Goodbye to A and Hello to Unkown

Phooey! I got a call from my caseworker late this afternoon. There are changes happening where I get my mental health services. One of the changes is that my caseworker — let’s call him “A” — will not be with me after the first of the month. In a matter of days, I will have a new caseworker.

“A” has been a staunch supporter, ally, cheerleader, confidant, and friend to me. One time, my insurance declined to provide authorization for a certain medicine my doctor prescribed for me, and “A” got involved. He called them, got straight to the point, listed all my symptoms as to why I needed this particular drug, and did not take no for an answer. The call lasted approximately 30 minutes. He is fearless and unstoppable when it comes to getting what his clients need.

“A” is a genuinely good man. He cares about his clients. He introduced me to the job that I currently do.

He changed my life.

Thank you, “A”.

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When Things Go Awry

I am teaching WRAP to a group. It’s my first time to facilitate a group instead of doing WRAP one-on-one with a client. We met for an hour last week to get started. I introduced myself, and we made a Comfort Contract for the class. A Comfort Contract is a group-directed list of guidelines to keep us all at ease talking to one another. I make these contracts with individual clients, too, but it’s vital for a group. Each member has to feel at ease.

We met again today, and we moved into the area of Triggers and a Trigger Action Plan. When a situation arises or an event occurs outside us that makes us feel particularly bad, it’s called a trigger. It may go so far as to worsen our symptoms. A very few examples of triggers include anniversary dates of losses or trauma, being overly tired, family friction, being judged or criticized, etc. The important thing to remember is that triggers are external to us.

In a WRAP class, we don’t stop at reminding us about the bad. We also gain power writing a Trigger Action Plan. An effective facilitator will reinforce this to the group. It’s easy to write a list of what makes us feel bad and have that snowball into actually experiencing the trigger. We take breaks, and we remember we are striving for recovery.

The Trigger Action Plan ideally contains some action to counter each triggering event or situation. Revisiting our Daily Maintenance List is high on the Action Plan. Are we doing everything we said that would keep us well? There are deep breathing exercises that anyone can learn to aid in getting through troubling emotions. Talking to a person we are close to is a valuable resource. Exercise cannot be underestimated in these situations either. The number of items on the Plan can go on and on.

The group went further today. We tackled the next section of WRAP, the Early Warning Signs and its accompanying E.W.S. Action Plan. While Triggers are external events that may cause us to feel bad, Early Warning Signs are internal. These signs indicate that all may not be well with us. Some examples are anxiety, forgetfulness, avoiding doing things on our Daily Maintenance List, increase in smoking, failing to buckle seat belt, etc.

The Early Warning Signs Action Plan is similar to the Trigger Action Plan. Each item relates to an Early Warning Sign. We may choose to meet anxiety with deep breathing or other relaxation exercises. Forgetfulness may cause us to renew our efforts at meditation. Avoiding doing things on our Daily Maintenance List is serious, and we may have to look deep and talk to a trusted friend about it. An increase in smoking may indicate a rise in stress, and we might decide to take extra rest and ask for assistance with responsibilities. Failing to buckle a seat belt is also serious, indicating a deeper issue that one might wish to bring up with a therapist or doctor.

Both Action Plans are important. They empower us. We don’t have to be hostage to our Triggers or to our emotions and their indicators.

It was at this point when things were winding down for the hour that something went awry for a participant. No sooner had I announced we were almost complete for the day, than she rushed from the room. Fortunately, this class took place at a center with lots of other people around, and one of the staff was soon by her side. She had not been feeling good since the morning, She bravely stated that her symptoms were worse. She was in distress, and the staff called an ambulance. I am sure she is now receiving the best care afforded by our local hospital.

I believe this incident illustrates why it is important to do WRAP with a certified facilitator and not alone. All people are vulnerable, and we with mental illness may have unique ones. A trained WRAP facilitator is often not a clinician but should have the experience to recognize a group member going off the beam, as it were.

My Schpiel

New clients view me with a mixture of distrust and curiosity. I am usually introduced to them by a case worker who gives little information about me or about what I do. Initially, I am seen as part of the system.

I have to break through any figurative walls quickly and carefully to reach a level playing field where I can teach the skills I’ve learned. Passing along what has helped me is my whole reason for working. Giving the tools that help me stay well and not relapse into crisis is what being a Certified Peer Specialist is all about. It’s my job.

In training, I was coached on how to introduce myself. I was given the Five Key Concepts and directed to use them when I meet a new client or group. Those concepts are

  • Hope
  • Personal Responsibility
  • Education
  • Self-Advocacy
  • Support

My introductory pitch to a new person is important. It will determine how we are going to interact. Once the mood is set, it is difficult to change it. I have to be vigilant in my own recovery and follow my own WRAP daily to be ready for these precious meetings. They are precious. Each meeting and each session and each client is a gift to my recovery. I heal freely sharing what I was taught.

My schpiel or pitch is conducted completely using “I” statements. It’s my story. It’s never exactly the same, but it meanders along an outline something like what follows:

When I was diagnosed with a mental illness 12 years ago, I was devastated. I felt like I’d hit a brick wall with no possibility of going around or over it. I lost my job, the respect of my family and many friends, and my self-respect. I felt utterly worthless. My life as it had been was over, and I felt damaged. What’s worse was I felt abandoned by society as a whole. I was an outcast.

I had many dark times. There were days when I had no energy to get out of bed except for the most rudimentary needs. There was a time I wouldn’t leave my apartment for days. I despaired that things would never improve.

I had no hope. Darkness swallowed me.

Luck put a group of loving friends in my life. They listened to my complaints and distracted me with silly card games and other activities. They dragged me into the sunshine when all I wanted was to stay locked behind my door. I also had a kind prescribing psychiatric nurse practitioners and at other times good psychiatrists. I have been extremely lucky to be in therapy with a highly regarded psychologist. All these people gave me a few tools to get through each day.

They showed me that hope was possible. Trying different combinations of medicine gave me ideas that I could improve. Getting out to socialize even in simple settings like the coffee shop was a labor for me, but I did it regardless of my internal desires. I began to exercise. I clung to my friends. I renewed my interest in meditation or guided visualization. I began to see how taking care of my most basic needs was an act of self-love.

Hope rekindled in me. It was slow, and over the course of years, I realized that I had a stake in making me feel better. I was miserable, and I wanted not to be. Those little daily tasks like taking my medicine, socializing, exercising, and meditating became a mantra of sorts. I saw that I had to take some responsibility if I wanted to feel good.

I also had a lot to learn. I was fortunate growing up to have an older sister who worked in the mental health field. I knew a lot about the importance of taking medicine each day. I heard about her experiences with patients, and I knew I did not want to be sick. I wanted good mental health, and I had to educate myself on my illness. Living with the Internet, this process was much easier than just a few years ago. I had a wealth of information at my fingertips, and I used it.

I began using the new information I’d gleaned from the Internet and books and sundry other resources to talk to my healthcare providers about my treatment. I became an active participant. Looking my psychiatrist in the face and stating plainly that I wanted help with a particular problem altered my life. I was a force in my own decision making. I was not a pawn of any system.

Finally, I permitted myself to have a group of supporters who have my best needs at heart. Today, I have an excellent prescribing nurse practitioner, and we work closely together on my medication needs and talk openly about events in my life. I have a top-notch therapist that I’ve known for over twenty years. I have a case worker who is one of my greatest cheerleaders. I have loving children. I have friends who truly love and support me in my endeavors.

I have a new lease on life.

The above is a broad example of my schpiel or introduction. It’s tailored for each setting and each new client, but it’s my joyous responsibility to follow the Five Key Concepts and model them in my life.

If there is anything I would like to emphasize it is regaining hope. Without it, I was lost. I cannot say enough how thrilled I am to do the work I do, to live the life I have, and to practice my own recovery. Today, I am hope-full.

A Wide-Ranging Session

One client during my internship has grown into a really interesting case. Readers will remember him as the combative one. He has returned several times since that appointment, and his attitude has always been good. He enjoys lively conversation, but he’s never returned to the highly argumentative tone.

Today, he arrived and sat down and informed me he’d almost taken the bus to a town about two hours away. Taking this trip is his way of saying he wants to kill himself. He’s taken the trip many times in the past decade, but he’s thankfully never followed through. His routine there is always the same. He drinks rum on the bus ride and then continues to drink the first day there. He also smokes cigars that first day. He sleeps outdoors and awakens with the intention of killing himself the second day. Instead, he takes the two-hour bus ride back to the care home where he has a bed.

I knew about this habit of his, and I’ve known about his chronic suicidality since I first met him. My response to him this morning was to thank him for telling me about his plans. Then I said that I was glad he hadn’t gone on the trip, because it would have left me without a client and I would have been bored.

He quickly said, “That’s not a good enough reason for me not to go.”

I responded that I completely understood, but that I still didn’t want to be bored. He was really interested in my seemingly nonchalant answer.

My real answer was to then launch into continuing to fill out his WRAP folder. We approached the section entitled Crisis Plan, which requires a lot of writing by the client. They have to think thoroughly about how they want their care to be conducted in case they fall into crisis. My client mentioned simply that he didn’t want to do it. I agreed that we should stop since I’ve been trained that WRAP is self-directed. He did say he wasn’t ready to completely give up on the Plan. He wants a hook. He’s looking for something that will give him a lease on life.

I told him again of my own WRAP and how it changed my life. I went from having chronic negative self-talk to none. I talked about the dark times I’d seen, and I called them that: the dark times. I kept it general. Using “I” statements, I mentioned that since writing my WRAP, I had not relapsed into dark times, and I had not required a stay in the hospital. My WRAP has kept them at bay.

His reaction was to announce that dark times are the natural state of mankind, and they shouldn’t be fought. I thank him for telling me his ideas, and then I surprised him. I agreed with him. Dark times may be the natural state for many, but I don’t have to stay stuck there. I was careful to mention that I was speaking for me.

This client has a set of interesting ideas that he regularly says for all to hear. “Man is a primate.” “Man is alienated from life.” “Life is meaningless.” “God is dead.”

I surprised him again today. I agreed with him once more. I told him I thought it was indeed difficult for people to find an ultimate meaning in life. He smiled and said he had nothing to say in response. I continued with my story and how important WRAP was to helping me out of the dark times and into a state of serenity. That piqued his interest. I explained how the Daily Maintenance List kept me on an even keel so I wouldn’t fall back into a crisis.

“The whole meaning of WRAP is to keep us out of crisis,” I said.

He looked at me quizzically and muttered something about the meaninglessness of life.

I answered him by describing the meaning I find in a string of small things. I love my job. I love my family. I enjoy reading and writing for myself and others to read. Finally, I have a passion for theater. While I reserved my speech to “I” statements, I tried to steer the conversation to his enjoyments. He loves classical music and speaks about it with fervor.

Then I mentioned the word “pleasure,” and we started a tangential discussion of how a meaningless life could or couldn’t possibly have any. The talk was fascinating. We spoke about hedonism, and yes, we used that word. He’s a smart man and has read a good deal of philosophy. I threw Epicurus into the mix, and he was impressed when I mentioned that Epicurus was a champion of the middle path rather than what Epicurean philosophy has come to represent, namely hedonism. My client said he preferred a more stoical way.

We ended our time together with a talk about Shakespeare’s sonnets and specifically, the unknown lady mentioned therein. My client called Mozart and Beethoven eternal, and I said the lady of the sonnets was, too. Shakespeare even tells the lady she will be eternal in his words. My client appreciates the beauty of those words. He was surprised at me again that I seemed so enthusiastic about the Bard. For our session next week, I’m going to take a few of the sonnets for us to study, I think.

It was indeed a great session. I am blessed to know this man. He touches me with his candor. He honestly appears to be searching for something that he can’t or is afraid to grasp. I’m not so presumptuous to imagine I will help him find it, but I truly hope I can demonstrate that reaching out doesn’t have to be painful. A desire can sometimes lead to pleasant surprises.

Working and Bipolar

I am happy to announce that after discovering, waiting, researching, waiting, applying, waiting, being accepted, waiting, training, and waiting, I am now a Certified Peer Specialist Intern in mental health licensed by the state I live in.

I am going on a three-week trip to attend a family reunion and visit my parents. I will leave next week and return in early June. As soon as I return, I will start my internship at the state-run Community Mental Health Clinic here. That’s right. I have a job.

I am so grateful for this opportunity to work in the field of mental health. I want to help. I want to recover.

Coping with Anxiety

Yesterday was not an easy one for me. It was busy with emails flying about and doctor appointments and phone calls. The emails were unfortunately very confrontational, and they caused me a lot of anxiety.

Over the years of therapy I’ve been grateful to have, I’ve come to recognize negative emotions in my body right from the very beginning. For me, they start in my stomach. When I feel it churning or burning, I know that I’m experiencing anxiety or fear. When my chest tightens, then I’ve already missed the early warning signs, and the situation grew. If my face muscles clench or I have a headache, then things are out of control.

Thankfully yesterday, I caught my emotions while they were still in my stomach. It was extremely unpleasant, and I was relieved to have two appointments with health professionals. I saw my psychiatric prescribing nurse practitioner and my psychologist. Both are very competent women with many years in their fields, and I trust them fully.

The nurse practitioner and I had a good opportunity to discuss the situation, and she had some great feedback. She suggested that I begin to disengage from the volunteer organization that I spend so much time and energy giving to. She didn’t tell me to quit, but to let others in the group step up and do much of the work. I have been doing this since the beginning of the year, and I’m continuing it.

My psychologist had even more concrete ideas about easing the trouble causing my upset stomach. I had been insulted by one conversaion, and she suggested I write a very short note to the friend who had hurt me. I did that. I wrote clearly that my feelings were hurt. I did not write in anger. I did not express any either. I stated simply what words hurt me. Just discussing the idea of writing the note eased my churning stomach. Actually doing it and hitting the send button on my computer gave me more satisfaction. Later, I received a simple and heartfelt apology. All was well.

My psychologist paid me a great compliment. When I began counseling with her many years ago, it would take us many sessions to dig up my emotions. Yesterday, I entered her office and immediately explained my upset stomach and what was causing it. We came to a good conclusion, and I followed through. All that was accomplished in one sitting.

I have learned to pay attention to my body. It doesn’t lie to me. If something is wrong in my environment or with a situation that I can’t put my finger on, I can trust the sensations my body is giving me. I did not learn this overnight. It took many years, and I am still perfecting it. I will always be a work in progress.

Anxiety is awful. It robs us of clear thinking and overall enjoyment of life. Causes of anxiety are as numerous as grains of sand on the beach. I used to be terribly frightened to drive in parking lots. Life is not simple, and I needed a coping mechanism to allow me to park with minimal fear and greatest safety. I learned to plot my course. I visualized entering the parking lot from the same spot and turning down the same lane each time. My decision was to park in the first available stall regardless of its distance from the store’s entrance.

It worked. I learned to practice this visualizing and planning technique with many other situations in my life. Whatever gave me fear would be met by clear thinking and discussions with caregivers and planning.

I am not alone today. I have people who care about my success at daily living. They help, and I am learning to accept help.

One Nice Thing

My friend suffering from major depression contacted me after a long quiet spell. Actually, I initiated the communication reaching out to him. We’ve been sending text messages for a number of days now. He doesn’t seem to have the energy to speak on the phone.

I’ve known him for about six or seven years now. I’ve talked to him in times of deep crisis and in happy ones, too. When my internship begins, I am going to strongly urge him to join in the WRAP classes.

A Wellness Recovery Action Plan as taught by certified facilitators has the capacity to alter lives. It changed mine. I cannot stress enough my personal transformation. I walked into the job training a frightened individual who believed he was defined by his illness. I leaped through a stage or two of recovery the first week. My eyes opened. I shed my negative self-talk miraculously.

Recovery works. It really works.

My friend can’t see that as yet, and I do not push. I offer understanding. I have been in the dark pit of despair and made it out with the help of a cadre of supporters. I had family, friends, case workers, a therapist, a psychiatrist, and a psychiatric prescribing nurse practitioner all working to find what would work for me. I believe it allowed me to reach a place of acceptance, opening me to the possibilities of recovery.

My mantra encourages those suffering depression to do just one nice thing for themselves each day. Just one. A simple one.

Many years ago when I was at my lowest, my one nice thing was brushing my teeth. I was incapable of more. Gradually, I was able to exert a bit more energy and add activities to my list each day, but I began slowly.

It’s important for people with mental illness to practice loving acts of self-care. We, who often feel the opposite, are worthy. I am worth it.