Mental Illness: A Guide to Recovery

By Bob Bennett

Mental Illness: A Guide to Recovery gives you information, gleaned from many sources, which can help you learn to recover. Coping skills needed to deal with the illness can be developed. Materials which can help you reduce symptoms are presented. Recovery does not happen overnight, but step by step, most can make significant recovery.

Humpty Dumpty had a great fall... and all the king's horses and all the king's men couldn't put Humpty Dumpty back together again. The same holds true for those of us with a mental illness. The psychiatrists, psychologists, social workers, etc. can assist, but it is up to the individual to create conditions which will allow recovery to happen.

The neurobiological basis of mental illness is often presented in a fatalistic way. That's the brain chemistry you've got, and that's what you're stuck with; as if the individual was unable to change the chemistry inside his or her own head. Breathing changes brain chemistry. So does exercise, the food you eat, the words you speak, the thoughts you think as well as how often you smile.

While drugs are capable of making radical changes in the chemistry of the brain, it is the slow changes over time which will help most in recovery.

"Thorough and informative without being technical ...fascinating...very enlightening." Psychiatric Rehabilition Journal (Vol. 28 No.4 Spring 2005 )

"You have made a complex issue easier to understand." Chief Kathryn Landreth, Las Vegas Metropolitan Police.

• Language: English
• Publisher: Trafford Publishing
• Release date: Aug 30, 2006
• ISBN: 9781412225588

Bob Bennett

Bob Bennett has a Certificate in British Archaeology and an MA in Classical Studies from the Open University. Mike Roberts has a degree in South East Asian Studies from Hull University. Both social workers by profession, they met and discovered their mutual enthusiasm for the ancient world over ten years ago and have been researching the Successors of Alexander the Great ever since, creating a website dedicated to the subject.

Book preview

Contents

Acknowledgements

Introduction

What Is Mental Illness?

The Brain

Coping With Mental Illness

If I’m Cured Can I Stop Taking My Meds?

Grief

Schemas

Voices, Tapes, And Nightmares

Communication

L.E.A.P.

Listen … Empathize … Agree … Partnership

Anger

Suicide

Alternatives / Complementary Treatments

Readings For Recovery

Appendix A

Ego Defense Mechanisms

Appendix B

Suicide Hotlines

Appendix C

Glossary

Appendix D

Organizations

Sources

Acknowledgements

Many people and organizations have made this book possible. The Journal, which was published by the California Chapter of the National Alliance on Mental Illness (NAMI), was a major factor in my recovery. They have graciously allowed me to reprint a number of articles.

The NAMI Knowhow Group; consumer advocates told their stories and gave suggestions from experience. Barbara Jackson, a friend and co-facilitator with a fledgling recovery group, helped me to realize such a book was needed, and gave many valuable insights during its development. Carolyn Tobolski, Margot Murray, Max Dine, and Howard Trachtman for their contributions. Sarah Jones of the National Mental Health Association for her early suggestions. Jim Lamoreux for his illustrations. Rosalie Henry for opening the door fully to alternative / complementary modalities. Victoria Dolma for her editing. Roy Diment for his design work. To each of you and many more; you have my heartfelt gratitude.

Technical definitions presented in this book generally come from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association, 1994. Permission pending.

Bob Bennett

Introduction

I was first given the diagnosis of manic depressive while an inmate at the Los Angeles County jail by a man who had a stethoscope hanging out of the pocket of the white lab coat he wore. While speaking to a deputy sheriff a few minutes later, I referred to this man as Doctor. She laughed and said He ain’t no doctor, he’s a social worker. He just dresses that way so he gets respect from the prisoners .

Some months later, I wound up living at a board and care facility. I asked the social worker what bipolar was. She gave me a dirty look and said, "That’s what you’ve got". She then turned, giving me the ubiquitous Los Angeles County salute, and walked away. For those of you who never had the misfortune of living in Los Angeles, the L.A. County salute has many individual variations, the basic form being the exaggerated wiggling of the buttock. Lawyers, social workers, and others use it daily as a sign of contempt towards those they are suppose to be helping.

It was six years before I started receiving answers to my question. It began when my mother started sending me copies of The Journal, a magazine published by NAMI of California. As I read the articles, I recognized that some of the symptoms I began experiencing at six or seven years of age. I never knew other people generally didn’t experience them.

Three years later, after going through cognitive therapy, I got off disability and returned to work. While cognitive therapy does not eliminate all the symptoms, for me it was one of the more important items in my recovery. I also explored a number of alternative therapies and devised some strategies on my own. As I look back at the stages in my recovery, each was marked by changes in the way I processed my thoughts.

It has been thirteen years since my last arrest and hospitalization, nine years since I got off disability. During this time my recovery has progressed at varying rates. Recovery is a journey. But, as NAMI’s Peer to Peer course states; living with a serious mental illness is an experience of trauma, and the recovery path occurs in predictable stages.

This book is designed to help those with a mental illness on the path to recovery. It can be beneficial to those with a mental illness, family members, social workers, peer mentors, police, and just about everyone who ever comes in contact with people who have a mental illness.

The President’s New Freedom Commission on Mental Health

states that recovery from mental illness is now a real possibility. It also states that the mental health services and supports are fragmented, disconnected and often inadequate, frustrating the opportunity for recovery. …the system presents barriers that all too often add to the burden of mental illnesses for individuals, their families, and our communities.

The Goals of the New Freedom Commission are:

1.   Americans Understand that Mental Health is Essential to Overall Health

2.   Mental Health Care is Consumer and Family Driven

3.   Disparities in Mental Health Services are Eliminated

4.   Early Mental Health Screening, Assessment, and Referral to Services are Common Practice

5.   Excellent Mental Health Care is Delivered and Research is Accelerated

6.   Technology is Used to Access Mental Health Care and Information

Achieving the Promise: Transforming Mental Health Care in America, Final Report, July 2003

The National Consensus Statement on Mental Health Recovery

The 10 Fundamental Components of Recovery include:

1.   Hope: Recovery provides the essential and motivating message of a better future-that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process.

2.   Self-Direction: Consumers lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.

3.   Individualized and Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.

4.   Empowerment: Consumers have the authority to choose from a range of options and to participate in all decisions-including the allocation of resources-that will affect their lives, and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.

5.   Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services (such as recreational services, libraries, museums, etc.), addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports.

6.   Non-Linear: Recovery is not a step-by step process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.

7.   Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). The process of recovery moves forward through interaction with others in supportive, trust-based relationships.

8.   Peer Support: Mutual support-including the sharing of experiential knowledge, skills and social learning-plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.

9.   Respect: Community, systems, and societal acceptance and appreciation of consumers-including protecting their rights and eliminating discrimination and stigma-are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives.

10.   Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.

The National Consensus Statement on Mental Health Recovery is available at SAMHSA’s National Mental Health Information Center at www.mentalhealth.samhsa.gov or 1-800-789-2647.

What is Mental Illness?

Mental illness is a stroll through hell. Go too fast and you’ll find yourself being jumped and possibly held down by creatures with straps of leather. Move too slow and you can become mired in the quicksand of your mind.

However, recovery is a real possibility. Recovery is not the quick and easy process our society prefers. Getting to know yourself takes time. While each of us experience mental illness differently, the patterns we experience are remarkably similar. The process of recovery is understandable, although different challenges face each of us.

The first step is to understand what the illness is and how it can take even relatively minor occurrences in life and turn them into high drama.

What is mental illness?

The simple scientific answer is that mental illness is an imbalance of chemistry in the brain which causes various forms of dysfunction. While much work needs to be done, it has been determined that there are numerous neurotransmitters, chemical messengers which carry information between the nerves of the brain. Too much of one chemical or too little of another can cause problems in processing information.

A less scientific viewpoint is that somehow a person’s humanity has been violated; and this violation is the basis for the sometimes strange and mystifying behaviors which are hallmarks of the various mental illnesses. The surprising thing is that the two viewpoints don’t necessarily contradict each other. If the brain chemistry is out of balance, why did it go out of balance in the first place, and what is preventing it from getting back in balance?

A somewhat more complex scientific answer is that there are four main causes of brain dysfunction.

1.   Anatomical abnormalities or damage

2.   Lack of oxygen or glucose

3.   Electrolyte imbalance

4.   Neurotransmitter deregulation; the imbalance of brain chemistry.

Anatomical abnormalities or damage result from brain injury due to trauma, brain tumors, or problem in brain development. The damage can disrupt functions of any portion of the brain, or the tracts which carry information between parts of the brain. injury to the frontal lobes, for example, can result in lack of judgment or foresight, impulsiveness and euphoria.

Lack of oxygen occurs when the blood flow to the brain is slowed down or if the person does not get enough oxygen into the blood. Alterations in blood flow have been related to dementia (senility), schizophrenia, as well as various problems following head injury. Lack of glucose occurs when there is insufficient food intake for a period of time.

Electrolytic induced psychosis, due to below normal levels of sodium, chloride, potassium, and magnesium in the diet can be the cause of delusions and hallucinations as well as stupor and mania. illnesses that may be related to calcium deregulation include anxiety disorders and mania.

Neurotransmitter deregulation, not all causes of which can be identified at this time, can be caused by a variety of sources including use of substances such as alcohol, nicotine, street drugs, huffing, caffeine and carbon monoxide. Some over the counter drugs and prescription drugs can also have major effects on neurotransmitters.

Caffeine has been linked to depression in people who are prone to depression. Diets high in sugar and fat do not provide the nutrients needed for the body to manufacture the various neurotransmitters.

Neurotransmitter deregulation results in serious difficulty with information processing and coping with daily life stresses. An important part of recovery is learning more about the daily stressors in life; and ways to more effectively cope with them.

Diseases associated with neurotransmitter deregulation include major depression, schizophrenia, bipolar disorders and panic disorder.

Neurotransmitters

The five major neurotransmitters are:

Dopamine-believed to be related to how clear, without delusions or paranoia, we think. Too much dopamine in certain areas of the brain is viewed as one of the major problems in schizophrenia. Serotonin-A mediator of impulsive and aggressive behavior.

Too little serotonin leads to greater impulsivity and aggression.

Acetylcholine-Mood stability. People with a tendency towards depression have a heightened depressive response to increases in acetycholine or similar neurotransmitters.

Norepinephrine (also called Noradrenaline)-How sensitive or reactive people are to events, people or other stimuli in their environment. Too little Norepi-nephrine is believed to lead to depression and decreased interaction with others. Too much leads to irritability, over reactivity or an extreme reaction to the environment. G-Amino-n-Butyric Acid (GABA)-Involves restraint.

Fifteen different receptors have been found for serotonin (involved with depression), five for dopamine (implicated in schizophrenia), six for Norepinephrine (involved with both anxiety disorders and depression).

Environment and heredity are both believed to be factors in the onset of the illnesses. Heredity can make one more or less prone to get any of the group of illnesses which are known as mental illnesses or neurobiological illnesses as they are sometimes called. A large percentage of people with schizophrenia have eye movements (pursuit eye movements) which are not smooth. For those with this condition, forty percent of first degree relatives (siblings, parents, aunts, uncles, children, first cousins) also have non-smooth eye movements.

The environment, particularly stressful or traumatic incidents usually trigger the onset of mental illnesses. Even after stabilization on medication stressful incidents can induce future incidents. A goal of psychiatric help, both group therapy and individual sessions, is to have the individual re-evaluate harmful learned responses to stressful situations and choose a more beneficial response.

Therapy can substantially reduce the likelihood of serious incidents; however there is no guarantee that incidents will not happen, nor is the process as quick as some would like it.

Medications can reduce symptoms, but generally do not eliminate them. While many of the newer meds were designed to block specific neurotransmitters from occupying their receptor sites, the scientific community has little or no idea of why many of the older medications work. In any event medication regimes need to be highly individualized to minimize the side effects, many of which are very serious.

Unlike other illnesses, mental illness is diagnosed by the symptoms a person exhibits, not the causes of the symptoms. As knowledge of the brain increases, I expect the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) will be completely rewritten to reflect not only which specific areas of the brain are malfunctioning, giving way to the various symptoms but also how strongly held beliefs may actually hinder recovery.

In Western psychology, however, I think there may be a tendency to overemphasize the role of the unconscious in looking for the source of one’s problems. I think that this stems from some of the basic assumptions that Western psychology starts with: for instance, it does not accept the idea of imprints being carried over from a past life.

-from The Art of Happiness by The Dalai Lama & Howard Cutler M.D., published by Riverhead Books

By concentrating on smaller and smaller fragments of the body, modern medicine often loses sight of the patient as a human being, and by reducing health to mechanical functioning, it is no longer able to deal with the phenomenon of healing. This is perhaps the most serious shortcoming of the biomedical approach. Although