Mental Illness: Flashbacks

This post is meant to provide a brief overview on symptoms of mental illness and then insight into living with the symptom. It should not be used as a diagnostic tool, but if you relate to what you read, it may be time to have a conversation with a mental health professional.  

A flashback is a vivid memory experienced as if it is happening currently. Flashbacks can take different forms. They can be emotional, visual, auditory, olfactory, tactile or a combination of senses. Someone who experiences flashbacks may experience different types of flashbacks depending on their mental state or the trigger for the flashback.

Flashbacks are primarily a symptom of PTSD or C-PTSD as result of the memory processing issues created by trauma. Basically, your brain does not properly make a complete memory of the trauma and is trying to recall the memory by associating it with current stimuli. As a result, any stimuli that reminds a person of their trauma can become a trigger for flashbacks. These can be internal stimuli such as thoughts or emotions OR external stimuli such as a smell, taste, or physical sensation. 

Reactions to flashbacks can be emotional (i.e. shames, fear, anger, etc) or physical (i.e. racing heart, feeling disconnected from your body, etc) as your brain tries to process the trauma in real time. Some people find flashbacks more distressing than others and tolerance for flashbacks can change over your healing journey.

There is not a way to prevent flashbacks but there are ways to manage them.

1. Create a safe space to go to when having a flashback 

2. Practice calming breathing exercises

3. Use ground techniques ( I like my EMDR app or using the CALM app. Doing a mindfulness exercise that focuses all five senses can also help a lot. - D.M.)

4. Ask for support from family, friends, or mental health professionals

*Mental Health Care may include medications or therapy. EMDR therapy is often used for people with PTSD and CPTSD to help process traumatic experiences. 

5. Create a self-care plan ( See our posts on maintaining physical and mental health)

Helpful Links

Post-traumatic stress disorder (PTSD) - USA

PTSD: National Center for PTSD (USA)

Understanding PTSD flashbacks and triggers (UK)

Scientific Article: The neural basis of flashback formation: the impact of viewing trauma

What are Flashbacks? (Rape Crisis UK)

"I had PTSD for a number of years before I started having flashbacks. I often track the beginning of my PTSD experience to chronic nightmares I clearly remember starting when I was fourteen/fifteen years old. I did not start having flashbacks until after I was with an abusive romantic partner.

My flashbacks are often visual or emotional. I find scents to be a particularly strong trigger for me and have a small list of scents I now avoid. 

The most common time for me to have flashbacks is in the shower. I don't have any specific trauma that relates to being in the shower but I have a habit of seeking a hot shower to calm down and ground myself. Its also considered reasonable to lock a bathroom door even when things are spiraling. Sometimes when I am particularly uneven it feels like I close my eyes to rinse my hair as an adult and I open them to find I am back to being a teenager trapped in an abusive relationship. Same bathroom, strawberry shampoo, dim light... its all the same. It can be very disorienting and the desperate panicking that sets in can ruin my whole day. 

A couple years ago, I had a day where I woke up and looked in the mirror to see my ex's blood splattered on my face again. I knew it wasn't real and tried to just ignore it as I did my normal make up before I went about my day. It was the first time I had a flashback like that and to say I was unsettled would be an understatement. I felt so sad, like I would never ever find normal again. 

Interestingly, I got a tattoo on my shoulder a couple years back and its really helpful for grounding me for flashbacks in the shower or when I am getting ready because if I look down and don't see the tattoo... it isn't real. If I have the tattoo, then I know I am safe at home as an adult. I find it helps me a lot when I am struggling to keep myself in the current time.

That being said, I have also had extended visual flashbacks with no emotional reaction that lasted days. I continued through my normal day, working and even training staff, while doing my best to ignore the involuntary video reel in my head. It was a very strange experience because I objectively knew I was watching some of my worst memories but I had no emotions about them. I was complete apathetic to them and they were mostly annoying me because I couldn't focus. It lasted about three days and hasn't happened again. I never sorted our what triggered that one.

My final thoughts are ... time is hard when you C-PTSD between the flashbacks and dissociation. Time is slippery and my grounding in it is not as concrete as other people's seems to be. I often cant tell you how old I was when something happened and I am missing whole chunks of time because the stress was so bad that my brain just... didn't save the memories properly. There have been years of my life where I kept notebooks so I could jot down my days, more so when I am around people who make me question my reality. I am finally at a place in my life where a planner for work is all I really need. Home is safe and I don't need to stress everything so much."

- D.M.

Mental Illness: Addiction

This post is meant to provide a brief overview on symptoms of mental illness and then insight into living with the symptom. It should not be used as a diagnostic tool, but if you relate to what you read, it may be time to have a conversation with a mental health professional. 

Need help with addiction?  SAMSA National Helpline Call 1-800-662-HELP

Addiction can be an issue someone struggles with separate from any trauma but it is not uncommon for people who have trauma to struggle with some form or substance abuse or addiction when attempting to self medicate. This disorder is complex and can have multiple factors that contribute to an addiction which includes genetics.

Addiction is considered a chronic condition meaning it is life long. It is a disease. People with addiction issues compulsively seek and take a substance (or perform an activity) despite negative consequences. These can be consequences that impact your health, relationship, work, and/or overall quality of life.

There are two main categories for addictions.

• Substance (alcohol, drugs, medications, etc.)
• Non-substance (behavioral addictions such as sex, porn use or gambling)

Alcoholism is the most common addiction that comes up and as a result there are a variety of resources available to assist. We have included links to resources in the USA, UK, and Canada below. Nicotine and marijuana use are the next most common substance abuse addictions.

What is the signs of an addiction?

• Inability to stop
• Increased tolerance
• Intense focus on the substance or activity
• Lack of control
• Personal problems
• Health issues
• Withdrawal

How is Addiction Treated?

• Therapy
• Support Groups
• Medication
• Rehabilitation
• Hospital Management (especially important for withdrawal from substances that can create serious health concerns.)

Personal Experiences

"I personally do not struggle with addiction issues. A portion of my abuse was by someone who was struggling with abusing medication and as a result I have been very weary of substance use to the point of being extremely reserved in my alcohol consumption and medication use.

A friend of mine who does struggle with alcoholism and addiction as part of their journey has kindly offered to provide some insight. I will be adding them to our collaborators page as they plan to contribute to multiple subjects moving forward." - D.M.

"A Reflection on Addiction

Being an addict colors my thoughts, and actions in many ways. There’s the obvious desire thoughts like I want a drink, a joint, or to get laid. It's deeper than that as well, when I reflect or ruminate it’s from the perspective of an addict.  Anything I do or say serves the purpose of getting relief.  This doesn’t mean I'm ingenuine or only self-serving like addicts are often portrayed.  It means in addition to anything I do there is an underlying need for more. Accepting and not demonizing that fact has been important.

 My mental health is such that I'm riddled with insecurity, self recrimination, and anger. I don’t feel or accept love in the way other people seem to.  I’m constantly overwhelmed with emotion and thought.  I need it to stop if only for a while.  Drugs help the thoughts mellow, sex keeps the insecurities at bay, cutting provides control over my emotions.   It's not about good or bad coping, healthy or unhealthy behavior.  It's about function.  

  Over the years of self work and therapy I’ve learned to accept certain aspects of myself and learned to expand my coping.  I quit drinking, but still smoke weed, and do shrooms. I don't cut as often, but use rubber bands for small doses of pain.  Sex and touch still are the only ways I can process affection and love.  I’m working on it, but it still persists.  Mostly I’m working to unlearn the need to catastrophize or vilify my feelings.  It’s ok to be angry, sad, and insecure. It's the actions we do that matters, a simple enough concept, but it took me a while to really understand it.

  My goal isn’t to beat addiction, any more than it is to beat ADHD, depression, or trauma.  My goal is to live in such a way that I'm not destroyed by anything.  I want to be someone that can be depended on, and manage the requirements of living.  It’s not easy, but most days it seems doable. I have more hope and love for myself than I ever have.  Hopefully my experiences can help others.

Addiction is tough to talk about, because there is a zeitgeist around it being sad, but unsympathetic.  It's hard for people to understand why someone would choose to harm themselves in such a way.  I’d like to reframe how people see addiction.  There is a component to it that is like hunger. A need that can't be easily satisfied. A chemical imbalance, a trauma, or coping mechanism.  The reasons matter when trying to understand. " - R

Resources you may find helpful

National Institute on Alcohol Abuse and Alcoholism - USA

NHS Webpage on Addiction with support links - UK

Addiction resources - Canada

For Loved Ones

What is Substance Abuse Treatment? A booklet for Families (USA)

NHS - Advice for families of people who use drugs (UK)

CAMH - Information for Families (Canada)

Mental Illness : Hallucinations

 This post is meant to provide a brief overview on symptoms of mental illness and then insight into living with the symptom. It should not be used as a diagnostic tool, but if you relate to what you read, it may be time to have a conversation with a mental health professional. 

Hallucinations are false perceptions of sensory experiences that feel real - sight, sound, taste, smell, and touch. Most people will experience hallucinations in their lifetime. It is considered normal to have them when falling asleep or waking up. They can be a symptom of a physical illness such as a fever, dehydration, or migraines in addition to being caused by drug and/or alcohol use. Certain medications can cause hallucinations as a side effect. 

There are neurological conditions that may cause hallucinations such as Parkinson's Disease, Alzheimer's Disease, Lewy body dementia, Narcolepsy, and some forms of Epilepsy.

Multiple mental illnesses can also cause hallucinations with schizophrenia being the one most people immediately have come to mind. Severe PTSD, bipolar disorder, different personality disorders, Major Depression Disorder and delusion disorders can also cause hallucinations as a symptom. 

The treatment for hallucinations will depend on the cause. Chronic hallucinations as part of a mental illness are typically treated with medications such as antipsychotics. It is considered a manageable symptom.

Types of Hallucinations

• Auditory - Sounds
• Visual - Sights
• Tactile - Touch
• Olfactory - Smells
• Gustatory - Taste
• Presence - Feeling as if someone if in the room or standing behind you
• Propioceptive - Feeling as though your body is moving when it is not

How do you know you are hallucinating?

You may not realize it all, but it is possible to be aware you are hallucinating due to context clues in your environment (i.e. hearing someone who has passed away talking to you, being in a room alone, etc.)

Can you do anything to prevent hallucinations?

There are some things you can do to reduce the frequency, but they will not prevent hallucinations if you have an underlying medical issue.

• Ensuring you have good lighting
• Checking for sounds that may be misinterpreted (i.e. sounds from an appliance)
• Correcting lighting that can cause shadows, reflections or distortions
• Covering mirrors

If you are medication for hallucinations, taking it consistently as instructed.

How do I help my loved one having a hallucination?

It depends on the type of hallucination they are having but a good starting point is to stay calm and assess the situation. Listen to the person having the hallucination and then decide on a course of action.

• If asked, calmly confirm if you are experiencing the same thing. 
• If they are adamant that the hallucination is real, you may be crossing over into delusion territory, in which case playing along may be more comforting.
• Understand that you may not be able to do anything but be a calming presence until the hallucination has passed.
• If this is a new development, encourage them to see a medical professional.

The information for this section was pulled from the Cleveland Clinic's website

My Experiences with Hallucinations - D.M.

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Mental Illness : Depression & Anxiety

This post is meant to provide a brief overview on symptoms of mental illness and then insight into living with the symptom. It should not be used as a diagnostic tool, but if you relate to what you read, it may be time to have a conversation with a mental health professional. 

Mental Illness comes with a constellation of symptoms and can vary from person to person even with the same diagnosis. Depression and Anxiety are common symptoms as well as being a diagnosis on their own.

Anxiety is an intense, excessive, and persistent worry and fear about everyday situations. There are many types of anxiety disorders such as Agoraphobia, Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, etc.

According to the Mayo Clinic common symptoms include:

• Feeling nervous, restless or tense.
• Having a sense of impending danger, panic or doom.
• Having an increased heart rate.
• Breathing rapidly (hyperventilation).
• Sweating.
• Trembling.
• Feeling weak or tired.
• Trouble concentrating or thinking about anything other than the present worry
• .Having trouble sleeping.
• Having an upset stomach or other problems with digestion.
• Having difficulty controlling worry.
• Having the urge to avoid things that trigger anxiety.

Anxiety is more common than depression with a third of adults in the U.S. experiencing it within their life time. It can interfere with daily life and routine activities such as holding down a job, managing schoolwork, and relationships.

Treatment for anxiety typically involves therapy and/or medication. There are many types of medications that may be used to treat anxiety with SSRIs, SNRIs, benzodiazepines, buspirone, and beta-blockers being common choices depending on the type of anxiety.

More Information Here: National Institute of Mental Health

Depression is more than just being sad or having a bad day. It is a persistent feeling of sadness and loss of interest. Depression can be a symptom of many mental illnesses or a diagnosis on its own such as Major Depressive Disorder. It may also be part of a cycle of mood changes for those with Bipolar Disorder.

Hormones can also play a role in depression symptoms as part of Postpartum Depression and Premenstrual Dysphoric Disorder (PMDD).

According to the CDC* symptoms of depression include:

• Feeling sad or anxious often or all the time
• Not wanting to do activities that used to be fun
• Feeling irritable‚ easily frustrated‚ or restless
• Having trouble falling asleep or staying asleep
• Waking up too early or sleeping too much
• Eating more or less than usual or having no appetite
• Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
• Having trouble concentrating, remembering details, or making decisions
• Feeling tired‚ even after sleeping well
• Feeling guilty, worthless, or helpless
• Thinking about suicide or hurting yourself

Depression is extremely common with 1 out of 6 adults experiencing it sometime in their lifetime. The most common treatments for depression are therapy and medications (typically SSRI or SNRI varieties). Those with Postpartum Depression or Premenstrual Dysphoric Disorder may also be treated to balance hormones.

More Information Here: National Institute of Mental Health

" Depression and Anxiety are the primary symptoms I am being treated for as part of my PTSD. 

The anxiety impacts my daily life the most because I am borderline agoraphobic without medication. I get physical symptoms of anxiety even if I feel calm mentally. Its so frequent that I stopped wearing a smart watch because it was logging my racing heart as workouts when I was just sitting at my desk at work answering emails. I will mix liquid holy basil with tea to sip at work to help maintain that anxiety symptoms at a lower level so that I can work more efficiently.(Note: Holy Basil is a supplement that some people find helps with anxiety but you should absolutely tell your doctor if you are taking it because it can impact blood clotting.)

The anxiety seems to mix heavily with the hypervigilance for me, so being in places with lots of people or without clear lines of sight can push me into panic attack territory. Most of the time I can still function through a panic attack enough to walk out of a place or get somewhere "safe", usually my car. My heart will be racing and its hard to focus and breath but I just make myself practice box breathing and try to stay focused on the next simple task.

Sometimes I am otherwise having a good calm day at home and I can feel the anxiety in my chest, so I will be sitting watching youtube videos with my husband and just be like... man this really sucks and I don't want to feel like something is going to attack me. Usually my husband will just rub my shoulders until my heart rate comes down. It makes it hard to sleep or even stay asleep after waking up.

I have rescue meds I can take for panic attacks. Its a type of antihistamine that can act as a sedative. It works pretty well but also makes me very very sleepy so I don't like having to take it at work.

Interestingly, I don't have social anxiety. I am confident with interpersonal interactions and don't seem to struggle there.

My experience with depression as an adult is mostly that it makes me tired and gives me brain fog. I struggled a lot with it becoming more of an issue when I used hormonal contraceptives, so much that I had to be taken off multiple types because I was getting the severe side effects for it that you are supposed to immediately tell your doctor about. There was also some issue with suicidal ideation increasing with both hormonal birth control and some SNRI medications.

The depression symptoms were definitely more of an issue when I was in my teens, but it is hard for me to gauge how much of that was caused by my hormonal birth control use throughout those years."

-D.M.

* I have included a link to the CDC's website in this post because at the time of writing it is still functional. The current changes happening in the USA may result in this no longer working, at which point we will begin looking for alternate sources to reference.

Personal Growth: Healthy Expression of Negative Emotions

 Personal growth, like healing, is not a linear process. 

Learning how to express negative emotions in a healthy way can be one of the most challenging parts of your healing journey. It takes conscious thought and intention to build new healthy patterns of behavior. It means having to deal with situations you wish you could avoid and making a commitment to doing better. Sometimes you will "get it right" and other times you will fall back into old patterns.

Where do you start?

To break a pattern of behavior, you first have to recognize it and decide you want to change it.

"I got out of my relationship with my abusive ex and sort of stumbled into the relationship I had with J. It wasn't really something we planned on and I hadn't put any thought into what behaviors I needed to work on at all. A couple years in, we got into an argument and I threw a wooden spoon at him. He caught it and set it on the floor telling me that was unacceptable. 

It was the first time I had to really consider that how I handled my anger was not appropriate. I had grown up watching my mom throw things when she was angry and I had only really been in a relationship where violence was always a possibility. 

I decided then and there that I didn't want to be that kind of angry. I wanted to be the sort of person that my partner felt safe talking to or arguing with. I didn't want to be like my ex. It was not a good feeling but it motivated me. I still had to work on yelling and learning how to communicate my anger but it was where the change started." - D.M.

Once you have noticed the pattern and decided to change, you need to decide how you DO want to handle things moving forward. This is now your goal and it is going to take practice.

Also weird is not necessarily bad if it works and doesn't create an unhealthy pattern. (i.e. coloring on yourself instead of self harming)

"Anger is hard. Learning to sit still and be quiet and measure my own voice when I feel the rage rolling off me has been a huge part of my journey. There have definitely been occasions where I was just too tired or stressed to manage myself and ended up screaming at people I love. I then had to own that action, apologize and make amends.

Likewise, I have had to learn to rationalize out feelings of guilt and shame rather than resorting to self harm. The impulse is still there but this year I celebrate twenty years since I last cut myself. Its easier these days because they have more awareness and they even have apps for it like Calm Harm. " - D.M.

What if I mess up?

You own it. Apologize and make amends if necessary. Forgive yourself and try to do better next time. 

What if I can't do it by myself?

That's okay too. 

Therapy and Anger Management Classes are tools you can utilize to help you on this journey. 

Personal Growth: "Hitting A Wall"

This post is more of a pep talk because we all need one sometimes on this path.    

 Personal Growth is a journey and sometimes you will "hit a wall" in that journey where you don't have the resources to continue. This is normal and you aren't failing.

    Personal Growth is asking you to make a lot of small decisions that lead to big changes. It is a consistent effort and active choices that need to be made day after day. Some days you wont have the energy, or the time, or the tools to make the choices you wish you could. Some days your mental health will not let you make the effort you want to make. Some days are just bad days.

    It is important to remember that when you hit a wall, tomorrow will be another day. When you hit a wall, you can reach out to others for help be that a supportive community or support group or just a close friend. The ability to give yourself the kindness and grace you give others is as important of a choice toward personal growth as any other.

So if today is a bad day, a no good sort of day where everything feels like too much, then its time to go back to basics.

Have you eaten a real meal today?

Have you had a glass of water today?

Have you gotten enough rest?

Have you had a chance to run to the bathroom recently?

Do you need to take two minutes in a quiet place to breathe?

Have you been in sunlight today?

You will function best if you have these basic things and it wont make a bad day into a good day but it will make sure it is a slightly less bad day. It will give you what you need to get through today so that tomorrow can be a better day.

And if tomorrow is also a bad day, you will do the basic things and it will be a slightly less bad day than today because you now have two days of self care done. And you might have the energy to reach out to someone who you trust to ask for a little help. They might make you laugh and the day will be a little less bad. 

If you hit a wall. That is normal and that is something you can get past. You are not alone in this journey.

Personal Growth : Breaking Cycles of Dysfunction

    The next section of is about Personal Growth and taking back control of our own journey. It is the conscious decisions we make to heal ourselves. This entry is specifically about breaking the cycles of dysfunction in your family and your life.

    Dysfunction, like abuse and growth, comes in a myriad of varieties but it will have a pattern and is often generational. There are a set of unspoken rules for how the dysfunction works and continues. Families may unwittingly pass these unspoken rules and dysfunction down through generations, even while attempting to break their own cycles. 

    The first step to breaking a cycle is to acknowledge that one exists in the first place. It is taking a step back to observe patterns of behavior within a family unit and/or within your own actions and to access if this pattern leads to healthy behaviors or dysfunctional behaviors. It may include empathizing and sympathizing with why this pattern has emerged while also recognizing its overall impact to the family and personal health.

" My examples will largely be from the perspective of someone breaking family cycles. The hardest part of seeing the pattern for me was that I was too close to it. I could understand why people were behaving that way and I was giving them a pass. Understanding why someone behaves badly can be helpful in pattern recognition but it should not be a pass on behaving better or holding someone accountable." - D.M.

    The next step is to decide what you are going to do about this cycle of dysfunction that you have recognized. Depending on the type of dysfunction, even making small changes for yourself  can generate a reaction in others around you. It can be hard to decide where to start making changes - Are you going to start therapy? Confront your family with the issue? Get sober? Take an anger management class? Go low or no contact with people? Use Cognitive Behavioral Therapy to modify your own behavior?

    Once you have decided what to do you need to act on that decision.

    Most issues are the sort that you need to start with personal work and changes in your own life before you can incorporate any others in making changes. While therapy can be a great tool for some, it may not be the best fit or even accessible to all. The starting point has to be taking accountability for your own actions and making an effort not to repeat patterns of dysfunction in your own life. 

"I know that saying to make an effort not to repeat a pattern sounds over simplified and in some ways it is but that is the base of what breaking the cycle is. It is taking a long hard look at the life those around you live, noting the behaviors and outcomes and then making a decision for yourself on what you want. For example, I made note of my parents communication styles and how they handled anger. I knew the way their actions made me feel and I decided that I would not be handling my anger the same way they did. It has been an imperfect process of learning what management style works for me but ultimately I have reached my goal of not weaponizing my anger but using it as a conversation piece when moving toward a solution with my own partner and community. I still struggle with feeling like I have rage and anger issues but my feelings do not dictate my behavior. I am not continuing a cycle where my anger is used to create fear in others. " - D.M.

    Ways to break cycles of dysfunction

• Be honest and open to healthy criticism
• Be open to good faith conversations about how your behavior impacts others
• Be willing to sincerely apologize and make an effort to change problematic behaviors
• Disengage from bad faith conversations that continue patterns of dysfunction, this may take practice to learn to recognize
• Make a consistent effort to engage in healthy behaviors
• Accept that you may not know what a healthy behavior is and seek out information and resources to help you learn - its okay not to know what you don't know
• Seek professional help as needed, especially for mental health or addiction issues
• There are some struggles that simply can not be managed alone and it is okay to ask for help when you need it.
• Surround yourself with a community who supports your healthy choices
• Sometimes the family we are born into is not the most supportive, you may need to reach out to your found family or to a support group instead
• Be willing to set firm boundaries with others
• You have to advocate for yourself even if that initially makes you feel guilty or mean
• No is a full sentence
• You can love someone unconditionally without tolerating their behavior unconditionally
• Its okay to put yourself in time out if you need space
• Remember that progress is not linear and that your growth will come with both victories and defeats, but you can always try again tomorrow

   

     Some issues are worth a discussion with your family about why a pattern has emerged and about how it no longer serves to help the family. Whether this is something that is safe or that you have the spoons for is a serious consideration before starting a discussion. A discussion does not mean change on the part of others is guaranteed. 

Some discussions may be heavier one on one conversations with a parent or partner. This can be a place of growth if both parties are receptive to it.

    "Following up on my previous example, once I had addressed my own management of anger and worked through some of my own trauma I had a conversation with my mother. She was receptive to having an adult conversation where she explained to me the personal work she had done and acknowledged the way her anger impacted my upbringing. She then resolved to continue her personal work and the result is we have a much stronger healthier relationship today."- D.M.

    Some discussions will be a series of conversations with multiple people over time that result in an overall change for a wider family unit.

    In my family, the discussions that we have been having focus on mental health and how we talk about it primarily. It is myself and one of my cousins driving these conversations. They are not big sit downs with everyone in the extended family but rather a series of short conversations we have as they come up organically. The overall result is a gradual shift in how most of our family talks about and treats people who are openly struggling with mental illness resulting in more compassion and awareness.

    We do still have family members who are not open to change, but they have identified themselves as not being a safe place to seek help in mental health situations and the rest of the family has been able to adjust their expectations accordingly." - D.M.

    Family or group therapy may be a good fit for some situations but it is important to remember that certain types of abusers can make this an ineffective option. 

    Breaking the cycle of dysfunction is more about a million small choices you make rather than one big one. You may find that you break some cycles and not others. You can always make the decision to try again tomorrow or to try to help someone else in your family or community break a cycle you can not.

    " I talk a lot and I am close to both my grandmothers. It has been an eye opening experience to hear what cycles they broke in their own family before I was born. I think it is important to appreciate that sometimes there is a lot that needs to be fixed and each generation is working within its own paradigm. Again, I am not excusing some behaviors that still came down through the family but understanding why has helped me better evaluate why I make the choices I make.

    One of my grandmothers waited to have children until she could provide a stable home away from her mentally unwell mother in law. The other made a point to be a supportive mother and grandmother in a way she did not have in her own life. They each made their own mistakes but these were big decisions where they were learning as they went and wanted BETTER for their own children. Its imperfect and flawed as all humans are but I still see they act on the motivations for those decisions even today in their attempts to make our family a safe and happy place to be.

    And at the end of the day, both of these women are still willing to have conversations with me about their choices, their successes, and their failures so that my generation can learn from them and do better. This is them breaking a cycle still, because it is a relationship I have with them that neither could have had with their own grandmothers." - D.M.

   

    

Resource: Psychiatric Advance Directives (PAD)

Obligatory I am not a lawyer disclaimer here. 

A Psychiatric Advance Directive (PAD) can be one of the most empowering tools you have at your disposal if you have chronic mental illness that needs crisis intervention. Unfortunately, not all states recognize a PAD although you may be able to alter a advance directive ("Living will") to include mental health provisions in other jurisdictions. You can read more about what US states accept here.

What is a Psychiatric Advance Directive?

A Psychiatric Advance Directive is a legal document in which you describe the types of mental health treatments that you would or would not be filing to receive. It also allows you to designate an authorized decisionmaker for mental health decisions on your behalf.

It is essentially a "living will" for mental health.

How does it work?

You fill out a PAD form with your preferences. The forms are fairly self explanatory where it asks a question and you fill in a blank. A witness or notary may be required to be present when you sign the form to make it legally binding. (FYI: Many banks and post offices have a notary on staff in the US)

This form is then copied and put on file with your therapist, psychiatrist, or doctor for use in medical emergencies. It may also be wise to carry a copy on your person or take a copy with you to the hospital if necessary in a crisis.

You can request this form be removed from your file at any time if you need to update it.

Where do I find the form?

Forms for the US can be found here - https://nrc-pad.org/states/

Form provided by the NHS here

"I am going to be honest, this is not going to be an easy form to fill out for most people. You will need to sit and think about where you are at your worst and be realistic about the treatment you will need as well as what you want to happen. The idea is you let your most stable self make decisions for your most unstable self. 

This also means you are designating someone else to be able to make decisions for you and it will require at least one big conversation with that person to ensure they know what you want and agree to act in that capacity. 

Personally, while my husband knows my mental illness the best and I trust him the most, I did know that he will need emotional support if I am in crisis. I made the decision to make additional notes that he should reach out to two friends we refer to as "The Vulcans" if he was ever unsure of what I wanted because one could emotional support him while being rational and the other is someone I know would make the same choice as me in that spot 98% of the time, so if he was unsure she could provide insight. I know this may not be an option for everyone, especially if you don't have a community that talks about mental illness as openly as mine does. " - D.M.

An important part of being an adult is making sure you have a plan in place for when things go wrong. This includes ensuring you have done some estate planning, even if you are younger, because it ensures your wishes are followed when you do not have control. This can include having a Power of Attorney, Advance Directive (Living Will), and Will drawn up. A Psychiatric Advance Directive may be an excellent addition to these documents. 

" I am a firm believer in my mental illness not being my fault but being my responsibility.

Before I had surgery I needed to get my legal documents in order and I wasn't sure where to begin. My grandma gave me a little list of documents people normally put together so I could google forms. I ultimately decided to sign up for the free trial for Law Depot and use their software to create my forms. They do an excellent job of breaking down this process (here) and I was able to get everything notarized at the post office." - D.M.

Adverse Childhood Experiences (ACE) Test

 In my Vlog about taking classes to become a foster parent I mention the ACE Test. I wanted to provide our readers with more information about what the ACE Test is and what information it provides. - D.M.

The Adverse Childhood Experiences (ACE) Test is a ten question quiz that identifies specific childhood trauma experiences which could be linked to a higher risk of health issues as an adult. The higher the number of ACEs, the greater the negative effects. 

This test is limited. It covers only ten types of trauma and does not include traumas related to poverty, housing insecurity, various forms of discrimination, or isolation. It is possible for a person to have faced greater levels of adversity and trauma than this test reflects. 

It also does not account for protective factors that may have an overall positive effect. Nor does it account for genetic factors that may make a person more sensitive to ACEs.

What do ACEs do?

They generate toxic levels of stress that have life long heath impacts such as:

• Increase risks for depression, asthma, cancer, and diabetes
• Increase risk of heart disease
• Increase likelihood of risky behaviors such as smoking and heavy drinking
• Increase risks of disordered or unhealthy eating habits

Yes. The trauma you experienced as a child could have a life long impact on your health. It is not a foregone conclusion but it is worth knowing your score and considering if you need to make life style adjustments with an increased risk factor.

Want to know what your ACE Score is?

Take the test here

Learn more here:

CDC*

American SPCC

NIH

* I have included a link to the CDC's website in this post because at the time of writing it is still functional. The current changes happening in the USA may result in this no longer working, at which point we will begin looking for alternate sources to reference.

Self-Care : Stress Management

 Continuing our section on Self Care is Stress Management.

No one is surprised to hear that stress can be bad for you. The kind of chronic stress that many people with mental illness and trauma live with is especially hard on the body. Symptoms can include pains, insomnia, sleepiness, low energy, being unfocused, nightmares, changes in appetite, increased alcohol or drug usage, emotional withdraw and more. It can have long lasting effects on your cardiovascular and mental health.

The most common advice you will see about managing stress are the same things we included in the post on Self Care: Maintaining Physical Health. Occasionally you will see suggestions for therapy or medication tossed in along with lots of recommendation to meditate. Those are excellent ways to support your overall health.

There are some additional healthy techniques and strategies you can use to manage stress in your day to day life.

• Set Realistic and Maintainable Boundaries
• Learn to say "no"
• Set aside time for yourself to decompress
• Learn to walk away 
• Seriously- GO FOR A WALK. It helps.
• Minimize your to-do list
• Its okay to have a "Good Day" list and a "Bare Minimum" list
• Consider how many of your to-dos are necessary, wanted, or just an obligation or expectation from someone else
• Take a break if you need it
• Build a reliable support network AND use it
• Being able to have honest compassionate conversations with those around you will give you the freedom to ask for support or for space depending on what you need
• Give yourself multiple ways to ask for support if you need them
• Talk out complicated feelings with a trusted friend
• Avoid unnecessary stressors 
• Don't get into emotional charged topics if you don't have the energy for it
• Delegate work if you need to
• Rationalize
• Your emotions are valid and your feelings are very real but sometimes they are not rational, take a moment to breath through it
• Don't try to control what is uncontrollable 
• Be Silly
• Will a dance party fix a fight with your boss? Probably not but the movement and some silliness might help you breath
• Sometimes all you can do is laugh, so embrace those moments as best you can
• Breathing and Stretching
• Stress can make you tense which is only going to make you sore later- be nice to future you and stretch. 
• Unwind
• Take time to disconnect from work and people. Give yourself a few minutes to just BE
• Consider setting a rule in your house that when someone walks in the door they get 10 minutes before being asked to do anything for anyone

There are also some unhealthy coping mechanisms that can create long term issues such as self medicating with alcohol or drugs, excessive sleeping, various forms of escapism, and unhealthy relationships with food or sex.

You can read more about healthy stress management here: Managing Stress (CDC)*

Stress management has been one of the biggest forms of self-care I partake in because the build up of stress brings out the worst in me. It makes me less than I am capable of - less kind, less compassionate, less whimsical, less myself. It takes a toll on my work, my family, my relationships.

Part of me is always thinking... but you've endured worse. You have survived worse. This should be nothing. 

Its not nothing though. We are not meant to live a life of constant unrelenting stress and because of trauma my whole nervous system goes into hyperdrive. I don't want to live like I did when everything was bad. I want to be able to enjoy the good in my life and I desperately envy those who live without the anxiety and spiraling.

But HOW do I manage stress?

It depends on the stressor. 

Work Stress - I ask my boss for help and I give myself grace to be less productive for an hour, an afternoon, or a day. I take PTO if I need to. If I am angry, I walk around the building a few times. If I am anxious about something irrational I take a few minutes to talk to my work bestie until the anxiety eases up.

Relationship Stress - I talk to my spouse. We have built a healthy marriage with strong communication and I rely on that foundation. I won't say the conversations are always pleasant or easy but I do typically feel better after a talk, and maybe a good cry with cuddles. We work to remember its us against the problem and that we are a team. He is my partner.

*This is similar to how I handle friendship issues. I try to only cultivate friendships where I can have serious conversations and address issues directly. It is not always successful and I am not perfect at it. I have come to accept that some friendships are not meant to be forever.

Family Stress - I reach out to those that can relate. I have built strong meaningful adult relationships with the women in my family so that I can reach out to my mom or my grandma or my aunt depending on the particular drama of the moment. I will discuss major issues with my husband. If I am really expecting something crazy, I may schedule a therapy appointment.

In-Law Stress - This is a particular subtype of family stress. I talk to my husband about how he wants to handle the situation and then I step back to let him handle his family directly if necessary. Occasionally a therapy appointment is helpful if I am really dwelling on something.

Mental Illness - Sometimes I just have to accept that I can't stop the physiological symptoms of my mental illness and I just try to breath through the worst of it. There are times where I just sit and rationalize and others where I just keep repeating "It isn't real." because that is all I can do. I also allow myself to take some time off work when necessary and sometimes I run away from everything for an afternoon or evening. If rage is the issue, sometimes I use free writing to get it all out. Exhaustion is always better than misery.

Physical Illness- Again, sometimes you cannot stop your body from doing what it is going to do. I have worked on giving myself the permission to take the time off to rest and to not be ashamed of what is out of my control. I breath through pain and try to meditate. Sometimes it works and sometimes swearing helps more. 

At the end of the day, sometimes there is no good solution so I either cry my face off or go for a walk/run. 

-D.M.

* I have included a link to the CDC's website in this post because at the time of writing it is still functional. The current changes happening in the USA may result in this no longer working, at which point we will begin looking for alternate sources to reference.

Self- Care - When Good Enough is Good Enough

 In addition to our posts about Self Care, I have recorded a Vlog about some real challenges and what it means when "Good enough is Good enough."