Month: December 2018

The Struggle with – LOOK, A SQUIRREL!

I have ADHD. Surprise! Who would have guessed, right?! Actually, to most of my friends, it’s pretty obvious. My train of thought is more of a streetcar on detour rather than a train, and my stories have virtually no end. But why did it take 24 years for a doctor to actually diagnose me?

When I was a kid, my teachers told me I was “gifted” and “above average”. I finished all my work before everyone else, and often got bored in class. Instead of acting out, I would zone out or work on something different. Sometimes it was writing stories, or reading a book under my desk. By the time I was in 6th grade, I was running a gum and candy business from inside my desk. I never really got in trouble, because my actual school work was finished and I was always the first to hand in my exams or in class assignments. My parents thought I was just bored because the content was too easy.

In reality, I struggled with focusing. I struggled with doing one task for an extended period of time, and would rush through tasks before my attention span ran out. There was constantly an attention hour glass that ran out just a bit too soon.When I was young, it was cute – I had messy writing, didn’t color in the lines, and couldn’t cut a piece of paper in a straight line. Everything was a race, and quality slipped through the cracks. As I got older, it became less cute and more annoying. School got harder, and I didn’t magically know all the answers anymore.

I tried to explain to my parents that I thought I had ADHD when I was about 12 or 13. When they took me to a doctor, I didn’t fit the usual ADHD bill. I wasn’t disruptive, I didn’t act out, I didn’t have bad grades. I wasn’t necessarily hyperactive. I just wasn’t disciplined enough because I had always had it so easy.

In university, I skipped a lot of class, because I barely got anything out of lectures, and when I was in class, I would be doing a million other things. I struggled with studying, and could only accomplish anything if I was having a “power hour”. I didn’t realize my “power hours” were actually a part of ADHD. In the ADHD world, it’s called “hyper focus”, which means that you have these bursts where you put so much focus into one thing, that the rest of the world is basically shut out. It was brilliant for writing papers and studying when it happened, but the problem was that it never really happened when I needed it to. Sometimes, it would happen when I was trying to work, but my focus was directed at something completely irrelevant. I always finished exams early because I could barely pay attention in a 45 minute lecture, let alone a 3 hour exam.

PC:”Auntie, Me & My ADHD” via Facebook

ADHD impacts every little bit of my life – from getting restless at work and needing to walk around every hour or so, to losing my keys, wallet, shoes, etc. to forgetting important dates like birthdays and social obligations. I lose track of more things than I can count, and find it difficult to follow through on a lot of things I commit to. It’s like being scatter brained on steroids. It’s also incredibly stressful.

This past year, my doctor asked if I ever had issues with attention and focus. I was seeing her because I had gone into a deep depression and my anxiety was out of control. Her question seemed irrelevant and surprised me, but when I did some of the diagnostic tests and realized I actually experienced a ton of ADHD symptoms, something clicked. It turns out that it’s really common for undiagnosed ADHD to manifest itself as anxiety and depression. We learned that part of the reason I was “treatment resistant” was because some of my anxiety and depression came from my ADHD. The stress of not being able to stay organized or the anxiety that comes with having a messy apartment (and let’s be honest, kind of a messy life), actually heightened my anxiety and depression.

I was actually quite relieved to get my diagnosis, but a big part of me was sad too. Why did it take so long to get diagnosed? What could have been different had I not struggled with my ADHD for so long without knowing? Could I have done more? Achieved more? Could I have avoided my depression and anxiety getting so severe? I’m not sure, and I guess I’ll never really know.

But I do know that we talk a lot about people being misdiagnosed with ADHD, and stimulants being over-prescribed, but we don’t talk nearly enough about how women and girls are often looked over and not diagnosed. The way that ADHD manifests itself can be quite different for young girls and boys – girls are more likely to retreat and disconnect, while boys are more likely to act out. Therefore, the boys get diagnosed because it’s a lot easier to see. Girls are more likely to be “inattentive” (like me), while boys are more likely to be “hyperactive”. We also think of hyperactivity as being a physical thing – like running around or being disruptive, but “hyperactivity” (in girls especially) can be more emotional – like having outbursts or emotion that don’t quite make sense or fit. This leads to the inattentive girls being labelled as lazy or stupid, and the emotionally hyperactive girls being labelled as drama queens or crazy.

Stimulants (medication for ADHD) can be dangerous and very easy to abuse, so it’s important that we are not over-prescribing these medications. It’s also important that we don’t under-prescribe to those who need it, especially girls who are already under-diagnosed. 

Now that I’ve bounced around enough, I should probably get to my main point which is this: a proper diagnosis can be absolutely life changing. And getting it sooner rather than later is really important, not just for medication, but because it can explain a lot. I struggle a lot with my self-esteem and always felt stupid or forgetful, but it was really just a part of my ADHD. It’s a lot easier now that I know what’s going on, but it was a long road to get here. When we let our knowledge of a condition be guided by misinformed stereotypes, we become blind to some important warning signs. When that happens, we let people slip through the cracks or misdiagnose them and treat problems with the wrong medications, which is dangerous and expensive.

Keep Surviving by Living.  

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The Price You Pay

The cost of mental illness is now becoming more of a topic of discussion, as a way to propel the conversation forward due to the large economic costs to our society.

When we talk about it, we talk in terms of lost labour hours and wages, or the cost to our health system. We talk in macro economic terms because the problem is of such great magnitude that it actually can impact our economy. If you Google what mental health costs in Canada, you’ll learn that it costs our economy over $50 billion every year. You’ll learn that the cost of mental illness represents almost 3% of our nation’s GDP.

It’s estimated that 6.7 million Canadians are struggling with their mental health, vs 2.2 million dealing with diabetes and 1.4 million with heart disease (CMHA). Despite mental illness effecting 20% of the population, only 7% of our health care budget is spent on mental health.

But, I’d like to focus on the micro economic costs of mental illness – the costs we don’t talk about that impact how well or how poorly we can line our pockets. Because I’m angry about it. This post is not a happy one, but it’s a necessary one.

We know the numbers on the national impact of mental illness, but what about on an individual basis? How expensive is it?

We need to discuss these concerns, because it’s important that we acknowledge that accessing mental health care in our country is reserved for the privileged. Our public health care system is inadequate, underfunded, and overburdened, leaving those suffering to seek out private care options. Canada boasts being a country with public health care, but the mental health side is largely privatized. This points out one flagrant fact: our health care system does NOT see mental health and physical health as equally important. As a result, far fewer resources are allocated to mental health care and the ratio of needs to resources is grossly disproportionate.

Beyond that, the public health care system only provides support in a couple of very small areas – emergency intervention (hospitalizations) or PRESCRIBING pharmacological support (like anti depressants). A note about pharmacological support – you don’t have to pay for the doctor to prescribe it, but in order to not pay for the pills themselves, you have to have fantastic extended health insurance (so basically private). Personally, these two areas represent less than 10% of my actual mental health care needs. The other 90% is self funded.

So what does that 90% cost? Well, in the past year alone, I’ve spent almost as much of my money on mental health care as I have on rent. I maxed out my extended health converge from work within the first month.

It costs a ton of money – in fact, therapy alone is close to 2x what my annual university tuition was  (and I was in one of the most expensive undergrad programs).

In Ontario, the average income is less than $60,000, which is less than $45k after tax. The running rate for therapy in Ontario is $225 per hour. So if you’re an average person in Ontario and go to therapy weekly, you’re paying $12,000 a year. More than a quarter of your income is going just to therapy. Considering a good insurance plan for that income bracket is $1000 a year for mental health, you are covered for just over one month of the year.

The cost of mental health goes beyond therapy, however. There are costs I incur for physiotherapy and massage therapy, because the physical symptoms of mental illness are very real. That’s another couple thousand bucks a year. Since my illnesses are largely “treatment resistant”, meaning most medication doesn’t actually work for me, not to mention I’ve had horrible side effects from pharmacological support, I’ve had to use a naturopath to find more natural remedies and adjust my diet. So tack on another couple grand. When I do take prescription medication, it can cost hundreds of dollars a month. I remember being in university and being apprehensive about trying a new medication because there was no generic version, so it would cost me $400 a month. This past year I tried a new medication, and a trial of just 6 pills cost $45. Part of me was relieved when it didn’t work because I didn’t know how I would afford it otherwise.

Even without doing a bunch of math, it’s clear that having a mental illness is expensive. In fact, it’s basically unaffordable. And you might be thinking that there are some free programs available to people who really need it, and you’d be right. The issue is that those services are largely inaccessible due to them being over-burdened. Wait times are staggering and it can take over a year just to get an assessment for what programming you’d be eligible for. Then you wait again for a spot to open up in that program. When you’re struggling with your mental health, that wait time can quite literally be a death sentence. It would be like being told you have cancer, but you can’t get chemotherapy for another year, even though waiting could mean you die within that year.

When we find out someone is struggling, our first thought is to reassure them that help is available. But do we ever think about if that help is actually accessible? Do we stop to acknowledge the financial barriers that could get in the way of them getting help? When we tell people to get help, do we recognize that because the cost is so high, they may have to make significant life sacrifices? We shouldn’t have to ask these questions. People shouldn’t have to pick between taking care of their mental health or putting food on the table. In a country with universal health care, we shouldn’t have to open our wallets to buy access to services because the free services become basically useless when they’re inaccessible. But we do.

Until we as a society can finally recognize that mental health is just as important as physical health, we will always have to ask these questions. People will have to spend five digits annually out of pocket to take care of their mental health needs. Until we bolster our services enough to reduce the strain on current infrastructure, people will continue to slip through the cracks.

Keep Surviving by Living.

“Yes, and” not “Yes, but”

The concept I want to describe is one that I’ve never quite been able to put into words, so bear with me here. Luckily, I have a couple of very insightful and thoughtful friends who understood the concept when I tried explaining it to them, so I’m borrowing their words.

For as long as I can remember, I’ve tried to separate my depression from me. I demonized it and made it this big villain that wasn’t a part of me – it was a battle I had to fight, an enemy I had to destroy. Time and time again, I hear myself saying “I am not my depression” and how I’m not really myself when I’m anxious and depressed. I still stand by those statements…sort of.

I am not my mental illness, I am not exclusively my mental illness, but it is a massive part of me. It influences the way I act, the way I speak, the people I associate with. It’s in every deep breathing exercise I do, in every therapy session I pay for, in each conversation I have. It does not (always) consume me, but it plays an integral role in my life. As much as I would like to believe I am not defined by my mental illness, it defines a part of me. And that’s not to say that my mental illness has to dictate my life and I just have to accept that, but rather, it means acknowledging how this part of me is not a demon to destroy, but a wound that needs healing. It means acknowledging that though my mental illnesses have made life really hard, they’ve also allowed me to become a better listener, they’ve guided me towards people who have better intentions, they’ve taught me valuable lessons about the universe that some people may never learn. They’ve made me more fearless in knowing what I want and going after it.

I’m learning that because my mental illness is part of me, I have to learn to love it somehow before I can truly love myself. I have to love the beautiful bits, and the parts I think are ugly, and I have to try and see the beauty in the ugly. I can’t accept myself wholly or give myself love if I’m constantly vilifying a part of me that can’t be silenced or ignored.

Part of that process of loving all of me, is being loved by the people around me. Letting them love the good, the bad, the ugly. Being loved simply because of me, and not in spite of something else.

Let me make this part crystal clear: my mental illness is not something to be “looked over” or loved in spite of. I don’t need you to look past my struggles and mental illness in order to love me. I need you to see that there is ugliness in me, but that ugliness is just as worthy of love as the most beautiful parts.

I’m tired of the rhetoric that exists around being loved even though you have pain or baggage or struggles. I deserve better than “I love Ameera, but she has anxiety and depression”. It’s not something that diminishes how deserving I am of love.

I was really frustrated with this one day, and tried explaining it to a close friend. She understood what I meant immediately, and described it as needing people to say “Yes, and”, not “Yes, but”. It was a simple concept I learned in improv class – that when someone offers something in a scene, you accept it. Whether it makes sense or not, whether it makes the scene harder or easier, you accept it, and you work through the scene together.

Moving from language of “Ameera has depression and anxiety, but I still love her” to messaging of “Ameera has depression and anxiety, and I love her.” It’s reaffirming that I can be loved with what I have, rather than mental illness being something that should detract from the amount of love I am worthy of.  It’s a mixed bag, and you don’t get to pick and choose which parts you get.

Another example is when I have a bad day or I’m going through a rough patch and feel bad about it, and people (with only the best intentions) respond with how they know how I really am, and they don’t judge me for this part. They see that I’m actually this happy, funny, lively person and it’s “just the depression talking.” I really, really appreciate the sentiment that I am not my illness, and sometimes my depression and anxiety make me act differently. However, that depression and anxiety is a part of me too. They may be a part I try to hide a lot more, but they’re a part of my journey and my experience. They are not just something to be overlooked or ignored.

When we make our mental illnesses something to be loved in spite of, or we allow them to be ignored so we can be loved, we create the perfect breeding ground for shame. Shame that makes us hide who we are, shame that makes us hide our pain and our struggles, and shame that makes us feel unworthy of the love we need and deserve. It fosters guilt that we can’t be “enough” because we deal with these issues. And it’s not right. No one should be made to feel more isolated and guilty and ashamed because of their mental illnesses. There’s already enough of those feelings because of the mental illness alone, we don’t need the problem exacerbated because it’s easy to love the “good” and hard to love the “bad”.

I realize I’m basically contradicting myself by saying my mental illnesses don’t define me but also they totally do, and I also recognize that it’s difficult to be a positive support when you have to navigate a paradox as complex as this one. This journey isn’t an easy one, but it’s easier when we’re in it together. Even if the people around me don’t know what to say, just knowing that they can love me with or without my mental illnesses, because it has no bearing on how they feel about me, is enough. Reminding me that depression and anxiety don’t have to be looked over and brushed under the rug in order for them to still think I’m great speaks volumes.

Regardless of if you deal with mental health issues or not, think about who you love. Do you love all of them? Do you love them through the messier parts? Do you show up when not showing up is easier? If the answer is no, think about how you can make that move from “yes, but”, to “yes, and”.

If you’re struggling with mental health issues, and you feel like people have to love you in spite of what you deal with, or you feel you have to hide the hard parts so that you don’t lose that love, you’re not alone. That fear is totally valid. I hope we can learn to love the beautiful bits and the ugly bits of one another, and see the ugly bits as beautiful in their own way, so that we can break down the walls and boundaries built by bricks of shame and guilt. I hope you remember that you have pain and struggles, and you are loved. Not despite it. Not in spite of it. Not when it’s ignored. You are simply loved. I see your pain and your struggle, and I love you.

“Yes, and”, not “Yes, but”.

Keep Surviving by Living.