Course of Treatment: Treatment Options — Home Care

Let me get this out of the way first. Being able to take care of your mental health at home is pretty awesome, but it isn’t for everyone. As a primary treatment, home care works best for people who have experience dealing with their mental illness. You need to be able to recognize a downturn and get professional help when needed. Otherwise, home care should NOT be your only treatment choice.

However, home care is almost always a good support while pursuing more intensive therapy.

Understanding Home Care

Home care for mental health can involve a wide variety of things. What it is, is learning what works to manage your mental illness and taking steps every day to keep your illness under control.

Home care is “maintenance mode.” For some people home care is enough to keep their mental illness under control. Others combine home care with other maintenance treatments; medication is probably the most common.

Everything from diet to exercise to meditation to having a cup of tea before bed can be a part of home care. Everyone’s home care is different, and depends on their needs, experiences, and how their mental illness functions.

Types of Home Care

Meditation

Let me get this one out of the way first. Meditation is one of the first suggestions of a lot of able-minded people. And one a lot of mentally ill folks have learned to hate.

Personally I have often enjoyed and benefited from meditation. But I learned meditation as a personal practice first, and applied it to my treatment much later. For people who do not have practice mediating, using meditate to help mental illness often just makes things worse. I think this is because “clear the mind” styles of meditation are the most talked about and the meditations people are most likely to try first.

Clearing the mind meditations can be some of the worst for many mentally ill folks. When you focus on not thinking and clearing away all your conscious thoughts, it leaves space in your mind. Space that gets filled by all the poison your mental illness creates. So you end up spending 15 minutes or so “meditating” on how you are a worthless pathetic piece of shit who could be a functional human being if you would only try hard enough. Not because that’s what you are trying to meditate on, but because that’s what your mental illness shouts at you when you try to stop thinking.

I have found clearing the mind meditation to be useful for understanding what is going on in my head. But to be useful, and not damaging, (at least for me) it needs to be just a few minutes. Stop, close my eyes, and clear my mind. As soon as I can clearly “hear” the poison my mental illness is spewing, get out of the meditation.

You know those days when you are an absolute wreck, your mental illness is out of control, and you don’t know what triggered it? Those are the days that I use “clearing the mind” meditations. Once I know what is going on, I have at least a chance of addressing the problems.

Breathing meditations are another useful type of mediation. These are where you sit and focus on your breath. Breathe in for a count of 4, hold for a count of 4, breathe out for a count of 4, repeat. For me, this type of mediation gives my mind a rest. With all my concentration on my breathing, with my body focused on the feel of air rushing in and out of my lungs, my mind stills. My mental illness doesn’t have anything to grab hold of and hurt me with. For a little bit, my mind can rest, and I can relax without my mental illnesses ambushing me with more poison.

Different meditations will have different effects for different people. If you want use meditation to manage your mental illness, experiment with several different types of meditation. It can take time to find one that works for you. And immediately stop any meditation that triggers you or makes your illness worse.

Herbs, Dark Chocolate, and Other Home Remedies

When I reviewed alternative medicines, I said you shouldn’t take herbs without professional guidance. A few herbs, however, are mild enough to be the equivalent of over-the-counter medication. Things like lavender, most mints, and chamomile. That doesn’t mean they won’t sometimes have unexpected effects. The first time my mother gave me a lavender sachet to help me relax, I had a panic attack. It took me a long time to realize that the lavender did relax me. It relaxed me enough I was actually able to feel a the anxiety I lived with day in and day out! Which triggered the panic attack.

Herbs for home use can be crushed leaves and flowers in sachets, essential oils in the bath, or herbal teas. I favor teas, but use what works for you. Lavender and chamomile are calmatives. Mint is good for alertness and those awful low energy days. Lemon and lemon grass are cheering and energizing.

Dark Chocolate, according to some preliminary studies, has a similar effect of antidepressants. Dark chocolate may be an alternative treatment for people who don’t have health care coverage. It isn’t cheap, but it is less expensive than paying for antidepressants out of pocket. And if your depression is under control, a bar of the dark stuff can be good to keep on hand for the bad days.

I’m sure there are other home remedies I’m not familiar with. Talk with your doctor first, try in small doses and stop immediately if a remedy makes things worse.

Exercise

Jane Fonda wasn’t making shit up to sell videos, endorphins are real. So is the satisfaction of meeting a goal and the wrung-out relaxed good feeling of working your body. And like tears, sweat can help clear toxins from the body. Exercise can’t address specific symptoms of mental illness, it can be a generalized mood lifter, an outlet for frustration and anxiety, and a great way to boost your self esteem and self confidence.

Exercise doesn’t need to be a big production. A ten minute walk each day is a good start. Bonus if you combine exercise with something you enjoy like hiking, dancing or swimming. Or, you could reward yourself for exercise until it becomes a regular part of your routine. I used to walk down to the corner sore each day, about a half mile round trip and pick up a small treat. Little things like that can help you get up and going.

Stretching

Stretching is separate from exercise. Most experts now recommend you exercise and stretch separately, instead of stretching right before exercise. Stretching is definitely useful for people dealing with anxiety or depressive disorders. These mental illnesses tend to put strain on the muscles: anxiety from the constant tension, depression from the way it makes us curl in on ourselves. Stretching counters the physical effects of mental illness and keeps our blood flowing, bringing more energy to our brains.

Sunlight

A shit ton has been said elsewhere about the benefit of sunlight in treating mental illness. In fact, light bulbs that give of light in the same wavelengths as sun are available to help people battle seasonal affective disorder.

The full effect of sunlight on mental illness isn’t fully understood. However, we do know that getting out in the sun for 10 or 15 minutes a day can help lot. Combine your sunlight time with some exercise for a double boost.

How to Access Home Care

There is a wide variety of information on all forms of home care available online. That said, it’s the internet, with all its awesomeness and flaws. Especially be careful about taking internet advice on meditation, giving the possible complications.

Herbs and dark chocolate are often available somewhere local, and if not can be ordered online. Chocolate tends to be on the expensive side, even more so if you are aware of and prefer to buy Fair Trade chocolate.

Exercise, stretching, and sunlight are there for the taking, but mental illness will usually make it hard to actually get up and take them. Gotta love the way the mind fights to stay broken and miserable.

Impact on Poly Partners

Unless a significant part of the food budget is going to buying dark chocolate, home care is not likely to have a large impact on poly partners. That said, there is a great deal you can do to support your mentally ill partners in home care.

  1. Participate. Join in the exercise, sit on the porch and get sun together while you catch up, have a cup of chamomile tea when you are over, etc
  2. Ask them what you can do to help. If they are homebound, can you pick up lavender at the store? If they have trouble motivating themselves, can you remind them to meditate each day? Ask first. They are in charge of their care, but there are lots of things you can do that will help.
  3. If your partner is managing their mental illness only with home care, be alert for signs they are entering a downswing and may need more help. Someone on the outside can sometimes see problems before we can.

If you haven’t yet, check out the other treatment options for mental illness. Don’t forget to subscribe to the Poly on Purpose newsletter, so you never miss a post.

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

Fucked Up Parts of Mental Illness: Punishing Myself for Having Fun

Okay, once again not the post I was planning on writing. This time I could probably push through and write about home care for mental illness, but I think what’s going on today is kinda relevant to a lot of folks with mental illness.

This week has been awesome for me. Depression has been largely not a thing. Anxiety has been mild. I not only got caught up on all the shit I haven’t been able to do, but I got far enough ahead that I started sorting out the shit I’m going to need to do in the near future. Those of you with moderate to severe mental illness will now how freaking awesome this is.

I found a schedule that worked for me, ways to accommodate my mental hang ups that kept me from getting triggered, and actually had a fucking clean home for the first time in I don’t know how long. I made the goddamn beds, even.

I was feeling positive about myself and the future, I still didn’t have a buffer for my blogs and shit (obviously) and catching up on my book writing was going to take a while, but still…

I got caught out in the rain running errands yesterday. A mile walk in the rain is not most peope’s idea of a good time, but I used to got out in the first rainstorm of the summer and dance in the puddles. In my then-frame of mind, the rain wasn’t a bad thing, but a chance to revel in just being alive and able to enjoy it.

For most of a mile, I laughed and grinned as the rain soaked through my clothing to the point I had to hold my skirt up to keep it from falling off. Even walking in slippery leather sandals couldn’t steal my fun. I jut took my sandals off and walked barefoot through the puddles.

Eventually the rain tapered off. And a dagger slammed into my side. Pain. Pain pain painpainpainpainpain. I gasped for breath. I blinked back tears. I bit back a scream.

When I was younger, I would have thought I was sick. Something was wrong. Maybe I had appendicitis. No. For whatever reason, for me, emotional pain manifests as this feeling of being stabbed right in the viscera. I sure actually being stabbed hurts worse, but the mind-body connection is real enough to send people to the hospital thinking they were having a hear attack. I know this main. I walk through it, the rest of the way home.

I try to review what might have set me off. My mind diverts me into thoughts about my children. The aftershocks of my custody case (I STILL don’t even have regular phone calls)  are always guaranteed to be painful to think on. But there is nothing new there. Nothing to cause this sudden pain, nothing but old and familiar aches.

My mind was tricking me, but I let it.

The rest of the day did not go well. It wasn’t a complete loss, but the smooth productively I had been enjoying was gone. Doing anything was a struggle. I blamed the way my computer was stuck in unending updates, the date who canceled dinner b/c he decided to try getting back together with his ex. I tried not to think about that stabbing pain, which had quickly faded anyway as my mind successfully diverted me from thinking about whatever had caused it.

 

Then I woke up this morning and couldn’t think. It took me an hour to get breakfast for my kid, because I couldn’t get up off of the couch. I couldn’t begin to try to stuck to my schedule. Trying to finish my half-completed blog post that was already late wasn’t even a possibility.

And I didn’t know what happened. Nothing that happened yesterday was bad enough to explain this crash. After the way the afternoon went, I might have expected a rough day, some trouble focusing, not this complete break down to the point I could manage the most basic tasks.

I finally got myself moving, and with momentum, came a small amount of clear headedness. “Why?” I asked myself. I probed my head using everything I learned in 2 decades of working to explore and understand my mind and my mental illnesses. My mind tried to divert me again, but this time I wasn’t willing to let it. Painful or not, I HAD to know what was going on.

And I remembered that walk in the rain. I remembered the fun. And I finally “heard” the evil thought that had been attacking me from my subconscious. I had enjoyed myself yesterday. not just enjoyed myself, not just taken pleasure in getting stuff done. I had had FUN. Simple, joyous, fun unshadowed by any fears or worries or self recrimination. I’m not allowed to have fun. I’m broken, pathetic, mentally ill. I’m  healthy or normal or capable. I don’t deserve anything as pure and simple as enjoying a walk in the rain.

My mind was punishing me, attacking me, destroying me, because as a mentally ill, broken, shattered, pathetic wreck of a person, I don’t deserve to have fun.

God, the mind is a fucked up thing sometimes.

If you grew up in the US in the 80s or eary 90s you probably remember the old GI Joe cartoons that ended with a ittle moral sermon. The kid would say “Now I know.” And Sgt. Slaughter always replied with “And knowing is half the battle.”

It’s surprisingly true in dealing with mental illness. Once I identified this vicious thought pattern, it became a lot easier to function. Not easy. This is still going to be a fucked up painful day. But fucked up and painful is a huge improvement over shut down and broken to pieces. I can pick up my schedule now. Go back o getting my work done. I’ll slide a bit. but I’ll be able to keep going. Just pacing myself, like always, while this knew and strange psychic wound heals. Because I know those thoughts are lies. And now I can deal with them like any attacks from someone I love. Does it hurt when someone I love attacks me? Yes, but as long as I know what they say isn’t true, it doesn’t destroy me.

That’s what 20 years of healing has given me. The ability to recognize that these destructive thoughts are lies. That I completely and totally deserve my awesome walk in the rain, and many more like it. But it wasn’t always that way.

I used to believe those destructive thoughts, and then I helped my illness destroy me, adding my own actually self hatred to the fake hatred of my sickness. If I was still in that place now, I would be in desperate need of professional help right now. Because it is that kind of destructive thought, backed by the power of true belief, that can lead people to pick up a knife, a gun, a rope.

 

I don’t know how common it is to believe we don’t deserve the good things in life. I do know that when we internalize the idea that being mentally ill makes us less deserving, less worthy, less HUMAN, than the people around us, we are on course for our own destruction.

This can manifest in ways that vary from seeking out destructive and unhealthy relationships, to creating drama in the relationships we have, to, in a similar case to my own, attacking and hating ourselves for daring to take joy in our loved ones. NRE can be a particularly bad time for this, as every burst of joy t losing ourselves in a new partner is countered by a flare of self hatred that we have dared to embrace love and life.

If you or your mentally ill partner often find yourself taking a bad turn after something great happens, whether its as simple as jut being happy walking in the rain, or as big as a commitment ceremony within your polycule, you might want to ask if maybe you might be punishing yourself for the good things that happen to you.

Don’t. You deserve every bit of it.

And poly partners, don’t be afraid to tell your loved one this. As loudly and longly as you need to.

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



Course of Treatment: Treatment Options — Alternative Therapies

Sorry for the late post. Next post should be on time tomorrow.

Understanding Alternative Therapies

For purposes of this discussion, I am using “Alternative therapies” to refer to mental health therapies which are not commonly available and/or are often not covered by insurance.

Alternative therapies cover a lot of ground, and I can only begin to introduce them here. Because of the diverse range of alternative therapies it is impossible to effectively summarize them, and I’m not going to try. Instead I’m goingt o introduce three of the most well known and accepted alternative therapies.

Types of Alternative Therapies

220px-Crayones_ceraArt Therapy

Art therapy uses art creation as a means of treating mental illness. Art therapy can take several forms. Every form of art therapy starts with a person suffering from mental illness creating art to express how they feel. Two very common forms of art therapy are the use of art therapy as a spring board, and the use of art therapy to express and come to terms with emotions.

Art therapy as a spring board–some psychologists, and all trained art therapists, are able to use art to identify a patient’s needs. One of my teachers in college described working with a young boy who constantly drew pictures of guns firing, trains, and a few other things. My teacher described putting these drawings together with the boy’s interest in Superman (faster than a speeding bullet….) to understand that the boy’s drawings were expressing a desire to be strong and powerful, a desire the boy wasn’t able to express directly. In my own experiences with art therapy, I once drew a multi-colored star, using pastels (my favorite art medium). When I finished the star I was compelled to take the black pastel and draw thick lines caging the star in. If had been working with an art therapist who was using my art as a spring board for further therapy, they probably could have easily identified what I didn’t recognize until years later–that I was feeling trapped and unable to express myself.

Art therapy as expressing and coming to terms with emotions–the old G.I. Joe cartoons used to end with a moralistic skit and the phrase “Now you know, and knowing is half the battle.” In an odd way, this is true in mental health. Our mind is a dark and mysterious place, and we can only shine a light on parts of it. If we can’t recognize that (as a random example) we are feeling trapped and unable to express ourselves, we aren’t able to start getting ourselves out of the trap.

Art, as my own experience demonstrates, allows us to express things that we aren’t aware of feeling. This can be a powerful way of coming to terms with the dark spaces in our mind, and by extension managing our mental illness.

Music Therapy

Similar to art therapy, music therapy using self expression through music to help develop self awareness and encourage healing. Music therapy also has other applications in treating autism and other developmental disorders, pain management and other areas.

I have no experience with professional music therapy, but as a teenager I (like many kids in the US) took piano lessons. When I was depressed, I would pull out my song book for Les Miserables, and play, over and over again, the most depressing songs from that musical (and if you know Les Mis, you know it has a LOT of depressing and sad songs). The singing seemed to purge the worst of the sadness and depression, and I would always get up from the piano able to function at least a little better. To this day when I find myself reaching a non-functional level of depression, I start singing. It doesn’t stop the depression, but it does purge the fog enough that for a short time I can get things done.

512px-FEMA_-_10669_-_Photograph_by_Jocelyn_Augustino_taken_on_09-11-2004_in_FloridaAnimal Therapy

Most people are familiar with Seeing Eye Dogs. But fewer are familiar with the use of therapy animals. Therapy animals generally take two forms, a service animal trained to provide therapy, support, and assistance to a specific person, and therapy animals who visit a number of people for an hour at a time (sometimes called “animal assisted therapy). Exposure and interaction with animals to known to trigger a relaxation response in the mind and body, and for people struggling with mental illness the simple an unquestioned acceptance and caring of an attentive animal can be a wonderful thing.

Therapy animals that make “house calls” (usually hospital calls) need to be well behaved, love to interact with people, and not react badly to other animals or loud noises. People who are struggling with mental illness can spend time holding, cuddling, playing, or just sitting with therapy animals who are happy to give the humans they visit the love and acceptance they need. The instinctive relaxation that comes from an animals presence can allow people suffering from anxiety or PTSD a blessed break from the constant tension and stress caused by their illness.

Therapy service animals need to be everything regular therapy animals are, plus highly trainable. Therapy service animals are trained to recognize the signs of illness in their people and provide whatever assitance they can. Examples of therapy service animals include:

  • A cat who when her person was having a panic attack would sit on her chest and purr until the attack was over
  • A dog who would, without being ordered, fetch their person’s anti-anxiety medicine when their signs of an anxiety attack
  • A cat who, if her person was leaving the house, would stop her if she had forgotten to turn off the stove

Alternative Therapies to Avoid

The specific therapies I have covered here are generally accepted and promoted by medical and psychiatric professionals. Leaving aside any issues with the medical and psychiatric industry, that means they are at mininum safe to participate in.

However there are many alternative therapies, and not all of them have been subjected to studies or overview. A few years ago, a new alternative therapy known as “rebirthing” became popular for a time. Many psych professionals warned that it had not been studied and there was no reason to believe rebirthing actually helped. Spending time and money on a useless therapy is bad enough, but anyone seeking treatment for mental illness becomes familiar with it. But rebirthing wasn’t just a potentially unuseful therapy, several people were severely injured, and at least one died, during rebirthing “treatments.”

It is impossible for me to cover all possible alternative therapies here, especially since new ones are being developed all the time. And over time, many alternative therapies become accepted and standard treatments. At one time CBT was an alternative therapy. Art and Music therapy are slowly moving toward wide spread acceptance and regular insurance coverage. If you are contemplating an alternative therapy, do your research. Discuss the therapy with a psych professional you trust. Look for a professional association about that therapy and studies done to confirm the effectiveness of that therapy.

Be safe and protect yourself.

How Alternative Therapies Work

Sadly, we need to go with the usual answer here “Good fucking question.” While there are theories to why some alternative therapies are effective (such as the relaxation response to animals), how and why alternative therapies work is largely a grey area.

By and large, alternative therapies have been studies far less extensively than more standard therapies, and it is often impossible to even cite a success rate for alternative therapies, much less a reason for their success.

How to Access Alternative Therapies

The most accepted alternative therapies, such as art, music and animal therapy, are easiest to access through institutions. Psych wards, psych rehab centers, community clinics, etc, will often include the more accepted and mainstream alternative therapies. These are also the settings where alternative therapies are most likely to be covered by insurance (at least in the US).

You can also seek out private therapists who offer alternative therapies. If an alternative therapy has a professional association (For instance, the American Music Therapy Association) they will often have information for finding a therapist on their website.

Therapy service animals in the US are usually only available to people who are legally disabled. It is possible to pay for a privately trained service animal, but these animals will not benefit from the protections available to an “official” service animal. For instance, you cannot be denied an apartment if your service animal is “official” but a privately trained “unofficial” service animal will restrict you to housing that usually allows pets. If you feel you or a loved one would benefit from a trained service animal, you will need to seek out information locally on the requirements and availability of getting one.

Impact on Polyamory

Art and music therapy have a similar impact on poly as talk therapy. Especially the post session trauma and the growth-as-change impact. Animal assisted therapy usually won’t have an effect on poly unless one of your partners is allergic to dogs and you come home covered in dog fur.

Obviously, getting a therapy service animal will have an impact, especially on poly partners you share a home with. While adding a trained animal to the home is not like adding an infant or another poly partner, it will change the dynamics of the home.

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



The Course of Treatment: Treatment Options — Talk Therapy

Understanding Talk Therapy

Talk therapy is one of the most popular treatments for mental illness. Usually you will hear talk therapy referred to as counseling or simply “therapy,” but I use the (unpopular) talk therapy to distinguish between talk therapy and other forms of therapy such as music therapy or art therapy.

There are many types of talk therapy from the psychoanalysis developed by good ol’ Freud to the currently popular cognitive behavioral therapy to new and untested talk therapies such as ********.

The basic idea behind all types of talk therapy is that mental illness can be treated through some form of discussion or learning process.

Types of Talk Therapy

“Deal with” Therapies

Obviously official terms are flying out the window here, but bear with me. Broadly, talk therapies can be divided into two groups. The most well known grouping which includes psychoanalysis is all about “dealing with” stuff. In psychoanalysis, for instance, you spend a lot of time examining your childhood to identity what caused various hang ups in the your id and ego, so you can heal and grow past them. Other forms of “dealing with” talk therapy focus on other parts of your life than just childhood, have a different understanding of the way the psyche functions, etc, etc, but they all focus on “bad shit happened in your life that caused you to have mental illness, and we’re going to deal with those bad things so you can heal.

“Learning” Talk Therapies

Unlike “dealing with” talk therapies, “learning” talk therapies aren’t concerned with why you have a mental illness. It could be something from your child, a genetic predisposition, something in your brain chemistry, and “learning” talk therapies say “who cares?” “Learn” talk therapies are the occupational therapy of mental illness. “Mental illness is fucking up your life. Let’s look at how, why, and what we can do to fix this shit so you can go back to living.” CBT is the most popular “learning” talk therapy. CBT focuses on understanding the mind, body, and emotions interact, and why we think and feel the way we do. The idea being that mental illness is a downward spiral caused by the interactions of your mind and body. Find a way to interfere with the spiral–say by recognizing what thoughts are feeding into depression and replacing them with other thoughts–and you can at least mitigate, if not stop entirely the damage the disease causes.

How Talk Therapy Works

Good fucking question. You can see above the ways both psychoanalysis and CBT explain themselves. But do they really work that way? Researchers have been trying for decades to pin down what makes talk therapy work. If they could actually figure it out, they would be a huge step closer to figuring out a form of talk therapy that is effective more than 30% of the time.

How to Access Talk Therapy

Depending on the kind of medical coverage you have, there are two ways you can access talk therapy. The first is to call up a therapist who is included in your medical coverage and make an appointment. The second is to go to your primary care provider/general practitioner and get a referral to a therapist.

If you don’t have medical coverage, or if your medical coverage is insufficient for the care you need, many local and regional municipalities offer support and services to assist people dealing with mental illness. Free forms of talk therapy are sometimes offered by community clinics, religious organizations, and other non-profits.

As usual, folks who live in places with universal health care will have an easier time getting access than those of us dependent on private insurers or paying out of pocket. Easier doesn’t necessarily mean easy–access to therapists in a universal health care system may be restricted due to availability or other issues. (Thanks to Susan for providing further info.)

Impact on Polyamory

Talk therapy will rarely impact polyamory directly. It is, of course, hoped that talk therapy will lead to improved mental health and as a result improve relationships. Talk therapy does share with psychiatric medication the issue of over optimistic partners expecting improvement in a “reasonable” time frame. Always remember two things: the most effective forms of talk therapy have a 30% success rate, and all forms of talk therapy take time. Lots of it.

The Post Session Trauma of Therapies

This issue is most common to “dealing with” therapies, but might come up in “learning” therapies. Talk therapy sessions tend to be pretty rough on people. Spending on hour confronting your worst emotions, most traumatic memories, and unhealthy behaviors can have that effect. It is not uncommon for someone to need time recovering from a therapy session. Crying, withdrawal, needing comfort, and mood swings, and other reactions are common.

It is very important to respect the privacy of someone’s therapy session. If they want to talk about it, certainly be available. But don’t ask them to talk about it. If you want to express your concern and support “Did you have a good session?” is a wonderful, neutral question that doesn’t ask your loved one to share more than they are comfortable with. They might give you a one word answer, or they might give you a blow-by-blow of the entire session. Let it be their choice.

Mental Calisthenics Are Exhausting

Talk therapies require a great deal of mental effort. This is most noticeable with “learning” talk therapies, but that may be because the emotional impact of “dealing with” therapies obscures the sheer exhaustion. However, stopping the destructive thoughts caused by mental illness is a great deal like rolling boulders up hill with your mind. In addition, someone participating in a “learning” talk therapy will often come home with reading material, mental training exercises, and homework.

Depending on the type of “homework” your poly partner may begin making changes in their habits or surroundings. They may ask you to help or support them in the changes they are making, to do mental exercises with them, or to read the papers they bring home so you can better understand what they are going through and how they are trying to address their problems.

Growth is Change

If talk therapy is at all effective, it will lead to growth. Sometimes this will be a growing understanding of mental illness and how the mind works. Sometimes it will be a growing understanding of who they are and what they want in life. Sometimes it will be a growing understanding of how experiences in the past shape their behavior now.

When people grow, they change. And it should go without saying that change can really disrupt relationships. People in therapy may find they need to step back from one or more relationships, address ways their relationships are hampering or helping them to heal, change their own behavior in a way that impacts relationships, and a great deal more.

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



Course of Treatment: Treatment Options – Medication

Gah! Late again! Sorry folks, what was supposed to be a 2-hour out-patient deal yesterday turned into a full day at the hospital thanks to a mild reaction to anesthesia. 

 

Disclaimer: I have some very strong feelings about the use of psychiatric medication. I’m going to be as even handed as I can here, but please do your own research and come to your own conclusions.

Disclaimer 2: I am not a doctor, psych, or any other kind of health professional. As always, this blog is for informational purposes only and information found here is not meant to be used to diagnose, prescribe or otherwise treat mental illness.

Understanding Psychiatric Medication

Okay. That is a misleading title. There is very little we understand about psychiatric medications. We understand that sometimes they work and sometimes they don’t. We have theories about how they work. But for those of us on the receiving end, it often seems that psychiatric medication is prescribed by guess and the gods. But let me break this down a bit.

Types of Psych Meds

Anti-Anxiety

Just what it sounds like, anti-anxiety meds are intended to reduce anxiety and/or stop anxiety attacks. If you get a really bad panic attack, to the point you need to go to the hospital, they will give you an anti-anxiety med as an injection. The one time I had this happen I went from full-on panic attack to relaxed and calm in seconds flat. It was wonderful. Depending on your level of anxiety, these meds will be prescribed daily or as-needed. As a pill, anti-anxiety meds don’t work as quickly or effectively as injection–the digestive system slows things down a bit. However if taken soon enough an as-needed anti-anxiety pill can be effective in preventing an anxiety or panic attack.

Anti-Depressants

Anti-depressants are both the best known and most controversial of psych meds. The controversy is largely due to the difficulty of evaluating their effectiveness combined with incomplete understanding of how and why they work. If an anti-anxiety injection can take a person from full panic attack to calm in ten seconds, obviously it works. If anti-psychotics can stop hallucinations, obviously they work. These are extreme and obvious symptoms that are either present or they aren’t. Anti-anxiety and anti-psychotics may not work for everyone, but it’s hard to deny that for the people they help, they are effective.

Depression doesn’t have symptoms like panic attacks and hallucinations.  Things that you can *bam* it stopped. Depression is one of the most subtle of the mental illnesses, and there is no obvious way to tell is an anti-depressant is working or not. Doctors put you on an anti-depressant and ask “how are you feeling, do you feel better?” If you feel better it’s working, if you don’t feel better it’s not.

The problem with this is it’s like saying “If you don’t have allergy symptoms today, your allergy medicine is working.” Well…maybe the medicine is working, or maybe the pollen count is just down today. Did you check the pollen count? With depression, there is no good way to check the “pollen count.”

Anti-depressants have helped a number of people to manage their depression. Many people report that finding the right anti-depressant that works for them was a turning point in their treatment and allowed them to regain their lives.

The most popular anti-depressants are SSRIs, selective serotonin reuptake inhibitors. Tricyclics are older anti-depressants, only used today when SSRIs don’t work, and I’ve known several shrinks who won’t prescribe them at all due to side effects. Wellbutrin, Effexor and a few other new anti-depressants don’t fit in either category.

SSRIs and Tricyclics both effect the neurotransmitter serotonin, at different points in the neurotransmitter’s cycle

Anti-Manic (aka Mood Stabilizers)

Anti-manic agents, also known as mood stabilizers, are mainly used to treat bipolar disorder, but can be used for other mood problems. Anti-manic agents suffer from many of the same problems in identifying their effectiveness as anti-depressants, however the swing between mania and depression, which tends to include a predictable duration, gives a better measure for judging the effect than is available for anti-depressants.

Anti-Psychotics

Anti-psychotics are best know for treating hallucinations and delusions. As such, they are a class of psych meds who are unusually easy to measure the effectiveness of. Antipsychotics are also used to treat thought disorders (when something interferes with your ability to think), bipolar for short periods, and  recently have been tried with some success for extreme depression.

Anti-psychotics regulate the neurotransmitter dopamine.

Stimulants

Stimulants are exactly what they sound like, and many are closely controlled due to their close chemical relationship with methamphetamine. Stimulants are most often used to treat ADHD, as people with ADHD usually share an atypical reaction to stimulants. Instead of being stimulated, they are calmed down. This is, in fact, one of the rare cases where diagnosis by medication actually has some validity, because giving someone tentatively diagnosised with ADHD a stimulant is the best way to find out if they have this common symptom of ADHD. (That’s rather circular, isn’t it?)

Stimulants are also sometimes prescribed to treat depression, especially when lethargy is a primary symptom.

How Psych Meds Work

Anti-depressants and anti-psychotics work, as noted above, by affecting neurotransmitters levels in the brain. Serotonin and dopamine are both neurotransmitters that are believed to be involved in mood regulation. Lowered levels of serotonin are believed correlate with depression, and heightened levels of dopamine are believed to correlate with psychosis. The theory is that by bringing these neurotransmitters back to their normal levels, it prevents extreme moods caused by the neurotransmitters being out of sync.

It is important to note that this is a correlation. No one knows if depression causes low levels of serotonin or if low levels of serotonin cause depression. Proponents of the medical theory of psychiatry will say te cause is the neurotransmitters. Skeptics of the medical theory are more likely to say the neurotransmitters are symptoms of depression which is caused by something else.

My own (inexpert) knowledge of biochemistry leads me to believe that like many biochemical reactions, there can be many causes, and it may be that both are true–in some cases a disruption of biochemistry or genetic predisposition may cause high serotonin levels, which in turn leads to depression and in some cases outside influences affect our thoughts and moods, leading to changes in serotonin levels which are then a symptom of depression rather than a cause.

Stimulants psych meds work like any stimulant, and their metabolic pathway is well known. Most anti-anxiety medications are tranquilizers. Both stimulants and anti-anxiety meds are used to treat symptoms only, no one believes that they actually address the causes of mental illness. Anti-anxiety meds, in particular, should not be taken for long periods of time, due to long-term side effects.

The Argument Against Psych Meds

Even the most optimistic supporters of psych meds can only point to a 30% success rate. Some studies have found little to no difference between the effect of psych meds, anti-depressants in particular, and placebos. For a detailed review of the argument against psychiatric medication, review the work of Dr. Peter Breggin.

In addition, psych medications often have side effects that can be as detrimental as the illnesses they are supposed to treat. In the case of anti-depressants, a common side effect is an increased risk of suicide. (Yes, you read that right.) Some speculate that this increase is the result of the anti-depressant increasing an ill person’s energy without addressing underlying problems causing the depression. However, some studies have found an increase in suicide risk among people who aren’t depressed. These studies are inconclusive but concerning.

Other side effects common to psych meds range from chemical dependency, to liver damage, to reduced libido.

The first shrink who was actually able to help me was a follower of Dr. Breggin. His rejection of the medical model of psychiatry caused him to look passed the obvious chronic depression and recognize the symptoms of ongoing mental and emotional abuse that prior shrinks had ignored.

To this day, I remain extremely skeptical of anti-depressants and the arguments made for them. I have seen through personal experience and the experience of those around me how beneficial anti-anxiety, mood stabilizers, and anti-psychotics can be when used correctly.

How Psych Meds are Prescribed

Psych meds can be prescribed by a medical doctor or psychiatrist. From personal experience I highly recommend that if you are seeking treatment for the first time you seek out a psychiatrist who also offers counseling, or only see a psychiatrist alongside a licensed psychologist or counselor.

A medical doctor will not be as famliar with psych meds, and will be less able to recognize the best med for you or dangerous side effects. Psychiatrists that only prescribe medication will see you for 15 minutes once a month. Seeing a counsellor or psychologist while going on medication for the first time will allow you spend time with a trained professional every week who can help you evaluate the impact of the medication and recognize any side effects.

If you find a medication or combination of medications that are an effective treatment for you, and you know of any adverse affects it has on you, you can safely switch to just getting your prescription from a medical doctor or psychiatrist who does not provide counselling.

Impact on Polyamory

There are three ways seeking medication as treatment can cause problems in a poly relationship.

Over Optimistic Partners

Find the right medication, assuming any medication is right, is a fraught and exhausting journey. It will be very tempting for poly partners to expect immediate improvements, a quick solution, here’s your meds, what’s your problem?

Seriously, some people spend decades trying different medicaitons and combinations of medications before either finally finding one that works, or giving up on medication entirely. (And yes, I kjnow people who have finally found the right medication after decades of searching, sometimes it does take that long. Sometimes your are unknowningly waiting for them to discover a medication and sometimes it’s just dumb luck.)

You and your poly partners need to go into this treatment plan like a prospector hunting for gold. Not like someone with strep picking up an antibiotic.

The Rollercoaster Effect

Continuing my gold hunting analogy, the search is full or ups and downs. You think you find something that works, like a glimmer of gold at the bottom of a stream. But it turns out to be just a temporary up swing in how you are doing (fools gold) or a minimal improvement that isn’t enough to allow you to function (a bit of gold dust with no clear source).

It’s not just that the search is long, but the constant swing between hope and failure. The way for a few months you seem to be getting better, you are getting better, and then for some reason the medication stops working and you are back at square one. Was it ever working in the first place? Do something change your body chemistry so you know longer respond to it? What the hell happened? You don’t know. You just know that one day you had a successful treatment, and the next day you are picking up the broken pieces of your life and relationships.

This can seriously wear out a poly partner. You want to be supportive, you want your loved one to find help and heal and be able to be fully themselves. But watching them go through the up and down cycle, and living with them through their mood swings on the rollercoaster can be extremely difficult.

For both poly folk with mental illness, and their partners, this can put a huge strain on relationships.

Adverse Effects

As mentioned above, adverse effects from psych meds can be pretty scary at times–increased risk of depression, liver damage, etc. They can also be irritating–disrupted sleep schedules, stomach troubles, lightheadedness or dizziness. And they can be relationship time bombs, like loss of libido. And that doesn’t even consider the really odd adverse effects that they don’t warn you about because they’re just idiosyncratic–like the time I was put on Adderall for a couple weeks, and spent the entire time ready to rip someone’s face off. I’ve never heard of anyone else reacting to Adderall that way, but you can bet the next time a new doctor suggested it my answer was “Fuck no.”

Some adverse effects won’t impact your relationships at all, or will only do so in minor ways. If your medication makes you lightheaded, you probably won’t be going on rollercoasters with your poly partners, and really acrobatic sexcapades will need to take a back seat, but for most people that won’t cause a relationship meltdown. Loss of libido, on the other hand, is a common adverse effect of psych meds that can seriously mess with relationships.

For this problem, I can actually give some useful advice.

1) If your poly partner starts a new psych med, take any personality/behavior/attitude changes with a grain of salt for the first month or so.

2)  Both the person on the psych meds and their poly partners can work together to keep track of changes that occur in the weeks after taking the medicine. Poly partners doing this can actually be a big help because it’s easy to lose track when you are inside of it. So if you hear your partner complain of dizziness a lot, when they never were dizzy before, if your sex life changes drastically, if they start having stomach troubles, or personality changes (good or bad), or being more active, or less active, or happier or quieter or calmer, or anything at all, good or bad, take note, keep it in mind. Let your partner know that you’ve noticed this change.

3) Poly partners can help poly-folk on psych meds assess the effects–good and bad–of a new psych med. Is the good outweighing the bad? As hard as it can be, try to keep this assessment focused on their overall life and wellbeing, not just the impact on your relationship.

4) When poly-folk on psych meds find a psych med or combination of psych meds that work, they and their poly partners can work together to find ways to deal with the adverse effects that impact the relationships.

 

Okay folks, I’ve topped out at nearly 2,500 words–even for me this is a bloody long post! So I’m gonna wrap up here. I hope you’ve found this helpful. Sunday I’ll cover what you can expect from talk therapy, some of the different kinds of talk therapy, and how talk therapy can impact poly relationships.

 

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

 

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Course of Treatment: Treatment Options

There are a number of treatment options for mental illness, both in terms of types of treatment (medication, therapy, etc) and manner of treatment (hospitalization, weekly sessions, rehab). As part of looking at the course of treatment for mental illness, we’re going to take a close look at different kinds of treatment, their pros and cons, and how they will impact your polycule.

We’ll be covering:

  • Medication
  • “talk” therapy
    • psychotherapy
    • Cognitive behavioral therapy (CBT)
    • Family Systems therapy
    • others
  • Alternative therapies
    • art therapy
    • music therapy
    • animal therapy
    • alternative therapies to avoid
  • Alternative medicine
    • herbal treatments
    • massage
    • acupuncture
    • other
  • Home treatment
    • exercise
    • sunlight
    • dark chocolate
    • meditation
    • self expression
    • other
  • Treatment Intensity
    • Hospitalization
    • Therapy sessions
    • Medication only
    • Partial day programs
    • Rehab programs

Finding Treatment Options

Most pepole default directly to medication and talk therapy, exploring other options only if medication and talk therapy don’t work for them. This is the approach to treatment that mental health care in the US is set up for. However, you don’t need to feel trapped in one treatment approach. It may be harder to find resources for other approaches to treatment, but if it works for you, it’s worth it.

Some good places to find non-standard resources that are available to you, with or without insurance, include: you local hospital, your local welfare office (or equivalent), your local homeless shelter, your local Children and Youth Services office (or equivalent), your local halfway house, your local domestic violence shelter. Why these places? Your doctor, your shrink, and your insurance company will have all the information about the standard treatment options (medication and talk therapy). The homeless shelter, welfare office, and yes Children and Youth Services (and others I listed) are routinely needing to help the people that the standard treatment doesn’t work for, so they will often have a list of ALL local resources, and many of them are willing to give recommendations so you can avoid becoming one of the people they need to help.

This discussion is part of the Polyamory and Mental Illness Blog Series

Course of Treatment: Getting a Diagnosis

Once you’ve made the decision to get help, the first step is usually setting up an appointment with a doctor or counselor. Some people will go to a family doctor or general practitioner first, others will go straight to a psychiatrist. Some set up counselling through their employer, school, or religious organization.

In the US, insurance will only pay for psychological treatment if you are diagnosed with a mental disorder listed in the latest edition of the DSM (currently the DSM-5).[1] So for many people, getting a diagnosis becomes the crucial first step to getting the help they need.

There are several good references available for finding a mental health professional, so I’m not going to go into that here. I will say that if you have a bad feeling about a mental health professional, get the hell out immediately. I can’t speak for the rest of the world, but in the US mental health care is a seriously mixed bag ranging literal life savers, to people I wouldn’t trust to take care of a plant. I’ve heard finding a mental health professional compared to finding a babysitter–it can take several tries to find one who is actually worth the time and expense. I don’t recommend looking for a poly-friendly mental health professional unless you are in a large urban area. People advertising as poly-friendly just aren’t that common. You can often (thought not always) find someone open minded on the LGBT-friendly lists, or you can educate your own poly-friendly professional (I’ve usually had good results with this, including in rural PA and smack in the middle of the Bible Belt in Tennessee).

Getting Diagnosed

Most of the time getting diagnosed with a mental illness is scary simple. You meet with a therapist, doctor, etc, you describe your symptoms, and they say, “well it sounds like you have X”. There usually isn’t any testing. The famous Rorschach and other less famous evaluation tools rarely come into play. No blood tests, certainly no actual testing your biochemistry before declaring that you have a “brain chemical imbalance.” Just a review of your life history, discussion of your symptoms, and a diagnosis code you may end up carrying around for the rest of your life.

Simple, right?

What to Watch Out For

People unfamiliar with mental illness and mental health care often think that once you have a diagnosis the hard part is done. It’s understandable because this is actually the opposite of what you go through getting a medical diagnosis.

For five years my partner Michael suffered from pain, weakness, “false seizures” and a bunch of other stuff, to the point that twice he was told by doctors that if they couldn’t find out what was wrong and treat it, he’d be dead in a few years. Everything from rheumatoid arthritis to brain cancer to multiple sclerosis was tossed around. But no doctor would dream of diagnosing from reported symptoms alone. If they didn’t have a test to back it up, there would be no diagnosis and no treatment beyond basic painkillers. But as soon as he got a diagnosis, the doctors were able to pinpoint the most effective treatment, and he started improving. Because it took so long to figure out what was wrong, some of the damage is permanent, but once they found out what was wrong, the hard part was over.

This is what we expect from medicine. People who have actually dealt with long term chronic illnesses know it rarely works this way–getting diagnosed with multiple sclerosis is not the end of the struggle. But even with hard-to-diagnosis illness like multiple sclerosis, it’s understood that doctors ain’t doing shit until they have a verified diagnosis.

Mental health…doesn’t work like that.

So if you or your poly partners are just started to get treatment for mental health, you need to understand that getting diagnosed is at best a tiny step towards getting better. Sometimes, with an excellent shrink and a fair bit of luck, you can get the right diagnosis, find the right treatment, and start seeing real improvement in a few weeks.However, that is not the way to bet.

It is also important to be proactive in learning about and understanding the diagnosis. If what you learn about your diagnosis doesn’t fit your experience, talk to your mental health care provider. Yes, they are professionals who (should) know more about mental illness than you, but you are the expert on your experience. If they aren’t willing to listen to you, dismiss you out of hand, or in any way pull a “me expert-you stupid” schtick, get up and walk out. That is a huge red flag and sign of a horrible mental health care provider.

A good mental health care provider will either discuss changing the diagnosis, respectfully explain to you why they feel your experience fits the diagnosis or both.

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



1. This is one of the major reasons “gender dysphoria” continues to appear in the DSM. In spite of the stigmatizing effect of classifying the experience of trans folk as a mental disorder, it vastly increases the treatment accessibility. Insurance companies can still refuse to pay for hormone treatment or surgery, but they can’t deny counselling and assistance in social transitioning, as long as there is an official DSM diagnosis.

The Course of Treatment: Recognizing You Need Help

For many people, one of the hardest parts of getting treated for mental illness is recognizing and accepting that they need help in the first place.

Several cultures have a strong stigma against mental illness. In the US this stigma comes in two forms: first the denigration of anyone with mental illness as crazy, unstable, delusional, dangerous, etc; second the belief that someone who is “strong” enough can “just get over it.”

These stigmas are either misleading or completely false. (Are people with mental illness delusional? Some of them due suffer from hallucinations. But there are other kinds of delusional–like my father expecting me to be able to pull thousands of dollars out of my ass. In my opinion, anyone who claims to know US history and claims the US was founded as a Christian nation qualifies as delusional. Three words: Treaty of Tripoli.) Are people with mental illness dangerous? People with mental illness are more likely to victims than attackers, at least in the US. As far as the idea that mental illness a sign of weakness or something you can “just get over,” it’s just ridiculous. Mental illness is just as much a “real” illness as diabetes, heart disease or a severe vitamin deficiency. And no one would expect someone to just “get over” those.

Because of these stigmas and false assumptions about mental illness, many people refuse to get help until they are backed into a corner. In fact, there are are actually parallels to addiction, and the way many people refuse to admit they are addicts until they hit rock bottom. Refusing to consider the possibility of mental illness until you lose your job, drive away your friends and family, or are contemplating suicide makes the entire process of treatment and recovery that much worse.
For people diagnosed as children, the problems and challenges of (re)entering treatment are very different. It is very common for children with mental illness to bounce from one shrink to another, often getting pulled away from therapists they like and have a good rapport with, as their parents search for a headshrinker who will “fix” their problem child–preferably without ever suggesting or implying that they may in anyway be responsible for their child’s problems.

This means, for children with mental illness, their therapist often is not on their side, is not working for and with them, and will betray their confidence.

When these children grow up, it can be very hard for them to trust mental health professionals. So while people who were diagnosed with mental illness as children don’t have the same problem admitting they have a problem (hell, the fact idea they have/are a problem might well have been pounded into their head until it’s become *part* of the problem). But like people who have trouble admitting they have a mental illness, people who were diagnosed as children may need to hit rock bottom before accepting help–after all, it never helped before.
Obviously, I’m painting a worst case scenario here. Some people who develop mental illness as adults are resistant to societal stigmas and start looking for help long before they are forced to by life. Some children have good experiences in therapy, and have no trouble continuing with treatment as adults (assuming they need treatment).

My own experiences were middle of the road. The therapists my parents took me too see never violated my confidence, and they all gave the impression, at least, of working for me and not my parents, but the one therapist I had a good rapport with, who was really helping me (and who incidentally wasn’t taking in by my parents BS) they yanked me away from as soon as possible, and replaced with a therapist who assured me (sincerely) that my problems were all due to a chemical imbalance in my brain and would all go away if I took the right pills.

When I was old enough to get my own medical care, first thing I did was call back that one shrink actually helped me and ask if he had an openings. I dedicated my first book to him, and credit that man with saving my life and sanity.

 

For folks in poly relationships, admitting you need help can create some big changes in your relationships. If your poly partners have been having difficulty dealing with your symptoms, then telling them you are getting help can you all a chance to step back, focus on the good, and looking for ways to make things better. However, if your poly partners have stigma against mental illness, telling them you’ve decided to look into getting treatment could cause a major rift in your relationship.

If one of your poly partners appears to be struggling with an untreated mental illness, be supportive, and make sure they know that you won’t think less of them or stigmatize them if they seek out treatment. You can’t force them to get help, and staging an “intervention” can backfire badly, but you can be there for them, help them consider their options, and generally be supportive.

 

Once someone with mental illness accepts that they need help, the next step (at least in the US) is getting a diagnosis.

 

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

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Mental Illness: The Course of Treatment

I am seeking guest posters for “Living with” posts and “_______ Disorder and Polyamory” posts on schizophrenia, bipolar, OCD, and PTSD and other trauma-related disorders. If you are interested in sharing your experience, please contact me.

As I mentioned at the start of this series, getting treatment for mental illness can be a difficult process. So we’re going to take a few days to look at what you can expect treatment to look like, and how your poly partners can help the process (or at least avoid harming it).

This discussion will follow the “expected” process of getting treatment in Western-style psychotherapy/chemical therapy. I will touch briefly on other treatment approaches I have some knowledge of, and invite anyone with experience and/or knowledge of other approaches to mental illness to share information in the comments.

This discussion will cover:

Sorry for the short (and late) post. Sunday will be a double post to make up for missing last Wednesday.

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

Anxiety Disorders and Polyamory

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

Please note: everyone’s experience of anxiety is different. This is general information meant to give you an idea of what to expect. Nothing in this blog is intended to diagnose or treat. Please see a psych professional if you or someone you love is suffering from depression.

The Anxiety Disorders

  • Separation Anxiety Disorder
  • Selective Mutism
  • Specific Phobia
  • Social Anxiety Disorder (Social Phobia)
  • Panic Disorder
  • Panic Attack (Specifier)
  • Agoraphobia
  • Generalized Anxiety Disorder

Other anxiety disorders are anxiety caused by medication or substance abuse, anxiety caused by another medical condition and two varieties of “other” anxiety disorders (specified and unspecified).

Anxiety disorders can generally be divided into two categories: those that involve anxiety (fear of something that will happen/might happen) and those that involve fear of something that is currently happening. Separation Anxiety Disorder, Selective Mutism, and Generalized Anxiety Disorder involve anxiety. Specific Phobia and Agoraphobia involve fear. Social Anxiety Disorder (Social Phobia, Panic Attack Disorder, and Panic Attack (specifier) can involve either anxiety or fear depending on the individual.

Selective Mutism is only diagnosed among children and appears to be closely related to Social Anxiety Disorder. Separation Anxiety Disorder is primarily associated with children, but can be diagnosed in an adult.

Symptoms of Anxiety Disorders

With the exception of Selective Mutism, the main symptom of all anxiety disorders is an inappropriate or excessive fear response. The form the fear response takes varies, and the way it is described in each disorder varies. For most anxiety disorders the fear response needs to be ongoing for a long period of time. Generalized Anxiety Disorder’s first criteria is “Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).”

My experience with anxiety disorders is a combination of generalized anxiety, social anxiety, and panic attacks. My Living with Anxiety post last week was specific to generalized anxiety–it involved a great deal of fear of things that might happen and the majority of the fears I describe involved everyday, normal situations.

Where Generalized Anxiety Disorder is a near-constant fear response to everyday worries, other anxiety disorders are more situational. Social Anxiety Disorder is obviously related to social stuff–the fear response can be triggered by anything from performance, to being in large crowds, to family gatherings, to meeting and interacting with a stranger. Panic attacks are an extreme fear response that last for a short time. Panic Attacks can be triggered by a huge variety of things, but usually each person will have specific triggers related to their past experiences, phobias, or anxieties. Someone with generalized anxiety disorder who is frequently anxious about money may have a panic attack at the thought of losing a job, for instance.

Agoraphobia is often found with Panic Attack Disorder because for many people the only thing worse than having a panic attack is having one in public.

Separation Anxiety Disorder is anxiety about being separated from something that is a personal anchor. This anchor can be a person, a job, a safe place, etc. Being separated from this anchor triggers a fear response.

Each anxiety disorder has other symptoms apart from the fear response, but it is the fear response that makes these anxiety disorders.

Let’s take a closer look at fear responses for a minute. A “healthy” fear response follows the fight-flight-freeze pattern. You get a jolt of adrenaline to boost your body to peak condition until the cause of the fear is dealt with. You respond either by becoming aggressive (fight), getting away from the cause of fear (flight), or hiding and waiting for the cause of the fear to pass (freeze).

Adrenaline is rough on the body. It jumps your heart and respiratory rates, puts your muscles on hair trigger, shuts down your digestive system and does some really funky things to your senses. It is the biological equivalent of putting nitrous in your gas tank. Huge boost now, but you pay for it later.

As we’ve said before, mental illness is what happens when part of the mind metastisizes. In this case, it’s the fear response that’s turned into a life-eating mind-tumor.

In some cases the tumor creates unending fear responses. I swear I got at least 10 hits of adrenaline during the one hour I wrote that anxiety post. And each surge of adrenaline had to be diverted, controlled, sat on, because there was literally nothing to respond to. Factor in the way adrenaline burns through the body’s energy, the shutdown of your digestive system, and the difficulty sleeping when you’re getting constant hits of adrenaline, and you have a recipe for a life that swings between constant on-edge fear and utter exhaustion.

In other cases, the tumor creates supercharged fear responses. Imagine an adrenaline surge so strong you feel like you are getting a heart attack. Imagine your respiration speeding up to the point that you are hyperventilating and not getting enough oxygen. Imagine your muscles being flooded with adrenaline to the point that you are shaking so hard you can’t stand up. Welcome to panic attacks. Of course, being physically incapable of responding to the thing you fear usually just makes the fear worse. Which means the body sends out more adrenaline, and the feedback loop is off to a perfect start.

Mild forms of anxiety disorders can sometimes be ignored or written off “I’m just a worrier.” “I’m not really comfortable in crowds, but it’s no big deal.” ” ‘I can’t stand the thought of losing you.’ ‘Hey, I’m right here.’ ” The point where “normal” worries and concerns end and a disorder begins isn’t easy to pinpoint, even for professionals, but if your anxiety or fears are affecting your ability to do normal, everyday stuff, it’s time to talk to an expert.

Treatments for Anxiety

Medication

There are two types of anxiety medications, the ones you take every day to control and manage the disorder, and the ones you take “as-needed” that can stop a panic attack in its tracks. (The one time I went to the hospital with a panic attack, they gave me a shot and I was down in ten seconds flat. It was beautiful. I went to my doc the very next day and said “Prescribe me this. Now.” The pill version was only effective before the panic attack actually kicked in, but it was still a wonderful, wonderful thing.)

As with depression, everyone’s responses to medication will vary. The medication that worked for me might not work for you, and the medication that made my anxiety worse (yes, this can happen), might be exactly what you need.

Medication is a managing treatment for anxiety. It can’t cure the disorder, but it can keep it under control so you can get on with your life. The effectiveness of medication in treating anxiety disorders varies widely.

Therapy

There are several forms of therapy that are generally used in treating anxiety disorders. Cognitive behavioral therapy (CBT) is effective 70-90% of the time in improving anxiety disorders, and creates “substantial” improvement in 30% of patients.

Other forms of talk therapy vary in their effectiveness, though none are as promising as CBT. The “talk therapy” of popular imagination is usually less than useless for anxiety disorder. Something called Intolerance of Uncertainty therapy has shown promise in treating Generalized Anxiety Disorder.

“Fringe” therapies (ie those that are not part of standard psych treatments and need more studies but has the support of most psych associations) such as art therapy, animal therapy, music therapy, etc may help anxiety disorders, there just isn’t enough information.

Alternative Treatments

Trained service animals are very helpful in managing Panic Attack Disoders and some other anxiety disorders. Cats seem to be a popular therapy animal for anxiety disorders, but small dogs and other “lap sized” pets are common.

Breathing exercises, meditation, and biofeedback have at various times been popular for treating anxiety disorders. Their effectiveness varies widely.

Herbal treatments such as chamomile and lavender are generally mild enough to be taken safely, but definitely talk with your doctor about possible drug interactions. I have personally found that in some cases calmatives make the feeling of anxiety worse–if you are suppressing anxiety in order to function, relaxing enough to be aware of just how anxious you are can make it seem like the calmative triggered the anxiety.

Human touch has been shown to be very effective in dampening the fear response. Some people have had benefits from regular massage therapy, others have used cuddling as a home therapy.  I’ve known a few people who when they started getting anxious would do each others hair, the social grooming acting as a calmative. Be aware that massage/cuddling/etc can have the same effect as herbal calmatives, relaxing you enough to really feel how anxious/afraid you are. Be aware also that given the sensory effects of adrenaline, some people cannot handle being touched during a panic attack or other anxiety episode. For these people touch may help to prevent or reduce anxiety, but only when the anxiety is not currently active.

Physical activity, whether going for a run or cleaning the entire house, can be a good way to deal with the burst of energy from adrenaline, reducing the stress of anxiety on the body and mind (and anything that lets you turn a mental disorder into a way to get stuff done is a good thing!)

When Anxiety and Polyamory Collide

Because of the many and varied forms of anxiety disorders, it’s impossible to succinctly sum up the way anxiety can impact polyamory. A phobia of dogs probably won’t affect polyamory at all unless one of your partners has a favorite pooch they want to introduce you to.

Separation Anxiety Disorder, if your anchor is one of your poly partners, can have some obvious impacts and may appear as jealousy or controlling behavior if people don’t understand what is going on.

Social Anxiety Disorder can make going on dates difficult, or turn meeting your partner’s new girlfriend into an absolute ordeal. SAD can also make a person seem abrupt or rude as their focus is more on not running screaming from the room than how to be polite which can make for awkward first meetings and misunderstandings. I once witnessed a 10 year friendship dissolve when one person developed extreme social anxiety. The friend with social anxiety was having trouble with their heater. The other friend asked a relative if they could help out. Having a stranger in her home triggered an extreme panic attack in the friend with social anxiety, who hid in her room the entire time relative as working on the heater.  Relative complained about rudeness, other friend was extremely offended and upset that her relative was treated so poorly when he went out of his way to do a favor for the friend with social anxiety. Their friendship never recovered.

Generalized Anxiety Disorder can turn the normal worries and fears associated with polyamory into an unending nightmare, or might not have an impact at all, depending on the kinds of things your GAD focuses on. The exhaustion common to GAD and other anxiety disorders can have a similar impact to the exhaustion/enervation of depression, depending on how bad it is.

Ways to Manage Anxiety in a Poly Relationship

The biggest and most important thing is to understand the impact of anxiety on your partner. Asking someone with social anxiety to go out to the latest night club doesn’t work. Obviously someone with a phobia of heights is not going to enjoy a trip to the top of the Empir State Building.

But this applies in more subtle ways as well. If your partner’s social anxiety makes meeting your new girlfriend a challenge, then maybe you need to be okay with them not meeting. Or maybe they can talk over the phone, or using social media first.

Know what to do if your partner has a panic attack, and especially how they want you to react if they have a panic attack in public. Understand that someone with anxiety disorder may need to cut an evening short because they just can’t take anymore, and it doesn’t mean they didn’t have fun, or that they are trying to ditch you, it means that their illness is acting up and they need to go someplace safe to deal with it. Maybe you can go with them and help them deal, maybe you need to let them have some space. Either way it isn’t personal, it doesn’t mean they wanted to leave, doesn’t mean they didn’t really enjoy themselves. Just means anxiety is a bitch.

Learn your partners triggers and how to help bring them down. Learn how to give aftercare for panic attacks (yes, it’s a thing.)

Probably most important in terms of impact on poly relationships: 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.

How has anxiety influenced your poly relationships? What ways have you found to take care of your relationships in the face of anxiety?

Disclaimer

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