Eliminate Stigma - Parity is just one more step

This email was sent out this weekend to many of my NAMI members and friends. Parity is a major issue for better medical treatment, better recovery plans, early detection and the elimination of stigma and discrimination. I thought I would share this with you, the readers as well.
The need for Parity Laws only demonstrates that discrimination is alive and well in this country. What do you do to eliminate any type of discrimination in your world? Are the organizations you belong to biracial? Is the neighborhood you live in multi-cultural? Being culturally diverse means more than eating at an ethnic restaurant. Just some ideas to ponder. Please read on.



Date: June 18, 2008
From: Marilyn Richmond, J.D., Assistant Executive Director
for Government Relations
American Psychological Association Practice
Organization

I am pleased to announce that the Senate and House have reached an
historic agreement on the terms for a final full mental health parity bill. The compromise is expected to move quickly through both chambers.
From the time that the House passed its version of the parity bill, H.R.1424, in early March (the Senate passed its version, S. 558, last September), the two chambers have been engaged in intense negotiationsto reconcile differences between the two bills. The APA Practice Organization has been deeply involved in these negotiations, along with other key stakeholders from the mental health, insurer, and employer communities, including the National Alliance on Mental Illness (NAMI), U.S. Chamber of Commerce, the National Retail Federation, America's Health Insurance Plans (AHIP), BlueCross BlueShield Association, and Aetna.

The final gap between the Senate and House bills was closed as
negotiations led to agreement over three key outstanding issues-
* Preemption. The House accepted the stronger Senate language, which
defers to the current HIPAA standard. This standard is extremely
protective of state law, ensuring that stronger state parity and other consumer laws will remain in place.
* Out-of-Network Services. The Senate accepted the stronger House
language that makes clear that out-of-network mental and substance use disorder services will be provided at parity when a plan provides out-of-network physical health services.
* Covered Services. The House agreed to drop mandated coverage for all DSM diagnoses but ensured that all mental health conditions and
substance use disorders would be covered by mirroring the standard for mental health under the current federal parity law.

Together, we have worked for the better part of a decade to end mental health and substance use benefits discrimination. This tremendous breakthrough would not have been possible without the tireless perseverance and dedication of psychologists across the country who have advocated year after year on behalf of their patients. When enacted the new federal parity law will-

* Completely end insurance discrimination against mental health and
substance use disorder benefits for over 113 million Americans,
requiring full parity coverage with physical health benefits.
* Extend to all aspects of plan coverage, including day/visit limits, dollar limits, coinsurance, copayments, deductibles and out-of-pocket maximums.
* Preserve strong state parity and consumer protection laws while
extending parity protection to 82 million more people who cannot be
protected by state laws.
* Ensure parity coverage for both in-network and out-of-network
services.

We will get back to you with further details on the bill and the process
ahead soon.

This is a great happening!!!

I' m an Action Kind of Girl

I’m sick right now. It happens about once a year. Allergies combined with stress and a runny nose turns into a cold into whatever and knocks me down for a day or two.

I hate being sick, but I have to admit that the down time gives some time to ponder things I don’t take time for usually. Maybe it’s the cough syrup but my mind jumps in and out and I come up with some of my funnies one liners and best ideas for future projects during this time. If I remember them when I wake up…..

I was kind of half in, half out, watching “Sleepless in Seattle”. A chick flick from way back that I somehow have missed for all these years. Not a great movie since I missed most of it dozing, but it did bring up the idea of what makes a great love relationship. What I got out of it was Meg Ryan was in love with one guy but was drawn to another that she heard over the radio. Everything about guy #1 seemed perfect for her, but she kept getting these “signs” that something else lay out there for her. And it did – a guy who lived on the opposite side of the country, with a half grown kid. Oooookay.

So what about this love thing? I have been in love several times. Almost as many times as Elizabeth Taylor. Many people are hooked into thinking that we all have this one soul mate. However, if you are going to buy into that idea and the soul is something that is a part of heaven and lives forever, doesn’t it make sense that maybe you have more than one soul mate? Or at least soul connections? Soul friends? Soul acquaintances? Souls passing in the night? Soul one-night stands?

Okay… so I’m being a bit silly, but my point is – if we are expected to have generosity and compassion and empathy for all men as in peace on earth, good will to man, doesn’t it make sense that we also have great capacity to love and to love many?

While you roll that over and pick at it, let me share this with you. I have had the opportunity to love several men romantically. I married most of them. And in the past year or so, I have had the opportunity to have two of them come back into my life and reconnect for a bit.

And in conclusion, love is not enough to build a future on.

Oh wait, I left parts out. Just consider you have read the last paragraph of a really long news article and now you will go back to pick up the details. I do that all the time.

The first reconnect was my ex-husband who is my daughters’ father. I loved that man in a way that kept me connected to him like a bee just has to make honey. He was good looking, smart, a great conversationalist, liked to try new things and was, if not great in bed, at least long lasting enough for me to get the rest done.

He was also self centered, selfish, narcissistic, paranoid, a liar, a mind manipulator and his favorite saying was “I am who I am because of my mother. If I killed someone and buried them in the back yard, she would just help me cove it up and tell me they deserved it.”

Oh, and he was and still is gay. And the gay part is not what ruined our marriage. It was the stuff listed above that did.

And when he came back into my life and my daughter’s life after 16 years, he was still gay. But he promised me that all the other things listed above were no longer true. So I was willing to listen to him.

And I thought to myself, while I don’t need him as a husband, if he is all the good things he used to be and none of the bad things, what a great friend he could be to the daughter he had not been a father to.

And looking in my heart, I saw that I had good feelings for him still and he spent several months showing me the “new” him. So I let him back into her life. What a mistake!!

The “new” him was just a highly developed “old” him, whose purpose was to deceive those around him to support his need to control and manipulate. And 12 months later, we are still dealing with the damage he created for my daughter and our family and I don’t know that this will ever be a closed chapter in her life. So I will have to continue revisiting it with her, for her. She loves her father. I love her father. Love didn’t help either of us.

If I had not been able to recall the love I had had for him, I might have still made the same decision in an effort to better her life and let her have some closure on old wounds he created for her.

HOWEVER, if I had not been able to recall that past love, I might not have been so easily deceived. I thought I was being so careful for her sake, laying down rules, drawing out boundaries – remembering his old tricks and trying to second guess how he could use them against us today, in the now.

Love makes you vulnerable to having your heart used against you though. I so wanted him to care for our daughter and for her to not feel that he had abandoned her – that it had all been a mistake. So in a way, my love for her also created this scene where I feel that I failed to protect her as well.

The second reconnect was my first love. We were never married but together during high school. I have many fond memories of him and our time together. He made me feel cared for and important and safe. In his senior year, he decided to join the marines. This was a lifestyle I did not want for myself and I was angry at him for picking it and not asking me what I thought.

In a recent conversation, he asked why I didn’t speak up about what I thought. The answer to that is because I didn’t want to infringe on his dream in the same way he had infringed on mine. My lack of maturity and lack of knowing my own self prevented me from doing a lot of things. Consequently, I became distant and angry.

Now I know that I was actually suffering from depression that became worse when he left. He’s angry or was, I think, because all he sees is that I broke off because he was leaving. I refused to see him when he came home or take his calls. I couldn’t. It was physically and mentally painful to even think about him. I saw myself stuck in a no win situation and felt that I was drowning. The only security I had known since my parents divorce had walked away from me.

We reconnected after many years. We had lunch. I was nervous and became even more so as the lunch progressed as I realized that I felt just exactly as I did in high school towards him. That spark was there. But I also carry a spark for my love that died when I was 25. And for my daughters’ father; sick, perverse human that he is. And I carry a spark for my husband now.

So how does one pick which spark is the spark they want to live with, be with?

My first love is living a life that many people would love. He was in the military and traveled a lot. But he was also away from his family a lot. I wouldn’t have liked that at all. I don’t now what kind of husband he turned out to be or a father. But not having him home every night is a deal breaker in the plan for my life. And he showed me that when he joined the marines. It’s not a bad life, it’s just not the life I wanted if I were going to be married and build a family.

In our talks, he says we are friends. But I find his definition of friend and mine to be very different. I like calling my friends to share what is going on in our lives. I now I can call them anytime, and they can and do call me anytime. To me – a really good friendship is as intense and committed as a marriage, just without the sex.

I love my friends and like caring for them. He seems content with a chat on the internet about his latest work project once every few months. We’re not connected and it makes me sad. I would like to have someone in my life that knew me in my teens to talk about things.

My ex-husband is just not a whole person. His being gay is not the issue. His being mentally and morally corrupt in his assessment of what his duties are to others and how to treat people is the issues. If he had stayed in my life, I am sure I would have had a nervous breakdown or worse.

So what about the spark that is a part of my life now? He’s home with me. He supports me in what I do… so much that I was able to tell him about lunch with my ex-boyfriend and consequent chats and conversations later. So that makes him my best friend as well. And he has taken good care of my children, the ones he didn’t father but did parent like his own. And our major fights are about when he thinks he is not doing a good enough job and is letting me down. Imagine! A man who worries about doing enough for his family!

Love is wonderful. I love being in love and all that implies. But even more so, I love being cared for and thought about. That makes up for a lot of other things that love just doesn’t start to cover. Love is the emotion. Being cared for is the act.

I’m an action kind of girl.

Let's talk about bipolar disorder

From the National Institute of Mental Health
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

More than 2 million American adults, or about 1 percent of the population age 18 and older in any given year, have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

What Are the Symptoms of Bipolar Disorder?

Bipolar disorder causes dramatic mood swings-from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

* Increased energy, activity, and restlessness
* Excessively "high," overly good, euphoric mood
* Extreme irritability
* Racing thoughts and talking very fast, jumping from one idea to another
* Distractibility, can't concentrate well
* Little sleep needed
* Unrealistic beliefs in one's abilities and powers
* Poor judgment
* Spending sprees
* A lasting period of behavior that is different from usual
* Increased sexual drive
* Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
* Provocative, intrusive, or aggressive behavior
* Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with 3 or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, 4 additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:
* Lasting sad, anxious, or empty mood
* Feelings of hopelessness or pessimism
* Feelings of guilt, worthlessness, or helplessness
* Loss of interest or pleasure in activities once enjoyed, including sex
* Decreased energy, a feeling of fatigue or of being "slowed down"
* Difficulty concentrating, remembering, making decisions
* Restlessness or irritability
* Sleeping too much, or can't sleep
* Change in appetite and/or unintended weight loss or gain
* Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
* Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if 5 or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness-for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

Diagnosis of Bipolar Disorder

Like other mental illnesses, bipolar disorder cannot yet be identified physiologically-for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV).

Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:

Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless. [I am] haunt[ed] with the total, the desperate hopelessness of it all. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?

Hypomania: At first when I'm high, it's tremendous ideas are fast like shooting stars you follow until brighter ones appear. All shyness disappears, the right words and gestures are suddenly there uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria, you can do anything, but, somewhere this changes.

Mania: The fast ideas become too fast and there are far too many overwhelming confusion replaces clarity you stop keeping up with it-memory goes. Infectious humor ceases to amuse. Your friends become frightened. Everything is now against the grain you are irritable, angry, frightened, uncontrollable, and trapped.

Suicide

Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

* talking about feeling suicidal or wanting to die
* feeling hopeless, that nothing will ever change or get better
* feeling helpless, that nothing one does makes any difference
* abusing alcohol or drugs
* feeling like a burden to family and friends
* putting affairs in order (e.g., organizing finances or giving away possessions to *prepare for one's death)
* writing a suicide note
* putting oneself in harm's way, or in situations where there is a danger of being killed

What Is the Course of Bipolar Disorder?

Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When 4 or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

What Causes Bipolar Disorder?

Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder-rather, many factors act together to produce the illness.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes-the microscopic "building blocks" of DNA inside all cells that influence how the body and mind work and grow-passed down through generations that may increase a person's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.

In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene. It appears likely that many different genes act together, and in combination with other factors of the person or the person's environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.

Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses. , New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.

How Is Bipolar Disorder Treated?

Most people with bipolar disorder-even those with the most severe forms-can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.

In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.

This publication, written by Melissa Spearing of NIMH, is a revision and update of an earlier version by Mary Lynn Hendrix. Scientific information and review were provided by NIMH Director Steven E. Hyman, M.D., and other NIMH staff members Matthew V. Rudorfer, M.D., and Jane L. Pearson, Ph.D. Editorial assistance was provided by Clarissa K. Wittenberg, Margaret Strock, and Lisa D. Alberts of NIMH.

NIH Publication No. 02-3679

Assessing the Economic Costs of Serious Mental Illness

Assessing the Economic Costs of Serious Mental Illness
Thomas R. Insel, M.D.

It goes without saying that the excess costs of untreated or poorly treated mental illness in the disability system, in prisons, and on the streets are part of the mental health care crisis. We are spending too much on mental illness in all the wrong places. And the consequences for consumers are worse than the costs for taxpayers.
Michael F. Hogan (1)
What do mental disorders cost the nation? The costs of health care are considered one of the greatest challenges in U.S. public policy (2). In 2006, health care costs reached 16% of the nation's gross domestic product, on a path to reach 20% by 2016 (3). While mental disorders contribute to these costs at an estimated 6.2% of the nation's spending on health care (4), the full economic costs of mental disorders are not captured by an analysis of health care costs. Unlike other medical disorders, the costs of mental disorders are more "indirect" than "direct." The costs of care (e.g., medication, clinic visits, or hospitalization) are direct costs. Indirect costs are incurred through reduced labor supply, public income support payments, reduced educational attainment, and costs associated with other consequences such as incarceration or homelessness. Another kind of indirect cost results from the high rate of medical complications associated with serious mental illness, leading to high rates of emergency room care, high prevalence of pulmonary disease (persons with serious mental illness smoke 44% of all cigarettes in the United States), and early mortality (a loss of 13 to 32 years) (5). While indirect costs have been challenging to quantify, they are critical for informing public policy. Once we assess the key components of the economic burden of mental disorders, we can have a more informed discussion about what should be invested to prevent and treat these illnesses.
This issue of the Journal includes an important report by Kessler et al. (6) that focuses on one source of indirect costs: the costs from loss of earnings. The analysis is based on the National Comorbidity Survey Replication (NCS-R), a population-based epidemiological study of mental disorders. In this survey, data from nearly 5,000 individuals were used to estimate loss of earnings by comparing earnings in the previous 12 months of persons with mental disorders with 12-month earnings of persons without mental disorders. The analysis focused on individuals with serious mental illness. The results, based on a generalized linear model analysis, demonstrate a mean reduction in earnings of $16,306 in persons with serious mental illness (both with and without any earnings) and also that about 75% of the total reduction in earnings came from individuals who had some earnings in the prior year (versus those who did not have any earnings at all). By extrapolating these individual results to the general population, the authors estimated that serious mental illness is associated with an annual loss of earnings totaling $193.2 billion.
There are several surprises in this report. One is the gender difference in earnings: even when the earnings of men with serious mental illness dropped to $28,070 (compared with men without serious mental illness), these earnings were still higher than earnings in women without serious mental illness. This result cannot be explained by a large number of women outside of the workforce, because analysis of those subjects with positive earnings only demonstrated the same profound difference in earnings based on gender. A second unexpected finding is that the loss of earnings is not mainly a function of chronic unemployment. Finally, when one extends these findings to the general population, the financial loss is considerably larger than previous estimates (7, 8), which seems only partly explained by inflationary considerations.
While $193.2 billion seems enormous, it is important to recognize that the NCS-R yields a conservative sample for estimating economic impact. As a door-to-door survey, NCS-R did not assess individuals hospitalized in institutions, incarcerated in prisons or jails, or who are homeless. Indeed, NCS-R had so few subjects with schizophrenia or autism that these diagnoses were not part of the original epidemiological analysis, even though both are associated with chronic disability and lifelong loss of income on a far greater per capita basis than mood or anxiety disorders.
Accepting this conservative estimate of a loss of $193.2 billion in earnings each year from serious mental illness, can we estimate the total economic impact of serious mental illness? In Table 1 we begin to answer this question, adding the new estimates of income loss to data from 2002 on the direct costs of health care and disability benefits, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) cash assistance, food stamps, and public housing financed by federal and state revenues. Missing are the costs of health care for comorbid conditions. Missing are estimates for the loss of productivity due to premature death and the loss of productivity of those with serious mental illness who are institutionalized, incarcerated, or homeless. Missing is the cost of incarceration, although as many as 22% of individuals in jails and prisons have been diagnosed with mental illness (9). Missing is the cost of homelessness, although approximately one third of adult homelessness is associated with serious mental illness (8). And, of course, missing from any such tabulation is the cost to family members who bear much of the emotional and financial burden of these illnesses. The $317 billion estimated economic burden of serious mental illness in Table 1 excludes costs associated with comorbid conditions, incarceration, homelessness, and early mortality, yet this sum is equivalent to more than $1,000/year for every man, woman, and child in the United States.

Party Heartfelt

I had a surprise birthday party. The biggest surprise was how well it went. No, I’m just kidding.

My husband, who already does so much for his family, planned, cleaned the house, ordered food, picked up the food, invited the guest, and made sure I had a great day away from the house while he was working like a dog.

The party was wonderful. The biggest surprise was how many people we could fit in our house.

Actually, what was wonderful was knowing that these people had come together to honor me. As I was surrounded by friends and family, I realized just how blessed I am and I was a bit ashamed at how I hadn’t really been counting my blessings lately.

It had been a hard week just prior to my party. Josh had to be taken to the ER – he had been passing out and there was no explanation for it.

Caiti was cycling with her illness and it had been one manic ride for 7 straight days.
And boo hoo, this was my birthday week and why couldn’t anything go my way? You’ve had pity parties like that, haven’t you?

But to replace that party of ill gains was one of love and blessings. There were so many different types of people – old people, young people, married people, single people, all come together to wish me well.

Remember when I wrote earlier about how I think of myself as a wolf? For someone who thinks of herself as a lone wolf, this was quite a surprise. And a very special gift. For I realize I have one hell of a pack. People who are there rooting for me and in my corner and who I can count on. What else can I say about it – I am truly blessed.

Thank you to my husband. Thank you to my children. Thank you to my mom and extended family. Thank you to my friends.

Beatus

A day in our life

Be careful what you pray for. God does listen. Lately I have been praying for humility and for confirmation that working in the mental health arena is my purpose in life right now.

I am asking for humility as a means of being more empathetic and thus more at peace with myself and the world around me.

I am asking for confirmation of my purpose as I am getting older and I don’t’ want to waste one precious moment in my life.

Both of my prayers were answered yesterday. And it was shocking and surreal to me as it happened. And I was angered and outraged – but just for a moment. Then a wave of clarity overcame me and it is true what they say. Humility does give you more inner peace. So let me tell you what happened.

Caiti is still very ill. Caiti is my 17 year old daughter. Her diagnosis is bipolar disorder. At times, she appears to have bipolar disorder, borderline personality disorder, schizoaffective disorder and teenage angst preservers at all times.

We were at counseling and it was apparent to both her counselor and I that Caiti was not safe from herself and needed to be hospitalized. This is her fifth hospital visit since Thanksgiving. I was not sure I could take her to the hospital by myself, so the police were called.

Two Dallas police officers arrived. One was short and middle aged. The other tall and very young, obviously in training. In the past years, our family experiences in dealing with the police in Garland due to Caiti being ill have all been very positive experiences. They have been kind, cooperative, and understanding and have acted non-judgmentally.
As these two officers walked into the counselors office, it was obvious that Caiti and I were about to undergo a new experience.

The older, shorter officer immediately started barking at Caiti, without even looking at me or the counselor. “What is wrong with you?”

I try to make a point to allow police to do their jobs and not to interfere as:
a. They have a job to do and we asked for their help.
b. I believe that dealing with all kinds of experiences will help Caiti to realize what the world is about and what she has to expect.
c. The police carry a gun.

However, it became quickly apparent that this office did not know about mental illness or if he did, he did not care about anyone with mental illness, including my daughter. So I did the only thing that I could do based upon my knowledge of dealing with irate people – I stepped up and stood beside him.

This did exactly what I wanted it to do – it pulled his focus to me and away from Caiti. The officer then began asking me why I let her manipulate me and why I let her act the way she does. I choice not to say a word, which allowed him to keep talking and berate me until he was ready to take Caiti to the car. The counselor did on two different occasions come to my defense, trying to explain to him that this was not a manipulation but a sick girl needing help, but he didn’t even acknowledge that she was speaking.

By the time the officer was ready to take Caiti to the car, he had pretty much exhausted himself for the time being. He asked Caiti if she wanted handcuffs and she said yes. Her own way of rebelling against this cop and standing up to him – I got it, the counselor got it, and the cop didn’t. It shocked him. But to regain control, he then began telling her, that as her mother, I had no say in and don’t expect him to NOT cuff her, even if I begged him not to. Again, I didn’t say a word to him but held eye contact. At that time, the younger, quiet officer, took Caiti by the arm and escorted her out of the building.

Later I found out that the officer continued to have choice words of wisdom for Caiti. It became oddly enough a bonding experience for us when I visited her next in the hospital later that day. So in some ways, that officer did me a great favor.

After they had left, the counselor hugged me and told me she could not believe I had remained silent. I am known by this counselor for my true self – to be loud and outspoken and determined. And I had said a lot by being silent and had been just as determined in my posturing. And I was enraged, even though it had been a choice to be silent.

However, the rage was short lived. It was like having the breath knocked out of you when you are playing ball. I had just had an “in your face” experience of what our families deal with TOO MUCH, TOO OFTEN.

Yes, we at NAMI educate. Yes, we at NAMI are empowered. Yes, we at NAMI advocate. The battles are still going on and needing to be won. Dare I compare the plight of stigma to the discrimination against black Americans?

The black community has had Rosa Parks and Dr. Martin Luther King. There has been an abolishment of the Jim Crow laws and there have been riots about racial discrimination. Life has improved. Equality has been written into the constitution but discrimination lives on in individuals affecting lives that we never see, never hear of.

I could have spoken up to this man and told him – I’m a member and active educator through NAMI Texas. It wouldn’t have made a difference. He’s probably never heard of NAMI. But he will. Because I did the only thing I could think of that might make a difference. I called the person who handles the education of the Dallas Police dept and asked them to make sure this officer gets to attend the next class NAMI presents to the Dallas PD so he could be EDUCATED about mental illness and how to deal with individuals in the community. This officer may not CHOOSE to change, but at least we are giving him the tools to change if he so chooses.

In the mental health arena, we may not have the equivalent of Dr King. Yet, we have come a long way from where we were and we still have a long way to go. What we do have though, is many, many people, making a difference, one experience at a time, and one individual at a time.

So yes, I got my prayers answered – loud and clear. So I will continue on, one step at a time, to make a difference for my kids – for your kids – for us all.

I Say I'ts My Birthday!!!!!!

Today is my birthday. When you are younger, having a birthday marks the time in your life when you get to do things you weren’t able to do before. When you are 6, you get to go to school. When you are 16, you get to drive, get a ob, date.. many things. When you are 21 you get to drink… or maybe you did that when you were 18, depending on when you were born.

As you get older, though, things can shift. I hear a lot of my friends referring to the things they can no longer do…. Like stay up all night. Or drink all night… or do other things all night.

They can’t run as fast or as far or see as well and all kinds of things. And that seems like the top of a long hill slide down to me if you start thinking that way.

A good friend of mine gave me a card today that read almost like a book, it was so full of wisdom and positive ideas. I think that is something else that should happen when you get older instead of those cards with coffins and black balloons and wrinkly old ladies pictured on the front. You should get wonderful. uplifting cards that celebrate your life like it’s still 1999. I digress. Anyway this card talks about all the new things and possibilities that are available to me since life will be continuing. It reminds me that life is an ever evolving story that I am writing. And this is all true.

For me though, today, I am thinking about Thanksgiving. Not the day we have in November. But a true day of Thanksgiving.

First of all, I am thankful that I am celebrating a new birthday.

I am thankful my mother had me. She had other options.

I am thankful that I had a childhood in a southern, small town, growing up much like how Truman Capote depicted life in the “Grass Harp”. Colorful, eccentric characters that left me wondering what was going to happen next, almost ever moment of my short and much enjoyed childhood.

I am thankful for being the only girl in a neighborhood of boys. It made me understand much about power and control and being fearless and daring, very early in life – and how much fun it is to be that way. And if you have a choice, getting dirty is the best choice.

I am thankful that my parents divorced and my mother brought me to Dallas. At the time, it caused me great pain and grief, but the wisdom of hindsight allows me to see that I never would have been happy or grown in the way I did in that eccentric family that I so loved as a child. I would never have realized my full self in that small southern town. Even now, my family back there doesn’t get me. So I’m glad to visit, but I’m glad to come home.


I am thankful for my first love in high school. He gave me another important but very painful lesson in life. Love is not enough. It is the start and foundation. It took many more people and many more lessons for this to be a complete picture for me. But this was my first step.

I am thankful for all the men in my life – my father, my uncles, my cousins, my boyfriends, my husbands, my friends and my professional peers. Each one of them taught me something. Some taught me from a position of love, others from a position of power, and even others from a position of careless, self centeredness. Maybe I was dense and that is why it took so many lessons but I am grateful for each one.

I am especially thankful for the father of my son. He was the first man to see me as powerful and as his equal and to treat me as such. I never accepted anything less than that afterwards.

I am thankful for my woman friends now. Women did not play a large part of my life early on. When I was younger, I didn’t have many female friends. I did not know how to relate them and they didn’t know how to relate to me. With age, women finally learn that we always have a common bond – we’re smarter than people think and we are under appreciated (grin – just joking). Actually, after we have raised our kids, we finally have time for ourselves and that is when we can fully appreciate other women AND be able to make time for one another. I love my “sister women friends” and don’t know how I did without them before.

I am thankful for my son. He reminds me of who I was and who I continue to be.

I am thankful for my daughter. She reminds me of who I was and who I continue to be, unfortunately though, in some very less than positive ways. Young female power vs. older female power is not always a pretty sight. My mom remembers when I was on the other side of the fence. I hear her mumbling something like, “You pay for your raising.” I still don’t’ get what that means.

I am thankful for my husband. He’s the longest relationship I have ever had romantically and spiritually. It’s not been easy for me to be with one person and I feel bad for him. I’m not an easy person period. But he reminds me of what commitment and integrity mean and why they are important when other characteristics get week and threaten to fail you. It’s why you don’t go to sleep mad at night and why you don’t forget to hold hands.

Bottom line, when you consider the alternative, I am thankful to be alive. So thank you for your good wishes. I look forward to them again, and again and again. And if you have a chance tonight, raise a glass and drink to me and drink to you. And say a prayer of thanksgiving.

My Name Is Not Arrogance.

I needed something new for my blog, so it is quite fortunate that this conversation occurred yesterday. In my mind, this is already a great posting. I just hope it comes out as well once it hits paper.


Someone I consider with very high regard, yesterday, asked me if I thought I might be too arrogant and that could possibly keep me from learning from others.
For those of you who know me but not as well as you might, you are probably thinking to yourself – that’s not a bad question for Deborah.
For those of you who know me well enough to know my heart and my spirit, you are smiling to yourself, I know. The point that there are two groups here is a topic for another blog so I will move forward.

In answer to my friends question, the answer was no, I am not too arrogant. What is mistaken for arrogance is simply the calm, collectiveness of knowing who I am, flaws and strengths and being able to accept them, and being able to make cognitive decisions about how I will manage those traits.

Anyone can have this quiet. Not that I am always calm. That is a different matter. Regardless if my life is as I want it or if there is chaos surrounding me, I always know who I am and I am good with that. Do you know how you can have that in your life as well? I won’t dare even try to answer that for you. For me, though, I reached that point in a very early age in my life with two things.
I know the love, grace and forgiveness of God.
I know who I am in His eyes and I understand that I don’t have to understand anything else about His plan.

Do I like that I don’t know His plan all the time? Hell, no. Do I feel deserving of His unconditional love every single minute of my life? Again, it’s no.

It was a conscious choice of my part to accept His grace and to make it a part of who I am and how I deal with, accept, work with and love myself. If God can love me, who I am to argue with Him and say I am not worthy of love – His or anyone else’s or my own?

With that as my foundation, it makes everything else I do and have to deal with just a part of life that, even when it is not what I want, or what I would choose, I know that something good can come from it, even if I don’t see it or understand it. I also know that every day and every person is a lesson. I learn something from everyone I encounter, though I do not actively seek them out.


What I am saying is, I pray about everything I do. I’m not strong enough to always allow God to make my decisions. And I am not strong enough to always follow his direction. I pray to be a better person everyday of my life. I pray that I fulfill whatever goals He has for me. I pray that I am able to make Him proud of me, which is not the same thing as loving me.


When you think of me as arrogant, reframe that and see if that doesn’t seem more appropriate. Instead of saying arrogant, say passionate, someone who is driven who has given a lot of thought about the goal she is trying to reach and is excited about reaching it, frustrated when she is blocked from reaching it.

Instead of saying arrogant, say confident. She’s been down this road before and has a vast amount of experience that gives her the ability to see the different ways this could turn out and she’s willing to deal with any and all of the consequences.

Instead of saying arrogant, say determined. She’s not sure of what could happen or even what should, but she’s committed to a choice or a path, after asking for guidance that she relies on. She's not willing to back down to avoid conflict or even punishment if she believes she is doing the right thing or fighting for a just cause.

Instead of saying arrogant, say focused. She’s been given a vision and though she doesn’t understand what it all means, she has a purpose she is trying to fulfill. And she only participates in activities that she feels strongly about. Mediocre or milquetoast is not in her make up.

Instead of saying arrogant, say strong. She’s willing to take the heat for everyone involved if it will get the ultimate goal accomplished. While you might think she's like a dog with a bone, reframe it to being able to stand up under prolonged periods of stress.

Instead of saying arrogant, say isolated. She has committed her life to finding God’s purpose for her and sometimes that means doing things others don’t understand or doing things that even can be considered anti-social if you are not privy to her mind set.

Instead of saying arrogant, say fulfilled. She has choices, every day about everything and she has made her choice. If you don’t understand her or her actions, try asking more questions.

And again, remember, this is not everything that I am, just a part of who I have become, by choice.

What's Next - A cure????????!!!!!!

I have a celebratory story of recovery to announce to all my NAMI friends. My son, Josh, who has been on medication since 12 (for over 10 years now) for bipolar disorder, is now at the stage of what his doctor calls total remission.
This means his symptoms are not active, his mood is stable and the doctor has taken him off all medication! This was not a hasty decision on Josh’s or the doctor’s part. In fact, when the doctor first talked to him about weaning himself off his dosage of Lithium, Josh refused. After much thought, Josh and his doctor took the necessary procedure and weaned him off his meds. To support this decision, Josh sat down with my husband and I and we worked out a system to help him “gauge” his daily moods.
Josh will either email me or write on his blog and we make a point to talk on the phone at least every other day so I can hear his voice. This is as much to reassure him as much as support him.
Total Remission. What a concept!!!! When Josh was 15, he made it his goal to be off all medications by the time he was 25. He came to the conclusion that if his brain was controlled by chemicals, that he could control the chemicals by living a healthy lifestyle and working his brain, just like he would work out his muscles. He had a few set backs and screw ups. He knows his triggers. He has to get enough sleep – he HAS to. He has a laundry list of things that he has to do to feel his best. Frankly, it’s not much different than what I have to do to keep the pain of fibromyalgia at bay. And at this point, he’s managing his symptoms much better than I am.
Now he knows and we, his family knows, that he is not cured. Some day, he may need medication again. And when that happens, we will be the first ones at his door, insisting he see his doctor. Behind us, will be his friends and his girlfriend. They are part of his support team as well.
No one ever told us that this was a goal to even consider though. Except his first psychiatrist. Thank God for her. So our battle cry is Recovery! And recovery can include remission. Who knows, maybe the word cure will be our next goal.

My best to you always,
Deb Rose

Book Review - Finding My Way

Finding My Way – A Teen’s Guide to Living with a Parent Who Has Experienced Trauma.
Michelle D. Sherman, Ph.D and DeAnne M. Sherman.

Review by Deborah Rose

There just aren’t enough resources for teens in any areas dealing with the illness of a parent, much less when dealing with a parent with a mental disorder or emotional problem.
So I was very excited to have the opportunity to read Finding My way – A teen’s Guide to living with a parent who has experienced Trauma, by Michelle D. Sherman, Ph.D.

Right form the very beginning, I knew that this book would be helpful to teens as the examples were all very well done. The stories were easy to understand and relate to without v=being overly maudlin or dramatic.

While the book explains how the brain works, I felt this chapter needed more info, especially about how we filter information and how this can effect how individuals manage stress. Along this line of thinking though, there were examples of what people did after a trauma who developed PTSD and those who didn’t. I felt the examples failed to tie together the actions with how the brain was operating, thus possibly giving the incorrect impression that people should try harder and just do things differently, even though that wasn’t their intent.

A very nice addition in the book is where they ask the teen to make notes of any positive changes the parent might have made since experiencing the trauma. This section is very uplifting and I believe proves a much needed activity that helps the teen to see the parent through different eyes, starting the teen onto the path of developing empathy. At the same time, the book gives the teen permission to feel how they feel, and it is very well done in supporting the teen to help them to not get bogged down in feelings of guilt or remorse about how they have felt in the past.
I was disappointed in the coping skills section and felt it could have been more informative.

Chapter Eleven is About how to Support Your Parent and what it really should say is How Do I Feel Good About my Parent and Our Relationship.
Some of the helpful hints should have stressed more strongly and been main points, not side notes.
I don’t think they effectively differentiated between support and care giving. This is hard to learn as adults and teens need better examples for them to be able to practice these type of positive living skills.

Overall, I highly recommend this book and my only true concern is that the book is written in workshop format. I am not sure a teen would take this book and read it on their own. But whether they do read it on an individual basis or it is a group project, I feel that anyone reading this book would benefit from the tips and insight it offers.