This week is the 68th Mental Health Week founded by the Canadian Mental Health Association! That’s a whole heck lot of talkin’, learnin’ and awareness buildin’ about mental health!

My contribution this year is shedding some light on psychosis in the hopes it will increase compassion. I wrote this for my Psychology Today blog a few years ago, but it bears repeating.

Dear Hospital Emergency Ward Staff,

When you see me in a manic high, wrestled in here by my father; or as you watch my mother, sitting with me in the waiting area, holding my hand while I ramble gibberish to an invisible friend, please remember this: I may be crazy but I can hear. I may be mad but I can see. I may be insane but I’m still smart.

I can see you rolling your eyes when my behavior is bizarre. I can hear you when you shout to the security guard to ‘catch the crazy woman’ as I fly to find some scissors. I know you’re referring to me when you look at me but whisper to your colleague, then purse your lips and shake your head.

I don’t want to be running around the emergency ward in florid psychosis looking for God. I don’t want to be strapped to a gurney needing sedatives to calm the fire in my brain while I scream for the Mother Ship to beam me up.

Maybe it’s because you’re burned out, under-resourced, over-taxed, understaffed and over-stressed. But, I am a human being before I’m a ‘frequent flyer’, the ‘nut case who must be on drugs’, that patient who can wait because ‘she’s non-compliant’.

I understand that I’m hard to understand and hard to manage. I know your job is trying; that you do your best; that you do care. But please don’t forget that just like you, I have a heart. A heart that hurts when someone judges me for something that isn’t in my control; when someone doesn’t see that really I’m doing everything I can to get well even though it doesn’t look that way.

Because I also feel when you, the paramedic who wheels me through the hospital doors, stream such soft compassion from your eyes and gently nod goodbye to me. I sense when you, the nurse whose name I do not know, rests your hand on my shoulder with such respect that dignity rises from my feet.

So please remember, even when I’m laughing like a drunken hyena, and my father paces the green linoleum while my mother strangles her panicked hands, and all three of us wait for the attending doctor, I am aware of the kind light in your face as you tell us (including me) that you wish there was more you could do but hopefully it shouldn’t be much longer. No matter how crazy I may be, I am aware. And when your heart remembers that, my heart does too.

Let me know what you think. What has it been like for you if you’ve been in a psychosis or if you’ve been with someone while they’ve been in one?

© Victoria Maxwell



Every month I receive emails from parents (just like you perhaps) of adult children who have serious mental illness. You tell me many things, but the one on which you all agree is how painful it is to see your son or daughter in anguish yet at the same time not accept help. She’s angry with you, blames you, yells at you, yet needs your help desperately. You tell me how helpless, how lost and how hopeless you feel. It is a journey of great pain. But there is also great hope. I know. My parents were on this very same journey. For 5 years, I was in and out of the hospital because of psychotic episodes. I not only refused help but refused to accept the diagnosis of bipolar disorder with psychosis and generalized anxiety disorder.

“H.O.P.E.: Hang On Pain Ends” ~ Unknown

There are myriad reasons a person refuses treatment. They can (and for me did) include: denial, anosognosia1 (ie: the inability to recognize you are ill), shame, emotional overwhelm, stigma, lack of access to good treatment, insufficient education about mental illness, fear of change and lack of skills or support to move through change.

But there are steps you as a parent or support person can take, at least initially, if you are facing this situation.  The suggestions may help you feel a little less powerless, a little less alone and a little more hopeful.

Know this: change is inevitable, recovery is possible and your adult child can get her life back; maybe not the exact life she had before she got ill, but a life worth living.

 

“Recovery is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness…(it’s developing) new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” ~ Bill Anthony

 

I’m not a parent of someone who has a mental illness. But I am someone who saw what my parents went through as I struggled to make sense of my own psychiatric disorders and find my road to recovery. (On this  previous post on my Psychology Today blog my dad offers advice to parents trying to help their adult child. This post describes strategies to help someone with a mental illness who doesn’t want help.)

This is not only your adult child’s journey, the entire family embarks on it together. Mental illness becomes a whole family condition – chaotic and frightening. You know this.

But I also know this:

  • You can do it. But you can’t do it alone.
  • You can’t change your loved one. But things will change.
  • Recovery (for the adult child AND family) is possible.

Here are seven suggestions to help make your current difficult situation a little more tenable.

7 Steps for Parents who Love an Adult Child with Mental Illness

1. Stop the power struggles with (or judgements you have) of your daughter or son.

How do you do this? Listen to what your adult child is telling you. Don’t correct her, don’t try to change her or convince her. Just listen. Summarize what you hear her saying. Just because you are listening and reflecting back what she says, does NOT mean you agree with her. It does mean you are doing everything you can to understand her and her experience.

Like anyone, someone with mental illness wants to be heard, wants to be understood. And frequently for someone with a mental illness, this doesn’t happen. Really understanding what she is feeling (ie: empathizing) can rebuild trust. It’s not easy. Believe me. But it can build bridges where bridges were previously imploded. Check Dr. Amador’s website and book (I Don’t Need Help! I’m Not Sick) for more instructions on what it means to empathize and actively listen.

2. Remind her (and yourself) you are both on the same team.

But don’t just tell her, show her. Show her by working collaboratively: listen without an agenda; partner in decision making, set boundaries when necessary. Telling your adult child what she needs, what she should do, or what YOU know will help her will only make her dig her heels in more. You’ve probably already experienced this.

3. Recognize you might not be the best person to help her.

It may not be fruitful to say you are on the same team. Sometimes there’s too much animosity, so much trust broken (on both sides) that your adult child only see you (at the moment) as an enemy. Because of the current (yet temporary) volatile nature of the relationship it may be best to find out who, if anyone, she does connect well with. Is there someone who she will listen to; who she does trust or confide in? That person needs to be someone who has her best interest at heart (obviously), not someone who enables her or aggravates the situation. For example, not a person who she drinks with or who encourages her to believe you are an interfering parent.  A close friend, a trusted Uncle, a former teacher she admires, are options.

4. Ask your adult child what she needs to feel safe.

She may not know. She may not be able or want to calm herself down in order to express what she needs. It may be about helping her learn to calm her anger. Is she willing to go to counselling , not for mental illness but to sort out some life dilemmas; to solve some issues or secure some essential basics (housing, sleep, friends). Even if she blames everyone else for her problems, you can mention counselling can be a place to talk about that. And with that, a good therapist can help her gain insight and learn problem solving skills.

5. Let her know you are there for her.

Sometimes the only thing left to do (but also the most important) is letting her know you are there and not going anywhere. When or if she wants to reach out, you’ll be there, without judgement, with love and curiosity.

The most important element for me was to know that my parents (even as I pushed them away and argued with them), loved me unconditionally, and would be there. They might not like how I was behaving, but I knew they loved who I was. Even as I refused their help there was a part of my consciousness, a part of my soul that heard them, that registered how much they cared. This is true for your son or daughter.

6. Set boundaries.

You do not need to nor should you tolerate verbal or physical abuse (nor should your adult child). You may have to say ‘I love you. I’m here if you want help, but I will not allow you to berate me (yell at me, swear at me, threaten me etc). It might be about giving her space, you taking space or telling her she’s needs to leave. Always ensure she is safe and not at risk of suicide or harming someone else.  If she is at risk, then taking her to the emergency ward (or in the worst case scenario, the calling the ambulance or police) will be necessary.

For further excellent strategies watch Dr. Lloyd Sederer’s Chief Medical Officer, NY Office of Mental Health video ‘When mental illness enters the family’. https://www.youtube.com/watch?v=NRO0-JXuFMY

7. Don’t do this on your own.

Make sure you get help for yourself. The old airplane emergency adage applies: take care of yourself first, before you help someone else. You are no good to anyone if you are overwhelmed. There are other families willing to help and talk with you. Find a support group for parents of someone with a mental illness. The expertise in those rooms is invaluable, life saving even. Check with your local mental health clinics, your doctor, your community resources and local mental health organizations (DBSA, CMHA, SSC, NAMI)2. These connect you with people who have similar challenges, link you to community resources, and offer you emotional support and encouragement. The resources and support groups are usually offered at no charge.

This path may be long. It may be arduous. But it gets better. It’s not your fault. There is help. There is hope. You are not alone.

Please email me with your own strategies and feedback about my suggestions. I’d like to put them into a future post (anonymously of course, if you wish) because there is strength in numbers and wisdom comes from diverse and multiple perspectives.

© Victoria Maxwell

  1. If you’d like more information about anosognosia please watch this video which includes a talk from Dr. Xavier Amador, an expert in the area.
  2. Depending on where you are located, check with your local Depression Bipolar Support Alliance (DBSA) or National Alliance on Mental Illness (NAMI) chapter or if you are in Canada: your Canadian Mental Health Association (CMHA) or Schizophrenia Society of Canada (SSC) branch.  The SSC helps families dealing with ALL types of mental illness.

Bird Nerd I am.

I’m a bird nerd. They make me happy. Just watching them hop around, flitting here and there, puts a goofy smile on my face. I really love watching the ones in those small wee groups, like juncos, sparrows and robins. Oh and chickadees! Who doesn’t like chickadees? They’re so plucky!

And how cool is that to be named after the sound you make! Chick-a-dee-dee-dee, chick-a-dee-dee-dee. Wait that wouldn’t be so good for us humans, would it? The sounds we mostly make are burps and farts. Yes we talk, but our ‘organic’ noises aren’t our voices.

Anyway, moving on… I found this scientific tidbit about watching birds (see below to geek out on the research). It confirmed something I was already experiencing.

Simon Science Says: Just Add Birds!

Watch birds – any kind – from a window, in a garden or around your neighbourhood. Doing so is associated with lower levels of depression, anxiety & stress, according to a study from the University of Exeter in England.1

Everyday I work at my desk in my home office. I’ve purposely positioned it near a window that overlooks our back porch and old growth trees. Each morning I dribble a little bird seed on the railing. The aforementioned juncos, and others, enthusiastically gobble it up. See photo. Each time they jostle, doing their version of bird sumo wrestling to get access to the best feeding point, I smile. I feel like they’re my feathered co-workers. I don’t have to do anything except watch. I get this happy, present-moment-kind-of-feeling seeing them. Life feels simple and that feels good.

Try it out and see if you get the same benefit.

What does Simon Science Really Say?

According to a University of Exeter study which involved hundreds of people from both urban and rural settings, being able to see birds from windows, and on a daily basis around their neighborhoods, was associated with reduced rates of depression, anxiety and stress.

Drawing from the ‘attention-restoration theory’ which posits that being in nature, and even simply watching nature, promotes healing and lessens stress, researchers explored the potential benefit of nature to improve mood.

The researchers found no correlation between the species of birds seen, but instead the number, indicating that seeing common birds such as robins, crows and blackbirds on a regular basis is a key factor.

Evidence shows it’s not about identifying bird types, but instead, interacting with birds.

The UK Health Spectator rightly cautioned that “while the correlation between mood and nature was highly significant….(doesn’t explain) the cause of the relationship. For example, do happier people actively seek nature more or does a lack of exposure to nature lead to higher rates of depression, or is there some other factor?”2

As a fairly low effort and no-cost tactic that potentially could reduce anxiety and depression and boost mental wellness, it’s worth a shot, I’d say.

Do you already do this? What’s your experience? If you haven’t, try it out and see if you get any benefit. Email me or comment below and tell me!

For more Mental Health resources, tips & tools, sign up for my newsletter.

© Victoria Maxwell

References

1 https://academic.oup.com/bioscience/article/67/2/147/2900179

2 https://health.spectator.co.uk/just-looking-at-birds-may-help-to-keep-you-happier/

For the past month, I’ve been practicing a breathing meditation my Chi Kung teacher, Renate, gave me.

Each time, I’m amazed how calm, relaxed and alert I feel after about 5 minutes of this controlled deep breathing. Like really peaceful. And for someone who’s recently been as anxious as a hummingbird on cocaine, this is pretty cool.

Then just last week I went to see my GP, Dr. Yee, to get my medications renewed. While there, she also reminded me about Box Breathing (also called 4 square or tactical breathing).

“Tell me about it again.” I said.

“Pretty simple. Breathe in through your nose for 4, hold for 4, exhale through your nose for 4, hold for 4. And repeat it a few times. There’s good evidence it kicks your parasympathetic nervous system into gear and you’ll feel relaxed.”

Huh? A little light bulb went on for me. That’s almost identical to my 9 Breathings Tibetan Meditation.

I got home and went on ‘the google’ (as my husband and I like to call it).

Box Breathing, or controlled deep breathing, activates the parasympathetic nervous system (the ‘rest and digest’ system) and regulates the autonomic nervous system.

In other words, it helps get me out of the stress response when my anxiety is high, my trauma is triggered or I’m heading into a challenging work project even.

It’s called tactical breathing because, get this… Navy Seals are trained to use it. 1 Special forces, law enforcement and first responders use it when there’s a crisis or a threat is perceived. When their stress response is activated they need something that will bring them back to calm, and clear their head, so they can act effectively.

You’re probably quite familiar with the fight or flight response, yes? Or the lesser known “fight, flight or freeze” response. Heart rate increases, adrenaline and cortisol flood the body, eyes dilate, muscles tense and senses sharpen.

Military personnel, even athletes, learn box breathing to calm their system so they can think more clearly and operate effectively in high stress situations.

Who knew ancient yogis and Navy Seals shared a common practice to reduce anxiety?

The Mayo clinic has found deep breathing effectively helps with PTSD, generalized anxiety, depression, even insomnia and pain management.2, 3 It’s also been shown to decrease the release rate of cortisol, trigger the release of pleasure-inducing neurochemicals and eliminate toxins by bringing more oxygen into the bloodstream. 4

Box Breathing in a nutshell:

After some practice, it can be used anywhere, anytime if you’re feeling stressed, say before giving a presentation, about to have a difficult conversation, if you feel a panic attack coming on or feel yourself triggered.  Do this while seated comfortably.

  1. Close your eyes or soften your gaze. Inhale through the nose for a count of 4 until your lungs and belly are full.
  2. Hold for a count of 4. Try not to clench your jaw or muscles.
  3. Exhale through the nose for 4, emptying your lungs and belly.
  4. Hold for 4.
  5. Repeat at least 3 times or as much as you like.

Tip: If counting to 4 is too difficult, use a count of 3. If it’s too easy, increase to what feels right. As you get practiced, increase the length of the breath and hold.

My meditation includes additional elements: hand and finger postures (mudras) and visualization with colour, but the basic framework is the same. As are the results: clarity and calm.

I highly recommend using this practice when you feel generally stressed, or for more acute stress if a traumatic memory has triggered reactivity or panic.

Try it yourself or share it with your clients. Tell me if you found it effective. I’ll be practicing most mornings as part of my meditation and prayer practice (and if my computer crashes or I can’t find my cell phone! 😊).

For more Mental Health resources, tips & tools, sign up for my newsletter.

© Victoria Maxwell

References:

1. https://thepreppingguide.com/box-breathing/

2. https://www.medicalnewstoday.com/articles/321805.php

3. https://ritualize.com/box-breathing-military-secret/

4. https://unbeatablemind.com/7-tangible-benefits-of-breathing-exercises/

Watch Mark Divine, former Navy Seal, teach his version in this video here.