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MAGAZINE

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ISSN 2204-1966

ISSUE 3

ISSUE 3

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“Mindfulness is about being fully awake in our lives. It is about perceiving the exquisite vividness of each moment. We also gain immediate access to our own powerful inner resources for insight, transformation, and healing.� Jon Kabat-Zinn

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Ruth Myers Counselling

Based on my fields of experience and interests, I take a HumanCentered / Person-Centered approach, which focuses on what you feel your needs are and the direction you would like to take. It is a gentle approach with respect, genuineness and empathy and one which derives from the belief that you understand yourself the best. Contact me to book your first in‑person or online session. www.ruthmyerscounselling.com.au

“Humans’ ability to grow is infinite... when they feel safe.” Carl Rogers


a look inside ISS U E 3 56

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topics featured in this issue 6 8 16 20 42 52 56 84 87 88 94 98 106

Welcome, from the Editor Considerations when choosing your therapist Keir Wells talks about the numbers College bound with a mental illness Chronic pain, addiction and recovery Matching symptoms with disorders Mental illness on the big screen The distorted view of body dysmorphia How we view mental health at BMH Mag The power of talking to yourself When voices are inside your head A new Hearing Voices Network launches The changing face of mental illness treatment

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real people and real lives 36 50 64 66 70

Learning to start life over again Ethar shares about conflicting symptoms How David manages his mental health Life with anxiety and depression Achieving mental wellbeing through emotional wellness 76 Finding purpose after suicide 100 Nicolette’s depression in the Caribbean

improve wellbeing every day 28 Living a simple life to reduce stress 34 15 tips for minimalising life 44 Eating well for workplace wellness

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from the editor

Better Mental Health Magazine Issue 3 2 April 2015 ISSN: 2204-1966 (print) ISSN: 2204-1974 (online) Better Mental Health Magazine is published by Aporia Media Pty Ltd, PO Box 1579, Strawberry Hills, NSW 2012, Australia. While every effort has been made to ensure that the information in this magazine is accurate and up to date, it should not take the place of medical advice from your doctors or other medical professionals. The purpose of this magazine is to offer information of a general nature. This may or may not apply to you or your situation. The publishers believe all material in this magazine to be correct at the time of publication. They cannot, however, provide guarantee of this and do not accept liability in the event of any information later proven to be inaccurate. Personal submissions do not necessarily reflect the opinions of the publishers. This magazine is copyright. No part may be reproduced by any process without written consent of the publishes, other than any fair dealings for the purpose of private study, research, criticism or review, as permitted under the Copyright Act. Magazine design concept by Cyan Loves Magenta BMH Mag App developed by GGA Digital Australia. Subscriptions available through http://www.bmhmag.com Copyright Š Aporia Media 2015 ACN: 154 564 100 contact, engage and share with us through: w:www.bmhmag.com e:contact@bmhmag.com fb:facebook.com/bmhmag g+:google.com/+bmhmag tw:twitter.com/bmhmag p:pintrest.com/bmhmag li:linkedin.com/company/bmhmag

Printed in the UK by The Magazine Printing Company using only paper from FSC/PEPC suppliers www.magprint.co.uk

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I had a really interesting discussion with a clinician since the previous issue. Without having actually read the magazine, he argued that it could add little value as a tool for understanding mental health, as it is not purely clinical. Personal accounts, he said, were opinions and, without being entirely clinical and backed by empirical evidence, it would do, if not harm, at the very least, no good. I respect his opinion. It was an interesting situation where the clinician, who relies solely on empirical evidence, but had not read the magazine, had no evidence for his argument. My point is not to be critical of any approach. What I found interesting was the broad approach. For me, this is a perfect example of mental health and wellbeing. I regularly hear opposing views. That of harm reduction or total abstinence for addiction recovery. That of treating mental illness as a disease or an individualised condition. That


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of medication alone or a wholistic approach to managing disorders. That faith can cure severe mental illness or science is the only reasonable approach. There are many view for each aspect of mental health. Which is right? I don’t know. I’m not a clinician. When I ask clinicians I will have as many answers as the people whom I ask. Does that make any of them right? Does it make all of them wrong? Does it even matter? If not, then what does matters? I gave a copy of Issue 2 to a close friend who had recently started dating someone. He’s a big supporter of the magazine and showed it to his new partner to explain what it’s about. His partner read the magazine and said something like, ‘I wanted to tell you, but didn’t know how, but you seem supportive, and I have severe anxiety’. That’s what matters. That two people can have a conversation about mental health, that they have a starting point. That’s what matters. Any two people. Friends, colleagues, family… it doesn’t matter who or what. It just matters that the conversation can start. We often hear that the stigma of mental health is reducing. And it is, slowly. We hear from mental health professionals and bloggers who are quite comfortable talking about mental health. This is often within a closed community of people who are comfortable talking, personally or professionally, about mental health. But we also hear from people who don’t feel they can disclose to a potential employer or partner. We hear from people who have lost their job or partner because they’ve had

one too many ‘bad days’ and don’t feel they can have another job or look for another relationship without it ending the same way. Mental health can be discussed. It can be addressed. It can be managed. To do so, we need to start and maintain a reasonable and responsible conversation about mental health. But even the words “mental health” are shrouded by stigma. Physical health not only means a terminal illness. Even when it does, it’s now okay to talk about it. It not only means chronic illness and pain. Even when it does, it’s now okay to talk about it. But it’s so much more than that. It also means staying fit and healthy. It means physical exercise and nutrition, supplements and medications and everything needed to keep your body functioning as well as it can. And it’s okay to talk about that. We can talk about breaking an ankle or having a breakdown. We can talk about taking nutrients or taking medication. We can talk about going to the gym or the counsellor. It’s all the same. The mind is so much more complex than the body that we need to give it the time and respect and support it deserves. If not for today, then for whatever life throws at us, perhaps tomorrow, perhaps when we least expect it. And that’s what Better Mental Health Magazine is doing. Through the positive lived experiences of real people and with the realistic and responsible discussions by professionals, we are able to start and maintain that conversation.

Luke Myers Editor bmhmag.com

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SHRINK SHOPPING choosing your therapist

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By Amanda Gregory, LPC

Choosing a therapist has a strong impact on your treatment, as your relationship with your therapist is one of the top predictors of your success in therapy. Therefore, it’s in your best interest to find a therapist that’s the best fit for you. Therapists know that they are not good matches for every client, and they know that you should shop around before you commit. In order to shop around, you should arrange appointments with 2-3 therapists. You may want to check if these therapists are covered by your insurance or funding source. Not all therapists are covered by the same funding sources. Expect the therapist to want to gather information during the first session, which some call the Intake session. You should also gather information during this initial session, as this is your opportunity to interview the therapist. There are questions that you should ask prospective therapists who will help you to decipher their competence and compatibility. Also, there are certain red flags to look for when they provide their answers. Let’s take a look.

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not all therapists provide the same services Question: What types of services do you provide? Therapist: I provide individual, family, and couples therapy. I do provide group therapy. If you are in need of medication or psychological testing services, I can provide you with referrals. Not all therapists provide the same services. Some therapists may provide only individual therapy, family therapy, group therapy, couples therapy, or a combination of all these services. Psychiatrists can prescribe medication, but may not provide therapy services. Psychologists can provide

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psychological testing, but cannot prescribe medication, and may not provide therapy services. It’s important to know what type of services you need or want to have available. You may be seeking individual therapy, but you may want the option to participate in family or couples therapy in the future, if needed. If a therapist does not provide the service, they are likely to know colleagues in the area who do, and they can provide you with referrals. RED FLAG: Therapists who cannot commit to providing specific services. Therapy is not a specific service, family therapy is a specific service. Ask the therapist to be specific. Question: What populations do you typically work with?


featur e Therapist: For the past ten years about 70% of my clients have been teenagers, and their families. So, I have a lot of experience with teenagers and families. Yet, I have also worked with younger children and adults for about seven years, and I’m confident in my abilities in working with these populations as well. Certain therapists have more training and experience serving certain populations such as children, adolescents, geriatrics, and veterans. There are many therapists who serve a variety of populations. If this is the case, ask how much experience they have working with your specific population. For example: “What percentage of your clients have been veterans and their families?” or “How much experience do you have working with first generation Mexican immigrants?”

RED FLAG: Therapists who say they have experience working will all populations, but cannot tell you what specific experience or training they have when you ask about certain types of populations. Honest therapists should inform you if they have never work with a specific population. Question: What treatment areas/ diagnoses do you have the most training/experience? Therapist: I specialize in trauma, anxiety disorders, reactive attachment, and substance use. I have over ten years of experience addressing these areas. I also have more than five years of experience working with clients who have been diagnosed with various mood disorders such as depression and bipolar.

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Population refers to the type of people, while treatment areas/ diagnoses refer to the types of mental health issues which people are facing. A therapist could have a vast amount of experience working with a geriatric population, but no experience in addressing eating disorders within that population. As with populations, therapists can have more training and experience with certain treatment areas. Examples include: personality, psychosis, trauma, mood, and substance use. There are many therapists who treat a variety of areas. In these cases, you should ask how much experience they have in specific areas. Example: “How much experience or training do you have in working with clients diagnosed with Borderline Personality Disorder?” RED FLAG: Therapists who tell you they have addressed all treatment areas/diagnoses, but will not disclose the areas that they have the greater training/experience. It’s fine for a therapist to have general training/experience, but usually they can speak to having a bit more experience/training in a few specifics areas. Some have even researched or pursued additional training in specific areas while working with a general population. Question: What information is not kept confidential? Therapist: I have to break confidentiality in order to report any better

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you should also communicate any financial limitations disclosures of child or elder abuse. This also applies if you inform me that you will harm yourself or someone else, and if you have signed a release allowing me to share specific information. There are limits to confidentiality which can vary depending upon the therapist’s licensing board, state/ federal laws, and professional ethics. You should know what these limits are at the start of therapy or this can create a relationship of distrust with your therapist. If you are underage, you should ask if your legal guardians will have access to your information. RED FLAG: Therapists who report that all information is kept confidential might be unaware of their reporting obligations. Therapists are not lawyers, not all information is confidential. Question: Do you have a sliding scale or variable fee? Therapist: Yes, it’s based on your income, and this will be a set fee per session. Therapists are aware that some clients may not have insurance, may not have any funding source, or may simply choose to pay out of pocket. Also, there are times in which an insurance


featur e co-pay or rebate is greater than a sliding scale fee. Some therapists provide a sliding scale fee while others may not. It’s important for you to be aware of your financial obligations prior to beginning therapy so you can determine if you are able to participate and for how long. You should also communicate any financial limitations to the therapist. It’s productive to inform the therapist if you can only afford five sessions as the therapist might be able to work with you to increase the amount of sessions you can afford and/or address goals that could be accomplished in five sessions. Question: Who should I contact in the case of a mental health emergency? Therapist: My agency has a 24 hour crisis hotline which you are encouraged to use in cases of emergency. Please be aware that I am only available during office hours. I may not be able to see you immediately without an appointment if there is an emergency, but we have additional staff, some of which are internship students, in this office who will be able to meet with you.

RED FLAG: Therapists who seem unsure about their emergency services. Some therapists may not provide any emergency services, and they inform clients that they need to go to the ER or call 911. You need a straight forward answer from a therapist so that you are prepared in cases of emergencies. Question: What are sessions like? Therapist: Sessions are fifty minutes long. I usually do a check-in with you to see how you are and to ask if there is anything we need to cover today. Then, I will likely conduct an anxiety assessment which will take about 5-10 minutes and it will help us to measure any changes in your anxiety level since last session. We will likely use most of session time to focus on the goals that you and I will establish or any issues that you feel need to be covered.

You should know what resources your therapist can or cannot provide if you experience a mental health emergency. Some therapists are available for on-call emergencies, while others are not. Some agencies provide emergency services such as walk-in appointments and crisis hotlines, while others do not. bmhmag.com

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how do you plan to build a relationship with me? Just as therapists are different, so are their sessions. Another therapist who is working with a client with anxiety could have a completed differently style from how they conduct their sessions. You can get a good feel for a therapist by simply asking them what their sessions are like. RED FLAG: Therapists who cannot describe what their sessions could be like. It’s understandable if a therapist cannot speak in specific terms. They may need to assess your needs further before they are able to speak about sessions in specific terms. However, they should have an idea of their style, and can provide some examples even if these examples won’t fit your specific needs down the road. If a therapist has no idea what sessions could be like, then they do not know how to adapt their sessions to meet your needs. Question: Will I have to do anything when I’m not in session? Therapist: Since you are experiencing severe anxiety, and you want to learn coping skills to decrease your panic attacks, you should plan on practicing these skills repeatedly outside of sessions. I may also ask you to better

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document your progress on charts that I will provide. Therapists will require you to work outside of sessions, and it’s important to know what will be expected of you. However, some work, such as paper assignments, is not everyone’s strong suit. Therapists are aware of this fact, and some will tailor their interventions in order to increase your compliance and success. If the therapist is expecting something you cannot or will not do, let them know. For example, “I think I can do the coping skill practicing, but I know that I won’t do the charts. Is that a deal breaker?” RED FLAG: Therapists who answer no. All types of therapy require you to do something outside of session time, even if it’s simply to contemplate on what was discussed in session. Therapists should not believe that all treatment occurs in their office. Question: How do you plan to build a relationship with me? Therapist: It’s important to me that you feel safe, accepted, and a leader in your treatment. To create this relationship, I intend to provide you with active listening, empathy, genuineness, healthy boundaries, and assistance in creating and revising your therapy goals. Your relationship with your therapist is one of the top predictors of your treatment success, and therapists are


featur e aware of this phenomenon. Therefore, therapists should have extensive training on how to create and maintain relationships with you. It’s important to know that therapists are required to have safe relationships which avoid codependence, dual relationships, enmeshment, romantic/sexual friendships and exploitation. RED FLAG: Therapists who cannot answer this question. Therapists are required to know how to create and maintain safe relationships, and it’s the therapist’s responsibility to create such relationships. Therapists should be able to speak about relationship interventions. Question: How will you know when I don’t need therapy anymore? Therapist: That is something that we can decide together. What I will be looking for is a decrease in your anxiety levels. I will also talk with you about your confidence in your ability to manage anxiety on your own, without participating in therapy.

depends on your needs, the treatment environment (outpatient, inpatient, residential), and even the therapist’s own training. It’s important to know what your therapist is looking for in order to recommend that you are ready to leave the nest. RED FLAG: Therapists who cannot describe how they will know that a client is ready to end therapy. After they have assessed your needs, they should have some general idea. Unfortunately, it’s true that some therapists wish to keep clients in therapy longer than a single series is needed. There are many different types of therapists, and you have every right to find your best fit. So, make your appointments, ask your questions, and enjoy your shopping experience.

Therapy can be long term, short term, and anything in between. This all Amanda Gregory is a Licensed Professional Counselor who specializes in the treatment of Children/Adolescents, Attachment, Trauma, Anxiety, and Depression. She is also a freelance writer, and her work has appeared in New Therapist magazine. You can view her portfolio at http://amandagregorylpc.pressfolios.com

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Stuff The Statistics Is there really a line that can be drawn? By Keir Wells, regular contributor

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Keir Wells is a mental illness awareness and acceptance speaker and writer. He has carried manicdepression (never call him bipolar) since childhood and speaks openly of his lived experiences in trying to raise awareness and help others. He can be contacted through keir@wells.com.au or www.wells.com.au better

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By the way, Keir never made it to Officer Cadet School. He admits openly that his Company Commander was probably spot on with his observation. bmhmag.com

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College bound with a Mental Illness

By Stacy Fazio, LCSW First time college or university students are likely counting the sun soaked days of summer until send off. Students are excited, proud, and secretly apprehensive. Unstated worries may be even more intense if the collegiate bound teenager in question has been dealing with mental illness. The late teens and early adulthood years are often the time of onset for many types of mental illness. Leaving the structure, parental oversight, and routine of home life can throw a curve ball even to those individuals who effectively pool supportive resources and self-discipline to successfully manage the symptoms of their illnesses. The epic transition from high school student to burgeoning adult, set free on a college campus can be accomplished with the right preparation and planning. Here are some steps for the eager college bound student to consider before packing up the car for orientation week or when trying to settle in to college or university life. better

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TREATMENT At a time of major change in one’s life is never the time for significant changes in mental health treatment, whether therapy, medication management, or both. If the proximity of your chosen college is within a reasonable distance to allow maintaining consistent treatment with your existing therapist and/or psychiatrist, it is best to continue. College life will dish out many stressors – unruly dorm mates, paper deadlines, all night study sessions, relationships conflicts and unwavering professors. Seeking the refuge of support that a weekly therapy session can provide will help to offer a much-needed break. Also, providers that already know you will be more apt to notice changes or see if symptoms begin breaking through. Hopefully your ongoing relationship will also help you to hear and accept feedback as it is given. Even if your college is miles away from previous treatment providers, you should be thinking ahead to how you will continue treatment. Perhaps your existing therapist and/or psychiatrist can recommend someone more local to your school. Most colleges

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“ college life will dish out many stressors ”

also offer on-site counseling centers – an added bonus if you will not have access to a car or public transportation to leave campus when classes begin.

If at all possible, try to have treatment arrangements in place before you leave for school – schedule an in-person consultation or phone call if distance prohibits a sooner visit. Be sure to have your current treatment providers speak with your new providers so that you will not need to feel like you are fully starting over. It is also likely that you will resume treatment closer to home during long breaks or summer vacations, so you want to maintain the relationship with those previous providers and have your new providers give them periodic updates on progress. If taking medication to manage your illness, you will want to plan for how you will get refills. Will your parents pick them and bring them to you? Is there a local pharmacy? Can your meds be delivered via postal services? Again, this is not the time to be missing doses and chancing a relapse of symptoms. You want to maintain consistency with the regime that has been working for you. Make sure you have given consideration to insurance coverage as well. Will you be staying on your parent’s plan? Picking up the school provided coverage? It is important to know in advance so you that you can take insurance into consideration for ongoing treatment arrangements.

DORM LIFE Many students will opt for the boisterous, often chaotic, but friendship building and memorable experience of dorm life. 3am pizza runs, all night parties, unexpected floor crashers of unknown origin, and often crowded living quarters, make dorm life ripe for distractions. bmhmag.com

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“ talk to your dorm mates about this issue ”

These upsets in routine are a red flag for ongoing successful symptom management.

It’s important to seriously consider living at home and commuting or living off campus with friends you can chose (particularly in freshman year you are often not given a choice of dorm mate). It may be easier to maintain a structured schedule with family or friends you know you can rely on. As you think about dorm life, you will also need to realize that maintaining privacy is not always the easiest. Think ahead about where you will store your medications. You will not want to leave them sitting around for confidentiality reasons but also because unfortunately some prescription meds are attractive for recreational use and you do not want them disappearing. Prepping in advance for how you will store meds and keep to a medication dosage schedule will make it easier to stay on track when you have many other alluring college affairs to attend to.

MAINTAINING HEALTHY HABITS If you find yourself struggling to get in any sleep (aside from the naps during large 101 lectures), you will need to talk to your dorm mates about this issue. Getting a goodnight’s rest is an essential component to managing any mental illness. Difficult and stressful tasks always seem much harder and more daunting when overly tired. It becomes increasingly difficult to utilize coping strategies and mitigate symptoms when biologically deprived of restorative sleep. Along with sleep comes the need for good eating habits. Sure you will at times find yourself having mac and cheese twice in a day because its all you had left in your dorm room, but try to be sure that most days you are having a more nutritious balance of food. better

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featur e A more convenient way to keep up good eating habits is to make use of a college meal plan. They do all the prep, cooking, and cleaning. You just have to find some sweats clean enough to wear out and head on over to the cafeteria to eat. It may not always be the best or your favorite vegetable selection, but it is a precious time in your life when all your meals are a swipe of a card away. Aside from sleeping, be sure to engage in the activities of your former non-college student life that brought you joy, helped you de-stress, made you laugh, or let you take a break from it all. Whether it was getting in a daily run, writing in a journal, or taking part in drama club, these activities were more than just for fun – they were maintenance activities that help you keep emotions and symptoms in check. All too often individuals negate the crucial role of these types of activities in assisting them with managing their illnesses.

ALCOHOL AND SUBSTANCES That brings us to the next serious element of successful college life with a mental illness – alcohol and substances. The main message is don’t use them. However, it would be naive to think that there will not be endless temptation and access on college campuses.

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First and foremost, talk to your psychiatrist if you take medications. Mixing alcohol and/or drugs with some medications can cause serious or lethal side effects. Keep in mind that for some individuals, symptoms are made much worse by the introduction of alcohol or drugs.

“ diagnosis will grant you access to support services ”

It is really a time for total honesty with your treatment providers so you can monitor any negative effects that these recreational activities may be having on you.

SERVICES Finally, you want to think ahead about what supports the college can offer you. Most schools have Offices of Accessibility (formerly referred to as Offices of Disability). Some Universities have central counselling services. The services these offices provide can be monumental in your transition into a thriving college student.

Stacy Fazio, LCSW is a psychotherapist trained in clinical social work at New York University. A rigorous education and intensive training background combined with experience working in both outpatient and inpatient psychiatric treatment settings enables her to customize treatment for each individual’s unique needs. She has intensive post-graduate training in Cognitive Behavioral Therapy (CBT): including specialized application of techniques for psychosis, trauma, mood disorders, and anxiety disorders including Obsessive Compulsive Disorder, and in Dialectical Behavioral Therapy (DBT). Most recently Stacy has also begun teaching clinical social work classes to graduate students at Rutgers University. She sees clients at her private practice in Midtown Manhattan. http://www.stacyfazio.com

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A mental illness diagnosis will grant you access to supports which can include: extra time for tests, access to register for classes sooner so you get the time slots that work best for you (for example, avoiding late evening classes if your meds make you too drowsy at that time), extension on assignment deadlines, tutoring, assistance with writing papers, and many more. In most cases, the office will need documentation of your diagnosis, however, it should be confidential beyond that point, and professors should not need to know the exact reason you are receiving academic accommodations. You still do all the work and retain all the confidence in your collegiate achievements, but you get the adjustments in traditional academic structures that make college work for you.

NO BARRIERS Managing a mental illness does require additional preparation and planning but it should not take away from the prideful achievement of entering college. Knowing that your mental illness does not need to be a barrier to your goals can give you the fortitude to pursue all that college has to offer.

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how creating a minimal lifestyle helps reduce stress by Ruth Myers It was a serendipitous moment when I was asked to write an article on living with a minimalist approach. I was spending my Christmas holiday on a mountain in Southern Australia, in a town that consisted of five streets and two stores.

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a broken fridge I had no mobile reception, minimal internet access and no television. The owners of the bush retreat (a fancy word for an isolated cabin) where I was staying owned another property further into the mountain on a dirt track. They invited me to go for a walk on their property which, even in the summer heat, was surrounded by bountiful wildlife and mostly untouched bushland. Their abode had no electricity, no phone and no toilet. I was right in the thick of the article I’d been asked to write. They visited me on the way into town, asking to use my refrigerator for a while as their “retro” gas one, the size of a small icebox, had broken down. Now they had nowhere to keep their food cool. It reminded me of a dear elderly woman that I had met whilst working as a case worker to support victims of a bushfire. She also lived alone, humbly, and was still chopping her own wood at the age of 83. She also had a broken fridge when I met her, but this was of no concern, as her priority then was to help others who

had lost more than her in the fires. What struck me about the people I met then, was that they were very happy with owning very few material possessions. Their happiness did not come from what they had. Their happiness came not only from simplifying their life but they didn’t feel a sense of immediacy or desperation to replace an item which most of us would consider essential for daily living. They didn't feel they had any less or that they were unable to cope with the situation. In fact, they felt a deep sense of gratitude in their relationships with others over material possessions.

when less is more Confucius, the Chinese philosopher, wrote, 'life is really simple, but we insist on making it complicated'. So with my ‘Less Is More’ holiday at my fingertips, I asked myself three questions. Do we complicate our lives more by increasing what we have; by striving to have bigger, better, more prestigious items? Does possessing more create an illusion of happiness, something which fits our ego into believing that we have “made it” in bmhmag.com

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the world, and keeps us comparing ourselves with others rather than being happy within? Are we therefore making a choice about what we perceive are needs as opposed to wants? This leads me to think more about the meaning of living minimally. For some, minimalisation could mean 'the intentional promotion of our greatest passions and the removal of everything that distracts us from them'. It could be simplifying our life down to meeting our basic needs. For others, it’s an art movement where minimalistic fashion can actually mean accumulating ‘things’ that cost a fortune! I'm talking about keeping it simple and the feel good benefits for living

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a simplistic lifestyle. In the very basic sense, living with a minimal lifestyle is about trying to live with less. It's about trying to get back to the bare minimum of possessions and in doing so, it frees up your life to pursue the things you most value.

modern life The Industrial Revolution not only created a new onset of change in mass production. It also brought with it the diminishing role of hand crafts. The machine began to replace the historical knowledge and traditions of the personal interactions between texture, fibre, and nature as well as the social interactions within daily life. The ways of the old are often mocked


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in modernity as laborious traditions with little value other than being “hard work”. But with increasing concerns for the environment, we are now realising that the Industrial Revolution has a lot to answer for. Here are a few points to consider about the amount of waste we produce… Every 2 hours we throw out enough items to fill the world's largest container ship with trash. That's 12 container ships every single day, and 4380 container ships in one year and our waste production is increasing. By 2030 the amount of household waste will almost double to 3,000 million tons annually. And this is just the tip of the iceberg. Every bag of household waste has produced approximately 70 bags of waste upstream during extraction and production processes. So where does our waste go? Most waste goes to landfills or is burned. Burning waste is the world’s largest source of dioxins, which is one of the most toxic chemicals known to science. According to WHO (World Health Organisation), dioxins are highly toxic and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and also cause cancer. Sounds bad right? Well, the answer is yes, it IS bad. But with the knowledge and information at hand, we have the power to create change.

“ we have the power to create change ”

making a difference So you might be wondering how you can make an impact in reducing waste. With a modern day awareness of how much waste is produced, many have consciously chosen to have less in their life: less of chemicals, less paper, less plastic. The most common reasons for choosing less are often environmental concerns and making a conscious effort to look after the world rather than treat it as one huge dumping ground for toxins. But this is changing to a more fundamental reason. To reduce what we own is a resurgence and appreciation of traditional means of production such as handcrafted goods and consuming unprocessed foods. It wasn’t that long ago that living a simpler lifestyle was though of ‘just a hippie movement’. Now, reducing what we have and looking at how we can all incorporate living a simpler lifestyle is a topic that has become a much sought after part of modern culture. The increase of Internet sites, such as etsy.com, thrive on people selling their homemade wares. Recycling is another modern‑day example of making a conscious decision to reduce waste. Most households separate waste into general waste and items that can be recycled. Councils might provide recycling bins and even provide bmhmag.com

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workshops on how to recycle or turn waste into compost. In Australia, we had a Federal Government ‘Reduce Reuse Recycle’ campaign, as did the US National Institute of Environmental Health Sciences. It has now become embedded in the modern psyche (for many people) in teaching that we can all play a part in minimising waste. And an important component of minimising waste is reducing “stuff”.

clearing our mind clutter When we consciously choose to reduce the amount of belongings we own, or materials in our household, we have less. We have less to clean, less to throw out, less to see, so less to take up our thoughts and time. By reducing – or minimalising – all the better

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“extras” in our life and household, we are in fact reducing the time spent on things which are unnecessary, take up our time and energy, and which can lead to living a stressful life. By deciding to live a life which is “more minimal”, we are creating a step towards clearing out our “mind clutter”. One of the best benefits we gain from embracing a minimalist lifestyle is that there is less stress in our daily life. Less spending means less debt hanging over our head. There's less concern to make more money with which to buy the next gadget. Creating simple changes in our lifestyle through proactive and ethical choices means we begin to turn our values outward rather than inward. We then begin to think of the ways in which we live and how it affects our home, our environment and the world.


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creating more with less When we decide that we don’t need to clutter up our lives with placing absolute value on material objects, we begin to place value on the simple things in life. These are the things that bring pleasure to ourselves and to others. In doing so, we develop a sense of harmony and wellbeing. And this creates less stress. That doesn’t mean we have to go without a fridge or a toilet (or toilet paper!), but it does mean that we have a choice about how we can then reduce the material possessions that weigh us down. This could be the paperwork that hasn’t been sorted for years, the knick-knacks collecting dust, clothing which longer fits, or unused kitchen items. Once we decide that these items are not necessary to help with daily living, we can be active in finding a new home for them. There also comes pleasure from giving away items to people in need. You can do this by joining a ‘Pay It Forward’ group, holding a garage sale, giving to local charities and organisations. In giving to others, we not only reduce

in our daily life ”

our belongings, but we begin to feel good in making a positive change for someone else. For many of us, these are life changing things. They can seem daunting — and stressful — but they don’t have to be. Take one step at a time. Reduce little by little. Look at things and ask, ‘do I really need this?’. If the answer is ‘no’, then you’re on the right track. If the answer is ‘yes’, take a moment to think about it, think of the alternatives, think again, and if the answer is still ‘yes’, then go ahead and keep it. Now look around your home, open up your wardrobe or kitchen drawer, you’ll see items that are no longer useful, helpful or wanted. So why wait? Get started in reducing your waste and creating a stress free lifestyle, you’ll be glad you did. Minimisation is about simplification and getting back to basics, to appreciate and enjoy what we have. It’s not a punishment, but a gift we give to ourselves.

Ruth Myers is a professional counsellor in Sydney's Blue Mountains. She has worked in a range of roles involving family support, mental health, trauma, early childhood and disaster recovery. She believes in identifying a person’s strenghts and and assists in creating personal change through the use of their own strengths and hopes. She is a mother of two children who continually teach her about life; the joys as well as the challenges. She also continues to study in the field of Psychotherapy with a particular interest in loss and grief. She enjoys bushwalking, yoga, long drives and good coffee. http://www.ruthmyerscounselling.com.au bmhmag.com

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Tips for Minimising Life Here are just a few of the things we all can start doing today to create a minimal and happier lifestyle everyday

Stop buying new and fashionable products that have no other purpose and get rid of excessive things to reduce clutter, create space and help out someone in need

Simplify your wardrobe, put everything into bags and only keep the things that you wear in a season, at the end of a year give whatever hasn't been worn to charity

Declutter the digital life to replace time online with personal interractions, reduce the number of devices, the time on devices and the number of social network accounts

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Fix little problems before they become big ones following the old–word adage that a 'stitch in time saves nine' and reduce the amount of waste and easy replacement

Get rid of excessive furniture to reduce clutter, create space and help out someone in need and stop buying new and fashionable furniture that has no other purpose

Evaluate what we do with our time and choose to spend it purposefully on activities that we actually enjoy and benefit ourselves or even benefit other people

Purge unnecessary gadgets and seldom used entertainment equipment that take up time and energy that could be better spent with family or friends or just being mindful on our own

Simplify work tasks, reduce stress of difficult or repetitive tasks, cook in bulk and freeze or put away things as they're used rather than a massive clean–up effort


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Have a place for everything and put everything in its place when we're done with it to create a clearer space around us that creates are clearer space in our mind

Limit our buying habits to those things that we really need, such as food and bills, and wait a week or so before buying something we think we need right now

Eat healthy, simple wholefood, home cooked meals rather than eating out and having packaged foods that add little nutritional value and even less of the satisfaction

Learn what 'enough' is and stop there rather than upgrading and upsizing to the things beyond what's needed to enjoy the original experience

Be present and experience the moments in life that we will remember with satisfaction and gratitude because we are mindfully living the greatness of the little things

Purge unnecessary gadgets and seldom used entertainment equipment that take up time and energy that could be better spent with family or friends or just being mindful on our own

Buy second­–hand items to reduce our environmental impact and make good use of items that still do what we need them to without purchasing the latest and greatest

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Starting Life Over Again with

Cathryn Murray

Cathryn Murray is an amazing person. Not just for what she achieved, and lost, but for determination to rebuild her life after losing everything to mental illness. At 8 years of age, she founded the Global Teen Club International, a not for profit organization comprised of ethnically diverse and socially aware young people. In 1992 she received national recognition from Noxzema being named an Extraordinary Teen Finalist and the organization became affiliated with a United Nations program in 1996. In 1999, Cathryn launched a website and became well known as a plus size model while also working in the public sector. Happy, successful, independent, in 2009 Cathryn had a breakdown and was diagnosed with Bipolar I. She lost everything. Cathryn shares with us her story of loss, recovery and rebuilding her life with mental health. better

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people

“I lost my grasp of what was real ” BMH:

You achieved some really impressive things at such a young age, who inspired and supported you? Cathryn: My mother was very inspirational and encouraging. I didn’t want to be like the other kids. I wanted to do something useful so I set up a program called the Global Teen Club International. It was a not for profit organization comprised of ethnically diverse and socially aware young people. I published a monthly zine for young people around the world. The zine published young people’s writings and helped to connect young people around the world. We learned more about our similarities and not our differences. Through this program, I also helped to mentor young people, spoke at juvenile hall programs, published a poetry book Small Things, and was honoured as a successful youth volunteer as Global Teen of the Year. BMH:

You’ve done all these things as a teenager, then you’re working, you’re seeing someone, you’re modelling, you’re active in the church and community. What happened? Cathryn: It was too much. I was pushing myself far too much. In 2007, my mother died. That triggered my breakdown in 2009. I lost my grasp of what was real and then lost everything after that. bmhmag.com

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BMH: How did your breakdown impact your life? Cathryn: I lost everything. I lost my job, my apartment, my clothes, everything I owned. I had nothing, just what I was wearing. I was hospitalised under a 52-50 (a mandatory two-week hold). Then I was placed in a group home and was on disability for a year after that. I was put on the S.P.I.R.I.T. (Service Provider Individualized Recovery Intensive Training) program. This trains and educates those who would like to become better self-advocates and/or Mental Health Service Providers (MHSP). This program made me realize that I can continue with my education and accomplish things even with a mental illness. I attended this program at a local college in the SF bay area. I learned a lot from this program, especially about my diagnosis, and other people’s diagnoses, and it helped me to educate myself about mental illness and get the facts that I would need for myself and to help others. BMH:

That’s work and home. Was there an impact on family or friends or relationships? Cathryn: Everything changes. I lost a lot of friends during my breakdown. They turned their back on me, with reason, but they weren’t supportive and left. But I also realize now those individuals were not

Image courtesy of Juan J Mariaca

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people my true friends. True friends stay by you through the rough times and good times as well. When I was on medication, I wasn’t the same person and lost more of my friends. I made new friends during my recovery, through the ANKA behavioral program in Concord, CA.

I had nothing, just “what I was wearing

This program helped me to start opening up more with a therapist, meet people that were going through the same struggles I was going through, meet people that I could truly call my “friends.” It was through this program that helped me realize that I needed to go back to school and educate myself. After graduating from Anka, I was accepted into the SPIRIT program. They were there for me when I was at my worst and they’re a really important part of my life now. Some of my old friends have reconnected and are coming back into my life.

BMH: What does the program do to help? Cathryn: Concord Mental Health has helped me tremendously. I am assigned a case manager, money manager and psychiatrist. When I lost my apartment they assisted in placing me in a group home, they helped get me stable again and in getting a monthly income. CMH helps many people become independent again. BMH: How did all this impact personal relationships? Cathryn: My relationship from before the breakdown ended. But we got in touch again recently and we’re back together. That’s working out really well. We’re taking it slowly and seeing how things work out, but it’s good. As for my father, we did not speak for many years. I think going through therapy helped me learn to forget things that happened in my past and focus bmhmag.com

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more on the future. I reached out to my father a few years ago. My mother wanted me to get to know my family on my father’s side, and I was able to attend a family reunion and also have been able to spend the holidays with my father’s family. I realize now how important family is. It was something that took awhile for me to get to this point in life. I credit my therapist, Ziba, for getting me here.

“ You have to be positive ” BMH:

Now you’re studying and looking for an internship, you’ve started modelling again… Are you concerned that you’ll face another breakdown? Cathryn: No. I had so much energy before. I didn’t sleep and I took on too much. Now I’m calm. I make sure I sleep. I’m more in touch with my reality now. Everything was so overwhelming. I understand my disorder and I manage it. I’m really careful about what I take on. I’ve learnt to say no to things so that I don’t take on too much at once. I see my doctor every month and talk about what I’m doing and how I’m feeling and they suggest when I should maybe slow it down a little. BMH:

What does being a mental health advocate mean to you? Cathryn: It means writing and speaking out to others, people I meet in my community and wherever else I can. I think we need more positive role models and messages around mental health. When the media mentions mental health it’s usually negative and about crime. I have bipolar disorder and I live my life in a really positive way. I want other people to understand that. I want other people to know that you can lose everything and start again and be positive and that it can work out. BMH: How do you stay so positive? Cathryn: It’s just the way I am. You have to be positive. better

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people

I love writing and using my Wellness Recovery Action Plan. The WRAP model was developed with the help of a team of people with lived experience. It is kinda like a journal, but so much better. It was created by Mary Ellen Copeland. WRAP is program that can be adapted and modified to apply to mental health recovery; dealing with the effects of trauma, addictions, diabetes and fibromyalgia. WRAP can be modified for families, veterans, and kids, and other emerging recovery models. Some elements of WRAP focus on peer support and peer education. WRAP undertakes a strengths-based approach to recovery. We are encouraged to manage our own wellness and recovery in a manner that is comfortable to them and within their means. The key recovery concepts of WRAP are hope, education, personal responsibility, support and self-advocacy.

BMH: What’s next for you? Cathryn: I’m going to be placed in an internship, graduate from Heald College in April. In my future I would like to be involved in event management. I love putting on events, planning everything and working with people. I’m a really positive person and want to share that.

Cathryn can be contacted through her website http://www.cathrynmurray.com Image courtesy of Juan J Mariaca

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PA I N is real Pain is real. Pain is our body’s natural response to… pain. Whether physical or emotional, pain is real and can be treated effectively without reliance on potentially addictive medications. That was BMH Magazine’s take-away message from a talk by Dr. Mel Pohl that we recently attended about the co‑occurrence of chronic pain and addiction. While it may seem reasonably obvious, the many implications are significant to the treatment of chronic pain. Dr. Pohl explained how pain is our response to pain. In really simple terms, by attempting to mask the effect of pain (i.e. pain) with medications, our body responds by sending additional pain messages to our brain, reminding us that we are in pain. Add more pain medication and the brain increases the messages. It’s our brain’s way of telling us that we need to do something about it. When the pain is acute – severe pain, perhaps in response to a broken bone – this isn’t such a problem. Mask the pain and when the cause of the pain is resolved, then the pain messages will go away an the medication is no longer required. However, when that pain is chronic – ongoing for long periods of time, possibly a person’s lifetime – masking the pain with medication won’t be an effective long term solution. In fact, for many, it means becoming increasingly dependent upon an ever increasing level of pain relief. Dr Mel Pohl’s latest book dealing with managing chronic pain without the use of opiods or other prescription medications can be purchased through amazon.com

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For some, this may include prescription medications, alcohol or other substances, to the level of abuse or addiction. And, reasonably, that is a problem. Dr. Pohl also explained that emotions drive the experience of pain. As such, CBT can be more effective than pain medication. The talk was hosted by South Pacific Private Hospital in Sydney, Australia. Dr. Mel Pohl is the Medical Director at the Las Vegas Recovery Center in the United States. We’re grateful to Jacqueline Grant of South Pacific Private for extending an invitation to the talk. In a era where common


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Left to right are: Steve Stokes, Program Director, South Pacific Private Dr. Ben Teoh, Medical Superintendent, South Pacific Private Dr. Mel Pohl, Medical Director, Las Vegas Recovery Center

perception about treatment is based on cycles of recovery, it was reassuring to hear from two treatment centres that focus on a wholistic approach to recovery and managing mental health without a reliance on medication. Steve Stokes, Program Director at South Pacific Private, explained that both centres are well aligned as they take a wholistic approach to mental health treatment and recovery. He discussed how this means using a range of treatments other than medication. This includes therapy, such as CBT, mindfulness, using psychodrama (or role-play), nutrition, exercise and therapy (yes, therapy is twice because there’s a lot of therapy). At BMH Magazine we believe that mental health should be addressed in a wholistic manner. While this may include medications for some, it may not be the only approach. It was fantastic to hear how effective that can be for chronic pain and addiction recovery.

www.southpacificprivate.com.au 1800 063 332 or +61 2 9905 3667

lasvegasrecovery.com +1 888 535 7164 bmhmag.com

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Eating Well at Work With many people often eating more than their lunch on the job, workplace nutrition is important, not just for physical health but also workplace wellbeing. We take a look at why employers should encourage – or even provide – healthy food and snacks at work.

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Why healthy workplace eating matters Food supports our body and brain function. With a balanced diet we can lead a more balanced life. With most of us spending a third of our lives at work it is very important to be pro-active in eating healthily at the workplace. Our employers have a duty of care towards us and should provide us with healthy foods. The main aspects of a healthy diet we should concern ourselves with, and ensure our employers are focussing on are; preparation, quality and nutritional value. Content for this article was provided by meridian wellness, which provides organisational psychology, safety, nutrition, health and fitness, and training services. www.meridianwellness.com.au bmhmag.com

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Unhealthy workers require more medical care, take more sick days and are less productive on the job. Healthy eating along with living an active and positive life can lead to: ü reduced risk of some cancers and heart disease ü increased energy and an elevated mood with improved self-esteem reduced anxiety and stress ü ü the opportunity to spend more time with friends and family.

Influencing how people eat at work The workplace will influence not just what people eat, but the way in which they eat meals and snacks. Always remember that the workplace environment influences the health of its employees. It is important to look at what is offered to the employees at vending machines and workplace cafeterias. The workplace should provide refrigerators and microwaves so that meals can be stored and prepared safely and appropriately. Research was conducted within a work environment to investigate the means and methods we consume foods. It included the convenience of the food and its accessibility – whether easy or difficult to obtain. Secretaries were chosen to carry out one aspect of the research. Over a week the secretaries had a bowl of chocolate placed near their workstation. The bowl was filled each night to be full when they arrived at work the next day.

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wellbeing Over a three week period, the bowl was moved. The first week it was placed 3 metres away from their normal work position. Week two it was placed in their top draw. Week three it was placed within reach from sitting position, but behind a vase of flowers. Week one they consumed 9 chocolates each day on average, week two 4 and week three 6. Temptation was increased when the bowl was in full sight.

Healthy foods for the workplace Within workplace wellness programs, there has been much emphasis on screening and education to encourage individual employee behavior, and better health at work. Today there is mounting evidence that lasting behavior change is best achieved when education is joined together within a workplace which supports healthy choices. Workplace snack trolleys, cafeterias, and other food service options are the key to creating healthy food environments at work. Healthy vending offerings can also have a substantial impact. Not only do the majority of workplaces have vending machines, however recent studies have shown that: ü People are more likely to buy food from vending machines if the selections are healthier Reducing the price of low-fat items in vending machines ü is associated with increased sales of those items.

Encouraging healthier workplace eating Employers can support healthier eating in many ways: ü cafeteria foods - offer fairly priced healthy options ü vending machines - offer healthy foods in all vending machines snacks at meetings - offer fruits, vegetables and water ü rather than sugary snacks ü sweet jars - encourage a fruit basket instead. Types of food provided by the employer should include: ü wide choice of fruit and vegetables ü breads, rice, pasta or potatoes ü fish and chicken bmhmag.com

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ü include a variety of vegetarian options with recipes

including quorn, lentils, peas, beans, or eggs. use low fat and low sugar products when available, and ü provide healthier low fat spreads & yoghurts. The employer should also remove salt from the table, and reduce the amount of salt in all cooking. Also, when cooking, the workplace cafeteria should only use oils and sugar lightly. When using a catering firm, the employer can question the ingredients or set standards. Displaying and promoting food should help promote heathy foods. Try these: ü ensure salad bars, fresh fruit and a selection of breads are prominent in the serving area ü make baked potatoes more visible than chips for example ü offer salad dressings separately ü ensure healthier options are not more expensive.

Encouraging healthy snacking Be prepared, having a large pack of mixed nuts and seeds available is great way to satisfy the hunger cravings, and knowing you are consuming a nutritious food will ease the tension. Nuts and seeds are available in most shopping / grocery outlets. They are low cost high nutritional value. Nuts and seed blends can have protein and fibre, also contain fats that help many of the body’s ability to store energy. Work pressures can lead to feelings of stress. With many offices having a vending machine it is easy to get a sugary snack. Although this can be nice for about five minutes after consuming, once the sugar hit drops, so will your mood. better

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Foods help us at work Some foods will promote health and others will give satisfaction in other ways. Eating a nutritionally balanced diet at work can help lower blood pressure and add to energy levels and concentration. Food is a major source of physical and mental wellbeing. The correct foods can be calming, help to focus our minds and be energising. Good nutrition can give the feeling that we are working at our optimal level, feeling happy, energetic and aware. In the work environment we are looking to be engaged in the job, the work may require bursts of concentration and require you to stick to a task whilst having a level of productivity. Thus, you will achieve short and long term work goals, your expectations will be aligned with the business, and outcomes overall will be very satisfying for both employer and employee.

Occupational Health, Safety and Wellness Improve health and safety in the workplace

Health at Work Meridian’s Health at Work is the backbone of the wellness program. Health at Work is designed to “fit” your business, we ensure your wellness program launches well and runs smoothly for years to come. When used in conjunction with Meridian’s SAM program we guarantee success. Every business now has a requirement in occupational health, safety and wellbeing in the workplace. Meridian are your experts in the field, occupational health and safety professionals, organisational psychologist, trainers and health experts, your one stop to success. Ensure your businesses health and safety call Meridian Wellness to speak to our Occupational Health professionals. Call now.

meridian wellness

Organisational Psychologist, Safety, Nutrition, Health and Fitness, Training www.meridianwellness.com.au. info@meridianwellness.com.au. (08) 9245 3808

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watching

By Ethar Hamid

They are here. They were here when I was fourteen, and that was the worst of their presence, and now, they are here, again. “Why?” I want to ask them. “Why me?” But if anything, they will probably respond with a maddening “because.” They don’t care about me. They would be happy to see me spiral into a painful insanity. They are here; they are watching. That tinker behind the walls? That was them. That bump, somewhere in the house? That was them, too. But lately, they are not as owl-eyed as before. Before, they were unblinking … focused … and unforgiving. Lately, they’ve softened their gaze, a little. A few years ago, I had wanted to scream at these criminals – they were puncturing holes in my peace of mind; they were shredding up any feelings of security, all with nonchalant hearts and nimble hands. It is only now, at their second arrival do I question if they are the cause of my unsettled mind, or if it is my disturbed mind that produces them. Maybe this is a sign that I’m a little bit better than before. better

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Ethar hopes to be a writer in order to help people suffering from mental illness and mental health issues; she believes that stories can do more than let sufferers know they are not alone – they can help heal. She is the youngest in her family, and is currently studying Communication at George Mason University.


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Ethar explains how she view her own mental health and the difficulty of assessment, diagnosis and treatment when those symptoms could be shared by multiple disorders. Sometimes, I wish I could see or hear things that aren’t actually there (I wish I could hallucinate). To my limited psychiatric knowledge, that symptom would lead to a most accurate diagnosis of my mental disorder; perhaps schizophrenia, bipolar, or something else. The fact that I have never seen or heard stimulus that didn’t really exist is something of a let-down. It feels (to me, anyway) like my diagnosis is not as clear-cut. And after nine years of suffering from mental illness without an accurate diagnosis, one begins to crave a little definiteness and closure in the story. In other words, at this point, I just want a concluding statement — you have “this,” without a reasonable doubt. Then, I could join support groups, read books written by other sufferers, live as a person with the illness. But how can you begin to accept what you have (in terms of disorder) if you don’t know what you have? As of now, I am diagnosed with depression and OCD. But to me, the diagnosis doesn’t feel certain. As a result, I feel uncertain — I feel like a

leaf floating in the wind, not belonging anywhere. And I can confidently say that at this point in my life, I want probably more than anything to know what it is that I have. I can identify with paranoia, depression, obsessive-compulsive behavior, anxiety, and delusions. I hope I’m not leaving anything out, here. To be fair, this range is difficult to work with. It’s a cocktail of an illness — a little bit of everything. And despite my yearning to be a person with a classic case of so-and-so disorder, I’m glad I can (at least) pinpoint definite symptoms that I suffer from. To know that my unease with leaving the car even after locking its doors six times has a name, is reassuring. And to know that the feelings of being watched and plotted against has a name, is also reassuring. So, in my pursuit of closure, I may just have to find books written by people who have suffered from what I have suffered, and not who have what I have. Maybe I just have to live as a person with mental health problems and not as a person with a mental disorder. bmhmag.com

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Differential Diagnosis Matching Symptoms With Disorders Dr. Abimbola Farinde discusses the difficulty of differentiating between different mental health conditions when different mental health conditions share some or many of the same symptoms. Difficult at the best of times, Dr Farinade explains the increased difficulty when faced with ethnic or cultural characteristics and preconceptions.

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The ability to make a differential diagnosis refers to the use of a systematic method that can identify a syndrome or disorder that is presented in the form of signs and symptoms to the observer. The methods for making a differential diagnosis for mental disorders was first developed by Emil Krapelin and it turned out to be a more systematic process compared to the method of diagnosis by gestalt (Schultz & Schultz, 2004). The method of making a differential diagnosis involves formulating a list of possible diagnoses given a person’s presentation and then attempting to remove diagnoses from the list until at least one of the diagnosis remains at the end. In order to be able to accurately remove a diagnosis for the created list, observations are made and tests are performed that have the ability to yield various results depending on what diagnosis turns out to be the correct one. The methods for performing a

differential diagnosis should allow one to clearly understand the condition or disorder, assess for a reasonable prognosis, remove any life-threatening conditions, make treatment or intervention plans, and lastly allow the client to be able to integrate the condition or circumstance into their lives until it is removed (if possible). During the entire process all materials must be elicited, recorded, and evaluated with more and more questions being posed in order to narrow down the possibilities from the list until one identifies the single most likely cause of the condition. Additionally, the components that I believe are most suitable for making a differential diagnosis is the use of structured and semi-structured interviews that can be divided into those the focus on either Axis I clinical disorders or Axis II personality disorders (Hersen, Turner, & Beidel, 2007). When it comes to making differential diagnoses for mental condition there are few diagnostic exams or tests that can be used to rule out a given bmhmag.com

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diagnoses but the use of assessment tools and validated instruments become useful (Gregory, 2007). When it comes to making the determination as to what is the problem with an individual, it is important for clinician or non-clinician to develop or have a system in place that makes it possible for him or her to quickly brainstorm possible differential diagnoses for the patient’s case. It is by performing specific diagnostic assessments and using a reliable reference in order to narrow down from many of the differential diagnoses to one or two that may be the final diagnosis. It is imperative that a practitioner strive to use methods that have been validated and verified by others when it comes to confirming a diagnosis. This this will prevent the trial and error that is often times associated with providing mental disorder diagnoses. The existence of racial and ethnic factors have the potential to produce biases when it comes to making differential diagnoses. This may be because a clinician’s personal bias can significantly affect their final judgment as it relates to their client. Within many societies there are prevalence rates of symptom clusters that are being identified or are primarily associated with specific ethnic groups. For instance, according to Minskey et al (2003), there was a higher rate of depression within Latinos based on cultural variances better

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prevent the trial and error often associated with providing mental disorder diagnoses that clinicians automatically associate with the culture. They then use these when it comes to coming up with differential diagnosis. In the end, there are a large number of Latinos being diagnosed with a depressive disorder in the treatment setting when this diagnosis may not be the best fit. Additionally, the observation was made by Gonzalez et al (1997) that clinicians were restricting diagnoses of Mexican Americans to only a small fraction of disorders that presented in the Diagnostic and Statistical Manual of Mental Disorders. This shows that clinician stereotypes can distort or cloud the manner in which they choose to use the DSM-V as a reliable tool. Professionals must work to be objective and reasonable when it comes to determining the differential diagnoses of a client. This cannot rely heavily on ethnic or racial stereotypes, misconceptions, or other factors that have the potential to negatively influence the diagnosis that is ultimately given to their client. On the other hand, ethnic and racial factors can be useful because specific diagnoses may be more prominent in a particular group when compared to the rest of the population.


featur e For example, it is well known that Caucasians or Whites do tend to present for depression (especially females) compared to the rest of the population. However, an automatic assumption should not be made across the board that when it comes to making suggestions for possible mental disorder diagnosis, depression should always be on the list based on the fact that a person is female and Caucasian. It is important that the practitioner does not limit him or herself to a specific group of differential diagnosis based on a client’s racial or ethnic background. This is where validated assessment tools and instruments come into play to reduce the likelihood of this case, so that the final diagnosis is a well-researched and legitimate one.

References Gonzalez, M.,CastilloCanez,I.,Tarke,H.,Soriano,F., Garcia,P., Velesquez,R.J.(2007). Promoting the culturally sensitive diagnosis of Mexican American: Some personal insights, Journal of Multicultural Counseling & Development, 25(2),156-161. Gregory, R. J. (2007). Psychological testing: History, principles, and applications (5th ed.). Boston: Pearson Education, Inc. Hersen, M., Turner, S. & Beidel, D. (Eds.). (2007). Adult psychopathology and diagnosis. (5th ed.) Hoboken, NJ: John Wiley & Sons. Minskey,S., Vega, W.,Miskimen,T., Gara,M., & Escobar, J. (2003). Diagnostic patterns in Latino, African American, and European American psychiatric patients, Archives of General Psychiatry, 60(6), 637-644. Schultz, D. P., & Schultz, S. E. (2004). A history of modern psychology (8th ed.). Belmont, CA: Wadsworth/Thompson. Dr Abimbola Farinde, PharmD is a clinical pharmacy specialist who has gained experience in the field and practice of psychopharmacology/mental health, and geriatric pharmacy. She has worked with active duty soldiers with dual diagnoses of a traumatic brain injury and a psychiatric disorder providing medication therapy management and disease state management. Dr. Farinde has also worked with mentally impaired and developmentally disabled individuals at a state supported living center. Her different practice experiences have allowed her to develop and enhance her clinical and medical writing skills over the years. Dr. Farinde always strives to maintain a commitment towards achieving professional growth as she transitions from one phase of her career to the next. bmhmag.com

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The Other C-WORD Sitting at a café recently, enjoying my coffee and cake, I watched a woman lean in close to her friend. Fearful that even saying the word could be contagious, she murmured, ‘he’s crazy, proper, on medication, crazy.’ Speaking with Randi Silverman, the Producer/Writer of the new film No Letting Go, I was reminded that it wasn’t so long ago that cancer was the other, unspoken c-word. As a mental health activist and cancer survivor, she explained that through open and destigmatised discussion about mental health, a difference can be made. That’s what the film No Letting Go is aiming to achieve.

BMH: Hi Randi. Let’s start with you. You trained and worked as a lawyer, you’re a mother, and now a producer of a soon to be released major film. How does that happen? Randi: I set out to be an attorney and a mom, but I didn’t start out with the intention of making a film. I believe good things happen when you embrace the challenges that face you. Because of my family’s personal experience with mental illness, I have been a volunteer mental health advocate for the past 7 years. bmhmag.com

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A friend of mine, Carina Rush, was producing a short film called Illness and she asked me to look over the script. Ultimately, I became an advisor and associate producer of that film and worked with them on making the script accurate and realistic. It was a film about a family with a child who had mental health issues and it really hit home for me. Jonathan Bucari, the director and writer of Illness, wanted to make a film, not about, but in response to the Sandy Hook Incident. It was a terrible tragedy where a gunman opened fire in an elementary school, fatally shooting twenty young children and 6 staff. Illness explored the idea of families with children who suffered from mental health issues, but it was not about the shooting itself. BMH: What was your interest in mental health? Randi: One of my three sons was diagnosed with anxiety, depression and Bipolar Disorder at a very young age. He was ill for many years and it was a devastating period for my family. We were extremely isolated and had very little support from our community. As I learned more about childhood mental illness and as he became more stable, I decided that I needed to help other families. I started a support group about three years ago and over 400 families have come through the group. I now know that 1 in

Writer/Producer of No Letting Go, Randi Silverman with Actor Cheryl Allison, who won Best Actress for her role in Illness. Image courtesy of Ted Astor Photography

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featur e

1 in 5 “children

suffer from a diagnosable mental health problem

5 children suffer from a diagnosable mental health problem and that there are millions of families out there just like mine.

BMH: Your youngest son, Noah, starred in the short film, Illness? Randi: That was more of an accident. Four days before filming commenced, a local paper reported that we were making a film about the Sandy Hook Incident. It didn’t matter that we weren’t. The mother of the intended lead pulled out and we lost the filming location. We asked Noah whether he would consider the role and he said “Mom, this is an important story. We have to tell it!” He agreed to play the part of Tim and I found a new location. It was all very fortunate. BMH: How did a thirteen minute short film turn into a full length feature film? Randi: Illness was a snapshot only and easily taken out of context without the broader family issues and impact addressed. And yet, it received over 20 nominations and won 7 awards worldwide in film festivals. People would surround us and thank us for making such a powerful film; they wanted to know more. While the short film was a great way to start a conversation, we knew we could make a bigger impact if we could tell a broader story of what it’s like to have a child who suffers from mental illness. So Jonathan, Carina and I decided to make a full length film, which is No Letting Go. I co-wrote the screenplay with Jonathan and Carina helped keep us moving. She also helped cut it back from what could easily have been a four hour film. BMH: How did Eli feel about Noah playing a character based on him? Randi: Noah knows what it’s like to live with someone with a mental illness. He lived through it. There were times when Eli was not well that we would lock Noah in another room to keep him safe from Eli’s violent episodes. Eli said that the film was important and he wanted Noah to play the role because he knew he could do so honestly. He was incredibly supportive. bmhmag.com

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BMH: What was it like working with Jonathan and the rest of the crew? Randi: It was incredibly exciting to have an opportunity to work on a film set. Jonathan is a young, up and coming and very talented director. He brought in other incredibly talented people. There were 36 crew members, each better than the last. This was an ultra-low budget, independent film. We were extremely lucky to be able to get talented actors, who joined the cast because they loved the script and believed in the film. BMH: Tell us more about Eli. Randi: Eli has Bipolar II Disorder. It started with anxiety and led to depression. At around ten, he became very depressed. He was an antidepressants and anti­ ‑anxiety medication, which triggered his bipolar, then extreme irritability and then anger. BMH: And your oldest son, Max, how does he fit into it all? Randi: Eli has Bipolar II Disorder. It started with anxiety and led to depression. When he was nine he became very depressed. He was on antidepressants and anti‑anxiety medication, which triggered his bipolar symptoms, which included extreme irritability and anger. BMH: And your oldest son, Max, how does he fit into it all? Randi: Max and Eli were very close when they were little, and it hurt Max to see his brother withdraw. He was angry at us, his parents, for not handling Eli properly. It took a lot of talk therapy and teaching the kids that mental illness is like any other illness and it’s no-one’s fault. It took time, but he eventually understood and he’s been very supportive. BMH: How did you feel about Max blaming you? Randi: Everyone blames the parents. Eli is 18 now, but when he was first diagnosed nine years ago, people did not talk about mental health issues in children. That silence made it far more difficult. It’s impossible to ‘fix’ a problem that you don’t know can exist. When a child’s behavior is not “typical” there is an assumption that the cause is bad parenting. I blamed better

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I knew “something wasn’t right... he became afraid to go outside


featur e myself for a long time, as well, until I learned more about mental illness. Anyway, Max was only a child, too, and so it was natural for him to feel angry. BMH: But you didn’t just leave it there, as a parenting issue. How did you know there was more to it? Randi: I knew something wasn’t right. He was a very happy little boy until around seven or eight years old. He became afraid to go outside or get on the bus for school, so I met with the school’s psychologist to get some advice. The psychologist observed him and told me that he was okay at school. She suggested that I was the one who was anxious and that I needed to get help. But when my nine year old son said he was so miserable that he wanted to die, I knew something more serious was going on. BMH: How do you know the difference? Randi: You look at how they’re functioning. Can your child function — at home, school, socially — if your child isn’t functioning well in any one of those spheres, something isn’t right. Eli stopped playing with friends, he quit activities, and wouldn’t go to school. His behavior became so difficult and unpredictable that we couldn’t go out as family anymore. When your child is unable to function properly for his age, either in school, at home or with friends, on a somewhat regular basis, it’s time to seek help. I also encourage parents to listen to their gut.

On the set of No Letting Go. Having lived through the experience, Eli’s younger brother, Noah, has the perfect experience to bring something special to the lead role. Image courtesy of Ted Astor Photography.

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BMH: People assume that children who have mental illness must come from an abusive family or experience trauma. What do you say to that? Randi: That’s why the film is so important. I want to make it clear that there doesn’t have to be a reason for a child to have a mental illness. It can just happen, to anyone, for no apparent reason whatsoever. Eli came from a very loving, very supportive and stable home in a safe suburban neighborhood. His father and I are well-educated and I was lucky to be able to stay at home fulltime with the kids. I haven’t seen any other films like this, where a young child suffers from mental illness and there is no obvious trigger. Film is very powerful. A documentary is informative, but it’s for people already with an interest. A drama is engaging and people can relate to it. So it’s important that the film was made. BMH: And through this, life went on as a family. In the film, the mother is diagnosed with cancer. Randi: It really happened; I am a breast cancer survivor. In fact, I was diagnosed when Eli was in his second year at a residential treatment facility. BMH: How are you now? Randi: I’m okay now. I’m grateful for all the attention that breast cancer has received, in funding and research, or I may not be here. But it wasn’t so long ago that having cancer was very stigmatizing; we didn’t mention the “C” word. We said someone was sick, but never that they had cancer. Now, thanks to all the cancer activists, we see pink ribbons everywhere, and we’re not afraid to talk about it. The stigma around cancer isn’t there and lives are being saved because of it. That’s what we need to achieve with mental illness. There’s still the stigma. We still don’t talk about it. And lives are lost to it. We hope films like this will get people taking, and reduce the stigma and increase the research and improve lives. BMH: Unfortunately, we can’t talk with Eli. Why is that? Randi: Right now he’s crossing the Atlantic, somewhere on better

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there “doesn’t

have to be a reason for a child to have a mental illness


featur e his way between South Africa and Brazil. There was a time when we weren’t sure he would even finish school. But he did. He’s on a gap year program, with 22 students on a 122 foot sailing boat crossing the Atlantic. It’s a 90 day voyage and he’s taking classes and doing really well. He’s a fantastic young man. BMH: Are you happy with the film? Randi: Extremely! It’s so much better than I could have ever anticipated. We had a small private screening last week and people were sobbing. It’s such a high quality film and the production value is incredible. We’re really proud of it. BMH: What’s next? Randi: Our focus is getting attention at film festivals all over the world. This isn’t a big Hollywood production, so the film festivals are an important way to get distribution. We feel it’s an important and powerful film and hope that ultimately we will find a distributor who is willing to get this film to as many viewers as possible. Our goal is to promote awareness and greater understanding of mental disorders and let families who suffer know that they are not alone. BMH: Thank you, Randi. For more information about the film No Letting Go, visit http://nolettinggomovie.com. If you would like to know more about Bipolar Disorder, visit the International Bipolar Foundation website at http://ibpf.org.

On the set of No Letting Go, the feature film about one family’s all too common challenges in dealing with mental health in the family. Image courtesy of Ted Astor Photography.

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walking mindfully through anxiety and dissociative disorders David W. Jones shares his inspiring experience of how positive thinking, mindfulness and writing helps him stay connected with people despite his anxiety, depression and dissociative disorders.

In 2013 the woman I love moved farther away from me, from a short walk’s distance to a 30 minute drive away. I had recently filed for bankruptcy and had to give my house back to the bank. My car got repossessed as well. At that point I felt alone and like a complete failure. I was still gainfully employed with the United States government, but all the things I was supposed to be able to handle as a grown-up seemed intent on leaving me. The loss of the car particularly symbolized a loss of freedom and self-sufficiency which made getting to work or a store a matter of relying on the bus or friends for rides. I couldn’t go where or when I needed to anymore, let alone where and when I wanted. The real danger was that I would just stay at home every day that I wasn’t working. If I did that I would no doubt succumb to the depression members of my family had fallen beneath once they retired. So I chose a better route for me. Since I had started a blog in January 2013, I enjoyed finding an outlet in writing. But I still needed to get out of the apartment, because I write better when I’m around people. I feel the dynamic energy of humanity and I feel less isolated. better

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I felt like a complete failure


people There were a few fast food restaurants which had free Wi-Fi and outlets where I could plug my laptop in, and they didn’t care if I stayed there all day. However they were at least a 30 minute walk from my apartment. So I strapped on my laptop-toting backpack and walked every other weekend or on days off. In 90 degree heat or ankle-deep snow, I walked to be around people and write. I think that saved me. In time I met a wonderful couple who gave me rides to and from work since they lived down the highway from me and I was on their way. So I met new friends, got exercise, and staved off the specters of isolation and depression by making sure I got out of the potential tomb of my apartment, spent time around people, and kept writing as a focus for my life away from work.

I found my strength

In all, losing things made me choose to stand up anyway and find a way to avoid giving in to futility. It meant inconvenience, but I wouldn’t have found my strength if I hadn’t faced my weakness. David lives in a part of the US where mental health issues are still considered rather edgy, but he has been an advocate since being diagnosed with Anxiety‑based Depression and Dissociative Disorders. He blogged all through 2013 about how Mindfulness therapy helped him cope and grow.

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Michael’s Personal Perspective

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Better Mental Health Magazine talks to Michael Tomlin about life with a chronic mental illness interview by Laura McConnell

It’s warm and private in the leather booth we are cocooned in, a stark contrast to the hectic hustle of the café’s pulse that surrounds us. We seem to be in an impenetrable cone of silence as I listen to Michaels own experiences of living with a mental health condition. BMH: Michael:

BMH: Michael:

Can you tell us a bit about the mental health condition you live with? I suffered from major depression over 15 years with a disorder called dysthymia which is a mild depression that lasts for up to 2 years with periods of ups and downs as well as anxiety. When did these feelings of unease and depression first manifest? It was around 15 years ago. I had a nervous breakdown due to 2 years of bullying and towards the end of the 2nd year my body started shutting down and it sort of led from there. It took a while for the doctors to diagnose it. The child psychiatrist that I was going to on every visit diagnosed me with something new. We eventually found a psychiatrist that said “This is what you’ve got and this is how we are going to treat it”. bmhmag.com

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BMH:

Michael: BMH: Michael:

BMH: Michael:

BMH:

Michael:

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Did you address the bullying with your school? Did they do anything in regards to the bullying which triggered your mental illness and breakdown? The school said these things happen. So they did not do anything at all to help. Do you have a bag of tools you use to help you cope when the depression does creep in or things get extra tough? Well I have been on medication for 15 years. I am on a very low dose and in a way I treat it like diabetes. It’s a medication I have to take it every day. Other than that I exercise a lot, I exercise every day, some days I do meditation or breathing exercises. Diet as well plays a big part so yeah I have a box of tools that I use in various situations. Who helps you, besides you, to manage your personal mental health issues? The majority of the time it is just me. I do have a mental health team I guess you would call it. I do have a psychologist and a psychiatrist, but really it comes down to me, the majority of the time. Family does help of course, but again I guess like most people they might not understand really what’s happened or why the sudden mood swing, so basically it’s a lonely one. Mental health often gets negative images attached to it which leads to misunderstanding or fear from others. Have you gained insight about yourself that you have learnt from living with a mental health issue? Yes! Every day! (Laughs) Because you sort of have to I guess through education, reading and looking at yourself. You do have to be honest with yourself to understand what’s causing this? What has


people

is a bit of a “ everyday learning curve ” caused that? Why am I reacting like this? Why are these ups and downs happening? Yeah every day is a bit of a learning curve. BMH: Michael:

BMH:

Michael:

BMH: Michael:

Do you feel confident your doctors have a good understanding of what medications would suit you? I have been with my doctor for 12 years. My psychiatrist is very good. He is not a big medication pusher, which I like. I think sometimes they can be too pushy with that. He works with the psychologist as well, sort of complementing them, which is really good, yeah it’s really helpful. Do you feel comfortable and open discussing your mental health issues with others, with family or with people who are getting to know you? Yeah I am pretty up-front. I remember when I met my partner and stayed over at his for the first time and the next morning I am there at the table taking a pill and I was like “I’ll explain what this is,” (laughs) I explained what the medication was and what it helps with. The people who know me know that I’ve still gone on; I have still had a career etc. Not many people would actually realise when I have had a bad day because I manage it with the tools I mentioned earlier but yeah I am pretty up-front and sometimes you have to be. Did you receive a positive reaction from your partner when you told him? He wasn’t freaked out. He’s a pharmacologist (laughs) so he was like that’s nothing!

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a summer

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people

storm By LeesaMaree Bleicher

Staring into the morning sky I remind myself how lucky I am. Settling into the comfort of my outdoor couch, sinking into the softness of freshly washed pillow cases, inhaling the soft scent of morning dew, with a cup of ginger tea in one hand, a book in the other, I relax into the morning when my peace is interrupted. bmhmag.com

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It feels like a hand is tearing back my skull and all my memories, thoughts and feelings are being projected to the universe. The serene light of the sky is suddenly blinding forcing me to watch reel after reel of sordid vignettes that have been carefully catalogued in my mind over the years. Everything I lost, all my mistakes, all that I had endured these past years… comes in sharp, poignant snapshots. As swiftly as it appears it stops, leaving me shaken and weary. It has never come to me like this before in the daytime with such throbbing intensity, in full Technicolor complete with feelings of dread, panic, deep bone shattering fear and profound loss. Panic. My hands became lax, my body limp and I am feeling chilled despite the warmth of the day. Here we go again… it never goes away. She never goes away. Visions, memories, feelings tangle all together, in no particular way – makes no sense to me it is jumbled, like a giant jigsaw puzzle whose pieces are

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falling here, there, everywhere, too fast, too many to get any idea of how they fit together or if they even do… visions keep falling like sharp blades of images that scrape my skin like razor sharp glass – she is in control now. All I can do is watch and wait for it to be over. Like the dream I had last night, that woke me at 3am leaving me frightened and fatigued, I looked for shapes in the hearts on the walls, looking for any distraction, I turned on the light in the bathroom before coming back to bed because I did not know what to do so I began to write: Blood filled caverns, pure white woman’s torso’s fiends feasting on human flesh, the vampire saved her, offered her love forever, whisked her off her feet, flew to Italy but it was not enough, her heart being torn out by razor sharp teeth, fiends that were feasting on a woman who was still alive but could not scream…


people but I could feel her pain, I have always been able to feel pain in my dreams. Feebly, I reach for a pencil, she laughs at my attempts but even she knows I am not as weak as I once was – I have won many a battle. I sank into the fluffy white pillows, set my jaw tight as the tears sat frozen ready, but unable, to fall. The agonizing memory of my dear cats, Nottes and Bianca, of their illnesses. I could almost feel them with me. Months of care every few hours, feeding, helping them go to the bathroom, so much care, so much time absorbed, then both of them passing as I held them in my arms. My breath labored as each memory lingered a little too long on one long painful memory after another, my heart clutched in fear as my mind chattered away loudly. Notte and Bianca my dear companions dead. They had seen me through 20 years of drama, wrists dripping blood on the snowy comforter as they curled up and

all I can do is watch and wait for it to be over purred, watched me stumble after 200 too many pills. It’s been exhausting having a heart that sheds layers. When the reel ended, I paused only briefly, sat only for a moment in the dreariness of it all, then I got up and began to clean, trying to dust off the debris the storm left. After all that’s what you do you keep moving through it, no matter how bad it hurts, you keep going. When the boy came, for once in my life I had someone other than myself to think about. My life was different now; I could not just cocoon myself in bed or go back to the emergency room and have intravenous narcotics slowly lull me to rest. I had a child now, a foster son, troubled and more than a handful, a new boyfriend, graduate school and the weight of being in my mid 40s with no savings, no career and no real or solid life direction. My days were full with everyday tasks and the care of the boy, which oddly brought me a deep sense of peace. I spent half my day worrying about how to pay my bills and the other half praying I was being a good foster parent. Looking out my balcony at the dawn, taking in the hushed hues of the sky, I bmhmag.com

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tried to get a grip on the pain. It was excruciating. I tried to breathe in the cool air, tried to change the racing thoughts. But the pain pushed at my temples, gripping my stomach in a tight knot. There was so much to do, homework, housework, my foster son is bullying other children at school, Child Protective Services had to be dealt with, somehow I had to see a doctor, my homework was past due, my boyfriend needed court papers prepared and submitted, my mentor needed a grant written. And there was a gentle melody playing in the background. The poems called to me with a soft, yet forceful urgency. It was autumn, the cold was coming, so were the memories… Thirty-one years of loss, loneliness and madness. I had spent fourteen years negotiating the terrain of my mind and the fiends who inhabit it, who delight in driving me mad. It has been a long, exhausting negotiation but finally we had an uneasy truce – much to their dismay.

What you ask is it? Mental illness is what some people call it. No one really knows because it’s not a tangible thing you can see. Experiences and perceptions shape and color how I navigate in this world on every level… and its shifts and changes as I grow older… I relate differently to the world. Memories, settle into themselves. Some die but, while others may no longer spark an reaction, they still live in my bones. Except now, I don’t always feel the compulsion to scratch my skin until it bleeds or silence the pain with pills and I don’t like being labeled Mentally Ill. I prefer to call it Emotional Spiritual Sensitivity. Cause it’s not always bad. It is often brilliant and beautiful! Like today. I saw the spirit of sensitivity in the stark white cloak of winter and I realized that is the gift. We suffer from things people can not see or understand – but we also feel and see the beauty, the bliss and the possibility that others can not. LeesaMaree Bleicher, CADC II-QMHP Certified Trauma Counselor, has over 10 years experience working with a dual diagnose, criminal justice, multicultural population, most recently as a Program Director. Her passions are caring for high risk youth and advocating for change in the juvenile justice system, increasing sensitivity among those who work with youth and those who set policy. She speaks out against the stigma of mental illness and is a voice for those with lived experience, believing it is most effective when reaching out to help others.

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about

Mental Health Warnings

and why we don’t include them

Like many other topics, mental health media coverage is governed by a number of voluntary codes of practice. These include how mental health should be presented, the use of certain terms, the way to refer to conditions or people and the recommendation to include contact numbers for services, particularly help lines. Most countries have one, sometimes more, codes of practice with somewhat similar guidelines. While we support these guidelines, and add our own, we decided not to include “warnings” in each article. The entire magazine is about mental health. It is not a glossy fashion, news or entertainment magazine with a random article about an unfortunate or inspirational life event. To include references to the relevant services for all international readers would make little sense and add no value. Listing all services for all countries would be a magazine in itself.

In very practical terms, we considered that if a person is at an extreme point and needs immediate support, they probably won’t be picking up a magazine for a light but informative read. If we’re wrong, and you are considering harming yourself or someone else, or are in danger of being harmed, then stop reading now and contact your local support line, medical practitioner or emergency services. Where practical, or where it exists, we try to include a website that has a comprehensive list of support organisations or groups for a particular topic. This is not always possible. We hope you understand our decision to take this approach. If you have any questions or concerns, please contact us at contact@bmhmag.com. Luke Myers Editor, BMH Magazine

Safety First If at any time you are concerned about your safety or wellbeing, or that of your children, a friend, or a loved one… you NEED help and assistance. Your first point of call is to phone your local emergency number. You can also call your local hospital and ask to speak with the Psychiatric Team. Often, this will open the door for an individual or family receiving help, support and understanding. It’s not about “getting locked into a system”. Rather, try to think of it as “unlocking” what may be a very difficult and scary situation. Receiving help will shift things. Remember: NO-ONE deserves to be in an unsafe situation. bmhmag.com

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after the

STORM

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Some interviews are harder than others. This is one of them. Nina Bingham contacted us about her new book, Once The Storm Is Over, written following the death of her daughter. As we spoke to Nina, we realised that the story was so much more than she had originally told us; so much more tragic, so much more personal and so much more inspiring.

At only 15, Moriyah, young woman with a promising future, took her own life in a tragic escalation of circumstances. bmhmag.com

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BMH: Nina:

Hi Nina, can tell us a little about Moriyah? My 15-year old daughter, Moriyah, was an honor student who had been nominated by her teachers and invited by the Surgeon General to participate in a national medical forum for High School students. She was an outstanding student. She was also involved in giving back to the community; she was the Red Cross student representative, in choir, and on the dance team. Moriyah was always an introvert, a naturally quiet child. But when her father died of ALS (Lou Gerrig’s disease), the family propensity for clinical depression set in. For four years she waged a battle against depression, and during that time, developed Bulimia Nervosa, an eating disorder. Because she purged at school at lunchtime and had been a little over­‑weight, I had no idea she was also suffering with Bulimia. I believed her when she said her healthier diet and exercise was helping her to lose weight. Like many teenagers, she was adept at hiding her unhappiness from me.

Nina Bingham lives in Oregon, US and is an author, life coach and clinical hypnotherapist. In 2013 she lost her teen daughter to suicide. Her book, After the Storm, is an incredibly open and honest reflection of her journey through loss, grief and survival. She hopes to educate teens and young adults about depression and how to avoid suicide, and to reach out to suicide survivors and those affected by mental illness so they know they're not alone. She can be contacted through her website http://www.living-enlightened.com.

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“ I had no

idea she was also suffering with Bulimia

BMH: Nina:

How did her depression progress? It was incredibly painful for her to watch her father deteriorate and eventually pass away. She was constantly at his side and it affected her terribly. Instead of reaching out, she withdrew, which worsened her depression. Eventually, she became so severely depressed that she couldn’t get out of bed to attend school.

BMH: Nina:

What sort of treatment did you consider? She attended counselling over the four year period, which helped. In the end her doctor put her on an anti-depressants because the counseling wasn’t enough. We saw significant changes. She became engaged with life and began opening up again. We thought everything was okay, things were looking up… she was almost like her old­‑self.

BMH:

But, instead, one evening, you and your fiancée said goodnight to her and when you woke the next morning, you found that she’d ended her own life. Yes. She seemed to be rallying, and turning her life around. We found the journal she’d been keeping, hidden along with laxatives that she’d managed to get from the internet. It turned out that she had stopped taking her medication five days before her death, and had been obsessing about losing weight. She wanted to look thin in a bathing suit when she went to California for the medical forum. We learned that a side effect of suddenly stopping the antidepressant could be suicidal thoughts. The doctor thinks that’s what triggered the suicide.

Nina:

BMH:

She still hadn’t fully recovered from her father’s death? bmhmag.com

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Nina:

It was more than that. She was scared that the antidepressant would cause her to gain weight. The thought of visiting California and being overweight in a bikini was the start of an eating disorder. She hid that so well, we didn’t even realize; she was clever enough to hide it, and only vomited at school on her lunch hour.

BMH: Nina:

So, it was more than the one event? It was a combination of high-risk factors driving each other. There is a family history of depression. She inherited the proclivity for depression, and her father’s death kindled it into a flame. Then the stress of body image. There’s so much pressure on young women to be thin or underweight. Because eating disorders are so prevalent among High‑school girls, her friends knew she was purging at school, but they all kept the “code of silence.”

BMH:

You said goodnight, then woke up the next morning and found your daughter’s body in the room next to yours? How does anyone cope with that? You can’t get through a tragedy of this magnitude by yourself. But at first, I tried. I was so ashamed, because I was a mental health professional. I was riddled with guilt and self-condemnation. My own mental health began deteriorating significantly. I didn’t want to live – not that I wanted to take my life – I just didn’t want to go through the pain of surviving her. I saw a psychologist and he helped me to see that I would have to work through it, to find a way to forgive myself.

Nina:

BMH: Nina: better

And then you wrote your book about it? No, not really. I am a writer, but the book

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“ you can’t

get through a tragedy yourself


people wasn’t planned. As part of my recovery I started to journal. It was raw and emotional and very private, and I didn’t hold back. No-one was going to read it, so it didn’t matter how honest – and self-critical – it was. In the end I knew I held an important story in my hands, and I thought it might be able to help others who were grieving. BMH:

Nina:

Nina hopes that she can help others prevent the tragedy of suicide by sharing her story about surviving Moriyah’s tragic death

This may be difficult. As a mother and mental health professional, how did you not see that this would happen? Because I’d been trained as a mental health professional, I knew all the warning signs. I was very aware that she might be having suicidal thoughts. I repeatedly asked her if she was having thoughts of taking her life, and she always denied it. She was very convincing. She even fooled her doctor. She fooled everybody; even her boyfriend and closest friends had no idea. We saw her improving on the antidepressant. Everybody was hopeful.

BMH: Nina:

How did it impact your relationship? The reality is that very few couples who go through a suicide survive as a couple. Ours did not make it. We began to have a difficult time communicating, then became distant and a year later the relationship ended. Suicide has a huge impact on everyone it touches, especially on couples.

BMH:

Clearly, something as tragic and significant has broader impacts? Definitely. The trauma, loss and stress impacts relationships – broader family, friends, even the school community. It’s the loss of what she could have achieved and the positive impact she may have had that is so very tragic.

Nina:

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BMH: Nina:

BMH: Nina:

BMH: Nina:

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Do you have any other children? If so, the impact on them? They are adults now but they still have a difficult time talking about it with me, with anyone, but especially with me. At first they expressed their support of me and that they didn’t blame me, they felt it wasn’t my fault. But as time has gone by it’s gotten harder and harder for them to talk about it. Why did you decide to publish your journal as a book? Let me say, it’s my journal as I wrote it. I didn’t hold back or try to make myself out as someone who’s perfect. I did make mistakes. I wish I had been more persistent in knocking down my daughter’s walls. I would hope that anyone who reads it, who’s going through depression or who is a suicide survivor or experiencing grief might learn from my mistakes. I don’t want other parents to make the same mistakes I did. I hope it gives vital information and insights to help people to intervene for their children, and to find the path to healing. But it’s not just for parents of children with signs of depression? People who read it will understand depression and suicide from the inside; this is an eye-witness account from the perspective of a mental health professional, but also how it feels to know all the answers but still to have failed the test. It provides practical keys to recovery, including the subject of Post Traumatic Growth, which is relevant to anyone trying to recover from a traumatic experience. It enables growing despite roadblocks. It uncovers myths that cause so many people

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“ grief is an ongoing process ”


people to get stuck and mired in their pain, and can show the way to overcome what you’ve been through. BMH:

Nina:

BMH: Nina:

Nina’s fifth book, her account of dealing with loss and survival, Once The Storm Is Over, is published by Big Table Publishing Company. More information can be found at http://www. oncethestormisover.com

You’re trying to get the book out there, to help others. But each time you talk about your daughter must be difficult. How does it impact you? We think of grief as a one-time event, or as a period in your life where you mourn and then move on. But what I see among my Life Coaching clients, and what I’ve experience is not that. I believe grief is an ongoing process where you grief at different levels. Yes, life does go on. But I’ll grieve for my daughter, on and off, for the rest of my life. I’ve learned to acknowledge openly when it hurts, and I try not to hide it. I find most people are pretty understanding, because many people have experienced the loss of someone they’ve love.  Grief is a universal concept. I try to talk openly and unapologetically about it, and I find it doesn’t hurt as much when I share it with others. If sharing your story saves even one life? I didn’t write this book for anyone else. I felt compelled to write it, and I wrote it for me, as a way to recover. Writing or journaling can be incredibly cathartic. I noticed the more I wrote, the better I felt, so I just kept writing. Once the storm settled, I picked up the pieces of my life and am sharing this to both honor my daughter’s memory, and in hopes of helping others. If it saves one life, then my daughter’s life will not have been in vain.

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Discussing Body

DysmorphiaaihpromsyD Body Dysmorphic Disorder (BDD) is a reasonably common mental health problem that, one study suggests, could affect up to 3% of the population. It affects both men and women equally. BDD comes under the group of anxiety disorders which include generalised anxiety disorder and panic disorder. BDD causes a person to have a distorted view of how they look. This then causes the sufferer to spend a lot of time worrying about their appearance. For example, they may be convinced that a barely visible scar is a major flaw that everyone is staring at, or that their nose looks abnormal. This then causes the person to become distressed.

choose not to reveal their concerns to anyone, including a doctor or therapist. Also, they may first pursue dermatologic treatment or plastic surgery, and even when they do seek psychiatric care, they may be pursuing treatment for the depression, anxiety, and functional impairments which have resulted from the disorder. Unfortunately, many psychotherapists and physicians remain unskilled in assessing for the presence of BDD until the symptoms are extremely obvious.

Diagnosis Difficulties

Indicators and Diagnosis

Due to the nature of the disorder, the person may be experiencing shame regarding their appearance and so

While BDD can affect any part of the body, the most likely areas of concern are around head and facial features.

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Common areas of concern include: Ö skin – particularly skin tone and Ö Ö Ö Ö Ö Ö Ö

wrinkles hair – usually obsessing with hair thinning nose – too large or small, misshapen teeth - crooked or discoloured weight – obsessing about being overweight or underweight breasts – shape and size thighs – shape and size physique – body shape and size

As with many other conditions, BDD is only a disorder when it has impact on a person’s daily life or ability to enjoy normal activities.

Obsessional Thinking BDD involves obsessional thinking over the associated body part, to the point where the person may obsess over it for hours every day. There are numerous other behaviors which classify BDD, such as frequent or constant mirror checking or the opposite – mirror avoidance. Checking one’s reflection doesn’t have to stop with mirrors, as many other objects have reflective surfaces. These include shop windows, reflective photo frames or any other shiny and reflective surface. People with BDD often engage in camouflaging to try and mask the body part. Such as with the excessive use of make-up, if the concern relates bmhmag.com

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to the skin, or wearing a hat if the fear is associated with hair. Many with BDD will also compare their body part(s) to that of others, such as with friends or family members, or people in the public eye. Grooming excessively can be another problematic behavior, whether it is associated with putting on make-up, combing hair or shaving. Touching the affected body part and skin picking are also quite common. The person may pick at their skin to try and remove a blemish, for example. Unfortunately, this often may result in exacerbating the situation instead of improving it. Reassurance seeking is also a frequent behavior, though typically this results in only temporary relief at best. Muscle dysmorphia is a form of BDD believed to affect mostly men who believe that their body build is too small. As a result, they may engage in excessive exercise, and in the use of supplements and steroids at potentially dangerous levels. Treatment and outcome Body dysmorphic patients can be amongst the most difficult patients to treat. While they may appear as being overly vain, most are in fact desperate to appear “normal�. They want nothing more than just to fit in, and not to look grotesque as they believe themselves better

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to be. Because of this, it is perhaps understandable that they may go to great lengths to improve their appearance, especially if they believe that their wellbeing depends on it. Considerable relief can be found with proper medication and Cognitive Behavioural Therapy (CBT), as well as from the compassion and support of the medical professionals and therapists involved in their care. Particularly, a combination of CBT and medication is widely regarded as the most appropriate and effective course of treatment for BDD. For more information visit the Body Dysmorphic Disorder website at http:// bddfoundation.org or the Anxiety and Depression Association of America website at http://www.adaa.org, which also hosts on-line self-tests.


about

BMH Mag’s Mental Health what mental health means to us

Mental health is a broad topic that can mean different things to different people. Our own understanding or context will impact what it means to each of us. At BMH Mag, it covers the topics of mental illness, mental health and mental wellbeing. Mental Illness includes the diagnosable disorders. We use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the ICD-10 Classification of Mental and Behavioural Disorders for reference – sometimes one, sometimes both. Mental illnesses are the things that we’re trying to help people understand to reduce the stigma. These include disorders such as depression, bipolar, obsessive compulsive. They have been clinically defined. When we talk about Mental Health, we mean those things that affect everyone’s ability to thrive mentally, especially in the face of difficult events. Having good mental health is the equivalent of staying fit and exercising regularly so that we can get through our day as best as possible. It includes topics such as resilience and mindfulness. We also include Mental Wellbeing which, for some, may be the same as mental health. For us, we use mental wellbeing to include all things that give us an overall, holistic, better body and

mind to improve our mental health or reduce the impact of mental illness. Mental wellbeing means eating well, sleeping better, exercising, keeping our body healthy to ensure it can keep our brain – and our mind – performing well for a long as possible Better Mental Health Magazine is about all three. You may not have a disorder, but someone you know probably does. You might want to improve your general outlook and care about how you deal with stress or grief or trauma or just that annoying neighbour! You might want to ensure you keep your entire body and mind healthy. Your interest could be because you care about your family or friends or colleagues. We can’t include every mental health related topic in every issue, but we try to cover a broad range. Whatever your interest, Illness, Health, Wellbeing, we’ll try to cover it.

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SELF TALK A SIGN OF SUCCESS! By Sally Webster

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Talking to yourself was often referred to as the ‘first sign of losing your mind’. Hearing voices or having conversations with yourself could be a symptom of disorders such as schizophrenia or bipolar. But Sally Webster explains some positive aspects of self talk. When a plethora of hands-free phone devices started flooding the market a few years ago, I rejoiced at being able to talk to myself while driving. I could rehearse meetings, manuscripts and difficult personal conversations to my heart’s content in a travelling cone of silence. I would not be cast a perplexed glance by another motorist at the lights because anyone would know I was talking to someone else. As technology progressed and reasonably priced ear‑pieces got smaller, I realised if I did get caught accidentally verbalising thoughts while say, out walking, I could pretend to be taking a call on a tiny bmhmag.com

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“ we shrink from the stigma of mental illness

Bluetooth device nestled behind my left ear. If that happened, I’d probably even touch the imaginary device lightly, as if I was straining to hear the person at the other end… maybe even screw my face up slightly saying: “Sorry, John, I didn’t quite catch that?” Oh Shoot! What if my actual phone then rung at the same time? I’d have to pretend to have two ‘phones’ and say: “Oh hang on John, can you hold - someone’s on the other phone.” I’d have to then cut the real caller short so anyone listening didn’t think I was keeping John waiting on the ‘device.’ Then again, in the words of Shakespeare: ‘Oh what a tangled web we weave when at first we practice to deceive.’ Apparently, the act of verbalising ones thoughts to oneself is a habit that 9 out of 10 people practice; if you Google

‘talking to yourself’, it throws out 239 million results, most with comments that self-generate for years. That’s a lot of people talking about talking to themselves! Yet most of us are afraid of being ‘caught’ doing it. Whether we are well or ill, we shrink from the stigma of mental illness that mental health professionals and organisations try to quash. Particularly damaging to self-talkers is the age-old phrase: ‘The first sign of madness is talking to yourself.’ But this phrase grew from misunderstandings about mental illnesses like schizophrenia, or as we call it now, psychosis or psychotic episode. This condition does genuinely need to be treated, but it is not about self-talk, as American author and psychiatrist Dr Rob Dobrenski explains: “Schizophrenia isn’t about self-talk, it’s about ‘other’ talk. People hear voices that aren’t their own, that other people can’t hear, or sometimes it will be multiple voices giving a commentary in one’s head.” Given it only affects about 1% of Western populations and develops in young Talking to yourself, or vocalising a conversation, can be a healthy and positive thing, without meaning schizophrenia

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featur e people between 15 and 25 years of age it is unlikely your self-talk is a symptom of a psychosis type that affected creative icons like early 19th century Zelda Fitzgerald, Vincent Van Gogh according to some accounts, Picasso. It is best that people move past any stigma and realise that most self-talk is actually very good for you, as proven by a cachet of studies done in the last 10 years. Healthy self-talk is known to help decision making – a 2007 radio interview with Wall St Journal reporter Jared Sandberg revealed 96 percent of us hold conversations with ourselves. He proudly explained when he most uses it: “It’s the decision making stuff, I exhort myself, I coach myself sometimes.” Published in the Quarterly Journal of Experimental Psychology in 2011, psychologists Gary Lupyan (University of Wisconsin-Madison) and Daniel

Swingley (University of Pennsylvania) conducted a series of experiments that proved people find objects more quickly when they talk themselves through the task. Lupyan says the study was inspired by his own self-talk, and he learnt that some people happily practice it anywhere from an hourly to a weekly basis. Author and businessman Harvey Mackay used the Early to Rise website to expand on that in 2008. “There are those who think people who talk to themselves are crazy, but nothing could be further from the truth. People who talk to themselves are competitive and they are often trying to better themselves. I’m constantly talking to myself because when you do this you are coaching yourself. It’s an opportunity to give yourself some constant, immediate, unfiltered feedback.”

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Consultant psychiatrist and President of the Medical Association of Jamaica, Dr Aggery Irons offered the Jamaica Gleaner his thoughts in 2013, saying this practice adds another sensory input that the brain will process and add to what is already there: “…you are literally giving yourself feedback…literally thinking out loud. There is nothing wrong with that. In fact, it is very helpful and adds another line of sensory input”. The practice is well acknowledged in sport too. Using a dart-throwing gym class, Athanasios Kolovelonis and a team at the University of Thessaly in Greece documented the stages of self-talk: forethought about a goal or plan; carrying the plan out, or the performance; and lastly self-evaluation or

“ we shrink from the stigma of mental illness

reflection with the intention of bettering the next performance. It seems no one is exempt from selftalk – we all did it happily between the ages of 3 and 7 years, before self-consciousness grasped us, while engaged in a task or at play. Later we whispered or mouthed the words, then we internalised them as we neared adulthood. At this stage we call it ‘intrapersonal communication’; late 20th century psychologist Lev Vygotsky’s work observed that while adults learn to inhibit speech, they still experience speech within. A study conducted by Dr. Adam Winsler of George Mason University showed children at kindergarten who talked to themselves were more confident and participatory than their peers. Self-talk helped them to deal with challenges and reflect on them afterwards. Of course, there is a downside to selftalk, whether you verbalise or internalise it. When one only has oneself as a reference point – an increasingly common situation in an increasingly isolated lifestyle according to a Duke University study in 2006 – failing to be compassionate to oneself can be harmful. Think of all the times you’ve made a mistake and reprimanded yourself in a way you would never do to a loved one or someone you respected.

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featur e Ironically when someone does have an accident and is seen firing of loud profanities at themselves most people are understanding.

“For instance, phrases like: things won’t work out for me, I’m a loser, I’m inferior, are used. The person often describes an inability to ‘turn off’ the talk.”

New Zealand based psychotherapist Kyle MacDonald says one of the first things he asks people about is the quality of their relationship with themselves.

Wellness coach and author of 8 Keys to Stress Management, Elizabeth Scott, says there are techniques to help yourself notice negative self-talk patterns and transform your dialogue into positive talk, including changing self-limiting statements like “I can’t do that!” to questions like “How can I do this?”

“What is your self-talk like: is it kind, is it nasty? Depression is marked by negative or critical self-talk and these people will be quite mean to themselves. Anxious people will engage in worrying and doubtful self-talk, trying to find certainty where there is none.” Dr Dobrenski agrees, saying while healthy self-talk is a balance of positive and negative, if people become depressed there’s almost incessant selftalk that is inherently negative.

Dr Dobrenski adds that the healthiest self-talk is ‘balanced.’ “It’s not positive thinking outright. It’s about recognizing the positive and negative, the shades of grey, the fact that very little is all or none, black or white.”

Sally Webster coordinates freelance writing and communications work with attempting to bring up two “fabulous” teenagers, and passing her first papers in a psychology / sociology Double Major. Whilst Sally enjoys a wide range of journalistic disciplines in New Zealand, the ex-pat Brit has a special fascination with psychology and mental health: how do the body, mind and soul interact to bring about the lives we choose to live? If we desire a better life, do we look within ourselves or in the world outside? The 44 year old writer intends to use her passion for life to keep exploring these and many more ‘psych-social’ questions through the media for as long as she can type! bmhmag.com

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hearing VOICES INSIDE your head Hearing voices, or auditory hallucinations, is believed to affect between 4 to 25% of the general population at some point in their lives. Patients that have had a diagnosis of psychosis (impaired thoughts and emotions) are more likely to experience auditory hallucinations. The most affected mental illnesses are depression, bipolar and schizophrenia. People who have been diagnosed with schizophrenia are particularly affected with around 50-70% of these patients having had hallucinations. Auditory hallucinations belong to the family of “psycho hallucinations� which includes other hallucinations such as visual hallucinations, smell and touch. Auditory hallucinations are generally distinguished as noise and/ or sound hallucinations which are usually voices that speak directly to the sufferer and are often mocking or insulting. better

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Common Voice Characteristics While not comprehensive or necessarily the same for everyone who hears voices, these are some common characteristics. Ø The "voice" can be perceived in different ways; from outside the ears, or inside the head or other body parts Ø The voice may or may not be perceived as belonging to the person Ø Communication with the voice may or may not be possible Ø The voice speaks in the second or third person. According to research the volume of voices is like a normal conversation. The voices are usually male and they come from middle-aged people. Interestingly, the differences in power between the person and his voice are presented in parallel with the power differences between the individual and other members of his community. Thus, those who believe they belong to a lower social rank their voices are perceived in the same way in relation to other people around them.

Malicious voices Some people report being the target of voices: the voices commenting on their thoughts or actions. The most common function of the voice is the regulation of activities in the form of directives, judgements or questions to others. The voices usually appear individually and are intended only for that person, rarely appearing to other voices, or people close to the sufferer. When it comes to malicious voices, people generally try to ignore them. However, the more people avoid their voices, the stronger the voices become. Conversely, becoming friendly with the voices and engaging with them positively, the patient can learn to selectively listen to their voices and even engage a voluntary relationship with them. bmhmag.com

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hearing voices ... affects between 4 to 25% of the general population Management of hearing voices Hearing voices can be a terribly overwhelming experience, making it hard for the patient to deal with their life. These are a few strategies that can be useful. Ø Converse with other sufferers to share experiences and knowledge Ø For some, it is important to examine their voices. This helps the patient figure out how to perceive the voice’s tricks and traps, and so recognize patterns specific to particular circumstances. Ø Understanding where the voices originate from and why, and what triggers them can be useful in adapting to a life with the voices. Ø The key first step is acknowledgement of the voices. This is the most critical first step to take. Ø Voices can express what the voice hearers are feeling or thinking – for example, aggression or trepidation about an occasion or meeting. It is the feelings and emotions that are essential here, not the voices. Ø Telling what you’ve learned about voices to families and friends can be useful. Ø Finally, it is important to recognise the variety of individual circumstances and situations. The best advice is to attempt to increase the voice hearer’s impact over their voices, instead of heighten their weakness and powerlessness. better

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“Your vision will become clear only when you look into your heart. Who looks outside, dreams. Who looks inside, awakens.� Carl Jung

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H earing V oices Q ueen s la n d S tyle bringing regional groups together for greater support Hearing voices is, for many of the people who do hear voices, just a part of a normal human experience. For others, it can cause distress and even be debilitating. However, it doesn’t have to be a disabling experience. It is possible to ‘recover’ and achieve self-empowerment over hearing voices. That’s the message of the various Hearing Voices Networks around the globe. In some countries, as in Australia, they have been smaller groups coming together to provide greater services and support. Hearing Voices Queensland is one such network and it’s officially launching this April. Hearing Voices Queensland is the state version of the Hearing Voices Network Australia. Their aim, like other hearing voices networks globally, is not focussed on the various disorders that give rise to voices nor to actually rid a person of the voices. Instead, the Hearing Voices Networks share the same guiding principles of fellow Networks. David Facer David is the face – and voice – of Hearing Voices Queensland.

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Hearing Voices References Hearing Voices Queensland www.hearingvoicesqld.org Hearing Voices Network Australia hvna.net.au Hearing Voices Network www.hearing-voices.org Intervoice, the international hearing voices network www.intervoiceonline.org International Schizophrenia Foundation www.isfmentalhealth.org International Bipolar Foundation http://www.ibpf.org


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These fundamental principles are: • Learning to deal with the fear, anger and shame • Having support when and where it’s needed • Learning to maintain control. All Hearing Voices Networks share common visions of: • Developing local support groups • Raising awareness of the Hearing Voices approach • Campaigning for the human rights and social justice of those who hear voices • Providing information and support to those who hear, their family and friends • Providing practitioner training and education. If you, or someone you know, hears voices, look into the Hearing Voices Network. Information and support is available, thanks to dedicated individuals and volunteers and their supporting organisations. Make the most of it.

Details of the Hearing Voices Network Queensland Launch What:

Launch of Hearing Voices Queensland Network where Rufus May presents: Working with voices Where: Brisbane, Toowoomba, Noosa, Bundaberg, Rockhampton, Mackay, Townsville, Cairns When: 8th April – 27th April 2015 Details: Dave Facer 0417 104 488 or email david.facer@hearingvoicesqld.org Open to: Professionals, carers, family and friends, individuals Cost: $99 ex GST, or Concession $60 ex GST

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th is THING called D EPR E SSIO N

bean home From her Carib the eve of of Trinidad, on y, lette Ramsa carnivàle, Nico n e roach to h r ow shares her app ay as a positive w mental health g in understand of acceptance, anything hold and not letting her back.

For those of you who are blissfully unaware, it’s called depression. It is not some fairytale or mythological folklore. It is a mind crippling disease. It’s not sadness, nor is it some make believe excuse we’ve conjured to validate and justify our melancholic disposition. We don’t sign up for this in life. We don’t say, “Hey world, I WANT to be depressed!” Nobody asks for the emotional baggage that is depression. Not only does it screw with our minds, but it screws with our bodies too. It can make you physically ill; plaguing you with flu-like symptoms. It makes you sleep too much, or not sleep at all. It can make you eat nonstop, or it can make you stop eating on a whole because you simply have no desire for food. In fact, you desire nothing but to stay in bed all day and never see the outside world again. Sometimes you even desire death, as though it’s your soulmate and you need to find a way to unite yourselves. It’s not being a coward when we overdose. We’re not immature for cutting. We never choose for our brains to not work as they should. Why would anyone wish this on themselves? If you swapped brains with us for one better

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people

day, then maybe you’d understand how hard it can be to control this. Maybe then you’d sympathise, although we don’t want to be pitied. We just want support through these trying times. We want help, in case you didn’t hear the desperate cries for it. In case the blood dripping down our arms was not enough of a plea. We don’t want to continue running away, but with depression, you’d try to find any escape. It’s been a battle I’ve been losing for way too long. However, I see now, that regardless of how many losses I’ve faced in the past, this is NOT a losing battle. There is a way to win. There is a way to conquer this mental malaise. Today, we may be sad. Today, life may have us at the lowest of lows. What we need to do, if we truly want to rise above this, is sit down and reflect. Reflect on ourselves and our lives. Think about where we were, where we are now, and where bmhmag.com

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we want to be. Analyse the different events that have taken place. Maybe, upon reflecting, we’d see things now that we didn’t notice were there before. We may even realise that our way of thinking in the moment may be very different to how we view it now. Stop looking for a quick fix. Yes, we want more out of this life. We don’t enjoy the sadness that is taking over. We want to reacquaint ourselves with joy. The thing is, clinging to any and everything, hoping to get gratification from it, is not the way to go about feeling better. For the most part, we’d experience temporary satisfaction, only to end back up right where we were before. In times when we feel like all hope is lost; as though there’s no helping us… The times we want to be locked up in our bedrooms high off of some pill like Valium, and just longing to stay in bed for the rest of our lives, we need to remind ourselves that hope still exists, as long as we’re willing to fight for a change. You may think there’s no fixing you. The thing is, we’re people, not some item that needs repairing. We can’t take ourselves to be serviced and expect that everything will be fine afterwards. It is a process we must take one step at a time before reaching where we need to be; before finding our inner peace. What we need to do now is stop allowing self-pity to consume us. Stop being so bloody self-indulgent, and start realising that we hold the power to change our lives. The key to true happiness is inside of us; we’re not going to find it anywhere else, or get it from someone other than ourselves. So let’s start letting go better

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people of these unhealthy habits and start taking a step in a positive direction in order to make a real change. Paint a smile upon your face. See things through a different set of eyes. Change your perspective. Unchain yourself from the cruelties that pull you down. Step away from the edge, and start exploring a new way of life. The darkness may be our haven for now, but it isn’t our saviour. Don’t be fooled by the sweet nothings and promises of an escape which the pills and blades whisper lovingly into our ears. It’s all an adorned lie put in place to trap us in a pit of gloom and sorrow. Mentally, we may be prepared to start making a difference in our lives. However, emotionally, we might just be holding ourselves back. Emotions can sometimes be a challenge for the average person to keep in order, but when you’re a borderline person or suffering from any other mental illness, and fall victim to depression, you know that it is a never-ending struggle. It doesn’t mean that it is impossible to walk out of this triumphant.

we never choose for our “brains to not work as they should ” We can’t keep letting our feelings take control and run the show. Depression is not our master, so why are we letting it rule us? The moment we become the master of ourselves, is the moment we actually start seeing things beginning to improve. We all possess a great amount of potential. When trivial things stop mattering, when we realise what’s really important and learn what our real priorities are, when we make peace with our demons and finally let go and move on, then, and only then, shall we unlock our true potential. bmhmag.com

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Right now, we may be caught up in a whirlwind of emotions that we can’t fully understand yet, but the reality of things is that all hope isn’t lost yet. We can fight off these negative feelings. We can learn to develop self-control. Being mentally ill does not make us a weak person. In fact, it just goes to show how strong we are. We are strong. For having not given up yet. For still being able to face each day even though we’re scared. It’s not a losing battle, and knowing that we put up a fight every single day, trying to overcome it all, just shows that we do stand in chance in this world, and we should not give up. We may be feeling down, but it will pass. Ride the emotional wave, and when it’s over, know we will be better prepared for future challenges like this. Know that there will come a day when we win!

gles when There are numerous an f. defining the sel udly On the surface, I am pro ultural society ltic mu a m Trinidadian; fro ultural ancestry. with an equally multic ucational, Interests range from ed logy, and cho psy , including nutrition such as video , ies bb ho to ; programming deeper, I lve de games and writing. To passion sh eri fev a am a dreamer with life to my e giv d an als go to achieve my ideas. d when I was Though, my world pause id disorders: diagnosed with co-morb personality. e bipolar II and borderlin prolonged d ha l nia It felt surreal. De rapy the d an ing gg Blo existence. rspective. pe my in catalysed the change another y rel me are Now, the disorders . ge llen cha life-shaping

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what is crazy? development of mental health programs

Labels. Mensa means elite IQ. Moron connotes stupidity. Lunatic is mentally deranged. Crazy... that’s just crazy. Lois Greene Stone discusses the changing but still stigmatizing views of mental illness over the centuries.

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Swallow a pill. This is the 21st century. For most clinically depressed people, there are now medications. “The American Psychiatric Association says electroshock can be the only effective method to treat some people with severe depression… who do not respond to medication”, Gannett Democrat & Chronicle newspaper, July 19, 2001. Writer Daniel Smith said in the February 2001 issue of The Atlantic Monthly “… the popular image of ECT has persisted, sustained almost single-handedly, it sometimes seems, by the 1975 movie One Flew Over the Cuckoo’s Nest.” So this treatment, perhaps still valuable, has activist groups opposing use. Now, in 2015, might this still be the treatment of choice?

in the beginning Long ago, many ‘non-conformists’ were told that devils had overtaken them and were isolated from society.

By the 16th century, the ‘different’ were caged until killed. The selfrighteous thought the depraved deserved persecution. Witch-burning was a popular spectator sport. The Bethlem Royal Hospital, England’s first mental hospital, is often referred to as Bedlam, an early word for all forms of madness in the world. First used as an asylum in 1337, Bethlem Hospital’s earliest patients were secured by chains. Beatings, blistering, purging, and so forth, were considered treatments. Artist William Hogarth’s painting, A Rake’s Progress (1735), captures amused visitors looking on as a woman, perhaps grieving, peers at a man, the man’s head is hairless, only a cloth covers part of his nakedness, one arm and leg is chained to the floor; he is a patient of Bedlam. Startled from a deep sleep, or quickly roused during a dream, we may experience momentary disorientation. Eventually, we notice the clock’s time, bmhmag.com

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realize where we are, then become alert. Emanuel Swedenborg (1688 – 1772) wondered why society couldn’t see madness from such a point of view. However, his speculations about an unbalanced person and the parallel to the sleep-wake pattern convinced some people that he, too, was insane. In Little Journeys to the Homes of the Great, published in 1928, Elbert Hubbard wrote, “And who shall say where originality ends and insanity begins?”. “I am convinced that people are not incurable if they can have air and liberty,” said Philippe Pinel, an 18th century French physician. Pinel actually unchained a man who had lived for 40 years bound and without light.

not-so modern treatment America’s first course in psychiatry was given by Dr. Benjamin Rush in the early 19th century. Rush wanted total inaction for a patient and promoted the idea that a patient should be in a warm room lying in a coffin-like box with crib sides, hands and feet bound, and blinders covering eyes. When Hippocrates, in the 5th century B.C. called mental illness a disease amenable to treatment, it’s doubtful he assumed the treatment might be tantamount to torture. However, at the time, Rush was among the first to consider mental health a disease of the mind rather than demonic possession and his treatments aimed at healing the mind, were the start of modern psychiatry. Dr. Thomas Bond and Benjamin Franklin raised funds for the Pennsylvania Hospital in 1753. With an emphasis on treating ‘lunaticks’, six of it’s initial patients were psychiatric. Rush joined the hospital 30 years later and took it to the forefront of “modern” psychiatric treatment. The institution for mentally ill emerged as society modernized in the 1800s and increased significantly in the early 20th century.

Stigmatizing images of mental illness are still present today

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In 1908, Clifford Beers, former mental patient and founder of the American mental health hygiene movement, wrote A Mind That Found Itself, that significantly influenced the mental health movement. Two years later, he attended the first state association meeting of its kind in Connecticut. In 1909, he founded what is now ‘Mental


featur e Health America’. Also in 1909, Dr. William Healy opened the Juvenile Psychopathic Institute in Chicago, which was possibly the first dedicated child guidance clinic. Simon and Binet, both French doctors, had devised a test measuring and describing mental age and it was part of evaluation for patients at the Chicago clinic. Terman revised the Binet-Simon tests, and we know it today as the Stanford-Binet IQ test.

enlightened ideas alone Society reaches out and yet draws back. Indiana, 1907, made compulsory sterilization legal for low-IQ people, rapists, and criminals. The United States Supreme Court upheld sterilization for eugenic reasons in 1927. By mid 1930’s, more than half the states had this law on its books. Here is a passage from the Public Acts of 1929, #281, Michigan: “It is hereby declared to be the policy of the State to prevent the procreation and increase in number of feeble minded, insane and epileptic persons, idiots, imbeciles, moral degenerates, and sexual perverts, likely to become a menace to society or wards of the State. The provisions of this act are to be liberally construed to accomplish this purpose.” This passage appeared in a 1959 book, Fundamentals of Gynaecology, by Behrman and Gosling. Fifty-one years before this law, Dr. Donald Hack Tuke said “Just as

“ attach neither more nor less stigma to disease of the brain than of any other organ of the body ” the great truths insisted upon…are accepted by the community, will there attach neither more nor less stigma to disease of the brain than of any other organ of the body.” Furthermore, in 1878, he said, “On the first threatenings of insanity, let the person so threatened be removed from associations or surroundings which may foster morbid feelings: complete change of scene is desirable.” Since insanity is an illness that begins long before suicide attempts or assaults, he asked that attention be given to care as soon as one has an inkling that a friend/loved one has the disease. His 1878 book was titled Insanity in Ancient and Modern Life. It sounds similar to 2015 but we assume we’re modern now so early detection/ attention just has to be our 21st century idea! A National Committee for Mental Hygiene started in 1912, and its annual reports were available by 1917. Terminology was devised so readers might understand the meaning of the words used. Society, again, reaches out yet draws back. World War I saw medicine move forward but peoples’ attitudes retreat. Shell shock was called cowardice. bmhmag.com

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Was there a method to recognize mental and emotional disturbances in early stages? The Rorschach psychological test was devised. With no right/wrong answers, interpretations given of each ink blot enabled an examiner to evaluate the person being tested.

“ it took until 1911 for the first law to be passed regulating use of restraints ”

Clergy needed to understand how to handle troubled congregants; in 1930, their first training center, called the Council for Clinical Training, was established. The Academy of Religion and Mental Health was created in 1954.

Psychiatric Association, it was decided to not abandon restraints, and it took until 1911 for the first law to be passed regulating use of restraints. Massachusetts was the first state to enact it.

the ebb and flow

The National Mental Health Act, 1946, allowed states to have federal government’s financial backing.

Approaches did move forward. Committees became congresses: the First International Congress on Mental Hygiene was held, 1930, in Washington, D.C.. Paris, France was the site of the second meeting, 1937, then the third was held in London, England in 1948. However, the World Federation for Mental Health replaced the congress, which had replaced the committee, which had replaced the society. Did all this name change alter attitudes? Neither custodial caretakers nor organized groups really impacted rehabilitation of the mentally ill. It took another World War and the UNESCO constitution. But little changed in practice. Commitment procedures still resembled criminal cases: arrest, accusation, trial, verdict, and, if found ‘guilty’ (insane) then detention in a jail cell until institutionalized. In the 1844 meeting of the American better

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enter mass media Dr. Benjamin Spock’s popular Pocket Book of Baby and Child Care stressed the importance of mother-child relationships. Mass media, for that era, allowed more citizens to be communicationconscious. Even attendance at mental health society events became an ‘in-thing’, and suggestions for reform were aired. Dr. Tuke’s 19th century words seemed a ‘new’ concept. C.B.S. network radio produced, in 1949, an hour-long show called “Mind in the Shadow”; Dr. William C. Menninger spoke to listeners about the mental hospital structure he felt was not adequate. He also was the commentator for television’s Out of Darkness, a C.B.S. network 90-minute show allowing viewers to observe actual psychotherapeutic sessions.


featur e Hollywood, 1946, 20th Century Fox presented the film The Snake Pit. Did those in the theatre sympathize with the screen’s main character? The American Theatre Wing Victory Players, 1942, developed short theatrical sketches about mental health. National fund-raising and publicity. Let’s set a specific period aside for local, state, and national fundraising. Mental Health Week began in 1949.

a new era Eventually, ‘take the key and lock him up’ gradually reverted to being a child’s sing-song game. Researchers had developed drugs. Sakel discovered insulin shock treatment in Vienna, 1933; this, and metrazol was introduced in the United States in 1936. By 1938, electric convulsive shock therapy was in operation. The biggest change for institutions was the introduction of tranquillisers. The 1950s, and the word ‘hope’ seemed real. A stressed-out ‘well’ person could better understand the sick because both could ingest a tranquillizer for help.

Dr. George Zeller, 1902, believed that recovery from mental affliction also had a social obligation. His ‘open hospital’ in Illinois, was a move forward. By 1970, some institutions actually had a goal to prepare inmates to function (live) outside the confines of the hospital. During the 1970’s, as people began to learn about the complex causes of mental illness, the pretty parklike settings of a hospital, available medications, and such, seemed important. Perhaps because more people realized anyone might be susceptable to mental illness such as depression and dementia. October 31, 1963, the late President Kennedy signed a bill enabling the entire country to work towards altering the conditions of life of the mentally ill “…we can procrastinate no more… it is time to begin the job of returning the mentally restored to a fully productive community life” requiring “the full coordination of all resources in the hospitals, clinics and community.” This Citizen Participation in the Quiet The “modern” treatment of medication may already be outdated

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Revolution Annual Report 1963–64 Mental Health Chapter also sounds as though it were a real breakthrough. Now, 52 years later, how have attitudes really changed? A Halfway House is much of what its name implies: it’s a stop-gap half way from the institution, half way to the full community. As a boarding house, it’s not sheltered as the institution but not ‘outside world’ unsupervised. Geared to aiding an ex-institutionalized person return to the community, the main requirement is that this building not be on hospital grounds. Woodley House, circa 1960’s, one such place, wanted to be a setting “…in which anyone, regardless of the state of his ego, could feel comfortable.” Joan Doniger, in Buffalo, NY preached to the New York State Mental Health Association in April 4, 1964. Patients had jobs, social lives, yet shared the day’s frustrations with peers until, hopefully, able to function ‘outside’.

prescribed categorization Now, in this 21st century, we categorize mental health problems. Clinical depression, for example, is a familiar term. Treatment with drugs such as Prozac, Zoloft, Paxil seem to be ‘safer’ than those used years ago. “Collectively known as SSRIs, or selective serotonin re‑uptake inhibitors, they interact with the regulating mechanism for the neurotransmitter and hormone serotonin in your brain.” In December 1999 you could ‘Ask Dr. Weil’ on health.com and get this answer. Today, better

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we have smartphones to ask and get a computer-voice reply, but the information would be unchanged. Some HMO’s don’t want to recognize that mental illness needs medical coverage because, perhaps, it can’t be seen. Yet it is no less real.

acceptable indifference Teen mental health has been called to everyone’s attention since the April 1999 school shootings/suicides in Colorado. Adolescent mood disorders may be an early indication of potential suicides and, perhaps, respond to medical attention. The 1990s closed with violence so profound that some schools had metal detectors installed like the ones currently used in airports. Serial killings continue, but new mental disorders causing road rage took us into the 2000s. Carjackings crept in to terrorize as the 20th century ended and don’t show signs of lessening. We have people shaking babies so hard that either permanent damage ensues or the baby’s brain bleeds to death. A teen gave birth during a dance, destroyed the infant, then went back to dancing. Children carry guns and perpetuate acts of violence. What drives these people to indifference or anger or destruction? Societal indifference or genetics? A U.S. News & World report, week of January 3, 2000, covering The Human Genome Project said “...perhaps as early as the end of 2000, they will have accomplished…uncovering the


featur e complete genetic instructions of a human being.” This may help us understand why we do, say, act in specific ways. Perhaps mental illness can be recognized and treated rapidly. Perhaps. With Early treatment genetic testing, of mental health however, “… warning signs is not people with a new concept a genetic predisposition to diseases…could be vulnerable to losing health or life insurance.” Trying to figure this out in 2015’s health insurance is creating havoc for the healthy. How can we assist those not emotionally or intellectually equipped for the Affordable Health Care Act chaos?

a precious something The late Martin Buber, in his 1947 book Ten Rungs: Hasadic Sayings, expressed, “In every man there is something precious, which is in no one else.” With funds, knowledge, specialized training, community resources, public awareness, scientific material, the mental or ex-mental patient needs assistance, still. Robert Kennedy edited a special report in December 1999 that appeared on medscape.com, and noted:

“Stigma is a burden that we all share and it is, indeed, especially serious when it comes to mental illness.” The long history of mental illness from Hippocrates to modern times has seem a back and forth of attitudes and treatments. The understanding of the few and the stigmatization of the many has been consistent throughout history. An open conversation about mental illness and mental health, an acceptance and general acceptance, is still needed for real change.

Lois Greene Stone, writer and poet, has been syndicated worldwide. Her poetry and personal essays have been included in hard & softcover book anthologies. Collections of her personal items/photos/memorabilia are in major museums including twelve different divisions of The Smithsonian. bmhmag.com

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casting-on for wellbeing Monica Lonergan, an avid knitter, explains the hows and whys of knitting to improve mental wellbeing

When I say knitting is good for your mental health, you might not see it at first. After all, it’s a skill now seen as something almost mystical. How could you learn such an archaic art? Why would you want to, when the process of learning a new skill can be so stressful? If you can get past that doubt and try it, you’ll see why knitting helps with mental health. Knitting is especially useful for those suffering from anxiety disorders like myself. When my mind gets busy I pick up the sticks and string and let the meditative motions refresh me. It turns out there’s a reason it works so well and there are studies to back it up. Until recently knitting was a necessary craft rather than one done for relaxation. Though I am sure many people enjoyed it, that was a bonus rather than the point. For a long time knitting was a job, not a hobby. Prestigious and powerful people used knitted items but rarely made them. I can’t see Queen Elizabeth I picking up needles to whip up her fine silk stockings. Knitting was a cheap way to make clothes and accessories with no special equipment. The result was a better

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love for knitwear that has crossed centuries. The mental and emotional benefits are a more recent revelation. It is not difficult to see why people spent little time knitting for fun. The knitters of Shetland sold their lace to feed their families. The fishermen wore their knitted ganseys to stay warm while they worked. There was always a purpose to the knitted items. Today we have knitting machines in huge factories to make the necessities which grants knitters a new freedom. After all, who wouldn’t want a hobby that gives you a head start in fighting off ‘mild cognitive impairment’? In a recent study we saw that knitting can fend off at least some of the mental degeneration as we age. Then there are people like Betsan Corkhill, a UK-based researcher who calls knitting a constructive addiction. A lot of knitters would agree with that term, especially the addiction part. Knitting might make you think of little old grannies in flowery armchairs but times are changing. It is becoming a socially acceptable form of relaxation. Many people use the repetitive actions of knitting to line up their thoughts as they line up their stitches. Some consider it akin to meditation. It can be a barrier against anxiety or the aimlessness that so often goes hand-inhand with depression. Having something tangible to focus on can help more than you know. For many people it can also fend off isolation which is a big problem that can increase mental unrest. At one of bmhmag.com

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my lowest time I found a knitting group and never looked back. Wherever I am, whatever my mood, I find comfort in the community of knitters. It is a good way to make friends with the assurance that you will have something to talk about as soon as you meet. People of all ages in all areas gather to natter while they knit. It is a hobby that comes with an insta-community even if you are the anti-social type. Ravelry.com is a great place to pick up knitting patterns. But for millions of users it is also a thriving collective of craft-minded individuals always on hand to offer advice, comfort, or just plain old aimless conversation. Crafting creating this sense of community and wellbeing isn’t new. Maybe you know about the Make Do and Mend campaign during World War II. Aside from being a practical way of offering help to the war effort, it also gave people a sense of community. They worked together to create useful items which gave them purpose. The fighting and desolation of the world at war could easily have left them feeling secluded and aimless. Today, we are fighting different battles. Mental illness is pandemic and mental wellbeing is difficult to come by even for those without a handy diagnosis. With busy lives, many of us neglect our own dreams for those we are told to want. better

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wellbeing Knitters have found a way through this. With just two sticks and some string we carve out a slice of the world to feel safe and comfortable. It takes a while to reap the benefits but once you have the basic skills down it is smooth sailing. You’re left with a hobby (or obsession of the harmless type!) that is relatively inexpensive but brings you meditation-like qualities, social benefits and protection against mental degeneration. Perhaps it is not so different to the times of old where people knitted to keep one another warm. When we do that now it’s with a different type, a warmth that goes much deeper. Knitting is just a hobby. Yet it is one that comes with a feeling of increased productivity and an enormous sense of wellbeing. That is as good a reason as any to cast on another pair of socks. If you want to try out knitting, check Google for your local yarn stores. Most have classes available for beginners. If you don’t want to venture that far into the craft world so soon, Youtube has great tutorials. Your library is also a good place to start. Pick up the needles and some fabulous yarn and soon you’ll be reaping the benefits like so many before you!

Monica grew up in Dorset and spent a few years hopping between English towns before emigrating to Toronto to be with her Canadian partner. She is owned by a dog, three cats, and an abundance of snakes. Though she has Generalised Anxiety Disorder and is recovering from Obsessive Compulsive Disorder, she has found knitting an invaluable help in coping with life.

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of these people... one has a mental health issue one is a family member one is a partner one is an employer one is a health worker

all of them read

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MAGAZINE

Better Mental Health Magazine Issue 3  

Read personal lived experience stories of mental health from real people, plus useful professional information.

Better Mental Health Magazine Issue 3  

Read personal lived experience stories of mental health from real people, plus useful professional information.