tag:blogger.com,1999:blog-5549570283870160082024-02-20T16:49:09.176-06:00No BS from a BSWI'm not a Social Worker...but I played one at the Office.HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.comBlogger21125tag:blogger.com,1999:blog-554957028387016008.post-63883903429210572532009-04-26T08:10:00.002-05:002009-04-26T08:18:09.773-05:00Articles About Manic Depression/Bipolar DisorderI recently published seven articles about Manic Depression at Associated Content. If you are interested in reading them, you can email me at holly 76209 at gmail dot com. [Spambots must die!]<br />I'll give you the information you need to locate them on the AC website.<br />They cover a broad range of topics from signs and symptoms of depression cycles and manic cycles; dealing with recovery; treatment strategies; where to find information about Manic Depression; resources available for the disorder; how to cope with the disorder and answers the basic question of what it is.HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com81tag:blogger.com,1999:blog-554957028387016008.post-81206982751938520532009-03-25T22:01:00.000-05:002009-03-25T22:03:20.804-05:00New Brain StudyI found this story on Google News yesterday. I found it very enlightening, but it also raises a few questions. Read it and see what you think.<br /><a name="trackingEnabledModule"></a><a name="midArticle_start"></a><a name="midArticle_byline"></a><span style="color:#000099;">CHICAGO (Reuters) - People who have a high family risk of developing depression had less brain matter on the right side of their brains on par with losses seen in Alzheimer's disease, U.S. researchers said on Monday.<br /></span><a name="midArticle_0"></a><span style="color:#000099;">Brain scans showed a 28-percent thinning in the right cortex -- the outer layer of the brain -- in people who had a family history of depression compared with people who did not.<br /></span><a name="midArticle_1"></a><span style="color:#000099;">"The difference was so great that at first we almost didn't believe it. But we checked and re-checked all of our data, and we looked for all possible alternative explanations, and still the difference was there," said Dr. Bradley Peterson of Columbia University Medical Center and the New York State Psychiatric Institute.<br /></span><a name="midArticle_2"></a><span style="color:#000099;">His study appears in the Proceedings of the National Academy of Sciences.<br /></span><a name="midArticle_3"></a><span style="color:#000099;">The findings are based on imaging studies of 131 people aged 6 to 54 with and without a family history of depression.<br /></span><a name="midArticle_4"></a><span style="color:#000099;">The team was looking specifically for abnormalities in the brain that could signal a predisposition to depression, rather than changes that may be caused by the disease.<br /></span><a name="midArticle_5"></a><span style="color:#000099;">The thinning on the right side was only linked with a family predisposition to depression. People who actually were depressed also had thinning on the left side of cortex.<br /></span><a name="midArticle_6"></a><span style="color:#000099;">"Because previous biological studies only focused on a relatively small number of individuals who already suffered from depression, their findings were unable to tease out whether those differences represented the causes of depressive illness, or a consequence," Peterson said.<br /></span><a name="midArticle_7"></a><span style="color:#000099;">He said having a thinner right cortex may increase the risk of depression by disrupting a person's ability to decode and remember social and emotional cues from other people.<br /></span><a name="midArticle_8"></a><span style="color:#000099;">They did memory and attention tests on the study subjects and found the less brain material a person had in the right cortex, the worse they performed on attention and memory tests.<br /></span><a name="midArticle_9"></a><span style="color:#000099;">"Our findings suggest rather strongly that if you have thinning in the right hemisphere of the brain, you may be predisposed to depression and may also have some cognitive and inattention issues," he said.<br /></span><a name="midArticle_10"></a><span style="color:#000099;">Peterson said the findings suggest medications used to treat attention problems such as stimulants might be useful in the treatment of depression in some patients.<br />(Editing by Maggie Fox and Xavier Briand)<br /></span>For years it has been an article of faith that if the balance of neurotransmitters is adjusted the neuro-physical component of depression will improve. In fact, there is a billion dollar industry based on this line of thought. So are the neurotransmitters effected by this thinning of the cortex? And what are the implications for other mood disorders, such as Manic Depression?HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com12tag:blogger.com,1999:blog-554957028387016008.post-4559256068019335502008-10-16T20:42:00.001-05:002008-10-16T20:45:51.345-05:00For Family and Friends of Manic DepressivesWhen I started this Manic Depressive project, I said I wanted to write a post about what it's like for the family and friends of someone suffering from this disorder. It can be summed up in two words, “Challenging” and “Confusing”.<br />When the person you care about is cycling through their mood states and confused, how can <strong>YOU</strong> be anything other than confused? The challenge will still be there, but I'll try to clear up some of the confusion.<br /><br />1st and foremost, <strong><u>YOU</u></strong> cannot “manage” your loved one's Manic Depression. Managing someone else's M/D is like trying to sight in a rifle while crossing the railroad tracks in a car with bad shock absorbers.<br /><br />2nd Look into finding a support group for yourself. Other people <strong>ARE</strong> going through the same confusion and challenges you are experiencing.<br /><br />Next, talk to your loved one. Sit down and <strong>ASK</strong> what you can do to help. Let them know you care about them, even though you may not understand exactly what they are experiencing. Tell them they have your support.<br /><br />It may be helpful, for them and YOU to keep a log of behaviors and feelings they express at different times during a cycle of mania or depression. This can help in both their treatment and in recognizing the onset of a change in cycles. If the treatment provider is informed, s/he can makes changes to medications IF the symptoms are recognized early enough.<br /><br />I also refer you back to the earlier post [from Sunday, October 5] where I listed things to know, things to say and things NOT to say to your loved one with M/D.<br />Keep in mind that your loved one's mood swings are NOT a character flaw or a deliberate effort to alienate you. This is an inherited disorder. They did not do something “wrong” and become M/D, they were born with the genetic coding for this disorder. It IS possible to cope with this disorder and regain functionality. It's hard work and requires an effort from all parties involved.<br /><br />If you have any questions or comments you don't want to ask in the “Comments” section, you can email me at holly76209 at gmail dot com.HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com2tag:blogger.com,1999:blog-554957028387016008.post-59364662410201194882008-10-10T22:07:00.000-05:002008-10-10T22:07:23.544-05:00Manic Depression Treatment Modalities<a name="Table_01"></a>Recovery, as defined by SAMSHA (the Substance Abuse and Mental Health Services Administration/Center for Mental Health Services) (<a href="http://www.samhsa.gov/" target="_blank">http://www.samhsa.gov/</a>) is:<br /><br />Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.<br /><br /><br />There are a broad range of treatments for Manic Depression. The best page I've seen is this one at the Depression and Bi Polar Support Alliance: <a href="http://dabsa.convio.net/site/PageServer?pagename=about_depression_treatmentmain">http://dabsa.convio.net/site/PageServer?pagename=about_depression_treatmentmain</a> . There are a TON, almost literally, of links on that page to cover every aspect of treatment.<br />The NIMH treatment page can be found here: <a href="http://www.nimh.nih.gov/health/publications/bipolar-disorder/treatment.shtml">http://www.nimh.nih.gov/health/publications/bipolar-disorder/treatment.shtml</a><br /><br />I'd like to touch briefly on the treatments with which I have the most familiarity. Let me preface my remarks about medication by stating Psychotropic medicines should be prescribed by a Psychiatrist. While regular M.D.s <strong>CAN</strong> prescribe medicines to treat Manic Depression; Psychiatrists have more experience treating Manic Depression and are more knowledgeable about the latest medicines, drug interactions and and side effects.<br /><br />Medications know as ”mood stabilizers” are on the front line in the battle against Manic Depression and its cycling feature. There are also anti-convulsant drugs that have mood stabilization as a side effect. For a list of medications please go to the NIMH's treatment <a href="http://www.nimh,gov/health/publications/bipolar-disorder/treatment.shtml">page</a>:<br />[<a href="http://www.nimh.nih.gov/health/publications/bipolar-disorder/treatment.shtml">http://www.nimh.nih.gov/health/publications/bipolar-disorder/treatment.shtml</a>]<br /><br />A caution about using anti-depressants to treat the Depression aspect of M/D. Studies, according to the NIMH have shown:<br /><br />"that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, “mood-stabilizing” medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. "<br /><br />The anecdotal evidence supports the assertion that people on antidepressants are more likely to have a more severe Depression when the manic period ends. I like to call This side effect “Rebound Depression.”<br /><br /><br /><span style="font-size:180%;">Psychotherapy/Talk therapy</span><br /><a name="content"></a><br />Therapy can help prevent prevent inappropriate and negative behaviors. It can help the patient [and their family if involved in Family Therapy sessions] recognize the signs of the early stages of each cycle. Once this recognition is established, steps can be taken by the patient, family, therapist and psychiatrist working together to prevent a full blown episode of That aspect of the disorder.<br />The DBSA has a list of the benefits of therapy:<br /><a name="Table_011"></a><br />Understand your illness<br />Overcome fears or insecurities<br />Cope with stress<br />Make sense of past traumatic experiences<br />Separate your true personality from the mood swings caused by your illness<br />Identify triggers that may worsen your symptoms<br />Improve relationships with family and friends<br />Establish a stable, dependable routine<br />Develop a plan for coping with crises<br />Understand why things bother you and what you can do about them<br />End destructive habits such as drinking, using drugs, overspending or risky sex<br />Address symptoms like changes in eating or sleeping habits, anger, anxiety, irritability or unpleasant feelings<br /><br /><br />Therapy can also help you come to terms with the fact you will need medicine for the rest of your life. You <u>CANNOT</u> stop taking it because you feel better. That doesn't mean you're cured. If you go off of medication <strong>ALL</strong> your symptoms will return. You may be able to stop talk therapy once you've met your goals for therapy, but you will always need medication. The first medicine [or combination of medicines] you try, may not be the one for you. You may have to try several different medications before you find the one[s] that work for you. You may need to tweak the dosages over time, as well.<br />Despite the effort involved in finding the medicine[s], it's worth it when you fine the correct one[s] for you. The depressions are so much less intense and the mania is just enough to give you energy and creativity without causing the negative aspects of a full blown manic episode.<br /><br /><br />Another important aspect of treatment is a Thyroid Function test. According to NIMH, many Manic Depressives have abnormal thyroid functioning. Too much or too little of the hormone secreted by the thyroid can play hell with the patient's mood and cycling between moods. If necessary, get the medication and take it.<br />In some rare cases when medication and therapy are ineffective, ECT [electric convulsive therapy] may be utilized. The NIMH says:<br /><a name="content1"></a><br /><a name="primary_content"></a>In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.<br /><br /><br />Even though Manic Depression is what's called a “long term illness” it can be treated. It IS possible to find recovery. The DBSA website :<br /><a href="http://dabsa.convio.net/site/PageServer?pagename=home">http://dabsa.convio.net/site/PageServer?pagename=home</a><br />contains many links with suggestions that can help a newly diagnosed patient, a patient who has been diagnosed at sometime in the past, and family and friends cope in effective ways with this complex disorder.<br />If you are a Patient, take comfort in knowing there ARE many resources and solutions available to you. If you are a family member or friend looking to help, there are many strategies and methods you can utilize in supporting the patient. Both websites I've used for my references contain more links to help. Use them, and the sites they refer to as starting points on your personal journey to recovery. It IS possible.HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com4tag:blogger.com,1999:blog-554957028387016008.post-73437548461405941822008-10-08T22:46:00.001-05:002008-10-08T22:48:51.037-05:00Treatment Blog in the WorksI'm workin' on the installment for this project about treatment options.<br />Just wanted y'all to know that.HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com0tag:blogger.com,1999:blog-554957028387016008.post-87655971191981779392008-10-05T16:11:00.004-05:002008-10-06T07:38:06.927-05:00Answering Comment QuestionsAnonymous said...<br />How do you help someone with bipolar disorder? No insurance. Psychiatrists here are about as sane as Freud.<br /><br />Well, Anonymous, there are a LOT of ways to help. The Depression and Bipolar Support Alliance [http://dabsa.convio.net/site/PageServer?pagename=about_helping]<br />has this list:<br /><br />Helping Someone With A Mood Disorder<br />Mood disorders such as depression and bipolar disorder (also known as manic-depression) affect millions of people. Their family members and friends are affected too. If someone you love has a mood disorder, you may be feeling helpless, overwhelmed, confused and hopeless, or you may feel hurt, angry, frustrated and resentful. You may also have feelings of guilt, shame and isolation, or feelings of sadness, exhaustion and fear. All of these feelings are normal.<br /><br /><span style="color:#660000;">What you need to know:</span><br />Your loved one’s illness is not your fault (or your loved one’s fault).<br />You can’t make your loved one well, but you can offer support, understanding and hope.<br />Each person experiences a mood disorder differently, with different symptoms.<br />The best way to find out what your loved one needs from you is by asking direct questions.<br /><br /><span style="color:#660000;">What you need to find out:</span><br />Contact information (including emergency numbers) for your loved one's doctor, therapist, and psychiatrist, your local hospital, and trusted friends and family members who can help in a crisis.<br />Whether you have permission to discuss your loved one's treatment with his or her doctors, and if not, what you need to do to get permission.<br />The treatments and medications your loved one is receiving, any special dosage instructions and any needed changes in diet or activity.<br />The most likely warning signs of a worsening manic or depressive episode (words and behaviors) and what you can do to help.<br />What kind of day-to-day help you can offer, such as doing housework or grocery shopping.<br />When talking with your loved one's health care providers, be patient, polite and assertive. Ask for clarification of things you do not understand. Write down things you need to remember.<br /><br /><span style="color:#990000;">What you can say that helps:</span><br />You are not alone in this. I’m here for you.<br />I understand you have a real illness and that’s what causes these thoughts and feelings.<br />You may not believe it now, but the way you’re feeling will change.<br />I may not be able to understand exactly how you feel, but I care about you and want to help.<br />When you want to give up, tell yourself you will hold on for just one more day, hour, minute - whatever you can manage.<br />You are important to me. Your life is important to me.<br />Tell me what I can do now to help you.<br />I am here for you. We will get through this together.<br /><br /><span style="color:#660000;">What you should avoid saying:</span><br />It’s all in your head.<br />We all go through times like this.<br />You’ll be fine. Stop worrying.<br />Look on the bright side.<br />You have so much to live for; why do you want to die?<br />I can’t do anything about your situation.<br />Just snap out of it.<br />Stop acting crazy.<br />What’s wrong with you?<br />Shouldn’t you be better by now?<br /><br />The National Institute for Mental health has a <a href="http://www.blogger.com/www.nimh.nih.gov/health/topics/getting-help-locate-services/index.shtml">list</a> of suggestions for finding services<br /><br />and the DBSA has a list of suggestions called <a href="http://dabsa.convio.net/site/PageServer?pagename=empower_choosingprovider">"Choosing a Provider"</a> and <a href="http://dbsa.convio.net/site/PageServer?pagename=empowerprofessionalreferral">Professional Referral </a>has tips on what to remember when choosing a provider of Mental Health Services as well as links to <a href="http://dabsa.convio.net/site/PageServer?pagename=empower_resources">resources.<br />http://dabsa.convio.net/site/PageServer?pagename=empower_resources</a><br /><br />I hope these links help...and I'll comeback to discuss this in more detail later.HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com1tag:blogger.com,1999:blog-554957028387016008.post-13439435100663108292008-10-01T21:06:00.000-05:002008-10-01T21:06:44.272-05:00Signs and Syptoms of Manic Depression<span style="font-family:verdana;color:#663366;">The below was shamelessly copied and pasted from</span> <a href="http://www.nimh.nih.gov/health/publications/bipolar-disorder/symptoms.shtml">http://www.nimh.nih.gov/health/publications/bipolar-disorder/symptoms.shtml</a><br /><span style="font-family:verdana;color:#663366;">Keep in mind, while readin' this that some folks are MIS-diagnosed as depressed when their manic episodes are mild or what's called “hypomanic.”<br />I'm going to put my comments and observations in a different font and color from the NIMH text.</span><br /><br /><br /><br /><br />Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.<br /><br /><br />Signs and symptoms of <u>mania (or a manic episode</u>) include:<br />Increased energy, activity, and restlessness <span style="color:#660000;"><span style="font-family:trebuchet ms;">Lots and lots of energy leads to lots of activity. But the restlessness can cause a person to start multiple projects when they're manic, then never complete them because the depressive cycle hits.</span><br /></span>Excessively “high,” overly good, euphoric mood<br />Extreme irritability <span style="font-family:trebuchet ms;color:#660000;">Snapping turtle sound familiar? How about rantin' and ravin'?<br /></span>Racing thoughts and talking very fast, jumping from one idea to another<br />Distractibility, can’t concentrate well <span style="font-family:trebuchet ms;"><span style="color:#006600;"><span style="color:#660000;">See the above comment under energy</span>.</span><br /></span>Little sleep needed<br />Unrealistic beliefs in one’s abilities and powers<br />Poor judgment<br />Spending sprees<br />A lasting period of behavior that is different from usual<br />Increased sexual drive <span style="font-family:trebuchet ms;color:#660000;">When combined with poor judgement...bad things can happen</span><br />Abuse of drugs, particularly cocaine, alcohol, and sleeping medications<br />Provocative, intrusive, or aggressive behavior <span style="color:#660000;"><span style="font-family:trebuchet ms;">As if they no longer have a censor feature in their brain.</span><br /></span>Denial that anything is wrong <span style="color:#660000;"><span style="font-family:trebuchet ms;">Because no matter how bad it IS, there are also positive aspects to Mania. More about that later.</span><br /></span>A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.<br /><br /><br /><br /><br /><br /><br />Signs and symptoms of <u>depression (or a depressive episode</u>) include:<br /><br />Lasting sad, anxious, or empty mood <span style="font-family:trebuchet ms;color:#660000;">lasting is the Key word in this clause.</span><br />Feelings of hopelessness or pessimism <span style="font-family:trebuchet ms;color:#660000;">Hopelessness is also a suicidal precursor</span><br />Feelings of guilt, worthlessness, or helplessness <span style="font-family:trebuchet ms;color:#660000;">helplessness is another suicidal precursor</span><br />Loss of interest or pleasure in activities once enjoyed, including sex <span style="color:#660000;"><span style="font-family:trebuchet ms;">A low libido is the counterpart of the hypersexuality sometimes seen in Manic episodes</span><br /></span>Decreased energy, a feeling of fatigue or of being “slowed down” <span style="font-family:trebuchet ms;color:#660000;">lethargy, to those unaware of symptoms, can be mis-interpreted as "laziness" instead of a legitimate symptom</span><br />Difficulty concentrating, remembering, making decisions<br />Restlessness or irritability <span style="font-family:trebuchet ms;color:#660000;">which can also be a mania symptom</span><br />Sleeping too much, or can’t sleep <span style="font-family:trebuchet ms;color:#660000;">the extremes and the difference between sleep patterns when in a Manic episode or on an even keel is the Key factor to this symptom</span><br />Change in appetite and/or unintended weight loss or gain <span style="color:#660000;"><span style="font-family:trebuchet ms;">As with the above, it's the extremes to look for</span><br /></span>Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury <span style="font-family:trebuchet ms;color:#006600;"><span style="color:#660000;">which is why a lot of people with depression are <strong>MIS</strong>-diagnosed as having Fibromyalgia</span>.</span> Thoughts of death or suicide, or suicide attempts<br /><br />A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.<br /><br /><br /><span style="color:#660000;"><span style="font-family:trebuchet ms;">Other sources, the Medical Library Association [in conjunction with NIMH, btw] also lists inflated self esteem, lack of self control and binges of eating or drinking as Manic Episode Symptoms. What NO source lists, and what many M-Ds are reluctant to sacrifice are the bursts of artistic creativity they experience during manias. To them, being medicated is the same as losing their Muse. Jamison writes about this aspect of treating Manic Depression in <u>Touched</u> <u>with Fire: Manic Depressive Illness and the Artistic Temperament</u>. She urges treatment that doesn't kill that fire in the process of "curing" the Disorder. </span><br /><span style="font-family:Trebuchet MS;"></span><br /><span style="font-family:Trebuchet MS;">That last would be because there IS no "cure" for Manic Depression. There's treatment, but if you're an M-D, you're always going to BE and M-D. You may get the mood swings under control with medication, but you will need that medication for the rest of your life. Kinda like being hypertensive or a diabetic.</span><br /><br /></span><span style="font-family:trebuchet ms;color:#006600;"><span style="color:#660000;">Okey, dokey. We clear on all that? I didn't think so.</span> </span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com44tag:blogger.com,1999:blog-554957028387016008.post-83181710920094523432008-09-30T22:38:00.003-05:002008-10-15T21:04:54.312-05:00Manic Depression ProjectOne of my favorite authors on Mental Health topics is Kay Redfield Jamison. I first read her <u>An</u> <u>Unquiet Mind</u> about 3 or 4 years ago. It impressed me because she was brave enough to discuss her own struggle with Manic Depression. Because despite what people may say about “enlightened” and accepting attitudes, there is <strong>STILL</strong> an incredible amount of discrimination against some diagnoses.<br /><br />The openness of many high-profile Depression-affected individuals helped to erase the ignorance and attendant stigma associated with that diagnosis. Manic Depressives have not enjoyed the same acceptance. The last time I heard about someone with Manic Depression [or Bi-Polar Disorder] it was because they had “gone off their meds” and committed some high profile crime, i.e. a mass shooting, kidnapping a child, murder/suicide in a domestic arrangement.<br /><br />Redfield broke new ground by telling about her disorder and how it affected her pursuit of an advanced degree. Since she is on faculty at Johns Hopkins Medical School, she may have an advantage in gaining the acceptance of her co-workers. One would assume, once she had tenure, she could say a LOT of things an un-tenured professor could not. I think her expertise in the psychological field is ENHANCED by her disorder. She has a view of Manic Depression from <strong><u>Both </u></strong>sides of the desk. Training new psychologists and psychiatrists, she is in a unique position to expand their understanding of future patients.<br /><br />I want to talk about Manic Depression here. What it's like for the patient; what it's like for those close to the patient. There are some unique challenges to this disorder. You may have a Manic Depressive in your life who has been a mystery to you. You may work with one, for one, love one, or have your life impacted by this disorder, and not even recognize what's going on.<br />I want to make this, ideally, a multi-part posting. I will talk about symptoms and signs in one post. The next will talk about various treatment modalities. Yet another will address what it's like to live with a Manic Depressive and how to cope/ help them cope with those pesky mood swings.<br />SO, y'all think about questions you might have. You can leave them in comments, if you like. As I progress through this opus, I'll try to cover any questions posed, as well as writing about the subjects I outlined above.<br />Stay tuned.HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com2tag:blogger.com,1999:blog-554957028387016008.post-20009684442137278462008-01-30T20:05:00.000-06:002008-01-30T20:28:03.795-06:00A Question from North of the Border<span style="font-family:verdana;color:#663366;">I got a letter from a student in Canada. S/He [in the interest of anonymity] wanted some advice about working in Parole specializing with women or youth populations. </span><br /><br /><span style="font-family:verdana;color:#663366;">I have NO idea how the Parole system operates in Canada, to be perfectly frank.<br />Here in the USA, the Parole systems vary from State to State. Some states combine Parole with Probation and others, like Texas [where I am] keep them seperate.<br />The average citizen, one who has never been or had a family member, on Probation or Parole tends to confuse the two very different jobs.<br /> As far as specializing in Women or Youth... the only way I can think of to do that [and I'm just takin' a WILD Assed Guess here] would be to take a position as what is called [here in Texas] as an Institutional Parole Officer. IPOs work <strong><u>IN</u></strong> the prisons interviewing prospective parolees about their plans for release and verifying those plans with the friends or family. Those same plans would apply to working in a youth facility where young women are incarcerated. I think, but don't know, that parole officers working with youthful offenders have more contact with their "clients" than IPOs do.<br />That's the drawback with being an IPO...there is no on-going contact with the parolee. If that's what you're loooking for. Of course a lot of Parole Officers with burn-out issues find the limited contact a nice change from the intense contact with the same parolees. <br /><br />What you might want to consider, if you're just starting a career in Criminal Justice, with a degree in Sociology, is a year working for Juvenile Probation. offenders. That would give you a chance to see if you actually<strong><u> like</u></strong> working with youthful offenders. Some caseworkers think they will like working with troubled youth because they like working with youth populations in other situations. Youthful offenders are a different kettle of fish, however. </span><br /><span style="font-family:verdana;color:#663366;"></span><br /><span style="font-family:verdana;color:#663366;">You could always call the Human Resources office and ask questions. If they are as desperate for workers as all the State Agencies down here are, they will be happy to answer your questions. You might even be able to set up a meeting with a Supervisor to discuss your interests and how they mesh with the requirements of the Canadian system.<br /><br />Good Luck and let me know how thing work out.<br /><br />If any of you readers have knowledge or experience with the Canadian Criminal Justice System, please share that info with this blogger and the Student writer.</span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com1tag:blogger.com,1999:blog-554957028387016008.post-20013279576443544002008-01-19T21:49:00.000-06:002008-01-19T22:04:39.654-06:00Haiku about being a P.O.<span style="font-family:trebuchet ms;color:#663366;">For those of you who don't read my other <a href="http://hollys-hystrionics.blogspot.com/">blog</a>...here's one of the Haiku I submitted Wednesday last in the Haiku contest <a href="http://chromedcurses.com/allatwitter/">Sparrow</a> sponsors every week:</span><br /><span style="font-family:Trebuchet MS;color:#663366;"></span><br /><span style="font-family:Trebuchet MS;color:#663366;">Parole Officer</span><br /><span style="font-family:Trebuchet MS;color:#663366;">sending felons back to prison</span><br /><span style="font-family:Trebuchet MS;color:#663366;">Wish they would stay there!!!</span><br /><span style="font-family:Trebuchet MS;color:#663366;"></span><br /><span style="font-family:Trebuchet MS;color:#663366;">That wasn't the one that won..but it was my second favorite. </span><br /><span style="font-family:Trebuchet MS;color:#663366;"></span><br /><span style="font-family:Trebuchet MS;color:#663366;">If any of y'all have a yen to send a Deluxe Care Package to any member of our Armed Services currently serving in harm's way...come on over to Sparrow's on Wednesday and enter the Haiku contest. That's what the winner gets...besides the honor of winning. They get to designate the recipient of a Deluxe Care Package.</span><br /><span style="font-family:Trebuchet MS;color:#663366;"></span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com0tag:blogger.com,1999:blog-554957028387016008.post-78213501049185633252008-01-11T16:58:00.000-06:002008-01-11T19:15:19.465-06:00Advice to a Would-Be Parole Officer, Part Deaux<span style="font-family:verdana;color:#663366;">Well, it's two days late, but it's here.</span><br /><br /><span style="font-family:Verdana;color:#663366;">This post will be about what I LIKED about being a Parole Officer.</span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">When I first started working for Parole my [then] husband was with the Sheriff's Office. That gave us some common ground. Also, when I had to go make a jail visit, I could drop by his office at the S.O. and visit for a few minutes if he wasn't busy. [Do NOT give me any feminist rhetoric! I'll wager I've been a man-loving feminist since before most of you little bitches were BORN. Growin' up with four brothers, and a succession of Step-fathers will do that to you. So just take a GIANT step back off my ass.]</span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">I met my [now] husband when he came to serve me with a subpoena so that I could testify against one of my miscreants after he committed a new offense. It's not that the Board has anything against P.O.s testifying against parolees who reoffend, they just want the subpoena, so that they can maintain the fiction that the P.O./parolee relationship is NOT adversarial. [In actuality, if you're lucky about 1/3 of your caseload will truly be non-adversarial, another 1/3 will be semi-non-adversarial, and the other 1/3 will be flat out I am gonna slam your ass back in Jail the very first chance I get and we BOTH know that's where you belong, don't we, Dickbreath? I mean NO offense to cocksuckers, some of the nicest people I know engage in that activity.] ANYWAY... I might never have met The Dearly Beloved had I not been a P.O. and had he not worked as a D.A. Investigator. But he came with that little piece of paper in his hand, and waited in my office, looking at my collection of Warren Zevon music while I got rid of an ATF agent I was talkin' to on the phone. [Those feebs could NEVER find my parolees who lived in the boonies. I had to let them follow me out there and pull into the driveway, because those <strong>MORON</strong>S could not even understand what SOUTHWEST corner meant. HOW the Dallas office ever made any busts is beyond me. I swan, every ATF guy, and they were always guys, never laughed at my, "Nice to meet you, I use all your products" line. Even if they WERE tired of hearing it, they could have chuckled out of professional g'damn courtesy!] He [Dearly Beloved] asked me out to lunch based on a common liking for Zevon, and the rest is history. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">I liked feeling that I was "protecting" my community when I was able to get a revocation on a parolee who had violated his parole by drinking when his conviction was for what used to be called Involuntary Manslaughter [now it's called what it is, Intoxication Manslaughter] or DWI. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">Convincing the Board to impose a NEW special condition after the parolee had been in Society for a while and wasn't adjusting well, that was something else I liked. It meant that I had spotted a problem, and was trying to do something about it. One case that stands out is a fellow that went down for drug possession but was now having... "anger management" problems. He hadn't hit his wife, yet. I was able to get him into sliding scale counseling BEFORE it could progress to a domestic violence situation.</span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">I live in a College Town. At the time I was a P.O. I had a Jeep CJ-7. I was driving with some friends in an area where a lot of young people hang out. It was Friday or Saturday night, we were going to get pizza. As I turned the corner I spotted one of my Involuntary Manslaughter parolees sittin' on the curb with some of his buds having a beer. Fortuitously, a car pulled away just as I turned the corner. I slid to the curb, it was so perfect, I stopped even with said parolee, my door was off b/c it was a warm Spring night. I waited for him to look up and notice who was driving the Jeep that had just slid to the curb right in front of him. "Oh SHIT!!!" I grinned, "That's riiiight. Be in my office at 9 am Monday!" Do I have to tell y'all I had a blue warrant by 8:30? For the civilians: a "Blue" warrant is called that because they are printed on blue paper. It is a warrant issued by the Board for the arrest of a Parolee when they have violated one of the conditions of their parole and are subject to revocation. A Parolee cannot make bail on a blue warrant. They have to wait for the Board to withdraw it, or for a revocation hearing. It can take up to 90 days to schedule a Revocation Hearing! </span><br /><span style="font-family:Verdana;color:#663366;">I will admit, I was positively Gleeful over this incident and did a happy dance. I did a happy dance as the Deputies marched him down the hall when they arrested him and I did a HUGE, office wide happy dance when I got the notice that he had been revoked for drinking. You see, he had gone to prison for killing a BICYCLE rider who was on the OPPOSITE side of the FM road upon which he was driving. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">This next had to do with Parole, because making Home Visits are a very big part of your job. You have to go out and see the house where they are living, or the trailer, or the apartment, or the motel, or in one memorable case, the school bus. You learn to have a higher tolerance than you thought possible for "unpleasant" odors. Although there was that one place...the Grandmother opened the door, and I staggered back two steps just trying not to retch from the stench that escaped in a miasma cloud when she'd opened the door. Thank GAWD that parolee wasn't home so I didn't have to go inside! Generally I liked doing home visits. I learned the county liked no body's business. I have a good sense of direction, it's just one of those natural talents I was blessed with. I also am good at following even the lousiest directions, when they give you landmarks, but not street names. Course out in the boonies, there aren't a lot of street names, sometimes. Keep in mind, this was back in the days before the 911 system required all streets, everywhere to be marked. I don't know what it's like NOW. </span><br /><span style="font-family:Verdana;color:#663366;">But that was a side benefit, I got to cruise around all over the country side, stereo blasting, and just hope out for a few minutes at each parolee's house, chat for a few minutes, try to verify this was where they actually lived and then on to the next one. See, that's the flaw with scheduled home visits. They KNOW when you're coming. So you never know if they really live there or if they just dropped in to meet with you. </span><br /><span style="font-family:Verdana;color:#663366;">Oh, one more thing, I learned this when I was an intern at Child Protective Services: NEVER, Never, sit on or next to upholstered furniture. If you can't sit on a wooden wooden chair that's at least 6 feet from an upholstered surface, stand. No reason to be rude about it, just politely refuse their offer of a seat. "No, thanks, I've been sitting in the office and sittin' in the car. It's nice to let my legs unfold for a bit." Something like that. See, lice live in upholstery. And they can jump up to 6 feet. Just thought I'd warn you the way I was warned. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">And in case, no one thinks to tell you in the office... NEVER let the parolee sit between you and the door. Never. Just DON"T do it. It's a matter of safety. You always want an unobstructed path to the door. This rule applies to home visits, too. Even more so. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">The conventions, schools, and other chances to get away from the office. No matter how inane the training, and some of it was, I loved gettin' together, especially out of town with other P.O.s. Especially after becoming a Sex Offender Officer. DAHM, but did we cut loos and have fun, or WHAT? Back in the day, there were just a few S.O. P.O.s and we went crazy when we got out of town, or just away from the office in a group. We drank too much, we smoked too much, we laughed, we danced on the tables, we swam in the pool in our underwear [because we were drunk], we needed to release all this tension that had built up since the last time we'd been together. None of the other officers understood what it was like to have to work with Toxic Waste wearing the disguise of a human being. Nobody, but another S.O.P.O., knew what it was like to have to listen to their bullshit excuses and rationalizations. "She seduced me" His victim was SEVEN years old! Or the guy who told me he didn't need counseling because he'd found Jesus in prison and his faith and love for Jesus would keep him from reoffending. He got REAL pissy when I told him that I'd hadn't had any messages from Christ lately, so he'd need to go to counseling and submit to a monthly <a href="http://www.dshs.state.tx.us/csot/csot_pleth2.pdf">penile plethysmograph</a>. [the link will take you to a site that explains the term and how the measuring is used with sex offenders] I just HATE it when criminals not only try to con me, but use the name of the Almighty to do it. But what I liked was getting together with other S.O.P.O.s to brainstorm about ways to cope with this bull and just to decompress in a way we couldn't with other officers.</span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">And, this is kind of a dirty little secret, I guess...BUT the Parole Officer badge looks a LOT like the DPS badge. And I had a badge case that had the flap that held my badge on one side and a pocket for my TDCJ ID on the other. THAT badge case was where I kept my Driver's license. Every time I got stopped for speeding the entire time I was a P.O., I'd whip that badge case out and the Officer or Deputy or Trooper who had stopped me would see that badge while I was pulling out my D.L. It gave them pause. They'd ask who I worked for and I'd tell them I was a P.O. in the _______ District Office. They'd ask if I knew so-and-so at such-and-such P.D. or S.O. or the D.A.'s office, or Trooper so and so or Ranger so and so. Almost always I did. You get to know these guys after you've gone to get their help on an investigation, or because your parolee lives in their area and you just want them to know he's there or back. And you get to talking about this and that and before you know it he's grinnin' at you and says, "Ah, slow down, Girl and get outta here!" And you drive off. Badge America, nothin' finer.</span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">I went into Social Work because I wanted to help people. I went into Parole because I wanted to have a feeling of helping people in my community. I think I can say, with a straight face, and a clear conscience, I did that and I gave an honest day's work for an honest day's wage every day I was there. If you can stand the office and agency politics, it's not bad. I just couldn't. I burned out after being on a sex offender caseload too long and having a conflict with my immediate sup. So, I say...give it a try, but if you see it's grinding you down, sucking out your soul...Get Out! There are other ways to make a living. </span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com40tag:blogger.com,1999:blog-554957028387016008.post-82307493502513321562008-01-11T11:28:00.000-06:002008-01-11T16:45:41.703-06:00A Belated Note of Thanks<span style="font-family:trebuchet ms;">To the Anonymous Parole Officer with whom I corresponded in September:</span><br /><span style="font-family:Trebuchet MS;">The blog I posted Wednesday [about the negative aspects of being a Parole Officer] would not have had as much authenticity without the input I received from you. </span><br /><span style="font-family:Trebuchet MS;"></span><br /><span style="font-family:Trebuchet MS;">As I have stated many times, I've been out of the "game" a long time. But our letters back in September let me know that things haven't changed. The mere fact that you were thrilled to have a blog based on the letter you wrote to me back then and the things you said in answer to my questions let me know that The State in general and The Board and its minions in particular haven't changed in my absence. </span><br /><span style="font-family:Trebuchet MS;"></span><br /><span style="font-family:Trebuchet MS;">Thank you for the information. But more importantly, <strong>THANK YOU</strong> and every other P.O. for doing the jobs you do. Thanks for keeping an eye on these men and women released from our prison system, some because their good behavior warranted it, and some because their good time + their time served = their total sentence so they get released whether they deserve it or not! </span><br /><span style="font-family:Trebuchet MS;">Thanks for being over-worked and underpaid. Thanks for paying for a Bachelor's degree and now taking home less than $2k/month after taxes, retirement and insurance are deducted. Bet you're wishing you'd Majored in Business or Computer Science now, huh?</span><br /><span style="font-family:Trebuchet MS;">Thanks for taking the crap, the nitpicking and petty BS you have to put up with from burned out Unit Supervisors, Regional Supervisors, and seen-it-all Hearing Officers who have forgotten what it was like to <strong>BE</strong> a P.O. </span><br /><span style="font-family:Trebuchet MS;">Thanks for the unpaid overtime you have to put in every week in order to get all the office visits, home visits, case file documentation, Reports of Violations and all the other myriad duties accomplished. And thanks for taking on the job of Lab Tech, too. Don't you just love how you have to go into the restroom and supervise the collection [or beg an officer of the same gender to do this for you w/you opposite gender parolees] of Urine Samples? And then, after Duty Day is done, you get to test all those stinky little cups. Is the State paying for your HepB vaccination, by the way?</span><br /><span style="font-family:Trebuchet MS;">Jaysus, Mary and all the Apostles!!! It's been 17 years and things are worse than ever! </span><br /><br /><span style="font-family:Trebuchet MS;">So <strong><u>THANK YOU, THANK YOU ALL SO VERY, VERY MUCH!!!</u></strong></span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com4tag:blogger.com,1999:blog-554957028387016008.post-53261347227981441952008-01-08T21:38:00.000-06:002008-01-09T00:28:25.280-06:00Advice to a Would-Be Parole Officer<span style="font-family:verdana;color:#663366;">I got a letter about 3 weeks ago from a fella who is considering a career change. He wants me to give him the straight story on what it's like to be a Parole Officer. Well, wanting to be fair, I have to tell you, I LEFT Parole and didn't let the door hit my ass on the way out in November '91. So my personal experience is not exactly up-to-date. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">However, a few months ago I exchanged email with a current Sex Offender P.O. and I spent several hours reading web page propaganda on the <a href="http://www.blogger.com/www.tdcj.state.tx.us/parole/parole-home.htm">TDCJ </a>site. I also spent a few years working for TDHS [TX Dept. of Human Services]. That's your first lesson, class. When you go to work for Uncle Sam or Uncle Sam Houston, be prepared to start learning a different language, the language of abbreviations. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">I used to drive my kids and Mother <u>NUTS</u> talking in abbreviations. They hated that. I still lapse back in to that letter-speak from time to time. My Daughter, the English major, gets all uppity and makes snide remarks about wasting my education and fine vocabulary. I just smile inwardly, and bide my time. When she becomes a teacher she'll have her very own secret language from TEA and PTA <em>et al</em>. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">Next on my list of warnings... it all depends on the Unit Supervisor you draw. The person who supervises you on a day to day basis can determine whether you have a successful or a shitty career. As can your ability to keep your head down and out of office politics. Listen very carefully to my next: <strong><u>ALL</u></strong> State Agencies, by their very existence and dependence upon the Lege for funding and their bureaucratic structure <strong><u>always have been and always will be political</u></strong>. Unless you can stay out of the politics, or you are an EXPERT political animal or you can survive having your ass handed to you by someone who IS a Political Predator...reconsider going to work for a State Agency. Or, try it for a year, and if things are working out, then you can try it for another year...but please don't start planning a career until you've lasted at least 5 years. If you have not risen to P.O. III, or Hearing Officer after five years...consider switching to Probation or the Feds. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">The beginning salary and what you can expect after 2 years and then 5 years can be found by navigating through the link I gave you above. I will say it's more than what I was making when I left, 17 yrs ago, but that's to be expected after all this time, what with COLAs and the fact that they were literally <em>bleeding</em> new P.O.s for awhile. They had to increase salaries in an effort to keep them. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">They induce the Type A P.O.s to take on the specialized caseloads that I discussed back in September [I think, maybe it was October] by appealing to their egos. "Oh, not just any P.O. can handle a caseload like this." "It takes a SPECIAL officer to handle the challenges of a caseload made up of these kinds of releasees." Do <strong>NOT</strong> fall for this trap!! I can't even believe they are still gettin' away with using that crap!</span><br /><br /><span style="font-family:Verdana;color:#663366;">In 1988 I was one of the first Sex Offender Parole Officer Texas had. I was one of their guinea pigs. We went to Austin for a week in the Spring. Then in December we went to Padre Island for a week and that was what they called training. Of course we started seeing sex offender parolees right after we got back in the Spring. There wasn't then and isn't now a distinction made between Rapists and Pedophiles. However there is a world of difference in the way to approach those offenders, both because of the way their minds work and for officer safety reasons. <strong>BAD</strong> JuJu, very bad JuJu!</span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">But the 'crats at the top of the heap at TDCJ-PPD have been gettin' away with connin' the best officers into workin' these high stress caseloads because they choose the officers who <u>love</u> a frickin' challenge. Oh, yes we do. [do I sound bitter? I get that way when my soul is sucked dry and the husk thrown away. I'm touchy about that.] </span><br /><br /><span style="font-family:Verdana;color:#663366;">The workloads? Oh, lets see they are about 1/2 again as much as normal humans can handle during a 40 hour work-week. Of course there IS no such thing as OT when you work for the State. We used to be able to accumulate "Comp" time which we had to use in the same week we earned it. In other words, if you worked late on Tuesday because you had to do home visits, then you had to take the same number of hours off before 5 p.m. Friday or you just gave the State your time. However, if you got stuck with Friday as a "Duty Day" and had to be in the office that day and a bunch of parolees got released on Thursday and reported on Friday and their P.O.s were out and you had to see them instead as well as your own parolees who were there for their monthly report and you wound up working until 6 or 7 pm, well the entire TDCJ appreciated the donation of your time. I don't imagine that has changed either, but YMMV.[your mileage may vary]</span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">I hope by now that they have switched to computerized records, but I doubt it. It is after all a State Bureaucracy. When I left, they were just getting computers. By now I'm sure every P.O. has a desktop and some may even have laptops for field use. BUT, and I hope I'm wrong, but I'd bet you $5 that officers, at a minimum, have to print off a copy of everything they put in the E-file and maintain a paper file, too. That's the bureaucratic mindset. If it's not on paper, it's not real. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">In any case, every contact with or in connection with a releasee <strong><u>MUST</u></strong> be documented. Every phone call, every office, home and job site visit must be written in the case file. If the parolee goes to counselling, the documentation he brings in to prove to you he has attended and paid for his counselling must be noted and a copy placed in the file. His documentation for AA/NA must also be written in your notes and a copy placed in the file. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">When I was still with Parole they were experimenting with having P.O.s collect and test urine samples from parolees. We had three different test kits so we could test for opiates, cocaine and marijuana. [BTW, you would have to eat a ridiculous amount of poppy seed hamburger buns, the BIG ones before your urine would test + for opiates, same for being in the same room where other people were smokin' dope and that's why you tested + for MaryJane. <strong>What?</strong> Were they super chargin' you? Go peddle that story somewhere else, cause I ain't senile so I'm not buyin' it.] Now when you submit your application for employment to the Human Resources folks, they don't warn you about this kind of stuff. My degree is in Social Work, not biology or chemistry. I most definitely did <strong><u>NOT</u></strong> sign on to carry some felon's hot pee around in a plastic cup and then run 3 tests on it, <strong><em><u>AFTER</u></em></strong> work hours when I should have been home with my kids or going out to dinner with that long, tall, gorgeous, hunk of man who is now my Dearly Beloved. So, you up for that, Pilgrim? </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">If I had been able to get OUT of my District Parole Office and become a hearing officer or get a transfer to Institutional Parole Officer, I probably would have stayed with Parole until retirement. Two things worked against me. Well, maybe more like three. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;"><u>Firs</u>t, I have a big mouth and I seem to be unable to keep it shut, even when it would be politic to do so. </span><br /><span style="font-family:Verdana;color:#663366;"><u>Second</u>, I went to one little State Employees Union Meeting in Austin, talked to some legislators, on my OWN time and the Regional Supv was so paranoid after that... every time he called the office or my Unit Supv called him for something, he asked where I was. If I wasn't in the office, he assumed I was out doing "Union Business." I had to start bringing in Proof of where I had been, when I took comp time. A receipt from the Library, a local restaurant, a note from my kids, a copy of my travel sheet for the home visits, anything to prove I hadn't "snuck" down to Ft.Worth and the Union Office.</span><br /><span style="font-family:Verdana;color:#663366;"><u>Third,</u> my Unit Supervisor was a Bitch on Wheels. If I could have had the good luck to have kept the first Unit Sup I had...but that's water under the bridge. One evaluation from this woman would be glowing, the next would be awful, six months later...glowing...six months later...shit... This went on for FOUR years. </span><br /><br /><span style="font-family:Verdana;color:#663366;">I had started volunteering with a non-profit about a year before I left Parole. They finally got a grant they had applied for and offered me a job. I jumped at the chance to get paid to do something I enjoyed and that I'd been doing for free. The fact that I'd be making the same money, working with co-workers who <strong>VALUED</strong> me and a client base who <strong>APPRECIATED</strong> me was as good, if not better than not having to take a salary cut. </span><br /><span style="font-family:Verdana;color:#663366;"></span><br /><span style="font-family:Verdana;color:#663366;">I realize I have probably scared you away from Parole work. So I'll try to write a blog tomorrow telling you the things I LIKED about it. Believe it or not, there WERE some things I liked about being a Parole Officer. </span> <span style="font-family:Verdana;color:#663366;"> </span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com373tag:blogger.com,1999:blog-554957028387016008.post-66259557964531768272008-01-04T12:19:00.000-06:002008-01-04T16:17:37.864-06:00Defining DepressionHow do you know when the "Blues" have gotten out of hand and you need medication to be able to get past it?<br />Not related to post partum depression, just an over load of stress and crap in life. Is it possible to expect to get back off the medication some day? <br />If you don't have a GP, where do you start? I go to my OB/GYN annually for my medical needs.<br /><br /><span style="font-family:verdana;">This is probably one of the <strong><u>MOST</u></strong> common questions Social Workers, Doctors, Nurses, Nurse Practitioners, Counselors,Psychologists, and Psychiatrists hear.</span><br /><span style="font-family:Verdana;"></span><br /><span style="font-family:Verdana;">Almost everybody gets the "Blues" from time to time. But there are definite signs and symptoms that differentiate the Blues from a Depression that can be treated with medication and/or therapy. </span><br /><span style="font-family:Verdana;"></span><br /><span style="font-family:Verdana;">I need to take a detour here onto one of my famous tangents [if you read my other blog, you've been on one of my <u>"Tangential Thinking Road Trips</u>" before]. I am one of those helping professionals who believe that therapy never hurt anyone and has helped just about every one who gave it an honest try. So <u>IF</u> you meet the criteria for Depression, please consider therapy as well as medication. </span><br /><span style="font-family:Verdana;">I also attended the Nature <strong>and</strong> Nurture School of Causation for Depression. I think there is, in addition to the neurotransmitter/chemical imbalance component of depression, something in almost every one's background that contributed to their depression. Does this make you nuts? <strong><em><u>NO</u></em></strong>, it does not! Is it a criticism of your Mother or Daddy or the way they raised you? Not necessarily, unless you were abused physically, sexually, or emotionally. Or neglected physically or emotionally. The point is: YOU get to set the parameters for discussion in therapy. And, you can say <u>ANYTHING</u> within the confines of your therapist's office and it's confidential. Now, I know there may be a smart-ass or two out there to nit pick that last statement...so I have to include this modifier: if you tell your therapist you are planning to harm another person said therapist is obligated to inform the authorities and your intended victim [I think]. But that is the only time they are allowed to violate your confidentiality. </span><br /><span style="font-family:Verdana;"></span><br /><span style="font-family:Verdana;">OK, side trip over, let's get back to the main topic...</span><br /><span style="font-family:Verdana;">I went to some websites I found through Ask.com, my search engine of choice, using Depression Symptoms as my search criteria. These come from the National Institutes of Mental Health website, <a href="http://www.nimh.nih.gov/health/publications/depression/complete-publication.shtml#pub3">http://www.nimh.nih.gov/health/publications/depression/complete-publication.shtml#pub3</a>, just in case you want more info than what I'm relating here. I also liked their definition of Depression: <span style="color:#993399;">When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious illness, and most who experience it need treatment to get better.</span></span><br /><p><span style="font-family:Verdana;">Here are the symptoms:<br />Persistent sad, anxious or "empty" feelings<br />Feelings of hopelessness and/or pessimism<br />Feelings of guilt, worthlessness and/or helplessness<br />Irritability, restlessness<br />Loss of interest in activities or hobbies once pleasurable, including sex<br />Fatigue and decreased energy<br />Difficulty concentrating, remembering details and making decisions<br />Insomnia, early–morning wakefulness, or excessive sleeping<br />Overeating, or appetite loss<br />Thoughts of suicide, suicide attempts<br />Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment </span></p><p><span style="font-family:Verdana;"></span> </p><p><span style="font-family:Verdana;color:#993399;">As for the 2nd part of the writer's email: Where to start if you don't have a GP, or Primary Care Physician and only see an OB/Gyn once a year for Well Woman Check-ups? </span><span style="font-family:Verdana;">There are, in most communities, mental health resources even for people without insurance. I don't know where this particular person lives. In Texas, we have an agency known as Mental Health/Mental Retardation [how UN-PC of us!!] or MH/MR. They accept <u>anybody</u>. The charges will be based on your ability to pay. If you are employed, but have no insurance, the eligibility worker will look at your income, family size and other medical expenses. Your fee per service, both medicine and therapy will be based on a sliding scale. </span></p><p><span style="font-family:Verdana;">But, if you have private insurance, you will need to check your individual plan's coverage and requirements before beginning therapy. They may require you to only see provider's from an approved group of professional with whom they have negotiated fees. Otherwise your benefits may be reduced. </span></p><p><span style="font-family:Verdana;">When seeking a physician to prescribe anti-depressant medication, I think it's important to consult a psychiatrist. They are specialists. All they do is treat disorders like depression. Their expertise can be invaluable in choosing the right medication for you. Often a medication regimen must be tweaked over a period of time before finding the correct dosage or even the correct medicine or combination of medicines for a particular patient. This is not a process to be left in the hands of the physician who goes from room to room treating coughs one minute and a sprained ankle the next, and then someone else's hypertension.</span></p><p><span style="font-family:Verdana;">Trust me on this, even if it costs a little extra for the co-pay, go to the Shrink. They know their stuff. And don't get discouraged if the first medicine doesn't work. Or if your dosage has to be increased. Or if it has to be changed after 6 or 9 or 12 months. These things happen in a large percentage of cases. Treating Depression isn't like treating an ear infection or bronchitis. It's not one medicine works for everybody. </span></p><p><span style="font-family:Verdana;">In the last 32 years, I've been on at least 13 different anti-depressants. So I know what I'm talkin' about when I speak of tweaking doses and making other adjustments. The brain is an amazingly adaptable organ. You put one chemical into it long enough and it will accommodate that chemical to the point where you have to try another chemical to achieve the same balance of Serotonin and Norepinephrin [the two neurotransmitters that get out of whack when we're depressed].</span> </p><p><span style="font-family:verdana;">I think I answered the questions. If anybody is still in doubt after this and going to the NIMH site, leave me a comment or send me another email and I'll take another shot at it. </span></p><p><span style="font-family:Verdana;">Tomorrow I answer a question about being a Parole Officer by someone considering a Career change.</span></p><span style="font-family:Verdana;"></span><br /><span style="font-family:Verdana;"></span><br /><span style="font-family:Verdana;"></span><br /><span style="font-family:Verdana;"></span><br /><span style="font-family:Verdana;"></span><br /><span style="font-family:Verdana;"></span><br /><span style="font-family:Verdana;"> </span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com3tag:blogger.com,1999:blog-554957028387016008.post-85045821433087710102007-12-01T20:12:00.000-06:002007-12-01T21:24:53.965-06:00Question About Manic Depression and Medication<p><span style="font-family:verdana;color:#336666;">This week, I received this letter in the mailbox. I've underlined </span><span style="font-family:verdana;color:#336666;">the key questions and terms.</span></p><br /><span style="font-family:arial;color:#663366;">I was talking to a friend recently and although I'm generally a completely manic person, (my doctor called me hypomanic) I've been going through a huge personal transition that has its <u>stresses</u> and I've been feeling down occasionally. </span><br /><br /><span style="font-family:arial;color:#663366;">My friend then used the term <u>"manic depressive</u>" and said that was what I was experiencing, and though I never recognized it myself, I know she was absolutely right. </span><br /><br /><span style="font-family:arial;color:#663366;"></span><br /><br /><span style="font-family:arial;color:#663366;">My question is, if I'm <u>generally just hypomanic, what's the harm in me just going through life being unmedicated and an overachiever?</u></span><br /><br /><span style="font-family:arial;color:#663366;"></span><br /><br /><span style="font-family:arial;color:#663366;">If I <u>really focus, I CAN do normal things like sleep and maintain routine</u>, I'm just channeling my inner terrier, is all. Honestly, anti-depressants saved my life a couple years ago, and I'll always keep the <u>possibility of Lexapro in reserve as a life-preserver</u>, but generally, is it possible it's okay for me to <u>be hypomanic and not drive others crazy</u> and still have a fulfilling life? I mean, <u>could I fall in love and have a happy life and not just annoy the crap out of other people without relying on pharmaceuticals, or is this an unrealistic hope?<br /></u></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;">Well, first of all, let's make sure we're all on the same page with our terminology. Manic Depression, while a vastly more descriptive term for what's actually going on with the emotions, fell out of favor with Mental Health practitioners at the beginning of the Politically Correct movement in the late '70's and early '80's. It was replaced with the term Bi-Polar Disorder. </span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;">Personally, I prefer the term Manic Depression. I think it describes the disorder in a more understandable fashion for client, family, friends, and any interested party. Besides, I've been involved in the Mental Health field long enough to see the pendulum swing to both extremes in a lot of areas. And, besides, that what this writer calls it. A provider of advice, counsel, therapy should always be guided by the "client," so that's what I'll call it. </span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;">Now, first off, you mention <u>stresses caused by a personal transition.</u> Stress can often bring on what is called "cycling" in someone with Manic-Depression. Cycling is the transition between the mania and the depression. Most people with this disorder, when looking back, [and isn't hindsight a wonderful diagnostic tool?] realize their symptoms began to manifest during their teens and early '20's.</span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;">Before that time they may only have experienced depression. Therefore when the manic side of the disorder began, especially, if it was "hypomanic" as in this person's case, they may have, experienced the mania as a period of what they perceived as normalcy. And who wouldn't want to feel mania after depression. Hypomania brings energy, creativity, a feeling of being on top of the world. After the sadness, lethargy and mental sludge and memory lapses of depression, who wouldn't welcome the ability to think one great idea after another? </span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;">The problems begin to arise when those wonderfully creative thoughts begin racing through your mind and you cannot control them. The problems begin when you begin to make really <strong><u>BAD</u></strong> choices about spending too much money, drinking too much booze, taking too many drugs, having sex with too many people or in inappropriate places. These are what <strong><em><u>can</u></em></strong> happen with unmedicated Manic Depression.</span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;">What is <u>MOST</u> important about making the decision about whether or not to start medication is to do a realistic inventory of your life. Are your decisions being influenced by your mania? Are you making good decisions, and by that I mean are the decisions you are making impacting your life in a negative or positive way? Are you financially stable, or has your mania caused you to overspend to the point that you are in a financial bind? How about your use of alcohol or other drugs? Are you endangering your health with the use of too much booze, or too much food or too much of any substance? Do you drive when you are impaired, thus endangering yourself and others? Are you having sex with people you don't know or don't know well? Are you having sex when you're drunk or otherwise impaired? Male or Female, HIV, HepC, HepB, STDs, love is fleeting Herpes is forever. </span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:verdana;color:#336666;">If you answered "Yes" to one or more of these questions, you need to be on some type of medication. Being medicated doesn't mean you will give up the energy, the creativity, the ability to think. You won't lose your "inner terrier" if you start a course of mood stabilizing drugs in combination with anti-depressants. </span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:Verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:Verdana;color:#336666;">It may take some tweaking to find the right combination of the right drugs for you. But with all the research being done by pharmaceutical companies, new drugs hit the market almost monthly. The problem with being afraid of taking medicine, is that you may not recognize a problem until you're hip deep in it. Denial is an awesome coping mechanism, but it's not always the most productive one. </span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:Verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:Verdana;color:#336666;">So, yes, you can go on being unmedicated, <strong>IF</strong> you are self-aware enough to do an inventory on a regular basis. But, would you walk on a sprained ankle, if support in the form of a brace was available? Would you walk around with hypertension when there was medicine to control it if dietary changes alone weren't bringing it down into a safe range? </span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:Verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:Verdana;color:#336666;">I see a lot of clients who think that once they stabilize, they don't need their medicine anymore. Not just Manic Depressives, but all across the Neurotic board, and most of the psychotics, too. They view their mental health issues as something they can control through an effort of will. What I see is someone who doesn't have an understanding that their disorder is <strong><u>FIRST</u></strong> an imbalance of neurotransmitters in their brain, and then a disorder of psychology caused by their individual circumstances. Until the brain chemistry is under control, through the use of modern chemistry, any counseling, behavior modification, therapy, or spiritual intervention is ultimately less than effective because it only treats symptoms and not the underlying biological disease. Some, the lucky or smart ones eventually "get" it, find the right combination of meds and stay on meds, making changes as necessary. And changes will be necessary. The brain is a living organ, it adapts and changes over time. Changes in medication are inevitable. </span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:Verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:Verdana;color:#336666;">Manic Depression, left untreated, will usually get worse. Sometimes it takes years. But in most cases, it does get worse. Especially as the client ages, as stressors multiply, as women give birth, approach menopause, as men reach their mid-life crises and own hormonal changes. Doesn't it make sense to be prepared with your own arsenal of medication already in place?</span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:Verdana;color:#336666;"></span></span><br /><span style="font-family:arial;color:#663366;"><span style="font-family:Verdana;color:#336666;">Please feel free to contact me again if you have more questions. </span><br /></span><span style="font-family:arial;color:#663366;"></span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com3tag:blogger.com,1999:blog-554957028387016008.post-45736669814133762942007-10-27T11:14:00.000-05:002007-10-27T12:25:50.422-05:00Grieving for a Parent<span style="font-family:verdana;color:#993399;">This week marked the 3rd anniversary of my Daddy's death. Because he had "beaten" cancer in 1991, and reached that all important 5 year, Cancer-free milestone, he, and we thought he was home free. When, in 2004, he began to have some back pains, he wrote it off to "old age." At 77, he had to expect <strong><u>some</u></strong> aches and pains, right? By the time he went to see the Dr. in July of 2004 because of bloody stools, the cancer had metastasized from his remaining kidney to his spine, stomach, liver,and lungs.</span><br /><span style="font-family:verdana;color:#993399;"></span><br /><span style="font-family:verdana;color:#993399;"></span><br /><span style="font-family:verdana;color:#993399;">It was August before all the tumor typing and classing was done. That was when one resident finally gave us a prognosis, none of the <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Attendings</span> would be that brutal. But this one Resident talked to one of my Stepbrothers and me. He wouldn't say anything in front of Daddy or my Stepmother, they had so much hope and faith, he just couldn't, I guess, or maybe the <span class="blsp-spelling-error" id="SPELLING_ERROR_1">Attendings</span> had told him not to say anything. But, we cornered him and just bluntly said, "Look, we're not like Mom and Daddy. <em>WE</em> know it's bad. Just give us a round number so we can start to prepare ourselves and the rest of the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">sibs</span>, and our kids and nieces and nephews. They deserve that much. We'd like for them to be able to see him while he's still in good spirits, not when he's too weak or in too much pain to respond. " God Bless him, He took us at our word. "Well they want me to tell you a year. But I think that's <strong>way too</strong> optimistic, I don't see him lasting much past Thanksgiving, Christmas at the outside."</span><br /><span style="font-family:verdana;color:#993399;">That knocked me for a loop. This was August. But I took a deep breath and gutted it up and thanks the Doc and shook his hand. </span><br /><span style="font-family:verdana;color:#993399;"></span><br /><span style="font-family:verdana;color:#993399;">I went downstairs, cried for a few minutes and then I started calling. I called my kids, I called Daddy's closest out of town Cousins. I told them they didn't have to come <u>that</u> weekend, but they needed to come soon. </span><br /><span style="font-family:Verdana;color:#993399;"></span><span style="font-family:verdana;color:#993399;"></span><br /><span style="font-family:verdana;color:#993399;">I also called members of his High School football team. The remaining members still got together for lunch once a month. I told them, honestly how serious it was. He was as close to these men and their wives as as he was to brothers. He loved them. And they came. The ones who lived close to the hospital came often and came to see him at home, too. </span><br /><span style="font-family:verdana;color:#993399;"></span><br /><span style="font-family:verdana;color:#993399;">I am proud of that. I think it was a kindness and that it helped Daddy. I know it helped me and eased my mind to see him surrounded by all that love and affection. </span><br /><span style="font-family:verdana;color:#993399;"></span><br /><span style="font-family:verdana;color:#993399;">As I was watching Daddy die, I was watching myself go through the classic stages of grief at the same time. Anger, Denial, Bargaining, Depression, Acceptance, <span class="blsp-spelling-error" id="SPELLING_ERROR_3">yeppers</span>, went through all of them. Though not necessarily in that order and I went through some of them more than once. It was surrealistic at times because I'd get this detached, clinical feeling of watching myself from a distance, "yes, now I'm Angry." "OK, now I'm in the Bargaining Stage." "Look, Holly you're in Denial again, and you KNOW that's not productive!"</span><br /><span style="font-family:verdana;color:#993399;"></span><br /><span style="font-family:verdana;color:#993399;">One of the most useful tools I learned when I was in training to be a Grief Counselor was to give the client permission to be ANGRY at the person who is dying/has died. I hear what you're thinking, "<strong><u><em>WHAT</em></u></strong>?!?! How can you be mad at someone for dying?" Simple, when you think of dying as abandonment. And, if you're honest with yourself, emotionally, death feels like being abandoned now doesn't it. When a friend lost her Mother and was going through a really bad bout of depression a couple of weeks after the loss, I went to visit her. I said, "You know, it's okay to be mad at her. After all, she <em>DID</em> abandon you." If you want to yell at her and get it off your chest, I won't tell anybody." For a couple of seconds she just looked at me with this shocked expression on her face. Then she was crying and grinning at the same time, "I am pissed off at her. She DID go off and LEAVE me here. How <strong>dare</strong> she do that to me? I've still got a family to take care of and problems to go through, and, and and..." </span><br /><span style="font-family:verdana;color:#993399;"></span><br /><span style="font-family:verdana;color:#993399;">See what I mean? When you're given permission to feel an emotion that is somewhat shameful, it is liberating. It allows you to own that emotion and work through it instead of keeping it bottled up and having it fester inside. Emotions <strong>WILL</strong> find a way to express themselves if you don't do it verbally,trust me. Ever had a tension headache? Known someone with an ulcer? If they'd express those nasty old emotions...</span><br /><span style="font-family:verdana;color:#993399;"></span><br /><span style="font-family:verdana;color:#993399;">Losing a parent is one of the most stressful events that an adult experiences. We expect to loose them at some point, but we dread it, too. Unless there was a history of horrible abuse, and sometimes even then, we hope for a final showdown or resolution before our parents leave us. But for the lucky among us, our parents death symbolizes the loss of a layer of "insulation" between us and the world. NO matter that we are functional, independent adults and our parents may have been the infirm of body and mind; we may have been the caretakers with them in the dependent role. We still have the illusion of our parent as Protector, as guardian from all things dark and menacing. </span><br /><span style="font-family:Verdana;color:#993399;"></span><br /><span style="font-family:Verdana;color:#993399;">Losing that illusion is a blow. One that it takes time to heal. I have been granted that time by a loving and understanding family. </span><br /><span style="font-family:Verdana;color:#993399;"></span><br /><span style="font-family:Verdana;color:#993399;">I hope that those of you who have lost or face losing a parent have been or will be comforted or in some helped by reading this entry. AS always, if you have questions or comments, you may leave them anonymously in the comments section or send me an email at the <span class="blsp-spelling-error" id="SPELLING_ERROR_4">addy</span> listed to your right. </span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com31tag:blogger.com,1999:blog-554957028387016008.post-28622763397353705832007-10-20T16:42:00.000-05:002007-10-20T17:00:21.831-05:00An interesting blog someone else wrote<span style="font-family:trebuchet ms;color:#993399;">I got this from a Blog named: Rickety Contrivances of Doing Good. You can find it <a href="http://improbableoptimisms.blogspot.com/">here</a>. I have highlighted in <span style="color:#993300;">orange</span> the phrases and words I found most significant. I hope y'all find this useful, too. The author's name is at the bottom of the blog.</span><br />Sunday, October 14, 2007<br /><br /><a href="http://improbableoptimisms.blogspot.com/2007/10/narrating-trauma.html">Narrating Trauma</a><br /><span style="font-family:arial;">I've posted here before about the work I'm doing with the University of Nevada School of Medicine, helping them integrate more </span><a href="http://improbableoptimisms.blogspot.com/2007/08/grand-rounds-volume-3-number-49.html"><span style="font-family:arial;">narrative medicine</span></a><span style="font-family:arial;"> into the curriculum. Since I have a PhD in English and volunteer in an emergency department, the UNSOM folks like having me there, and I certainly like being there; it's a place where I can integrate several areas of my life that otherwise seem far-flung.In the ED itself, I think of myself as practicing a kind of narrative medicine, encouraging patients to tell stories and listening carefully to what they say. But I'm well aware that most of the medical staff has very little time to do anything similar (which is why chaplains are so important!). In the ED, narrative medicine seems like a luxury better suited to slower-paced specialties where caregivers develop relationships with their patients over time. And that's a real shame, because for patients able to speak at all, turning their fear and worry into narrative can have powerful healing effects. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">A few weeks ago, I gave a very basic lecture on trauma theory to my freshman composition class. Trauma -- used here more broadly than medical caregivers define it -- <span style="color:#993300;">is any event that</span> <span style="color:#993300;">overwhelms the individual's ability to cope</span>. Trauma takes many forms, but all of them share certain characteristics:</span><br /><span style="font-family:arial;">1. Trauma is unpredictable and uncontrollable.</span><br /><span style="font-family:arial;">2. It threatens the individual with death, not-being.</span><br /><span style="font-family:arial;">3. It threatens and undermines meaning, toppling previous belief systems.</span><br /><span style="font-family:arial;">4. Because it is so overwhelming, the individual carries it inside even when it appears, to outside observers, to have ended. It is always now and always here. </span><br /><span style="font-family:arial;">5. Because it is so overwhelming, it is extremely difficult to talk about: partly because it defies language, partly because <span style="color:#993300;">the individual fears invoking it again</span>, and partly because often, no one wants to listen, or is able to understand.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">And yet talking about the trauma, shaping it into narrative -- a story -- is essential, because narrative is the opposite of trauma:</span><br /><span style="font-family:arial;">1. Storytellers control what happens in the story, so telling a story about the trauma gives the victim control over it, the very control that was lacking in the event itself</span><span style="font-family:arial;">.</span><br /><span style="font-family:arial;">2. Telling a story is a way of asserting survival and existence: "This happened to me, but I'm still here to talk about it."</span><br /><span style="font-family:arial;">3. Telling stories is how we make meaning of what has happened to us, shaping chaos into coherence.</span><br /><span style="font-family:arial;">4. Telling a story about trauma externalizes the trauma, moving it from the victim's brain and body into public space. Story-telling helps survivors birth their own experience. </span><br /><span style="font-family:arial;">5. Shaping the trauma into language, taming it into a tale, helps survivors "rejoin the land of the living" by casting what has happened to them into shared language. </span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">Stories build a bridge of words and images between the trauma and the rest of life. This is why I believe that narrative is as vitally important in the emergency department as it is anywhere else in medicine. Of course, many ED patients are unable to speak, and of those who can, some may be so overwhelmed that it will be days or weeks before they can begin processing what has happened to them.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"> But we've all met ED patients or visitors who compulsively narrate what has brought them there, who repeat the same tale to everyone who enters the room: even if the doctor's already heard it, even if most of the details have no possible bearing on anything medical. "I was eating a tuna-fish sandwich, and he just keeled over into his tomato soup, and then I was trying to pull his face out of the bowl and call 911 at the same time, and oh, gosh, these slacks are covered with tomato soup, aren't they?" "I was in Home Depot buying nails when I felt this crushing pain in my chest, and one of those guys pushing a huge lumber cart asked me if I was okay, and I couldn't answer! It was so scary not to be able to talk. It reminded me of that time in third grade when the other kids pushed me into the water and held me down, and the guy with the lumber was kneeling down next to me, and I didn't know how I'd wound up on the floor, and I'd dropped my nails and I wanted to pick them up, but he kept telling me just to stay there, the ambulance was coming."</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;"> Compulsive repetition of such stories isn't just a sign of shock. It's an essential coping strategy: the speaker is desperately trying to regain control by turning the event into a known, predictable narrative. If your ED has a chaplain, social worker, or someone else whose primary job is to listen, by all means try to have that person visit the room.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">If you're a medical caregiver and you have two extra seconds, by all means listen, and try -- without interrupting -- to give some active sign that you've heard. Body language and facial expressions count for a lot here. But what if there's no chaplain or social worker in sight? What if the department's so busy that you don't have two extra seconds to spend listening to anyone? One easy answer is, "There will be someone to listen later, in or out of the hospital," and of course that's true. But I suspect that the earlier this process begins, the better. And so, if patients or bedside visitors are able to write, why not encourage them to start putting their stories down on paper? I've linked here before to </span><a href="http://archives.cnn.com/2000/HEALTH/03/16/health.writing.wmd/"><span style="font-family:arial;">this article</span></a><span style="font-family:arial;"> about the healing effects of writing. I've often told my ED patients about this, and they're almost often intrigued. Several times, I've given a patient pen, paper, and encouragement to write the story down. It seemed to help.</span><br /><span style="font-family:arial;"></span><br /><span style="font-family:arial;">If nothing else, writing is something to do, something to focus on during an overwhelming time in a chaotic environment. And paper always listens, even when people can't. The paper will contain the story until other people can make the time to listen too.</span><br /><p><span style="font-family:arial;"><br /></span>Posted by Susan Palwick at <a href="http://improbableoptimisms.blogspot.com/2007/10/narrating-trauma.html">7:06 PM</a> http://improbableoptimisms.blogspot.com/2007/10/narrating-trauma.html<a href="http://www.blogger.com/email-post.g?blogID=31590574&postID=8214392150721051514HYPERLINKhttp://www.blogger.com/post-edit.g?blogID=31590574&postID=8214392150721051514"></a><br /><br />Labels: <a href="http://improbableoptimisms.blogspot.com/search/label/chaplaincy">chaplaincy</a>, <a href="http://improbableoptimisms.blogspot.com/search/label/hospital">hospital</a>, <a href="http://improbableoptimisms.blogspot.com/search/label/medical%20school">medical school</a>, <a href="http://improbableoptimisms.blogspot.com/search/label/narrative%20medicine">narrative medicine</a>, <a href="http://improbableoptimisms.blogspot.com/search/label/teaching">teaching</a> </p>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com2tag:blogger.com,1999:blog-554957028387016008.post-79661540359270858612007-09-09T06:49:00.000-05:002007-09-09T06:52:12.565-05:00Out of Town<span style="font-family:verdana;color:#336666;">I'm takin' a short hop down to Houston for a few days. My Bro down there hasn't been dragged into the 21st century, yet, so I won't be posting until I'm back home. I'll try to have something helpful to say when I return. </span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com0tag:blogger.com,1999:blog-554957028387016008.post-37516151295080351082007-09-07T11:40:00.000-05:002007-09-07T12:16:02.329-05:00Question from the Mailbox<span style="font-family:verdana;color:#336666;">A Reader wrote in with a question about Worker's Compensation. Reader didn't say what state the person having a problem lives in, so my answers will be for Texas, but the basic steps for finding your own answers will be the same. And Worker's Comp rules are fairly standard from State to State.</span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">So, let's get y'all started: </span><br /><span style="font-family:Verdana;color:#336666;">Use your Search engine of choice and enter {your State} Workers Compensation.</span><br /><span style="font-family:Verdana;color:#336666;">I got several choices, and choose the <a href="http://www.tdi.state.tx.us/wc/employee/workerrights.html">official State agency</a>. From their home page, I clicked on the <span style="font-family:courier new;color:#993300;">Division of Workers Compensation Home. <span style="font-family:verdana;color:#336666;">I found a treasure trove of information and links on that page. </span></span></span><br /><span style="font-family:Verdana;color:#336666;">When you are injured at work you can choose your Doctor from the Workers Compensation Health Care Network, if your employer is a member. If your employer is NOT a member of that Network you can choose <strong>ANY</strong> Doctor from the Approved Doctor List kept by the Division of Workers Compensation. So remember, it is <strong>YOUR </strong>choice which provider you see, <em>NOT</em> your employer's choice. If you are unhappy with the provider, go see another one. Just remember, when you go see a new Doc, take all your employer's contact info, including their Human Resources information, or whoever the person who handles W.C. claims is. Or the name of their W.C. insurance carrier and that contact information. If you already have your claim number, that would speed things along, too.</span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">If you are unhappy with the way your employer is treating you after you are injured; if you feel that you are being discriminated against, or if you have been demoted or fired because you filed a W.C. claim...you can contact the Office of Injured Employee Counsel at 1-866-393-6432, if you live in Texas for <strong>FREE</strong> legal advice.</span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">The page also lists an Ombudsman for further assistance. But you can find that on your own by following the link and clicking on the Division like I did. </span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">Of course, State provided counsel is always going to be overworked. So if changing Doctors doesn't solve your problem, as I understood it from your letter, you might have to hire your own Attorney. Since the person with the injury was terminated after filing a W.C. claim, despite being told it was for other reasons, when other, lighter duties could have been assigned while the injury healed, I would suspect that a good case could be made for a discriminatory termination. Back pay and reinstatement would be the minimum to be recovered. The employer also could be fined. Given their reprehensible behavior, I say they need to be fined and given a good swift kick in the rear! Waiting on the Injured Party, hand and foot, taking care of their house, doing the laundry and cooking for them doesn't sound bad either, but that ain't gonna happen. </span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">I hope this info was helpful to you and others. </span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">Now...I gotta go write three 500 word articles I'm gonna try to sell. Mama needs a laptop!</span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com0tag:blogger.com,1999:blog-554957028387016008.post-53340197966765168062007-09-06T19:57:00.000-05:002007-09-06T21:28:07.661-05:00Questions about the NEW days...<span style="font-family:verdana;color:#336666;">In the absence of anyone writing in with questions or problems, I'm just gonna take the bit in my teeth and address myself to the Anon. Texas P.O. </span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">I will be completely honest [because I've never been shy about admitting my ignorance] I had to go to the <a href="http://www.tdcj.state.tx.us/">TDCJ</a> [Texas Department of Criminal Justice] website so I could look up the collection of letters you used. I have been out of the loop so long [over a decade] that it wasn't at all familiar. I better find a way to stop using all these brackets or the Grammar Police will come and slap me with a Big Ol' Fine. </span><br /><span style="font-family:Verdana;color:#336666;">Anyway, for those of you, like me, who were puzzled by the "SISP/EM/SO" in the comment the P.O. left, I will share my new found knowledge. It stands for Super-Intensive Supervision Program/Electronic Monitoring/Sex Offender. </span><br /><span style="font-family:Verdana;color:#336666;">Show of Hands...how many of you had a flashback to "Animal House"; Dean Wormer, and laughed when you read "Super-Intensive Supervision Program"? I know I did. </span><br /><span style="font-family:Verdana;color:#336666;">Anon.P.O., please forgive me, I mean NO disrespect. In fact as someone who has toiled in the vineyards of the Board of P&P, I KNOW how frustrating it can be. I was reading about all these new "special programs" they have instituted in the years since I left. I was wondering about the COST of these programs. I noticed on the home page that P.O.'s got a raise in pay and a raise in "Hazardous Duty" pay. </span><br /><span style="font-family:Verdana;color:#336666;">Hazardous Duty pay was something the State Employees Union was pushing for when I left, back in the early 90's. That was when the physical assaults on officers were starting to increase. And Officers "could" carry pepper spray and stun guns but weren't required to carry them. And cell phones, in the early 90's? Forget that! No way was the Board gonna pay for THAT expense! SO tell me... did HD pay take the place of something like longevity pay? or is it truly a benefit that other State Employees, who are NOT exposed to dangerous convicted felons don't get? Because if all they did was replace one benefit with another, essentially changing the name from longevity pay to Hazardous Duty pay that's not much of a dahm benefit, but about what I came to expect from the State. </span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">Also, about a year after I left, I heard that because most of us who were in the FIRST Batch of Sex Offender P.O.s started burning out after a year to 18 months, it was decided to rotate the P.O. off that caseload every 9 mo. or so. Did they implement that or not?</span><br /><span style="font-family:Verdana;color:#336666;">I had a caseload that was about 40 Sex Offenders with the balance of my caseload, about 80-85 parolees, being everything from burglars to murderers, male and female. But then, I had some female sex offenders, too. </span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">Also, I'd be interested to know just how many of the folks on your caseload who have alcohol or other substance abuse problems actually benefit from the <strong>ENTIRE</strong> 4 hours of counseling they get in the SACP. The Parole Division Counselors, did they get their alcohol and substance abuse counseling training from the State, or did they go out and go through an independent course and internship? </span><br /><span style="font-family:Verdana;color:#336666;">I see the wisdom of the SACP-ISF</span><span style="font-family:Verdana;color:#336666;">, it keeps them from going back to TDCJ-ID. Back in the OLD Days, at least 75% of my caseload had a substance or alcohol abuse problem in their history. I have a story in my archives on Holly's Hystrionics about the Old Drunk who had about 6 pages from TCIC, going back 40 years, of DWIs. And he just kept on drinking and driving. Do you still see guys like that?</span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">The Therapeutic Community Substance Abuse Aftercare Treatment Program is bound to be an expensive program. Has it proved cost effective yet in terms of reducing the recidivism rate, or are the figures not in,yet? Because we had a recidivism rate of close to 66% for all parolees, and closer to 80% for drug offenders and this was BEFORE the meth explosion. It was around, sure and one of our county had a bunch of labs, but it wasn't as big a prob as it is now. </span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">Does every District have a District Resource Center? Because my District was composed of 4 counties. The District Office was in the County Seat and once a month the Officers responsible for the outlying counties would go there and take report for the Parolees who simply could NOT make into the DPO.</span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">I'm gonna take a big leap here and guess that the Serious and Violent Offender Reentry Initiative Program is offered to guys who are gonna be released on Mandatory Supervision anyway, right? 'Cause if it's being offered to some felon so he can get PAROLE, I Thank GAWD I don't live in Bexar, Dallas, ElPaso, Harris, Nueces, Tarrant or Travis Counties. In fact, where I live is not far enough away from those counties. I am now giving serious thought to moving to Brewster County!</span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">The Special Needs Offender Programs for the mentally ill, mentally retarded, terminally ill, physically handicapped, and medically recommended intensive supervision offenders, seems like it would take a toll on the psyche of the officer. When I got hired in the mid-80's they were hiring anyone with a degree in the Social Sciences. By the time I left, there seemed to be a preponderance of CJ degree holders. I don't mean this as a criticism of people who choose Criminal Justice as a degree field, but I fear for their mental heath working with this particular group of offenders. What do you hear about these officers and what they do to cope with the stressors of their particular offenders? Is there a time restriction placed on their tenure with this caseload?</span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">I'm glad I went to the website to see what's going on with these new programs. I hope you have time to reply and answer my questions. </span><br /><span style="font-family:Verdana;color:#336666;">The website makes it sound like <em>all</em> these programs are available <em>all</em> over the state. But I know that all too often the good programs are <em>only</em> available in the big city areas. I truly hope that the Drug treatment programs are available statewide. The Parolees in the cities can always find help. It's the Parolees in the rural areas that are usually SOL. I know that about 1/3 of the parolees I handled, if they'd had access to a better treatment and aftercare system, like what the State has in place NOW, they wouldn't have re-offended. So it will be interesting to see how these programs fare. And if the Lege is willing to continue to fund them. </span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">Also, what are caseloads like now? Because a caseload of 125+ was not at all uncommon when I left. We were just runnin' ourselves ragged trying to keep up with all the home visits, job visits, and documentation, jail visits, violation report writing, hearings, applications for warrants, and then of course there was the much loved Duty Day! If a Parolee came in on whom you had a Blue warrant, you had to stall and find a way to keep him from getting suspicious until the P.D. or the S.O. could get there to arrest him. Reading the entire Parole Certificate to the Parolee on his first visit; whether he was YOUR Parolee or he was to be assigned to someone who was out of the office that day. Yeah, my Duty Day was Friday, so lots of days, it was the Supervisor, the Secretary, and ME. </span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;">And then of course, we started doing UAs in the OFFICE! Do y'all still test the pee of Parolees there in the office? If that's one of your duties from the beginning I guess you are conditioned to be used to it. BUT, on the other hand, I spent those years getting a degree,Ididn't plan on testing somebody else's URINE at the end of a long hard duty day! If I'd wanted to handle someone bodily fluids I'd have gone into a <strong>Health Science</strong>, NOT a Social Science!</span><br /><span style="font-family:Verdana;color:#336666;"></span><br /><span style="font-family:Verdana;color:#336666;"> </span><br /><span style="font-family:Verdana;color:#336666;"> </span>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com0tag:blogger.com,1999:blog-554957028387016008.post-23306430326011716582007-09-03T16:35:00.000-05:002007-09-03T17:26:30.600-05:00Welcome to my Office!<span style="font-family:trebuchet ms;color:#336666;">Sit down, make yourself comfortable, let's talk for a bit. </span><br /><span style="font-family:Trebuchet MS;color:#336666;">No, that's OK, you don't need to shut the door, let's just let the breeze blow through. </span><br /><span style="font-family:Trebuchet MS;color:#336666;"></span><br /><span style="font-family:Trebuchet MS;color:#336666;">Since you're my very first client here in my new office, let me explain the office policies:</span><br /><ul><li><span style="font-family:Trebuchet MS;color:#336666;">If you should bump into another client coming in or on the way out, just nod and give each other a polite greeting. There's no need to trade life stories in the waiting room. </span></li><li><span style="font-family:Trebuchet MS;color:#336666;">For now, I'm letting all comments be anonymous. Whether or not Google will let you be Anonymous, is completely out of my hands. And as long as I don't get spammed, I'm not doing word verification, either. I hate that on other folk's blogs, so I'm not putting it in here. </span></li><li><span style="font-family:Trebuchet MS;color:#336666;">I'm also not doing comment moderation, for now. If any commenter should flame, or otherwise be unkind to another commenter, I may have to start that. So please, don't be the cause of me starting comment moderation. </span></li></ul><p><span style="font-family:Trebuchet MS;color:#336666;">That's pretty simple, nu?</span></p><p><span style="font-family:Trebuchet MS;color:#336666;">The purpose of this blog is to help you, the reader, with any problems of the type that my training and experience in Social Work and a variety of Social Service agencies qualifies me to help with.</span></p><p><span style="font-family:Trebuchet MS;color:#336666;">Right about now, if you are not a regular reader, you might be asking, "Well, just what have you done that makes you think you can help <strong>ME</strong>, Miss Smarty Pants?" I would answer that I have done work with Alcoholics, Drug Addicts, Parolees, the newly diagnosed HIV+ and the end-stage AIDS patients and their families. I have helped retired folks, who were living on fixed incomes apply for Medicaid benefits that would pay for their Medicare premiums, deductibles and co-pays. When you're 70, trying to live on $700/month, having those medical bills off your shoulders can be a literal life saver! I have also shown the grown children of elderly folks living in nursing homes how to save Mama's house and still get Medicaid to pay for her Nursing Home care. And it was all legal, above board and I was a State employee when I did it. Did you know that if your spouse needs Nursing Home care you have one year to transfer ALL your jointly held assets into YOUR name without penalty?</span></p><p><span style="font-family:Trebuchet MS;color:#336666;">How about this one? I used to give Safer Sex talks to groups of strangers. SO I can help you talk to your kids about HIV, STDs and Teen Pregnancy. I can tell you where to go to find the latest stats for your state on all three, but since most teens think they are bullet-proof and immortal they think it won't happen to them, that probably won't do you much good. But, I have some tricks up my sleeve that might work. Email or leave a comment for me and I'll be off and galloping on this subject. It's my favorite hobby horse.</span></p><p><span style="font-family:Trebuchet MS;color:#336666;">The drugs and alcohol experience I have has served me well in my own fam. I can trace the addiction in my family back 3 generations. Two of my siblings are effected. I somehow managed to dodge that bullet. So far, all of our children are relatively unscathed, too. So bring on the addict and alcoholic relative problems, I've heard it <strong>ALL</strong> before.</span></p><p><span style="font-family:Trebuchet MS;color:#336666;">Since some of my time with Parolees included time working with Sex Offenders...I can handle listening to your tales of sexual assault, incest, emotional abuse, psychological abuse, physical abuse. Bring it on. I can say, "there, there", but then I will tell you what you can do to start healing, and how to get OUT of that situation if you are still in it.</span></p><p><span style="font-family:Trebuchet MS;color:#336666;">I've done some grief counseling. Being 52, I've suffered my own losses as well. I can honestly say I <em>KNOW</em> what it's like to lose someone you love. There are many strategies to deal with loss, not every one works for every person, but I can help you find the ones that will work for you. </span></p><p><span style="font-family:Trebuchet MS;color:#336666;">So, what do you say? Ready to come back for another session? Hey, at least the price is right!</span> </p><p><span style="font-family:Trebuchet MS;color:#336666;"></span></p><p></p><p><span style="font-family:Trebuchet MS;color:#336666;"></span></p>HollyBhttp://www.blogger.com/profile/17644166795449256850noreply@blogger.com10