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I have severe and persistent mental illness. I now work as a public mental health professional. Ask me anything.
Symptoms from my diagnoses of bipolar 2 and social anxiety disorder kept me from working, socializing, forming relationships, and living independently for more than a decade.
I worked my ass off to improve my wellness, and for the past 6 years I have worked as a Peer Support Specialist for 2 different public agencies. I tell my story to other people with mental health and substance issues as part of my work. If anyone’s interested, I’d love to share it here too.
My fiancé is struggling with his mental health, and has tried several therapists/psychologists/emergency care options and he feels like none of them are helpful. Because of this he rejects the very idea of seeking outside help and has been in a constant state of mental anguish that ebbs and flows but never goes away. Do you have any advice on how I can help him find assistance that is effective? Currently his past experiences with mental health care are a barrier.
I meet a lot of people who have had negative experiences with “the system” and don’t trust or believe in the help being offered any more. My advice would be encourage him to keep trying. There are good therapists and shitty therapists. (And, importantly, there are good therapists who just aren’t the right therapist for YOU. Trust and rapport are crucial.)
Remind him that these people work for him. He is allowed to fire and replace them if they are not serving him. Yes, even in the public system.
Finally, the sad truth is that mental health treatment is largely trial and error. It sometimes takes a lot of time to find what works for a particular person. What helped me was taking an active role in that process. I finally asked my shrink “What have you diagnosed me with? What does that mean?” Then I went home and got on google and learned as much as I could about what he’d told me, and came back to him with more questions. And suggestions. Lo and behold, I’d been misdiagnosed. Educating myself, and taking a leading role in my treatment team made all the difference.
Best wishes for both of you, and thank you for supporting him.
There are so many different types of therapy out there. Right now I believe CBT is still the most common and likely whats not working for him so understandably hes had poor experience in the field.
I would definitely validate that hes had poor providers in the past, and then see if hes open to reading about different therapies first and using that to figure out who to see. Now that telehealth is more acceptable your ability to access specialized therapy is more available.
Therapies to look at that aren't as widely available so he may not have tried yet but could be helpful
EMDR
DBT
Acceptance and commitment therapy (ACT this acronym is used too much in the MH field to use alone)
Bibliotherapy
There's a really interesting episode of Invisibilia that talks about CBT and ACT. It does a great job of explaining these approaches to therapy with some really interesting examples of it helping people.
I'd like to add that psychodynamic therapy could be helpful. I was a skeptic at first but I found it really helped me. Getting a good therapist is extremely important, though-- there are many bad ones out there unfortunately. Imo you probably have a better chance with a doctorate level clinician as they're better trained than master's level, but there's really no telling who's good until you've spent some time with them, unfortunately.
Try to ask around if you can. I more or less learned about local therapists who had questionable practices from talking to a friend who's had bad luck with therapists, and I pass that info on to anyone who might find it useful. I also have some therapists I trust that I mention to anyone who asks.
Of course, individual preferences may vary, but at minimum you want someone with a strong track record of following evidence-based practice (which is less common than you'd hope).
I am so profoundly happy for you. You've taken the incomprehensible cards you were dealt and figured out a way to grab the jackpot of life with them through hard work and perserverance. So hard to do ... so impressed. And thank you for helping others: what an amazing gift you're giving others.
I lost my brother, also with bipolar, to suicide so I've witnessed at least a little bit of what that illness can do and it's consequences. Please do everything you can to continue to take care of yourself and be well.
That means so much to me, and I’m so sorry for your loss. As far as hard work and perseverance, I had a lot of help. :) We all need help. No one does this alone.
When I was younger, I delivered food to a place that offered immediate counseling and recommended services for addiction of various kinds. Most of the counselors that worked there were mentally unstable. I often have noticed that a good majority of people that work in the field are either unstable or are very close with someone that is unstable.
Do you feel it is more of a recognition thing or a sympathetic thing? What are some strategies that the rest of us can use to help those that need help get the help they need?
Define “unstable”. A lot of people who decide to work in substance treatment have their own history or are close to someone who does, yes. But I’m curious how the professionals were behaving that made you think they’re unstable. Were they smoking crack in the lobby?
I delivered food twice a day for 3 years. One day certain people would be bouncing off the walls, jumping, giggling, etc. The next day they would be tired, grumpy, barely able to talk on the phones. Usually whatever thought was in anyone’s head came blurting out. Especially if it was related to sex, drugs, or alcohol. As I got to know the ones that lasted, they would fill me in on their experiences that led them to drugs or alcohol, or they would talk about some of the things they did while under the influence that made them realize they had a problem. Everyone was in recovery (some also relapsed while working).
That’s not the norm in my experience. Professionalism is really strongly encouraged for behavioral health workers, regardless of their lived experience.
I think its helper thing as well as empathy. You see similar in nursing homes or hospitals. These are not high paying fields and the field takes advantage of the we are a non profit passions to under pay people.
Depending on the place we're they true counselors and using that term or were they volunteers that were guiding people via their own views. I'm not sure of the place you were at but I've seen both good and bad places.
There are unfortunately some places that use their morals to "help" and can truly hinder people. Of the facilities around here there are two locations I detest due to what I feel is them causing more harm than good. They do not allow medications at their location because they don't morally believe in them. They do provide housing though. So unfortunately homeless people have to make a choice, temporary shelter without med or no shelter and have medication but might lose it on the streets.
How is this legal? Are you in the US or somewhere else? In the US at least I would think that this would violate the ADA (Americans with Disabilities Act) because they're refusing to give (very) reasonable accommodations to people with disabilities (many people have disabilities where literally the only "accommodation" they would need is to be allowed to treat it with a particular medication, or maybe 17 medications, as was the case with my neighbor who had a liver transplant, although he may have needed a few additional accommodations too).
Anyway, it sounds like someone needs to sue these places into allowing medications. "Not believing" in medication doesn't give them the legal right to ban it.
What are some common things to have in my mind and watch out on pregnant women and recent mothers that are under a lot of stress, and how can husbands better support them?
(I know that not all pregnant women have "husbands" but I'm using this term here because that's more or less what I am and maybe there are some specific observations in that case)
Having been a mother of small kids (who are now teens) with mental health issues and a supportive husband who made all the difference, here are some thoughts:
When the child is still a baby and not sleeping through the night, making sure that at least one feeding and diaper change at night is handled by the father so that mother can get more uninterrupted sleep. Note this can work even when breastfeeding with pumping and bottle feeding breast milk once a night.
Share child care duties, make sure mother is not doing all or most of the child care.
Provide mother plenty of opportunities for me time - where father takes child for a walk or encourages mother to go out on her own to get a break.
If mental issues get bad, seeking out professional help may be in order. therapy and/or antidepressant.
Encourage mother to seek out her friends. Also make friends with other families with little kids ideally.
Support network is important. For some people church can help or another community organization designed to provide peer support.
I wish I had more personal experience with pregnant/new mothers experiencing MH issues, so I could more directly address this. But I can refer you to an amazing resource in NAMI (National Alliance on Mental Illness) Here’s a piece on maternal mental health:
https://www.nami.org/About-Mental-Illness/Treatment/Mental-Health-Medications/Maternal-Mental-Health
Hi! Thanks so much for opening this up. I’m very grateful to have a space like this to ask a real person a real question I have. I hope it is ok to ask this; it is a bit of a tough question.
So I have experience with, and have heard a lot about, the “pathology of psychology,” aka the idea that a lot of people who go into psych do so because they have their own mental illnesses or traumas, which can hinder healing, as well as do harm to others. That’s not to say that people with mental illness shouldn’t go into the field! They (we?) obviously know better than most how these things work. But I feel like it’s a valid concern that we end up with people who truly need help finding solace in attempting to help other people, perhaps to their (and others’) detriment. It’s certainly not impossible— Freud had a couple horrible (imo) ideas that seem informed by his own issues. I personally had awful experiences with therapists who had trauma of their own, and they justified my abuser. It was the worst. I am having difficulty believing in psychology and talk therapy as a helpful therapy at all.
Can you speak to how the community addresses these evident problems and reacts to them? I would love to trust “the system,” but frankly, it has so far gone badly for me personally. (Fyi I’m also doing great now, but it was in spite of this supposed therapist and not because of him).
Please please please understand how much I respect your personal journey. I am one-hundred-percent not doubting you or your abilities or intentions. I just am also a person with ptsd who would like to better understand my fellow human people, and especially those I want to be vulnerable with.
Also wait I had to edit this comment to just express how proud I am of you! Fantastic, fantastic job. Well done, homie.
I hate to say this, but I am extremely biased against those who practice therapy with social work degrees and biased in favor of those with doctorate level degrees. It's just that in my experience not only are doctorate level degrees significantly more academically rigorous, but they have more of a "weed-out" effect due to how competitive they are. PhD and PsyD degree programs are competitive enough that they can get away with more or less rejecting anyone and everyone they want for whatever reason they want. If you give off the slightest hint in your application or during your interview that your personality may be problematic, you'll get rejected. There's an article that I came across some time back about kisses of death in psychology grad school applications, which indicates the following:
and
So already at the door before they even decide whether or not to interview you these programs weed out people who fail to show complete professionalism.
While social work programs will also often try to do their best to weed out questionable personalities, such master's programs are often one of the (among many) "cash cow" programs for schools, since students are expected to cough up the money for the degree (whereas doctorate level programs often have waived tuition and a stipend, which loses rather than gains the university money). As such, schools tend to want as many master's students as they can enroll while they severely limit doctoral student enrollment.
The point is, weed-out effects are real. Of course, anecdotes are not evidence, but anecdotally about 80% of the master's level clinicians I've met (mostly with a background in social work but one or two with a background in mental health counseling) and 15% of PhD/PsyDs I've met (in all sorts of contexts) have had "questionable" personalities.
Of course these are rough estimates and I am judging these individuals particularly harshly (I'm talking mostly small red flags that don't necessarily mean these were bad clinicians just tiny signals that it may be good to avoid them, although for a few select individuals the red flags were huge, and notably none of those had a PhD/PsyD).
Regardless, these are just the trends based on my totally subjective experiences with mental health professionals. It's going to be hit or miss regardless of whatever credentials your therapist has, but I really to believe that the better educated ones (who are not only better educated but have survived an inherent weed out process, which by the way also includes the process of getting through years of school and writing a dissertation which more or less requires you have your shit together) are more likely to be "stable," as you put it.
So yeah, I hate that I'm biased in this way, but I feel strongly about it because when it comes to my mental health and the mental health of people I care about, choosing a high quality therapist is extremely important, and all of my knowledge and experiences point to certain credentials being a better indicator of quality than others.
Thanks so much for the thorough and helpful response! There’s a lot of this I hadn’t considered— or had thought about, but didn’t actually know. I appreciate your time and perspective on it, especially since my question was difficult and kind of vulnerable-feeling while having the potential to be “sticky” emotionally. Thanks again.
https://en.wikipedia.org/wiki/Peer_support_specialist?wprov=sfti1
My wife struggles with anger and quick impatience. Also anxiety (worst case scenario for everything). She doesn't take medication and seems to think that talking to anyone about it is weak and admittance that something is wrong with her. If I had to guess, she's a suffer of slight autism (aren't we all?).
Any ideas on how to get her round to actually going to see a therapist or councillor that could help?
It’s so hard to normalize asking for help for some people. Education helps. Maybe offer to go to a therapist with her for the first couple visits? Just to support her and ease the anxiety. Also, let her know that these angry outbursts are affecting you as well as her, and that at least looking in to some help would be a wonderful gift to you and to your marriage.
How do you maintain healthy psychological boundaries between natural empathy and incidents or stories that might be triggering for your own issues?
I ask this in the context of my own unipolar MDD and decades of various treatments. I volunteered with Crisis Text Line during the pandemic, and had to quit because it was just too overwhelming, even with the peer support mechanisms. [Admittedly, Crisis Text Line has some very serious flaws, which are covered in detail elsewhere, but there's little question that lives were saved.]
And thank you for your openness, honesty, and generous willingness to share your experiences here.
I practice really thorough self care, and see a therapist regularly. One thing that’s nice about peer work is you’re able to communicate with clients on a level a therapist can’t. If something in their behavior is triggering you: “I’m feeling a little anxious right now. Can we talk about it?” If they’re sharing trauma that’s too close to home: “I’m so glad you trust me enough to share this, but I’ve got a little trauma of my own in this area. Could we leave out the details and talk about how it made you feel?” Doing it in the moment like that not only protects me, but demonstrates to them how to protect themselves.
I have an intermittent FMLA approval in place - if you don’t know, the Family and Medical Leave Act can be invoked with documentation from your doctor, and grants you up to 12 weeks of medical leave for a serious medical condition, for which an SPMI qualifies. Taking it intermittently means basically if I have severe symptoms at work, I can go home, no questions asked. I can take a day off when I need to for my mental health. I highly recommend this for anyone with a diagnosis, whatever field you work in.
Finally, I lean on my coworkers. We’re all fucking nuts, have to be to get the job. We laugh it off, blow off steam, and advise each other on how to get through the weird shit.
I’ve had really bad mental health days on this job. But the victories more than make up for it.
Thanks for the generous response! I'll admit that the rigidity of the formulaic response framework and emergent nature of the texters' problems in CTL's model were difficult for me - we couldn't stop and say, "This is getting a little too close for my mental health".
Everything was focused on quick fixes to get people past moments where they might hurt themselves or others, and safety for volunteers was crammed into the same quick-fix model.
Oh of course! Sorry I neglected to factor in that the work you were doing was crisis-related. A lot of that will of course not apply in that situation.
That’s a big part of the reason I avoided crisis work in the beginning of my career. It’s a really intense situation to jump in to when you haven’t yet built the skills to protect yourself. Funnily enough, crisis is now what I do - I respond in person with a clinical team and sometimes law enforcement when someone is suicidal or potentially dangerous to others. It can get intense, and there’s no way I could have done this work when I was just starting out.
So maybe start smaller? Look for a community organization that supports people day-to-day, and not just when they’re at the end of their rope.
You're right about seeking out other community organizations - I'm doing political volunteering with a local LGBTQ-friendly candidate's campaign these days. It's closer to my native talents and not so much of an emotional stretch.
Based on what I heard in CTL, a substantial proportion of the mental health crises we dealt with were due to lack of physical and mental safety in families/communities that rejected LGBTQ+ people, lack of economic resources, and poorly managed schools that permitted bullying to continue unchecked. Essentially, political problems, not intrinsic to the person.
At the time I was volunteering with CTL, I was seeing a therapist, getting other health stuff squared away, and thought I was taking care of myself adequately... but I was in a new community, with all the pandemic stresses and lack of in-person contact in play.
Confronting other people's trauma while carrying your own baggage isn't something most people can do gracefully - I certainly couldn't, and I admire your strength and resilience.
Ive been diagnosed with GAD and probably have some other stuff that hasn’t been diagnosed. I finally found a therapist that I like but I struggle with finding a word to describe what I’m feeling during “episodes” besides crazy. Do you have any recommendations on positive vocabulary?
Are you looking for clinical language to make the therapist understand what you’re experiencing? Or just general better ways to express yourself and describe it?
I’m looking for better ways to express myself and describe it. Not just when I’m talking to them but for myself.
Why is your assumption that someone with severe and enduring mental illness is unable to provide this kind of support? People can have very good insight into how their illness affects them, and about when to seek additional support if they're having a rough time.
Bipolar is a severe mental illness. It requires medication, and often therapy to cope with the fallout of meds and illness. But many people find the illness is well controlled and they're able to live full and rewarding lives. Even if it's well controlled, the bipolar remains which is why it's labelled with terms such as "persistent" or "enduring". It's labelled as severe because the consequences for people when it's uncontrolled can be pretty rough.
Peer support workers are an important part of a multi-disciplinary team. There are doctors, pharmacists, nurses, therapists or psychologists, social workers, occupational therapists - and peer support workers. PSWs are an important part of this team because they can help the patient self-advocate, they can explain complicated health care systems.
Mental health care has complex medico-legal interactions and PSWs can signpost to sources of advocacy (in England this is free legal advice provided to anyone detained under the Mental Health Act, and there's probably similar in most countries that are paying attention to the UDHR ).
Mental health also lies in a complicated web of "Bio-psycho-social" stuff and this is where PSWs shine. The lived experience of interacting with a bunch of different organisations who are all providing bits and bobs of services to you is Very Important Experience, and is much more useful to patients than a healthcare professional who "knows" the referral pathway but doesn't know the patient experience of trying to access those services.
Sometimes the thing that's important to a patient ("I want to make sure I don't lose my job", "I want to stay living in my home, I don't want to be evicted") is less important to a dr ("Don't worry about it, the meds will make sure you're functioning and that's what will keep your job / home", "it's only a short hospital stay, and they'll understand"), and so having someone on the team who understands this and who can support the pt to articulate it is important.
Not a question, more of a boast. I haven't told anyone this yet because of years of disappointments. I'm 44 and struggle with mdd, PTSD, agoraphobia, social anxiety, and addiction. Probably some more letter things I'm forgetting since my memory is horrendously.
I was diagnosed with manic depression at 13 and that was the beginning. Through med changes, hospitals, self medication, etc, I've been fighting the battle ever since. It has been ROUGH. Especially the last five years. I had something happen to me that pulled the rug out from underneath me and set back what little progress I had ever made. It felt like I was a baby learning to do things all over again. Drive, public, conversations, hygiene, to name a few. I had been having ideations for the last 6 months or so, but felt like I couldn't say anything to my doctor because I never knew who that would be. Since COVID started there's been a revolving door of doctors either quitting or staying at their home offices, leaving me with a phone, Skype, or in person session. Who knows what it is this month. It was pretty hard on me, but I was thankful to have access to these services so I shut it.
Enter new doctor a month ago. I already like him because he's personable and I can physical sit in an office to talk. We discussed my current meds, which were wrong in my notes (surprise surprise). He immediate took me down to my original dose of Wellbutrin, which was 600mg a day. I had continued taking this dose even though I told the doctor that I was seeing shadow people. As a meth addict, I know what I'm talking about. He also added abilify to my current cocktail. I. Am. Blown. Away. The change happened in a week. I can do things. I can talk to people. I even went to the store by myself yesterday.
I know that this may change in the future as psyc meds are gonna psyc med, but I'm pretty optimistic. I've never had such a drastic swing in my mood, in a good way. So I'm going to shout from the (tildes, I'm not ready for the world yet) rooftop that I'm DOING OK! And ok is pretty good for me. I appreciate what you and everyone in your field does for people with mental illnesses. It can be a thankless job. I know. I've been thankless for years, probably undeservedly.