How mental Health Advocacy Is Important To All, By Sarah Jeanne Browne

My Story:

I was diagnosed with bipolar 1 disorder December 2015 when I was 25. It was due to my first hospitalization during a manic episode in which I saw hallucinations, experienced extreme paranoia and had grandiose delusions (meaning I felt like a superhero and was elated). When I first arrived in the psych ward, I thought other patients were secretly the FBI being wiretapped to listen to my conversations. It was a very disorienting experience on top of already being in psychosis.

When my delusions and overall mania didn’t dissipate completely, I was moved to an inpatient facility for 5 months called The Care Center: Long Term Structured Residence. I became stable almost right away, but I had trouble accepting the label of bipolar. I was always a perfectionist and workaholic. I thought failure would be the end of me, so you can imagine my reaction to having a breakdown. But I learned it wasn’t the end of me.

Once I accepted my bipolar, I had a breakthrough. I wouldn’t hide my story for the sake of my image. I would tell it and own it. Owning our struggles helps us find common humanity. Once I owned it, I became an advocate as a writer and a podcast guest on the subject. I had a relapse in October 2017 due to a negligent psychiatrist who didn’t taper me correctly when switching medications due to side effects. The second time I was hospitalized and went to the LTSR also wasn’t the end of me. It was the start of my story. I became purposeful in being happy, and my worth was no longer about what I would produce. My worth wasn’t about working like a machine. Manic Sarah had many benefits but the cost was a lack of balance. Stable Sarah found delight in the simple things and learned how to live for the first time.

What is Mental Illness?

Mental illness can happen to anyone, but unfortunately, it can go unchecked and unhelped due to shame and stigma. Many people feel it is a failure to fall apart. But often, it can lead to a breakthrough- the step towards gaining a diagnosis and treatment so you can stop suffering. 1 in 5 Americans have experienced a mental health issue. 1 in 10 people have experienced a period of major depression. 1 in 25 Americans have lived with serious mental illness. Suicide is the 10th leading cause of death in the US.

There are over 200 mental illnesses. These can be:

• Anxiety disorders
• Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder
• Bipolar
• Borderline personality disorder,
• Depression
• Eating disorder
• Generalized anxiety disorder,
• Obsessive Compulsive Disorder
• Panic Disorder
• Post-Traumatic Stress Disorder
• Schizophrenia
• Social phobia

For more information on each one, click here.

They can look different for each person, too. While some symptoms are universal, your experience of life is not. Some causes of mental illness are genes, experiences such as traumatic events, brain injury, having another disease such as cancer and isolation.

To get a diagnosis you must have your medical history reviewed, a physical exam and a psychological evaluation.

But that’s not to say everyone with symptoms of any of these mental illnesses may actually have a mental illness. To feel depressed sometimes, worried about what you’re eating, anxious or other symptoms is part of the human experience. You can have poor mental health and not a mental illness. Self-care is important for both. Treatment is still encouraged to manage your symptoms. Your therapist will help you decide on how intensive your treatment is based on symptoms.

So what stops people from getting help? Stigma which is perceived as a mark of disgrace with the diagnosis or person. Then we have stereotypes which are oversimplified generalizations of something or someone. There are 7 types of stigma:

1. Public stigma- The public perception of mental illness which may include fear or misconceptions
2. Self-stigma- Shame for own mental illness
3. Perceived stigma or beliefs others have stigma towards you
4. Label avoidance- Having a diagnosis but not wanting to be known as that diagnosis
5. Stigma by association- Worry about another’s mental illness affecting your image
6. Structural stigma- Institutional stigma affecting opportunities and access
7. Health professional stigma- Your mental illness downplayed by a professional such as a doctor or therapist

Sometimes, when you ask for help, you enter the roadblock of ignorance and indifference. That’s why education is so important. It’s important to know that you matter and your story matters.

Self-advocacy is key. There’s the suicide hotline which is 800-273-8255 and therapists out there. You can find a therapist here. Open Path offers a tool to find affordable therapists if insurance doesn’t cover it.

Tools to Develop Resilience in Recovery and Even Relapse:

Note: These are lessons I learned in my mid-to-late twenties when first diagnosed with bipolar 1 disorder. This is everything I was taught following diagnosis (hospitalization, inpatient facility and one relapse of both, psych rehab and lots of therapy). Hope it helps.

1. Find positive supports. These are people you would ask for help from that can include anyone you feel safe with like a family member, friend, mental health professional, spiritual advisor or sponsor. Make a list and update it continually. Reach out when you need to. Know it’s okay to ask for help.
2. On Disclosing: You may be afraid to share your mental health journey with another, but the more you learn to self-advocate, the less fear you will have. That’s stigma talking. That’s not anything you did wrong. Come up with a plan for how much you want to share. There are support groups out there if you need help opening up. It’s your choice ultimately who you tell and how much you let them know. Tell when you’re ready. Make sure you are able to express yourself honestly with the people you choose. It’s normal to be afraid of authentically being, but in order to heal, you must be open to it.
3. Come up with a Relapse Prevention Plan. List your diagnosis such as bipolar, depression, anxiety or anything else that fits. List three symptoms you experience of your mental illness such as panic attacks, rumination or distress. List triggers that could cause you to relapse and create stress putting you in a crisis. A trigger can be a subject matter that upsets you. For example, if you have anxiety or stress, putting yourself in a high stress environment might not be best. Or if you have depression, listening to sad music might trigger you. Create a trigger avoidance plan- what can you do to avoid the known triggers you have, what are current triggers in your life? You might avoid certain people or situations to reduce chances of triggers. List three coping skills that you can do when at risk for being triggered. For example, you can meditate, journal or watch a movie that you love. Now, you can list your positive supports. These can be friends or family that you trust. It can also be a mental health professional such as your psychiatrist or therapist. You might be in a support group which can also be listed. What will you do if you find yourself relapsing? Come up with who you will call, what self-soothing coping skills will you try and where you will go and what you will do. For example, if you are depressed and having suicidal feelings, you might tell your therapist or call a hotline. Answer these, and you have your plan!
4. Maintain your mental health. What are you like when you are well? List ways you can know or someone else can know you are doing well. What triggers affect your ability to handle things? List some warning signs that others can know so they can help. Ask them if they comfortable intervening and come up with a plan for how you would want that to happen.
5. Find the motivation. When you are struggling, you may not feel motivated to do anything about it. Viktor Frankl, holocaust survivor and author of Man’s Search for Meaning, said “Those who have a ‘why’ to live, can bear with almost any ‘how’.” What is your Why? Then, in order to get what we have never had, we must do what we’ve never done. Change your routine. Use positive supports to help you make that change and to help you feel supported. Lastly, reward yourself. Even if you just tell yourself “good job” and acknowledge what you’ve done, you’ve found the motivation.
6. Set Up for Set Backs. Know setbacks are going to happen. That’s part of life. Learn to self soothe your stress through a relaxation technique of your choice. You can meditation, do yoga, journal, listen to relaxing music, etc. Your inner critic may be its loudest at this moment. Learn to give compassionate attention to yourself. Don’t give up, and don’t panic. Try to find the source of what caused the setback and try to fix what you can. Learn how to prevent it for the future. Take care of yourself so you can take care of others. Don’t spread yourself too thin. Plan for imperfections.
7. Have Boundaries. A boundary is a limitation of what you will accept. Do whatever makes you feel safe. Your sanity is worth it. This is about self-respect. A boundary should be easy to understand and enforceable. In a healthy relationship, you will be listened to, heard and understood for your boundary. More than anything, you will be respect. If we communicate clearly and not with anger, we are more likely to be understood. Make sure to follow through on enforcement of your boundaries, even if you feel uncomfortable at first having them.
8. Create a self-esteem inventory. List positive attributes you have. Come back to this list when your inner critic starts to list flaws. You don’t have to be flawless, you just may need a better perspective. This list will help you feel better about yourself.
9. Stay Positive. Put things into perspective. Will it matter five years from now? Then don’t waste five minutes on it. There will be things that DO matter more, but discerning between what does and doesn’t is the point. Prioritize. Accept what is so you can make the necessary changes. Don’t do the “Shoulda, Coulda” game with yourself. Seek lessons from everything, and this will help you tune out the temptation to beat yourself up. Remember, there is no such thing as failure, it’s an investment in learning.
10. Resolve not to ruminate. This is when you dwell on a problem and get stuck in a loop causing distress. You start to ask “Why me?” questions when you should be remembering your “Why” (see number 5). Instead, resolve the problem by brainstorming solutions and taking action. Rumination can happen to any of us, and if you find yourself having trouble, come back to this resource.
11.  Create a timeline of your life. Do this with dates and ages. Include your first memory, general memories throughout life and pick out good or bad life events which shaped you. The benefits: You will see how you’ve been resilient all along. This will foster more resilience in you and drive.
12. Problem Solving. List your problems, factors contributing to your problems and your goals for solving them. Brainstorm lists of possible solutions. Create a Pros and Cons list for your top few solutions chosen. Lastly, create action steps once you decide on one or two solutions. Attach it to a timeline. Did it work? Why or why not? You can come back to this exercise anytime. “Fear melts when you take action toward a goal you really want.” – Robert G. Allen
13. To Do Lists. Date your to-do list, write out your to-do list items and then prioritize your list by marketing each item A, B or C in order of importance. A= must do today, very important. B= need to do but not necessarily today. C= can wait until you have some free time. Place a number next to each item according to urgency within a lettered group. Ask “How time sensitive is it?” Number 1 is most important. So the letters indicate importance, but the numbers indicate both urgency and sequence. That way you order the list each day that you do it by urgency and importance. Then, you can prioritize tasks and this will lead to greater task management.
14. Socratic Questions. Challenging your negative self-talk is important in recovery and preventing relapse. Answer the following questions: What is the thought to be questioned? What is the evidence for this thought? Against it? Am I basing this thought on facts, or on feelings? Is this thought more black and white, when reality is more complicated? Could I be misinterpreting the evidence? Am I making any assumptions? Would other people have different interpretations of the same situation? What are they? Am I looking at the evidence of just what supports my thoughts? Could be thought be an exaggeration of what is true? Am I having this thought out of habit or do the facts support it? Did someone pass this thought/belief on to me? If so, are they a reliable source? Is my thought a likely scenario or is it the worst case scenario? This is essentially Cognitive Behavioral Therapy. You are analyzing a thought and finding its source and evaluating the reliability. You are retraining your brain how to think.
15. The ten forms of cognitive distortions.  Does your thinking fit in any category? This will help you know if you are having an irrational thought without evidence or if your negative self-talk is reflecting a cognitive disorder. Labeling these negative thought patterns helps you to cope, get resources, note triggers and ask for help. Recognition prevents relapse. Remember- you are not your thoughts. Mindfully become an observer to your thoughts and decide which thought patterns of yours are following:
    1. All or Nothing Thinking- you see things in black or white
    2. Overgeneralizations- you see a single negative event and say “always or never” about this as a pattern.
    3. Mental Filter- you pick out a single negative detail and dwell on it exclusively so it is perceived as all of reality.
    4. Discounting the Positive- Reject positive experiences by insisting they “don’t count.”
    5. Jumping to Conclusions: You interpret things negatively when there are no facts to support your conclusion i.e. mind repeating or fortune telling thinking all is negative
    6. Magnification- Exaggerate the importance of your problems and shortcomings
    7. Emotional reasoning- You assume that your negative emotions necessarily reflect the way things really are.
    8. “Should Statements”- You tell yourself how things SHOULD be rather than seeing the positive of how they are
    9. Labeling- Extreme form of all-or-nothing thinking. Instead of saying “I made a mistake” you attach a negative label like “I’m a loser.”
    10. Personalization and Blame. You hold yourself accountable for an event that isn’t entirely under your control
16. Containment Exercise. This is a meditation you can use anytime. Get into a comfortable position. Visualize a container. It can look and feel however you’d like. Go into as much detail as possible. What is the color, shape and size? Give your container a name. Now, put all your negative thoughts and feelings- anything bothering you- into this container. These can be worries, stressors, fear and your inner critic. For example, if you are ruminating on a worry that you will fail a test, you can put that worry in the container because you’ve already prepared enough. Or if you are thinking you’re unworthy and alone, you can put this thought in a container and separate yourself from it. Take a moment to do that. Then, put your container in a safe place. You can bury it, toss it in the ocean, lock it in a safe, anything you choose. The key is to separate yourself from the negative thoughts and feelings. This is so you do not overidentify with the emotion. You are not “Sadness” itself, you are “feeling sad.” There is a difference. It is all temporary- feelings are not facts, and you do not have to deal with them at all times. It’s okay to give yourself a rest. This may aid in some clarity.
17. Worry Scheduling: Along with the containment exercise, you can decide to schedule time to worry in your day and week. The time you worry is called a “worry window.” The point of this is to give your mind a break to focus on other things. Then, during the worry window, worry journal for 20 minutes anything that you are worried about. Lastly, come up with solutions to them. That way, you can better cope and manage your worries without them overtaking you.
18. Grounding. If you are having a difficult emotion or thought come up, ground yourself into the present by focusing on your senses. Think of what you can see, smell, taste, hear and touch. Go into as much detail as possible. Breathe deeply and focus on breath. If you need more stimulation, focus on another object and another and another until you are at peace again. Be with this moment, practice some Mindfulness. The present is all that needs attention. Come to this when you are in emotional distress…

Know that no matter what you are going through, you are not alone. Keep this resource handy, so you can reference it when you are seeking resilience in your recovery.

Here are some other mental health resources to educate yourself and become involved as a mental health advocate:

• Mental Health America
• National Association of Behavior Healthcare
• American Psychiatric Association
• Substance Abuse and Mental Health Services Administration
• National Alliance on Mental Illness
• American Psychological Association