Faith vs Fear

Faith vs Fear

Monday, January 31, 2011

Words Matter

With all the focus lately on the need for civility going on in the national dialogue, I've been thinking about the power of words. Pundits from both sides claim that violent metaphors used to describe political and social conflict don't really matter because "they are just words." It reminds me of the old childhood rhyme: "Sticks and stones may break my bones, but names will never hurt me." But words do matter, and names can hurt. Words are what we use to convey thoughts, ideas, and emotions. What we say to others can build them up or destroy them. Elisa Brinton, a young writer I interviewed last summer put it this way: "It has often been said that the pen in mightier than the sword, and that’s very true. You can change the world with words. For example, the Declaration of Independence was just words, but look what it led to."

I like the words to the hymn "Let Us Oft Speak Kind Words to Another":

Let us oft speak kind words to each other
At home or where'er we may be;
Like the warblings of birds on the heather,
The tones will be welcome and free.
They'll gladden the heart that's repining,
Give courage and  hope from above,
And where the dark clouds hide the shining,
Let in the bright sunlight of love."

Hymns, 232

Or in the immortal words of John Lennon:
"You say you've got a real solution
Well, you know
We'd all love to see the plan
You ask me for a contribution
Well, you know
We are doing what we can
But if you want money for people with minds that hate
All I can tell is, brother, you'll have to wait."


And what we say to ourselves also matters; it influences our feelings of self-worth. For instance, when I get discouraged and down on myself, my whole attitude suffers. But when I say to myself, "I can get through this crisis," I feel confidence returning, and I can work through my problems better.

One of the recent threads at Spouses of Bipolar in an Active Relationship was on the subject of what we love about our spouses. It was a great exercise to list some of the things that I appreciate about David, and helps me keep things in perspective, especially when he's being cross. Here is my list:
* Hard-working.
* Creative and innovative, especially around the house or when he wants to try cooking something. It can be a bad thing, but he's come up with good things, too.
* Honest and sincere.
* Adventurous; we love going on short drives and taking off down unexplored and sometimes little-travelled roads.
* Funny.
* Really good with children. I love watching him interact with our grandchildren as well as children in our ward and neighborhood.
* Plain-spoken; says what he thinks.
* Caring, especially to those who are older and need help.
* Takes his disorder seriously; works hard to manage it.
* Muscular (all those workout sessions at the gym).
* Quiet; he knows the value of companionable silence.
* Willingly helps around the house, doing dishes, laundry, etc.

David's moods have been reasonably steady, but the cold, overcast weather is taking a toll on his spirits. I think that one of the reasons he gets depressed is that he doesn't have enough to do. He really needs a part-time job, but we're having trouble lining one up, and he's having a hard time motivating himself to really look. He also still doesn't sleep enough. His dr. prescribed another sleeping pill for him so we'll see if that will help him get some more rest.

The weather gets me down, too. I'm looking forward to the return of warmer weather. A recent highlight: I saw the layout for the story I wrote on leadership for the magazine. I'm excited to see it in print in another few months. That's what I love about my job: getting to work with words!

Friday, January 14, 2011

Tucson tragedy

Along with the rest of the country I have been saddened by the shooting tragedy in Tucson. The President's speech helped heal some of the wounds, but so many questions and conflicts remain to be resolved. I especially liked it when he said, "Already we've seen a national conversation commence, not only about the motivations behind these killings, but about everything from the merits of gun safety laws to the adequacy of our mental health system. And much of this process, of debating what might be done to prevent such tragedies in the future, is an essential ingredient in our exercise of self-government.
"But at a time when our discourse has become so sharply polarized — at a time when we are far too eager to lay the blame for all that ails the world at the feet of those who happen to think differently than we do — it's important for us to pause for a moment and make sure that we're talking with each other in a way that heals, not in a way that wounds."

Too often mental health issues doesn't hit the radar until a tragedy happens like that in Arizona and other places, and even then some of the stories are filled with old stereotypes and fear that fuels the stigma about mental illness and makes it that much harder for those who are suffering from it to feel comfortable about getting help. I wish we could have a rational, productive national dialogue on the subject without hysteria and finger pointing. So much more needs to be done to really understand mental health issues.

I remembered the last paper I wrote when I was in school on the subject, and decided, even though it's long, to post it here.

When my husband, David, was diagnosed with severe bipolar disorder two years ago, I knew very little about the disease. All I knew was that he had wide mood swings and anxiety attacks that made it nearly impossible for him to function normally. Receiving the diagnosis was both heartbreaking and overwhelming, and I had far more questions than answers. We were fortunate to find a psychiatrist who works well with David in managing his symptoms. When I asked him for information about the disease and how best to help David work through it, he handed me a three-page article with a general description and a few vague suggestions on how to cope with bipolar disorder. I discovered then that there needs to be more information about mental health that is easily accessible to the general public as well as to family members, clergy, and law enforcement officers.

The National Institute of Mental Health (NIMH) is an organization that focuses on understanding and treating mental illness through research. They estimate that about one in four adults, 18 and over, have a diagnosable mental disorder. In a press release dated May 7, 2008, they report that a study conducted by the World Health Organization, the World Bank, and Harvard University, found that “mental illness, including suicide, accounts for over 15 percent of the burden of disease in established market economies, such as the United States. This is more than the disease burden caused by all cancers.”

Mentally ill people are found in all walks of life, and in all classes of society. They are found in the jail population, homeless shelters, and hospitals. The U.S. Department of Health and Human Services estimates that almost 7.6 million hospitalizations in 2004 were related to mental health or substance abuse disorders.

A report on the United States public mental health care system that was conducted by the National Alliance on Mental Illness in 2009 is sobering. They found that the national average grade, based on 65 specific criteria, is a D. The economic crisis leads to budget cuts in mental health services and that causes “a vicious cycle that destroys lives and creates more significant financial troubles for states and the federal government in the long run.”

The cost to society as a whole is staggering. NIMH estimates that “major mental disorders cost the nation at least $193 billion annually in lost earnings alone.” And that number does not include the cost of medicine or doctor and hospital visits. For those afflicted with mental health concerns, finding affordable health care has long been a burden with many insurances covering mental illness at a lower rate than physical illnesses.

Statistics alone don’t tell the whole story. Behind each number is an individual who also has friends and loved ones. Mental illness doesn’t just affect the person who has the disorder; it also affects family members, friends, and coworkers. Mental and emotional disorders take a big toll on spouses, and these marriages often end in divorce. In an abstract on “Couples and Mental Illness,” Michael Crowe writes: “This is an under researched area in the mental health field, despite the fact that a large number of patients suffer from psychiatric problems and many of them are in relationships with a partner. There is typically a change in the relationship involving extra responsibilities being taken by the partner. The partner may indeed become depressed as a result of the stresses experienced. . . . Professionals need to increase their awareness of this issue, to treat the partner with understanding and to consider the stability of the relationship as part of their management.”

There has been a long history of myths and harmful stereotypes about mental illness that have caused others to misunderstand and mistreat those who struggle with mental problems. Society, as a whole, is slowly becoming more accepting, but more work needs to be done to bring it to the general public’s attention.

David J. Miklowitz, a professor of psychology at the University of Colorado, noticed the need for more mental health education and wrote a book about bipolar disorder. In the preface to his book, The Bipolar Survival Guide, he said, “I wrote this book to respond to a need voiced by virtually everyone with whom I have worked, along with their family members. People with the disorder wish for more understanding from relatives, friends, and coworkers. Their family members, in turn, want to know how best to help their bipolar relative without becoming angry, controlling, or overprotective.”

Sandy Naiman, who blogs at “Coming Out Crazy,” has suffered from the stigma associated with mental illness from the time she was a young teen. When discussing depression, she wrote, “It’s frightening. Steeped in negative stereotypes, prejudices and discrimination. “By far, the biggest barrier to gaining help with our emotional and/or mental health needs, is that we, women and men, find it so difficult to face our emotional pain and talk about it. Not only is it painful to process, it’s complicated by deeply-rooted fears about how our words and our feelings and our problems will be received. The real repercussions—like being ostracized or isolated or abandoned or losing our jobs and our security. Our connections to the people we depend on and love.”

Too often, mental health issues are only talked about when someone has a tragedy, such as what happened to Brian Cardall in June 2009. Brian had recently been diagnosed with a mood disorder, and was taking medication for it when he had a psychotic break. His wife called 911 for help. When the police officer who responded to the call tasered him, he lost consciousness and died. NAMI-UT said that Utah has a 40-hour training program on mental crisis, but that more officers need to be trained, including those in rural areas. The director of NAMI-Utah, Sherri Witwer, said “this training really does help officers identify the behaviors connected with mental illness and to adapt their approach with those people.”

A group of graduate students in social work at Brigham Young University noticed another need: members of the clergy who feel inadequate to help members of their congregations with mental health issues. They found that about 40 percent of those struggling with mental health concerns first go to their spiritual advisors for help. They recently published a manual to help clergy reach out to their congregations, and established a website to give them more information.

When I looked for information about my husband’s disorder I found a number of books and websites on the subject, but the information is scattered, and as one significant other of a bipolar sufferer commented, “most everything you find will be the same vague and uninformative list of symptoms or it’s get your dictionary out and try to follow along with the over-the-top medical terms while weeding theory from fact.” She believes that most people would like something that answers simple day-to-day life questions, and directs them to where to go for support and help with this disorder.

In my search for information I have come across several sites and organizations, such as DBSAlliance, NAMI, NIMH, the Copeland Center for Wellness and Recovery, WebMD, and PsychCentral, that have valuable information. These and other sites are helpful, but it takes a lot of time and effort to find them. There needs to be a central place on the web with information to direct those who are looking for help. For instance, the BBC has a page devoted to helping others understand mental health. The PBS website, probably the closest thing the United States has to the BBC, does not have anything comparable. More obvious links about mental health at popular sites like PBS, Google, or USAToday would be helpful for those seeking help on mental health issues.

I noticed that Great Britain is taking a proactive course to educate and break the stigma of mental illness. Three organizations funded by the British government and private organizations, Rethink, Mind, the Mental Health Charity, and Time to Change, work together to actively educate the public and reduce the discrimination that those who have mental illnesses struggle with.

In January 2009 they launched a campaign to bring mental health problems to the public’s attention. They did this through media advertising and coverage, online activities and websites, and a program to work with medical schools and teacher training colleges to help reduce the stigma of mental illness.

With these and other efforts, a British government report in June 2009 showed that public attitudes toward mental health are finally turning. They found, among other things, that:
* 77% agree mental illness is an illness like any other, an improvement of 3% on last year and up 6% since 1994
* 73% think that people with mental health problems have the same right to a job as everyone else, up 7% on last year
* 78% judge the best therapy for people with mental illness is to be a part of a normal community, up 8% on last year

They also discovered:
* 11% would not want to live next door to someone with a mental health problem, an increase from 8% since 1994
* 65% underestimated the actual prevalence of mental illness and only 13% were aware than 1 in 4 people will experience a mental health problem.

The Chief Executive at Mind, Paul Farmer, said, “We have seen some real improvements this year in the tolerance and empathy that people have toward mental health issues. There has finally been a decrease in the number of people who wrongly associate mental health problems and violence. We are also seeing attitudes turning on people’s right to employment but we can’t be complacent.”

More focused attention, education, and campaigns like Time to Change will help reduce the discrimination and prejudice that exists now toward those who are suffering with mental health challenges.

In the years since David’s illness was diagnosed I have spent hours researching the subject of mental health, trying to understand and help him manage his illness. I have learned that mental illness comes in all shapes and sizes and is as individual as the person who suffers from it. There are no easy answers, and much research still needs to be done to learn more about mental diseases, how best to treat them, and how to change public perceptions.

Sandy, from “Coming Out Crazy,” said it well when she wrote, “Depression [and other forms of mental illness] is a ‘human’ issue, not only a ‘health’ issue. In order to effect change in public policy, we need change in public perceptions. All of us have to own our emotional and mental health issues. Openly and honestly. They belong to all of us. Either indirectly or directly. . . .

“In order to heal, we must make peace with ourselves and accept ourselves, emotionally and mentally, as we endeavour to change public policies and perceptions for everyone.”

When that happens, more of those who silently suffer from the various forms of mental illness will be able to get past the stigma and receive the help they need to live happier, healthier lives.

Endnotes
1. Vicki Koenig, “Mental Illness—Information for Families,” Sanctuary Psychiatric Centers’ Information Network, http://www.spcsb.org/pdfs/resources/f-mental_illness.pdf.
2. National Institute of Mental Health, Statistics, http://www.nimh.nih.gov/health/topics/statistics/index.shtml. For a breakdown of specific mental illnesses included in the statistics, see http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml, accessed on July 1, 2009.
3.The Bureau of Justice, Statistics, “Mental Health Problems of Prison and Jail Inmates,” http://www.ojp.usdoj.gov/bjs/abstract/mhppji.htm. In one state, Texas, “there are almost as many psychiatrically ill inmates in the Harris County Jail on psychiatric medications as there are patients in all of the Department of State Health Services hospital beds across the entire state” (Steven B. Schnee, “Mental Illness Deluging Local Jail Facilities,” Houston Chronicle, June 27, 2009, editorial section, http://www.chron.com/disp/story.mpl/editorial/outlook/6500788.
html. Accessed on July 31, 2009.
4. National Coalition for the Homeless, “Who Is Homeless,” NCH Fact Sheet #3, June 2008, http://www.nationalhomeless.org/factsheets/who.html. Accessed on July 1, 2009.
5. Agency for Healthcare Research and Quality, Data and Surveys, Healthcare Cost and Utilization Project (HCUP), Care of Adults with Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004, http://www.ahrq.gov/data/hcup/factbk10/factbk10b.
6. National Alliance on Mental Illness, Grading the States 2009: Overview, http://www.nami.org/Content/NavigationMenu/Grading_the_States_2009/Grading_the_States_20091.htm, accessed on August 5, 2009.
7. NIMH, Science News, Science News from 2008, http://www.nimh.nih.gov/science-news/2008/mental-disorders-cost-society-billions-in-unearned-income.shtml. Accessed on July 1, 2009.
8. The U.S. Congress passed the Mental Health Parity bill (the Paul Wellstone-Domenici Parity Act) in November 2008. Beginning January 1, 2010, the bill will ensure that individuals with a mental illness will receive the same level of insurance coverage as those with a physical illness. The Depression and Bipolar Support Alliance discussed the new bill in its November 2008 update. See Depression and Bipolar Support Alliance, eUpdate November 2008: Advocacy, “The New Parity Law—How Will It Work in 2010?” http://www.dbsalliance.org/site/media_eupdateNov2008#advocacy. Accessed July 31, 2009.
9. Michael Crowe, “Couples and Mental Illness,” Sexual and Relationship Therapy (London: Carfax Publishing, Aug. 2004), 19:3.
10. David J. Miklowitz, The Bipolar Disorder Survival Guide (New York: The Guilford Press, 2002), viii.
11. The Toronto Star, http://www.thestar.blogs.com/mentalhealth. Accessed June 10, 2009.
12.        Ethan Thomas, “Not All Utah Officers Get Mental-Crisis Training,” Deseret News, June 11, 2009, http://www.deseretnews.com/article/not-all-Utah-officers-get-mental-crisis-training.html. Accessed June 12, 2009.
13. Carrie A. Moore, “BYU Students Create Mental-Health Manual for Clergy,” Deseret News, April 4, 2009, http://www.mormontimes.com/
people_news/education/?id=7323. Accessed June 8, 2009. For more information, see Clergy Bridge at http://clergybridge.org.
14. MDJunction.com, http://www.mdjunction.com/forums/bipolar-in-the-family-discussions/general-support/631347-looking-for-input#63341. Comment posted on July 1, 2009.
15. BBC, “Health,” http://bbc.co.uk/health/conditions/
mental_health/index.shtml.
16. To read these organizations missions statements, go to Rethink.org, http://www.rethink.org/about_rethink/index.html; Mind.org, http://www.mind.org.uk/; Time to Change.org, htt://www.time-to-change.org.uk/home. Accessed Aug. 5, 2009.
17.http://www.time-to-change.org.uk/what-were-doing/our-campaign/about-campaign/campaign-january-2009/how-did-it-go. Accessed August 5, 2009.
18. Time to Change.com, “Attitudes Towards Mental Health Heading for Tipping Point,” June 12, 2009, http://www.time-to-change.org.uk/news/attitudes-towards-mental-health-heading-tipping point. Accessed August 5, 2009.
19. Sandy Naiman, “Coming Out Crazy,” June 10, 2009. Accessed June 12, 2009.

Tuesday, January 4, 2011

A Look Back at 2010

We enjoyed a quiet Christmas at home this year; our first as empty-nesters. We found that by keeping holiday plans simple, and sticking to routine as much as possible helped David stay calm and enjoy the season. I was excited and touched when he surprised me with an early Christmas gift—refinishing my mother's old maple drop-leaf table. It had been one of her prized possessions, and several years after her passing, I got it. Over time it became worn out so we retired it and bought a new table. I'm so happy to have it looking good again and being able to use it. 
My new/old table
Looking back at the last year, I realize that we had a lot of good things happen during 2010. The best part was watching David get progressively better at managing his moods. It's true that there were some bumps in the road, but for the most part he can sense when his moods are changing and knows how to better control them so they don't take over. I am really proud of him. I also became more involved in an online support group for spouses with bipolar. I enjoy the friendships and appreciate the insights found there.

There were a number of exciting events with our children, including two new grandbabies; Jeffrey finishing up his Navy contract, coming home, starting a new job, and buying a house; Brian and Wes moving forward in their military careers; Ben finishing up his degree, starting his new career, and moving his family into their new home.

We went on a road trip, had several fishing expeditions, and had a camping trip with the family. I went to McCall for a visit with my dad and siblings. And in May I went to Seattle with Ben and his wife to visit Brian's family.
An Indian ruin in southeastern Utah
Near Boise Idaho, from the air
Buckeye Lake in the Uintah Mountains
At the cemetery
Spokane Falls
Monroe Bridge, where Dad hung out as a boy
One of the highlights of the year for me was the trip to Spokane, Washington, for the magazine. My dad grew up in the Spokane area, so after I finished up working he joined me for a few days. I always love being with and talking to him, but those were an especially sweet two days. He showed me the important places of his childhood, including his parents' and grandparents' graves, the homes they lived in during the Depression, and the schools he attended. I took pictures and recorded the stories he told about each site we visited.

We also drove to an area two hours north, along the Columbia River, where he grandparents settled, and where his parents grew up. It is beautiful, sparsely populated country, and I understood why they were drawn there around the turn of the century.
The Columbia River near the Canadian Border

His grandparents were prominent citizens of one of the towns, which at one time had a population of nearly 5,000 people. They also planted a large orchard; unfortunately, fumes from an ore smelter upriver eventually killed the trees, the Depression hit, and the creation of Lake Roosevelt behind the Grand Coulee Dam destroyed the town. There are a few homes remaining in the area, but all that is left of the town are a pile of rotting wood from my great-grandfather's store, and one remaining apple tree loaded with ripening fruit. It was a stark reminder that nothing stays the same.
The last apple tree at Bossburg, Washington
Last remnants of Bossburg
My great-grandparents moved to the city and he became a groundskeeper for the railroad station (where my grandfather also worked), and did other gardening job that gave him satisfaction and an income. Dad says, "Grandpa chose not to dwell on the past and his difficulties. He understood that changes are a part of life and that it is important to move on to the next phase." Dad also commented that we are in constant motion between the past, present and future. The important thing is to learn from the past, enjoy the present, teach and train the next generation for the future, and then step aside for them.
At 85-years-old, he was in a philosophical frame of mind, and I loved being there with him for that glimpse into the past.

Spokane Railroad Station Tower
I appreciate their legacy of making the best of a situation, and hope to follow their example more often during this coming year.