I feel scared…concerned….insecure…startled…restless…fearful…panicky….shaken…

As I’ve begun learning about my mental illness and how it affects my life, I’ve started to look back through journals I’ve written in the past.  It’s interesting to see what I wrote in a different light and to see how far I’ve come. Also, it’s pretty hilarious to read about my past crushes—glad I ended up with Sidney.

Another huge benefit for me is that it sheds a bit of light on one of the questions I identified my previous post. “Why do children not share the extreme of their emotions with adults?” One reason for me was an inability to express my emotions.  Two phrases I see over and over in my journals are “It feels so dark in my body” and “I am losing control of my mind”.

I was never able to describe that feeling better—but instead wrote it over and over. I knew I was feeling awful, but I didn’t know how to express it. I would tell my parents, “I’m stressed” or “I’m sad”.  Or I’d cry and scream but was not able to explain why I was doing it. Or I’d give a reason I was crying, but it did not convey the intensity of the feeling.

One friend of mine tells a story of sitting on her front porch crying uncontrollably before school. Her dad promised her she wouldn’t have to go if she would only tell him what was wrong.  But she couldn’t. All she could say was “I’m sad”.

In therapy one of the first skills Rick and I worked on was learning to identify my emotions. Rick claims this was to help me, but I’m pretty sure that he was bored listening to the same conversation.

Rick: “How are you today?”

Nicole: “Anxious”
Rick: “Anything else?”
Nicole: “Sad”

After about three weeks of that, Rick introduced me to my feelings list.  I have a sheet of 100 feeling words that I am can use to identify in various situations. There are 30 words alone that go under the “anxious” category.  If they would put these words on the GRE I’d knock that out of the water! Instead there’s words like noxious.

We teach kids to write descriptive paragraphs about scenery, explain how to perform mathematical operations, support a thesis with detailed evidence…yet do we teach them to identify feelings? I’m not even sure how we would start to do this—after all, many adults are not good at it.  But I think it would be a big step towards helping kids manage their emotions!

Bridging the Gap between Parent and Child Perception of Emotions

I had an interesting childhood. You could maybe say I “rode some wavez”.   J

On one hand, I lived a rather easy life. My parents were still married, my siblings loved me (even if my brothers pretended not too), I never went hungry, we had spare money to go on vacation (“ARE WE THERE YET?!”), and I had a trunk full of sparkly princess dresses. What more could a girl want?

But on the inside, I was obsessively thinking about hurting myself, overly anxious about circumstances and yes, I was one of those “sensitive” children. Those negative emotions are part of how I remember my childhood.

Unfortunately, I did not get diagnosed until I was in graduate school. As such, I find the research discoveries being made in early detection and prevention particularly fascinating. I recently read this study that identifies an important obstacle to early identification of mental illness in children.

Here’s the abstract:

“Three studies assessed parent-child agreement in perceptions of children’s everyday emotions in typically developing 4- to 11-year-old children. Study 1 (N=228) and Study 2 (N=195) focused on children’s worry and anxiety. Study 3 (N=90) examined children’s optimism. Despite child and parent reporters providing internally consistent responses, their perceptions about children’s emotional wellbeing consistently failed to correlate. Parents significantly underestimated child worry and anxiety and overestimated optimism compared to child self-report (suggesting a parental positivity bias). Moreover, parents’ self-reported emotions correlated with how they reported their children’s emotions (suggesting an egocentric bias). These findings have implications for developmental researchers, clinicians, and parents.”

In English, the study indicates parents UNDERestimate the intensity of NEGATIVE emotions their children face. They also OVERestimate the intensity of POSITIVE emotions.  As the abstract suggests, this demonstrates a “parental positivity bias”. This bias is similar to hearing comments like “Susie only gets in trouble at school because she is just so smart the class material is boring her”….”Little Johnny sat on the bench the whole soccer game to give that poor other team a chance”….”My Mikey just has the cutest butt” (oh was that third comment too far? Little Mikey must be an only child…..)

I realize there are many questions and “what ifs” related to this study. If you are a nerd like me and what to see the statistics and research parameters of it, read the full article (citation at end of post). But if you are more normal and don’t enjoy the research aspect, while no study is perfect, trust that this study was published by a team from the University of California in a well respected academic peer reviewed journal, Journal of Experimental Child Psychology. So for the purpose of this blog—let’s take that main finding as gospel.

As you can guess, this finding was not surprising to me. My parents would likely have underestimated the frequency and intensity of the anxiety I faced as a child.  But in their defense, if we had been in this study our answers would likely have matched. There is no way I would have admitted on a survey how terrible I was feeling.

How do we fix this problem?  I do not want anxiety disorders and depression to become the new “flavor” of the week; after all, growing up is hard! Anxiety and depression are an expected and normal part of development; majority of the children in this study likely did not suffer from a mental illness. But a few of them might show early signs of a mental illness. Either way, the children could use more support and help handling these complex emotions. As adults we have to bridge this gap between the emotions of the children we interact with and our perceptions of their emotions.

I believe the first step to tackling this problem is to answer the question, “Why does this gap exist?”.  I want to explore the many possible answers to this question—I’ve been looking through research, combing blogs of individuals parenting children with mental illness, and reflecting on my own experience as a child with mental illness. But before I go too far preparing the next blogs, I want your thoughts and input.

Here’s a few questions below to hopefully get some dialog going—but feel free to branch off from them.

• What can adults do to increase understanding of child emotion?
• Are children hiding their negative emotions? If so, why?
• How do you differentiate a mental illness from “normal growing up”?

Here’s the citation to the mentioned article and other related resources:

1. Lagattuta KH, Sayfan L, and Bamford C (2012). Do you know how I feel? Parents underestimate worry and overestimate optimism compared to child self-report. Journal of experimental child psychology, 113 (2), 211-32
2. Children develop anxiety disorders: Too often the problem goes unrecognized http://www.dispatch.com/content/stories/local/2012/10/21/children-develop-anxiety-disorders.html

Am I a Client or Patient?

Last week I introduced the topic of integration of primary and behavioral health care. I’ve been listening to some podcasts about it (got to love those) and heard about an interesting system a local hospital is piloting. Each general care practitioner clinic is required to have a behavior health professional on staff. That professional has two roles.

• See individuals referred by the general care staff.
• Keep the staff current on new mental health medications and research.

Evaluations of the program have been positive thus far. The primary care physicians have seen a dramatic decrease in the resistance of individuals in scheduling and attending an appointment with a mental health counselor. The doctor will write a note in the individual’s chart, and when they check out the receptionist will ask when they would like to schedule an appointment with the mental health professional. Often, they are able to make same or next day appointments. Moving the mental health professionals into the same clinic as the primary care doctor increases convenience and lessens the stigma attached to therapy. The clinic has found the convenience of same day appointments is especially beneficial to low income individuals who have transportation concerns.

I love this idea—and will be interested in seeing if it spreads throughout the larger Indiana community. I’m not ashamed of therapy—but I still have some awkward moments in the waiting rooms. Everyone there is trying to avoid eye contact with you, and you start wondering why they are there. And figure they are trying to figure out why you are there……or what if you run into someone you know? What’s the protocol on that?  So sometimes I think it would be nice to park my car in my general care doctor’s office, and sit in the waiting room. Then people could just assume I was there for an allergy shot or something.

But now I need your opinion on something! The administrator presenting the pilot project, said one of the most basic problems they are encountering is a debate between primary care practitioners and mental health practitioners. Are individuals being seen by mental health practitioners “patients” or “clients”? Primary care practitioners identify them as “patients” the same as every other individual they see. Mental health practitioners believe they should be addressed as “clients”.

Seems like a simple concern—but there’s actually a lot riding on this debate.  I see the case for both sides.

• Client:  The connotation is of the individual having more responsibility and control over their treatment.
• Patient: This connotation brings to mind someone who is sick—on one hand, I think that can be a good thing. I want to start to associate this anxiety/depression crap with physical illnesses so people realize it’s not my “fault”. But on the other hand, not everyone in therapy has a physical illness and sometimes when I am doing well I do not like to think of myself as sick.

So—I can be swayed either way on this issue!  VOTE and then leave a comment with your thoughts on why you voted the way you did (if you would like to!)

How slippers diagnose an anxiety disorder…

Take a good look at the slippers below, because you’re about to get to read a whole blog post about them. Don’t stop reading, I’m only kidding.  Kinda…

My amazing dolphin slippers

My husband brought these slippers home from the zoo the other day.  He picked them for two main reasons: one, in my fantasy world I’m a dolphin trainer and two, my hands and feet are always cold! I tell you the first reason as just a fun fact about Nicole. The second reason is the connection to my mental illness and reason behind this post.

Dr. Andrew Weil is founder, professor, and director of the Arizona Center for Integrative Medicine at the University of Arizona. He’s a great resource for understanding the science behind mental illness as well as alternative health treatments.  In a few of Dr. Weil’s books he claims he can diagnose an anxiety disorder in five minutes. How? Dr. Weil shakes the patient’s hand and if the patient’s hand is exceptionally cold asks, “Are your hands typically colder than the rest of your body?”.  (After all, he lives in AZ so even I would be warmer there….). If the answer is yes, Dr. Weil says this is a signal to continue to explore the possibility of an anxiety disorder.

Seems like a random and rather haphazard way to diagnose an anxiety disorder until you understand the biology of the illness. During panic attacks or intense anxiety, the body’s sympathetic nervous system activates, preparing you to “fight or flee”. This causes your body to undergo a series of very dramatic changes, such as activation of the immune system, increased heart rate, and shortness of breath. In addition, blood is shunted away from extremities to the vital organs such as the heart and larger muscles groups needed to “flight” or “flee”.  This lack of blood to the extremities results in cold hands and feet.

I address this biological reaction of anxiety disorders for several reasons. First, I always like when things explain characteristics about me that I didn’t understand (especially if they are things about me that are annoying…who doesn’t like an excuse for something they don’t particularly like?!).

The second reason is more important.  While I usually address the more emotional and less measurable signs and symptoms of mental illness, educating the public of these less obvious but still valuable and useful signs of a mental illness can be especially beneficial. Being aware of these sings can lead to earlier identification and treatment. My personal story underscores this point. Around the age of 14-15 I saw a specialist for the constant headaches I was having.  After numerous tests, he determined that I had poor circulation.  He suggested several activities to help mitigate the symptoms, but doctor did not check for other signs of an anxiety disorder. This is one moment of my life I look back on as a “What if…” moment.  Now life can’t be changed and I don’t say this to blame anyone.  Instead, it’s a lesson learned that I want to be certain to pass on to others so they do not suffer as long as I did.

Finally, it’s one more reminder and proof that my illness is truly a chemical imbalance. I’ve noticed on days when I’m more anxious or feel a panic attack coming on, my hands and feet get colder. When I’m calm I notice I’m not constantly rubbing my hands together to warm them up!  It’s good for me to have these physical reminders that my craziness is not my fault!

The added bonus of it all? It gives me an amazing excuse to wear all my warm soft fuzzy clothes that my husband hates.  The slippers (his words when he gave them to me “I hated them so I figured you’d love them”), my onesie, knee high socks…….

Bad thoughts be gone! Poof! *swing magic wand*

I’m sure you have noticed that I tend to keep my blog related to my personal experience and stories. What I don’t often show is my more academic side (I know…with my writing style you’d never know I had one!). I assumed that if people wanted to read more academic journals related to mental illness they would find it on their own.  However, I think I’ll start including a few here or there—I do A LOT (probably too much!) of reading related to mental illness, so this will be just the ones I find most intriguing.

This research discovery has me very excited. It’s a treatment for depression and suicidal ideation that can work in a matter of hours or days!  Typical medications take over three weeks to begin targeting depression, and for those with suicidal thought that can feel like years. While this is likely to be a groundbreaking drug for crisis situations, I look forward to the possibilities for those in “recovery” as well. About six months ago I was going through a depressive spell and when I woke up wanting to die, I remember thinking “gosh—I wish I had a xanax for this.”  See, with my anxiety I can take a very very low dose xanax and it is often takes off just enough of the edge that I can start practicing my tools. With depression there is currently nothing like that.  So when you’re severely depressed, there’s nothing to “jump start” your brain enough that you can start using the techniques you have learned.

But I’m also reminded of my recent post, “Long Black Train (8-9-12). In it I discussed holding on to hope that one day there will be a better cure for bipolar.  It’s exciting to see that possibility becoming a reality!

http://bbrfoundation.org/discoveries/ushering-in-a-new-era-in-depression-and-bipolar-disorder-medications