like. Right? So, I get suspended from school. I come home, mom and dad sit me down and they say, OK, Gabe, OK, well, we have to curb this behavior. This is bad behavior. So, my parents ground me, they ground me. And for the three days that I’m suspended, I have to work in the garden. And then I go back to school a week later and suddenly I’m good, I’m perfect. I’m respectful to my parents. Everything is fine. In my parents’ mind, the punishment worked, grounding me worked. That is a reasonable thing to think. But in reality, had my parents done absolutely nothing, the next week when I went back to school, I wouldn’t have been manic. The disease process would have shifted and I would have been perfectly fine.

Gabe: But they didn’t realize that. And here’s why that’s a problem, because the next time that I was the class clown, they thought, OK, no problem, we’ll ground him for a week and we’ll make him work in the garden. But that didn’t work the next time and that only gave them the option to be like, OK, we have to push harder. We have to ground him for two weeks and make him work in the neighbor’s garden. I don’t know. And they thought I was being obstinate.

Lisa: What you’re saying is that your mood would cycle in and out of a period of normalcy, as is the way with bipolar disorder, but your parents would attribute it to something they did

Gabe: Correct, yes.

Lisa: Like he was acting all out of control. We grounded him. He stopped doing it. Therefore, the grounding worked. Therefore, next time he acts all out of control, we will ground him again. And if that doesn’t work, we’ll just escalate and escalate and escalate.

Gabe: Right.

Lisa: But in reality, this was just the ups and downs of bipolar disorder. It actually wasn’t related.

Gabe: Yes, exactly, but there’s another little insidious piece there, and that’s what I really want people to focus on, my parents believed that I could do it. You’re asking why would they try to ground the symptoms of an illness out of their child? How sick is that? Could you imagine if I came home with a broken arm and they’re like, well, you’re grounded until your arm is not broken? We’d call Children’s Services. That’s sadistic. You grounded your son for having a broken arm? But remove broken arm and put in mania, depression, rage. That’s what they tried to do. They literally tried to punish the symptoms out of me. And you’re asking why on earth would they do that? Because it worked. At least they thought they saw it work. They knew that I could be good. They’ve seen it. It’s like an intermittent problem with their son. It’s like when you take the car to the mechanic. What’s that saying?

Lisa: Oh, every time you take the car to the mechanic, the problem is gone.

Gabe: Yeah, their son just happened to have an intermittent problem, so every time they took me to the mechanic, I ran fine.

Lisa: Their thinking was that because there were times where you did behave normally, where you were asymptomatic, they thought, OK, clearly, he can control it. If he’s capable of doing it sometimes, he’s capable of doing it all the time.

Gabe: Exactly, exactly. But here’s the thing that sucks. I thought that, too. I wanted to be a good kid. I think that’s important to understand. My parents pictured me as intentionally malicious, intentionally acting up. That’s what they saw. I was not trying to do that. Well, I thought that my parents were boring and, well, stupid. And I didn’t want their life in any way because of the aforementioned boring and stupid thing. I did respect my parents. They worked hard. They paid their bills. They were active in their community. And make no mistake, even in my angriest moments, if I got in trouble, I called them. There was never a time, never a time, that I got in trouble that I thought, well, I can’t call my parents. I always knew that I could call them. But yeah, yeah, I yeah, I don’t even know what to say. I just I. I felt.

Lisa: I always knew I could count on them.

Gabe: So to summarize, did I have a relationship with my immediate family members? Yes, but it was incredibly strained because of, well, all the things that we just talked about.

Lisa: We’re talking about did you have a relationship with your immediate family at the time of diagnosis, that was when you were 25. You must have left home at 18 or 19. What happened in those intervening years?

Gabe: I moved out when I was 18 and still in high school because I just had to get away from them, I just, I couldn’t stand them.

Lisa: But you moved in with your grandparents, right?

Gabe: Yeah, I could stand them, I like them.

Lisa: It’s not like you moved out on your own, you just went to stay with other family.

Gabe: Yeah, I was willing to go out on my own, I, I just.

Lisa: But your parents thought that was a terrible idea.

Gabe: This is where memories change, right? Here’s what 18-year-old Gabe thought happened. My parents were assholes. I can’t take them anymore. I’m not dealing with this shit. I’m out of here. Grandma saved me. Right? That’s what Gabe thought was happening. Here’s what actually happened. Gabe was ready to run away from home and do whatever it took to be away from them. And my parents called my grandparents and said, OK, we need to work together to make sure that he graduates high school and save him from himself because he’s getting ready to run face first into fire. And he’s too stupid to realize it. And they all work together for the next two years to make sure that I got a high school diploma, to make sure that I matured, to make sure that I made friends, that I was in mock trial, that I had something to fall back, that I learned computers. My parents still paid all my bills, even though, you know, under my breath, I called them assholes all the time and they knew that I call them assholes. They’re not stupid, but I ran away from them. That’s what actually happened. That’s a really big difference. So, it’s hard to be mad at them now that I see the full picture. But I was so mad at them when I left, Lisa. So mad.

Lisa: But why were you so mad, what were they doing wrong?

Gabe: They were punishing the symptoms of bipolar disorder.

Lisa: But none of you knew that. You thought it was bad behavior and so did they. Why would you be angry about that?

Gabe: Because I just felt so strongly that I was trying and that they didn’t recognize it. I don’t think my parents realized how desperate I was to make them happy. Who wants to be a bad kid? I did want my parents’ respect. Hell, I still want my parents’ respect. I never thought my parents were bad people. I thought they were boring. I’m not trying to rewrite history to where I suddenly thought might, no. I thought my, hell, I still think they’re boring. If I have to hear about one more episode of Ice Road Truckers, I may scream, but who cares?

Lisa: Your father has regaled me with many stories of the cinematic masterpiece that is Ice Road Truckers. Yeah.

Gabe: Oh, that’s awesome.

Lisa: It never gets more interesting. Never. But your parents weren’t completely oblivious that there was more than normal teenage angst going on here, because they did take you to a psychologist.

Gabe: That’s true.

Lisa: This would have been in the early 90s, the idea of how you treated children and mental illness in children was just completely different. It would have been extremely unusual to take your kid to a child psychologist.

Gabe: You’re right, in the early 90s, it was completely unusual to take your kid to any sort of therapy. But wait, there’s more. My father is a truck driver. He’s blue collar. He believes that all problems can be resolved by rubbing mud on it. And he took his child to a child psychologist. In the early 90s there were white collar professionals with MBAs that wouldn’t take their kids to child psychologists. My parents were actually just so ahead of the curve. My parents admitted that they weren’t able to handle this and took me to a therapist. We got family counseling. Are you kidding me? There are families that struggle with that in 2020. They were progressive.

Lisa: Well, it couldn’t have been easy, there weren’t very many child psychologists running around, it was probably quite a lot of effort to even find someone.

Gabe: I have no idea how they found my child psychologist, but yes, we went to family counseling.

Lisa: What made them decide to do this, what was the breaking point?

Gabe: I honestly don’t know what the breaking point was, but, yeah, like what a question that would be, you know what I mean? I’m.

Lisa: We should call your mother and ask. That might be the next episode.

Gabe: Maybe I don’t want the answer.

Lisa: Well, I want the answer.

Gabe: It just when it comes to like rewriting history or retconning, as the kids like to say today. My parents did not fit the mold of people that utilized psychological services, therapy, child psychologists, we were very stereotypically blue collar. My father drives the 18-wheeler semi, honks the horn for kids. He says things like, we’re going back to the house. He couldn’t be more of a stereotype if they tried. My mom, a housewife with a part time job when the kids got older. I mean, it’s like Americana. You just want to vomit. It’s so stereotypical. We eat dinner together as a family, just like.

Lisa: It’s Leave it to Beaver without the white-collar income.

Gabe: Yeah, basically, how on earth did these people be so progressive that they admitted that they needed help with their kid? Like, is that how messed up I was that I was able to break that mold? Like, that’s messed up, right?

Lisa: Was your dad gone for long periods of time as a truck driver?

Gabe: No, no, no. Not long periods of time, he left one day and came back the next day. So, he would be gone like every other night.

Lisa: So, he was gone every other night, he was absent from home quite a bit.

Gabe: Yeah, yeah, three nights a week he was not home. He had a very varying schedule, especially when I was younger and he was newer.

Lisa: Yeah, not high up in the union yet. Meaning that it was even more of a burden for him to go to the therapy appointment.

Gabe: Yeah, yes.

Lisa: Because it’s not like he could just send you with your mom, you all had to go.

Gabe: Huh, you’re kind of blowing my mind because I didn’t even think of that.

Lisa: Well, yeah, it couldn’t have been easy to schedule around him.

Gabe: I. Do you want me to give them a medal? I just look, when I was diagnosed at 25, I was positive that they screwed me up.

Lisa: Because you thought that bipolar disorder was the fault of poor parenting?

Gabe: Yes, I also thought that I could have been violent at any moment and that I was going to die and that I needed to live in a group home, remember. . . 

Lisa: So we’re doing myths of bipolar here.

Gabe: But they weren’t myths at the time, but.

Lisa: Well, they were always myths you just didn’t know that.

Gabe: Ok, yes, yes, but perception becomes reality. 

Lisa: Right.

Gabe: When I was in the psychiatric hospital, I was locked behind the doors. I was staring at a doctor. They diagnosed with bipolar disorder. And all I could think of was, thank God I didn’t kill my family and I need to live in a group home and I’m going to die soon because everybody with bipolar disorder was violent, lived in a group home and eventually killed themselves. That’s all I understood. And then, of course, I learned more and more and more and my memories changed. Things shifted. 

Lisa: Gabe, you’re skipping back and forth a lot, it’s kind of confusing.

Gabe: What do you need clarified? This is just my life, it’s all jumbled in my brain as 

Lisa: Well, let’s go back to the part where your parents are taking you to the child psychologist, so clearly, they’ve discovered something is wrong. This is more than just being a normal teenager. We can’t handle this. We need to reach outside for professional help. What happened? Did it work?

Gabe: I don’t know.

Lisa: Did you get better?

Gabe: I don’t know.

Lisa: Didn’t you go there for, like, years? I mean, it’s not like they took you once and stopped.

Gabe: I honestly don’t know if it helped me understand them, but in some ways, I think that it helped my parents understand me. My family believes in paddling. My dad had a paddle, it had a handle and he whacked me on the butt with it. And I was terrified of this thing and it was demeaning and degrading. And plus, it’s violence. I see it very much as violence. And I, I said all of the things that I just said in the therapist’s office, and he said, you know, Gabe’s really old. Why are you still threatening him with violence? And my dad’s like, well, it’s just paddling. And he’s like, well, but, but it’s violence. You’re saying that the way to work out problems, if you don’t like how your son is behaving, is not to talk to him, but to threaten him with violence. And this made my parents get rid of not only the actual paddle, but the threats of it. And it forced them, whenever there was behavior that they didn’t like, to discuss it with me. There’s this little piece of me that still pissed off that I had to endure this shit for 13, 14 years. But my brother and sister, who are younger, it disappeared immediately for them, too. So, you’re welcome.

Lisa: Hang on, we’ll be right back after these messages.

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Gabe: And we’re back, talking about my teenage years.

Lisa: Your parents had a specific way of disciplining their kids that they probably learned from their own parents and this is what they did because this is what they knew. But what you’re saying is that as soon as someone else, a professional, a child psychologist, said to them, yeah, that’s a terrible idea, don’t do that, they stopped immediately. They didn’t argue. They didn’t try to equivocate. They were like, huh? All right. Well, now that we have better information, we’re going to not do that anymore.

Gabe: I don’t think that it had ever occurred to them how it looked from my perspective, because from my perspective, what you were saying is I’m not interested in your ridiculous little opinion. Do as I say. Do as I say. And the therapist was able to point out, your son is a few years from being out in the world and he’s not going to be able to threaten people with violence when he doesn’t get his way. And if he is unable to articulate his needs, wants, desires and unable to argue with people, then you are stunting his development. I don’t think my parents realized that. I think they were taking the path of least resistance. We told you to do it. You said no, we’re going to threaten to whack you on the ass and now problem solved. But it never occurred to my parents that this debate had value. They only saw the debate as disrespect. And the therapist was able to say, look, discussing something with your children is not back talking and it’s not them being disrespectful. It’s them learning to use their voice and articulate their wants and needs. I think that was a big game changer for my dad. Again, I’m sure that their experiences are going to be much different from mine. But I really felt like in those sessions was the first time that my parents actually heard me, heard my words, rather than just saw it as a behavioral problem, that I had the audacity to question them.

Lisa: You’ve told me in the past that your parents’ style of parenting changed dramatically once they took you to a child psychologist

Gabe: Yeah, yes.

Lisa: In part because the psychologist gave them all sorts of new advice and, frankly, told them that a lot of what they were doing was either wrong or at least not working. That they started taking parenting classes, that they just made these huge changes in how they treated you and your siblings once they had this information.

Gabe: One of the things that my parents learned, and it’s really one of the only examples that I have that my mom told me when I was an actual teenager because she told everybody that she could find. It was don’t trick your kids, the don’t set your kids up to fail concept. And the example that she always used is if you know that your child didn’t go to Molly’s house, even though they said to go to Molly’s house, when they come home, don’t say where have you been and set them up to lie. When they come home, say, I know you didn’t go to Molly’s house, get it right out of the way, and that this setting up your children to lie is just exacerbating the problem. Your kids are going to mess up. They’ve already messed up. You’ve already got a problem. Just address the problem that you have. Don’t create new ones. This made a profound impact on my mother. So much so that she just told everybody that she could find. And again, I learned that when I was a teenager, that’s how big of a deal it made to her, that she talked about it openly in front of her kid.

Lisa: Because most of the things that changed for them, they did not discuss with you until many, many years later when you were an adult. There was a lot going on behind the scenes that you didn’t know about.

Gabe: Yes, one of the things that I learned as an adult is that my parents actually asked the therapist if they were bad parents. I was not in the room, obviously. It was, for those who have not been to family counseling, they talk to the child alone. They talk to the parents alone. Then they talk to you all together. And one of the things that my parents just flat out asked is, are we bad parents? And do you know what kind of humility?

Lisa: Yeah, that must have been difficult for them.

Gabe: It takes to be able to sit in a room with a doctor or a therapist and ask honestly, are we bad parents? And then sit quietly and wait for the answer? If you would have asked me at 15 if my parents had any doubt that they were awesome, I would have been like, no, they’re awful. They don’t give a shit. But they actually had this self-doubt, this care and concern. I did not know at the time that they were capable of that because after all, I just saw them as this overarching force that got to make all the rules and had all the power. When in actuality they were struggling.

Lisa: And they did not let you know how much they were struggling and how much they changed in response to this,

Gabe: Yeah, yeah, I had no idea.

Lisa: When you’ve talked to me about this in the past, you’ve always described things as getting a lot a lot better after you started going to family therapy. But of course, things certainly were not perfect and it didn’t really work in that you continued to struggle. You continued to be extremely symptomatic and got in all sorts of trouble, dropped out of high school, just on and on and on. Does that mean it didn’t work or does that mean that just, hey, you were still bipolar?

Gabe: This is where my dad is very angry, my dad believes very strongly that the child psychologist should have realized that I had bipolar disorder and diagnosed me with it and got me help before I really got into a lot of trouble. We have spent a lot of time, my family and I, my father and I, debating and discussing this point. For what it’s worth, I understand why my dad wishes that I would have gotten help sooner. He’s not wrong. And I understand his frustration because he’s like, look, I did everything I could.

Lisa: Right, what more was I supposed to do?

Gabe: Right, but 15-year olds just weren’t diagnosed with bipolar disorder back then, they’re not really diagnosed with bipolar disorder now. I don’t blame the child psychologist for not diagnosing me. I’ve thought about this a lot. I’ve gone back and forth a lot. And I am 100% confident that diagnosing me with the information that he had with what he heard from my parents and what he saw would have been wholly irresponsible and would lead to way more false positives than it would actual positives. So, I want to say that very, very clearly. But yeah, my dad is still frankly, he’s pissed about it. It comes up pretty much once a holiday.

Lisa: Well, but again, that just isn’t how it was done at the time.

Gabe: Yes. But to your question, yes, things got a lot better. But of course, the underlying issue of bipolar disorder was not actually resolved. The grandiose thinking, the demons under the bed, the anger, the mania, the depression. My parents started doing things better and having more patience and more understanding and moving forward in a much healthier way. But ultimately, if you don’t rectify the core problem, you’re sort of handcuffed on how much better you can do.

Lisa: So things got better, but obviously were not fixed or completely cured because certainly your parents’ behavior towards you might have made things worse, but you weren’t behaving like this because of their parenting, you were behaving like this because you were bipolar.

Gabe: Yeah, I was still an untreated bipolar. That’s probably an oversimplification, but it’s more correct than it’s incorrect.

Lisa: But at the time, you were very angry with your parents and thought that they were doing a terrible job, and you continued to think that for a long, long time, right? When did that stop?

Gabe: When I reached recovery with bipolar disorder, I started to see life very differently and I started to see the world very differently. And when I was on my second divorce, Lisa, which was ours, the world looked really differently, too. Like it was it was much more difficult to be an egotistical, arrogant person facing my second divorce and facing rebuilding my life from the bipolar diagnosis. And I had messed up so many things that some of the arrogance of, oh, I’m better than you went away. I realized that a lot of what happened to my parents wasn’t an example of them being idiots. It was an example of circumstance and them being idiots. I, I.

Lisa: There were mitigating circumstances.

Gabe: I did not see any of those mitigating circumstances when I was a kid. Some of the things that really gave me a great amount of pause was spending more time with young children. You know, young children are difficult. I’m going to go with difficult. I started mentoring a teenager. And the stuff that would come out of his mouth in the four or five hours that we would spend together were frankly, just like, what is wrong with you? What are you? What? And then I would reflect back on me doing the exact same thing to my parents. And then the more I understood about my illness and it occurred to me once I reached recovery that my perspective was skewed by symptomology, my perspective was skewed by bipolar disorder. The way that I was remembering the story is incorrect. I would always say me and my dad got in an argument, but in reality, that’s not what happened. What happened was, is my dad got in an argument with a person with untreated bipolar disorder experiencing grandiose thinking, bipolar rage, who was actively delusional. That’s a very different memory. And what, of course, was even worse is that neither one of us knew. I thought that I was perfectly fine and had 100% complete control of my faculties. And my dad thought that he was in an argument with his teenage son who was being a brat. The situation that we thought that it was was not the situation that it actually was. That changes things, changes things dramatically.

Lisa: In the spirit of the original question, though, that’s how you felt once you were in recovery or that’s how you feel now. How did you feel at the time you were diagnosed?

Gabe: That they did it, it was their fault.

Lisa: Ok, so you had a lot of anger still

Gabe: Yes,

Lisa: By the time you were diagnosed

Gabe: Yes.

Lisa: And it was this process of reaching recovery that helped you get rid of a lot of that.

Gabe: And here’s the sick part, right? I was so angry at them. I was so angry at them for letting me languish and not getting me help, they’re my parents. It’s their job. But I called them five times a day from the hospital.

Lisa: Yeah.

Gabe: I still wanted my mommy. That’s all I can say. I, it was both my mother’s fault and I wanted her so desperately. And my parents, as you know, they came later after I got out of the hospital and they helped me move. There was a lot going on in my life, etc. And they like swooped in and solved all of these problems for me while I largely sat in the corner crying. And I was still pissed at them as I was watching them carry my stuff.

Lisa: As they were fixing your life, you were still angry.

Gabe: Yeah, because they messed me up.

Lisa: And at this point you were an adult with your own home, etc.

Gabe: I was twenty-five. Yeah, I was going through my first divorce. Isn’t it great that we can, you know, chop up Gabe’s life into wives?

Lisa: Yeah, yeah.

Gabe: Like those were during the Megan years. Those were during the Lisa years. Now we’re in the Kendall years.

Lisa: But those are the years that will never end.

Gabe: I know. I mean, I know.

Lisa: So, your parents at the time you were diagnosed, they’re falling over themselves to help you, you needed a lot of help because you were a wreck, but you were still extremely angry and your relationship was difficult.

Gabe: It was, but there was. There was some moments and I didn’t realize how amazing they were at the time.

Lisa: Even adult children are selfish when it comes to their parents. You just feel like they kind of owe you.

Gabe: I was a jackass, I was moving out of the house, it was the house that my first wife and I lived in and I was moving into an apartment. That has a whole long back story. But let’s just describe it as a shithole.

Lisa: It wasn’t that bad.

Gabe: It was pretty bad, especially moving out of a real nice house.

Lisa: It was a nice house,

Gabe: Come on.

Lisa: It was a very nice house.

Gabe: And they had got me all moved in and I was at the corner of the apartment building just kind of trying to stand out of the way and hide.

Lisa: As they did all the manual labor.

Gabe: As they did all the manual labor, while I did nothing. I should probably point out, you know, at this point, my dad is like 60, and my grandfather, who was like 70 at the time.

Lisa: So the healthy 25-year-old stands off to the side so that he can watch his elderly relatives assist him with manual labor.

Gabe: I think they would both object to being called elderly, but, yes, that is that is correct. But there’s, there’s moments in this mess. One, nobody ever yelled at me for this. They just did it. So, I just want to put you in the mindset of my father, who has literally worked all day on this stuff. And I’m standing at the corner of the apartment building because I you know, I don’t want them to see me cry or be upset. I don’t even know why I was hiding. And my dad comes over and asked me if I’m OK. And I’m like, you know, yeah, I’m fine. And, you know, he’s kind of standing there. It’s kind of awkward. And I said, you know, I don’t, I don’t like it here. It’s not nice. And my dad looks at me and he said, Well, but this is just a footnote in your story. It’s not the end. You’ll be out of here before you know it. And then he just walked away.

Lisa: He’s just dropping wisdom and then leaves you in the dust.

Gabe: Yeah, like, literally, and I just, he, it was kind of a powerful moment because all I could think of was this is where I’m stuck. This is where I’m stuck. And my dad’s point was, no, this is just where you are. That’s a big difference. I do remember little things like this, but I didn’t know them at the time. I don’t want anybody to think that my life got dramatically better after my father said that or I didn’t spend the next, you know, four years fighting mental illness and I didn’t suffer a great deal. Or I still thought, you know, my parents are idiots, and they did this to me on and off. And we still struggled and had problems. But looking back now, they knew damn well I was pissed at them. They knew damn well that their son was an idiot. They knew and they were scared of bipolar disorder because it’s a terrifying illness. They didn’t know what to do and they had to drive 700 miles with old people to carry my shit. And yet here they are. Here they are. And I didn’t carry anything. I carried nothing. 

Lisa: Well, also, they both had responsibilities at home, they both still had jobs, your mother was caring for grandchildren and they dropped everything and drove to another state

Gabe: They did.

Lisa: To try to rescue you.

Gabe: I mean, when you say it that way.

Lisa: Yeah, well, to be fair, I did not see it that way at the time either. At that point, every story you’d ever told about your childhood was more horrifying than the last.

Gabe: Yeah.

Lisa: It was just constant horrifying. You told me this horrible story about how your mother actually knocked you unconscious once.

Gabe: Ah, the softball story.

Lisa: The way I heard this story is, Gabe was a teenager and was being difficult, as teenagers are wont to do, when his mother couldn’t take it anymore and threw a softball at his face, knocking him unconscious. And then you’re like, oh, Lisa, meet my mom. What? Oh, this will be great.

Gabe: You know what a fish story is.

Lisa: Ok, fair, fair.

Gabe: A fish story, of course, is true in that the person was fishing and the person did catch a fish, but the six-inch fish becomes a two-foot-long fish. The story is true. My mother did, in fact, throw a softball. And it did hit me and it knocked me down. Don’t I didn’t lose consciousness. I don’t and I don’t remember saying that, to be honest. I think that might have been inferred. But it doesn’t matter.

Lisa: You told me that you got fuzzy and that you had a terrible headache for the next couple of days, and I thought to myself, well, that’s a concussion.

Gabe: That’s, that could be true. But the devil’s in the details, right? Let’s get a little more of the scene. At this point, I would have been almost 17 years old. I weighed 400 pounds. I was six foot three. And I was screaming at my mother. I was just screaming at her, yelling every word that I could think of because, frankly, I was enraged. Now, remember, not only am I twice as big as my mother, a foot taller, I am also an untreated bipolar who is clearly symptomatic. And upon the yelling back and forth, my mother picked up a softball and threw it over my head. I want to be clear. I knew she threw it over my head at the time because I didn’t even duck.

Lisa: So she wasn’t throwing it at you.

Gabe: No, she wasn’t throwing it at me at all, of course not, but it hit the wall behind me and bounced off and hit me in the back of the head and it knocked me over. And at that point, I became even angrier and just left. I just got in the car and drove off.

Lisa: What did your mom do?

Gabe: I don’t remember. I don’t think she did anything at that point. Obviously, when you tell the story, hey, mom and son got in an argument. Mom lost her temper, threw softball. Yeah, my mom comes off really bad in that story. And I come off looking like the innocent child. When you tell the story, giant enraged man screams at woman. Woman defends herself by throwing softball above head that happens to make contact. Well, that starts to move the needle a little bit on culpability. I’m not defending my mother. She never should have thrown the softball. She doesn’t think she should have thrown the softball. Nobody thinks that she should have thrown the softball. What my mother should have done was walk away. And we know that now. But it’s a little bit unfair to hold my mom 100% accountable for the aftermath of dealing with somebody with untreated bipolar disorder. It’s a chaotic scene. Again, do not throw anything at your mentally ill loved ones. My mother was 100% wrong.

Lisa: Or any of your loved ones.

Gabe: Yeah, that’s, that’s a good point. Lisa.

Lisa: Wow.

Gabe: I am not advocating for throwing softballs at your children, but I am saying that.

Lisa: Or anyone outside the context of a softball game. I can’t believe I need to clarify this for you.

Gabe: Also, good advice. Can I make my point now?

Lisa: I just, whoa.

Gabe: Yes, this was obviously not my family’s finest moment, it was not my mother’s finest moment. But when you start to dig into the details a little bit, it’s a little more tragic from my mother’s perspective than I realized. I don’t know what she was thinking. I don’t know why she did it. I don’t know why she lost her temper. I don’t know what was going through her head. It’s really easy to Monday morning quarterback now and say that that was a mistake, but

Lisa: Well, it was a mistake,

Gabe: It was.

Lisa: It’s just.

Gabe: But in the moment, hell, maybe that was her only move. It did, in fact, end the issue. I left. So, who knows? Maybe if she hadn’t thrown that thing. I can’t even speculate. I’m just. You know, sometimes things just happen that don’t turn out the best. And it’s not because your parents are bad. It’s because of a momentary lapse of reason or a mistake. I mean, Lisa, you got in a car accident. You don’t consider yourself a driver that needs to turn in your license or you would not drive for fear of killing yourself or others.

Lisa: I had heard this story about your mother. I heard it before I met her, and it definitely shaped my impression of your mother for a very long time. And it does not leave a positive impression of your mother. And it actually wasn’t until we were discussing this show last night and you started giving all of these other details, all of this further information, that I started thinking, huh, maybe that isn’t quite the situation I had initially thought, especially as you started saying, look, she was dealing with an untreated bipolar who was much bigger than her in a full on rage. Do you think she was scared? I mean, was she physically scared of you? Was she afraid that you would become violent?

Gabe: No, I don’t think so. I don’t think my mom thought that way at all. I do think that there was an element of her losing her temper. I think there was an element of her wanting to shake things up. I think there was an element of her wanting to break my thought pattern. You know, I was, I was just in this cycle. You’ve argued with me when I’ve been in this, it’s everything leads back to the same thing. No matter what you say, it’s

Lisa: You get on a loop and you can’t break out of it.

Gabe: And she broke that loop by throwing the softball.

Lisa: So you’re thinking that she just got so desperate and also who knows how long this had been going on?

Gabe: Yeah.

Lisa: That she just thought, oh, God, we got to do something here?

Gabe: And of course, in the moment, I was extraordinarily symptomatic, I was enraged. I was a person with untreated bipolar disorder. So, you’re asking me what happened? But the only memories that I have are heavily influenced by untreated bipolar disorder. So, you know, there’s got to be so much more that we are not taking into account here. But you’re right. When I was angry at my mother, I spun the story.

Lisa: But you didn’t realize you were doing it.

Gabe: I didn’t. I spun the story even for myself so that I could maintain my anger at my mother.

Lisa: There were a lot of extenuating circumstances to the problems you had when you were a teenager and looking back on it now, especially from a position of recovery, you’re willing to give your parents a lot more slack than you were when you were a teenager or even when you were diagnosed.

Gabe: A watershed moment for me, Lisa, was when I was in a support group and I started complaining about my parents and a couple of the people in the support group started talking about theirs. Their families had abandoned them, like literally one woman talked about how she hadn’t talked to her father in a decade and her mother was not allowed to talk to her, but opened up a private email account so that they could email a little bit. But her mother made it perfectly clear that your father is not on board with this and I will never meet you in public and I will not provide any help for you in any way. And other people talked about just horrific abandonment and name calling and.

Lisa: And abuse.

Gabe: Yeah, and I’m sitting there thinking, oh, I’m mad at my parents because they didn’t move me into my new place fast enough and of course, my parents made a ton of mistakes. And I want everybody to listening to this to know, ton of mistakes. I could write a book on all the mistakes that my parents made. But you know how you make mistakes. You’re there. You’ve got to be there. These other people, their parents made one mistake. They abandoned their kids. That’s it. That’s all they had. They abandoned their kids. Whereas my parents, they just kept trying shit. And the stuff that they tried was awful because they didn’t have, you know, guidance or understanding. And they thought that the myths of mental illness were real and on and on and on and on and on and on and on. But you have to be there in order to screw up. It never even occurred to me that my parents would leave. I like, I didn’t know that was possible, Lisa. I just, I did not know it was possible. I just. And you know what’s messed up about that? My biological father abandoned me when I was a baby, and it still didn’t occur to me that my mom and dad could abandon me. Like, what’s up with that? 

Lisa: If you haven’t listened to other episodes or know Gabe’s back story, your mother got pregnant with you in high school, she and your biological father had a shotgun wedding,

Gabe: Yeah,

Lisa: And within a year

Gabe: Yeah.

Lisa: Of your birth, he’d taken off never to be heard from again.

Gabe: Yeah.

Lisa: And eventually she met and married your father

Gabe: Who adopted me,

Lisa: Who adopted you.

Gabe: She met and married another man who adopted me as his own and is the only person I’ve ever known as Dad. But he is not my biological father, he’s just the man who raised me as if I were his own, which is hilarious because I’m six foot three, giant and have bright red hair and he’s like five foot three, tiny and has black hair. So, yeah, anybody that thinks that he’s my biological father is a moron.

Lisa: Your dad has some fun with that, too,

Gabe: He does.

Lisa: Because people will ask you all the time, where did you get that red hair? And he’ll go, Oh, he got it from his dad.

Gabe: My dad’s a dick.

Lisa: He just stares at them. Like, what?

Gabe: It is funny, it is funny to think about, but but yeah, it didn’t occur to me that people could lose their parents. I just, I thought that I was abandoning my parents because they were bad and I was punishing them. But I always knew that as soon as I forgave them, they’d come back. Like, you recognize that I keep saying that my parents did all of these things so horribly wrong, but the foundation that they built was that I knew that I could count on them 100%.

Lisa: To come and do the wrong things.

Gabe: Well, right, yes, yes,

Lisa: Right.

Gabe: I would judge them implicitly. This is why mental illness is so messed up. My parents are good people. I want to be very, very clear. But they believed all of the myths of mental illness. That really is the take away here. They believed the pop culture representation of mental illness. Mentally ill people aren’t smart. Mentally ill people don’t own houses. Mentally ill people don’t get married. Mentally ill people have bad parents, specifically bad mothers. It was a moral value. And why wouldn’t they? That’s all they were taught. That’s what they were taught growing up in their lives. That’s what I believed. That’s what pop culture, television shows, movies, that’s what it all showed. Mentally ill people were in a corner, rocking back and forth, drooling and violent and came from broken homes. I’m not mad at them anymore for not realizing that I was sick because society kind of set them up to fail in this way. It’s one of the reasons I became an advocate because I thought, you know, my parents love me.  They desperately tried to do the right thing at every single turn and they missed this glaring thing.

Lisa: Well, everybody missed it, including the professionals they took you to.

Gabe: Right, I want to talk to all of the people with mental health issues and mental illnesses who are mad at their families. Listen, I don’t know your families. There’s certainly toxic families. There are certain families that have done unforgivable things and on and on and on. I’m not pretending that every single family is my family. That is complete and utter nonsense. But I am saying that I realized along the way that my family was in the same impossible situation that I was in. So, it’s, I want people to forgive me for the things that I did when I was symptomatic. Why would I not forgive the people around me for the things that they did while I was symptomatic? I should be extending the same forgiveness to them that I want society and my family to extend to me. And I think that’s a very powerful message. Your circumstances pending. But then there’s sort of a shit or get off the pot mentality here. Look, you got to decide. If you’re not going to forgive your family, then cut them off and never talk to them again. Call it a day. Just, just don’t torture yourself. And if you want your family in your life, constantly reminding them of all the mistakes that they made five, 10, 15, 20 years ago is not the way to build a positive relationship moving forward. And that all ties back to your perfect quote, Lisa.

Lisa: You can’t go back and change the beginning, but you can start where you are and change the ending?

Gabe: Exactly, so with your family, you can’t go back and change the beginning, you can’t fix all of the things that your parents, brothers and sisters, aunts, uncles, grandparents have done. But if you make the decision right now to forgive them, radical acceptance, radical forgiveness, you can change the end. The reality is, is that my parents messed up. That’s fine. I messed up. That’s fine. I’d much rather talk about what we’re doing this Christmas than worry about what they did 20 Christmases ago.

Lisa: Well, and speaking of apologies or messing up, your parents have apologized to you.

Gabe: Oh, yeah, yeah, yeah, on video.

Lisa: Yeah, good point, your father especially was like, well, yeah, we just tried to punish the symptoms of bipolar disorder out of him and he feels very badly about that now, even though he couldn’t possibly have known.

Gabe: Yeah, and we did not get there overnight, my family and I didn’t have some Hallmark movie moment where music played and it started to snow and we all hugged each other and the camera panned away, showing the half a million-dollar house that we can afford on the kindergarten teacher’s salary. No, it didn’t work that way. We just started building new memories and that’s what we did. And as we started building new memories, the older memories sort of either faded away or became more in focus.

Lisa: But, Gabe, you do have happy memories from childhood.

Gabe: Aat the time that I first met you, Lisa, the answer to that question would have been no. I would have said no. I have no happy memories of childhood. But now, yes, because once I started looking at the entire picture, I realized that my parents can both have made a lot of mistakes and have done a lot of things right. I was very much in black and white thinking. Either my parents have to be all good or my parents have to be all bad. And at the time I met you all bad, all bad, 100% bad. They sucked.

Lisa: Yeah, it made it difficult. You have a much better relationship with your family and your parents now than you ever did when we were together, and it’s made a big difference for you. It’s brought you a lot of happiness.

Gabe: True that.

Lisa: And here you are changing the ending.

Gabe: Hey, next week, we should do you and your family.

Lisa: Oh, I would like that. I have a lot to say, and they’ll love it, too. So everybody wins.

Gabe: Yay! Thank you, everybody, for listening to this episode of the Not Crazy podcast. My name is Gabe Howard and I wrote the book, Mental Illness Is an Asshole, available on Amazon. But if you head over to gabehoward.com and buy the book there, not only will I sign it, but we’ll send you a bunch of Not Crazy podcast stickers. And that’s really awesome. You can put them on your car, your laptop, give them to your friends. And remember, wherever you downloaded this podcast, please subscribe. Also, use your words and rate it. Write a review, give us as many stars as possible and tell all your friends.

Lisa: Don’t forget the outtake after the credits and we’ll be back next Tuesday.

Announcer: You’ve been listening to the Not Crazy Podcast from Psych Central. For free mental health resources and online support groups, visit PsychCentral.com. Not Crazy’s official website is PsychCentral.com/NotCrazy. To work with Gabe, go to gabehoward.com. Want to see Gabe and me in person?  Not Crazy travels well. Have us record an episode live at your next event. E-mail show@psychcentral.com for details. 

The post Understanding a Dysfunctional Childhood first appeared on World of Psychology.

In today’s show, Gabe talks with Robert Kolker, author of the New York Times bestselling — and Oprah’s book club pick — book Hidden Valley Road. This non-fiction biography is the true story of a mid-century American family besieged by schizophrenia. Of their 12 children, 6 struggled with the severe mental disorder. 

Join us for the incredible story of the family who became science’s greatest hope in the quest to understand schizophrenia.

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The post Podcast: Large Family Beset by Schizophrenia first appeared on World of Psychology.

Now that we’re in the middle of a pandemic, more people than ever are experiencing anxiety, especially those who struggled with mental health issues before COVID-19. And to make things even worse, many of our coping mechanisms, like going to the gym or hanging out with friends, have been taken away.

In today’s show, our host, Gabe Howard, talks with Dr. Jasleen Chhatwal, who helps explain why so many people are having anxiety symptoms and what we can do about it.

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Jasleen Chhatwal, MD, is Chief Medical Officer and Director of the Mood Disorders Program at Sierra Tucson, a premier residential behavioral health treatment center. Dr. Chhatwal also serves as Assistant Professor at the University of Arizona College of Medicine. Board certified in Psychiatry and Integrative Medicine, she is well versed in psychodynamic psychotherapy, cognitive behavior therapy, psychopharmacology, neuromodulation including ECT & rTMS, and various emerging modalities. 

Dr. Chhatwal is active in the mental health community, advocating for her patients, colleagues, and profession through elected positions with the Arizona Psychiatric Society and American Psychiatric Association. 

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of The Psych Central Podcast, I’m your host Gabe Howard and calling into the show today, we have Dr. Jasleen Chhatwal. She is the chief medical officer and director of Mood Disorders Program at Sierra Tucson, a premier residential behavioral health treatment center. Dr. Chhatwal, welcome to the show.

Jasleen Chhatwal, MD: Thanks for having me. I’m delighted to be here.

Gabe Howard: Well, we are super excited to have you here today because you’re also an anxiety expert, and many people who aren’t used to feeling the effects of anxiety are because of COVID. I want to start with, are you seeing people that never had anxiety and stress issues before suddenly developing anxiety disorders because of the global pandemic?

Jasleen Chhatwal, MD: I am noticing that there are a lot of people who notice anxiety type symptoms, and since they’ve never really experienced them before, they’re really taken aback and they don’t really know what’s going on. And so I feel like one of our big duties at this time is to help people become more aware, because I think once you can name the beast, then it’s a lot easier to tame the beast. And I think a lot of individuals will have a hard time if they don’t know what to call it or what to do with it.

Gabe Howard: The Psych Central Podcast has been on the air for almost five years, PsychCentral.com has been around for 25 years. So we are well versed in mental health advocacy. And for the most part, it’s always sort of been in its own little corner. There’s the people that have a mental health issue or a mental illness and they understand it. There’s people who develop one or have a loved one who develops a mental health issue or a mental illness, and they’re searching for information. But by and large, the majority of the population was not discussing this openly. We’ve seen that change dramatically in the last six months where suddenly it’s sort of mainstream news about how adults that never had any mental health issues before are suddenly suffering from the symptoms of depression, anxiety, stress, and on and on and on.

Jasleen Chhatwal, MD: So a lot of people talk about anxiety like it’s a pathological thing. I really try to explain to people how anxiety is normal. You have to have the neurobiological fear response to be safe as a human being. Like you’re going to the Grand Canyon and walking over the skywalk, the fact that we don’t just climb over the rail and try to jump down is because we do have a biological response to anything that’s not within the normal human experience or scope. If you think about having a snake by your chair, you want to have an anxiety response so that you can quickly panic and run. And what will happen if you don’t have that fear response is you will die because the snake will bite you or you’ll have some pretty negative consequences of that. How can you not have anxiety when you’re being told all day on the news that you need to take all these extra precautions to just be safe, to not fall sick, to make sure your loved ones don’t die. That is something that just normally will cause some degree of anxiety. The difference between that type of anxiety and what can be called a DSM anxiety disorder ends up being that it becomes overwhelming to the point that you can’t function. And what we start to see is people who may have had a higher level of anxiety before, but were being able to do things to help themselves, like going to the gym to work out or going for a run outside or spending time with loved ones. All those people, their coping skills have been taken away. And that is where you start seeing that they now fall into more of that clinical anxiety disorder category. If you look at most mental health conditions, they are on a spectrum. And it just really depends on how far along the spectrum you are today. It could be that today it’s a disorder. But, you know, a week ago or two weeks ago, it wasn’t quite meeting the criteria.

Gabe Howard: One of the themes that runs through The Psych Central Podcast is we try to explain that mental health and physical health actually are, they have a lot in common. Meaning most people have good physical health most of the time. But you can still get a cold. You can still get injured. And that’s a very temporary problem. But you can also have, for example, diabetes, which is severe and persistent and lifelong. Mental health is the same way. I think a lot of people think that you either have good mental health or you’re mentally ill and that there’s nothing in between. Do you believe that because of the pandemic, people are starting to realize that everybody has mental health and that you can have the equivalent of a cold, which in this case is stress and anxiety or panic? Do you think this is helping to educate people that we all have mental health and anything can trigger bad mental health?

Jasleen Chhatwal, MD: Yeah, I think reading a lot more content about that in very popular channels. Maybe your podcast or me like this is our world, but other people

Gabe Howard: Sure, yeah.

Jasleen Chhatwal, MD: For whom this is not their world, we are seeing them talk more about mental health. And in my own world, I try not to talk about somebody having just mental illness. I think about mental health on a continuum. You can do things every day to improve your mental health and you can do things every day that may not really be serving it well. The kind of food that you eat, the places that you go to, the people you spend time with, each of those things can help build up that mental health.

Gabe Howard: Dr. Chhatwal, thank you so much for establishing that more people are suffering from anxiety and that it’s a very real thing. We’ve been doing this work for a long time, so we’re not surprised by this. But I think that the general population is and one of the hallmarks of being surprised by something is that you don’t know what to do about it. Do you have advice for listeners who are overwhelmed, anxious and filled with stress due to the COVID-19 pandemic?

Jasleen Chhatwal, MD: The one thing that we can all do and maybe do a little bit better is starting to become more aware. Naming what is going on for you is really important and naming not in the sense of saying, oh, I have so-and-so disorder or diagnoses, but more naming like how does it feel for me? How am I feeling in my body? What are the signs that I’m seeing for myself? What are the changes that I’m seeing in my behavior? So recognizing that you’re not as engaged, you’re not as motivated or fulfilled to saying, OK, well, I don’t really feel like doing my work or when my children ask me a question, I feel exasperated and want to roll my eyes that that can be a step to saying, OK, something is definitely going on. And now let me sit and think how I’m feeling physically. What are the emotions I’m feeling? Some of us have a broader language for emotion and some of us have a narrower language and words for emotion. And that’s OK. Even being able to identify I feel good, I feel bad. That may be a great place to

start. And then starting to look at what are really options for you to start to change things that make you feel bad? Is it something related to your job, like either the hours are now feeling too much or the workload is feeling too much. Talking to your human resources department, or when it comes to your home life maybe getting together with your partner or people who live in the household with you, or if you live alone connecting with friends and starting to really talk through this and asking for the support that you might need. Another strategy can be then to start to follow some degree of a schedule, because we hear a lot about pajama sales are on the rise or that people are doing the zoom uniform with the formal top and shorts at the bottom.

Gabe Howard: I love that.

Jasleen Chhatwal, MD: Yeah, it’s comfortable and it can also give your mind a signal that you’re just supposed to be relaxing. However, what you’re doing is sitting in front of your computer and working. So now your mind is really confused. It’s like, well, I’m supposed to be feeling relaxed, but I’m doing work. So what we’re hearing from people is that they’re working longer hours because now they’re just connected on the computer all the time. They still have to take care of their children and now they have to go pick up their groceries and wipe them all down like everything’s become just a tiny bit or a whole lot more complicated. And so trying to at least get your life into a little bit of a schedule may make you say, OK, I start my workday at eight and then I am going to end it at five, just like I would normally clock out.

Jasleen Chhatwal, MD: And then maybe in that evening time you can start to recognize what are pleasurable activities that you can do in your home environment? I’m hearing from people that they can’t work out, but I can tell you, like doing push ups doesn’t take a lot of equipment. And so it may be deciding here right now I can only do five pushups a day. Within the next two weeks or a month, I’ll get up to ten. So setting realistic goals that make you feel like you’re being able to achieve something and that are in a direction of something. For myself, I think two or three months ago I was feeling like, oh, I’m just at home going to work, coming back. But I got myself an easel and canvas and I picked up something I hadn’t done in about a dozen years. I made a painting. It’s not great. I’m not going to sell it, but I did something that was enjoyable. Finding anything that you can do that serves your soul is really very important at this time.

Gabe Howard: When all of this started, we sort of had this mindset that, OK, we just need to hunker down and get through it, it’s only going to be a couple of weeks or even a couple of months. Now, here we are and we’re starting to learn that we don’t really know when this is going to be over.

Jasleen Chhatwal, MD: Yeah.

Gabe Howard: So now we’re sort of in this kind of like a limbo state where we don’t know if we want to make new habits that we want to last for years or if we should still stay in this, oh, things are going to get back to normal tomorrow. The example that I always use is, look, if I lost my job, I would understand that that job’s not coming back and I would prepare for a new future. But if I was laid off from that job and they told me that as soon as things pick up, we’ll call you back. Well, now what do I do? Do I look for a new job? Do I wait for things to pick up and they call me back and I resume my life? We don’t know when this is going to end. We don’t have that hard stop.

Jasleen Chhatwal, MD: My advice to people and my thought for myself and my loved ones is that this is maybe a time for us to really start reinventing and reconsidering what our new normal is going to be. We know that not only has the pandemic obviously affected our way of life drastically but also that there’s a potential financial crisis that’s brewing. So really looking at restructuring our lives and seeing are we really on the right path? And even as a human species is the direction that we’re going really the direction we need to go? In all the things that we cannot control, the thing we do get to control is how we’re going to react and how we’re going to start to make our own decisions in our lives. Connection is fairly important. Make sure that there is a regular way to connect with other human beings, even if you’re working from home. I’ve heard these amazing stories about families that do Zoom sessions every week or who will play card games on Zoom or might even just turn on something like a video platform and have conversations throughout the day.

Jasleen Chhatwal, MD: We’ve done things like with my in-laws and family where we watch a movie at the same time. Also, I think, starting to look in terms of employment and what are sustainable ways to work, because as a culture, we work a lot. And I think a lot of companies are now realizing that maybe people don’t need to be clocked on or on site as much as we previously thought they needed to be. So starting to really see if that is OK for you, because for some people, like telework does not work, and for others, telework seems like the best thing since sliced bread.

Gabe Howard: You’ve hit on a very interesting point there with your example of telework, some people absolutely love it other people absolutely hate it. We’re seeing this a lot with anxiety. Some people are handling this pandemic no problem. They have literally zero anxiety. Other people are falling apart at the seams. Why is it hitting some people harder than others? And then there’s this tendency, if you’re one of the people who anxiety is hitting you really, really hard to find somebody who’s managing this global pandemic like gangbusters and compare yourselves to them. And I imagine that makes it much more difficult to manage the anxiety and move forward.

Jasleen Chhatwal, MD: Comparison has always been one of those things that kills your drive and really starts to make you feel deflated because we don’t know what that other person’s life looks like. We don’t know what their life experiences have been. In mental health, now, we’ve noticed for a long time that our early lives have a huge impact on how we respond later on. And some people who are more anxious than others either at this point don’t have access to their usual coping strategies or the other thing could be that a person who has more anxiety likely had more adverse childhood experiences or early life trauma. Some of that trauma can get relived when you’re isolated, alone, don’t have support. And then finally, it can also sometimes be that you’ve had a really comfortable and quote unquote, normal life. And when suddenly something comes and upends your way of life, it may be your first time really facing something that feels overwhelming. So you may not have had practice at managing that before. So the more we think that others are doing well, the more likely it is that we’re more focused on them rather than ourselves. Rather than just sitting and saying, well, you know, Tom seems to be doing really well and I see that

Gabe Howard: Right.

Jasleen Chhatwal, MD: Gabe’s kind of killing it, being more connected with yourself is probably your best bet in being able to find that new normal and move forward post pandemic.

Gabe Howard: I really like what you said there about if we’re paying attention to others, were clearly not paying attention to ourselves and anxiety is not going to clear up by convincing it that Bob or Jane is living their best life and therefore I should be living my best life as well. It involves more nuance and work than that. Which leads me straight into my next question of how can I know if I’m being realistic about the risks and dangers and when I’m letting anxiety just simply get the better of me?

Jasleen Chhatwal, MD: Anxiety can get the better of anybody. It is a neurobiological response. We have this tiny area in our brain called the amygdala, whose job it is to give us fear signals. It’s really once you start feeling like you can’t quite function in your life, you’re not really being able to do the things that you typically can get done, or especially if you start having thoughts about suicide or not wanting to live or starting to feel like your life is not worth it. Those are danger signs and those are times I would say don’t even think, go seek help. There’s really no harm in seeking help. And if nothing else, most of our communities have what we call warm lines. And you can call those and speak to somebody and see if that starts to help you, because a lot of us may not be able to clearly think about what’s happening to us till we start speaking about it. I usually say, you know, if you go to a therapist, you can always decide you don’t go for the second visit. It’s not like they’re going to force you to come by. You at least start to tell your story and start to try that out as an option for if that’s going to help you or not.

Gabe Howard: We’ll be right back after these messages.

Sponsor Message: Gabe here and I wanted to tell you about Psych Central’s other podcast that I host, Not Crazy. It’s straight talk about the world of mental illness and it is hosted by me and my ex-wife. You should check it out at PsychCentral.com/NotCrazy or your favorite podcast player.

Sponsor Message: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: We’re back discussing COVID-19 anxiety and stress with Dr. Jasleen Chhatwal.

Gabe Howard: Now, Sierra Tucson has started a program called Health Care Heroes, and that’s specifically designed to treat doctors, nurses, and other frontline health care workers coping with the trauma of disease and death from coronavirus. How can you help health care workers heal from this tragic experience? Because up until now, we’ve been talking about just lay people managing the pandemic, but they’re literally on the front lines.

Jasleen Chhatwal, MD: Health care workers are already at a greater risk of fatigue, burnout, suicide, and that was pre-pandemic. Most of us generally go to school and do years of training with the goal of helping other fellow humans. And so now that the pandemic has really challenged our own lives and we’ve also had to go to work with having increased anxieties about being exposed, most of us may also know fellow health care workers who may have contracted coronavirus and may even have lost their lives to coronavirus. From a health care worker perspective, I feel like life is more stressful than it has ever been. You are being called to really show up and help people. However, we also haven’t quite had all the tools that we typically need, for all the shortages of PPE, shortages of ventilators, increased hospital bed capacities. People are working longer hours. There is more expected of them and there’s less reward because we are losing our patients. We are seeing people be sicker. Health care workers themselves are experiencing helplessness. And there has been so much stigma around seeking mental health support for even lay people and then for health care workers, it’s compounded because we then have to start reporting it to our boards or we need to start telling people that we’re getting mental health treatment. A lot of health care workers are used to kind of putting on their armor and saying, I’m OK, I can work long hours, I can do what needs to be done. So, Sierra Tucson as a group, when we started looking through, how could we show up and help our community and help our people, we decided to try to create this program which we want to make it OK for people to say I’m not OK. That’s the message that we’re trying to give. It’s OK to need support. And we’re here for you. We are also health care professionals and we’re experts in trauma healing. And we’re uniquely positioned at this time to support our fellow health care professionals with a nurturing environment, trauma focused therapies, and then also additionally peer support. So finding ways to help them get back on that spectrum of mental health, to move closer towards mental wellness and further away from having a mental health diagnosis or mental illness. There are health care workers who already live with mental health conditions prior to this. So making it OK for them also to know that they can take time off and really care for themselves because they’re the most important person.

Gabe Howard: From my perspective, it doesn’t serve the greater society to have a health care worker who is so stressed out, so overwhelmed or is suffering from a mental illness or a mental health condition, not seek treatment, because how beneficial are they going to be to my care if they themselves are in crisis or potentially in crisis? So, do you want health care workers who know that they’re at risk for a mental health issue, not seek help because they’re afraid of the stigma, the discrimination, the judgment? That doesn’t serve the greater good. Are people starting to realize that? Do you see a shift both in terms of health care workers being willing to seek help and in the general society understanding that, hey, health care workers are people too?

Jasleen Chhatwal, MD: Interestingly, it seemed like maybe the pandemic has helped, that people are more accepting that, oh, this is traumatic and you’re hearing the word trauma a lot more. I would like to say it’s slowly improving. And I think the more the general public accepts mental health conditions, the easier it will be even for health care workers. But it’s still very hard. It’s still not a good place. We’re not doing well by our people. I think the big piece of that is that we’re separating physical and mental health and you just can’t do that. One thing affects the other. Even with something like anxiety, which is what

we’ve been talking about, you have physical symptoms. You feel like your heart is beating. You have chest pain. People show up to the E.R. thinking they’re having a heart attack when they’re having a panic attack. Unless we as a society, the health care system, insurance companies in their own areas start to really marry the two together and say it’s whole health, we really can’t get away from stigma. Like we said right in the beginning, everybody has mental health and everybody has physical health. And like the WHO says, there is no health without mental health. So we’ve got to get them together.

Gabe Howard: I completely agree with your assessment that the pandemic does seem to be helping mental health understanding because so many people are in the exact same boat. They themselves are suffering from anxiety because of COVID. So therefore, they’re less likely to be judgmental against somebody else who’s suffering from anxiety. Also, if a global pandemic doesn’t cause anxiety, I don’t know what will. For some reason when somebody says I’m anxious, our first question is why? And then we decide if that’s a good reason, that’s very unfair. Right? To determine if somebody is allowed to be anxious based on the reason that they give — anxiety doesn’t work that way. Is that correct?

Jasleen Chhatwal, MD: You’re exactly right, Gabe, anxiety can only be assessed by a person’s own barometer. So, myself, I’m not scared of heights. I used to skydive, but I have a friend. We went together to the Grand Canyon and they have a walkway on the Nevada side. And we were walking over it and she was like, nope, not doing it, not doing it. And I was like, oh, come on, we’ll walk and well, I’m trying to hold her hand. And she just couldn’t. So I can’t say she is more anxious than I am because it’s not the same for everything. She may not be anxious in a lot of other situations that I may be anxious in. And so anxiety is per your own context, and it is per the lessons you’ve learned in life for things that are fearful to you, the stories you tell yourself. And it’s usually from early life experience, you’ve either had a negative experience with something, so you’re more fearful of it, or you’ve been told stories about that thing that make you more worried. So there are all those components which fall into the nurture category. And then some people do have just a slightly higher sensitivity.

Jasleen Chhatwal, MD: And that becomes the nature element, which is your genetics, how your amygdala, which is the fear center, like how that’s tuned. And some people just have a more sensitive amygdala. Their fear response is greater. And then we also know that having negative experiences early on in life will make it that your fear center kind of reacts a lot quicker or may start to be easy to get stimulated. So if you’ve had a lot of early life trauma, it’s almost like your fear muscle is stronger so you can react a lot quicker and that is an evolutionary mechanism for human beings to keep themselves safe. So when we were hunter gatherers, if we were roaming around dangerous areas and there were going to be javelinas chasing us, then our fear around javelinas would need to be a lot more to protect ourselves. And for your listeners who don’t know what javelina is, you can Google it. It’s a wild animal. It’s a wild boar that we have here in Arizona. So that’s really my

Gabe Howard: Oh, wow.

Jasleen Chhatwal, MD: Closest context. They’re mean looking creatures.

Gabe Howard: Dr. Chhatwal, I have one more question, which is kind of an ironic question, and that’s why I saved it to the very end. All of the content surrounding COVID-19, it can be overwhelming. It can be disturbing. It can be hard to listen to. How can our listeners balance staying informed with the information that they need to stay safe like this podcast, for example, but also not be overwhelmed by this onslaught of negativity brought on by just constant COVID-19 information? Much of it scary, quite frankly.

Jasleen Chhatwal, MD: It really is. I’ve recommended and I practice this in my own life to take sort of a news break or a news holiday to stop listening to the news. Because when people are sitting at home, they’re just listening to the news channels all day sometimes. So really giving yourself a sliver of time when you look at whatever content that you want to look at and then put it away. Also looking at platforms that maybe present this news in a more palatable format. So maybe like your podcast.

Jasleen Chhatwal, MD: Everybody can tune in to Psych Central. You have a great sense of humor and you try to make it approachable. Some people listen to the late night comedy shows which will give you the information you need, but with a chuckle. You can also subscribe to news outlets now have daily newsletters that they can send you with the headlines. So maybe that you say, I’m not going to read all the news, I’m just going to get a newsletter and look at it once in the day. So that’s one way of reducing your exposure, not only in quantity, but also just in intensity. And then it’s good to balance it out with positive things, things that bring you pleasure, things that make you feel better about your world. I hope your listeners will do something to add value to somebody else’s life. And that may be in the form of helping out their neighbors who are elderly with their grocery shopping and may be checking in with their friends who are also stressed out. Creating some sort of a book club, whatever it is that is part of their own interest, but a way to start feeling better about yourself, because whenever we give value to somebody else, that’s really our best way of getting some positive back to us. That can be a way to move forward at this time with more kindness in our world and really being able to rebuild our communities in a more wholesome way and going in a direction, as a country, as a human species that will take us all in a positive direction with the lessons that we’ve learned from the pandemic. We can’t let these lessons go to waste. That would be a waste of a pretty awful condition. And usually, I think if there’s adversity, you want to try and get something out of that adversity, learn a lesson, build some resilience so that in the future you have more skills to move forward in your life.

Gabe Howard: We want to find the silver lining in the cloud.

Jasleen Chhatwal, MD: Definitely, yeah.

Gabe Howard: Thank you so much for being here. Where can folks find you online?

Jasleen Chhatwal, MD: I’m present on LinkedIn, which is one of the places I’m trying to get better at. I’m also on Twitter. I haven’t quite gotten the hang of Twitter yet, but I just started last week. That’s my goal for the next month. I’m going to try to learn this. And if any of your listeners are excellent at Twitter then I would say, please send me tips and I will help you with mental health education and sending you interesting information about mental health.

Gabe Howard: That sounds like a great deal. Once again, thank you so much for being here. We really, really appreciate it.

Jasleen Chhatwal, MD: Thanks so much, Gabe, it was so wonderful to talk to you.

Gabe Howard: All right, everybody, my name is Gabe Howard and I’m the author of Mental Illness Is an Asshole, which is available on Amazon, or you can get signed copies for less money by going to my website at gabehoward.com. You can also subscribe to the show’s Facebook page just by going to PsychCentral.com/FBShow. Please remember to subscribe to the podcast. Share us on social media. Rate, rank and review. Use your words. Tell people why they should listen and remember, you can get one week of free, convenient, affordable, private online counseling any time anywhere, simply by visiting BetterHelp.com/PsychCentral. We’ll see everybody next week.

The post Dealing With Anxiety in the Time of COVID-19 first appeared on World of Psychology.

Can people with schizophrenia fall in love? Can they date or even get married? In today’s episode, host Rachel Star Withers (a woman who lives with schizophrenia) and co-host Gabe Howard review their own past romantic experiences.

They also interview Andrew and Stephanie Downing, authors of Marriage and Schizophrenia: Eyes on the Prize. Listen to learn about their incredible journey of overcoming schizophrenia and building a healthy, rewarding, and happy marriage.

About the Guests

Andrew was diagnosed with schizophrenia at the age of eighteen. One year later he was engaged to Stephanie. After two more years, they were married. Schizophrenia and mental illness in general have been the main obstacles in their fourteen-year partnership. Their marriage has been transformed by the healing power of Christ. They live and work in Grand Rapids, Minnesota, and have two wonderful children, Ella and James. Glorifying Christ in all they do is their goal. They strive to make Him the center of their personal lives, marriage, and family.

Marriage and Schizophrenia: Eyes on the Prize Amazon Link

(https://www.amazon.com/Marriage-Schizophrenia-Andrew-Stephanie-Downing/dp/151276485X)

www.andrewdowningmusic.com

Computer Generated Transcript of “Love, Dating, Marriage with Schizophrenia” Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.

Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference? There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.

Rachel Star Withers: Welcome to Inside Schizophrenia. I’m Rachel Star here with my co-host, Gabe Howard. Gabe today, an interesting topic, love, dating, marriage while having schizophrenia. As if those three things weren’t hard enough.

Gabe Howard: Yeah, you can see why we waited so long to do this, because I’ve known you for a long time, Rachel, and in all that time you’ve never wanted to discuss love, dating or marriage.

Rachel Star Withers: No.

Gabe Howard: You’re OK discussing schizophrenia,

Rachel Star Withers: Yes.

Gabe Howard: But not love dating or marriage. So this is gonna be fun.

Rachel Star Withers: Yeah, I’m not a great source for relationship advice because I’m single. Like, that’s the end of the story, I you know,

Gabe Howard: That’s very fair.

Rachel Star Withers: Yeah, I have been. For a long time.

Gabe Howard: And you’re happy being single, you’re.

Rachel Star Withers: Yeah, sure, whatever.

Gabe Howard: No, I mean, seriously, are you happy being single?

Rachel Star Withers: I’d rather be single than unhappy.

Gabe Howard: That’s fair. OK.

Rachel Star Withers: So I’m fine as I am. We’ll say it that way.

Gabe Howard: You’re fine as you are.

Rachel Star Withers: Yeah.

Gabe Howard: I think the important thing for the audience to understand, though, is that you’re not single because of schizophrenia. Right? You don’t feel that those two things have any relation. You do have schizophrenia and you are single. But they’re, you understand what I’m trying to say.

Rachel Star Withers: If you’re asking me, could I just find someone, yes, I could.

Gabe Howard: But you’d be unhappy in that relationship,

Rachel Star Withers: Right, yeah.

Gabe Howard: I know that schizophrenia wraps around your entire life, but you don’t feel that schizophrenia is holding you back. You just haven’t met the right person. And you have very high standards and you’re an impressive woman.

Rachel Star Withers: I do, I do.

Gabe Howard: You should have high standards.

Rachel Star Withers: Another way for high standards is shallow,

Gabe Howard: You’re not shallow,

Rachel Star Withers: That’s all I like to say, shallow,

Gabe Howard: You’re not.

Rachel Star Withers: High standards, shallow, whichever.

Gabe Howard: Luckily, luckily, we found a married couple, we found Andrew and Stephanie Downing, who are the authors of Marriage and Schizophrenia: Eyes on the Prize. I had no idea that this existed. But, Rachel, you’ve been aware of this book for quite some time, even before we interviewed them for the show.

Rachel Star Withers: And what’s cool is so Andrew, the husband, he has schizophrenia and they found out and then they got married. So, it wasn’t like they’d been together, and then suddenly something happened a few years. She went in knowing that this is something that they’re going to have to deal with together for the rest of their lives.

Gabe Howard: And what was really cool about the interview, which is coming up a little later, is we interviewed them both at the same time, and I thought they were very, very candid. It was really interesting to hear their thoughts on this idea that people with schizophrenia shouldn’t get married and shouldn’t have kids. Rachel, what do you think about that concept that people with schizophrenia either should not be in romantic relationships or, what we most often hear, cannot be in stable relationships?

Rachel Star Withers: I think people with schizophrenia can do anything relationship wise, that doesn’t mean it’s going to be easy, as is most things in life. The schizophrenia is just something else added on. The reason two people break up may have nothing to do with schizophrenia. It could be the mother in law’s terrible. I mean, it could be they’re just really annoying. They snore at night and you can’t take it. You can only take so many years without sleep, you know. So there’s like silly reasons and like serious reasons why people do or don’t get married or do or don’t stay married.

Gabe Howard: Backing off from schizophrenia for a moment, just talking about general mental illness, as longtime listeners of the show know, I have bipolar disorder and I have been divorced twice. And I’m fascinated at the number of people who hear that I have bipolar disorder, and hear that I got divorced, that’s it. That’s all they know. They weren’t around when I was married. They’re just meeting me for the first time. I’ve been happily married for eight years now. And they’re like, oh, you got divorced twice? Bipolar disorder, right?

Rachel Star Withers: I mean, Gabe, I’ve always assumed you ran them off.

Gabe Howard: I understand why people feel that way, I do. It is an easy conclusion to draw and much in the same way with schizophrenia, bipolar disorder is all encompassing. To say that it had zero to do with it is certainly disingenuous. Rachel, I feel that following these stereotypes removes agency and responsibility from the people involved. And I think this doesn’t give us an opportunity to grow. I believed the divorces were my fault and that allowed me to be very introspective, look into myself and grow as a person. If I would have taken the company line, oh, it’s because I have bipolar disorder, then I don’t know that I would have improved and I don’t think that I would be happily married now. How do you feel about people who just blame their love woes on schizophrenia and then don’t improve as a person? I imagine that you don’t feel good about that because I’ve never, ever seen you use schizophrenia as an excuse for anything.

Rachel Star Withers: I think if you want an excuse, you’re going to find an excuse. Schizophrenia is a really big one that you could be like, well, no one wants me because of this reason. And there’s other things like, yes, the medication makes you gain weight. Yes, the medication makes you want to sleep. Most of them have sexual side effects. And you can say all of that does contribute. Absolutely. But at the end of the day, I’m responsible for me and it’s my job to find a way to love my life, you know, because those same things I could immediately flip in like, oh, man, I have a really bad job. No one’s going to want to be with me. My hair is falling out. Mine is, so don’t feel like I’m just pointing out the guys, it’s mine too. You know, there’s so many things, though. If you want an excuse, you will always have one. That’s not the way to look at it. And honestly, no one wants to be in a relationship with that.

Gabe Howard: We talked about in preparation for this show, and you told me that you were on dating apps. Do you list yourself on dating apps? You know, hi, woman living with schizophrenia, likes dogs?

Rachel Star Withers: No, if it’s someone that I like and we want to meet up for a date, I want them to know that ahead of time. I rather them know going in, hey, she has a mental disorder, blah, blah, blah, the more you get attached to them and then bring it up three weeks later and then they leave, I rather you leave than me get attached to you. The downside of that is, yeah, it probably makes a lot of people leave, but those don’t sound like good people for me.

Gabe Howard: This, of course, is a rampant discussion on mental health message boards. When is the right time to tell? Some people advocate like you, immediately. Some people advocate putting it in your dating profile. Other people say before the first date, some people say in person on the first date, somebody says by the sixth date. Some people say it’s none of their business, tell them on your wedding day. And when you read through it, all of the reasons seem rational. Now, you said that you tell people before you meet them in person and the number one objection to that is, but isn’t that a lot? I mean, you’ve never even laid eyes on this person and they’re already sending you their health history. How did you arrive at that being the perfect time to tell them rather than in person or on date number three?

Rachel Star Withers: I don’t just like send this message being like, hey, by the way, guess what? Can’t wait to see you tomorrow night. But I am at a different situation than most people with schizophrenia. I have a Web presence. I make a lot of media and different things. And it’s usually listed in most of my bios. And I always make sure that we’ve either looked at each other’s Instagram’s or something where I have a lot of schizophrenia stuff. Twitter. Like if you were to look over any of my social media and you didn’t realize that I had it, I mean, I don’t know. If it’s a case where I’m not sure if they looked at my Instagram like we haven’t friended each other, I usually send them a link to something I’ve done or just straight up to my website. And I say, hey, by the way, this is me. I work in mental health making media and I also have schizophrenia. I’ve only had to do the text thing probably about like five to ten times. So it’s not like I’m constantly sending out these texts. Most of the time, people will just see the social media or whatnot.

Gabe Howard: It’s interesting about texting people before you go on a date with them and telling them that you have schizophrenia. I want to say that I am against this method. I think that it’s kind of a lot for somebody to see in a text before they’ve laid eyes on you, met you as a person, been in your orbit. All of that said my wife, Kendall, I texted it to her and we’re now married and just celebrated our eighth wedding anniversary. So it worked. And people are you know, Gabe, you’ve just said that you were against it, but you did it. Yeah, I had just had a relationship end where I decided that I was going to tell the person on like the third or fourth date and it took about six weeks to get there. So a lot of texting, a lot of phone calls, but we only hung out three or four times. And finally over lunch, I told the person, I said, you know, hey, I want to let you know I have bipolar disorder. And a couple of days later, she’s like, hey, it’s too much for me. And like you said, I got attached. The reason that I told that person is because I liked them. I enjoyed the six weeks. So here came Kendall on the same dating app. And I was like, I’m just going to get rid of you. And it all worked out. Do you think maybe there just is no right answer? It’s whatever happens to you happens to you?

Rachel Star Withers: I would say there’s absolutely no right answer, your gender, your age, your other situations, all of that stuff plays in. Every situation is different and every person is. You shouldn’t feel like you have to tell anyone up front. That’s your personal business.

Gabe Howard: You mentioned gender differences, do you think that there’s a gender difference between a woman telling a man that she lives with schizophrenia versus a man telling a woman or even in the LGBTQ community? Do you think it’s different than in the straight community? I know I’m asking you to speak for a lot of people. I know that’s a lot. But you’re the research queen. What have you found?

Rachel Star Withers: Our two episodes we did on gender and schizophrenia, definitely check those out if you haven’t yet.

Gabe Howard: They’re great, they’re great.

Rachel Star Withers: We learned that women with schizophrenia tend to have a better social outcome and longer lasting relationships and children than men with schizophrenia. Men tend to be diagnosed with schizophrenia, significantly younger, around late teens. And then you have women, the average age, which doesn’t apply to everybody, didn’t apply to me around like 30s to mid 30s. So there’s a very good chance that a lot of women are already married before it ever is a diagnosis. Whereas you have guys going in knowing, oh, no, I have to tell this person this thing, whereas the women you’re already married already probably have kids and then it comes up. So I think just the social constructs are kind of stacked against men in that situation. You know, we always have the joke in society that women are crazy. So I do think a woman would probably get away with saying she has a mental disorder and the other person taking it easier than if a man says it. And unfortunately, like we also learned with gender, with the males, usually people hear males with schizophrenia and they think violence.

Gabe Howard: I can imagine this would be hard for dating because your friends would be like, wait, you’re dating a schizophrenic? Doesn’t that mean that you will be X, Y, Z in your sleep? That’s unfortunate, because please listen to that episode. Schizophrenia and violence. Small, tiny percentage, yes, but there’s a small, tiny percentage of violence that exists in society. Schizophrenia doesn’t raise or lower it. It just sort of exists within it.

Rachel Star Withers: Let’s talk about that other person in the relationship, so the person who does not have a mental disorder, who is, and we’re talking just waiting to full on marriage, whatever went with that. And that’s kind of where I mean, you are a little bit different, Gabe, where you’ve had multiple marriages and I’ve had none nor been in even close to a stage where that would happen. And in a way, it’s good because I don’t have anything hanging over my head. I don’t feel that I impacted anyone’s life that negatively. And I’m not saying, you know, you are a horrible person, but same thing. You know, that is a lot to kind of weigh on you, that your symptoms did affect another person.

Gabe Howard: It’s true, and I imagine it’s a silver lining to being single. I know I’m prying. Rachel, thank you for being vulnerable, but do you feel that the fact that you’ve never been married is sort of a plus for you? Because, like you said, you don’t have any regrets. Your schizophrenia did not impact a love interest.

Rachel Star Withers: It’s a good and bad thing. While I haven’t had to deal with those negatives, I also haven’t gotten any of the positives. I’m sure you had great moments, positive moments in that marriage. And I think that’s something hard for a lot of people with mental disorders who are single. They’re like, well, I want that. I want to be in love. I want to have someone. When you look at just your support network, you kind of think, oh, well, what if I’m alone at age, such and such? You know what’s going to happen to me after my parents pass away, after, you know, my friends get married and have their own families? Like, what about my support system? And they’ve even found research that people with schizophrenia, when you’re unhappy with your relationship status, you will have worse symptoms than those who are happy with their current relationship.

Gabe Howard: In many ways, it’s one of the meanest things about schizophrenia that the disease process is impacted by external factors. If you’re in a healthy relationship, your symptoms are less. If you’re in an unhappy relationship, your symptoms are worse. But now if you’re in no relationship, your symptoms are less or worse, depending on how you feel about that. Rachel, as a single woman, are you happy being single and therefore getting the benefits of less symptoms or are you unhappy being single?

Rachel Star Withers: I personally am very happy with my relationship of nothingness right now, like, I don’t feel like, oh, wow, I really wish, you know, I was married, I really wish, you know, and at age 35, as a woman, most women are either married or they’re not happy that they are still single at thirty five, that’s not like a good thing. They’re like, you know, really throwing that net out there, whatever I can catch at this point. So I do think it’s different. I actually get asked quite a lot, why are you single? Different things like that. And I’m like, oh, you don’t know me, that’s why.

Gabe Howard: Rachel, you kind of brought up an interesting point there, that you’re 35 years old and you’re single and that society doesn’t like that. I know that my 35 year old single female friends who do not have schizophrenia just get all kinds of pressure to just relationship up right now, because after all, the biological clock is ticking. You’re not getting any younger. Do you get more or less pressure because of the schizophrenia in comparison to your non schizophrenic 35 year old contemporaries?

Rachel Star Withers: I get a lot less, and that’s been something that’s kind of come up and I don’t really let people know that it hurts me, but it does. It will kind of come up like subtlely.

Rachel Star Withers: It can be frustrating because I feel that the schizophrenia label is just so like put on certain people and that even people closest to you, your family, have these biases against you. And they don’t mean to. They absolutely don’t mean to. But it is what it is.

Gabe Howard: But an unintentional bias is still a bias. Do you think that people would be surprised if you got married?

Rachel Star Withers: I absolutely think they would be surprised if I met someone and I was in a relationship and then got married. I think it would have some bad sides, too, because, oh, well, thank goodness someone saved her.

Gabe Howard: Really, even though you’ve been living for 35 years all by yourself, if you got married tomorrow, the full credit would pass to the spouse?

Rachel Star Withers: I really think so, and, oh, thank God we were so worried about her and OK, now we don’t have to, you know, worry she’s taken care of. Like, I really do think that there would be a bad side to that of just seeing me. Like, yeah. As if that other person is my caretaker as opposed to a spouse.

Gabe Howard: When it comes to schizophrenia, caregivers are very important. The problem, I think, is I don’t know that we have like a good definition of caregiver. In many cases, the term caregiver is simply given to the person standing next to the person with schizophrenia. I would like a more robust definition. A caregiver is somebody who is actually giving care on a daily basis, and the person that they’re giving care to cannot live without that care. That is what I consider a caregiver. For example, when I had surgery, my wife was my caregiver for a couple of days because I couldn’t stand up without her. That seems like caregiving to me. But two years after surgery, when people are like, oh, well, that’s Gabe and his caregiver. What? What care is she giving? Well, you know, because you live with mental illness. OK, so you’re literally just calling her my caregiver because she’s standing next to me. Good marriages are based on being equal. And for the most part, people don’t consider people living with schizophrenia equal to their caregivers.

Rachel Star Withers: And that’s a very important point, especially for anybody who is looking to get married in the near future, is to think about that and even set up some kind of like boundaries because one partner is going to get really burned out quickly if they feel that they’re that caregiver, if they feel that they have to take responsibility over this other person, that’s just too much for anybody to handle. And that’s why support systems are so important. It shouldn’t just be you two against the world. It doesn’t work in most normal relationships. And it’s definitely not going to work when you’re dealing with schizophrenia thrown in there, too. Make sure that you stay in contact with your friends, that you bring your parents around whenever you feel comfortable, if possible, let them come to the therapist with you or the doctor at least like get to see that side of you and understand. Even for the partner without the mental disorder, it’s important that they have a support group, too. You shouldn’t be their only sounding board because they’re going to get frustrated, they’re going to get stressed out. They’re going to need other friends to talk to and be like, hey, he did this. And I don’t know if this is schizophrenia or that’s just what being married to a man is like. So both sides need a support system and they need to be able to talk openly without judgment. If there comes a time when one of them needs more care than others, you should already kind of know what you’re going to do, kind of have that plan in place. So, hey, I’m going to be making sure that you take your meds every day when you get sicker. I’m going to help with this. All right, cool. And then when you have your throat surgery next month, I’m going to buy you so much ice cream.

Gabe Howard: Rachel, people ask me about my marriage all the time and they want to know the differences between my marriage and regular marriage, and that’s the first thing that I want to say. There is no difference. I do have a regular marriage. In a regular marriage, there will be challenges. It’s for better, for worse, in sickness and in health. That applies to all marriages. I just happen to have this sickness that I need help managing. And some of that help is very, very tiny. Most days, the only help that I need is my wife reminds me to make a doctor’s appointment, not because I’m not managing my mental health, but because the minutia of life gets in the way and she’s like, oh, shoot, you need a physical this week. Don’t forget to work in your blood work and pick up the dry cleaning because your blood work is next to the dry cleaner. That’s just what life is like. I’m surprised at the number of people that are like, well, no, no, no, no. Your marriage must be completely and entirely different because of this one thing. It’s not. We can’t figure out what to have for dinner either. We’re largely not special. I think that is a key component.

Rachel Star Withers: And we’ll be right back after a message from our sponsor.

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Rachel Star Withers: And we’re back talking about love, dating and marriage while having schizophrenia.

Gabe Howard: Rachel, we have a great guest interview, and you were very impressed with their online presence, their book. Honestly, it’s one of my favorites, but I might be a sucker for love stories.

Rachel Star Withers: Yes, Andrew and Stephanie Downing, who wrote Marriage and Schizophrenia: Eyes on the Prize, and they are a married couple. He has schizophrenia. Whenever you’re looking for books about schizophrenia, not many of them are really upbeat. And then you think, oh, wow, marriage and schizophrenia. I’m thinking that can also work as a horror title. You know, this could go a lot of different ways. And I was reading different parts of their book and I just really loved their attitude to take on life. And I was surprised by the interview, Gabe. I don’t know what I was expecting, I was just so taken that they were like an open book with us.

Gabe Howard: I thought they were super cool, let’s listen right now.

Rachel Star Withers: Today we have Andrew and Stephanie Downing, the authors of Marriage and Schizophrenia: Eyes on the Prize. Andrew, first of all, I’m excited to talk to you, a fellow person with schizophrenia. What’s up?

Andrew Downing: Hey, I’m doing good, how are you?

Rachel Star Withers: Very good, and especially to talk to the both of you. Earlier in the podcast, I said so I’m single, pretty much forever, so I don’t have much to put in when it comes to having a major mental disorder and long term relationships. So I’m excited to talk to both of you, inspired to talk to the both of you. I want to jump right in. What has been the biggest obstacle?

Andrew Downing: We’ve been through so much, we’ve been together for 18 years and we’ve gone through so many different periods, and if you look at the first period of our relationship, there was different challenges and obstacles at that time. And now fast forward to 18 years later. Now there’s new obstacles. And so schizophrenia has just really brought us on a really long, different journey with so many different angles and all the questions you could ask us are going to be different at different times in our life.

Stephanie Downing: As I reflect back, the biggest obstacle was when Andrew was in the middle of a psychotic episode, meaning when he did not have a good sense of reality and he was having hallucinations, he was delusional. We were engaged at the time and he ended up in the psych ward. The night before he ended up in the psych ward, he gave my engagement ring back and it felt like the Andrew that I fell in love with, the Andrew that I knew died on me. It truly felt like a death. And the person I knew and fell in love with was gone. And I would say that that was the biggest obstacle showing up at the psych ward and visiting him there and realizing that this person that I love is very, very sick. And I was young. And so we’ve been together now for 18 years. That was the most difficult time. And that was 16 years ago.

Rachel Star Withers: So that was kind of the biggest obstacle right there at the beginning, so you got the hardest part over. That’s amazing. But what have been some of like the constant stressors throughout your marriage?

Stephanie Downing: The big stressors, I would say, is just instability. Also, a big stressor for us has been health care. Medication is a stressor, finding the balance between working through challenges and then also just accepting challenges.

Andrew Downing: Yeah, and when I was first diagnosed with schizophrenia, I was taking a load of medication and now you fast forward to this part of my life and I’m on a lot less medication. That has made life a lot easier for me in general. The medication and the side effects have been so intense and dealing with that from the age of 19 and now I’m 38 has brought so many challenges. Like Steph mentioned, the health care as well, just the stress of not knowing that I can afford my medications or finding the right health care plan so I can continue to take my medications. All these hoops that we’ve had to jump through around schizophrenia with medication and health care has definitely been an obstacle and a major stressor.

Rachel Star Withers: Speaking of medication, how do you two deal with changes, so, for instance, if the doctor wants to change you to a different type of medication, do you talk to Stephanie about it? Do you all weigh out the consequences? Because believe me, I understand side effects.

Andrew Downing: Yeah.

Rachel Star Withers: Yeah, I think how much it’s disrupted my life. I can’t imagine also being a parent and having a spouse with it.

Andrew Downing: It’s an incredible challenge and that probably eight or nine years ago, maybe a little bit more, because of the medications and the side effects, trying to keep up to Steph and trying to be a good husband for her and trying to be a good father. I didn’t know that I could keep doing it. The side effects from the medication were so intense, they’re still intense. And just trying to keep up to people that are not on those medications was incredibly difficult. And there’s been many times in my life I thought, I don’t know if I can do this anymore. So I just feel fortunate to have survived. And fortunately, Stephanie has been patient and just willing to deal with my ups and downs and more importantly, my downs. You know, how willing she was to sacrifice to be in my space and allow me to heal.

Stephanie Downing: When I first started dating Andrew, he was on a very low amount of medication and he was so lively and talkative and energetic. And that’s the guy I fell in love with and I didn’t really know any better. And when he started getting sick to the point where he was starting to have more symptoms, he then had to increase again. And he was so different. He was so tired. He was so just lethargic. And he looked sick to me and that was medication side effects. And so that was very new to me to experience that. And that went on for years that he was just so tired and he seemed so sick to me. And I would question like, is everything OK with us? Like, does he just, is it things just not going well in our marriage? Is he unhappy? But a lot of that was truly the side effects of the meds. And we’ve watched him try to adjust and tolerate. But it’s had so many effects that it’s really a lot to talk about, just even thinking about how he’s had to change his lifestyle. And if we want to go on a trip making sure he has his medication and thankfully he can be the night driver because if he doesn’t take his nightly meds, he can stay up all hours of the night. But then he’s kind of punished in the next day. We all kind of feel a little punished when he’s so tired throughout the whole entire day. So I think a lot of people think that people go off their meds because they’re feeling better and they don’t need them anymore. But I think another part of it is that people truly feel sick and tired on their medication.

Andrew Downing: I was not very honest with my medications right away. I didn’t really want to even talk to doctors about my medications. I just wanted to avoid doctors. And I was very closed off as far as discussing medication with people in general. I was more comfortable with Steph and we did and continue to talk just about everything. And she’s been so great for that. We just have gotten the pattern of communicating and communicating as much as possible. And I’ve betrayed that confidence many times with the medications and not told her that I was going to not take the medications anymore. But she’s definitely been a process of are you on enough meds? Do you need more? Do you need to talk to a doctor about this? But in general, I would say that Steph has acted as my therapist and my med provider and just somebody who I should like, everything should be should go through her. And that role that she played, that instrumental role, that being a therapist, being a med provider in a marriage was a lot of stress for her. And I believe that got really frustrating after a while. And so eventually I needed to find a way to do this more on my own where it was less of a burden for her so she could have more of a regular life. And we’ve transitioned into that now where, you know, I don’t talk to her about the meds as much. And I’m really consistent and locked in with what I want to do. We’ve communicated about everything and usually been on the same page with what medications to take and what to do next.

Rachel Star Withers: You’re not just married, you also have children. Your children are pretty young. How have you dealt with pretty much your schizophrenia being part of the family relationship? Do they know? Has it caused any issues?

Stephanie Downing: It has been pretty normal overall, and both Andrew and I work in the mental health field, so I think that helps a lot. And our daughter is 14 now and our son is 7. And so it’s just kind of where they’re at developmentally to know how to talk about it with them. Our daughter just read our book last summer, I believe we said it seems like a PG-13 book. And she had questions, but she’s very mature and actually, you know, considering genetics and things that are passed down, I mean, I can already see anxiety and depression kind of forming and, you know, the concerns about her future mental health. But because Andrew and I are so open and honest and we work in the field, I think that conversation and that encouraging communication and comfort talking about what’s going on has been really helpful. We try to take things seriously at times and then at other times we have to take things lightly and joke about things and use humor and just try to keep it balanced that way a bit.

Andrew Downing: Yeah, and we have a 7 year old boy and we’re driving down the road, and there was something on the radio about mental health and my son James in the back, he goes, hey, dad, you have mental health, right? And I was like, yeah, yeah, I got mental health. My daughter’s in the car, too. And we just started laughing. So Ella being 14, she gets it and she says the word schizophrenia, whereas James is more like, oh, dad has mental health or I think he says schizophrenia once in a while. But it’s a total different experience. I’ve tried to use mental health and my journey as inspiration for them too and not been afraid to tell them, yeah, I am mentally ill because living a lie or pretending that I don’t have it is really, really bad for me. I have to be up front if I want to feel close to people. They usually need to know that I have schizophrenia and I have this issue because it’s such a major part of my life. And so my kids are no different. You know, I feel like they need to know what’s going on in my life.

Rachel Star Withers: When it came to having children, were you worried at all about them having schizophrenia or how that how Andrew’s schizophrenia might affect that?

Stephanie Downing: I would say yes, because of the reactions of others for one. I think it’s probably people’s number one question that they ask us when we’re sharing or talking about the kids and having that fear. And I think that it’s there, it’s in the back of my head but, like Andrew tries to remind me and I try to remind him, is that with schizophrenia or with mental illness, there’s also so many strengths in a person that we try to just really focus on those and try to build those up and build those skills. Because whether our children end up with schizophrenia, which does run in Andrew’s side of the family, even beyond Andrew, or if they end up with anxiety or depression or anything, it is just to have those skills to be able to manage it. And then even beyond that, the hope of a recovery.

Andrew Downing: Right away, at the beginning of our relationship, we had certain medical professionals, teachers and different people in places of power or influence who were definitely worried about Stephanie having a relationship and having children and we were told don’t have children. And I think that attitude has changed a little bit. And I’d like to say that I’m more on that revolutionary side or that really super hopeful side that says, why do we have to be so afraid of schizophrenia? Because I enjoy my life. I’m a happy human being. I like my daily life. And sometimes I feel more healthy or happy than people that don’t have schizophrenia. So other people in my life I see are struggling with alcoholism and they’re struggling with drug addiction or they’re struggling with this, you name it. What life isn’t going to have a struggle? And why do we have to think that schizophrenia is this just awful, horrible thing that you can never enjoy your life on? Part of my training as a peer support specialist was really rejecting the notion that schizophrenia was this endless, hopeless struggle and that you couldn’t get better and that you couldn’t be happy. So I’ve tried to have that forward thinking and not being afraid. And Stephanie has really helped me understand that if we can be there for our kids and talk to them and have this open relationship and be able to talk about mental illness and not be afraid of it. And if we had early intervention, we even have less to worry about.

Rachel Star Withers: That’s absolutely awesome, Andrew, I love that attitude, obviously, schizophrenia is a very serious mental disorder and whatnot, but I’m always like, you know, it’s not that bad. I was like in a lot of things could be worse, you know, compared to the world’s problems of like, you know. Oh, but that’s a really great attitude. And I love your answer. I have so many people ask me, should people who have mental disorders have children? And I’m like, I don’t have any children. So I don’t feel like I should answer that because I’ve never even been remotely in the situation. It hasn’t happened. So it’s really interesting to get to talk to you two who have already been there and have such a great outlook. What advice do you have for couples who are thinking about getting married and one of them has a very serious mental disorder like schizophrenia?

Andrew Downing: Steph, you want to go first on that one? You took the big risk, you were the one, you’re like, yep, I’m going to sign up for this. So I just feel like you might have the best advice right away on this one.

Stephanie Downing: Ok. Again, communication is a huge part of a healthy relationship, and that got us through a lot. That communication piece is huge and we needed to talk about things, we needed to process things. And I needed to know that he was going to be receptive of what I was going to say. And we got to this point in our relationship when we talk about love. And a lot of that was can you put that other person’s needs and happiness before yourself? And I tried to do that for him. And I think he could see that. He saw me model that through the time and the sacrifices that I made to be with him, to show up, to leave my college dorm and show up at the hospital and visit him there and just to be there with him through those really difficult times. And then in turn, I could see that he wanted to do that for me. And if his sickest moments, I didn’t see that and that hurt. But pretty much the majority of the time I knew that he wanted to put me first and make sure that he was going to be able to meet my needs in a relationship. And so I saw that potential and I knew that we were going to work through a lot together. But because he had that desire and he wanted to make those choices, I can tell that, you know, hopefully with the time and practice and training in every relationship, you want to teach different things. And now it’s trying to get them to load the dishwasher properly. But I knew that he was responsive and receptive to what I wanted.

Andrew Downing: Yeah, and advice I would give to other couples or maybe someone that has a serious mental illness and is considering being in a relationship would be to make sure you feel prepared for an incredible journey and climbing a mountain. It’s going to be difficult. And if you’re taking a lot of medications that are making you super tired and sick, being in a relationship is going to make that more difficult. And it has been a really big challenge for me to have a wife and have kids. And I felt like at the beginning of the journey and throughout different periods of our life, that mountain has felt like it’s just too hard to climb. And thankfully, I’ve been able to keep going. But I think you need to ask yourself what kind of intensity or what kind of pain can you put up with? What can you deal with? And everybody’s going to be different. So everybody has a unique set of challenges and has different stressors. And so my advice might not be the best for somebody else in a relationship situation. I have a background in hockey. And I played hockey through two torn rotator cuffs and three traumatic brain injuries. And so being in a marriage and having kids, I was used to training my body and used to taking a punishment. And so, I just want to make it clear that it is a big adventure and it’s not something to be taken lightly because you’re joining two lives together and possibly more with kids. And it’s not something to just rush into. And I feel so lucky that I found Steph because I feel that most other people I knew couldn’t have put up with me. I was so lucky to find her because she was willing to deal with some really intense, weird stuff.

Stephanie Downing: It just keeps ringing in my mind to take your vows seriously in sickness or in death. I mean, I did take those seriously and as I went, I think I was 21 when we got married, pretty young. And when I said those vows in sickness and death, like, I knew that that must mean somebody is going to get sick, somebody is going to struggle. And how am I going to respond to that?

Rachel Star Withers: I have a question for you, Stephanie, when Andrew may be starting to have a hard time, whether it’s an episode or maybe side effects kicking in from medication, how do you know that’s coming and how do you deal with it? How do you bring that up to him?

Stephanie Downing: So that is difficult to answer, but one thing that I do look for is irritability and anger and frustration. There’s the right time or better times to talk to somebody about things. My children know not to talk to me when I’m tired or hungry. They’re just not going to get a good answer from me in the right tone and stuff. So looking for that with Andrew has been helpful. If he is seeming really agitated that I’m going to back off. But then it really, truly is important to confront at times. And as long as they know that you are somebody that is going to be consistent in their life, that you want to be the person that is accountable for keeping them accountable. I think if they can have that sense and use wisdom or discernment and it’s a good time to talk about it, then you’re just going to bring it up and you’re going to let them know how you’re feeling or I’m feeling and just letting them be aware. And this seems really off right now. And so not being afraid to have those conversations, but also considering the right timing of it.

Andrew Downing: I would just add too that Steph has done a good job of challenging me on things that she was certain that I was being delusional or that I needed to change courses in my life or needed to recognize that I was feeling mentally ill. And she hasn’t got it perfect every time. But she has taken those chances and been willing to say, Andrew, you’re not doing well right now. I think you need to recognize that these thoughts that you’re having are they’re delusional or that they’re wrong. And that you need to make an adjustment in your life. And there’s been other times in my life where she’s backed off at just the right time and just given me space to feel. And so that is such a hard thing to know. Which one does he need? Does he need this challenged? Does he need this confrontation or does he need space? And that is that is very difficult.

Stephanie Downing: But I will say when we work through the chaos and the challenge, that there’s usually a lot of growth and healing after that and a lot that we both learn from the experience. So it does prove worth it.

Rachel Star Withers: Obviously, all marriages have conflict. Does any normal marital issues ever get blamed on the schizophrenia?

Andrew Downing: That’s a good question. I think at times, maybe once in a while it does, I think, normal things get changed into schizophrenia things. But Steph has been amazing for one, just not accepting the label. She doesn’t see me as somebody with schizophrenia and therefore she doesn’t have this set expectation from that. And I think that is a really destructive thing. So if you see somebody as a label or somebody with schizophrenia, then you’re going to have that problem more often with regular things are getting attributed to schizophrenia. And she has been so great of not seeing me as somebody with schizophrenia, but more just as a person, just seeing me as Andrew and that has really helped.

Rachel Star Withers: Hearing you both speak, you just hear an absolutely wonderful, very happy, supportive couple, the schizophrenia takes a back seat, which is awesome. So I actually want to end the interview with Stephanie, if you could tell us about Andrew and then Andrew about her.

Stephanie Downing: Ok, so Andrew was on my crush list in ninth grade, and he was just this amazing person that was very skilled at hockey and then he was this talented or is this talented musician that can play right now every instrument. And not only that, but he paints, too. And when I first started hanging around with Andrew, which was like in college when we first started dating, looking at his paintings and the depth and the creativity of his brain and the way it works is so fascinating to me. And we just kind of went on a journey together. I just knew that he had these qualities and these values that I loved and he was so sensitive and easy to talk to. I fell in love. And he’s been an absolutely wonderful husband. We do have our difficult times, as everybody does. I just am so thankful to be with him and I’m proud of him.

Andrew Downing: Stephanie has been on my radar since ninth grade as well. That’s a long history. And, you know, I have actually a pretty hard time talking about the subject without just starting to cry like a baby because she really saved my life. You know, she came to me when I was at absolute rock bottom and was basically the only person willing to get in my space, not just be from a distance or say one thing here and there and just be really distant. She was not afraid of schizophrenia, was not afraid of mental illness, was not afraid of anything. She came into my life and stayed there. And I was so lucky to fall in love with her. She was willing to go somewhere really uncomfortable and be willing to be in somebody’s space that was kind of scary. And I was scary when I was 19. I was a kind of a person you didn’t want to be around because you were afraid of what was going on. And because of my success in hockey, my name was known across the country. And yet at that time, 19 years old, nobody wanted to be around me except for Stephanie. She saw me walking on the hill and she called me up and has changed my life. And I feel so fortunate to be with her and to watch her grow through all of this and to be such an impactful human being in the mental health service world. She’s getting her graduate degree now, and I’m just so proud of her. She’s such an asset for this community, for kids in the community, for adults. She has served people all the years of my life. I’m so proud of her.

Rachel Star Withers: That’s awesome. Is there anything else that you two would like to share with our listeners here on Inside Schizophrenia?

Stephanie Downing: I would say just having hope is such a big deal and to know that we strongly support the mental health field and believe that having wraparound services is so important, but then also just knowing that if it’s your neighbor, if it’s a friend and you’re just there to support through having those conversations and being willing to go in those uncomfortable topics is really important. But having hope and the value of loving somebody in a way that sometimes you do have to have some sacrifice.

Andrew Downing: Our culture, we’ve moved towards isolation so much, and I know that part of that is to do with COVID right now, but I would just encourage others to get involved in other people’s lives and not from a distance and not from a safe place, but really get up close and personal and spend time with people and reach out and try to make a difference. Not just from a comfortable space at home, but to get out there in the community and try to reach people that are struggling. Try to help others avoid isolation.

Rachel Star Withers: Awesome, so I know I have the book here, Marriage and Schizophrenia. Is there anything else you want to promote?

Andrew Downing: We do have our book available, Marriage and Schizophrenia: Eyes on the Prize, it is on Amazon and most other places for the paperback copy, but you can get the ebook for a dollar right now. Also, my music is available out there. My debut solo jazz album, Fighting Time. So Andrew Downing, Fighting Time is available on all the streaming platforms. Check it out. I think you’ll enjoy it.

Stephanie Downing: It’s awesome for sure, he plays all instruments, and writes the music.

Andrew Downing: So to clarify, I don’t play all instruments, but yes, I do play piano, bass, drums and guitar on that album.

Rachel Star Withers: How can our listeners find you? Are you all on any social media?

Andrew Downing: Andrew Downing music is on YouTube. I’m also on LinkedIn, Twitter, Instagram, Andrew Downing music, the social media platforms that we have are more geared towards the music. But I also put stuff on there for our book as well.

Rachel Star Withers: Thank you so much for spending this time talking to us. It’s good and bad, but you’re a rarity. It was incredibly hard for me doing research for this episode. Getting to meet you both and hear you talk and how just absolutely uplifting you are. And just honestly, #relationship goals. Like it’s really, really awesome. Definitely I know giving our listeners and me also a lot of hope.

Andrew Downing: Awesome. That’s really great.

Stephanie Downing: Thank you. Thank you for having us.

Andrew Downing: Yeah, thank you so much.

Gabe Howard: And we’re back. Rachel, what are your thoughts?

Rachel Star Withers: I was taken away, you know, the whole time they were talking, I loved it, it was very sweet. I think you can hear in their voices when they’re talking back and forth and sometimes you hear his voice begin to crack a little and you kind of hear it in hers that you could just see that they’ve both been through a lot and they both love each other a whole lot. I don’t know. I was so inspired by them. If I’m going to get married, that’s what I want. I want that kind of partnership.

Gabe Howard: It was nice, it was hopeful.

Rachel Star Withers: And I absolutely love the way that they had already brought it up to their children, the young son saying you have mental health. Like those kids, you know, are able to ask questions. They’re able to be knowledgeable and not be afraid of stereotypes.

Gabe Howard: The schizophrenia was just something that as a couple they had to deal with. Like managing the household or taking care of the children or taking care of the dog or planning a vacation, manage schizophrenia was just something on the list. It wasn’t the focal point, but it was important and something that they as a couple had to address. And I thought that was amazing because so often mental illness permeates too much and that’s all they focus on or one person tries to handle alone and not utilize the resource of their spouse or support system. And that never turns out well either. I liked their management style. They didn’t ignore schizophrenia, but they also didn’t make it the focal point of their marriage. They made each other the focal point of their marriage.

Rachel Star Withers: And this sounds like a mushy thing to say, Gabe, especially you know me, I’m pretty cool, but they gave me hope. They really did. You know, just how uplifting they were and the fact that they both kind of were like, hey, this is life. Relationships are not easy for anyone. Recently, a psychiatrist, who I only went to once, asked me why I was single, and she kept pressing me for answers. And I was getting really annoyed about this because I was there because I have severe depression also, and I needed a medication change. I understand why she was asking. She was asking pretty much how was I responding with sexual side effects of what I was currently on. And I’m like, no, I need medicine so I won’t hurt myself not to go on the dating game. And a lot of times I feel people with schizophrenia are like me. We have so much to deal with, hallucinations, delusions, depressions. Just getting out of bed, taking a shower some days is monumental. So trying to find a relationship, a person to date, is the least important thing on my list. But listening to Andrew and Stephanie, it really helped me see that a relationship wasn’t out of the picture for me. It didn’t have to be, you know, the last thing on my list, it was more of a possibility. Thank you so much for listening, like, share, subscribe with all of your friends and family, and we will see you next time here on Inside Schizophrenia.

Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail talkback@PsychCentral.com. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.

The post Inside Schizophrenia: Love, Dating, and Marriage with Schizophrenia first appeared on World of Psychology.

Mental fatigue is something that occurs when your brain goes into overdrive. You can’t stop thinking, worrying, anticipating, planning, etc., and this constant parade of changing thoughts can lead to exhaustion. This isn’t uncommon, most of us have experienced this at one point or another, usually when there’s a big project or event coming up. But lately mental fatigue seems to be the rule rather than the exception for many.

Why Your Brain May Be More Tired Than Normal

Most of us feel we’re rolling with the punches to some degree while the world around us changes. But the truth is these changes take a psychological toll on us all. You may be working, but your work has changed. Kids are in school, but school has changed. You may be healthy, but for how long? And there are marches, riots, and an upcoming election to consider. No matter how much you try to focus on your own small piece of the world the world around you is having an effect on you. 

In a normal environment, you know what to expect and how to navigate things. You probably have work under control, school schedules are structured, and the regular chaos of life ebbs and flows at a fairly predicable rate. Sometimes you’re stressed, sometimes you’re not, and occasionally you feel mentally fatigued when things are particularly crazy. 

But our current state of prolonged instability and change is something different. It’s like noise that’s always playing around us as we try to get through the day-to-day. Our brains naturally try to assign structure and normalcy to our personal environments, but the current noise can be deafening and distracting, and is changing all the time making it all that more difficult to put things in order and operate normally. This means your brain must work even harder to try and be productive and create routines and stability. 

What Happens When Your Brain Is Tired for Too Long?

If you work your shoulders or legs too hard, they get sore, right? Well, your brain may not become sore like overworked quads, but it absolutely shows signs of overuse. 

Mental fatigue has several tell-tale signs. See if any of these sounds familiar:

• Inability to focus. When your brain is tired, it isn’t working at optimal levels. Just like your legs won’t carry you through marathon after marathon (or even fractions of that for most of us), your brain will eventually slow down too. This often shows up as an inability to stay focused on tasks and responsibilities, leaving you feeling scattered, disorganized and impeding your ability to complete tasks successfully. 
• Physical exhaustion. Yes, your brain affects your body. When your brain is tired, it can make your whole body feel tired, effectively signally that you need a break. Shutting down through sleep is our normal physiological method for relieving the stress on our brain. Unfortunately, mental exhaustion itself can make sleeping difficult.
• Difficulty sleeping. While you may be tired and your brain may need a break, it can often be very difficult to turn things off. The overstimulation caused by the environment around us means that we may not sleep as well. How many times have you tried to solve the world’s problems while laying in bed? Or stewed over the things you should have said or done earlier in the day?
• Constant feeling of stress and anxiety. Mental exhaustion and the persistent noise around us can lead to a constant feeling of stress and anxiety. It can feel like there’s ALWAYS something to worry about, so even if your corner of the world is handled and organized, there’s no relief or sense of calm. Over time, unrelenting stress and anxiety can lead to depression as well. 
• Lack of patience or sudden bursts of anger. If your fuse suddenly seems shorter than normal and you find yourself feeling irritable and angry all the time it can be a result of an overworked brain. When you’re not operating at optimal levels and feel scattered, tired, and stressed it can be very difficult to exercise the appropriate levels of patience.

Any of these ringing a bell?

Tips To Rest and Reset

This can be harder to do than it sounds. Turning off and tuning out the noise around us initially requires concentration which is difficult when you are already having a tough time concentrating. But the focus in this case is on being mindful and calm in order to give yourself a break.

Mental exhaustion won’t just get better — you need to give your brain a rest and break the cycle. Any of these can be helpful.

• Get outside. Nature is calming, so use what’s around you. Being mindful of what you’re seeing and experiencing. 
• Turn off the TV and internet. There’s bad news everywhere right now, don’t let yourself be inundated with it. Try music instead.
• Exercise. This is a good idea for so many reasons. By getting physical you’ll relieve stress, sleep better, and improve your physical condition. 
• Read. The escape into something that has nothing to do with the world around you can provide a healthy break.

The longer we let mental fatigue continue the harder it becomes to break the cycle. Over time you may experience physical issues, emotional problems, or full-scale burnout. And these all leave you incapable of navigating your life in a healthy and happy way. 

The post Is Your Brain Tired? You May Be Mentally Fatigued first appeared on World of Psychology.

Fast forward a couple of years later, with the right medical support, proper medication and education, we are not only in a good place, we are in a better place than we ever were. We have a deeper understanding of who we are and what we need — forever changed by this new truth that will always be a part of us.

My husband’s diagnosis was the hardest and greatest thing that happened to our family. Here are some ways that it has changed our family for the better:

1. We talk frequently and openly about mental illness.

We talk regularly as a family about how everyone is feeling. We explain how some brains work differently than others and how medication, nutrition, sleep and exercise can affect our moods. We talk about the chemicals in our body. We talk about drugs, hormones, anger, sadness and anxiety.

We encourage our kids to talk to us about anything that makes them feel different, free of judgement. This is a place where you can bring your complete self. You will always be loved, heard and safe.

2. We put the odds in our favor.

My father repeated this throughout my childhood: luck is a residue of design so put the odds in your favor. 

We all have triggers that cause us not to be our best selves. As an introvert, I need at least an hour each day where I am alone to read, write, listen to a podcast or do something creative. This time is necessary for me to be a patient mom, a supportive partner and a pleasant human the other 23 hours of the day. My husband needs something else: a good night’s sleep, his morning medication and he feels his best when he is eating healthy, exercising regularly and getting out of the house for a daily change in scenery.

Through trial, error, observation and many conversations, we’ve learned more about what we need to be the best version of ourselves. This is what we intentionally and deliberately prioritize each day. This allows us to live like the odds are forever in our favor. Thanks Dad.

3. We accept that there will be bad days.

Living with depression means you will have good days and bad days. We expect these to happen and remember that not every day will be like this. Bad days are temporary; we acknowledge them and try not to dwell over them more than we should. We forgive quickly and completely. There will be many good days too and we never take those days for granted. We don’t pretend to be perfect or thrive to be flawless. In this family, when you are unlovable, we come together and love you harder until you are ready to love yourself again.

My husband talks about his depression journey every chance he gets. He selflessly takes any opportunity to help someone and make them feel like they are not alone. I’ve never felt the things he describes feeling. But I have lived through the heartbreak and the bad days. I’ve also seen how this has given us the tools to prepare our children, who might inherit this disease, to recognize the signs of mental illness. I’ve learned how to make choices that increase our chances at happiness. I’ve learned that perfection is not the goal. And after every storm, the sun always shines again. Bullet proof, he says. After 19 years, I can honestly say that there is no one else I would rather be taking bullets with.

The post How My Husband’s Chronic Depression Forever Changed Our Family -- for the Better first appeared on World of Psychology.

If someone you care about changes in some way, something may be wrong. The difficulties go beyond available support. According to statistics, most people who ultimately end their lives are dealing with a mental illness or behavior disorder — whether they realize it or not — though this is not always true. Excessive stress or a combination of things can be factors that also might lead to thoughts of suicide.

Signs? Sometimes there are none. Sometimes changes in personality are complicated by attempts to self-medicate with substances like alcohol or drugs or excessive behaviors such as spending money wildly or doing something uncharacteristic such as making sudden major decisions about lifestyle or beliefs. These are just a few examples. Sometimes you may have only a vague feeling a problem exists; not everyone displays telltale behavior changes. To complicate matters, not all changes like this are serious, especially in the volatile teen years, though young people and children can become mentally ill. 

If you think there might be a problem or if you feel you need help yourself, here is what I want you to know.

• Mental health is a spectrum that affects us all. We can fall on various points of the spectrum at different times in our lives, and stress does affect our mental health. Appropriate care is important just as it is for the rest of your body. 
• There is no shame in seeking help for mental health or behavioral issues. If others disagree, they are either inexperienced or ill-informed. Be patient and either share what you learn with them or minimize contact if it hinders your well-being or that of your loved one.
• Millions of people live successful and productive lives while dealing with mental issues. Throughout human history, this includes some of the most creative, intelligent, and kind individuals. You can do this.
• There is always hope for improvement. Learning about your condition and following through with mental health professionals takes time, but if you feel you do not have a good match, seek help elsewhere. Staying with it is worth the effort. Today, there are many tools that can help.
• It’s okay to ask questions, and it’s okay to have boundaries that you ask others to respect. 
• Support of all kinds can help. Family and friends, as well as professionals such as counselors and nutritionists, peers taking care of their own mental health, and support groups can be part of your wellness team. 
• If you have co-occurring problems, these need to be addressed, too. Alcohol Anonymous (AA) meetings are offered virtually now as well as locally, and confidentiality is respected. Other groups operate in similar ways. Ask your doctor for guidance if you need help with withdrawing from drugs or alcohol. Counselors can help you work through relationship or family issues.
• The stress of life and of dealing with mental illnesses, behavioral disorders, and substance abuse or familial problems may seem overwhelming sometimes, but there are coping strategies and options for medications you can use. If thoughts of suicide seem like a way to escape, know that these are only thoughts, not truths. They are temporary. Yet, they are serious and can become consuming. Knowing these are lies and having resources, plans for coping, and a suicide crisis line handy is your best line of defense.
• Suicide leaves behind deep pain and destruction. The lives of loved ones and friends are changed forever, and the struggle to survive is difficult.
• If you love someone who is suicidal, don’t leave. Call for help. Be patient. Reassure him or her that your love is unconditional, that he or she can survive this, that things will get better. Repeat some of the information on this list to provide light in a dark place or sit quietly and listen to share your strength. Remind your loved one these feelings will pass. 
• Also actively take care of your own mental health. Be in this together with those you love. Educate yourself. Ask doctors or counselors how you can help, even if it is just by sending them a letter that could shed light on the situation. 
• Be courageous. Seek support, and involve yourself in appropriate groups like Al-Anon or Narc-Anon.
• Encourage your loved one by offering to take a walk outside with him or take on some of her chores. 
• The future is unwritten. Whatever the problems are, they are not insurmountable though they certainly may feel that way. 

The post What I Wish I Had Said about Mental Health and Suicide first appeared on World of Psychology.

One of the largest impacts may be felt in the mental health field. We know that COVID has increased the incidence and intensity of anxiety and depression.¹ Clearly that burdens the current mental health care system. However, it also means that many more people are becoming aware of the realities of mental health issues.

While we know that 1 in 6 people experience a mental health condition in their lifetime, we now have far more people experiencing an acute episode exacerbated by the pandemic, and many more family members and friends also impacted by loved ones, finding themselves also learning how to provide support. This is working to heighten the awareness of mental health issues and may help to diminish stigmatization and accelerate a change in societal attitudes.

Moreover, COVID has had an impact on the delivery of psychological services: some therapists are offering tele-sessions. Though such sessions diminish some aspects of a complete sensory person-to-person office visit, they do have advantages, particularly seen with younger clients. While many find the office to be a stressful, formal environment, being at home may allow the client to be in  a more familiar, comfortable space making it easier for them to open up. In addition, some therapists are reporting that seeing clients in a sliver of their home space may also give them glimpses into their world, through the setting and items displayed as meaningful to them. This can be particularly helpful for working with a more reserved or reticent individual.

COVID has challenged our normal means of socialization and maintaining interpersonal relationships. While this has increased the instances of domestic violence and stoked toxic relations, it has also been an opportunity for families to strengthen their bonds and rekindle their connections as they have been required to spend more time together. There are numerous anecdotes of parents and older children conversing more and thereby gaining a better understanding of each other as well as learning to enjoy each other’s company.

Parents are learning about social influencers and TikTok and how teenage angst, while still based on the same anxieties, has transformed since their time. Teens are learning that their parents actually can may understand more than they previously assumed, even though their experiences are different, and they may also find humor and insight into their own challenges from their parents’ experiences. The slowdown that COVID has demanded has allowed many people to discover pleasures at home they were not aware of or had forgotten, from cooking and sharing a meal, to movie night in, to gardening and looking at a starry night while listening to the howl of neighbors at 8 p.m. This experience has compelled us to rediscover and reimagine community. 

Connections have definitely been redefined with technology playing a far larger role. We are quick to observe the deficiencies of virtual communication, but there are also advantages. Older adults have lagged behind this generation in technological savviness, but not only that, reticently testing and dipping into their primary modes of communication. Now, we are faced with learning to communicate by their primary modes, which result in increasing the technological competency of a greater part of society. This has a number of positive ramifications. First, virtual visits allow more people to speak to one another across vast geographical distances, and not only to speak but to see one each other. Grandparents and grandchildren living states apart can visit, letters to pen pals from different countries can be replaced by real time synchronous visits. Virtual connections may actually help older people, shut-ins, and those with chronic conditions to avoid feeling lonely and isolated. We have the possibility to connect more with those we love and those we know little about to better appreciate the lives of others who are different than our own.

We also know that COVID has forced dramatic changes to learning. First, it is important to distinguish between online and remote learning. Online learning, to  professionals, means asynchronous lessons completed without real time interaction.  It allows for widespread dissemination and is less appealing to students as it is less interactive, more passive form of learning. Remote learning engages teachers and students in real time. All students do not have access to the technology needs for successful remote or online learning; however, in the twenty-first century, that access is becoming more fundamental to student success since technological skill is also significant in employability. Given that we will need to address that need, consider how learning is being innovated.  In remote teaching (as well as business), teachers and presenters can share far more material of their own design and from around the world through the enormous “library” of the web. Moreover, teachers and students become more skilled in multi-media forms of communication which also enhances their critical thinking skills.

Crisis often propels innovation, and at this time that is particularly true on the technological front. We face security concerns and a diminishing of in-person interactions, but there is also much to be gained from the expansion of our abilities to connect to others throughout the world. It can be refreshing to take a moment to consider the potential fruits that can emerge from the current storm.  

Reference:

1. Mental Health America. (2020, August 11). More Than A Quarter Million People Screened Positive For Depression, Anxiety Since Start Of The Pandemic.

The post Are There Potentially Positive Outcomes from COVID-19? first appeared on World of Psychology.

Please note that this post discusses eating disorders.

Weight — the loss of it, the gain of it, the way our bodies fill out our clothes or take up space in public — is a concept that can completely occupy our thoughts. For some of us, obsessing about weight is a daily reality. The perfect size seems ever out of reach, and I don’t think there’s anyone out there who truly feels their body is the perfect size and shape.

I struggled with an eating disorder when I was in my teens. I never felt thin enough—even when my BMI was in the flashing-red-lights-get-this-girl-a-sandwich-before-she-passes-out range. As long as I had soft flesh anywhere on my body, I felt somehow vulnerable and out of control. The harder and smaller my body was, the safer I felt on some level. I found a way to sublimate hunger pangs into a kind of willpower practice that could make me feel a little high.

I felt strong and in control when I could ignore my body’s most basic needs, but I was neither. It’s hard to be strong when your muscles are disappearing into your body to try to keep your brain functioning, and it’s hard to be in control when your brain is in alarm mode because you are starving. In order to be strong and healthy, to focus on my work, to love my partner and family and friends, I need fuel. I need food in order to think.

It’s natural that during some periods of your life, you put on weight and, at other times, lose it. Hormonal changes, pregnancy/lactation, medications, times of grief, stress, or change—these are all phases where your body might cling to more or less weight. These fluctuations can themselves be stressful, and they can be triggering if you have a history with an eating disorder. Thankfully, even here, you can use mindfulness tools to manage these changes and love yourself all the same.

One tool I use is to continually return to how I feel on the inside, not what I look like on the outside. Bodies can be healthy within a huge range of sizes, and studies have shown that it’s generally healthier to be a little overweight than underweight. Whenever I get into a panic about whether or not I’ve gained weight and how much, I try to focus back in on how I feel in my body. Have I been giving my body healthy movement that it likes? Have I been feeding it nourishing foods? Have I been sleeping enough? These questions remind me that my priority is not looking good for someone else, it’s feeling good so I can live the life I want to live.

Another tool I use is to remind myself of what I’m not doing when I’m obsessing about weight. For many of us, food obsessions allow us to avoid feeling our feelings pretty effectively. I want to be a present and engaged person, to be able to think critically and serve my community. I can’t do this well when I’m busy worrying about how many calories a dried mango has. Food obsession is a kind of internalized oppression. It might feel like power to vanquish my hunger pangs, but true power comes with freeing myself from that internal oppression.

It’s normal for our bodies to be bigger or smaller at different times in our lives depending on what we are going through. When we can return our focus to self-care and nourishment and let go of the external result, we return to a loving relationship with the bodies we do have.

This post courtesy of Spirituality & Health.

Photo by Motoki Tonn on Unsplash.

The post How Mindfulness Can Reframe Body Image first appeared on World of Psychology.

If you binged last night should you still be compassionate to yourself this morning? Or if you didn’t work out yesterday like you promised to do should you still have self-compassion? Shouldn’t you punish yourself for your bad behavior with harsh talk so you learn your lesson once and for all? After all, isn’t being kind and forgiving just a way of letting yourself off the hook?

People assume that getting angry at themselves is a good motivator for self-improvement. They think, “If I really crack the whip and show myself I mean business by calling myself ‘fat and ugly,’ then maybe I’ll become so remorseful, I’ll just stop bingeing.” Unfortunately, yelling and criticizing yourself always backfires. It may even make you want to run to the comforting embrace of food in order to feel better!

When we are self-compassionate we speak to ourselves like a kind and loving parent speaks to a child — with tenderness, understanding, curiosity, and encouragement. We establish a state of grace with ourselves by turning away from self-punishment and turning towards self-acceptance.

Self-compassion is not about letting yourself off the hook, but rather about providing a quiet and gentle space to reflect and plan how to improve your bingeing, purging, chronic dieting, or body image dissatisfaction. It is about coming to a calm place in your heart where you accept that you do not have to achieve perfection but simply want to commit to making progress one step at a time.

Critical self-talk may jolt people to take a beginning action (“I hate my thighs. I don’t deserve to eat cookies ever again!”) But when they cannot keep up their latest drastic self-improvement plan or the severe self-talk, then either rebellion or resignation sets in, and then people throw in the towel on their eating project.

What does self-compassion look like “in action”? Here are two examples from my clients before the pandemic, but clearly applicable for today:

Pamela began bingeing furiously after the birth of her daughter, who had significant health problems. Her anxiety and fear about her child coupled with guilt for her baby’s problems led her to compulsively overeat with a vengeance. As she gradually came to terms with the sacrifices needed to raise her child and felt more organized with a plan of action, I pointed out that she would never treat her baby with the anger she treated herself.

Pamela came to the conclusion, “Yes, my stomach and I could be better friends. I really have beaten up my poor stomach with all my worried bingeing. How can I find a way to soothe myself without hurting myself? Help me find a better way.” Her more compassionate attitude to her plight allowed us an opportunity to strategize how she might comfort and care for herself without the abuse of food.

Amanda had been bulimic for over twenty years when she first came to therapy. She described a typical day: after work, she would drive to a grocery store, buy a cake, and gorge on it while driving home. Once home, she would make herself throw up. Then feeling utterly disgusted with herself, she would drive out again, buy some more cake, and throw up again.

“I must totally change my behavior right now,” Amanda declared with ferocity and self-hate. Given that she had been bulimic for so many years, I doubted that she could curtail her bingeing and purging overnight.

I suggested an alternative: She should buy her cake as usual, drive to a quiet block and park, and then calmly savor the cake, rather than wolfing it down while driving. I added, “Before tearing into the cake, give it a kiss and thank it for helping you cope with whatever anxiety you are feeling at that time. Then relish it slowly, try to stop eating when you’re full, and let it stay inside your tummy.”

“That sounds really weird,” Amanda said. But the following week she reported several peaceful rendezvous with the cake. Self-loathing and yelling at herself had not helped motivate her to stop gorging and purging. A shift in attitude made a difference. My suggestion enabled her to realize that devouring the cake was her way of comforting and taking care of herself. It did not mean she was a bad person. She developed more self-compassion and self-acceptance — and with that came hope.

Slowly and gently, Amanda became more motivated to make increasingly supportive changes and began to progress in ending her bulimia. One step at a time. One day at a time.

The author and philosopher, Tara Brach, believes that feeling compassion for ourselves in no way releases us from responsibility for our actions. Rather, it releases us from the self-hatred that prevents us from responding to our life with clarity and balance.

Quotes that can help us stimulate self-compassion:

“Although the world is full of suffering, it is full also of the overcoming of it.” – Helen Keller

“Dreams without goals are just dreams. And they ultimately fuel disappointment. I try to give myself a goal every day.” – Denzel Washington

“Create the kind of self that you will be happy to live with all your life. Make the most of yourself by fanning the tiny, inner sparks of possibility into flames of achievement.” – Golda Meir

“Compassion is the strongest human therapeutic agent in existence. Its potential for constructive growth and human creative possibility is almost limitless.” – Dr. Theodore Rubin.

“Anything worth doing is worth doing imperfectly.”

Even Facebook has become more compassionate! The emoji of “I feel fat” with its fat cheeks and double chin was removed from the site in 2015 following a petition of 17,000 signatures against this fat-shaming symbol.

I recommend to all my clients: “Cultivate the language of curiosity not criticism and learn to practice self-reflection not self-attack.”

Each day we should take a moment to declare our heartfelt and genuine promise to be gentle with ourselves and to reach out for support when we need it.

The post The Power of Self-Compassion to Heal Pandemic Eating first appeared on World of Psychology.

The next time this happens, reflect and ask yourself:

• Who is in the room with me?
• Who did I just talk with?
• What did I just experience?
• What’s going on around me?

Negative emotions from the people around us — including fear, worry, anxiety, and stress — pass from one person to another quickly, often with few or no words, like a highly contagious virus.

If you spend an evening, for instance, social distancing outdoors with stressed-out neighbors who are drinking heavily, do you have a hard time keeping your own drinking in check? Does your workday start out productive but end up derailed from a snarky colleague’s endless rants? If you’re volunteering in your community, do you come home feeling de-energized after being pelted with committee members’ countless complaints?

Even our physical health and our susceptibility to medical diseases are related to the company we keep. What we eat, how much we sleep, how sedentary we are, and how much exercise we get is strongly influenced by the people we choose to associate with.

But why, exactly, does all of this happen?

It’s all in the way we’re hardwired.

The human brain has evolved over many thousands of years to pick up any and all potential threats and negative feelings expressed by those nearby. Neurobiologist Dr. Charles Stevens, a nationally recognized expert at the Salk Institute’s Molecular Neurobiology Laboratory in California, told us, “There’s a neural basis for how we share emotions. Cells in our brain will fire in the same way as the nervous system that we’re watching. Our nervous systems respond similarly. They’re linked — they mirror each other — to whomever we are observing and close to.”

As if tethered by invisible cords, we’re wired to replicate the moods of others — including worry, anxiety, and sadness — just by being in the same room. The positive moods of others are just as easily replicated.

Other research shows that moods can spread among networks of people like a social contagion. Sociologist Nicholas Christakis of Harvard Medical School and political scientist James Fowler of UC San Diego looked at data from a 20-year study that included information on the social networks of 4,739 people.

Called the Framingham Heart Study, the research followed people from 1983 to 2003. The results were startling: On average, they found that for every happy friend in your social network, your own chance of being happy rises by 9 percent. For every one unhappy friend, your chance of being happy decreases by 7 percent. Happiness — as well as unhappiness — was essentially spread and shared.

Three ways to manage your reactions:

The good news is that, with practice, you’ll become better at detecting — and then avoiding or managing your reaction to — the people around you who are frequently swimming in their own private thoughts or negative states of mind. Conversely, you’ll also be able to better detect those people who lift your spirits and support your goals and move to secure close relationships with them.

Here are three ways to start:

1. Get comfortable saying no. You’re not obliged to give yourself over to others — not your time, not your energy, not your happiness. Give yourself permission to question or say no to situations that pull you down.

This is an especially important skill to practice around authority figures, family, and highly persuasive individuals. Saying no can be as simple as stating, “I wish I could do that, but it’s not possible for me.” Create a simple phrase and rehearse it many times before you meet up with highly demanding people.

2. Mitigate negative interactions when it’s impossible to escape them. It’s not always possible to walk away from difficult people. Workplaces are particularly challenging. You come into direct, prolonged contact with groups of people under stress. In that environment, it’s all too easy to pick up negative emotions, and this can seriously rob you of your agency.

In these situations, try this strategic psychological operations (PSYOP) technique: selectively ignore certain people, and navigate around the drama to keep your mind clear. Instead of engaging, shrug or make a lighthearted joke when coworkers become negative or competitive.

In personal situations, turn to humor. We know one couple who imagine their loud, self-absorbed in-laws as characters in a Woody Allen movie, and they encourage each other to keep talking even when these family members monopolize the conversation. It’s an amusing (and effective) way to keep negative emotions from ruining every holiday dinner.

3. Address your stressors head-on. Sometimes, the tensions we perceive as negative — and about us — have nothing to do with us at all. For example, let’s say your coworker invites you to a Zoom call in preparation for an upcoming sales meeting. He’s curt and visibly frustrated. After a few minutes, you ask, “You seem stressed. Are you concerned about our meeting?”

Your coworker releases a long, deep breath and smiles. “No,” he reassures you. He explains that he’s been juggling back-to-back meetings while homeschooling his kids, and he hasn’t had a break in what feels like ages.

It would have been easy to mistakenly attribute your coworker’s stress to yourself — or speculate that there was impending bad news related to the meeting. The takeaway? Always ask for clarification. Don’t assume that what you’re sensing is directly related to you or that it must continue. Tensions can often be defused, or disappear entirely, simply by facing them squarely.

The post Have You Caught an ‘Emotional Virus’? first appeared on World of Psychology.

Each day, from every corner of the world, people left in the devastating aftermath of suicide call out to other survivors of such loss wherever they gather. It is helpful to connect with people who have experienced similar tragedies and are trying to make sense of what happened to their lives.

Another, more painful reason they seek comfort from strangers is this: in the case of suicide, those who knew them best often withdraw or are unable to help because of misunderstanding and fear. Most do survive and go on to rebuild, but some experience multiple suicides and a few follow loved ones by ending their own lives.

As a survivor myself, I listen to their voices. I hear the pain they feel. I share it. And I try to pass on the positive things I’ve learned on my own grief journey. 

Healing is possible.
It won’t always feel as heavy as it does now.
Love outlasts pain.

I’m an old-timer in the suicide loss survivor world. But I know some level of hurt will always be there, even as they find ways to honor lost loved ones and stitch their own lives back together. Understanding, acceptance, processing this grief … all are bits of a puzzle never to be completely worked, a mystery that changes lives forever.

Though these words were in print, I heard the despair as one parent asked, “Why are there so many 19-year-old sons dying by suicide?”

By now, it is common knowledge that the epidemic is growing and has been for quite a while. The current pandemic and its effects on jobs and the economy have added to the toll worldwide. For young children, teens, and adults of every age, there are no barriers to suicide, no 100-percent prevention methods. Love cannot stop a person from taking his or her life. Even constant vigilance can’t prevent such tragedies.

For all the work done in the prevention area — which is so very important — no economic class or race is immune to suicide. Little is known about survivors left behind, though that is beginning to change as survivors themselves speak out. 

Suicide is now a public health problem as well as a mental health problem. What do we need to do to break this cycle? 

Suicide isolates. It generates fear. A millennia of myths and disinformation have shrouded everything about suicide in a cloak of secrecy. So, the first and most important thing we can do is tear that cloak away and find out what is true and what is false. The second most important thing to do is to share the truths we find with others, especially younger generations whose life experience and knowledge base may not be as developed on the issue. 

Research and education can only go so far in changing how suicide is viewed. And the challenge is great as can be proven by sharp division over something as simple as the infection-prevention method of wearing masks to help stop the spread of COVID-19. If people can be so divided by today’s spread of myths and disinformation related to the pandemic, what hope is there for increased understanding of suicide and its aftereffects?

Hope comes in many forms. Here are a few.

Don’t turn away. Find out what might help survivors after a suicide and implement that. Community education programs guided by mental health centers or local mental health professionals need to set up in every area, large and small. The resources already present need to receive support and funding to help get their materials and opportunities out to communities.

Spread the truth. Materials about suicide prevention and suicide loss aftercare are available and should be explained to every outlet that deals with possible suicide victims. Fire departments, law enforcement, EMS units, hospitals, local counselors and mental/behavioral health centers, doctors, civic organizations, food banks and other relief organizations. Educate your local news outlets as well. Well-written news stories do not sensationalize suicide, but they can offer hope and resources that actually prevent suicide contagion and clusters.

Do what you can. When a suicide occurs in your community, do something. Coordinate with churches or relief groups to send a representative to the family. Bring a “care kit” containing information about local and online support, a fact sheet about suicide, a book about surviving this kind of loss, and other items that might provide care in the first days and weeks post loss. Even a case of bottled water and encouragement to stay hydrated can help.

Invite speakers. Ask people with related experience to present material and answer questions in schools, churches, places of employment and other locations. From college campuses to fall festivals, reaching people is important.

Saving lives begins and ends with you. 

The post Suicide After Suicide: What We Must Do to Break the Cycle first appeared on World of Psychology.