Dec 21

Asking For Help: Why So Hard For So Many?

I think the number one reason why people don’t ask for help is simply fear. Fear that others will judge them for seeking help, fear that others will see them as weak or damaged. This fear is the same kind of fear that holds many people back in their lives. John Grohol, Psych Central

Why is asking for help—of any kind, not just the therapy kind—often so hard?

Peggy Collins, author of Help is Not a Four-Letter Word (2006), thinks many of us suffer from “Self-Sufficiency Syndrome,” which is “characterized by an inability and unwillingness to ask for help or delegate because of the belief that no one can do it as well as you can.”

Jeana Lee Tankh (Huffington Post) lists some other aspects of this syndrome:

There are short-term payoffs that self-sufficient people experience such as singular control, approval from others, career enhancement and self-confidence, all of which act as a catalyst for the behavior. Yet, when self-sufficiency is taken to the extreme, the burden of too much responsibility can cause stress, unrealistic expectations, lack of self acceptance and no acknowledgment of personal needs.

When writer Alina Tugend (The New York Times) also researched why we don’t ask for help, she cited  both M. Nora Klaver‘s May Day! Asking For Help in Times of Need and Garret Keizer‘s Help: The Original Human Dilemma. Some of the various reasons include, said Tugend, “not wanting to seem weak, needy or incompetent,” fear of “surrendering all control,” fear of obligation and indebtedness, and lacking the skills to do it effectively.

Dr. Deborah Serani can remedy that last one. But first she cites (in a blog post) some myths that can prevent us from asking for help:

  • It makes us look vulnerable.
  • Holding things in and keeping personal issues under wraps keeps us secure.
  • It bothers others.
  • Highly successful people never ask for help.
  • I am a giver. I don’t like when others help me.

The truths, in a nutshell, are that help-seeking is empowering, connects us with others, helps other people feel needed, and aids success. Plus, as with the last one, our resistances are just plain worth getting over.

How to increase one’s ability to ask for help? HELP, Serani says:

  • Have realistic expectations for the kind of help you are seeking
  • Express your needs simply and clearly
  • Let others know you are there to help them as well
  • Praise your pals for their assistance and pat yourself for asking for help

What about asking for help from a therapist—what specific factors hold people back?

Dr. John Grohol, Psych Central, cites researchers Clement et al. (2014, Psychological Medicine) who back the idea that self-sufficiency is one of them. Others include, but are not limited to, mental health stigma, financial barriers, lack of local availability of therapy, being unable to get an appointment soon enough, and prejudice and discrimination.

Some of these are very real for some people, some are untested internalized beliefs. Most can be overcome, partly by researching the various available alternatives—online therapy, for example, versus in-office therapy, just to name one intervention that could be effective for those in certain circumstances. But in order to even look into such things, many people need a bit of assistance.

And now…? Aren’t we back to square one?

Oct 07

Patrick Kennedy Portrays “A Common Struggle” In His New Book

Former U.S. Congressman Patrick Kennedy (RI-DEM) is probably best known and appreciated professionally for what he’s done for mental health parity—as he says, making “the scope of mental health coverage the same as all the rest of physical health care coverage.”

And he hasn’t stopped there. Since leaving the House of Representatives in 2011, he founded the Kennedy Forum, an organization that supports various mental health initiatives, and co-founded One Mind for Research, which studies brain disorders. One common thread among his different pursuits is his desire to eliminate mental health stigma.

Patrick Kennedy is probably at least as well known both for being the son of Joan and Ted Kennedy and for having well-publicized though not necessarily publicly understood personal problems.

Believing in the 12-step program maxim “You’re only as sick as your secrets,” Kennedy has come out in recent years about the specific nature of his long-term battles with substance abuse and mental health issues. He has also finally, after repeated efforts throughout his lifetime, made his sobriety stick—four-plus years worth, he says.

In his new book A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addictionco-authored with journalist Stephen Fried, Patrick Kennedy expands not only on his own story but also on that of his famous family—thereby breaking what he calls “the Kennedy code of silence.”

A code, by the way, that extends to psychotherapy, in case the “psychiatrist” breaks confidentiality.

This past Sunday, the evening before the book’s publication, Kennedy was interviewed by 60 Minutes anchor Lesley Stahl. He expressed his awareness that many of his family members will not be happy with his revelations and/or perspectives.

“It’s a conspiracy of silence,” he notes, “not only for the person who is suffering, but for everyone else who’s forced to interact with that person. That’s why they call this a family disease.”

Although he writes mainly about his own issues, Patrick Kennedy also addresses certain family secrets—examples include the extent of the alcohol problems of both parents, the probable PTSD of his father (related to the tragic assassinations of brothers JFK and RFK), and the effects of no one discussing or processing these incidents as well as others, e.g., Chappaquiddick.

Stahl: “You actually say that because nobody talked about these things in the family, you were all kind of like zombies…”

Kennedy: “Well, we were living in a limbo land where all of this chaos, this emotional turmoil, was happening. And we were expected just to live through it.”

Somehow he has lived through it, and now he’s also managed to turn himself around. Currently he does what he can to maintain his sobriety, which includes daily 12-step meetings, and to treat his bipolar disorder, which includes taking appropriate medication.

So far, notably, it seems that news about A Common Struggle has focused more on the family’s negative reactions to it and less on reporting or reviewing its actual contents. The Boston Globe, however, calls the book “strikingly raw and emotional,” while other readers have applauded this Kennedy’s courage and openness.

Apr 27

“Shrinks” and “Madness,” (History) and Future: Two New Books

If you have an interest in the history of mental health treatment, two new books may be for you: Shrinks by Jeffrey A. Lieberman and Madness in Civilization by Andrew Scull. But if you’re anything like me, you’ll skip ahead to sections on the present and future.

I. Jeffrey A. Lieberman, Shrinks: The Untold Story of Psychiatry

Natalie Angier, New York Times, sums up today’s psychiatric care:

Ultimately, though, the real secret to psychiatry’s success is drugs…He glides over the very real problem of side effects, and the fact that psychiatric drugs don’t always work or stop working over time. Still, for all the hand-wringing in some quarters that we are an overmedicated society, psychiatric drugs give patients what no rubber hose or hectoring daddy can: peace of mind, a piece of sky, a life.

Drugs aren’t the only answer, though, Lieberman tells Scott Simon, NPR: “The cornerstone of the healing profession and the physician is the patient relationship…So medications were extraordinarily important — they were miraculous developments — but medications alone can’t do it.”

The author’s take on the DSM (also from the New York Times):

Lieberman hails the advent of the ­Diagnostic and Statistical Manual of Mental Disorders…He recounts, at rather too much length, the infighting that erupted over different editions of the manual, including the latest version, published during his tenure as president of the A.P.A., but he makes a convincing case that its format has given the field a precision and reliability it lacked in the past…

On what’s currently working, Julia M. Klein, Boston Globe: “For Lieberman, talk therapy — especially scientifically-validated modalities such as Aaron Beck’s cognitive-behavioral therapy — retains a role: Psychiatry, he writes, must ’embrace the mind and the brain simultaneously’ and ‘touch upon fundamental questions about our identity, purpose, and potential.’ But promising research at the frontiers of neuroscience, biological medicine, and genetics clearly excites him more.”

Who uses the available treatments offered by shrinks? Publishers Weekly: “While people are ‘more likely to need services from psychiatry than any other medical specialty,’ the stigma attached to mental illness means that most sufferers consciously avoid the very treatments now proven to relieve their symptoms’.”

II. Andrew Scull, Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine 

Kirkus Reviews: “Scull is sharp on every point, but some of his best moments come when he explains the introduction of psychoanalysis into pop culture in the postwar period, thanks in good part to Hollywood, and when he takes a sidelong look at both the drug-dependent psychiatry of today and its discontents, such as Scientology…Often brilliant and always luminous and rewarding.”

Scull explains (Psychology Today) his choice of the term “madness”:

So I have chosen to speak of madness, a term that even now few people have difficulty understanding. Using that age-old word has the further advantage that it throws into relief another highly significant feature of our subject that a purely medical focus neglects. Madness has much broader salience for the social order and the cultures we form part of, and has resonance in the world of literature and art and of religious belief, as well as in the scientific domain. And it implies stigma, and stigma has been and continues to be, a lamentable aspect of what it means to be mad. If we are to grasp madness in all its dimensions, these are some of the subjects with which we must engage.

Regarding the deficiencies of both the DSM and mental health treatment overall:

…(T)he DSM remains enmeshed in controversy, even at the highest reaches of the profession itself…After all, despite the plethora of claims that mental illness is rooted in faulty brain biochemistry, deficiencies or surpluses of this or that neurotransmitter, the product of genetics and one day perhaps traceable to biological markers, the etiology of many mental illnesses remains obscure, and its treatments largely symptomatic and generally of limited efficacy. Those who suffer from serious psychoses make up one of the few segments of our societies whose life expectancy has declined over the past quarter century – a reflection in part of the generally poorer overall health of psychiatric patients, but also one telling measure of the gap between psychiatry’s pretensions and its performance…

Another intriguing critique, via a book excerpt posted by Scientific American:

Like the poor folks waiting for Godot (who, as it happens, were quite possibly waiting for a madman), we are still waiting for those mysterious and long-rumored neuropathological causes of mental illness to surface. It has been a long wait, and on more than one level a misguided one, I think, if the expectation is that the ultimate explanation of madness lies here and only here.

Why is that? It makes no sense to regard the brain (as biological reductionists do) as an asocial or a pre-social organ, because in important respects its very structure and functioning are a product of the social environment…

Mar 02

“Resilience”: Jessie Close’s Memoir About Bipolar Disorder

You would have thought that after Glenn starred in Fatal Attraction, our family would have had a serious discussion about mental illness. Even Glenn didn’t see the connection between the crazed Alex Forrester character she’d portrayed and me. Jessie Close, Resilience: Two Sisters and a Story of Mental Illness

Many familiar with actress Glenn Close may already know she’s had an active role in helping to eradicate mental health stigma and that both her younger sister Jessie Close and her nephew Calen, Jessie’s son, have spoken openly about their own mental health issues.

In this PSA for their organization Bring Change 2 Mind, Calen, who has schizophrenia, is front and center. Glenn and Calen’s mom are also featured:

Recently Jessie, assisted by both Pete Earley and Glenn, wrote a memoir, Resilience: Two Sisters and a Story of Mental Illness, which reveals that a diagnosis of bipolar disorder with psychotic features was a long time in coming for her. 50-ish when she began to learn about her condition, Jessie had already experienced five failed marriages and a history of drug/alcohol addictions. And her son had been diagnosed with schizophrenia.

From an excerpt Early provides on his website, we learn that Jessie had actually been haunted by voices since her teens. She refers to the voices as “the Creature”—and they often told her to kill herself.

Was there anything significant from Jessie’s childhood that may have affected her mental health? Possibly. Kirkus Reviews describes a history of parental abandonment and family cult involvement:

…(H)er story quickly escalates into a harrowing ride for readers unaccustomed to the ups and downs of someone living with a mental disorder. When her parents joined the Moral Re-Armament [a cult] in the 1950s, Close’s childhood became chaotic, with frequent moves, one of which led the family to Switzerland and another to the Belgian Congo, where her father was physician to President Mobutu. By 15, she’d moved back to America to live with her grandmother and instantly began experimenting with sex, drugs and alcohol, three things Close would continue to abuse for the next three decades.

Selected Book Reviews

Publishers Weekly: “Close’s story alternates with brief corroborative vignettes written by her sister in a belabored and grim memoir that will nonetheless reach its intended audience thanks to the author’s famous sister and their shared nonprofit group geared toward mental health, Bring Change 2 Mind.”

Keith Herrell, Bookpage: “With a title like Resilience, it’s a foregone conclusion that the book will end on a hopeful note—in Close’s words, ‘a new chapter in my life, one of sobriety, hope and purpose.’ With her sister’s encouragement, Close is telling her story to the world in hopes of removing the stigma from mental illness. It’s a story well worth reading.”

Sharon Peters, USA Today: “Keep plugging through it. She has lived a life that even at her worst was spellbinding, and it’s a definitely-worth-the-read memoir.”

Jul 29

“Remnants of a Life on Paper”: Borderline Personality Disorder

There I stood, in a hole, deep in the ground. Did I dig it or just get in? Did I fall into it? Did someone else dig it and throw me in? Pamela Tusiani, Remnants of a Life On Paper: A Mother and Daughter’s Struggle With Borderline Personality Disorder

In the memoir Remnants of a Life on Paper: A Mother and Daughter’s Struggle with Borderline Personality Disorder (2013), authors Bea Tusiani, Pamela Tusiani, and Paula Tusiani-Eng describe Pamela’s struggles with this psychiatric illness, often considered one of the hardest to treat successfully. Pamela’s “remnants” in question are from her journals and visual art, culled posthumously.

Pamela was diagnosed at the age of 20 with severe depression and wound up having multiple hospitalizations and 12 ECT treatments. Although Pamela had been excelling in college, she had to leave there because of her difficulties.

According to Dr. Lloyd Sederer, The Huffington Post, it was after all the above occurred that Pamela finally received the more accurate diagnosis of BPD. “She was often suicidal, took overdoses of pills and cut herself frequently and deeply. After five months and five hospitalizations she seemed to be doing worse, not better.”

Next up was 19 months at an expensive residential facility in New England—and when this program wasn’t enough, a program in California, Road to Recovery. “Pamela’s course at Road to Recovery was labile,” states Sederer, “with times of sobriety and rebuilding her life and times of falling into states of impulsivity and self-abuse. She developed seizures, which proved to be ‘psychogenic,’ meaning that it was her psychology, not her neurology that produced them. Such is the power of the mind.”

Medications were never helpful enough and often harmful. Eventually Pamela’s prescriber agreed to try a drug called Parnate, something her mom had read could be useful with the type of “atypical depression” that’s often linked with borderline personality disorder.

Sederer: “Pamela was well into her journey of recovery when a series of treatment program and medical errors conspired to kill her. The awful irony was that she did not take her life, but irresponsible, stigmatizing and poor residential and medical care did.”

An example of one such error involved Pamela having severe side effects to the Parnate, which unfortunately was misdiagnosed—in all probability because she was viewed as a “mental patient.” Some of the other experiences mentioned in the book similarly seem representative of mental health stigma affecting not only the patient but also the parents.

Kirkus Reviews weighs in on what readers glean from the back and forth between Bea’s information and the viewpoints of her daughter:

The contrasts are often dramatic, as mother and daughter pull together, apart and back together in a painful dance that hurtles toward a tragic conclusion. Tusiani enumerates the unique difficulties of dealing with a mentally ill family member, from finding Pamela bleeding from a self-inflicted wound—she had a proclivity for cutting her arms and legs so she could ‘feel something’—to learning that Pamela, either through maliciousness or delusion, falsely accused her father of raping her. The unpredictable is always around the corner.

From Sederer’s concluding remarks:

…(N)o parent, no mother, should see a child die. And to lose a child who may have recovered is all the more agonizing. Bea Tusiani only tells us at the end of the book that she is a writer — though it is plain enough how powerful a writer she is as she lets the story, the events she chronicles, show us so much about her daughter, her family, and our flawed mental health and medical systems. What is also so inspiring about the book Bea Tusiani has given us, which is why I found hope (reason to believe), is how she gives us a front-row seat, so we witness the courage, love, determination and stamina of the Tusiani family. I am sure that Pamela would be proud to see how her pain, spirit and resilience — and that of her loved ones — have been so sensitively and cogently captured in these ‘remnants …on paper.’