Appreciating life...

Every day at work I am face to face with some of the saddest cases in the world. I work with people who are really struggling to make sense of their lives in light of the fact that the not only have to juggle living expenses, relationships, jobs, raising children and all of the stuff we all go through, they have to do it while trying to manage a serious and persistent mental illness. And let's face it - with the stigma attached to the words "mentally ill" who wants that? It's a battle sometimes to get people to understand the concept of recovery and how it doesn't mean a cure but rather a way to understand what triggers their symptoms and what's necessary (good nutrition, no alcohol or other drugs, plenty of sleep, getting out and about) to be able to manage it appropriately.

And then sometimes I meet people who are simply bound and determined to be unhappy at all costs. Now I know this is also a symptom of their illness but it never fails to amaze me when I meet someone who chooses to see the down side of everything. Today, I met a woman who wanted to be in our program, who did just that. She could see nothing of value in her life though she talked with great love of her grown children and grandchildren. She talked about making jewelry and being creative. She talked about going out with her friends. When I would point out that all of these things were truly good things she struggled find something more negative to say about them. When I finally said, "You know, sometimes the hardest choice someone can make each day is to find one thing to smile about." She stopped and thought about that for a while and then...it happened...she smiled. She knew I was on to her!

You see, sometimes, people who have severe depression get so deep into being depressed that they cannot see the forest for the trees. Sometimes someone else has to point out that there is good all around them and that good isn't just there for them to look at but it's there because of them! Her children are great because she raised them. Her grandchildren are the off shoots of the lessons she taught her own kids. She is creative and sees things in a beautiful way and can make jewelry to reflect what she sees. She has true friends who support her because she is a good person and they see that in her. A part of her may feel she doesn't deserve all of that. That's too bad. Because regardless of her feeling that way, it  is what it is - they love her even when she cannot love herself enough. And she knows that. Hence the smile.

We all have to work sometimes at appreciating life. I know I do. I let little things fog my vision and I complain like the rest of them. But when I stop to think - I know I am lucky and I have so much good around me. And so do you.

If everyone just does what I tell them to do then no one will get hurt...

I have a certain amount of responsibility at work and I accept that. I kind of like it, actually. But I get incredibly frustrated when those people I supervise just do the bare minimum to get by. Normally, I would tell you that I have a bunch of dedicated case managers and I do! But every once in a while, I find one or two that are just slipping by in their work and that angers me.

In working with the mental health community, I work with people learning to deal with how to live with a serious and persistent mental illness and that alters their lives in many ways. These are not people who can afford top end mental health care because, for the most part, they are all disabled, living on only Social Security benefits and struggling day to day. They struggle not only with their mental health symptoms but with simply getting their basic needs met. So it makes me upset when I come across a case manager who doesn't get that and who wants to put demands on these folks that they may not be able to live up to. While I do think having high expectations is good, demands are not. First of all, it's not about what we want for our people - it's all about what they want for themselves. And our job is to teach them the skills they need to achieve those goals, whatever they may be. I get really pissed when I hear a case manager say "I told him to do this and this and this and this and he just doesn't listen!" My first question to them is "Are YOU really listening to him?" Because overall they are not. Unreasonable demands are usually made to make the case manager's life easier and that's just not how I roll.

Today I have to have a talk with one of my workers. She's not cutting it and this is the part of my job I dislike. I know that most of the time people are really trying to do their best but when I see someone who is slacking I have to stop it and get them to step it up. The clients we see deserve more than shoddy care and I have to make sure everyone understands that. This agency is the one place most of these folks have where they are guaranteed to be treated as human beings with unconditional positive regard. Out there, in the world, they are avoided, called names, given funny looks or taunted. The stigma of mental illness is overwhelming! No one wants to be "crazy" and to be seen as that on a daily basis must be incredibly heart breaking. So I won't have it inside these agency walls. Least of all from the very people our clients need to be able to trust.

So, that's my day. Giving a colleague what for. Not a great way to start the day but, in this case, entirely necessary.

Sing, sing a song...

Last time I wrote about a documentary I watched about a choir of senior citizens called "Young At Heart". It was touching to watch these folks, under the leadership of a very talented director, come together in mind, body, and singing spirit and shared their lives and happiness together. I was inspired and thought, "Why can't I do that at work?"

As you know, I am a social worker who works with people living with serious and persistent mental illness. There is amazing research out there about how music, in specific singing, can increase happiness, peace of mind AND reduce the severity of mental health symptoms such as high anxiety and even audio or visual hallucinations. So, the answer to my question of "Why can't I do that at work?" is - I can. I mentioned to my supervisor that I was thinking of trying to put together a choir and explained my reasons why. Alex is on board with playing keyboards and acting as my musical director while I will be the vocal director. Some of my staff are very excited about this and want to participate along side the clients who may be interested. One of the staff plays guitar and is interested in playing with us too.

But the best part is that today, at a meeting with a residential service provider, someone mentioned in passing that I was going to put a choir together. The CEO of that company was extremely interested in the idea and said, and I quote, "We'll sponsor you!" And he meant it! I asked him what that meant and, this was the best part, he said, "Whatever you need."

That means we can get a P.A. system with a couple of good mics, sheet music and even choir robes if we want them! Amazing!!

So now I'm going to be getting information and activities together to start a group that has little experience to sing together and love it! LOL I've sung in choirs for the majority of my life so I've got this. I can do this. And I can't wait to start!

The view from my office door...

is making me sad.

It is the sister of a friend of mine who is really struggling right now with her illness.

She is a beautiful woman, usually bright eyes, personable, gifted in that she sings like an angel and is a talented actress.

Right now, she's wearing dirty clothes, her stomach handing out over her pants, her hair unwashed and her eyes dull.

If she would accept she has an illness and work to manage it so she could have a quality of life she would become that bright eyed, talented woman again. But she doesn't and so she won't.

I've known her since high school and seeing her like this and not being able to help breaks my heart. It really does.

The finer things in life...

It snowed here yesterday and today is seasonably cold. I arrived at work this morning to find one of our early risers waiting outside in the cold. We have strict rules about letting our clients in early because 1. we don't officially open until 7:30am and 2. there's no one at the front desk to supervise them. What can I say? Things have gone missing from here once in a while.

But this morning, there he was. Standing out in the blowing cold in a hoodie and tennis shoes with no socks, hat or gloves. He asked me if would let him in and the "agency" side of me said no. At first. I explained that I wasn't trying to be mean but he really needed to try to time his arrival to get there at our opening hour so he wouldn't have to wait outside. I explained that this was an agency policy and I could get in trouble for letting him in. He explained he knew this and promised it wouldn't happen again. I explained that I really shouldn't.

Then I let him in.
And gave him a pair of boots.
And a microwave we had just gotten donated. And made arrangements for someone to take him home with it so he wouldn't have to carry it on the bus.
The boots were a neccessity. The microwave may have been me overcompensating for my own guilt. But he really did need a microwave.

I know he will be out there again Monday morning. Hopefully, he will keep his word and show up slightly later, closer to our opening time. We'll see.

In the meantime, I couldn't, in good conscience, make him wait out there, in tennis shoes, without socks. So, I might get in trouble. I'd do it again in a heart beat.

Punching through...

There is a young man I work with who struggles everyday to reconcile the fact that he has a mental illness. He doesn't want it. Who would? He watches other people thinking they are "normal" and asks why he cannot be like them. I struggle each day trying to get him to see and understand that he is like them. We are they. They are us.

I give shoddy examples of how people live with chronic illnesses all the time - diabetes, painful arthritis, and others - and he answers, "Yes, but people don't think you're crazy when you have arthritis." And he's right.

He wonders how he will ever have a serious relationship with anyone because, though he wants that more than anything, his illness makes him paranoid and doubtful of everyone. Even those who love him. So he stays alone, purposefully isolating himself from others which, he says, makes him look even "crazier".

He wants a job but his illness has caused him to do things in the past that have tarnished his record so he cannot find an employer willing or able to take the time to give him a chance. He wants friendships but pulls away after a while because they become too taxing to maintain. The daily inner dialogue reassuring himself that his friends are not out to get him or harm him is exhausting.

He doesn't like his medications. Who would? There is no magic pill that makes the illness go away. Only pills that make the illness bearable and that is to varying degrees. The pills come with side affects - weight gain, hair loss, slow or slurred speech, sleeplessness, or too much sleep, no motivation, low libido, and sometimes Tardive Dyskonesia - involuntary muscle movements in the limbs or face that cannot be reversed, only masked by more pills.

He doesn't like not taking his pill though he hates them. Not taking them means the illness wins. It takes over. No one is to be trusted. No thought is real. No sound is true. Everyone, everywhere is out to get him. So he strikes back. He becomes "crazy".

How do you reach someone to let them know that they can have some quality of life once they can target their triggers and understand their symptoms? Even if that quality of life is altered in someway? How can I show a young man, with his whole life ahead of him, that he can handle this, that he is not crazy, that he is worth the fight and I am willing to fight with him? It's a lot to think about.

Broken people...

In my work, I meet people who have gone through and are going through some of the worst events of their lives. I work with people who have been diagnosed with severe and persistent mental illness. My hope is that our program can help them understand their illness, work through it, and learn ways to live with it that will allow them some quality of life. It's harder than it sounds.

No one wants to hear they have a mental illness. The stigma that is placed on those two words - mental illness - is enormous. So much so that, often, their own families would rather not have anything to do with them because of it. Overwhelmingly, the people I work with have lived through horrible trauma in their lives as well. They are broken. Almost daily, I speak to good people who cannot see their own worth because they have lived through years of other people telling them they are worth nothing and will never be worth anything. It's very sad.

We all have incidents in our lives that cause us trauma. We are confronted with abuse, sometimes neglect, and deal with the deaths of loved ones that take us by surprise and knock us down. Most of us have learned ways to deal with these incidents and we get on with our lives. Some people, those who have an underlying mental health diagnosis, have an extremely hard time moving past those incidents. And sometimes those events of trauma, abuse and neglect are so severe that it stops them in their tracks.

The stories I could tell would make you cry. But, I cannot dwell in the sadness of their situations. I have to be the one to find that one tiny moment of hope and spotlight it so they can see it. When it works, it's magical. To show someone that they can achieve their goals in spite of their illness is really a miracle. To see someones happiness when they realize they can do it, that's amazing. And it's why I do what I do.

But, I'm not magical or a miracle worker. I'm just a person who can listen and ask questions and guide them as best I can. Sometimes, it's just the listening part that is the most important. Because, you see, like all of us, the people I work with have stories to tell. Life stories that I learn from every day. They give me more hope than I could ever give them. It's easy to pass these people by. They act weird. They might look strange. They may talk to themselves or someone who isn't really there. They might even smell bad. They are the ones who make us uncomfortable when we're riding the bus or in line at a bank or McDonald's. They are the ones we tell our kids to avoid. That's the saddest part because, without a doubt, they are people who could teach us all a lesson.

If you ever get the chance to volunteer at a shelter or a soup kitchen I highly recommend it. You will learn more about yourself and open your heart to so many good people that you will feel full. Full of hope. Full of honest love. Full of humanity.

How do you measure personal growth?

I work in Social Work. For the past 17 years, I have seen trends in Social Work come and go. Currently, we used Motivational interviewing and Illness Management and Recovery techniques to help people move forward in their recovery journeys. Now, the people in charge of our mental health programs are looking for "measurable" goals. I get it. It means, if someone has a goal for themself how do we, the workers, measure their progress. It makes sense from a beauracratic point of view because in this day and age of cut backs and diminishing budgets, the government wants hard data to show that people are getting better.

I'm conflicted about the methods being bantered about as to how to do this. I believe that individuals are their own best measuring tool. Unfortunately, the tools we're given want to measure things in percentages. For example, if someone states their goal as "I want to be more socialable." The tools ask us to give this a percentage which might look like "Joe will attend Social Group 3x per month." Now that doesn't look so bad except I have to wonder if Joe only shows up for 2x per month, does make Joe a failure? Or what if Joe increases to 5x per month, does that make him an overachiever? The problem I have is that these measurable goals say very little about Joe's personal experience at that social group. It leans more toward making poor Joe another statistic than seeing him as a human being.

I remember 17 years ago, when I was just starting out, these types of percentage goals were very much the norm. Case management was like being a broker and all we managed was numbers, not people. It saddens me to think that we seem to have come full circle. I hope that there is a way to keep the person at the center of it all. I wish there was some way to convince funding sources and government agencies that just talking to people is the best measure of how successful a person is in achieving their goals. And, when someone is living with a mental illnes, those goals are fluid, they change, they take small steps and relapse is expected but not devestating. Isn't that the way it should be for all of us?

Climbing that mountain...

Some of the people we work with have co morbidity. This means that they are not only struggling to manage a mental illness but are also deep in the throws of addiction. It's a horrible sight to see when someone is intent on drinking themselves to death. Sorry to be so blunt but that's exactly what they're doing. We offer them all the possible opportunities to start a journey to their recovery. We have an addictions specialist on board. We have Peer Support staff who have "been there, done that" for them to use as mentors. We talk to them every single day about what their lives might be like if they would take that first step.

Yesterday, one of these souls came in, fell twice, was severely dehydrated and refused treatment when we called an ambulance. She stumbled back out to her waiting ride and went home to drink some more. She came in again later, still in bad shape, still refusing to let us help her. But, in good conscience, we had to do something. We actually had to force her to get to an ER by making a refusal on our part. We refused to keep seeing her here if she did not, at least, go to the ER to get checked out. Sometimes this works. This time it did. She went and was admitted to the hospital. I say sometimes this works because the mental illness side of some of these folks wants our help so badly that they will continue to come in spite of their alcohol issues. But, we are also realistic enough to know, in this case, that when she is released to go home she will drink again. It's a slow miserable death.

Alcoholism is treatable but the person has to buy into the idea that there is something inside them that is worth saving. That's the hardest part. So many of the people we see have had their self esteem whittled down throughout their lives that it is almost non-existent. They don't think of themselves as worth anything, let alone life itself. They seek out and endure horribly abusive relationships again and again. You'd be surprised at how many sick individuals are out there that prey on people they can take advantage of and become co-dependent. They get some weird kick out of breaking people down and then being a "hero" by being there to pick them up again only to start that cycle over again.

But we keep trying. It's that hope thing I wrote about previously. We keep trying and hoping and maybe, just maybe, one of them will get it and they can start to make a change.

One word that stands strong in all of us...

The title to this entry is a quote from one of my program participants. He's a guy with a serious mental illness. He talks slow, shuffles along because of his medications, often has the worst hair days, wears a heavy Packer jacket - even in summer. The word he's referring to? Hope.

Today he came in to say hello and I made a comment about the blue sky and the sunshine which had been eluding us for the past week. He said, "Maybe it will warm up today." I replied, "I hope so!"

He thought for a long time, a thoughtful look in his eyes and said, "That's one word that stands strong in all of us."

I know our conversation was about the weather but, at that moment, I knew he was talking about so much more. And I have to tell you, it always give me hope to know that even these down trodden, ill, struggling individuals I work with have a strong sense of hope. Hope that there's something better. Hope that today will be a good day. Hope that someone will give them a smile or a kind hello.

We all have hope. I like that.

How hard it must be...

It's no secret. I work with adults with mental illness. In any given day, I see people fighting the good fight and surviving with severe and persistent mental illness. Best case scenario, I've seen people come to some degree of acceptance that they are living with a chronic, life long illness that will always need medications to control. Those people find a way to live with it and get on with life, forging relationships, having families and whatnot. The stuff we all do in our own way.

I've seen others who trod into our agency on a daily basis, consigned to a life of taking medications and seeing themselves beat down by life. They walk with their heads down, their life-spirit gone, and never regain the belief that they really are someone.

The hardest people I work with are those that are young, newly diagnosed, and defying the diagnosis at every turn. You see, with a mental health diagnosis, a trip to a psychiatrist or counselor, a prescription for psychotropic medications comes a terribly stigma placed upon them by friends, family, society as a whole, and themselves. Think about it. How many times have you said "That guy is crazy!" when someone has said or done something out of the ordinary. With the medications come the side affects. There are no psychotropic meds out there that don't offer some side affects. Some are worse than others but overall one can expect drowsiness or sleeplessness, or a foggy feeling, or intense weight gain as much as 20 - 50 pounds, hair loss, impotence. Sounds fun, doesn't it? What 29 year old male wants to feel that way? Or a 20 year old female for that matter. Oh, and there can also be drooling, blurred vision and a general apathetic attitude. Try taking a college entrance exam like that. Or interviewing for a job. Often the choice to not take medication is the difference between choosing to hear voices and "feel" relatively normal or not hear voices and "feel" like a load of useless crap. And try explaining to a girl you meet or a boy you like that you are schizophrenic. Most people hear that word and think "serial killer" or "rapist".

I try to equate mental illness with other chronic disorders, like diabetes for example. If you are diabetic, you have to take insulin or the results are horrible and can be fatal. The same is true with mental illness. But we rarely hear of a stigma attached to someone with diabetes.

I don't have a diagnosed mental illness so I can only imagine, from what I have learned over the years, how hard it must be to come to terms with having one. My heroes are those who pull through, after years of hospitalizations, jail time, evictions, and losing everyone around them to manage to create a life for themselves in spite of it all. I can only hope those young people I work with will find a way to do just that.

In the meantime, I urge you all to do some research. Contact your local National Alliance for Mental Illness (NAMI) and open your mind to the possibilities of what treasures each of us, even those with mental illness, have to offer.

Damaged goods...

I overheard one of our clients refer to himself as "Damaged goods" because he has a mental illness. I can't tell you how sad that made me.

Think of yourself on an average day...
Maybe you get up, get some breakfast, get the kids off to school, get ready for work, take on whatever the work day brings you, a yelling boss, a disgruntled customer, a co-worker in a bad mood. You have expectations put on you. Whatever it is you do, you have to produce. Then you go home. You may have to stop and pick up a gallon of milk or a loaf of bread. Then you pick up your kids and the teacher tells you how their day went. You get home, make dinner, clean up. Watch some tv, maybe? Pay some bills?

Now think of yourself on an average day with schizophrenia...and your voices...
Maybe you get up ("you lazy son of a bitch, you're worthless") get some breakfast ("you don't deserve to eat, you piece of crap!") get the kids off to school ("they hate you, they've always hated you, you're a piece of shit!") get ready for work ("failure!! you're a screw up!! you can't do anything!!") take on whatever the work day brings you ("how can you possibly think you can do this!! you're an idiot!! STUPID ASS!!") a yelling boss ("worthless!! no one needs you here!!! IMBECILE!!!") a disgruntled customer ("I told you you would fail, ASS!! You smell, you're stupid, they'd be better off without you, you should just die!!!") a co-worker in a bad mood (EVERYONE HATES YOU, JUST DIE!!!"). You have expectations put on you. Whatever it is you do, you have to produce. ("You should just kill yourself. Go ahead. Everyone would be better off without you!!")

You get the picture. Try recording your family or friends shouting those things on a loop. Then put the ear buds in your ears and go to the grocery store and try to buy a gallon of milk. It's almost impossible to think. It can even effect your ability to walk straight or go up a single stair.

My point is this, everyday I see people living with mental illness. They're trying to maintain a job, keep their family together, or just have one friend they can trust. They have to maneuver through each day hearing or seeing things only they can see or hear. They have to take medications that add weight, make them impotent, make them drowsy, make their food taste bad, decreases their sex drive, their appetite or increases those thing which has a whole different effect on their lives. Their families don't always understand it and want them to "snap out of it". They often choose to not have friends or socialize because it's too difficult. They persevere, fail, bounce back and try again...and again... and again.

I don't see them as damaged goods. I see them as champions. I know I couldn't do it. Could you?

Inside A Darkened Mind

SCHIZOPHRENIA
noun
"any of several psychotic disorders characterized by distortions of reality and disturbances of thought and language and withdrawal from social contact"

I work for a not-for-profit human service agency and in the course of my work day I meet and talk to people with many personal roadblocks - things that I can't imagine having to live with on a daily basis. One of the people I have met is a woman in her mid-40's or early 50's named Kathy. She has schizophrenia and, though she consistently takes the prescribed medication, her illness is such that it barely responds. I've known her for 12 years and she never gets any better. Every morning when I arrive to work she is there waiting for the nurse to arrive to get her morning meds. She waits for over two hours every morning. She sits at the side of our building rocking back and forth and talking to the voices only she can hear. Her personal hygiene is horrible. She's dirty and has a pronounced body odor though she is fully capable of showering and taking care of herself. Her illness makes her afraid of water. I speak to her every day and each time I am struck with how "normal" she can sound. I also see other people walk past her either ignoring her or looking at her with disgust.

Kathy started out the same way we all did. A normal birth to normal parents. Somewhere in her early life, her brain become cross wired. She started hearing voices telling her to do things that she normally wouldn't which led to her incarceration and several years in prison. The thing that strikes me when I talk to her is that she is always positive. She is happy when she sees me. She takes joy in what she might be doing on any given day - shopping, watching a movie, seeing a friend. She delights in those same things we all find happiness in. It's evident when I speak to her that she is struggling to hear me over what is going on in her head. She has taught herself to shut them out if someone in the real world is speaking to her. Despite her appearance and blatant symptoms, she is nice and likable person.

It bothers me that people don't know this about her, that there are co-workers at the agency that complain that she is there every morning. Her presence disturbs them. I think I know why. I think it's because that we all feel, somewhere inside, that Kathy could be any one of us. Then we would be that person, rocking back and forth, talking to inner demons, who gets ignored and spat upon. To me, Kathy is the face of who we all could be given other circumstances. She scares us. That in itself makes us uncomfortable because we know that we should respond to her in a more decent humane way. She makes us see ourselves and we don't like what we see.