Feeling Lonely
(From my book, The Room)

Lies so sweet settle like snowflakes,
covering passion with a blanket of white,
and the cold season begins again,
without warmth, without vitality.

It is a time to seek a warm fire,
and snuggle into the folds of a hot body,
and enter into the world of sweet dreams.

But sometimes they are just dreams.
Sometimes there is no warm fire.
Sometimes there is no hot body
and we find we are alone,
buried under the cold blanket of white.
And we feel the loneliness.
And we face the cold reality
that in this life we are always truly alone,
alone with our own thoughts,
alone with our own feelings,
feelings that can never be shared
with someone who says they love us,
because they are beyond the grasp of words.

And then, inevitably, we have to learn
to wrap ourselves up with ourselves,
and dance to the beat of our own heart,
and seek the goodness of our own soul.

Then at night we can collapse
into our own snug bed,
and say it is okay to be alone,
because we can sleep with ourselves,
and know there is a spirit of love
that is always there in the bed beside us.

Last week we looked at a dialogue between two people – one with borderline personality disorder and one with post-traumatic stress disorder. I had an interesting response to that article that I would like to share with you today. Let’s take a look at the comments and questions and I will try to respond to them appropriately.

I wonder, do we become our labels?

There is certainly a danger in that. In one of the best articles I have found on the topic, Lauren Restivo, a health systems specialist at the Psychological Health Center of Excellence , identified Self-Stigma as one of the problems with labeling. According to Restivo, individuals may have a tendency to internalize labels resulting in negative perceptions and beliefs about themselves. I believe that when we identify ourselves as being different with a different genetic predisposition, it can affect our belief systems. We may perceive ourselves as not being normal and that we may never be normal. The label can then lead to low self-esteem and feelings of helplessness. We can become dependent on the medication and therapy for our mental survival. It can also become a reason or perhaps an excuse why we believe we cannot live a normal life.

Is one kind of disability label more challenging than another kind?

I believe labels can all have the same impact and results when it comes to Self-Stigma. However, different labels certainly create different responses when it comes to how they are perceived by other people. Restivo identified another issue that she refers to as Public-Stigma. She states that the public in general has a tendency to engage in stereotypes when it comes to mental health conditions. She also believes that Public-Stigma can be unintentionally propagated by government and public institutions in the process of trying to define, help, and support. Schizophrenia, bi-polar, and PTSD have definitely received a lot of negative and mostly unfounded public attention. For example, people with bi-polar are often viewed as having wild mood swings resulting in sex binges and engagement in extremely high risk behavior. This can result is discrimination in the workforce and even in the process of choosing life partners. When it comes to perceptions of dangerous behavior, movies and media like to excite the fear mechanisms in their audiences or a feeling that people with mental disorders are unpredictable and should be shunned or isolated. People with schizophrenia are often portrayed as living on the edge of reality and may strike out at imaginary demons (negative term – psychopath). People with PTSD have been portrayed as unpredictable and may act out subconsciously and hurt a loved one. Antisocial and narcissism personality disorders have been associated with serial killers (negative term – sociopath). However, the rate of dangerous behavior associated with these disorders is no greater, and sometimes even less, than the general population. There is little danger to the public; they are more likely to cause harm to themselves and, therefore, need our positive attention and support.

Can we vie for which condition is the hardest to face or deal with?

It does no good to try to compete with who has the greatest disorder, but on the other hand it does help to understand the intricacies of each one for the purpose of intervention and treatment. I think this is one area where we can look to science to see the specific traits we have and the effectiveness of the therapies involved. For example, both bi-polar and schizophrenia involve chemical imbalance, and when treated with appropriate medication, these people can live normal lives. When we look at the other disorders, such as clinical depression and generalized anxiety, these disorders are usually a result of life circumstance which can cause a temporary chemical imbalance. Medication helps the patient restore balance so that therapy can be employed to the point where the patient feels in control again. The medication should then be slowly dropped. PTSD is situation based. Therapy helps people deal with the trauma and gain control of the emotions attached to it. If it is accompanied by generalized anxiety, temporary medication can help but it is not always necessary. On the other hand the range of personality disorders are difficult to treat through medication (with the exception of the anxiety that is often involved). Therapy is much more difficult. We can deal with specific feelings and problems as they arise and deal with specific strategies for specific circumstance, but the underlying tendencies may always be there.

I have a friend who has steadfastly increased her health by refusing to submit to any label. She is dealing with symptoms like OCD and ultra-anxiety. She spent some time in a mental institution and was medicated/ over-medicated. She vowed “never again” when she got out. She started out with traditional cognitive therapy after that.

There will always be horror stories, but we should not generalize to whole populations. The need is too great right now to focus on the negative. However, we have to systematically listen to these people and use these examples to gain more clarity and to patch up the system. There may be flaws in the system, but the people involved are good people trying to do the best job they can with limited resources.

Endless therapy and medication are also very expensive ($200/hour) and time-consuming. 20, 40, 60 years! Also, resulting grief from trying to find the best fit for a therapist is also disillusioning and depressing. All family and friendships are also affected by the process. Usually, negatively.

That is why I believe medication has to be used wisely. It has its purpose and that is to restore chemical balance. In cases like schizophrenia and bi-polar, medication may be needed for a life time, but even then, it should be monitored and adjusted from time to time. For most other disorders it should be temporary with the goal of having natural chemical balance restored by the brain once the life situation changes. It is also important to shop around for the right therapist or psychiatrist without feeling that somehow the failure is our fault. The effectiveness of therapy often depends on the relationship between the patient and the therapist, and the therapist has to be sure that rapport has been established before beginning treatment. Therapy should also include family counselling if needed. Our triggers for our disorder are often bound together with our family dynamics. We have to change these group-thinking and behavior patterns to facilitate the treatment. Time lines are also important. A disorder does not mean a disorder for life. We should reach a point within a year when we are functioning again and may just need to monitor our traits and symptoms with occasional support.

Treatment for mental disorders is different than just seeing a counselor to cope with life pressures. If we are still functional and just dealing with traits and symptoms, psychologists can provide short term therapy with costs that most of us can cover. If financing is a problem, mental health counselling services may be sufficient; however, these services are woefully underfunded and antiquate resources have to be provided to meet the overwhelming present need. If we have been diagnosed with a mental disorder, we should seek out a specialist who can monitor our medication and treatment. This should be treated as an illness and all costs including medication should be covered by the health care system.

My friend has removed any kind of pharmaceutical drug, and is seeking deep alignment with spirit. I wonder if she is right since total health has been her sole obsession for at least 20 years

If it works for her, then great. She has found a way to control her symptoms and traits. She has learned to function with it and perhaps even thrive with it. Dealing with mental issues is usually a life time process. Those of us who have to live with symptoms know that maintaining our physical and mental health is absolutely necessary for us to survive and thrive. The positive side is that through this “obsession” we often arrive at life’s greater truths. Regardless of how we deal with our issues, developing spiritual habits can do no harm and can only result in good. By spiritual I am not referring to religious miracles but merely opening our minds and souls to sound practices such as meditation and mindful activities.

I think there is a danger, however, in saying that if it works for her it should work for everyone – therefore, we should get rid of therapy and medication. We do not need skepticism right now; we need more confidence and more participation and support from our communities so we can return to normal (whatever that is) functioning. At the same time the profession needs to be open to feedback in order to improve its services.

If I am diagnosed with cancer, am I “my cancer?” Am I diabetic and not human? Small-minded, rich, poor, black, alien, alienated?

No, you are not your negative label. Why limit ourselves? We are beautiful and powerful spirit beings.

Are there good labels? “Health-conscious”? Loving? Curious? Interested? BFF (best friend forever)? Spiritual?

Yes. Not all labels are bad. In fact, even labels dealing with mental disorders can be positive. Some of these labels help us understand our feelings and our thinking and behavior patterns. Once we recognize and accept them, we can take steps to live with them and even turn them into positive aspects of our being. Secondly these labels help the medical profession, including psychiatrists and psychologists, hone in on specific medications and therapies that have been proven to work with people with similar traits and symptoms. The key is to not view the labels as something permanent leading to helplessness, but something temporary that leads to greater self-awareness and understanding. The goal is to eventually lead more powerful and productive lives.

My Recommendations

1. We do not wear our labels proudly or with shame. We recognize them for what they are, verbs not nouns, evolving not static. They are thought patterns and behavior patterns that can be changed. For some of us it will require medication, for most of us we may just need a helping hand from time to time. For example with my BPD symptoms, I am not a BPD person; I do not even have a borderline personality disorder; I have borderline personality traits that are NOW COMPLETELY MANAGABLE without medication. However, a little therapy may help me from time to time while for others it may be essential for their survival. Our suicide rate is 50 times greater than the general population and 10 times greater than with depression alone. As a group we need your help.

2. We can closely examine public policies related to mental health for potentially stigmatizing language and labels. Words do matter. Health care providers, educators, and people in entertainment who have a tremendous influence on the minds of the general population should work to try and choose their words more carefully and avoid inadvertent labels and potential negative terminology. And please no jokes. This is not funny.

3. We can avoid Self-Stigma by focusing on the short term objectives and processes of treatment to build our self-esteem and gain self-control. We take control of our own therapy. The therapist or psychiatrist is not a god figure. They only can work with what we tell them. When we receive a diagnosis we can challenge it, study it, and engage with the doctors and therapists to get clarity. Once we are confident in the diagnosis, we can then work with them to determine if it is short term or long term and build a timeline for outcomes. In other words we take ownership for our own minds.

4. If medication is recommended, we can again engage with the doctors and psychiatrists to examine the benefits and side effects, agree on a system of evaluating the effects of the drugs, and set a time-line and evaluation process for how long the drugs will be needed. For most of us, especially in the midst of our dysfunctional symptoms, this may be difficult to do. Doctors and pharmacists may have to take the lead in getting their patients engaged.

5. We can make it our business to look at all aspects of our lives including beyond the labels and conditions. Other good health practices can be developed such as exercise and diet. We can also open up our minds and souls to spiritual practices that can help us develop self-love and self-empowerment. Once we are functioning again, we can strive to take the focus off ourselves and our diagnostic labels and begin to develop a life of meaning and purpose by working for others and for the greater good. Having been there and done that, we are now experts in the field, and we can use our knowledge to help others, and in the process, we help ourselves.

(1) Restivo, Lauren. Words Matter: The Effect of Stigma and Labeling on Mental Health Care in the Military. Psychological Health Center of Excellence. March 19, 2018.