Continuing Education 🔄

I was asked to write down three things I cannot live without on a piece of scrap paper for a seminar on interpretation.

At that time, I was floridly psychotic, self-referential, tangential, and totally detached from what was happening to me, around me, and despite me. On the paper, I wrote down three things : (1) Ensure, (2) Education, and (3) Language. My belief is that I choose Ensure, and each other word for their complex, profound importance in my life and multiplicity of meanings. Due to my symptoms, I was in basic survival mode, and my body responded by signaling that I need to focus on my most basic needs if I was to survive and continue to follow my dreams. My familiarity with basic artificial nutrition has a rich past with the Ensure drink. My grandmother had passed away years ago, but I still remember the various life-sustaining and life-preserving measures our family took to keep her alive and ensure her health and vitality.

My family ordered cartoons and trays of the beverage, which arrived at my grandmother’s apartment for over a decade during her final years. I am no stranger to artificial nutrition. In the Oncology unit. Nursing homes. Keeping the body alive through any means necessary is something I have been exposed to as a profound ethical dilemma, and continue to question my own personal end-of-life plans. Capacity issues, my own situation, and history with losing the ability to care for me legally. Knowing that I have lost capacity once before, I was told I might not ever get it back. The associated thoughts and feelings of being totally powerless to make decisions on my own behalf were as devastating as it was frightening. The feeling of not being in control was something that I have always feared, like many people do, but are never put in a space where physiologically they cannot control themselves.

But in 2008, I was young, unaware of my illness, and pulling on every and any survival method I could think of to stay alive, healthy, and seemingly able to take care of himself when I was told I was losing my grip to make rational judgment calls and increasingly, using bad decision-making skills. Then, I heard these behaviors as life choices, so I ignored this deafening warning bell, which should have signaled a serious problem at work. I was a young adult, though. I had just learned how to live independently in the community as an adult and function at the level of a college student in upstate New York.

Something was happening to me that turned back the hands of time, both developmentally in terms of my own capacity to self-manage, exercise sound judgment, and be rational about my living situation and life circumstances. I knew that my situation was becoming more and more serious and knew if I was to survive on my own, I would have to be more resourceful and clever about managing my money, conserving food and energy, and living totally independently. The choice became I was preceding to live a new lifestyle.

Indeed the drink Ensure, and other artificial nutrition drinks, snacks, medications, even gasoline, and eventually sugar, basic glucose to keep the heart pumping I began to progressively stockpile. If I would have to lose weight for an extended period of time due to limited access to local soup kitchen from lack of available, affordable transportation, I began asking friends to bring me packages of fresh groceries from week to week. It got so bad towards the end of May that I was eating leftover meals from the common fridge, not knowing whose meal it was, its freshness, or visibility when it goes missing. The owner begins to point fingers at the person who was eating his or her leftovers without permission. But this was a minor infraction in the litany of boundary transgressions, threatening gestures, and non-verbal articulations, and unrecognizable signs I would point to when making a point or trying to broadcast a message to my peers through my thoughts at school, home, or when driving.

Ensure thus became a more and more friendly visitor in my fridge. I stockpiled everything that could potentially be depleted. I knew full well I may not have another opportunity to make up for the provision I would simply have to do without it to continue on the struggle and work cross purposes with the university of which I I refused to accept graduation, and move on in my life unless the school overturned its rejection of my application to its English graduate school. While it continues to be important to me, education was regarded by me then as something above reproach and indefensibly pure in nature as noble, regal, and the highest gift I could give my school was to continue on at the apex of the academic affairs. The deepness of my belief in Education still echoes in the chamber halls and libraries I passed through then and hung up signs making myself a victim of political academic game, and unfair practices in higher education.

The extreme nature of the English department’s victimization inflicted upon me went deep into the psychological wellspring of crimes that persisted to continue without retribution, the intervention of the law, and mediation by a party at the university or by friends and relatives. Collateral intervention and treatment could have put things into a more accurate or relative perspective. If had been nonjudgmentally applied to my situation, it might have helped connect me to treatment sooner before the psychosis was in full bloom. Instead, the very language I was seeking, completing my unpolished rhetoric, and years spent learning about how words work would also fail me. About the time I began running out of medication, I began hearing voices. About the time I realized my body was so ridden with involuntary spasms and tremors, I went looking for any and all medication I could find to ensure I would continue as a student in pursuing higher education.

That was when I noticed the signs were changing all around me. Words were taking on double, sometimes triple meaning. I could not read or speak coherently without getting tongue-tied on a phrase, common expression, or any colloquialism that was generally assumed to have a particular meaning. Given I was in the mindset of challenging everything, and everyone, and all meanings to de-stabilize and create a new altogether different language, I began to get confused when communicating with people, reading directions, and even simple hand gestures which we all have an unspoken understanding of their intended meaning.

But then again, I was bowing instead of saying hello or goodbye because it was in fact, non-verbal. Since I was losing speech a fairly substantial rate, I knew I would have to begin planning my responses, greetings, and salutations with limited capacity. This was difficult, especially because some language was becoming unclear, wholly useless at different rates, and trying to implementing basic interactions, or sustain situationally inappropriate language became increasingly a struggle. For example, since I wasn’t supposed to speak with my professor directly, and I had to communicate with him for class each week face to face, I began bowing instead of saying hello, goodbye, or anything that would orally contribute to tension between myself and the staff I was supposed to keep a distance.

Knowing full well my situation was precarious, I commissioned the Doctoral Guard. This band of imaginary compatriots in the battle against the academy and transnational freedom would be the subject of my many messages on voicemails, requesting the location, position, and success of my transnational freedom with friends and family. After being arrested, I fully well believed I needed someone watching my back. Given the increasing number of unfortunate situations that seemed to keep happening. It was my last sincere hope before I lost all impulse control that these imaginary friends would somehow intervene in my personal affairs and move back into a space of fortune and favor again. My very last hope was returning to the earlier manic periods. This was when I experienced extreme euphoria and little interference from increasing symptoms.

So, I began stealing medication at home. About the time I was searching through the drawers of my housemates and swallowing unknown pills that weren’t prescribed for me I was also hearing very commanding voices to keep taking more medication, all of the medication, or begin fortifying my home from the Binghamton police who were broadcasting on the telephone poles from speakers that they would enter my home with force if I did not do one thing or another at their will. I refused to listen. Not because I knew they were just voices but because the voices were all the self-doubt, negativity, and shame I had experienced before in my life that I was determined not to let it follow or consume me. I believed if I continued on and lived a normal life, it would mean adjusting to my newfound stiffness, a condition that would blossom into catatonia, and other physical complaints that were making it increasingly difficult to move around ambulate without confusion and extreme agitation.

Ultimately, despite having all three items on my list: (1) ensure, (2) education, and (3) language I was still not able to survive without intervention from the authorities. Moments after I lost all control of my body I heard voices that resembled a bomb timer ticking away, and then, a countdown to what seemed like it was going to an explosion. Running out of my house naked and totally paralyzed with fear, I ran into the local police, investigating the broken windows in my car. It seemed that in my confusion I had thrown a giant rock through my car window, and then according to a re-telling of the story. Written documentation of my alleged description of the events, I had crawled through the broken window, took the same rock, and threw it through the other window and side of the car to make the glass appear more even.

Anything for the semblance of normality. Anything to ensure education and the pursuit of my dream. To be a language expert. In the end, the very language I used to survive, turned on me, or became so inaccessible and ineffective to continue without eventually going into free fail and in need of immediate help. When I got into the police car, I looked at the monitor in front of the car. The monitor said “Suspicious Signs” and I knew then, as I know today, to be very suspicious of anything which goes without explanation or plausible rational solution. Anything that takes more than three words to explain, three to clarify and another three to challenge the original meaning is nine words too long without producing or identifying a solution to the problem. Instead, we all need to let you each other know more clearly and urgently before symptoms become unmanageable. Always safely impart critical messages for a course correction in your new condition to avoid the path to relapse. Ultimately, listening, keeping an open stance, and being less blocked to suggestion might have supplied the right perspective to pause the rapid destabilizing and mental status free fall and spin out we are all susceptible to acute crisis.

Interview with Author of the “V-papers” and founder of Mental Health Affairs, J. PETERS

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Interviewer: Please tell us, J., why do you insist on writing about Mental Health when it continues to be so widely discussed and covered by talented authors in recent years?

JP: I write because my message continues to be different than all the other authors out there in academia and clinical practice, even from folks publicly sharing their lived experience in biographies and self-help books. At the very moment, my readers interact with the text. A deep connection is forged. It is a relationship like no other. It is a deep psycho-social and spiritual connection between the reader and the world of possibilities, realities, and non-normal experiences from the eyes of someone who has lived in both worlds. Not a sick and a healthy dual-experience, but a very human, and very real, a constellation of in-betweens, successes, failures, and tested knowledge in its most platonic form.

Interviewer: Your work continues to stand apart from your counterparts in mental health and academia. Can you say more about this?

JP: Well, you have to understand my stance. My philosophy is no Pat Deegan flowery and sugar-coated version of the reality of mental health disorders. I speak from my experience. You’ve heard it before, I am sure.

There are an entire discourse and cannon of so-called strengths-based jargon and self-appraising, self-vindicating nonsense out there in the world of “recovery.” I’ll never forget the first and last time I listened to Pat Deegan speak at a conference. It was as if privilege and consumerism had joined hands in the name of mental health and recovery. Well, Pat Deegan doesn’t speak for myself or my readers. I am not willing to give my readers any of that garbage or opportunist ideology passed off as hope and healing.

Interviewer: Why ‘Mental Health Affairs‘?

JP: There is no question that the re-appropriation of the language used by the Nazi party to justify and organize the Holocaust is fundamentally important to re-balance both the social impetus and human rights necessity, situate in the problem in a context of historical grand-scale and enormity, as well as the required organizational feat ahead of us. Whether it be the documentation and planning aspect of reform or the “final solution,” we need to solve it to move the discourse out of the 20th century finally.

The implications are as clear as day. Without further delay, we need to act swiftly with institutional, systemic, and cultural reform in grand harmony and with the highest moral and ethical high ground when thinking about moving towards universal access and integration. Nobody can deny these implications have global reaches and affect us all as humans equally and without regard for the lines that all too often divide and distance us from peaceful co-existence. Yet, we continue to ignore the proximate and ultimate possibilities of deferring any final solution in mental health and its treatment to expect a real resolution to this universal and truly worldwide crisis.

Interviewer: You said you give readers this and that. Tell us, please, what exactly do you give your readers?

JP: Authenticity. Any way you want to describe or put language it. My writing is the most candid, transparent, and vividly analytical appraisal of experiencing first-episode Psychosis you can find in a library or internet database. I hold nothing back. Even if it means admitting to my own ethical and spiritual limitations and biological flaws from anatomy to my human emotions’ governance. There is no way to have a conversation about illness’s true experience without talking about things in sometimes very overtly negative and alarming ways. In my own opinion, there is no way to prepare the world better than to be completely honest about my experiences, even if it means losing the respect of a few members of my audience. At least, in the end, everyone will be the most prepared for bad times when if and when you draw the short stick in life.

Interviewer: You’ve said it a few times in your works. You are arming your readers with information. How does this intended aim fit with the aim of your so-called V-papers?

JP: I’ve been public about my love of language and advocacy and how both intersect in mental health and forwarding the discourse for some time now. I’ve also spoken about the overtly visible urgency in achieving both of these aims, simultaneously and in harmony, should there be any hope of lasting reform and progressive changes to the care system.

I’ve been less candid about my belief in moving forward at lightning speed and certainty, at all costs, until our global culture can declare word-wide victory over the fallacies and atrocities committed by negligent and outright criminal treatment of mental illness in the past. We need to be fanatical in our approach to reform.

Blocking admissions, establishing mental health courts, and being aware at all times of the impetus to move the discourse beyond the limits of today’s shortcomings and the possibilities of a future painted in broad strokes of hope and recovery from whatever ailment we come across in our lives or need relief. Indeed, the vengeance papers are the metaphysical manifestation of my theory in practice and the convergence of praxis in working seamless harmony.

Interviewer: You speak of great harmony. But there is no such harmony in the mental health research base. In terms of forced treatment, what harmony is there?

JP: Look, I am an overweight, self-identifying Jewish native New Yorker with an active schizophrenia diagnosis. My mother’s last name is Goldstein. I might as well pushed Kendra in front of that train regarding how much stigma and push-back I have felt when working in the world of mental health treatment and it’s enforcement on ACT teams and other modalities enforcing mandatory mental health treatment. In the end, Kendra might have died for us. Not in some Jesus-like, religious bend, but for society to realize how much farther we need to extend the research and reform measures before we can say mental health care is no longer in immediate crisis.

I am suggesting that in this regard, I would have without hesitation pushed her in front of the subway train, too, if it meant the public finally accepting that we have no choice but to reform the system and find a solution to universal access and integration of mental health services before there is no real threat of immediate harm or danger from having a diagnosis as severe as Goldstein had when he went without the care he sought out so desperately before Kendra’s law became a lived reality.

Celebrating Support and Services for People with Disabilities (SSD)🎗

At the very end of my semester in undergraduate school, I attended a reception on campus in which I participated in honoring faculty that was special with and dedicated to people with disabilities. In my entire time as a student, I had never had a disability, or a documented disorder, but in April of that Spring, I was not only receiving assistance through the disabilities office on campus, I was also speaking at their ceremony and reception for graduating students. The story of how I became connected with disabilities services, and the event that transpired at the end of the Semester, is one of deception, intrigue, respect, and courage for both facility and students taking part in the event.

This story begins during course registration six months earlier. I had just run into a professor I had my very first semester in Binghamton. Her name, was Dr. D, and she both respected my work, and had disappeared for two years totally off my radar until the final semester. When we ran into each other in the department, we talked about this loss of connection, our finding each other again, and the timeliness of it all that we could bookend my experience in the English department with her courses. Indeed, Dr. D suggested that upon matriculation to the Graduate program, I take her course and finish out undergraduate school with the same staff member I had began it with in Medieval Literature years back.

But when I reviewed notice I was rejected from the program I needed to change my courses, re-register for some, and de-register from others due to my status as a student and a restriction placed on my course selection. Dr. D was outwardly fairly understanding from the point of departure into the fall out from the graduate school and the initial events that unfolded around miscommunication with my intentions to re-apply to the program and how to proceed with my undergraduate-graduate status conflict as a result of being ready to graduate but still taking courses as an un-matriculated graduate student. Due to all this confusion, Dr. D suggested I speak with the disabilities department and explain to them my confusion and ask for guidance on how to proceed.

Indeed, I contacted the disabilities department. I was interviewed and along with being provided access to a library carousel, which is a story for another day, I was provided with documentation and a plan to handle moving forward with graduate study in the future. Unfortunately, I did not follow the plan. In fact, I made it more complicated to make future plans and problem-solve issues in the department without creating more. By mid semester, I was very paranoid, and becoming delusional. Dr. D took the seminar to a talk in the library where a speaker was presenting a paper. I found the whole affair very adversarial. I found many things to be more and more adversarial, especially when attached to university affairs. I observed at the speaking event the author being interrogated by people in the room including our class sitting in on the reading. The audience made a series of hostile criticisms on the merit, validity, and value of the authors scholarship. I remember the author sweating, fidgeting, and speaking with pressure as he answered each successive question from the listeners.

When I explained how I perceived the event Dr. D laughed. She said:

“It was just a friendly academic conversation”

I couldn’t have disagreed more with Dr. D. And as time unfolded, and a larger term paper was due, I realized I was no shape to write a paper for a graduate seminar unless I was more focused and devoting my energy to coursework and not fighting windmills across the academy. So, I agreed to withdraw from the class without pause. I didn’t see much of Dr. D after I withdrew from the class, but her legacy that semester was firmly intact. I was a self-identifying student with disabilities. Specifically, a psychiatric disability. Now I had a label, and was a giant moving target for university staff ready to document my forced withdrawal from the semester.

The office had all my medical information and I signed-off on papers to release everything to the school regarding my psychiatric history. This was a big mistake when my medical information was used to build an argument that I was unfit to continue as a student. My current behavior, given the history also down on paper, signaled to poorly trained staff on people in psychiatric crisis that I might also be sick right now. As much as past history is a predictor of future behavior, in my case, my new symptoms were attached to a new emerging disorder and first episode psychosis.

By the time I was in a full blown psychotic break, it was time for the disabilities reception. I had the opportunity to honor three people who were important to my success, albeit ultimate demise, with coursework, campus life, and any access issue I had with campus services due to my disability. I choose to take the time to honor these people because in that last semester, I had fewer than few allies, and the ones that were there, mattered very much to me in keeping hope alive that I would resolve the graduate school issues, my loitering charge, and all problems created as a result of responding to the admission decision so reactively and without thinking about the long-term effect my behavior on campus would have on my health for a very long time into the future.

These people mattered so much I wrote a little blurb for each honoree. The first person I honored was my department secretary, of the English undergraduate department. Stephanie was always very friendly, respectful, and concerned with my happiness even in the final throws the semester. She was very supportive, even when she couldn’t directly change the political climate in the department, and helpful when the restrictions limited my ability to visit the department office in person. For the later phases of the semester, I was only communicating with Stephanie via email, largely because I wasn’t allowed in the office without a campus police responding. Stephanie was always there to help, even when I wasn’t there to be present.

The second faculty member I honored was Dr. W. Dr. W. offered counseling to me as a friend, and former professor who taught my Shakespeare class. I visited Dr. W as much as possible, updating he regularly on the unfolding of events and she would offer her feedback, in the most reassuring yet critical manner as possible to both soothe my anger and offer an alternative perspective. Dr. W was the only staff member to recommend me to the Graduate School in English. To this day, I have her recommendation saved and re read it to reflect on my standing as a student in “reality” versus the delusion I created, or at least participated in, without consent. Reading her recommendation and knowing she stood courageously in the face of the department and beside her student when she knew the outcome would be the catastrophic or at least a giant nuisance to the integrity of people in the department who marked my file rejected for graduate study. Dr. W. did her very best to make sure the fall out didn’t hurt me or jeopardize my work as student. I visited Dr. W when I returned to campus as a social worker student. She was still there in her office when I went back to the department. She told me very candidly she was battling new demons and handling other incidents with students on campus. Even more candidly, she said another student one year after I graduated from Binghamton succumbed to a similar condition and might have also had a similar response from the department staff if it wasn’t from the lessons learned by some faculty from my incident on how improve campus response to people in psychiatric crisis.

The final faculty member I honored was Dr. G. Dr. G was my professor in English for several courses. He believed in my passion, my skill, and my dedication to learning. He was also a friend to me when I began to unravel. He never judged the changes in my personality, speech, or behavior. Indeed, when I was with Dr. G it felt like old times on campus, even when the very department was becoming unhinged. Dr. G was very authentic, and I learned more about being an academic with heart and integrity, than being the elitist ladder climbing scholar with an agenda that I had come across again at the beginning of the year with Dr. D. I never felt like dismayed, disillusioned, or without hope when I was in the presence of Dr. G. To this day, I keep taps on his whereabouts, and his own journey through the chronicles of higher education.

Addressing Symptoms: Extended Metaphors, Ideas-of-Reference

I was an English major in college. Like many students studying language, I loved words, meaning-making, and using rhetoric to both dazzle and re-orient my listener to whatever I was spitting out of my mouth. Indeed, like most students, and English majors, I loved buzzwords, and the word-of-the day. But unlike most students, my word of the day wasn’t the language thrown around in the classroom it was my own specially crafted rhetoric. Back then, I was both learning and interested in British English, literary theory, and transnationalism. Therefore, it was only natural and expected I would build my future lexicon in the same fashion I learned new words and perspectives on thinking and talking about language. What I didn’t expect however, was that this new way of speaking and talking about language would become my world. In many ways, in the same way I spun the rhetoric, I experienced the world. My world was the very limits of language, and I was at the rostrum.

This all began when I first decided I had to contest the admission decision from the graduate school that had turned down my application for an Masters in English. With this said, when I first sat down to try to capture the events on paper and document them, as emails between departments were firing back-to-back without pause concerning the shift in my behavior on campus, and my decision to force a new admission decision without consent from the university staff. The physical manifestation of this documentation was the essay I wrote Contesting Admission. Contesting Admission is one extended metaphor that seeks to capture the events unfolding in 2008 within the Binghamton University English Department immediately following the Graduate’s School decision not to admit this writer into the English Masters program. The paper was written while at the same time I was beginning to experience first episode psychosis, isolated, and becoming very disconnected from reality. Contesting Admission has been edited from its original version after my recovery from Schizophrenia for the benefit of the reader. The edited version allows the reader to evaluate my clinical picture in 2008 & the gradual degradation of my mental status as the story progresses.

I wrote the paper Contesting Admission in the style of Michel Foucault and cite incidents in my life quoting with primary documents (e.g court orders, lists from the B.U English department, & publications in the community which followed my story at the time). When I first wrote the paper in 2008 I was trying to make sense of the world around me as it became more and more distorted and irrational. But alas, the frequency and intensity of my symptoms over a six month period continued to worsen, initially, after the graduate school’s admission decision, and then steadily throughout my final semester. Contesting Admission ultimately, despite its aim, achieved its intent. I identified a “~~concern~~” in the Humanities. Initially I set out in the paper as well as all my daily endeavors on campus to identify why I was rejected from graduate school in English. In the paper, and due to my ever presence in the department, I was successful in identifying a tremendous concern. I was very much in crisis and under the radar of the entire University, which, ultimately, without the help of the school my behaviors became so extreme I was taken to the hospital by the local police department. This was directly following throwing a rock through my car window, twice, which, according to hospital records, was to make the car more symmetrical looking.

In the paper, I began with a discussion of history of words, their etiology, versus the future of language, or, as titled in article, “Historical Cultural Cosign Scientific Perspective(s)”, which said in the paper: “I obedient investigations at the academy at SUNY Binghamton”. Here, I am writing about my call for an urgent and immediate review of my application for graduate school. There is no question I am trying to make sense of how the decision to not admit this writer into the graduate program at B.U was a departure from the norm or previous scientific method for selecting students for the program. Noteworthy, and clinically significant is the language I used: “obedient”, gesturing to a superiority of myself over other candidates, program, and decision-making progress, as well as all those whom have applied, and generally, assertion of my will over the entire process of admission to the program.

As the paper unfolds, “Transforming Sign Acheology” or as translated into English, and what I was trying to say at the time, is how a decision to “Admit” can be “Declined” by the department. At that time, in early Spring, the department had implemented a policy not to allow me into specific areas of the department, or, as referenced in the paper, “to lay down the threshold it must not cross”, gesturing to the line between safe for me to walk through without getting arrested. It is clinically significant, to note that I referred to myself as “it”, as here, in early Spring, I was already becoming both self-referential, and experiencing depersonalization. Later I will quote a line from my summons for my court appearance, “The People of New York versus Max E. Guttman” and compare it to “Transnational English Terorism”, which can be understood as a very black and white “everyone is against me” bend of viewing the world.

In “Rhetorical Sciences”, I begin talking about Madness and “day to day observations” of my everyday life in Binghamton. Which, again, signals to irony of the state of my mental status, and the very fact I was being observed by the department on the level of behavior and as stated in the email from the Dean, “assessed for safety to continue as a student”. I go on to talk about hygiene, which, clearly, at that time, was an issue, also noted by the Dean of students. However, the issue I discussed in the original paper was how hygiene was used as something to hinder me instead of my own deficit in self-care, which, at that point, was a clinically significant issue and again signals to where my mental status was at that time.

In the passages “Empire” through the “Second American Revolution”, was the point in time my friend was writing a paper on my arrest for loitering. While it is obvious I understood this arrest to apart of my own political revolution, and, and “illness in the humanities”, the illness was definitely my own, and not of the humanities in Binghamton. The passage “Diagnosing Technologies of Crystallization”, in which I was summarizing my work, I was definately, diagnosable myself. This is where I discovered the word, “meta-power”, a new word I thought in language, but that was in fact when the voices truly became disturbing, and spoke to me, a departure far enough from reality to think anything was happening, but what was really happening, was my imminent hospitalization in which my illness would be diagnosed by a team of clinicians at Binghamton General Hospital.

Ultimately, this paper was in fact written from the point of onset to hospitalization. I showed this paper to very few people at the time. But there were a few people I did share this with, who, commented very little on its meaning and intent. The paper was intended to overturn the admission. I made that clear to those I discussed the paper with and again, heard very little feedback. Later posts will discuss what to do when someone you care about is writing in this manner and brings it your attention. It may be critical in your friend getting the help he or she needs. While writing can be therapeutic, it very much depends as always, on the authors intent and belief on what the writing will set out to achieve or its purpose.

Meta-power is a word that I use often during the paper. It signifies the power of language and those who wield it (i.e Dr. Heywood the English department chair) to make decisions that change the world, from globalization down to day to operations in English departments. Throughout my last days in the community, I wrote day and night for months trying to identify the root of power that discontinued my path to graduate school in English and ultimately, the mysteries embedded within language.

Fully Alive💯

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We all have impairments, limitations, and restrictions. However, choosing to live ‘fully alive’ in the face of our so-called deficits is critical to feeling happy, fulfilled, and complete.

For most of us, the task ahead is how to think outside of our flaws and experience the world fully alive.

There are several ways of envisioning our world in more colorful terms and painting our universe in broader, more vibrant vistas. The first method is thinking more positively. Indeed, living fully alive starts with eliminating negative thinking and framing the world in a narrative that captures a more positive daily experience. From more positive thinking, a long catalog of techniques is available to live a full existence.

Fully alive means more than just framing the world in more favorable terms. Fully alive means broadening the scope of our daily experiences. To do this, begin by challenging everyday norms, routines, day-to-day habits and integrating new content and perspective into each moment. Turn the usual day on its head and embrace the unknown. When we spend our days in a routine, engage in the same habits, and generally focus on the same social news feed, we defer feeling new emotions and thoughts, which can enrich the way we understand the world around us.

One practical way of challenging our daily norms is to ask more questions when presented with the similar or usual content. For example, instead of taking the information you get for granted, think more critically. Contemplate the news and its origins. Embrace the journey the information embarked on to reach you and your decision about its relative importance in shaping your life moving forward.

Will you use the information for the same old purposes? Or new uses and applications? Challenge your life assumptions and consider alternate possibilities. All too often, people dismiss alternate ways of completing a task or attaining a goal in life.

What exactly is this information or data? Data is everywhere. Data is the information our brain processes. Our brain is continuously processing information. We smell, we breathe-in, we look at. Examples of data processed are noises, images, visceral feelings, and things we touch or smell.

Our minds pattern and process information for interpretation and experience. How we choose to interpret the data depends on how we approach the collection of the data. So, instead of reading a book. Read the book jacket and the author page first to get an even deeper, more FULL and complex understanding of the data in the book’s pages

The Criminalization🚨of Mental Illness

There are a lot of articles out there all over the internet, newspapers, and mental health forums talking about the increasing violence in the community stemming from inadequate mental health awareness, access to treatment, and laws surrounding forced treatment. Even more abundant is writing on people with severe and persistent mentally illness in the corrections system due to a fundamental misunderstanding of mentally ill needs for rehabilitation. In some cases, the mentally ill are remanded to jail without offending due to bed shortages in psychiatric hospitals. Whatever the reason people with a mental illness intersect with the courts, and/or corrections departments, the manner in which law enforcement handles and interacts with the mentally ill must change. I am talking about the police, courts, judges, lawyers, and people charged with the processing of mentally ill people suspected to have committed crimes and thus, under the auspices of criminal justice system for rehabilitation.

There is also a rising number of articles on school shootings, violence in our university system, and other unfortunate incidents rooted in again, a fundamental lack of awareness of mental health issues associated with students in general, and more importantly, the developmental and systemic underlying factors for university students to be in crisis. Most traditional college students entering college between ages 17–19 years of age have never have been diagnosed with a mental health illness in their life. However, there is an important caveat to remember here. There is no question many people go undiagnosed in high school suffering from depression, anxiety, and other serious mental health issues without treatment. These are students entering college without support services, or insight enough into their mental health to get help when they need it since they have never been in crisis before. For most students living away from home for the first time in their lives or just attending college in their own community as a commuter, research suggests the risk of having a new mental Health disorder going undiagnosed during their college years is high, especially if they were never diagnosed in high school. For students with a previous diagnosis, I recommend securing your mental health service early on and even before matriculation into college. Many treatment centers, in rural areas especially, have long wait lists for services and treatment options are far and few between in some cases.

In my case, as a student in upstate New York at Binghamton University, I already had an existing diagnosis from high school. Suffering from some anxiety and depressive symptoms I was recommended to find services in college. The irony though, and important lesson from my college experience wasn’t that my existing illness went untreated, the problem instead was the emergence of a new diagnosable condition and totally new disorder developed. I am talking about my Schizophrenia condition which in most cases for this disorder the symptoms begin to activate in early adulthood, and for most traditional college students, these are the years that people are truly at risk of becoming sick.

Like I talked about earlier, I was connected to treatment already, aware of my existing illness, and knew how to get help when I needed it. But back in 2008, when my schizophrenia became activated, I wasn’t aware of my symptoms and their impact on my behavior and perception. At the time, I was an English major applying to graduate school. I was also a very eager student to learn, connect with the professors of my classes in the English department. There is no question that I stood out among other students, if not for the large volume of time spent on campus and in the department offices, then it was for speaking with staff or walking around campus all day and into the night. As my condition developed, and I began to unravel, I was even more visible to the staff. Indeed, I was in the department offices so often and behaving so bizarrely that the department contacted the Dean and the University Ombudsman to enact a set of rules and establish boundaries between the department staff and my ongoing presence in the office.

While some staff members suggested I had a mental health problem at that time, and indeed, I was sent for an evaluation to determine if I was safe to continue as a student, but, alas, I passed the evaluation, and returned to the classroom the same day more confused than ever, and frustrated and angry with staff from suggesting there was an issue with my behavior at the time. In my eyes, at that time, I was simply trying to continue as a student after being rejected for further study in graduate school. I thought I was in uncharted territory, and I guess, in some respects, I was, because students that get rejected from graduate school are usually not already enrolled as a student in the college’s bachelors program and quite often, if they are, finish there schooling upon completion of their degree. In my case, I kept going. Applying for non-matriculated graduate courses, and other classes, to stay connected to the University and figure out a path to acceptance into a graduate program. While retrospectively, even after my recovery, my logic doesn’t seem completely irrational, it was bizarre, and extremely distressing to the staff involved at the time. Like I said though, I was already on their radar, and still didn’t get connected to the treatment I needed so desperately at the time. Instead, one day, upon entering the department office, the graduate secretary of the English Department picked up the phone and called the police. I still remember walking into that office, looking up, and seeing the secretary pick up the phone and say: “I am calling the police”. Believing I was a victim, I didn’t think the police would do anything or respond to her call. I was wrong, again, and within minutes, I was approached by the university police, who handcuffed me in the department corridor, and walked me out of the building, only to put my person in the police car and take me to the university barracks.

Very much visible and now on everyone’s radar, I found myself handcuffed to a pole in the university police barracks, crying uncontrollably, and very agitated. Now, if my illness then, its identification, or rather, misidentification, wasn’t taken seriously prior to being arrested by the department or university staff, it certainly wasn’t handled well afterwards by the police on campus. The charge was loitering, and the original document detailing the incidents summary, crime, and participants is the image above this articles title in this blog entry. It summarizes no real crime, just the mishandling of my mental health condition, and yet another missed opportunity for connecting this writer to a mental health service or intervention that could have identified my new condition before it worsened further. Instead, I was left to my own devices, feeling like a victim, and totally petrified of the staff on campus. Certainly, I was not going to go to them for help. Even If I thought I had a problem moving forward after being arrested, I wouldn’t go to staff to address it. In my case, I was left isolated, agitated, and totally without treatment, help, or an intervention by the university that could have halted the progression of my schizophrenia before full blown psychosis and state hospitalization.

On a more global level, what happens to students that are not on the campus radar? These are the students I talked about earlier, the undiagnosed high school students at risk of going without treatment in college. Are these students, too, left to their own devices if they are in crisis on campus? These are the students I fear for, the students without a voice, without support, insight into their own mental health, and without access to treatment when the time comes. Anxiety disorders from stress, depression, and in cases like mine, schizophrenia, among a catalog other conditions that college students are more at risk for and prone to due to systemic systems issues with treatment on campus and developmental organic risk for brain disease and mental illness. In my case I had a therapist, and still, my diagnosis went untreated and misidentified by school staff and my own therapist. I cannot imagine what might have happened if I didn’t have any help at all, or people observing my communication with school staff, and reporting on my behavior at department meetings. While the manner in which the department handled my situation was abysmal, it was still handled on some level. Indeed, their was some level of oversight, however clumsy, regarding the treatment of my condition by staff and my therapist in the community communicating and coordinating with the university. If I had gone without any assistance, like many students in college do, this article’s conclusion may have been different. But until colleges have adequate mental health services, and approach individuals with a mental health diagnosis, or suspected diagnosis, with dignity and respect, students will continue to be the very first victim of the society’s criminalization of mental illness.

When I returned to the Binghamton University a year later as a graduate student in social work, I visited the English department. I spoke with the department’s staff and learned the very next year, another student had a serious mental health crisis. The staff informed me that this time this particular student’s situation was handled more appropriately, and that the extreme nature of my crisis and it’s unfortunate outcome finally signaled to staff that mental health crises require a different approach than when I was spinning out. Indeed, we learn from our mistakes, at a macro level as a society and at a micro level as individuals. In the case presented here I would hazard to say mistakes were made by both the system at the university level and by individual staff involved with handling my situation in the department. There is no question events unfolding in Binghamton in 2008 and events that followed mirrors a larger fundamental problem existent in our approach to mental health systemically in the higher education system and as people that intersect the legal system as a result of their mental health diagnosis.

Be sure to also read the blog entry Contesting Admission if you like this post. Contesting Admission has been edited from its original version after my recovery from Schizophrenia for the benefit of the reader. Contesting Admission is one extended metaphor that seeks to capture the events unfolding in 2008 within the Binghamton University English Department immediately following the Graduate’s School decision not to admit this writer into the English Masters program. The paper was written while I descended into a psychotic episode, isolated, and very disconnected from reality. The new edited version of Contesting Admission allows the reader to evaluate the clinical picture & my mental status as the story progresses.

Addressing Symptoms: Stilted Language, Perseveration, Word Salad

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Anyone who knows me personally or professionally is aware of my love of language. As a person diagnosed with schizophrenia and a lover of language, the road to recovery and symptom stabilization has been difficult and frustrating. Schizophrenia impacts the speech centers and hemispheres of the brain. I passed through several phases of speech problems, some more observable than others.

This article will focus on two common speech-related symptoms people with schizophrenia experience: 1) Stilted language, & 2) Word Salad. I will tie in my own lived experience with these symptoms and my experience treating the disorder as a clinician with experience in chronic disorders and serious and persistent mental illness.

Schizophrenia and psychosis related symptoms worsen over time. When I first began experiencing each of these symptoms I was a college student studying English and Rhetoric. Just to give a little background, I was always a bit pompous even before my schizophrenia symptoms became active. As a student studying English, I also liked to use language that was extraordinary and heightened above the common colloquial of college students and most native English speakers.

When my symptoms began to activate I was preparing for my last year at college and my brother was getting married. As the best man at his wedding, I had the honor of writing the wedding toast. Given my love of language, and already elevated vocabulary, and knowledge of rhetoric from years of study, I wrote then what I thought was a great wedding toast. But upon reflection, and the timing of the activation of my symptoms during my final year of college, I truly believe that my choice of wording and rhetoric was impacted by my symptoms.

The wedding toast is a great example of stilted language. The toast itself was written in the style of Jean-Paul Sartre. At that time, I was very much interested in literary theory and philosophy of language. I had also just finished reading Being and Nothingness and wanted to put theory into practice. The toast talked about my brother’s relationship with his then soon to be a wife and it’s evolution. I thought that their history together would be the perfect material for a toast. So, I talked about how something, that is, their relationship, evolved from nothing or the time before they knew each other. The toast followed this theme and in one great crescendo, I launched into the metaphysics of all of it, their relationship, and how this phenomenon yielded the very wedding I was toasting.

I also remember writing the toast and sitting down reviewing multiple drafts of the toast with my parents before finalizing on the version I read at their wedding. To be quite honest, every memory I have of speaking and using language after the wedding until I was finally hospitalized for full-blown psychosis was stilted and gradually more pompous, flowery, and excessive until ultimately unrecognizable and incoherent.

This is when the word salad emerged and what was a catalog of symptoms activated. By the time I was in the hospital, I couldn’t speak recognizably. Indeed, I suffered a major deficit in language and loss of it altogether as my symptoms worsened. However, the language I was using to communicate was jumbled up, to say the least. The syntax, word order, and sentencing structure of my spoken word “choice” were all over the place. In the hospital, I had a very hard time communicating with staff and even worse, my needs at the time due to these language issues.

There were other speech issues too, as I experienced many of them due to the activating psychosis. Indeed, I was experiencing perseveration and echolalia which is when a patient repeats the language of staff or people around him or her instead of communicating an original message. The worst symptom was the word salad, however, mostly because nobody knew what I was talking about on the unit. Given I have all my clinical records from the unit,

I have gone ahead over the years and reviewed the staff notes, as well as my writing, is done on the unit. I observed a trend and common degradation of language from the time I was first admitted to transferring to the state psychiatric center for unresolved psychosis. As time continued to unfold, and my length of stay increased, symptoms including word salad, and stilted language too, became more intense and more visible in the records, Similarly, my situation on the unit, condition, and prognosis worsened.

Hindsight is twenty-twenty or so the expression goes. Sure, looking back today I can identify these symptoms, chart their frequency and intensity over time, and evaluate my overall condition. But back then, all of this was new and I was working in the unknown. Many people that experience these symptoms from psychosis don’t realize they are even experiencing them. This can be due to the gradual progression and onset which is hard to self-identify in the moment and over time.

Even as a clinician, I can make mistakes in early detection with my patients and the activation of their psychosis symptoms. Certainly, in my case, these symptoms seemed very normal for a while until I was too detached from reality to understand how bad off I was in terms of remaining connected to the world around me. I was disconnected by language, above all, and perception ultimately, which only served to further complicate my capacity to relate with others in a meaningful way. To this day, my speech continues to heal, and I am being more vigilant these days about the quality and content of wording and status of my language.

(more…)

The Myth of High Functioning📊

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I hear it all the time working in Mental Health and also as a person carrying a diagnosis. It’s a term that is both misused and overused, infantilizing, and laden with ableism. The expression I am talking about is “high functioning.” Clinicians use it to categorize and label people they feel are doing well and have their diagnosis managed. These are the “worried well” to quote my friend Sabrina Johnson LMSW or the people carrying a diagnosis that also works and goes without too many day-to-day crises.

Most people do not realize that there is no such thing as high-functioning. It’s a myth. Without question, this is a misleading myth as it is dangerous to consumers labeled by it. Sure, some folks carrying a mental health diagnosis are managing just fine in their lives. But this is an entirely different phenomenon. People holding a diagnosis that is not symptomatic are “in remission.” There is no high functioning term thrown around in the DSM-5. Instead, the DSM uses the expression “in remission, partial remission, sustained remission, etc.” to describe the status of people’s active or inactive symptoms.

But somehow, somewhere along the road, clinicians and people started talking about the mentally ill and began using the term high functioning. The term, however, doesn’t carry a stable meaning. Because of the terms inherently valueless status, GAF scores from clinician to clinician will shift and take on a whole new meaning – Inaccurately and ineffectively describing a mentally ill person’s general situation. They use it to talk about their capacity to work, perform ADL’s (Activities of Daily Living), relate with others, and talk about how “well” a person is doing.

But “well” isn’t a clinical term either. So why do people continue to use the term high functioning? I suspect it is rooted in applying the DSM-4 when there was once a GAF score (Global Assessment of Functioning) to evaluate how a person manages across different living domains and how they “function” in these areas. A low score gestured to a person struggling to perform essential life functions, and a high score signaled that the consumer was managing their illness well. The GAF was not only used to score and diagnose. Government agencies and disability determinists used it to rate a person’s general prognosis and even predict if they would need government assistance. A low score might award a person carrying a diagnosis of disability payments, and a high score disqualifies them from services.

Where the myth emerged in mental health, the GAF score and its application and implementation in clinical practice were rife with inaccuracies and misuse. It was unhelpful in determining the real clinical picture of the person diagnosed. Inter-rater reliability between clinicians was low. The scores were often unreproducible from the same clinician using the scale multiple times, evaluating the same person’s health at different times with the same health status and client reporting.

When I talked with a therapist years ago, still using the GAF to evaluate my health in a treatment plan review, I would joke with the therapist and ask: “What is my GAF this time?” Since I was a clinician at the time, and I knew how ineffective and inaccurate the GAF score indeed was, I would question my therapist’s score. If I scored at a 70, I would say: “You know, I think I am really at 75”, and my therapist would clumsily go over the scale with me, and we would pick out a number that “seemed” more representative of how I was doing. But the reality of things was that this number was only a marker. Besides it being a lousy diagnostic tool, so many government agencies continued to award people much-needed services like case management and housing services for consumers.

At the crux of it, the term high functioning carries with it an assumption. The assumption that the person had the diagnosis is doing just fine. Clinicians, caregivers, family, friends use this term to justify the untimely termination of assistance and the elimination of not only benefits and but the enrollment of patients into programs to maintain their progress. Without question, the so-called high-functioning patients are left to their own devices when they have reached a point in their recovery that they can be independent. With this said, many consumers fall back into the system. They become symptomatic because their programs or Medicaid or disability is cut off. They are left to navigate their lives without the help they have always been accustomed to because of their condition.

Most times, consumers cycle back into the system when they reach a certain point in their recovery and are no longer eligible for services. In many cases, chronic patients with inactive symptoms become active again and perhaps even more symptomatic when they relapse. Many patients without benefits are very much at risk of going into “free-fall” because they aren’t connected to treatment anymore and are supposedly recovered. In many cases, these are the patients that fall through the cracks of the system.

To change the system, we need to fundamentally change the language and the very meaning in clinical practice. Once the language is stabilized and more accurately used to highlight a person’s clinical picture, we can then begin to assimilate a new lexicon to talk and think about how the experts handle mental health treatment and people with a vested interest in a loved one or family member.

Edited: Autumn Tompkins

MHBC2018

Psychreg will host the 1st Mental Health Bloggers Conference (MHBC 2018) in London on 15th December 2018 – and as part of the event we will also recognise mental health bloggers for their contributions to increase understanding of mental health issues, and provide support to those that live with them.

Nominations for the 2018 Psychreg Mental Health Blog Awards are now open. Nominations are only open for individuals i.e., we will not accept nominations for platforms which are managed by more than one person e.g., charities, businesses, and organisations.

There are three categories for the award:

• Blog Category – Blog whose content is created and managed under a blog name and for the purposes of that blog alone. The blog should managed by a single person.

• Social Media Category – Social media accounts (Twitter, Facebook, and Instagram) which are updated on a daily basis and used for the promotion of mental health. The social media should be managed by a single person.

• Vlogger Category – Vlogger on YouTube, Dailymotion, Vimeo, etc. The vlog should be managed by a single person.

You can send your nominations through this link – and you can nominate for yourself.

Once we receive all the nominations, Psychreg readers will have the opportunity to vote in an online poll for who they believe should be named this year’s winner of Psychreg Mental Health Blog Awards.

The five finalists for each category will be decided from the result of the online voting. Judges will then work together to discuss this year’s finalists and decide a winner for each category based on achievement, quality, and influence of each finalist.

Important dates:

• Deadline for nominations: Friday, 15 September 2018, 12 midnight (GMT)

• Online voting will run from 16 September–16 November

• Announcement of finalists: Monday, 03 December 2018

• Awards day: Saturday. 15 December 2018

Repositioning symptomatology for mental health conditions post DSM-5

In the throes of madness, I have found some form of peace to hold on to like an anchor while discovering my innermost serenity. Only at the very end of my tormented nights was I unable to identify a technique to self-manage the chaos around me. At that point, I would not suggest self-managing the dysfunction around you; instead, I would recommend finding a safe space, a hospital or other service, that can help you sort out the extreme distress you are experiencing. This presentation is intended to arm readers with the tools necessary to self-manage their own frustration tolerance throttle. In plain English, this article will help people regulate their thinking and feelings while tuning into his or her own mental status and internal barometer for healthy living. Consumers should feel empowered to always live peacefully and independently, regardless of their chosen path to serenity and peace, even when the world before it becomes too chaotic to live without medical or psychiatric intervention.

Background

There are a few additional caveats to remember. The first, when dealing with the interpersonal world, no level of calmness and serenity can prepare you for what someone will throw at you when they are in crisis and mishandling a situation. In cases like this, you may not have to dig deep into your psychological profile to unhinge your frustration; but instead, you can remind yourself that other people’s problems are their own. Feeling or thinking for them will only make their jobs more complicated and difficult to manage independently without you in the future. The second and last caveat: Sometimes you should be, or need to be, anxious. Our anxieties are signals that tell us we need to make changes in our lives. If you can’t locate the deep-seated issue, and you know something has to give, sometimes just going ahead without digging too deep into your subconscious or psychological wellspring might provide you with a fast and very much needed change to feel better in the next few moments. The most ornate and complex set and manifestations of symptoms exist in the schizophrenia and related psychosis family of mental health diagnoses.

Schizophrenia has both positive and negative symptoms. The symptoms are labelled differently to address and explain the experience of the symptomatic person. To identify which is a negative and which is a positive symptom, differentiate between an added feature to your presentation or an internal sensation or belief at work in your thought process. One example is thought broadcasting. This is a positive symptom in which a person believes his or her own personal thoughts are available to other people seemingly anywhere in the world. It differs from telepathy in that these thoughts are not transmissions per se but a vast web of shared knowledge amongst the people listening or accessing the information being broadcasted.

Without a lot of clinical jargon, this post targets reducing the impact of a specific symptom common to mental health issues: paranoia. Paranoia is disabling. It limits us by cutting off our world and making us feel too uncomfortable to explore and live our lives without fear. There is no reason to live with paranoia. Paranoia is fear, and fear stops us from celebrating every moment of our existence. So, how do we stop it? Eliminate it? The most important place to begin is with assessing what you are afraid of and categorizing it into three domains of fear. The categories include: 1) letting our small critical thoughts snowball into major fears; 2) eclipsing hopes and limiting our future-oriented thinking; 3) combining our fears or apocalyptic projections.

We are critical because we care. We want to manage our lives effectively and precisely. But these small critical thoughts can snowball into major crippling fears that stop us from getting out of bed or being social and making new friends. Why let that happen? Check in with yourself. Self-monitor and find an internal balance with your thoughts. Ever look forward to something? Future-oriented thinking keeps us motivated and happy about time elapsing, or in plain language, experiencing every moment of every day. Paranoia stops us from experiencing our days because we become so pained that we stop and detach; we do anything to stop the internal fear from strangling other aspects of our lives. The worst thing you can do to make paranoia worse is to combine fears. A hurricane is bad news, but flooding due to high winds and high water is even worse. See what I mean? Don’t do it!

First episode psychosis, delusional symptoms, and thought disorders

Delusions put the crazy in madness and mental health disorders. This means, simply, when we think he or she is “out there” and “nuts”, we are referring to the delusional systems within a person’s larger set of symptoms. Delusions carve out the imaginary and marry it with our orientation in various ways that complicate and distort our reality and sense of self. When we say someone is delusional, clinically we mean someone’s ideas and the beliefs they hold about their world are more than just unusual, they are a departure from reality: what is happening internally isn’t congruent with the external world. Usually, with most mental health disorders featuring psychosis, delusions are more abundant than one isolated, disordered thought. Delusional systems are either fixed or solvent. This means that no matter how a person’s recovery progresses and how much the external world changes, the delusion persists. This post targets how delusional systems are born and evolve in the person experiencing an altered realty and what the implications are for practice and treatment.

When a delusional system is born, it isn’t yet complex. In fact, it may be as simple and benign as a newly formed idea or routinely repeated habit executed internally by a person trying to complete their ADL’s or go to school or work. For example, a person might be cleaning wax from their ears when a switch flips in the brain and slowly, seemingly organically, the thought transforms. Suddenly, and conversely over time, the person cleaning the ear is no longer purposefully removing wax, he or she is doing something much different and likely more malignant in design than when the idea was first executed by the brain. In my own experience, when I first experienced the birth of a delusion it was my relationship status with a friend and, ultimately, my marital status. At one moment I knew myself as single, then over time and yet suddenly, I knew of myself as married with a kid on its way, depending on the health of my friend’s womb and a piece of fruit on my windowsill that I connected to the health of her uterus. This is an example of how one distorted thought can evolve into a complex system with both fixed and solvent features.

The manner in which a delusional system forms directly informs how it is to be devolved and taken apart by clinicians treating the person with altered realities. Since delusional systems develop over time and are realized suddenly by the person experiencing the change in their external world, the clinician must identify where and when the “break” or shift occurred and what that meant for the person experiencing the shift in reality. For example, if a person, over time, thinks there is a microchip implanted in his or her brain, the clinician must identify when the break originally occurred for the person and what it means to experience the symptom. This means, similar to performing a math equation, that charting the clinical picture’s distance from the shift in reality in terms of each aspect of their mental status (e.g. time, place, judgement, insight etc.) is the first step in unwinding the delusional system’s content and breaking fixed-thought structures into less toxic and maladjusted patterns.

I’ve experienced this symptom first hand during my final days in the community before I was hospitalized for full onset of first episode psychosis. This symptom is not so much scary as it is confusing and disorienting to experience. I was driving down a major interstate when I first heard my thoughts and believed they were being listened to by friends and family, who were hundreds of miles from me in reality. However, when experiencing the symptom first-hand, I felt as if my family could personally hear my thoughts immediately and without regard to space or time and the even the beginning of their response to my transmission if my imagination or subconscious really had a choice about things. In this sense, voices and delusions collide together to make this feature of psychosis even more difficult to experience without breaking from reality. The break is not a sharp departure in orientation but, rather, noise and interference of thoughts; the addition of these positive symptoms and the space needed to hold on to these overly complex delusional system takes time to process information effectively as it occurs. This is why very psychotic people speak slowly, and their reaction time is longer; there is so much more to process to maintain even basic life functions. So much is happening or not happening in the person’s speech and language centres in the brain that the person experiencing the symptom must sort out the overabundance of stimuli in order to stay connected to the world without getting lost in internal preoccupation.

In order to broadcast thoughts, the person transmitting must be listening. Since thought broadcasting is a symptom and not existent under normal circumstances, the person must acknowledge that it’s happening as it is happening. Thought patterns that are too involved and overly complex are even more diffused and difficult to decipher as either real or a symptom of illness. This is why, as this symptom progresses, people get increasingly lost in internal preoccupation and are unable to come out of their heads per se and spend their time just listening to or even responding to his or her internal thoughts externally or aloud. This is when you typically hear of people responding to their voices. When this happens, it becomes extremely problematic to not attract attention or appear bizarre to others. Since this also occurs late in the progression of the diagnosis, people experiencing the symptom are usually already in the hospital. Without experiencing this symptom, it is hard to believe it can happen to a person. I thought I had extra powers from a government experiment and needed to use them in order to solve the mysteries already at work from a growing delusional system. In my case I was driving. You may be walking the dog. Just be safe in any event and remember safety is first and foremost the goal when you begin experiencing something so otherworldly and yet so personal that it breaks the very conventions of time, space and communication between people subject to physics and human anatomy.

The final night I was hospitalized in the Community Hospital, I heard screaming all night long from my neighbour’s room on the unit. She was carrying on like a child. The screams resembled those of a baby’s cries. I kept pressing the button next to my bed to summon the staff, but nobody arrived until the next morning. Given the sleep deprivation and my compromised mental status, I was delirious at this point. By the time the staff from the unit was in my room addressing the situation, I was feeling so nauseous from the noise all night that I leaned over and vomited on the social worker and lunged towards the psychiatrist for help. I was immediately placed in the Quiet Room to be monitored and assessed for safety every 15 minutes until I was stabilised. About an hour later, the doctor came into my room and advised me that I would be transferred to another hospital and that I would be staying there for a very long time. We all have limitations. Some of them are more visible to the naked eye; others are more covert and hidden away from the public but still an internal struggle we battle every day. As a therapist, I have the opportunity to listen to other practitioners talk about their patients and their ideas on how to help them in their treatment.

Sometimes my head spins from the ideas circulated around the table; hopefully, now it will be clearer to practitioners what treatment fit means in the context of supporting people in their healing with functional impairments. Mania can seem like the best high in the world and must be undersold as an affective state impairment in functioning. Mania is all intoxicating. Mania can make you believe and buy into fantasies of all shapes, sizes and forms. During a manic episode, you can transcend historical points of reference and religious symbolism/iconography prescribed by your belief system and find yourself incorporated into it despite anachronistic markers, which should signal there is a problem with your perception. In this case, mania will, in fact, create a new reality, if only for the moment, and shift your guidance system into a space that will seem like anything is plausible when there is something very wrong with your affective regulation. I have experienced first-hand manic episodes in which I have been awake for weeks at a time without sleeping or 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 just to find out their bodies would later feel the shock of these poorly planned acrobatic theatrics. With certain 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 further complicates a person’s insight into and judgment of their symptoms. For most generic mood disorders, extreme euphoria, decreased need for sleep, hyper-sexual arousal, and religious ideation are the usual suspects when manic symptoms present. Should these symptoms activate in a subclinical or mostly unproblematic manner in your life, you may be working with hypomania.

In terms of self-management and self-regulation, there are several options for reducing the harmfulness of a manic episode on your interpersonal life and your capacity to execute activities of daily living without incident. These strategies are dependent on the manner in which mania was activated and how severe your symptoms are. Stimulant and drug-induced mania is just as dangerous as organically driven manic episodes. Considering substance abuse treatment for cases like this will be an important step in managing your symptoms for the long haul. Like most people, even minor stimulant use from caffeine can trigger an episode. Living a chemical free lifestyle isn’t for everyone, but it can provide a baseline, at least temporarily, with which to gauge further consumption of foods and beverages that might trigger an episode. For non-chemically induced episodes, internal and external barometers are essential for knowing your affective state baseline. Listen to your friends and colleagues. Maybe there have been recent complaints about your behaviour. Or maybe you feel like it’s hard to maintain a balanced mood. Begin to create markers in your living environment and for your internal g There will be times when you have to live with unresolved symptoms. However, creating a plan for friends and family will greatly reduce the risk of potential harm from an episode. This means making friends and family aware of your symptoms and triggers so they can help you avoid the ups and downs of mood dysregulation and even help you make decisions if your judgment and insight are too impaired for rational decision making. I send emails to friends and family when I feel like my moods may be impaired or have impaired my decisions or, in the future, might harm others. Preparedness and attention to details are always essential when managing an illness. Surround yourself with supportive people and allies in your recovery. You should never feel embarrassed by your behaviour, but you always need to accept responsibility for it. That’s how recovery works: acknowledging that change is necessary and moving forward in the process of adapting our behaviour until it serves our purposes

Personality disorders, interpersonal distress and identity issues

Previous research suggests that the gathering of “grandiosity and defensiveness” in people typically carrying this diagnosis creates complications for people undergoing treatment with psychotherapy. I am now suggesting a new approach that realizes these so-called symptoms for narcissistic personality disorder (NPD) and understands them as strengths for therapists to capitalize upon for treatment of the disorder. Firstly, it must be said that, by and large, people don’t come in through the therapy office door requesting treatment for their NPD. NPD can contribute to other diagnoses as well as psychosocial and psychological problems for patients to manage on their own without treatment. For example, typically NPD patients present with depression or related anxiety because of various symptoms and unmet needs, which drive these patients into treatment.

Based on this assumption, I would hazard to say that the primary focus of psychotherapy should not be on treating the NPD symptom but, instead, on its manifestation in other psychiatric and psychological problems, such as depression, anxiety, and other affective state regulators which become corrupted when the NPD symptom becomes active. Thus, instead of reinventing the wheel in psychotherapy, practitioners can focus on treating the real problem with the same sophistication as any other disorder that fits the treatment approach. This can be done in group therapy, which has proven to be helpful for clients to gain the reflective lens necessary to cultivate personal insight into their interpersonal landscapes. With the exception of “lacking empathy”, most, if not all, of the so-called indicators for NPD can be mobilized into strengths for consumers of NPD treatment. I will use the example of grandiosity and requiring excessive admiration from others to illustrate how this “deficit” can be flipped into a strength, even an asset, to the person carrying this label.

In a previous article, I talked about a concept I term “Too Big to Fail”. In short, this means it is in the interest of people carrying a diagnosis to mobilize all of their resources and support to meet their day-to-day challenges and reduce the likelihood of their opportunities coming up short of their expectations and hopes. Simply put, there is never a reason not to be fully prepared for the day’s endeavours and to be ready for anything. In a world where the unlikely is possible and there is no definite, I can fully understand why people carrying this diagnosis are labelled as grandiose, when it is really about being mindful and articulate about your needs as a consumer and what it will take for you to be successful in life. Finally, it is not the therapist’s role to teach empathy unless that is the stuck point in the work that is keeping someone from realizing a missed opportunity for insight. Empathy, however, can be reframed and posited as a skill or technique for people to learn in psychotherapy to barter for their own goals without walking over the needs of others in his or her life. Through bartering, people carrying this diagnosis will be less inclined to feel envious because they are participating in a system that leaves room for greater currency and a greater exchange of ideas. Instead of placing limitations and teaching restraint, people with this diagnosis are taught to reach for the upper limits of their personal success.

The intersectionality of functionality and ableism within mental health

Depending on the functional impairment or limitation in completing self-directed tasks to maintain a standard of living and quality of life, certain practitioners put together plans to address the interfering symptoms. I am suggesting that, depending on the goals of the individual, the interfering symptoms should not be the focus of treatment in people carrying a diagnosis; instead, we need to be focusing on strengthening the weak points in functioning, regardless of the particular symptoms blocking the person’s ability to maintain their desired quality of living. Interfering or unresolved symptoms can be treated, but they certainly should not be the focus of treatment. Some people never experience relief from their symptoms due to extreme chronicity and untreatable impairments. Not every symptom is rooted in a diagnosis. Sometimes, flaws in our personalities govern the expression of our limitations. We need to refocus treatment to target and identify the weak points in a person’s functioning, whatever the symptoms are that block abilities and create impairments. I have seen first-hand clinicians and peers dwelling on unresolved and chronic symptoms as if strengthening a person’s weaknesses in functioning wouldn’t help them move forward in their healing.

Conclusion

Let’s be completely honest about healing. We can address our impairments, but sometimes the wounds don’t close and the scars don’t fade. They need daily, ongoing care. Like the emphysema patient on oxygen, sometimes daily maintenance and care is the only way to keep moving on in your healing and recovery. Being honest with yourself about your mental and physical status will go much further than waiting for the miracle cure or, even worse, ignoring the problem because it’s unmanageable. Well, if good health means healing, then feeling better will require us to have better self-management skills, moving forward. It isn’t the problem that is the important thing to always focus on resolving, it’s the solution. Accepting the solution for what it’s worth will require you to always sharpen your self-management skills to live the quality of life you want and choose for yourself. I have always been a guru when it comes to relaxation and recreation. It seems to be a special talent of mine to be able to find nothing to do when the world was lighting up with opportunities for me to insert myself and begin, when all I really was interested in doing was sitting down to a glass of iced tea and the newspaper. I’m sure my co-workers can vouch for this personal phenomenon and would endorse me for this do-nothing talent.

Ultimately, however, doing nothing is often what is required of people to remain goal-oriented and engaged in their lives. Conversely, sometimes a situation calls upon people to “right the ship” and be more authoritative and directive in their approach to self-managing their lives and particular situations. I suggest starting here to locate your internal barometer. This is a little more involved then tuning into your gut and doing what feels right. During a looming personal crisis, tuning in to your feelings is only the beginning. If a situation needs fixing, it should capture more than just your feelings on the subject. There should be some ethical or, at the very least, problem of energy flow, and the mechanics involved to complete the task should be jeopardized or require retooling for future projects. My point is, your “feeling” world and your “rationality” need to be interlinked if you are to truly tune into your moment and decipher or filter out a better way ahead. This is true for most situations, not just work projects or tasks you are involved with that require your attention and focus to complete without incident. Therefore, when managing agitation, be prepared to look at your entire situation before coming up with a new plan.

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Tag: Self Help

Continuing Education 🔄

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Tag: Self Help

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We all have impairments, limitations, and restrictions. However, choosing to live ‘fully alive’ in the face of our so-called deficits is critical to feeling happy, fulfilled, and complete.

For most of us, the task ahead is how to think outside of our flaws and experience the world fully alive.

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