Category Archives: Medical Stuff

Fluid Bonding and Safe Sex

Fluid bonding is a common term in polyamory safe sex discussions. Fluid bonding commonly means having sex without a condom or other barrier method. The idea being that your fluids are mingling and joining together.

In hierarchical poly relationships, fluid bonding it usually reserved for the primary couple or group. In egalitarian or solo poly fluid bonding is a sign of a highly entwined relationship and a great deal of trust. It is also a potential minefield.

Fluid Bonding and STIs

One of the more popular discussed reasons for fluid bonding is it reduces the risk of getting infected with an STI. By only having barrier-free sex with people you trust, you get some of the benefits of a closed relationship (barrier free sex, lack of worries about infection with the people you have sex with most often) while still being open. So far so good, right?

Here’s where the trouble comes in: barriers are not 100% effective in preventing STIs. For instance, the last time I checked the research, male condoms were believed to be 80% effective in reducing transmission of HIV. 80% risk reduction is damned good—but it is not risk-free. And barriers still only protect against some STIs. It is still possible for people in fluid bonded relationships to pick up an infection and spread it to their fluid bonded partners.

Whether or not you are fluid bonded, you still need to get tested, regularly.

Fluid Bonding and Pregnancy

Whether or not you prefer to practice fluid bonding, pregnancy throws a wrench in the works. Some people rely on fluid bonding to prevent pregnancy outside the “main” relationship. Some people prefer not to fluid bond, but want to have a baby. In both cases, it is vitally important to remember that there is no such thing as 100% effective birth control.

I’ve harped on this point until I’m blue in the face. The vast majority of people who think they are protected from unexpected pregnancy, aren’t.

This doesn’t mean you shouldn’t use fluid bonding as part of your birth control plan. It does mean you need to be honest with yourself about the risks of whatever approach to birth control you choose.

Fluid Bonding and Assumptions

Fluid bonding requires using barrier methods with everyone other than your fluid bonded partners. Simple, right?

Well, if your partner agreed to fluid bonding because they were worried about pregnancy, they may not see a need to use dental dams. You, in the meantime, are trying to reduce your STI exposure and assume barrier methods are being used with all genital contact. Can you say “Recipe for drama?”

Whatever your reason for fluid bonding, check your assumptions at the door. Make sure you and your partner(s) are on the same page about what you expect. Whether your relationship is built on agreements or boundaries, don’t let assumptions bite you on the ass.

What Do You Want to Learn About STIs and Safe Sex?

I’m going to pick up and finally finish my extremely drawn out blog series on safe sex and STIs. Last spring I finally finished a run down of various STIs and their symptoms, causes, treatments, etc. Now I want to go back to that series and talk a bit about options when you or someone in your polycule has an STI, communicating about safe sex with your partners and a few other things.

But before I get too deep into that, I’d love for you to tell me if there is anything you really want to know about STIs and safe sex in polyamorous relationships. I can’t promise to have an answer, but I’ll damn well try. Leave a comment below, or contact me privately!

Posts so far

(Updated February 8, 2016)

  1. STDs/STIs
  2. What are STD/STIs?
  3. STD/STIs Protection (Introduction)
  4. Protecting Against STD/STIs: Barrier Method
  5. Preventing STD/STIs: Testing Agreements
  6. Preventing STD/STIs: Be a Smart Slut – Open Relationships, Promiscuity and STD/STIs
  7. Protecting Against STD/STIs: Abstinence/Closed Relationships
  8. STD/STI Testing: Introduction
  9. Polyamory and STD/STIs: Getting Tested
  10. What Does STD/STI Testing Involve?
  11. STD/STIs: How often should I get tested?
  12. The Long List of STD/STIs
    1. Bacterial Vaginosis
    2. Chancroid
    3. Chlamydia
    4. Crab lice
    5. Cytomegalovirus (CMV)
    6. Genital Warts
    7. Granuloma Inguinale
    8. Gonorrhea
    9. Hepatitis (A, B & E)
    10. Herpes (1 & 2)
    11. HIV & AIDS
    12. Human Papillomavirus (HPV)
    13. Molluscum Contagiosum
    14. Pelvic Inflammatory Disease (PID)
    15. Pubic Lice (Crabs)
    16. Scabies
    17. Syphilis
    18. Trichomoniasis (Trich)
  13. Fluid Bonding and Safe Sex
  14. Safe Sex Vs Safer Sex

Polyamory and PTSD (and other trauma and stress related disorders) Part 2

Part 1

Ways to Manage Trauma and Stress Related Disorders in a Poly Relationship

Okay, I said this about anxiety and the same goes here:

If anxiety manifests in ways that look like jealousy or controlling behavior, do not follow standard poly advice for dealing with jealousy. Learn to tell the difference between anxiety-induced and jealousy-induced behavior. Treat jealousy like jealousy and anxiety like anxiety. Your partner has tools for managing anxiety for a reason. Use them! Treating anxiety like jealousy just compounds the problem.

Similarly, treating PTSD like abuse just compounds the problem.

When someone’s trauma causes them to act other unhealthy manners—including abusive manners—treating them like an abuser doesn’t help. That doesn’t mean their harmful behavior should be allowed to pass. But telling someone in the middle of a triggered response to past trauma that they are guilt tripping you and you won’t stand for it doesn’t help anyone.

Similarly, calling someone out for gaslighting and telling them that you aren’t going to put up with this shit, does no good when they honestly believe what they are saying.

This is also a good place to link to an old rant of mine. At some point in the healing process, people with trauma and stress related start to recognize that their thoughts and feelings are distorted. “I know what I’m feeling isn’t real, but I can’t stop feeling this way,” or any similar statement is not an invitation to tell your partner all the reasons why they are wrong to feel that way.

Managing trauma and stress related disorders starts with everyone involved learning to recognize what is the real person and what is the disorder. This can be as simple as not taking it personally if a partner needs to cancel a date because they can’t drive that night. It can also be as complicated as learning to recognize the unintentional gaslighting of a partner who honestly remembers things wrongly.

You can’t deal with the disorder until you can recognize when the disorder is fucking with things.

Next, focus on small steps. If the very idea of polyamory is triggering flashbacks of past betrayal, scheduling your first date next week will not work. In fact, this is one of the rare situations where I would actually encourage a couple to date together. Either both date the same partner or double dates with both their partners. Yes, this is completely against The Big Book of Poly. Explain the situation to potential partners, be VERY aware of the difference between a triangle and a T, and it can work.

Another option, if you are living with a partner and that partner going out on dates is triggering is for your partner to try having “date nights in.” I hope it goes without saying, but this absolutely needs to be your partner’s decision. Date nights in is something I’ve done a fair bit of in the last few years. Not because of mental health issues, but because my most entwined partner is disabled and we have a young child. Leaving my partner who sometimes couldn’t stand up w/o help alone with a young child (or worse, infant) he might or might not have been able to take care of was not something either of us were comfortable with. So poly partners and potential poly partners would come to our home, usually after the kid was asleep for the night. My live-in partner would put on his headphones and lose himself in a computer game or video. My visiting partner and I would have a “date night” on the living room couch, bed, or front porch.

Now, moving slowly doesn’t mean refusing to make changes. You can start out dating together or having date nights in to reduce the amount of triggering someone in your polycule is dealing with. Eventually you will want and need to move towards dating separately/having date nights out. Exposure is a big part of treatment for trauma and stress disorders for a reason—the only way to heal is to slowly push the boundaries of the disorder. Note, NOT your boundaries, but the boundaries imposed on you by the disorder. And ONLY at a pace you agree to. Note also, I didn’t say “a pace you are comfortable with.” When it comes to trauma there ain’t no such thing. Like doing physical therapy for damaged muscles, if you stick to what is comfortable you will not heal. But it needs to be your pace, and no one else’s. Poly partners can support, encourage, suggest, or set their own boundaries on what they are and are not willing to deal with. They can’t set the pace for you.

Once the effects of the disorder are recognized, everyone involved needs to be involved in setting ways to work around, with, and through these things. For something like not being able to drive, or needing to avoid dogs, this can be as simple as making alternate transportation available.

For problems directly triggered by polyamory it can be more difficult. I suggest having two levels of response for most trauma related problems. “This is triggering me but I can deal with it (maybe with a bit of support.” and “OMFG help!!!”

If a poly partner recognizes signs that someone’s reaction or action is due to a disorder, point it out. “Hey love, it sounds like this is triggering you. I get you are angry and scared. How do we deal with this?”

If there are things that can make it easier to deal with your partner leaving, ask for them. If there is nothing that will help, but now that you recognize being triggered you can deal with it, this is a good time to try to push through. There may be backlash later but you can probably manage until your partner gets back from their date—tell them that. They’ll go out, and you’ll deal as best you can until they come back, and when they come back you can ask for whatever aftercare you might need.

If you absolutely can not deal, tell your partner. DON’T assume that they know how badly you are doing. Have an “OMFG help!” response you’ve discussed and agreed to try ahead of time. Maybe your partner doesn’t go out when you are doing this badly. Maybe they call their partner and switch to a date night in. Maybe your partner doesn’t leave you alone, but helps you contact another partner, friend, relative, etc, to come over and be with you while they are out.

Trauma and stress related disorders that are severe enough to regularly impact dating and relationships—especially if dating and relationships are triggers—definitely need to be discussed upfront. And that doesn’t mean just the person with the disorder discussing their needs with potential partners. It means their partners discussing it with their potential partners. Everyone who might be impacted by the disorder needs to know what to expect. Otherwise they do not have the opportunity to give fully informed consent.

Okay, But What If I’m Just Starting to Date Someone with a Trauma and Stress Related Disorder?

The above discussion is mostly directed at people with trauma and stress related disorders and their long term partners. If you are just starting to date someone with a trauma and stress related disorder—or if you are starting to date someone whose entwined partner has a trauma or stress related disorder—you are in a very different boat.

But it starts out the same. Learn as much as you can about their disorder, how it affects their behavior and how it affects you.

There is a line from the musical Rent that is very relevant here, “I’m looking for baggage that goes with mine.” As I’ve said before we all have baggage. Mild trauma and stress related disorders, especially when they are largely under control, can go with most people’s baggage, as long as you are willing and able to work with them a bit. Severe trauma are stress related disorders are a very difficult type of baggage to match. If your baggage doesn’t “go” with he baggage of someone who has a trauma or stress related disorder that’s okay. But if you find them attractive, interesting, and generally someone you’d like to be in a relationship with, and they tell you some of their baggage is labeled “PTSD” or “Acute Stress Disorder,” don’t give up on them just based on the label. Get to know them and their baggage enough to see if maybe their needs and challenges can actually fit with yours.

Be prepared for an adjustment period. Dealing with something like severe PTSD has a steep learning curve, and like I’ve said before flashbacks can be horrible to watch. In general, the longer its been since the trauma that caused the disorder the better a grasp your potential partner will have on it and the better they will be able to tell you what they need and how it affects things. But that is only “in general” because everyone, and every trauma, is different. My experience has been that trauma from a single incident (bad car accident) causes a smaller range of problems than trauma over a long period of time. That isn’t to say that trauma from a single incident is easier to deal with—but trauma related to a bad car accident will usually only have triggers related to cars. Trauma related to single incident of rape will have triggers associated with that single incident (where it took place, what was done, sex in general). Trauma from a long term abusive relationship can be triggered by a wider variety of things. The trauma isn’t just associated with being in the car—it’s associated with being in bed, and sitting down to dinner, and saying something foolish in public, and the smell of burnt bread, and the scent of the abusive partner’s shampoo, and broken dishes, and, and, and, and…

So depending on what caused the trauma (and how severe it is), a potential partner may not be able to tel you everything about how the trauma affects them. They may not realize that the smell of burning bread triggers them until you get distracted in a make out session one day and they forget dinner is cooking.

What they can and need to tell you is a general idea of how severe the problem is, what areas of life it affects, what they need from you if they are triggered while you are together (or triggered when you are supposed to get together), and as much as they can of their major and common triggers.

Once you now what you are dealing with, it’s a matter of patience, flexibility, and awareness.

When Disorders Become Abusive

I said before that treating a partner with PTSD like an abuser when the disorder causes them to say things that are gaslighting or otherwise abusive doesn’t work. But what does work? How do you respond in a healthy manner when negative thoughts start to sound like a guilt trip?

First off, you need to be able to recognize what is happening. If you can’t recognize 1) what my partner is saying right now sounds like gaslighting and 2) they are saying this not to manipulate me, but because they really believe it, you will not be able to deal with it. And dealing with this is, at least initially very much on the ill person’s partners. Why? Because you can’t even begin to fix something you don’t realize is happening. And from the perspective of a person with a trauma or stress related disorder, all they are doing is expressing ho they feel. Polyamory is supposed to be about communication, right? So why do people keep getting angry when they try to communicate how they are feeling or the way they perceive things?

Once you recognize what is happening, you need to NOT address it right away. Instead you need to address what is under it. Let’s say a partner with PTSD says that obviously they aren’t important, they don’t matter, they might as well just die for all anyone cares about them.

You recognize it as a potential guilt trip. But you also recognize that your partner is genuinely hurting and is really attacking themselves, not trying to get a reaction out of you. What do you do?

In my experience the best way is to address it head on. “I’m sorry you feel that way. I love you very much, and I love having you in my life—even when (you drive me crazy/things don’t work out/we have a fight). I’m sorry I can’t (give you what you need right now/make this right/etc).” If you can do something for/with them, “How about we do X for a while, I think that might cheer both of us up.” If you need to take care of yourself or need to get out the door, “I really need to do this right now, but maybe when I get back we can do X.”

Reassure, offer support, and don’t let their negative thoughts/outbursts/etc keep you from doing what you need to do.

Later, when they are in a better place mentally and you are calm, is the time to bring up. “When you get upset and say things like that, it comes across as a guilt trip/manipulative/emotional abuse. I know you don’t mean to or want to do that. I need you to be aware of the way you say things.”

It will take TIME to make a change. Because they are not fully in control of themselves, because their thoughts and perceptions are distorted, and because they are dealing with psychological arousal, they won’t be able to “stop and think before you speak.” But if they aware of the problem, they will work to be aware of how they communicate and get better. It will probably start with their saying something about it after they calm down, “Hey, I shouldn’t have said that before, I’m sorry.”

I have had PTSD, I have had a long term partner with PTSD, and I have had a metamour with PTSD. Of all the mental illnesses I have dealt with, PTSD is the most difficult in a polyamorous relationship (or, I believe, any relationship). The flashbacks, dreams and memories are horrifying, but at the end of the day they are just a thing. You get through them. The psychological arousal combined with negative thoughts are destructive. Both destructive to the person with the disorder and destructive to the people who care for them.

Mild trauma and stress related disorders aren’t easy to deal with. But most people I have known who are willing and able to do the work involved in polyamory have also been full capable of doing the work involved in maintaining a health relationship while dealing with the disorder. Severe trauma and stress related disorders demand a huge amount of time, energy, and compassion. Polyamory can work with severe trauma and stress related disorders—in fact, a healthy polycule can make the disorder easier for everyone involved and help the person with the disorder heal. But it is definitely not a relationship that is right for everyone.

 

This post is part of the Polyamory and Mental Illness blog series.



Polyamory and PTSD (and other Trauma and Stress Related Disorders)

This post and others discussing specific mental disorders will reference the Diagnostic and Statistical Manuel of Psychiatry and Psychology, Edition Five (DSM-5). Apologies to my international readers, I’m just not familiar enough with the ICD to use it as a reference.

Trauma and Stress Related Disorders

  1. Post Traumatic Stress Disorder (PTSD)
  2. Acute Stress disorder
  3. Reactive Attachment Disorder
  4. Disinhibited Social Engagement Disorder
  5. Adjustment Disorder

PTSD is the best known of the trauma and stress related disorders. In the US it is widely associated with military personnel and the psychological damage of military service. However Trauma and Stress Related Disorders, including PTSD, can be caused by any type of trauma. Car accidents, abuse, natural disasters, and high-stress jobs such as working in an ER or fire department are only a few of the possible causes of trauma and stress related disorders.

PTSD and Acute Stress Disorder are can be caused by trauma that has happened in the past or long term ongoing traumas.

Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are childhood disorders. From what I can find they result from trauma related to loss of caregivers or damage to a child’s ability to connect with their caregivers. While these disorders develop in childhood, they don’t magically disappear when people become adults. Residual effects can cause difficulty with social interaction or forming attachments to loved ones.

Adjustment Disorder is a (relative) mild disorder caused by ongoing life stress. These stresses don’t need to reach the level of trauma. Anything from a family illness, to job instability, to loss of a relationship, can cause adjustment disorder. An important facet of adjustment disorder is that it is not an ongoing psychological condition. As soon as the stressor causing adjustment disorder is removed, the disorder will go away on its own.

Symptoms of Trauma and Stress Related Disorders

Symptoms vary a great deal, and everyone’s experience of trauma and stress related disorders will be different. However most symptoms fall into a few general categories:

  1. Re-experiencing the event—flashbacks are the best known form of this. Literally reliving the event or events that caused the trauma. However it can also take the form of dreams, obsessive thoughts, or disturbing memories popping up out of no where. One note about flashbacks: most people assume flashbacks are either visual (seeing the event again) or full-sensory (experiencing it with all your senses). However flashbacks can take other forms. A person may suddenly feel their abusers hands on them, reliving the physical feeling of the abuse. Of hear screaming or other sounds associated with the trauma.
  2. Heightened arousal—Arousal in the psychological sense is not the sexual arousal we usually associate with the word. In fact, arousal in psychology is a lot closer to what laypeople call the “fight-flight-freeze” response. In a state of arousal, everything is more intense. Arousal can lead to everything from aggressiveness to impulsiveness. It often causes hyper-vigilance and sleep disorders.
  3. Avoidance—someone with a trauma or stress related disorder will often go out of their way to avoid anything that reminds them of or is associated with the trauma or stress.
  4. Negative thoughts, mood, or feelings—this can take a lot of forms, from negative thoughts about yourself, to negative thoughts about the whole world. At base it is a distorted perception caused by the trauma or stress. Someone with adjustment disorder related to job loss might think that there is no point in trying to find a job. Obviously they just aren’t worth hiring. An abuse survivor will often expert other people to act like their abuser did. Etc. Memory loss from the trauma is also associated with this symptom.

Treatments for Trauma and Stress Related Disorders

Medication

There are no medications specifically for trauma and stress related disorders. Unlike many mental illnesses, with these disorders there is a very clear, non-biological cause. Effective treatment needs to address the experience and associated feelings.

That said, medication is sometimes used in association with other treatment. Anti-depressants, anti-anxiety meds, and sleeping medications are sometimes used to treat the symptoms, especially with PTSD. These medications can help a person with a trauma or stress related disorder to continue with as close to normal life as possible while they heal.

Therapy

Cognitive behavioral therapy (CBT) is often cited as the most effective treatment for trauma and stress related disorders. Exposure therapy—gradually exposing yourself to the trauma and things that remind you of the trauma in a safe place—is often used and can be very effective. Even more than other forms of therapy, exposure therapy requires the right therapist. You NEED to feel safe and secure in order for exposure therapy to work. Support groups for survivors of various traumas often include unofficial exposure therapy, as people discuss their own experiences with others who they know will understand.

Eye movement desensitization and reprocessing (EMDR) is a relatively new approach to trauma therapy. Ever notice it’s easier to talk about hard stuff if you have something to distract you? A lot of people like to have “something in their hands” when discussing emotionally difficult topics. This is because having something benign to focus on helps distance our emotional reaction. EMDR uses this tendency to help trauma survivors face and deal with their trauma without the extremes of emotional reaction. There is still a lot of speculation about how and why it works. It does seem to allow trauma survivors to better cope with their trauma, reducing symptoms and speeding healing.

Alternative Treatments

I don’t know of any alternative treatments that I would trust which are specifically for trauma and stress related disorders. That said, herbal calmatives may help reduce arousal symptoms, meditation can also be helpful in dealing with negative thoughts and gaining space from strong emotions, and I personally have found that Massage Therapy can be a huge help in healing from trauma associated with sexual abuse.

When Trauma and Stress Related Disorders and Polyamory Collide

Some problems that come with trauma and stress related disorders are obvious. I’ve had flashbacks, and I’ve held loved ones while they relived the worst experiences of their life. I honestly can’t tell you which is worse.

Other problems are both more subtle, and more frustrating.

Someone whose trauma or stress was related to betrayal, abuse within a relationship, abandonment, and similar issues will find themselves triggered by many things that are a normal part of polyamorous relationships. And constantly waiting for your current partners to abuse you/betray you/abandon you like the people who caused your trauma never does good things for a relationship. In a poly relationship, your poly partners spending time with someone else—or even just the expectation of them spending time with someone else—can definitely be triggers.

Worse, the combination of psychological arousal and negative thoughts can come across as anything from a jealous rage to a guilt trip to gaslighting. (Remember—distorted perspective. Someone with a trauma or stress related disorder literally doesn’t see the world the way it really is.) And while the person lost in their trauma doesn’t intend or even realize that this is how they are acting, the people around them can still be hurt by it.

Let me note that this level of problem is not universal with trauma and stress related disorders. Please do not assume everyone with a trauma or stress related disorder will be affected this way. This is the most damaging effect trauma and stress related disorders can have on relationships—that does NOT make it the most common.

Other types of trauma can cause other types of problems. Trauma from a car accident may make riding in a car difficult to impossible—which interferes with going on dates, poly meet ups, or just picking a visiting partner up from the hospital.

For partners who don’t understand the impact trauma and stress related disorders can cause, refusing to do something that seems simple to them can cause other problems. “Why do I always need to come visit you. It’s just a short drive!”

Because of my specific trauma, I used to get flashbacks eating certain foods. The consistency and texture of food is a big meal to me, which many people have never understood or accepted. Being invited over to dinner was a mine field. I would struggle to navigate trying to be polite, trying to avoid conversation ending-explanations, and trying not to trigger myself. So as awesome as it might sound for a poly partner to offer to put together a picnic for us…

And of course, having a panic attack, flash back, or other trauma related freak-out as your partner is walking out the door to go on a date—no matter what the trigger or cause—is not only disruptive to your own relationship, but to your partner’s relationships as well.

Part II on ways to manage PTSD and other Trauma and Stress Related disorders.

This post is part of the Polyamory and Mental Illness blog series.



Course of Treatment: Treatment Options–Treatment Intensity

In Western medicine, there are varying levels of treatment for mental illness. In theory, the more you are able to take care of and manage your own mental health care, the lower the level of treatment you receive.

Hospitalization

Hospitalization for mental illness has a bad reputation. A reputation that is historically valid but far less of a problem today. At least in the US and Europe, the vast majority of people in the hospital or mental illness are their voluntarily. They recognized a need for more help than they could get at home. Most hospitalization is short term. Intensive care and/or 24 hour supervision is available for someone who lost control to depression, bi polar, or other mental illness. These people need time in a safe place to regain their balance with the help of trained professionals. They may spend a few days or a few weeks in the hospital. When they leave, they switch to partial hospitalization or out patient therapy and resume their normal life.

In the US, anyone experiencing problems with mental illness can go to the nearest hospital and request admittance for 72 hours. This observation period allows doctors and the patient to work together to determine if hospitalization is needed. Often the patient just needs their medication tweaked, or referral to an out patient program.

Last December my partner went into the hospital for an observation period. He ended up staying 4 days because the doctors wanted to make sure he was adjusting well to the medications they put him on. He left the hospital with a referral to a partial hospitalization program, medication he had needed for over six months and the hope that comes from finally having help with a problem that has been overwhelming you.

Long term hospitalization is an option for people who just can’t function on their own. In the US, long term hospitalization can only be mandated if you are a threat to yourself or others. But people with severe mental illness who need help eating, taking their medications, getting dressed in the morning, etc, may admit themselves for long term care.

Hospitalization often mixes group therapy, individual talk therapy, art and/or music therapy, and plenty of down time to relax without the stresses of daily life constantly triggering a mental illness. Some hospitals also offer alternative medicine, meditation classes, and other programs.

Partial Hospitalization/Partial Day Program

Partial hospitalization probably has other names in other parts of the world–god knows it goes by enough different names in the US! Whatever they are called, these are intensive treatment programs. Patients spend 8 hours a day, 5 days a week, participating in various forms of therapy. At the end of the day they go home and tend to their own needs.

Partial hospitalization is available for people who need intense and ongoing access to mental health care, but are still able to take care of their own day-to-day needs. Unlike being in the hospital, someone in a partial hospitalization program takes care of their own meals, hygiene, clothing, etc while they are at home in the evening. They are able to go out and socialize with friends if they so choose, and can spend time with family in the morning and evening. Partial hospitalization programs offer many of the same therapy approaches and options as hospitalization.

In my experience, someone with mental illness cannot check themselves into a partial program. A referral is usually needed from a hospital or therapist.

Mental Health Rehab

Mental health rehab programs vary widely. From what I have seen and what my research has found there is no clearly defined idea of what mental health rehab should be or should consist of. Most rehab programs I have seen focus less on traditional therapy and more on helping someone with mental illness re-integrate into society. This may involve a back-to-work program, classes in community action and involvement, and a great deal more. However these programs are largely unique and each one will be different.

In terms of intensity and time commitment, rehab seems to fall somewhere between partial hospitalization and outpatient therapy. Participants may spend several days a week in various classes and activities, but will rarely spend a full day in rehab.

Out Patient Therapy

Out patient therapy is what most people think of when they think of mental health therapy. You spend an hour or so with a therapist and go home. Depending on your needs, you may see a therapist three times a week or once a month. Out patient therapy covers every form of therapy. Talk therapy is far and away the most common out patient therapy, followed by group therapy.

Out patient therapy is ideal for people who are managing to keep up with daily life, but have difficulty managing their mental illness. It is also a good safety net for people who are starting medication.

If your therapist is a psychiatrist, they will often offer medication in combination with therapy. This can be a very good option for people who are still trying to find the right treatment combination for managing their mental illness.

Medication Only

It is becoming increasingly common for psychiatrists to offer medication without any therapy or much in the way of support. You see them for 15 minutes month, tell them about any changes you’ve noticed, and they give a prescription for your next bottle of pills. For people who have been living with their mental illness for years and are on an established medication schedule that works for them, this approach can be effective.

However, I have seen psychs who did not know me at all, knew that I was not currently on any medication and did not know what medication would work for me. They spent 20 minutes getting to know me and y history, wrote out a script for psych meds, and told me to come see them again in a month. Given some of the possible side effects that psych meds have, I don’t have words for how fucked up this is.

Thankfully, most of these psychs will tell you the same thing I will: you need to get counseling as well. Until you have an established med plan in place, it is very important to combine medication with out patient therapy. You need someone to help you manage the effects of the medication and to help you catch signs of side effects early, before they become dangerous.

(You might notice I have strong feelings on this topic)

For some people, mediation only can be a great low stress approach. You need to have your mental illness largely under control with home care and medication. You also need to know exactly what medication you need. If you can do this, than seeing a psych once a month for medication work. But if you are still juggling medications, dosages, and treatment options, please also see a therapist.

 

This post is already pretty damn long, so next week we’ll take a look at how these different treatment options impact polyamory.

This post is part of the Polyamory and Mental Illness blog series.



Polyamory: Laws and legal practices impacting our health

As always legal practices vary widely around the world, and I am not a legal expert. This post is for informational purposes only. Please contact a legal professional for advice and expert information.

Insurance Law

People living in countries with single payer and universal health care systems probably don’t have to worry about losing access to health care based on their relationships. Other systems have the potential to cause problems for poly folk. In employer-sponsored health care systems you only have insurance if you are employed with benefits or are legally married to someone who is employed with benefits. These systems have the potential to leave poly folk in group relationships and triads out in the cold. The US had an employer sponsored health care system before the passage of the ACA. The current mix of public and private health care under the ACA still privileges legally married couples. Married couples pay lower premiums on health insurance plans from the public market than unmarried couples–or the unmarried member of a triad.

Privacy Laws

I’m having a bitch of a time finding information on medical privacy laws regarding what medical professionals around the world can and can’t share with family members. Most of the easily available information focuses on how privacy laws are being re-designed to protect electronically stored information. In the US, doctors used to be able to share info with legal spouses freely. Today under HIPPA doctors can’t share information with anyone (including other doctors) without a signed form telling them exactly who they can talk to, and how much much they are allowed to share.

Any countries which have laws similar to the older US system will give an advantage to folks who are legally married–an option not available to many poly folk. France and other countries with a mix of private and public health care may or may not offer similar advantages to married couples (and similar disadvantages to many poly folk).

Hospital Rules and Regulations

Hospitals and health clinics often have rules about who is allowed to visit, be present during a procedure and more. When my former metamour Lauren had an emergency c-section, only one person could be in the room with her during surgery. When I went for an ultrasound recently, the clinic allowed one person in the room with me. In other situations only family members are admitted.

These rules will vary between hospitals and clinics. I won’t even attempt to review world wide approaches because within jurisdictions. the way things are handled varies so widely there is no way I could give an idea of rules in the US versus, say, Brazil.

However, these rules have obvious issues for polycules where many people want to be present and give their support but only some are allowed.

Medical Power of Attorney

Power of attorney is the legal right to act on behalf of someone else. This means you can spend their money, manage their property, and make decisions regarding their medial care. Power of attorney goes by different names in different countries (in Italy it’s called procura). I’ve been told that power of attorney exists in most countries of the world. My (admittedly brief) internet search has confirmed power of attorney exists in Italy, Ukraine, Russia, Ireland, Parts of the UK, and the US.

Medical power of attorney is the US term for a restricted type of power of attorney. Medical power of attorney allows a person access to your medical information and the ability to make medical decisions for you if you are incapacitated. A similar form of power of attorney exists in England and Wales, and (I have been told) most countries that allow for power of attorney.

Medical power of attorney is a way around laws and regulations restricting access to your medical records and defining who gets a say in your medical care. In the US, if you are unable to make decisions for yourself, unless you have medical power of attorney your next of kin will make decisions for you. Your next of kin is your legal spouse, or if you don’t have one your children, or if you don’t have any your parents.

Medical power of attorney can grant members of a polycule who are not legally married access to their loved ones in the hospital and a say in their loved one’s care. More than one poly partner has been blocked from their loved one’s bedside by parents (next-of-kin) who don’t approve of polyamory.

 

Next Sunday will be the last post in the Polyamory Legal Challenges blog series. If you have a topic you’d like to see covered, contact me and let me know!

Course of Treatment: Treatment Options — Alternative Medicine

Last week, we look at alternative therapies. This week we’ll be looking a bit further afield, at alternative medicine. What’s the difference? Alternative therapies all try to fit within the framework of psychology. Even the alternative therapies you should run like hell from (like rebirthing) use psychology to explain why they are supposed to work.

Alternative medicine refers to medical practices that are an alternative to Western medicine. In some parts of the world these medical practices are widely used and accepted, in others they are barely known.

Alternative medicine takes two forms. On type of alternative medicine is “alternative” only in that the form of treatment doesn’t meet the demands of Western medicine–functionally, there is little difference between willow bark and aspirin, in fact, aspirin is basically a manufactured version of the active ingredients in willow bark. But willow bark tea can’t be given as precise a dosage as modern medicine demands, while the dosage of aspirin in a pill can be measured to the limits of modern equipment.

The other type of alternative medicine doesn’t fit with in the framework of Western medicine at all. The germ theory of medicine, and all the curlicues it’s developed over the years, simply has no room in it for treating illness with gems and chanting. While massage is a very valuable treatment for injuries, no one can yet explain how it can benefit mental illness in a way that first the theories of Western medicine. Often ways that alternative medicine is explained (such as the idea of storing emotions in muscles, mentioned below) sound ridiculous to folks who prefer the scientific approach of Western medicine.

Today we are going to take a look at three alternative medical approaches that I and others I am familiar with have found most useful, which also have at least some studies supporting their use.

Types of Alternative Medicine

Massage

First off, whether or not massage is “alternative” medicine depends on where you live and what it is used for. There is nothing “alternative” in using massage to treat muscle injuries, help the healing process after an accident, and basically do anything that involves damage to the muscles and tendons. A trained massage therapist can use massage to realign muscle tissue, preventing and reducing scarring and restoring mobility to an injury. While still not as widely known and used in the US as it could be, the rest of the Western world accepted this type of massage treatment long ago and have no doubt it belongs in the annals of Western medicine.

Massage as treatment for mental illness is less accepted. The most accepted theory behind why massage can help mental illness is that clears stress toxins from the body and triggers a relaxation response. Another, less accepted theory, is that our bodies somehow “store” negative emotions and mental problems in our muscles. By stretching and relaxing the muscles, these negative things get released, allowing us to move on without the burden of those problems. Anecdotal evidence in support of this theory is that many people dealing with trauma or mental illness will find themselves swamped by unexpected emotions during massage. When I worked in massage, I was frequently told “Don’t worry if I start cries/have a panic attack/freak out during the massage. I always feel better after.” From my own experience, the worse my mental state gets, the more the right side of my body locks down, to the point that one really bad days I have a distinct limp and trouble raising my right arm. Obviously there is some connection between the state of our mind and the state of our muscles. What that connection is, and what effect massage has on it, is harder to define.

Studies into the effect of massage on mental illness have largely focused on use of Swedish massage to treat depression or anxiety. Many studies found a temporary improvement after massage.

Herbal Treatments

Digitalis_lanata_ParisThe rule of thumb with herbal treatments is that is science has created a synthesized version, it’s Western medicine, and if you are taking the actual herb it is alternative medicine. Part of this is that it takes years of studies to confirm the effects of a treatment, and there simply hasn’t been enough time to test all the herbs that are supposed to be beneficial. Even more than massage, herbal treatments are among the most accepted by Western medicine–if only because so much of modern medicine, from aspirin to quinine to most of the common heart medications, wouldn’t exist if they hadn’t come from herbs first. The other part, as mentioned above, is the Western medicine has very precise dosing standards, and these standards are difficult with herbal treatments.

The attitude of many doctors and researchers I’ve discussed herbal treatments with is “Some of these herbs are definitely helpful, some we don’t know yet, some are a waste of time. Until we can confirm side effects, dosage, etc, you’re better sticking with known and tested pills–but herbs definitely have potential.*” When it comes to psychiatric treatment, where a 30% success rate is the gold standard, whether or not you are “better” with Western medicine is a matter many find highly debatable.

St. John’s Wort is well known as a treatment for depression. It is also known to have some potentially dangerous side effects. As some one who has spent a lot of time recovering from the side effects of standard psych meds, my reaction to that is “And this is different how?” However, if you do want to try St. John’s Wart, please use it under medical supervision, just like you would standard psych meds. Side effects aren’t something to fuck around with.

For more on herbal treatments for mental illness, consult a trained herbalist–and always check with the herbalist and your doctor for potential interactions and side effects.

Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) is a system of medicine first developed in China several thousand year ago. It has continually evolved and adapted during that time. TCM is the best known of the Asian systems of medicine, and most of the medicine of SouthEast Asia is based on TCM.

Unlike most other alternative medicines, TCM is a complete system of medical theory and practice. This has led to a giant problem in studies testing the effectiveness of TCM. Put simply, when researchers study TCM, they have never started with verifying or disproving the basic theories underlying TCM. Instead researchers have taken specific TCM treatments, and tested them on Western diagnosis. This is kind of like if a society that had never heard of the germ theory of medicine tested penicillin by using it as a treatment for a cough with fever and headache–but because they didn’t know the germ theory, were testing antibiotics on both bacterial infections and viral infections. So they run a test during the height of flu season, and of course the antibiotic doesn’t work.

This is the way researchers have been testing TCM. So while there are some studies that support TCM, and some studies that don’t support TCM, my opinion is that all the studies are completely useless. (I have actively sought out studies evaluating the theory behind TCM, and not found any. However I am not a professional researcher, and don’t have access to many medical journals. If anyone has any further info on this, please contact me!)

There are three basic theories underlying TCM

1) That everything in life exists in cycles, including our bodies. This theory is in complete accord with Western science–from the day/night cycle, to the metabolic cycle, to the sleep cycle, to the cycle of the trade winds, yeah, life is made up of cycles.

2) That illness and disease are caused by something disrupting our normal bodily cycles. These causes are broken down into internal and external. Here, science can quibble with the details–wind is considered an external cause of disease in TCM. So is dampness. Of course, dampness brings mold and mildew, so for a society with no concept of microscopic organisms, it may just be that they were describing the ancient Chinese doctors were just describing the causes of disease as best they could within their knowledge of the world.

Overall, the basic idea that there are internal and external causes of disease, and that these things cause disease but disrupting healthy cycles, isn’t something Western medicine can quibble with, and the specific causes can be studied and identified or eliminated, just like Western medicine had to adapt Germ theory when it recognized not all disease is caused by germs–the basic theory is still sound.

Five Element Interaction. A metaphor.

Five Element Interaction. A metaphor.

3) That the cycle of the elements and the way they interact is an accurate metaphor for the cycles of the body, and disruption of the cycles of the body can be accurately described and diagnosed using this metaphor. On these, Western science got nothing. Researchers never bothered to test this metaphor to see if this theory is sound. If this theory is sound, then the basic ideas and practices behind TCM are likely sound, and the individual practices just need to be continually refined through further research. If this theory is not sound, than we are wasting our time testing treatments from TCM, because the very basis for determining those treatments is flawed. Also if this theory is sound, we can begin testing and studying TCM treatments within the framework of this theory. As opposed to doing the medical equivalent of testing the claims of quantum mechanics using and the theory of relativity.

Now, in TCM, everything is connected. What I said before about the connection between the mental state and the muscles? According to TCM, of course they are connected, and you can’t treat one without treating the other. So a trained TCM practitioner is not going to treat you for depression. Instead they are going to look at your sleep pattern, the color of your eyes, your physical symptoms, your emotional symptoms, how you move, the state of your tongue and fingernails (did you know that our fingernails develop ridges when we are under high levels of stress? the body is fricking weird sometimes), and a whole bunch of other stuff.

They will use all of this to diagnose you with a specific disruption of your bodily cycles, which will mean absolutely nothing to you unless you are familiar with Chinese medicine, but will sound something like “Your heart is overactive and there is a blockage in your liver.” This doesn’t mean your literal heart and liver, it means the bodily cycles that the metaphor of Chinese medicine associates with your heart and liver. Then they will use acupuncture, herbs, massage, and other treatments–some of them damn odd to Western eyes–to calm your heart and unblock your liver. Which, if they have correctly diagnosed you and if the TCM theory of disease is accurate, will correct the symptoms you describe–including the depression.

Like Western medicine, TCM treatments may be a one-time thing (take an antibiotics for two weeks and call me if the symptoms come back), an on going thing (take your anti-depressant every morning, and we’ll evaluate the dosage in a month to see if it is working), or a palliative (I’m sorry, the cancer is deep in the brain where we can’t operate, and chemo isn’t working. All we can do is make her comfortable.) If you do decide to pursue TCM as a treatment for mental illness, make sure you discuss with your practitioner what TCM says the likely cause of your illness is, and whether they think you will need ongoing treatments or not.

Other Alternative Medicines

There are many more types of alternative medicine, from Ayerveda (an ancient system of medicine from India, and to my knowledge the first system of medicine to include dentistry and plastic surgery), to crystal healing, to colon cleanses. Some of these alternatives to Western medicine have a great deal of value to offer, others are probably little more than placebos. Do your research, and be aware that unless your country regulates the type of non-Western medical treatment you are interested in, it will be up to you to verify that a practitioner is trained and knowledgeable. Quacks and snake oil salesman are just as much part of the medical world today as they were 100 years ago, and the unregulated nature of alternative medicine makes it easy for them to hide there.

How to Access Alternative Medicine

If your country uses and insurance model to pay for medical treatments, whether a single-payer system or privatized, or anything in between, access to alternative medicine through insurance will be hit or miss-and often miss.

Some insurance coverage will cover some types of alternative medicine–it will be much easier to get insurance coverage for massage in Canada or Europe than it is in the US, for instance. US insurance companies are more likely to cover acupuncture treatments these days, but that’s far from universal. I would expect it to be far easier to get coverage for acupuncture in Japan or China, but I haven’t been able to confirm this.

If you don’t have insurance, or if your insurance doesn’t cover the alternative medicine you are interested in, you will be paying out-of-pocket.

You’re best option for finding an alternative medicine practitioner is to do your research. Many alternative medicine practitioners have formed groups which provide training, information on the treatments available, fund further research into the effects of their form of alternative medicine, etc. These groups will have information on the training available to practitioners and how to find a trained practitioner.

If the type of alternative medicine you are looking for is regulated, that can help, but check your local regulations! While massage is becoming increasingly regulated in the US, the national standards are still 500 hours of training. 500 hours of training is plenty for people who just want a relaxing massage after a hard day. If you want massage for medical purposes, you probably want someone with more intensive schooling.

Impact on Polyamory

The impact on polyamory will vary widely depending on the type of alternative medicine you are considering. However the biggest impact may be the views of your polycule on alternative medicine. If your poly partner wants to try Traditional Chinese Medicine, but you’ve read all kinds of studies that say it is a waste of time…at the very least there may be hard feelings, at the worst their may be blame and judgement thrown around related to quackery, people who aren’t really interested in getting better, and people who are too busy judging to see what’s in front of their faces.

If your poly partner is suffering from mental illness and wants to try alternative medicine, but you believe alternative medicine is all quackery, the best thing you can do is be honest but supportive. Even if you believe any benefit from alternative medicine will be a placebo, remind yourself that placebos do make people feel better. In the world of mental illness, where we can spend decades trying to find a treatment that works, would you really blame your partner for wanting to try something–anything–that will help them feel better and regain control of their lives?

If you are suffering from mental illness, and your partner thinks you should try alternative medicine, but you think it’s quackery–it’s your illness and your treatment. Politely thank your partner for their concern, but tell them you want to stick with treatment that you are comfortable with. It’s your illness, it’s your treatment, it’s your choice.

 

If you haven’t yet, check out the other treatment options for mental illness, and don’t forget to subscribe to the Poly on Purpose newsletter, so you never miss a post.

This post is part of the Polyamory and Mental Illness blog series.

*I have met a few doctors who insist that herbs have nothing to offer modern medicine, and no herb has ever provided a successful medical treatment. To which I am tempted to ask how they treat their heart patients if they believe digitalis is ineffective.

Course of Treatment: Treatment Options — Alternative Therapies

Sorry for the late post. Next post should be on time tomorrow.

Understanding Alternative Therapies

For purposes of this discussion, I am using “Alternative therapies” to refer to mental health therapies which are not commonly available and/or are often not covered by insurance.

Alternative therapies cover a lot of ground, and I can only begin to introduce them here. Because of the diverse range of alternative therapies it is impossible to effectively summarize them, and I’m not going to try. Instead I’m goingt o introduce three of the most well known and accepted alternative therapies.

Types of Alternative Therapies

220px-Crayones_ceraArt Therapy

Art therapy uses art creation as a means of treating mental illness. Art therapy can take several forms. Every form of art therapy starts with a person suffering from mental illness creating art to express how they feel. Two very common forms of art therapy are the use of art therapy as a spring board, and the use of art therapy to express and come to terms with emotions.

Art therapy as a spring board–some psychologists, and all trained art therapists, are able to use art to identify a patient’s needs. One of my teachers in college described working with a young boy who constantly drew pictures of guns firing, trains, and a few other things. My teacher described putting these drawings together with the boy’s interest in Superman (faster than a speeding bullet….) to understand that the boy’s drawings were expressing a desire to be strong and powerful, a desire the boy wasn’t able to express directly. In my own experiences with art therapy, I once drew a multi-colored star, using pastels (my favorite art medium). When I finished the star I was compelled to take the black pastel and draw thick lines caging the star in. If had been working with an art therapist who was using my art as a spring board for further therapy, they probably could have easily identified what I didn’t recognize until years later–that I was feeling trapped and unable to express myself.

Art therapy as expressing and coming to terms with emotions–the old G.I. Joe cartoons used to end with a moralistic skit and the phrase “Now you know, and knowing is half the battle.” In an odd way, this is true in mental health. Our mind is a dark and mysterious place, and we can only shine a light on parts of it. If we can’t recognize that (as a random example) we are feeling trapped and unable to express ourselves, we aren’t able to start getting ourselves out of the trap.

Art, as my own experience demonstrates, allows us to express things that we aren’t aware of feeling. This can be a powerful way of coming to terms with the dark spaces in our mind, and by extension managing our mental illness.

Music Therapy

Similar to art therapy, music therapy using self expression through music to help develop self awareness and encourage healing. Music therapy also has other applications in treating autism and other developmental disorders, pain management and other areas.

I have no experience with professional music therapy, but as a teenager I (like many kids in the US) took piano lessons. When I was depressed, I would pull out my song book for Les Miserables, and play, over and over again, the most depressing songs from that musical (and if you know Les Mis, you know it has a LOT of depressing and sad songs). The singing seemed to purge the worst of the sadness and depression, and I would always get up from the piano able to function at least a little better. To this day when I find myself reaching a non-functional level of depression, I start singing. It doesn’t stop the depression, but it does purge the fog enough that for a short time I can get things done.

512px-FEMA_-_10669_-_Photograph_by_Jocelyn_Augustino_taken_on_09-11-2004_in_FloridaAnimal Therapy

Most people are familiar with Seeing Eye Dogs. But fewer are familiar with the use of therapy animals. Therapy animals generally take two forms, a service animal trained to provide therapy, support, and assistance to a specific person, and therapy animals who visit a number of people for an hour at a time (sometimes called “animal assisted therapy). Exposure and interaction with animals to known to trigger a relaxation response in the mind and body, and for people struggling with mental illness the simple an unquestioned acceptance and caring of an attentive animal can be a wonderful thing.

Therapy animals that make “house calls” (usually hospital calls) need to be well behaved, love to interact with people, and not react badly to other animals or loud noises. People who are struggling with mental illness can spend time holding, cuddling, playing, or just sitting with therapy animals who are happy to give the humans they visit the love and acceptance they need. The instinctive relaxation that comes from an animals presence can allow people suffering from anxiety or PTSD a blessed break from the constant tension and stress caused by their illness.

Therapy service animals need to be everything regular therapy animals are, plus highly trainable. Therapy service animals are trained to recognize the signs of illness in their people and provide whatever assitance they can. Examples of therapy service animals include:

  • A cat who when her person was having a panic attack would sit on her chest and purr until the attack was over
  • A dog who would, without being ordered, fetch their person’s anti-anxiety medicine when their signs of an anxiety attack
  • A cat who, if her person was leaving the house, would stop her if she had forgotten to turn off the stove

Alternative Therapies to Avoid

The specific therapies I have covered here are generally accepted and promoted by medical and psychiatric professionals. Leaving aside any issues with the medical and psychiatric industry, that means they are at mininum safe to participate in.

However there are many alternative therapies, and not all of them have been subjected to studies or overview. A few years ago, a new alternative therapy known as “rebirthing” became popular for a time. Many psych professionals warned that it had not been studied and there was no reason to believe rebirthing actually helped. Spending time and money on a useless therapy is bad enough, but anyone seeking treatment for mental illness becomes familiar with it. But rebirthing wasn’t just a potentially unuseful therapy, several people were severely injured, and at least one died, during rebirthing “treatments.”

It is impossible for me to cover all possible alternative therapies here, especially since new ones are being developed all the time. And over time, many alternative therapies become accepted and standard treatments. At one time CBT was an alternative therapy. Art and Music therapy are slowly moving toward wide spread acceptance and regular insurance coverage. If you are contemplating an alternative therapy, do your research. Discuss the therapy with a psych professional you trust. Look for a professional association about that therapy and studies done to confirm the effectiveness of that therapy.

Be safe and protect yourself.

How Alternative Therapies Work

Sadly, we need to go with the usual answer here “Good fucking question.” While there are theories to why some alternative therapies are effective (such as the relaxation response to animals), how and why alternative therapies work is largely a grey area.

By and large, alternative therapies have been studies far less extensively than more standard therapies, and it is often impossible to even cite a success rate for alternative therapies, much less a reason for their success.

How to Access Alternative Therapies

The most accepted alternative therapies, such as art, music and animal therapy, are easiest to access through institutions. Psych wards, psych rehab centers, community clinics, etc, will often include the more accepted and mainstream alternative therapies. These are also the settings where alternative therapies are most likely to be covered by insurance (at least in the US).

You can also seek out private therapists who offer alternative therapies. If an alternative therapy has a professional association (For instance, the American Music Therapy Association) they will often have information for finding a therapist on their website.

Therapy service animals in the US are usually only available to people who are legally disabled. It is possible to pay for a privately trained service animal, but these animals will not benefit from the protections available to an “official” service animal. For instance, you cannot be denied an apartment if your service animal is “official” but a privately trained “unofficial” service animal will restrict you to housing that usually allows pets. If you feel you or a loved one would benefit from a trained service animal, you will need to seek out information locally on the requirements and availability of getting one.

Impact on Polyamory

Art and music therapy have a similar impact on poly as talk therapy. Especially the post session trauma and the growth-as-change impact. Animal assisted therapy usually won’t have an effect on poly unless one of your partners is allergic to dogs and you come home covered in dog fur.

Obviously, getting a therapy service animal will have an impact, especially on poly partners you share a home with. While adding a trained animal to the home is not like adding an infant or another poly partner, it will change the dynamics of the home.

This post is part of the Polyamory and Mental Illness blog series.



The Course of Treatment: Treatment Options — Talk Therapy

Understanding Talk Therapy

Talk therapy is one of the most popular treatments for mental illness. Usually you will hear talk therapy referred to as counseling or simply “therapy,” but I use the (unpopular) talk therapy to distinguish between talk therapy and other forms of therapy such as music therapy or art therapy.

There are many types of talk therapy from the psychoanalysis developed by good ol’ Freud to the currently popular cognitive behavioral therapy to new and untested talk therapies such as ********.

The basic idea behind all types of talk therapy is that mental illness can be treated through some form of discussion or learning process.

Types of Talk Therapy

“Deal with” Therapies

Obviously official terms are flying out the window here, but bear with me. Broadly, talk therapies can be divided into two groups. The most well known grouping which includes psychoanalysis is all about “dealing with” stuff. In psychoanalysis, for instance, you spend a lot of time examining your childhood to identity what caused various hang ups in the your id and ego, so you can heal and grow past them. Other forms of “dealing with” talk therapy focus on other parts of your life than just childhood, have a different understanding of the way the psyche functions, etc, etc, but they all focus on “bad shit happened in your life that caused you to have mental illness, and we’re going to deal with those bad things so you can heal.

“Learning” Talk Therapies

Unlike “dealing with” talk therapies, “learning” talk therapies aren’t concerned with why you have a mental illness. It could be something from your child, a genetic predisposition, something in your brain chemistry, and “learning” talk therapies say “who cares?” “Learn” talk therapies are the occupational therapy of mental illness. “Mental illness is fucking up your life. Let’s look at how, why, and what we can do to fix this shit so you can go back to living.” CBT is the most popular “learning” talk therapy. CBT focuses on understanding the mind, body, and emotions interact, and why we think and feel the way we do. The idea being that mental illness is a downward spiral caused by the interactions of your mind and body. Find a way to interfere with the spiral–say by recognizing what thoughts are feeding into depression and replacing them with other thoughts–and you can at least mitigate, if not stop entirely the damage the disease causes.

How Talk Therapy Works

Good fucking question. You can see above the ways both psychoanalysis and CBT explain themselves. But do they really work that way? Researchers have been trying for decades to pin down what makes talk therapy work. If they could actually figure it out, they would be a huge step closer to figuring out a form of talk therapy that is effective more than 30% of the time.

How to Access Talk Therapy

Depending on the kind of medical coverage you have, there are two ways you can access talk therapy. The first is to call up a therapist who is included in your medical coverage and make an appointment. The second is to go to your primary care provider/general practitioner and get a referral to a therapist.

If you don’t have medical coverage, or if your medical coverage is insufficient for the care you need, many local and regional municipalities offer support and services to assist people dealing with mental illness. Free forms of talk therapy are sometimes offered by community clinics, religious organizations, and other non-profits.

As usual, folks who live in places with universal health care will have an easier time getting access than those of us dependent on private insurers or paying out of pocket. Easier doesn’t necessarily mean easy–access to therapists in a universal health care system may be restricted due to availability or other issues. (Thanks to Susan for providing further info.)

Impact on Polyamory

Talk therapy will rarely impact polyamory directly. It is, of course, hoped that talk therapy will lead to improved mental health and as a result improve relationships. Talk therapy does share with psychiatric medication the issue of over optimistic partners expecting improvement in a “reasonable” time frame. Always remember two things: the most effective forms of talk therapy have a 30% success rate, and all forms of talk therapy take time. Lots of it.

The Post Session Trauma of Therapies

This issue is most common to “dealing with” therapies, but might come up in “learning” therapies. Talk therapy sessions tend to be pretty rough on people. Spending on hour confronting your worst emotions, most traumatic memories, and unhealthy behaviors can have that effect. It is not uncommon for someone to need time recovering from a therapy session. Crying, withdrawal, needing comfort, and mood swings, and other reactions are common.

It is very important to respect the privacy of someone’s therapy session. If they want to talk about it, certainly be available. But don’t ask them to talk about it. If you want to express your concern and support “Did you have a good session?” is a wonderful, neutral question that doesn’t ask your loved one to share more than they are comfortable with. They might give you a one word answer, or they might give you a blow-by-blow of the entire session. Let it be their choice.

Mental Calisthenics Are Exhausting

Talk therapies require a great deal of mental effort. This is most noticeable with “learning” talk therapies, but that may be because the emotional impact of “dealing with” therapies obscures the sheer exhaustion. However, stopping the destructive thoughts caused by mental illness is a great deal like rolling boulders up hill with your mind. In addition, someone participating in a “learning” talk therapy will often come home with reading material, mental training exercises, and homework.

Depending on the type of “homework” your poly partner may begin making changes in their habits or surroundings. They may ask you to help or support them in the changes they are making, to do mental exercises with them, or to read the papers they bring home so you can better understand what they are going through and how they are trying to address their problems.

Growth is Change

If talk therapy is at all effective, it will lead to growth. Sometimes this will be a growing understanding of mental illness and how the mind works. Sometimes it will be a growing understanding of who they are and what they want in life. Sometimes it will be a growing understanding of how experiences in the past shape their behavior now.

When people grow, they change. And it should go without saying that change can really disrupt relationships. People in therapy may find they need to step back from one or more relationships, address ways their relationships are hampering or helping them to heal, change their own behavior in a way that impacts relationships, and a great deal more.

This post is part of the Polyamory and Mental Illness blog series.



Course of Treatment: Treatment Options – Medication

Gah! Late again! Sorry folks, what was supposed to be a 2-hour out-patient deal yesterday turned into a full day at the hospital thanks to a mild reaction to anesthesia. 

 

Disclaimer: I have some very strong feelings about the use of psychiatric medication. I’m going to be as even handed as I can here, but please do your own research and come to your own conclusions.

Disclaimer 2: I am not a doctor, psych, or any other kind of health professional. As always, this blog is for informational purposes only and information found here is not meant to be used to diagnose, prescribe or otherwise treat mental illness.

Understanding Psychiatric Medication

Okay. That is a misleading title. There is very little we understand about psychiatric medications. We understand that sometimes they work and sometimes they don’t. We have theories about how they work. But for those of us on the receiving end, it often seems that psychiatric medication is prescribed by guess and the gods. But let me break this down a bit.

Types of Psych Meds

Anti-Anxiety

Just what it sounds like, anti-anxiety meds are intended to reduce anxiety and/or stop anxiety attacks. If you get a really bad panic attack, to the point you need to go to the hospital, they will give you an anti-anxiety med as an injection. The one time I had this happen I went from full-on panic attack to relaxed and calm in seconds flat. It was wonderful. Depending on your level of anxiety, these meds will be prescribed daily or as-needed. As a pill, anti-anxiety meds don’t work as quickly or effectively as injection–the digestive system slows things down a bit. However if taken soon enough an as-needed anti-anxiety pill can be effective in preventing an anxiety or panic attack.

Anti-Depressants

Anti-depressants are both the best known and most controversial of psych meds. The controversy is largely due to the difficulty of evaluating their effectiveness combined with incomplete understanding of how and why they work. If an anti-anxiety injection can take a person from full panic attack to calm in ten seconds, obviously it works. If anti-psychotics can stop hallucinations, obviously they work. These are extreme and obvious symptoms that are either present or they aren’t. Anti-anxiety and anti-psychotics may not work for everyone, but it’s hard to deny that for the people they help, they are effective.

Depression doesn’t have symptoms like panic attacks and hallucinations.  Things that you can *bam* it stopped. Depression is one of the most subtle of the mental illnesses, and there is no obvious way to tell is an anti-depressant is working or not. Doctors put you on an anti-depressant and ask “how are you feeling, do you feel better?” If you feel better it’s working, if you don’t feel better it’s not.

The problem with this is it’s like saying “If you don’t have allergy symptoms today, your allergy medicine is working.” Well…maybe the medicine is working, or maybe the pollen count is just down today. Did you check the pollen count? With depression, there is no good way to check the “pollen count.”

Anti-depressants have helped a number of people to manage their depression. Many people report that finding the right anti-depressant that works for them was a turning point in their treatment and allowed them to regain their lives.

The most popular anti-depressants are SSRIs, selective serotonin reuptake inhibitors. Tricyclics are older anti-depressants, only used today when SSRIs don’t work, and I’ve known several shrinks who won’t prescribe them at all due to side effects. Wellbutrin, Effexor and a few other new anti-depressants don’t fit in either category.

SSRIs and Tricyclics both effect the neurotransmitter serotonin, at different points in the neurotransmitter’s cycle

Anti-Manic (aka Mood Stabilizers)

Anti-manic agents, also known as mood stabilizers, are mainly used to treat bipolar disorder, but can be used for other mood problems. Anti-manic agents suffer from many of the same problems in identifying their effectiveness as anti-depressants, however the swing between mania and depression, which tends to include a predictable duration, gives a better measure for judging the effect than is available for anti-depressants.

Anti-Psychotics

Anti-psychotics are best know for treating hallucinations and delusions. As such, they are a class of psych meds who are unusually easy to measure the effectiveness of. Antipsychotics are also used to treat thought disorders (when something interferes with your ability to think), bipolar for short periods, and  recently have been tried with some success for extreme depression.

Anti-psychotics regulate the neurotransmitter dopamine.

Stimulants

Stimulants are exactly what they sound like, and many are closely controlled due to their close chemical relationship with methamphetamine. Stimulants are most often used to treat ADHD, as people with ADHD usually share an atypical reaction to stimulants. Instead of being stimulated, they are calmed down. This is, in fact, one of the rare cases where diagnosis by medication actually has some validity, because giving someone tentatively diagnosised with ADHD a stimulant is the best way to find out if they have this common symptom of ADHD. (That’s rather circular, isn’t it?)

Stimulants are also sometimes prescribed to treat depression, especially when lethargy is a primary symptom.

How Psych Meds Work

Anti-depressants and anti-psychotics work, as noted above, by affecting neurotransmitters levels in the brain. Serotonin and dopamine are both neurotransmitters that are believed to be involved in mood regulation. Lowered levels of serotonin are believed correlate with depression, and heightened levels of dopamine are believed to correlate with psychosis. The theory is that by bringing these neurotransmitters back to their normal levels, it prevents extreme moods caused by the neurotransmitters being out of sync.

It is important to note that this is a correlation. No one knows if depression causes low levels of serotonin or if low levels of serotonin cause depression. Proponents of the medical theory of psychiatry will say te cause is the neurotransmitters. Skeptics of the medical theory are more likely to say the neurotransmitters are symptoms of depression which is caused by something else.

My own (inexpert) knowledge of biochemistry leads me to believe that like many biochemical reactions, there can be many causes, and it may be that both are true–in some cases a disruption of biochemistry or genetic predisposition may cause high serotonin levels, which in turn leads to depression and in some cases outside influences affect our thoughts and moods, leading to changes in serotonin levels which are then a symptom of depression rather than a cause.

Stimulants psych meds work like any stimulant, and their metabolic pathway is well known. Most anti-anxiety medications are tranquilizers. Both stimulants and anti-anxiety meds are used to treat symptoms only, no one believes that they actually address the causes of mental illness. Anti-anxiety meds, in particular, should not be taken for long periods of time, due to long-term side effects.

The Argument Against Psych Meds

Even the most optimistic supporters of psych meds can only point to a 30% success rate. Some studies have found little to no difference between the effect of psych meds, anti-depressants in particular, and placebos. For a detailed review of the argument against psychiatric medication, review the work of Dr. Peter Breggin.

In addition, psych medications often have side effects that can be as detrimental as the illnesses they are supposed to treat. In the case of anti-depressants, a common side effect is an increased risk of suicide. (Yes, you read that right.) Some speculate that this increase is the result of the anti-depressant increasing an ill person’s energy without addressing underlying problems causing the depression. However, some studies have found an increase in suicide risk among people who aren’t depressed. These studies are inconclusive but concerning.

Other side effects common to psych meds range from chemical dependency, to liver damage, to reduced libido.

The first shrink who was actually able to help me was a follower of Dr. Breggin. His rejection of the medical model of psychiatry caused him to look passed the obvious chronic depression and recognize the symptoms of ongoing mental and emotional abuse that prior shrinks had ignored.

To this day, I remain extremely skeptical of anti-depressants and the arguments made for them. I have seen through personal experience and the experience of those around me how beneficial anti-anxiety, mood stabilizers, and anti-psychotics can be when used correctly.

How Psych Meds are Prescribed

Psych meds can be prescribed by a medical doctor or psychiatrist. From personal experience I highly recommend that if you are seeking treatment for the first time you seek out a psychiatrist who also offers counseling, or only see a psychiatrist alongside a licensed psychologist or counselor.

A medical doctor will not be as famliar with psych meds, and will be less able to recognize the best med for you or dangerous side effects. Psychiatrists that only prescribe medication will see you for 15 minutes once a month. Seeing a counsellor or psychologist while going on medication for the first time will allow you spend time with a trained professional every week who can help you evaluate the impact of the medication and recognize any side effects.

If you find a medication or combination of medications that are an effective treatment for you, and you know of any adverse affects it has on you, you can safely switch to just getting your prescription from a medical doctor or psychiatrist who does not provide counselling.

Impact on Polyamory

There are three ways seeking medication as treatment can cause problems in a poly relationship.

Over Optimistic Partners

Find the right medication, assuming any medication is right, is a fraught and exhausting journey. It will be very tempting for poly partners to expect immediate improvements, a quick solution, here’s your meds, what’s your problem?

Seriously, some people spend decades trying different medicaitons and combinations of medications before either finally finding one that works, or giving up on medication entirely. (And yes, I kjnow people who have finally found the right medication after decades of searching, sometimes it does take that long. Sometimes your are unknowningly waiting for them to discover a medication and sometimes it’s just dumb luck.)

You and your poly partners need to go into this treatment plan like a prospector hunting for gold. Not like someone with strep picking up an antibiotic.

The Rollercoaster Effect

Continuing my gold hunting analogy, the search is full or ups and downs. You think you find something that works, like a glimmer of gold at the bottom of a stream. But it turns out to be just a temporary up swing in how you are doing (fools gold) or a minimal improvement that isn’t enough to allow you to function (a bit of gold dust with no clear source).

It’s not just that the search is long, but the constant swing between hope and failure. The way for a few months you seem to be getting better, you are getting better, and then for some reason the medication stops working and you are back at square one. Was it ever working in the first place? Do something change your body chemistry so you know longer respond to it? What the hell happened? You don’t know. You just know that one day you had a successful treatment, and the next day you are picking up the broken pieces of your life and relationships.

This can seriously wear out a poly partner. You want to be supportive, you want your loved one to find help and heal and be able to be fully themselves. But watching them go through the up and down cycle, and living with them through their mood swings on the rollercoaster can be extremely difficult.

For both poly folk with mental illness, and their partners, this can put a huge strain on relationships.

Adverse Effects

As mentioned above, adverse effects from psych meds can be pretty scary at times–increased risk of depression, liver damage, etc. They can also be irritating–disrupted sleep schedules, stomach troubles, lightheadedness or dizziness. And they can be relationship time bombs, like loss of libido. And that doesn’t even consider the really odd adverse effects that they don’t warn you about because they’re just idiosyncratic–like the time I was put on Adderall for a couple weeks, and spent the entire time ready to rip someone’s face off. I’ve never heard of anyone else reacting to Adderall that way, but you can bet the next time a new doctor suggested it my answer was “Fuck no.”

Some adverse effects won’t impact your relationships at all, or will only do so in minor ways. If your medication makes you lightheaded, you probably won’t be going on rollercoasters with your poly partners, and really acrobatic sexcapades will need to take a back seat, but for most people that won’t cause a relationship meltdown. Loss of libido, on the other hand, is a common adverse effect of psych meds that can seriously mess with relationships.

For this problem, I can actually give some useful advice.

1) If your poly partner starts a new psych med, take any personality/behavior/attitude changes with a grain of salt for the first month or so.

2)  Both the person on the psych meds and their poly partners can work together to keep track of changes that occur in the weeks after taking the medicine. Poly partners doing this can actually be a big help because it’s easy to lose track when you are inside of it. So if you hear your partner complain of dizziness a lot, when they never were dizzy before, if your sex life changes drastically, if they start having stomach troubles, or personality changes (good or bad), or being more active, or less active, or happier or quieter or calmer, or anything at all, good or bad, take note, keep it in mind. Let your partner know that you’ve noticed this change.

3) Poly partners can help poly-folk on psych meds assess the effects–good and bad–of a new psych med. Is the good outweighing the bad? As hard as it can be, try to keep this assessment focused on their overall life and wellbeing, not just the impact on your relationship.

4) When poly-folk on psych meds find a psych med or combination of psych meds that work, they and their poly partners can work together to find ways to deal with the adverse effects that impact the relationships.

 

Okay folks, I’ve topped out at nearly 2,500 words–even for me this is a bloody long post! So I’m gonna wrap up here. I hope you’ve found this helpful. Sunday I’ll cover what you can expect from talk therapy, some of the different kinds of talk therapy, and how talk therapy can impact poly relationships.

 

This post of part of the Polyamory and Mental Illness blog series.

 

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