Talking to kids about mental illness

20150918_161622

At dinner tonight my  kids were joking about various things and my younger child started joking about being in the “mental health room” and the “mental health unit” and basically laughing about people being crazy.

I felt frozen.  I’m a social justice warrior parent and I’ve been quick to call in, correct, and stop my kids around issues like racism and oppression.  But I was tired today and I wasn’t sure how to broach the subject that I’ve been a patient in mental health hospitals.   My older daughter knows about some things from my past.  They both have seen my scars and know that I used to self harm.  My older daughter knows a bit more, she was more aware of my depression before I left her father.  But they don’t know even a fraction of the story.   I wondered today about what they will think of me when I tell them.

I wanted to jump into the conversation with “it’s not polite to joke about people with mental health problems.”  But that didn’t seem like enough and I was so tempted just to honestly say: “I’ve been in mental health hospitals and it’s not something funny to joke and tease about.”  I wasn’t ready for the conversation and they were happy and I didn’t want to add stress to the evening.

But now, hours later, I’m thinking about it.  What will I tell my kids about my past?  When will I tell them?  Will it be planned, or will it spill out one day in a situation like this one?   I don’t want to talk too much about things that might upset them, but I also don’t want them to feel like mental illness is a taboo or a stigma that people should be ashamed of.

How do we talk to children about mental illness?   Before my first child was born I downloaded a fact sheet from CAMH called “talking to children about mental illness.”  I told myself that I had a few years, until she was 2 at least, to fully recover.  I told myself that she would never know and that I’d be 100% better by the time she was old enough to be aware.

I was optimistic.  But even when I downloaded the fact sheet, I think a part of me realized that it wouldn’t be that simple.  Anorexia, depression, anxiety and PTSD weren’t going to disappear the moment my new baby was born.  It made me (and makes me) so sad to think about talking to my children about my mental health struggles.

The fact sheet suggested reassuring the child that they were not responsible for my health.  Reassuring the child that I was seeking my own help and talking to other adults about my issues.  In this way, she would not feel responsible for me or worry about my health.

I struggled with postpartum depression after both my kids were born.  My older child was impacted more severely because she lived through both episodes.  I struggled to cope with taking care of my toddler after my second baby was born.   I hated myself for it and I still struggle to forgive myself for how I felt during the postpartum depression after my second baby.  By the time my older one was 5-7 years old, I was again coping with depression due to the abuse in my marriage.

My child was bright and extremely emotionally aware and emotionally intelligent.  I knew she worried about me and it broke my heart.  I knew she was aware that I was not happy.  When she was about 6, I read her some books from the public library which explained depression to children.  I told her the words from the fact sheet: “I love you,  I talk to my doctor and my friends when I am sad, you aren’t responsible and it’s not your fault.”  But it was difficult and I felt like a horrible mother.

My eldest was 18 months old when she first noticed my scars.  She was sitting on the potty and she looked at my arms and said “draw, draw?”  She thought they were marker marks on my arms.  I told her they were just marks and not to worry.  I knew I was only buying time until she would ask again.

When my eldest was 7, I separated from her father.  My mood improved and we no longer talked about depression. But over the next year she started to ask me incessantly about my scars.   For a year I told her that I would “explain when you are older,” but after a time it wasn’t enough.  She began to cry at night, get angry at me and say that I didn’t trust her enough to tell her.  She started refusing to talk to me about her problems because I wouldn’t explain the scars.  I spoke to my doctor and together we came up with a plan of how I could talk to my daughter.   He said that the fighting was likely more damaging to our relationship than just telling her an age appropriate version of the truth.

So I told her.  I told my 8 year old child about my past self harm.  I told her that all the scars were due to me injuring myself.  It was very difficult for me and I had a lot of guilt.  I told her a version of the truth.  I told her that when I was younger someone was mean to me and not respecting me and that I never told anyone.  I told her that sometimes when you keep secrets like that inside you start to cope in bad ways like hurting yourself.  I explained to her that this is why I always encourage her to talk to an adult about her problems.   My daughter was sad.  She told me that self harming was a very bad decision and that I should have talked to someone.  She asked me such a wise question: “If someone was hurting you, why did you hurt yourself?”

Since I told her, the questions stopped.  Once in a while I notice her looking at my scars with a sad expression, sometimes when I read to her at night she touches them and looks wistful.  I hope that my honesty will allow her to make choices to help herself in her own life and not turn to such negative coping.   My younger child still thinks the scars are cool, like battle wounds that make me funky and unique and a warrior of sorts.  She knows on some level that they are from self harm, but I’m not sure she is ready to accept that and she doesn’t ask questions.

I don’t think that talking to an 8 year old child about self harm is ideal.  But what options do I have?  My scars are obviously visible and it’s impossible to deny them or hide them.  If I had another type of physical disability I would have to explain that to my children.

Why is it so difficult to have open and honest conversations about mental health and mental illness?

I would like to tell my children that joking about the “mental hospital” isn’t funny.  I would like to tell them that it is triggering for me and could be upsetting for other people as well.  I want them to know that there is no shame in asking for help and getting treatment for a mental illness.  I do want them to know some aspects of my story when they are a bit older.  I want them to know because I made a lot of mistakes, and I hope that the knowledge I’ve gained on this journey could help them avoid the same mistakes.  I also want them to be the kind of people who help others rather than judging them or putting them down.

I want to shatter the stigma.  But today I was tired, my kids were happy and I didn’t want to put a shadow over a good day.   The conversation that started at 18 months old with an innocent “draw, draw” is likely one that will be taking place in stages as they grow up.  My psychiatric survivorship story IS my life, it is a part of me, and because of my scars I can’t hide it, even if I did want to.

And maybe one day I won’t feel ashamed and embarrassed to talk about it.

September 10 -World Suicide Prevention Day

20160509_204444

On this day I remember the friends I have lost to suicide.  I think of the friends I know who are suicide survivors.  I think about the service users I work with who struggle with suicidal thoughts.  I think about what it means to be a suicide survivor.

I am a suicide survivor.

I can’t speak to the experiences of other people who have survived suicide attempts, but I would like to share my own thoughts.  I think there are a lot of myths out there related to surviving suicide, how to help people who are suicidal and why people attempt or complete suicide.   It’s a taboo subject, one that people skirt around.  Sometimes the mere mention of suicide can silence a room, create uncomfortable looks and make those around you ill at ease.  I think this is mainly due fear.  It’s almost like people think that suicide is contagious.

I rarely talk about my experiences as a suicide survivor.  There seems to be a tacit agreement that it is not a suitable conversation topic.  Even in therapy there is the worry that talking about suicide will lead to unwanted consequences, trips to the hospital, worrying others, making others think that you are “crazy” or “unstable.”

Here are some of the myths surrounding suicide that I’d like to dispel.  These are my own thoughts and I don’t claim to speak for everyone who has these experiences.

  1. Suicidal thoughts and suicide attempts are impulsive reactions and pass quickly.
  2. Talking about suicide means that someone is not serious and is not really at risk
  3. Suicide attempts are always a “cry for help” and the person doesn’t want to die
  4. People who survive suicide attempts are grateful to be alive and recover quickly
  5. Talking about suicide will just “give someone ideas” and it will increase their risk
  6. The best way to help someone who is suicidal is to call 911 or take them to hospital
  7. If someone is habitualy suicidal, the experience is normal for them and they don’t feel afraid or need support.

Realities

  1. I’ve struggled with suicidal thoughts on an ongoing basis since I was 17 years old.  That’s almost 20 years.  My suicidal thoughts can sometimes be impulsive, but in my experience they are usually long lasting, persistent and even obsessive in nature.  I wouldn’t even like to hazard a guess as to the number of hours I’ve spent planning ways to die and thinking about ending my life.  In my experience, the impulsive thoughts are the most dangerous and the scariest, but the chronic obsessing about suicide is more exhausting and creates  a sense of hopelessness.   Many people struggle with suicidal thoughts over a long period of time, just because they don’t act on it or don’t talk about it, does not mean they are not at risk.
  2. I hear this a lot.  “If she is willing to talk about her suicide plan it means she isn’t serious and she really wants help.”  This is a dangerous assumption.  Every person is different, every situation is different.  Some of the times I tried to kill myself I didn’t tell anyone, I didn’t talk about it before hand, there wasn’t an opportunity to intervene.  Other times I spoke about it to many people, I asked for help, I went to the hospital without harming myself, and I often found that I was not believed or taken seriously.   It was incredibly frustrating because when I went to the hospital AFTER harming myself the doctors were angry that I didn’t “ask for help.”  When I went without harming myself, they assumed I was safe and rational and did not need help.  It was a vicious unhealthy cycle.  In my opinion, if someone is talking about suicide you should listen and you should take it seriously.  Many people who complete suicide have talked about their thoughts prior to taking the final step.  On the other hand, if someone never talks about suicide we can’t assume they are not at risk.
  3. Suicide attempts are not always a cry for help.  Sometimes the suicide survivor really did want to die and their attempt failed.  Suicide attempts are not a way to seek attention.  They are not a way to control or manipulate people.
  4. When I attempted suicide and survived, I was not grateful.  I felt like a failure.  I felt worthless and ashamed.  I felt like I couldn’t do anything right.  I felt ill and I had physical effects from harming myself.  I felt alone and I felt stigma. Even today, years later I regularly wish I had died years ago when I attempted.   Not all suicide survivors are happy to be alive.  We don’t all wake up the next day, thankful for a second chance.  It’s also common to be happy to be alive sometimes and wish you had died at other times.  The recovery process can take a long time and will last far longer than the short time someone might spend in the hospital or away from work/school.
  5. Talking to someone who you think may be suicidal will not increase their risk.  It’s far more risky to stay silent, not ask the questions, not check in with someone.  If you are concerned about someone you care about, I recommend asking them directly if they have thoughts of harming themselves, ending their lives, or wishing they were not alive.  Ask them if they feel like a burden, ask them about what connections they have in their lives, ask them if they feel hopeless.  It’s better to know the answers, then to assume someone is not suicidal.  Sometimes a suicidal person feels like nobody cares about them, and staying silent could reinforce that belief.  I can’t even remember the number of times that I was stopped from harming myself by receiving a phone call from a friend, or a connection with someone around me.  Connection is the opposite of depression.  Asking someone about suicidal thoughts is not easy, but losing them to suicide will be harder.
  6. Calling 911 or taking someone to the hospital is not always the best way to help a suicidal person.  Sometimes involving the police, ambulance or hospital can escalate a situation.  Sometimes it can destroy the trust you have with that person.  In many situations it can be helpful to give the suicidal person choices and options.  Thank them for opening up to you.  Ask them what they feel would be most helpful.  In my experience, suicidal feelings are often linked to feeling out of control and overwhelmed.  Taking away choices from someone or punishing them for suicidal thoughts can add to feelings of powerlessness.  Offering choices can be an antidote.  Maybe the person wants company, maybe they don’t.  Maybe they just want a chance to talk about their suicidal feelings without being judged.  Maybe they do need medical intervention, maybe you can take them to the hospital and stay with them.  If someone is suicidal and impaired by drugs and alcohol, or has access to lethal methods such as a gun, you may have fewer options.   But calling 911 without somoene’s permission should be a last resort.  Hospitals don’t even always admit someone who is suicidal.   I’ve been in the ER, highly suicidal and at huge risk, and just sent home.  I’ve been told “she isn’t psychotic so  she can go home, she isn’t at risk.”  I’ve often felt WORSE after unpleasant and unhelpful interactions in the ER.  It’s a myth that hospitals always help suicidal people.  Consider all your options and include the suicidal person in decision making as much as possible.  Also make sure you take care of yourself.  You are not responsible for saving anyone.
  7.  People like me, who struggle with suicidal thoughts on a chronic basis, still get scared.  Feeling suicidal is a scary thing.  It doesn’t matter that I’ve felt this way hundreds of times before.  I’m afraid.  I always worry that I will become impulsive and make bad choices.  I always feel afraid of telling someone, afraid of their reaction, afraid of the stigma.  Afraid people will think I shouldn’t be working, parenting, left alone etc.  If you know someone who chronically talks about suicide or habitually harms themselves, don’t give up on them.  Don’t assume they don’t want to get better.   Suicidal thoughts and self harm behaviours can be a coping mechanism for many survivors of violence.  Sometimes thinking about harming myself feels like the only way I can have control in an out of control and scary world.  Suicidal people need and deserve compassion.  Never underestimate how much good you can do by just non-judgmentally acknowledging someone’s struggle:  “Those thoughts sound very scary, you must feel pretty overwhelmed right now, I’m sorry you are struggling, what can I do to help?”

 

I miss my friends who completed suicide, but they are not cowards.  They are some of the bravest, most beautiful people I have ever known.  Suicide survivors are all around us.  We are regular people, living regular lives.  Suicide isn’t just something that happens to “crazy” people.  It can happen to anyone.  Breaking down the stigma helps everyone.  I think about suicide on a regular basis, but I still have an ordinary, productive life.  If you struggle with suicidal thoughts, or have lost someone to suicide, you are not alone and you should not be ashamed.  Be good to yourself, I’m happy you are alive.

Migraines.

635787012203546833-1156820432_01-memorable-quote_2x.imgopt1000x70

This will be a short post because I’ll be heading back to bed shortly.

Migraines and other chronic pain issues seem to overlap frequently with PTSD.

My migraines are genetic and heavily hormone related. I also have certain food triggers and stress is a factor, especially in the severity and duration of the migraine.

Basically for 10-14 days of the month my migraine threshold is lowered due to hormonal changes.  If during that time I also have a high amount of stress, I will be more likely to get severe migraines that last for multiple days without relief.  If I also eat certain things like caffeine, chocolate, red food dyes and artificial flavours or colours during that time…well…you get the idea.  It’s not a pretty picture.

If you have never experienced a migraine consider yourself lucky.  If you do live with migraines, you have my sympathy.

For me, migraines are much more than “just a headache.”  I get visual distortions and blurry vision in my right eye.  This makes it difficult to drive and difficult to focus.  I get a fog in my brain which makes it hard to think clearly (probably due to the severe pain).  I often get nausea and occasionally in the past even vomiting.  I become extremely sensitive to smells and the smells make me more nauseous and make the pain worse.  The worst smells are perfumes, peeling oranges, and coconut scented lotions or air freshners.  A random collection of scents, but things I can’t tolerate during a migraine.  Bright lights hurt my eyes and cause me to squint.  Loud noises and even vibrations will cause increased pain and sensory reactions.  During some migraines I also experience a lot of dizziness and sometimes shaking or general feelings of weakness.

But I don’t look sick and this happens on a regular basis so I can’t just put my life on hold, take day off or stop caring for my kids.  Sometimes I have to leave work early or ask for help with the kids, but the majority of the time I just keep on going.

I have had trouble getting treatment for my migraines for various reasons.  One of them is that because of my scars and my mental health history doctors don’t believe me.  They won’t prescribe me narcotics, even though pure codeine does help me with a severe migraine.  I’m always afraid to go to Emerg for pain relief because sometimes I will be believed and treated and other times ignored as a “drug seeker.”

The intersection between chronic pain and mental health stigma is real.  I also have a less common form of arthritis which took years to be properly diagnosed and treated because doctors blamed the pain on my depression and eating disorder.  They didn’t seem to understand that it is possible to have a physical and mental health problem simultaneously.

When my migraines are bad I know that I need to get a referral to a neurologist and explore other treatment options.  But when they are bad I have no energy to get this done.  When I’m feeling better I go into avoidance mode due to my fears of facing discrimination when seeking health care.  It’s a vicious cycle resulting in more pain because I don’t have a doctor following this.

Today I’ve spent quite a few hours lying in bed with ice on the back of my neck, the room spinning whenever I open my eyes.  It’s discouraging.  I have things I want to do, I have plans, I have work…but my body is saying NO! and I am forced to listen.

People with chronic pain aren’t lazy.  They don’t want to be sick or to need to slow down.  People with chronic pain are doing the best they can and even if their limitations are invisible they are valid.

Please don’t say “you don’t look sick” to anyone ever again.  You never know what battles people are facing (physically or mentally).  As with surviving trauma, sometimes the most helpful thing to hear about my chronic pain is “I believe you. How can I help?

Scars.

20160515_210419[1]

What is it like parenting two children when you are a psychiatric survivor?

Pretty damn scary.

I remember when I first got pregnant and for the first 2 years of parenting my kids, my biggest fear was that someone would call Children’s Aid and report me as an unfit parent.  I worried that my first baby would be taken from me at birth.  You might ask why would someone whose baby isn’t even born worry so much about being an unfit parent?

My body is covered with scars from self inflicted wounds.  I was terrified someone would see this, make assumptions about me, and consider me a danger to a child, especially my child.

I’ve been parenting for almost 10 years now and so far this fear has never materialized.  I still worry about being considered “crazy” and thus “dangerous” and thus “unfit.”  In fact, this is the weapon my ex-husband has used against me since the time I began leaving him.  Just accusing someone of being crazy tends to impact the way others view that person.  My ex-husband took moves out of Dr. X’s playbook and began telling everyone, including the children’s health professionals, our neighbours, the kids’ school AND Children’s Aid that I had borderline personality disorder.

Despite the fact that my own doctor and many other doctors have testified that I do not have borderline personality disorder, this label is still haunting me 15 years after it was first, incorrectly, applied by Dr. X.

Let’s just break this down for a minute.

In the days of insane asylums, a man could have his wife committed against her will since she was essentially his property.  I’m sure asylums were full of women who were wrongly diagnosed as “hysterical” or something, just because they spoke out against the men in their lives.  Maybe they were being abused and dared to say something, maybe they didn’t conform completely to patriarchal societal standards, but one way or another they were put away.

The days of asylums are gone, but the stigma of diagnoses like borderline personality disorder remains.

It’s a very convenient excuse to deflect responsibility for perpetrating abuse.  “Oh, she’s crazy don’t you know.  You can’t believe her story because she’s mentally ill!”

Sound familiar to anyone?  Yes, accusing survivors of being “crazy” is an aspect of rape culture.  Survivors are not crazy.  They are speaking a truth that many in society do not want to hear and thus they are labelled, marginalized and stigmatized.

Every spring when the weather gets warm and t-shirts start to appear, my fear returns.  In the winter I can usually “pass” as “normal.”  My scars are safely hidden under layers of winter clothing.  In the summer, I stand awkwardly with my hands behind my back when I meet new people and when I pick the kids up from school.  I keep a cardigan at work to throw on before meeting with service users.  I see the scars myself, day after day, and sometimes it triggers me and makes me think about a time in my life I’d rather forget.

I still worry that people will view me as an unfit parent because of the coping choices I made.  But I wear t-shirts, because it’s hot outside in the summer.  I won’t hide under clothing everyday for the rest of my life.

If you have used self harm to cope, don’t be ashamed.  You survived and that is the most important thing.  Your scars tell the story of your survival.  If I could tell you a hundred times that you aren’t crazy I would.  But honestly, I’m spending a whole lot of energy reassuring myself that very same thing these days.

My scars tell my story.  Sometimes I wish my story was different, or that I had the privilege of having an invisible mental illness, but that isn’t my reality.

And believe it or not, some people think my scars look pretty damn cool.