My last blog post referenced those with mental illness and addiction issues under the same umbrella of “behavioral health.” A fellow blogger had the insight to question use of the term “behavioral health” which is used widely in the US but perhaps not elsewhere. She is at: https://mentalhealthathome.org.
The challenge for me is finding a term that includes mental illness and addiction in the same breath. At first glance “behavioral health” does that – include mental health and addiction diagnoses. But as my fellow blogger and friend pointed out “behavioral health” is a weird way of describing mental illness and addiction. The use of the term “behavioral health” seems to imply that all that us mental illness or substance abuse sufferers need to do is change our behavior and all will be well.
Further, the term “behavioral health” does not include the more common understanding that both mental illness and addiction are associated with or caused by a chemical imbalance in the brain. The chemical imbalance is clearly an illness.
While there is room for behavioral change in any illness diagnosis including cancer and heart disease, the idea that a diagnosis can be reversed through behavioral change is missing the point. If I have heart disease, I can change my diet and exercise regime. If I have cancer, I can also adopt a healthier diet and exercise. However, my diagnosis of heart disease or cancer is not defined by my behavior. It is defined by the diagnosis and prognosis of the illness itself. If you are dying of heart disease or cancer, no one says “change your behavior and all will be well.”
So why should we term mental illness and addiction as “behavioral” issues? The key to understanding mental illness and addiction is in understanding there is a chemical malfunction in the brain. Sure, you can mitigate this some with behavioral changes, but that does not mean that mental illness and addiction are explained best by our behaviors or changes to our behaviors.
What are your thoughts on using the term “behavioral health?” Is there another term you choose to use to describe mental illness and addiction?
Has behavioral health always been the red-headed step-child in terms of research and funding levels? If these levels of research and funding followed the severity and reach of mental illness and addiction, might we see the following results? What if behavioral health funding were equal to say cancer funding or heart disease funding or diabetes funding?
- For one we would have adequate beds to treat people who needed inpatient care for behavioral health or addiction.
2. For another, we would have adequate funding to develop psychotropic drugs and other interventions without such severe side effects as weight gain and Type II Diabetes onset and memory loss.
3. Additionally, we would be treating war veterans for mental health and addiction impacts that can go untreated.
4. Fourthly, we would have enough resources to fund the Cohort Model discussed previously for people experiencing a significant event or setback.
5. Fifthly, with more co-mingling of people with and without a behavioral health diagnosis we might be able to reduce stigma substantially.
6. Finally and most importantly, by being proactive in our behavioral health and addiction programs in the United States, we may be able to develop some early warning signs among people struggling with depression and/or paranoid thoughts and/or addiction so that we can care for those patients before their symptoms become dire.
Adequate resources for mental health in my book would include funding allocated to the development of a Cohort Model to assist those experiencing a debilitating health event to gradually reenter society. In my opinion, it would be less expensive for the State (at the State and Federal levels) to offer a Graduated Reentry Program than it is to provide disability insurance payments for all those who are unable to work a full-time job due to some sort of behavioral health or developmental disability. This might include a mood disorder and/or an addiction issue. In my opinion, people with behavioral health diagnoses ought to be able to work a 10 to 20 to 25 to 30 hour week and bring home enough pay so as to be a valid contributor to a family’s income. Today this is generally not the case. There are few part-time jobs available in the market today and the ones that are available do not provide a living wage or health insurance or occur during times of the day that are generally associated with sleep or family time. Also, disability payments in the US are few and far between and very difficult to qualify for.
The idea of a “Graduated Reentry Program” is that behavioral health consumers would progress from a 10-hour work week to a 20-hour work week to a 30-hour work week to a 40-hour work week depending on their health. Participants would still be eligible for health insurance during this time provided they were engaged in all prescribed wellness activities. When the hourly work week is at a reduced level, participants are expected to attend any given number of behavioral support meetings with their doctors or their therapists or in their community in order to prevent a repeat occurrence. The reduced work week would be coupled with a regime of self-stewardship that might include mood support and recovery meetings, meetings with a therapist and/or meetings with a psycho-pharmacologist. This time might also be time spent developing an exercise regime to reduce stress and limit unwanted thoughts.
The idea of a “Graduated Reentry Program” assumes: 1) behavioral health patients have serious work to do that is not part of a paying job typically and 2) it should be cheaper in the long-run for the State to sponsor a partial work week for behavioral health patients until such a time that they are ready to work a 20, or 30 or 40 hour week. 3) This type of program would allow people who manage a serious behavioral health disability or addiction to still earn a “living wage” even if they were working 25 or 30 hours of work per week. 4) This ability to work at a reduced level in order to dedicate time to managing aspects of the prescribed illness through support groups and support group programs, exercise and diet regimes, talk therapy programs and med management programs is hugely different than how that juggling act occurs today.
Many people with mental health conditions, including myself, may not be able to work a full-time work schedule. These people should have the sponsorship in society of working a 10 or 20 or 30 hour a week job as they are able. Many people with mental health conditions seek financial assistance through Social Security Disability Insurance payments. While this is often considered a critical financial development for some people with a mental health diagnosis, consider if more emphasis was additionally provided on programming to reentry society and the economy.
Again, it is my belief that such a Graduated Reentry Program would pay for itself by increasing the productivity of workers who may move from a disability status to a 10 or 20 or 30 or 40 hour a week job status. If it does not pay for itself, I believe the cost savings from the Paranoia Hotline / Paranormal Institute would pay for this Graduated Reentry Program. (See prior post regarding Paranoia Hotline).
Through the on-going development of this text, I am becoming more and more clear to myself and in myself as to my current emotional challenges. While I am clear that a high paying job in project management is not a fit, I am not completely clear what type of job might be a fit for me. While just a few years ago I was a keen advocate for a Graduated Reentry into society of working first 10 hours, then 20 hours then 30 hours a week, I currently am of the mindset that applying for Disability Insurance may be an important option for many people particularly in the absence of the Cohort Model in today’s America. If I am to continue to place a premium on our daughter’s development and on my own health, this may mean not working a job in the traditional sense. This leaves the door wide open as to the possibility of making writing like the writing of this text to become “my work.”
Has behavioral health always been the red-headed step-child in terms of funding levels for medical research and treatment?
If the statistics on mental health and addiction were more widely publicized, would we begin to see more clearly the widening funding gap between dollars to treat and cure mental illness versus research and treatment dollars dedicated toward heart disease, diabetes or cancer? Currently, while mental health and behavioral health including the opiod epidemic and addiction pose tremendous challenges, the funds and expertise to tackle behavioral health and addiction just aren’t forthcoming at the same rate say for cancer research or funding. What would happen if we as a society could place as much money and effort into mental health and addiction research and treatment as we do into cancer? The projected impacts would likely be enormous.
- For one we would have adequate beds to treat people who need inpatient care for behavioral health or addiction.
- For another, we would have adequate funding to develop psychotropic drugs and other interventions without such severe side effects as weight gain and Type II Diabetes onset and memory loss.
- Additionally, we would be treating war veterans for mental health or behavioral impacts that often can go untreated or undiagnosed.
- Fourthly, we would have enough resources to fund a Cohort Model of support for those in a crisis or post-crisis state.
- Fifthly, with more co-mingling of people with and without a behavioral health or addiction diagnosis we might be able to reduce stigma substantially.
- Finally and most importantly, by being proactive in our behavioral health and addiction programs in the United States, we may be able to develop awareness of early warning signs among people struggling with mental health and addiction before their symptoms become dire.
It only follows that research for and treatment of mental illness and addiction is proportional to the level of medical challenge that is presented with these diagnoses.
What strikes me as poignant is that the stigma/judgment/prejudice associated with mental illness is less visible or more delayed while the stigma/judgment/prejudice associated with darker skin seems more immediate. To the average Joe, I look like a white housewife with no major troubles. It is not until my mental health behavior gets in the way that someone might recognize me as having a behavioral health disorder and therefore might judge me as less than. Behavioral health stigma is not generally associated with the way a person looks right off the bat unless that person shares that information upfront. Whereas, with black and brown skinned people, it seems to me (from the outside looking in) there may be no such “delay” or “invisibility.” Someone with brown or black skin appears to be judged even before any behavioral questions good or bad emerge just because of how he or she looks on the spectrum of dark skin to light skin.
I hope I have not offended anyone of color with this comparison or that you think I think I can comprehend what it is like to be black or brown and to be judged by your appearance alone.
I do not make the comparison to mental health above because I know how it feels to be judged by the color of my skin. I don’t. I have not experienced that. But I would like someone of color to know that I do understand very well what it is like to be judged for something I was just born with. Perhaps I am not at liberty to make that comparison because I am not dark-skinned. But I do think part of the solution in the Black Lives Matter movement is that we become unafraid to talk about our perceptions of race and racial stigma.
From here the conversation atrophies into the question: why make a comparison between skin color and a disability? It is not a good comparison to make. Yes, I agree a disability is not the same as skin color. The whole “Black is Beautiful” movement underscores that.
Then the conversation atrophies again, as a person with a disability, I am supposed to think of myself as a person WITH bipolar illness not that I AM bipolar. I am not my illness. I am supposed to not let that “label” define me. Should we in turn say someone of African American heritage is a person with black skin rather that black? Probably not. For the behavioral health person, we typically don’t want labels to define us. But for those with black and brown skin, the difference may be in embracing that difference and celebrating it along the lines of “Black (or Brown) is Beautiful” from the 1960s or 1970s.
Somewhere also in the midst of this conversation is the reality that up until the 1950s people with behavioral health problems were locked up in institutions largely for life. Families sent them away to institutions where they were often forgotten and buried as a number in a mass cemetery for the mentally ill rather than by name.
So all in all, the parallel between having a disability and having darker skin has limits. Perhaps this is just an ice breaker into a conversation of what can be and what we want to be different for those experiencing racial pain and stigma and those experiencing mental pain and stigma.
This is a reworking of a comment I left on a prior blogpost I read and commented on….
I did not meet my husband (one and only) until I was 38 years old. Before then I had been in a series of relationships, some lasting a while (almost three years) and some not lasting long at all. I seemed for years to go back and forth between men who were like my father and men who were like my step-father. This yoyoing back in forth consumed all of my twenties and some of my early thirties. I was engaged to be married to someone before my current husband arrived on the scene.
I learned from that failed engagement that a couple does well to share a belief in God and to argue well. My fiance had clinical depression so on that level we understood each other’s behavioral health challenges. I have bipolar illness. But our relationship was toxic. We always had the same argument over and over. Why aren’t you opening up? Why aren’t you letting me in? Eventually he would call off the engagement, but it was a friendly parting. Years later he wrote and seemed to wonder about our getting back together. I had already moved on.
After the engagement broke off, I began a period of celibacy. This lasted for almost 7 years. During that time I stopped with the yoyo dating and focused inward on myself and my job. It was very important for me to validate myself during those years with something other than a relationship (short-term or otherwise) with a man. I did not even kiss a man for this 7 year period before I met my soon-to-be husband.
I met my current husband (one and only) at an online data service in 2001- this was very early in the web dating sphere. That is a story in and of itself. The first thing I noticed was that our mutual faith in God seemed to make things easier. I also noticed a couple of other characteristics of our relationship as it started to grow and mature. These are my insights into what has made my marriage a successful endeavor for someone with bipolar illness and someone with addiction issues.
For me there are three keys that help my marriage work – though I cannot guarantee these will work for everyone. Hold some sort of faith belief in common. It helps me through the darkest hour if that is not a topic that I argue about with my spouse but one that grounds me in that relationship. Second, be able to argue well. I try not to always go back to the I told you so’s. I try to make each argument have a beginning, middle and end. I try to learn from it once it’s over instead of drudging it up over and over. Finally, a sense of humor goes a very long way. I find it important to be able to laugh at myself and with my partner. It is amazing how a good laugh clears the air.
In addition to these three items, I am adding the ability to be thankful to God for people who are helpful in my life’s journey. I am still working on being thankful every day instead of always asking God for something. There is so much to be thankful for. So here is my two moments of marriage wisdom. Took me until I was 38 to figure it out – still figuring it out at 56. Oh well, later is better than never. 🙂
Becoming a Mom has been the greatest gift God has ever given to me.
I got married at 38, got pregnant at 39 and had my child at 40. I often talk and think about how as a person with a behavioral health diagnosis I have done everything “late.” I have to talk with myself about how life events like graduating from Ivy College or graduating from Business School or obtaining my professional project management certification may have occurred on God’s timeline rather than on my own.
Perhaps I am not late in achieving these life events any more than I am early in my perceptions or thoughts about time and matter and anti-matter. Perhaps all of these thoughts and events and timelines are under control with the ultimate project manager – God himself.
Still, I have a hard-time accepting that these successes are on God’s timeline rather than my own. I want to be able to say “I’m normal” and therefore “my successes have occurred in the way I have prepared for, planned and executed.” In reality these successes are contingent upon allowing myself some “grace” and the opportunity to pursue my accomplishments in an elongated timeframe. There are many goals that I have currently that I continue to pursue – the message to myself along these pursuits is that God is in control of these developments, even though I would prefer to be in control myself. I would prefer to be in control just as that ten-year-old child within does so as perhaps despite myself to take full blame when things don’t go according to plan. If my child within is six and/or if God is in control, I am no longer in control of the outcomes of my life. If I give my life over truly to God, then every outcome including the potential for child abuse at age six is part of his plan for me and I need not accept any particular outcome as “my doing” or “my fault.” Perhaps my role in God’s eyes is to tell my story of abuse so that others will not have to endure such happenings or at a minimum can feel some solidarity surrounding those events.
So it was with having my daughter — the biggest accomplishment of my life. For years, I heard that Lithium was contra-positive toward being pregnant and carrying a child. For years in my twenties and my thirties, I asked to change my meds so that I might be ready once I got married to carry a child. When I met my husband, we talked at length about the fact that bipolar illness has a huge genetic component and that there would be some risk of passing the illness along to my child. I considered this strongly and even looked into the idea of surrogate eggs and surrogate Moms. In addition, there was a study occurring at a local university hospital which posited that risks to the fetus for heart impacts associated with lithium use by the mom were grossly overstated. My husband was not keen on the surrogate or adoption alternatives, so about 7 months after we were married, we started to try through traditional methods to get pregnant. I was 39 at the time. I believe that prior to this time, I may not have been ready to be a Mom, at the same time I do not really advise people to wait too long to have kids. My husband and I were very blessed to become pregnant within two months of trying. For most people at the age of 39 in vitro and other pregnancy/fertilization tactics would have been needed.
Even amidst the throes of postpartum depression and related problems, having my daughter in my life and experiencing her as part of my family with my husband continues to be the greatest blessing in my life. Even now in the midst of the teen years and our occasional head-butting, my daughter continues without a doubt to be the love of my life tying with my husband.
This has come up today in reviewing and updating comments from an earlier post of mine. It has been suggested that people who are accustomed to mental health and behavioral health issues may be able to empathize not just sympathize with people who are experiencing depression and anxiety for the first time due to covid-19.
Therefore mental health “veterans” like us may be able to help others in some small way. I am very curious to hear what those of us who are familiar with depression or anxiety might say to those who are first encountering symptoms due to covid-19 – likely situational depression and anxiety and uncertainty. These folks may not have clinical depression or clinical anxiety but that does not diminish the impact of what they are experiencing.
What might that look like if we were to reach out to those who are not familiar with or are new to depression or anxiety or uncertainty of all kinds?
During my work life and career, I have had to deal with being (or feeling) ahead of the curve by about ten to twenty years. The things I like to think about – circular time versus linear time, matter and anti-matter, quantum mechanics or quantum physics, an equation to designate the development of time, new treatment protocols for cancer or behavioral health or HIV/AIDS, development of biofuels as a substantial source of our energy supply – all tend to surface at least ten years before the topic reaches the mainstream. For example, I wrote three grants to the USDA to use farm and animal waste for energy back in 1999/2000. (I did not get the grants.) Biofuels did not hit it big until about 2010 (this is a guesstimate) and in 2020 are still not in widespread use as a way to process farm waste and generate energy.
In some respects I have gotten used to the ten year gap and do not have expectations that my thoughts and insights will be useful to society. I also have recognized that throughout the course of history many people with certain thoughts are often not recognized during their lifetimes. Knowing this helps me not to get too frustrated when my inroads go nowhere. And then again, perhaps nowhere is where these thoughts are intended to go.
This sense of “being ahead of the curve” may relate back to the imaginary thoughts of that six-year-old child within. Just as with any young child, my younger child within believes that all things are possible including things that logic and reason cannot readily address. That younger child within for example believes she may have developed an equation to characterize the passage of time. As I have no training in that area of science or even remotely connected to that area of science, any work I might have achieved in this regard must be due to the imagination projected forward onto the page by that younger child within. Regardless, science is needed to fact check any or all of these musings.
This sense of “being ahead of the curve” most likely requires a scientific approach to validate whether any of my early perceptions are valuable or truthful. As mentioned before, I consider this younger child within to be almost autistic. (My therapist has asked me to consider whether I feel I am on the spectrum.) Therefore is it possible that certain impressions of that child within may lead to the ability to work out complex problems without prior training just as an autistic person can perform complex mathematic calculations without any training in higher math?
Also, I do not have much perceived anxiety in regard to these perceptions. They are what they are and nothing further. I consider them to be perhaps inspired by the Divine but in need of fact-checking by good science in order to move forward. Until then they are just thoughts.
I am curious, do other people ever feel like they are ahead of the curve?
Note – several names and places have been changed throughout this text in order to keep my story somewhat private. Thanks for understanding that need. I hope you will tell me what most interests you from my story so I can focus on that moving forward.
Although I had had no prior fear of flying, my first episode of bipolar illness was in a tiny airport near my Ivy League college (hereafter known as Ivy College). While I was waiting for the plane to get ready to taxi off the runway and take me to my first interview for a job after college in advertising, I was consumed by runaway thoughts. My thoughts were anywhere but on my interview for an Account Executive position at Chicago Avenue Advertisers. I had no specific directions for my fears but I took out some papers I was working on for my undergraduate thesis at Ivy College and was writing and writing furiously in and around the margins of the pages of the papers I previously had written. The thoughts seemed to co-mingle with the characters in the fiction as well as characters or people I knew in real life. The writing was fast and furious until I finally heard the flight that I was to take to Chicago on the puddle-jumper called.
For some reason I did not feel safe in myself enough to board the plane once the flight was called and I came to the conclusion that the plane was going to crash. I did not communicate this fear with anyone. Instead I determined that I did not want to get on a plane that was going to crash, so I got my suitcase together and asked the airplane attendant if I could check my bags on the plane but not board the plane myself. For some unknown reason, the contents of my suitcase were of paramount importance. I recall a navy suit that I had packed and feeling like that suit should reach a friend who I was going to see in Chicago. The label on the suit became extremely important at the time – it was an Evan Picone double-breasted navy wool suit. The airport personnel immediately got suspicious and asked me why I was putting my suitcase on the plan and asked me to move away from the plane with them. When I refused, the safety patrol man exerted more force and tried to get me to go with him. In my fears, I turned to run down the runway away from the scene of the fears and ran completely down the airport runway up into a stand of pines, one shoe flying off in the process and resting in the snowy runway. I recall exactly what I was wearing – a plaid pleated wool skirt in muted tones, a long sleeve silk blouse and a double breasted woolen gray or taupe sweater. I don’t recall a coat or over-coat. The safety patrolmen at the airport followed me into the woods with snow all around and made a chair with their arms for me to sit on. I was in some stage of delirium and thought they were providing me some sort of throne to safety.
Instead the next thing I knew I was being handcuffed to the backseat of a patrol car with the patrol lights flashing blue and white and was being escorted to the police station down the road. When I arrived at the police station I kept telling the police that I was a Senior and straight A student at Ivy College and they must have made some mistake. On the walls there were pictures of wanted criminals – I kept trying to figure out what the pictures meant. There were three pictures: a young woman who I thought looked like Ayn Rand, a man with a long beard who looked in my state to be like a long-haired Jesus and one other picture of a youngish man whose face I cannot recall. What I do recall is feeling like a criminal and being treated like a criminal until a kind policeman named Michael started to ask me questions. Once I started to talk with Michael I began to calm down.
After what felt like days of swirling and runaway thoughts and a myriad of questions, the police finally called my family and called the school clinic and I was escorted there. Soon after, several of my college roommates arrived to be with me while the admission process continued. After talking briefly with the clinic staff, I was transferred to the local hospital’s Psychiatric Unit.
Within the next few hours my parents arrived in town and tried to begin to make sense of what had happened. I recall my parents visiting me in the hospital mostly my Dad whose anxiety I could sense was through the roof. Within a couple of days, we made arrangements to go back home to Augusta, Georgia. I unenrolled from classes and moved back home to live with my parents for the spring and summer of 1985. No one was sure yet if this was a temporary reaction to stress as a Senior and as a Senior thesis writer or the beginning of a lifelong behavioral health diagnosis and challenge.