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.

Course of Treatment: Treatment Options — Home Care

August 6, 2015October 9, 2022 Jess Mahler

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.

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
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.
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.

Course of Treatment: Treatment Options — Alternative Medicine

July 23, 2015October 20, 2022 Jess Mahler

Last week, we look at alternative therapies. This week we’ll be looking a bit further afield, at alternative medicine. What’s the difference? Alternative therapies all try to fit within the framework of psychology. Even the alternative therapies you should run like hell from (like rebirthing) use psychology to explain why they are supposed to work.

Alternative medicine refers to medical practices that are an alternative to Western medicine. In some parts of the world these medical practices are widely used and accepted, in others they are barely known.

Alternative medicine takes two forms. On type of alternative medicine is “alternative” only in that the form of treatment doesn’t meet the demands of Western medicine–functionally, there is little difference between willow bark and aspirin, in fact, aspirin is basically a manufactured version of the active ingredients in willow bark. But willow bark tea can’t be given as precise a dosage as modern medicine demands, while the dosage of aspirin in a pill can be measured to the limits of modern equipment.

The other type of alternative medicine doesn’t fit with in the framework of Western medicine at all. The germ theory of medicine, and all the curlicues it’s developed over the years, simply has no room in it for treating illness with gems and chanting. While massage is a very valuable treatment for injuries, no one can yet explain how it can benefit mental illness in a way that first the theories of Western medicine. Often ways that alternative medicine is explained (such as the idea of storing emotions in muscles, mentioned below) sound ridiculous to folks who prefer the scientific approach of Western medicine.

Today we are going to take a look at three alternative medical approaches that I and others I am familiar with have found most useful, which also have at least some studies supporting their use.

Types of Alternative Medicine

Massage

First off, whether or not massage is “alternative” medicine depends on where you live and what it is used for. There is nothing “alternative” in using massage to treat muscle injuries, help the healing process after an accident, and basically do anything that involves damage to the muscles and tendons. A trained massage therapist can use massage to realign muscle tissue, preventing and reducing scarring and restoring mobility to an injury. While still not as widely known and used in the US as it could be, the rest of the Western world accepted this type of massage treatment long ago and have no doubt it belongs in the annals of Western medicine.

Massage as treatment for mental illness is less accepted. The most accepted theory behind why massage can help mental illness is that clears stress toxins from the body and triggers a relaxation response. Another, less accepted theory, is that our bodies somehow “store” negative emotions and mental problems in our muscles. By stretching and relaxing the muscles, these negative things get released, allowing us to move on without the burden of those problems. Anecdotal evidence in support of this theory is that many people dealing with trauma or mental illness will find themselves swamped by unexpected emotions during massage. When I worked in massage, I was frequently told “Don’t worry if I start cries/have a panic attack/freak out during the massage. I always feel better after.” From my own experience, the worse my mental state gets, the more the right side of my body locks down, to the point that one really bad days I have a distinct limp and trouble raising my right arm. Obviously there is some connection between the state of our mind and the state of our muscles. What that connection is, and what effect massage has on it, is harder to define.

Studies into the effect of massage on mental illness have largely focused on use of Swedish massage to treat depression or anxiety. Many studies found a temporary improvement after massage.

Herbal Treatments

The rule of thumb with herbal treatments is that is science has created a synthesized version, it’s Western medicine, and if you are taking the actual herb it is alternative medicine. Part of this is that it takes years of studies to confirm the effects of a treatment, and there simply hasn’t been enough time to test all the herbs that are supposed to be beneficial. Even more than massage, herbal treatments are among the most accepted by Western medicine–if only because so much of modern medicine, from aspirin to quinine to most of the common heart medications, wouldn’t exist if they hadn’t come from herbs first. The other part, as mentioned above, is the Western medicine has very precise dosing standards, and these standards are difficult with herbal treatments.

The attitude of many doctors and researchers I’ve discussed herbal treatments with is “Some of these herbs are definitely helpful, some we don’t know yet, some are a waste of time. Until we can confirm side effects, dosage, etc, you’re better sticking with known and tested pills–but herbs definitely have potential.*” When it comes to psychiatric treatment, where a 30% success rate is the gold standard, whether or not you are “better” with Western medicine is a matter many find highly debatable.

St. John’s Wort is well known as a treatment for depression. It is also known to have some potentially dangerous side effects. As some one who has spent a lot of time recovering from the side effects of standard psych meds, my reaction to that is “And this is different how?” However, if you do want to try St. John’s Wart, please use it under medical supervision, just like you would standard psych meds. Side effects aren’t something to fuck around with.

For more on herbal treatments for mental illness, consult a trained herbalist–and always check with the herbalist and your doctor for potential interactions and side effects.

Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) is a system of medicine first developed in China several thousand year ago. It has continually evolved and adapted during that time. TCM is the best known of the Asian systems of medicine, and most of the medicine of SouthEast Asia is based on TCM.

Unlike most other alternative medicines, TCM is a complete system of medical theory and practice. This has led to a giant problem in studies testing the effectiveness of TCM. Put simply, when researchers study TCM, they have never started with verifying or disproving the basic theories underlying TCM. Instead researchers have taken specific TCM treatments, and tested them on Western diagnosis. This is kind of like if a society that had never heard of the germ theory of medicine tested penicillin by using it as a treatment for a cough with fever and headache–but because they didn’t know the germ theory, were testing antibiotics on both bacterial infections and viral infections. So they run a test during the height of flu season, and of course the antibiotic doesn’t work.

This is the way researchers have been testing TCM. So while there are some studies that support TCM, and some studies that don’t support TCM, my opinion is that all the studies are completely useless. (I have actively sought out studies evaluating the theory behind TCM, and not found any. However I am not a professional researcher, and don’t have access to many medical journals. If anyone has any further info on this, please contact me!)

There are three basic theories underlying TCM

1) That everything in life exists in cycles, including our bodies. This theory is in complete accord with Western science–from the day/night cycle, to the metabolic cycle, to the sleep cycle, to the cycle of the trade winds, yeah, life is made up of cycles.

2) That illness and disease are caused by something disrupting our normal bodily cycles. These causes are broken down into internal and external. Here, science can quibble with the details–wind is considered an external cause of disease in TCM. So is dampness. Of course, dampness brings mold and mildew, so for a society with no concept of microscopic organisms, it may just be that they were describing the ancient Chinese doctors were just describing the causes of disease as best they could within their knowledge of the world.

Overall, the basic idea that there are internal and external causes of disease, and that these things cause disease but disrupting healthy cycles, isn’t something Western medicine can quibble with, and the specific causes can be studied and identified or eliminated, just like Western medicine had to adapt Germ theory when it recognized not all disease is caused by germs–the basic theory is still sound.

3) That the cycle of the elements and the way they interact is an accurate metaphor for the cycles of the body, and disruption of the cycles of the body can be accurately described and diagnosed using this metaphor. On these, Western science got nothing. Researchers never bothered to test this metaphor to see if this theory is sound. If this theory is sound, then the basic ideas and practices behind TCM are likely sound, and the individual practices just need to be continually refined through further research. If this theory is not sound, than we are wasting our time testing treatments from TCM, because the very basis for determining those treatments is flawed. Also if this theory is sound, we can begin testing and studying TCM treatments within the framework of this theory. As opposed to doing the medical equivalent of testing the claims of quantum mechanics using and the theory of relativity.

Now, in TCM, everything is connected. What I said before about the connection between the mental state and the muscles? According to TCM, of course they are connected, and you can’t treat one without treating the other. So a trained TCM practitioner is not going to treat you for depression. Instead they are going to look at your sleep pattern, the color of your eyes, your physical symptoms, your emotional symptoms, how you move, the state of your tongue and fingernails (did you know that our fingernails develop ridges when we are under high levels of stress? the body is fricking weird sometimes), and a whole bunch of other stuff.

They will use all of this to diagnose you with a specific disruption of your bodily cycles, which will mean absolutely nothing to you unless you are familiar with Chinese medicine, but will sound something like “Your heart is overactive and there is a blockage in your liver.” This doesn’t mean your literal heart and liver, it means the bodily cycles that the metaphor of Chinese medicine associates with your heart and liver. Then they will use acupuncture, herbs, massage, and other treatments–some of them damn odd to Western eyes–to calm your heart and unblock your liver. Which, if they have correctly diagnosed you and if the TCM theory of disease is accurate, will correct the symptoms you describe–including the depression.

Like Western medicine, TCM treatments may be a one-time thing (take an antibiotics for two weeks and call me if the symptoms come back), an on going thing (take your anti-depressant every morning, and we’ll evaluate the dosage in a month to see if it is working), or a palliative (I’m sorry, the cancer is deep in the brain where we can’t operate, and chemo isn’t working. All we can do is make her comfortable.) If you do decide to pursue TCM as a treatment for mental illness, make sure you discuss with your practitioner what TCM says the likely cause of your illness is, and whether they think you will need ongoing treatments or not.

Other Alternative Medicines

There are many more types of alternative medicine, from Ayerveda (an ancient system of medicine from India, and to my knowledge the first system of medicine to include dentistry and plastic surgery), to crystal healing, to colon cleanses. Some of these alternatives to Western medicine have a great deal of value to offer, others are probably little more than placebos. Do your research, and be aware that unless your country regulates the type of non-Western medical treatment you are interested in, it will be up to you to verify that a practitioner is trained and knowledgeable. Quacks and snake oil salesman are just as much part of the medical world today as they were 100 years ago, and the unregulated nature of alternative medicine makes it easy for them to hide there.

How to Access Alternative Medicine

If your country uses and insurance model to pay for medical treatments, whether a single-payer system or privatized, or anything in between, access to alternative medicine through insurance will be hit or miss-and often miss.

Some insurance coverage will cover some types of alternative medicine–it will be much easier to get insurance coverage for massage in Canada or Europe than it is in the US, for instance. US insurance companies are more likely to cover acupuncture treatments these days, but that’s far from universal. I would expect it to be far easier to get coverage for acupuncture in Japan or China, but I haven’t been able to confirm this.

If you don’t have insurance, or if your insurance doesn’t cover the alternative medicine you are interested in, you will be paying out-of-pocket.

You’re best option for finding an alternative medicine practitioner is to do your research. Many alternative medicine practitioners have formed groups which provide training, information on the treatments available, fund further research into the effects of their form of alternative medicine, etc. These groups will have information on the training available to practitioners and how to find a trained practitioner.

If the type of alternative medicine you are looking for is regulated, that can help, but check your local regulations! While massage is becoming increasingly regulated in the US, the national standards are still 500 hours of training. 500 hours of training is plenty for people who just want a relaxing massage after a hard day. If you want massage for medical purposes, you probably want someone with more intensive schooling.

Impact on Polyamory

The impact on polyamory will vary widely depending on the type of alternative medicine you are considering. However the biggest impact may be the views of your polycule on alternative medicine. If your poly partner wants to try Traditional Chinese Medicine, but you’ve read all kinds of studies that say it is a waste of time…at the very least there may be hard feelings, at the worst their may be blame and judgement thrown around related to quackery, people who aren’t really interested in getting better, and people who are too busy judging to see what’s in front of their faces.

If your poly partner is suffering from mental illness and wants to try alternative medicine, but you believe alternative medicine is all quackery, the best thing you can do is be honest but supportive. Even if you believe any benefit from alternative medicine will be a placebo, remind yourself that placebos do make people feel better. In the world of mental illness, where we can spend decades trying to find a treatment that works, would you really blame your partner for wanting to try something–anything–that will help them feel better and regain control of their lives?

If you are suffering from mental illness, and your partner thinks you should try alternative medicine, but you think it’s quackery–it’s your illness and your treatment. Politely thank your partner for their concern, but tell them you want to stick with treatment that you are comfortable with. It’s your illness, it’s your treatment, it’s your choice.

If you haven’t yet, check out the other treatment options for mental illness, and 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.

*I have met a few doctors who insist that herbs have nothing to offer modern medicine, and no herb has ever provided a successful medical treatment. To which I am tempted to ask how they treat their heart patients if they believe digitalis is ineffective.

Course of Treatment: Treatment Options — Alternative Therapies

July 18, 2015October 20, 2022 Jess Mahler

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

Art 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.

Animal 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.

Course of Treatment: Treatment Options – Medication

June 26, 2015October 9, 2022 Jess Mahler

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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Mental Illness: The Course of Treatment

June 10, 2015October 9, 2022 Jess Mahler

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:

Recognizing that you need help
Getting a diagnosis
Finding a doctor/therapist
Figuring out treatment options
The treatment roller coaster
Managing/healing
When mental illness strikes again

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.

Polyamory and Mental Illness Blog Series

May 11, 2015December 20, 2022 Jess Mahler2 Comments

The Mental Illness blog series is on hiatus for a few months. It will resume when I finish the series on abuse in polyamorous relationships.