Transformation and Healing After Trauma, Loss and Grief

My Mythic Garden

A blog by author and trauma expert Gary W. Reece, Ph.D.

Seismographs/Assessing Mental Health
By
Gary Reece, Ph.D.

In my last bog I wrote about fault lines in the human personality, indicating that these create developmental vulnerabilities which could and have been responsible for major and minor episodes of violence and social disruptions. A colleague, a very discerning and valued mentor wrote and commented that this was all well and good, but so what. In essence, did knowing this do us any good?

He as usual had exposed one of the major problems we in the mental health field have, assessing the state of another person’s mental health as well as the ability to predict whether that person is “a danger to himself or another.” The first problem in recognizing and dealing with this issue, for example, the Diagnostic and Statistical Manual of the American Psychiatric Association which I have on my desk; it weighs 10 pounds and makes a wonderful door stop. It contains 1,000 pages of various kinds of disorders, all carefully classified. To give an example, I quote: “The need for classification of mental disorders has been clear throughout the history of medicine but there has been little agreement on which disorders should be included and the optimal method for their organization.” (Pg. XXIV) To further illustrate the difficulties and nuances of classifying mental illness, it was only in the last 20 years that homosexuality was declassified as a mental disorder.

My sole purpose in writing this blog is to raise awareness of issues pertaining to mental health. So, the first point I wish to make is the complexity of mental health and the issues related to what constitutes mental illness. It would be nice if like in the physical sciences we could develop a mental seismograph and hang it around everyone’s neck and then get a reading, some pr-event signal which would warn us all when someone was about to have a major mental health crisis. This is precisely the problem; we in the profession have developed hundreds of tests and procedures for evaluating and detecting signs of mental disorders but they are very imprecise and have little predictive value. I refer to the problem in the courts where two “expert witnesses” testify as to the mental competence of someone being charged with a crime. You get wildly differing opinions. This problem of complexity is only the first of many when it comes to clarifying the issues and providing useful information.

A second problem is that of awareness. For the most part the general public is not good at assessing the mental health of themselves or others. It usually has to get to a crisis point before anyone becomes aware that there is a problem and it unfortunately is often after the fact when we assess a catastrophe and see all the red flags and early warning signs. How do you know when you are in trouble and have a problem serious enough to seek professional help? Well interestingly enough we have such a system. It is our body. We have a system designed to evaluate and respond to threat. It is our own unique “stress response system.” This is a system most people ignore or only complain about when they are stressed. As if it was a badge of honor.
This system tells us all kinds of things about the quality of our lives. Signs of distress are numerous: fatigue, irritability, depression, insomnia, eating disorders, high blood pressure, gastric distress, tension, anxiety attacks, headaches, and burnout. All of these are telling us that we are under prolonged threat; feeling overwhelmed leads to our systems being flooded with stress hormones which are the result of too much chronic demand. The body, just like a car engine is not designed to run all out all the time. Eventually our bodies break down and we start having multiple illnesses and can’t seem to recover.

Pay attention to your stress level, it is your best friend! To be truly healthy we need to intersperse periods of stress with relaxation and recovery time. Finding your optimal level of functioning requires real awareness and discipline to not exceed our limits.

What do you do if you suspect that someone you know needs professional intervention? To illustrate how difficult it is to get help for someone who does not think they need help I use the following example. A client of mine, a woman was in therapy dealing with an abusive husband, he found out she was seeing me and called and made a threat against my life. I reported this incident to the local sheriff’s department and they investigated. They went to his home, talked to him, he became belligerent and they took him to county hospital and put him under a mental health hold. This is called a 5150: meaning they felt he was a danger to others. In California the person is put on a 72 hour hold for evaluation, and then there is a hearing. The judge asked him if he was a danger to others and he said “no, your honor.” He was released. There have been many recent examples of police being given warnings, they have often investigated and did not detain only to have the individual do very bad things, often killing many people. The two most prominent examples are the Santa Barbara College shootings and the Naval Yard rampage where the individuals were evaluated and released before beginning their killing spree. Several other shooters were even in therapy at the time of their episode. This is a very difficult issue for all concerned. The police need better training in evaluating distressed individuals and then knowing what to do with the individual after evaluation. It is also a delicate problem to approach a friend and ask them if they have thought about seeing a therapist. We all know how well that often turns out.

This raises another issue and that is one of stigma. Mental illness is still one where the individual who has been diagnosed carries with that diagnosis the stigma of being “mentally ill.”
We seldom read a headline, “Former Dental patient goes berserk.” The complexity and stigma of the problem are complicated by the fact that our mental health system is broken and often services are not available or at least are difficult to obtain. It is easier for the wealthy to receive services in confidential surroundings; the poor and impoverished have a much more difficult time finding and receiving care.

The system is underfunded, mental health clinics are over burdened by the chronically mentally ill, and there are not enough qualified individuals to meet the needs of the indigent. I had a client who worked in a county mental health clinic in downtown Los Angeles. His job was to take care of “walk ins” all day long. They were the homeless mentally ill; always in crisis. He had nowhere to refer them. He would talk to them and send them back out onto the streets. The job really got to him: the despair, hopelessness and helplessness of their plight, as well as public indifference.

It would take too long to document the failure and demise of the mental health system in America. Suffice it to say it began under Ronald Reagan in California when he decided to close down the large state run mental hospitals and return the patients to their local areas for care. What happened is that local providers were overwhelmed and there was no corresponding increase in local budgets to provide services. It requires 16 times the funds to treat patients at the local level. It is cheaper and more efficient to warehouse them in large facilities. This is why we have the homeless mentally ill living on our sidewalks. Poverty is one of the largest causes of mental health problems and yet we have a very small budget to serve this population.

Complexity, stigma, lack of awareness, and lack of access to services all present major obstacles to having a society which produces fewer mental health catastrophes. But in terms of awareness, there are things ordinary citizens can do for themselves and for the community.

Generally I look at the problem in three categories: Mood, Thought, and Behavior Disorders. What to be aware of? One of the first indicators is a change in a person’s mood and behavior. If you find yourself depressed, with difficulty sleeping, and having suicidal thoughts along with wanting to withdraw and stay in bed all the time, these are signs of major depression and you ought to consider having a conversation with a mental health professional, or at least your doctor. Another sign of a mood disorder is racing thoughts, restlessness, hyper-vigilance and excess energy. When moods are wildly fluctuating it is categorized as a “Major Disorder; this is often referred to as bi-polar disorder. It is typified by very unstable and erratic behavior: the individual is flooded with energy and typically makes very poor decisions and usually causes family chaos when in a manic episode.

Another Major Disorder is Schizophrenia. When a person’s personality changes and they begin having strange thoughts, hallucinations, and delusions this is a classic sign of a thought disorder and should be given immediate attention, particularly if the thoughts are paranoid and the person feels that others are following or wanting to harm him or her. This condition must be treated with psycho-active medication. It can be treated with good results if the person continues to take their medication. Schizophrenia is one of the more frequent problems of the homeless and it is hard for them to get and remain on their medications. Hence we frequently see bizarre behavior exhibited by people on the sidewalk as we drive or walk by. When I used to see people talking to themselves as I passed by I thought they were probably hallucinating, now I understand they are just talking on their cell phone.

Assessing children and adolescents becomes even more difficult because they are changing so rapidly. If your child or teenager appears preoccupied with violent games and spends all their time playing them and does not want to socialize with others, or is always on their phone, this could be an early sign of difficulty. This is a difficult one because of the proliferation of violent video games. Is this a cause or an effect? Isolation, depressed mood, lack of interest in normal activities, increased angry out bursts, not interacting face to face, and feeling alienated from others are all important signs of possible difficulty and should be assessed. Increased use of drugs and a change of behavior and friends also suggest possible problems.

For younger children it is not hard to know when they are distressed. They let you know immediately. Children become Dysregulated when they experience changes in routine, are tired, hungry, or frustrated. They need attention, structure, and stability as well as security.

Another factor to be aware of is stress and stressors. If someone has been under a lot of stress recently and then there has been a major loss or event: called a precipitating stressor, then particular attention should be paid to the individual for possible erratic behavior. Many crises are precipitated by loss. It is also important to pay attention to suicidal thoughts and even veiled references to life not being worth living. There are usually many warning signs of suicidal behavior before it actually happens. Increased consumption of alcohol and other drugs is also a red flag.

In sum, there are lots of things to be aware of in ourselves and others; it means that we need to pay more attention to what is going on both inside ourselves as well as what is happening in the lives of those closest to us. There are usually signs, we just have to be aware and know what to look for, it is better to be overly cautious and concerned than to let someone or something happen because we didn’t know how to get help or didn’t want to interfere in someone’s privacy. Talking, though difficult, increases the possibility of improving the relationship as well as decreasing the risk of episodes of fractures and failures leading to mental health crises.

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