Poly Advice for the Mentally Ill: “Set Clear Boundaries and Expectations”

May 8, 2016October 9, 2022 Jess Mahler

I’ve written a fair bit about boundaries in the past. There is a fair bit of theoretical discussion in polyamory about the benefits of using boundaries or agreements in relationships. Theory aside, no matter which you use for relationships, we all have personal boundaries. For instance, many people have a boundary about respect in relationships. They will not be in a relationship with someone who does not respect them.

According to the Big Book of Poly, it’s important to have clear boundaries. Unclear boundaries lead to miscommunication and people accidentally infringing our boundaries. Which is why clearly stating our boundaries is important.

However, the idea that we need to set clear boundaries assumes that are needs and desires are generally stable. Or at least predictable. “I need to be left alone right after work so I can recharge, but after I come out f my room I love to have you cuddle with me.”

Okay, I’m not phrasing it as a boundary, but it is a clearly set expectation, right?

So, for me, most of my triggery issues involve sex. I love to have my breasts played with–except when my anxiety or PTSD are acting up, in which case you can send me into a panic attack just brushing my nipple. Worse, sometimes I don’t know what’s going on in my head. I can think I’m fine for some sexy time, until you touch me and my brain blows a circuit.

How do I set a clear boundary or expectation about that?

“I love it when you play with my boobs, except when hate it. And I can’t always tell you ahead of time if it’s okay or not. So…we’ll play it by ear, okay?

Well, that’s clearly stated, at least. But not exactly a clear boundary.

When our partner’s ask us about our boundaries, or needs, or what works for us, there’s a pressure to find a way to smush all our illness-related unpredictably into a neat box that we can explain and understand. We owe it to our partners, right?

We don’t owe our partners clear boundaries. We owe are partners the truth.

Own Your Randomness

I don’t know anyone with mental illness who doesn’t wish that the random firings of our brains would go the fuck away. It would be nice to be able to predict for ourselves how we’re doing and what we need from one day to the next, never mind our partners.

Since we can’t, the best we do for our partners is the same thing we do for ourselves: own the randomness and try to plan for it.

“I can’t give you a clear idea of my needs and boundaries. I’m sorry about that but what I need changes a lot with how my mental illness it doing. I can promise to tell you in each moment what I need or want to the best of my ability. And I’ll try to explain how my illness affects me and my needs, so you have some idea of what to expect depending on how I’m doing.”

It’s not a perfect solution, but it’s honest, it’s respectful, and it’s the best we’ve got.

This post is part of the Polyamory and Mental Illness blog series.

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Mental Illness and Polyamory Recap

April 10, 2016October 20, 2022 Jess Mahler6 Comments

This blog series is already one of the longest I’ve written, and I’m about to add a bunch more information. So before we dive back in I decided it would be good to do a quick recap of the key points of the series so far.

Educate Yourself

If one of your poly partners suffers from mental illness, take the time to learn about their illness and how it affects them. This includes both reading up on the general information about the illness and learning about how your partner experiences their illness.

There is No Quick Cure

Mental illness is not something people can just “get over” and there is no fast treatment or cure. Medication can help manage mental illness but is NOT a cure or fix. And just finding the right treatment approach can take months, if not years.

Mental Illness Can Mimic Relationship Problems

Mental illness can mimic jealousy, abuse, loss of interest, and a number of other relationship problems and red flags. Treating mental illness like relationship problems just compounds the problem. Treat mental illness like mental illness and relationship problems like relationship problems.

The Big Book of Poly Doesn’t Always Apply

There’s a lot of great advice for folks in poly relationships. However, some of that advice doesn’t work when combined with mental illness. Following the standard polyamory advice may not work or may even make things worse. If this happens it doesn’t mean you/your partner are bad at poly. It just means advice formulated by and for mentally healthy people doesn’t always apply when dealing with mental illness.

Sometimes Mental Illness Isn’t

Michon Neal shared a horrific experience of being misdiagnosed and having physical illness dismissed as “all in zir head” and mental illness. In Michon’s case the problem was compounded by the way doctors tend to overlook or dismiss all black women’s problems as mental illness.

For Michon this meant, ze was not only NOT getting the treatment ze needed, but was put on unnecessary medications with severe adverse effects. Nearly as harmful is when the wrong mental illness is diagnosed. Depression and bipolar may seem similar from the outside, but the respond very differently to treatment. Bipolar and schizophrenia are often mistaken for each other.

Irrational Feelings Are Still Feelings

Mental illness makes people feel things that have no basis in reality. Telling someone feeling abandoned because of depression “You are wrong to feel that way!” or “how dare you say I don’t do enough!” or anything like this doesn’t help anyone. That doesn’t mean you should try to fix problems that don’t exist. But understanding and empathy go a long way. “I’m sorry you feel that way. I hope you know that I love you and would never abandon you. Would cuddling for a bit help?”

This post is part of the Polyamory and Mental Illness blog series.

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Polyamory and Mental Illness, Part II

April 2, 2016December 20, 2022 Jess Mahler

Okay, folks. After a much needed hiatus, I’m going back to tackling polyamory and mental illness. For those who are interested, the old polyamory and mental illness posts are below.

Mental Illness: Monster or Myself

My approach to mental illness frames it as something outside “who I am”. It is very similar to how I frame cancer. My father is not a cancerous person, he is a person who is battling cancer. I am not an ill person, I am a person who is battling mental illness. As part of framing mental illness as separate from myself, I speak of it as a monster, invader, or in other extremely negative terms. Being able to frame my mental illnesses as something apart from myself has been a major factor in my healing.

However, not everyone frames mental illness this way. Some learn to embrace and accept mental illness as part of themselves. My mother, who has multiple sclerosis, rejects the idea that she is a person with disability. She is a disabled person who has learned to accept and love herself, disability and all. Similar, some people with depression, or anxiety or PTSD have embraced their mental illness. It is a part of themselves, and learning to love themselves, including their illness, has been a major part of their healing.

Through this blog series, I have framed mental illness as something separate from the person suffering from it. I frame it that way because that is the framing that works for me and because it is the framing I am familiar with. Unfortunately, for people who frame mental illness as part of themselves, my framing can be hurtful. I’m sorry for that, and equally sorry that it took me so long to realize this.

If you have a mental illness, you need to frame it in a way that works for you. If your partner has a mental illness, you need to learn how they frame it and support their approach. If your partner frames mental illness as a part of themselves they are struggling to love and accept, please DO NOT use my framing. Speaking of mental illness as a monster that is taking over their lives, an illness that is distorting who they are, or similar terms can be extremely hurtful to people who use that framing.

For the rest of this series, I am going to try to be more aware of my framing. I am going to try to present information in a way that will work for both frames. When I can’t, I’ll differentiate which frame a certain approach or idea is best suited to.

Polyamory and Mental Illness Blog Series:

This post is part of the Polyamory and Mental Illness blog series.

Abuse and Mental Illness

December 3, 2015October 20, 2022 Jess Mahler4 Comments

Abuse or Mental Illness?

In discussing mental illness, and specifically PTSD and other trauma-related disorders, I mentioned that some symptoms of mental illness can mimic abuse. I say mimic because while these symptoms may look the same as abuse, they are not about trying to control.

Here’s a classic example:

My partner has several mental illnesses which interfere with his perception and memory. So he might ask me for a drink, I bring him something, and half an hour later he says, “Where is the drink I asked for?” I say I brought it, but he insists that I never got it for him, and he needs a drink right now. If I tell him that he’s wrong and I did get it, he might try to convince me that I am misremembering and never brought him anything.

This could very easily be gaslighting, but it isn’t. He didn’t actually see me bring the drink, doesn’t remember drinking it, and is honestly upset because I told him I would do something, and to the best of his knowledge I didn’t. He isn’t trying to control me or rewrite my memories—his memories are deceiving him.

In similar ways, someone with mental illness trying to express their feelings may come across as guilt tripping, manipulative, etc. Not because they are trying to control or manipulate, but because there are damn few ways someone in the depths of depression can say, “I feel like I’m a useless waste of space and you are going to leave me because I’m such a piece of shit” and NOT come across as overdramatic at best, manipulative and guilt tripping at worst.

This makes it difficult to identify if a partner’s behavior is the result of mental illness that is out of their control or abuse.

Abuse AND Mental Illness

While mental illness often mimics abuse, mental illness can also occur alongside abuse. Having mental illness doesn’t magically stop a person from being abusive. In fact, some of the roots of abuse (like insecurity) can be worsened by mental illness.

When mental illness and abuse occur together, it can be very difficult to separate out which is which. After all, you can’t get into someone’s head to find out if they are trying to control you or not. In fact, I suggest you don’t even try.

We want to be supportive of the people in our lives. Abusive partners with mental illness can and will use this against you. You cannot support them and help them heal while they are using their illness as a tool to control you. In fact, they may actively resist healing. If they get help and get their illness under control, they lose a powerful tool for maintaining their hold on you.

How to Recognize a Mentally Ill Person Who is an Abuser

Okay, this is inexpert and based entirely on my experience.

Working to Get Better

Mental illness is hell. The vast majority of people with mental illness want to get better. Not everyone who wants to get better can or will do the work. Gaining control of mental illness is hard. And just about everyone will, once in a while, say “Fuck it, I can’t do this anymore” and stop trying for a while. But most people will (sooner or later) pick themselves up and start trying again. An abuser who is using their illness as a tool for control may be one of the people who doesn’t want to get better. Being mentally ill is too useful to them.

Not Willing to Support You

Someone with severe mental illness may not be able to give you the support they (or you) want. But they will try. A few days ago, I wanted to take our son to the park, but I wasn’t feeling well enough to go out alone. Michael was in a real bad way, hadn’t slept all night, and was having paranoid/delusional thoughts about terrorists attacking our small town. But he said, “If you need me to go, I’m there.”

Now, there have been times, lots of times, he couldn’t be there for me. But no matter how bad he got, he did what he could. Sometimes that was just holding me while I cried. Sometimes it was watching our son for a few hours so I could get out.

The mentally ill abusers I’ve known have not been willing to support anyone but themselves. They make promises about when they are feeling better, they make excuses about how bad they are doing. Any request for support (or even understanding) becomes about them and how unreasonable you are to ask them for anything when they are so ill and need so much help.

If they do help or support you in some way, it comes with a massive guilt-trip and/or is something that also benefits them.

Their Illness is About You

When people who are mentally ill say things that sound abusive, they are focused on themselves. When they talk about wanting to kill themselves because no one loves them, they aren’t trying to get a reaction. They are lost in their pain and their maelstrom of a mind. Very likely nothing you can say will effect how they feel because your voice can’t overcome the horror in their head.* (Exception: if a specific trigger set off the mental illness than addressing the trigger can help—won’t fix everything, but will help.) If you ask what you can do to help, unless they have a shit ton of experience managing their mental illness, the likely response is “Nothing,” or “I don’t know.” If there is something you can do it will usually be simple “Sit with me” “Hold me” “Get my comfort snack out of the fridge” “Make sure the kids are quiet for a while.”

A mentally ill abuser who says the same thing will be looking for and needing a reaction. They want you to comfort them, to reassure them, to tell them that you love them and will always be there for them. And at some point they will probably slip in something you can do to prove that you love them. If you ask what you can do to help, they will ask for some change in your behavior, “Don’t call her for a few days” “Promise you’ll do X from now on” etc.

Their illness becomes about the things you do or don’t do. Their mental health crisis, their panic attacks, their bad days are your responsibility to fix (and often, according to them, your fault).

Now, these aren’t constant. Someone who is mentally ill but not an abuser will sometimes do things that an abuser does. Someone who is mentally ill and an abuser will sometimes not do these things. Look for patterns. Someone who is not an abuser will usually ask for nothing more than “get me some water and sit with me a bit,” but once in a while might ask “Please don’t go out tonight, I need you with me.” Someone who is an abuser will frequently ask for you to change how your behave (using their illness to control you), but might sometimes ask you to just hold them until they feel better.

Look for those patterns.

Standard Disclaimer

*That doesn’t mean you shouldn’t say anything. Your presence, your support, and your love mean a great deal and can help a mentally ill person through some horrible times. But just like hugging someone with a broken leg doesn’t make the pain go away, reassuring someone in the depths of mental illness doesn’t make everything (or even anything) better.

This post is part of the Abuse in Polyamory blog series. It is related to Polyamory and Mental Illness.

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Living with an Abusive Metamour (Guest Post by Liz Gentry)

November 27, 2015October 20, 2022 Jess Mahler10 Comments

This week Liz Gentry of Learning Many Loves has chosen to share her experiences of living with a mentally ill and abusive metamour. Many thanks to Liz for opening up about this difficult experience.

Don’t forget to stop back next week, when we’ll be taking a close look at the intersection of abuse and mental illness.

First, a little background: I met my partner Jon a couple of years ago. Jon was dating another woman, Lora for about nine months before Jon and I started dating. A few months into Jon and I dating, Lora moved in with Jon. After dating Jon for a bit over a year, the three of us moved in together. We lived together for about fourteen months before Jon broke up with Lora. His reason for breaking up with her was (as he has told me) the abusive cycle that their relationship followed.

In writing about a day in the life of my experience living with someone who is verbally abusive and emotionally, the first thing I need to say is that what I expect from the day varies greatly with where we are in the cycle. The beginning of the cycle has no abuse. Lora and Jon would get along fine. Then small instances of verbal abuse and control would begin to creep in. Those instances would escalate over a several month period. Then there would be a huge screaming fight where Lora was repeatedly verbally and abusive towards Jon. The week after the fight, there’s a period of constant low-level fighting with a lot of controlling behavior and attempts to impose control through badgering, gaslighting, black and white thinking, and threats. Eventually, a resolution was reached, and there would be a honeymoon period again, with no abuse for some days to a few weeks before slowly beginning to escalate again.

The hardest thing for me (being a metamour living in and observing this abusive dynamic) was watching someone I love be abused, ridiculed, mocked, screamed at, and badgered. I am definitely someone who would rather be hurt myself than see someone I love being hurt. For all that experiencing this second-hand hurt, as I was not the one being abused, there was a deep sense of powerlessness about this. I couldn’t control my partner’s boundaries about what behavior he would accept. But I did need to figure out where it was appropriate for me to draw my boundaries, without becoming controlling or coercive myself. Although I viewed Lora’s behavior as abusive, Jon didn’t always agree at that time (later, he painfully came to the conclusion on his own that her behavior was really abusive many of the times when he said that it wasn’t). This put me in a very uncomfortable spot – if he doesn’t believe the behavior is abusive, is pushing him to understand that it is gaslighting? Even if I’m doing it out of pure concern (we could say “for his own good”), do I have a right to push until he agrees with me?

I think the answer to that is no. Even if I’m doing it out of concern, forcing Jon to agree with me about Lora abusing him is still forcing Jon to do something, and that is abusive. He had to come to his own conclusions, and live his life accordingly.

But trying to let him live his life, and live with him and his abusive partner was incredibly hard. It was scary. It was enormously stressful. When Lora was gaslighting Jon, I doubted my own ability to evaluate situations for harm. I repeatedly went to my friends and asked “Is this normal? Is this healthy? Jon doesn’t seem too upset about it, so maybe I’m just causing problems by being upset by it. Maybe I’m not really poly. Maybe this is a way that jealousy is manifesting itself and I’m really just trying to get rid of Lora so that I can have Jon all to myself. What is wrong with me?”

Admitting to myself that Lora behaved abusively took a long time, because I didn’t want to have an abusive metamour. I didn’t want to believe that my partner was willingly being in a relationship with someone who was abusive. Complicating matters were Lora’s diagnosed mental illnesses of PTSD and anxiety disorder. Was a behavior really abusive if it was fueled by those mental illnesses? Having gone through several hard times with depression myself, not cutting Lora slack with her mental illnesses felt hypocritical, shitty, and like I was being a bad metamour and a bad person.

Inside myself, there was a cycle of anger, fear, guilt and doubt. Anger at the way Lora treated Jon. Fear at seeing how it impacted him and wore him down over months. Guilt for not cutting Lora some slack and being more understanding, given her mental illnesses. Doubt that I was really poly, doubt that I was overblowing things, as I seemed to be the most concerned of the three of us, when it came to Lora’s behavior and the impact it had on Jon. But then, that doubt would give way to anger the next time I heard Lora and Jon fighting and she told him that he was as abusive towards her as her drug addicted ex had been.

Lora’s ex used to do things like “punish” Lora by having unprotected sex with other women, and then telling Lora that he’d done so while he and Lora were having sex the next day. Knowing this about Lora was painful and evoked a lot of sorrow in me for what she went through, while simultaneously enraging me that she would compare our loving, supportive partner to such a dirtbag. Who wouldn’t get angry at that and think to him/herself “No matter what is going on with me, it is WRONG to say that to a loving partner in a fit of anger”?

Living with Lora was also hard because I didn’t know how to treat her. She seemed to like me. She claimed to want to have a closer relationship with me. She wanted us to be close friends. In theory, I wanted that too, but seeing how she treated Jon…did I really want to get closer to Lora? And as time went on, she slowly began to treating me in ways that concerned me deeply.. She didn’t hear that I said to her, and attributed behaviors to me that I’d never do, but she would. For example, one day, I was getting home from work as she was leaving to go to the store. She said to me “Jon is a little sick, and he’s sleeping. I wanted you to know so that you don’t get angry with him that he doesn’t come and greet you as soon as you get in”.I have never been angry at a partner for not coming up and greeting me as soon as I got home. But a long-standing fight between Jon and Lora was that if Jon didn’t drop whatever he was doing and greet Lora when she came home, it was a sign that he didn’t really love her. Because Lora felt that Jon should always be excited when she gets home, and eager to greet her immediately, if he really loves her.

There’s a lot in that paragraph, that describes the level of control and expectation of behavior that Lora had towards Jon. It’s also a good example of the kind of difficult situation I was in. We all have our quirks and vulnerabilities. Was Lora feeling strongly about Jon greeting her as soon as she gets home just a little quirk? If Jon agreed to do this, then did it mean it wasn’t controlling? Did I have any right to judge or have an opinion about these things?

I didn’t know the answers to those questions. I did know that if getting closer to Lora meant that she would expect the same of me, then I didn’t want to get closer to Lora. I’ve never expected such a thing from a partner, and I didn’t want to be close to someone who would have that kind of expectation of me.

Because of the number of things that Lora could take offense to, coming home slowly become stressful and unpleasant. I never knew what small thing would send Lora into an enraged tailspin. I never knew when a quiet night would turn into a stressful night, as Lora found fault with something that Jon said or didn’t say, did or didn’t do. There were many instances where it seemed like Jon couldn’t win. When he wasn’t being berated for saying something Lora didn’t like, he was being berated for not talking to her enough.

While these fights fueled by Lora’s insecurity and masked as problems with Jon’s behavior raged on, I would think to myself “What does he see in this relationship? Do I have the right to judge it? What do I do about this? Can I do anything?”

This is a glimpse of what it was like, living with an abusive metamour. The self doubts, the anger, the hatred, the fear…it was all terrible. It took a toll on my health, my sleep, my ability to function at work, my ability to trust myself. I restarted therapy to work through these problems.

I’ve become passionate about having a dialogue and creating some form of action plan for other metamours who find themselves realizing that their hinge partner is being abused by another partner. I believe it’s very important to address controlling and coercive behaviors as soon as they begin and to push back against them immediately. I think that – had we all been willing to open our eyes and admit that Lora’s behavior was abusive earlier – it’s possible that our relationships could have been salvaged. By denying the reality of her abusive behavior for so long, I hit a point of no return, where I cannot have anything to do with her. Likewise, Jon (who is still in contact with Lora) isn’t certain if he’s able to have her in his life in any capacity. He’s trying to figure that out, but he’s said that it would have been easier to stay a part of her life had the abuse not escalated to the degree it reached while they were together.

The abuse of one partner by another will reverberate into the relationships with all other partners. I think we owe it to ourselves, as people committed to multiple loving relationships, to figure out different ways to handle this kind of situation. We need to work through finding the tools to do what we can to combat abuse, while respecting the agency and humanity of all those involved. Doing so would reap enormous benefits not just for the poly community, but potentially for our other friends and family members who may be dealing with abuse.

Liz Gentry is a pragmatist disguised as an optimist. In addition to her day job as a corporate desk-jockey, she specializes in hoping for the best, but preparing for the worst. Though of a poly-friendly mindset all her life, she didn’t start living polyamorously until about five years ago. She chronicles her polyamorous journey at https://learningmanyloves.wordpress.com/.

This post is part of the Abuse in Polyamory blog series. It is related to Polyamory and Mental Illness.

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Polyamory and PTSD (and other trauma and stress related disorders) Part 2

October 1, 2015October 20, 2022 Jess Mahler22 Comments

Part 1

Ways to Manage Trauma and Stress Related Disorders in a Poly Relationship

Okay, I said this about anxiety and the same goes here:

If anxiety manifests in ways that look like jealousy or controlling behavior, do not follow standard poly advice for dealing with jealousy. Learn to tell the difference between anxiety-induced and jealousy-induced behavior. Treat jealousy like jealousy and anxiety like anxiety. Your partner has tools for managing anxiety for a reason. Use them! Treating anxiety like jealousy just compounds the problem.

Similarly, treating PTSD like abuse just compounds the problem.

When someone’s trauma causes them to act other unhealthy manners—including abusive manners—treating them like an abuser doesn’t help. That doesn’t mean their harmful behavior should be allowed to pass. But telling someone in the middle of a triggered response to past trauma that they are guilt tripping you and you won’t stand for it doesn’t help anyone.

Similarly, calling someone out for gaslighting and telling them that you aren’t going to put up with this shit, does no good when they honestly believe what they are saying.

This is also a good place to link to an old rant of mine. At some point in the healing process, people with trauma and stress related start to recognize that their thoughts and feelings are distorted. “I know what I’m feeling isn’t real, but I can’t stop feeling this way,” or any similar statement is not an invitation to tell your partner all the reasons why they are wrong to feel that way.

Managing trauma and stress related disorders starts with everyone involved learning to recognize what is the real person and what is the disorder. This can be as simple as not taking it personally if a partner needs to cancel a date because they can’t drive that night. It can also be as complicated as learning to recognize the unintentional gaslighting of a partner who honestly remembers things wrongly.

You can’t deal with the disorder until you can recognize when the disorder is fucking with things.

Next, focus on small steps. If the very idea of polyamory is triggering flashbacks of past betrayal, scheduling your first date next week will not work. In fact, this is one of the rare situations where I would actually encourage a couple to date together. Either both date the same partner or double dates with both their partners. Yes, this is completely against The Big Book of Poly. Explain the situation to potential partners, be VERY aware of the difference between a triangle and a T, and it can work.

Another option, if you are living with a partner and that partner going out on dates is triggering is for your partner to try having “date nights in.” I hope it goes without saying, but this absolutely needs to be your partner’s decision. Date nights in is something I’ve done a fair bit of in the last few years. Not because of mental health issues, but because my most entwined partner is disabled and we have a young child. Leaving my partner who sometimes couldn’t stand up w/o help alone with a young child (or worse, infant) he might or might not have been able to take care of was not something either of us were comfortable with. So poly partners and potential poly partners would come to our home, usually after the kid was asleep for the night. My live-in partner would put on his headphones and lose himself in a computer game or video. My visiting partner and I would have a “date night” on the living room couch, bed, or front porch.

Now, moving slowly doesn’t mean refusing to make changes. You can start out dating together or having date nights in to reduce the amount of triggering someone in your polycule is dealing with. Eventually you will want and need to move towards dating separately/having date nights out. Exposure is a big part of treatment for trauma and stress disorders for a reason—the only way to heal is to slowly push the boundaries of the disorder. Note, NOT your boundaries, but the boundaries imposed on you by the disorder. And ONLY at a pace you agree to. Note also, I didn’t say “a pace you are comfortable with.” When it comes to trauma there ain’t no such thing. Like doing physical therapy for damaged muscles, if you stick to what is comfortable you will not heal. But it needs to be your pace, and no one else’s. Poly partners can support, encourage, suggest, or set their own boundaries on what they are and are not willing to deal with. They can’t set the pace for you.

Once the effects of the disorder are recognized, everyone involved needs to be involved in setting ways to work around, with, and through these things. For something like not being able to drive, or needing to avoid dogs, this can be as simple as making alternate transportation available.

For problems directly triggered by polyamory it can be more difficult. I suggest having two levels of response for most trauma related problems. “This is triggering me but I can deal with it (maybe with a bit of support.” and “OMFG help!!!”

If a poly partner recognizes signs that someone’s reaction or action is due to a disorder, point it out. “Hey love, it sounds like this is triggering you. I get you are angry and scared. How do we deal with this?”

If there are things that can make it easier to deal with your partner leaving, ask for them. If there is nothing that will help, but now that you recognize being triggered you can deal with it, this is a good time to try to push through. There may be backlash later but you can probably manage until your partner gets back from their date—tell them that. They’ll go out, and you’ll deal as best you can until they come back, and when they come back you can ask for whatever aftercare you might need.

If you absolutely can not deal, tell your partner. DON’T assume that they know how badly you are doing. Have an “OMFG help!” response you’ve discussed and agreed to try ahead of time. Maybe your partner doesn’t go out when you are doing this badly. Maybe they call their partner and switch to a date night in. Maybe your partner doesn’t leave you alone, but helps you contact another partner, friend, relative, etc, to come over and be with you while they are out.

Trauma and stress related disorders that are severe enough to regularly impact dating and relationships—especially if dating and relationships are triggers—definitely need to be discussed upfront. And that doesn’t mean just the person with the disorder discussing their needs with potential partners. It means their partners discussing it with their potential partners. Everyone who might be impacted by the disorder needs to know what to expect. Otherwise they do not have the opportunity to give fully informed consent.

Okay, But What If I’m Just Starting to Date Someone with a Trauma and Stress Related Disorder?

The above discussion is mostly directed at people with trauma and stress related disorders and their long term partners. If you are just starting to date someone with a trauma and stress related disorder—or if you are starting to date someone whose entwined partner has a trauma or stress related disorder—you are in a very different boat.

But it starts out the same. Learn as much as you can about their disorder, how it affects their behavior and how it affects you.

There is a line from the musical Rent that is very relevant here, “I’m looking for baggage that goes with mine.” As I’ve said before we all have baggage. Mild trauma and stress related disorders, especially when they are largely under control, can go with most people’s baggage, as long as you are willing and able to work with them a bit. Severe trauma are stress related disorders are a very difficult type of baggage to match. If your baggage doesn’t “go” with he baggage of someone who has a trauma or stress related disorder that’s okay. But if you find them attractive, interesting, and generally someone you’d like to be in a relationship with, and they tell you some of their baggage is labeled “PTSD” or “Acute Stress Disorder,” don’t give up on them just based on the label. Get to know them and their baggage enough to see if maybe their needs and challenges can actually fit with yours.

Be prepared for an adjustment period. Dealing with something like severe PTSD has a steep learning curve, and like I’ve said before flashbacks can be horrible to watch. In general, the longer its been since the trauma that caused the disorder the better a grasp your potential partner will have on it and the better they will be able to tell you what they need and how it affects things. But that is only “in general” because everyone, and every trauma, is different. My experience has been that trauma from a single incident (bad car accident) causes a smaller range of problems than trauma over a long period of time. That isn’t to say that trauma from a single incident is easier to deal with—but trauma related to a bad car accident will usually only have triggers related to cars. Trauma related to single incident of rape will have triggers associated with that single incident (where it took place, what was done, sex in general). Trauma from a long term abusive relationship can be triggered by a wider variety of things. The trauma isn’t just associated with being in the car—it’s associated with being in bed, and sitting down to dinner, and saying something foolish in public, and the smell of burnt bread, and the scent of the abusive partner’s shampoo, and broken dishes, and, and, and, and…

So depending on what caused the trauma (and how severe it is), a potential partner may not be able to tel you everything about how the trauma affects them. They may not realize that the smell of burning bread triggers them until you get distracted in a make out session one day and they forget dinner is cooking.

What they can and need to tell you is a general idea of how severe the problem is, what areas of life it affects, what they need from you if they are triggered while you are together (or triggered when you are supposed to get together), and as much as they can of their major and common triggers.

Once you now what you are dealing with, it’s a matter of patience, flexibility, and awareness.

When Disorders Become Abusive

I said before that treating a partner with PTSD like an abuser when the disorder causes them to say things that are gaslighting or otherwise abusive doesn’t work. But what does work? How do you respond in a healthy manner when negative thoughts start to sound like a guilt trip?

First off, you need to be able to recognize what is happening. If you can’t recognize 1) what my partner is saying right now sounds like gaslighting and 2) they are saying this not to manipulate me, but because they really believe it, you will not be able to deal with it. And dealing with this is, at least initially very much on the ill person’s partners. Why? Because you can’t even begin to fix something you don’t realize is happening. And from the perspective of a person with a trauma or stress related disorder, all they are doing is expressing ho they feel. Polyamory is supposed to be about communication, right? So why do people keep getting angry when they try to communicate how they are feeling or the way they perceive things?

Once you recognize what is happening, you need to NOT address it right away. Instead you need to address what is under it. Let’s say a partner with PTSD says that obviously they aren’t important, they don’t matter, they might as well just die for all anyone cares about them.

You recognize it as a potential guilt trip. But you also recognize that your partner is genuinely hurting and is really attacking themselves, not trying to get a reaction out of you. What do you do?

In my experience the best way is to address it head on. “I’m sorry you feel that way. I love you very much, and I love having you in my life—even when (you drive me crazy/things don’t work out/we have a fight). I’m sorry I can’t (give you what you need right now/make this right/etc).” If you can do something for/with them, “How about we do X for a while, I think that might cheer both of us up.” If you need to take care of yourself or need to get out the door, “I really need to do this right now, but maybe when I get back we can do X.”

Reassure, offer support, and don’t let their negative thoughts/outbursts/etc keep you from doing what you need to do.

Later, when they are in a better place mentally and you are calm, is the time to bring up. “When you get upset and say things like that, it comes across as a guilt trip/manipulative/emotional abuse. I know you don’t mean to or want to do that. I need you to be aware of the way you say things.”

It will take TIME to make a change. Because they are not fully in control of themselves, because their thoughts and perceptions are distorted, and because they are dealing with psychological arousal, they won’t be able to “stop and think before you speak.” But if they aware of the problem, they will work to be aware of how they communicate and get better. It will probably start with their saying something about it after they calm down, “Hey, I shouldn’t have said that before, I’m sorry.”

I have had PTSD, I have had a long term partner with PTSD, and I have had a metamour with PTSD. Of all the mental illnesses I have dealt with, PTSD is the most difficult in a polyamorous relationship (or, I believe, any relationship). The flashbacks, dreams and memories are horrifying, but at the end of the day they are just a thing. You get through them. The psychological arousal combined with negative thoughts are destructive. Both destructive to the person with the disorder and destructive to the people who care for them.

Mild trauma and stress related disorders aren’t easy to deal with. But most people I have known who are willing and able to do the work involved in polyamory have also been full capable of doing the work involved in maintaining a health relationship while dealing with the disorder. Severe trauma and stress related disorders demand a huge amount of time, energy, and compassion. Polyamory can work with severe trauma and stress related disorders—in fact, a healthy polycule can make the disorder easier for everyone involved and help the person with the disorder heal. But it is definitely not a relationship that is right for everyone.

This post is part of the Polyamory and Mental Illness blog series.

Polyamory and PTSD (and other Trauma and Stress Related Disorders)

October 1, 2015October 20, 2022 Jess Mahler

This post and others discussing specific mental disorders will reference the Diagnostic and Statistical Manuel of Psychiatry and Psychology, Edition Five (DSM-5). Apologies to my international readers, I’m just not familiar enough with the ICD to use it as a reference.

Trauma and Stress Related Disorders

Post Traumatic Stress Disorder (PTSD)
Acute Stress disorder
Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
Adjustment Disorder

PTSD is the best known of the trauma and stress related disorders. In the US it is widely associated with military personnel and the psychological damage of military service. However Trauma and Stress Related Disorders, including PTSD, can be caused by any type of trauma. Car accidents, abuse, natural disasters, and high-stress jobs such as working in an ER or fire department are only a few of the possible causes of trauma and stress related disorders.

PTSD and Acute Stress Disorder are can be caused by trauma that has happened in the past or long term ongoing traumas.

Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are childhood disorders. From what I can find they result from trauma related to loss of caregivers or damage to a child’s ability to connect with their caregivers. While these disorders develop in childhood, they don’t magically disappear when people become adults. Residual effects can cause difficulty with social interaction or forming attachments to loved ones.

Adjustment Disorder is a (relative) mild disorder caused by ongoing life stress. These stresses don’t need to reach the level of trauma. Anything from a family illness, to job instability, to loss of a relationship, can cause adjustment disorder. An important facet of adjustment disorder is that it is not an ongoing psychological condition. As soon as the stressor causing adjustment disorder is removed, the disorder will go away on its own.

Symptoms of Trauma and Stress Related Disorders

Symptoms vary a great deal, and everyone’s experience of trauma and stress related disorders will be different. However most symptoms fall into a few general categories:

Re-experiencing the event—flashbacks are the best known form of this. Literally reliving the event or events that caused the trauma. However it can also take the form of dreams, obsessive thoughts, or disturbing memories popping up out of no where. One note about flashbacks: most people assume flashbacks are either visual (seeing the event again) or full-sensory (experiencing it with all your senses). However flashbacks can take other forms. A person may suddenly feel their abusers hands on them, reliving the physical feeling of the abuse. Of hear screaming or other sounds associated with the trauma.
Heightened arousal—Arousal in the psychological sense is not the sexual arousal we usually associate with the word. In fact, arousal in psychology is a lot closer to what laypeople call the “fight-flight-freeze” response. In a state of arousal, everything is more intense. Arousal can lead to everything from aggressiveness to impulsiveness. It often causes hyper-vigilance and sleep disorders.
Avoidance—someone with a trauma or stress related disorder will often go out of their way to avoid anything that reminds them of or is associated with the trauma or stress.
Negative thoughts, mood, or feelings—this can take a lot of forms, from negative thoughts about yourself, to negative thoughts about the whole world. At base it is a distorted perception caused by the trauma or stress. Someone with adjustment disorder related to job loss might think that there is no point in trying to find a job. Obviously they just aren’t worth hiring. An abuse survivor will often expert other people to act like their abuser did. Etc. Memory loss from the trauma is also associated with this symptom.

Treatments for Trauma and Stress Related Disorders

Medication

There are no medications specifically for trauma and stress related disorders. Unlike many mental illnesses, with these disorders there is a very clear, non-biological cause. Effective treatment needs to address the experience and associated feelings.

That said, medication is sometimes used in association with other treatment. Anti-depressants, anti-anxiety meds, and sleeping medications are sometimes used to treat the symptoms, especially with PTSD. These medications can help a person with a trauma or stress related disorder to continue with as close to normal life as possible while they heal.

Therapy

Cognitive behavioral therapy (CBT) is often cited as the most effective treatment for trauma and stress related disorders. Exposure therapy—gradually exposing yourself to the trauma and things that remind you of the trauma in a safe place—is often used and can be very effective. Even more than other forms of therapy, exposure therapy requires the right therapist. You NEED to feel safe and secure in order for exposure therapy to work. Support groups for survivors of various traumas often include unofficial exposure therapy, as people discuss their own experiences with others who they know will understand.

Eye movement desensitization and reprocessing (EMDR) is a relatively new approach to trauma therapy. Ever notice it’s easier to talk about hard stuff if you have something to distract you? A lot of people like to have “something in their hands” when discussing emotionally difficult topics. This is because having something benign to focus on helps distance our emotional reaction. EMDR uses this tendency to help trauma survivors face and deal with their trauma without the extremes of emotional reaction. There is still a lot of speculation about how and why it works. It does seem to allow trauma survivors to better cope with their trauma, reducing symptoms and speeding healing.

Alternative Treatments

I don’t know of any alternative treatments that I would trust which are specifically for trauma and stress related disorders. That said, herbal calmatives may help reduce arousal symptoms, meditation can also be helpful in dealing with negative thoughts and gaining space from strong emotions, and I personally have found that Massage Therapy can be a huge help in healing from trauma associated with sexual abuse.

When Trauma and Stress Related Disorders and Polyamory Collide

Some problems that come with trauma and stress related disorders are obvious. I’ve had flashbacks, and I’ve held loved ones while they relived the worst experiences of their life. I honestly can’t tell you which is worse.

Other problems are both more subtle, and more frustrating.

Someone whose trauma or stress was related to betrayal, abuse within a relationship, abandonment, and similar issues will find themselves triggered by many things that are a normal part of polyamorous relationships. And constantly waiting for your current partners to abuse you/betray you/abandon you like the people who caused your trauma never does good things for a relationship. In a poly relationship, your poly partners spending time with someone else—or even just the expectation of them spending time with someone else—can definitely be triggers.

Worse, the combination of psychological arousal and negative thoughts can come across as anything from a jealous rage to a guilt trip to gaslighting. (Remember—distorted perspective. Someone with a trauma or stress related disorder literally doesn’t see the world the way it really is.) And while the person lost in their trauma doesn’t intend or even realize that this is how they are acting, the people around them can still be hurt by it.

Let me note that this level of problem is not universal with trauma and stress related disorders. Please do not assume everyone with a trauma or stress related disorder will be affected this way. This is the most damaging effect trauma and stress related disorders can have on relationships—that does NOT make it the most common.

Other types of trauma can cause other types of problems. Trauma from a car accident may make riding in a car difficult to impossible—which interferes with going on dates, poly meet ups, or just picking a visiting partner up from the hospital.

For partners who don’t understand the impact trauma and stress related disorders can cause, refusing to do something that seems simple to them can cause other problems. “Why do I always need to come visit you. It’s just a short drive!”

Because of my specific trauma, I used to get flashbacks eating certain foods. The consistency and texture of food is a big meal to me, which many people have never understood or accepted. Being invited over to dinner was a mine field. I would struggle to navigate trying to be polite, trying to avoid conversation ending-explanations, and trying not to trigger myself. So as awesome as it might sound for a poly partner to offer to put together a picnic for us…

And of course, having a panic attack, flash back, or other trauma related freak-out as your partner is walking out the door to go on a date—no matter what the trigger or cause—is not only disruptive to your own relationship, but to your partner’s relationships as well.

Part II on ways to manage PTSD and other Trauma and Stress Related disorders.

This post is part of the Polyamory and Mental Illness blog series.

Polyamory and Mental Illness – The Wrong Diagnosis (Guest Post by Michón Neal)

September 10, 2015October 9, 2022 Jess Mahler3 Comments

Receiving the proper diagnosis can mean the difference between life and death, acceptance and ostracism, understanding and confusion. The right treatment can be an important part of functioning well, forming and maintaining relationships, and finding peace with your limits. However, when you’re a queer and poly female-bodied person of color the lines start to blur between experience and illness.

What do I mean? Well, I was misdiagnosed with bipolar disorder and depression at a young age. Black women are much more likely to be misdiagnosed. We are also more likely to have our sexual history interpreted differently, through the lens of mental illness rather than through sexual agency. So the doctors took one look at my sexual history, my mood swings, and my suicidal tendencies and decided that I was bipolar. It didn’t matter that I was suffering from PTSD due to my history of sexual and physical abuse. It didn’t matter that the reason I’d come in for help was because I only felt insane when I was having my menstrual cycle. My large sex drive was seen as an aberration, as dysfunctional instead of simply being part of who I was.

I could have died from being treated for conditions I didn’t have. I’d been treated with medications for depression and bipolar disorder. These medications wrecked my body and only ended up making things worse because the underlying problems actually turned out to be physical and not mental. There’s very little education about the overlap between physical disabilities and mental disorders. Many of the physiological effects can be similar or overlapping. And for black women in the US, it is much more likely that our physical symptoms will be ignored in favor of mental ones. It is often so easy to simply believe that we are crazy rather than ill.

For physical illnesses it is also incredibly difficult to find treatments for the mental effects. Doctors tend to focus only on the physical aspects and you’re pretty much on your own mentally. Which of course means that you’re still experiencing chronic condition-related mental illness yet cannot always take the same medications as someone who developed it in other ways. And if you’re of a different race and sex they are also less willing to try alternative treatments, often going for the extremes. Many black people forgo treatment for mental and physical illnesses due to poverty, lack of access to quality care, and because they aren’t receiving the correct care. Sometimes the healthiest choice they can make is to self-manage and self-treat, at least until they can afford better.

In the polyamorous community there are plenty of people who say they absolutely will not date anyone with a mental disorder. Or they stress not dating anyone who’s unmedicated, regardless of the cause, history, or severity of their mental illness. Even simply not dating outside of one’s race is one of the hidden biases of the community. And when you have physical illnesses and a traumatic past that can actually lead to mental disorders like anxiety and depression then it becomes even murkier. When you take birth control that can actually cause anxiety, things really get fun! Imagine trying to explain to potential lovers that you were diagnosed with bipolar, but wait, no, it’s really PCOS and endometriosis and fibromyalgia, oh, and did I mention that I have depression and anxiety caused by PTSD and my illnesses but I’m still totally fine?

For many people it’s hard enough to try to understand mental illness alone. And most never hear about disabilities beyond the obvious physical ones. And very few understand how health interacts and intersects with race, class, sex, and sexuality. While poly people like to think they know a lot about emotional health they do tend to disguise their preferences for healthy, drama-free people as not being ableist, racist, or offensive. It’s rather tempting for poly people to make very clear and exclusive lists of the types of people they’re looking for, regardless of circumstances. And getting left out is simply par for the course for those of us who have mental and physical illnesses on top of being from other races. While everyone has a right to ask for exactly what they want it also behooves them to examine the source of those preferences. There might be more to the story that they’re not seeing. In short, they might be misdiagnosing a hell of a lot of people.

This post is part of the Polyamory and Mental Illness blog series.

About Michón

Michón Neal writes a mix of scifi, fantasy, erotica, and autobiography called cuil fiction about unique people in unique circumstances. Ze is currently working on The Cuil Effect Project, a ridiculously long tale about healing, absurdity, and all the different ways people interact. Zir books are available on Kindle, Smashwords, Scribd, Kobo, and more. You can find more details, sneak peaks, links, and absurdity on zir blog, Shadow in the Mirror.

Mental Illness Treatment Intensity and the Impact on Polyamory

August 27, 2015October 20, 2022 Jess Mahler

FYI, depression is once again trying to kick my ass. Posts may be delayed while I’m getting it back under control. Thankfully, so far I seem to be winning.

Last week I talked about the range of treatment from hospitalization to home care–ie the different levels of intensity of care that is available to people struggling with mental illness. This week we’re going to look at how those treatment options affect polyamorous relationships.

Hospitalization and Polyamory

Let’s start with the obvious: it doesn’t matter why a member of your polycule ends up in the hospital. This is one area where mental illness or heart attack or emergency C-section doesn’t matter. If one of your polycule is in the hospital, you may need to deal with disruptions of your normal routine, financial challenges from loss of income, fears for their health and well-being, limitations on when and how long you can see them (visiting hours suck!) and other issues.

Shorter hospital stays have less of an impact than longer hospital stays.

The one way I am aware of that mental illness makes a difference, is for caregivers. Caregivers for your loved one during their mental illness can deal with everything from making sure they take care of their meds to helping them shower to cooking their meals, in addition to helping them through panic attacks and differentiate delusion from reality. For a caregiver, having your loved one enter the hospital can be a huge weight off your shoulders (their life is no longer literally in your hands). It can also be a source guilt (if only you’d done enough, been good enough, helped enough, etc…). If there has been friction between a caregiver and another member of the polycule, there may also be blame–in either direction.

Don’t go there. No the caregiver(s) blaming the rest of the polycule for not giving more support and help. No other members of the polycule blaming he caregiver for not doing enough. Just don’t fucking go there.

Partial Hospitalization and Polyamory

From a practical perspective, entering a partial hospitalization program is much like starting a new 9-5 job. Loss of income may be a problem if the person entering the program had a job. Otherwise, you are dealing with the same schedule changes etc that come with any commitment to be out of the house from morning til evening.

However, partial hospitalization can be mentally and emotionally draining far more so than most jobs. You are literally spending all day every day in various types of therapy. Someone in partial hospitalization will come home drained and needing significant self-care some days. Other days they’ll be hyped with plenty of energy and excitement. And this may have nothing to do with how good or bad the day was!

In some ways, this can strain relationships more than hospitalization. Your loved one is RIGHT THERE but doesn’t have the energy or focus to give to their poly partners. Patience and some adjustments are needed. It sucks if the one evening a week you have to spend together your poly partner wants to do nothing but watch YouTube and recover from the stress of their day. But sometimes that’s what they need. Try to be understanding–it really isn’t personal. If it happens every week, you might want to ask about their schedule, and what is happening on that day every week that is leaving them so drained. If art therapy, or that one group activity, or program outings to this or that local thing are hitting them particularly hard, you might want to reschedule your regular time to a day when that activity isn’t on their schedules.

Partial hospitalization is a mixed blessing for caregivers, on the one hand, you have time during the day that can actually be for you. Heavenly! On the other hand, you need to help your loved one get ready and out the door, when they may barely be able to get out of bed.

Outpatient Therapy and Polyamory

Outpatient therapy will not usually affect regular schedules, family incomes, or other “major” issues. For caregivers–as opposed to supportive friends and family–outpatient therapy has a lot of the same challenges as partial hospitalization. “I know you feel like shit, love. But you can’t afford to miss another appointment. Come on, I have your clothes here…” without the benefit of several hours a day you can take for yourself and your priorities without fear of interruption. On the plus side, outpatient therapy is usually once a week, at most 2 or 3 times a week, so it’s not an everyday struggle.

For all poly partners, the rest of the day after a therapy session can be the same emotional rollercoaster as evenings after partial hospitalization. You never know what state your partner will be in when they come out of a session. They may be happy and relaxed, stunned with a new realization, broken and weeping…. it can definitely be rough on all concerned.

Whenever possible, don’t schedule important shit–whether it’s a family discussion about a recurring problems, or a special date, or your kid’s birthday party–after a therapy session. No one–not the person in therapy and not their poly partners–needs the stress that can bring with it.

Medication Only and Polyamory

For someone who has found their equilibrium and just needs a bit of help to keep their mental illness under control, medication only therapy can be just what is needed. Medication only might mean medication that needs to be taken every day, like lithium for mood stabilization. Or it might mean medication that is only taken as needed–such as many anti-anxiety pills.

Medication only therapy should not have a direct impact on polyamory. However, it is generally a good idea to know your more entwined partner’s medications and possible side effects. If only so on the day they have the flu and are on doctor ordered bed rest, you know what you are doing when they ask you to get the Haldol for them.

Sometimes people miss their regular medication. They might be caught out of town unexpectedly, lose their meds and need to wait for a refill, or just forget. If your poly partner isn’t able to take their medication as scheduled, you may see some personality changes, mood swings, or withdrawal symptoms. Try to be patient and remember that this time is even harder on them than it is on you.

Home Care and Polyamory

Whether in combination with medication and/or outpatient therapy or on it’s own, home care is critical for most people with mental illness. Ideally, whatever home care is necessary–be it meditation, some time in the sun, or a cup of chamomile tea before bed–is just a part of your normal routine. Much like taking a shower or combing your hair when you get up in the morning. Sometimes, especially when mental illness is acting up, home care can be disruptive. For instance, needing to cancel a regular activity because of a bad anxiety day.

When home care is part of a routine, it usually won’t impact polyamory directly. It can be helpful for poly partners to take part in or at least support, parts of the routine. Join in the meditation, have a cup of tea together etc.

When home care needs to disrupt routines and expected activities it can definitely have an impact. Someone going through a bad patch may need to cancel dates, ask for additional support, ask for additional space, and a great deal more. These disruptions can range from a loved one calling you up randomly “I’m having obsessive thoughts about X, help distract me please.” to “I’m having a panic attack, I need to cancel our date. Can you just come over and spend time with me instead?” to “No, I can’t go on our planned weekend outing my mental health is too shakey, and I don’t want to risk being away from my support system,” right up to “the suicidal thoughts are back, can you please give me a ride to the hospital/clinic/therapists? I don’t trust myself to drive right now.”

That last is, thankfully, rare.

Mental illness tends to run in cycles. Depression is a mildly annoying problem until it swamps you out of nowhere. After a few weeks you manage to get back on your feet and depression is a mildly annoying problem again. Until the next wave. During a bad part of the cycle, home care will have more of an impact on polyamory, and your poly partner may need more help and support. During a good part of the cycle, you may not even be aware of the steps they take each day to take care of themselves.

How often and how extreme these cycles are vary, and some people find the cycle takes them from home care to hospitalization and back. For others, they can rely on home care as their primary treatment throughout the cycle, but some months they won’t take a single as-needed pill while other months they are taking the maximum allowed every day.

Standard disclaimer

This post is part of the Polyamory and Mental Illness blog series.

Course of Treatment: Treatment Options–Treatment Intensity

August 20, 2015October 9, 2022 Jess Mahler

In Western medicine, there are varying levels of treatment for mental illness. In theory, the more you are able to take care of and manage your own mental health care, the lower the level of treatment you receive.

Hospitalization

Hospitalization for mental illness has a bad reputation. A reputation that is historically valid but far less of a problem today. At least in the US and Europe, the vast majority of people in the hospital or mental illness are their voluntarily. They recognized a need for more help than they could get at home. Most hospitalization is short term. Intensive care and/or 24 hour supervision is available for someone who lost control to depression, bi polar, or other mental illness. These people need time in a safe place to regain their balance with the help of trained professionals. They may spend a few days or a few weeks in the hospital. When they leave, they switch to partial hospitalization or out patient therapy and resume their normal life.

In the US, anyone experiencing problems with mental illness can go to the nearest hospital and request admittance for 72 hours. This observation period allows doctors and the patient to work together to determine if hospitalization is needed. Often the patient just needs their medication tweaked, or referral to an out patient program.

Last December my partner went into the hospital for an observation period. He ended up staying 4 days because the doctors wanted to make sure he was adjusting well to the medications they put him on. He left the hospital with a referral to a partial hospitalization program, medication he had needed for over six months and the hope that comes from finally having help with a problem that has been overwhelming you.

Long term hospitalization is an option for people who just can’t function on their own. In the US, long term hospitalization can only be mandated if you are a threat to yourself or others. But people with severe mental illness who need help eating, taking their medications, getting dressed in the morning, etc, may admit themselves for long term care.

Hospitalization often mixes group therapy, individual talk therapy, art and/or music therapy, and plenty of down time to relax without the stresses of daily life constantly triggering a mental illness. Some hospitals also offer alternative medicine, meditation classes, and other programs.

Partial Hospitalization/Partial Day Program

Partial hospitalization probably has other names in other parts of the world–god knows it goes by enough different names in the US! Whatever they are called, these are intensive treatment programs. Patients spend 8 hours a day, 5 days a week, participating in various forms of therapy. At the end of the day they go home and tend to their own needs.

Partial hospitalization is available for people who need intense and ongoing access to mental health care, but are still able to take care of their own day-to-day needs. Unlike being in the hospital, someone in a partial hospitalization program takes care of their own meals, hygiene, clothing, etc while they are at home in the evening. They are able to go out and socialize with friends if they so choose, and can spend time with family in the morning and evening. Partial hospitalization programs offer many of the same therapy approaches and options as hospitalization.

In my experience, someone with mental illness cannot check themselves into a partial program. A referral is usually needed from a hospital or therapist.

Mental Health Rehab

Mental health rehab programs vary widely. From what I have seen and what my research has found there is no clearly defined idea of what mental health rehab should be or should consist of. Most rehab programs I have seen focus less on traditional therapy and more on helping someone with mental illness re-integrate into society. This may involve a back-to-work program, classes in community action and involvement, and a great deal more. However these programs are largely unique and each one will be different.

In terms of intensity and time commitment, rehab seems to fall somewhere between partial hospitalization and outpatient therapy. Participants may spend several days a week in various classes and activities, but will rarely spend a full day in rehab.

Out Patient Therapy

Out patient therapy is what most people think of when they think of mental health therapy. You spend an hour or so with a therapist and go home. Depending on your needs, you may see a therapist three times a week or once a month. Out patient therapy covers every form of therapy. Talk therapy is far and away the most common out patient therapy, followed by group therapy.

Out patient therapy is ideal for people who are managing to keep up with daily life, but have difficulty managing their mental illness. It is also a good safety net for people who are starting medication.

If your therapist is a psychiatrist, they will often offer medication in combination with therapy. This can be a very good option for people who are still trying to find the right treatment combination for managing their mental illness.

Medication Only

It is becoming increasingly common for psychiatrists to offer medication without any therapy or much in the way of support. You see them for 15 minutes month, tell them about any changes you’ve noticed, and they give a prescription for your next bottle of pills. For people who have been living with their mental illness for years and are on an established medication schedule that works for them, this approach can be effective.

However, I have seen psychs who did not know me at all, knew that I was not currently on any medication and did not know what medication would work for me. They spent 20 minutes getting to know me and y history, wrote out a script for psych meds, and told me to come see them again in a month. Given some of the possible side effects that psych meds have, I don’t have words for how fucked up this is.

Thankfully, most of these psychs will tell you the same thing I will: you need to get counseling as well. Until you have an established med plan in place, it is very important to combine medication with out patient therapy. You need someone to help you manage the effects of the medication and to help you catch signs of side effects early, before they become dangerous.

(You might notice I have strong feelings on this topic)

For some people, mediation only can be a great low stress approach. You need to have your mental illness largely under control with home care and medication. You also need to know exactly what medication you need. If you can do this, than seeing a psych once a month for medication work. But if you are still juggling medications, dosages, and treatment options, please also see a therapist.

This post is already pretty damn long, so next week we’ll take a look at how these different treatment options impact polyamory.

This post is part of the Polyamory and Mental Illness blog series.