In mid-December, when my “seasonal stress” looked a lot like clinical anxiety, I found a task force. Christmas was nearing and I’d been trying–not very successfully–to soothe myself with spiritual reflection. The biblical story would soon tell of the Magi, opening their treasure chests to give gold, frankincense, and myrrh to an infant in a barn. And in the meantime, my wise wo(men) opened their webcams to send spiritual treasure to a woman in Philadelphia.
With a splitting headache, I clicked the link to a presentation called “Self-Compassion: Navigating Life’s Challenges Series”. The Saving Lives Taskforce, a non-profit organization addressing substance abuse issues in North Carolina’s Outer Banks hosted the panel. My cousin Louisa is a member.
Louisa is a seasoned healer, deeply committed to the slow, sacred work of regeneration. She’s both an Occupational Therapist for older adults, Coach for recovering addicts and kitesurfing Instructor. I’d put myself in her capable hands any day.
I probably would have skipped it if not for Louisa. I’m wary of compassion talks after seeing so many wellness professionals and self help influencers beat the topic to death with less than insightful articles, TED Talks, and books. Whenever any concept is stripped of its full complexity for easy digestion, the meaning gets rinsed clean. Compassion content had lost its spark.
As the panel jumped into discussion of gratitude and challenges, I felt immediate solace just being in the company of people who have accepted the constancy of pain and its opposing force, love. Effective healers like these know that we rebuild after loss with the raw material of compassion. Full stop.
The presentation was excellent. While discussing boundaries, someone said “make sure when you say yes to someone else, you’re not saying no to yourself”. I loved that–a self care one liner I haven’t seen on Pinterest, Etsy, Instagram or the New York Time’s Best Seller List.
And then the most meaningful experience arrived during Louisa’s guided meditation. I went to the back of my apartment where it’s quiet and sunny in the afternoon. My cousin’s steady, judicious voice moved me as soon as I heard it. How much comfort there is to be found in the sure footed voice of another! How weary I get, always listening to mine!
We were gently directed to close our eyes and find our breath.
Louisa asked us to call up one physical or emotional pain and hold it without fighting back. My head hurt so much that it took enormous strength to not writhe, rub my temples and tense my muscles. My jaw locked with the effort. The pain obliterated all other sensation.
With each breath, Louisa invited us to join her in silent acknowledgement of what we felt.
“This is Suffering”. Deep exhale.
“This is Suffering”. Lungs open to take in breath.
“This is Suffering”.
My eyes filled with tears. There we were, strangers holding our own and each other’s pain in exquisite solidarity. THIS was the feeling I worked so hard to summon in my work as a writer and mental health advocate. I return to it all the time because in the presence of unbearable pain, we find ourselves in dark echo chambers. In those arid spaces, we die. And in the light of community, we survive.
Psychiatrist M. Scott Peck described this paradox well, writing: “How strange that we should ordinarily feel compelled to hide our wounds when we are all wounded!
Community requires the ability to expose our wounds and weaknesses to our fellow creatures. It also requires the ability to be affected by the wounds of others. But even more important is the love that arises among us when we share, both ways, our woundedness.”
In the immediate aftermath of the webinar and now a month later, I hold the “love that arises” close. This love born from a mere 60 seconds of sitting with my suffering in the presence of others fighting the same fight. Think of how everyday when we encounter each other in public, the very same thing is happening but we don’t acknowledge it.
And when I ponder the inherent connection between vulnerability, compassion and strength, I know this is the stuff worthy of all the lectures, articles, books and videos we can produce.
The last month of 2021 didn’t have a single big story but that doesn’t mean we should sleep on the highlights. It’s my job to sift through the noise and find what matters–here’s the fruit of my labors (better late than never). Happy New Year, everyone. I have a feeling this is going to be a good one.
A new study looked at societal stigma in the U.S. over the last 20 years. Researchers wanted to determine if attitudes toward mental illness and alcohol dependence have changed and if so, how much. Survey data from 1996 to 2006 showed improvements in public beliefs about the causes of schizophrenia and alcohol dependence, and data from a 2018 survey noted decreased stigma for depression.
Doctors are recommending young people spend no more than 1 to 2 hours of screen time a day. after an open paper connected worse mental health with hours spent on electronic devices.
Is insomnia a predictor for mental disorders? Researched conducted a review of studies on insomnia finding baseline insomnia was associated with a significant, 2.6-fold increased odds of mental disorder.
The use of antipsychotic medication decreases the risk of assault for emergency response personnel says this study.
Gum disease is connected with a nearly 40% increase in risk for mental illness says a major study out of England.
Schools have a small but important role in early adolescents’ mental health says this study.
Time in nature for city dwellers lessens loneliness says this study.
Hormone therapy is linked with decreased risk of suicide in trans teens says this study.
In the largest meta-analysis of trials on digital interventions for the treatment of depression, researchers found that computer- and smartphone-based treatments offer a promising method to address growing mental health needs.
More than 80 percent of oncologists frequently see mental illnesses in their cancer patients.
Anxiety and depression top the list, but addiction and PTSD also show up.The study also found nearly half of physicians believe they have inadequate resources available to support their patients with mental health needs.
I’ll be back with more in January. Until then, be well.
I happen to be one of the lucky ones. My state, Pennsylvania, decided to extend COVID state of emergency legislation through March of 2022. That’s a big deal for me because I get to keep receiving virtual therapy from my New York based psychiatrist. While legislation allowing for streamlined cross-state licensing procedures is being adopted in more and more parts of the country, many states have reverted to the pre-COVID status quo. I had trouble finding information about my state’s status online so I’d like to provide these helpful sources in case you want to know you’re doing your own searching.
When COVID started demolishing pillars of communal life, many Americans found themselves hovering close to an emotional edge. The demand for mental health treatment spiked sharply, reflecting an increased need from current patients and a new call for services from first time sufferers. In January 2021, 41% of adults reported symptoms of anxiety and/or depressive disorder, a number that has been stable since spring 2020. Early 2020 data showed that drug overdose deaths were particularly pronounced from March to May 2020, coinciding with the start of pandemic-related lockdowns. Access to treatment was, and continues to be, a life or death issue. At the same time, something else was happening: with no magic bullet in sight, Americans started weighing the relative merits of the old versus new. Change had come overnight and in some areas of life, it felt like an improvement.
Residents of states observing federal and state restrictions expressed satisfaction with less hours spent working from the office. The Economist cites data showing pre-pandemic Americans spent only 5% of their working time at home. By spring 2020 the figure was 60% and the transition was going more smoothly than expected.
No profession was more impacted by this shift than psychotherapy. The standard practice has always been for treatment to take place in an office setting, doctor and patient seated across from one another in close proximity, Covid’s restrictions forced therapy out of the office and into the virtual sphere, thrusting the whole field into uncharted territory.
State of emergency laws were passed to accommodate new challenges. One particularly welcome overhaul was the suspension of confusing, restrictive state licensing laws that prevented clinicians from treating patients in different states. Psychiatrists had been treated like lawyers under the former legislation, permitted to practice only in states where they had passed a regional exam. The regulation makes sense for lawyers, given the variance of state laws, but not for doctors, who treat the same psychiatric symptoms regardless of geography. Clinical depression looks no different in California than it does in New York. With restrictions lifted, access to treatment grew exponentially. Residents of rural areas, historically underserved because of clinician shortages, got care. People sheltering in place out of state did not experience any harmful interruptions to their therapeutic work. Without the increased flexibility, millions of people would have been left to navigate the distress of isolation, economic uncertainty, and grief, all alone.
As a new resident of Pennsylvania, I benefited personally from these adjustments. My treatment was in flux—while looking for a local doctor, I continued working with my longtime psychiatrist, licensed to practice in New York State. The policy overhaul kept me and countless other vulnerable patients from reaching a crisis stage.
With ample time to observe the effects of virtual treatment, the merits of teletherapy, an already vastly successful modality from the perspectives of app enthusiasts, gained mainstream acceptance from clinicians and patients alike. A branch of medicine slow to move towards telehealth flourished and grew. Anyone observing or participating in the phenomenon witnessed a beautiful thing; not only did many more people get treated, studies collecting feedback from patients and doctors showed absolutely no compromise in the quality of care. Patients reported feelings of deeper intimacy towards therapists and additional comforts unique to the modality, like the presence of pets during sessions and an increased openness connected to sharing from relaxed spaces.
With respect to the life saving impact remote care has had on Americans who struggled before and during COVID, along with the sizable projections for emerging needs from formerly untreated groups, the temporarily relaxed laws need to be made permanent. Legislative action from both federal and state authorities will prevent widespread tragedy. We should all be asking our lawmakers, “if not now, when?”.
The American Psychiatric Association put forth an informed and well organized list of policy suggestions. If implemented, the modifications will eliminate crippling barriers to care going forward. Each proposal concerns one of the four problematic areas of former legislation: reimbursement, HIPPA/privacy standards, licensing, and prescribing power. The continued improvements in treatment outcomes and access to care rely on their passage.
1) Extend the telehealth waiver authority under COVID-19 beyond the emergency deceleration to study its impact
2) Remove geographic restrictions for mental health and allowing the patients to be seen in the home
3) The Drug Enforcement Agency should finalize regulations for Ryan Haight Act to allow for the prescribing of controlled substances via telehealth without a prior in-person exam
4) Continue to pay telehealth services on par with in person visits
5) Allow for the use of telephone (audio) only communications for evaluation and management and behavioral health services to patients with mental health and substance use disorders when it is in the patient’s best interest, and should be paid at no less than an in person visit
6) Maintain coverage and increased payment for the telephone evaluation and management services
7) Remove frequency limitations for existing telehealth services in inpatient settings and nursing facilities
8) Include all services on the expanded Medicare-approved telehealth list including group psychotherapy
9) Allow teaching physicians to provide direct supervision of medical residents remotely through telehealth
There is no middle ground when it comes to reimagining the framework denying the necessity of easily accessible care for a traumatized country. Failure to act will leave us all vulnerable.
© Copyright 2020, American Psychiatric Association, all rights reserved.
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In my personal experience, when I see large scale ugliness in the world, my depression does a little victory dance. My depression is like, “see! I was right all along”.
Same with set backs in my personal life. Someone I love back at a bottom, work being stalled, loneliness, and things in my apartment breaking.
As my depression gains ground from these sources of validation, it starts chipping away at my most reliable source of strength. My faith.
People are so quick to hurl the trite sentiments “everything happens for a reason” and “what doesn’t kill you makes you stronger” and “pain builds strength and character.”
Please refrain from speaking those silly words.
Because there exists a tipping point for everyone, and as you fumble towards yours, strength and character aren’t doing so well.
Some say that in order to become whole, you must first break. That’s always made sense to me. What then about life post-brokenness, when you thought a new worldview had coalesced, and you see that’s just a straw house about to be razed by a slight wind?
People pick up their pieces many times throughout a life. Endings are the surest thing out there: divorce, death, estrangement of any kind.
From where does the stamina come for those who have to pick up those pieces on a regular basis?
That’s a serious question that I ask myself all the time.
If I can’t meditate or pray because those activities lost their palliative properties, depression is celebrating a sizable victory.
And that’s the kind of month it’s been.
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- That’s the title of Andrew Soloman’s brilliant book about depression. I looked up the phrase’s origin and found this:
In the original Christian context, “Demon” is a kind of indifference to the spiritual life, “a lack of spiritual energy.”
And then there’s “Noonday”. The qualifier implies an unafraid visitor, confident enough to appear in broad daylight.
This week I’ve been slaying a dragon. Someone I love very much suffers from bipolar disorder and we’re waging war against an enemy that possesss boundless energy. We meet our foe with a profound deficit: a “lack of spiritual energy”.
How do we even begin to meet the challenge? What’s our path to victory? The answer is simple.
We fight as a family. We fight with every fiber of our being. We fight for the one we love more than life itself.
And victory will be ours.
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