Saturday, July 23, 2011

When Mental Illness Stigma Turns Inward

By Margarita Tartakovsky, M.S.
Associate Editor

When Mental Illness Stigma Turns InwardIt’s said that people with mental illness face a double-edged sword.
Not only do they have to contend with serious, disruptive symptoms, they still have to deal with rampant stigma. Sadly, mental illness is still largely shrouded in stereotypes and misunderstanding.
Stigma also can lead to discrimination. Yes, even in this enlightened day and age, it doesn’t appear as though prejudice and discrimination against individuals with mental illness are decreasing. (This study shows in some cases, it might even be increasing.)
We see stigma everywhere. Every time violence is automatically connected to mental illness in an article or news report, we see it.*
We see it in movies and other forms of media. We see it at work where stereotypes might be perpetuated, where employees are afraid to “come out” with their diagnosis.

We see it with our families or friends, who might say versions of “just snap out of it” or “get over it already” or offer “advice” like sleep more, eat less, look on the bright side and try harder.
There’s also just pure ignorance, especially when it comes to serious mental illness such as bipolar disorder and schizophrenia. As E. Fuller Torrey, M.D., wrote in Surviving Schizophrenia: A Manual for Families, Patients, and Providers, “Schizophrenia is the modern-day equivalent of leprosy, and in the general population the level of ignorance is appalling.”
But what happens when that stigma comes from within — when people with mental illness internalize these negative public perceptions?
An excellent article in Esperanza magazine — whose tagline is “hope to cope with anxiety and depression” — explored the issue of self-stigma. Not surprisingly, internalized stigma can worsen a mental health condition. How?
According to the article, self-stigma makes people less likely to seek treatment. (Other studies have confirmed these findings as well.) From the article:
“For example, a 2009 study from Leipzig University in Germany identified internalized stigma as ‘an important mechanism decreasing the willingness to seek psychiatric help’—and of far more influence than ‘anticipated discrimination.’ Likewise, a U.S. study of college students, published in Medical Care Research and Review in May 2009, found that personal stigma (as opposed to perceived stigma) was ‘significantly’ associated with unwillingness to seek help.”
Even medical students — who suffer from depression at high rates — report concerns about stigma. In a recent study published in the Journal of the American Medical Association, 53.3 percent who reported high levels of depressive symptoms worried that disclosing their diagnosis would be risky.
Also, 34.1 percent of first- and second-year students and 22.9 percent of third- and fourth-year students reported that they’d feel less intelligent if they sought help. And these are the individuals who’d presumably be more comfortable than the average person in seeing a professional.
Self-stigma also can lead to isolation, lower self-esteem and a distorted self-image. “People with a mental illness with elevated self-stigma report low self-esteem and low self-image, and as a result they refrain from taking an active role in various areas of life, such as employment, housing and social life,” according to David Roe, professor and chair of the department of community mental health at the University of Haifa. He and other researchers are exploring the efficacy of a new intervention to minimize self-stigma.
So what can you do? The Esperanza article suggested these tips to combat self- and social stigma:
“Explore therapy to help you reframe your life experience, improve your self-image and replace negative self-talk with more positive language.

Use the Internet for peer support. Twitter with others who have depression, trade recovery stories with Facebook friends, or join an online mental health forum (such as those at or Esperanza’s new peer-to-peer forum at or
Practice strategic disclosure. Tell your story to a peer or person with a realistic view of depression.
Get involved in outreach. Join advocacy groups. Participate in or help organize a walkathon or mental health fair. Write protest letters to media outlets or companies that spread negative stereotypes.”
Whether you have a mental illness or not, push past the misperceptions, and educate yourself with the facts.
Realize, for instance, that someone with depression isn’t able to just snap out of it. (Trust me, if they could, they would!) Realize, too, that eating disorders are serious illnesses; the person can’t just eat to fix it. (Anorexia nervosa has the highest mortality rate of any mental illness.)
Such is the same with all mental illnesses.
Educating yourself about what mental illness is and what it isn’t can help tremendously. So can spreading the word to others and getting involved in advocacy.
And, importantly, remember that you are not alone! Mental illness is common, and it touches everyone’s lives in one way or another. Consider checking out support groups or online forums to connect with others who are in similar spots.
?Have you experienced stigma? Have public perceptions of mental illness affected you or your seeking treatment?
* – Research has shown no causal link; risk for violence increases with drugs and alcohol, which is true for people without mental illness, and with the presence of past violent behavior.Go To Psych Central to learn more.

Wednesday, July 20, 2011

Breaking Barriers and the Doctor-Patient Relationship

I have been in active recovery from my eating disorder going on 3 years now. There
are very few, if any, services in Idaho for those with eating disorders. My treatment
is handled by two MD’s, a clinical psychologist and a registered dietitian that does
specialize. It’s an incredible orchestration of teamwork and communication. The
doctor-patient relationship is really important, but when you have to work on that with
4 different providers it gets a little hairy.
I see my primary doc every week. She monitors my weight and my meds. She will
review what I’ve eaten and what’s been going on in general. And, sometimes, we’ll talk
about knitting and good stuff like that. She told me one time that she’s going to have
to teach me to spin. That was quite a while back.
So I asked her again about the spinning. And she invited me to her house to learn.
Sure, that’s cool. I’ll get to meet the family and her critters she’s got.
Jocele and I chilled in a room upstairs in her house. It was painted this light blue
color and flooded with the afternoon sun. Plum orchards graced the scenery from the
window. She sat on a couch and did some embroidery while I tried desperately to not
break the fiber I was trying to feed the spinner. I asked her a lot of questions.
Where did you go to school?
What do you like to do?
What do you like to eat?
You was kinda like playing 20 questions. And she answered every single one.
When she taught me the
actual spinning, she would
stand up beside me and guide
my fingers on the fiber. She
literally pulled my fingers
down with hers. She did this
one other time with knitting,
and I couldn’t stand the
human touch. I would try to
get up the nerve to shake her
hands off. This time, though, I
don’t think I cringed too bad.
The frustration this time was
getting the tension right on
the yarn! She put some
classical music on, and I just
zoned out, producing crappy yarn but loving the moment. I spent hours in that room. Feeling safe. At peace. And really enjoying getting to know Jocele.

I had completely lost track of time and all of a sudden she was standing in front of the window asking if I wanted tostay for tacos, salad, and apple crisp. Inside my mind, I was questioning everything. I looked up, and the woman I had been bugging for the last two years to smile more gave me the biggest “come on...”
type of smile
I hate eating in front of people. I always have. Jocele treats my eating disorder. And
here she is wanting me to eat with her. problemo. I don’t really know
anyone too well, some friends of hers are coming over and I’m wondering why this is
even happening. But, nothing that I thought would happen happened. No one looked
at me funny. We dished about tattoos and ink. No one monitored my food. I was made
to feel....welcome. No one treated me like a patient or a client. I was treated like a
normal human being.
I don’t know how often experiences like that happen. It felt so good though - not
to discuss my disorder or medications. I was captivated by her son and daughter. I
enjoyed seeing Jocele with a bucket for collecting eggs instead of a stethoscope around
her neck.
One thing I had always told my therapist was that I didn’t want to be known as the
girl with the eating disorder. It’s not who I am. So, that being said, two very important
goals were reached that afternoon I walked around with chickens at my feet.
I fought the urge to get out and let myself see where it would go. I let myself be social.
Jocele treated me with pure human kindness and dignity. For an afternoon, I was not
her patient. I felt equal to her. Her patience level is astounding as demonstrated by me
duking it out with her spinning wheel. Maybe she just …....saw me.
To be treated with human kindness and dignity. I am always pushing for this in my
blog. Exposing myself and sharing experiences that society alienates me for. Feeling
Alone. Deeply saddened.

Jocele blew that out of the water. She did just that: treated me with kindness and
dignity. She proved with just one action that there are people that will look past the
outside struggles. What she did was get inside. Gave me a chance. Met me. And gave
me the hope that there are people that care about each other. Actions like that are
rare. And it chips away at the disorder.

Maybe next time I’ll get the tension right on the fiber. Maybe I’ll relax enough so I
don’t produce another batch of dreadlocks. But I’m totally thrilled Jocele will be there
to help!

Eating Disorder Awareness Week Video

Tuesday, July 19, 2011

Soul of the Healer

This includes the soul of the healer.
This was posted a while back on the face book wall of a doctor I'm fb friends with. What a profound statement. The caption the doctor put was, essentially, that the same rule applies to the soul of the healer. While it makes absolute perfect sense, have you ever stopped to wonder how the doctor is dealing with it all? I know for a fact that they get just as frustrated as the patient. Be encouraged to work together. Communication will go everywhere. And be respectful towards each other. 

Thanks for reading.

Monday, July 18, 2011

Preparing for Guest Posts

So, here at Renegade I am going to start focusing on a different point of view. The process of recovery can take years, I'm told. I'm entering year number 3 right now.
It's exhausting. Not only for me but for my family and my treatment providers. If I'm frustrated in recovery and hitting walls, can you imagine how my doctor must feel?

So, I'm going to start guest posts. My personal physician agreed to do a guest post. I just want to see things from her point of view as well. I'm really super excited about her posting!!

Recovery is not just about me. It impacts everyone. I'm hoping the posts by my guests will shed some light on the "other side".

Thanks for reading!

Sunday, July 17, 2011

My Beautiful Life: Laying it Bare

Meagan is a great writer and makes so many valid points in what she shares. I love her selfless attitude about it all.

My Beautiful Life: Laying it Bare: "While I was at the Hotel California (intermountain) they are huge advocates of journaling. They gave me a journal and after using it for abo..."

Let's talk poop.

****go back if you're squeamish or easily offended. Consider yourself warned.****

Ok, let's talk about what you've been dying to know about: POOP! As an abuser of laxatives (well...formerly) I am plagued with....can you guess.....chronic constipation. Bad. My dietitian Rhonda said that that's the issue she first wants to tackle.'s to wishing for luck.

I did them for years. Off and on. There was a period, though, where I was doing 10 a day every day for about a month or so. I started bleeding. So I kept telling Dr Skinner what was going on. I can't remember if I told her about the laxatives. I think I did...anyway. As an introduction to my 30s I was given a colonoscopy. Happy Birthday? Have you ever had one?? I testify to this day I did the prep correctly. I drank that thick, horrendous junk. Gagged on it many times. It's like swallowing a THICK oil. Well, based on every other patient's experience, I should have been cleaned out over night!
Hellllllooooo?! NOOOOOOOOOOOOOO, not me. Nothing happened with the prep and I began to get nervous the morning of the procedure. I will tell you just a few things about my experience:
1. I woke up very wet on my backside. Manual cleaning. Enough said. (yikes!!)
2. I love propofol. I don't remember a darn thing. Some of my friends work in surgery and were there.....they've got stuff on me now.
3. I was 30 years old. That shouldn't have had to happen.

I still can't really poop well. I'm 32 now. I am ingesting 2 tbsp of ground flaxseed in my yogurt every day. That seems to be doing something. I sure hope so. Chronic constipation is just one of the unfortunate consequences of an eating disorder. Laxatives are toxic to the body. Not to mention you start messing with all your electrolytes and body fluids. Dehydration big time baby!! Did I lose weight? Initially, yes, I did.
Did I gain it back? Oh yah. But now I am paying the price. Dr Skinner said it'll take a long time for my bowels to get back into proper working order. It could always be worse though.

I could have had part of my intestine removed and given a colostomy bag. Some days....when I go 1 or 2 weeks without any pooping (that's my norm) I wish I had a bag.
In reality....

I'm lucky. Chronic constipation is a small price to pay for all the damage I did.

Thanks for reading.


Coming soon.....time to dive in to the nittie gritties of recovery. The yuckies and nasties.
Get ready to behold a blog about poop!!!! We often don't think about the consequences..

Friday, July 15, 2011

Dietetic Diaries

My second meeting with my dietitian, Rhonda, was yesterday. She's the only one in my area that specializes in eating disorders, so I thought it best that I hook up with her. After our first meeting I could tell a significant difference between one who specializes and one who does not.
When I left the second meeting yesterday, I was ready to run away forever!

All she did was mention being welcome to eat in her office. I'm thinking to myself no, no, no. She then explained how she has a client that she eats with pretty much on a regular basis. Here's where the thoughts in my head crashed together:

Wow, that's really neat you do that with your client!
Heck no, I could NEVER do that!

So that's all I thought of when I left yesterday. I've had a lot of appointments this week, and couple that with being exhausted.............I wanted to cry.

However...the way things are presented to me in Rho
nda's office makes total sense. The options and choices that are given to me there free me up and allow me to feel like recovery is entirely possible.

Eating disorders are hugely about some other aspect of one's life. Food is merely a numbing out tool....for me anyway. But it still blows my mind how critical the food part in recovery is. It's become one of the hardest areas for me to work on.

And, sadly, that's the hardest part for many.

Thanks for reading. :)

Thursday, July 14, 2011

She Must Be Grateful

In no particular order, these are some of the reasons why I choose to recover instead of dying of cardiac arrest in my 30s because of an eating disorder. I'm a very fortunate gal.
Great friends.
Writing is my life.
My sobriety matters.

My brother, John. Your US Sailor
My boys, Andrew and William

Receiving a doggy facial

My family and friends

First time on a plane

My husband of 11 years

Tuesday, July 12, 2011

Being Alone in Recovery

As lacking in services for treatment in eating disorders as Idaho is, that's not what I mean when I say being alone in recovery. Being alone with my own thoughts for much of the day has been one of the biggest blessings as of late. Let me explain.
I lost my job on June 17th. I am 32 and had been working continuously since the age of 19. Despite having two kids, I have never been a stay at home mom. Not until now. I have no job. I watch my kids during the day. My recovery efforts with the eating disorder have been "half-assed" according to my husband. My work life deeply affected my home life. I wasn't focusing on my recovery at all - merely going through the motions hoping something would change. But being home during the day has opened up a new way of life.
I was given the choice to work on my recovery fully or look for another job right off the bat. While solely focusing on doing the actual hard work in recovery terrified me, I chose that. I have the time. I have the resources. I have people. How do I choose NOT to do it?  And so I've been alone in my own thoughts. Alone in recovery.

It's been extremely liberating. My biggest challenge right now is the actual food. I now work with a dietitian that specializes in eating disorders. I am extremely fortunate to work with her. One thing she did while creating my meal plan was give me choices. For each meal. While it seems extremely obvious, I had never had it presented to me like that. I'm allowed choices! That tweeked something inside me.
I have a wrist watch with three different alarms on it to remind me to eat. Yep. I am notorious for "just forgetting" or some other lame excuse. And I was clearly instructed to eat even if I was not hungry. The whole point is so my body can get its metabolism back in balance and function normally. Because, right sure does not!
Being alone during the day has put everything on me. There is no one watching me. I'm on my own. And that is scary to me.

It's getting done. Some days my food choices are whacked all out of order, but food is getting in. I look over my plan each morning and try to mentally plan what I'm going to eat for the day. But, as it turns out, it's actually remembering my times that is most difficult. I can't just eat when I feel hungry....I've kind of lost that sense in my body. It's starting to slowly come back. But making the conscious effort to eat is where the work is really being done. I do well most days, and overall, I'm pretty proud of myself. And yes, it's true. When the body is properly nourished, the mind soon follows. My mind is now focused on my relationships in life and how to properly interact with different people. And yes, food is one of my relationships that need to be worked on. As far as eating goes, my therapist flat out said, "It has to be done."
Find the courage to be yourself.

Being alone in recovery has been a good thing. It puts a lot of accountability on myself. And reporting back to my team in an honest fashion is what follows. That's a little hard sometimes, but today my doctor was pleased with my food intake. When stuff like that happens, it keeps me motivated. Work harder. And my husband has been a freaking trooper with me. We talk honestly and openly about everything, and finally I can now talk freely about food and my own body image. What a whole new thing.

No, being alone in recovery is not so bad at all....

Be Coolio