The Invisible Wounds of Mental Health Disorders

The Invisible Wounds of Mental Health Disorders

Mental health disorders often strike in two ways. On one hand there are the symptoms, the distress, and the disabilities caused by serious mental health disorders. On the other, are the impacts of stigma and the pain that people struggling with these disorders feel as a result of social disapproval. In both cases, the strikes leave invisible wounds.

Invisibility, at first, may be considered a magic power to those experiencing symptoms of mental health disorders. Because one can hide them, and nobody will notice, right? Like the monster under our childhood bed, it will just disappear, right?

Wrong. In fact, signs and symptoms will likely just grow even bigger until they can no longer be hidden.

In this article, we’ll be looking at:

  • Stigma and its detrimental effect on seeking help
  • Coping mechanisms and the negative outcomes of not seeking help
  • How to detect mental health distress in a colleague or employee
  • How to open up the conversation about mental health in the workplace
  • Strategies on how to fight stigma in the workplace

To help shed some light on those issues, we’ve asked the expert advice of Dr. Sandra Primiano, a psychologist who serves as Homewood Health’s Senior Director for the Homewood Clinics.

The Monster Under Bill’s Desk

Let’s bring in Bill as a fictional character for the illustrative purposes of today’s read. Bill has a mental health disorder. Other than that, who’s Bill? He could be your colleague, your employee, your friend. Bill could even be you. He could really be anybody as no one is immune from experiencing a mental health disorder and the corresponding challenges.

Mental health disorders arise from a complex interaction of genetic, biological, personal and environmental factors. Mental illnesses affect people of all cultures, ages, education and income levels. Yet, specific risk factors do exist. They include a family history of mental illness, age, sex, substance abuse, chronic diseases, workplace, and life event stresses (2). But then again, the vast majority of people have been subject to risk factors.

Nevertheless, the stigma factor brings in many reasons for Bill to hide his mood swings, energy loss, rising anxiety and the many other wounds that manifest themselves inside his mind and body. Within the workplace environment, where the pressures of performance are high, temptation to hide the wounds are equally high.

That means many, like Bill, will try to hide the monster under their desks. In 2015, the Financial Post headlined that more than half of employees who are living with a mental health disorder do not seek help (3). Similar results have been obtained in studies on white-collar workers and the utilization of an Employee Assistance Program (EAP). One study found that employees were worried that their managers would have a negative opinion of them if they were aware of their use of mental-health services (4). Moreover, employees were reluctant to use counseling services at work if they believed it would negatively affect their career opportunities (5).

Stigma can be defined as a mark of shame, disgrace or disapproval which results in an individual being rejected, discriminated against, and excluded from participating in a number of different areas of society.

Source:
World Health Organization

Who could blame them? Even psychiatrists are reluctant to divulge, as 50% of 567 psychiatrists surveyed by the Michigan Psychiatric Society admitted that they would treat themselves in secrecy rather than have mental illness recorded on their medical chart (6).

As Dr. Primiano says: “All that fear of judgement, and then the repercussions: could I lose my job, maybe my team will think I’m unfit. I think there are so many barriers linking to fear of judgement and then self-judgement. Why do I feel like this? None of my colleagues have these kinds of problems, I’m a bad professional, and I must be terrible. You add all of this judgement to whatever you may be feeling and it ends up being a very bad situation.”

Indeed. People living with mental health challenges and illnesses and those who care for them report that stigma and discrimination negatively impact almost every area of their lives and can frequently be more harmful than the illness itself (7).

The Coping Mechanisms

But what happens if Bill doesn’t seek help?

“Depends on what your issues are,” says Dr. Primiano. “Some people can have a natural recovery when they have stable personalities, no childhood adverse experiences, and good support as they may get through certain issues that have come up with family and friends. Without those protective factors,” she says “they’re at a high risk of experiencing numerous negative consequences to themselves.”

With the gradual impact of depression, for example, an employee might be coping and coping until they can’t cope anymore. Coping mechanisms might be positive, such as seeking a support network outside the workplace, but if the network is weak, the issues too severe, then coping mechanisms might include damaging behaviours, such as denial, rationalization, workaholism, or self-medication through alcohol and drug abuse. Different people will react in different ways to similar issues.

“For example, if you look at the veteran population,” says Dr. Primiano, “50% have alcohol use disorders, why? Because they’re self-medicating symptoms that they can’t get rid of. So there’s a high incidence of substance abuse disorders in people who suffer from PTSD and anxiety disorders as well.”

How to Detect Mental Health Distress in a Colleague or Employee

Let’s get back to Bill. He’s feeling increasing pain and suffering from the wounds of mental illness. But he doesn’t talk. No one seems to notice. You’re his colleague. How can you notice that’s something’s wrong?

“You might not notice symptoms but you may notice behaviours, says Dr. Primiano. If we focus on a workplace environment, we see a lot of absenteeism or people’s productivity can go down. There can be issues with concentration, memory and you’ve got to repeat things many times. Other things colleagues and managers can notice, but they don’t know what it’s related to, are changes in people’s personality, for example, shifting from someone who’s generally friendly and good-humored to having angry outbursts or appearing suddenly anxious.”

Some of these signs can be subtle, she mentions, such as leaving the room suddenly in a meeting.

Dr. Primiano adds that those are things to pay attention to as a colleague or as a manager as it gives an opportunity to start the conversation that will put an end to Bill’s isolation. But how to go about it?

How to Open up the Conversation About Mental Health in the Workplace

Dr. Primiano suggests starting that conversation openly, such as “I noticed those behaviours and I wanted to check in with you. We all have off days… How is it going?”

That can give them the opportunity to open up or share something in terms of their well-being, their mental health, which could allow you to guide them to resources such as an employer’s EFAP (Employee & Family Assistance Program). It lets them know it’s a safe place and that this person is open to me talking about this…

From a manager’s perspective, while starting the conversation doesn’t mean Bill is going to share, Dr. Primiano argues it’s more likely to occur than if you open by saying: “Why aren’t you performing well?… That needs to change, get your numbers up!”

Preparation for that talk is key, as linking an employee’s health to performance issues or behaviours in the workplace can be a very delicate matter to tackle. It’s essential to maintain an employee’s privacy. Managers cannot ask about one’s mental health, the conversation must focus on performance issues and/or concerns. Firstly, you should get informed about the resources, accommodations and processes your organization can offer an employee in distress. Then, when approaching a colleague or employee, make the best use of your interpersonal skills to help the person feel safe and comfortable and don’t forget to value the person’s strengths as a person and contributions as an employee. And of course, encourage the person to seek help (8).

There are some things to stay away from, such as delivering a pep talk; finger pointing; saying you’ve been there unless you really have in a way the person can relate to; labeling an issue as a specific diagnosis; invading someone’s privacy about the underlying causes of issues. The focus should be on listening and finding solutions (8).

“Of course, a person may not be ready to open up and may not acknowledge mental health challenges right away,” says Dr. Primiano. “The reaction might be strong and defensive. If this happens, just back off. At least, you will have planted a seed.” It’s essential to note these conversations are private and further action must be at the direction of the colleague, employee, friend or Bill, as illustrated in our discussion, unless there is an underlying risk of harm to the person and/or their immediate family members.

Kharoll Ann Fouffrant, a social worker specializing in gender and woman’s studies, knows a thing or two about stigma, being a black woman living with a mental health disorder. She says: “People perceive me as being strong even though I talk openly about having a mental illness. That being said, when I have a rough day and express it, people don’t seem to take it seriously. Or if they do, often I end up having to manage the person’s discomfort while I’m the one needing help.”

The open conversation about mental health is indeed important, and not only when the going gets tough.

Strategies on how to fight stigma in the workplace

Studies have shown that contact strategies (fostering positive interactions with people disclosing lived experiences of mental illness) yield the best results in fighting stigma, especially when it comes to changes in behaviour.

While education strategies, such as campaigns aimed at debunking myths about mental illness, might have some impact on attitude, their effect on behaviour is limited (9). Different conditions can improve the effectiveness of contact strategies (10), such as:

  • Treating the person as an equal;
  • Giving the individual the opportunity to interact and exchange ideas about mental health and recovery;
  • Sharing common goals.

Those conditions can be established in the workplace. One way is to encourage peer support by offering a safe place for employees having recovered from mental illness to share their stories. For Dr. Primiano, it makes sense because one is more likely to open up in such an environment. “They will trust and connect with people who understand them because they have been through similar things and are able to guide them.”

But in the end, good services and resources have to be in place for Bill, or anyone, to seek help.

References

  1. Corrigan, P. et R.K. Lundin (2014) Coming out proud to eliminate the stigma of mental illness. Illinois. USA. Link: http://comingoutproudprogram.org/files/COP%20Resou…
  2. Public Health Agency of Canada’s website. Link: https://www.canada.ca/en/public-health/services/ch…
  3. Link: https://business.financialpost.com/executive/caree…
  4. Walton L. Exploration of the attitudes of employees towards the provision of counselling within a profit-making organisation. Couns Psychother Res. 2003;3(1):65–71. Link: https://onlinelibrary.wiley.com/doi/abs/10.1080/14…
  5. Carroll M. Workplace counselling: a systematic approach to employee care. London: Sage; 1996. Link: https://books.google.ca/
  6. Myers, M. (2001). Presidential address to the Canadian Psychiatric Association. New century: Overcoming stigma, respecting differences. Source: Mood Disorders Society of Canada (2006) Stigma: The Hidden Killer. Link: http://www.troubleshumeur.ca/documents/Publication…
  7. Mental Health Commission of Canada (2015) Guidelines for Recovery-Oriented Practice. Link: https://www.mentalhealthcommission.ca/sites/defaul…
  8. Mental Health Works’ website. Link: http://www.mentalhealthworks.ca/how-can-i-approach…
  9. Corrigan, P. W. and A. K. Matthews. (2003) Stigma and disclosure: Implications for coming out of the closet ». Journal of Mental Health, 12(3), 235-248. Link : https://www.researchgate.net/publication/232073439…
  10. Groupe provincial sur la stigmatisation et la discrimination en santé mentale (GPS-SM). (2014) Cadre de référence : La lutte contre la stigmatisation et la discrimination associées aux problèmes de santé mentale au Québec. Link : https://aqrp-sm.org/wp-content/uploads/2014/04/cad…

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Addiction and Recovery: Insights from Homewood Alumni

Addiction and Recovery: Insights from Homewood Alumni

When you’ve lived with addiction and had the courage to get treatment, by working through your obstacles, you usually end up facing life lessons and gaining life experience that is often relatable to persons in similar situations and useful for those who are unaware of the challenges that addiction brings.

Interestingly enough, two aspects that almost always surface are: 1) how someone’s family has played an important part in their recovery journey and 2) how redeeming it’s been to learn about the science of addiction.

In this article, we’ll hear from some Homewood Alumni who have generously agreed to share their insights and key learnings when facing their addictions. We’ll also hear from Dr. Michael Berry, Clinical Director at Homewood Health’s Ravensview treatment facility in Victoria B.C., an expert who guides individuals on the path to recovery and helps people write new chapters focused on their healing and attainment of sustained sobriety. When stories are shared with such honesty and transparency, they can radiate hope and help others who may be early in their recovery journeys or who are experiencing some setbacks along the way.

Family Ties

Like other diseases, addiction can have a profound effect on your own life, but equally so for family members and others that you care about. There is a certain measure of complexity with their involvement in securing a recovery path: family members often have significant influence in helping you find your way to treatment, and they also need to learn about addiction as a disease and be well supported to understand that recovery is a life-long process.

Research has shown that stress is a significant risk factor and catalyst for “activating” an addiction (1). Living with a family member who has an addiction can upset relationship dynamics, and this often stresses the family to the breaking point as the addiction takes a stronger hold on their lives (2). As much as the addicted person is often using an addictive substance like alcohol to cope, family members can unknowingly take on certain dysfunctional behaviour patterns to help them deal with what is happening to their loved one, and become part of the addiction ecosystem.

Dr. Michael Berry emphasizes the importance that Homewood’s inpatient programs place on exploring these types of stress-response roles within family systems and the interactions they precipitate as part of the recovery process. “There’s the addict, the enabler, the peacekeeper, and the black sheep to name a few,” he says. He went on to describe a popular and very practical model used to help patients, a social network diagram that places the addicted person in the middle, and then spreads out people they care about in concentric circles according to who they are closest to. It helps people visualize the relationships, the dynamics and the vulnerabilities that are all around them to help make peace and make choices.

James, a Homewood alumnus who in June celebrated four years of sobriety, spoke about how much he wanted to move away from his alcoholism but was fearful. A combination of help from his employer in the form of a “last chance,” his girlfriend at the time (now his wife), and his father brought him into the program:

I had shown up to work and shouldn’t have been there. My girlfriend was under so much stress, and she was also an enabler for my alcoholism. My employer told me that I needed to get treatment, starting immediately, because as a first responder, I couldn’t perform my job safely and while they had been patient with me, my job was now on the line. So, even though I was worried about being away for 30 days, I agreed to go to Homewood. My girlfriend reassured me that she would take care of everything at the house, and I should “just go!”. It was very hard. While she was relieved that I was going to be getting treatment, she cried every single night I was away. That day, I needed to tell my parents about my alcoholism because I needed their help to get to Homewood. I was terrified of their reaction. The people at Homewood spent two hours with my dad, talking to him about addiction and explaining about how it was a disease and how my recovery was going to start as long as I was willing to participate. That really opened up his eyes and helped him understand.

I was in treatment for 35 days and a lot of the work I did there set me up to see the value of experiences. I was able to bring my parents in for picnics, I immersed myself in all of the activities to get the most I could from my time there. For the first time in my life, I learned how to talk to the people I cared about and how to listen. Homewood had some of the best meetings I have ever been to. The videos they showed us of other first responders made me realize I wasn’t alone and that there was a way forward. In the end, all of the right people were in the right places at the right times for me. This time was a chance for me to reset my life, not pick up a drink, and not be stressed. It was the start of a lot of really hard work that helped me learn how to be accountable for who I was.

Dr. Berry believes that family conferences are critical during the entire course of someone attending an inpatient program. They help address the blame that people affected by addiction can feel. Meetings emphasize how recovery is about treating the whole person rather than just the disease, an important distinction that recognizes the biological and environmental influences inherent with addiction. Dr. Berry further indicated that alcoholism can be passed from one generation to the next and that children of alcoholics move through the stages of addiction more rapidly. Having information about the science of addiction can generally help everyone move forward in recovery.

Addiction is a Disease

It’s essential to recognize that addiction is a disease caused by a combination of behavioural, environmental and biological factors that actually change someone’s brain (3). And while Homewood’s Dr. Michael Berry agrees that research has shown there are genetic links – some studies report that genetic risk factors account for about half of the likelihood that an individual will develop addiction – he focusses on a model where someone’s genetic predisposition might be activated through stress (4) that ties to the neuro-biological elements of the brain that are on the lookout for rewards (through addictive substances) to get relief and feel satisfied.

Our Brain on Drugs

Different addictive substances – drugs or alcohol — affect the brain’s neurotransmitters within the body by mimicking chemicals that are naturally produced there. Unfortunately, they aren’t exact copies of natural brain chemicals. While these imposters work, they don’t actually send the same messages that the natural chemicals would. And each substance affects different parts of the brain in their own way. As a result, the body receives abnormal messages in a kind of broken telephone game, and sometimes too many messages create over-activated circuitry that causes disruptions in our thinking and makes it hard for the natural chemicals to regain control over the processes (5).

Substance abuse changes our brains over time because we learn that these substances feed the pleasure-seeking part of our brain and cause it to release dopamine as a reward. Our brains respond favourably, by learning that something important is happening and needs to be remembered. The brain makes it easier to achieve this feeling again without having to think about it because it changes neural connections, forming a habit. It’s these large surges of dopamine brought on by substance abuse that teach the brain to seek drugs at the expense of other healthier goals and activities.

Ridding the body of the addictive substances that are mimicking naturally produced brain chemicals is key to starting recovery, but is also very dangerous if not done correctly. Gillian, another Homewood alumnus, shared her lifelong struggle with substance abuse and how not having the right supports available to her early on affected her recovery journey.

I’ve struggled with my physical and emotional health for over 35 years. Early on, I was prescribed morphine for a painful health condition. I found I was staying in the hospital up to four days per month. I supplemented this with alcohol. I needed treatment and came to Homewood for help. It was scary. After two days, I called my husband because I wanted to go home. On the fourth day, I had a seizure. I completed five weeks of treatment and was done with the morphine. Unfortunately, I returned to alcohol within three months. I would start drinking in the morning and blackout by early evening. I wouldn’t eat all day, but I would wake up hungry and try and eat something.

I was fighting with my son and decided that I couldn’t keep this lifestyle, so I went back to Homewood after 3 or 4 months. This time, I opened up and maintained my sobriety for eight years. I got a new doctor who in the process of learning about my health, ordered a full medication review and took me off everything. I became very sick and actually spent 12 days in the hospital. I lost 30 pounds in 7 weeks and started to experience panic and anxiety. The only thing I could keep down was two meal replacements a day. I was actually detoxing.

Science continues to look for different ways to treat addiction, everything from new forms of aversion therapy where long-term doses of medication are implanted in a recovering patient’s skin that cause the person to vomit if they drink, to investigating medications that can prevent people from falling prey to unseen triggers (6). While this research is interesting and in some cases, promising, Dr. Berry states that the combination of pharmacological treatment; psychotherapy, such as CBT (Cognitive Behavioural Therapy); and alternative therapies such as art, horticultural, and music therapy have clinically proven to produce the best results for many people. This model is grounded in Homewood’s philosophy of treating the whole person and not just the disease. Gillian agrees that a more holistic approach is better in the long run, “Alcohol is so much more than drinking – a pill wouldn’t change things for me. Quick fixes are easy but not the most effective and they don’t help me clear the wreckage of my past”.

A Model for Sustainable Recovery

Recovery is a lifelong process and takes effort. While addiction is not a choice, recovery from addiction is. The path to recovery improves work, finances, family life and health and uses many different pathways … including professional treatment services, informal supports and support groups (7).

Both James and Gillian attest to how helpful a wide variety of supports are, especially peer support groups such as Alcoholics Anonymous (AA). Talking to people and sharing their stories continues to be a big part of their recovery journeys. Planning for and being aware of what may cause relapses allows James to be proactive and not hold stress about this. He embraced many tools learned from Homewood, AA and keeping connected with his sponsor such as journaling, time management, and maintaining a regular routine.

Dr. Berry agrees that an action plan should cover a broad range of supports that ultimately, puts the emphasis on experiencing an engaging and gratifying life filled with meaning, purpose and fulfillment. In the end, if those things are missing, and a person is disengaged with the activities of life because they are so focused on the addiction, the journey has no point.

The Basics for an Addiction Recovery Plan (8)

  1. Stay engaged with your recovery and treatment.
  2. Attend to basic responsibilities – these will help you stay on track
  3. Make a relapse checklist where you:
    a. List your triggers
    b. List tools that you have that can help you stay grounded when in stressful or encountering triggers
    c. List people in your support network who you should contact
  4. Prioritize self-care, healthy relationships and remember to celebrate all achievements, no matter how small.
    a. Avoid negativity and have honest conversations with yourself
    b. It may mean changing jobs
    c. Ask yourself if you are focused on what you want to be doing, and if you feel supported.
    d. Stay connected to formal programs.

Recovery may also have you confronting relationships that are not safe and leave you wrestling with some of the choices you have to make about whether connections and contacts you have need to be altered, adjusted or avoided. “It’s not easy, and it requires candid conversations. Sometimes we can manage these as part of therapy, but other times it’s going to happen outside of it,” says Dr. Berry.

Gillian recognizes how difficult that can be. She lives with her husband, who is a first responder, in a community where drinking is one of the main activities everyone does. “We have golf-carts where we drive around the condos, and everyone is always outside with a drink in their hands,” she said. Even her husband jokes that he needs to slow down – but he isn’t ready to do that himself yet. That’s one of the toughest things Gillian has to deal with since reminders and triggers are literally right on her doorstep. Through her work with Homewood, she recognizes those vulnerabilities, and also sees how different aspects of the programming she has benefited from over the years would help others she cares about too – from neighbours to her husband and her children”. She keeps on track by, “accepting the recovery rules, taking it a minute at a time and going with the flow.” She realizes that things won’t happen overnight and that continuing to attend daily recovery-focused meetings and practicing her faith helps her deal with the challenges she faces in the environment. She is also looking at getting back into volunteering and becoming more involved in service for others in recovery to help her find things she can be proud of accomplishing.

James, too, is working towards becoming a certified peer support to help other first responders confront their own situations and addictions courageously. He spoke about the pressures of being part of the culture within his profession – where there are a lot of people with big personalities who are controlling, and where socializing can be hard. “It’s a tough place to be sometimes, but I’m trying to be the better version of me that I know I have to,” he said. It’s for himself, but also his (now) wife, and their two young daughters. What he does differently now is talk with honesty and purpose, to everyone who will listen, and cultivate positive experiences and spaces at home, at AA, and at work.

Dr. Berry adds that kindness and self-compassion, understanding blame, and accepting accountability for all of your actions should be paramount in any recovery plan too because while you’re, “not solely responsible for all of the problems you face, you are ultimately responsible for the solutions.”

References

(1) Heshmat, Sharhram, Ph.D. (2017, May 10). Stress and Addiction, Psychology Today. Retrieved on June 19, 2019 from https://www.psychologytoday.com/ca/blog/science-ch…

(2) Alvernia University (n.d.), Coping With Addiction: 6 Dysfunctional Family Roles. Retrieved on June 19, 2019 from https://online.alvernia.edu/infographics/coping-wi…

(3) Centre on Addiction (n.d.) Addiction As A Disease: The Disease Model of Addiction. Centre on Addiction website. Retrieved on June 19, 2019 from https://www.centeronaddiction.org/what-addiction/a…

(4) Centre on Addiction (n.d.) Addiction As A Disease: The Disease Model of Addiction. Centre on Addiction website. Retrieved on June 19, 2019 from https://www.centeronaddiction.org/what-addiction/a…

(5) National Institute on Drug Abuse (n.d.) Drugs and the Brain. Drugs, Brains and Behaviour: The Science of Addiction. Retrieved on June 19, 2019 from https://www.drugabuse.gov/publications/drugs-brain…

(6) Smith, Fran. (2017) How Science Is Unlocking the Secrets of Addiction. National Geographic Magazine, Online. Retrieved June 19, 2019 from https://www.nationalgeographic.com/magazine/2017/0…

(7) Canadian Centre on Substance Use and Addiction (CCSA).(2019) Life in Recovery from Addiction in Canada. Report at a Glance. Retrieved June 19, 2019 from https://www.ccsa.ca/sites/default/files/2019-04/CC…

(8) Futures Recovery Healthcare (2018, October 29). 10 Tips For Creating A Sustainable Addiction Recovery Plan. Creating An Addiction Recovery Plan after Rehab. Retrieved on June 19, 2019 from https://futuresrecoveryhealthcare.com/knowledge-ce…

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