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26 Jan 2022

Category: health issuesCategory Archives:

Allies in Recovery: Use and Overuse of Collateral Support

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Burnout exists among practitioners & caregivers for those carrying a mental health diagnosis. Our allies, collateral contacts, and both natural and artificial supports are all susceptible to burnout. This presentation is designed to prevent and disrupt behaviors that contribute to burnout among people working with psychiatric disabilities. In doing so, burnout will be evaluated two-fold: 1) caregiver burnout, & 2) practitioner burnout, to improve continuity of care and uninterrupted service delivery by systems of care, family members, and organizations which provide mental health treatment. This article follows the assumption that when burnout decreases among allies in recovery, the quality of life of people carrying a mental health diagnosis will improve.

There are several stages of burnout. Each step is visible to a third party vested in the care of people with psychiatric disabilities and to the consumer receiving services. Burnout is also a visceral sensation to the person experiencing this symptom. The symptom is a product of inadequate self-care, self-awareness, and tolerance of extreme exhaustion and repetition of behaviors, circumstances, and unfortunate turns in a person’s recovery. Burnout is experienced in several ways by caregivers and practitioners. All allies in the recovery process can be victims of burnout. Still, in most cases, it is very much preventable with experience in practicing mental health treatment and with access to psychoeducation of their family members’ diagnosis.

In my recovery, I have observed burnout among my treatment team. It is painful to watch, especially knowing I might have contributed to the problem. While some might term this self-awareness, no such feelings should be experienced by consumers. Therefore, it isn’t a question of depth of client insight into their own behaviors. Instead, consumers can focus on their own feelings without worrying about their treatment team’s emotional state. I am not suggesting abusing your staff, therapist, or otherwise, but instead, your treatment’s focus shouldn’t include the biases and insecurities of your workers.

Enough focus, consideration, and insight will need to be cultivated by consumers to work on their own stuff.

I have also observed burnout among family members and friends with a vested interest in my mental health treatment. I have seen friends abandon my journey and walk away because it was just too difficult. When unpacking the negative patterns that contribute to burnout among friends and family. Essential to consider age, maturity, education, and resources available to the ally to continue investing in their loved one or friend who may not produce for themselves. People carrying a diagnosis may or may not contribute in the same way their healthy counterparts do in various areas of the social & interpersonal landscape allies journey alongside their peers struggling with a diagnosis.

Simply put, healthy clinicians and healthy family members will provide better treatment and care to their loved ones. It is demoralizing for people carrying a diagnosis to work towards their recovery and feel as though they are a burden while seeking out help. Healthy workers are less likely to abuse or mistreat people carrying a mental health diagnosis or take out their personal problems on vulnerable groups that are institutionalized. The benefits are without bounds, but ultimately, it is the quality of life of people carrying the most critical diagnosis in improving.

Burnout is a temporary symptom. It may signal to some workers to seek work in another field. Still, it should also gesture to the profession without proper administration of treatment delivery. Expecting positive outcomes in care & hiring or retaining staff who has the skills to provide treatment without collapsing is irrational and unlikely without further research. Self-care practices and best practices in mental health care go a long way in reversing this trend. From both the peer perspective and the professional lens, we need to continue researching how burnout can be prevented without clients experiencing harm from staff or negligent family members who have had enough caregiving for their family members due to an increase in uncontrolled symptoms or otherwise.

Chronic Illness & Recovery: Setting the Pace for Sustainable Healing

For people with a chronic illness and long-standing mental health diagnosis, finding the right pace for recovery and healing can be difficult and even misleading at times during the life of a disorder.

Acute disorders provide people with space and room to misapply energy without jeopardizing success in recovery. Stated, the active symptoms are more short-term, and the breadth of dysfunction typically less pervasive.

When people have a severe chronic mental health diagnosis, a misstep in applying energy and symptom management can leave a person vulnerable and open to breakthrough symptoms. Even worse, other unwelcome symptoms can emerge and reactivate. Moving forward, mismanaging opportunities to recovery is like shooting yourself in the foot.  

When a lot is going wrong, there is no reason not to take every possible solution coming your way to ameliorate your condition. I highly recommend taking every chance to heal to expect good rejuvenating outcomes.

From the very moment I began my battle with schizophrenia, I learned that positive outcomes for people in recovery required a degree of self-awareness of their symptoms. Only after insight is cultivated, will our own illnesses’ chronicity will a path forward be revealed. Therefore, careful notetaking and self-knowledge are a must if you are hoping for a less disordered future. As a clinician, I believe having ownership of my disorder also means applying the science available to measure my symptoms from baseline to a hopefully dormant or managed state to track progress.

This level of sophistication in measuring progress or the lack thereof requires completing ongoing activities, ADL’s or some indicator which can be translated into a scalable event. When a person goes to work every day or has steady collateral contacts, the diagnosed person will have a barometer to measure goal completion in cases like this. 

Isolation and other impairments make ADL’s lousy markers. In cases like this, the introduction of a would need a third-party observer like a case manager, therapist, or any collateral would help fight against relapse.

Third parties behave as another set of eyes that can observe a person’s functioning when they do not participate in the usual demands of the day.

Therefore, lasting recovery in the wake of chronic illness requires a depth of insight that only allies with a vested interest in my recovery can produce when a person doesn’t work or isolates. Given the turnover of caseworkers, friends and family are the real point people and allies in healing. Moving into each new phase of recovery will necessitate drawing from supports and partnering with them for seasonal, round-the-clock, and year-long support required when someone has a chronic severe diagnosis. There will be times when symptoms become active & there will be times when a person is vulnerable.

Only natural supports and the organic point person can help the person with a chronic illness achieve a sustainable healing and recovery pace. Artificial and hired workers are assigned to people with a chronic disease. Hired workers may be slightly more out-of-touch with the organic needs of someone who continues to struggle and will continue to battle their disease long after a case manager gets re-assigned or leaves their agency and his or her clients journey in recovery. Family, friends, and natural point people are connected and real allies to chronic disorder people. Conscripted hessian case managers will leave when the insurance has a problem, or the money runs dry. 

These people are not to be depended upon when thinking of recovery as a sustainable path to healing. Next to insight, sustainable healing requires the challenging of previous assumptions. There are skills to be learned for every phase of recovery. Plan to use every device in your arsenal for healing. Never discount the importance of further adapting old skills to target new problems.

Assume nothing will work to manage new or existing symptoms in your recovery until every avenue is explored and each solution is put to the test. Challenging assumptions every day, everywhere, with applied scientific reasoning, may mean the difference between symptoms becoming active again or breakthrough symptoms demoralizing the progress of someone with a chronic mental health diagnosis. 

Given the mood instability and collateral chaos I experienced for so many years, I learned to appreciate the safety of a static, unchanging healthy mental status. While we all live with residual symptoms, either active or in remission, acknowledging the dangers that lurk behind every turn in your recovery will prepare you for the pitfalls of someone who still hasn’t accepted the chronicity of their disorder. A giant first step is admitting that self-control, behavioral and otherwise, means seeking and accepting help.

Since no one can ask for help and seek it out all the time, organic connectors in care, like family, are available when artificial supports are not working. 

Recovery is a stance. 

There is no moment when a person magically becomes ‘undiagnosed’ or even un-symptomatic. In the end, how we recast struggle win our life is the key to lasting health and wellness.

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Too BIG to Fail

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One of my biggest mantras and theories around experiencing a successful recovery is ‘too big to fail.’ 

I am borrowing this phrase from the automotive bailout under President Obama’s administration. Back during the automotive bailout, the president deemed the industry and critical companies “Too big to fail.” 

Industries too vital and essential to the economy to go out of business are too big to fail. Whether the companies employ large amounts of workers or are a symbol of American prowess, the auto industry, and all that stems from its existence, needs to be saved. President Obama believed then, as I continue to think now, that some things are too important to disappear or die off. 

Of course, I am drawing a comparison. I don’t own a major American company and don’t employ many workers.

I share the same belief as the president. Some companies are too critical to the country’s economic well-being to fail personally and micro level.

I am also too important to wither away and unravel. I am too big to fail. I have too many friends to care for and too much to offer the world. With this sense of self-importance and self-love, I am more likely to seek help when I am in danger or need something to move my recovery forward. 

Undeniably, our support systems, both natural and artificial, play a vital role in our health and capacity to heal from sickness. Our supports have several crucial functions in our recovery and ability to problem-solve challenging situations without incident. 

As a clinician and peer struggling with a significant mental health disorder, my professional experience has taught me that we are only as strong as our weakest support. The “weak link” in your support system may be a bad or unempathetic friend. Maybe the weak link is a poorly trained service worker (e.g., case manager or therapist). 

The formula I am dispensing needs to signal to all people carrying a mental health diagnosis that proper and speedy healing means identifying your helpers and finding players who have a vested interest in your mental health.

I have been privileged in my recovery and healing in so many ways. Without these resources, I would not be able to conceptualize this idea of too big to fail.

A big piece of Too Big to fail theory intersects privilege. 

The more privilege you have available in your life, the more likely you will access available support in times of need. Of course, knowing when you need help comes before understanding how to access your supports. If you arent self-aware enough to know you are sick or need help, why would you even seek additional help? You wouldn’t. 

In my life, most of my recovery after first onset psychosis, I have always been blessed with a litany of helpers to guide and oversee my journey through the mental health system. When I was first diagnosed with schizophrenia, I had family visiting me regularly in the hospital with their ever-present gaze (watchful nurturing eyes) to ensure there was no mistreatment by staff members. 

In addition to my parent’s treatment participation, my family was a large part of my discharge plan back to the community and my rehabilitation from unresolved symptoms that weren’t “cured” quite yet at the time of discharge from the state hospital. 

I had the opportunity to witness countless patients without the same support I had from my family. I noticed patients without visitors, friends, or outside professionals visiting them in the hospital. Even worse, patients without a real home call their own in the community. Some folks are released after their recovery in the hospital to a group home and have no natural support during their recovery. 

Whatever the problem was during my’ break.’ The hospital staff’s complaints regarding my behavior and treatment progress had an outlet. I had family for the team to lodge their complaints. I had friends visiting from time to time to ensure there was no mistreatment by staff, and I was relatively comfortable in the hospital. 

Supports and friendly visitors became unofficial members of my out-patient treatment team. When I re-entered the community and began out-patient treatment, my team of helpers was always there to advocate and facilitate my healing at every next turn in my recovery. In addition to family and friends, I leaned on my professional contacts to push the system along. 

There will be “stuck moments” with complex cases. Complexities may incur holding patterns before benefits or services can are dispensed to the patient, in which many people slip through the cracks due to lag time. My regular contact with the more extensive system played a large role in getting the benefits I needed so I wouldn’t relapse and re-enter into the system at a lower level of care and lose ground.

Failure or a sense of defeat and isolation has never emerged in my landscape of health and healing. My horizon reaches beyond my immediate personal space into a large, unending pool of resources I continue to draw from when I feel like I am not making the progress I want to experience. There are external mechanisms that a valuable support system can fix to continue healing and recovery. With this said, you want motivated helpers. 

You want helpers proficient in designing the plan of care and your personal history struggling with your diagnosis. This way, your supports can operate without your immediate supervision if you are sick and act on their terms when you might not be available, given your priority is healing.

Too Big to Fail means you have so many people in your corner that you can fall back into a learning moment without losing ground . 

I have also seen people move the system to work for them because of their interests and the key people that espouse shared interests. Shared interests may be a case involved with multiple agencies and on everyone’s radar.

I have noticed the government is more motivated to squash “noise” and complaints out of fear patients might relapse without extra support or create an unseemly public display. 

Such displays jeopardize the veneer of hope the system is supposed to develop for those it serves.

Ultimately, there are limits to leaning on your helpers for support. Calling upon your helpers, whether it be friends or family, to do everything is not only unrealistic, it can become abusive. Helpers should be understanding and accepting of your limitations. There is never a license issued for the next phase of your healing to be bound up in learned helplessness. Healing is a product of your strength in the end. It should reflect your work in recovery predominantly and not your helpers’ political, financial, or family obligation to be there when you need it the most.

Why is Mania so Intoxicating? What can I do to manage it?

The Hidden Issues Underneath Mania

During my young adulthood, I experienced Mania firsthand in my sophomore year of college in upstate New York. While I won’t get into the specifics of which Bipolar diagnosis I was labeled with, one thing is sure. I was suffering from a mood disorder. My ‘highs’ were mountaintop experiences filled with euphoria, drama, risky behavior, gambling, and poor judgment calls.

Mix in stimulants and cocaine. My young adulthood had all the ingredients of a recipe for disaster. If it weren’t for my friends in college who were constantly looking out for safety and checking in with me every day, I would have likely dropped off the map in some speedy scene and drug den in the unsavory side of Binghamton, New York.

I’m not going to mince words. Mania can seem like the best high in the world. Mania is all intoxicating and appears to be the glue binding all your most fiery bodily properties into a caldron of energy and creativity. I’m not the only person who believes this. Just ask any other person who has experienced extreme Mania. The stories and symptom descriptions are all the same.

During a manic episode, it can seem as though you are transcending history and yet entangled into it at various points of reference. Even religious symbolism/iconography will get enmeshed into your new perception and new emerging belief system as the Mania takes full effect. At which point, be ready to become incorporated into a bold new exciting reality, if only for the moment. At this point, anything is plausible, and there is something very wrong with your affective (mood) regulation.

 Identifying a Manic Episode

Manic episodes have kept me awake for weeks at a time without sleeping or feel the need for rest. I have witnessed other people so dysregulated from Mania that they would do somersaults across the floors of the psychiatric ward floors to find out their bodies would later feel the shock of the poorly planned acrobatic theatrics. With specific diagnoses, manic symptoms become more difficult to identify. People carrying diagnoses that include psychotic symptoms should pay even closer attention to their moods because psychosis can worsen with extreme elevations of mood, which then complicates a person’s insight and judgment into their symptoms further.

For most ‘generic’ mood disorders or bipolar types, be prepared for extreme euphoria, decreased need for sleep, and hyper-sexual arousal. Sometimes, religious ideation can be indicative of activating psychosis or a diagnosis on the schizoaffective spectrum. The usual suspects seem to always be at play when manic symptoms are present. Signs of an underlying issue may start in a subclinical or mostly unproblematic manner in your life but then take a radical turn and escalate. You may be working with hypomania. 

Implications for Self-Management:

There are several options for reducing the harmfulness of a manic episode in your interpersonal life in terms of self-management and self-regulation. Stated, your ongoing capacity to execute daily living activities without incident will be your barometer or meterstick for completing ADLs and self-managed tasks successfully to remain as independent as possible during an episode of active mania symptoms. These strategies are dependent on how Mania came into being and how severe/intense your symptoms are to manage.

Stimulant and drug-induced Mania is just as dangerous as organically, internally driven manic episodes. Considering substance abuse treatment may be an essential step in managing your symptoms for the long haul if this is your issue. Like most people, even minor stimulant use from caffeine can trigger an episode or lead down the causeway to self-activation. By self-activation, I mean inducing, as much as possible, Mania by engaging in unhealthy activities or stopping your medication without medical oversight.

Living a chemical-free lifestyle isn’t for everyone. It is vitally important to consider your baseline mood (everyday mood) when engaging in stimulant or caffeine use like coffee or energy drinks. To gauge whether or not consuming one more coffee or caffeine drink will trigger a manic episode, understand your baseline. First, get a feel of where you are on an average day in mood and energy levels.

For non-chemical-induced episodes, internal and external barometers are essential for knowing your affective status baseline. Listen to your friends and colleagues and take in their assessment (even if informal) assessment of your mood. 

Ask yourself these questions to create a barometer to self-assess for Mania:

  • How do you feel when collaterals think you are upbeat? 
  • Is this the case? or are your collaterals misinterpreting your mood?
  • How many coffees/hours of sleep did you get, or are you still awake from the previous day? 
  • How is your behavior, in its congruency to your mood? 
  • Have there been recent complaints about your behavior? 
  • Or are you the model employee at work? 
  • Are you able to make it to work? Or are you too tired to get out of bed and depressed? 

Begin to create markers in your living environment and for your internal guidance system to signal that there may be a potential problem. For example, when you are feeling speedy on the climb up to Mania, locate safety areas that you can go to when you aren’t feeling very safe. Mania may feel awesome at first, but ultimately, it will put your safety at risk. So, find safe zones that will keep you protected when you are manic and lacking your usual insight into your behaviors. While in your safety zone or on the way to it, begin to recalibrate your internal guidance system to register that you are manic and require to return to a calmer, more stable baseline. Visualize what that will look at feel like to begin the recalibration process. 

Living with Unresolved Episodic Mania

Ultimately, there will be times when you have to live with unresolved symptoms. Creating a plan for friends and family will significantly reduce the risk of potential harm from an episode. Making new friends and family aware of your mania symptoms and their triggers will help you avoid the ups and downs of mood dysregulation. Friends and family can even help you make decisions if your judgment and insight are too impaired for rational decision-making.

I send warning emails to friends and family, flagging them down when I feel like my moods may be impaired or have impaired my decisions and or might in the future harm others. Preparedness and attention to detail are always essential when managing an illness. Surround yourself with supportive people and allies in your recovery. You should never feel embarrassed by your behavior, but you always need to accept responsibility for it. That’s how healing works: acknowledging that change is necessary and moving forward in the process of adapting our behavior until it serves our purposes.

On Self-Care: Monitoring our ADLs

This article seeks to highlight the unquestionable importance of self-care in everyday life. Self-care is paramount to survival, and this article will review the essential skills necessary to continue and maintain basic to complex life functions. While each of us individually has different job functions and carries out different life operations, there are certain Activities of Daily Living (ADLs) that must be nurtured and maintained to continue living without running into medical and psychiatric problems that can be avoided by adhering to the care of the self. As always, be sure to review these self-care skills with your PCP (Primary Care Physician), psychiatrist, and mental health professional bore implementing them in your living environment.

The most simple basic measure for caring for the self with a mental health diagnosis is your nutrition. Poor nutrition is often overlooked by people carrying a mental health diagnosis as a reason for mood dysregulation and a litany of other diagnoses including ADHD, and other behavioral problems in children & adolescents. For example, dysregulation of diabetes in adolescents can cause behavioral problems, acting out, and other oppositional features associated with many conduct disorders. Be sure to consult with a nutritionist at the onset of any mental health diagnosis to rule out medical conditions exacerbating your condition.

A more moderate skill or technique to promote self-care with a mental health diagnosis is daily exercise. There are many disorders and medication therapies that increase lethargy and the propensity for obesity. Sometimes, if you are taking enough medications that have sedative side effects, you may not want to get out of bed to do anything. Laying in bed all day is the worst thing you can do to begin to re-balance your metabolism again and maintain a healthy weight which, if not taken seriously, can become a further complication for the medication management of your mental health condition. Some psychotropic medication therapies have side effects that promote weight gain. If you cannot care for yourself and maintain a healthy weight, certain medication therapies will be restricted or not considered appropriate for you given your evidence of difficulty monitoring your weight.

An even more complex activity of daily living, maintaining socially acceptable hygiene is something that requires self-awareness and practice if you have a mental health diagnosis limiting your insight into how to effectively care for yourself. There is no question getting into the shower, remembering to use deodorant, and keeping clean is even more challenging when you are carrying specific diagnoses which decrease your motivation to stay on top of your daily functions and increase other functions which complicate ongoing self-care activities. So, if you can’t get your hygiene taken care of in the morning, remember to complete minor tasks during the day. Keep travel-size hygiene supplies with you at all times so when you are up to completing your ADLs, you can, anywhere, and be ready for any activity clean-shaven and odor-free.

The most difficult self-care strategy for those carrying a mental health diagnosis is tuning-in to yourself. Are you tired? Overworked? Are you taking time for pleasurable activities? Are you having effective sessions with your therapist or psychiatrist? Monitor your moods and thoughts regularly to check-in with yourself often and identify if you need to do some work or time spent in therapy around cultivating mood regulation techniques or for learning skills to re-frame negative thought patterns into more positive associations.

Future blog posts will review these more advanced skills in further detail. Check back here soon for regular self-care updates.

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Edited: Autumn Tompkins

Managing the Unknown: Reducing Rumination and Committing to your Goals

Too many disorders have a common symptom: rumination, perseveration, and the greater experience of fear that disturbs our moments and may even evoke enough agitation to land us in the hospital. Our anxieties can not only get out of hand for us personally, but they also have the potential for complicating our social worlds when we interact with our friends and colleagues. Anxiety has an uncanny way of entering not only our life but the lives with touch in our everyday lives as if our mental health was a communicable disease.

Like most diseases that are viral, we have the power to prevent it from spreading from ourselves to those we interact with at the point of inception. Anxiety, fear, rumination can begin and end with us, if we choose to commit to goals and not let the ifs in life and unknowns fill our every day. It begins with goal-setting and ends when you’ve decided your dreams are worth fighting for anymore.

Choosing to adhere to our dreams and wants for ourselves and believing in the joy and peace of mind having what you want in life is not only a positive mindset, it’s a productive one that will allow you to cultivate the gains to you need to do accomplish your goals. Rumination, fears, and other anxieties are not only unproductive distractions, but they are unavoidable.

Fortunately, this unavoidable disruption is both manageable and can be an asset that drives your progress towards your goals forward. Identifying exactly what is that’s in what seems like a perpetual holding pattern, taking up unbearable and unwelcome mental energy is a great first step. Realizing that your rumination is just your fears of not reaching your goals manifest is an even further step in demystifying the disturbance and making it accessible to manage it effectively. By providing you with the insight you need to reduce the disturbances harm and prevent further harm from interfering with your achieving your goals is just another reason to stop you from worrying.

Knowing what’s going to stop you or what won’t let you think about what’s productive doesn’t mean you can’t make the disruption into another skill or technique to drive you forward in recovery and managing yourself in the manner that suits you attaining your goals.

Edited: Autumn Tompkins

Mental Health Affairs 2022

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