How Does Your State Rank When it Comes to Mental Health?

I don’t want this entry to get political, but I feel many people are going to interpret it that way. That’s the problem with providing data these days. There are no such things as facts if people don’t want to believe objective information, and most people take their talking points from whatever cable news channel fits their political party’s agenda.

Mental Health America, a well-respected, non-profit, non-political organization that is now 111 years old released their annual status of the country report that ranks states (and Washington DC) in very specific areas of cases of mental health and access to care.

I can only encapsulate their results, so I urge you to check out their full overall rankings at: https://mhanational.org/issues/ranking-states

I also don’t want this to become too ridiculously dry, so I’ll highlight only a few areas and if you don’t see your state listed, you can find it at the link above.

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Adult Mental Health

The MHA ranked adult mental health using seven metrics, including adults who: have diagnosed mental illness, serious thoughts of suicide, are uninsured, have disabilities who could not see a doctor due to costs and a few others. States that ranked highest have lower prevalence of mental illness and highest rates of access to care for adults. The lowest ranked have higher cases of mental illness and lower access to care.

The Top 5:

  1. Hawaii
  2. Iowa
  3. Minnesota
  4. New York
  5. Maryland

The Bottom 5:

  1. Oregon
  2. Utah
  3. Idaho
  4. Wyoming
  5. Nevada

Youth Mental Health

The MHA also used seven measures to determine the state of youth mental health in America. Among them were youth who: had a substance use disorder in the last year, were diagnosed with mental illness but did not receive services, had private insurance that did not cover mental or emotional problems and had at least one major depressive episode in the last year.  As with adults, the highest ranked have a combination of the least cases and best access to care, while the lowest have a combination of most cases and worst access.

The Top 5:

  1. Washington DC
  2. Pennsylvania
  3. North Dakota
  4. Rhode Island
  5. Massachussets

The Bottom 5:

  1. Nevada
  2. Wyoming
  3. Alaska
  4. South Carolina
  5. Oregon

Access to Care

The MHA goes deeper with many of their categories, and I’m not listing several here for space reasons, but one of the lists I found quite compelling was about overall access to care. The list is comprised of nine metrics covering both adult and youth needs, including quality and cost of insurance, access to special education and mental health service both available and rendered.

The top states have the best access to mental health care while the bottom have the worse.

The Top 5:

  1. Vermont
  2. Massachusetts
  3. Rhode Island
  4. Iowa
  5. Maine

The Bottom 5:

  1. Texas
  2. Georgia
  3. Nevada
  4. Mississippi
  5. South Carolina

Now here comes the bugaboo that I’m hoping doesn’t draw the ire of those from mostly conservative states.

I’ve given you just a snapshot here. I urge you to go look at the rest of the lists. If you look at the Top 10 or Top 20 and their bottom counterparts, along with the maps they provide, one of which I included here, you’re going to see some patterns emerge. The southeast, south and northwest sections of the U.S. tend to score lower than those in the Northeast, Great Lakes area, and California. What does this remind you of?

Looking at the maps and their color-coding, it reminds me of the electoral map of US presidential elections. Those states that are traditionally states that cast their vote for the Democrat candidate are those that have the combination of the lowest cases of mental health issues and the best access to care. The states that traditionally cast their votes for Republic candidates are the ones that consistently have the most cases of mental health issues and worst access to care.

Did I make a fair generalization? Is there any connection between political affiliation and opinions/priority place on mental health care? Is this just a coincidence?

I’m not going to wade into that debate here. I just wanted to provide you with the information and let you draw an informed conclusion.

Goodbye, Carla

Last night I needed to find an old photo, so I briefly reactivated my personal Facebook account to track it down. I only have about 15 people as “friends” and they are all from my rehab days. I haven’t talked to any of them in at least three years. One, a young woman who was in the eating disorder program, wrote that another (who I’ll call Carla), died late last week of a heart attack. While the odds seem to have favored someone going sooner, this is the first person I knew from rehab who has been confirmed dead.

Carla wasn’t well when I knew her. Probably around 30, she mostly kept to herself and in the morning meeting where everybody at the rehab has to say a couple of things, she never seemed comfortable. Even those who don’t like public speaking eventually got comfortable around the group of 30. She arrived sometime before I got there, was there for the entire 7 weeks I attended, and remained after I left. I have no idea how long her stay was, but based on talking to some of the other women in the eating disorder program, it sounded like Carla had among the most severe trauma and her mental health was not solid.

The place where Carla and I bonded was before breakfast. She and her only friend (who wrote the Facebook entry) were the first two up in the morning, along with me. The dining room didn’t open until 6:30, so it would usually be the three of us sitting around in a common room adjacent from around 6:15 to 6:30. The two of them would sneak out and go for a walk at 5:45 a.m. to burn calories. Apparently it was a no-no, but I didn’t subscribe to the “rat out your peers” theory until jail.

The women in the eating disorder program had to wait until 6:45 to eat breakfast, when they could be coached on what they chose to eat and then made sure to eat by a monitor. I’m not a big breakfast guy, so some days I’d remain sitting there and in those 15-30 minutes, I got to know Carla probably better than any other person, except her one other friend, and I still feel like I didn’t really know her.

She wore the same ratty, oversized sweater every day. One of the first mornings I was there when she came in from her walk, she sat down and said, “You probably wonder why I wear this every day.”

“It means something special to you, reminds you of someone, makes you feel safe, hides your body or some combination I’d guess,” I said. “Whatever makes you feel good is good with me. You don’t have to explain anything.”

I think that was the initial bonding moment. Later that morning, she told the entire group she didn’t want anyone asking her why she wore that sweater every day because if they didn’t get it, she didn’t want to explain. And then she smiled at me.

We also found that we shared a mutual disdain for the phrase, “How are you?” as a greeting. Sure, it’s just something we say, but it’s not something an unhealthy person wants to hear. We know the person asking doesn’t care and doesn’t want the truth if it’s not “good” so they can move onto the next thing.

Carla and I decided to stop saying that to each other. We thought a more appropriate greeting was, “I see you there” because that’s all “How are you?” means to most people.

I think I was the only male, and certainly the only one in the sex/porn program that she spoke to with any regularity. My guess would be that there was some kind of sexual assault in her past that made her scared of men and sex, but as she slowly heard my story she asked a few questions. Nothing too prying, but I think it was part of her trying to process her own demons.

While we both had alcoholism issues in the past, neither of us were there for that kind of treatment. We often talked about how that was a more clear-cut disease to fight. The goal is to stop drinking. With both porn/sex addiction and eating disorders, the goal is to find a healthy balance. Yes, I needed to stop looking at porn, but I also needed to develop the healthy sexuality that eluded me in life to that point. She needed to figure out how to have a healthy relationship with food.

You can’t stop having a sexual identity and you can’t stop eating if you’re going to be in recovery. These kinds of recovery are very individualized because what is one person’s demon doesn’t bother the person next to them. Healthy eating, or sexuality, can look very different to two people who have the same problem.

I never had any illusion we’d stay in touch after rehab. I talked to her friend a couple times after we were both out and she told me Carla wasn’t doing well, but I even lost track of that woman pretty quickly. It surprised me when I read her announcement of Carla’s death on Facebook, but it didn’t shock me that Carla didn’t make it to old age. It still shocks me more when an addict does. Goodbye, Carla.

 

The term ‘Gaslighting’ Comes From a 1944 Best Picture Nominee, And I Can See Why

It’s been somewhat of an every-few-years tradition of mine to listen to War of the Worlds on Halloween night, ever since I stumbled upon it on the radio when I came back from an eighth-grade party where I kissed a girl for the first time. BTW, the mass hysteria we all have been retroactively led to believe happened that night, didn’t actually take place. The original broadcast of War of the Worlds, I mean. Not me kissing a girl, although it was a phenomenon rarely duplicated in the next few years.  The War of the Worlds “hysteria” is a fascinating story, but you know how to use the Internet and I’m not wasting space here. Instead, for the first time, I watched a nominee for the 1944 Best Picture Oscar (based on a 1938 British play and remake of a 1940 British movie) that is probably better known for creating a key piece of the Addiction/Recovery/Betrayal Trauma lexicon: Gaslight.

Starring Charles Boyer and Ingrid Bergman, it’s quite a far-fetched story, even for early cinema standards, and I’m not talking about the actual gaslighting that takes place. Any plot that involves assuming another person’s identity and jewel thieves automatically goes into the “ya, sure, whatever” category for me. That must be why I don’t like Nicholas Cage films.

The psychological part of the movie, however, is very well done, and it is indeed the place that we get the term “gaslighting” from. Boyer hatches a plan to make his wife, Bergman, think she’s going crazy, hoping it eventually results in eventual financial gain. He does this slowly by setting her up to believe she’s a kleptomaniac when in fact, he’s taking things and planting them on her. For good measure, he also deliberately dims the gas in the lights in their house. He insists he never touches them and claims they are always the same brightness, yet they get darker, night-by-night, contributing to Bergman’s self-doubt and belief she is losing her mind. Finally, Boyer flirts with the maid (played by Angela Lansbury, about 300 years before Murder She Wrote) in front of Bergman. Lansbury develops a bit of a disdain for Bergman because she reciprocates the flirting, but when Bergman brings it up to her husband, he again tells her that it’s all in her head.

You’ve had 75 years to see the movie, so I’m going to slightly ruin it. In the end, the husband is tied to a chair by police and Bergman’s learned about his deception…however, he can’t stop. When the police briefly leave the scene, Boyer tells Bergman to untie him so they can escape and be free together. She comes to her senses and lets the police take him away.

While it’s the Hollywood ending the viewer wants and can somewhat see coming a mile away, real life often doesn’t end like that and the gaslighting takes place over many years, not months. It’s not just pornography or sex addiction either. If there’s an addict in your life, there’s a gaslighter in your life.

I heard of cases much more worse than me when I was in rehab and recovery, but I think that’s because I had my hand involved in so many different things I didn’t have to convince any single person of anything too ridiculous. I didn’t spend enough time with any one person for them to get too close to my addictions.

My wife – just like with every couple that has a male addict – was the biggest victim of my gaslighting. Most of the time, it was convincing her that I wasn’t nearly as drunk as I was and fully capable of driving.

Occasionally, she would say things like, “I guess you don’t like us anymore” or “Nobody has to work that much.” I didn’t like anybody, especially myself, at that point, which is why I wanted to be alone. And she was right about how much I worked, but it was the only place I felt like I was in control of my life until the end. I always convinced her she was wrong and acted offended she’d even bring up such things. I even surprised myself  how often I was successful. The last person to say “sorry” loses and I was never the last person. Like I said, not the worst gaslighting stories, but I certainly knew the drill.

Manipulating someone into believing they’re the crazy one, to the point it becomes second nature: Yep, that’s gaslighting and now you know where the term came from.

While none of the Q&As I sometimes post on the site are in the Top 10 most popular you can find on the right side, the one that I wrote a while back about gaslighting is by far the most popular and talks more about the nuts-and-bolts of what it is. If you’d like to take a look at it, click HERE.

If You’re Not Willing to Ask For Help, You’re Not Going to Overcome Addiction

I think there are three basic steps in achieving recovery: 1) Admitting to yourself have a problem, 2) Asking a professional for help, 3) Following through with treatment. I think the second step is the toughest part for most people and where recovery either happens, or doesn’t.

I don’t think admitting you have an addiction problem is difficult. Sure, it’s the first step, and I can only speak for myself, but even with mild denials I provided my brain, I always knew something was different and abnormal with my pornography use and alcohol consumption compared to most people. When I reached the critical point, it was clear something was wrong, even if I had no idea exactly what was going on with me.

Treatment comes in all forms and sizes, but if you follow through with it, you’ll achieve some level of recovery. I have met plenty of people who think they are the special one who can’t recover, but in reality, I have only met one person I ever thought to myself, “I don’t know if they’re constitutionally capable of long-term recovery.” Thankfully, I was wrong. They have been sober for 5 years now. I’ll tell that story in a few days. My point here is that if you are committed to recovery, you will recover. It’s not a complex recipe.

As some of you know, I have a side hustle giving specific one-on-one advice to addicts and/or their loved ones. It’s featured in the ad on the side of the homepage of the website, and you can access it HERE.

I always tell people that it’s a big step they asked me for help, but at the end of the day, I’m not a professional. I’m somebody who can be the first person they talk to who isn’t going to judge and will create a safe space. I can be the person who lets them know what the next several steps could/should be. Talking to me is like easing your toe into the water. It’s asking for help, but the sugar-free, “light” version.

One of the reasons I started this consulting/advisement service is because I know just how hard it is to ask for help. I usually work with someone for 3-6 major interactions (phone calls/skype/email) and it’s all about getting them to recognize they need real help. They can practice telling their story with me and I can get them ready for a therapist or a 12-step meeting. If I can remove any of the fear, it’s not as big a leap to getting the help.

The biggest pushback I get is not in somebody feeling that they don’t have a problem, but feeling that their problem doesn’t rise to the level of needing professional help, or being too proud to take that leap and becoming the kind of person who “has to get help.”

I try to kill both of these birds with one stone. I tell them that if their doctor referred them to cardiologist because of a heart issue, they wouldn’t compare themselves to other heart patients, they’d just go. If you need glasses, you go to the eye doctor. You don’t worry about people with better or worse vision. If you see an oncologist and they give you one year to live, you don’t stop seeing them because they give some people only three months.

I also try to address their pride. I have to admit, I’ve never been a prideful person. It probably has to do with my imposter syndrome. I’ve worn so many masks, pride doesn’t phase me all that much. I think it’s just another mask I never wore. But I’ll point out the fact that Pride, much like Lust, is one of the seven deadly sins. Also, I’ve never heard of anybody on their death bed complain that they didn’t have enough pride or were glad they didn’t ask people for help. The deathbed is for regret and never getting professional help will be a huge regret.

So why do the naysayers point to inpatient rehabs and 12-step groups as having historically low success rates? Having been to a couple, I can tell you that those who are forced to go, either by their family or the law, never actually asked for the help. You can’t skip to step three without step two. I’d guess between 50% and 75% of the people at both my rehabs didn’t want to be there. And if you’re at an AA or NA meeting, watch how many people only show up once or twice — likely pushed by family — or need to have their “court card” signed by the leader at the end of the meeting. A judge told them to be there. They aren’t there because they are seeking help.

As far as the self-imposed stigma of being one of “those people” who are in the minority of asking for professional help, you’re actually in the minority if you aren’t wiling. According to a 2018 study by the Barna Group, 42% of American adults have seen a counselor at some point, 13% are in active therapy and 36% haven’t seen a therapist but are open to it. Not being willing to see a therapist actually makes you one of the few, not many.

You know you have a problem. If you want it bad enough, you can get through the treatment. You just have to be willing to ask for the help. Don’t let fear hold you up.

‘Radical Acceptance’ Has Been Crucial to My Successful Addiction Recovery

One of the more important tools I developed in recovery has been the practice of radical acceptance. I was once called out for not having any radical acceptance ability when I was in rehab and it forced me to reflect on the accusation.

Several of the residents were allowed to attend an “outside” 12-step meeting, meaning they went to a Narcotics Anonymous meeting off the rehab property with regular community members. On their way back, they stopped off at a store and bought candy and energy drinks, which were both forbidden at the rehab. Their car was searched upon return and the contraband was discovered.

The next day, at our large group morning meeting, one of the counselors told us because of the actions of those four residents, all visitor’s passes would be cancelled the following weekend.

A few of the residents who had family or friends visiting got visibly upset and/or angry.

“This is meant to make you all accountable to one another,” the counselor told the group. “It’s a skill you need to develop. If you were in an office and one of your co-workers was flaunting the rules, your co-workers would come together and set them straight.”

I had always thought I had an overdeveloped sense of justice/injustice, and it was going off like a light on top of a firetruck. I couldn’t stand to see many of my friends denied visits with their families.

“Your rationalization is bullshit,” I said loudly.

“What is that, Mr. Shea?” the counselor asked.

“That’s a pathetic rationalization. First, if we were co-workers, that person would get fired. The entire team wouldn’t. Sure, we could complain to the boss about them, but none of us even knew what these guys did. Second, making each other accountable isn’t actually the way the world works. That’s why we have police and the legal system. We don’t punish all of society for one person’s wrongs.”

“Mr. Shea, do you family visiting you?” the counselor asked.

“No, they’re all in California or the northeast. They’re not flying to Texas to see me,” I explained.

“Then why does this particular situation concern you?” she asked.

“Because it’s not fair,” I said. “It’s not fair to the people who have family and friends coming.”

“Yet none of them are talking,” she said. “It’s you, who doesn’t even have a stake in this.”

“Whatever,” I said, and let it go, seething silently.

It kind of bothered me none of the people affected spoke up. It bothered me even more when a few hours later, I saw them joking and laughing with each other – and the counselor who delivered the news. It dawned on me that I was more upset about a situation that had no bearing on me whatsoever, than people who were directly involved. Something didn’t make sense about it.

Later that day, I sought out that counselor and told her that while the (in my eyes) unjust punishment was still bothering me, the others seemed to move on, and I didn’t understand how they could just do that.

She told me that she knew I believed I had a strong sense of justice and injustice, but she recognized it for what it was. It was really about power and control. I disagreed, but she pointed out as long as it was my allies, I was fine with other people in control, but the moment someone had it and I felt threatened, I confused it with injustice.

“You know you’re probably going to see a little jail time for what you did, right?” she asked.

“I don’t know,” I explained. “Technically, I already pled guilty, but when I get home, they’ll look at the fact I went here and to another rehab for alcoholism and that I’m in therapy…”

“You’ll probably do 6 to 12 months,” she interrupted.

“My lawyer is hoping for no time,” I said.

“They always hope for that, and I hope you get no time, but if you do, be prepared that there is nothing you can do about it,” she said.

I looked at her somewhat blankly not wanting to admit she was correct.

“Do you know why none of your friends are still freaking out about their visitors? They’ve learned to practice radical acceptance. That’s where sometimes, no matter what happens, you’re not in control and you just have to accept it and move on.”

It took some reflection, but I was able to recognize plenty of times in my life that I tried to manipulate a situation I didn’t want to accept under the guise of injustice. I also recognized how many times I ended up begrudgingly accepting something I couldn’t control, and how when I finally let it go, it rarely stuck with me very long.

As I’ve made my way through recovery, I’ve done a lot of reading about radical acceptance. That counselor simplified the concept. For me, what’s it really about is the pain and suffering that comes from not being in control.

When I don’t let something I can’t control go, I suffer more pain than if I just moved on. Refusing to accept the pain by refusing to let things go just brings additional suffering, and who really wants that?

About eight months after my conversation with the counselor, I got a sentence of nine months (of which I served six.) As the judge was reading her verdict, a bit of a calm came over me. I now knew what my punishment would be, and I was at peace with it because there wasn’t anything I could do about it and it would be a waste of time to try.

Radical acceptance doesn’t mean being lazy. It doesn’t give an excuse to not standing up against the real injustices of the world, but for people who were power-hungry control freaks like I was, it’s a way to gain perspective.