I am woefully behind on certain aspects of my life including moderating this discussion forum, and while I hope that is not the case for each of you, I can’t say that it’s all bad…and that’s pretty much what I want to put forth in this topic: functional prioritization when everything seems like it might be too much.

At the core of this topic is what — at least for me — I wouldn’t trade for the world, despite the occasional difficulty. The truth is that I can’t complain about a sometimes overwhelming life. I am fully cognizant of how lucky I am to have the opportunity to be overwhelmed by stresses and triggers and “too much.” There were (and may in the future be) times in my life when that was not the case, when all I could do all day each day was work on keeping my head in one piece. So, I do not intend to complain about my good fortune, but it is a very important part of my daily existence that I be able to gauge when it’s necessary to step back and take a mental inventory of my life so as to keep that life going.

Without dumping it all here (although I probably will in the discussion), let’s suffice it to say that, as I’ve mentioned briefly before, my life has been upended, and I’m hoping the Me that emerges is a more aware and intact me than I’ve ever been. This however takes time and attention.

So, here are the questions: Given the responsibilities — to our loved ones, to our jobs, to our lives, to ourselves — that we are fortunate enough to have, that we’ve worked hard to create, How do you step back when you need to? Are you able to recognize if or when you need to? How do you explain needing to take some time away from your typical activities? Do you try to explain? And, lastly, because my sense of responsibility and obligation has caused rather self-destructive decision making in the past, What happens if you don’t step back when you need to?

As a final note, it seems now would be a good time to remind everyone that you should always feel free to send me topics for discussion. I’ll be happy to post them up for the group.


As usual these days, I’m a little late to the party. This past week was NAMI’s Mental Illness Awareness Week, which provides an easy means toward reminding everyone that Define Functioning is collecting contributions for its first book project.

The project (first announced, conceived, and introduced in May) simply asks one question: What do you want people to know? The responses gathered are being collected into a small publication to be launched in time for next year’s Mental Health Awareness Month (May). The hope is that among the other methods of spreading awareness, we may not only add our voices but that we may also bring attention to the issues and concerns of our particular corner of the MI community.

I will continue to collect responses until the very last moment I can. Until then, feel free to enter contributions into the comments of any post about the project (like this one right here!) or to email them directly to definefunctioning [at] gmail [dot] com. Specific contributions will not be attributed, although credits will be listed (by the screen name under which responses are submitted) at the back of the book.

Thanks again for everyone’s participation!

I found out via Jen’s Place in the Blogosphere that it was National Invisible Chronic Illness Awareness Week a couple weeks ago. I am (as I am usually) a little late to this party, but given that awareness is one of those things that shouldn’t really be limited to a week, I figure there’s no harm in suggesting you bloggers out there contribute your thoughts via this 30-point meme.

[PS — The new and improved DF layout lets me post “asides” in addition to full-blown entries. Pretty cool, right?]

Insurance Ad, 1935 (Click for source)

Without going into too much boring detail, let’s just say that I’m in the middle of two completely separate health insurance problems, with completely separate insurance companies. On one hand, I’m trying to resolve a series of claims with my previous insurance company from last year with regard to which that company is exhibiting some of the most asshole-ish, unprofessional, and borderline illegal behavior I’ve seen in a long while. On the other hand, I’m trying to establish new coverage with a different company that is clearly operating in some sort of discriminatory loophole.

So, I gotta ask: How do you pay for your mental health care? If you are insured, do the technicalities of your insurance plan have an effect on your care? (Does it affect your visits, your provider choices, which medications you take?) If you are uninsured, how do you manage?

On top of all that, shall we start a discussion on mental health parity in general? It’s no secret that mental health care is really very expensive. It’s also no secret that more often than not mental illness impedes one’s ability to work. Further, it’s no secret that pharmaceutical companies are out there to ruthlessly gouge whomever will pay and that insurance companies really don’t feel like being gouged. Tack on the stigma that suggests that mental health disorders aren’t “real” illnesses…and we’re looking at some serious problems, in the middle of which I am currently sitting.

Coming Clean (click for source)

Sometimes (perhaps if and when we are so lucky) there comes a time and a need to tell some (perhaps unsuspecting) soul about the things we think, the things we feel, the things we hear, the meds we may or may not take. My hunch is that it’s a conversation that some of us have practiced and that others have for the first time each time. Maybe there are long versions and short versions we tell. Maybe it’s something some of us have done more than a few times and something some of us have never really done.

To whom, when, and how do you come clean?

Regardless of the differences, it’s not easy. And wrapped up in its difficulty are fears and misconceptions and persistent stigma and questions of responsibility. Compounding that difficulty is the understanding that this conversation crosses multiple thresholds, all of which constitute points of no return. Nothing said can ever be unsaid — and whether it’s with a friend or colleague or someone we’re starting to date, if a relationship will change after mental illness is disclosed, it will stay changed. We cross our fingers and hope for the best.

As I wrote “…and hope for the best,” I realized I have spent most of my adult life not knowing what it is that I’m hoping for in that conversation, not knowing what I thought the “best case scenario” really looks like. And, so I want to ask: What is it you hope for when you come clean?

To take that question just a tad further, For whose benefit do we talk about our illnesses? And what do you personally gain from it?

Clearly my routine has been shattered in the last few months. Perhaps almost as clearly, we know that routines are good for us as they are for everyone. It is my routine that adds a reliable sense of stability to my life, gives me something to count on each day and each week. In that way it provides a baseline measurement for me against which I can gauge myself. My routine is an important and necessary component of my own self-awareness.

That does not mean I live without surprises or spontaneity. It simply means that there are certain things I need to happen in a fairly predictable and regular pattern. I feel that might be the same for a lot of us, and given the last two discussion topics (here and here), it may be worthwhile to discuss those positive routine-oriented things that help us along on a day-to-day basis…whether they be as simple and mundane as waking up at the same time each day, indulging in some morning coffee ritual, regularly exercising, or something far more elaborate.

So, what’s your routine? To what extent do you think deviating from that routine may bring about triggers? How proactive are you in maintaining your routine, or how flexible are you able to be with it?

Lastly, I offer the all-important loaded questions: Do you feel limited by your routine? Do you ever wonder if the perceived need for reliable stability may be hiding new options and alternatives?

As mentioned in the last discussion topic, one of our forum members is currently hospitalized. All things considered, Alan Smithee‘s spirits are as up as much as be hoped. Her sense of humor is more or less intact. Still, there are serious frustrations and (what I would consider) degradations at play.

Pertinent Background: Four times in the last four days, since the day Alan was admitted by her doctor, I’ve gone to what is considered a perhaps better-than-decent teaching hospital in NYC. The first two visits were to the psych emergency room. The second two visits were to the inpatient ward. To be clear and fair, what I’m about to write is my opinion, some of which is derived from what Alan has told me of her experience…which is honestly good enough for me.

Some things that have happened in the last few days:

(1) Alan was first assigned a windowless shoebox of a room, with a sheet-covered bench and minus a clock, and made to wear paper.

(2) Alan has been informed of brand new and ludicrous possible diagnoses by psychiatric residents who’ve studied psychiatry for a fraction of the time Alan has spent dealing with psychiatrists.

(3) One of these new diagnoses was told to her in public. Alan was ambushed in a group session she was told to attend — a group for a disorder no one ever mentioned she may or may not have.

(4) Despite being an incredibly accomplished and intelligent person, Alan has been condescended to repeatedly under what I can only assume is the belief that mental illness makes a person stupid.

(5) Such condescension (I mean “condescension” in the most generous way) has manifest as clapping at her to signal meal time. That’s right, mental illness might also make a person a dog.

(6) This pejorative view of what Alan can and cannot comprehend has also led these newly minted resident doctors to decide that she should be informed of issues concerning her mental health and care on a need-to-know basis, wherein she is completely baffled by whom and how one decides what she needs to know.

(7) Alan’s attempts at (what she swears, and I believe, are calm and rational) voicings of reasonable frustration have been called “unsubstantiated anger” and have led to discussions of another possible diagnosis. I can only deduce then that treating a person with an operational vocabulary and the capacity for reflective critical thought as though they had neither would not anger just about anyone. I can also deduce that there may be no need to apologize if a person feels so disrespected.

(8) And for comic relief: I am glad that the hospital offers meal options that cater to dietary restrictions due to religious belief. Sadly, the hospital staff decided Alan’s relgion without inquiring and spent multiple meals feeding her accordingly, despite her attempts at clarification.

And those are some highlights.

(9) Oh. And she’s been called a liar.

Clearly, Alan’s functioning has been affected to the extent required for hospitalization. For the record, however, so much of what allows her to function throughout her life until this point is very much intact. Still, these frustrations and degradations have nothing to do with levels of functioning. I argue that a basic level of respect and humanity are prerequisite for treatment regardless of functioning or cognitive capacity. Have doctors forgotten the need for establishing trust with their patients in order to further treatment? Have they deluded themselves into thinking that psychiatry and psychiatrists hold any authority greater than that which their patients give them through that developed trust? (Sorry for the repeat question. I admit this is a hot-button issue for me.) Have they forgotten that the healthy development of self-worth is necessary for the treatment of so many mental health disorders and that such unabashed condescension does nothing but erode whatever self-worth is left? Do they fail to realize that this sort of unprofessional behavior only underpins, reinforces, and perpetuates the dehumanizing stigma that continues to keep people from treatment, that it only contributes to the shame-spiral so many suffer?

Lastly, what is an empowered patient to do when no one acknowledges his/her empowerment?