What would people like to talk about?

[Mark]

All,

It's been suggested to me that the community would benefit from my greater presence, and not just as the behind the scenes plumber helping to keep the pipes flowing. Time is a very fleeting resource at the moment, but I will see what can be done to make this happen.

A few topics were suggested for threads I might moderate, but I'm concerned that if we limit this to one or two threads, that some issues will get lost. I supposed if we leave it undefined, the opposite problem will occur where things are too scattered. We'll try to find a middle ground.

So - what would people like to talk about?

Mark

[Bluerose]

On the whole, I think we members manage to support each other quite well. Where I have a slight ‘problem’ is with the lack of professional help and advice. I became curious recently about another aspect of DID and no one was around to answer my query. I appreciate you ‘experts’ are very busy but a little professional impute might help. I’m just saying.

[Symora]

Well, since you're asking , I'd like to know how familiar doctors are with the links between hormones and mental illness. I've seen psychologists, doctors, phychiatists, therapists, and frankly hormones has never really come up. But as I look back at my life I can clearly see how tied my bipolar cycling has been to my mentrual cycles. I remember mentionning it in passing, I now know I should have pressed more :-( I'm wondering how come it was not given more weight in screening...?

[David O]

Good morning Mark,

I get the sense, and I could be wrong, that you're asking what we would like to discuss in terms of broader topics, such as the recent thread materials surrounding Susan Clancy, taboo subjects on the forum (and there are a few) that would require a special section like the SPS one, etc.

I also would like to resurrect an older topic, one where there was a suggestion that we revamp and add to the forum. There were several good ideas mentioned then, these were mine at the time:

• Create an Urgent Care or Urgent Help forum for those who are in need of rapid response or just to have someone to talk to quickly. 2-3 members could make it point to be responsible for making sure they checked on this forum every 6-10 hours. I would volunteer to be one of them. This forum would be like triage and from here, members could be slowly moved to look at specific forums addressing their concerns.
  
• Add a career advice forum for those who made need assistance with interviewing, career decisions, resume writing, etc. this would be especially helpful for those who have been hospitalized or have a severe mental illness and are just returning or trying to enter the workforce.
  
• Change Addictions section into a Recovery Forum
  
• Have a books and articles section where members could recommend practical, user friendly self help books and readings (such as articles on the net or a magazine) for other members.
  
• Have a Sanctuary and Spirituality Forum for members of any faith to offer compassion, support and wisdom to each other. This could take the form of prayers, meditation, Yoga and other expressions of a spiritual nature. This forum is not intended for debate and is not centered on religious talk.
  
• Have a forum on: Living with a family member with mental illness
  
• Create local forums so that members could become aware of services in their area. This would take some time to complete, but as one member refers to services in a local area, the member could also post the website and name of agencies who can help in various cities. For example, the name and number of the local Community Mental Health Center and hospitals who provide psychiatric services.
  

Is this correct or am I just adding too much to your idea?

David

[IrmaJean]

David, I love these ideas! I think the urgent care place could have been very helpful yesterday...

I know it's not necessarily the purpose of the site, but I would love a place to discuss psychological theories or methods of therapy. I have many amateur thoughts on this.

[Bluerose]

I like the idea of a form titled with something covering those topic that might trigger someone. It could be mark with a warning that it might trigger. This would give others the chance to deal with those type of subject and allow those who don’t want to be involved to simply give that forum a miss.

[musemuse]

Have a Sanctuary and Spirituality Forum for members of any faith to offer compassion, support and wisdom to each other. This could take the form of prayers, meditation, Yoga and other expressions of a spiritual nature. This forum is not intended for debate and is not centered on religious talk.

That would be very good for me. I am a believer and don't have anyone to talk to about the problems that I go through, while waiting for some sort of resolution. ie with scriptures and testimonies. /http://msmusedwr.wordpress.com/

sometimes I really need help and maybe it's an emotional help and maybe something like a forum of that nature would help, if I felt safe/free to talk.

Thanks,

[Mark]

Well, actually, I was not thinking about how to best expand the current forum configuration, but these are all good ideas, which we can easily implement. My one concern is that if we scatter discussion too much across different forums, the place becomes harder to manage from the perspective of a person trying to figure out where to post. Maybe not a realistic concern, but on my mind at least. How about I put David's suggestions into practice shortly and we see how it goes?

What I did have in mind was something more along the lines of questions I could help answer on specific topics. I will come at this (necessarily) from a more intellectual perspective than some here, but I will do what I can to provide relevant responses nevertheless. And David and Allan and other professional types who are here can chime in if they have information to add, as can anyone else who has something to add.

For instance, the question of mood disorder episode relationships with hormonal changes. Professionals are very much aware of this relationship but in a sort of general way. They know it is an influence (particularly between menstrual related hormonal changes and mood) but I believe this is primarily limited to straight up depression sorts of moods, and less so to manic stuff in most professionals minds. There is a condition described in DSM (whether actual or proposed I don't recall at the moment) which has to do with depressive symptoms and irritability secondary to menstruation - late luteal phase dysphoric disorder is the name that is coming to mind. Though many women get crabby at their time of the month (I think that is safe to say), most all of those women do not have this thing - it is reserved for those women who have the most significant problems that go far and above what most women experience.

There is also a large body of research that has looked at thyroid and mood/depression. Not super familar with it myself, but it's well known.

Psych medications are mostly defined in terms of their ability to affect how neurotransmiters in the brain are altered in functioning as a result of taking the medications. However, neurotransmitters are just chemical messangers in the nervous system. Hormones serve a similar function but they carry messages across the entire body. I would be surprised to learn that they did not play an important role in driving mood and other disorders, but I'm not specifically up on what is known in this arena. Wish we had a friendly psychiatrist or neurologist who might know more.

Regarding Bluerose's suggestion that we provide professional help and advice, mostly this place is *intended* to be a peer support community only. We are not simply not staffed or set up to provide professional consultation or to provide help and advice. I don't think it is a good idea that any *therapy* type activity happen here, for a lot of reasons, practical and legal both. That said, I'm happy to be a resource in ways that will work well, and that should be useful I hope. This is not a lack of compassion; but rather a practical limit to what can be accomplished here.

Mark

[Symora]

Thanks for your answer Mark. I'm going to look up late luteal phase dysphoric disorder since I know nothing about it. I definitively went way beyond the normal depression cranky PMS symptems - when I look back I can see that I was totally off my rocker, delusional I would say in the emotional department... I think it actually prevented me from forming a stable personality it was so disruptive and chaotic. I'm just about menopausal and am still suffering from hormonal imballances but now they do tend to be more in the depression spectrum. I can't wait to see how I will be when all the hormones stabilize... only another 5-10 years to go

Anyway, thanks for the info and I'll continue my own research.

[Bluerose]

What I did have in mind was something more along the lines of questions I could help answer on specific topics.

I for one would welcome this.

[finding my way]

I would like to understand dissociation better. A careful discussion of what it is and what a person can do about it would be helpful, I think. Thanks.

[goose]

I would like to understand the topic of Secondary Depression more. In my case I think it is secondary to anxiety (I have avpd). I have also had pnd on 2 occasions. Am I to understand that if you get the primary condition under control that Secondary Depression is unlikely to occur? So I am looking at not being on longterm medication?

Goose

[Guest ASchwartz]

Hi Goose and all,

Forget about "secondary depression." It does not exist and the term means nothing. Depression is depression. Yes, it often happens that people have more than one symptom. It is common for people to experience both depression and anxiety. Trying to figure out which came first is the same as the old chicken and egg problem. In terms of psychotherapy, they both get treated. In terms of medications, anti depressants often help both sets of symptoms.

Goose, I really think its a good idea to tell your therapist that you are seriously wanting to end psychotherapy.

Allan

[goose]

Thank you Allan.

I just have a need to understand it all. I believe that the more I understand what is going on the better I will be able to manage. I am like this in all areas of my life.

It is not enough for someone to give me medication without knowing why or how long it has to be taken - I am not adverse to the fact of taking medication longterm if it is necessary.

You know it is difficult when your Psychiatrist tells you that you have resistant depression (and medicates you accordingly) and your Psycholgist tell you you have secondary depression and may not need the medication. I know Doctors differ, but where does that leave the patient?

Goose

[David O]

Goose and Allan,

Actually, there is a "secondary Depression" and it is often associated with milder symptom patterns connected to a primary illness, anxiety, an addiction, hypothyroidism, schizophrenia, etc. Secondary Depression doesn't always respond to anti-depressants.

Primary Depression arises by itself, whereas secondary Depression develops as a result of another mental or physical disease. It's important to differentially diagnose between primary and secondary mood disorders as the treatment plan is likely to be very different. In primary mood disorders, the mood disorder is treated directly, but in secondary mood disorders, underlying condition should be treated first as it is likely the mood disorder will subside as a result. In your case Goose, it is possible that successful treatment of your anxiety may result in your Depression also subsiding.

There has been discussion in the DSM V (Diagnostic and Statistical Manual of Mental Disorders, 5th edition-- comes out in 2113) committee to look at isolating primary from secondary Depression since they have different etiologies.

David

[Mark]

All,

I've created a few new forums and have moved around a few other forums so as to implement some of David O's suggestions earlier in this thread.

I've moved "Cognitive Reframing Help" under "Special Topics"

I've repurposed the old (and underutilized) "Children's Mental Illness" as "Living with People Diagnosed with a Mental Illness" and have placed it under "Special Topics"

I've created a new "Sanctuary and Spirituality" forum and placed it under "Special Topics"

I've created a "Recommended" forum under "About the Community"

I've created an "Urgent Need" forum under "About the Community"

I personally don't like the idea of renaming "Addictions and Impulse Problems" to "Recovery". I know that term is commonly used in the addictions community, but really, it is a general term for what everyone here is trying to do - get a handle on issues they are dealing with. So I see the process of recovery rather broadly and don't want to limit it to addictions. Also, "recovery" tends to evoke AA/12Steps more than other forms of addiction treatments, and I have evolved a complex understanding of AA/12Step at this point - I'm fine to promote it but also want to promote other ways of going about dealing with addictions equally as much and so do not want to use a term more associated with AA/12Steps than other approaches.

Mark

[Bluerose]

I would like to understand dissociation better. A careful discussion of what it is and what a person can do about it would be helpful, I think. Thanks.

I wouldn't mind helping with that.

I've come through the worst of it and would be very happy to answer any questions on it So long as others keep an open mind about how weird or crazy some of the aspects of it may sound.

I put in a request for my med notes and expect to have them soon. I'm sure this will provide me with more information that I can share.

[goose]

David

I really appreciate your post. That seems to be the angle my Psychologist is coming from too.

Goose

[Mark]

All,

My plan is to post on the topic of Dissociation here shortly. Full day today and cannot do it right now, but don't want people to think I've forgotten the request.

Mark

[Luna-]

I feel a bit timid replying to this, since I'm so new here, but if I may say...

I used to belong to depressionforums.com (and long ago, Walkers) and am still a member of Pendulum (a whole forum for bipolar) and I was disappointed not to find a room specifically for Medication when I joined. I gather this fits under Psychotherapy and other Treatments. I understand this site comes from the psychologist's perspective but medication becomes an integral part of our overall Rx and it would be great to have an area where people could ask about others' experiences, how to deal with side-effects, ask for and get explanations about meds, encouragement to stick with Rx (for those of us who need to), questions about specific meds etc.

At first I thought that "Psychotherapy and other Treatments" meant psychotherapy and other psychological, self-help type Rx's. Things we can do and influence, apart from swallowing the pills. I thought there was no discussion area for meds. But then I found meds under the above heading. I'm still a bit disappointed that there isn't more meds discussion here, but this is probably not the intent of this forum.

Perhaps it seems more important to me than to others because meds are such a significant part of my bipolar Rx and I will live on them for the rest of my life. And not everyone does, and for many drugs are not the answer.

So it would depend on the focus you intend the forum to have.

Just coming from my perspective...

[Mark]

to address Luna's suggestion, we don't have a medications forum because ... no good reason . Actually, the thinking was probably something more like no one here at a professional level is qualified to dispense medication information (as none of us are psychiatrists), and all of us here are psychotherapists in one form or another. So we are focusing on what we know about and can make a contribution with. It would be an appropriate forum to have for peer to peer discussions along the lines of "does anyone here want to talk about their XXXXX experience" - where XXXXX is some medication they've been on. If that would be of use, let me know and we'll create that forum. But it would be strictly for peer to peer discussion, however.

I would like to understand dissociation better. A careful discussion of what it is and what a person can do about it would be helpful, I think.

So - I want to address the question about dissociation that Finding raised. This is a very complicated topic, so I'll just get us started and people should feel free to chime in with their additional questions and experiences.

First let me say that I'm not a dissociation expert. It was of great interest to me when I worked as a professor/researcher years ago but I've not kept current on the latest research. So what I have to say may be somewhat out of date. So, take what I say here with a grain of salt.

There are probably a few definitions of dissociation. broadly, it has to do with the separation of one thing from another when normally those things would not be separated. There are several senses in which the word is used. The way I think about it most often, it involves an interruption in the continuity of consciousness. A blank spot is created, like an alcoholic blackout - a bit of amnesia. However, the term is also used to describe what happens when you are supposed to feel a certain way but you don't feel anything - instead you just feel numb. That's what the experience is like in the broadest sense, and those of you who dissociate know this far better than myself.

From the perspective of a psychologist or researcher type, we think about dissociation often from a functional cognitive perspective, meaning, what is happening in terms of attention and memory and emotion when dissociation takes place. And what happens is something along the lines of a compartmentalization of memories or experience such that what should be accessible is not. Like you filed away some memories and now you can't find them again. Or you filed away some feelings and now you can't fine them again.

There is a wide range of ways that the process operates. It is a normal process actually - most people dissociate to one degree or another. Just not as severely as the people who go on to have dissociative disorders. When the process is in the normal range we call it daydreaming or spacing out. and people vary in terms of how characteristic this is of their experience.

When someone is "spaced out", they get focused onto something. Like a thought or idea or fantasy, and while they are attending to that thing, they lose touch with the world around them. It's not that they cannot go back to that world, but more like they temporarily forgot it was there. And while they are not attending to that word, it is like it's not there for them. They don't have access to it until they come out of their "trance".

I use that term trance here intentionally because many people who study this stuff consider dissociation and hypnosis to be functionally the same thing. Only sometimes people hypnotize themselves or fall into self-generated trances (which we call spacing out), and other times people guide them into trances intentionally.

When someone is dissociated in this fashion, their attention is fixed on some things and other things that would normally be attended to are inaccessible, at least temporarily. So there is a sense where there is a kind of compartmentalization that occurs, but it may be very much a temporary thing.

People are probably familiar with the various dissociative disorders, but to briefly restate them, they include depersonalization/derealization amnesia, fugue and DID or dissociative identity disorder. DID is the most famous, and also (along with Fugue) on the more rare side. Not uncommon really, but stuff like depersonalization is far more common.

Depersonalization is dissociation in the sense of emotional detachment. When you are depersonalized/derealized, you feel like reality, or your identity has become deeply weird and unrecognizable. You don't feel like yourself, or it seems that the world has become unrecognizable. In a similar vein are the states that some people who cut themselves get into where they feel totally numb and detached from emotion to the point where they get frightened because it is so weird, and thus get motivated to cut themselves so as to have a vivid experience that helps pull them back into reality (so to speak). These are temporary states mostly.

In contrast, fugue and DID are dissociation as a lifestyle. In fugue you have a person who develops amnesia (memory loss) and then travels to a new physical place and settles down to have a new life for a time. the old identity is dissociated (not accessible), and in its place, develops something new.

In DID you have dissociation happening from an early point in life, where key experiences and memories become cut off from one another such that there is no smooth and continuous experience of consciousness. Like moving from one daydream to another without the experience of there being a single observer to observe all the daydreams. If this happens when you are young enough (and nobody really knows why it happens - we used to think it was a traumatic reaction to abuse, but now we know that while that can be the case, there are also DID cases that happen without abuse), if it happens when you are young enough, then in the spaces between the discontinuous sections of experience you have distinct identities that grow up. Normally, these would be distinctively toned aspects of one continuous identity, but in DID each part does not recognize the others as "self" and so grow up under the illusion that they are actually distinctive. And they are distinctive in as much as their own experience suggests. it's just that under that surface of consciousness, there is a single continuous (but dissociated) being of which all the parts are facets of experience.

Hopefully that is enough to get us started. Sorry if it is disjointed. I'm not composing this, but rather just writing off the cuff. I suppose if it is disjointed, that would fit the theme however. Does this help answer the question of what dissociation is? Are there follow on questions that will help to clarify what people want to learn? Please ask and help shape what we talk about.

Mark

[Luna-]

... we are focusing on what we know about and can make a contribution with. It would be an appropriate forum to have for peer to peer discussions along the lines of "does anyone here want to talk about their XXXXX experience" - where XXXXX is some medication they've been on. If that would be of use, let me know and we'll create that forum. But it would be strictly for peer to peer discussion, however.

Thank you Mark.

I had peer-to-peer discussion in mind, absolutely. If you ever decide to create this, could that be emphasised in a sticky thread (?) as well as the fact that 'no size fits all' so no drug is better than any other.

Where I've found this especially useful is when I've experienced a side-effect that the doctor says is not related to the med. Then I've asked if others have it and some have! Because so many of our pdocs haven't been on our meds, they often don't know of the rarer, often disconcerting SEs, and I've found it very reassuring to know something is just an SE and not me imagining things.

But while I'm the only one suggesting it, I'll just continue to put meds in Psychotherapy and other Rx's, no problem

Thanks for your reply.

[finding my way]

Thank you, Mark. The term covers a range of conditions, and I think many here can relate to some aspect of it. Are there things a person can do when they know they are struggling with dissociation?

[mscat]

I've suffered from Depersonalization ..... And it sucks. I become use to the not feeling of anything, and the floating out of myself. Especailly when nothing is real , or me , the numbness caan be so pitiful I self harm to feel real again. To feel something , is better then nothing at all. It gets so bad I see myself in parts , n othing is connected . Body parts are separated and unattached , this may be something else that is not depersonalization anymore, because I can't see or feel my limbs or body attatched anymore, or even recognize my own voice at times .

that is what I end up struggling with , and I sometimes think that drugs would have the same effect ... However , I do not do drugs..

What helps me if it is not too paralizing , because sometimes it is, as if I am dreaming and can't wake up...

I try to get up and do something... Dishes , pet my dogs, or anything to get myself busy , because the loss of oneself is and can be frightning. With me it happens so much that I am use to it .. I just try not to allow myself to become so disconnected , that "I am disconnected" I hear the little nursery rhyme play, "humpty dumpty " over and over again. because this is what it is like for me. Totally broken and into pieces , and nobody can put me back together again, not even myself.

This is as bad as it becomes, and this is what can or may trigger me into a major self harming incident. Pain , at least is something felt , and it is a wake up call to me , internally that I am still alive . THe problem is though, is that if I do this in that state of mind, I always go too far with the self harming . Way too far without knowing myself what and why I hurt myself as badly as I had....

It can be a vicioius circle that I must be extremely careful with.

[Mark]

I was away from the boards for a few weeks (birth of a baby boy!!) but I'm more or less back now, and can continue this discussion if people want to.