Mental Health Recovery Newsletter

Contents

Recovery Topics:
Triggers by Mary Ellen Copeland
Crisis as an Opportunity for Growth and Change by Shery Mead
Motivation: The Courage to Live Creatively by Richard Weingarten

Wellness Toolbox:
Changing our Attitudes and Habitual Responses by Mary Ellen Copeland
Sleep by Jill McGann

News from Mary Ellen

New Resources

Introduction

Welcome to Mental Health Recovery Newsletter, begun in March 2000 and published quarterly from the office of Mary Ellen Copeland. This newsletter is for anyone who wants to learn more about recovering from uncomfortable, often disabling psychiatric symptoms. If you would like a copy of previous issues of this newsletter or would like to enter your subscription, please see the paragraph below. Subscription is free to individuals, by email or ground mail. Institutional subscriptions available: 50 copies for $25 plus mailing; 100 copies for $45 plus mailing. Please contact us and let us know whether we can send you the email version to save a tree. You may freely copy and distribute this newsletter, giving credit to Mary Ellen Copeland.

If you would like a copy of previous issues of this newsletter or would like to enter your free subscription, please contact the office of Mary Ellen Copeland by e-mail or click here.

A Special Note From Mary Ellen Copeland

These are hard days in the world. As this newsletter goes to press, there is a war. I pray for your safety and well-being, and for a normal day--something I don't think I appreciated enough in the past. And I pray that our world leaders will use peaceful means like negotiation and diplomacy to resolve the issues that are tearing the world apart.

Recovery Topics

Triggers  
by Mary Ellen Copeland

A Wellness Recovery Action PlanT includes these parts: developing a Wellness Toolbox, a list of simple, safe things you can do to help yourself feel better and to stay well, a

1. daily maintenance plan or list of things you have discovered that you need to do every day to keep yourself well,
   

2. a list of triggers or upsetting things that can happen and make you feel badly along with an action plan of what you can do to help yourself feel better,
   

3. a list of early warning signs like increased anxiety or shortness of breath and an action plan that you can use to relieve those symptoms,
   

4. a list of indicators that you are feeling much worse and an action plan that you can use to help yourself feel better and
   

5. a crisis plan that tells others what you need them to do for you when you cannot take care of yourself.

These days every one of us has been TRIGGERED so I wanted to focus on that part of the plan. When I am working with people on developing their lists of triggers, I encourage them to jot down the things that might happen in any day, like having someone be rude to you, getting a big bill, or the anniversary date of a loss. I discourage catastrophizing--inventing horrific things that have only a remote chance of occurring--explaining that if something really horrific happened, you would have to use your triggers action plan more intensively as well as other Wellness Tools.

Now a truly horrific thing has happened. By the time you read this, more terrible things may have occurred. If you actually experienced some of the terror, like you had to escape from a burning building, saw a terrorist act, or someone you know was hurt or killed, you are probably having symptoms like lots of anxiety, trouble sleeping, excessive crying, irritability, and are easily startled. This is normal. If you take very good care of yourself, follow your daily maintenance plan and your triggers action plan, these symptoms may go away over time. If they persist or are too hard for you to manage, seek help from a mental health counselor.

Others of us whose connection to the tragedy has been through newspaper, radio and television reports, will also be experiencing unusual symptoms like having a hard time focusing, forgetting things, being easily upset and feeling very unsettled. This is the time to get out your wellness toolbox and review it. Remind yourself of those you use often and make a commitment to yourself to use them even more often. Make a list of other wellness tools that you think might help, give them a try and if they help, use them regularly. This means you will have to set aside more time each day to take care of yourself. The benefits of this to both you, your family and other people in your life make it a worthwhile thing to do.

In addition, I recommend that you review your entire plan each day, even though you may think you know it so well you don't need to do that. A quick review might help you notice a symptom or an action you have overlooked that might be very important at this time. You should have received a Special Edition of this newsletter in September (if you didn't, call or e-mail my office for a copy) that has other ideas on how you can help yourself feel better.

Keep in mind that everyone has troubling and uncomfortable feelings during these hard times. They probably won't go away quickly. Accept them, "be with them", do whatever you can to help yourself feel better and patiently give them time to go away.

Words of advice for dealing with hard times:

"Speak your mind to anyone who will listen, stack wood and keep in touch." quote from Martha Bauman

(Authors note: In New England, stacking fire wood is what we do to get exercise, use up excess energy and relieve stress. It may be some other activity where you live.)

Crisis as an Opportunity for Growth and Change
By Shery Mead

Shery Mead is an independent consultant and trainer working with peer support programs towards the development of a strong theoretical, practice and research base reflecting true peer support values. Please visit her website at www. mentalhealthpeers.com.

Note from Mary Ellen Copeland--These are hard times for everyone. The realization that the world and life are totally unpredictable is "right in our face". It can easily cause anyone to have a crisis--a crisis is a time when you can no longer take care of yourself. In crisis, you may feel very disconnected from others, further worsening this difficult time. Shery Mead is studying how crisis can be handled so that, rather than making you feel worse, it can actually help you to learn more about yourself and change patterns that have been troubling to you in the past. I hope you will consider carefully what Shery has to say and that you will find her article as helpful as I have.

The concept of crisis in mental health is an interesting one. In spite of the fact that many traditional theorists have viewed crisis as an opportunity for growth and as an essential experience in the context of one's development (Erikson, 1976), we in mental health want to medicate it, lock it up, and restrain it. We have forgotten that perhaps there is something we can learn from this experience, something that will enable us to "do" it differently and understand ourselves in new ways.

Many of us, at times have felt out of control, that our pain was more than we could manage and even that life was not worth living. It has left us feeling isolated, alone, different and "crazy". It is not something that most of us want to go through again and again. And yet, we have been told and have come to believe that it is something that "happens" to us because of our illness. We are told that we are "decompensating" and that the goal is to return to a "pre-morbid" state. And so we go through life afraid of when it will happen next, believing that we must be careful not to get "stressed", believing that we are fragile and out of control without our medications and our services. Instead of living life we learn to avoid it as if it were dangerous. We have come to believe this because our experiences have been named for us. We are no longer individuals with unique perspectives but rather a set of generic symptoms that need a generic treatment. Though being labeled has been helpful to some, others of us have found it debilitating and limiting.

Peer support can offer a fundamentally different approach to crisis in that there are fewer assumptions about what it is people are experiencing. People may compare stories and strategies and ways of making meaning, but in the end, no one person has the power to name or to treat. Following is a way of thinking about being with people even through very difficult times that honors crisis as an opportunity to learn and grow and, most importantly, stay connected.

• Building Mutual Relationships: It is only in relationships that are constantly negotiated that we build mutual respect and trust. When we consider that both of us have needs and expertise, we learn from each other while taking chances in becoming more vulnerable and consequently more "whole". We take new risks in Being with "big" feelings. We are not a culture that has a lot of tolerance for intensity or "big" feelings. We tend to want to calm people down or make it stop because we are uncomfortable. In peer support we can recognize that people have a lot of big feelings and they aren't all dangerous, they are in fact, rich with information.
  

• Understanding the "story": I've always thought it was interesting that when people were having tough times they were always asked what was wrong with them. What if, for example we asked, "What happened to you?" Could we begin to understand the ways in which people's versions of their own stories impact the way they make meaning of their experiences now?
  

• Sharing ways that "stories" are understood: One of the most valuable aspects of peer support is our ability to share our stories with each other. It's amazing to me what happens the first time we realize that we're not the only person who's been through some of these things. We can hear how each of us has learned to think about ourselves and can share strategies that take our whole story into account.
  

• Challenging the current story. When trusting relationships develop and when both people are in control of the relationship, we can gently begin to challenge the ways each of us have learned to make meaning of our experiences. We can let each other know what works for us and what doesn't. Perhaps we are not "de-compensating". "Maybe we're justifiably angry and we don't know ways to express it. Perhaps we're not in suicidal depression; maybe we just feel tremendous shame and guilt for things we learned to believe were "our fault". When people compare and share, inevitably new stories are created and relationships deepen.
  

• Creating a new, shared story As relationships deepen we tend to take more risks, share our vulnerabilities and try on ways of "seeing" that were not previously available to us. We find ourselves in the process of examining our own beliefs and assumptions and we continuously try these out in relationship. We find that we are growing through the context of relationship. There are no limits to the possibilities because there are no static roles. We have the opportunity to be vulnerable and strong, helper and helped. We find that others are finding hope through our successes and that they are taking new risks.

Peer support is a culture of healing. As people practice new ways of "being" through even the most difficult times, possibilities for breaking old patterns and creating new opportunities are endless. Crisis then just becomes another word for re-defining our experience and ourselves and instead of needing to be locked up we can begin to break free.

Motivation: The Courage to Live Creatively
By Richard Weingarten, M.A., RPRP

Richard Weingarten is the Director of Consumer Initiatives and Education at the Connecticut Mental Health Center in New Haven. He wishes to acknowledge the editorial assistance of Flo Conway and Edward Mattison on this article

In my teens and twenties motivation seemed like my strongest suit. But when I suffered from depression in my thirties and forties, I, oftentimes, had no energy, no will, no hope and no motivation. When I was depression-free, I found that I was motivated and could engage in doing things that motivated me all the more. I could and did schedule in activities that I'd force myself to go to even if I was depressed because I knew I'd feel better getting out of my apartment and being around people. Nevertheless, I had to struggle constantly to pick myself up and get my life going again after a day or two of depression. What follows are the many ways I motivated myself and found motivation when I wasn't totally incapacitated by my illness.

Motivation, for me, was first, wanting to live an exciting and interesting life; second, wanting to be an interesting person; third, being dissatisfied with my situation or myself; fourth, being willing to do the hard work every day to develop discipline and good work habits and last, but not least, having the courage to engage my imagination and live creatively. These were the things that motivated me during the years when I was ill, unemployed or underemployed. I saw each day as an opportunity and challenge to make the best, most interesting day I could for myself.

I've always liked people and helping people except for the early, reclusive years of my illness. Helping someone gave me a good feeling about myself. So taking an elderly neighbor to a medical appointment even when I wasn't feeling that great helped me feel connected to my neighbor and to myself. I was also motivated to take care of my personal needs (food, exercise, adequate rest and sleep, hygiene and grooming) as I had developed these into habits since high school.

In the process of taking care of my basic needs, I made friends with people. At the supermarket where I shopped for example, I made friends with the produce clerk, the girl behind the fish counter and the cashier at the check out counter. So shopping was a pleasant experience for me, and I looked forward to going there. I did the same thing at the health club where I worked out. When depressed I forced myself to go for a workout knowing that I'd feel better afterwards.

I love to write. When I was struggling to get myself going in the mornings, I wrote letters to friends. With each friend, I had a "thing" to write about. With one friend it was the movies, with another it was things of a spiritual nature. I also love knowledge, and I went to lectures whenever I could. Asking a question of the lecturer was also a motivator, giving me a good feeling about myself that often lasted a day or two.

Sundays were my best days. I experienced spiritual uplift at morning church services and with my friends during the Fellowship Hour. After lunch I went to the art museum and went on their "Gallery Walks." A regular group of people went on the "Walks" each Sunday, and we became friends and often had tea or coffee after the tour, with the docent from the museum sometimes joining us.

Before I became ill I was a news reporter for a wire service agency. This experience, and my interest in current affairs, made me a voracious reader of newspapers and magazines. I suppose if I were a cat fancier, I'd read magazines and books about cats. But I read The New York Times cover to cover every Sunday. I'd done this religiously since I was an undergraduate. Sometimes when I read a book review, I'd write down a quote that
appealed to me, or I'd go to the library in search of a book that had gotten a good review. Like an actor or a singer - or a writer -I learned where to find motivation and I went looking for it.

Motivation, then, is definitely not genetic or automatic like many people think. Rather, it is a way of thinking about your personal resources - what inspires you, what you like in yourself and others - and building on those strengths. Motivation comes from reaching out and connecting with people. It means tackling the hard problem of motivating yourself one day at a time. It means learning to initiate things in your life. Like a leaf riding an eddy in a stream, I followed my interests until I was picked up by the mainstream.

The desire to be an interesting person with an exciting life requires steady habits and good discipline. All of this, I know, is part of the secret to being motivated and living creatively.

WELLNESS TOOLBOX

Personal responsibility is key to using any wellness tool. It is up to you to notice how this tool is making you feel, to decide whether or not you want to use it, and how much use of this tool is best for you.

Changing our Attitudes and Habitual Responses
by Mary Ellen Copeland

"The last of the human freedoms -to choose one's attitude in any given set of circumstances." (Victor Frankl: Man's Search for Meaning) I found this quote to be very meaningful to me at this time. While tragedy may take away much of what you have, you are in charge of how you think.

In the past when I started to notice symptoms or early warning signs--things like feeling a bit anxious, forgetting more than usual, having a hard place in my chest or not feeling like getting up, my usual response was to "catastrophize". I would say things to myself, like "Oh no, not again". "You are going to get so depressed you won't be able to go to the wedding". "You'll never get that job now". "This is just going to get worse and worse and worse". "This is all my fault because I ate junk food all day yesterday". "Everyone will think I am a failure and desert me".

Now I have realized that this response--my attitude--rapidly worsens my symptoms and perhaps even causes my worries to become reality. Through practice, I have learned to respond in a different way. First, when I notice symptoms, I do just that. Notice them. No catastrophizing. Next, I check out my Early Warning Signs action plan in my WRAP and do the things on it. In addition, if I have time, I check my list of Wellness Tools to see if there is anything else I can do to help myself. Things like work on my quilt, go birding or chat with a friend. Then I stay with the symptoms for as long as I have them without being anxious for them to go away--just being patient and giving myself a chance to heal. I know that it is OK to be uncomfortable for a while. It's no big deal. And that's it. It really works.

Sleep
by Jill McGann

(Description of how Jill learned to sleep on her own after fourteen years on sleeping medication)

Two years ago I ran out of medication options for management of mania and depression. I decided to take full responsibility for my health. My psychiatrist was wonderfully supportive but now I was on my own searching for anything and everything that might provide the right management tools for me to achieve wellness. I took daily inventory of my emotional, physical, intellectual, and spiritual state. I began to make progress using the very management tools you describe in your books.

As I slowly gained control of my waking hours I was inspired to reclaim my sleeping hours as well. My sleep was not refreshing because I was so drugged. I wanted to be free to sleep like the rest of the world.

By this time I was really working on balance through exercise, yoga, and stress management techniques.

I started by reducing my medication by very small increments over the course of eight months. If I ever went without good sleep for three days I would go back up to the previous dose and try again to reduce the dose after I was well rested. Since I was taking so much medicine this was indeed a slow process. As I reduced my medicine to minimal amounts I really hit a wall. I pushed through this with pure determination. I was "soloing" but it was not a pretty sight. I just couldn't get the signal to my brain to gracefully "turn off".

I consulted with a psychiatrist that takes a more natural approach to mental wellness and he started working with my specific chemistry issues. I changed my diet and the supplements I was taking. By increasing my seratonin levels in the evening I can now get to sleep most nights. Sure, I have the normal sleepless nights that other people experience but most nights I am in bed and asleep by nine and wake up refreshed at five. Voila!! This has been a great lesson for me to learn. Just because things have been a certain way for a long time doesn't mean that things can't change. Change is always possible. It just may take some time.

Help Wanted

Are you gainfully employed? Too many mental health consumers are told they'll never work again. Let's challenge this disheartening stereotype. I am putting together a book of "Consumer Voices in the Workplace." I wouldlike to hear from other consumers who have managed to maintain their careers while coping with psychiatric symptoms. Please e-mail me, Ellen Alderton, at
elalists@hotmail.com or call me at (703)548-1968. Thank you!

A note of apology

A person e-mailed me and said that he found my title Keeping Well When the World has Gone Crazy in the special edition of the newsletter to be stigmatizing. I was so overwrought about the world situation when I wrote that article (and continue to be) that the word crazy seem to really fit. But if even one person finds it to be stigmatizing, I will not use that word again in any context. My apologies to anyone who was offended by it.

Quotes in the New Zealand native Maori language

Carolyn Doughty from Christchurch, New Zealand came to Vermont in September to attend the Mental Health Recovery Training for facilitators. She said in the native Maori language "Tangata Whaiora" means a person seeking wellness.

And from another New Zealander, Gwen Fuergeson from Auckland,
Akakoa he uaua , kia kaha, kia toa, kia manawanui
Although there may be difficulties, be strong, be brave, be patient and take heart.

NEWS from MARY ELLEN

Upcoming Presentations

• October 22-26 Birmingham, England Mental Health Recovery Facilitator's Training
  

• October 30, and 31 Limerick, Ireland--Mental Health Recovery Seminars
  

• Nov. 16 Phoenix, Arizona--Mental Health Recovery Conference
  

• Nov. 22 Wanganui, New Zealand--Good Health Wanganui Conference,
  

• Nov. 26-Dec. 6 Auckland, New Zealand--Te Korowai Aroha Mental Health Recovery Facilitator's Training
  

For information on attending any of these seminars, contact the office of Mary Ellen Copeland

Educational Opportunities

Mental Health Recovery Correspondence Course

The four-part Mental Health Recovery Correspondence Course is a great way to learn mental health recovery and how to develop a Wellness Recovery Action PlanT for yourself and/or to share with others. It meets the prerequisites for attending Mental Health Recovery Seminar II: Facilitator Training. If you want to attend the Facilitator Training in the spring, this is a good time to begin the Correspondence Course.

The course includes reading and written assignments, projects, activities and phone discussion with the instructor. The three texts for the course are: The Depression Workbook, Living Without Depression and Manic Depression, and Wellness Recovery Action PlanT. The cost is $200 per participant, plus the cost of any texts you need to purchase.

Mental Health Recovery Seminar II: Facilitator Training
May , 6-10 2002 in Brattleboro, VT

It's time now to begin making your plans to attend the 2002 Spring facilitator training. Over 250 people have attended these training in the last several years. The training has given them the skills and strategies they need to teach mental health recovery skills and strategies including Wellness Recovery Action Planning to individuals and groups.

Anyone who has met the requirements for the training is welcome. You can meet the prerequisite for this training if you have taken a basic Mental Health Recovery including WRAP training or have completed the Correspondence Course described above. Contact Mary Ellen's office to see if you qualify or have questions about your qualifications.

The cost of this seminar is $900, including the new Facilitator Training Manual. Add your travel and personal expenses.

Mental Health Recovery Seminar III Refresher Course for Facilitators
April 2-4 2002

Anyone who has completed Mental Health Recovery Seminar II is encouraged to come to Brattleboro for an intense three days of problem-solving and strategizing to 1. increase your knowledge and skills, and 2. to plan strategies for educational opportunities and career building. Topics to be addressed include quality assurance, responding to disasters, working with people with special needs, advanced directives and post-crisis planning, networking and program administration.

The cost of this training is $450.

New Resources

Spanish WRAP

The very popular Wellness Recovery Action PlanT (Copeland, M. Brattleboro, VT: Peach Press 2000)--"the little red book"--has been translated into Spanish.

Creating Wellness Video

The first part of the two part Mental Health Recovery Video series is now available. This first covers the following topics: Hope, Personal Responsibility, Education, Self Advocacy, Support, Getting Good Medical Care, and Medication Management. This video is designed to be used by individuals and groups and is accompanied by a guide. The second video (not yet available) will take you step-by-step through the process of developing a wellness toolbox and your own Wellness Recovery Action PlanT. Announcement of the availability of this video will be made through this newsletter.

WRAP on CD-ROM

In response to repeated requests, two versions of WRAP--one for adults and one for adolescents--will soon be available on CD-ROM (both versions will be on one disk so the user can choose the one they want to use). This means that you can copy the WRAP format from the disk onto your computer and use it to develop your own WRAP or to help someone else develop their WRAP. I have my WRAP on my computer. It makes the plan easy for me to use and revise on a regular basis.

Recovery Brochure

The booklet, Recovering Your Mental Health: A Self-Help Guide, is available free from the Center for Mental Health Services. I developed this booklet with the assistance of a focus group of ten people from around the country--people who are working on their own recovery. You can get free copies from the Knowledge Exchange Network (KEN) by calling 1-800-789-2647 or through www.mentalhealth.org. Refer to booklet SMA# 3504.

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