Monday, March 16, 2015

The Importance of Using Strength-based Language

“Sticks and stones will break my bones, but words will never hurt me.” We have all heard this saying, but if you are like me you have always known that it isn’t quite right. Sometimes words can hurt us much deeper than any weapon could. Those of us who have been exposed to verbal and emotional abuse know just how much pain words can cause, yet we use words that hurt to talk about ourselves and others all the time. Many times we don’t even realize how much our word choice is impacting how we see ourselves.

“I’m a borderline”, “he’s schizophrenic”, “she’s bipolar”, “I’m too low functioning to hold a job”, “John is dangerous when he has a meltdown”, “Susan is depressed”. The way we talk about ourselves and others affects the way we see ourselves and them. These kinds of phrases have no hope in them, and hope is essential for those struggling with mental health issues to take control of their own lives and believe they can get better.

Most of us are familiar with the medical model:
  • ·          a narrow focus on treatment goals which are dictated by our care providers
  • ·         mental illness as a chronic problem with low expectations
  • ·         behaviors are seen as pathology
  • ·         symptom focused and only works to stabilize
  • ·         self-directed care is seen as “non-compliance”
  • ·         techniques are more important than the therapeutic relationship
  • ·         focus is on symptom categorization rather than individuals
  • ·         the provider is in control and responsible for fixing things


Back in the 1980s and 90s some of those struggling with mental health issues and not finding what they needed in the “system” they began to fight back. The psychiatric survivor’s movement was born and consumers of mental health services began to strategize about what needed to change for healing to begin. They discovered that some helpful things were missing and some existing things in mental health care were actually harmful- and this was the start of the recovery model.

The recovery model of mental health emphasizes a self-directed journey toward wellness, empowerment and hope. It includes:

  • ·         Basic needs met- access to food, shelter and appropriate clothing for the weather is essential before any real effort can be put towards improving spiritual, educational or mental health states (Maslow’s hierarchy of needs).
  • ·         Hope that recovery is possible- without hope that things will get better, those experiencing symptoms of emotional distress have no motivation to try to make any changes.
  • ·         Self-responsibility- taking personal responsibility for our own lives and recovery.
  • ·         Education- learning as much as you can about yourself and becoming aware of your triggers and warning signs, learning more effective coping skills.
  • ·         Self-advocacy- learning how to ask for and find help when you need it
  • ·         Support- finding positive people who believe in you and your ability to get better and reaching out to them when you need them. 


“Great, but what does all this have to do with language and me?” you are probably thinking. Well, medical model language and attitudes can be stigmatizing and marginalize the people that are supposedly being helped. When someone is described as “a borderline” they are seen only as a set of symptoms. Their humanity is not even considered. No one considers the damage done to make a person “borderline” or what is going on inside of them that causes their behavior. When you instead describe that same person as “someone who experiences extreme emotions” you put their humanity first-they are someone- and then describe their actual experience rather than simply labeling them. Someone who is emotionally overwhelmed elicits more sympathy than someone who is “borderline”. It is the same when we think of ourselves with stigmatizing language.

If I think of myself as being “borderline” when things aren’t going well I am judging myself. What my mind hears is “bad, I am just bad”. If I instead think of myself as experiencing overwhelming emotions I am able to see myself more compassionately and have fewer negative feelings about myself in the process. The same thing when others react to me. If someone reacts by calling me “crazy” or “psycho” or even says I am “acting borderline” I feel even worse about myself. Their negative reaction combines with my own negative self-talk to double team me. My feelings are invalidated by the stigma. If those around me react by asking me what is upsetting me and validate my feelings though, then I feel empowered and more in control of my journey.   

Some people believe that in order to truly gain power over these words we need to accept them, to reclaim the words that have been used to marginalize us. I have no problem with attempts to reclaim your power by playfully using words that stigmatize. I even jokingly refer to myself as “crazy” sometimes. But I would never call anyone else “crazy” because when someone else says it, it hurts. For years I was known as “the crazy lady” in my hometown. The people who called me that were not trying to lift me up. Let’s try to be aware of how our choice of words can affect others. You don’t have to be perfect, just do your best!

Some examples of strength based alternatives to stigmatizing language:

Harmful language                                                     Strength based language
A borderline                                                    someone who experiences extreme emotions

An addict/junkie                                             a person struggling with an addiction

High functioning                                             really good at…

Low Functioning                                            has a tough time caring for themselves right 
                                                                        now     

Acting out                                                       person disagrees with treatment team

Unrealistic                                                      person with high expectations

Denial/unable to accept illness                       person disagrees with diagnosis/that they have a                 mental illness

Resistant/non-compliant                                 not open to… chooses not to… Has own ideas…

Weaknesses                                                    barriers to change; needs

Unmotivated                                                   person is not interested in what system has to                                           offer/preferred options not available  

Relapse/failure                                                person is re-experiencing symptoms/
                                                                        re-occurrence    

Maintaining clinical stability                           promoting and sustaining recovery

Puts self at risk                                                takes chances to grow and experience new 
                                                                         things

Noncompliant with meds                                prefers alternative coping strategies

Patient                                                             individual, person receiving services, consumer

Enable                                                             empower through empathy and encouragement

Frequent flyer                                                 takes advantages of services as needed

Dangerous                                                       specify the behavior

Manipulative                                                   resourceful, getting needs met, really trying to get 
                                                                         help           

Entitled                                                           aware of ones’ rights

Baseline                                                           what someone looks like when doing well

Helpless                                                           unaware of capabilities

Hopeless                                                          unaware of opportunities

Grandiose                                                        has high hopes and expectations of self

User of the system                                          resourceful, good self-advocate

Mentally ill                                                      lives with a mental illness

Manic                                                              has a lot of energy right now/hasn’t slept in 3 
                                                                        days

Paranoid                                                          experiencing a lot of fear

Delusional                                                       worried about someone hurting them

Difficult                                                          not on the same page as me

Committed suicide*                                        died by suicide

Successful suicide                                           suicided

Completed suicide                                          ended their own life

Failed suicide attempt                                     non-fatal attempted suicide

Unsuccessful suicide                                       attempted to end their life                 


*There is also a movement to stop using the term “commit/ted suicide” when referring to someone dying by suicide. There are a couple of reasons for this, the most common being the idea that people “commit” crimes and suicide is not a crime. It adds even more stigma. The other reason is that when someone commits to something it implies that they made a rational, logical, well thought out choice. Many people would argue that except for cases of euthanasia, someone taking their own life is never rational -hence it is not factual to say someone “committed” suicide. 


Sources:


Tuesday, February 3, 2015

Life After Attempting Suicide (my Sound Out for Life story)

Life After Attempting Suicide (my Sound Out for Life story)

My name is Julie. I've been married for 15 years, I’m 42 years old and an only child from a small town in southern WI. I keep myself busy as a blogger, author, community organizer, mental health advocate, peer counselor and amateur photographer. I am also a suicide survivor. That's what I am going to talk about today.
           Artist, photographer, peer counselor... I have a lot of titles these days. There used to be a time, where I only had one title though, a title I didn't choose and I surely didn't like. When I was around 18 the people in my community began to refer to me as the "crazy lady" or the "psycho bitch", depending on their generation. When I go home to visit, I still hear it whispered behind peoples’ hands. That stigma hurts me, to this day.
            My family life wasn't the greatest growing up, as is the case with a lot of people. I was a sensitive kid whose feelings were easily and often hurt. My mom loved me and did the best she could, but she was struggling with her own stuff. She tried to get me help, but that wasn't successful. My father was MIA from 7-13 years old and I had no real friends. I was bullied, sometimes violently, by my peers. I felt like no one in my world really cared about me. At 4 years old I was abused by a close family member, but my mom was the only one who believed me. Everyone else accused me of lying. Over the years I developed a mental illness known as Borderline Personality Disorder
            Borderline is a disorder that makes it hard for those with it to regulate their emotions. We are easily stimulated and it seems impossible to stop the emotional flood that ensues. Once we are emotionally triggered we also lack the ability to self-soothe. I heard it described somewhere that people with Borderline are like emotional burn victims. Even the kindest touch can cause unbearable pain. Around 10% of Borderlines die by suicide and for years I just knew I would be part of that 10%. Despite a diagnosis at 15, I was never treated for anything other than major depression for years.
            My teenage years were spent in and out of mental institutions and psych wards. At 15 I was committed to the state mental hospital for a year. I got no treatment there; I was basically just warehoused since I was too troubled for foster care. After a long stint as a teen runaway I was shuffled among family members until I turned 18 and was completely cut loose on my own.
            After I turned 18 I was drinking to deal with my trauma and ended up in 5 point restraints in the hospital often. I basically become psychotic when I drink. The police would charge me with disorderly conduct and resisting arrest, despite knowing I was having a mental health crisis. They never took me to jail at first, they always called an ambulance to do a 5150 on me at the same time as charging me criminally. Eventually all of these arrests landed me on probation.
            Around the time I went on probation the psych ward in my local hospital closed. From that point on my mental health crises were dealt with by putting me in jail. I know they knew that it was actually mental health problems, rather than a criminal issue, because they used probation as a way to force psychiatric treatment on me.
            My criminal/mental health issues were unfortunately made worse by psychiatric drugs. While on probation I was forced to take meds on and off, once by a doctor using me as a guinea pig. He had me on so many drugs I was so out of it I would half wake-up at night, light a cigarette (I still smoked back then) and pass back out. One night I set a couch and my own self on fire without realizing it! I finally couldn’t take it anymore. On top of all that, I have a rare and somewhat disabling bone disorder. The extra weight on top of that almost completely incapacitated me. Every time I complained about side effects though, the doctor would add more drugs to the mix.
            The thing that got me into the most trouble while on probation was my use of medical cannabis. I use cannabis to treat pain from my bone disorder as well as my anxiety and other PTSD symptoms. I tried dozens of psychiatric drugs over the years and had horrible reactions to every single one. Some of them made me violent, some made me suicidal. Cannabis has been the only drug that eases my pain and anxiety without causing me dangerous, possibly deadly side effects. Unfortunately I would go to jail at least once a month for using it while on probation. During the time I set the house on fire though, I had been abstaining for several months because I was so sick of jail. I was trying to do things "the right way".
            A day or two after the fire I decided that the psychiatric drugs were killing me so I stopped taking them, cold turkey. I found out quickly that cold turkey caused brain seizures, it felt like my brain was being given an electric shock every second or two. I didn't know how to stop it, was starting to think of hurting myself, until someone said cannabis controls seizures. The cannabis stopped the seizures virtually instantly, so I started smoking it again. At that time I was on parole, stopping the drugs that were killing me and using the drug that helped me were each a violation of my parole conditions. They revoked my parole and I went to prison for one year and 11 days.
            There are other ways mental health struggles can be stigmatized, as well.  Back East I was jailed twice after suicide attempts. The first time the police officers didn't do the 5150 on me when they brought me to the ER, so when they showed up the next day to do it they were told by my doctor it was too late. The officers called my probation officer, who put me in jail for 2 weeks instead of taking me for professional help. The reason? Violating my probation by misuse of prescription medication. The other time I went to jail for an attempt the judge appointed me a public defender, against my protests that I couldn't afford it, for the release hearing. Months later when I couldn't pay the public defender fees I was held in contempt of court. I spent 6 weeks in jail that time, while my husband worked overtime to pay off the $800 I owed to get me out.
            It isn't just cops, even doctors can stigmatize us. Another time at the hospital, when I came to after an attempt I had the ER doctor screaming in my face. He told me repeatedly what a selfish little delinquent I was, among other nasty names. He screamed, just inches from my face, about how if my liver didn't start working again I was going to have to have a transplant. With spittle spraying all over my face I heard how some poor sick child would die because they would have to give me a liver that I didn't deserve instead of it going to the poor sick child who did deserve it. If I could have found a way, I would have tried again right then and there. It seemed I had managed to drag myself down even deeper into self-loathing and misery with my desperate attempt to escape them. I wanted to die even more and here was a doctor screaming agreement to my worthlessness.
            When I finally got out of the criminal justice system about 15 years later, as you can imagine, I ran. I came to San Francisco with no money, no job and no place to stay. I lived on the street for about a year before I was awarded SSI and given housing in an SRO, where I still live. I came here because I knew that my mental health issues would be addressed by mental health professionals rather than the Department of Corrections. I knew that medical cannabis was recognized here- I could be a patient rather than a criminal for the only medicine that has worked for me. I knew I had a chance here.
            It was here in San Francisco, after my last suicide attempt, that I met my savior. I was hooked up with an agency that provides services and emergency housing to homeless people (SFHOT). Once I got housing the agency had to close my case. It was the final appointment with them that I met him. My case manager wanted desperately to help me before she closed my case and brought Burt in to help her figure out something. When he was told my diagnosis he had the answer. He said, “If I could wave a magic wand and give you anything in the world, I would give you DBT”. I was instantly intrigued! With a magic wand he wouldn't wish me health, or peace, he would wish me DBT. But wait, “what the fuck is DBT?” It had to be something pretty amazing and I couldn’t wait to find out. (DBT is Dialectical Behavior Therapy. It is specially created for people with Borderline. It teaches mindfulness, distress tolerance, interpersonal effectiveness, emotion regulation and gives HOPE.)
            With his magic wand Burt gave me hope, for the first time in my life. I had hope that things could get better. “Better” seemed a path that was securely closed off from me until that moment. My case manager now knew what I needed and was quickly able to find it for me. Within 2 weeks I was in DBT groups and individual therapy that I had faith in for the first time, ever.
            For about 18 months I spent nearly every day at this agency going to DBT, therapy and other groups full time. I was finding some control over my emotions and my life, it was an amazing time. While there I gained confidence in myself enough to go back to school, something I had always wanted to do. School had just never seemed possible before that; mental illness was controlling my life.
            Up until finding DBT I had lost every bit of faith I had ever had in the mental health system. It had done nothing but hurt me before this, physically and mentally. I hated it and spoke out against it regularly in public and on social media. DBT was such a miracle to me that I decided I wanted to try to give that miracle to others too. I enrolled in City College into the Community Mental Health Worker program, where I was delighted to discover that mental health was undergoing a transformation. The old medical model system is on its way out and the wellness and recovery model is on the way in. This is something I can believe in!
            I am doing things today that would never have been possible for me before that last suicide attempt. I have graduated from City College as a certified mental health worker, do community organizing work, do art, advocate for social justice issues and work in my community to help my neighbors keep their housing and access to services that we need. My life isn't perfect, not by a long shot. Things still really suck sometimes. But today, I have HOPE that the rough times will pass. HOPE was something I had never felt before Burt waved his magic wand over me. Today it has become my mission to bring that hope to others who need it.
            Last November I saw Burt at a Project Homeless Connect event. He looked really busy and I was feeling really shy about approaching him, especially if he was as busy as he looked. It took me almost an hour to work up the courage to speak to him. I’m really glad I did. I told him, “you probably don’t remember me but you saved my life a few years ago.” He suddenly stopped what he was doing and looked at me very intently. “How on earth did I do that?” he asked. I told him about the magic wand and DBT and how he had given me the gift of hope. He just kept looking at me for what seemed like forever. Finally he said, “That kind of sounds familiar. I wish I could remember!” He looked at me some more and said, “You just made my day. Thank you for telling me that.”

            Always be kind to people. Always listen to their needs, you never know when you will hold the magic wand, the HOPE that has the power save another person’s life. You never know when your simple kindness, one you don’t even recall it is so inconsequential to you, could transform another person’s life.          

How to Be There for a Suicidal Friend

Originally posted WEDNESDAY, AUGUST 13, 2014

How to Be There for a Suicidal Friend

With the news of Robin Williams' death by suicide the other day there has finally been some public discussion around the topic. I have known for a long time that we, as a society, don't talk about suicide. It struck me over the last 2 days why that is. It's because people have no idea what to say; and when someone does say something, many times it can be more harmful than helpful. We need to break the stigma, end the judgmental attitudes and open up a safe space for a real conversation. If someone tells you they are thinking of killing themselves there are a few things you can do, and some things you should avoid, to help them.

Do Not Panic

It isn't easy to tell other people when you are thinking of hurting yourself. If someone has said it to you that means they want help, and this is a very good thing. Most people who consider suicide don't really want to die, they just want their pain to end. Sometimes it seems that it won't end unless you make it impossible for yourself to feel pain anymore. If a person is talking about it they want help to try to ease that pain- without hurting themselves physically. By staying calm and offering to talk with the person you are giving them an alternative solution. This is much more helpful than freaking out and making them sorry they opened up to you.

Do Not Report Them

Don't call 911, their therapist or any other entity that can take away control of the person's life, their freedom and ability to make decisions for themselves. (**This does not apply if the person tells you they have a plan that includes when and how they will do it.**) Unless they are in immediate danger you are not only going to make things worse, you are going to make them mad, will lose all of their trust and even possibly the relationship. When you make a call like that, you expose a person to all kinds of dangers, the least of which is being locked up and/or medicated against their will. "Locked up" can be anything from simply being put in jail to being admitted to a locked facility to being physically or medically restrained (aka-drugged into oblivion) to being stripped naked and left in a cement room with only a sheet to cover yourself. Not only does this really suck and not help, it can add more trauma onto the pile of pain the person is already experiencing.

Do Listen Without Judging

One of the worst things you can do for someone feeling suicidal is to pass judgement on them. Things like: "that is stupid", "how can you be so selfish", "that's the coward's way out" are pretty obvious judgements. Ones that might not be as obvious are things like: "don't say that", "how could you do that to your kids/parents/me", "if you do that you will go to hell", and even things like: "it's not that bad" or "shake it off". The person already feels so bad about themselves that death seems the only relief possible, adding shame and guilt to their burden is only going to convince them that it is the only option.

Do Validate Their Pain

You don't have to "understand" or "get" the reason(s) your loved one feels this way. You don't even have to agree that their feelings are correct (e.g. they tell you "no one cares about me") but it is very important that you acknowledge that THEY FEEL that way and how painful that must be. Telling them "that's not true! everyone loves you!" is NOT going to help. Not only does it not change how they feel, it will tell them you don't really care about how they feel about it. Think about it, would you want someone to tell you "oh it's not that bad" if you had cancer or even a broken leg? That would be very invalidating and is a great way to shut someone down. You don't want to say "Yeah, everyone hates you", that isn't the kind of validation I am talking about either. Validation just means you honor their feelings on the subject and won't try to talk them out of those feelings or tell them they are incorrect. Acknowledge how difficult you see that this is for them.

I am not a psychiatrist or any kind of expert in suicide but I am a certified peer counselor and have tried to end my life 4 times and continue to struggle with suicidal ideation quite often. I know what it feels like to think that death is the only way out and I know what has helped me and what has made me feel worse. I have also spoken to several people who have attempted or thought about attempting and found these same things helpful or hurtful. If you really want to BE THERE for your loved one though, you really have to ask them what they need and believe them when they tell you. Sometimes all we really need is to talk about it and we will feel much better. The urge will subside because we let it out and someone is helping us carry the burden. You can be their savior with just your open heart and open ears.