Are Mentally Ill People Dangerous (TW)

Let me start off by stating four quick points:

• What happened in Newtown, Connecticut was a tragedy.
• The following view is not to discuss why? how? who is to blame or gun control.
• The following post uses facts and intellect rather than blanket statements and accusations.
• It is written by a well-educated adult whose career and education serves as a platform to form the following viewpoint.

I'd ban ALL guns for convicted criminals and ANYONE with ANY mental health history whatsoever.
— Piers Morgan (@piersmorgan) December 14, 2012

Along with this tweet, after finding out the news I found myself with a whole slew of people stating the shooter "must be mentally ill/sick/psychotic," and a guesses of his diagnosis from laymen as well as some news casters, as well as Piers Morgan, who tweeted the above tweet to his nearly 3 million followers.

So are those with mental illness more dangerous than those without? Are those with mental illness more violent? 

The answer may seem obvious to the general public, given the popularity of movies, TV shows and books in which mentally unbalanced individuals are portrayed as homicidal maniacs. Three-quarters of Americans view mentally ill people as dangerous, according to a 1999 study in the American Journal of Public Health. Another 1999 study from the same journal found that 60% of Americans believed patients with schizophrenia — a condition characterized by disordered thought processes, paranoid delusions and auditory hallucinations — were likely to commit violent acts.

But while the data show that people with certain psychiatric problems do commit violent crimes at a higher rate than those who are seemingly healthy, the vast majority of homicides, arsons and assaults are perpetrated by people who are not considered severely mentally ill.

What's more, other factors, such as unemployment, divorce in the last year and a history of physical abuse, are better predictors of violent behavior than a diagnosis of schizophrenia, according to a 2009 study in the Archives of General Psychiatry.

"If a person has severe mental illness without substance abuse and history of violence, he or she has the same chances of being violent during the next three years as any other person in the general population," the study found. (source) (many more sources here)

So simple, the big question is solved, now let's look at the negative impact this lie-telling and guessing game causes:

The discrimination and stigma associated with mental illnesses stem in part, from the link between mental illness and violence in the minds of the general public (DHHS, 1999, Corrigan, et al., 2002).  The effects of stigma and discrimination are profound. The President’s New Freedom Commission on Mental Health found that, “Stigma leads others to avoid living, socializing, or working with, renting to, or employing people with mental disorders - especially severe disorders, such as schizophrenia. It leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking and wanting to pay for care. Responding to stigma, people with mental health problems internalize public attitudes and become so embarrassed or ashamed that they often conceal symptoms and fail to seek treatment (New Freedom Commission, 2003).” (source)

So telling lies, jumping to conclusions and assuming violence is perpetrated in increasing numbers by those whom are mentally ill, hurt those who are mentally ill creating this ongoing stigma that mental illness equals danger.  So why does the general population think those with mental illness are dangerous?

"Characters in prime time television portrayed as having a mental illness are depicted as the most dangerous of all demographic groups: 60 percent were shown to be involved in crime or violence" (Mental Health American, 1999).  "Most news accounts portray people with mental illness as dangerous" (Wahl, 1995).  "The vast majority of news stories on mental illness either focus on other negative characteristics related to people with the disorder (e.g., unpredictability and unsociability) or on medical treatments. Notably absent are positive stories that highlight recovery of many persons with even the most serious of mental illnesses" (Wahl, et al., 2002). (source)

How can those in the public eye become honest with their viewers instead of perpetuating lies and stereotypes?

 Choose your words wisely: Learn about the impact your words can have on those with mental illnesses.   Words are very powerful. 

• When we say someone is "crazy" or "that's totally mental" we're perpetuating stereotypes.
• Avoid the verb "suffers" when discussing mental illness. Instead, choose, "lives with mental illness" or "is affected by mental illness."
• Use "person first" vocabulary. When we say a person is schizophrenic, we make their mental illness fully define their identity. Instead, be clear that this is a disease that individuals manage and live with -- "He is living with schizophrenia."
• There are many phrases and terms; "crazy," "nuts", "psycho", "schiz", "retard" and "lunatic" that may seem insignificant, but really aren't.
• While there may be times when it is too challenging or simply not possible to politely correct someone else's insensitive use of language, you can always watch your own. (source)

How can those with mental illness begin changing the stereotype of mental illness?  Bring Change to Mind is an organization started by Glen Close, who's sister has Bipolar Disorder and nephew Schizoaffective about changing the stigma.  Here are the 6 ways to help: Take the Pledge, sharing your story, spread the word, donate, download the toolkit (which has helpful handouts regarding awareness), walk to raise awareness (source)

So what can we do now to begin healing, newscasters, talking heads, normal people, heck even Piers Morgan could use a hug right now?  Susan Pivers is a Buddhist Public Speaker whose work focuses on meditation and self-awareness.  She wrote this wonderful piece including a meditation for this incident (source)

Lastly I want to end with this quote from Fred Rogers, better known as Ms. Rogers:

“When I was a boy and I would see scary things in the news, my mother would say to me, "Look for the helpers. You will always find people who are helping.” ― Fred Rogers

BPD and Relationships

In group I have my clients work on the Power and Control Wheel numerous times in the 6 month program.  I think it is really important for those with mental illness and addiction issues to be able to identify what is abuse.  The most interesting part is when I ask them to identify ways in which they were the abuser and used the P&CW against someone else.  It's harder to come to grips with, but a few are vocal about using abuse against someone else, most of the examples are holding children as pawns, physical abuse, comments about a man's sexual performance to belittle him and cheating as a way to demean him.  I bring this up because as I have been considering writing about Borderline Personality and Romantic Relationship, but everyone I try- I get distracted and a more optimistic blog idea pops up.

Until I read "A Woman With BPD Explains Her Actions in Romantic Relationships"  by the author of Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder. In it she has the very honest and personal account of someone with BDP who explains her past relationships and the abusive tactics she has used:

• Purposely broken a gift you gave me 
• Flirted with several other people at a time or having a crush on others while I'm still dating you
• Said some of the most cutthroat things you've ever heard .
• Talked about suicide even though I know it hurts you
• Pulled a "Dr. Jekyll and Mr. Hyde"
• Pushed you away then pulled you right back
• Started an argument out of nowhere

The author of the article goes into depth about why someone with BPD would act this way, most of it boils down to the fear of abandonment as well as mood swings that can cause quick fluctuations of love and hate. Reminds me of I Hate You--Don't Leave Me: Understanding the Borderline Personality.  And yes according to the Power and Control wheel the above 7 bullet points could be broken down like this:

• Purposely broken a gift you gave me Intimidation & emotional abuse
• Flirted with several other people at a time or having a crush on others while I'm still dating you Intimidation & emotional abuse & using coercion and threats
• Said some of the most cutthroat things you've ever heard emotional abuse & isolation & minimizing, denying and blaming
• Talked about suicide even though I know it hurts you emotional abuse & using intimidation & isolation & using coercion and threats & denying, blaming and minimizing
• Pulled a "Dr. Jekyll and Mr. Hyde" emotional abuse 
• Pushed you away then pulled you right back emotional abuse, denying, blaming & minimizing
• Started an argument out of nowhere emotional abuse, minimizing, denying and blaming

So that's the bad news, those with BPD are often the abusers (not saying they are not as often abused) in romantic relationship.  And it may sound like a broken record, but there are ways to get better and once again this is why boundaries are so important. So what steps can be taken to have healthy relationships?  Here is a great article from BPD Central with the 10 Essential Limits for Romantic Relatonships:

The 10 Essential Limits

Keep in mind that a limit is not about rules or telling the other person what to do. You can't control their behavior; you can only control your own. Limits are based on your personal values and about what you will do to take care of yourself. For more information about limits, what they are and what they're not, and how to set and observe them, see my book The Essential Family Guide to Borderline Personality Disorder.

1. No mindreading. Your job is verbalize your own thoughts, feelings, concerns and preferences. By contrast, assuming you know the other person's thoughts and motivations (e.g., "You think that.." or, "You did this/said this because....") is almost always guaranteed to get you into trouble. Mindreading is one of the biggest obstacles to effective communication; it is invalidating, provocative, and almost always based on misinterpretations.

2. Build routines of taking a time out when things begin to get heated. People who are furious simply can't think straight; their brain is so focused on their feelings that logic gets thrown out the window. This is especially true with BPs and NPs. You can test this yourself. Think about something you said in the moment of anger that you regretted the next day (or week).

Talk about time-outs at a calm before they are needed, letting your partner know how this will work and assuring him or her that you two will come back to finish the discussion when you are both calmer. (Your partner, of course, has the option of initiating a time out too.) Find a safe place that is sacrosanct to you where no one else can enter when you need to be alone.

Early exits when either of you is beginning to feel a temperature rise prevents unsafe, hurtful mistakes--verbal as well as physical. Take the pot off the stove by removing yourself early on from a situation you may not be able to handle calmly.

3. Regularly do things you both enjoy and share positive reactions to your partner. The two of you need positive shared time and interactions to keep the relationship connection solid.

Positivity makes relationships worth having. The more appreciation, agreement, affection, playfulness, attention, etc you offer each other, the sunnier your relationship will be.  And the more you give, the more you'll get.

4. Focus on what you can do to improve situations rather than criticizing each other. And if you do feel it could be helpful to say something to your partner about what she or he has been doing, offer it as feedback, not as a criticism or complaint. People with personality disorders take criticism very badly, so it doesn't work to change their behavior.

Instead, learn ways to bring up your concerns without being critical and triggering the other person's defenses (well, as much as you can for a person with BPD/NPD). To give feedback offer a when-you statement, as in, "When you xyz, I feel abc"). Especially avoid the phrase, "You make me feel."  That's blame.

Remember that it's not your job to tell your partner what he or she should or shouldn't be doing. It is up to you to be honest about how you react as a consequence of your behavior. Your partner's concern for your feelings will tell you a lot about their capacity to show their love.

Just because you stop criticizing them won't stop them from criticizing and blaming you. With your own therapist or one of my books, formulate a strategy for how you will respond. My books go into this in detail.

5. Do not speak with contempt, ever. Studies have shown that couples who communicate contempt for each other are the most likely to break up. This principle is most important with regard to listening. Dismissive or eye-rolling as a form of listening dooms relationships.

6. No hostile touching; no putting hands on each other in anger. No threats or hurting property, either. Have a zero tolerance policy. Men, take any physical aggressiveness by your girlfriend or wife seriously; abuse of men is an underreported epidemic. Document, document, document, and be in communication with the police.

Never put your hands on your partner. Even if it is a mild pat, your partner may exaggerate it and make false abuse claims. You may end up in jail and unable to see your children.

7. Each person needs to have his or her own space, private time, and friendships as well as joint ones. Keep up with your friends and family and never become isolated. Isolation is the kiss of death to your confidence level, well-being, and sense of reality. Find at least one friend or counselor you can be honest with about what's going on. You need outside perspective, even if that threatens your partner.

8. Take responsibility for having and managing your own feelings, verbalizing your concerns and preferences, and being responsive to your partner's concerns and preferences.

9. Come to a mutual agreement about monogamy (or lack of) so you are honest and on the same page. Do not put up with infidelity (however you define it) that goes against your values. With infidelity, your sense of self-esteem will take a huge nosedive and your marriage will eventually be in name only. Again, formulate strategies with a therapist.

10. Work on problem-solving, not blame, and find win-win solutions so "Your-way" and "Their–way" differences lead to an "Our-way" solution that you both feel good about.

BPD Community Pinterest

I love Pinterest and I find myself spending more and more time sharing inspirational quotes I find on there.  So, I decided to create a Pinterest Community page.  E-mail, comment here or DM on Twitter with your e-mail address and you can view, share and add your own pins.  

As an FYI I had to set it up as a business account, otherwise it would sync with my personal account (and only so many people can look at Corgi boards!) 

I won't be doing any kind of "screening" before someone posts on there, so if you see anything triggering or inappropriate let me know and I will be quick to delete and if necessary un-invite someone.

BPD Community

Blog Roll

Just wanted to make a short post to bring attention to the blog roll on the right. New blog coming soon on romantic relationships and BPD.

Hope you are enjoying the winter (or summer depending on where you are!)

Mental Illness and Self Identity

Since the book contest has been going on for a week (congrats winners!) I have not been blogging, but now my ideas are running amok so it's time to put down on paper what's swirling around my mind.

I have been getting a lot of questions about the new changes to the BPD diagnosis in the DSM5 coming out in May 2013, which was just finalized this weekend.  The new diagnostic criteria for BPD in my opinion is vague and covers too many people.   But what if looking at the current criteria, and after years of therapy, DBT, CBT, therapy, heck even EMDR therapy you now meet 1 or 2 of the criteria when 5 or more criteria equals a Borderline Personality Diagnosis?  Well, first off you no longer have a BPD diagnosis (per the DSM IV-r) but does this make you "cured?"

"Recovery may seem like an illusory concept. We still know very little about what this process is like for people with severe mental illness. Yet many recent intervention studies have in fact measured elements of recovery, even though the recovery process went unmentioned. Recovery is a multidimensional concept: there is no single measure of recovery, but many different measures that estimate various aspects of it. The recovery vision expands our concept of service outcome to include such dimensions as self-esteem, adjustment to disability, empowerment, and self-determination. However, it is the concept of recovery, and not the many ways to measure it, that ties the various components of the field into a single vision. For service providers, recovery from mental illness is a vision commensurate with researchers’ vision of curing and preventing mental illness. Recovery is a simple yet powerful vision  (Anthony, 1991.)"

I have worked with many people whom were diagnosed with a mental illness, and though therapy, groups and sometimes medications, were doing better; holding down jobs, attending college, making friends and felt like they were lost for a while, "I have been Bipolar for so long who am I now?"  I think this mindset can be especially true for some with BPD, since the therapy is so intensive and the community is so tight-knit.

Take for instance a client I worked with whom had Bipolar disorder with psychotic symptoms; he had been attending NAMI groups for years, most of his friends were from the mental health clinic I worked at, his calendar was filled with Bipolar workshops, meetings, and events he had been attending for years.  After years of therapy and medication he was still attending these events and at some point I told him he was the poster child for "Bipolar Success."  He was confused by this term "success," he asked, "am I cured?"  I opened the DSM IV-r and read through the criteria for his current diagnosis- he meet 2, when 5 was needed.  After I assured him that he was not going to be dropped from services due to this (oh, insurance woes,) we spoke about if he should continue to spend 20 hours a week surrounded by those with a mental illness he no longer has? Should he drop all his friends? Was it appropriate to discuss at NAMI meetings issues surrounding a mental illness he no longer has? Should he tell people?

After a 50 minute session and a follow up phone call (he was "freaking out!") we decided his plan of action; it is okay to continue the relationships he has created, he can be a role model for others regarding what recovery looks like; attending NAMI meetings-okay BUT new doors are now open he didn't think were when he was diagnosed before; college classes, a healthy relationship (he was too embarrassed prior to have one,) and  full-time employment over collecting disability.  He was (understandably) so attached to his identity that he didn't know who he was without it.

I understand this isn't the case for all people with Mental Illness, as some hide their mental illness from others, are not properly diagnosed and some even avoid the reality of their illness.

Here is a great list of people's stories regarding their mental illness recovery Connections: Stories of Recovery from Mental Illness:

"Today, LeRoy doesn't see any doctor for therapy. He sees his doctor simply to refill his prescription when needed. His treated Delusional Schizophrenia affects him as much as treated diabetes or high blood pressure would. He takes responsibility for it, and life goes on.  "I take my pill at bedtime. I haven't really had any side effects," he says.  But perhaps there has been a side effect his job. As a survivor of a mental illness, LeRoy realized he now has a responsibility not only for his own recovery, but for the healing of others. So he's made a career of it. LeRoy helps other people with mental illnesses, called clients, as they walk their own road to recovery.  He says he may be making less money than he set out to earn, but he's helping more people than he ever thought he could.   In addition to mentoring and supporting people with mental illnesses, LeRoy tries to teach the public about mental health issues. He speaks to churches, schools, and practically any group or individual who wants to hear about the bravery of those who battle mental illness.  It's easy for LeRoy to talk about bravery, because it's bravery that helps him accept himself, accept his diagnosis, and go forward.  "You can't deal with your mental illness until you can agree with yourself that, 'Hey, I have a mental illness so I need to be responsible and take care of it.' "  He's brave. He's responsible. He's taken care of it. LeRoy Simmons is a survivor, (pg. 13.)"

 I would love feedback from anyone who no longer meets the criteria for BPD regarding how they got recovery and how (if at all) their identify was wrapped up in their diagnosis.

Book Contest Winners!

*The e-books were e-mailed out today and the other 2 books were ordered and will arrive shortly*

I am happy to announce the winners, whom  all have been notified.  I received 53 entries and had 12 winners in total- twice as much as November's contest.  Some of you entered here and on twitter and a few daily.  Below are the winners.  If you won Buddha and the Borderline or Gift of Imperfection please e-mail (alicia.paz.ma(at)gmail.com) or DM on twitter your physical address so I can have it shipped to you via Amazon.  I will send the e-books and 2 other books out once I get everyone's e-mail and physical addresses- hopefully Monday.) I abbreviated all names listed below for privacy.

Stop Sabotaging: 31 Day DBT Challenge to Change Your Life

• Stephanie J (Blogger)
• Jennifer C (Blogger)
• Paul K (Twitter)
• Tee B (Twitter/Blogger)
• Befuddled N (Twitter)
• The Guy... (Twitter)
• HeavensP (Blogger)
• Rhonda (Blogger)
• Cass (Blogger
• Dltd (Blogger)

The Buddha and the Borderline

• MsStitch (Twitter)

The Gift of Imperfection

• Stephanie E (Twitter/Blogger)

Grieving The Death of Your Counselor

This week I received an e-mail from my boss stating my co-worker (of a team of 4) passed this week.  I was at first dumbfounded and was unable to continue the conversation I was at the time having with one of the inmates.  Two hours later we held a "Family Meeting" to announce it to the 95 total clients, and her group of 17 clients.  The moment it was announced the room feel apart; women were sobbing and the staff was still in disbelief and shocked.

I worked as a grief counselor at a hospice about 6 years back in which my primary job duty was to call the next of kin listed and "check in;" how are you eating? sleeping? coping?  It was a difficult job at times and at age 20, I often went to the bathroom to cry between calls.  In my life I have not experienced loss to the extend that many of my client's have, and I have the coping skills to handle some things the clients/inmates do not.  The e-mails began at 4pm on Friday about what to do to provide the client's closure and a place to express their feelings about the grief.  They have had 2 process groups since, and have had been talking about it among each other, each client is in their own place with the grief cycle.  The ideas have been back and forth including having a memorial ceremony, creating a paper quilt/banner to display at graduation and having them 'bury' goodbye letters to her.  I am open to ideas about what we can do in a prison to help these women with the process, as a ex-grief counselor I feel like I "should" know what to do/say to these women and yet with 17 different views, mental illnesses, and past trauma related to loss it is a difficult task to begin unraveling as each person handles grief differently.

If you are dealing with grief here are some ideas of how to work through it [source]

Coping with grief and loss tip 1: Get support

The single most important factor in healing from loss is having the support of other people. Even if you aren’t comfortable talking about your feelings under normal circumstances, it’s important to express them when you’re grieving. Sharing your loss makes the burden of grief easier to carry. Wherever the support comes from, accept it and do not grieve alone. Connecting to others will help you heal.

Finding support after a loss

• Turn to friends and family members – Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient. Draw loved ones close, rather than avoiding them, and accept the assistance that’s offered. Oftentimes, people want to help but don’t know how, so tell them what you need – whether it’s a shoulder to cry on or help with funeral arrangements.
• Draw comfort from your faith – If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Spiritual activities that are meaningful to you – such as praying, meditating, or going to church – can offer solace. If you’re questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.
• Join a support group – Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counseling centers.
• Talk to a therapist or grief counselor – If your grief feels like too much to bear, call a mental health professional with experience in grief counseling. An experienced therapist can help you work through intense emotions and overcome obstacles to your grieving.
  
  
  
  

Coping with grief and loss tip 2: Take care of yourself

Face your feelings. You can try to suppress your grief, but you can’t avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems.When you’re grieving, it’s more important than ever to take care of yourself. The stress of a major loss can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time.

• Express your feelings in a tangible or creative way. Write about your loss in a journal. If you’ve lost a loved one, write a letter saying the things you never got to say; make a scrapbook or photo album celebrating the person’s life; or get involved in a cause or organization that was important to him or her.
• Look after your physical health. The mind and body are connected. When you feel good physically, you’ll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising. Don’t use alcohol or drugs to numb the pain of grief or lift your mood artificially.
• Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It’s okay to be angry, to yell at the heavens, to cry or not to cry. It’s also okay to laugh, to find moments of joy, and to let go when you’re ready.
• Plan ahead for grief “triggers.” Anniversaries, holidays, and milestones can reawaken memories and feelings. Be prepared for an emotional wallop, and know that it’s completely normal. If you’re sharing a holiday or lifecycle event with other relatives, talk to them ahead of time about their expectations and agree on strategies to honor the person you loved.

When grief doesn’t go away

It’s normal to feel sad, numb, or angry following a loss. But as time passes, these emotions should become less intense as you accept the loss and start to move forward. If you aren’t feeling better over time, or your grief is getting worse, it may be a sign that your grief has developed into a more serious problem, such as complicated grief or major depression.

Complicated grief

The sadness of losing someone you love never goes away completely, but it shouldn’t remain center stage. If the pain of the loss is so constant and severe that it keeps you from resuming your life, you may be suffering from a condition known as complicated grief. Complicated grief is like being stuck in an intense state of mourning. You may have trouble accepting the death long after it has occurred or be so preoccupied with the person who died that it disrupts your daily routine and undermines your other relationships.

Symptoms of complicated grief include:

Intense longing and yearning for the deceased Intrusive thoughts or images of your loved one Denial of the death or sense of disbelief Imagining that your loved one is alive

Searching for the person in familiar places Avoiding things that remind you of your loved one Extreme anger or bitterness over the loss Feeling that life is empty or meaningless

The difference between grief and depression

Distinguishing between grief and clinical depression isn’t always easy, since they share many symptoms. However, there are ways to tell the difference. Remember, grief can be a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

Other symptoms that suggest depression, not just grief:

Intense, pervasive sense of guilt. Thoughts of suicide or a preoccupation with dying. Feelings of hopelessness or worthlessness.

Slow speech and body movements Inability to function at work, home, and/or school. Seeing or hearing things that aren’t there.

Can antidepressants help grief?

As a general rule, normal grief does not warrant the use of antidepressants. While medication may relieve some of the symptoms of grief, it cannot treat the cause, which is the loss itself. Furthermore, by numbing the pain that must be worked through eventually, antidepressants delay the mourning process.

When to seek professional help for grief

If you recognize any of the above symptoms of complicated grief or clinical depression, talk to a mental health professional right away. Left untreated, complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. But treatment can help you get better.

Contact a grief counselor or professional therapist if you:

• Feel like life isn’t worth living
• Wish you had died with your loved one
• Blame yourself for the loss or for failing to prevent it
• Feel numb and disconnected from others for more than a few weeks
• Are having difficulty trusting others since your loss
• Are unable to perform your normal daily activities