Читать книгу Self-Acceptance - Victor Ashear - Страница 13
ОглавлениеOrientation to Self-Acceptance
Not long ago, serious mental illnesses such as schizophrenia, bipolar disorder, and recurrent major depression, among others, often meant resignation to a life of institutionalization, a life devoid of any satisfaction or accomplishment. Fortunately, this prognosis of doom no longer applies.
With the rise of the recovery movement over the past thirty years, now more than ever before, hope exists for people diagnosed with serious mental illness to live full, meaningful lives. In fact, many people diagnosed with serious mental illness are leading normal lives that include career and family.
Improvements in the effectiveness of psychotropic medication contribute to this positive and optimistic outlook. In addition, newer forms of psychotherapy, including psychosocial rehabilitation approaches, such as social-skills training and illness awareness and management programs, have proven supportive of recovery. Most recently, cognitive enhancement therapies have been effective in improving ability to focus, organize, and problem-solve.
Even more important than these developments, in my opinion, is mental-health-services consumers’ expanding awareness of the possibility of personal change and growth despite the devastating impact of mental illness. Many peer-supported and self-help resources have become available to recovering individuals. The Wellness Recovery Action Plan (WRAP),1 developed by recovering consumer Mary Ellen Copeland, is but one example of such tools. The National Alliance on Mental Illness (NAMI) offers peer-led support groups for both consumers and family members of consumers to help recovering individuals help themselves.
With such a broad array of recovery resources, including self-help materials, what makes self-acceptance so important and why is this workbook necessary?
The Importance of Self-Acceptance
Loss of identity and self-esteem are among the most significant casualties people diagnosed with mental illness experience. For people diagnosed with schizophrenia, disorganized thinking and difficulty with accurately perceiving reality can interfere with maintaining a clear sense of self. Individuals diagnosed with bipolar disorder also struggle with identity: During the manic state of the disorder, the self may take on “grandiose” or superhuman proportions, but during the inevitable depressive state, feelings of guilt and inadequacy lead to feelings of worthlessness. For individuals diagnosed with recurring major depression or persistent depression, feelings of worthlessness may continually interfere with maintaining a realistic sense of self-esteem and a positive identity.
The nature of these illnesses can lead to a snowball effect in that diagnosed individuals commonly experience losses of employment and educational opportunity, as well as in relationships with family and friends and in other important areas of life. Because we often define ourselves by our vocational and social roles, when we lose these roles, we lose part of our identities, and this inevitably results in a diminished sense of self. This is especially true for those struggling with an already diminished sense of self due to mental illness.
In addition, stigma—negative attitudes or prejudice—associated with mental illness exerts an extremely harmful impact on consumers’ identities. This stigma leads many consumers to believe they are grievously flawed, which in turn, exacerbates their illness. A 1997 online survey conducted by NAMI2 showed that a majority of consumers were more negatively impacted by stigma than by the actual symptoms of mental illness—this even though the barriers mental illness symptoms pose to maintaining a positive sense of self are themselves substantial.
In the face of stigma and lacking a sense of self, any given diagnosed individual will feel undeserving of a life of quality, be less likely to engage in self-care, and be unable to understand that the possibility of recovery exists. Suicidal thinking may even occur. However, in spite of these devastating impacts, hope is not lost.
Patricia Deegan, PhD, is both a consumer and an advocate for diagnosed individuals, explained recovery from mental illness as a dynamic process that incorporates an individual’s strengths and weaknesses. She regards it as a personal journey that includes awareness and management of the psychiatric disorder but also growing into a positive regard for oneself and meaningful life roles beyond the illness.3 In short, the recovery process includes working toward a more positive sense of self in the face of the illness-related obstacles that threaten it.
Nathaniel Branden, PhD, defined self-acceptance in terms of being willing to take ownership and responsibility for our feelings, ideas, and behaviors without denying them and without condemning ourselves.4 I believe self-acceptance is the most ideal way to begin the work of rebuilding and enhancing one’s identity as the basis for recovery. This workbook is intended to help you as a consumer of mental health services increase your self-acceptance, enhance your sense of identity, and contribute to your growing awareness of your potential for positive change.
The Evolution of This Tool
My ideas about self-acceptance stem from a forty-year career of assisting people diagnosed with serious mental illness. I spent more than thirty-three of those years at the VA Medical Center in Sheridan, Wyoming, where I had the privilege of developing and refining programming, including this workbook, to help suffering individuals to recover. While at the VA, I had the honor of working with veterans over an extended period and the opportunity to observe the recovery process firsthand. I came to understand that even individuals with serious mental illness can recover, given supportive circumstances and appropriate tools—not the least of which is self-acceptance.
Much of the research on recovery from mental illness corroborates my experience. The next part of this introduction provides a brief overview of the history of our understanding of how mental illness and the stigma associated with mental illness undermines identity and recovery and how rebuilding one’s sense of self aids recovery. Following is a sample of the distinguished theorists and psychotherapists who believed the experience of self is central to treatment of and recovery for people diagnosed with mental illness.
Paul Eugen Bleuler coined the term “schizophrenia,” which literally means, “split mind.”5 Bleuler intended to convey that one of the paramount symptoms of schizophrenia is the fragmentation of the thought process, including the sense of identity. Building upon Bleuler’s work, Sue Estroff, a contemporary researcher in the field of the subjective experience of people diagnosed with serious mental illness, called schizophrenia an “I am” illness, conveying that having a mental illness strongly and negatively impacts sense of identity.6
Alfred Adler, noted psychoanalyst and associate of Sigmund Freud, the father of psychoanalysis, was one of the earliest mental health leaders to recognize the association of mental illness and low self-esteem, which he called “the inferiority feeling.”7 Adler was also one of the first to employ psychotherapy to assist people with serious mental illness, and he regarded helping patients pursue useful roles to promote their self-esteem as a goal of treatment.
Harry S. Sullivan, also a psychoanalyst, was well known for his work in enhancing the understanding and psychotherapeutic treatment of psychotic disorders. Sullivan theorized that problems existed in what he termed the “self-system” in individuals who developed conditions such as schizophrenia.8 Sullivan and his followers relied, in part, on improving patients’ self-systems to assist them in their recovery.
Carl Rogers, renowned psychologist and originator of “client-centered therapy,” worked with individuals suffering from a variety of psychological problems, including serious mental illness. He maintained that low self-esteem is a major component of all mental health problems.9 His methods of “active listening” and “unconditional positive regard” were shown to be associated with improvement in the self-esteem of his clients and the amelioration of their symptoms.
The psychiatrist R. D. Laing devoted his career to assisting individuals diagnosed with serious mental illness. In his book, The Divided Self, Laing described how suffering individuals lose their connection not only to the social world but also to parts of their identities.10
Over the past thirty years, researchers in the field of recovery from mental illness have demonstrated several key points you might find useful in your own journey of recovery:11
• Mental illness contributes to confusion or impoverishment about one’s sense of identity or “who I am.”
• Stigma associated with mental illness also plays a huge role in eroding self-worth and identity. Stigma can exist internally, stemming from one’s own negative attitudes about mental illness before illness onset, while the attitudes of other people, including family, coworkers, and neighbors, can perpetuate it.
• Recovery seems to proceed best when the diagnosed individual accepts the fact of having an illness but does not self-berate or self-stigmatize.
• Awareness of and building upon personal strengths and interests support the recovering individual. Therapeutic techniques aimed at increasing awareness about one’s identity also facilitate recovery.
• Psychotherapy techniques such as cognitive behavioral therapy (CBT) can foster a more realistic and holistic sense of self, helping to improve self-acceptance and facilitate recovery.
• Peer and family relationships can be vital to promoting recovery.
The remainder of this introduction features the story of Vanessa Hastings and her experience with mental illness. Vanessa describes classic symptoms of anxiety and depression, including obsessive thinking, social withdrawal, sleep disturbances, weight gain, crying spells, fatigue, and suicidal thoughts. Depression, anxiety, and other mental illnesses are often associated with experiences of loss. In Vanessa’s case, childhood losses included a separation from her parents at an early age, domestic conflict that left her with unmet needs, and a traumatizing altercation with her father during her teens.
Later, various medical problems and her father’s chronic illness and early death added to her anxiety and sense of loss. Yet, she has managed to actively support her recovery from mental illness by not only relying on psychotherapy and medication but also by engaging in frank yet gentle self-reflection, moving beyond blame, allowing herself the space and time to grieve her losses, and remaining determined to rise again after each setback. I hope Vanessa’s story inspires you to work toward self-acceptance and come to believe that you too can recover.
My Recovery from Anxiety and Depression
By Vanessa Hastings
As I recall my nearly lifelong battle with mental illness, I envision the phoenix, that fiery mythical creature so often depicted in slow, laborious ascent, the embers and ashes of its apparent destruction sliding from its golden wings. This imagery serves as one small component of my recovery.
The first signs of my depression surfaced in junior high, when I started to become a little edgy and cynical. Many adolescents temporarily exhibit these characteristics, but they became ingrained in my personality, protective and even fun on simmer but harmful at a boil, and my teenage angst became a long-term love/hate affair with obsessive thinking.
In high school my first serious romance thrived on and fed my dysfunction. To be fair, my boyfriend and I brought out the worst in each other, engaging in intermittent periods of verbal and physical abuse that eventually became the norm until I found the strength to break it off. My parents, divorced now for the second time, were missing in action, and I fended for myself on a number of levels. When my generally loving and doting father tried to reassert his authority during my senior year, I stood my ground; he physically attacked me, and then I moved out. These situations put me in a state of hypervigilance, a place I’ve visited more than a few times since then.
The transition from high school to college kicked off my first serious bout of depression. I managed to excel academically, but otherwise, I made few friends, slept often, gained weight, and cried almost constantly. My first sessions with a therapist shed some light on the roots of my distress, but I continued on a path of dysfunction, not only in my relationships with men but also in my friendships with females and in the way I conducted myself in the workplace.
Despite considerable stigma against help-seeking here in rural Wyoming, where people tend to revere stoicism, I read numerous self-help books and saw therapists through the rest of my twenties and into my early thirties, relying on one in particular to gain significant personal insight and to survive my maternal grandmother’s suicide and my mother’s suicide attempts. I continued to experience debilitating depressive episodes, but I sensed the key to my recovery hovering just beyond my grasp.
My epiphany came after a particularly short but destructive romantic relationship and an online study of abandonment issues. I called my dad’s sister, who had taken me in during times of domestic violence between my parents throughout my childhood. “When did I first come to stay with you?” I asked.
She hesitated. “Well, you were about two and a half, and things were pretty bad between your mom and dad,” she said. “I asked them if I could take you, and they agreed. We even arranged to have custody of you, so we could make decisions in case of any emergencies. In fact, I think we still have custody of you.”
Despite feeling slightly stunned, I laughed a little at that. “How long did I stay with you?” I asked.
“About six months,” she said, adding that I saw my parents only a few times during that period.
I felt immense pity and grief for that helpless little girl and gratitude for my aunt and uncle, who surely saved her from a much more destructive life and an early death. At the same time, I understood that any child who endures trauma, such as a lengthy separation from a primary caregiver before the age of five, is likely to suffer and struggle into adulthood.
After that call, I finally knew what was broken, and I knew I could fix it. I began to ask more questions about my past and consider its place in the bigger picture of my family’s journey, partly to prevent dark history from repeating itself, partly to gain better self-understanding. But I have tried not to spend much time blaming my parents and their parents for the harsh parts of my childhood and the resulting challenges I face today. Instead, I try to compassionately view my elders as my peers in shouldering the burden of the negative aspects of our legacy. Otherwise, wallowing in blame eventually gets me stuck.
I also found that self-reflection plays a crucial role in recovery. This grueling but worthwhile process involves finding the courage and strength to study your flaws and take responsibility for them without beating yourself up, an exercise featured in this workbook. Initially, this means tuning in to, examining, and possibly changing your inner dialogue. In my case, I began to notice an anxious and critical tone to my conversations with myself. That quickly led to another crucial insight: My primary problem is anxiety, which, in turn, underlies my depression. Discussing this discovery with my therapist and friends who work in the mental health field clarified the evolution of my mental illness.
As a child growing up in a sometimes-volatile environment, I learned to prepare for the worst and remain on high alert so I could respond accordingly at the first sign of trouble. If I “failed” to ward off negative outcomes—even those beyond my control—then I took a berating not only from external sources but also myself, which exacerbated my anxiety and led to feelings of worthlessness. “Success” at keeping the peace reinforced my reliance on this survival technique, which, like any repeated behavior or activity, deeply entrenched neural pathways in my impressionable young brain, setting the stage for a general mode of operation that caused more problems than it solved in the first twenty years of my adulthood.
These discoveries and ongoing self-reflection have helped me make considerable strides over the past decade: I married a sweet and supportive man, developed healthy and mutually satisfying friendships, and improved my workplace conduct. Major life challenges during that period, however, threatened my overall recovery from mental illness.
In 2006, I moved from Casper, Wyoming, to Sheridan, a small community in the northern part of the state and my hometown, to spend time with my father and take care of him because I knew his time was short, even if he didn’t. At that point, my depression was in remission, but I began to experience intense pain and spasms in my lower back, among various other symptoms. Running, which had provided me with fitness, weight-control, a competitive outlet, and a certain level of mood management, slowly became unbearably painful. A seemingly never-ending search for answers ensued, and my medical issues forced me from self-employment as a freelance writer and editor into the local nonprofit sector, where I eventually became the county’s suicide prevention coordinator. As I spiraled into yet another depressive episode, I asked my gynecologist to prescribe me Cymbalta, an antidepressant my father had found useful for pain and mood management. Since half of my DNA comes from him, I reasoned, the drug would likely help me, too.
While Cymbalta somewhat alleviated my physical and emotional pain, I still could not engage in running and many of the other activities I enjoy without hurting. Believing that I deserve to live life to the fullest, I refused to give up my search for the underlying cause of my debilitation. Near the end of 2010, at the recommendation of my gynecologist, I underwent exploratory surgery, which revealed the presence of endometriosis. I opted to undergo a hysterectomy, hoping that would resolve my pain. Since I had decided early in my adulthood to forego having children for many reasons, I did not grieve the loss of my uterus. However, I chose to keep my ovaries to avoid going into surgical menopause at age thirty-seven. The procedure did help to some degree, and once I fully recovered, I was better able to narrow down another source of pain: my hip. Still, none of my local healthcare providers could pinpoint the exact nature of my problem.
At the beginning of 2012, my father became critically ill with end-stage chronic obstructive pulmonary disease (COPD) and nearly died. For several months after that episode he seemed to rally, and I fell into a false sense of security. Despite my chronic pain and because of my frustration with the side effects of Cymbalta, I decided to stop using the drug. Even with my primary care doctor’s guidance, I found withdrawal physically and mentally hellish, but I eventually stabilized.
That summer, six years after the onset of my chronic pain, I saw a Denver surgeon who concluded that running on a malformed hip joint for years had caused significant damage. When he explained that he could repair the injury and that I would be able to run again, I rejoiced, and we scheduled surgery for October. That August and September, however, my father experienced his second COPD episode, ultimately receiving intensive care in Billings, Montana, 130 miles north of Sheridan. As his medical power of attorney and his only child, I spent most of that five-week period with him, watching his suffering in horror and beginning to endure the most drawn-out, excruciating heartbreak of my life.
Dad managed to pull through again, to my uneasy relief. But by the time my surgery date arrived a few weeks later, my fight or flight response was “on” twenty-four hours a day. Completely frazzled, I agonized over the possibility that he might require another hospitalization or even die while I was in surgery or recovery six hours away in Denver. My anxiety skyrocketed as I simultaneously plunged into the deepest depression of my life.
Dad and I both made it through my surgery without incident. Managing his doctor’s visits, staying on top of my physical therapy, and trying to navigate a major transition at work made my recovery particularly challenging. When I burst into tears during one of Dad’s appointments, our shared physician convinced me to resume my antidepressant use; this time I chose Wellbutrin. I also began seeing my current therapist.
Around Thanksgiving, Dad endured his final hospitalization and passed away in his sleep at home just a few days after his release. Only people who have watched a loved one slowly slip away into the great unknown can understand the awful combination of devastating grief and guilt-ridden relief that follows.
As 2013 began, I made a promise to honor my father as well as myself: I would allow my grief process to unfold naturally, ignoring any societal pressure to stuff my emotions or avoid discussing my pain. At the same time, I strove to continue my recovery from surgery and to resume a normal work schedule. Six months later, my employers fired me. Undoubtedly, my job performance had declined, but the news initially came as a significant blow to my ego and my finances.
Yet, I soon began to view my firing as a blessing in disguise. I found suicide prevention gratifying, but my role had forced me to extend myself far beyond my natural boundaries as an introvert, requiring great amounts of energy without allowing enough time for rejuvenation. Now I could take time to rest, grieve my father, and resume my quiet career as a freelancer. Dr. Ashear, whom I met through the Sheridan County Suicide Prevention Coalition, asked me to help him prepare this outstanding workbook for public use; getting to know this gentle and compassionate man has been a privilege, and our collaboration sometimes feels serendipitous. I also started making a number of lifestyle changes, from incorporating vitamins and supplements into my diet to reducing my alcohol consumption to scheduling regular massages and chiropractic adjustments.
Meanwhile, just when I thought my life was beginning to settle down, I realized my hip surgery seemed less than successful overall. My physical therapist explained that my injury had left me with stretched ligaments and that no amount of strengthening would rehabilitate them completely. The implication that ongoing pelvic instability would haunt me for the rest of my life, perpetuating my chronic pain and making running impossible, crushed me.
Not long after that, I noticed the onset of new internal pain. My gynecologist suspected that my endometriosis had returned, and she advised that only the removal of my ovaries would solve the problem. So, with the first anniversary of my father’s death looming among the holidays, and in the face of turning forty without his goofy rendition of “Happy Birthday to You,” I chose to undergo yet another surgery. I felt uncertain about my decision for I feared I would find surgical menopause even more debilitating than living with endometriosis. Chronic pain and associated exhaustion had already overshadowed the most recent decade of my life, dulling the shine of milestones, stealing peak years of athleticism, forcing me to give up endorphin-inducing running, and ultimately worsening my depression.
After so much hardship, and with so much uncertainty ahead of me, I finally crumbled. I cried out to my father, begging him to rescue me, to pull me mercifully from the void of anesthesia into his new world, where I could rest easy with him, free of physical and emotional misery. I told my husband, my closest friends, and my therapist that I yearned for the convenience of death on the operating table, not for dramatic effect, but so that if my father did come to guide me home, they would take some measure of comfort in knowing I was ready.
As the former suicide prevention coordinator for my community, I possessed the training to recognize that I was passively suicidal, but I just didn’t care. I was tired of physical pain, tired of my anxiety and depression, tired of being tired.
When I came to after my surgery, I felt both disappointed and grateful that I survived: I still longed for my father, and I dreaded continuing to live in pain, but I felt a small spark of hope that I might enjoy life again. Since then, I have continued to grieve my father on my own terms. Under the care of a naturopathic doctor in Billings, I have undergone unpleasant but successful prolotherapy treatments on my ligaments, and I have resumed running. That same doctor has helped me manage my hormone replacement therapy, and she diagnosed me with a thyroid disorder, which very likely has played a role in my depression. Treatment for that condition is proving effective, and after a long weaning process, I discontinued Wellbutrin. I take care to monitor how much responsibility I take on in all aspects of my life, and although I am not religious in the traditional sense, I have made a practice of daily prayer, which has made a positive difference.
Last but not least, going through the process of working this workbook has provided me with the opportunity to take my recovery to a new level. For one thing, sharing my story and my responses to the enclosed exercises to help you and others boosts my self-esteem. For another, the exercises have reinforced the positive strategies I previously used to cope with my struggles. I have also gained new insights, particularly understanding and acceptance of my limitations, and I am developing new coping mechanisms, most notably the ability to treat myself with the same gentleness I would extend to anyone else suffering from physical, emotional, or mental pain.
To my fellow phoenixes, this workbook will challenge you, but if you see it through, the thundering of your wing beats will soon fill your ears as you soar higher than you ever imagined. Warm wishes to you as you embark on this leg of your journey.
