Thursday, December 29, 2011

Up All Night: Schizophrenia and Sleep Disturbance

"He has nights and days reversed."  That is a statement that I make A LOT about my loved one with schizophrenia.  I tell psychiatrists who want to do morning appointments as well as social workers, case managers, therapists and much of the known universe.

It's not easy scheduling appointments for a person who has trouble waking up by 4 p.m. But that is very, very common for people with schizophrenia, a new study out of Oxford indicates.

The Oxford research team studied 20 patients with schizophrenia. All 20 were stable on medication. And all 20 had severe disruption in their sleep.

The study, reported in the British Journal of Psychiatry, found all of the individuals with schizophrenia took longer to fall asleep, stayed in bed longer, slept longer and had variable sleep patterns. Half of them had irregular body clocks, meaning they often had nights and days reversed. When awake, they have, in effect, constant jet lag.

The Oxford team says the issue is not that people with schizophrenia tend to have unstructured days, as the control group was unemployed people who also had no structure.

The research said the severe impact of the sleep disturbances needs to be considered in treatment, because it has a strong impact on mood, social function, mental abilities and quality of life. The only problem is too few psychiatrists have office hours at 1 a.m. when the patient is awake and ready.

Monday, December 26, 2011

What the Cats Taught Me About God

Eleanor arrives at the vet: How could Cat Mom allow me to suffer so?
God loves cats. (Yes, He does, you cat-dislikers.) Consider the evidence: He made 49 known species of cat, big and small but otherwise quite similar.  And He made sure to have cats on all continents around the world.  I think it's, in part, because cats remind Him so much of people.

A few years ago, He sent me two of them ... one rescued from a barn and the other who had been abandoned as a newborn kitten at a vet's front door.  These two ... Eleanor and Clarence ... are just the latest of God's creatures to teach me a lot about God ... and the mysteries of suffering.  This happens every time we go to the vet. 

In this scenario, I play the God role, while the cats are people. I know why we are going to the vet.  Sometimes we are healing an injury. Sometimes we are getting an inoculation so the cat won't have something more awful happen to it. 

I would love to explain to Eleanor and Clarence why, but I can't.  Face it, I'm a lot smarter than they are.  And we can't communicate directly about this.  So I just have to hope that they trust me as we get out the carrier and head for the vet. 

Well ... to Eleanor and Clarence  ... trust isn't a natural reaction. They run when they see the carrier.  They fight me with claws and bad attitudes when they are getting in the carrier. They howl in the car. They are scared. Clarence is so scared that he actually poops in the carrier as we drive to the vet and when we are driving FROM the vet.  Every single time. At the vet, neither wants to get OUT of the carrier. They look at me as if I have betrayed them. When the vet offers them cheese ... a favorite snack ... they sniff it with suspicion and refuse the gift. And it takes as much as 24 hours after the vet trip before the cat will allow me to approach them again. 

Frankly, that's a lot like God, me and suffering.  I don't understand why I have to go the Symbolic Vet of Suffering, and God can't tell me.  Face it, He's a lot smarter than I am, He's driving the car, and He understands why I have to get a shot of suffering, even if I don't. 

Eleanor at the vet not speaking to me
God hasn't changed when I suffer, just as I haven't changed when I take the cats to the vet. I'm doing what's best for them. And I wish I could explain it. But I can't.

Saturday, December 10, 2011

How Caregiving Impacts Business. And Why You Should Care.

The bottom-line first.  More than one in six Americans with a part-time or full-time job -- 17 percent -- is a caregiver. They means that they assist with the care for an elderly or disabled family member or friend. And they have to take time off work to do it.

Recent Gallup research sponsored by Pfizer/ReACT (Respect a Caregivers Time) found that caregivers miss an average of 6.6 days of work every year because of their responsibilities. The cost of lost productivity due to absenteeism among the full-time working caregivers is more than $25 billion annually, a figure that rises to $28 billion when you include the part-time workers.

Who are these people?  Take a look.

The time off is generally paid or unpaid vacation time.  Which means the caregivers are the ones losing, not the employers.

But Gallup did analyze the the options that employers can provide to see which helped reduce absenteeism.  The four top benefits were:
  • Counselors to discuss options for assisted living and nursing homes.
  • Access to networks of support groups.
  • Employee Assistance Programs to discuss emotional distress.
  • Health counselors to answer questions about the person being cared for. 
The recommendations suggested that businesses with fewer than 1,000 employees could offer access to support groups and health counselors, while the larger businesses would most benefits from Employee Assistance Programs.

Why should you care? If you work with more than six people, you likely work with a caregiver.  It would be better for you if they has enough support that they could concentrate on doing a good job.  

Sunday, November 20, 2011

The Mental Illness Caregiver Holiday Survival Guide

The holidays can be some of the worst days of the year when your family is dealing with mental illness.  Not only is it TOO DARN DARK AND COLD, but it's also a time when expectations of being Merry and Bright can seem especially hard for your family. The stress can make your loved one have more symptoms, and that can make you even more anxious.

To help, I'm repeating the tips from last year's holiday planning post, plus some new thoughts on being your own caregiver this Christmas. 
  1. Accept this ain't gonna be pretty.  If you can get rid of your unrealistic expectations and be honest with your loved one and all the other family members, it will go better.
  2. Help your loved one to keep her dignity. Provide a gift fund or another way to allow her to give gifts, so she won't feel left out if she has no money. Scan every situation that's coming up to make sure that your loved one won't get unwelcomed attention.
  3. Hey, it's a good excuse to keep the unofficially crazy family members away.  You want a small gathering of your own family.  Period. Otherwise it's too stressful for your loved one.
  4. Keep it short. Keep it informal.  If you have to do the Big Family Thing, let your loved one stay home. Big groups are too much for your loved one, especially when you have to Put On a Happy Face. And do your own celebration. 
  5. If any of your extended family members really want to see your loved one, they know your phone number and where you live. Something private is better.  And try not to be bitter if no one asks. (There's a reason God chose you to be this person's lifeline. Not everyone can deal with this.)
  6. The best answer I've found to the question ... How is he? ... is "About the same." That's tough enough for you to answer.  So please don't put your loved one in a situation where he or she has to answer the question.
  7. If you are having an event at your house, discuss it in advance with your loved one so he or she knows what to expect. Accept his limits.  Accept her choices. Acknowledge his feelings. 
  8. If the person wants to be more visible during the holiday, brainstorm some things in advance.  What will he say when asked how he is? What will she do during the gathering? Is there a quiet place to retreat if needed?
  9. Tell the person whose home you are visiting what you may need in advance.  Please don't put yourself in a position ... helping cook at someone else's home, for example ... where you can't leave with little notice. If you are stuck, have someone ... a sibling or spouse ... available to get the person home if needed. 
  10. All your great preparation may result in your loved one refusing to participate at the last minute. And that's OK. 
  11. If someone offers to help you with any holiday preparation, ACCEPT. 
  12. When you make out your own Christmas wish list, see if you can ask for things that will reduce stress, whether it's a massage, a day trip, a cleaning service or a gym membership. 
  13. Eat right. Avoid the alcohol. Sleep. And write out a list of things that you are grateful for this year.
  14. A nice thank you card to people who have been helpful to your loved one personally or professionally is always good.

Monday, November 14, 2011

11 Warning Signs of Mental Illness in Children

The Mayo Clinic released a list of warning signs indicating that children may have mental disorders recently.  The clinic listed 11 "action signs" that Mayo psychiatrist Dr. Peter Jensen described as  "crisp, easily understood messages that parents, teachers, health care providers could ... relate to." 

This is especially important because more than half of children with serious mental disorders are untreated, according to the U.S. Surgeon General. 

Here, then, is the list of warning signs, endorsed by everyone from the American Academy of Pediatrics to NAMI:
  • Feeling very sad or withdrawn for more than two weeks.
  • Seriously trying to harm or kill himself or herself, or making plans to do so.
  • Sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing.
  • Involvement in many fights, using a weapon, or wanting to hurt others. 
  • Severe out-of-control behaviors that can hurt the child or others.
  • Not eating, throwing up, or using laxatives to lose weight.
  • Intense worries or fears that get in the way of daily activities.
  • Extreme difficulty in concentrating or staying still that puts the child in physical danger or causes school failure.
  • Repeated use of drugs or alcohol.
  • Severe mood swings that cause problems in relationships.
  • Drastic changes in behavior or personality.
Quick diagnosis can make a difference for children. So, if you are concerned, seek a professional evaluation. 

Sunday, October 30, 2011

I Can't Complain But Sometimes I Still Do

I shouldn't be here.  I should be driving home from visiting my daughter in New York. But a nor'easter got in the way, forcing us to rise at 3 a.m. the day before our scheduled departure and drive as rapidly as possible across Manhattan, New Jersey and Pennsylvania to stay ahead of a giant storm.

And for that I am grateful. Somehow God managed to get me to New York a day early ... for a client event that was cancelled ... so I got to see my daughter as much as I would have without the storm. We stayed ahead of the storm until New Stanton, Pa., and the drive wasn't nearly as awful as it could have been. And I have an extra day to get ready for a challenging week.

So, in the words of Joe Walsh: I can't complain, but sometimes I still do.  And when I do, I have to move a bracelet from one arm to another.  Fans of "A Complaint-Free World: Take the 21-Day Challenge" by Will Bowen will recognize that I have, in fact, taken the 21-day challenge that takes the average person about eight months to achieve. I may be wearing this bracelet, switching it from arm to arm whenever I complain, criticize or gossip, for months to come.

It turns out that St. James was right. The tongue is like a rudder to a ship. If it becomes negative, your life becomes negative. So we need to control the tongue with the help of grace as much as possible.  Yet, even if we stop complaining, we still have those thoughts. That's why I'm grateful for the other book I'm reading: "Choosing Gratitude: Your Journey to Joy" by Nancy Leigh DeMoss.

Gratitude and praise are the keys to moving our thinking out of a terrible torrent that she calls "the undertow of life in a fallen world."  It's the place where you focus on what you "should" have that you don't. It's when you think life is hard and overwhelming, and you start to believe the original lie that God is not good.  Gratitude and praise get you to the place where you know that life is broken, but God is good.

Indeed, my meditation passage this morning was wisdom from Francis of Assisi. Christians follow a broken Christ into a broken world. Disappointment and challenge are our landscape. This is the place where we can be a light, where we can glorify God, where it matters the most.

So whenever I think "I shouldn't be here," I try to remember.  Yes, I'm supposed to be here. A good God allowed this, and let's look for a reason to be grateful for it.

Sunday, October 16, 2011

When Love Is Even More Patient Than Usual

I'm taking an e-course titled Contemplative Discernment ... it just started so I think you can still sign up ... that asks students to spend each day contemplating the famous words found in 1 Corinthians 13. "Love is patient.  Love is kind,"  Paul wrote. 

The words are read at many a wedding. But they also would be appropriate for the moment when you learn that a loved one has a diagnosis of severe mental illness.

I wrote recently about the need to help our loved ones understand that they are not only their mental illnesses. How hard is that? Wow. 

In the book, "A Balanced Life," Tom Smith has several good suggestions for implementing two strategies: minimizing the negative impact of mental illness on self-esteem and maximizing the positive impact of, frankly, love.  You say nothing that adds to the person's feeling that they are worthless because they are mentally ill.  And you create a climate of acceptance, openness and respect.

Of course, people with mental illness get plenty of negative feedback that you can't control.  And some illnesses feature the charming symptom of grandiose self-esteem. (In this case, the kindness is helping the person be more realistic.) Still, the only person you can control is you, and you can make sure at least that you are part of the solution, rather than part of the problem.

This is where patience and discernment come in.  You have to learn to separate the person from the illness.You can't tolerate unacceptable behavior. But you need to set reasonable expectations that are based on a realistic assessment of what the person can control. When the behavior is out of the control and the person can do nothing about it, you need to get help, plain and simple.  Otherwise, try these steps:

  1. Don't spend much time looking back on what the person was capable of doing before the illness.
  2. Maintain a positive attitude as much as possible. 
  3. Don't take insults, anger or disrespect too personally.  But don't ignore them either. If your loved one is becoming volatile or violent, get help. And don't stop until you get actual help. 
  4. Respond patiently to symptomatic behavior. 
Love bears all things, Paul writes. One of the most profound impacts of having a loved one with mental illness is the growth in your own ability to love. 

Sunday, October 9, 2011

Losing Their Religion: Families Dealing with Mental Illness

It's official. Churches overall are not providing services to families dealing with mental illness.  And people are leaving the church and their faith behind as a result.

A study by Baylor University, released in June and published in the journal Mental Health, Religion and Culture, found these results. Baylor, which is a private Christian university, surveyed nearly 6,000 participants in 24 churches representing four Protestant denominations. It was apparently the first study to explore how the mental illness of a family member influences an individual's relationship with the church.

As you may know, I am a member of Vineyard Columbus, which has allowed me and my co-leader, to develop a small group ministry for families dealing with mental illness. Our group, Loving Someone with Mental Illness, meets in Columbus at the Vineyard Cooper Road campus at 7 p.m. on the first and third Thursdays, except in November.

This group and ministry came after decades of involvement in two other churches that did little or nothing to support the families of the mentally ill. Evidently that's the norm.

The study found that families who are dealing with mental illness tend to have less involvement in faith practices, but they did want the congregation to help them.  In our group, Job One is to help these families ... and let's face it, it's usually Mom ... to develop the kind of faith practices that allow them to survive and even thrive.

But the families are basically invisible to most churches, even though the survey found that ... believe it or not ... 27 percent of families surveyed were dealing with mental illness.  Those families had double the number of stressors, including financial strain and work-life balance issues, compared to families that did not deal with the mental illness of a family member.

Families dealing with mental illness ranked the need for the church to provide help for dealing with depression and mental illness as second ... No. 2 ... in priority.  Families without mental illness ranked it 42nd. Dr. Matthew Stanford, a professor of psychology and neuroscien at Baylor, said, "The data gives the impress that mental illness, while prevalent within a congregation, is also nearly invisible."

Baylor called for churches to work with mental health providers to help raise awareness in the church community and offer more assistant to struggling families. PsychCentral's Therese J. Borchard suggested that churches take five steps toward improvement:

  1. Get educated about mental illness.
  2. Talk about it.
  3. Create support groups.
  4. Provide literature to the congregation about it.
  5. Host a special service. 
Jesus must be quite unhappy when people in horrible pain walk away from his church because they cannot get help. I hope this study serves as a wake-up call.

Sunday, September 18, 2011

You Are Not Your Mental Illness

One of the major goals for a caregiver is to help the person with mental illness accept his or her illness as a reality, but become determined not to be totally defined by it. That's tough.  People with mental illness often feel bad about themselves. Some are overwhelmed by raging emotion. Some feel continual apathy. Both can struggle with hopelessness.

This excellent first-person video about having schizophrenia and obtaining a recovery that was posted on YouTube a few days ago. It describes the situation better than I ever could.

Enjoy!

Thursday, September 8, 2011

Economic Impact: Caregiving Costs $25.2 Billion in Lost Productivity

Caregivers may feel like they are always on the job, but they know the extra obligations and duties impact their performance in the workplace.  A Gallup poll released in July found that 17 percent of American workers, across all socioeconomic and demographic groups, are caregivers. And a majority of them said caregiving has had at least some impact at work.

On average, caregivers miss 6.6 days of work to deal with their other responsibilities.  With 17 percent of the working population acting as caregiver, the amounts to 126 million missed workdays a year. This costs the U.S. economy an estimated $25.6 billion in lost productivity.

Gallup discovered that nearly one-third of all working caregivers are in a professional occupation,with 12 percent in service jobs and another 12 percent in management.

About 71 percent of the caregivers said they told their employer about their situation, although the rest did not.

About 25 percent of the group said they had access to workplace support programs. This is not surprising under current economic conditions, yet the support groups, financial/legal advice and assisted living counselors evidently do help a great deal.

As the population ages, the number of caregivers will grow significantly. Evidently the folks who are doing a lot of work for a loved one for free are not only paying a huge cost ... they are costing the economy as well. 

Sunday, September 4, 2011

Words and the Lack of Them in Mental Illness

Mental illness is a "no casserole" disease that also provides a vocabulary that smart people misuse at will. It's all part of the stigma. Yet it causes much resentment in the mental health community. Much of it mine. Thus, this rant:

One of my friends who dealt with the mental illness of a child put it best. The mental illness got few signs of sympathy or concern. But when she got cancer, the casseroles and cards never stopped coming. It made her angry. She says dealing with the cancer was nothing compared to dealing with mental illness.

It's OK to ask about the illness. If you would ask how a person with cancer is doing, ask how the person with mental illness is doing. And if you are on the receiving end of the question, and the real answer is "just awful," the quick polite response is: "About the same." 

Cancer used to have stigma, and we are all glad that it has changed. Cancer is also one of those illnesses that has contributed vocabulary.  Nixon had "a cancer" on his presidency, John Dean famously said. Maybe that bothers people with cancer, too. I don't know.

I do know that people in the mental illness community are upset at the misuse of terminology. I literally stopped reading or listening to a famous female Bible teacher because she misuses the word "schizophrenic." People somehow think it's OK to use this word to describe a dysfunctional situation. That is profoundly disrespectful to everyone who suffers from the disease. Too many people who try to be politically correct about every other part of language fail to use psychological terms accurately. It contributes to stigma. 

Feeling resentment about the "no casserole" effect and misused language of mental illness isn't good for anybody, of course. And few caregivers have the energy to inform people of how offended they have been by the lack of caring. So just know this: They have been offended.

So, now and again, ask how things are. Try not to use disease names to describe non-diseased states (or even Congress, given that it is kind of diseased). End of rant.





Sunday, August 28, 2011

The Time Has Come: The Blessing of Christian Mindfulness

"Give your entire attention to what God is doing right now, and don't get worked up about what may or may not happen tomorrow. God will help you deal with whatever hard things come up when the time comes." -- Matthew 6:34  The Message

Continual stress is unfortunately a daily reality when you are any kind of  caregiver ... especially, the surveys show, the caregiver of a person with a severe mental illness. We want to follow Jesus' instructions, to not worry, but how?

Christian mindfulness is one of the best ways to "give your entire attention to what God is doing right now." In fact, the discipline of Christian mindfulness sees every activity in your life as an opportunity to meet God where you are. To do this, we must be "all there" in the moment. 

Most of what you read about mindfulness comes from a Buddhist slant. Indeed, some of the best techniques that I have learned have come from Jon Kabat-Zinn, a Zen Buddhist who has brought the practice to people under enormous stress and in terrible pain. It's important to understand that, while the techniques can be similar, Christian mindfulness has a different philosophical base and a different goal.

Simply said: The Buddhist techniques can be transferable to Christian mindfulness by adding the presence of God. Buddhists look at the moment. Christians look at the presence of God in the moment.

To get there, we must give up our fantasies in favor of living in reality. Like many people, I can tell you exactly how my life was supposed to work out.  In vivid detail. But daydreaming (or more accurately, brooding) about that blocks the ability to see God, who has decided that my life will work out somewhat differently than my plan. Instead, we live in the reality of the present while being loving to God and the people we find in our lives.

Therese of Lisieux, whose book "Autobiography of a Soul" has been an inspiration for me, got it. As I learned more about her, I've discovered that her father struggled with severe depression, so she knew what it's like to have mental health issues in the family. Yet her sole concern was to carry out the will of God as it was revealed to her second by second. It was her famous "Little Way," doing everything, no matter how small, with great love. She wrote: "I just keep concentrating on the present moment. I forget the past and preserve myself from worries about the future."

It is a pathway to a more peaceful, holier life. People, actions and events are the medium through which God comes. The given moment is the only place where you can meet God. Cultivating a strong spiritual life involves paying attention to the now. And doing the next right thing. One step at a time. One moment at a time.

Sunday, August 21, 2011

The Day's Own Trouble and How to Deal With It

"Therefore do not be anxious for tomorrow will be anxious for itself. Let the day's own trouble be sufficient for the day." -- Matthew 6:34, Revised Standard translation

"Give your entire attention to what God is doing right now, and don't get worked up about what may or may not happen tomorrow. God will help you deal with whatever hard things come up when the time comes."  -- The Message translation

- Jesus of Nazareth

Observing the suffering of someone you love with a mental illness is an extremely painful thing. The nature of the illness is that the symptoms come and go unpredictably. You never know what to expect.

You're likely to experience a wide range of emotions as well as a tendency to rummage through the past to see if you can figure out what went wrong ... and a dread of the future. Last night the telephone rang at 1:14 a.m. and I awoke in instant and escalating panic. This time, it was a wrong number.

Night can be rough. It is easy to wake up and spend hours on the "what ifs" and "if onlys."

What would Jesus say about this? He said we only need to worry about one day: this one.  It can be easier said than done. But it starts with the acceptance that trouble will come.

In a commencement address based on Matthew 6:34 and given at the Garrett-Evangelical Theological Seminary in May 2009, the Rev. Dr. Robert Allen Hill told a group of soon-to-be-pastors that, much like caregivers of people with mental illness, they will see trouble.  And often. His rule: "Expect it. Accept it. Address it. Forget it."

Several classic Christian practices ... and I think of them as treats rather than disciplines ... can cultivate attentiveness and awareness of what God is actually doing in your day: recollection (meeting God inside yourself) and the practice of the presence of God. A third practice, Christian mindfulness, will be covered in the next blog post.

Recollection is the habit of "centering down" and becoming still.  The best description of it is in one of my favorite books, "Celebration of Discipline: The Path to Spiritual Growth" by Richard J. Foster.

He describes an exercise called "Palms Up, Palms Down" in which you sit quietly with your palms down on your lap and offer God all the things that upset you, one by one.  Then put your palms up and ask to receive the graces you need: the serenity to accept the illness, the love to be a force for good in the person's life, the peace to trust God with the situation and on and on.  Then sit quietly for a moment and listen. Maybe you'll get an impression from God, and maybe not.

The practice of the presence of God is often associated with Brother Lawrence, a humble cook from a long-ago monastery who learned to spend every day, moment by moment, with God. Many people use cues, such as the ringing of a telephone or the passing of hours, such as 10 a.m., noon and 3 p.m., to remind themselves to focus for a moment on the presence of God with them.

Now is all we have. And it is also where God lives.  The people, actions and events of right now are the medium through which God comes. So whatever you are doing, focus on it and see God's presence. It's the only way to find inner peace.


Saturday, August 6, 2011

Yoga Benefits Patients with Schizophrenia

Believe it or not ... doing stuff this crazy may help people with schizophrenia.
My first yoga class was at Ohio State University ... sorry, The Ohio State University ... in September 1972. I took yoga for two quarters to help satisfy my dreaded phys ed requirement. I also had to take archery, which it turns out I didn't dread half enough. Yoga was a keeper, and I've practiced it as least once a week since, through thick and thin ... waistlines, I mean.

Now a new study has found that yoga, in combination with conventional treatment, seems to benefit patients with schizophrenia.

Researchers assigned 18 stable patients with schizophrenia to either a treatment that used yoga or a wait-list group. The patients' symptoms and quality of life were measured using Positive and Negative Syndrome Scale and the World Health Organization Quality of Life questionnaire before and after eight weeks of Downward-Facing Dogs, Cobras and relaxation exercises.

The patients who did yoga had significant improvements in paranoia, depression, general psychopathology and quality of life. New York-based psychiatrists are offering it now as part of treatment, I'm reading.   

I can completely see how this could work, although I'm not sure I could convince the person with schizophrenia in my life to try it. Music therapy also shown positive results, while hyponosis not so much.

Saturday, July 30, 2011

Planning for the Future With Mental Illness in the Family

Note: This is a guest post from my husband. 

Chaos and unpredictability are not new to the human experience.  In the Old Testament, God's people experienced a series of battles, famines, enslavements and other seemingly insurmountable circumstances.  In each story God came through for his people but only after they had suffered and nearly lost hope.  In the modern world we need look no further than the evening news to see chaos of all forms reported in detail.  Here in modern America we usually have problems of lesser scope than the Old Testament or the Third World. Our typical problems are still substantial enough however to make us lose sleep.  Possibilities of unemployment, under performing 401k retirement plans, health concerns and on and on occupy the minds of a typical family.

Then we take up the case of the family with a mentally ill member or two. Those special family members are more prone than the general population to volatility in their employment, their relationships and their overall health. They often lack motivation or insights sufficient to succeed at the more challenging tasks of adult life.  Mistakes that some others would learn from and move on may be repeated time and time again.  Addiction and substance abuse challenge a high percentage of the mentally ill community.

So how should we as caregivers and stewards of our mentally ill family members manage without either  falling into despair, or, as some have done, over committing ourselves in unhealthy ways? I've found some success with three concepts:  Prayer, Stewardship, and Margin.  You may be thinking Hey wait a minute. This is a Christian blog. I expected to see words like prayer and stewardship but what is this margin business? Sounds like something from an MBA program.

Prayer and faith are staples of the Christian life. God loves you. He loves your mentally ill family member. And as hard as his plan may be to understand some days, we can all count on the fact that he is working things out for our well being in eternity.

Stewardship sounds simple enough.  None of us wants our family member living under a bridge or on the street regardless of what he or she may have done or not done.  Most of us will go to great lengths to see that our mentally ill family member has as good a life as possible.

This is where the margin concept becomes important.  As caregivers, it can be tempting to make bold and generous commitments of our time and resources toset things rightfor our family member.  Where this is likely to fall apart is when all the time and resources have been committed only to have a new problem crop up.  I propose that as responsible caregivers we need to hold in reserve some time and some resources as margin against the next unforeseen event.  Remember I started this article with commentary on chaos and unpredictability and the propensity of our family members to have more than the typical amount of both.

So what does margin look like where the rubber meets the road?  It may be more helpful to pose these ideas as a series of questions to consider since each family is different.

         Have you planned your family budget so you can cover a year or so of doctor and medication costs in the event your loved ones health insurance or government benefits are disrupted?

         For your loved ones transportation needs, would a basic cell phone and a bus or subway pass provide the basics for now?

         Would the use of your spare room or help with basic rent keep them safe without the risk or long-term commitment associated with buying a house or condo?

         Would a group session be sufficient or perhaps even more beneficial than one-on-one counseling?

         Would a couple of semesters at community college make a good low risk way to see how they can perform in a college environment?

         What community or support group resources may be available to my loved one in lieu of fee for service providers.

         Have you talked to an attorney about setting up a trust to ensure the resources you leave behind when you die are managed for your loved one's benefit and according to these same principles?

         What do you need to do to keep yourself well and strong so you are in good shape if your loved one has a crisis?

Remember the idea here is not to be as cheap as possible but rather to provide stewardship of basic needs while retaining some margin in the time and resource budget to account for changing circumstances. If it sounds a little to you like a survival plan that is because it is a lot like a survival plan.  One for you and your loved one.

Prayer, stewardship, and margin. Please let us know if you have ideas or examples of creative ways to cover you loved ones basic needs while still holding a little in reserve for thatrainy day.

Sunday, July 24, 2011

17 Tips for Navigating the Mental Health System


Navigating the mental health system can be very tricky business. Some of the 17 tips below come from a document that Neal Edgar, Franklin County's mental health ombudsman, prepared for the NAMI Family-to-Family class, and others are just hard-won wisdom.


  1. Know the system as best you can.
    1. Get a resource directory.
    2. Go to meetings and get involved. 
    3. Get to know a social worker in the system.
  1. Get support from others in the same situation.
  1. Lower your expectations, and kick up your prayer life.
  1. Get the facts right and learn the language so people will listen to you.
  1. Know who to contact: case manager, team leader, Client Rights Officer, clinical director.
  1. Make friends with advocacy people.
  1. Be assertive, but polite and positive/empathetic/appreciative. Try not to be negative, threatening or critical.
  1. Get an agreement on a timeline.
  1. Document your contacts and your conversations.
  1. Make copies of everything you mail.
  1. Try to get a Release of Information signed.
  1. In a private hospital, the primary therapist (usually a psychiatric nurse) knows the most. In a public hospital, talk to the social worker assigned to the ward. Get an appointment at his or her convenience. The earlier, the better. Make it short.
  1. Ask for practical information about what to do when the patient is at home.
  1. Write letters of appreciation.
  1. Call and provide information, even if the worker can’t tell you about your loved one.
  1. Keep your loved one involved and informed as much as possible.
  1. Prioritize your relationship with God, your own health and the overall family’s welfare.

Friday, July 15, 2011

Shame on US: Veterans and Mental Health

Item: More than 202,000 veterans returning from Iraq and Afghanistan were seen for potential Post-Traumatic Stress Disorder at Veterans Administration facilities between January and March 2011, an increase of 10,000 over those seen in the last quarter of 2010.

Item: Veterans diagnosed with PTSD and other mental health issues face long waits for treatment that leave them at risk for suicide, according to testimony at a Senate hearing Thursday and new reports from the Department of Veterans Affairs Inspector General.

Item: PTSD and traumatic brain injury are the signature wounds among soldiers returning from combat in Iraq and Afghanistan. An estimated 1 out of 5 veterans who have served in those wars have one or the other.

Item: Suicide has claimed as about many lives of active-duty service members as the enemy has in recent years.

Item: President Obama has decided to send condolence letters to the families of active-duty service members who commit suicide in combat zones, reversing a long-standing practice of ignoring military suicide survivors.

All this was in today's Virginian-Pilot, the fine newspaper that chronicles life around the naval base in Norfolk. It also reported that two Navy ships that cost $300 million and were never used will be going to a scrap heap.  Maybe we should have spent that money on mental health care for our soldiers who were used.  Used in more ways than one.

Sunday, July 3, 2011

Loving Someone With Mental Illness

My son's case manager calls them "your Earth friends."  They are the people you know and love who do not have a mentally ill family member. They can sympathize. They can listen. But they really can't understand, no matter how hard they try.

Here are some things you have to live to understand:

1. Removing your child from yet another activity because other parents are complaining.

2. The sound of the psych ward door locking behind you during visiting hours.

3. Getting a slip of paper without comment that contains a diagnosis that changes your life forever.

4. Waiting with dread to hear from MIA adult children with mental illness .. and the instant relief when you discover that they are cursing out someone online. So they are alive!

5. What a really bad day is ... and what it is not.

That's why it's so important to find companions who have been there. I have had the good fortune of meeting many fine people at Families in Touch, the Mental Health America group, as well as our Support and Recovery Group, Loving Someone With Mental Illness, at Vineyard Columbus.  Laughing together at jokes that everyone else would find in poor taste is such a great stress reliever.

I co-founded Loving Someone With Mental Illness because I wanted the opportunity to pray with others about our mentally ill loved ones. For me, the best way to live faithfully in a secular work as a radical Christian is to belong to a small group of spiritual companions. Our group is there to allow us to share each other's burdens and point each other to Jesus in good times and bad. Loving Someone With Mental Illness meets on the first and third Thursdays at 7 p.m. at Vineyard Columbus' main campus on Cooper Road, Westerville.

Don't go through the pain of caregiving for a mentally ill person alone. Having someone other than your "Earth friends" to help you is truly a godsend.

Sunday, June 26, 2011

Prayers God Likes

Sometimes everything seems like a struggle. Caregiving becomes crisis management. Negotiated agreements result in you keeping in your word and the party of the second part ...  not so much. And in the midst comes a challenge, clearly from God, to sincerely pray the words found in Habakkuk 3: 17-18.

"Though the fig tree should not blossom and there be no fruit on the vines, though the yield of the olive should fail and the fields produce no food, though the flock should be cut off from the fold, and there be no cattle in the stalls, yet I will exult in the Lord. I will rejoice in the God of my salvation."

Boy that was a fun night!  In a hotel room in Woodside, Queens, devastated by a situation I had just discovered, I spent a night wrestling with God, waking up over and over, knowing that the Spirit wanted me to pray this prayer. Finally I did. But I sure wasn't happy about it.

I felt that I was letting God down that this was so hard to do. Until I read something in "Introduction to the Devout Life" by Francis de Sales ... a wonderful, dense book that I have been struggling through since Ash Wednesday as a Lenten reading project (and yes, I know that's it's late June now). Francis wrote this in 1608, so the language seems dated:

"Among many persons, especially women, the great mistake is made of believing that the services we perform for God without relish, tenderness of heart or sensible satisfaction, are less agreeable to His Divine Majesty. ... Works performed with tenderness of heart are more pleasant to us who are only concerned with our own satisfaction. When performed in times of aridity, they are sweeter and become more precious in God's sight.

"It is no great merit to serve one's King in the piping days of peace and amid the delights of court life. To serve him during the hardships of war and amid troubles and persecutions is a true mark of constancy and fidelity.

"Blessed Angela of Foligno says the prayer most acceptable to God is that which we force and constrain ourselves to say. Such is the prayer we turn to not for the pleasure found in it, but purely to please God."

That put my concerns about struggling in prayers to rest. I hope it helps you, too.

Sunday, June 19, 2011

Mental Illness Most Common Illness for Young People Worldwide

Mental illness is the No. 1 cause of disabilities among young people across the globe, a study from the World Health Organization has confirmed.

Not only is it the largest cause of disabilities, it comprises about 45% of the "disease burden" that people ages 10 to 24 have.  And people ages 10 to 24 compose 27% of the world's population.

The study, released June 8, showed that major depression, alcoholism, schizophrenia and bipolar disorder constitute nearly half of the diseases in this age group.  Most of the illness occurs beginning during the late teenage years and early 20s.

So why on Earth isn't this taken more seriously?

Sunday, June 12, 2011

For Better or Worse: Mom's Attitude Impacts Child's Mental Illness

"In short, what Mom thinks matters."  That was the comment from Dr. Fred Markowitz, a professor from Northern Illinois University in releasing an interesting study on June 8.

Markowitz and his colleagues looked at how the attitude of family members toward mental illness impacts the mentally ill relatives.The researchers found that, while family members often provide critical support, they also can have attitudes that hurt the recovery of their family member.  And Mom's attitude is the key.

The study looked at 129 mothers of adult children with schizophrenia over an 18-month period.

"We found that when those with mental illness exhibited greater level of initial symptoms, lower self-confidence and quality of life, their mothers tended to view them in more stigmatized terms ... for example, seeing them as incompetent, unpredictable and unreliable," Markowitz told Psych Central.

When mothers held these views, their children were most likely to see themselves as incompetent, unpredictable, unreliable, etc., the study found. When they saw themselves this way, their symptoms got worse, their confidence dropped and their quality of life lowered.

Now, there's a little bit of chicken and egg here. And any advice on how to deal with consistently unreliable behavior without coming to view the mentally ill person as unreliable was, of course, not offered. In fact, the researchers said that some of the problem mom behavior came from mom trying to help and being "well meaning." (I have now deleted four different sentences that were filled with sarcasm from this paragraph, so I'll just move on.)


But the research does point out that stigma actually seems to make the illness worse. So the old advice to stay as positive as possible and to allow your loved one to do all they can on their own seems sound.



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Sunday, June 5, 2011

Through the Looking Glass

Alice laughed. "There's no use trying," she said. "One can't believe impossible things."

"I daresay you haven't had much practice," said the Queen. "When I was your age, I always did it for half-an-hour a day. Why, sometimes I've believed as many as six impossible things before breakfast."


Lewis Carroll
Through the Looking Glass

1. Our  loved ones have an illness ... an illness that consumes their lives and can alter their personalities. They are more than that illness.  And you must sometimes carry the memory of who they are for them.

2. Our loved ones are ultimately  responsible for their own senses of self-worth. And self-worth is based on a number of things -- a sound family, good relationships with friends, marriage, a meaningful job -- that may be very difficult for them to sustain. And you must help them to remember that they are worthy of love anyway.

3. People with mental illnesses deal with some tough stuff: hallucinations, out-of-control emotions, terrible fears, deeply negative thinking patterns, voices that reinforce those deeply negative thinking patterns, fear of letting people down, actually letting people down, loneliness, loss, feeling like a burden to others, fear of what others expect them to do. And you must avoid any words or actions that add to their sense of poor self-worth.

4.  Our loved ones can behave in a manner that's most unlovely. They can say mean things  and create messy situations that you must help resolve. You may hate what they do. But you must love them unconditionally and treat them with respect.

5.  You will never really know what behavior comes from the illness and what comes from factors the person can control. But you must separate the person from the illness, establish expectations with gentle firmness,  and respond to whatever happens next with patience and understanding.

6.  God did not create mental illness. That would be one of Satan's Greatest Hits. But he does knows that you are in this situation. And He uses it to transform you. Because the way we need to respond to a loved one with mental illness is often the way that God responds to us. 




 

Sunday, May 29, 2011

It's Official: Caregivers of Mentally Ill Suffer .. a Lot

It's official.  It's harder to be a caregiver for a person with a mental illness than for a person with dementia. Not that I would wish either on anyone.
 
A study from Concordia University, the University of British Columbia and AMI-Quebec released this month reports that being a caregiver for a person with a mental illness is a difficult experience often characterized by high levels of stress, self-blame, substance abuse and depressive episodes.

The finding that most surprised the researchers:  how hard it actually is, the Montreal Gazette reports.  "We found it (the level of burden) was substantially higher than for caregivers of dementia patients.  They (the caregivers of the mentally ill) are extremely burdened and it constrains their lives," said the survey's lead author, Concordia psychology professor Carsten Wrosch.

Caregivers who do the best are those whose expectations for their own lives change the most.  They are willing to drop career goals and even goals for vacation and travel. The caregivers who adapt also are those who use alcohol and drugs the least. 

The scientists followed 121 people over a 17-month period. "Some people can disengage from unattainable goals," said AMI-Quebec executive director Ella Amir. "People who can do that move forward. People who can't adjust pay with their own well-being."

Sunday, May 22, 2011

My Life as a Lighthouse

Once I asked God for an image of my life's meaning. What I saw was a lighthouse.

That won't seem unusual to those who've been to my house in summer when lighthouses become a decorative item.  We've always been drawn to them, and we generally buy an image of each lighthouse we visit.  Only my husband has been brave enough to climb the scariest of old spiral staircases to the top. But we both love them.
A non-codependent lighthouse at work.
Being a lighthouse is also an image of the difference between being loving to someone who is experiencing a storm of mental illness and being codependent.  The lighthouse shines its light to guide the ships to safety.  It does not drag itself off its rock and wade into the storm in an attempt to grab the ship and drag it to safety.  It sounds the foghorn, it's true, but it doesn't engage in a lengthy argument about why the ship should head in its direction.

Fortunately, the lighthouse is attached to its rock, just I am attached to my Rock. So we allow the ship to use us as a guide or to ignore all our sound advice. We look strong, maybe even stronger than we feel, and we shine our light so that all can see it. 


Sunday, May 15, 2011

The Best Medicine for Caregivers

About 28 percent of the U.S. population serves as unpaid caregivers for someone, generally a relative.  That figure is from a 2010 report by Emblem Health and the National Alliance for Caregiving.  I find that to be a shockingly high figure.

Debbie Wilburn wrote a piece in the Gainesville Times about this, pointing out that the stress of being a caregiver can make for an exhausting, even humorless life.  To counter that, she suggests deliberate use of humor.

I'll use any excuse to laugh, but, until I looked into Debbie's comments, I didn't realize what good medicine laughter actually is.  Here's some information from the  Mayo Clinic:

  • Laughter stimulates your heart, lungs and muscles.
  • It increased the endorphins released by your brain.
  • A big laugh fires and then cools down your stress response, increasing relaxation.
  • Laughter improves your immune system.
  • It causes the body to produce its own natural painkillers.
About.com's article on Stress Management and Laughter says laughing reduced the level of the stress hormones like cortisol, epinephrine (adrenaline), dopamine and growth hormone.  Laughter as a stress management tool is also "free, convenient and beneficial."

So fire up that DVR and record your favorite funny shows. Buy a bunch of funny books. And take a laughter break if you haven't laughed hard by 5 p.m.  About a third of the U.S. population needs it!

Sunday, May 8, 2011

Four Steps to Dealing with an Overwhelming Life

How are you feeling this Mother's Day? Loved? Appreciated? Over your head?

In case you are more overwhelmed by your to-do list than by appreciation, here is some of the smartest things I've hear about dealing with a busy ... make that VERY busy ... life.  The tips are from Joanna Weaver, author of one of my favorite books, "Having a Mary Heart in a Martha World."

When your responsibilities get to be too much, do this:

  1. Invite Jesus to rule your life.  Present this day to Him, and ask Him for wisdom and guidance.
  2. Ask God to reveal the next step, the one thing you need to do next.
  3. Have faith that what needs to get done will get done. What you couldn't do either was unnecessary or is being taken care of by God.
  4. Be open to the Spirit's leading during the day.  You may find your schedule interrupted by a divine appointment. Instead of resisting, flow with God's decision to insert something new in your day. 
My days lately have included the beginning of the "Loving Someone With Mental Illness" support group at Vineyard Columbus.  We meet at 7 p.m. the first and third Thursdays at Vineyard Columbus in the Pastor's Lounge, with no meetings scheduled in March, July and November.  If you are in Columbus and need prayer to help you love a person with mental illness, you are welcome to join us! 







Sunday, April 17, 2011

When Hysterical Isn't Funny

When you love a person with a mental illness, you either make yourself learn advanced communication skills ... or you sit in a corner and talk to yourself. One of the most challenging skills is dealing with hysteria. 

Good old-fashioned hysteria seems to have slipped away from the diagnostic criteria. But you know it when you see it.

When you are in the midst of dealing with it, remember one thing: Your goal is to calm the person down, not to solve the problem that caused the meltdown. There's something about being in the company of a person who is crying uncontrollably that makes me forget that.  I just want to fix it. And I have plenty of strategies to suggest.  Amazingly this isn't useful.

I haven't been able to find much advice about what to do, particularly when the person on the telephone and not standing in front of you.  But these basic emergency communications guidelines apply:

1. Stay calm.
2. Be accepting and listen. Don't argue.
3. Recognize agitation and allow the person to escape to a safe place.
4. Be brief.
5. Make clear, specific and firm demands: "Put down the knife."
6. Take a break if you need it.  Call for help if either of you need it.
7. Do something physical if you can. Getting the person to drink water or hot tea can calm things down.

 You have my permission to do all these things imperfectly when under pressure. It's the No. 1 rule of caregiving: Do the best you can, and don't feel guilty about what you can't do.

Sunday, April 10, 2011

They Love You, Phillip Morris

People with schizophrenia smoke. A lot.  And it's really hard to quit.

Well, at least we now know why. A team of researchers out of the University of Maryland School of Medicine studied 100 smokers with schizophrenia and 100 mentally healthy smokers aged between 18 and 65 years. The two groups had no significant differences in levels of nicotine dependence, number of cigarettes smoked per day, expired breath carbon monoxide or age at smoking initiation.

What they did find was a significant different in tobacco craving that occured 10 to 15 minutes after smoking a cigarette. Breaking down the subject of craving, the people with schizophrenia had higher scores in emotionality (anticipation of relief from negative mood or withdrawal symptoms), compulsivity (lack of control over tobacco use) and purposefulness (intention and planning to smoke for positive outcomes).

The report of the study in Schizophrenia Research said the scientists hope the study will help doctors to figure out how to prevent and treat cigarette smoking among people with schizophrenia.

This is important because 80 percent of people with schizophrenia smoke, according to The Complete Family Guide to Schizophrenia by Kim Mueser and Susan Gingerich. They suggest foregoing the cold turkey approach, and having your loved one keep track of how many cigarettes they smoke a day, trying to gradually reduce it.  This is less stressful, and, of course, stress makes the symptoms worsen.

Since people with schizophrenia have lifespans that are about 25 years shorter than average people, it would seem smart to find a way to help them stop. But this also helps me, at least, decide that, in a world where you have to choose your battles everyday, this moves further down the list.

Sunday, April 3, 2011

Educating Yourself About Mental Health

Learning as much as you can about mental illness can improve your mental health.  You will discover more about what is really going on, as well as good information about what you can do about it.  The best websites to visit for basic information about mental illnesses are:

National Alliance on Mental Illness (NAMI)

Mental Health America

A Healthy Place

Psych Central

National Institute of Mental Health

NAMI also has a new website on schizophrenia, just announced on March 31.

Monday, March 28, 2011

How to Feel Better in Five Minutes

It really works!  One of my favorite stress relievers is a book series, "Five Good Minutes" by Jeffrey Brantley, MD, and Wendy Millstine.

"Calm, focus and serenity are just five minutes away" promises the back of "Five Good Minutes: 100 Morning Practices to Help You Stay Calm and Focused All Day Long." (I pause so that those who actually have seen me all day long can enjoy their own jokes about how calm and focused I am. Well, I'm better than I would be without it!)

I use the morning, evening and work version of this series, and they are helpful.  You can find out more about Dr. Brantley in this interview from PsychCentral by Elisa Goldstein here.

I've been through the morning and evening book several times.  One favorite is Exercise 14: Push All the Right Buttons.  First, you visualize a volume knob for your stressful thoughts, and then you turn it down. Then you visualize a button for instant calm, and you push it.  Am I instantly tranquil?  No. But  I do feel better. 

The books have dozens of exercises, often focused on paying attention to your inner life, that actually help.  I do them regularly.  It's easier than vibrating with worry or getting addicted to Xanax. Just try and see!




Friday, March 25, 2011

Encouragement for Dads

My husband contributed this guest post.

I've been the Dad in a blended family with mentally ill children for 12 years. Along the way I've learned a few things that might be helpful to other Dads.

With your partner or wife:

Understand that the situation is devastating to the children's mother and adds to her everyday stress in a significant way.  Give her lots of slack as she works through learning to handle it.  If you can help by getting appointments handled...do it.  It will mean a lot to her.  Be prepared to pick up dinner or do other errands that will lessen the load on tough days.  Most of all....try to be a calming influence.  A Dad who is steady and even-tempered helps the whole family.

With your ill loved ones:

Keep in mind you are an important role model.  I know my son really notices when I'm gone on business.  It make him less anxious if I simply tell him when I'll be gone for a few days and when I'll be back.  Have those brief simple conversations on a daily basis.  Your loved one's self esteem is probably pretty damaged by their limitations.  So talk to them in a positive way at a level appropriate to their understanding.

For your self:

You have no doubt had to let go of a lot of dreams you had for your children and the relationship you hoped to have with them.  Allow yourself to grieve in healthy ways and reach out to other men for support.  Venting your feelings with their mother or, worst of all, with the children will probably not end with you feeling any better, but it certainly will end with the Mom and the kids feeling worse.  Educate yourself regarding the condition at hand.  You and your family will all do better working from realistic expectations.

In summary:

It is a high calling being the Dad and partner or husband in a family supporting mentally ill members.  God has trusted you to help care for some of his most vulnerable creations. If you can show love and be grateful that you have the opportunity to do such important work...everyone will benefit.

Sunday, March 20, 2011

The Transfiguration of a Caregiver

The Transfiguration  - that moment in which Peter, John and James saw the reality of  Jesus' being - was both preceded and followed by a discussion of suffering. Even in the moment of his greatest revelation of glory in his earthly life, Jesus alerted his followers that he was headed toward suffering and death.

In Matthew, the story is preceded in Matthew 16:24-25 with this statement: "If anyone wishes to come after me, he must deny himself, and take up his cross and follow me. For whoever wishes to save his life will lose it; but whoever loses his life for my sake will find it."

Caregiving has a lot of losing your life to it. And if you are doing it, even in part, because you believe that God is asking you to, you will be blessed by it.  You will find your life. And you will find it as you drag a heavy cross through winding streets to a sad end.

You, too, can be transfigured. That's why you got this job to begin with.  The greatest honor that God gives to a soul, I once read, is not to give it great things, but to ask of it great things. 

How to be transfigured? It's in the sentence, too.  "Follow me." Or, in the final recorded words of the Virgin Mary at Cana, "Do whatever he tells you."

When the cross is very heavy, you may need help. Even Jesus did. We're starting a new Support and Recovery group at Vineyard Columbus on April 7 to help people who are caregivers to those with mental illness. If you'd like to know more, you're welcome to contact me at karentwinem@gmail.com

Sunday, March 13, 2011

One at a Time

People with bipolar disorder aren't the only ones with racing thoughts. Who has not had one of those moments when you start to contemplate the consequences of a situation? And one idea leads to another, leads to another, leads to another.

I am fairly good at sizing up people and calculating events for their effect. This is often known as "being negative" among people who are later shocked when things don't turn out as well as they had hoped (or, from my perspective, when things turn out exactly as I had expected.)

Those who teach mindfulness would tell me not to go there, to stay in the moment. This requires the ability to control your attention or focus. Those who are good at this ... certainly not I ... say this brings with it emotional stability. That's something all of us caregivers can use in large doses.

I can see this: A racing mind is either running into the future or hurrying back into the past. Getting disciplined about focus involves staying the present moment and bringing your full attention to the things at hand.

This is quite hard for me. After all, the only way I have ever successfully completed housework is to put an interesting podcast on my iPod and listen while I work.  This way, my right brain is distracted and does not come up with a suggestion every five seconds of better things to do than scrubbing the bathtub.

So before I risk visits from the Health Department, I need to start on something simple. Like actually paying attention when I eat or when I am talking to someone.  If I can tame my restless right brain, maybe my entire brain will be calmer. We'll see!!

Sunday, February 27, 2011

There's an App for That

Do you have the App-itude to make your life easier? Amy Drouin, RN from the Visiting Nurse Service of New York, who blogs for the organization's A Day in the Life blog, did two good posts on iPhone apps for caregivers. 

My favorite among Amy's choices:

Pillminder: A medication reminder for you to help your loved one keep track of daily medication. This one is free.

Cleveland Clinic Stress Meditations:  This $1.99 app is on my phone. It has Body Scan, Mindfulness, Guided Imagery, Letting Go, Self-Confidence, Loving-Kindness, Miracle Around Us and Calm Mind meditations.

Crock-Pot Slow Cooker Recipe Finder: Another free app that allows you to get dinner on the table even on bad days ... if you start early enough. My trick: I cook in the Crock-Pot overnight and then warm up the next day. This way you won't be late for work.

Several additional apps that I like in dealing with caregiving:

YOGAmazing: Chaz Rough, a yoga teacher in Louisville, is a good teacher and a social media wizard. This $2.99 app allows you to have a yoga class pretty much anywhere.

Simply Being:  Good guided meditations for relaxation with soothing music and the voice of Mary Maddux from Meditation Oasis for 99 cents. She also offers the $1.99 app "At Ease: Anxiety and Worry Relief."

iTalk to God: A free app that links you to Bible verses based on your emotional state at the time.
 
NIV Bible:  Easy to read, easy to use app. It's $5.99.
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Sunday, February 20, 2011

Slowing Down to Sustainable Living

Getting pushed around? Probably. 

One of the hallmarks of the 21st century so far is that people are increasingly pushed to do more things faster so that they can do more things, period. This is how people have ended up having crucial conference calls while they drive 70 mph down a freeway.

In response came the rise of the Slow Movement, which is said to have been ignited in this century when someone tried to build a McDonald's in a scenic part of Italy. Now there's Slow Food, Slow Parenting, Slow Gardening, Slow Travel, etc. Plenty of well-written material on this is found at the Slow Movement and Slow Down Now, home of the International Institute of Not Doing Much.

It's a good idea - although counterintuitive - to slow down when you are asked to do more. My experience in cutting back to a 30-hour work week is that I had two choices: a) work at warp speed or b) figure out what has to be done and what can be left undone.

When you are a caregiver, slowing down is a morale imperative. Burning yourself out will damage more than just you. So you need to take care. Some of the best advice I've ever gotten from this comes from Berkeley's famed meditation teacher Eknath Easwaran, particularly his book, "Take Your Time: Finding Balance in a Hurried World."  He notes that all negative emotions are fast: anger, fear, compulsive cravings. Slowing down makes it possible to think more clearly, even in an emergency, and to be more caring.

His thoughts on how to do this:
1. Get up early.
2. Don't crowd your day.
3. Ask "What is important?"
4. Take time for relationships.
5. Take time for reflection.
6. Don't let yourself get hurried.
7. Respond with patience.
8. Slow down the mind.

Slowing down to me doesn't mean missing deadlines or being late. Punctuality has always been more about integrity (doing what you said you would do when you said you would do it) and respect for other people's time. But it may give all of us clearer thinking. The way the century has turned out so far, we certainly need that.

Sunday, February 13, 2011

The Tone of the Voices in Your Head

So how kind are the voices in your head?

I'm serious. One of the most interesting concepts I learned while reading How People Grow by Dr. Henry Cloud and Dr. John Townsend centers around the idea that a harsh internal critic ... a mean conscience ... can actually inhibit spiritual growth.

Cloud and Townsend, whom many know from their excellent book "Boundaries," talk about how external relationships become internalized as "voices."  A woman in one of their groups slept with an abusive old boyfriend, causing her to berate herself in front of her group. The author made a wise observation to her that, while she knew internally that the action was a bad idea, she did it anyway in part because "The voices in her head that correct her and warn her are meaner than her boyfriend's." So she didn't listen to the mean voices and moved toward the boyfriend, who became abusive again shortly thereafter.

The point? Building relationships with caring people who correct you lovingly is an important part of stilling the harsh voice in your head. Your conscience is there to guide, but it should be a loving, kind voice. If it's not, it would be good to find a loving small group to be supportive as you deal with your problems.

Eventually, Cloud and Townsend say, a caring voice will replace the harsh one.  And maybe you'll listen to that voice before you get yourself in a bad situation. The authors report that the woman in their group actually said, in another encounter with the old boyfriend, "I was getting into him ... and then ... it sounds strange ... I could hear you talking to me saying, 'Don't do it! He will hurt you. ... We will be here for you.' " And she went home without Mr. Bad News.

Now, if that's true for the worried well, it's also probably true for the mentally ill.  None of us want to be one of the harsh voices of criticism and derision that they hear, particularly if they are dealing with auditory hallucinations (voices in the head) anyway.

Dealing with a person who has a mental illness may often feel like dealing with a person who is willingly being difficult and defiant. But our behavior actually should be the same toward both: Move toward grace. Encourage with love. And go vent in your journal. You can always destroy a written entry, but never can you take back a harsh word.

Tuesday, February 8, 2011

What the Good Days Can Teach Us

When living with a person with mental health issues, it's common to obsess about the bad days. Here's a wise idea: Rather than noticing the problems, notice the exceptions. Look for the times when the difficult mood or the problem behavior does not happen.

When is it when your loved one doesn't feel so sad, so depressed, so angry? When is it that your teenager turned in his homework on time? When did your spouse act in a loving way?  Sometimes you will find clues to things that will make life easier.

It's also useful to use this approach to help your loved one, even a child, see things with some insight. Conversation starters include:  "I need your help.  I'm worried about things, and I know that you are not happy either. How would you like things to be? When was the last time they were like that? What did I do or you do to make that happen? What can we try for a week?"

Trying something for a week to see if it makes a difference is usually good enough, unless you are dealing the medication that takes time to take hold. Overall, focusing on the behaviors rather than the emotions may make improving things easier.

Sunday, February 6, 2011

Major Advance: Schizophrenia Gene Mutation Found

A major advance in schizophrenia research was announced this week. An international research team has found a gene mutation that is strongly linked to the development of schizophrenia, which is, in effect, finding a pathway to the development of new drugs to treat the disease.

Dr. Jonathan Sebat of the University of California, San Diego School of Medicine, leads a large team of researchers - the list of researchers is 28 lines long in the press release - from the United States (Harvard, Columbia, University of Washington, McLean Hospital, Mount Sinai Hospital, Cold Spring Harbor Laboratory and UCSC), Chili and Ireland.

In the release, Dr. Sebat said, "This is the kind of gene that the pharmaceutical industry has been waiting for. Its activity can be modulated by synthetic peptides, and some have already been created."

Frankly, I don't understand much else of the press release, but it was announced as the first conclusive evidence that rare mutations can cause schizophrenia.  The illness occurs in 1 percent of the general population and 10 percent of people who have a first-degree relative, such as a parent or sibling, with the disorder. Good news at last. 

Sunday, January 30, 2011

When Your Child or Teen Has Mental Illness Part 2

It's easy to forget how hard it is. When a mother (and it's always the mother) who has a child with a mental health issue appears at my support group, it all comes flooding back: the desperate search for ideas and answers, helplessness, determination, fear and hope in the face of constant criticism. 

Luckily, I wrote a lot down.  Here are more lessons learned from raising a child with a diagnosed mental illness:
  1. Let her do as much for herself as she can. At the same time, watch carefully to step in quickly when needed.
  2. Establish a stable structure with a few simple rules in writing. Set up the consequences for violating the rules before the violation takes place, if possible. When your child is well enough, use negotiation and ask for input into the rules.
  3. When what you are doing isn't working, change it. This is particularly true regarding arguments and confrontations.
  4. Think before you speak.
  5. Choose your battles carefully.  Depressed children and teens can only work on one improvement at a time. If you insist on getting your own way all the time, your home will be a battlefield. 
  6. Keep your marriage as stable as possible or make the divorce as civil as possible so you can talk things out to always present a united front. 
  7. Don't take hateful words personally.
  8. Recognize agitation and allow the child or teen to exit from the conversation when it is occurring. 
  9. Ask her if she wants your advice before you give it.  Try not to talk too much because she stops listening if you do.  (By the way, this also is a good rule with all young adult children.)
  10. Make your requests in a positive manner with a pleasant expression on your face.  Accent positive feelings, and be specific, as in "I would feel much better if you would ..."

Sunday, January 23, 2011

When Your Child or Teen Has Mental Illness Part 1

For my own mental health, I kept a list of things I learned as the mother of a young girl with juvenile bipolar disorder, skewing toward depression. She was one of the first children in the world diagnosed with this mental illness, and thus, an experiment much too often for my peace of mind. I had no peers that I was aware of, anyway.

Many, many children  today deal with depression, and many, many people, including a lot in the school system, still have no clue how to deal with it. I forgive people relatively easily. But I still honestly hate a handful of teachers and principals from that period for what they did to my child. 

Here are some of the truths I discovered:

1.  Separate the child from the symptoms. Your child would like nothing better than to be a happy, fulfilled person. Learn the symptomatic behaviors, and don't take them personally.  Try to view the situation just as you would if your child had a stomach virus. You will have to clean up the vomit sometimes. At the same time, love your child as she is, not as she used to be or as you hope she will be.

2. Take it one day at a time. When the day is done, reflect on what you and your child did right. Practice gratitude.

3. Treat your child with respect. Remember: Many people will let your child know that they think that she is a failure every day.

4.  Be realistic.  A depressed teenager will not get straight As or do chores with a smile.

5.  When you speak in an angry manner, a depressed person will only hear your anger. He or she seldom gets the point you want to make.

6.  Make sure that there is fun in your relationship with your child. (This is why I have a huge collection of seasonal decorations. We celebrated everything.) 

7.  Take breaks away from your child when you are upset. Pace yourself. This is a marathon. You can only offer long-term support if you protect your relationship with your child and take care of your own health ... mental and physical.

8. Look for and comment on even small signs of improvement. One symptom of depression is not being able to remember the positive, so stress it.

9. Develop realistic goals, but don't trash her big dreams. Try to help her understand that small steps every day are important to working toward big goals.

10. Acknowledge the strength, courage and perseverance you see in your child every day. Your child's life is much more painful and difficult that most children's and teenagers' lives.

Sunday, January 16, 2011

Arizona Aftermath: With Eyes Wide Open

For caregivers of people with schizophrenia and other mental illness, the shootings in Tucson last week were just another reminder of how bad things can get. We know little of Jared Loughner and less about his parents, who lived with him. We do know this: Nearly three million Americans have schizophrenia, and surveys vary in what their actual rate of violence is.

The May 2009 issue of the Journal of the American Medical Association reports the latest I could find: The increased risk for violent crime associated with schizophrenia is largely due to the subgroup of patients who are substance abusers. People who had schizophrenia and substance abuse problems were four times as likely as the general population to have a violent-crime conviction.

Whatever problems there are usually happen at home.  A 1986 NAMI study found that 38 percent of families reported that their ill relative had been assaultive or destructive in the home at least once. How often the police were called, the study does not say.

Let's be honest here. A lot of people with schizophrenia who are not in treatment are self-medicating and have substance abuse problems.  Getting help for them is terribly difficult, even when you are trying very hard, because our mental health system is broken.

We also know that Pima Community College told Jared Loughner's parents in September that he could not return to school until he had a letter from a psychologist stating that he posed no danger. The New York Times reported Friday: "No record of Mr. Loughner seeking or receiving mental health care has surfaced."

That really doesn't mean that his parents did nothing because of the waiting lists involved in getting psychiatric help.  For example, when my son's psychiatrist suddenly closed his practice, the waiting list to see the psychiatrist at the community mental health center was eight months long. We were able to get medicine only by going to a psychiatrist who does not accept insurance of any kind.  For some, that's no option. The list to get a psychiatric evaluation may be just as long in Tucson.

Nonetheless, I feel strongly about three things. 
 
1.  When you are asked by an outsider ... a school, a workplace ... to get your loved one a psychiatric evaluation, move heaven and earth to do so. Go to a NAMI or Mental Health America support group to find out the tricks for getting it done in your area.

2. Become the Gladys Kravitz of your family. Snoop. Set up a Google alert in the person's name. Search YouTube. Search periodically for alcohol, for drugs, for weapons, for bizarre writing.

3. Fight to change the privacy laws to require colleges and universities to notify parents about troubling behavior by young adults. Schizophrenia and serious bipolar issues often begin in the late teens and early 20s. I continue to believe that the Virginia Tech shooting would not have happened if someone had called Cho Seung-Hui's parents to tell them how he was acting. Because Virginia Tech had Cho institutionalized briefly, it's clear that his parents had some idea that he was sick. And they seemed like responsible people in the aftermath.

That said, I feel very sorry for Jared Loughner's parents. Parents of 22-year-olds who are acting oddly often think it is a phase or a drug issue. And it's hard for a person developing paranoid schizophrenia to tell parents and others what is happening to them because ... surprise ... they are paranoid. Still, violence is not a common symptom.  The person getting ill is much more likely to hurt himself than to hurt anyone else. We need an accessible system of care. And we need it now.

Sunday, January 9, 2011

What Ohio's Mental Health System Needs Now

It's been a week in which a homeless man in Columbus with a dream voice turned into an instant celebrity. A week in which a person who appears to be psychotic took Sarah Palin at her word. A week in which Ohio welcomes a new governor who has a brother with a serious mental illness. 

The mental health system is this country is broken. Recognizing that Ohio is beyond broke, NAMI Ohio has called on Gov.-elect Kasich to provide sufficient funding for community-based care for Ohioans with severe and persistent mental illness.

"Not only is this the compassionate thing to do, it will save money by reducing the use of expensive and inappropriate institutionalization such as hospitals, nursing homes, prisons and jails," NAMI writes. The budget platform that NAMI endorses has five components:

  1. Ohio's Medicaid program discriminates against people with mental illnesses because it doesn't pay for mental health services the same way it pays for physical health services. SOLUTION: Move the responsibility for paying Medicaid to the state so local communities can concentrate resources on people with the greatest need. 
  2. Ohio is in violation of the Mental Health Act of 1988 because it does not use the dollars saved by moving people out of state hospitals to support them with community services. SOLUTION (well, sorta): Keep the current level of funding in the state fund for community mental health services. 
  3. Psychotic people don't get well when they are homeless, hungry and alone. SOLUTION:  Include language in the state statute directing local board to provide critical services to adults and children with chronic mental illness before they can spend state or local dollars on less critical services.
  4. Access to medication means the difference between sanity and insanity, life and death. SOLUTION: Prohibit limited on access to mental health medications for people with severe, persistent mental illness.
  5. Because there are not enough beds in Ohio for psychiatric hospitalization, patients are released before they are stable and not linked to community services. SOLUTION: Provide incentives to hospitals that accept Medicaid to provide more psychiatric beds. Prohibit state hospitals from releasing unstable patients and for them to link patients to community services before release.
Ohio dealt devastating cuts to mental health services last time. Gov. Strickland says he lost sleep over it; others lost family members over it. Let's hope Gov. Kasich, who should know better, does better.