June 2019 – The LonePack Blog

“Boxing Away” Mental Health

“You have social anxiety? No way! You just spoke on stage, stop complaining”

“Yeah right, you aren’t an introvert. You aren’t shy and you’re talking to me well right now aren’t you?”

Well, count these as the most common responses I’ve gotten when I tell people that yes, I do indeed suffer from anxiety and yes, I also realise that I spoke on stage right now. Those two aren’t mutually exclusive.

[Image source: Tumblr]

A lot of our perspectives on mental health issues are drawn from what we see on social media. Films that are seeming to include more characters that cover the spectrum of mental health still have a long way to go when it comes to covering them practically. And the rise of internet “slangs” aren’t helping the situation. You see, mental health is not just one thing. Depression is not just “feeling sad” all the time. Not everyone who has depression fit the “symptoms” of depression. There are many who can function normally, still be social but still suffer from overwhelming depression. Same goes for any other mental health issues there are. Personally, the biggest problem that I’ve faced has come in the form of “boxes”.

Allow me to digress for a bit. Everyone you meet is different. They have different personalities and different tastes in music and movies and hobbies. And the same goes for their mental health as well. Ask people you know who are overcoming mental health issues and you will find that none of their experiences is similar even though they might have been diagnosed with the same issue. It is ignorant of us to assume that everyone deals with their issues the same way or goes through the same thing. And with people lacking this awareness, there arise situations in which people assume it is okay to make generalisations and comments, essentially stereotyping mental health into set “boxes”.

I deal with anxiety and am not an overly social person. But that doesn’t mean that I don’t have any friends or that I’m shy. I just take some time to talk to people I’ve just met and if I’m with my friends while meeting the new person then I feel so much better and at ease talking to the person for the first time. A lot of people who might be going through the same social anxiety that I am can be shy and just not talk or can be extremely social yet still feel overwhelmed and nervous inside. But all that people see is that I am a competitive stage speaker and hence, I am suddenly not allowed to feel that anxiety pumping through my veins every time I come onto the stage to speak. I realise that feeling stage fright and nervousness are common to everyone but feeling extremely overwhelmed yet pushing yourself to speak through the knots in your stomach is not. But even though the anxiety is overwhelming, I still love to speak on stage. And I refuse to be boxed away for that.

[Image source: Tumblr]

Everyone you know is going through something that might not fit your assumptions. Chrissy Teigen and Adele openly spoke up about post-partum depression while under the public’s eye and we did not know that they had gone through that until they told us. Jennifer Lawrence is one of the most charismatic people in interviews but has openly stated that she suffered from severe anxiety. A lot more examples can be drawn to make this point but at the end of it all, the only thing that matters is that people turn a little bit more understanding when it comes to how mental health issues manifest themselves.

[Image source: Pinterest]

If someone tells you that they’re going through something, listen to them. Please do not make generalisations and make them think that their feelings are invalid. The world is a very kind and welcoming place and a little bit of awareness with these issues is all one will need to help a thousand more. Let us not box away mental illnesses or file them away under certain tabs. These issues are complex and we can all do our bit to spread information and awareness.

The Romanticization of Mental Health

I want to kill myself is pretty much the response to every slightest inconvenience that happens in a day of the life of the current generation. Talking about Mental Health to parents is still an ‘awkward’ topic for discussion and very few people attempt to even take a chance to start a dialogue about it with their parents. So, that leaves people with only a few options when it comes to looking into and searching about mental health issues, and at the top of it is social media.

The wide social media presence of today is not a joke. Social media platforms act as tools to get to know a person’s life; their likes and dislikes, their opinions on every issue, where they are and what they’re up to at the moment. And amongst all these bombardments of information on social media platforms about friends, family, celebrities and events, over the years, the awareness with regards to mental health has also increased but has managed to give room to a lot of myths and misconceptions.

The worst of everything is that nowadays, the idea of romanticising depression, anxiety and other mental health issues is trending.

How? As humans feeling of belongingness is one of our primary needs, it is always better to be in the company of people who feel the same way as we do, to connect. But, here’s the thing. Are we sharing the stigma?

We are finding an increasing amount of content on social media, of normalising mental health issues to the point where these issues have become “slangs” and everyday words to express dramatic exasperations. And the result, the slowly accrued seriousness and awareness built up on mental health issues shatter in a second to being viewed as something normal and unimportant.

We all know how important and powerful stories can be. Millions of people have found their sense of belonging and community by sharing their stories with the world, stories that others can relate to, stories that others can connect with. So, it is very important to realise that there are many who are battling mental health issues and are struggling to cope up with it and the things we carelessly put out there on social media for the world to see, can affect those who are genuinely suffering.

Even in films, the supposedly “depressed” and “brooding” character is looked at as being mysterious and attractive as their romantic interest swoop in as cheerful and oblivious people who then go on to “mend” and “fix” the said “brooding” person’s heart as they then ride into the sunset. People do not seem to realise the issue with these stories and films and content. It will only serve to silence those who are actually suffering from mental health issues as they can begin to downplay their suffering and start viewing themselves as being dramatic or worse, silence themselves because others might not take them seriously. It can begin to form a vicious mentality that mental health issues are “normal” and not something to seek help for to feel better and that these issues somehow will make them “special” to stand apart from others.

Suffering from mental health issues is not a joke and is not attractive.

It’s planning for your best friend’s surprise birthday party for a week and not wanting to leave your bed on that day. It’s in the gloomy weather when you thought you’d feel peaceful if you travelled alone away from the crowd, but end up sobbing in front of strangers solemnly because they’ll never know or ask you what your problem is. It’s when someone compliments you, tells you that you look pretty, but how you find every flaw in your body each day before you step out of your house. It’s a beautiful family dinner with all your loved ones sharing jokes, revisiting the memories, escaping busy, restless lives and just once, just once the memory of you before depression flashes and how you silently feel your heart sinking amongst the laughter, controlling your tears. It’s when you find someone you really admire, but secretly punish yourself because you know you’ll not be good enough and doubt they’ll also leave. It’s about how you tell yourself each day it’ll get better because it always does, but slowly get exhausted because of how awfully long it is. It’s the disappointment that shakes your world and opens a door of gazillion questions asking if you were ever good enough. It’s always about needing a mask but never wanting to wear it again.

I’m not trying to underestimate or belittle anyone’s feelings or experience BUT it’s very important for us to understand the level of intensity about the words you’re referring to.

1) Feeling anxious does not mean you have anxiety.

2) Feeling sad, low, dull does not mean you’re suffering from depression.

3) Not wanting to hang out with people, initiate a conversation with friends, enjoying social situations does not mean it’s social anxiety.

4) Panicking or feeling nervous does not mean you’re having a panic attack.

If you feel like you might be genuinely suffering, please do not hesitate to reach out for help and consult a professional to diagnose the condition and get better. But if not, then please do your bit to raise awareness about these issues using your social media platforms but most importantly, do your bit to stop the romanticization of mental health issues.

High Functioning yet Dysfunctional

Some of the worst times for me was when I was 17 and felt extremely confused and left out about what I was feeling. The world seemed too big and too heavy on my shoulders and I was feeling downright miserable. My anxiety skyrocketed to the point where it manifested as physical pains and I was pretty sure that there had to be a name to call out to all the helplessness and sadness I was feeling. But I was very young and unexposed to the world of mental health, so as any other person would do, I took to Google. I put in all the things I was feeling and thought that I’d arrive at some sort of an idea as to what was going on with me. None of the people around me looked like they were suffering like I did and I didn’t have the courage to talk to it to my parents. But then my confusion increased manifold as I stared at the screen; all my signs led to Depression but I fit none of the “symptoms”. I wasn’t losing appetite, my sleep pattern didn’t change drastically yet I knew I was feeling miserable. And this prompted me to start doing more research into what I was feeling and if anyone else out there was feeling the same as I yet didn’t fit into the box of “depression and anxiety symptoms”. And a revelation was made; High-Functioning Disorders.

Let me digress for a bit. You see, the students and working professionals that make a majority of people who take their lives seem to fit a certain profile. Most of them were academically well off and seemed to have a normal relationship with their friends and family. No visible symptoms of depression or anxiety could be visibly seen and they didn’t look any different, their daily activities weren’t affected in any way, and all of them seemed normal and as they would every other day. Their suicides came as a big, unpredictable blow to their friends and family since to them, literally, nothing pointed to their loved one suffering from any kind of mental health issues or, so they thought.

This observation or the lack of it reveals a darker truth. Most of us aren’t aware of a class of disorders that has now become to be known as “high-functioning” disorders. It is a recent development in the field of psychology and one that has come in a much-needed time.

For those who don’t know what they are, High-functioning disorders are the same as any other mental health disorder that one may suffer from but possess a darker trait, they do not affect your daily life. Psychologists are more worried about the people who suffer from this class of disorders since they are extremely difficult to diagnose. People with high-functioning versions of disorders such as anxiety and depression will not seem any different from a person without the disorders, superficially. They will continue with their normal lives as if nothing affects them at all, their body and brain cope very well with their conditions and as a result, their work and academic lives remain undisturbed. They’re social and active, all smiles and whatnot but on the inside, they’re still suffering and unable reach out to anyone.

[Image source: Betterhelp]

For someone who is suffering and looks to the internet first to arrive at some kind of a self-diagnosis, it really doesn’t help when none of the mental health disorders’ so-called “symptoms” fit them. Not many articles relating to these high functioning forms of disorders are present even on the internet, which is one of, if not the largest communicative space globally. And hence understandably, not much awareness is present with regard to these issues.

However, people, one by one, are now coming forward to share their experiences with high-functioning disorders. This is an article written by a woman who suffers from High-Functioning Anxiety and Depression – https://themighty.com/2017/11/high-functioning-anxiety-depression-looks-like/

If you are suffering from not being the best version of yourself and doubt that it could be anxiety or depression or any other issues but experience none of the visible giveaways, do consult a psychologist.

It is never easy to battle these on your own and you shouldn’t either. The world is here to listen and to help. And if you doubt that one of your loved ones is suffering but do not know what to do since they do seem normal to everyone else, sit them down and talk to them. Ask them if they’re doing okay and if not, tell them that you’re there to help them get through this.

Everyone needs a hand sometimes. You could end up saving a life from further suffering because of the lack of awareness. Do your bit and spread the word.

Living a life where every moment is filled with suspicion and doubt – A review of Paranoid Personality Disorder

Paranoid Personality Disorder(PPD) belongs to the class of Personality Disorders. Paranoia involves extreme levels of distrust and suspicion. People with this personality disorder may be hypersensitive, easily insulted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions that may validate their fears or biases. They are eager observers and they think they are in danger and look for signs and threats of that danger, potentially not appreciating other evidence. Some other common recurrent beliefs include beliefs that someone is plotting against them, they are being watched closely, everyone is conspiring against them among others.

Following is a case study of a Paranoid patient:

A woman believed, without cause, that her neighbours were harassing her by allowing their young children to make loud noise outside her apartment door. Rather than asking the neighbours to be more considerate, she stopped speaking to them and began a campaign of unceasingly antagonistic behaviour: giving them “dirty looks,” pushing past them aggressively in the hallway, slamming doors, and behaving rudely toward their visitors. After over a year had passed, when the neighbours finally confronted her about her behaviour, she accused them of purposely harassing her. “Everyone knows that these doors are paper thin,” she said, “and that I can hear everything that goes on in the hallway. You are doing it deliberately.” Nothing that the neighbours said could convince her otherwise. Despite their attempts to be more considerate about the noise outside her apartment, she continued to behave in a rude and aggressive manner toward them. Neighbours and visitors commented that the woman appeared tense and angry. Her face looked like a hard mask. She was rarely seen smiling and she walked around the neighbourhood wearing dark sunglasses, even on cloudy days. She was often seen yelling at her children, behaviour that had earned her the nickname “the screamer” among the parents at her children’s school. She had forced her children to change schools several times within the same district because she was dissatisfied with the education they were receiving. An unstated reason, perhaps, was that she had alienated so many other parents. She worked at home during the day at a job that required her to have little contact with other people. She had few social contacts, and in conversation was often perceived to be sarcastic and hypercritical.

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[Image Courtesy: https://infograph.venngage.com/p/63184/paranoid-personality-disorder]

According to the DSM-V, PPD is characterized by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts. To qualify for a diagnosis, the patient must meet at least four out of the following criteria:

Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them.
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them.
Reads hidden demeaning or threatening meanings into benign remarks or events.
Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

Many of these symptoms are clearly reflected in the case study.

PPD first emerged as a cluster of symptoms for Schizophrenia. It was in 1921, that Kraepelin first proposed three distinct presentations of paranoia that resembled the diagnosis of schizophrenia, delusional disorder, and paranoid personality disorder. However, for a very long time, PPD was considered only as a cluster of symptoms for schizophrenia. Paranoid personality disorder first appeared in the DSM-III in 1980. The major problem facing the study of this disorder was the initial neglect of the scientists. Secondly, not many patients would agree to participate in research studies. Yet, in reality, PPD is a severe, relatively common clinical problem that is difficult to treat. Fortunately, our understanding of PPD has improved as research has accrued.

But the question is, why is PPD important? One of the major reasons is because PPD heavily dictates the adverse outcomes in the treatment of personality disordered patients. Persons with PPD, when not disabled, stop working earlier than non-personality disordered individuals. In clinical populations, it is one of the strongest predictors of aggressive behaviour. PPD is also associated with violence and stalking as well as excessive litigation. It also has serious implications on the individual’s mental well-being often resulting in depression and has less likeability to be cured despite intense psychiatric treatment.

There are multiple risk factors involved in the development of PPD as no direct biological causations have been attributed. Childhood trauma has consistently been identified as a risk factor for PPD. Studies have shown that childhood emotional neglect predicted PPD symptom levels in adolescence and early adulthood. In adolescence, PPD has been cross-sectionally associated with elevated physical abuse in childhood and adolescence, but not sexual abuse. In a study of psychiatric adult outpatients, PPD was found associated with both sexual and physical abuse. Although these studies have focused on chronic trauma from caregivers, acute physical trauma in the form of childhood burn injury has also found to be a risk factor for adult PPD traits.

What can be some effective measures for treating PPD?

In a case report titled, “Paranoid Personality Disorder”, medics Amy Vyas and Madiha Khan have outlined certain major points with regards to treating PPD.

Because paranoid personality disorder patients are unlikely to seek or remain in psychiatric care, relevant treatments for this disorder have received less research relative to those of similarly prevalent personality disorders. Much of the published literature takes the form of case studies or case series. One such case report found cognitive analytic therapy to be an effective intervention, while another suggested that in the short-term, the use of antipsychotics(drugs) in patients with paranoid personality disorder was associated with improved prognosis. Cognitive therapy has been endorsed as a useful technique for the general psychiatrist. Recommended approaches to psychodynamic psychotherapy for these patients include working toward helping patients “shift their perceptions of the origin of their problems from an external locus to an internal one”, while maintaining special attention to the management of boundaries, maintenance of the therapeutic alliance, safety, and awareness of how the therapy may be integrated into the patient’s paranoid stance.

In conclusion, PPD is a serious mental illness that requires more and more fruitful research and in-depth understanding. No such biological or physiological causes have been found but several risks factors have been identified. With regards to treatment, there is a need for more effective intervention.

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[Image Courtesy: https://www.papermasters.com/paranoid-personality-disorder.html]

To know more about Paranoid Personality Disorder:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793931/

References

[1]Lee R. (2017). Mistrustful and Misunderstood: A Review of Paranoid Personality Disorder. Current behavioral neuroscience reports, 4(2), 151–165. doi:10.1007/s40473-017-0116-7

[2]Paranoid personality disorder. (2019, March 11). Retrieved from https://en.wikipedia.org/wiki/Paranoid_personality_disorder#DSM-5

[3]Vyas, A., & Khan, M. (2017, May 16). Paranoid Personality Disorder. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2016.110103

Not Alone: Coming to terms with my Mental Health [Trigger Warning]

Trigger warning: skin peeling, mentions of self-harm, nightmares and grief

Think about this for a solid minute.

“You’re 16. What problems you’d possibly have to suffer depression?” ” You are simply over thinking” “You’ll get over it” “There’s no such thing as depression, it’s just a phase”.

Sound familiar?

You see, depression is a very personal feeling. I might be sitting right next to you, joking around about the memes you’ve shared with me or having a very deep conversation about life and the purpose of it or maybe just sitting there, hanging out with you and yet, you will have no idea of the things that go on inside my head.

For almost a year, I slept only around 3 AM. And even then, I would experience nightmares where this soul of mine would be pleading, crying my name out really loud in the darkness; most of the times in the middle thick dark woods. Walking with my friends in school, I’d feel like someone was choking me, trying to push me down and drown me. I used to hysterically cry and begin to laugh very loudly just like a baby, locking myself in my room. I’d cry all night, not knowing why.

This became worse when one night I became downright delirious, trying to make the pain go away, trying to hurt myself while also rubbing my chest to calm myself down. Physically, I had developed so much acne, a very irregular menstrual cycle and a weak immune system. And yes, I even periodically suffered strokes. I’d bite my lips, nails, keep peeling my skin.

What made me such a monster in my own eyes?

[Image source: Gemma Correll]

I’d say the fear of losing my identity that involves this image that I’ve built for myself. We are not perfect and we will never be. All of us have our own flaws and we learn and grow through our experiences in this journey of life. And it is necessary to go through these experiences in order to learn from them. But never be afraid to ask for help when you need it.

We all are very familiar with motivational quotes, “This too shall pass” “Love yourself” “I’m proud of you” do the rounds on social media all the time. But just saying them out loud isn’t enough. Start small, get help if you feel like you can’t make through this journey of acceptance alone. For me, the fact that I wake up ALIVE every morning, the fact that I’m able to still breathe and body is functioning, is something to be grateful for; granting me another day. The little things, the journey. I accepted.

After the longest time, I saw myself in the mirror and smiled for once.

The fact that I’ve been gifted time, ability to take another chance at people and perspectives made me understand that things will start working out, at least someday. Healing can NEVER happen overnight, it is a long road, it’s every single moment you live.

And slowly but surely, you will get better. In fact, it’ll be revolutionary when you wake up one day and can actually feel light enough to pull yourself out of your own bed. There will be struggles and relapses, but there will also be support and love and kindness.

Depression isn’t directly proportional to your age group. Depression doesn’t know numbers, doesn’t know care about your sexual orientation or your bank balance. Never ever feel shy to accept this, you’re no less of a human being you deserve to be equally loved.

YOU MATTER. There’s Absolutely NOTHING to be ashamed of in acceptance.

More power to you.