Who's Doing the Driving? (Part I)

A couple of months ago I was giving a speech (my first) on mental health skills. Planning it, I had to ask myself: what is the single most important skill the mentally ill can learn?

Answer: learn how to tell that you have entered an altered state (psychosis, panic, mania, etc).

Now, this is not simple. If you think of the altered state of dreaming, you notice that while you are dreaming all the impossible things that happen make perfect sense to you. It is only when you return to waking life and try to describe it that you find the logic and chain of events don’t work. But there are some people who can occasionally, while in the dream state, say to themselves “This is a dream.” That is similar to what I suggest we develop. It is an inner ability to detach, just a little bit, and see ourselves.

This is not a replacement for taking your medicine. This is more a way of dealing with those ‘breakthrough’ symptoms that so many of us live with.

There are enormous advantages to understanding, for instance, that you are having a panic attack or hearing voices that are not there. Once you know, you can take action: call a doctor, take a pill, get off the freeway, go in your room and close the door, whatever your personal experience has taught you is effective. This minimizes the damage. If you don’t know you’re not in ‘standard reality’, you will keep bumping up against other people’s reality, and that could end in a screaming fight or the police station or other unpleasant places. You will then be at the mercy of what other people – maybe strangers – decide to do about it.

So here’s how you learn to catch yourself. This is a practice that develops over time, it is not a quick fix. At the end of each day, review the day briefly to yourself and ask something like, “How sane was I today?” or “Did I have symptoms today?” Go over the day and see any place where maybe you lost it a little (or a lot). This is not the time to beat yourself up. This is the time to analyze calmly. Zero in on the incident. What did it feel like? How did it feel or sound in your head? What was going on with your body? Were you all tensed up? Were you overwhelmed and shaky? Did you have a headache or anything else that was noticeable?  Is there something that you say or do every time that happens? Really go over that experience in your mind and then compare it with whatever your personal version of ‘normality’ may be. How are they different? Can you get a feel for that? Would you recognize it next time? What could you do next time that would be helpful?

If you do this nightly scan for awhile – not criticizing yourself, just looking for information – you will start to find repeating patterns and sensations that are familiar. These can be your “clues” that you have gone over the line and need to take rescue measures. After some time, you may even start to notice triggers. Do you always end up sick if you do x? Do you suffer if you overdo y?  You’ll start to understand some of what sets you off, or just generally makes things worse. I do not mean that we always have external triggers or “reasons.” Sometimes  there’s just an arbitrary chemical surge in your brain, and you have to deal with it. But you can learn to avoid some of the unnecessary stressors in your life. You can begin orienting your activities away from those triggers.

Of course, this does not work for anxiety reactions. If you hide from everything that scares you,  you will soon be living in the broom closet. For anxiety problems, you are better off facing these things in small doses, one by one. But you are still better off recognizing your reactions when they happen. Naming things takes some of the fear and strength out of them. You can say to yourself, “oh – this is not me, it is my disease.” That gives you a little power over it.

Over time, this kind of self-monitoring will help you to live life with fewer outbreaks. Or you can recognize them sooner, and head them off at the pass before they get too extreme. It’s worth the time and effort you put in to make a more functional, peaceful life – and believe me, your loved ones will appreciate fewer storms as well.

Next week we’ll discuss some other ways to catch on to what your brain is doing.

Deborah is the author a one self-help manual, Is There Room For Me, Too? 12 Steps & 12 Strategies for Coping with Mental Illness.  You might also like to explore her award winning comic romance novels set in the 1800s in England. See Amazon.com, BarnesandNoble.com, Kindle, or Apple's iBookstore.

Affordable Health Care Update

I attended a lecture Thursday night on the status of the Affordable Care Act (health care reform) that became law in March of 2010. There was a lot of interesting information, not all of it new, that I think anyone with a mental health challenge ought to know. We do, after all, have a chronic condition that requires regular medical care, and the bills can be a lot higher than we can afford.

You probably know that there is now a sort of exchange where people with pre-existing conditions can go, but do you know how to find it? Go to www.pcip.ca.gov (in California), or call 877-428-5060 Monday through Saturday. I’m sure they can give you information on out-of-state sources to contact, as well.

Here’s a quick summary of the provisions active so far: lifetime coverage limits have ended, no pre-existing conditions are allowed for children under 19, coverage can’t be dropped midstream, and Medicare (which many of us are on) has eliminated copays and deductibles for preventive care. So if you need a checkup or a mammogram and you don’t have money, go anyway. Also, parents can keep children on their insurance to the age of 26. Those are a few of the more important items.

Now here’s a rundown of additions for 2011: Most important for Medicare Part D beneficiaries, there’s a 50% discount on brand name drugs during the infamous “donut hole” period (which won’t be eliminated till 2020). Also, Medicare payments are supposed to now be connected to quality outcomes – so you aren’t given just the cheapest treatment whether it is right for you or not. The speaker I heard also claimed that access to long term care at home and in the community is increased, and that community health centers are expanded. What that looks like in real terms, I don’t know. Also, insurance must use 80 to 85% of your premiums ON HEALTH CARE.

Some of the things coming up:

2012   - a voluntary option for long term care insurance

2013   - increase of payments for Medicaid primary services. Increase of Medicare

doctors and nurses

2014   – Insurance exchanges come online for individuals and small businesses.

-       Discrimination due to pre-existing conditions or gender ceases.

-       Medicaid is expanded to everyone below 133% of the poverty level, which right now is $29,000 for a family of 4.

-       No more annual limits to coverage

2020   - Medicare Part D “donut hole” terminated

I also understand that ultimately on the California State Exchange insurance will limit out-of-pocket expenses to a maximum of $11,000 in any calendar year. So you won’t get wiped out by one big injury or illness. I don’t know what year that becomes law.

You can find out anything else you need to know at the new federal website: www.healthcare.gov (or in Spanish at www.CuidadodeSalud.gov).

And if you’re already stuck with a big bill, get help here: www.hospitalbillhelp.org

All this information is courtesy of the Unitarian Universalist Legislative Ministry of California, which can be reached at www.uulmca.org or 916-441-0018. I’m sure they’ll be happy to refer you to out-of-state sources.

Good health to all, and I’ll see you next week.

Deborah is the author a one self-help manual, Is There Room For Me, Too? 12 Steps & 12 Strategies for Coping with Mental Illness.  You might also like to explore her award winning comic romance novels set in the 1800s in England. See Amazon.com, BarnesandNoble.com, Kindle, or Apple's iBookstore.