I had mixed emotions about contacting my psychiatrist, even though he’s the best psychiatrist I’ve ever had, and I’ve been going to him for 12 years, ever since I had my last psychotic break. We trust each other, and he’s always made good decisions for me. Yet, I still fell into common mental traps about admitting my concerns to myself and reporting them to a medical professional.

Minimizing Your Observations and Dismissing Them

You don’t want to admit to yourself that you could be relapsing, because it means so much to all of us to think we have recovered, have made so much progress, and will never have to go back to that level of pain and personal damage. Part of feeling normal and good about yourself is this belief that the unfortunate period of your life is totally over and there is no reason to that it could all happen again. That’s how so many of us keep going and believe in ourselves again. You can’t bear for this to be happening to you again, so you tell yourself it really isn’t. Or you say, if it starts happening on a regular basis, or a second time, then I’ll tell my spouse, friend, or parent about what’s happening. And only if it gets really bad, do I contact my psychiatrist. However, this isn’t necessarily the best strategy. It is better to tell your provider what is happening immediately. That can be difficult when reluctance and fear in seeking help and itself contribute to poorer insight during early warning signs of a .

What is happening is real, whether you like it or not, even if it is super inconvenient. Keeping what’s happening to yourself doesn’t make what you are experiencing any less real or less indicative that you could have another psychotic break. You can kid yourself or deny your symptoms, but it is what it is. And the truth is that for anyone, even someone like me who was completely symptom-free for over a decade, it’s important to be careful and be a good observer. Having a symptom after all this time was also a confirmation to me that I am doing the right thing by being on medicine for life because what I have is chronic.

Common Myths About Contacting Your Provider

I realized I was hearing something that wasn’t there, and then I lost trust in myself about what I was actually hearing and what I wasn’t late at night when I couldn’t sleep. I hesitated contacting my psychiatrist, because I equated that irrationally with “getting in trouble” and doing a potential psych ward visit. Part of the difficulty was admitting reality to myself, and part of it was admitting it to my psychiatrist who documents it. That’s when it seems really real and that there is no going back. So even though it has been over a decade since my last break, and I have such a great, trusting relationship with my psychiatrist, I fell into common traps and fears about telling my provider about what was happening.

You can also think you know what the psychiatrist will decide to do, based on your own limited knowledge of medicine and assumptions motivated by fear. The truth is, you are not a professional when it comes to medical , even if you are like me and have been taking antipsychotics for 25 years. I assumed, out of fear, that if I told him, it would mean I would have to go back to my former antipsychotic, which gave me a bad side effect, the same side effect I’ve had with every other antipsychotic I’ve ever tried over the past 25 years. This new one I am trying is the first one in all that time to not cause the side effect, so I want to believe so much that it will work long term.

Having a Real Dialogue With Your Provider Can Pay Off

Contacting your provider can pay off. The provider has the chance to hear you and make a great decision for you, one that you could not have necessarily thought of yourself, which saves you from further heartbreak and damage caused by . My provider kept me on the new antipsychotic I prefer but just increased the dose. It turned out that I was given an option that I not only felt good about and agreed with, but he also reassured me that while I was having a questionable symptom, he thought it was highly unlikely it meant I was going into another break. So, I let him have a real dialogue with me and let him draw his own conclusions without my assumptions getting in the way. In doing so, I received reassurance that I’m most likely safe but that we are upping my dose just to be careful. And not only was this a solution I like that still prevents a side effect I don’t like; it also solved my problem where I am now symptom-free again.

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I tried so hard to listen and retain knowledge on tools to stay present and other life skills in DBT, but for the most part, my reality was so painful that I did everything to avoid these big emotions and circumstances that seemed intolerable to me. It’s not just psychosis that calls for acceptance; it’s all the collateral damage that makes life so excruciating and difficult to accept without judging yourself — loss of job, school, or , loss of friendships and/or family members, , potential legal trouble, and facing diagnosis of a stigmatized, . Today, I am fully present and have a clear mind, but it has taken me a long time to get here. The concept of radical acceptance got my 25 years ago, and I still haven’t forgotten this concept as a guiding principle, which has helped me reach my current state of mind.

Radical Acceptance Defined

Resisting reality has consequences involving an internal struggle, where accepting difficult circumstances helps absolve pain and transition you into a peaceful state of mind. Accepting your situation does not mean you approve and does not mean giving up. You accept that your situation is outside your control and cannot be changed – without judging it. It is through this process that you lose this to your pain and can let go. You can thereby let go of recurring thought traps like “this is unfair,” “why me?” and “why now?” This is not an easy process, especially with psychosis, and it can take a lifetime to apply it to your life effectively. It certainly has for me.

Fully Accepting Realities You’ve Experienced That Weren’t Real

It’s only natural to reject and resist realities you have experienced when psychotic that are potentially harmful to yourself and you feel socially punished for, especially since they are false. Sometimes psychotic breaks, while bogus, still touch on personal themes and truths from your life that make such crises seem much more like a targeted, personal attack that is emotionally painful. It’s hard not to judge what you’ve been through when you can feel judged by others and blamed for something beyond your control. Part of radical acceptance is accepting that there are matters out of your control, and a psychotic break is the quintessential circumstance where you have no control whatsoever.

Despite every understandable reason there is to judge your psychotic breaks, accept them as part of your story and stop fighting them. Don’t judge your hallucinations and delusions, no matter how terrifying or embarrassing they are. Don’t judge yourself for having them, and let go of . It is what it is. These painful events happened, and there is no changing them. Pretending they didn’t happen won’t make them go away. You don’t have to forget them (if you actually have a of them) to move on.

Disclosure Is a Form of Radical Acceptance

It’s not just any act of disclosure that is radical acceptance. It is disclosing without assigning a value to it or judging it. It is disclosing matter-of-factly, without or assuming what another will think or react. I’m 12 years out from my last psychotic break, and I am just getting to this point. Sure, I have disclosed this many times before, but the way I do it now is different. My practice of disclosure is shifting from apologetic, apprehensive, and fearful to a matter-of-fact statement with no positive or negative emotions involved. It truly is what it is now, nothing more and nothing less.

I’m not assigning a value to my mental health history whatsoever, and I’m not trying to play both people in the conversation, allowing myself and the other person to have an authentic conversation based on the present. My biggest problem has been assuming how others will judge me based on how I already judge myself. You really have to look inward and decide not to judge yourself before you have an accurate and healthy perspective on how others would see your illness.

A Powerful Means of Self-Assertion

Radical acceptance means coming to peace with your reality in an integrated way with your mind, body, and spirit. In other words, it is what it is. It is not caving and saying that what happened to you is okay when it is not. It is actually the opposite. Just like the concept of — where you forgive for yourself and not for the other person, and set yourself free in the process — it is the same idea with radical acceptance. Through radical acceptance, you are able to feel power over something (psychotic breaks) that used to have so much power over you once you let yourself off the hook for having them.

As soon as you can state what happened to you without judging, you are asserting yourself and defining your future without the framework of mental illness. Just as it is with forgiveness, you will find yourself with a greater sense of peace — like you have let go of this huge load on your back. Once you are content and at peace with who you are, these regrets and painful memories from the past seem irrelevant to who you currently are. In this way, you can separate the core aspects of self and your personal from such an intrusive illness.

Radical acceptance is a very personal process of coming to terms with our circumstances that hits at the core of our identity and . If you can practice radical acceptance successfully with psychosis, then you have developed an invaluable life skill that can be applied to other life circumstances, too.

References

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I worked so hard to return to college after my first bout with . I managed to graduate, only to be underemployed in jobs where I was mistreated and ultimately forced to resign multiple times. I was hard-working, nice, and did what people told me to do, but somehow, I was misunderstood in a way that was beyond my control. I was on during this time, while what was my actual problem was a mystery to psychiatrists. When I had few options with work, I went back and got a Master’s degree, which led to joining a Ph.D. program. Academia suited me well. But during this time of academia, I had three full-blown psychotic breaks in two years. I left the Ph.D. program after a year, closing what was an exciting direction for me, and went back to square one. I went from being a promising junior faculty member at a major university to not being sure if I could ever work again.

I did recover and entered the workforce again, where I was willing to do the work to relentlessly seek employment, start from an entry-level position, and chart a new path. I now do , which is how I pivoted from academia, and I also use my writing skills developed in school to write about psychotic breaks and emotional recovery. Everything finally fell together for me over the course of a decade, as if this is how it always was meant to be for me. Here are my thoughts on reestablishing yourself professionally after psychosis.

Reconsider What Work You Truly Find Meaningful and What You Really Enjoy

Experiencing psychotic breaks is so devastating that it can be life-altering. When I had to fight for my will to live, anything other than what made me happy got filtered out. I’ve heard before that if you know what you love, you better just go ahead and do it now because that’s what you’re going to end up doing anyway. Limitations gave me clarity on what matters, and part of my choice to endure these psychotic breaks, where I chose life, was doing what feels meaningful. When looking for to live, sometimes that personal reflection provides perspective and clarity. Are you living through your own eyes or someone else’s when it comes to your career? In a way, having psychotic breaks was like getting a reset for me. I believe it can be a crossroads where you have the opportunity to reevaluate what really matters to you and begin anew.

Keep an Open Mind About Where Your Professional Life Takes You

I thought my life was over when I had psychotic breaks that led to disability papers to sign. I thought there was only one profession I could do, and I couldn’t do that anymore. The truth is, there are multiple options for all of us that can feel just as rewarding. We always must keep in mind that we are not capable of knowing where life will take us. We don’t always know how we get from our current circumstances to where we actually want to be through everyday opportunities and choices we make. Sometimes you just have to take the next step offered, or take what may not sound exactly what you have in mind professionally, to segue into what is right for you. Every little positive decision we make, whether we realize it or not, can take us in a new direction which can actually be a better one, where you just have to have faith and patience in yourself. Getting that first job is a huge accomplishment and a step in the right direction, regardless of whatever job it is. You never know how the experiences on your resume line up to be the perfect fit for a specific future job offered that you will really want. Just remember that having any job makes it so much easier to get that job you really want.

Sometimes There Is Such a Thing as Great Mistakes

Some people believe that everything happens for a reason, and I eventually became one of those people. I did not feel this way at all when I was in the acute stages of recovery from psychotic breaks — when I was penniless, jobless, homeless, and totally in debt from school loans and hospital bills. I didn’t see how my life or career for that matter, could recover. I didn’t see how I could ever take pride in myself again.

The truth is, though, had I not let go of academia and research, I would have never learned I am a creative writer and blogger, too. I had a dissertation topic that I was set to study and become the authority on for the rest of my professional life, but now I have a new topic, emotional recovery from psychosis. In addition to blogging, I’ve published a number of poems and have finished a memoir on the same topic. This new topic is much more important to real people in their daily lives than my other topic. I think I’m making a greater difference this way.

Everything I do, through both marketing and writing, is in one huge defiance of the illness I battled against. The greatest mistake would have been to not learn from my psychotic breaks and improve myself for the better. So as devastating as psychotic breaks are, maybe they were great mistakes that knocked me off course, because maybe I was headed in the wrong direction. I know that I am headed in the right direction now.

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Friends and loved ones may sense you are not yourself and actually be scared of you. Knowing how they felt after the fact can feel devastating and humiliating, leading to self-blame and shame. Another situation is when they don’t know what to believe, where at first, they may believe, too, that the delusions and hallucinations you report are real. Sometimes, it can take people around you a while to understand what is really going on. It’s easy to feel responsible for putting others in this situation, when perhaps you had no choice but to reach out to them for support.

It’s unfortunate that you can be remembered for thinking and doing things that your normal self could have never thought of or created yourself. Sometimes psychotic breaks can involve your worst fears coming true or where your brain concocts a scenario that is scandalous and involves other people in your life in a perilous narrative. Because of this, your psychotic break can involve the real people in your life, where you say and do things with people in real life, based on your delusion and hallucinations, which can jeopardize relationships and hurt people’s feelings. And, of course, that is the last thing you would want, to scare or hurt anyone, where you can lose people in your life.

I myself have experienced embarrassment when others have witnessed psychotic breaks of mine, including what I thought, said, and did. Here is what I have learned through my own battle to put these feelings aside and focus primarily on my recovery and well-being instead. Only then while moving forward on your own path can you make a resolution with others.

Delusions and Hallucinations Are Not Yours to Own

It’s easy to think that if you thought it, or your brain created this delusion and these hallucinations, no matter how messed up or uncomfortable they are, you have to own them as part of who you are and what you really think about. While you might be inclined to think this way, that is 100 percent not the case. While my psychotic breaks did contain some themes of my life and aspects of my personal reality, the logic, conspiracies, and conclusions drawn were not my own at all, and nothing I could have come up with myself.

The way these certain aspects of my life were rewoven together, where a new reality was created out of them, does not reflect my belief system, values, and real-life relationships with people. Just because you are living in some type of alternate reality does not mean that you chose this reality as one you desire, and it does not reflect some wish or line of thinking on your part that drove you to this conspiracy, delusion, or accusations toward others. None of it says anything about you as a person. So, remember that if you still feel humiliation over what happened and who witnessed it, all that really matters is that you first understand that these psychotic delusions are not a reflection of who you are before you worry about what others think.

Just Keep Moving Forward on Your Journey to Recovery to Right Yourself

Even if you have inadvertently embarrassed yourself among people you know, where some people may look at you the same but others don’t, just focus on your own healing and recovery. You have to keep your eyes on your own path ahead of you, and when you start healing and returning to the person you always were, or maybe even a new normal, these people on your journey will notice or hear about it from others. And, ultimately, anyone who truly cares about you, who really knows you, and is worth knowing, is typically much more concerned with your healing and recovering and less concerned with themselves or their experience of it.

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I felt sorry for myself and isolated. One reason is that no one talks about this illness and everyone is secretive about it. I was at a loss with moving forward because I knew no one else in my situation. And because I knew no one similar to me, I had no idea how to process what happened to me and move forward positively and constructively.

Self-Pity Is Not an Effective Response

Self-pity stems from the familiar feeling that life is particularly unfair to you. It can seem like everyone else has this everyday, predictable life, but yours is bizarre, stigmatized, and painful, and just doesn’t seem to make sense.

I felt self-pity for a long time, which stemmed from this negativity and resentment. Holding onto my gave me power, especially because I was unwilling to let the past go. If I let go of my anger and self-pity, it would mean that I didn’t deserve better than my experiences. It would mean that what I have been through was OK and that I’m the type of person this weird stuff happens to—that I shouldn’t expect a “normal” life.

In time, though, as one positive experience led to another, I started to rebuild my life through patience. In time, I began to develop empathy and grace for myself, which guided me forward. For the first time in my life, I truly accepted who I am through developing genuine self-love and respect for myself. True self-love does not align with self-pity.

Self-Pity Does Not Take You Anywhere

In the wake of experiencing a psychotic break, self-pity was all I could muster for myself. It’s such a primal feeling that perpetuates the idea that what happened to me is not OK and that it wasn’t fair. While that sentiment can feel very accurate, self-pity embodies this resignation about the situation that you are a helpless victim. While you have no control over a medical condition like psychosis, you can take charge of your life afterward and make better decisions for yourself out of love instead of making decisions out of pity.

Feeling sorry for yourself does not make you feel good about yourself. Self-pity does not help you take active steps to improve your life. It breeds a sense of helplessness and a feeling that you can do nothing to change your situation.

Self-pity sabotages progress. Even though you feel sorry for your current predicament, self-pity keeps you paralyzed in a place where you believe there is nothing you can do about it. Self-pity leaves you frozen in time, wishing you could go back and have a different life when that is impossible. Instead, you must focus on how to do your best with the life and lot you actually have.

Compassion Leads to Action

What I have come to learn in my recovery from schizophrenia is what it means to love yourself. What happened to you is not your fault, but only you can take active measures to advance and aid progress. While it’s not your fault, only you can do what it takes to fix it.

If you feel sorry for yourself, you think it isn’t fair that you have to take an antipsychotic that is so stigmatized, so you don’t have to take it. You think you shouldn’t have to deal with all this. It isn’t fair to have this diagnosis that is so embarrassing and shameful, so maybe you give up.

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Going back to college in your 40s is hard.

Doing it as a single father is even harder, and doing it while battling an opioid addiction would be a daunting task for anyone.

William Brown considers it a blessing. Sitting at a picnic table before his first class of the day at Wayne Community College, he recalled his addiction began around age 14.

“I believe it was peer pressure. I wanted to fit in, so I started doing things my friends did,” Brown said. “One of the things I tried stuck with me, and it was opioids.”

By 20, Brown said he had enrolled and then dropped-out of college due to his addictive behaviors.

By 35, he had multiple run-ins with the law for larceny.

Each time, Brown said he had stolen things to pay for drugs.

It was during his last sentence when he got a call he always feared.

“The woman I was seeing, she passed away from her addiction,” Brown said. “I probably would have been with her and I would probably be deceased now as well.”

It was that call that Brown said was the catalyst for change.

“Both of us had planned on starting a journey of recovery together, getting married, starting a family and living a good, wholesome life
 she didn’t get the chance,” he said. “I feel like I would dishonor her memory if I didn’t do something different and change.”

Brown shared the pain of that loss still hurts today.

“I wasn’t directly responsible but still, I feel responsible, and I think I always will. I was living that life too,” he said.

In January 2019, Brown sought help through what is now șÚÁÏÍű REACH.

The medical clinic in Raleigh offers a variety of services, combining physical health, mental health and substance abuse resources.

“I want to show people that just because I lived that way, doesn’t mean I still am and that I can change and people do change,” Brown said.

Dr. Michael Baca-Atlas with the clinic tells WRAL News reducing addiction across North Carolina requires more facilities to provide multi-faceted approaches to treatment.

“Where I think we’re headed is being able to address all of these things in more one-stop-shop kind of places where people can get services and maybe don’t have to work with three, four [or] five places,” Baca-Atlas said.

He continued, “I say we have professional patients. Their calendar is chocked full of things they have to go to and do. When we can make it easier to get services, whether that’s harm-reduction services, mental health, physical health, I think we’re going to start to see a change.”

Baca-Atlas said reaching people who misuse or are at-risk of mis-using opioids varies greatly on the individual.

For example, he said reaching incarcerated people who have substance abuse issues is different than someone looking for a benzodiazepine or stimulant medication who unknowingly uses a street-bought medication laced with fentanyl.

“I think there are a lot of training gaps to overcome to become more knowledgeable about serving our community for individuals who do use substances,” Baca-Atlas said.

The doctor said he makes a point to regularly ask patients where they are getting medications from.

“Some of these pills just look so good and so real it is very difficult to tell the difference, even if you are someone who has an understanding of how the medications are manufactured and branded,” he said.

Baca-Atlas noted the rise in products containing xylazine and fentanyl, either alone or a mixture, further underscores the need for more available support resources

Brown said the fear of not knowing if fentanyl could be in a product is another motivator for his continued sobriety.

“That’s what I want people to understand, one second
 that’s all it takes and you’re gone. An amount you can’t even see can kill you,” Brown warned.

Now a single father to a toddler, Brown said he is committed to helping others know help is available.

“To know my son has grown up in a sober household from the time he was born until now, and if I have anything to say about it for the rest of his life, then I’ve done something right,” he said. “There is another way. I didn’t know there was for the longest time. I thought this was the hand I was dealt and that was it, but there are so many resources out there for people like me.”

He continued, “Every day you’re going to encounter something that’s going to trigger you or make you feel a certain type of way but people, like at șÚÁÏÍű REACH, teach you different ways to handle different situations.”

Brown acknowledged living with an opioid-use disorder is a daily battle. He now takes suboxone daily to help suppress his cravings.

He said the difference in his behavior is “night and day” compared to before he started the medication.

“Suboxone has 100% saved my life,” Brown said. “I went from not being able to go without [opioids], to not thinking about it at all.”

Brown said he plans to be open about his struggles as his son grows older, to ensure his child stays safe if he ever finds himself around people using opioids.

“I don’t think kids realize the decisions you make may stay with you for a very long time and sometimes you don’t get another chance. Especially nowadays with the drugs that are on the street,” Brown said. “Your parents are going to get a call or your loved ones are going to get a call saying you’re gone. I’ve gotten that call
 I don’t want to be the reason somebody gets that call.”

How to get help

According to the , nearly 23,000 adolescents between 12-17 years old and over 320,000 adults misuse opioids.

If you or a loved one is looking for support, șÚÁÏÍű REACH Enhanced Primary Care is open Monday-Friday and is located at 401 E Whitaker Mill Road in Raleigh.

Those with questions can also call 984-974-4832 to be connected with local resources.

On July 1, the state rolled out a new to help those with certain medical needs, including substance use disorders.

The national Substance Abuse and Mental Health Services Administration (SAMHSA) can also be reached 24/7 by calling 1-800-662-HELP (4357).

In North Carolina, you can also call or text “988” to reach the state’s crisis line to be connected with a trained crisis counselor.

Original story posted by WRAL on July 12, 2024.

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I think what was most frustrating was knowing and feeling who I was, my core, and where I wanted to go in life, but my brain was ill, so others could not always see who I was or understand where I was coming from. I was a good person, but I was mentally ill. After over a decade in this holding pattern, my acute mental illness came to life, and I had to be hospitalized multiple times.

With every step of progress I made out of such a terrifying ordeal as psychotic breaks and a diagnosis of schizophrenia, I wanted to distance myself from my twenties and early thirties, like a bad dream that never really happened. I wanted to reject who I was then and never look back. I would run towards the future and not look back like my life depended on it.

However, it just simply doesn’t work this way. I can’t truly love and accept myself now if I can’t go back and reclaim who I was in my twenties, the missteps, the embarrassments, and the regrettable setbacks. To reclaim these years hindered by serious mental illness, I have to know the common threads of my existence and acknowledge that they were present during those years so I can reclaim who I was then with pride and fully understand and embrace who I am now. The following is what mental illness cannot take away from you and is never lost.

Character

I don’t believe you can lose your character during a psychotic break. You can make atypical choices based on delusions and hallucinations. Still, I don’t think basic goodness or your essential nature can be altered during or as a result of a psychotic break. For me, my brain as an organ was failing me, but I never stopped making the right decisions based on sound character, where goodness in me ultimately steered me in the right direction. The most important thing to remember is that we are more than just a brain, where mental illness cannot touch essential elements of our true selves.

When it comes to critical junctions where a life decision is to be made, I think being psychotic can make important decisions more difficult. Still, I think character and our essential nature can overrule our illness. When it comes to my story, I have no regrets from that time when it comes to my ultimate choice-making, with all things considered. I made some choices technically out of character, but when it came to the biggest decisions that mattered, I made correct critical decisions that carried me during that time. I believe that character is a bridge from a life previous to mental illness to a life in recovery afterward.

Intentions

No matter how bad you feel or if you just want to give up, I believe that you always have the choice to choose love. As difficult as it can be when you are so frustrated with yourself and feel hopeless, I believe you can always choose to love yourself and choose to love others. You can operate through a lens of love, utilizing it in how you interact with others. To me, this is what goodwill is.

As soul-crushing as psychotic breaks can be, I never lost the ability to love other people and act in love, as well as the ability to let kindness direct my intentions. In other words, I never lost goodwill towards others, even when I didn’t want my life and wished I had someone else’s. It wasn’t easy when I was sometimes rejected by others, and even though I could feel saddened at times, I never stopped seeking goodness with my heart and letting that direct me.

Willpower

, as catastrophic as it can be, does not necessarily take away . No matter what setback or how devastating it can be, willpower matters. Let me be clear that willpower does not cure mental illness, as if mental illness is an affliction for the weak-willed, which it is not. I do, however, think that willpower affords the patience and perseverance to get to remission. Even when things look hopeless, willpower is a mechanism that helps you hang on for a better day, even when the end of your illness is not in sight.

At times, though, I was losing my will to live, and I became indifferent about being alive and was ready to die. Ultimately, though, I clung to a will to fight for the kind of life that I wanted. Through my chaotic 14 years of illness that could be unpredictable and unstable, my willpower, while it wavered, still pushed me through hopeless and confusing times. I believed I would find my purpose and be the person I knew I was supposed to be. I would do whatever it took to heal and improve my quality of life because I was on a mission to create a future ahead of me. In the end, I did not give up.

Losing Regret

My life was in a holding pattern for a significant portion of my life. I could always look backward and wonder what if. I could always point fingers at my illness and blame any setbacks in my current life on my illness to provide an excuse to myself to give up or feel sorry for myself. But the truth is that I am in a race with time; we all are, and I will miss the good surrounding me now if I look back, expecting answers as to why this happened to me. To dwell in the past is to lose the present and future.

With that said, now that I can open my eyes to the world around me and fully embrace it, I realize that this person I was who I shunned is my hero and champion. As a mentally ill person in my twenties, I was my own warrior, overcoming insurmountable obstacles, all for the benefit of my future self, because my younger self knew my future life was worth it.

I never thought I’d say this, but I am incredibly proud of who I was in my twenties. Despite psychotic breaks and difficult circumstances, I came out of there with everything intact that matters. So, I reclaimed my former self as a relentless fighter and a dreamer, where I didn’t settle for my current circumstances and fought for my . No matter how bizarre and painful this time in my life was, I lived to see the other side of it. Yes, I want to be the person I was and claim her because this person is the hero of my current life and will not stop until I get to where I am supposed to be.

I believe there is an unsung hero in all of us who experience mental illness, and we need to give ourselves credit and respect our personal journeys, even if they don’t always seem linear. We can only truly love and accept ourselves if we embrace our lives in their entirety with compassion and acceptance.

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Understanding It’s an Unavoidable Medical Diagnosis

The first way to stop blaming yourself, though, is to realize that is not a character flaw or a you deserve. No one deserves psychosis or the collateral damage involved. There is nothing about psychosis that marks you as the certain type of person who contracts a stigmatized mental illness. Medical illnesses like psychosis are beyond personal control, and they do not discriminate. No one can will themselves out of cancer, heart disease, or any other medical condition by simply being a strong, virtuous person. Once you can see your brain as just another organ of the body, not having to do with your essential self, you can have objectivity and see this situation clearly.

While we can be so worried about other people’s toward our experiences, sometimes we miss our own personal stigma toward what happens to us as individuals. It’s easy to think that since psychosis is “bad,” I’m not a “good” person if I have them. Psychotic breaks are not a mistake you have made, and just having a break is not the same as committing a . Sometimes, in a ward, you can feel like you are there for doing something wrong. Unfortunately, some people with psychosis are kept in jail (even if they haven’t committed a crime) because there are no hospital beds available, but it’s still and easy to think what you have done is bad in this case.

Accepting There Is Nothing I Could Have Done Differently

As a patient with serious mental illness, it is easy to ask what-ifs. What would my life be like had I never had psychotic breaks? What would life be like if I had never gone off my ? And from those questions, it makes you think you had a choice or option whether you have this illness. Believing you had the choice whether to have this illness (but you blew it) feels so defeating and self-shaming. The truth is that mental illness is present through no choice of your own and has been possibly influencing this very . Even though I did go off my medication, which led to my first and third hospitalizations, I told myself that I was not well enough to make a good decision to stay on medication. I did the best I could, considering my health condition at those points. Today, many years later, I consider that I am in control as long as I take my antipsychotic. It is a hard lesson learned, but if there is any way to control my well-being and environment, it is to take an antipsychotic for life consistently.

Forgiving Myself

Letting go of judgment on yourself and yourself for your experiences takes grace, , and humility. You have to realize that you can’t judge your behaviors and decision-making when psychotic the same way you would if you were stable because when you are psychotic, you lose all insight and control. You can’t set the same personal standards and expectations for both the stable and unstable versions of yourself.

You have to give yourself credit that you are but one human being, and you are capable of having any type of mental illness like anyone else. I was so hard on myself about psychosis and my diagnosis of schizophrenia, like I was weak and a failure to all who knew me. How could I have made unwise decisions like I made? How could I have acted so bizarrely and out of character? How could I have embarrassed myself like that? The only thing I can do at this point is have grace with myself, focus on how well my present health is, and put myself in a position to succeed through life balance, , and medication use.

My years of mental illness have been a humbling experience, where I have learned to not be so much harder on myself and hold myself to an impossible standard, especially given the illness I have. The truth is, I really should not have to forgive myself for anything because having a medical condition is not my fault, but it does feel like it sometimes. That’s when I have to embrace that no one, including myself, has complete control and then let go of the past. I must appreciate the person I am now and the future I have ahead of me instead of looking back with regret and self-assigning blame for the past.

I have had to learn that I don’t have this magic to transform unavoidable circumstances within me and around me. I have to appreciate what I can control, allow myself to just be human, and let go of what I realize no one has control over.

Image credit: ‘Creating Understanding with Loved Ones’ by Karolina Grabowska/ Pexels

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I have no symptoms of schizophrenia, so I can see where someone might doubt my diagnosis who doesn’t understand the power of . Yes, I have no symptoms, but it is because I am taking an antipsychotic for life, and I am so fortunate to have responded so well to medication.

My thoughts and reactions to these contradictory opinions have been many over the years, and my response when someone says this to me has evolved over time. I think in my early years of diagnosis, I struggled with cognitive and emotional healing, as well as coming to terms with such a stigmatized diagnosis, so I welcomed such feedback. But now, I have reversed logic. I now wear the label “schizophrenia” as a badge of honor, where it bothers me when people say I can’t have schizophrenia.

Feeling Redeemed

In my early years of recovery, I loved for someone to tell me they didn’t think I had schizophrenia because the weight I felt under the word seemed crushing and condemning. When I headed toward complete remission, a licensed professional counselor who specializes in schizophrenia told me that maybe I didn’t have schizophrenia because I had made so much of a recovery. I felt redeemed, like there must have been nothing wrong about me in the first place, through my therapist questioning this diagnosis.

I wanted someone with a magic wand to make it all go away so I could move forward, and if someone questioned my diagnosis, that seemed to be the magic I needed for it to all be a bad dream. If someone could remove that word, it meant that my past would disappear, and I could indeed start over again.

Of course, telling someone they must not really have a diagnosis can be risky and cause harm. Telling a patient that a mistake must have been made may lead a patient to question the diagnosis, medicinal treatment, and the value of their psychiatrist’s opinion.

Feeling Invalidated

I have had two other licensed social workers tell me the same thing the first one did, but now I have a different reaction years later. When someone now tells me I can’t have schizophrenia, I feel like I am short-changed, like they are entirely undercutting everything I have endured to get where I am today. Most people today cannot imagine what my life was like over a decade ago, and it is a triumph that I physically survived my breaks and emotionally survived them, too. I have worked so unbelievably hard to get to where I am today through weekly for two decades, visits and medicine adherence for two decades, and endless patience. For someone to say that to me means I didn’t go through what I thought I went through, that it must not have been that bad if I am doing so well now.

The flip side is that I disclosed to another medical professional that I have schizophrenia, and they took the opposite stance, that instantly upon my disclosure, I am no longer a safe or reliable person. Again, this person could not reconcile the word schizophrenia with the fact that you can go into complete remission and be a fully stable, symptom-free person. In this sense, I also felt invalidated. This person at my son’s pediatrician’s office told my husband in front of me that I could not be left alone with his son, as if I didn’t give birth to him, all because I shared with her my diagnosis in a routine questionnaire when she asked about mental health history in my son’s family.

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The Center has its roots as far back as 1993 when Dr. Gilmore and his team received a șÚÁÏÍű Hospitals Innovations Grant to develop a psychotic disorders specialty inpatient unit (Cover Photo). Programming developed for the unit was expanded into the outpatient setting with the establishment of the STEP (Schizophrenia Treatment and Evaluation Program) Clinic and the rest, as they say, is history.

From the beginning, the Center recognized that the fullest recovery possible requires an “all of the above” approach – medication, therapy, community-based recovery and rehabilitation, integrated behavioral and physical health care, and a focus on the social determinates of health such as housing, food, and employment. The Center has experienced enormous growth, and its programs now serve patients throughout central North Carolina. Furthermore, the Center’s training and technical assistance programs have a state-wide and even national reach.

The Center is full of creative and passionate people whose hard work and vision have been the basis of our innovative growth. We are proud to help lead this incredible team, and we are thankful for our partners and collaborators, our funders, our Advisory Board members, and everyone who has supported us over the years. We could not have done this without you. There is so much more to do, and we are already at work on many exciting ideas for the Center’s next chapter. Next time you see one of us ask “What’s next?”

Want to see what the Center has been doing over the past 15 years? Check out the timeline on our About Us page!

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My psychotic breaks took hold instantly, and when they did, my self-awareness and critical thinking were gone. I could no longer question myself or the false reality I was thrust into. I could no longer distinguish between real life and this entirely different narrative and interpretation of events and recollections that had taken siege of my mind.

Once this complete distortion took over, I was unable to understand that this fabrication was false or that I was ill. I was in so much danger and was so vulnerable because I had lost my ability to reason, and hence, I lost the ability to make appropriate choices. I couldn’t check my behavior or decisions with reason and reality to protect myself and be adequately understood by others.

“Lack of insight” is also known as anosognosia. It can occur with serious mental illness where a person cannot understand that they are ill. Unfortunately, this condition is a leading reason why people with severe mental illness refuse and treatment. It is mostly common for those with schizophrenia, , , and Alzheimer’s.

Anosognosia is most common with schizophrenia, where it can affect between 50% to 98% of this population. It is important to note that anosognosia is not a choice but a medical condition in the brain. It is not a matter of escaping the present or being unable to accept or handle actual reality.

Appreciating Insight

As I have schizophrenia, I know what it means to experience anosognosia. I understand what it feels like to be thrust into a completely alternate reality that seems 100% real. I also recognize just how life-changing it was for me to recover from anosognosia and how important it is to hold onto it.

I am so incredibly that even though I could not distinguish or question my reality when I was hospitalized multiple times for , I still mostly complied with taking my medication anyway after being released. My recovery happened through taking an anti-psychotic, where I regained an adequate amount of self-awareness, could accurately perceive reality, could be open to feedback from other people, and was able to rebuild life skills—so I could thrive independently and safely. Usually, we don’t think twice about having insight, but after losing it, I will never take it for granted again.

Using Insight While You Still Have It

The best option, however, is to use this power of self-awareness and critical thinking to seek help for yourself while you still have insight—before things get worse. It is such a gift to sense you might be in trouble and then have the and fortitude to seek help and engage in activities that promote self-care before irreparable harm is done.

Self-awareness can vary, allowing you to acknowledge your illness at certain times but not others, so it is vital to use insight when you have it.

It is a slippery slope, having insight in enough time to identify something is wrong and needing help before it is too late, and you lose insight altogether. It is essential to know yourself, how you feel when a psychotic break is about to happen, and identify cues that can sometimes be subtle.

It is also crucial to listen to loved ones and accept their feedback if they are concerned. Using your innate knowledge and the observations and feedback of people you trust can help ensure you receive the care you need before matters get worse.

Choosing The Right Lifestyle and Having Coping Strategies

Even though I did not utilize enough insight when I had it before my hospitalizations, I can at least use my hard-earned self-awareness now to help prevent acute illness from happening again. I have intentionally chosen a more relaxed lifestyle with less and external pressures, where I carefully monitor my state of mind.

It does not happen often, but if I feel unstable or out of sorts in any way, I go home immediately, lie down, and re-center myself. I call a loved one and let them know how I feel. The critical point is knowing I’m in trouble and doing something about it before it’s too late when I have already lost my insight.

As much as I’d love to run and never look back at a decade ago when I had three psychotic breaks in two years, I accept and understand that I always have to be careful and know when to put on the brakes. As much as I’d love to consider myself mental illness-free since I have made a full cognitive recovery and I’m thriving in my life in a way I could never have anticipated in my wildest , I know I have to watch and be critical. I have to be discerning to avoid acute illness that could jeopardize everything I have built for myself in my life —a , a , and motherhood.

I value personal insight like a salvation and will never take it for granted again. It is our brain’s natural response to protect ourselves. Now that I have insight again, I have a second lease on life I never thought possible, and I will continue to use my self-awareness to protect and preserve this new life I have.

References

Image credit: ‘Insight is Valuable And Vital to Self-Awareness’ by Victor Miyata/ Pexels

The post How to Appreciate and Cultivate Self-Awareness After Psychosis appeared first on șÚÁÏÍű Center for Excellence in Community Mental Health.

This partnership began in response to the U.S. Department of Justice settlement agreement with the state of North Carolina for failing to provide mental health services in the least restrictive environment as required by the U.S. Supreme Court decision .

Supporting the activities of daily living of adults with severe mental illness should be a high priority in policy change. However, there is no existing evidence-based tool to screen adults in this community for challenges with these activities which are needed to identify intervention targets relevant to their independent living and community integration. There is an urgent need to develop a living-skills screen so community mental health providers across the state can quickly identify which supports are needed for their clients. Further, there is a gap in resources to help stakeholders support the functional independence and sensory health of adults with severe mental illness.

Project Description

The project team will partner with adults with severe mental illness (SMI), caregivers and community mental health providers to develop interventions and materials that support and ultimately improve the sensory health and community integration of adults with SMI.

Team members will engage in collaborative, participatory research to identify and understand the living skill and sensory health needs of adults with SMI. They will then work together to develop and disseminate resources (e.g., website, podcasts, videos) to stakeholders to support the sensory health and independent living skills of adults with SMI in the community. They will also develop a feasible and acceptable living skills screen for community behavioral health providers and modify the screen according to stakeholder feedback.

Anticipated Outputs

Activities of daily life screen; videos; podcasts; peer-reviewed manuscript; conference presentations

Project Team

Timing

Summer 2024 – Summer 2025

• Summer 2024 (optional): Seek IRB approval; identify and recruit working group participants
• Fall 2024: Hold weekly meetings; start focus groups; analyze data; develop screen
• Spring 2025: Continue to develop screen; start working groups; obtain feedback; refine screen; develop media and resources
• Summer 2025 (optional): Produce and post developed media; draft manuscript

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