Thursday, May 30, 2013

It's Not Only in My Head: Physical Health Implications of Mental Illness

It's Not Only in My Head: Physical Health Implications of Mental Illness
By Carl Blumenthal
Where I have been and where I am today
In mid-2006, I fell off a manic cliff into a deep depression—the worst of my life. Through 2010, I couldn't work, socialize (including barely talking to my wife and other family members), pursue any hobbies, any creative or spiritual practice, and my activities of daily living (ADL's) became minimal. My physical health declined too.
Plus, two psychiatric hospitalizations left me over-medicated. I was no longer suicidal. I could sleep. But, my hands shook so badly, I couldn't write nor feed myself without using a big soup spoon. My concentration and memory were poor.
The list of other physical conditions/symptoms included anorexia (105 lbs. for a 5' 7" frame); psoriasis, acne, rashes, skin cancer (2nd stage); tooth decay and broken teeth; elevated cholesterol and blood pressure, chest pains (including what seemed like two mini-heart attacks); hemorrhoids, constipation, diarrhea, bloody stools, gastritis; urinary retention (from an enlarged prostate); deteriorating vision and "floaters" (spots); a disabling ankle/foot injury, arthritis of the knees, and lower back pain.
Granted, I was in my late 50's at the time. But I had always been physically fit, eaten well, taken all my meds (including dietary supplements) and seen my doctors regularly. During the depression, I stayed indoors (even when the weather was nice), took only psych meds, and avoided treatment for my physical ills. I struggled to eat; comfort food was all I could tolerate.
Between 2011 and 2012, my physical health improved as did my mental health, and vice versa. In other words, I'm here to testify: "The mind and the body are connected!"
Unfortunately, this is a lesson the psychiatric and medical professions are still learning. When psychiatrists notice that major, especially chronic depression often "presents with somatic (bodily) features," it doesn't mean the sufferer is just a hypochondriac. I became over-dependent on an air brace for my injured ankle/foot. Otherwise, I "denied" the existence of my other physical symptoms because knowing my body was "falling apart" deepened my depression. Such neglect creates a vicious cycle which most medical doctors don't understand either.
There's a lot of talk about "mental and physical wellness" these days. The new Medicaid Health Homes program is predicated on integrated case management. Peers are even being trained, and in some cases, hired as "wellness coaches" to "encourage" holistic healthy behavior in others with mental illness. But, until clinicians "get the connection" in medical school, consumers face an uphill battle. That's why the personal case for mind-body interactions is so political. We must advocate for changes in medical education while taking responsibility for our own wellness.
So how am I doing with my case?
I've gained 30 pounds because my appetite returned and I now enjoy cooking healthy food for myself (and my wife). My skin has cleared up. I shower more regularly and had a dermatologist remove the cancer. A dentist fixed my teeth with root canals and crowns; I floss and brush more often. I'm back on meds which have reduced the cholesterol and blood pressure to safe levels. Diagnostic tests by my cardiologist showed my heart is still in good condition. And I walk vigorously for half an hour most days.
An endoscopy and two colonoscopies have removed potentially cancerous polyps from my stomach and colon, respectively. The endoscopy also identified the cause of my gastritis as a common bacterium, successfully treated with antibiotics. I now take meds which have improved urination and a sonogram of my kidneys revealed cysts that need monitoring. I got new prescription glasses, reducing eye strain, and the floaters proved to be benign (no retinal detachment). As for the aches in my bones, exercise and better sleeping posture have minimized them.
I take fewer and smaller doses of psych medicine--a combination of two mood stabilizers, an anti-depressant, and synthetic thyroxin for an under-active thyroid, a contributor to depression. Ironically, 25 years of taking lithium caused this hypo-thyroid condition, damaged my kidney function, and gave me a permanent case of the shakes. (Thanks to a vigilant psychiatrist, I stopped using lithium 10 years ago, before it could do further harm.) Even with reduced medication, my hands still tremble, but I only need a teaspoon to eat. My concentration is tip-top. However, when you get to be 61, memory could always be better.
This physical re-birth was possible because my wife's private health insurance covered me. Even so, for a long time I failed to take advantage of it because I didn't think life was worth living (well). If the problem didn't hurt or bleed too much, I ignored it. However, the better I felt emotionally, the more initiative I took looking after my physical health. At first, I would schedule doctors' appointments and cancel them at the last moment, or not follow through on recommended treatments. Next, I showed up regularly and did what the docs told me to do. Finally, lately, I do my own research, make suggestions about what I need, and reach a consensus with the professionals about what to do.
As for my mental health care, I was in day treatment in 2007 and 2008. Since then I've been a weekly outpatient. It took three years to find the right social worker and psychiatrist, and even longer for me to be willing to work with them. A lot of resistance had to wash beneath the dam of denial before that happened. Fortunately, a breakthrough came, at the beginning of 2011, when my social worker (therapist) challenged me to write about a film I admired. "An Angel at My Table" is the autobiography of Janet Frame, who survived eight years in mental hospitals during the 1950's, including 200 electro-convulsive shock treatments, to become one of the best New Zealand writers of the 20th century. I entitled my article "Saved by the Imagination."
During the last year and a half, I've gone back to writing about the arts for a local newspaper. I'm also working as a peer advocate again. I volunteer for a political group and worship regularly. I stay in touch with my family and old friends. I take care of our cats and car. (The computer is my wife's responsibility. We split the other household chores.) These activities are what psychologist/peer Patricia Deegan terms "personal medicine." Mary Ellen Copeland, another consumer turned professional, includes them in her "wellness toolkit." Whatever you call them, they keep me alive and lively. Damned if I'm going to die 25 years prematurely—the average for folks living with mental illness.

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