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Mental Health: What Is Sensory Defensiveness?

I’m currently reading a book called Too Loud, Too Bright, Too Fast, Too Tight by Sharon Heller. Sounds like erotica, I know, but it’s actually about what it’s like to be a sensory defensive person in the world, and how to cope. My coach recommended it a few weeks ago after I told her how spending a half day in a noisy, busy hair academy (chosen because it was cheap), getting my gray colored over AND foils AND a haircut, left me completely shattered. My plan had been to go to my office afterward and work for the rest of the day, but when I got there, I lay curled in fetal position on my beanbag chair for 30 minutes before I could even attempt to look at words on a page. I considered shaving my head and getting a nice wig, rather than ever go through that kind of torture again (I have way too much hair; the foils pushed me over the edge).

A surge of books and articles have been written recently about what it means to be an introvert; as it turns out, the concept has historically been rather misunderstood, so the material filled an information need. It helped a lot of people, me included, understand why we have no problem engaging with groups of people—leading meetings, facilitating workshops, public speaking, etc.—but then require anywhere between hours and days of quiet time to restore our energy balance. Many of us have also heard of highly sensitive people (HSPs), a term introduced by Dr. Elaine Aron in 1996. But sensory defensive? That’s a term we don’t see kicked around as much, even though it has been around since the 1960s (although called “tactile defensive” until the 1980s).

As defined by Dr. Heller, “sensory defensiveness is a condition that encompasses a constellation of symptoms, including tension, anxiety, avoidance, stress, anger, and even violence, that result from aversive or defensive reactions to what most people consider nonirritating stimuli.” The stimuli can include anything from irritation to tags in clothing, to touching dirt, to an aversion to cutting your nails, to getting carsick.

There’s some science behind why some people can find themselves with this condition. Three particularly important senses are involved, and those are the “proximal,” which tell you what’s going on inside your own body: 1) the tactile system, responsible for information on touch, pain, temperature and pressure, 2) the vestibular system, which involves inner ear structures and is used to detect movement and changes in the position of your head and 3) the proprioceptive system, which provides feedback from your muscles, joints, and tendons that enables you to know your body’s position in space. Then, these three sensory systems send messages to the three parts of your brain: 1) the brain stem, or primitive brain, 2) the limbic system, or emotional brain, and 3) the neocortex, or thinking brain.

When integration is lacking between the proximal systems, and/or connectivity blips in the three brain parts make it difficult for the brain to organize the inputs from the proximal systems, you find people who are sensory defensive. This isn’t to say that the other senses – touch, vision, hearing, smell and taste – aren’t also involved. Oh yes, throw them all into the sensory defensive stew!

From the reading I’ve done about introverts, HSPs, empaths, people with anxiety disorder, and the sensory defensive condition, there is an unsurprising amount of overlap in symptoms and traits. In fact, sensory defensiveness is often misdiagnosed as anxiety, Heller writes. And, it largely boils down to one core concept: our brains receive and process signals differently, then tell our bodies how to respond. For whatever reason—biological, environmental, psychological—some people’s brains and bodies respond in a more dramatic way than others. That could range from having physiological reactions of nausea, headaches, etc. to stimuli such as light, smells, and touch, all the way to a fight-or-flight cortisol spree, which, while unpleasant at the moment of occurrence, also has long-term health implications.

Having read about a third of the book so far, I’m not convinced either way yet as to whether I’m sensory defensive or not, and while I may be, I’d certainly fall in the “mild” category in terms of symptoms (some with this condition find things such as the sound of a bag of potato chips being opened excruciating!). However, I’m about to get into the tips and tricks section for how to cope as a sensory defensive in a stimulating world, and given that I do know I’m an introverted empath who has had anxiety disorder, something tells me the information will be useful in some capacity or another! I will be sure to share the highlights in a future blog post.

Have you had experience with sensory defensiveness, or any of the other conditions I’ve listed? Whether diagnosis-driven or anecdotal, I’m interested to hear stories of your experience in a world that can feel too loud, too bright, too fast, too tight.

George Clooney Got Engaged, and We Acted Like Assholes

By Laura Zera 14 Comments

George Clooney keeps his personal life so private, and held on to his bachelor status for so long, that we, the media-watching world at large, pretty much figured hell would freeze over before he got married again. Plus, that’s what the media told us.

Last week’s announcement of Clooney’s engagement caught us off guard, then, hey? Nope, nope, I never saw it coming, either. Just who is this Amal Alamuddin he’s going to marry, anyway? She sure is purdy. And she’s a lawyer. Who provides consultation to high-powered leaders (Kofi Annan) and represents high-profile cases (Julian Assange). Wow. She’s smart and accomplished, then, too.

This is just about where we–now I’m referring mainly to my female counterparts—threw our sisters under the bus. Because everywhere I turned, the news stories said something like, “it took a woman like Amal to get George to commit,” or “he’s finally met his equal,” or “look at her credentials, it’s no wonder he finally got engaged.” When I saw these sentiments, I totally agreed, and I’m betting I’m in good company.

It was only later I realized that in first assigning such high value to Alamuddin’s education and career, and then nodding my head with regard to the obviousness that it would take a woman like her to “get Clooney to settle down,” I was devaluing the women who dated him prior. Because, as the stories imply, of course Clooney wasn’t going to marry a cocktail waitress (Sarah Larson), or an ex-professional wrestler (Stacy Keibler). And what about the one who had no known career in America to speak of (Elisabetta Canalis)? Gadzooks, this engagement makes perfect sense!

For a woman who is all about supporting other women, and, even bigger, espousing that we are all fundamentally equal on this planet, I sure wasn’t walking the walk.

Of course, this was just celebrity news, and I don’t know any of these women, but that’s part of the point. Who are we—now I’m back to the media-watching world at large, but with special emphasis on my female counterparts—to rank Clooney’s girlfriends in terms of marriage worthiness? We don’t know a single thing about their hearts and souls. God, I feel like calling them up and apologizing on behalf of the world for being such an asshole.

Wait a minute. This has farther-reaching implications. Who else do we do this to? Rather, who else do we profess to support, and yet, nod our heads slyly when one gets a job promotion over another, or when we lose 10 pounds while a gal pal (had to say it, since we started out in “celebrity-talk mode”) gains 20? Or when someone we know gets a degree, and we think, “Oh, it’s only in Arts.”

I do it regularly at the gym. I’m always all like, “It doesn’t matter what shape or size or fitness level you are, it just matters that you’re here,” but then I gloat a bit when I sit down at a weight machine after another woman and can notch the peg a few bars further, to a heavier load.

Here’s the thing: I’m not writing this post to catch the attention of the semi-permanent assholes out there, the people who are so miserable in their own lives that they can’t even barf out a kind word for Mother Teresa. Not my target audience.

My message is aimed at those who are trying to be kind, authentic, supportive people (the way I like to think I am). Yes, we can be assholes, too! But we’re trying. Not to be, I mean. We strive to be kind, authentic, supportive people, so when we fall off the wagon, we don’t need to judge ourselves, we just need to be aware. Watch that thought (or spoken digression). Look at it, turning it like a Rubik’s cube, then scratch your head. Where is that judgment coming from? What do you think might have made you react that way? (Because it’s so out of character for you! Yes, okay, now I’m sucking up.) Chances are good that it’s stemming from something you feel or believe about yourself, and instead of disposing of that crap at the hazardous waste center, you’re letting it trickle down your driveway and into the main sewage system. Don’t do that. It’s icky, and you know it, because you can feel it.

As for George and Amal, congratulations to them! We wish them much happiness. And that’s enough. Full stop.

Have you teetered across the line into asshole territory lately? Do tell! And change names to protect the innocent.

Unaltered image of George Clooney taken by Angela George and available under the Creative Commons Attribution-Share Alike 3.0 Unported license.

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.

When 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?

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: Finding the Help to Thrive

By Laura Zera 4 Comments

Boop! It’s a guest posting week! I hope you’ll hop over.

The whole survive vs. thrive thing is one of the tabs in my brain browser that I’ve been leaving open all the time lately. I’m looking at my own behaviors, developing an awareness of when I step out of thrive mode and back into the survive state. I’m looking at other people’s behaviors, on an individual level, and as a society. I’m reading some good stuff on feelings, emotions and behaviors, and how they can shift entire societies. And I’m developing some ideas around it all.

I won’t go into definitions of survive and thrive here, because they can both mean many different things, and can be explored through many conversations (and I plan to do that here over time). To kick things off, though, I’ve done a guest post on Elaine Stock’s blog “Everyone’s Story” this week, and it’s all about finding the help to thrive. Elaine writes Christian fiction, and she found me through one of my previous mental health posts. As it turns out, her mother also suffered from schizophrenia. I’m honored that she asked me to be a guest on her site, and I’d be tickled if you’d have a visit and say hello to her. Also, please do share your thoughts about survive vs. thrive and asking for help, either here or there!

Namaste, my friends.

Mental Health Takes Center Stage at Davos in 2014

By Laura Zera 14 Comments

World leaders and change agents from the business, environmental, health, and other sectors met last week in Davos, Switzerland for the 44^th 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.”

If 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.

De Klerk and Mandela at the 1992 World Economic Forum — 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

In 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).

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

There’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.

The 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?

Mental Health: Psychiatric Bed Shortages and Boarding

By Laura Zera 8 Comments

Even though I read the entire Internet every day, I’m always gobsmacked by the sheer volume of things about which I know NOTHING. Sometimes, you have to go out into the real world to get wind of some of these things. That’s how I found out about the escalating number of cases of boarding in Washington state. I went out. In public.

Seattle’s Town Hall was the site of last week’s King County Mental Health & Substance Abuse Legislative Forum. It was the first time I’d attended one, but I figured it would be a great place to hear what some of the county government representatives identified as pressing issues in Washington’s most populous county (and the 13^th most populous in the country). The issue that stood out was how a shortage of psychiatric beds has caused a steep increase in hospital boarding over the last five years.

What am I talking about when I say “boarding?” Sort of like it sounds, boarding refers to the temporary placement of psychiatric patients, most of who are in crisis, in a regular old hospital emergency room. There is often no psychiatric staff available, and while a person may receive medications, they don’t receive proper assessment and treatment, sometimes for days. Like, six days, in the case that Seattle Times journalist Brian Rosenthal wrote about in his eye-opening piece “‘Boarding’ mentally ill becoming epidemic in state.” And quite often, restraints are involved, or isolation, or both.

You should be thoroughly horrified right now, and if you’re not, then I suspect you also don’t like puppies or kittens. Fine. Carry on. But for the rest of us, well, it’s hard to imagine having a friend or loved one who is going through a mental health crisis locked up in restraints and left in an ER hallway for days on end. It hurts our hearts. It hurts the heart of our society.

The event I attended was a legislative forum, so not surprisingly, the advice given as to how an individual can effect change with regard to the bed shortage and boarding issue was to tell your elected officials (and this issue is definitely not isolated to King County or Washington state). Find out who is voting to fund mental health care and who isn’t, then put the latter on speed dial. Attempts to get face-to-face meetings with your elected representatives were encouraged, as in-person meetings are still regarded as highly effective.

In King County, the increase in boarding – up from 425 in 2009 to 2160 in 2012 – is directly related to both the decrease in available psychiatric beds and to changes to Washington state law which have made it easier to commit people involuntarily. And while Washington doesn’t usually stand out as first or last on any state rankings list, I’m embarrassed to say that it comes in at the very bottom of the body politic for psychiatric beds per capita in the U.S.

I hate ending a post on a low note, so I will leave you with this companion piece that Rosenthal wrote for the Times, which illustrates just how intensive outpatient and early-intervention programs have been successful at keeping psychiatric patients out of emergency rooms in another of Washington’s counties, despite the lack of beds there, too. More money for that, please, dear legislators. More money for that.

Have you heard of or experienced a problem like this where you live? And is it recent, chronic or in retrograde?

**Updated in Jan. 2014: Sadly, the very same day I posted this piece, the story came out that mental health workers were unable to locate a bed for inpatient psychiatric treatment for Virginia State Senator Creigh Deed’s son. This occurred the day before he stabbed his father before fatally shooting himself.

– Image of WA State Legislative Building from Wikipedia Creative Commons, user Jason (Cacophony)

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