Women and Mental Health

Women and Mental Health

Episode 38

Helen Sneed: Welcome to our award winning podcast Mental Health Hope and Recovery. I'm Helen Sneed.

Valerie Milburn: And I'm Valerie Milburn.

Helen Sneed: We both have fought and overcome severe chronic mental illnesses. Our podcast offers a unique approach to mental health conditions. We use practical skills and inspirational true stories of recovery. Our knowledge is up close and personal.

Valerie Milburn: Helen and I are your peers. We're not doctors, therapists or social workers. We're not professionals, but we are experts. We are experts in our own lived experience with multiple mental health diagnoses and symptoms. Please join us on our journey.

Helen Sneed: We live in recovery, so can you.

Valerie Milburn: This podcast does not provide medical advice. The information presented is not intended to be a substitute for or relied upon as medical advice, diagnosis or treatment. The podcast is for informational purposes only. Always seek the advice of your physician or other qualified health providers with any health related questions you may have. Welcome to episode 38, women and mental health. This is the second of our two part series on the similarities, differences and clashes between the genders as they deal with mental health challenges. And you know Helen, we decided we didn't need a guest for this episode because we are two women with mental health challenges and experience and a road of our own. So what do you think about no guest?

Helen Sneed: Well, I fully expect that we can discuss this with great authority today.

Valerie Milburn: I think we can with our journeys and we hope you, our listeners, will visit episode 36 which is about men and mental health as well as listening to today's. We have been amazed by what we learned about men and women and their mental health journeys and today we're going to take a comprehensive investigation into women and their mental health and we're going to ask some key questions along the way, we're going to ask what are the most common illnesses, symptoms, treatment methods and relationships that impact a woman's fight for recovery? What are the breakthroughs that research and science are discovering to promote healing in women? And Helen, you and I are also going to relate our own personal experiences as women fighting and recovering from mental illnesses.

Helen Sneed: Now let's begin to explore the complex universe and challenging reality of women with mental health issues. As we delve into this immense topic, there are certain drawbacks that prohibit a full exploration. As with men, there's a deficiency in research that's only now being rectified. So this means that most of our discussion today is based on binary research. Men and women in traditional roles, research that now can seem limited. Valerie and I are committed to inclusion of underserved communities, LGBTQ gender identity, people of color, women veterans, especially when new research shows that the mental health challenges in these groups can be more severe, wide reaching and destructive. We'll explore this alarming phenomenon in future episodes. The subject is too vast to do it justice today, so please bear with us as we start from scratch.

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Helen Sneed: To begin with, mental health challenges for women have become an epidemic with female adolescents and young female adults. Fortunately, this age group is receiving increased attention in the scientific and treatment communities and it's one we focused on in previous episodes. Now for this episode we'll focus on mature women because that's where the consequences of childhood trauma and adolescent illness can escalate into severe symptoms, self destructive behavior and mental illnesses decades after the fact. It is impossible almost to understand women's mental health today without some sort of historical perspective. The National Institute of Health has reported extensively on the biases and discrimination towards women with perceived mental health issues over the ages. For millennia, women were considered to be weak, irrational creatures, to be driven and tended to by men. The first mental order attributed to women was hysteria, meaning literally the womb. This concept lasted for 4,000 years, from the Egyptians in the 2nd century BC until beyond Sigmund Freud. The belief was that hysteria, and hence women's madness, was caused by something poisoned in the womb. In most instances it was blamed on a woman's not fulfilling her only roles to marry and to bear and raise children. The treatment of society and doctors was cruel and punitive and the cures were barbaric. Women were locked away in insane asylums for disobedience, adultery, witchcraft, frigidity, and a host of other primitive reasons. In some cultures it was believed that women could cause mental illness, such as forms of love sickness in Men. It wasn't until the 18th century that some progress was made. Hysteria was seen to be an illness of the brain and not the uterus, which was a great breakthrough. Now, skipping ahead, Freud believed that women were frail creatures who had to manipulate others to get their way. But he did admit that there were men with hysteria as well. In the early 20th century, World War I soldiers who were shell shocked manifested many of the symptoms of hysteria. And this promoted understanding and progress, although the treatment still could be torturous. But ultimately, the diagnosis of hysterical neurosis wasn't removed from the DSM until 1980. Now, the DSM, the Diagnostic and Statistical Manual of Mental Disorders, is really sort of like the bible of mental illness. And so this was on the books until 1980.

Valerie Milburn: Hard to believe, but change is slow. 4,000 years, some of those beliefs.

Helen Sneed: No one was in a hurry.

Valerie Milburn: No one was in a hurry. But let's be grateful for the change. And as we go through the episode today, we will see that there are good things happening in women's health treatment and research. So we will look forward to sharing those sharing that progress. So let's take a look at the gender differences in mental health disorders. And this information is from the American Psychiatric Association. And there are indeed differences between men and women in mental health disorders. We saw that in the episode on men. But these differences are in regard to risk, prevalence, how the disorder presents and its course, and in treatment. So we're going to take a look at some of those differences. First of all, let's look at rates of mental health conditions. And research shows that women and men overall have similar rates of mental health problems, both affecting 1 in 5 adults in the U.S. but the types of mental health conditions may differ between men and women. Depression is the most common mental health problem in women. Twice as many women experience depression in their lifetime than men. Post traumatic stress disorder rates are much higher in women. In fact, compared with men, women are twice as likely to experience post traumatic stress disorder. And with ptsd, women are more likely to have hypervigilance, feel depressed, and have trouble feeling emotions. Men, on the other hand, with PTSD, are more likely to feel angry and have problems with alcohol and drugs. And women are twice as likely as men to experience generalized anxiety disorder and panic disorder. When it comes to suicide, women attempt suicide more often than men. However, men are four times more likely to die by suicide.

Helen Sneed: Well, these are. These are terrible numbers.

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Helen Sneed: But there's one thing that I never see mentioned, and that is not the impact of being a suicide survivor. You know, they can say, oh, it's so great, you know, that it didn't, you know, you didn't die, you're all right. But it is really takes a lot of, a lot of work to overcome the shock and the various emotions from being a survival. I mean, you and I both know this, Valerie.

Valerie Milburn: Right. And the impact it has on the survivor's family and loved ones.

Helen Sneed: Yes.

Valerie Milburn: And it does need to be talked about more, unfortunately. There are a lot of support groups for, for survivors of suicide and for their family members. And another statistic is about eating disorders. Approximately 85 to 95% of people with anorexia nervosa or bulimia and 65% of people with binge eating disorder are women. That's large difference between men and women with eating disorders. Alcohol use is interesting. Women are less likely to experience alcohol use disorder than men. But recent studies, including one from Harvard Medical School, show that this gap is narrowing. And something that also narrows this gap is that women are less likely to disclose problems with alcohol to their health provider. Now there's one other thing I want to look at about this difference in symptoms. I mean, this difference in rates. There, there are also certain disorders that are unique to women. And this is from the National Institute on Mental Health. For example, some of these disorders that are unique to women, some women experience symptoms of depression at times of hormone change, such as during or after pregnancy. That's perinatal or postpartum depression. Also around the time of their period, that's premenstrual dysphoric disorder. And during menopause perimenop related depression. Now, the impact of these hormonal changes on women's mental health is so important in relation to treatment that I will explore all of this further when we discuss treatment.

Helen Sneed: Yeah, there's a, there's a lot to.

Valerie Milburn: To look at here, a lot to look at. That has often been ignored by health providers. And there's some interesting info on that coming up now. A bit on women's mental health risk factors. Women disportion disproportionately experience the following risk factors. Factors more than men have these risk factors and these are women earn less than men. Still the poverty rate is higher for women. An estimated 65% of caregivers are women and they may spend as much as 50% more time providing care than male caregivers. And this impact of caring for others does have an important role in increasing the stress that is related to bringing on a mental health disorder. So here are some of the differences in seeking and receiving mental health services. Women are more likely to seek help and disclose mental health providers to their primary healthcare physician, while men are more likely to seek out a mental health specialist that impacts treatment. Women are reluctant to disclose a history of violent victimization unless physicians ask about it directly. Women are more likely to be prescribed psychotropic medications than men are, and physicians are more likely to diagnose depression in women compared with men, even when both genders have identical symptoms or similar scores on standardized measures of depression. A Little Bit More About Treatment the key barriers to mental health treatment for women are economic barriers, either lack of or high cost of insurance, lack of awareness about mental health issues, and lack of awareness about treatment options and services. Stigma of course, always the stigma associated with mental illness is a barrier to treatment and lack of time or related support to get to treatment, such as time off from work, childcare and transportation. Let's Take a Look at the Symptoms the National Institute for Mental Health shows that women and men can develop most of the same mental disorders and conditions, but they may experience different symptoms. First, let's look at some common symptoms for both men and women, and those include persistent sadness or feelings of hopelessness. And Helen, you and I have gone over these symptoms before, but we think it's really important to let people know about the symptoms common symptoms of a mental health disorder

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Valerie Milburn: so that we all.

Helen Sneed: Know and so we can look at the uncommon as well.

Valerie Milburn: That's right. So another common symptom of mental health disorder is a noticeable change in mood, energy level, sleeping or appetite, the misuse of alcohol, drugs or both, decreased energy, fatigue, excessive worry or fear, seeing or hearing things that are not there, extremely high and low moods, anger, irritability and thoughts of death or suicide or suicide attempts. Those are common symptoms for men and women, but there are symptoms that are specific to women. Women are more prone to internalizing mental illness than men are, leading to symptoms such as withdrawal, rumination and loneliness. Another symptom that is not specific to women but much more common in women is self injury. The past research shows that self injury is three times more frequent in women than in men, but recent data reveals less gender differences. Isolation and agoraphobia is more common in women. Some women who suffer from depression systems symptoms find social activity to be overwhelming and seek isolation as a result. Now with eating disorder symptoms, men report more overeating while women have more body checking, avoidance, binge eating, fasting and purging. I want to look at post traumatic stress disorder for a minute because women experience PTSD differently from Men. Women with PTSD may be more likely than men to be easily startled, to have more trouble feeling emotions, or to feel numb, to avoid things that remind them of the trauma, or to feel depressed and anxious. And this is really interesting. Women usually have PTSD symptoms longer than men before diagnosis and treatment. On average four years for women versus one year for men.

Helen Sneed: Well, having heard about these symptoms and difficulties that women face, we want to obviously look at treatment methods. Now. Valerie, you've got some things I think that you wanted to to mention first.

Valerie Milburn: I do. Before we go into the specific effective treatment methods for women, I wanted to share a bit of the guidance I ran across from the American Psychiatric association that they give to mental health practitioners. Because this is a great framework for our discussion of treatment. It makes it clear that women and men have different mental health treatment needs. Now, the American Psychiatric association recommends that a thorough psychiatric history should include a female patient's symptoms in relation to menstrual cycle, the perinatal period, the time following a miscarriage or abortion, the perimenopausal years, the possible history of sexual trauma or physical abuse, and gender identity and sexual history seems logical. For example, it is important to ask whether, for example, a patient's depressive symptoms remit during certain portions of her menstrual cycle. Now, these questions are often asked when taking a medical history, but their importance is often forgotten in a psychiatric history.

Helen Sneed: Well, Valerie, I have to just interject here that I learned during my research that testosterone, which we know is very dominant in men, actually acts as an anti anxiety and antidepressant, which I think is just, you know, who said life is fair? But I think that that's something that, that really bears examination.

Valerie Milburn: Yes. And is also something that can be tested in a full medical history when taking, you know, course of treatment action toward psychiatric illnesses. So that's a really important thing to be looking at. So another thing that is an overview of a treatment plan that the American Psychiatric association points out to practitioners is that several recent studies have suggested a link between the high prevalence of depression and anxiety in women and the well documented higher percentage of psychosocial stressors typically present in women's lives. So a link between depression and stressors, and this link is especially important in women from minority

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Valerie Milburn: groups. So these psychosocial stressors for women include lower wages, poverty, racial discrimination, and as I mentioned before, the unrelenting responsibility for the care of others. Now, as was for me, women report increased stressors before many episodes of depression. So the APA recommends that psychiatrists Ask women patients about financial and social support, help them address problems that are causing stress in their lives. And this is no surprise to you and me, Helen. Emphasize the utmost importance of self care.

Helen Sneed: Well, that's an easy one to overlook when you are already so stressed out by other responsibilities, you know?

Valerie Milburn: Yes.

Helen Sneed: So treatment to begin with, women. Within a 12 month period, women were almost twice as likely to seek treatment as men. Now, the reasons why women are more likely, emotional expression, health care and asking for help are all framed as feminine traits. Whereas men are expected to be emotionally stable, independent, strong and self reliant. Now, another reason I find this really, really a new disturbing breakthrough that they're looking at, another reason is women are seeking relief because increasingly research is showing that women experience more pain than men. As Dr. Ed Keough from the University of Bath in England said, the bottom line seems to be that women are suffering more than men. Now, people often ask which treatment methods are most effective. Well, it's psychotherapy and medication in combination that are considered the most effective ways to promote recovery. So let's look at some of these methods. All right, there's, as I said, there's psychotherapy. That's one on one individual therapy. And in therapy, women often are better suited to the one on one intimate nature of the relationship and are more patient with the therapeutic process, which as we know, can take a long time. But an interesting pattern has emerged. The use of therapy diminishes with age. Ages 18 to 44, 13% use therapy, 45 to 64 drops to 9% and 65 and older less than 5%, which is really quite a change.

Valerie Milburn: Yeah, that's really interesting. I did not know that.

Helen Sneed: Yes, apparently this is new, but I was really surprised by it. Now another treatment method of course is group therapy. It can help a woman in many ways. One of the key objectives is to establish safety, a safe place where the woman can discuss abuse and trauma with other women who have suffered similar experiences. Experiences. And with a trained female group leader. All female groups are increasing and increasingly in demand. And being part of a group, you know, can bring a whole host of benefits, such as a sense of belonging, and it can help alleviate loneliness.

Valerie Milburn: Another treatment method is sobriety groups. And our listeners know that a 12 step program, a sobriety group, got me sober 24 years ago and has kept me sober all these years. My understanding of the efficacy of sobriety groups as a treatment method comes from the positive outcomes I have seen over the last 24 years. But research backs this up. The hallmark of sobriety groups Is peer support, one alcoholic or addict supporting another. And research shows that treatment efficacy of peer support is solid. In fact, insurance companies now pay for peer support services.

Helen Sneed: Well, that's extraordinary. And that's very good news. Well, medication, the big topic, you know, and medication, as I said in conjunction with individual therapy is the most effective treatment for, again, for, for, for most people. And now, although not everyone uses or wants medication. And Valerie, Valerie and I always bear this in mind when we're talking about can be a critical method though for achieving recovery. The center for Disease Control reports that of adults who have retrieved who received any treatment over the past 12 months, 21% of the women are on medication and 11% of the men. While millions of women take psychiatric medications, there is a great deal more to learn. Because

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Helen Sneed: much of the research in the development of these medications was done on men only. It's hard to fathom this. Much more research is needed to ascertain the impact of medications on women. The physiological differences, genetics, and now they're really focusing on the female brain. One very encouraging factor is that drugs are now being designed specifically for women. I take one myself so I can attest to this. Hospitalization. Okay. The admission rate is about 50, 50 male and female. The National Institute of Health reports that more women than men contact psychiatric hospitals, but men are more often admitted at first contact. There are other ways women patients can be discriminated against. Now, a lot of this is what I witnessed from my three hospitalizations. I noticed that displays of anger in women patients were not tolerated as they were with males. Women patients spent much time on crafts and creative therapy and groups, but few had therapeutic outlets for negative thoughts and feelings. Now, over the past 20 years, a woman's treatment during hospitalization has greatly improved. Once run almost exclusively by powerful men, hospitals today have more female doctors and therapists, administrators and staff. And many offer the safety of all female units if that's needed.

Valerie Milburn: Yeah, that's some of the progress we were talking about. Yes, ran across a lot of that in my research and wonderful, wonderful progress. So the next thing we want to look at is a treatment method is something we do on our own and it's our self care and our lifestyle. And I noted previously that the American Psychiatric association encourages doctors to emphasize this utmost importance of self care as part of a treatment plan. Helen, you and I know about this firsthand and we both include in our daily wellness plans the self care and lifestyle skills that are backed up by research as beneficial for achieving and maintaining mental health. And I'll say them again because these are the proper. These are the proper amount of sleep, healthy eating, exercise. And we know that exercise can start with just walking 10 minutes a day and the other really important self care skills or social or community interaction, having a routine, journaling and other positive active endeavors. And I want to mention one thing that I'm going to put in the show notes that's a wonderful self care action. It's called a Wrap Wellness Recovery Action Plan. You can do it on your own, you can do it with a partner and it's a wrap. I'm going to put it in the show notes.

Helen Sneed: Now. There's always something that we like to talk about, which is skills training for women. Dialectical Behavior Therapy DBT has had tremendous success and it was created and designed by women for women. Originally for those with borderline personality disorder, DBT creators, therapists, teachers and students were primarily women. But today, one of the top borderline personality disorder researchers and clinicians, Dr. Blaze Aguirre, has devoted his practice to adolescent boys. You can see that DBT has become a universal treatment method and survival skill for men and women. Valerie, you

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Helen Sneed: and I have really discussed treatment methods for women and the differences and whatever, and we kind of came up with a wish list. You know, we did treatments that we wish existed that don't exist or they're barely in the formative stages or no one's ever heard of them or whatever. So here are some of our here's part of our wish list. Treatment plans and medication tailored specifically to women. Assertiveness training more practical life skills such as writing a Resume goal setting, diet and nutrition. I would stop here and Recommend Our Episode 9, Goals and Goal Setting because it really, really is helpful in getting something going.

Valerie Milburn: It is. It's really practical and it's a very popular episode, actually.

Helen Sneed: Yeah. And manageable. It shows you how to set a goal and do it in a way that's not overwhelming and makes you quit, which of course I to do all the time. Now, other things that we would love to have as treatment for women, self defense and best practices to avoid abusive situations. Body work. Learning more about one's body and its impact on mental health and the chance to deal directly with trauma buried within the body. More creative methods such as writing, painting, dance, music, sewing, knitting and more about parenting skills. More about a successful family dynamic and how to have one. And finally, a health care system that treats mental illness the same as physical illness.

Valerie Milburn: That's the ultimate goal. And again, there are some treatment centers like that are focusing just on treatment for women. Again, we don't want to forget about the fact that there is hope and progress on some of these wishes we have. So. And speaking of hope and progress, I want to talk about the cutting edge research and new methods that are out there. And there are. Here are the three newest treatments for mental health disorders. And the first one is pharmacogenomics. The second one is telehealth and APP implementation. And the third one is transcranial magnetic stimulation tms. So all three of those are still new and require further exploration and trials. But all three of these have shown promise in addressing a variety of mental health conditions. So the first one, pharmacogenomics, is the study of how genes affect a person's response to drugs. And the goal is so wonderful. The goal is to develop effective, safe medications that can be prescribed based on a person's genetic makeup.

Helen Sneed: This is just so exciting and frankly, it makes so much sense. I mean, I have always wondered, why does a medication work brilliantly for one person and do absolutely nothing for another? And this probably is going to reveal that and allow people to tailor them for an individual. It's very exciting.

Valerie Milburn: Yeah, it really is. And it's going to bring home the beginning of the, you know, genetic testing that I had done years ago, where they just were able to, you know, my doctor was able to tweak just a little bit some of my medication just based on the bare bones of genetic testing. And this is going to just bring it, you know, narrow it like an arrow into what can be done for medication management. It's so exciting. So the second one is telehealth app implementation. And this has brought us the ability to have virtual appointments with our medical professionals from our homes and has brought the use of Internet applications that offer tools to manage and track our health through our phones, our tablets, our computers. And you know, it's just opened up all sorts of opportunities.

Helen Sneed: Whole new day, don't you think?

Valerie Milburn: It's just great. And so the third is transcranial magnetic stimulation and that's tms and it is a non invasive form of brain stimulation that is particularly effective in treating treatment resistant depression. Totally non invasive. They just place a magnet on the outside of your head. We took a deep dive into TMS in episode 32, dissecting depression part two, and take a listen to that episode for a thorough explanation of transcranial magnetic stimulation and the incredible treatment breakthroughs it has brought about. Overall, the cutting edge research in the field of mental health and new treatment methods for numerous disorders brings new hope for those with the mental health disorder

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Valerie Milburn: to live a life in recovery based on these breakthroughs. And so exciting.

Helen Sneed: Yes, I think that the future is looking very bright. Now here's something that we always, I think I always think about in terms of women, and that is relationships. And in so many instances, women have excellent skills at building relationships. And some can be healthy and enriching and some can be unhealthy and diminishing or dangerous. Despite the strong urge to isolate and not be with people, connection is key to recovery. For the individual woman, it can be advantageous to look at the people in her life and identify those who can be trusted. I mean, the support of just one trusted person can make all the difference. So let's look at some potentially enriching relationships. All right, there's the professional relationship, the therapeutics. You know, this has been explored in depth in episode four, Recovery and Therapeutic Relationships. Psychiatrist and therapist. This is a real eye opener and it's got a lot of very good practical advice in it in terms of dealing with your therapy therapist. So I recommend that people visit that. Now, this relationship is the bedrock of recovery for many, many women. It's invaluable to focus on the importance of finding the right person, the right chemistry. So if possible, interview more than one before making a choice. And one question that a woman can ask, or some women, I guess, want to ask, is, can an abused woman work productively with a male doctor or therapist? Well, for me, it's just not possible. You know, it's a lack of trust and the potential for triggering is just these are insurmountable factors. Valerie, what about you?

Valerie Milburn: Well, I have been blessed with the 30 year relationship with the male psychiatrist. And our listeners know him from the episode you just referred to. And that's episode four. And that's Dr. Trey Allye and his support and guidance and medication management. You know, it really helped me survive my psychiatric Crisis in my 30s and to live the life and recovery I enjoy now. But even Trey knew to refer to refer me to a female EMDR therapist for the intensive work I had to do on my sexual trauma. And I could not have done that sexual trauma work with a male therapist.

Helen Sneed: Well, your doctor was very wise to know that. Now there's also personal relationships for a woman in her life. Family, friends, caregivers, children. Now, with so many women, the chief caregivers, it can be very difficult for them to accept care. Building a strong network of healthy support requires asking for help, which can be difficult, and delegating tasks and responsibilities. So what are the most valuable relationships for a woman with mental health challenges? I think that that is a good place for a woman to start is with that question, who can I trust? What about family and friends? As always, it's highly recommended that these caregiving individuals be certain to take good care of themselves. Dealing with a mental illness is hard on everyone who's part of the support system. A particular concern for women with mental health issues is functioning as a parent while battling mental illness. Our award winning episode, Parenting Skills for Symptomatic Parents, thoroughly investigates the issue and offers skills and strategies for coping in this really, really difficult area. Now, another area of concern, asked by many is how do I help someone in the throes of pain and painful thoughts and these horrible symptoms? Well, here's what Terry Chaney recommended. After a lifetime of living with a mental illness, I've discovered that the most helpful thing someone can say to me when I'm suffering is tell me where it hurts. I don't want advice. I don't want to be cheered up. I just want to be listened to and truly heard.

Valerie Milburn: I can really relate to that. That's a wonderful quote.

Helen Sneed: It's good advice. Yeah. Now, the final set of relationships we would like to look at. This is really very, very complicated. It's workplace relationships. So many difficulties in admitting to mental health problems exist within a work culture. How to deal with the boss or manager, how to deal with colleagues. Can a certain friend be trusted with confidences?

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Helen Sneed: And then there are the difficulties of getting the job done while symptomatic. This is very tricky terrain I, in the past, have stopped at nothing, including my mental health, to get the work done. No sacrifice was too great to do the job and do it well. And this worked for me for a time. Some time, actually, until I became so sick I hit the wall and lost my career and my mental health.

Valerie Milburn: You know, my path was similar in my career. And, Helen, you and I did what we did with our careers and work, work, life, when we were sick. And, you know, we didn't always do it right. I like to say, yeah, we didn't. But I like to say if I had known better, I would have done better. I mean, if I had told my boss when I was being put on a performance contract, which is the first step to getting fired, if I had said, hey, I have five bottles of pills in my purse and a bottle of tequila in my glove box and I need to go to treatment, maybe I would have gone to treatment instead of being fired. Who knows? But, Helen, I was in such deep denial and in fear of losing my job and the salary that was helping to support our family that I was like you. I just kept barreling forward until I. I was plowed under by my mental illness.

Helen Sneed: You know, Valerie, I. This example that you just gave is. Is. Is so. Is so interesting, and it's so. It just. It's so. It's so intelligent and so. And. And so informative for those of us. And I. I would love to hear more of your story, telling it from a woman's point of view.

Valerie Milburn: I can do that. And, you know, when I think about my story, I first think about the biological effects of being a woman and how that's impacted my mental health. And what comes to mind for me is how blessed I've been in the area of treatment. Definitely not blessed in all areas, but in the area of treatment, I have been so blessed. Because here's the first example. When I was in my 30s, I was continuously in my gynecologist office with acute premenstrual and menstrual pain and drastic mood swings at both of those stages of my menstrual cycle. And at one visit, my gynecologist and I were talking, and I don't know what I was saying, but I do know I was sobbing, and she said something like, get dressed and meet me in my office. And I did. I met her in her office, and she handed me her telephone and a little business card, and she said, you're not leaving my office until you have an appointment with that psychiatrist. And that was Dr. Trey Allye's. Business card. And he became my psychiatrist at that point in 1993. And like I said, he's still my psychiatrist 30 years later. And you know, I am so grateful and fortunate that my gynecologist recognized that I had mental health issues going on with my physical issues. So, you know, it's was very perceptive of her.

Helen Sneed: You know, a lot of people miss that.

Valerie Milburn: Yeah. So here's another blessing. When I was in my, my 40s, Trey, my psychiatrist was super proactive very early about the possibility of hormonal changes prior to and during menopause causing havoc with my mood disorder. So, you know, menopause could, could possibly cause mood swings and, or affect the efficacy of my medications. And he recommended books for me to read. He ended up coordinating care and medication, medication changes with my gynecologist when they did indeed become necess. Yeah, I'm lucky in another way, she was still my gynecologist 15 years after that initial referral to my psychiatrist. So those are the ways I was blessed. Now, there are several ways my mental health condition has impacted me that I think are particular to being a woman. And I know men have symptoms and reactions of equal significance, just different. So here are some of mine. I had intense hatred for my body when I weighed, I don't know, about 50 or 60 pounds more than I do now. At that point I could only associate the words fat and ugly with my body. And my self. Harm dramatically increased when I was most symptomatic with my mental illness. You know, when I was barely functioning, I could

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Valerie Milburn: not even have defined the term self care. I mean, I didn't even shower sometimes for three or four days, much less go to the dentist to get my teeth cleaned. And it was such a chore to get my hair cut when I was extremely depressed that once when I did go for a haircut, I had it cut so, so short just to keep me from having to go get another haircut for a long time. And Helen, oh my God, you should have seen it. It was horrible. It was the worst look ever on me. But I did it. And other things that showed my lack of self care. I didn't exercise, I ate terribly. And talk about improper sleep. I would go for days with basically no sleep or I wouldn't get out of bed for a few days. And I kid you not, it was that extreme. So other things about my mental health impacting me, particularly as a woman, is I am still cautious in situations of being alone with a man whom I do not know, particularly in an Isolated place. For example, if I'm alone, waiting for an elevator, and the elevator opens and there is one man alone in the elevator, I don't get into that elevator. My strategy is I say something like, oh, that's going up. I'm going down, and I don't get in the elevator. Or I say, oh, oops, I forgot something, and I walk away. And I could give lots of examples of how I protect myself from situations like this. Since substance use disorder is indeed a mental health disorder, I would be remiss if I didn't include how my addiction came into play after my second childbirth. I gained 70 pounds during my second pregnancy, and I wanted that weight gone now. At the time, I had been clean from methamphetamines for about four years, but I made a conscious decision to use speed to lose the pregnancy weight. Now, I nursed my son for six weeks because at the time, the medical recommendation was that it was necessary to nurse for six weeks in order to get the immunities from breast milk to be provided to the baby. Yes, at the time, they said six weeks was enough. So that's what I did. And then after six weeks, I weaned my son from nursing. And then I called my old drug dealer, who unfortunately still had the same number and unfortunately answered the phone. And thus began a journey. Valerie, I know. Thus began a journey I wish I had never taken. So. So while I'm on the subject of the aftermath of childbirth, I want to talk about postpartum depression, which we've mentioned. And with my history of depression, I feel really lucky to have escaped. I mean, I went the other way and ended up being manic from getting back on speed. But I did not have postpartum depression. But my daughter, who had no history of depression, suffered terribly with postpartum depression. It hit her hard and fast. I was with her for the birth of her first child and for the week after. And then I flew home. And then the day after I got home, she called me and said, you have to come back, Mom. You have to come back. She was terrified by how she was feeling. And when I got there and on the phone a lot, she would say, where's the joy, Mom? Where's the joy? And then the depression hit her again with her second pregnancy, and this time she was about five months pregnant when it hit. But you know what p***** her off, Helen? When she was on the other side of it and she would share with someone about what she had gone through, she often got the response, oh, I went through that too. And she, you know, she thought if the stigma of mental illness hadn't kept those women silent, she would have had them to support her through her dark journey. And, yeah, she had a lot of support from friends and family during her struggle, but these were additional people in her life with wisdom and support whom she needed and would have reached out to if they had not had that stigma and shame. Keep them silent, keep them from talking about it. And, you know, that's why we do this podcast, Helen. We want to shatter that stigma and that shame and silence.

Helen Sneed: Well, that. What a story, Valerie. All of it is just. It's just. It's riveting. And I think so much of what you brought up is going to be very helpful to people who, you know that. It's just what you said about your daughter, you know, you can think you're the only one that has it, and then you find out later that all these other people did, but just, again, because of. Because of shame or stigma, they just. They couldn't bring themselves to. To reach

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Helen Sneed: out. And I think that. That what you just told us, Valerie, is exactly why we have this podcast. And. And what you just did was help shatter some stigma and shame.

Valerie Milburn: I hope so. And my daughter.

Helen Sneed: Yeah, thank you.

Valerie Milburn: And my daughter talks so openly about her postpartum depression, hoping to help others. And so I talked about the impact of mental illness on me as a woman. And I know you as a woman, having lived with mental illness for a long time and now being in recovery, have your own perspective, and I would love for our listeners to hear your perspective. So will you share that, please?

Helen Sneed: Yes, I will. And I decided, Valerie, that I think it's such a vast subject for anyone who's trying to talk about, first of all, what it means to be a woman, but then a woman with mental health problems. And so I decided I want to focus on the impact that being a woman had in my treatment history as a mental patient. And there was a pronounced prejudice based on my gender that was destructive and ongoing in many treatment settings. Now, on the other hand, most of the male professionals also were good therapists in some respects, but it was their biases that disturbed me to this day. The wasted time, money and suffering, at least in part because I was a woman in a man's treatment world. Now, I'm going to give some examples, and I'm going to talk about some doctors. Obviously, I've changed their names. So the first one is Dr. Thomas, and he was my GP. And the first person that I went to with these Issues. And when I did see him, I was so thin from anorexia that my body would bruise if I lay on a hard surface. And I had begun to have many convulsions because my body had no fat and was devouring muscle. My periods had stopped. I looked like a living skeleton. So this doctor examined me and said I was the most malnourished woman he'd ever seen. His only treatment recommendation was that I should eat more beef.

Valerie Milburn: Yeah. Yeah.

Helen Sneed: Several months later, I almost killed myself and was hospitalized for the first time. And one night, I was at the nurse's station getting the usual ton of medications, and I was so thin, you know, my clothes were just hanging off me. And someone came up behind me and put his finger in the drooping waistband of my skirt. And I turned around, and it was Dr. Thomas. And he was just beaming at me. I mean, and there I was, you know. You know, I was. I was locked up in a mental institution. And he. He was just so happy and beamed at me and said, you sure have kept that weight off. So then when I was in treatment in. In the hospital, I did see some biases against women at many turns. Now, again, this has changed. At the time, hospitals were essentially run by men. But at the time that I was there, there was absolutely no interest in a woman's physiological differences or hormones or any of their impact on mental health. The guys, the guys, the men couldn't seem to even comprehend my hatred of my body and how deeply it damaged me and disturbed me really daily. Then there was anorexia, which I really think they just. They just couldn't get it. You know, it wasn't because they didn't want to. They just couldn't understand it. And then in this hospital, the oddest thing. Dating was considered a sign of recovery. And to me, it wasn't just me. It was quite a number of the other women who were my friend patients, who were my friends there. Dating was like the last thing on our minds, you know, and for many people, it would have been triggering. So again, there was very strange, you know, policies there. Now, the one thing they did more than anything else in my treatment was they pushed me to show anger, to show my anger, because they said that depression was anger turned inward, which I agree with. And they pushed me and pushed me, but I just couldn't let it out, you know? Well, after a year of being a leader on the unit and a role model, I finally got angry and I let it show. I didn't scream, I didn't curse. I Didn't throw anything. I didn't attack anybody. But my doctor immediately pulled me aside and said to me, and I quote, that I was being a b**** and my timing was lousy. Well, it turned out that the unit was in a bit of, you know, of an uproar, and it was about to go on shutdown. And he needed me to be the exemplary leader I always was. My anger was just, you know, too bad for me. It was bad timing. So I never dealt with it there.

Valerie Milburn: Then there was deteriorating. Speaking of being angry, I'm angry.

Helen Sneed: No, it was. I

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Helen Sneed: don't know, is my big opportunity. But anyway, did I. You know, what can you do? It's the past. Then there was Dr. Cook, and he is the first person I told that I thought something sexually abusive had happened to me as a child. And, you know, I have amnesia about my childhood, almost perfect amnesia. But I had this. Started having these. These vague memories of some kind of horrible things happening to me. Well, Dr. Cook was a Freudian, and he looked at me and he said, but, Helen, that's what little girls want. I can assure you it is not. But he had embarrassed me and shamed me to the extent that I never brought it up again because I thought I was. So. I felt so horrible, you know, that.

Valerie Milburn: That.

Helen Sneed: Well, anyway, that was it. It was dropped. And this turned out to be the doctor that initiated a sexual relationship that lasted for six years. So that was not a good. Not a good experience with him. Now, medication, I really have had quite a run with it. I've been on drug trials. It's been now over 40 years. And I. Because I just added a new one. So I'm still at it. But again, I'm having terrific good fortune now with medications, and I should. Because I tried more than 60. Little did I know that they had been tested only on men and in trials, virtually all of them. So the doctors had no concept of what these drugs would do to a woman, you know, in terms of dosage or side effects or the physical impact on a woman's body. I mean, who knew? And one male doctor that I had kept upping the dosage. He was madly in love with this new medication. It was so new that he was talking to the drug manufacturers as he was giving it to me, and he kept upping the dosage above their recommendation for the top dosage. He kept saying, I just know if we go a little higher, it'll work for you. It'll work for you. Till finally the drug manufacturer told him he had to stop that he was going to do me great harm. And he stopped. And of course, the medication didn't help in any way. So these are some responses. Again, I had some, you know, again, really dramatic symptoms. One of them was cutting. And the first time I did it, I mean, the very first time, I told my doctor and I showed it to him and he just looked and he said that I was doing it to get attention. And that was the only comment he ever made. And, oh, brother, I felt so bad that I was so manipulative that I would, you know, resort to such a. Such a. Such a terrible thing. And that was that. And then I also tried to tell this. This man how. How self conscious and repulsive I felt in his presence. You know, I. I was that bad off around men. And he began to comment on my appearance in wardrobe regularly. And he was very flattering about my appearance and he was very critical about my wardrobe. And he kept saying that I wore too many clothes, that I shouldn't hide my body. You know, he just didn't get it. So you can see that my relationships to male doctors were based on my desire to please them and the incredible amount of shame I felt around men and the impact of the trauma and frankly, a complete inability to trust men. And, you know, it's sad. I needed to learn to be more assertive in all personal relationships and stop pleasing people all the time. But anger was discouraged. And one of them told me, he even told me he didn't like it when I cried in therapy. So, as a woman, I have five diagnoses. But the two illnesses I have that generated the most prejudice and contempt were anorexia and borderline personality disorder, both very much associated with women. I was turned away from Bellevue Hospital, which is a really tough place, because on top of everything else, I had an eating disorder. And the head of the program said that because of that, I would be too much for his staff and trainees. Now, borderline personality disorder is a whole different category. The worst prejudice against female patients I have ever seen and the worst that I have ever encountered in a treatment universe. And actually in just out anywhere in my life, you see my own credibility, my word, my reason were shattered when I was diagnosed as a borderline. It's like it happened overnight. And I use the term borderline. We don't use it anymore. It's too pejorative. But that's exactly what it was, and that's exactly what I was called. So after I've been in treatment for more than a decade with males, a female Therapist, a group leader suggested that I might be better off working with women. Well, I went into body work with a woman, an

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Helen Sneed: all female group. DBT skills designed and taught by women, meds from a woman. Although I have to say, to be fair, the biggest medication breakthrough I had was by a man who was so kind and compassionate, I had no problem working with him. But mainly it was having a woman therapist where I could relax more, be more candid about my body and my symptoms, and benefit from just from the female take on things, that point of view. So for me, the all female approach has been right, but I'm in no way suggesting that it was perfect. One of the most destructive therapeutic relationships I've ever had was with a woman. So here I am, you know, trying to look back on this and to assess the full scope of my treatment with men and women. And one thing is abundantly clear to me, so much of it is about power. I became so sick because I was a powerless child. And I was strong enough to build a rich life in recovery because I became a powerful woman.

Valerie Milburn: You are a powerful woman. There's no doubt about that. And I don't know, I kind of think being turned away from Bellevue Hospital is a badge that you can carry with pride.

Helen Sneed: People can say that you can kind of. You can kind of dine out, out on it because it's so unusual. But anyway, it was. It was. Yeah. In hindsight, it's one of those extraordinary things I've ever been through, and I've had a very interesting life.

Valerie Milburn: So, yeah, I mean, it's definitely walking.

Helen Sneed: Out the gates of Bellevue turned away.

Valerie Milburn: It's one of those things that is definitely only funny in hindsight.

Helen Sneed: Exactly.

Valerie Milburn: But it's one of those. You either laugh or you cry. That's for darn sure.

Helen Sneed: Well, I've decided that's a lot. A lot of this is about trying to. I don't know, I'm so glad I have a sense of humor. But I think that one of the things that you and I always want to do, and one of our goals really is to get the conversation about hope and our hope for women today. So I want to start with something that just has just absolutely made my month. And it's a study from the Substance Abuse and Mental Health Services Administration called samhsa, which is a big, big, huge government body that works with mental health and substance abuse. And so they had this new study that just came out in September of 23, so it's just a couple of months old. So what they learned is of the 58 million adults who perceived they ever had a mental health problem, 66%, 38 million, that's 2/3 considered themselves to be in recovery or to have recovered from their mental health problem. And their definition of recovery was really a very good one. It said recovery is characterized by continual growth and improvement in one's health and wellness while managing setbacks, which were a natural part of life. I mean, Valerie, don't you think those are wonderful numbers?

Valerie Milburn: They're wonderful numbers. And that has been SAMHSA's definition of recovery for a long time. And I gotta say, SAMHSA is my favorite government agency and I love their definition of recovery. And Helen, you and I used that when we taught the peer to peer classes for nami. That was one of the early exercises. Can you. How do you define Recovery? We gave SAMHSA's definition as a. As an example. Can you read that definition for me again, please? I love it so much.

Helen Sneed: Yes, it's. Recovery is characterized by continual growth and improvement in one's health and wellness while managing setbacks, which are a natural part of life. There you have it.

Valerie Milburn: There you have it.

Helen Sneed: Now, another reason or one of the main reasons I'm hopeful for women based is based on my own experience, and it's due to our improved status in society. Now, there's a long way to go. We all know that. But today there are many more avenues for a woman to defend herself from discrimination, stigma, or abuse. And to me, this can create more strength and pride that can help a woman deal with mental health challenges. I mean, we just talked about this. The struggle for recovery requires just one woman to keep fighting, and that's for herself and to not quit. And Maya Angelou put it beautifully. She said, I can be changed by what happens to me, but I refuse to be reduced by it. And those, to me, that, to me, those are fighting words.

Valerie Milburn: Yeah. What beautiful words. So I was encouraged by the number of treatment centers with programs specifically for women that I discovered as I did

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Valerie Milburn: my research for this episode. There were many treatment centers exclusively for women. So, you know, recovery is possible, but treatment is necessary. So any advancement in treatment, whether research, breakthroughs, accessibility, or treatment that better meets the needs of women, those things make me.

Helen Sneed: Well, I can see why you are. I can see why I am. And so let's close on these images of hope for women everywhere. I mean, there has been real progress in the treatment and empowerment of women in the mental health field. So here's to more progress in the days and years ahead. Sooner Rather than later.

Valerie Milburn: Yes.

Helen Sneed: And now, Valerie, would you lead us in a mindfulness exercise?

Valerie Milburn: I will. I will lead us in our traditional way of closing every episode with a mindfulness exercise. What is mindfulness? I always give a definition. Mindfulness is a mental state achieved by focusing one's awareness on the present moment while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations without judgment. Today's mindfulness exercise is called Tapping into our Inner Strength. We talked about self care today, and taking time to be mindful of my inner strengths is part of my self care. This exercise is a great way for us to identify our strengths. Let's get mindful. Close your eyes if you can. Settle in and let's breathe together. As always, we'll begin with a few diaphragmatic breaths. Whether your eyes are open or closed, let's steady our breathing with two diaphragmatic breaths. When you do this on your own, take as many breaths as you need to become calm and centered. If you're driving or walking, please adapt this exercise so that it's safe in your surroundings. Let's breathe. Inhale through your nose, expanding an imaginary balloon in your stomach. As you inhale. Exhale through your mouth, pulling in your stomach as you do so. Again, inhale through your nose, expanding that balloon in your stomach. As you inhale. Drop your shoulders. Exhale through your mouth, your stomach, all the way. Exhale. Keep this slow, steady breath going. Bring to mind an event that you felt strong about today. It could be a conversation, an action, a relationship, something you completed around. What event did you feel strong today? What strengthened you today? Was it words you read? Something someone said to you? Prayer? A hug? Exercise? A memory? What strengthened you today? In what ways did you rely on your inner strength today? Did you use resilience? Self? Compassion? Gratitude? Determination? Courage? Wisdom? In what ways did you rely on your inner strength today? Breathe in. Breathe out. Be mindful of these strengths

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Valerie Milburn: you have tapped into. What you felt strong about, what strengthened you, the inner strength you relied on. Be mindful of your inner strengths. If your eyes are closed, please open them and gently bring yourself back to the room. Thank you for doing this mindfulness exercise with me.

Helen Sneed: Oh, thank you, Valerie. That was a great opportunity to examine Personal Power Hour. I really appreciate it.

Valerie Milburn: You're welcome. And before we close, I want to remind listeners that both you, Helen, and I will be on the Two Lives podcast coming up quickly. My episode will be available on January 30th. The Two Lives podcast follows the theme that we all have two lives. The second one begins the moment we realize we only have one. Two Lives is an award winning podcast and it's absolutely wonderful. So again, my episode will be available on January 30th and Helen's yours will be available in the next few months. So please tune in to Two Lives. It's available on all major platforms.

Helen Sneed: Our thanks to our listeners everywhere. You are the reason we are so excited to be entering our fourth year as podcasters. Our work is for you and the listeners that we hope to cultivate. Please review us wherever you get your podcasts, mention us to your friends on social media and share your comments and insights on mental health. Hopeandrecovery.com you are our best hope to reach those who need information and inspiration. Speaking of which, our next two episodes will be about the condition the U.S. surgeon General has named a national epidemic. It is loneliness. Besides coursing through the nation, many of us know that loneliness for a person with mental health issues can be severe and sometimes lethal. What can be done to alleviate loneliness in ourselves and others? Join us and we will find out together. Until then, I leave you with our favorite word. Onward.

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