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March 1, 2012 Volume 3, Issue 8
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The Weekly Highlights archive is a virtual library of information on recovery. Topics range from peer specialist training and recovery-oriented systems to personal accounts of addiction, mental illness, and wellness. If you have missed a week's publication, check out volumes 1, 2, and 3—more than 75 archived issues are available.

Depression Can Be a Straitjacket on Your Brain: My Recovery Journey
by Bill Rogers
My story seems to have many beginnings and an ending I continue to search for. Based on my experience at Johns Hopkins Mood Disorders Center, I believe the use of occupational therapy (OT) methods to treat mental health disorders is extremely valuable. I think these methods are even more valuable for decreasing the likelihood of relapse. At the same time, for folks like me who suffer from mental illness, I feel there is disparity between the need for OT and what is currently being delivered.

OT sessions can be one on one or held within a group. At first, you work with a therapist individually, then join with others to practice social skills, engage in outside activities (shopping, cooking, etc.), and form a small, safe community where listening and sharing are encouraged.

When you're depressed, depression becomes your whole world. You may be a father, mother, son, daughter, husband, wife, friend, or coworker, but you can't see or feel beyond yourself when depression strikes. In my opinion, depression can be a straitjacket on your brain. I have struggled with depression on and off for 15 years.

In atypical fashion, my first depression occurred when I was 40—about 15 years ago. I had secured a Help Desk Manager position in Colorado, but the day before I was supposed to leave Pennsylvania, I suddenly decided I didn't want to go. We had already sold our house and said our goodbyes. Twenty-four hours later, I collapsed and could barely get out of bed for a week. I saw my family doctor and was prescribed Paxil. I started seeing a psychotherapist, which continued for about a year.

My most recent episode began about 5 years ago. My wife and children noticed I had become aggressive and argumentative with them, which led to a 15-month separation. At the end of that separation, my wife and daughter asked a psychiatrist to speak at a local church about depression and bipolar disorder. They encouraged me to meet with the psychiatrist and when I did, I was diagnosed with bipolar II disorder and prescribed a regimen of mood stabilizers. The treatment was part of 7 years (off and on) in psychotherapy. All was well for the first year, but then a slow decline and 14 different medications in 10 months culminated in a weeklong stay at the local hospital. In the weeks and months that followed, I left and returned to work several times. Finally, I was admitted to a private psychiatric hospital.

The hospital was a rough and taxing experience. There were no shoelaces and no belts—no caring if your pants were falling down. Going outside was not an option and the windows were covered with such thick film, you couldn't see out. I received very limited attention from medical staff, had no OT, and participated in a seemingly purposeless number of group sessions. After 3 days, I called my wife and begged her to get me out of there.

Immediately after the hospitalization, my psychiatrist recommended the Johns Hopkins Mood Disorders Center. A past patient of the clinic also suggested the program. When I asked him what he liked about the clinic, the first thing he said was, "Pay attention to OT. It's very helpful."

I was admitted to the program on a Friday afternoon. After talking to the attending and resident physician for several hours, I had a different diagnosis: major depressive disorder. The medications I was on were gradually eliminated and I started taking lithium and nortriptyline. Hopkins' medical staff hit the nail on the head as I'm still taking these two medicines.

I was at the center for 7 weeks—primarily for the inpatient program. During the last 2 weeks, I participated in the day program. While there, my insurance carrier would not cover OT. I had minor relapses during my stay. Fortunately, an occupational therapist worked with me after each collapse to understand what happened and how we might decrease the likelihood of another episode. The therapist helped me understand how to use positive affirmations during a crisis, how to schedule my time so I would get out of bed and keep myself occupied throughout the day, and most importantly, the importance of using the Relapse Prevention Plan.

If I had to describe what the occupational therapists at Johns Hopkins Mood Disorders Center can provide, I would focus on these five areas:
  1. Socialization
  2. Flexible and individualized treatment
  3. Increased ability to think about and describe your illness
  4. Positive affirmations
  5. The Relapse Prevention Plan: a 30-page document that covers what you're like when you're well, when you're marginal, and when you're in crisis. It also emphasizes things you can do to stay well.
Some additional areas where I've found OT helpful are SMART (specific, measurable, action oriented, realistic, and time framed) goals, battling perfectionism, and breathing and relaxation techniques.

I am a good example of how OT can help a patient in the recovery process. I feel confident it can contribute to preventing a full-blown relapse or hospitalization. The question I have now is how OT can be introduced into other treatment areas so it serves as an adjunct to traditional psychotherapy. What else can it offer someone like me?

I've been back at work now for more than 3 months. Although there have been ups and downs, most days are manageable. I still see a psychiatrist and cognitive–behavioral therapist. Overall, I'm doing extremely well.

Bill Rogers is a Program Manager for a large technology company. He travels to customer sites throughout the country.

Register for the RTP Webinar
Understanding and Building on Culture and Spirituality in
Recovery-Oriented Practice
The next RTP Webinar will describe three components of culture and spirituality in recovery-oriented care: cultural and spiritual assessments, culturally appropriate interventions, and ways in which spirituality and culture can shape an individual's recovery journey. Our presenters will introduce a range of strategies that ensure care is responsive to a person's cultural identity and discuss approaches for fostering cultural strengths and spirituality in care planning and recovery practices. An important facet of culture and spirituality in recovery-oriented care addresses the aging process—how can practitioners be cognizant of person- and family-centered culturally specific needs?

April 4, 2012

3–4:30 p.m. EST

Three multidisciplinary specialists will share their perspectives. Reverend Laura Mancuso, M.S., CRC/CPRP, will describe practical tools for making assessment culturally and spiritually oriented. Dee Bigfoot, Ph.D., Assistant Professor of Pediatrics at the University of Oklahoma Health Sciences Center, will discuss recovery-oriented interventions that have spiritual and cultural components. Finally, National Association of Peer Specialists President Gladys Christian will address how spirituality and culture have affected her recovery journey.

Click here to register.

NEW! RTP Resource
Psychological Care and Religion
"Psychological Care for Persons of Diverse Religions" describes a continuum of mental health care that recognizes positive psychological attitudes developed through community membership. The continuum promotes professional clinical assessment and treatment for those of diverse religions with serious mental disorders and supports recovery through ongoing collaboration between consumers, clinicians, and religious communities.

There are ethical concerns about religion's role in clinical care. In addition to a wide divergence of beliefs across religions, there is great ethnic diversity within religious practices—a challenge for clinicians. Authors Glen Milstein, Ann Marie Yali, and Amy Manierre say practitioners should assess religious values and their cultural variations when designing inclusive psychotherapy for clients.

Learn more about this article.

Get 'In SHAPE'
The average lifespan for people with serious mental illness is decades earlier than those who don't suffer from psychological disorders. In SHAPE (Self Help Action Plan for Empowerment) is a program that pairs health experts with participants to develop wellness plans for exercise, good nutrition, and smoking cessation. The program has been so successful at Monadnock Family Services that New Hampshire received a $10 million Federal grant to offer it statewide at community mental health centers. Right now, the program serves 150 people, but within the next 5 years In SHAPE hopes to have up to 4,500 participants.

Read more.

A Patient’s Journey from Depression to Fulfillment
Malaina Poore's adolescent years were plagued by deep despair. Though she leads a full and happy life today, Malaina still suffers from occasional depression. When she finally found a way to cope with her condition, the breakthrough jump-started her career as a mental health consumer advocate. She now promotes recovery awareness by encouraging people to share their experiences.

Read Malaina's story.

This article was originally published in the Journal of Participatory Medicine.

The RTP Resource Center Wants to Hear From
Recovery-Oriented Practitioners!
We invite practitioners to submit personal stories that describe how they became involved in
recovery-oriented work and how it has changed the way they practice.
The RTP Resource Center Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit stories or
other recovery resources, please contact Cheryl Tutt, MSW, at 877.584.8535,
or email recoverytopractice@dsgonline.com.

We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topic,
please contact the RTP Resource Center at
877.584.8535, or email recoverytopractice@dsgonline.com.

The views, opinions, and content of this Weekly Highlight are those of the authors, and do not necessarily reflect
the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.