Call Me What I Tell You to Call Me

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Vanity Fair’s July 2015 issue features a glamorous woman on the cover with the words, “Call me Caitlyn.” Inside is a 22-page article about that woman’s journey to trans-womanhood. If you didn’t know any better, you would have no reason to suspect that this woman used to be a man. But because of the media coverage (hysteria?), almost everyone knows better. The irony is that Caitlyn Jenner probably would like nothing better than to be left in peace to be the woman she’s always longed to be. But because she’s a celebrity, she will probably never have that experience.

And yet I think her decision to “come out” in such a public way was actually quite brilliant. Stories about her “fluid” gender identity have been circulating for quite a while now and I applaud her decision to tell her own story. Less than two months ago, Jenner gave his last official interview as Bruce, with ABC’s Diane Sawyer, in which he explained his struggle to become and accept the person he believes he was really meant to be. The Vanity Fair feature is her first public appearance as Caitlyn. And, in his words, “As soon as the Vanity Fair cover comes out, I’m free.”

As you might expect, the public’s responses have been all over the place. Jon Stewart of “The Daily Show” made the astute observation that now that Jenner is a woman she is going to have the unfortunate experience of being treated like one; in other words, as if the only thing that matters is her appearance. Many other people have applauded her bravery. Still others feel that she is, at best, in need of some soul-saving, and at worst, an abomination. And then there is the transgender community, which might well see her as its ambassador.

There is also a fair amount of cynicism leveled at Jenner’s actions. She has been accused of doing all this as a publicity stunt and a way to drive traffic to her reality show, which is set to debut this summer on E! Network. She laughs at the idea that she would go through all this (including surgery to feminize her features) just to pay the bills. On the contrary, she sees this as an opportunity to educate the public about what it means to be transgender as well as offer hope to other people who are transgender.

Many people believe that it’s impossible to be “born in the wrong body,” that saying you’re the opposite sex (from the one you were assigned at birth) doesn’t make it true; and that being transgender is a choice. But even the DSM (the manual  used by clinicians and researchers to diagnose and classify mental disorders) recently revised its terminology from “gender identity disorder” to “gender dysphoria” to remove some of the stigma and enable trans men and women to get help with their “profound state of unease or dissatisfaction” about the gender they were assigned at birth. It’s not exactly saying that transgender is as “normal” in its way as heterosexuality or that it’s just one of several ways to be gendered in our society, but it has backed off from treating it as a mental illness.

We need to stop treating being transgender as a disease or a sin and start listening to the people who claim it as their gender identity. There must be some reason why they feel the way they do; it’s not likely something they would make up as a lark. Imagine having others tell you that you’re crazy or perverted just because you’re trying to express who you feel you are at the fundamental core of your being.

When I first saw the Vanity Fair cover, I thought “Call me Caitlyn” was a plea, for understanding and acceptance. But the more I thought about it, the more I hoped that it was a command instead. We all have the right to tell others what to call us and we need to exercise that right without apology. To do otherwise is to lose who we are.

 

 

Obesity and Mental Illness: Are They Linked?

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Depressed Overweight WomanWhen the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was being put together, a proposal was received that obesity and overeating be included as mental illnesses. Although this proposal was rejected, it does raise some interesting questions about the mental health of obese individuals.

Weight loss is a complicated process. People who have never had problems with obesity tend to think that losing weight is merely a matter of eating less and moving more. When obese people have trouble losing weight, others think they’re just not trying hard enough. This is the main reason for the hostility that is directed at obese people in our society: they are seen as lazy whiners who cost the health care system billions of dollars a year because of health problems that “they bring on themselves.”

The fact is, it’s not that easy to lose weight. There are myriad factors that play into weight gain. Some people inherit the tendency to gain weight. Others become heavy from poor eating habits, often instilled in childhood. Still others gain weight because of medications they’re on. Certainly lack of exercise plays a role as well. But the main reason obese people have trouble losing weight is that their obesity is all mixed up with mental health issues.

That’s not to say that obese people are mentally ill. But they are often depressed, have low self-esteem and lack confidence because of the way society judges them. If you were constantly being beaten down by “normal” weight individuals who see you as inferior, you’d have trouble mustering the courage and motivation to embark on a weight loss program, too.

That’s why it’s extremely important to have a mental health assessment if you find that you’re constantly trying and failing to lose weight. Clinical or bi-polar depression, anxiety disorders, PTSD, even ADD (Attention Deficit Disorder) can cause overeating. Sometimes medication and/or therapy can bring you up to a healthy level of functioning which in turn can be critical to your success.

This can be a two-edged sword, however. Most psychotropic medications cause weight gain, making it that much harder to accomplish your weight loss goal. Your doctor or therapist needs to be sensitive to the mental anguish this can cause. And you need to be aware that this is not your fault.

Even talk therapy can bring up issues that upset you and make you want to turn to food for comfort or to alleviate anxiety, further complicating your efforts to lose weight. It’s important to not get caught in a cycle of self-recrimination when you have these setbacks. It’s all part of the learning process.

In at least one study, obesity was associated with a 25-50% increased risk of lifetime psychiatric disorders (depression, mania, panic attacks, social phobia, agoraphobia), any lifetime mood or anxiety disorder, suicidal ideation, and suicide attempts. These issues must be dealt with or the obese person will find it nearly impossible to lose weight and maintain that weight loss, let alone be a fully functioning individual.

For more information about the DSM-5 and eating disorders, see this report by the American Psychiatric Association.

See also this article by Dr. Arya Sharma, “Obesity is Not a Mental Illness.”

 

 

 

 

 

How About a Marathon for Mental Illness?

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I’ve never heard of a marathon for mental illness.* We have them for birth defects, breast cancer, AIDS, muscular dystrophy, heart disease and even some “orphan” diseases. But not for mental illness. Not for depression, anxiety, bipolar disorder, schizophrenia or other kinds of psychosis.

It can’t be because there aren’t that many people affected by mental illness. Mental illness is the leading cause of disability in the U.S. and Canada. (See source below.**) What if it could be treated successfully, or even cured? Just think of all the anguish that could be assuaged, the marriages that could be salvaged, the prison populations that could be reduced and the individuals who could be restored to full productivity. And of course all of that translates into billions of dollars in savings.

So why don’t we do more to alleviate the problems associated with mental illness? There are principally three reasons why we don’t.

1) Mental illness is grossly misunderstood. Most people are confused about what constitutes mental illness. We don’t know how to differentiate between “normal” depression or anxiety and the kind of depression or anxiety that completely debilitates a person, for instance. Not even the medical profession agrees on the causes and appropriate treatments.

2) Crazy people scare us. We are afraid that they’ll do damage to themselves or others. We steer clear of them whenever possible. Sometimes we even act like we think that mental illness is contagious. We joke about it (“Mental illness is catching. I caught it from my kids”), but never treat it seriously. We don’t talk about it in polite company in the same way that we would talk about cancer or even alcoholism.

3) Because mental illness can’t be “seen” in the same way as other diseases, we tend to think that it’s all in the sufferer’s head. It’s a figment of his or her imagination or a matter of learning how to think good thoughts. We don’t believe that it can be a real disability; we assume that the mentally disabled person is just playing the system.

I’m very familiar with all of these reasons. I don’t even understand my own mental illness. And yes, it scares me sometimes. And I constantly doubt whether or not I’m really disabled.

It’s humiliating to admit that you can’t handle things that other people seem to be able to. It’s frightening when you exhibit behavior that others consider to be just plain crazy. And it’s a terrible feeling when you realize that you don’t have control over your own mind.

One thing I try not to do is blame my mental illness for my behavior and personality traits. But it’s hard to draw the line between staying home and feeling sane and putting myself in situations where I get so anxious I can barely function. I try to keep my life as uncomplicated as possible because I don’t handle stress well at all, but even I get impatient about the lack of excitement in my life.  I understand why some people go off their meds: they’re tired of not feeling anything.

The problem is, there is no one effective treatment for mental illness. (Not to mention that there are so many different kinds of mental illness.) And so far there is no cure. I will probably always have to take medication for my depression and anxiety. When I don’t (as I have discovered when I run out of meds or am lax about taking them), I fall apart. Even when I do take them, I can easily tip over the edge. And yet I hate that weakness within me.

But what is even worse is how others look at you when they know you have a mental illness. Some people just flat out don’t believe you. Others worry about you unduly. And still others steer clear of you completely. You become afraid that people won’t want to befriend you, date you, marry you, have children with you, vote for you, or hire you. And often you’re right. Sometimes even you doubt your ability to do these things. And the sad thing is, sometimes you can’t. At least, not without help.

My own children doubt the extent of my mental illness. They think it’s awful that I take so many medications. They think if I had a different psychiatrist I’d be able to overcome them.

Each mentally ill person deals with their condition as best they can. It’s easy to be on the outside and prescribe ways to “get over it.”  But until you’ve suffered from a mental illness, you have no idea what the mentally ill person is up against. She has to use her own mind to deal with things that are going wrong with it. He may not even realize that he has a mental illness. But the main reason why the mentally ill don’t get treatment is because of the stigma associated with it.

It’s obvious that society is not willing to deal with mental illness. Most health insurance plans are woefully inadequate when it comes to mental health coverage. 10-15 visits a year is average; inpatient care has high deductibles, and brand name medications, which are usually Tier Three, are expensive. Hour-long visits for psychotherapy are almost never covered; you’re lucky to get a 15-minute medication check for when you go in for one of your limited number of appointments.

We don’t lock people up in insane asylums the way we used to (partly because the state doesn’t want to pay for mental hospitals any more). But being mentally ill is like being in prison and even when you’re being treated for it, you feel like an ex-con.

When there are marathons for breast cancer the participants proudly advertise that they are or know breast cancer survivors. No one would announce that fact if we were having a marathon for mental illness. In fact, it’s likely that no one would come.

**Read David Schimke’s essay on mental illness from the latest issue of Utne Reader.

Read about the father who has run over a hundred marathons on behalf of his daughter who suffers from schizophrenia. His dream is to organize marathons to help to erase the stigma associated with mental illness. I hope he is successful.

*That’s not entirely true: I did find some information about a STOMP OUT STIGMA  (SOS) marathon to be run in October, 2011 which is sponsored by the Depression and Bipolar Support Alliance of Greater Chicago. But that doesn’t erase the fact that public support for mental illness is almost non-existent.

Women and Depression

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Women are almost twice as likely to experience depression as men are. I don’t mean that they get the blues more often, although that may be true as well. What I mean by depression is clinical, or major, depression, the kind where your mood seriously impairs your ability to live a normal life.

That doesn’t mean that getting depressed occasionally isn’t normal. Most people react with sadness, grief or despair when certain events occur in their lives. But what differentiates normal depression from clinical depression is that the latter comes over you when there is no apparent reason or doesn’t go away within a reasonable amount of time after the precipitating episode has passed.

Many of you reading this will go, “Yeah, whatever,” and stop reading. You either don’t think that it can happen to you or you have an ingrained prejudice against the idea of depression being a mental illness. You think that you, or others who are depressed, should be able to “just get over it.” If that works, then you were probably experiencing normal, or situational, depression. If it doesn’t work, they you may be experiencing clinical depression.

You’ll need a doctor to determine if you’re experiencing a major depression. But there are warning signs. Some of them are:

  • Persistent sad, anxious, or “empty” mood
  • Loss of interest or pleasure in your usual activities, including sex
  • Restlessness, irritability, or excessive crying
  • Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
  • Sleeping too much or too little, early morning awakening
  • Appetite and/or weight loss or overeating and weight gain
  • Decreased energy, fatigue, feeling “slowed down”
  • Thoughts of death or suicide, or suicide attempts
  • Difficulty concentrating, remembering, or making decisions
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, or chronic pain

Generally, if you’ve been experiencing more than 3 or 4 of these symptoms for more than two weeks, you should see your doctor. That doesn’t necessarily mean that you have to book an appointment with a psychiatrist. Your family doctor may be able to treat you initially, or determine whether or not you need further treatment. However—and this is an important point—if your family doctor doesn’t take your complaints seriously, bypass him and make an appointment with a psychologist or psychiatrist. Tell the doctor’s office that you want an assessment to determine whether or not you’re clinically depressed.

Be prepared to be prescribed medication. Most doctors will try some kind of anti-depressant for at least a trial period. If you’re not comfortable with that, say so, and ask about alternative therapies. But I urge you to remain open to the idea of taking meds, at least for a while. Sometimes that’s all that’s needed to “jump-start” your body’s natural resources for dealing with depression and then you can discontinue the medication, but only under your doctor’s supervision. Some medications have withdrawal symptoms that are worsened when you abruptly stop taking them.

There are two other kinds of depression that women need to be aware of. One is manic depression, or bipolar disorder. This is where you cycle between mania and depression. During the manic periods you might experience:

  • Abnormally elevated mood
  • Irritability
  • Severe insomnia
  • Grandiose notions
  • Increased talking
  • Racing thoughts
  • Increased activity, including sexual activity
  • Markedly increased energy
  • Poor judgment that leads to risk-taking behavior
  • Inappropriate social behavior

The other kind of depression is dysthymia. A person suffering from dysthymia will experience symptoms of depression to a milder degree but for more than two years. Although I was never diagnosed with dysthymia prior to being diagnosed with major depression, I’m convinced that I was dysthymic for most of my life. I can’t remember ever not being depressed. I used to wake up every morning with this overwhelming feeling of self-loathing and despair, even as a child. Once I was treated for major depression, these feelings went away. I can’t tell you how wonderful it is to wake up and look forward to living!

Sources: Psychology Information Online and the National Institute of Mental Health (NIMH).

Book Review: Another Life Altogether

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We all long for “another life altogether” at some point. Thirteen-year-old Jesse Bennett has more reason than most to want to escape into another life. She has lived all her life with her mother’s eccentric behavior, which has just culminated in a suicide attempt and hospitalization. Even though she knows that she will be found out eventually, Jesse tells her classmates that her mother is away on a world cruise that she won in a contest. To bolster her story, she writes detailed letters which are supposedly from her mother (after having researched each destination) and reads them aloud in home room.  Of course, in a small town news travels fast and Jesse’s ploy is revealed–and ridiculed. Soon after her mother returns from the mental hospital, her father moves them to an even smaller town in the hopes that they can all get a fresh start.

Jesse is pinning all her hopes on this opportunity to start over. She “providentially” makes friends with a girl who is popular at her new school and she resolves to do everything she can to keep her position in the “in” crowd. At the same time she develops a crush on an older girl and she escapes again into writing letters that she never sends, this time to the object of her affections about their “life together.”

Meanwhile, at home, Jesse worries constantly about her mother, fearing that she will try to kill herself again. She has to take over a lot of the familial responsibilities while her father alternates between denial and hare-brained schemes to help his wife to “snap out of it.” Further complicating her family life is the boyfriend of her aunt who secretly torments her and her jail-bird uncle who comes to live with them after his release from prison.

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