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When Your Mother is Crazy, What Do You Do?

By Laura Zera 8 Comments

Without fail, each month one of my site’s top search phrases is “when your mother is crazy,” or “how to deal with a crazy mom,” or something similar. (Even more popular is “does strawberry flavor come from beaver butt,” but that’s a whole other story.) It seems like there are a lot of people struggling in their relationship with a mother who has a mental illness, just like I did at one time. I’m writing this post (and stuffing it full of love) for them. For you.

A few things about this topic that I know to be true:

  1. First and foremost: You are not alone.
  2. Your mom may not realize she has a mental illness or is behaving irrationally
  3. It’s difficult to get a person with a mental illness diagnosed. In most states and provinces, they don’t have to get checked out unless they’re deemed a physical threat to themselves or others, and getting to that stage usually requires police intervention.
  4. Whether your mom gets diagnosed or not, it’s a good idea for you to find a professional to talk to. Start with a family doctor or school counselor. You don’t have to share everything that’s going on if you don’t want to, just that you need a referral for a counselor. If you’re worried about money, look for a resource that is free or low cost. The National Alliance on Mental Illness (NAMI) is a good group for support resources, and they have local chapters, too. Some organizations can offer referrals for low-fee therapy, like NW Alliance for Psychoanalytic Study and Seattle Psychoanalytic Society and Institute.
  5. Mother child walkingYou may never get an answer to “what’s wrong with my mom?” and it’s not always black and white anyway. So, that leaves an open question hanging in the air, but it doesn’t have to stop you from living your life and planning your future.
  6. Your mother is doing the best that she can, given her circumstances.
  7. Even with a mental illness, your mother is an adult, and is responsible for herself. You’re not responsible for her or her actions.
  8. Don’t let the stigma of mental illness prevent you from getting help. Also, it’s not uncommon for a child of a mentally ill parent to experience a mental illness. For example, I suffered from depression; it started when I still lived with my mother (who has psychosis). I’ve had years of therapy. Besides helping me heal from the illness, it helped me grow as a person in a zillion different ways. I consider therapy an investment in yourself.
  9. You deserve self-care. If you have a bad day at home with your mom, take care of yourself. Go for a run. Make a painting. Watch a movie. Hug your pet.
  10. Your mother loves you, so hold on to that. It may seem the farthest thing from the truth sometimes—or a lot of the time. But her love for you is there, deep in her heart, hidden by “the crazy.” This I know for sure.

Here’s a list of additional resources I created a few years ago, so, possibly a bit outdated, but hopefully still helpful. And for a more narrative perspective on growing up with a mentally ill mother, this essay by Jeri Walker is a gem. ♥

Photos courtesy of Unsplash

The Third Act Is My Second Chance

By Laura Zera 36 Comments

IMG_5013 - CropIn screenwriting, the three-act structure can be broken down as exposition, rising action and resolution. In my relationship with my mother, the third act of “resolution” began in 2009, and followed the lengthy and excruciating first and second acts of “raised by crazy mom” and “estranged from crazy mom.”

The thing about our third act is that for many years, I had no idea if it would ever come. My mother could have passed away before I saw her again (and that dreadful scenario was ever-present in my imagination). We needed a transition between the second and third acts, which, mercifully, was facilitated by a social worker. Once the third act started, I didn’t know how long it would last, and still don’t, but now count every year as a bonus. And given the volatility of our first act, the nature of this final one is, well, quite bizarre.

The Enridges - circa 1970 - cropWhen my mother was crazy with undiagnosed psychosis, it was difficult to be anywhere near her. She was often in a rage, and when she wasn’t, my sister and I would be waiting on tenterhooks for the next rage to start. My sister left home at age 17 and I was out by 15 (and lived with my sister, a benefit of being the younger sibling). As I turned into a late-years teenager and then young adult, my mother behaved toward me the same way she had always interacted with the “outside world,” her rage replaced by a carefully controlled mask. It was fragile and fake, and, in the moments when cracks appeared and her behavior faltered, completely unnerving.

I tried to keep up a relationship – who doesn’t want a mother? – but the anxiety that came from dancing with the devil (or “dancing with the crazy person who is acting sane”) impacted my own mental health so much that eventually I had to sever all ties. I hid from her. She didn’t know my phone number. She didn’t know my address. She didn’t know that I got married. From my end, I knew where she was at all times, but was painfully aware that there was nothing within the law that I could do to help her.

After all of that, Act Three opened with my mother’s diagnosis of dementia. It was already quite advanced when an aunt took Mum to the hospital. She stayed there for three months before going to a nursing home, and that is where my sister and I met her again for the first time in 17 years.

Most people don’t count dementia as a blessing, but my sister and I do. My mother is no longer paranoid, suspicious of everything that moves. She has no anger left. Her delusions are gone. So is her memory and her verbal recall, but she doesn’t miss them anyway. In a magic twist of fate, she is the happiest, most cheerful and easygoing resident in her nursing home ward. And because of this, I have my mother back in my life. She doesn’t know who I am, but boy, do we ever enjoy each other’s company.

IMG_5016Mum turned 80 last Friday. To celebrate, I joined my sister, her ex-husband and their two sons, and we all took Mum for lunch and a walk in the park. We visited the petting zoo, where Mum was greatly amused by the children and I was greatly amused by the goats. We ate strawberries at a picnic table, and hamburgers and French fries at a restaurant. Mum chattered and sang and laughed. My brother-in-law, who hadn’t been near her for decades, was a bit freaked out. He said, “It’s almost like she’s faking it. You know, the last time I saw her, she tried to kick me in the balls.”

“Nope,” I said. “This is real. This is her.”

Our third act has been playing without intermission for six years now. Mum is physically healthy, and her dementia has leveled off quite remarkably, with no major changes in her symptoms for the last few years. I visit her whenever I can (she is in B.C., I am in Seattle) and just keep adding scene after scene to the screenplay that is our lives, filling those long-empty pages and feeling blessed that we never seem any closer to having to write an ending.

Mental Health Treatment and Mass Shootings

By Laura Zera 10 Comments

After each mass shooting in the United States, there are calls for increased gun control, better access to mental health services, or both. Fuelled by emotion, we seek solutions; I have been right in there, too, simultaneously grieving those lost and asking for system changes to prevent reoccurrences.

A bit ago, I came across an article which hypothesized that improved mental health treatment won’t impact mass shootings or school killings. The author, Dr. John M. Grohol, founder of website PsychCentral.com, focuses on school shootings in this piece, and posits that what will help most is restricted access to household guns, and more involved parenting.

Two pieces of a puzzleWhen I re-read this piece today, I pondered whether I agreed or not (and then I veered off to something about the Paul Simon and Edie Brickell arrests for disorderly conduct, and then I saw a Jennifer Aniston story that I just had to read—love her—and then I came back to this mental health piece. And so it goes. Sometimes it helps to break the tough topics into bite-size pieces.).

Like I said, I’ve let my emotions lead me into the debate before. After Sandy Hook, I was annoyed that some people focused on gun control, when for me, the shooter so clearly needed mental health services. “That’s what it’s about,” I said, “because a person with a mental illness can always find a weapon.” Then I read a comment on Dr. Grohol’s piece, which reminded me how complicated each and every case is. The commenter wrote:

I love how everyone thinks they have the answer to this problem. Intellectual humility seems to be in limited supply. “It’s the drugs,” “it’s mental illness,” “it’s the provision of inadequate services.” There are so many imponderables involved in human behavior, our point of departure for any enquiry into its determinants… …should be both skepticism and an acknowledgment of the limitations of human understanding.

As humans, we’re very good at pointing a finger and assigning blame. It deflects our own icky feelings. However, those getting pointed at and blamed feel shame, and shaming someone gets us nowhere.

So, can we do any better than we are now to prevent them? Yes, I still believe we can.

For starters, I agree with Dr. Grohol – locking down guns in a household is common sense. As for parenting, well, I can’t speak from personal experience, but I’ve seen troubled parents turn out well-adjusted kids, and vice versa, but I agree with his assertion in principle.

But kids grow up and move out. Then what?

Hand Over Hand I don’t want to oversimplify, but for treatment of both kids and adults with severe mental health issues, doesn’t a lot of it come down to communication and collaboration? Parents and doctors and lawmakers and community health nurses and hospital psychiatry teams and teachers and the child/adult in question all working together? Long-term relationships, not revolving-door appointments. Courage. People who aren’t afraid to talk, to question, and to course correct. To have some intellectual humility, rally all of our resources and push the limits of our human understanding. Or, rather, our understanding of one human.

What are your thoughts and practical considerations?

P.s. Here’s a story about parents of a son who had bi-polar depression, and who was killed by Seattle police. They’re lobbying for a bill that allows family members to request a judicial review if emergency in-patient psychiatric treatment has been denied to their loved one with a mental illness. I support this, because it’s another avenue for conversation and collaboration between parties, as opposed to decisions made in a vacuum, often due to cost or expediency.

Mental Health Resources for Kids

By Laura Zera 14 Comments

Teenagers on school stepsHaving just spent a morning speaking to AP Psychology students at a local high school this week, I thought it would be a fitting time to highlight a few mental health resources for children and youth. When I was growing up, there were few to no places for me to go to talk to a qualified adult or peer counselor about my turbulent home life, so I find it incredibly heartening when I learn of the variety of programs that are out there now. I hope their posters are plastered all over the doors and walls at every school in the communities they serve!

Events

First up, because it’s coming up soon, and is always the kick-off to Mental Health Week in Canada, is the Walk So Kids Can Talk. Planned for May 4, 2014 at locations all over Canada, the Walk is a fundraiser for the Kids Help Phone (see below). You can join a team, walk individually, donate online – it’s your choice!

The National Children’s Mental Health Awareness Day will be May 8, 2014 in the United States. Events are organized by community groups and health organizations, and while I don’t see anything posted for 2014 yet, here’s a list of the events held across the country in 2013, and by whom.

Teenage girl with depressionHelp Phones

Kids Help Phone is a 24/7 free, anonymous and professional counselling service supporting the mental and emotional well-being of kids ages five to 20 across Canada. If you want to understand why a line like this is so important, here’s an example of a recent (and real) call: Kevin Helps a Friend Being Bullied.

Australia has a similar resource, called Kids Helpline. It’s also available seven days a week, 24 hours a day.

In the U.S., both of the kids help lines I found are faith-based (when I was a teenager, this would have been enough to dissuade me from calling). The one run by Covenant House is called the Nineline Crisis Hotline, and is not currently operational (calls are being rerouted to the National Runaway Safeline).  The other is run by Boys Town, a Catholic organization, and is still in service.

The U.S. also has the National Suicide Prevention Lifeline for people of all ages, and TXT 4 Help, where teens who feel they’re in danger can send a text, and in return will be sent location details of the nearest designated “Safe Place” (fire stations, libraries, fast food restaurants, YMCAs, Boys and Girls Clubs, convenience stores, and other businesses all serve as Safe Place sites in different communities). There, a Safe Place volunteer or agency staff member will meet them to talk.

Programs

It has been a couple of years since I ran across the Kids in Control and Teens in Control programs, run by the British Columbia Schizophrenia Society as a resource for children who have a parent with schizophrenia. I hope to write more about this program in the future; it looks quite amazing.

Teenage boy on skateboardIt’s the 21st century, and resources have to be designed to meet teens where they already go. OK2Talk.org has done that by creating a unique Tumblr site. Although geared toward teens and young adults who suffer from mental illness, anyone can add their voice by sharing creative content such as poetry, inspirational quotes, photos, videos, song lyrics and messages of support in a safe, moderated space.

Another organization that is utilizing the digital world for its delivery of services is WesForYouthOnline.ca. A recent Aviva Community Fund grand prize winner in the At-Risk Youth category, this Ontario-based organization was recognized for its efforts in using an online counseling model, as well as for plans to build a local center that will offer face-to-face services and meet-ups. It’s a fantastic example of community members who saw a need and then went to work creating the solution themselves.

The U.S. federal government is behind Caring For Every Child’s Mental Health, and while I’m not sure about the availability of interactive resources, they have published a number of topical papers and links for young adults to help with the transition into adulthood.

I spent a bit of time looking for a youth-oriented program offered through the U.S.’s National Alliance on Mental Illness, but everything I found mentioned that it was for those who are 18 and over. What they do have, though, is a two hour in-service program for teachers (and parents, presumably those who help out in the classrooms), aimed at helping them identify and respond to early warning signs of mental illness in children. It’s called Parents & Teachers as Allies.

That’s my start to a round-up of mental health resources for kids. I will try to keep this list updated on an annual basis by checking that these resources are still available and adding new ones.

If you know of any other resources, anywhere in the world, that are targeted to children, teens or young adults, please share them in the comments section below. 

Mental Health: The Mysterious, Malleable (and Mini) Brain

By Laura Zera 13 Comments

I wonder if Martian kids are allowed to text in class
I wonder if Martian kids are allowed to text in class

Before you get depressed over not understanding why your noggin is prone to depression (I’ve been there, have you?), take some comfort in the fact that the human brain is the most complex computer in the world. The Universe, even. Neither Intel and AMD nor the Martians have come even close to developing anything as advanced as what God and/or evolution assembled; our brains consist of a hundred billion neurons, connected by a hundred thousand billion synapses. If a simple toaster can short-circuit after 367 days of use (two days past the expiry of the one-year warranty, of course), then imagine the opportunity for creative mayhem in our craniums!

The upside is that having a hundred billion neurons gives us a lot of freaking processing power, and with that, we can do things like grow mini-brains in labs and study them to further understand brain development. This experiment was conducted at the Institute of Molecular Biotechnology in Vienna, Austria, where scientists used stem cells to form brain tissue, which then grew into distinct regions of the brain.

Since these lab brains lack a circulatory system to feed them, they only grew to a size of three millimeters, but have already proven useful for things such as studying microcephaly, a genetic disorder that results in a smaller-than-normal brain size. One of the researchers, Dr Juergen Knoblich, said, “Ultimately we would like to move towards more common disorders like schizophrenia or autism. They typically manifest themselves only in adults, but it has been shown that the underlying defects occur during the development of the brain.”

Brain into computer image courtesy MicrosoftOver in neighboring Switzerland, furthering the quest for advancement in neuroscience, the Human Brain Project (HBP) launched last fall. HBP encompasses 80 European institutions, partnering in order to create a complete simulation of the human brain. Speaking of Dell and microprocessors, in order to accomplish this, new supercomputers must be built, ones that match the brain’s power and complexity. Several manufacturers, including Dell, have committed to building the first exascale machines by approximately 2020. To be brain-like, they’re expected to have 1,000 times more power than today’s supercomputers, and will still forget birthdays and anniversaries, just to keep things real.

To say that the HBP is an ambitious undertaking is like calling The Milky Way big. The project will cost about $1.6 billion, and aims to both develop new treatments for brain disease and clear the way for new computing technologies that will have brain-like intelligence. Professor Patrick Aebischer of EPFL (one of Switzerland’s technical universities) says he believes the 21st century will be the century of the brain.

Finally, not to be outdone, Germany announced a pretty cool accomplishment of its own last summer. After slicing the brain of a deceased woman into 7,400 half-a-hair-width pieces, researchers stained, scanned, and then digitally reassembled the pieces to produce the first high-resolution 3D model of the human brain. Called the “Big Brain,” it will allow neuroscientists to study human responses and map them to individual layers of the brain’s cortex, even down to a cellular level.

Active neuron image courtesy FotoliaAdd these three initiatives to the American-led one I wrote about last year, the Human Connectome Project, and soon you might start to feel like we’re on the verge of some remarkable advances in terms of understanding, preventing and treating mental illnesses. With no disrespect to Pfizer, figuring out how to make a penis stay erect was easy. Figuring out the chemical and electrical flows between a hundred thousand billion synapses, though? It’s the perfect start to a joke: “How many scientists does it take to… .” And if Viagra was science picking the low-hanging fruit first, now we’re finally about to climb the tree.

So what do you guys think? And, bonus question, how do you write a hundred thousand billion in numerals? (I tried to find it online, but couldn’t figure it out, so y’all would be doing me a favor by answering that one!)

Mental Health Takes Center Stage at Davos in 2014

By Laura Zera 14 Comments

Davos WEF Conference CenterWorld leaders and change agents from the business, environmental, health, and other sectors met last week in Davos, Switzerland for the 44th annual World Economic Forum (WEF), but this time, mental health occupied the agenda like never before. Roughly 10 percent of the more than 200 sessions were devoted to topics such as mental illness, dementia, and mindfulness. You heard right. Mindfulness. CEOs of companies with more than $5 billion a year in turnover (the minimum requirement for the funding members of the WEF) were learning about the merits of meditation.

How is it that the oft-overlooked subject of mental health became a priority at this meeting of forerunners and luminaries? Director Tom Insel of the U.S.’s National Institute of Mental Health wrote a blog post in which he reported three reasons:

  • Mental disorders have emerged as the single largest health cost, with global projections increasing to $6 trillion annually by 2030, more than diabetes, cancer, and pulmonary diseases combined. They also greatly increase the risk for other chronic diseases, giving rise to the expression “no health without mental health.”
  • Employers understand that mental illnesses, especially anxiety and mood disorders, are a threat to productivity
  • Recognition that the 21st century will belong to brain-based economies. In other words, “no wealth without mental health.”

Green pills w. dollar signsIf concern over economic prosperity is what drives large-scale mental health care reform and/or delivery, and sustainability, then so be it. I believe its good practice to frame any proposal or need in terms of the return on investment or economic impact, and mental health care is no exception to the rule. Money makes the world go ‘round, so the more we couple our compassion with cost, the greater the chance that the discussion will hold weight.

One in four will suffer from mental health issues at some point in their life, and a number of these issues — bipolar disorder, schizophrenia, depression, anxiety — can start early, in the teens and 20s. This is quite different to cancer, which is known to increase in occurrence in the later years. Economically, the earlier an illness starts, the greater the impact to productivity if it’s not given its due attention. But as Robert Greenhill wrote in an article on Davos for The Observer, “We need to find ways to create a culture in which nobody fears moral judgment in mentioning that they’re suffering from depression, any more than in describing how they broke an ankle. …Rehumanising health is one of the great opportunities of our time.”

The thing that resonated most for me in Tom Insel’s piece was his comment, “One Davos regular compared mental health in 2014 to AIDS in 1994, when the WEF declared the need for a global focus on an emerging, heavily stigmatized, frequently misunderstood disorder.” Hell, yes.

Of course I’m going to use a pic of Mandela at the WEF, given the chance!

I had this very conversation with über-humanist Jo-Anne Teal back in November. For those readers who are too young to remember the stigma around HIV and AIDS in the 80s and early 90s, the movie Dallas Buyers Club does a good job of bringing it back to life. Uninformed, and sometimes misinformed, people were completely freaked out by HIV and AIDS, and then there was a monumental shift.

Sometimes, it’s pop culture and celebrities who become the face or the force behind a cause. As Jo-Anne pointed out to me, Princess Diana’s work with AIDS charities and Magic Johnson’s admission that he had the disease both proved to have strong effects on shifting societal sentiment in the 90s. While Bono was at Davos (again) this year, his presence and platform weren’t core catalysts behind the building momentum for mental health issues. It came down to numbers. And if that’s the universal language that will kick this movement into high gear, then hand me my abacus, kids. We’re going to count some beans.

Have mental health issues had an impact on your bottom line? From business people to mental health service consumers, I’d love to hear how you’ve interpreted or had the cost presented to you with regards to how mental health hits your wallet, spreadsheet or stock price.

 

Photo of Davos World Economic Forum Conference Center in Davos: © MadGeographer / CC-BY-SA-3.0

Photo of Frederik de Klerk and Nelson Mandela at the Annual Meeting of the World Economic Forum held in Davos in January 1992: © World Economic Forum / http://weforum.org / CC-BY-SA-2.0

Photo of green pills courtesy Fotolia and Microsoft

 

Mental Health: Mobile Technology Use in Developing Countries

By Laura Zera 15 Comments

Cell phone image courtesy MicrosoftIn developing countries, almost everybody has a cell phone, and sometimes two or three to take maximum advantage of network coverage across different carriers. Not all phones are operational all the time; the predominant use of prepaid plans means that sometimes people let their minutes run out until they can afford to reload the phone. But where personal computers are still an anomaly, mobile handsets have become ubiquitous, and for good reason: they’re less expensive than other (computing) devices, increasingly “smart” and multifunctional, and both durable and portable for long and dusty trips from village to city and back again.

Erecting cell booster antenna - Northern Cameroon
Erecting cell booster antenna – N. Cameroon

For these reasons, problem solvers in the Global South turned to mobile technology before it had even caught fire in the North. In the banking industry, mobile payment operations started as far back as 2000, for example. Soon, ideas for mobile solutions for agriculture and education and health care were all popping up, and I’m pleased to see that this is now extending into the mental health arena.

Some of this momentum is being driven by dollars from the Government of Canada. Through an agency called Grand Challenges Canada, it was announced last week that more than seven million dollars has been allocated for 22 global mental health projects worldwide. These projects are delivered by local in-country agencies and institutions (a very important aspect, in my opinion).

Of the initiatives that were chosen for a grant, 13 of them include deployments of mobile phone technologies. Uses will include things such as screening and referral tools, and training and support for lay health workers (defined as those who carry out functions related to healthcare delivery, but have no formal professional or paraprofessional certificate or tertiary education degree).

Port-au-Prince, Haiti
Port-au-Prince, Haiti

The practical reality of mental health care delivery in the developing world is that the majority of services will come through lay health workers. As Grand Challenge’s press release states, there are fewer than 30 psychiatrists for 10 million people in Haiti, and data from other countries would reflect similar ratios. Ramping up the number of professionals in specialty areas takes too long, so community health care workers are the most available and direct way to create a greater availability of services. With mobile technology, these generalists will have more specialized resources at their fingertips, via a device that they probably already own.

The entire list of projects and related links and contacts is available on this Global Mental Health Media Information Sheet. It’s an interesting mix, and the geographic diversity is sure to lead to some unique challenges and results. I plan to follow up on some of them in the future.

Have you run across a mobile application that is designed specifically for mental health? Do you have field experience delivering mental health services in the Global South? All thoughts and feedback is appreciated!

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Haiti photo: Wiki Commons by Marcello Casal Jr, ABr

 

Mental Health: Peer Bridgers Reduce Hospitalizations, Boost Recovery

By Laura Zera 10 Comments

People standing in lineThere’s more news out of Seattle this week regarding innovations in mental health. A program called peer bridging matches a person who’s just been released from in-patient treatment with a person who can act as their advocate and help them navigate the requirements and resources of agencies in the community. The bridger helps with the sometimes-arduous tasks of obtaining a mental health case worker, filling out necessary documentation, finding housing, and other supports that are often available, but difficult to access due to a variety of barriers.

This recent piece in The Seattle Times, The Rare Mental-Health Fixers, explains that in Pierce County, just south of Seattle’s King County, peer bridging has been in use since 2009. The estimated first-year cost savings from reduced hospitalizations in Pierce, which has a population just over 800,000, was more than a half a million dollars.

King County is trying the program out by way of a two-year grant, money obtained through a Washington state settlement with Janssen Pharmaceuticals for deceptive marketing practices. (This is the second time I’ve heard about money obtained from a pharmaceutical company settlement getting earmarked to help the wider pool of victims of bad pharmaceutical practices. Nifty.) The county plans to keep it going afterward by using the money saved on inpatient treatment.

I love this idea. Twenty years ago I filled a similar role to the peer bridger as a volunteer for the Immigrant Services Society of B.C. There, I helped refugees figure out how to set up their new lives in Canada. They knew they could call me whenever they had questions or needed help, and in return, I was fed a lot of fantastic Iraqi and Ethiopian food. It was a total win-win. The program was designed to support people when they’re in a vulnerable transition phase of their lives so they know they’ve got a friend in the community who will be there for them.

Just imagine how helpful the peer bridging program must be for people who have just gone through a mental health crisis and are trying to reintegrate in their community. And just imagine how hard it must be for those people if they’re largely on their own. Close your eyes if that helps.

Image courtesy MicrosoftThe Times piece says, “At least 11 percent of psychiatric patients are rehospitalized within 30 days, according to national data, mostly due to sparse follow-up care.” I would bet money that the percentage increases dramatically at the 90- or 120-day mark. Programs like peer bridging demonstrate that we have solutions to address problems such as rehospitalization, and with the current shortage of psychiatric beds in King County and beyond, it kind of seems like a match made in heaven.

Have you come across any similar kinds of programs in your neck of the woods? 

 

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