I remember the day, or rather, the night, about 13 years ago when I discovered I had bipolar disorder. I did exactly what I tell people not to do: I went online and diagnosed myself. In my case, I happened to be right.
I remember the extreme pain, fear and shame I felt at realizing I had a mental illness. I remember the indignation I felt at the idea that I would have to take medication for the rest of my life. Mostly though, I remember the tears. I remember the candy apple-red face stained with hundreds of tears. That’s what I remember the most.
But that was 13 years ago and a lot has happened since. One thing I have learned though is that I didn’t accept my mental illness that night. Nor the next. I didn’t truly accept my mental illness for years.
Recently a couple of my posts / links / images raised eyes with some of my readers. Some complained and others requested that I put content warnings in front of them.
I talked about dialectical behavior therapy (DBT) in the last post. Dialectical behavior therapy is designed to work specifically with borderline personality disorder and part of this disorder is often self-harm so DBT uses specific techniques to try to stop self-harm urges and prevent self-harm.
What is Self-Harm?
Self-harm is a huge problem for many people. It is typically a sign of borderline personality disorder but it can occur with any disorder (or no diagnosis at all). Self-harm, also known as self-mutilation or self-injury, can be any form of self-abuse including cutting, burning, hitting and statistics often include those with eating disorders as well. Millions of people in the US practice some form of self-harm.
Self-harm is often practiced by teens and is more common in women than in men, but make no mistake about it, many adults self-harm and men do as well. It is a behavior to be taken seriously. Here are some techniques to stop self-harm urges.
In spite of what some people intimate, I do endorse non-drug solutions and one of the best adjunct treatments to medications is psychotherapy. Many types of therapy can work for different people, but one current and research-backed therapy is Dialectical Behavior Therapy (DBT).
Now, don’t let the big words scare you – this is not a scary therapy. This is simply a therapy that works to use reason to integrate and synthesize to opposite points of view. Meaning, the techniques taught are designed to find a balance in emotion, behavior and acceptance.
Dialectical Behavior Therapy and Borderline Personality Disorder
Dialectical behavior therapy was designed specifically to treat borderline personality disorder; however, it has shown usefulness in mood disorders and research is currently underway to see if DBT techniques are also useful in other disorders. This therapy represents a huge breakthrough as the first indicated treatment of borderline personality disorder.
… is the unifying voice of America’s behavioral health organizations. Together with our 1,950 member organizations, we serve our nation’s most vulnerable citizens — more than 6 million adults and children with mental illnesses and addiction disorders. We are committed to providing comprehensive, quality care that affords every opportunity for recovery and inclusion in all aspects of community life.
The National Council advocates for public policies in mental and behavioral health that ensure that people who are ill can access comprehensive healthcare services. And we offer state-of-the-science education and practice improvement resources so that services are efficient and effective.
From what I can tell, this organization believes in community care over hospitalization, advocates for people with a mental illness and are just one quality organization.
The awards are known as the Reintegration Awards and there are nine categories. The Reintegration awards have, for 15 years,
… celebrated the achievements of those in the community who dedicate themselves to improving the lives of individuals with serious mental illnesses, and the achievements of those living with schizophrenia or bipolar disorder who battle tremendous odds to improve their own lives and the lives of their peers.
And, as fun as it would be, the $10,000 is actually granted to an organization of the individual’s choice, and not the individual themselves. Most of us, though, would be thrilled to give a $10,000 cheque to a deserving organization.
First off, the Dr. Oz show is a source of entertainment, like anything else on TV, so he added drama that wasn’t particularly necessary. That is the way of the show, and TV, however. Specifically, the show started off with scenes of electroshock therapy being given pre-1950 which is when you see people having convulsions in the bad old days before people were anesthetized during treatments. This is not the best way to start a show that is supposed to educate about current treatment, but he does balance this later on.
The Good About the Dr. Oz Show
I was impressed really. They did do a lot of things right and they did share a lot of facts about electroshock therapy, now known as electroconvulsive therapy (ECT). What the Dr. Oz show did right:
Represented the modern procedure accurately and even showed the procedure being performed
Mentioned repetitive transcranial magnetic stimulation (rTMS) as an alternative therapy (rTMS uses magnetic waves rather than electricity)
Stated that almost all insurance companies cover ECT (to the best of my knowledge this is true)
Spoke that it should be used judiciously
Placed it in a reasonable historical context
Tried to reduce stigma and fear and increase awareness around the procedure
Mentioned memory loss (twice) as a side effect
The Bad about the Dr. Oz Show on Electroconvulsive Therapy (ECT)
As with all things in life, nothing is perfect. Some things you should know that weren’t altogether accurate about the show:
Only talked about right unilateral brief-pulse ECT – while this is considered the most modern form of ECT it is not the only type. Before getting ECT you need to know what type you are getting in order to accurately judge the risks.
Stated that ECT “reset the chemical messengers / receptors” in the brain – the truth is we don’t know exactly how ECT works, we only know that it does. It’s likely it works in multiple ways but “resetting chemical messengers / receptors” is mostly just a simplified concept and not medically accurate or at the very least, not medically complete.
Didn’t mention the other side effects of ECT – while memory loss is generally considered the most concerning, other side effects are also possible.
Altogether, I thought it was a good show, and if a tad flamboyant, represented ECT well but there are other things you should be aware of.
Now, I understand that this is a theory and will only be true for a percentage of people. And I understand that no matter what I say, I will have a deluge of people disagreeing with me.
When psychiatric illnesses first started being recognized, some doctors felt that unipolar and bipolar depressions weren’t really the binary options for an illness but really just opposite ends of a spectrum. So then, one would have a spectrum where one could be a 100% bipolar depressive, or 100% unipolar depressive or they could lay somewhere in the middle. However, as illnesses need names and diagnostic criteria and not really vague percentages, bipolar and unipolar depression were defined separately.
Bipolar II – Within the Bipolar Spectrum
Bipolar 2 though, is recognition of this false dichotomy. Bipolar 2 really sits in between unipolar and bipolar depression as more depressed than bipolar 1 but more hypomanic (emotionally dysregulatory) than unipolar depression. (See the difference between bipolar 1 and bipolar 2 disorders.)
And that’s fine as far as it goes. But there is also recognition from a lot of doctors that other states lie even more in the middle, and cyclothymia is one such disorder.
I, as a good little webmistress, keep an eye on my web analytics. So yes, I know some things about my audience, and one of the things I know is what people are searching for when they find me. This sometimes influences what I write about, like today: What is the worst mental illness?
What is the Worst Mental Illness?
That depends on how you judge it. You could judge it by suicide rate, in which case:
Anorexia is the worst with about a 20-25% suicide rate*
Bipolar is second worst with about a 15% suicide rate
Schizophrenia is third worst with about a 10% suicide rate
You could judge the worst mental illness based on disability rates in which case you would probably get:
Schizophrenia as the worst
Bipolar as second worst
Depression as third worst (although more people with depression are on disability overall)
Perhaps schizophrenia is the worst as it’s associated with more psychosis (delusions and hallucination). Perhaps major depression is worst because of the number of treatment-resistant cases.
Or perhaps the answer is simply this: The worst mental illness is the one you have.
Last week I discussed the antipsychiatry movement in general, including some of their critiques of psychiatry – in this piece I will look at why antipsychiatry exists at all. After all, there doesn’t seem to be an anti-cardiology or anti-oncology group – what makes psychiatry so special?
But in saying that, perhaps we should take a greater look at antipsychiatry and what the possible benefits are of such a group (other than giving me writing fodder, naturally).
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