Beyond
Struggle:
Flourishing
with Mental
Illness
W. Rand Walker, Ph.D.
History of Psychiatric and
Psychological Treatments
– From “clinical lore” and experimentation to a science of helping
– DSM
– Over time, we have been successful in helping people be less miserable
– We have found very effective treatments for . . .
– But, not incredibly successful in helping people be happy
Health: "A state of complete physical, mental and
social well-being and not merely the absence of
disease or infirmity “ . . .World Health
Organization
The Problem of Pain
Prevalence of mental health and
mental illness
Condition
Prevalence (%)
Mental Illness and Languishing
7
Mental Illness and Moderately Mentally Healthy
15
Mental Illness and Flourishing
1
Languishing (and no mental illness)
10
Moderate Mental Health (and no mental illness)
51
Complete Mental Health (Flourishing, no mental illness) 17
People With Mental Illness
– More likely to be unemployed
– Have less income
– Experience a diminished sense of self
– Have few social supports
– Deal with the stigma of MI (being labeled and labeling self)
– Becoming the mental illness (“I am”)
Successful Treatments
Recovery
– Clinical
– Symptomatology, social functioning, relapse prevention and risk management
– Personal
– “The establishment of a fulfilling, meaningful life and a positive sense of identity
founded on hopefulness and self determination “ (Andresen R, et al., 2003).
– Personal recovery tends to be unique to the person
– Living day-to-day without a false sense of security or sense of inviolability
– Living with the illness in the background (sometimes looming)
Successful Recovery
– Usually includes a team of people who care about the person suffering (thus the
focus is on the person not the disease or disorder)
– Family
– Treatment team
– Organizations and community
– Knowledge
– Commitment
– Includes a strong connection to the goal of living a full life
SAMSHA’s Model of Recovery
Substance Abuse and Mental Health Services Administration
Optimism?
– Is learned (not genetic)
– The calling card of a pessimist is that they are a “realist”
– Optimism isn’t thinking that only good things happen. We can expect good
things to happen and if they don’t, eventually good things come from whatever
happens
– What are you predicting?
Stress and stress diasthesis
– Resources versus demands
– Cumulative
– Three days
Trauma
Schizophrenia
– Psychoeducation (Vital importance of medications)
– Detailed analysis of previous episodes
– Triggers and early warning signs
– Recognizing prodromal relapse phenomena (insight)
– Including family, caseworkers, physicians, and partners
– State dependent compliance or non-compliance (primarily with medications)
– Booster sessions if not in regular counseling or psychotherapy
– Ongoing conversations about real versus psychotic experiences
The Role of Observers
– Establishing a relationship with trust and influence
– Agree (in a good frame of mind) that observations can be shared and how
– Agree on what are signs or symptoms that signify the person might be at risk
– Put it on paper if you can
Examples For Schizophrenia
– Mood changes
– Irritability
– Dressing in unusual or unkempt
clothing
– Becoming tense or agitated
– Sleep changes
– Concentration problems
– Appetite changes
– Saying or doing irrational or
inappropriate things
– Suspicion and hostility
– Ideas that people find unusual or
hard to understand
– Sensitivity to the environment (light,
sound, etc)
– Bizarre behavior
– Hearing or seeing things that other
people cannot see or hear
– Neglecting medication
– Saying things that don’t make sense
Bipolar Disorder
– Psychoeducation
– Detailed analysis of previous episodes
– Triggers and early warning signs
– Recognizing and coping (strategies) with mood changes (insight)
– Including family, caseworkers, physicians, and partners
– State dependent compliance or non-compliance (primarily with medications)
– Booster sessions if not in regular counseling or psychotherapy
– Develop separate approaches for depression, mania, and mixed episodes
Depression
– Psychoeducation
–
Thorough understanding of cognitive versus vegetative symptoms
–
Role of “depressogenic” behaviors and thoughts
–
Depressing versus depression
– Medications?
– Pay attention to possible seasonal factors (Fall and transition to spring)
– Recognizing and coping (strategies) with mood changes (insight)
– Don’t become depression (e.g. the flu)
– Booster sessions if not in regular counseling or psychotherapy
– Stress management
Anxiety Disorders
– Psychoeducation
– Understanding how the brain is involved in anxiety
– Cues
– Thoughts, images, and impulses
– Anxiety (or dysphoria of some sort)
– Pursuit of the finished feeling
– Acceptance of remote possibility, mindfulness, and emotional regulation
– ACT, exposure plus response prevention, and CBT.
– Medications?
Addiction
– Education
– One day at a time
– Peer support
– Inpatient, outpatient, or maintenance?
– Detoxification if needed
– Medications?
DrugAbuse.com
Ultimate Goal?
– To get to the point where the volume of your life is much louder than the
volume of your pain
– To live fully with mental illness in the background
Positive Psychology
1. The Pleasant Life, which consists in having as much positive emotion as possible and learning
the skills to prolong and intensify pleasures
2. The Engaged Life, which consists in knowing your character (highest) strengths and recrafting
your work, love, friendship, play and parenting to use them as much as possible
3. The Meaningful Life, which consists in using your character strengths to belong to and serve
something that you believe is larger than just your self
4. The Achieving Life, which is a life dedicated to achieving for the sake of achievement.
PERMA
Happiness
Struggle
Escape Route Thinking: The 8
P’s
– Permanence
– Pervasiveness
– Personalizing
– Projecting blame
– Persecution-victim stance
– Procrastination
– Perfectionism
– Prediction
The Top 10 Best Ways To Be
Miserable
1.
Think negatively. Be sure you accurately predict as many bad things as you can
2.
Isolate yourself from family and friends
3.
Commit to the things that make you feel bad.
4.
Find a way to make the same mistakes over and over again
5.
Be sedentary. Watch lots of television. Curl up in a ball until you feel better. Be passive if possible.
6.
Look for ways to make things more complicated
7.
Always look for ways to avoid or escape discomfort.
8.
Keep your focus on what you don’t want to happen
9.
Do just what comes easily. Play it safe. Don’t take any chances. Live life in a way that nothing bad it possible.
No exploration. Definitely wait until you are ready.
10.
Constantly seek out ways to feel differently than the way you are feeling (especially look for rescuers)