Have you ever had a day, a month, or, heck, maybe even a whole year or YEARS that really tested your resolve? A time that really pushed you mentally, physically, socially, spiritually to the edge? Maybe your sleep was troubled and you ate what you could when you could. Perhaps you forgot to call and text your family and friends back despite thinking of it a few times a day. Or you re-scheduled that dentist appointment for the fourth time because there just aren’t enough hours in the day. You were just going, going, going until BOOM – you crashed.

That was my year this past year. It started when my father-in-law passed away after a decades-long battle with multiple sclerosis. Soon after, I got pregnant with my first child, then quickly realized that my “morning” sickness would be all-day, everyday sickness, making basic daily life tasks and work nearly unmanageable. When my water broke at 26 weeks and 1 day, I was hospitalized with the intention of delivering at 34 weeks. That changed as my baby girl decided on New Years’ Eve that she was ready to party and I delivered her at 29 weeks and 6 days. She was in the NICU for nine weeks, the first six of which I spent desperately willing my body to comply with my diligent attempts at pumping and breastfeeding. 

Now, some of these challenges were of the “life’s tough, get a helmet” variety, and some of them were the “life’s tough, a helmet won’t help because you’re getting thrown in a life-sized dryer that’s set on 400 degrees while you’re constantly poked and ‘it’s a small world’ is being played on a loop for an unknown period of time.” We’ve all been there, I’m sure.

I quickly started to recognize how all of my systems were tested. I was physically drained; unable to eat when pregnant, then unable to eat enough while breastfeeding, weak from lack of movement for months of sickness and hospitalization, and exhausted from lack of sleep. I was emotionally depleted, a true roller coaster of emotions– going up high as I stared at my beautiful girl in her incubator and then plummeting into the darkness, enraged that she had to be in an incubator and blaming my body for not nurturing her longer in utero or producing enough breast milk to nurture her after delivery. Socially, I was a robot, reaching out to my support system when I could with updates and knowing I needed help but often not knowing where to begin. My faith oscillated between being upset with God and wondering why this was happening and pouring my faith out, asking for our baby to grow and thrive. Everything was at its breaking point.

In integrated care, we talk about having a whole-person, biopsychosocial-spiritual approach where we must assess and care for each of these systems and their intersection. And we see stories like mine often, in which all of the issues within our systems are exacerbated by one another. For instance, an older woman caring for her two grandchildren while dealing with depression and diabetes is unable to take the time to manage her diabetes because she is pulled in so many directions, leading to her struggling emotionally as her blood sugar irregularities impairs her mood and her depressed mood contributing to a lack of care for her diabetes. Or a farmer who is working sixteen hours a day at the cusp of a new season, terrified to see how much damage his crops experienced from the most recent freeze while also experiencing high blood pressure, ulcers, chronic back pain, and significant anxiety and depression. This, of course, all goes unmanaged because he must focus on ensuring that he feeds not only his family this year, but many others, and his social circle consists of those whose livelihoods depend on him. At times, it is a change-making conversation with a provider that can really turn things around, as was the case with me.

My lactation consultant, therapist, and my OB all let me know that I could stop pumping and trying to breastfeed, and to put my own health first. My daughter’s providers consistently asked about my well-being during rounds each day. And then there were the (frequently unanswered) texts and emails I received from friends, family, and colleagues, letting me know that they were there if I needed anything. So, slowly, I started looking at the different parts of my life that were suffering at my own hands. The internal and societal pressure I felt to breastfeed that was no longer serving me. The lack of sleep that was clouding my emotions and decision-making abilities. The very real postpartum anxiety I faced that rendered me a shell of the person I recognized, just going through the motions to survive each day. And with the support of others and some real action steps that tested me in new ways, I have made significant progress.

I have a healthy and beautiful four-and-a-half-month-old daughter and a partner who supports us in every way. I’m spending time with my family and friends, finally introducing them to our little JoJoBean. I’m able to move my body again when I want and where I want (and not just in the confines of WakeMed hospitals!) despite losing so much of my muscle mass. I am able to eat more than cereal and bananas and my appetite has returned in full force. My family and friends have finally gotten to meet and love on my daughter like I imagined they would one day during those months in the hospital. I utilize my faith to express my gratitude for the positive outcomes of this past year as well as for comfort when I have flashbacks to the darkness of that time. And I’m in therapy to work through the trauma of the past year and to ensure that I continue to nurture all of these parts of my being. I have a renewed drive to make sure that all of me, especially the parts of my life that I am in control of, are cared for. When we’re able to apply this same nurturing approach to all parts of ourselves, we can start to feel some peace and joy again within ourselves and our relationships– and we can wear our “life’s tough” helmet and feel safe to avoid a crash.

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

In the behavioral and mental health space, we talk often about the biopsychosocial (BPS) model that was developed in the 70’s by psychiatrist Dr. George Engel. As we move in to 2023, some might reference the BPS model when talking about whole person care, a phrase that is firmly taking hold in healthcare overall. Our healthcare systems are acknowledging that there are elements beyond the physical domain that need to be taken care of if we are going to see improvements in a person’s overall health and well-being. However, we all seem to still be working on incorporating one more component of truly whole person care, and that is spirituality. In 1996, quite some time after Dr. George Engel wrote about this new BPS framework, a group of clinicians (Wright, Watson, & Bell, 1996) emphasized the importance of beliefs and of making meaning around illness and health, adding in effect, the spiritual component to the biopsychosocial-spiritual framework. It is time we embrace this idea of spirituality even more and see the benefits it can add to our mental health.

Spirituality is often confused with the idea of religion or religiosity. For most people religiosity represents a concept that is based in an organization, whereas spirituality sits more within the individual and the meaning that the person makes around their life. Spirituality, however a person defines it, can be incredibly important to consider when thinking about mental wellbeing. Most people are looking for a sense of connection, a sense of meaning and greater purpose and a sense of where they belong in the world. All of these types of questions and explorations often bring conversations back to a spiritual part of life.

Often when a person is suffering with a bout of depression or anxiety, they can have a deep sense that they are alone in that experience. It can indeed feel incredibly isolating when those symptoms appear. It is important that we talk about building a skill set or coping tools to use when they feel that sense of disconnection. It can be quite helpful and that tool kit can involve elements of spirituality. For example, thinking about getting connected through community service, especially one where you work with others on a shared project (ie: packing boxes for a food bank). Speaking from personal experience, when I have had the opportunity to work with complete strangers on doing something good for people I will never meet…well, it did a world of good for my mental wellbeing and my sense of connection to a greater purpose. If a person is not quite ready to engage with people, spending time with nature outside can be an incredibly soft entry point to stepping into our sense of interconnectedness. Spending time outside observing the activities of local birds and wildlife, looking for the many patterns, or fractals, that can be found in nature. Spending time self-reflecting and journaling, though I acknowledge writing is not enjoyable to everyone, spending time thinking about things a person is grateful for can also help them get in touch with their connection to others and the deeper meaning of their life.

Spirituality can seem really personal, even when you are amongst friends, but often times I find that people have more in common with their beliefs than they have different. If we can see these commonalities then it can help foster an even greater sense of connection and deeper meaning.

Resources

NAMI FaithNet

Harvard Study on Spirituality and Better Health Outcomes (2022)

Mental Health America – Tips on Taking Care of Your Spirit

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

Can you think of a person in your social circle who makes you laugh easily, helps you feel heard and understood, and feels energizing to be around? Relationships, and relational health, are instrumental in our mental well-being. As part of our Mental Health Awareness Month series, which we kicked off last week (https://bit.ly/3VzZslH), we will be exploring mental wellbeing from a biopsychosocial-spiritual framework. Last week, we focused on awareness and recognition of some psychological symptoms of mental distress and avenues for support. This week we are diving into our social health, or relationships.

Having supportive social connections is associated with better mental health, higher self-esteem, better recovery from illness and disease, and a longer lifespan. The longest standing relationship we will have in our lifetime is usually with our romantic partner, but if we are lucky, we experience extremely fulfilling relationships in all walks of life: parenthood, friendship, colleagues, community, and more. Investing in our social health can be challenging if you are very introverted, isolated, or maybe are struggling with mental health symptoms that make it difficult to give energy to your relationships. Relationships can also be a source of stress when there is conflict or unhealthy boundaries, which we will talk about in a moment. First, let’s explore – how do we get support for our wellbeing through relationships?

Soliciting Support

Bringing you back to the person you thought of in your life who gives you joy and energy, what type of effect have they had on you when you were struggling? We can derive a lot of healing from being around people who feed us emotionally, rather than feed from us. During times of struggle, these key support people provide a safe space to ask for support. How often do you ask people in your support system for a venting or processing session, or even advice?

Keeping your emotions bottled up can lead to an increase in cortisol levels. Over a long period of time this will likely impact your physical and mental wellbeing. Whether you like to communicate over the phone, video chat, texting, or journaling, talking it out can be a big relief to your nervous system. When asking for support, clarify whether you need someone to listen, or if you are asking for solutions. It can feel awkward asking other people to explicitly support you, so here are a few conversation starters to have in your toolbox for initiating that conversation:

• Can I talk through something with you? I just need someone to listen to me right now, I’m not ready to take action or think of solutions.
• I’m having a tough day and just needed to share that with someone.
• I’ve been feeling kind of lonely lately. Do you want to meet me at the park for some quiet time? I think it would be helpful for me to be around someone right now.

Giving Support

When someone approaches us for support, our instinct is to try to jump in and offer a quick fix, or solutions to solve a problem. That can often be overwhelming to the person needing support, so try to temper that initial reaction to offer solutions and make sure you are “listening to listen” first, rather than listening to react. Here are a few suggestions to keep in your toolbox for how to respond when someone needs support from you:

• I hear you, and I am here for you. Do you want to share a little more about what has been going on, or do you want to think of some action steps together?
• I’m sorry that you have been dealing with this. I understand how you feel. Is there anything I can do to help?
• Hey, I was just thinking about you. You don’t need to respond, but I wanted to let you know I’m here for you if you want to talk.
• I hate that this happened to you, it sounds really challenging. Thank you for opening up to me, I will do what I can to support you.

Setting Boundaries

Remember that person you were thinking about when prompted with “brings you joy” and “makes you feel understood”? Now, think of the opposite. Do you have someone in your life who feels draining to be around, like they emotionally feed from you, but you get nothing in return? Maybe someone who is overwhelmingly negative and critical, quick to stir up conflict? Yes… them.

First, take a deep breath. You are not alone! We all have relationships that challenge us.

Second, can you find points of empathy for this person? If we can have empathy, it will help us be less reactive to the relationship dynamics that bother us. For example, understanding that your colleague is going through a difficult divorce may help you understand their bluntness during team check-ins. Knowing that your colleague has a high level of personal distress that has nothing to do with you can help you de-personalize their blunt comments in the team meetings.

Third, in all relationships, we need boundaries. Boundaries are perhaps the most uncomfortable, but most essential, function in relationships; especially to protect our mental wellbeing. Boundaries help us communicate our limits and teach people how we would like to be treated.

What does it look like to set a boundary? You decide for yourself what your boundaries are, and it is your responsibility to communicate them. Ideally, you communicate boundaries verbally and follow through with your behavior. Here are a few ways to clearly state your limit or expectation:

• I am not in a space where I can hear about that right now. I would appreciate it if you spoke to someone else about this.
• These conversations tend to turn into criticism about me, which makes me completely shut down. I can’t continue having these conversations unless you respond respectfully and listen, and I will offer you the same.
• I don’t let people talk to me that way. I think we should take a break from this conversation and revisit it in a few hours/days.
• I would love to help/attend, but I would be overcommitting myself. I am sorry.
• I am struggling myself right now and I don’t feel equipped to be your primary support.

Discomfort from setting boundaries often comes from other people’s reaction to them. But remember, in adult relationships, it is not your responsibility to manage the emotional experience of others. We are often guilty of not setting a boundary in fear of hurting the other person’s feelings. We should be respectful and kind, but we are each responsible for our own emotions. If you do not follow through on your boundary, the person it is most likely hurting is you. Also remember, the people who react most strongly to your boundary setting are likely the people who benefitted the most from your lack of a boundary.

While setting boundaries can sound like you are handing out restrictions left and right, it is usually very liberating. We invite you to actively partake in giving and receiving support this month in honor of Mental Health Awareness and explore boundaries for yourself that could benefit your mental and social health.

—

Relational Harm

Reading about giving and receiving support and setting boundaries may have made you consider whether you’re in a healthy relationship. Please know that there are resources available for you if you suspect you are in a harmful relationship.

If someone you are in a close relationship with says hurtful and demeaning things to you, threatens physical harm, uses violence such as pushing, restraining, or throwing objects, demonstrates jealousy and controlling behavior – that is NOT okay.

National Domestic Violence Hotline: 800-799-7233, or text START to 88788

North Carolina Coalition Against Domestic Violence

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

May is Mental Health Awareness Month and it cannot be denied that mental health has become a focal point of many broader discussions in our state and country over the last few years. There is no question that the COVID-19 pandemic worsened the state of mental health in North Carolina and beyond. According to Mental Health America, approximately 1 in 5 adults in our state are experiencing a mental illness.

Mental illness used to be surrounded by significant stigma, as something that people had a tough time understanding. There was a misconception that mental health concerns or illness could happen to “others” but not you or your family. For better or worse, this lack of understanding is becoming a thing of the past. For many people, the COVID-19 pandemic exacerbated a myriad of issues and mental health was certainly one of them. Isolation, fear of sickness, actual sickness, and loss were universal reasons that people across the globe came to understand what it was like to feel anxious or depressed. For those not doing well with their mental health, their symptoms tended to worsen over the course of the pandemic. And for those who did not have mental health symptoms before the pandemic, many began to experience these symptoms. Now that the world has seemingly picked up where it left off, many are still left with a feeling that things are not quite how they used to be before the pandemic. Mental health exists on a continuum and depends on several factors including, but not limited to, life circumstances, genetics, zip code, trauma, and resilience. Today, you may find yourself at a point on the continuum of mental wellbeing that you did not anticipate.

Recognizing the Signs

It can be difficult to recognize the signs and symptoms of a mental health disorder. Research shows that it can take upwards of ten years from the onset of symptoms to beginning treatment (NAMI) This common delay in receiving treatment, for whatever reason, makes it critical that we begin to recognize in ourselves and in our loved ones when we might need a little extra support.

People often miss these symptoms because they manifest physically such that they land in their primary care office wondering why they have periods of racing heartbeats or daily headaches. Gastrointestinal upset and even difficulty breathing can be physical symptoms of moving towards the illness side of that mental health continuum. This is not to say that these symptoms are always indicative of mental health concerns, but to consider that possibility when taking in the bigger context of a person’s life.

Stomach pain	Back Pain	Fatigue	Poor hygiene
Stomach upset	Headaches	Weight changes	Repetitive tics
Sore/tense muscles	Insomnia	Hyperactivity	Restlessness

Other symptoms might be less surprising, such as feelings of sadness for two weeks or more, or an increase in drinking or using substances, often to self-medicate or escape the thoughts that might be upsetting. So, what does a person do when they notice these in themselves or a loved one?

Examples…

               “I knew I was struggling when I had several weeks when I would finish work for the day and just wanted to go straight to sleep to get the day over with and go to the next one. There was nothing that I looked forward to or found joy in, and I wanted time to pass me by.”

               “I was so fixated on my family’s safety, to an extreme level. I would panic when they would go to school and work and could not sleep at night thinking of all the ways I needed them to be safe. My body and mind were on edge 24/7.”

               “I could feel myself being reactive and irritable towards my friends, coworkers, and partner. I was so annoyed with everyone. I just wanted to be alone. Then I would feel terribly guilty and try to re-engage, only to find myself so irritable again with no emotional energy to give to my relationships.”

Connection

Conversations about coping and toolboxes are often found in a therapist’s office, but there is no reason those conversations cannot be had among your support system, including friends, family, and colleagues. True connection with others makes a difference in our lives.

What do you do when you start feeling not quite yourself? When you find yourself worrying about a bunch of stuff or feel like a lead balloon and can’t quite get out of bed? These are the conversations that can help you feel validated about your emotional experience and prevent the slide down the continuum towards more severe mental health challenges. Connection is one of the best protective factors for managing and mitigating mental health concerns.

Coping

What could some of those tools or coping strategies be to help you stay in the mental wellness part of the mental health continuum?

• Keeping with the idea of whole person health, often strategies that ground a person in their body can be very helpful. Research has shown that getting into nature and getting outside can really provide a myriad of cognitive and psychological benefits. Walking, stretching, simply moving our bodies can also be extremely helpful as a coping tool.
• Developing a sense of connection either through personal relationships or volunteering can be helpful.
• Setting very realistic and achievable goals can be the first step towards deciding how to find what works for you.

Of course, these are techniques for when you just notice a slide into worsening mental health. If symptoms become more serious then additional support like talk therapy and medication may be in order. Many people are caught off guard when their mental health takes a hit, and they find themselves in what we would call a clinical distress category. A clinical level of distress is when symptoms impair functioning, such as mental health symptoms disrupting your work or home life. Having that level of disruption in your life indicates that professional support is needed. However, we do not want to wait until we are feeling that bad to start taking steps to take care of our mental health.

In fact, as much as exercise and nutrition have become integrated into conversations about our overall health, mental wellbeing management should become a part of that conversation as well. Let’s start talking about how we take care of ourselves and when we need additional support and help reduce the prejudice and discrimination that often still exists if professional support, such as therapy and evaluation for medication, is still needed.

In celebration of mental health awareness month, as licensed therapists ourselves, we will be sharing our insights into the bits and pieces that can help support mental wellness for the rest of the month and hope you will join our conversation.

Resources:

CDC Mental Health Toolbox

NC Therapy Directory

Find a Therapist

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

While the month of May flew by, the idea of mental health awareness, is here to stay. Now more than ever, Americans are talking about their mental health in a way that is forcing the conversation around the unnecessary stigma of seeking support. No longer in the shadows of healthcare, mental health is slowly gaining parity in terms of the conception of when and how people can seek support. Prevention is no longer just for our physical health, but it should be for our mental health as well. This month’s blog entries focused on the development of a young adult who benefitted from systemic changes in our healthcare system that provided him access to preventive mental health services. The Foundation for Health Leadership and Innovation has brought these words to life in this cartoon sketch of Alex. Let’s all take a minute to envision a life where our children are able to live a life of intentional wellness rather than a life of reactivity.

https://www.youtube.com/watch?v=lDD2GqGBvgA

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

*For the month of May, honoring Mental Health Awareness, the Center of Excellence for Integrated Care, a program of the Foundation for Health Leadership and Innovation, will host a series of blogs following Alex. These weekly journal entries from Alex begin in 2032 when Alex is 18 years old. Over the month Alex will reflect on the benefits gained from living in a system with preventive mental health policies as they grew up.

*Week 3 flashes forward to Alex in their late 20’s and fully engaged in adult life in their community. Alex is employed and continues in a serious relationship considering future plans with that person.   

“Life is plugging along nicely. I haven’t gotten a chance to write in this journal as much as I would like.  Life is busy now that I have gotten the promotion I was hoping for and Frankie and I have been traveling so much. Things are getting serious with Frankie and I am excited. I feel like we have found our groove as a couple, and we have the support of those around us as well if we decide to move forward.

When I graduated college, I realized I had actually made quite a good space for me there. Leaving college felt like I was leaving another nest or family of people who understood me and who shared a common goal. I felt like I floundered a bit looking for work and then meeting Frankie helped me not feel so lost out in the adulting world. Also finding other community groups that I took an interest in helped a lot as well with my overall wellness. Long ago during my pediatric days, I remember talking to Sam about being involved with groups or events around me to help me not get stuck inside my own head or in sort of an anxious state. In high school she got me to be involved in some clubs even when I did not want to, and what I probably liked most about those clubs was the community service. Now I volunteer even as an adult with a community food bank. Being involved and being helpful in that way always makes me feel useful and connected to others and somehow life seems more manageable. Yet another tool in my mental health toolbox that really doesn’t seem like a “tool” anymore, just seems like a part of my life that I enjoy and that makes my life more enjoyable.

I also finally found a church that fits for me as well. It might be a little different than what I grew up with, but I had to find a church that I felt good about and that I wanted to be connected with. It just so happens this church does a lot in the community as well and even serves as a distribution site for the food bank I volunteer with. I have been involved with a young adult group through the church as well and might be considering leading a group, but I am just not quite sure I am there yet. We’ll see what the future holds. It feels so good to talk to my parents about where I am in life and how well things are going. I think they were worried about how I would do moving from such a small town to a bigger area in the state. We talk a lot about how grateful they are for Sam’s role and my pediatrician’s role in preparing me to launch out on my own.

Well, who knows when I will get time to sit down and write again – but life is good! “ Thanks, Alex

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health

Posted in Mental Health AwarenessTagged #mentalhealth, Mental Health