Thursday, June 30, 2011

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,, Kindle, or Apple's iBookstore.