15 questions to ask your doc when diagnosed with a mental illness

Part of my life before I earned my PhD involved serving as a health educator in North Carolina. Armed with a master’s degree and a fancy certification, I helped people learn ways to communicate with their providers about what they could expect following diagnosis with a chronic disease. For example, it is common to develop “checklists” of questions that are important for patients to ask their providers when they discuss a diagnosis.

A good practice for your healthcare visit is to bring a notepad and a pen or pencil with you so you can take notes as needed. (Note: This practice is especially helpful in the age of COVID-19, when we can’t bring others into the office with us.) I also recommend that you bring a list of questions with you. It’s common during provider visits to forget what we want to ask or to feel overwhelmed and anxious when trying to process what the provider tells you. If you are diagnosed with a new condition or given more information about one you are already living with, you will want critical information about your condition and how it will impact your life. There are some “standard” questions you should ask, and sometimes it can be difficult to recall those questions in the heat of the moment.

Unsatisfied with other checklists I’ve seen, I developed my own for mental illness. Take what you like from it and add your own to come up with a checklist that works for you!

  • What condition do I have, and are there subtypes of this disease? If so, which subtype do you believe I have? Sometimes your doctor may diagnose you with a given type of your disease or leave that descriptor unspecified, based on your symptoms. For example, there are different types of bipolar disorder, characterized by the nature of the manias and depressions the sufferers experience. Further, “anxiety” isn’t a one-size-fits-all diagnosis. There are many types, like OCD, PTSD, and panic disorder.
  • What made you come to this conclusion? (How do we know?)
  • What (symptoms or outcomes) can I expect while living with this disease? (What is this disease like? What do people with my condition go through or experience? Might it impact my lifespan?)
  • What might have caused my condition? (Remember that disease does not develop in a vacuum. There are genetic, biological, environmental, behavioral, and/or social etiological factors.)
  • How rare is my condition?
  • Is this condition chronic? Will I be handling it for the rest of my life, or is it something that will go away with careful adherence to treatment? If the latter, how long does it usually take to go away?
  • What will I need to do to control my symptoms? (Lifestyle changes may be necessary to help minimize your distress. For example, some people benefit from yoga or meditation. You may also need psychotherapy or medication.)
  • If medication is recommended, how do I take it (day? night? with a meal?)? What happens if I don’t take my meds? What happens if I take too much?
  • What are the different treatment options that are available to me? (Note that this question reaches beyond simply, “What meds do I have to take?”) What is the gold standard treatment? Are any homeopathic treatments recommended? What do we know and not know about this medication or practice?
  • What side effects can I expect from my medicine? How do I know if they are problematic or to be expected? Will they go away over time?
  • What can I reasonably expect from my treatment? (Will my condition go into remission? It is also important to know what the effects on your body will be over time. Having this information could help you mitigate/reduce your risk. You may also want to know what percent of people benefit from treatment. Sometimes there is no magical solution for everyone, and it takes a little trial and error.)
  • Is there anything I should NOT do with my condition? (Examples may include drinking alcohol, staying up all night, exposing yourself to stress, taking aspirin or NSAIDs like Advil or Aleve, and being sedentary.)
  • Are you the right person to handle my treatment? [Don’t be afraid to ask doctors whether they are the best fit–and make that judgment yourself, too! Sometimes, generalists (internists, family medicine doctors) will be more comfortable referring you to a psychiatrist, and even some psychiatrists may recommend you see someone else who specializes in treating your specific condition.]
  • What are my next steps? (You should leave your doctor’s office with an explicit plan for what you need to do next to care for your condition.)
  • How regularly will I need to engage with you?

Never be afraid to ask questions of your provider. After all, we’re talking about your health, which is one of the most precious commodities you have! Also, do not be afraid to get a second opinion before you settle on a treatment plan, especially if you are uncomfortable or uncertain about the diagnosis you were given.

I hope this list is useful to you as you talk to your providers. Take what is useful to you and forget that which is not. This list is simply one more tool you have in your arsenal for fighting mental illness. I wish you the best in your journey. 

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Writing While Depressed

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I’m not a clinician, and this post is based solely on personal experiences.

Sometimes depression is about more than simply being “down.” Sometimes it means nothing has meaning for you anymore. As a writer, it can be especially frustrating because thoughts are jumbled and words don’t come. You have a deadline, but all you want to do is sleep. Or, you are so distracted by other things or unable to maintain your focus to sit down and bang it out. Dreams and expectations go flying out the window. The more pressure you put on yourself, the worse you feel.

For me, when I get this way, I’m like, screw it. I just want either to scrap my work or query it to get it off my desk. It’s “good enough.” But no, the sentences are choppy and mundane. I can’t paint a picture of what I envision my characters doing, or of their surroundings, because the words aren’t beautiful in the least. Or maybe they are, and I just don’t notice because I’m unfocused and concerned with how terrible I am as a writer.

Depression sucks, and it often requires treatment. If you are feeling so down you can’t function, or if you have any thoughts about hurting yourself, it’s imperative you call 911 or talk to someone in your life who can help you get care. [It especially sucks because psychiatrists often have 3-month+ waiting lists for getting into treatment. Try going to your general practitioner/internist, etc. in the interim. They may be able to give you something to tide you over and make a referral so you don’t have to wait as long to see the psychiatrist. — Topic for a different post!]

Here are some ideas to try when your depression gets in the way of your writing.

  1. Challenge (don’t force) yourself to sit down with your writing, even if just for a few minutes. Set a timer for 30 minutes. You can do anything for 30 minutes! If that feels like too much, try 10 or 15 minutes. Try to focus, and give yourself an opportunity to put some words down on paper.
  2. Don’t worry if they’re not the best words. Sometimes our beautiful, flowery language just isn’t going to happen when our brains are muddled with depression. Focus on getting something down on paper. Even if you have to draw arrows and boxes on paper to help yourself see the story, this exercise is useful because it helps get your thoughts out of your head and into the world.
  3. Accept that you are going to have to edit your work to get it where you want it. We all have to edit anyway. Give yourself room to be imperfect. Just upchuck the story for now!
  4. If sentences don’t come, write sentiments. Write key words and phrases. Write ideas. If even those won’t come, write what you feel when you think about your plot or your characters. Just write something.
  5. Don’t scrap anything. Use Track Changes, or save your new work as a new version of the document. Your judgment isn’t the greatest when you’re depressed, and sometimes it’s difficult to know what “good” is. Keep everything and make that decision when you are feeling more stable.
  6. Have faith in yourself. You will pull through this time by being gentle with yourself. Don’t force things. And if you really can’t do it at that time, give yourself a break. Go for a walk. Take a nap. Meditate. Talk to a friend. Go easy on yourself and know you haven’t failed. Knowing that you tried and couldn’t do it at this time means you didn’t fail. There will be many other times. Baby steps.

Remember: Depression lies. It tells you you’re not good enough. Not smart enough. Incapable. Don’t listen! You’re worth much more than that. See the lies for what they are and refuse to give into them. Sometimes just labeling the lies as lies can help beat depression.

For me, when I feel this way, nothing is ever good enough. I want to rip up my story. I try to seek external validation for something I know (in my rational mind under a normal mood) is already awfully damn good. It helps to know my mind is just playing tricks on me. It doesn’t make waddling through the mire any easier, but it does help me keep my head straight about there being nothing wrong with me or my writing.

And by the way, writing can be a form of therapy. It makes some of us feel stronger, better.

What are your experiences with this phenomenon? Feel free to leave comments below.

Best wishes in light and creativity,

Jaimie


Copyright (2020) Jaimie C. Hunter

Updates on Imagined Chaos

HAVE YOU HEARD?

> ImaginedChaos.com is now ALSO JaimieHunter.com. I made this change because I wanted to brand myself better as a writer and expert in Public Health. Queries to imaginedchaos.com automatically forward to jaimiehunter.com.

> I have a new newsletter! Whereas the blog sign-up allows you to receive blog posts directly to your inbox, the newsletter sign-up will allow you to receive updates, exclusive content, giveaways, tips and tricks, etc. that do not get posted to the website. If you signed up for the Blog, you will still need to sign up for the Newsletter if you wish to receive this content!

To sign up for the newsletter:
https://jaimiehunter.com/newsletter/

> Thank you for your support and positive feedback on The Seventh Light. I will be querying it soon. Wish me luck.

> Expect to see more posts like The Vampire’s Guide to Online Dating. I may pick that story up again soon, but in the interim I have other works in progress to share. Thank you for your support on that one, too.

I’m glad you’re here! Reach out anytime. I updated the Contact page.

Thanks! Stay safe, and happy writing!

Jaimie

Perfection: Being “The Best”

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Why is it so hard to accept our humanity sometimes?

For me, anything less than the best is bottom-of-the-barrel. “I almost did it” will never be as good as “I did it,” even if I learned incredible lessons and thoroughly enjoyed the journey.

Life is not black or white, good or bad, all or nothing.

I’m not perfect in all the things I do. I just gained 14 pounds. I rarely go to church. I’m not the world’s best writer, though I am good at being vulnerable. I suck at relationships. I’ve come in 2nd place twice on really important academic job searches.

I was an average student in my PhD coursework. (That sounds like I’m whining. I realize just being in the PhD program in the first place makes me pretty stellar.) I got into $200K worth of debt because I wanted to be called “Doctor.” Okay, there was A LOT more to it than that, but sometimes it seems that way. Especially when my degree is not marketable outside academia.

I had a house before I went back to school. I had to sell it when I didn’t know where I’d find a faculty position. It was a modest home, very nicely decorated and lovely on the outside. I always dreamed I’d have one of THOSE homes, though. The ones you see on the hill overlooking the lake. Or maybe they’re on a golf course. You get the idea.

Unattainable perfection. I learned to be happy with what I have. Jealousy only kills the spirit. I think this drive for perfection comes from an esoteric conflict between my humanity (the path I’m on now) and my spiritual downfall (would they call that greed?).

Maybe I’m trying to be something I’m not.

I wrecked my finances this way!

I can’t wait to publish my debut novel, THE SEVENTH LIGHT, which I am hoping to start querying next week. One of the agents to whom I want to submit accepted 1 out of 527 manuscripts in April. That’s intimidating as hell. I worry again about being second place. (Or third. Or two-hundredth.)

And yes, second place is really good, but it won’t allow me to use the word “Author” after my name. (OK, I already use it because I have a broad array of academic publications–from book chapters to journal articles to policy briefs–but I want literary credentials, too, dammit!)

I am tired of being average, second place, but maybe the Universe feels I still haven’t learned my lesson. Maybe it really is about the journey and not the end result. Maybe we are all supposed to be learning to accept things that are different from “the best,” but actually suit us and our needs even better.

And as I write these paragraphs, I’m thinking, wow, that sounds so cliche, like what we tell people who are runners up! Is “learning along the journey” just a consolation prize?

No. It’s the whole point of living. Not all of us get something we are “best” at doing.

There are other times when “be better” comes to mind. That comes with time. I submitted a poem for publication last night that I really thought was sheer perfection at the time I wrote it. However, picking it up 6 months after having written it showed even it needed some tweaking. I am impatient. I want to “be better” NOW.

And I want to be the best on my own terms, in my own unique style. If you ever read Young Adult fiction, Fallen, by Lauren Kate, is one of the best out there (in my opinion). Maybe that’s why it got picked up by Random House. I wonder where the beautiful prose comes from, what inspired her tone and voice and imagery. Mine’s pretty good, but hers is better.

Comparison is the mother of all misery. We shouldn’t compare, right? Except everyone else does. When I query this book, my letter will compare my book to Fallen because of its beautiful writing and intriguing plot, which no doubt are responsible for its commercial success. Will Seventh Light measure up? (Query letters have to compare stuff. If you don’t compare, others will do it for you.)

So, the pursuit of perfection is maddening. Perfection means, in part, being “the best.” It is a superlative and by necessity compares you to other people. As an adult, I would much rather be myself and be pretty damn good than try to outdo the others around me. But there remains that nagging part of my brain that goes, “I want to achieve what she has.”

I’ve actually achieved a lot. In my way. On my terms. Maybe someday, others will compare themselves to me.

. . . And then I think, what arrogance.

On the Loss of a Friend

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Who knew you could grieve the loss of a friend so acutely?

Apparently, everyone but me. You can grieve that loss. It’s unavoidable when you part ways with someone you love, and that very distinctly includes your friends.

“They” say we process grief in five stages: denial, anger, bargaining, depression, and acceptance. I really hate pop psychology. I don’t at all see myself following these stages, and honestly, I think that’s okay. I have kind of a massive, rapid-fire experience of many of the symptoms at once. It’s torturous. Still, we all grieve differently.

Am I fooling myself? I’d like to think my current experiences shouldn’t really fall under the classification of “grief,” instead representing the amorphous byproduct of severely stung feelings. I’d further like to pretend it’s somehow my own fault. Like many of you, I’m sure, I have a bad habit of gaslighting myself.

I’m sad, I’m angry, I’m hurting . . . maybe it’s grief? But surely, it’s some alien form of grief that no one has ever described and categorized before now. Actually, I think it’s just my original brand. For me, all of these feelings are coming at once. Except bargaining, perhaps because I have been doing it for months, begging for friendship on my terms, to no avail. I still have to grieve the good aspects of our relationship, and I’m uncertain whether I can escape these seemingly predestined stages.

Losing someone to separation rather than death results in a unique kind of anguish that really can’t be adequately described. I think I lost them before my conscious mind realized I had lost them. They had pulled away long before I did. I should have realized it, but I was in denial; I ignored my inner panic button and refused to see the signs. When the loss had become clear, I tried begging, bargaining, and compromising myself in a last-ditch effort to become what they needed. That is never a good idea, because you will lose them anyway. And if you’ve given yourself away in the process, you literally have nothing left to fight for.

The pain of great loss is compounded by cruelty. There’s (1) a bottom layer of devastation from losing someone you loved, and (2) a top layer of unadulterated rage both at them for victimizing you and at yourself for “allowing” yourself to be victimized. How could they be so mean? Do they treat everyone this way? Why did you not cut the cord after the first ten times? This adamantine rage will tear you apart from the inside out, starting with your heart. It is natural, but it is not worth it.

So, I let go. And I feel great for a few days because they are out of my life, and the pain dissipates, flooding me with intoxicating empowerment and almost manic joy.

But I am still grieving. I am human, and I can’t hold it in forever. When it erupts at last—be it days, weeks, or even months later—I will have to learn to cope with it. I don’t want to see them anymore. I don’t want them to call or text, or even to send me a message on social media. Leave me alone.

Depression lurks, according to myriad pop psychology expertise. But I can’t afford to grapple with depression. I have enough going on in my life that I don’t need to be trapped in its clutches. Seriously. I can handle sadness, sure. I realize I may not get the same pleasure out of doing the things we used to do together. Fine. But I cannot and will not allow myself to be depressed.

Still, I allow myself to feel the deep, soul-level sadness. This was someone I loved. My indulgence is perhaps superficial at first, though after my toes are wet, I wade in a bit further. I afford very few, specially chosen people the opportunity to know how I feel, how savagely the pain gnaws at my gut.

Meditation helps, but the activity that makes the biggest difference for me is running. As my shoes pound the pavement, I focus on my music and forget all about the pain, the betrayal that happened at my former friend’s calloused hands. I pound away grief. I sweat out all the anger. Somehow, the underlying grief does not dissipate.

No. Nothing I can do will command grief to go away. It has to run its course. That takes time. In the interim, I have to act like an ordinary human being. I have to go about my business like nothing was wrong. I prefer to think of myself as extraordinary.

Forgiveness? Maybe someday. Not today.

The Courage to Roar

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I have a theory about the way the world works: we all experience some form of imposter syndrome at some point during our lives. That is, there comes a time when each of us questions our own legitimacy, owing to an overwhelming perception of ourselves as fraudulent or less than capable in the face of increasing expectations and a higher level of accountability. Imposter syndrome is often associated with the experiences of young adults who, emerging from the carefully controlled confines of academia, begin to question their own skills and judgment in the real world. I would argue, however, that life finds each of us in this uncomfortable position at least once, and it is usually time-dependent and contextual. For instance, friends who have recently become parents tell me that all the book-reading, babysitting, and planning in the world could not adequately have prepared them for this latest leg of their journey. Some of them even admitted to feeling an overwhelming sense of fraudulence (“I’m not really an adult”) or not being capable of “parenting properly” despite their extensive preparation.

Here’s an example from my own experience. While earning my doctoral degree, I had an overwhelming sense of fraudulence, as if the program administrators hadn’t yet figured out that I just didn’t belong. At some point, they granted me my Ph.D., though it took me a while to realize I deserved it. Even after six years of successful training and a whole lot of blood, sweat, and tears, sometimes I feel doubt has become my permanent residence in my new academic position. Who am I to speak up, to try to contribute to a project or venture when everyone else has so much more experience? I’m just not “there yet,” right? I’d better keep my mouth shut!

And the weird thing is, these feelings are contextual. I have no problem speaking my mind or employing my considerable skills in “real life.” It’s only in the vocational arena that I feel so woefully unequipped and inadequate.

This sense of inferiority—in my experience, that’s the exact essence of it—is associated with anxiety, self-criticism, and feelings of depression. Moreover, self-suppression impedes our own growth and actualization, and it may even hurt our career because, when we tell people that we are a certain way (meek and unequipped), over time they begin to believe us.

My theory, however, is that we each are granted a moment that signifies we have arrived, that some notable milestone has been reached and our journey is valid, even if it is still burgeoning. In this moment, we emit a fledgling roar as a slow pearl of realization settles in our gut: we are legitimate. We are the real thing. We are intelligent, insightful, and skilled. We matter.

My moment was simplistic, and it came one sunny afternoon when my precocious three-year-old niece referred to me by my title.

“Who said you could have the last Oreo cookie?” my mother had asked her, furrowing her brow because she had earlier imposed a restriction on sugary indulgences for the day.

“The doctor did,” Kaydence responded matter-of-factly, not even cracking a grin as she enjoyed the treat I had surreptitiously slid to her.

My heart leapt at that little spark of recognition. Somehow, hearing that I am “the doctor” from my niece was more meaningful and validating to me than hearing it from my colleagues. After all, when a kid declares you official, you’re official. Did her one casual reference resolve my work-related feelings of inferiority and fraudulence? No, of course not. But it let me know that what I had achieved in my doctoral program was real and that I have a shiny, new, legitimate title now. That gave me the courage to keep trying. Something inside me roared.

Earning a Ph.D. is difficult. With mountains of readings, papers, statistical code, and comprehensive exams—and that doesn’t even include your life-encompassing dissertation—it can force even the strongest person to her knees. I’ve been told, though, that earning it from the second highest-ranked institution in the United States while suffering from type I bipolar disorder is damned near impossible. I did it, though. How I did it is beyond me. I wish I could say I adroitly channeled my inner badass into an almost military command of the program, all while wearing Louboutins and Chanel lipstick in Star Red. Honestly, though, I just dragged myself by my sweaty collar over each hurdle, bloodied and battered by the journey but fortified by my family’s love and a stubborn sense of determination. Okay, so there might have been some Chanel lipstick, too. All things are possible with Chanel lipstick.

We all have that sense of determination stirring inside us. Life challenges us to tap into it with conviction and take it out for a spin.

Rather than an exercise in frustration dominated by the Imposter, let’s allow life to be about recovering our voices, finding our truths, digging deep within ourselves, and transcending our challenges. It should be about living out loud, being real, and opening ourselves to experiencing the universe around us.

Life is about finding the courage to roar.

On Love and Mania

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One of the most heartbreaking things about living with bipolar disorder is not knowing whether what you are experiencing in a romantic relationship is truly love, versus a manifestation of mania. Both feel euphoric, like a great whoosh of wind has picked you up and tossed you around playfully in its embrace. Both are precarious, and both can leave you shattered.

I realize many people have written about love and mania (and how to tell the difference between the two). Most of them are far more qualified than I to write about the clinical manifestations of each. Here, I offer a personal and, I hope, balanced perspective based on my own experiences with each.

In perhaps their most (in)famous song, my beloved Def Leppard declare, “Love is like a bomb.” It kind-of is, right? Its explosion upsets your world because, all of a sudden, it’s not just about you anymore:

What are WE doing this weekend? WE really need to explore this city when we’re able. I don’t like the way this new highway system affects US; it makes it more difficult, not easier, to get to each other.

Love is like a bomb and should be incorporated into your worldview in a way that leaves you empowered, not shattered. If you find yourself bleeding from picking up shards, it isn’t love. The people who love us reinforce our strengths and offer positive complements to our weaknesses. What I can’t do, you can do. What you can’t do alone, we do together. Our love doesn’t care whether we are complete dorks or mean girls; we can be free to be ourselves expressively and with power. You feel good. You feel strong. You are confident in your feelings because you know they are returned.

But love can become an obsession when we allow the other person to take up residence in our minds, dominating our waking thoughts, nightly dreams, and everything in between. Obsessiveness becomes a special concern for people living with mania. We become addicted to the euphoria that is love and don’t ever want to let go. We may even find ourselves ending other valued relationships, slacking off on the job, or doing other things to harm ourselves socially so we can elevate the person we love.

If you find yourself doing these things and you have bipolar disorder, you might be manic. This is especially true if you also feel “sped up,” have racing thoughts, or are acting impulsively.

Let’s talk about mania for a moment. Super quick review.

Mania is characterized by feelings of euphoria and irritability. You become extremely impulsive and may act without thinking something through. In my experience, you can be quite single-minded. That’s a GOOD thing for getting work done, because you are task-oriented and driven. That being said, there’s also a flight-of-fancy aspect to your behavior, where you may find yourself distracted by normally mundane things that suddenly become vastly fascinating. You think quickly (“rapid thoughts”) and may start to feel super paranoid (“my friends are trying to ruin my relationship”). That obsessive focus on your partner could actually be dangerous to both of you, even though it feels really good.

So, how do you tell the difference? It’s not simple.

Love is responsible.
Mania is reckless.
Love heals.
Mania destroys (self or others).
Love hopes.
Mania assumes.
Love accepts.
Mania judges.
Love empowers.
Mania disempowers.
Love takes its time (which sucks, I know).
Mania rushes into things.
Love tries. And tries again.
Mania forces it. And continues forcing it.

I think it all comes down to trust and honesty. If you’ve lived with your bipolar disorder long enough, you know what mania feels like. You can trust yourself to identify it under normal circumstances. But when mania collides with love, it’s much more difficult to recognize the patterns of destruction because you feel so damned GOOD. I think the more self-aware we are, the greater our chances are of surviving this whirlwind. I believe only through honest self-assessment can we answer some of these questions:

  • Have I rushed into this relationship?
  • Am I destroying other things to see it through?
  • What am I losing? Is it worth it?
  • Am I obsessing to the point where it’s interfering with my ability to get things done?
  • Am I being responsible? (e.g., with sex)
  • Am I taking care of myself?
  • What am I gaining?

In my opinion, if you can answer those questions honestly and assess where you are, and if your answers are satisfactory to you and others with whom you choose to share them (objective views are critical with bipolar disorder), you’re probably not manic. Of course, a good evaluative visit to a mental health care provider may be in order as well.

You have to trust yourself. Even if your bipolar disorder has gotten you into trouble in the past, you have to trust yourself now to know whether what you are experiencing is real. Equally crucially, you must trust the other person not to feed the mania and to be honest with you about what he or she is feeling. This agreement requires a long, frank discussion about your condition and what it may mean for both of you.

Love, like mania, is intense. Both require TLC and patience. It breaks my heart when people say love isn’t possible for people living with bipolar disorder. That sentiment couldn’t be further from the truth. I think we love more intensely, more deeply and fully, than others do because of our condition. Perhaps mania intensifies everything it touches such that, even when we aren’t acutely “manic,” we can still feel ecstatically alive in love.

You have to remember than mania isn’t all bad.

Handel wrote the exquisite “Messiah” in two weeks; people often say he was manic. Mania takes you to new levels of passion and creativity. Treatment for mania feels like it is crushing those qualities, which is why so many of us do not stay on our meds. I think passion and creativity seep from our very DNA, directing how we interpret our world and shaping our personalities. It’s all connected. And such ferocious passion drives us to feel love at a whole new level compared to our “normal” counterparts. It’s a factor for which you have to account, but it’s also a very deep blessing.

In the end, trust yourself. You’ll know if it’s love or mania. Never be afraid of love. Just enjoy the ride responsibly.

–Jaimie Hunter, PhD, MPH

Life Lessons: Year 42 Edition

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As I prepare to begin my 43rd trip around the sun on Halloween, I paused to reflect on the surprises, joys, and devastating failures I’ve encountered in my 42nd. Weight loss, loving friends, and learning to love running again(!) have been the highs. Here is my synopsis.

  1. Don’t let pain interfere with loving people with all your heart.
  2. Love is infinite and can handle all possibilities. Imagine them.
  3. Be direct with people, but in a responsible way.
  4. Sometimes you just have to engage in exercises of futility.
  5. Pay attention when someone tells you or shows you who they are.
  6. Keep true to your word, or no one will have faith in you.
  7. Never break a confidence; it denigrates your integrity.
  8. You are more skilled than you think you are.
  9. If you don’t report unethical behavior, you’re unethical, too.
  10. Breathe. Breathe again.
  11. Don’t let anyone bullshit you twice.
  12. Choose to be kind, especially when it requires extra effort. Not doing so will haunt you.
  13. It’s funny how karma works.
  14. True power means acting and being willing to accept the consequences of your actions.
  15. Sometimes you don’t recognize how highly regarded you are. Be responsible.
  16. Harm no one with your words, actions, or intentions.
  17. Don’t banish someone unless you mean it.
  18. Trust your intuition, but don’t let it make you paranoid.
  19. Remember to ally yourself with former friends.
  20. If someone can’t accept you for who you are, that’s their problem, not yours.
  21. Don’t punish yourself for what others do.
  22. You are worthy, and you are exquisite.
  23. Never let a medical condition come between you and someone you care about.
  24. Earning back a friend you thought you’d lost forever is an amazing feeling.
  25. When there is no lesson left to learn, let go.

–Jaimie Hunter, PhD, MPH

An Open Letter to Parents of Children with a Mental Health Diagnosis

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I am not a parent.

I can’t identify with you on that level. I don’t know what it’s like to receive word that your child (even adult child) has been diagnosed with a mental health condition. I can only imagine what the shock, anger, anxiety, and fear associated with this diagnosis feel like for you. You want the best for your child.

Upon receiving a mental health diagnosis, some people feel an enormous sense of relief that they finally know what is wrong. This feeling may be juxtaposed joltingly with the realization that you’ll be fighting this thing for the rest of your natural life. And people often have so many questions: Why do I have this disease? What would treatment be like? What would people think of me?

But the biggest question of all, far too frequently, is, “You’re kidding, right?”

(It’s always okay–encouraged, even–to get a second opinion.)

So, I wrote this article to provide some insight into what your child may be experiencing, with the hope that these insights can provide some guidance, or at least some comfort.

It’s no one’s fault.

Your child probably thinks he or she did something wrong to “deserve” this condition. Or, perhaps they blame you for problems they perceive arose from childhood. Both are bogus; mental illness is no one’s fault.

OK, sure, some mental illnesses have a high heritability quotient (they get passed on readily through genes). But that doesn’t make it your fault.

Assuaging the sense of guilt by helping your child learn that he or she is not to blame for this condition is really important for recovery.

Mental illness belongs to the family, not just the child.

While your child is the one who carries the mental health diagnosis, it will take the entire household to help him or her recover from or live with the condition. Your child needs your support. She needs you to take your frustration with her down a notch. He needs you to acknowledge that he’s still there and still himself, regardless of what he is going through.

Support means actively seeking to understand what your child feels and how you can best help meet some of their needs. It means asking questions and being open to hearing the answers.

Support also means being open to your child’s questions and helping her find answers if you don’t already have them. You should be your child’s most staunch advocate and biggest cheerleader. He CAN survive this. Sometimes you just have to take it one day at a time.

Don’t blame the illness for things that are under your child’s control.

Support does NOT mean allowing your child to be irresponsible—i.e., using the illness as an excuse for not going to school or work when he is not experiencing symptoms (and should have no problem going). Responsibility is critical for people living with mental illness, as people might already assume that they are lazy or unmotivated.

It really bothers me when people use mental illness as a crutch for their actions. Most of the time, those with mental illness have the dominion over their behavior. They can still make choices and roll with the outcomes. Sometimes, blaming mental illness is legitimate—for example, my roommate once was so ill that she couldn’t get out of bed to go to a medical school interview. She lived and breathed medical school, so that was a huge setback. But when your child has the ability but not the desire to be responsible, it is inappropriate to blame the mental illness.

On the other hand, it can be incredibly difficult to discern whether your child is having genuine symptoms. You know your child better than I do. I would advise being gentle and nonjudgmental in assessing “where he’s at,” all the while encouraging him to do what he is able.

Most people will give your child some leeway upon learning of his condition; this goodwill can easily be eroded by abusing the privilege. My advice? Use what you need. Use it liberally; that’s why it’s there. But when you are better, stand on your own again.

What can I do?

I know parents often feel helpless to relieve their child’s symptoms and deliver peace. Rest assured: you are your child’s greatest ally in this lifelong battle. Here are some important actions you can take to be the best partner for your child.

  1. Learn everything you can about the condition. 
  2. Don’t be afraid to ask questions of your child. Research shows asking questions does not drive someone into self-harmful behaviors.
  3. If your child is under 18 and/or your adult child gives you permission, ask questions of his or her doctor.
  4. Learn patience. Whether you have to count to 10 or learn some yoga moves, you’re the one who is going to have to remain calm and centered when your child cannot.
  5. Learn the warning signs of crisis. These may include things like withdrawal, illicit drug use, and talk of suicide.
  6. In partnership with your child, identify a key word or phrase for use exclusively when your child is in crisis and needs immediate help. Alternatively, perhaps a rating system would work better for you. (For example, with bipolar disorder, you might use 0 to 10, where 0 is the lowest/most depressed you can imagine, 5 is average/having no symptoms, and 10 is the highest/most manic you can imagine.)
  7. Encourage your adult child to obtain care and stick with it. It can take months to get an appointment, so start early and make sure your child doesn’t miss the appointment. Ultimately, the responsibility for keeping appointments is your adult child’s, not yours, but your support helps.
  8. Don’t treat your child like he is somehow deficient. Eliminate words like “crazy,” “nuts,” and “retarded” from the household language.
  9. Remember there will be good days and bad days, ups and downs. Don’t let the bad days be devastating, and don’t let the good days give you a false sense of security. 
  10. Assure your child that you still love them and will always do so, no matter what. Never let go.

Jaimie Hunter, PhD, MPH