Family and Loved Ones with Emotional Regulation Issue Seminar

A week from today Sunday 9/29 from 4-5:30PST Debbie Corso from Healing from BPD, myself and guest Dr. Perry Hoffman from NEA BPD (National Education Alliance for Borderline Personality Disorder) will be facilitating an global seminar for family and loved ones of those with Emotional Regulation Issues.  We will be talking about how loved ones can help, what resources are available to both clients and their families and have an open Q&A session.  

There are 2 days left to get the discounted price.

If you have any questions e-mail dbtpath@gmail.com

My Job: Dual Diagnosis Counselor at a Womens' Prison

Today's post is a little off topic, but today was the inmates graduation and being the emcee I posted about my nerves on Facebook and told my friends with an interesting response.  I have been working there for 8 months and it always seems to be an interesting topic to talk about with friends, family even strangers.  The reactions are mixed, but people have the same few questions so here goes.  If I seem vague it's because well it's a prison and although some information is open, certain some things are not.

• My job is Dual Diagnosis therapist, although not all my clients are what the program considers DD.  To them DD is MH medication+therapist+diagnosis of MH & Addiction.  The medication they can receive is not the same medication they often have Rx with their regular MH doctor.
• The programs main focus is substance abuse and they attend 16+ hours of group a week including cognitive skills, seeking safety, and process.  They learn a lot of skills for their recovery and must attend 2-12 step meetings a week.  
• We have a wait list of over one year most times, some of them are parole-board recommended- which translates that they need to complete the program.  
• The program is 6 months long.  There are reviews of their progress every 30 days- it's very time consuming.
• My caseload is about 20 people, although not all people graduate due to various reasons most are due to lying, manipulating and confidentiality.
• The "program" is all housed together- the rooms hold from 2-6 people, most are "2-man cells."
• We utilize a peer-support program which includes 10 "lifers," all which are murderers some of which have been incarcerated for 25 years.
• We are contracted by the state.
• A vast majority of these women have been the victim of horrific abuse as a child (often sexual,) abusive relationships, raped, started using substances around age 13 and have or in the process of losing their kids permanently.  Most would meet the criteria for PTSD.

Now to the questions people have most often:

• I always feel safe- the rare time I don't is when I am with general population and someone s cursing or yelling at someone else.  There are physical fights- but rarely .  There has been 1 in the 8 months I have been there, and I don't think there was more than one prior.
• The "lifers" and inmates in general are not scary or mean.  Part of it is because they in some way need the program to parole or stay out of another more-strict.more dangerous unit (or they have an extra 2 years+ typically.)
• Some do recovery- this is probably the #1 question.  Some come back.  We don't know statistics on how many, but I would assume half of them relapse on substances with in first 2-3 years.  If they relapse they often go to a different program, rather than repeating this one although we have had a few come back 5 years later.
• Half of my co-workers are in recovery, my boss has 33 years and my co-worker has 13 years clean! We had a counselor pass this year and she has 13 as well, she died due to complications from her Hep C she contracted at age 17 using heroin.
• It's very, very stressful- these women have been through so much and get "caught up" in what we call "prison bullshit," relationships, manipulation and lying to staff.  A lot of my time is spend in crisis mode, especially in the beginning of the 6 months.  
• I cry, I try not to and most of the time I am fine.  They write an autobiography about halfway through and share it with the group- it's all triggering.  Some stories don't affect me so much and then there are a few that keep me up at night, make me cry or change the way I look at the inmate.  These women have such strength and perseverance and their stories are so tragic.  
• We can't hug!  Nope, no touching on shoulder, no embracing at all.  This is a strict rule and could lead to termination.  It is difficult and un-natural at times, especially when someone comes to be on-on-one and tells me their child died in the streets selling dope or there mom has terminal cancer.  Life goes on while they are in jail and they often feel and are powerless.I am called by my last name only
• Yes, they eat crap.  Carb and calorie heavy food is the norm around here. They are allowed to work out at times and watch videos during the day.  There really isn't healthy options and most gain weight while incarcerated. Food is a commodity and is traded like cash.
• There are drugs in the prison.  Seems strange, but like all institutions there are drugs.  Most often it's Rx drugs that another inmate "cheeks" and sells, but there is also narcotics.
• 3" toothbrushes, and other strange things (to me) are used as if it's normal.  They are allowed to purchase (or someone purchases it for them) certain products these mostly include non-name brand lotions and such.  They are not allowed make-up (they use paint,) nail polish, headbands, etc.  Many still have them though.  A "full size" toothbrush that is easily 15 years old can go for $25.

That's all I can think of off-hand, I am open to answering any questions as I often think people think I work in one of those "reality" TV shows that fill prime-time TV now.  Here's a secret- the inmates in one of those shows is told to yell obscenities and appear aggressive for the cameras...I know I have 3 people in my group that were on it!

**Trigger Warning: There is a movie Sin By Silence (trailer here) which is a documentary about abused women who kill their husbands.  It's very sad, and triggering but very empowering as they work to change California laws and get out**

Profiles of Borderline Personality Disorder: David O'Garr

After hitting a writer block earlier this week, I spoke to a fellow counselor about my work with DBT and that I specialize and take an interest in Borderline Personality Disorder.  As is often the case, my fellow counselor was stunned that my specialty was the one diagnosis she avoided working with "at all costs."  Being I speak with those with BPD on Twitter daily, I thought a simple way to change the stigma of "Borderlines" would be to do interviews with people with BPD and put a face with the diagnosis.  I was surprised when I put the ABP out and got 6 responses in a few hours.  The interview also took longer than I expected, but I hope to have 2 profiles out a week for the next month or two.

Being Misdiagnosed

Without further ado, I present David O'Garr, male age 29 years old and from Canada.  David is very open and honest in his life, and writes a blog about his struggles with BPD.  David comes from a large blended family, that were invalidating, although he remains close with his mother. Before his BPD diagnosis he felt jerked around by the Mental Health community, "It got to the point that every time I talked to a doctor they just wanted to prescribe me something else, and I kept saying that this isn't working we need to do something else. But instead of referring me to someone, they just kept telling me that the waiting lists for psychiatrists was too long and it wouldn't' help me."  He was diagnosed in March 2011 with BPD, Generalized Anxiety Disorder, Dysthyia and ADHD Inattentive Type. after 17 years of being diagnosed with depression and on a variety of antidepressants, "I was on meds off and on from 11 - 28  none of them worked."  David found out he had Borderline Personality Disorder after knowing something was amiss for years last March, after waiting almost 2 hours to see a Psychiatrist , "he spent 20 minutes with me, told me I had BPD, referred me to a different Psychiatrist and sent me on my merry way.  So I left there, not knowing up from down, not knowing what BPD actually was, basically thought I was being told that I was not a real person pretty much.  That everything I thought was me was a lie...And to top it all off, I felt disrespected, not listened to, and treated like I didn't actually matter."   

The Hardest Part: Romantic Relationships

As David read about the diagnosis he felt unsettled, "Well the first things I were reading was that it was most often diagnosed in women and gay men.  Which made me feel that the diagnosis was actually wrong, that the treatment of it in the medical field was actually sexist and misogynist in nature (I'd say homophobic, but homophobia also has it's roots in misogyny.)  That we were basically being treated for 'hysteria'  I also came across a lot of blog posts by men stigmatizing women with BPD.  Which was a bit heart breaking to read as well."  David is one of only 3 men, I have meet with the Borderline Personality Diagnosis, "I've also been basically written off in discussion and debates, and told well he's a 'borderline' so not worth engaging with.  It's actually those things that have made me really scared of being in a relationship.  That I would be seen as being 'psychotic' 'crazy' and 'clingy' and I have seen how I've been in relationships and it scares me."  David states he struggles with romantic relationships the most, having BPD, "I find love to be the hardest and most difficult emotion to regulate...It's the intimate relationship thing.  I want nothing more then to find a partner, settle down, create a home and a family for myself.  Get a dog, maybe adopt kids.  It's funny I actually wrote a piece about this not too long ago, about dating with BPD after some pretty crappy experiences this summer.  I have actually been really upfront with guys about what I'm like or I try to be before I had my diagnosis I have said like 'I feel things larger then life, it it's difficult for me to dial it back.' After my diagnosis, I explain what my diagnosis is, and what it meant."  "That I have no interest in dating someone, but if you're perusing me you need to know this, because I can't handle someone who is just going to run the first time I get triggered  and fly off the handle about something.  I get a lot of, 'that's okay', 'I'm still interested' 'I like you for you', or we'll work through it.  But then the first time they're confronted with me being angry and pissed off they totally and utterly just cut me off..tell me I'm melodramatic and they don't have time for that."   

"I pretty much hold that Marilyn quote pretty near and dear to my heart after my experiences: “I'm selfish, impatient and a little insecure. I make mistakes, I am out of control and at times hard to handle. But if you can't handle me at my worst, then you sure as hell don't deserve me at my best.”  Actually it's funny because I usually break it to them with that quote. It's like, do you know what this means? Do you know what this actually means? I think a lot of people use that quote because they think it applies to them, but I think that quote applies to people with BPD so much more.  We can totally be out of control and selfish and impatient, but we can also be so completely and utterly selfless and our ability for empathy and compassion I think is amazing too.  That we have bad things and good things, and our good ones really make it worth it.  If you can give us the time to prove that. 

Support

"I have an awesome support system.  My roommate, which I wish I could love romantically because it would make my life simpler.  He's an amazing man, he has his faults too, but when I freak out he just lets me do it and either walks away or goes out, and then when I done I usually apologize to him for having to see that and he just shrugs and we watch TV or a movie, or play video games.  There's also my mother, who's a big PFLAG mom, she's also trying very hard to learn what BPD is all about and doesn't quite get it yet.  And my best friend, who I am able to talk about pretty much anything and everything with.  She's been there for me through a lot of my life, and is really the strongest part of my support network."

Stigma

David would most like to change people's opinion of the diagnosis, "I wish people would understand the part about how difficult it is for us to deal with just every day.  The ups and downs of our emotions are a roller coaster and a lot of times we can't deal and really just want to get off the ride...That being melodramatic isn't us being vindictive or malicious, but a result of us trying to cope and ride the wave of emotions without having the tools to do it in a way that meets the limitations of acceptable behavior or the 'status-quo' of our pretty backwards society.  That being clingy, is me trying to be connected, and all I need is reassurance that you respect that, that you still care and you do want me.  That once I'm reassured, you can do whatever you want, within limits of course."  Exactly, the funniest thing is that it's that first part of the relationship that's the hardest, because that's when I need the most reassurance once the trust is built, and I know you're not going to leave, is when I know I'm more relaxed, but I can never get to that stage."

Getting Better

David has mostly utilized CBT therapy, although he found DBT group more helpful, "Well did a lot of CBT which I found unhelpful because none of my therapists really seem to understand what I was going through.  And I've had a few.  But still the same methods were applied over and over again, and I got really good at talking around my therapists, to the point where I have finished treatment with multiple therapists with them saying I didn't need anymore treatment...I got so good at telling people what they want to hear, that I just said it because I felt frustrated with them.  Then I have taken a six week DBT crash course and I found that REALLY helpful, and I am now just waiting for the year long treatment."

When asked what David has learned about himself since this journey began for him at age 11, "I have learned a lot.  I have learned not to change myself for other people, because once learning about that as a symptom I started catching myself doing that.  I have found that medications can help if you start taking the right ones.  I have found that I don't always need to be right, and my need and want to be just stemmed from my need and want to be accepted."

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