Posts Tagged ‘mental health’

Invisible Does Not Equal Imaginary

This week’s posts have developed a bit of a theme. Health is not a virtue, pain shouldn’t be hidden in silence.  Here’s another corollary of this line of thought.

When it comes to your health–invisible experiences are NOT imaginary.

There is a wonderful online movement based on the work of Christine Miserandino of the ButYouDon’tLookSick Foundation.  In an effort to explain the challenge of living with fibromyalgia, she wrote an essay that she called “The Spoon Theory.”  Essentially, the theory suggests that we each have a finite number of emotional & energetic “spoons” to get through our day.  Some days, it takes every single spoon we’ve got to get out of bed.  Other days we have to ration our spoons to participate in something important.

The reality behind the spoon theory, and the #spoonie movement that has grown out of it, is that a majority of the most painful and debilitating illnesses that we face (Crohn’s, lupus, depression, diabetes, cancer, MS, anxiety, & RA–just to name a few) don’t have any visible signs.  With the right makeup, clothes, and effort, a person with intense physical & emotional pain can sometimes look “just fine.”  Looking just fine doesn’t mean that we feel just fine.  In fact, that “just fine” face may hide a world of pain and suffering.

Since we live in a society where we are supposed to ignore our pain, many of us have bought into the story that we should feel fine.  That our pain is a sign of our weakness.  That if we were strong enough, courageous enough, hard-working enough, virtuous enough, we would be able to do all the things that a healthy person can do, in the same time that a healthy person could do it.  In short, we have bought into the story that maybe our invisible pain isn’t real pain.  We begin to feel that maybe our invisible pain is “just in our heads” or a sign of our failure.

This makes me so angry.  Unless you have  a broken bone with a cast, a wheelchair or another dramatic physical marker like hair loss, most illnesses don’t have a visible indicator.  There isn’t a pain rating scale flashing above your head.  Fatigue and depression don’t show on your face.  Almost all pain and suffering is invisible.  AND it is real.

People who are struggling to get through a “normal” day because of pain or other invisible health issues do not need to have their struggle questioned or discounted.  That kind of behavior is healthy privilege in action. So, let me state this clearly.

Invisible suffering is real suffering.

Instead of questioning the validity of people’s pain, let’s work on creating support systems that help them move through pain in healthy ways.


Remembering My Time in the Dark

Dear Reader,
 If you are a long-time reader of this blog, you may be aware that I am passionate about getting the support you need.  October is Stillbirth and Pregnancy Loss Awareness month, and in honor of that, I am re-sharing a blog post from 2012–a story of part of my life when I was most in need of mental health support.  I know that this is an unusual step for a psychologist to take.  However, I believe that each of us will face moments of absolute darkness and pain–and that we all deserve to have the support that we need to get through those times.  If sharing my story helps another person reach out for support, that is a wonderful outcome.  I apologize in advance for the longer-than-normal post.

The Background

I am from a large family.  Both of my parents are from large families.  I don’t think that I ever questioned my intention to have children–or my expectation that I would.  So, in 1999, when I was diagnosed with PCOS, a condition that creates multiple health complications–including possible infertility, I was stunned.  In addition to the challenges of managing a chronic health problem, I was face to face with the possibility of not having children.

In 2004, I had the joyful surprise of a positive pregnancy test.  I thought that I had dodged the odds and that maybe I could take away the power of that earlier diagnosis.  I got to hear a heartbeat and see a beautiful little person moving about on the sonogram.

The Crisis

And then.  Then there was the appointment when there was no heartbeat.  Then there was the sonogram where there was no movement.  Then there was a flurry medication and induced labor.  Then there was the recognition that I was spending Mother’s Day weekend delivering a baby who had died. Then something that had been a dream became a nightmare.

I don’t remember much–they told me later that I almost died too.  I have hazy memories of heat and pain and tears.  I know that I wanted to know when I could wake up and have my life back.  I remember holding my tiny, perfect little boy–whose fingers and toes were all there, but whose heart just quit working.

The Dark

It took over a month for my body to heal, for the doctors to release me from the activity restrictions and pronounce me ready to return to real life.  But the rest of the healing–that seemed like it was never going to happen.  Seeing pregnant women hurt me.  Seeing newborn babies hurt me.  Sunshine and laughter hurt me.

I think that, maybe, I didn’t want to heal.  It felt like healing meant letting go.  It felt like healing meant saying that it was okay that my son died while other babies were born into homes where they would be abused or neglected.

I stumbled through life.  My body went to work, my body did chores at home–sometimes.  I was moody and tearful–most of the time.  I’m pretty sure that I didn’t actually participate in most of my relationships.  I was too trapped in the darkness inside of my head and my heart.  The broken spaces that felt like they could never stop hurting.  The ugly spaces that resented everyone who had what I had lost.

Looking back now, I know that most of my family and friends were frightened for me.  They grieved the loss of my son, but they also worried that they were losing me.  I don’t think that their worries were exaggerated or off base.  I was feeling pretty lost myself. I know that, even if I wasn’t suicidal, I wasn’t very committed to my life at that time.

A Path to Light

Finally, in desperation, eight months after our son died, my partner suggested attending a perinatal bereavement support group.  And in that group, I (and we) found our path out of the dark.  Everyone sitting around that table, including the facilitating therapist, had lost children.  They understood my grief, my anger, my despair, my frustration.  They passed the Kleenex, and didn’t suggest that maybe I should just “be over it” by now.  They helped me feel found–and accepted.  They acknowledged my son as a real person and my grief as real grief.

Between the group and the individual support sessions, I found my way back to myself.  I allowed myself to think about a future, to plan for children, to redefine my world.  It wasn’t easy or fast.  I never approach Mother’s Day weekend without some sadness.  I am a different person than I was before the darkness.

My Hope

I didn’t choose to share this story so that you would be sad with me.  In fact, I have a loving partner, and beautiful children (there are lots of ways to make a family).  I would never have chosen my time in the darkness, and I know that because of it, I am kinder and more compassionate.  I value life more than I did before.

I chose to share this story because my darkness was changed by the presence of good mental health care.  Without that group, my outcome may have been different.  If you only take away one thing, I hope it is this: we will all face dark times, and we all deserve good support to find our way through them.  If you are in the dark, please don’t hesitate to reach out, to me or to other resources, for the help you deserve.

Is it Time for a Break?

One of my best mental health breaks is getting outside.

Next Monday, August 24th, I’ll be joining the #BCSM (Breast Cancer and Social Media) community again for their Monday night tweet chat.  Our topic is going to be “mental health breaks.”  I’ve been kicking this idea around in my head for a while, and one of the things that has come up for me is that many of the clients I work with in the office, as well as people that I interact with in health communities really struggle with the idea of taking a break.

Living with cancer can be a consuming experience.  It can feel like a full-time job to manage early treatment, and a very different job to cope with ongoing fatigue, chemobrain, and other long-term treatment effects.  In addition to that, cancer and other illness can be like an earthquake in your relationships and work life.  It makes a lot of sense that trying to create mental health breaks can feel unattainable or like a chore.

And all of that is why making space for breaks matters.  When your body has taken huge hits, and so much of your experience has been wrenched out of your control, it becomes really important to focus on what you can control.  And investments (big and small) in your overall mental health are definitely under your control.

So let’s look at some of the reasons we aren’t getting these mental health breaks.

Reason 1: I don’t have time to do that stuff.

Baloney.  Mental health breaks don’t need to be a week-long vacation. or an hour of meditation.  Not that either of those are bad.  You can give yourself a mental break in under one minute.  Try focusing for 10-12 seconds on a sensation of comfort, connection, or pleasure–the taste of your coffee, the sound of kids laughing, the warmth of a favorite blanket.  For that 10-12 seconds, really immerse yourself in how good that moment feels. Try to identify how you are seeing, hearing, smelling, tasting, or feeling that goodness. This is an exercise that neuroscientist Rick Hanson calls “taking in the good.”

Reason 2:  Treatment has taken up so much of my time, energy, money, etc that I don’t have any resources left over to take care of my mental health.

It can be easy to think of mental health & self-care as luxury items, but they aren’t.  Not only are they absolutely essential to our overall health, but you can take a break for your mental health in ways that don’t take up more of your resources.  You can change your scenery (get outside, get to a lovely indoor space, add a plant to your desk or bedroom).  You can move around–even some gentle stretches can begin to release endorphins & lift your mood.  You can breathe–3-5 deep breaths are enough to reset a stressed out-brain.

Reason 3:  It’s not fair to my spouse/kids/family/friends/employer if I focus on me. Isn’t that selfish?

Nope. No way. Not at all. Not even a little. Self-care is not selfish.  Focusing on mental health actually helps you be a better partner, parent, friend or co-worker.  Just think about how you act and feel when you are exhausted or upset.  Is it your best self? Can you make good judgments and extend compassion? I can’t.  I need to have a basic foundation of rest, self-care, and mental health time outs, so that I can be the best person possible in my relationships.  Taking mental health breaks helps me (and you) to be the person that others count on.  Without those breaks, we are all more brittle and likely to, well, break.

This is just a tiny sampling of how you can challenge the blocks to your own mental health breaks.  Want more? Join us on Monday night for the #BCSM Community tweet chat.


Medicine X and the Sneaky Impact of Stigma

This post was originally shared on the #MedPsych blog, but is cross-posted here for my practice readers.

 Ten days ago, I had the privilege of joining the participants at Standford’s 2014 Medicine X conference. I’ve written about this conference on my practice blog before, and it is a gathering with lofty aims. The conference was initially envisioned as a space to explore how health and emerging technology support one another. Over the three years it has been running, Medicine X has become the leader among healthcare conferences at integrating patient voices into the planning and narrative of the experience. This year, Medicine X invited some discussion of brain health related issues. One panel focused on the interaction between chronic illness and depression, and another focused on how brain health issues cut across diagnoses to be a “missing link” in whole person healthcare. I was thrilled to participate in both of these panels, and advocate for an issue that I believe is essential as we move into the future of healthcare.

Participating in these panels was a joy–I shared the stage with some courageous advocates whose stories are very powerful. However, my participation also reminded me of a critical topic.

Stigma is the elephant in the room when we are talking about integrating brain health more fully into healthcare.

I have written a bit about healthy privilege and the stigma of illness, so I won’t repeat that here. There is also a great deal of powerful writing about the more obvious ways that brain health issues are stigmatized. One of my favorite reminders of this is a pointed cartoon:

This cartoon cuts to the heart of the most obvious brain health stigma–which seems to be founded on the idea that brain health can be improved just by “adjusting your attitude” or “trying harder.” That piece of stigma is very real. So is the piece of stigma that has cost individuals facing brain health challenges their jobs or their relationships.

However, what I saw at Medicine X this year was a more challenging and subtle component of stigma. I saw an assumption that brain health issues are something that patients deal with, not a challenge that confronts health care professionals. People were willing to talk about providers who were burned out. They were much less willing to talk about providers who might be facing depression, anxiety, unsustainable stress levels, etc. That language still seemed taboo. And that’s a problem. As long as brain health challenges are something that “they” experience, stigma will continue. As long as it is not acceptable for a medical student to own that the intense demands of their training are difficult emotionally as well as practically, stigma will continue.

I also saw brain health discussed as something “other.” Medical students talked about not knowing how to approach a referral for brain health services without upsetting their patients. Until a referral for a brain health consultation is as automatic as a referral to an endocrinologist, stigma is still at play. Until we are trained to think about the brain and our social functioning as a vital component of health that we wouldn’t dream of ignoring, stigma will still be an issue.

I don’t want this post to be construed as pessimistic. At Medicine X, I heard medical students ask questions that showed they truly want to be part of this conversation. I saw patients who discussed their depression as a medical challenge on the same stage with diabetes or autoimmune disorders. I saw that there is so much hope and potential for the future.

I also saw that we have work to do. Let’s keep the conversation going. Shining a light is how we challenge the grip of stigma.

This past weekend was Mother’s Day here in the US (in case you somehow missed the onslaught of ads and social media). And what struck me on Mother’s Day is that we like to think and act as though there is one right way to approach life. On Mother’s Day, the “one right way” is to be grateful and excited. Grateful for your mom. Excited for the chance to be a mom. Except, what if:

  • I'm Blogging for Mental Health.Your mom has passed away, and you are missing her terribly.
  • You don’t have children, and you truly wanted that opportunity.
  • Your relationship with your mom or with your children is strained and difficult.
  • You’re a single parent, so there’s not really anyone to show you appreciation on Mother’s Day.
  • You’re working and don’t get the freedom to be “spoiled.”
  • You had a child who passed away, so you’re a mother with no visible children.

Those are only a few reasons why you might be having emotions that aren’t simply “grateful and excited.” This post isn’t actually about Mother’s Day.

This post is about the fact that there is no one right way to be human. There is no one right way to experience emotion. There is no one right way to cope with stress. There is no one right way to handle grief.

Out of the billions of people sharing this planet today, not a single one is entirely identical (even identical twins grow different over time). Our bodies aren’t identical. Our circumstances aren’t identical.

And yet, we often act as though there is a single correct way to cope with the challenges in life. I have lost track of how many of my clients share experiences of being told that they are “doing it wrong,” when it comes to experiencing their own feelings. I think that this messaging about how we should feel and how we should cope is truly harmful to our mental health. When you are already struggling to cope with life’s tough stuff, it can be overwhelming to be told that you aren’t doing it right. That message of judgement can damage a fragile self-image.

I believe that sometimes, healthy self-care includes feeling sad, or angry, or frustrated. Sometimes (most times) grief doesn’t disappear in a poof of smoke because you pass some imaginary time limit. Sometimes, you really are facing overwhelming things, and you need a few moments (or longer) to sort them out.

So, as we recognize National Mental Health Month this May, my hope for you is that you give yourself permission to experience your own life in your own right way. Please know that I’m not saying that all coping is equal. I’m not. Some choices lead to healthier outcomes than others (for example, you’ll probably benefit more from a walk than a bottle of vodka to manage pain). But when it comes to your feelings and how you feel them, there is no one right way.

Have you had an experience of being outside the “perceived normal” experience? Feel free to share it in the comments. If you need help finding the healthy coping choices for your unique journey, you can always connect with me.

Feel Free to Call Me Doctor


Maybe psychologists have been too well hidden>

In my office, I often invite clients to call me “Ann.” Dr. Becker-Schutte is a bit of a mouthful. And I deliberately choose to try to level the playing field as much as possible. I don’t need my clients to acknowledge my training just to make me feel better.

But I am wondering now if that is the right approach. Not really in my office–Dr. Becker-Schutte is still a mouthful, and not very conducive to conversation. But outside of my office, I think that I may need to claim the title more often.

This isn’t really about me. It’s about contributing to the bigger conversation.

I had a really interesting conversation this week. I was in a conference call with five other doctoral level psychologists. One of the issues that we were exploring was the identity crisis that seems to be present in psychology today. Psychologist and coach Dr. Susan Guirleo said, “It seems as though psychologists have always allowed other people to define them from the outside in.” Another was the concern that many of us have that the general public has absorbed some negative ideas about therapy. The reason this came up was this story, told by another mental health professional:

“While I was in a surf shop, the clerk was talking about struggles he was facing, including suicidal thoughts. He eventually said, ‘I probably should get some help. But I don’t want to be stuck in a room with some asshole.’ Clearly, if that’s the image of coming to therapy, we have a problem.”

In addition to this conversation, I have been thinking a great deal recently about the marginalized position of mental health in the bigger healthcare ecosystem. You may have gotten hints of this in the posts that I wrote after Medicine X, when I reflected that mental health practitioners have a lot to offer other health care providers.

So, using my title is about a bigger picture. It’s about standing up for my belief that mental health issues are just as valid and just as worthy of treatment without barriers as physical health issues. Not only that, it’s about shining a light on research that suggests that treating mental health concerns can lead to improvements in physical health. So, as long as we are keeping mental health in its own sequestered closet, we are fostering stigma and failing to contribute to the best possible health outcomes.

We talked on our conference call about the fact that most practicing psychologists aren’t terribly comfortable with the spotlight. We don’t want to brag about our training.

But I am coming to realize that there is a difference between bragging and educating. If I don’t stand up and point out that a licensed psychologist has generally completed rigorous clinical training and supervision–oh, and education in assessment, human development, cultural diversity, research analysis, and social & biological bases of behavior, to name a few–I am not giving people the information they need to make informed decisions.

If I don’t state that psychologists are excellent at focusing on strengths, encouraging healthy development, AND helping people deal with painful experiences, I’m contributing to the culture of misinformation.

So, if using my title means that I get a broader audience to hear about the value of mental health care, and its place in health care overall, then feel free to call me Doctor.

More Alike that Different–Redux

Another Medicine X-Inspired Reflection

For those of you reading who didn’t attend or follow Medicine X, and are ready for me to get back to my normal blog topics, I apologize. The experience of attending MedX was overwhelming and exciting and occasionally challenging–and I process those kinds of things by writing. But take heart, this post is both a reflection on things I learned at the conference and a reach back to something I have written about before–at the heart of things, we are more alike than we are different.

One of the things that I most appreciated about the three days of Medicine X was the deliberate effort to bring different identities and roles into contact with one another: patient with physician, designer with consumer, technology experts with technology users, academicians with practitioners. And one theme that I heard throughout the conference was a growing awareness that the experiences we share are deeper and broader than the experiences that distinguish us. Many patients, who had been accustomed to focusing on the communities of others who shared their diagnosis, noted that patients with other diagnoses seemed to be telling stories that felt closely parallel to their own. Physicians who had been firmly grounded in medical practice talked about learning about the power of good questions and close listening–key tools of mental health practitioners for decades. I could see patient’s eyes widen during one-on-one conversations and my panel when I brought up the point that, eventually, doctors are patients too.

And this reminded me of the summary I use to describe my practice: “help at the intersection of physical and mental heath.” Training models and insurance reimbursement have tried very hard to draw clear lines of separation between physical health and mental health. (If you’re not sure about this, just talk to anyone who has run into separate plan management, deductibles, and co-pays for “behavioral health.”) That separation has always felt artificial to me–and anyone who hangs out with me long enough will eventually hear me make a passionate argument for the fact that health is a big umbrella. And it doesn’t help anyone when we allow artificial separations to treat us like we are different.

We share common human experiences of joy, loss, excitement, struggle, achievement and pain–no matter what our job title or diagnostic category is. I love Dr. Daniel Siegel’s concept of interpersonal neurobiology, which he defines as this:

Interpersonal neurobiology is a field that draws on all branches of science – and now it even draws on other ways of knowing, like the arts, literature, and music, as well as the contemplative practices of meditation and even some insights from wisdom traditions and the contributions of religious practices, which are all about the process of being human. We try to learn, from all these different ways that people have been exploring, what it means to be human and to answer some fundamental questions. — Dr. Daniel Seigel

When I read things like this definition, I have a great deal of hope that we will do better and better at understanding that we are fundamentally more alike than different. I think this understanding is what will allow us to push forward and create better systems for health and health care. I think that respecting the wisdom and unique knowledge that we each bring to the table, while acknowledging our shared human experience, is what creates change. I saw some of this at Medicine X, and I hope to see more in the future.

What do you think? Is there something to this “more alike than different” track? Or am I missing a key concept?

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