Z – #AtoZChallenge on Mental Health

Welcome to the last day in the #AtoZChalleng eon mental health, dedicated to the letter Z. I am just in time to publish my post, as I was at my parents’ two hours way all day. I did take my computer, so don’t worry, this post was not my reason to leave. Anyway, today’s words are all on a common theme. Here goes.

Z-Drugs

Z-drugs are a few medications, most of whose generic names start with Z, eg. zaleplon, zopiclone and zolpidem. Besides the letter they start with, they have in common that they work similarly to benzodiazapines but are not benzos. There are three subgroups of Z-drugs, all of which are GABAA agonists, meaning they increase the availability of this neurotransmitter. Z-drugs are used in the treatment of insomnia. Some have advantages over benzdiazepine sleeping pills.

Zombie

Many psychiatric patients, especially those on long-term units, seem a bit zombielike to outsiders. I discussed this when discussing lethargy in my letter L post too. Negative symptoms of schizophrenia and other psychotic disorders may cause people to act like “zombies”, but so do many psychiatric medications, including antipsychotics, anti-anxiety medications and certain antidepressants.

ZZZ

Last year, I discussed sleep in my post on the letter Z for ZZZ. To finish off this year’s challenge, I am going to discuss the same topic. Sleep disorders are common among people with mental illness and of course can be a mental illness themselves.

There are two forms of sleep disorders. Dyssomnias are disorders in the quantity, quality or timing of sleep, such as insomnia or hypersomnia. Parasomnias are characterized by unusual physiological or behavioral events that limit sleep, interfere with certain stages of sleep or with the transition from sleeping to waking. Sleepwalking is an example of a parasomnia.

Like I said, sleep disorders can occur on their own but can also be part of another mental illness. For example, many people with clinical depression experience insomnia, usually waking up way too early in the morning. Some people with depression conversely experience hypersoomnia, sleeping far too much.

Y – #AtoZChallenge on Mental Health

Welcoe to the letter Y post in the #AtoZChallenge on mental health. This was definitely the hardest letter of all. In fact, I cheated a little, because I have only one word and it’s practcally unrelated to mental health. I use it to talk about an important topic in mental health though. Here goes.

Ypsilon

Ypsilon is of course the Greek letter from which the Latin Y is derived. However, it is also the Dutch organization for family members of people with schizophrenia and other psychotic disorders. Like I said, it’s a little out of left field, but I want to use this word to discuss the importance family plays in severe mental illness and recovery from it.

A few years ago, there was some debate that revolved around the question whether organizations of families of patients should receive government funding, or whether it should only be organizations of patients themselves. Ypsilon spoke up, saying that people with severe mental illness cannot necessarily advocate for themselves. Never mind that there’s an organization for people with schizophrenia and related disorders too, called Anoiksis.

Some other organizations, like the Association of Manic-Depressives and Relatives (that’s the literal translation of the Dutch name), allow both patients and family to be active members in the organization. I don’t know how each group is represented on the board of directors. However, this organization makes it clear that patients and family should really work together towards a common goal. Note that bipolar disorder is often as severe a mental illness as schizophrenia, so Ypsilon’s argument that people with severe mental illness can’t advocate for themselves, holds no ground.

Family are, of course, important in people’s mental health recovery. However, it’s still the patients who have the first-hand experience of mental illness. As such, they should always be at the center of their recovery process. Ypsilon is an okay’ish organization in this sense, often cooperating with Anoiksis and having destigmatization as a goal. Other organizations, however, often do not value patients’ input.

X – #AtoZChallenge on Mental Health

Welcome to the letter X post in the #AtoZChallenge on mental health. I have two words for you today, so this is a short post. Here goes.

(E)X-Patient

I have said this when discussing “survivor” in my letter S post, but many patients have endured traumatic experiences while in psychiatric care. As such, many are happy to be freed from psychiatry. There is a movement called the C/S/X movement. The C stands for “consumer”, ie. those still in psychiatric care. The S stands for “survivor”. Once consumers/survivors have completely freed themselves from psychiatry, many feel comfortable only with the label “ex-patient”, which signifies they are no longer involved with psychiatric care.

Xanax

Xanax, the brand name for alprazolam, is one of the strongest benzodiazepine tranquilizers. Xanax is commonly used to treat anxiety or panic. Other benzodiazepines are also used as sleeping pills, but I’ve never heard Xanax being used for this purpose.

Benzodiazepines are highly controversial drugs because they are often overused and they can become addictive. In the Netherlands, for this reason, people can only get benzodiazepines covered by insurance if they have epilepsy, an anxiety disorder for which they’ve tried at least two antidepressants, or if they have severe mental illness requiring high doses of benzodiazepines (for chemical restraint). On this last ground, many severely mentally ill people take benzos on a daily basis. Worse yet, people without mental illness can get only one prescription for ten sleeping pills, to be used over the course of ten weeks, and even then they have to pay for them out of pocket. People in the psychiatric hospital almost always take sleeping pills much more frequently and many take them everyday. When patients are in the psychiatric hospital, benzos are paid for by insurance. I wonder whether I’ll get my benzodiazepines covered once I leave the institution. Depends on whether my condition is seen as a severe mental illness requiring high doses of benzodiazepines.

W – #AtoZChallenge on Mental Health

Welcome to the Letter W post in the #AtoZChallenge on mental health. This was a hard letter. In fact, up till a few days ago, I could only think of one word for it. I have however managed to think of a few more words.

Wellness Recovery Action Plan® (WRAP®)

The Wellness Recovery Action Plan® is a plan that people with mental illness use to regain their wellness if they’ve endured a distressing experience that might otherwise destabilize them. WRAP® was developed in the United States by Mary Ellen Copeland, who herself suffered from severe mental illness. It is rooted in the recovery model of mental illness. WRAP® focuses on people’s strengths rather than their deficits. However, it does include a crisis plan too. This crisis plan or advance directive is written by the patient themself and lets others know when they need to take responsibility for the patient’s care. This allows the patient to stay in control even when they can no longer make decisions for themself. I found the interesting part was also the post-crisis plan, which is meant to reflect on ways to regain wellness and prevent another crisis. In traditional crisis plans, people are not taken care of after crises and their original plan is not revised.

Willpower

Of course, mental illness is not a choice. However, recovery is. It is often believed that willpower is the power to get over all one’s emotional or behavioral struggles, to be cured of one’s mental illness or addiction. I discussed willpower from a spiritual perspective a few months ago. In this light, willpower is the will to turn over one’s life to God (or another power greater than oneself). In the recovery movement, willpower is the will to take back control over one’s life in spite of mental illness. This might seem completely contradictory to the twelve-step view of willpower, ie. turning one’s life over to God. I see the two as peacefully co-existing. Allowing God to guide us on our journey, after all, does not mean we are not as humans responsible for the decsions we make.

Work-Out

Exercise is often thougth to greatly help with mental health. People who are depressed often benefit from getting moving. People with severe mental illness might use exercise, even if it does not cure their illness, to get into a daily or weekly rhythm.

V – #AtoZChallenge on Mental Health

Welcome to the letter V post in the #AtoZChallenge on mental health. Pfew, we’ve arrived at the last week and I’m looking forward to writing regular posts once again. This letter wasn’t too hard though. Here goes.

Visiting Hours

Mental hospitals, like most hospitals, have visiting hours. The difference is that they are particularly meant for patients from other units. Family often can come when they want.

Vitamins

Many mental institution patients take one or more vitamins or minerals. The reason is that many don’t have the healthiest diets and hence run a risk of vitamin deficiency. However, it is also thought that vitamin deficiencies may contribute to people’s mental illness. For example, depression may be associated with vitamin D deficiency.

Voice-Hearing

Many people with severe mental illnesses hear voices. Many people without severe mental illness do too, but they can function in spite of their voice-hearing. As such, voice-hearing itself does not indicate severe mental illness, even though until recently, you could be diagnosed with schizophrenia by merely hearing voices.

There is an international movement of voice-hearers. The most well-known organization supporting this movement is Intervoice in the UK. Intervoice aims to support people who hear voices, whether they’ve been diagnosed with a mental illness such as schizophrenia or not.

Core values of the hearing voices movement are:


  • Hearing voices, seeing visions and related phenomena are meaningful experiences that can be understood in many ways.

  • Hearing voices is not, in itself, an indication of illness, though difficulty coping with voices can lead to great distress.

  • When people are overwhelmed by their experiences, support should be based on respect, empathy, informed choice and an understanding of the personal meaning of this person’s voice-hearing.

Volunteers

Many mental hospitals and support organizations for people with severe mental illness employ volunteers. Volunteers might be visiting buddies, visiting the patient every so often. They may also help paid staff during day activities. My institution isn’t keen on employing volunteers. There was this staff member who would be laid off due to budget cuts and she offered to come back as a volunteer. The management said “No”, because volunteers cost some money too.

U – #AtoZChallenge on Mental Health

Welcome to the letter U post in the #AtoZChallenge on mental health. This was a hard letter once again and hence my post is very short. I have two words for you and they’re pretty irrelevant, but well. Here goes.

Unstable

People use the word “unstable” to describe the state of not feeling well mentally. In the description of care packages allocated to people, often the word “unstable” is used to describe someone’s psychological state. Of course, if a person is chronically depressed, for instance, they are not truly unstable in the literal sense of the word.

Unusual Experiences

“Unusual” is a word used to describe the experience of mental illness from an inclusive point of view. It sees mental illness as merely an experience that is uncommon. Everyone has unusual experiences at some point. For instance, many people experience totally benign hallucinations at times, for example when drifting off to sleep. As such, the experience of being mentally ill is merely an exaggerated form of ordinary human experience.

Fear of Demands

I admit it, I have a fear of demands. I originally wrote that I have a fear of independence. In fact, I thought for a while that I may have dependent personality disorder. People with DPD have a pathological need to be taken care of. They can’t make everyday decisions without a lot of counsel, need others to take full responsibility for the bigger decisions in their life, and may even stay in abusive relationships out of fear of losing someone to take care of them. They appear incredibly easy on therapists at first, agreeing with their every counsel. On a deper level though, this is just a way of maintaining the care relationship.

I still believe I have some traits of DPD, but this last bit is where I realized dependence may not be the core of things. I am not easy on a therapist at all. In fact, I remember being seen as very defiant when I was on a locked unit in 2007 and 2008.

I do have a fear of practical independence, I admit. Then again, it’s more a fear of other people taking contorl over what I can and can’t do practically. I’d love in fact to have full control over deciding what I can and can’t do independently. My fear is not of doing things independently myself, but of other people deciding I can do them independently.

This is where pathological demand avoidance enters the picture. PDA is a conditon along the autism spectrum in which people have a persistent anxiety of direct demands placed on them. They often appear defiant, but underneath this is a deep fear. It could be fear of failure in some ways, but it’s more.

There is an interesting aspect to my fear of doing things independently, and that’s that I can do them fine when no-one’s watching me. Also, when I take the initiative to do things independently I can do them much better than when others tell me to do them. I remember E-mailing around for a therapist to treat my dissociation in 2012 and I had no problem doing it. (I stll had anxiety about it, of course, but that’s more fear of the response.) I called the social consultant and client advocacy organization last week and was fine. On the other hand, when someone asks me to make a phone call or E-mal someone, it’s much harder for me. I also took the initiative to go live with my husband. Then, when my staff took away my control over it and demanded I show certain capabilities if I wanted to live with him, I backed away.

Unfortunately, the care system is built on the premise that psychiatric patients just need a little pushing to do things independently. Despite the rehabilitation and recovery models, which I applaud, people are only allowed to take control if they’ve shown their competence first. I cannot do this. It scares the crap out of me. I want recovery without having to prove myself. Hopefully, I’ll be able to accomplish this when I live with my husband.

Linking up with Finish the Sentence Friday. A little late, i know. The prompt sentence was: “One of the biggest fears that I’ve ever had to face…”.

T – #AtoZChallenge on Mental Health

Welcome to the letter T post in the #AtoZChallenge on mental health. I’m a little late once again to publish this post, because this was a hard letter and I have once again been very tired. Here goes.

Transition

Transition or transfer happens when a patient moves from one setting into another. This could be from an acute unit to a rehabilitation, resocialization or long-term care unit. It could also be from a psychiatric unit into supported housing or community care.

Trauma

Like I said yesterday, many psychiatric patients have endured some form of trauma. Trauma is experienced differently by different people. The diagnostic manual defines trauma for the purpose of diagnosing post-traumatic stress disorder as having endured, been confronted with or witnessed a situation that is life-threatening, threatened or actually caused physical harm, or sexual violation. Starting with DSM-5, it is made explicit that being confronted with such a situation through the media does not count. As such, people who for exampe watched the 9/11 terrorist attacks on TV (ie. virtually the whole world) cannot claim to have been traumatized by it. First responders who witnessed the events themselves, of course, can. So can people who lost loved ones in the terrorist attacks.

Please note that this definition is only used for the purpose of diagnosing PTSD. People can be diagnosed with another stressor-related disorder (eg. adjustment disorder with PTSD features) if their experience does not meet the criteria for trauma but is still distressing.

Treatment Planning

Treatment plans, like I explained when discussing care plans, describe the person’s overall treatment and diagnosis. On long-term psychiatric units, treatment plans are revised every six months or so. A patient has the right to contribute to their treatment plan and to review it, but on my unit, during the actual meeting, patients are not in attendance. I have only been asked to contribute once and am lucky if I know when my treatment plan revision is. Obviously, informal patients (and most patients on a section) must consent to their treatment plan before it can be implemented. In reality though, I’ve not seen my treatment plan in years so I think consent is automatically assumed.

S – #AtoZChallenge on Mental Health

Welcome to day 19 in the #AtoZChallenge on mental health. We’ve arrived at the letter S. Here goes.

Self-Injury

Self-injury or self-harm is the deliberate infliction of wounds upon oneself. Some scientists make a distinciton between self-injury and self-harm. Self-injury is then seen as leaving relatively minor, local wounds such as cuts or burns. Many people with depression, anxiety or emotion regulation issues such as in borderline personality disorder self-injure. Self-harm then is the infliction of grave harm onto the self, such as amputation. This is seen more often, according to these scientists, in people with psychotic disorders such as schizophrenia. In reality, of course, only a small portion of even the most severely psychotic patients engage in severe self-mutilation.

In DSM-5, non-suicidal self-injury was introduced as its own mental health diagnosis. Prior to that, many people who self-injure were misdiagnosed, often with borderline personality disorder. The DSM-IV guidelines even said that, if someone self-injured to cope with overwhelming emotions, BPD should be diagnosed, even though BPD has nine criteria, five of which must be met for a diagnosis.

Self-Medication

Self-medication refers to the abuse of alcohol or drugs with the goal to cope with mental health problems. It can also refer to the use of prescription medications that haven’t been prescribed to that specific person. Many people “self-medicate” with alcohol, even though alcohol does not have any medical benefits (except in mouthwash). In fact, it can make symptoms worse. Same for drugs. For instance, many people with psychotic symptoms use cannabis because it seems to calm them, even though it is in reality thought to worsen psychotic symptoms.

Of course, some drugs sold on the streets actually do help with certain symptoms. For example, people with undiagnosed ADHD might start using stimulant drugs to counter their symptoms. It is for this reason that self-medication needs to be taken very seriously. In my post on dual diagnosis last October, I addressed the complicated relationship between alcohol or drug use and mental illness

Survivor

Many people were and still are treated for mental illness against their will. In the antipsychiatry movement, people who come out of (forced) psychiatric care are seen as survivors. Many mentally ill people have indeed endured traumatic experiences at the hands of professionals. Many also have had other traumatic experiences, which may’ve contributed to their mental health condition. As such, they’re also survivors.

R – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, day 18. Today’s letter is R. Enjoy.

Recovery

Recovery is the patient-led process of learning to live a fulfilling life with or beyond one’s mental illness. It may mean overcoming one’s mental health problems, but recovery is also for people with lifelong mental illness. It is related to rehabilitation, which I’ll discuss below, but recovery is led by patients.

Like I said when discussing experience and jobs, I have participated in a recovery group. In these groups, people discuss different topics related to getting their lives on track. For example, we discuss sources of support, pitfalls in our recovery, our relation with our treatment providers, etc.

Rehabilitation

Rehablitation is the staff-led process of helping patients live a meaningful life with or beyond their mental illness. Rehabilitation has the patients’ wishes in mind but still is led by staff. It is a common belief, and I’m not entirely sure whether this is correct or not, tht rehabilitation is linked to resocialization, which I’ll discuss hereafter. As such, a patient’s wishes might only be the focus of staff support if they flow towards independence.

Resocialization

Resocialization is the process of going back to a less restrictive treatment setting or back into the community after institutional treatment. It may also refer to independence-focused training in general. Resocialization units in psychiatric hospitals usually allow patients to stay there for a specific time period, usually two years. Rehabilitation units in long-term care may be focused on further independence too, but they have more flexible guidelines on how long a person can stay there.

Restraint

Restraint is the physical, mechanical or chemical restriction of a person’s movement. Holding someone down or tying someone onto a bed are often recognized as restraint, but giving a person a high dose of an antipsychotic or benzodiazepine to tranquilize them is a form of restraint too. Restraint, like seclusion, can only be used to avert the patient being a danger to themself or others. In the Netherlands, mechanical restriants are hardly ever used in psychiatric hospitals. They were up till recently commonly used in nursing homes on patients with dementia who run a risk of falling, but I believe regulations have changed on this. Chemical restraints are still used, though not as often here as in other countries.