Wednesday, August 17, 2022

Comments by Mushka Ryce

Showing 2 of 2 comments.

  • The description in this of different labels such as depression or PTSD don’t seem to match DSM description or my understanding. For example, PTSD is far more complex & powerful than “avoidance”. Research shows a theory that the amygdala encodes those memories differently. Later when something triggers the PTSD response, the person becomes overwhelm with emotion– their limbic system giving a high arousal response *as if the event was happening right now*. It actually takes for the person to identify the trigger(s) and only then is the choice to avoid made. Avoidance is a coping mechanism; it isn’t the real problem. I’m not aware of cognitive therapy that is showing peer reviewed & significant results for the root cause. You cannot reason your way to not having that hyperarousal response. When it happens, all the positive self talk or “choosing” to dismiss it doesn’t doesn’t anything. The thinking part of the mind becomes secondary. Do you really believe a positive outlook & confidence in coping skills can somehow undo a profoundly negative-emotion encoded memory?

    Same goes for depression. It’s far worse than negative self image & giving in to discouraging thoughts. In some people, it’s an inability to string together complex thoughts– a brain fog — that makes even simple tasks like taking a shower seem too hard to deal with. Depression can take away a person’s ability to control the focus of their attention, to the point where normal negative physical sensations (background pain) become overwhelming. Some people may feel so unable to think and move, expecting them to show up to therapy regularly is unreasonable. It’s an insult to their intelligence to tell a chronic sufferer of major depression that they’re still depressed because they don’t believe the right things. It comes across as sounding like the layperson advice to a depressed friend: “Your life isn’t that bad. You can get over it. Stop believing you can’t. Get over it.”

    One thing you may with me about is the belief in therapy that stressors make symptoms far worse. Things that can really add to a person’s burden: shaming them, telling them they’re not trying hard enough to believe they’ll get over their issue, in a way blaming them for their own failure to get better. Invalidating their experiences & self knowledge. It almost borders on “gas lighting”: telling someone you know better than they do who they are & what they want to believe. In my opinion these things are more harmful than constructive.

  • I am so very sorry about your loss. It was a tragedy.

    I have been diagnosed as cPTSD. May I share my viewpoint? I’m in my 40s. Growing up my memories are of both of my parents being functional alcoholics. My first boyfriend was years of Statuatory Rape: it started when I was 15 (he was 25 & controlling) I clung to him for years because — to the mind of someone who has suffered serious emotional trauma — being abused again almost feels comfortable or deserved.

    Fast forward several decades. I have been through the mental healthcare system my whole life so I’ve seen it from the inside. I’ve also been on the outside, earning my license as RN & doing my own research.

    Question: Is labeling patients with diagnoses bad?

    Here’s the thing: maybe not ideal but necessary. It’s for insurance (stupid American health care), disability claims, schools (eg. IEP plans) . It’s also so that a patient can get the right type of care across multiple mental health specialists. For example, only a psychiatrist (or medical doctor) can prescribe medications, but that’s mainly what they specialize in. Other professionals such as Psychologists, psychotherapists, and counselors are who specialize the behavioral & psychological therapies. And here’s where it can be frustrating: there are many different types of therapies,. eg talk, Cbt, dialectical, family therapy, etc. It’s very unfortunate your sister didn’t get referred to the right type of therapist and/or her therapists did a poor job. I read somewhere it can take an average of 7 years for an adult to get the right diagnosis for mental health issue in the US. To add to the confusion, there are different tiers of training and qualifications. For example bad insurance or bad advice will keep someone seeing only a counselor, a license that has very low training requirements. Many insurance plans don’t like to cover more serious problems: it’s cheaper to manage the symptoms with a medication and occasional psychiatrist check-ins. They’ll do anything they can to not cover extensive long term therapy or psychiatric hospital treatments. The ONLY way this will change is if our government makes *proper* mental health care treatments mandatory for insurance. Or if the US goes to a single payer system where the law mandates full coverage.

    In the US, many areas are extremely under served for mental health care – period In my whole county there are only a handful of providers taking my insurance, and one can expect to be on a wait list 4-6 weeks before anyone will talk to you. Some are overwhelmed and never return phone calls. Obviously this discourages someone who is already struggling from getting more care. Don’t blame the profession. Blame insurance companies, high college costs, big forprofit corporations replacing clinics, and the challenges of the job. Reducing human beings to mere diagnosis labels is a function of insurance, but very few patients can afford to pay cash for their mental healthcare.

    When it comes to trauma, there are NO easy answers. Even if it is identified early and the person has great insurance, there isn’t one treatment that clearly gets great results. in the past few decades there are newer methods such as EMDR that are showing to get an improvement of symptoms in a majority of patients in the studies. There’s experimental work being done at the moment using guided sessions under esketamine (Ketamine), psycilocibin (mushrooms), and ecstasy. Esketamine has gotten FDA approval for mental health use, but training/use isn’t widespread yet. When your sister was younger, available were things like talk therapy, dialectical therapy, maybe some CBT — but these are hit or miss on who gets lasting improvement. For some, the wrong therapy can re-traumatize them and reinforce how broken/worthless they see themselves as.
    There’s no way to know if your sister would’ve had a significantly different outcome if her treatment wasn’t so medication focused.

    For anyone interested in research: if you like podcasts, I recommend Dr Huberman of Stanford University: The Huberman Lab. He is very science based and he covers trauma, brain chemistry imbalance, and the mechanisms behind neurotransmitters & of meds. Meds aren’t evil. It’s more like science is still in its infancy, trying to understand how the brain works.

    There is no clear cut fix for trauma, especially when it has its roots in childhood. Medications help people fit into society so we can hold a job & maintain relationships better. Therapy may or may not help. Family/relationship therapy might help, but the traumatized person cannot control if their loved ones will attend or are able to implement it. When it’s a situation of parent(s) who are addicts, all the treatment in the world may not help the child until she is able 59 permanently live elsewhere and can develop her identity away from the toxic person. Nobody can force the addict to get clean;he or she must do it on their own. Blaming the over use of meds may be overlooking the larger social, cultural, and financial issues. How do we prevent kids from being raised by addicts in the first place, in a culture where “partying” is cool and we value personal pleasure over obligation to family/community. The addict parent embraces their denial: “how could I be hurting my child? I love them and work hard to provide for them. If I need a few drinks after work to relax, it’s *normal*.” It comes as no surprise that many addict suffered their own trauma(s) in their own past. Trauma is like this infection that passes from one person to those around them.

    I understand the desire for an improvement on suicide prevention. But what could that look like? Currently a person can call a hotline, call 911, or drive to an emergency room. If someone hides their suicidal ideation, nobody could know to intervene. Simply admitting pain to a therapist or psychiatrist is common, and many people live in pain without ever considering suicide. Since about the 1960s, it’s been illegal to commit someone to a psyc hospital against their wishes (beyond a short hold period) . Perhaps I lack imagination but I don’t see any other way to prevent suicides?

    This is such a complicated issue. Any feelings of anger or outrage you have are valid. The world we live in does seem so uncaring and harsh. One thing I grapple with in my own trauma/depression struggles: accepting that things are not fair. Awful things happen to good people. People — even those we love or trust — are what they are. Flawed. Weak. Selfish. Dysfunctional. Mental health professionals are what they are: limited to the tools they were trained to use, limited how much they can do (insurance/financial), and unable to get too emotionally invested (risk for burn out). Government politics & regulations and cultural beliefs limit funding & freedom to try new treatments. We live in a world where having cancer gets a person sympathy but having a mental health diagnosis gets them shamed, distrusted, sometimes even losing a job or a relationship.

    In short: the world is a f-d up place. Identify the things that can be changed and pour yourself into that. Some things will never change. Crappy things happen to good people. You didn’t deserve that family environment yourself. You didn’t deserve watching your sister suffer so long and then losing her. You have my deepest sympathies. But be careful that you don’t own her pain and let it keep your from your own happiness.