Women and Mental Health

[00:00:00] The following podcast is part of the Mind Body Spirit.fm Podcast Network Welcome to our award-winning

[00:00:16] podcast, Mental Health, Hope and Recovery. I'm Helen Sneed and I'm Valerie Milburn. We both have

[00:00:25] fought and overcome severe chronic mental illnesses. Our podcast offers a unique approach to

[00:00:33] mental health conditions. We use practical skills and inspirational true stories of recovery.

[00:00:40] Our knowledge is up close and personal. Helen and I are your peers. We're not doctors,

[00:00:46] therapists or social workers. We're not professionals but we are experts. We are experts in our own

[00:00:53] lived experience with multiple mental health diagnoses and symptoms. Please join us on our journey.

[00:01:01] We live in recovery, so can you. This podcast does not provide medical advice. The information

[00:01:08] presented is not intended to be a substitute for or relied upon as medical advice, diagnosis

[00:01:15] or treatment. The podcast is for informational purposes only. Always seek the advice of your

[00:01:21] physician or other qualified health providers with any health related questions you may have.

[00:01:29] Welcome to episode 38, Women and Mental Health. This is the second of our two part series on

[00:01:38] the similarities, differences and clashes between the genders as they deal with mental health

[00:01:43] challenges. And you know, Helen, we decided we didn't need a guest for this episode because

[00:01:50] we are two women with mental health challenges and experience in a road of our own. So what do

[00:01:56] you think about no guest? Well, I fully expect that we can discuss this with great authority today.

[00:02:04] I think we can with our journeys. And we hope you are listeners will visit episode 36 which is

[00:02:11] about men and mental health as well as listening to today's. We have been amazed by what we've

[00:02:17] learned about men and women and their mental health journeys. And today, we're going to take a

[00:02:23] comprehensive investigation into women and their mental health. And we're going to ask some key

[00:02:28] questions along the way. We're going to ask what are the most common illnesses, symptoms,

[00:02:34] treatment methods and relationships that impact a woman's fight for recovery? What are the

[00:02:41] breakthroughs that research and science are discovering to promote healing in women? And Helen,

[00:02:46] you and I are also going to relate our own personal experiences as women fighting and recovering from

[00:02:53] mental illnesses. Now let's begin to explore the complex universe and challenging reality of women

[00:03:03] with mental health issues. As we delve into this immense topic, there are certain drawbacks that

[00:03:10] prohibit a full exploration. As with men, there's a deficiency in research that's only now being

[00:03:17] rectified. So this means that most of our discussion today is based on binary research, men and

[00:03:23] women in traditional roles, research that now can seem limited. Valorini are committed to inclusion

[00:03:31] of underserved communities, LGBTQ plus, gender identity, people of color, women, veterans.

[00:03:40] Especially when new research shows that the mental health challenges in these groups can be more

[00:03:45] severe, wide reaching and destructive. We'll explore this alarming phenomenon in future episodes.

[00:03:53] The subject is too vast to do it justice today. So please bear with us as we start from scratch.

[00:03:59] To begin with, mental health challenges for women have become an epidemic with female adolescents

[00:04:06] and young female adults. Fortunately this age group is receiving increased attention in the

[00:04:12] scientific and treatment communities. And it's one we focused on in previous episodes.

[00:04:18] Now for this episode, we'll focus on mature women because that's where the consequences of childhood

[00:04:24] trauma and adolescent illness can escalate into severe symptoms, self-destructive behavior

[00:04:31] and mental illnesses decades after the fact. It is impossible almost to understand women's

[00:04:40] mental health today without some sort of historical perspective. The National Institute of Health

[00:04:48] has reported extensively on the biases and discrimination towards women with perceived mental

[00:04:53] health issues over the ages. For millennia, women were considered to be weak, irrational creatures

[00:05:01] to be driven and tended to by men. The first mental order attributed to women was hysteria,

[00:05:09] meaning literally the womb. This concept lasted for four thousand years from the Egyptians in

[00:05:17] the second century BC until beyond Sigmund Freud. The belief was that hysteria, enhanced women's

[00:05:24] madness, was caused by something poisoned in the womb. And in most instances it was blamed on

[00:05:31] a woman's not fulfilling her only roles to marry and to bear and raise children. The treatment

[00:05:38] of society and doctors was cruel and punitive and the cures were barbaric. Women were locked away

[00:05:46] in insane asylums for disobedience, adultery, witchcraft, fragility and a host of other primitive

[00:05:52] reasons. In some cultures it was believed that women could cause mental illness such as forms

[00:05:59] of love sickness in men. It wasn't until the 18th century that some progress was made, hysteria

[00:06:06] was seen to be an illness of the brain and not the uterus which was a great breakthrough.

[00:06:12] Now skipping ahead, Freud believed that women were frail creatures who had to manipulate others

[00:06:17] to get their way. But he did admit that there were men with hysteria as well. In the early 20th

[00:06:24] century world war one soldiers who were shell shocked manifested many of the symptoms of hysteria

[00:06:30] and this promoted understanding and progress although the treatment still could be torturous.

[00:06:36] But ultimately the diagnosis of hysterical neurosis wasn't removed from the DSM until 1980.

[00:06:45] Now the DSM, the diagnostic and statistical manual of mental disorders is really sort of like

[00:06:52] the Bible of mental illness and so this was on the books until 1980. Hard to believe.

[00:07:00] But changes slow, 4000 years some of those beliefs held.

[00:07:05] No one was in a hurry.

[00:07:07] No one was in a hurry but let's be grateful for the change and as we go through the episode today

[00:07:12] we will see that there are good things happening in women's health treatment and research so

[00:07:18] we will look forward to sharing that progress. So let's take a look at the gender differences

[00:07:25] in mental health disorders and this information is from the American Psychiatric Association

[00:07:30] and there are indeed differences between men and women in mental health disorders. We saw that

[00:07:35] in the episode on man but these differences are in regard to risk, prevalence, how the disorder

[00:07:41] presents and its course and in treatment. So we're going to take a look at some of those differences.

[00:07:46] First of all let's look at rates of mental health conditions and research shows that women

[00:07:51] and men overall have similar rates of mental health problems both affecting one in five adults

[00:07:58] in the US but the types of mental health conditions may differ between men and women. Depression is

[00:08:04] the most common mental health problem in women twice as many women experience depression in their

[00:08:10] lifetime than men. Post-traumatic stress disorder rates are much higher in women. In fact compared

[00:08:17] with men women are twice as likely to experience post-traumatic stress disorder and with PTSD women

[00:08:26] are more likely to have hypervegillants feel depressed and have trouble feeling emotions. Men on

[00:08:32] the other hand with PTSD are more likely to feel angry and have problems with alcohol and drugs.

[00:08:39] The women are twice as likely as men to experience generalized anxiety disorder and panic disorder

[00:08:45] when it comes to suicide. Women attempt suicide more often than men however,

[00:08:53] men are four times more likely to die by suicide. Well these are terrible numbers but there's

[00:09:02] one thing that I never see mentioned and that is the impact of being a suicide survivor.

[00:09:10] They can say oh it's so great that you didn't die but it really takes a lot of work to overcome

[00:09:20] the shock and the various emotions from being a survivor. You and I both know this

[00:09:25] family. Right and the impact it has on the survivor's family and loved ones. Yes and it does need

[00:09:32] to be talked about more unfortunately there are a lot of support groups for survivors of suicide

[00:09:37] and for their family members. Another statistic is about eating disorders approximately 85 to 95

[00:09:47] percent of people with anorexia nervosa or bulimia and 65 percent of people with binge eating disorder

[00:09:54] are women that's a large difference between men and women with eating disorders.

[00:10:01] Alcohol use is interesting. Women are less likely to experience alcohol use disorder

[00:10:07] than men but recent studies including one from the Harvard Medical School show that this gap

[00:10:13] is narrowing and something that also narrows this gap is that women are less likely

[00:10:19] to disclose problems with alcohol to their health provider. Now there's one other thing I'm

[00:10:24] going to look at about this difference in symptoms. I mean this difference in rates there are

[00:10:33] also certain disorders that are unique to women and this is from the National Institute of Mental Health.

[00:10:40] For example some of these disorders that are unique to women. Some women experience symptoms

[00:10:44] of depression at times of hormone change such as durin or after pregnancy that's paranatal

[00:10:50] or postpartum depression. Also around the time of their period that's pre-menstrual dysphoric

[00:10:55] disorder and during menopause, paranemana pause related depression. Now the impact of these

[00:11:01] hormonal changes on women's mental health is so important in relation to treatment that I will

[00:11:06] explore all of this further when we discuss treatment. There's a lot to look at here. A lot to

[00:11:13] look at that has often been ignored by health providers and there's some interesting info on that

[00:11:18] coming up. Now I've been on women's mental health risk factors. Women disproportionately experience

[00:11:26] the following risk factors more than men have these risk factors and these are women earn less than

[00:11:34] men still. The poverty rate is higher for women and estimated 65% of caregivers are women and they

[00:11:42] may spend as much as 50% more time providing care than male caregivers. This impact of caring for

[00:11:50] others does have an important role in increasing the stress that is related to bringing on a

[00:11:59] mental health disorder. Here are some of the differences in seeking and receiving mental health

[00:12:05] services. Women are more likely to seek help and disclose mental health providers to their

[00:12:11] primary health care physician while men are more likely to seek out a mental health specialist.

[00:12:17] That impacts treatment. Women are reluctant to disclose a history of violent victimization unless

[00:12:25] physicians ask about it directly. Women are more likely to be prescribed psychotropic medications

[00:12:33] than men are and physicians are more likely to diagnose depression and women compared with men

[00:12:41] even when both genders have identical symptoms or similar scores on standardized measures of

[00:12:48] depression. A little bit more about treatment. The key barriers to mental health treatment for women are

[00:12:56] economic barriers, either lack of or high cost of insurance, lack of awareness about mental health

[00:13:03] issues and lack of awareness about treatment options and services, stigma, course always the

[00:13:10] stigma associated with mental illness is a barrier to treatment and lack of time or related support

[00:13:22] to get to treatment such as time off from work, child care and transportation.

[00:13:28] Let's take a look at the symptoms. The National Institute for Mental Health shows that

[00:13:35] women and men can develop most of the same mental disorders and conditions but they may experience

[00:13:41] different symptoms. First, let's look at some common symptoms for both men and women and those include

[00:13:49] persistent sadness or feelings of hopelessness and how I knew and I have gone over these symptoms

[00:13:53] before but we think it's really important to let people know about the symptoms, common symptoms

[00:13:59] of a mental health disorder so that we all know what we're doing. So we can look at the uncommon as well.

[00:14:04] That's right. So another common symptom of a mental health disorder is a noticeable change in

[00:14:10] mood, energy level, sleeping or appetite. The misuse of alcohol drugs or both decreased energy,

[00:14:18] fatigue, excessive worry or fear, scene or hearing things that are not there extremely high

[00:14:26] and low moods, anger, irritability and thoughts of death or suicide or suicide attempts. So those

[00:14:34] are common symptoms for men and women but there are symptoms that are specific to women.

[00:14:41] Women are more prone to internalizing mental illness than men are, leading to symptoms such as

[00:14:48] withdrawal, remination and loneliness. Another symptom that is not specific to women but much

[00:14:56] more common in women is self-endury and the past research shows that self-endury is three times

[00:15:03] more frequent in women than in men but recent data reveals less gender differences.

[00:15:10] Isolation and agoraphobia is more common in women, some women who suffer from depression systems,

[00:15:17] symptoms find social activity to be overwhelming and seek isolation as a result.

[00:15:24] Now with eating disorder symptoms, men report more overeating while women

[00:15:31] have more body-checking, avoidance, binge eating, fasting and purging.

[00:15:38] I want to look at post-traumatic stress disorder for a minute because women experience PTSD

[00:15:44] differently from men. Women with PTSD may be more likely than men to be easily startled,

[00:15:53] to have more trouble-failing emotions or to feel numb,

[00:15:58] to avoid things that remind them of the trauma or to feel depressed and anxious.

[00:16:03] And this is really interesting. Women usually have PTSD symptoms longer than men before diagnosis

[00:16:11] and treatment, on average four years for women versus one year for men.

[00:16:19] Well, having heard about these symptoms and difficulties that women face,

[00:16:25] we want to obviously look at treatment methods. Now Valerie, you've got some things I think that

[00:16:30] you wanted to mention first. Before we go into the specific effect of treatment methods for women,

[00:16:38] I wanted to share a bit of the guidance I ran across from the American Psychiatric Association

[00:16:44] that they give to mental health practitioners because this is a great framework for our

[00:16:49] discussion of treatment. It makes it clear that women and men have different mental health

[00:16:54] treatment needs. The American Psychiatric Association recommends that a thorough psychiatric history

[00:17:02] should include a female patient's symptoms in relation to menstrual cycle, the perinatal period,

[00:17:09] the time following a miscarriage or abortion, the parimenopausal years,

[00:17:14] the possible history of sexual trauma or physical abuse, and gender identity and sexual history.

[00:17:22] Same logical. For example, it is important to ask whether for example, a patient's

[00:17:28] depressive symptoms remit during certain portions of a menstrual cycle. Now these questions are

[00:17:34] often asked when taking a medical history but their importance is often forgotten in a psychiatric

[00:17:41] history. Well, Valerie, I have to just interject here that I learned doing my research

[00:17:48] that testosterone, which we know is very dominant in men, actually acts as an anti-anxiety and

[00:17:55] anti-depressant which I think is just who said life is fair. But I think that that's something

[00:18:03] that really bears examination. It has. Yes, and it's also something that can be tested in a

[00:18:11] full medical history when taking a course of treatment action toward psychiatric illnesses.

[00:18:19] So that's a really important thing to be looking at. So another thing that is an overview

[00:18:25] of a treatment plan that the American Psychiatric Association points out to practitioners

[00:18:33] is that several recent studies have suggested a link between the high prevalence of depression

[00:18:39] and anxiety in women and the well-documented higher percentage of psychosocial stressors

[00:18:48] typically present in women's lives. So a link between depression and stressors,

[00:18:55] and this link is especially important in women from minority groups. So these psychosocial stressors

[00:19:04] for women include lower wages, poverty, racial discrimination. And as I mentioned before,

[00:19:10] the unrelenting responsibility for the care of others. Now, as was for me,

[00:19:17] women report increased stressors before many episodes of depression. So the APA recommends that

[00:19:27] psychiatrists ask women patients about financial and social support, help them address problems

[00:19:34] that are causing stress in their lives. And this is no surprise to you and me, Helen,

[00:19:40] emphasize the utmost importance of self-care. Well, that's an easy one to overlook when you

[00:19:47] are already so stressed out by other responsibilities, you know? Yes. So treatment

[00:19:56] to begin with women are in within a 12-month period, women were almost twice as likely to seek

[00:20:04] treatment as men. Now the reasons why women are more likely emotional expression,

[00:20:10] healthcare and asking for help are all framed as feminine traits, whereas men are expected

[00:20:16] to be emotionally stable, independent, strong and self-reliant. Now another reason I find this

[00:20:23] really, really a disnew disturbing breakthrough that they've looked at. Another reason is women

[00:20:30] are seeking relief because increasingly research is showing that women experience more pain

[00:20:38] than men. As Dr. Ed Kio from the University of Bath in England said, the bottom line seems to be

[00:20:45] that women are suffering more than men. Now people often ask which treatment methods are most

[00:20:53] effective? Well, it's psychotherapy and medication in combination that are considered the most

[00:21:00] effective ways to promote recovery. So let's look at some of these methods. All right, there's

[00:21:07] as I said, there's psychotherapy, you know, that's one on one, individual therapy. And in therapy,

[00:21:14] women often are better suited to the one-on-one intimate nature of the relationship and are more

[00:21:20] patient with the therapeutic process, which as we know can be take a long time. But an interesting

[00:21:26] pattern has emerged. The use of therapy diminishes with age. Age is 18 to 44, 13% use therapy.

[00:21:36] 45 to 64 drops to 9%, and 65 and older less than 5%, which is really quite a change.

[00:21:46] Yeah, that's really interesting. I did not know that. Yes, it's apparently this is new but I was

[00:21:53] really surprised by it. Now another treatment method of course is group therapy. It can help

[00:21:59] a woman in many ways. One of the key objectives is to establish safety. A safe place where the

[00:22:05] woman can discuss abuse and trauma with other women who have suffered similar experiences

[00:22:12] and with a trained female group leader. All female groups are increasing and increasingly

[00:22:18] in demand. And being part of a group, you know, can bring a whole host of benefits such as a sense

[00:22:24] of belonging and it can help alleviate loneliness. Another treatment method is sobriety groups,

[00:22:31] and our listeners know that a 12-step program, a sobriety group got me sober 24 years ago and has

[00:22:38] kept me sober all these years. My understanding of the efficacy of sobriety groups as a treatment

[00:22:43] method comes from the positive outcomes I have seen over the last 24 years. But research backs

[00:22:52] this up. The hallmark of sobriety groups is peer support. One alcoholic or addict supporting

[00:22:58] another and research shows that treatment efficacy of peer support is solid. In fact, insurance

[00:23:07] companies now pay for peer support services. Well, that's extraordinary and that's very good news.

[00:23:15] Well, medication, the big topic, you know, and medication as I said in conjunction with individual

[00:23:23] therapy is the most effective treatment for, again, for most people. And now although not everyone

[00:23:30] uses or wants medication and Valerie and I always bear this in mind when we're talking about it,

[00:23:36] it can be a critical method though for achieving recovery. The Center for Disease Control reports

[00:23:42] that of adults who have received any treatment over the past 12 months, 21% of the women are on

[00:23:50] medication and 11% of the men. While millions of women take psychiatric medications, there is a

[00:23:57] great deal more to learn because much of the research in the development of these medications

[00:24:05] was done on men only. It's hard to fathom this. So much more research is needed to

[00:24:13] ascertain the impact of medications on women, the physiological differences, genetics, and now

[00:24:20] they're really focusing on the female brain. One very encouraging factor is that drugs are now

[00:24:26] being designed specifically for women. I take one myself so I can attest to this.

[00:24:32] Hospitalization. Okay, the admission rate is about 50-50 male and female. The National

[00:24:39] Institute of Health reports that more women than men contact psychiatric hospitals, but men are

[00:24:46] more often admitted at first contact. And there are other ways women patients can be discriminated

[00:24:52] against. Now a lot of this is what I witnessed from my three hospitalizations. I noticed that

[00:24:58] displays of anger in women patients were not tolerated as they were with males. Women patients

[00:25:05] spent much time on crafts and creative therapy and groups, but few had therapeutic outlets for

[00:25:12] negative thoughts and feelings. Now over the past 20 years, a woman's treatment during hospitalization

[00:25:19] has greatly improved. Once run almost exclusively by powerful men, hospitals today have more female

[00:25:26] doctors and therapists, administrators, and staff. And many offer the safety of all female units

[00:25:33] if that's needed. Yeah, that's some of the progress we were talking about. It's ran across a lot

[00:25:38] of that in my research and wonderful, wonderful progress. So the next thing we want to look at is a

[00:25:43] treatment method is something we do on our own and it's our self-care and our lifestyle.

[00:25:50] And I noted previously that the American Psychiatric Association encourages doctors to emphasize

[00:25:56] this utmost importance of self-care as part of a treatment plan. Helen, you and I know about this

[00:26:01] firsthand and we both include in our daily wellness plans, the self-care and lifestyle skills that

[00:26:07] are backed up by research has been official for achieving and maintaining mental health. And

[00:26:13] I'll say them again because these are the proper, these are the proper amount of sleep, healthy eating,

[00:26:19] exercise. And we know that exercise can start with just walking 10 minutes a day. And

[00:26:24] the other really important self-care skills are social or community interaction, having a routine,

[00:26:32] journaling and other positive active endeavors. And I want to mention one thing that I'm going

[00:26:37] to put in the show notes. That's a wonderful self-care action. It's called a wrap wellness

[00:26:45] recovery action plan. You can do it on your own, you can do it with a partner and it's a wrap.

[00:26:53] I'm going to put it in the show notes.

[00:27:03] Now, there's always something that we like to talk about which is skills training for women.

[00:27:10] Dialectical behavior therapy, DBT has had tremendous success and it was created and designed by women

[00:27:18] for women, originally for those with borderline personality disorder. DBT creators, therapists,

[00:27:24] teachers and students were primarily women. But today, one of the top borderline personality

[00:27:32] disorder researchers and clinicians Dr. Blaza Giro has devoted his practice to adolescent boys.

[00:27:40] So you can see that DBT has become a universal treatment method and survival skill for men

[00:27:46] and women. Valerie, you and I have really discussed treatment methods for women and the differences

[00:27:57] and whatever. And we kind of came up with a wish list, you know? We did.

[00:28:04] Treatments that we wish existed that don't exist are they barely in the formative stages or

[00:28:10] no one's ever heard of them or whatever. So here are some of our, here's part of our wish list.

[00:28:16] Treatment plans and medication tailored specifically to women, assertiveness training.

[00:28:22] More practical life skills such as writing a resume, goal setting, diet and nutrition.

[00:28:28] I would stop here and recommend our episode nine, goals and goal setting because it really,

[00:28:34] really is helpful in getting something going. It is, it's really practical and it's

[00:28:41] it's a very popular episode actually. Yeah, and manageable. It shows you how to set a goal

[00:28:47] and do it in a way that's not overwhelming and makes you quit, which of course I used to do all the time.

[00:28:53] Now other things that we would love to have as treatment for women, self-defense and best practices

[00:29:00] to avoid abusive situations, bodywork. Learning more about one's body and its impact on

[00:29:08] on mental health and the chance to deal directly with trauma buried within the body.

[00:29:14] More creative methods such as writing, painting, dance music, sewing, knitting

[00:29:21] and more about parenting skills, more about a successful family dynamic and how to have one.

[00:29:28] And finally, a healthcare system that treats mental illness the same as physical illness.

[00:29:36] That's the ultimate goal and again there are some treatment centers like

[00:29:44] that are focusing just on treatment for women. Again, we don't want to forget about the fact

[00:29:50] that there is hope and progress on some of these wishes we have. So, and speaking of hope and progress,

[00:29:58] I want to talk about the cutting edge research and new methods that are out there. And

[00:30:04] there are here are the three newest treatments for mental health disorders. And the first one is

[00:30:10] pharmacogenomics. The second one is telehealth and app implementation. And the third one is

[00:30:17] trans cranial magnetic stimulation, TMS. So all three of those are still new and require further

[00:30:24] exploration and trials but all three of these have shown promise in addressing a variety of

[00:30:30] mental health conditions. So the first one pharmacogenomics is the study of how genes affect

[00:30:37] a person's response to drugs. And the goal is so wonderful. The goal is to develop effective,

[00:30:44] safe medications that can be prescribed based on a person's genetic makeup.

[00:30:51] This is just so exciting and frankly it makes so much sense. I mean, I have always wondered

[00:30:58] why does a medication work brilliantly for one person and do absolutely nothing for another?

[00:31:03] And this probably is going to reveal that and allow people to tailor them for an individual.

[00:31:09] It's very exciting. Yeah, it really is. And it's going to bring home the beginning of the genetic

[00:31:15] testing that I had done years ago where they just were able to, my doctor was able to tweak

[00:31:20] just a little bit some of my medication just based on the bare bones of genetic testing. And this

[00:31:27] is going to just bring it narrow it like an arrow into what can be done for medication management.

[00:31:34] So exciting. So the second one is telehealth app implementation and this has brought

[00:31:41] us the ability to have virtual appointments with our medical professionals from our homes

[00:31:47] and has brought the use of internet applications that offer tools to manage and track our health

[00:31:54] through our phones, our tablets, our computers and you know it's just opened up all sorts of

[00:32:00] opportunities. It's a whole new day, don't you think? It's just great. And so the third is

[00:32:04] transcranial magnetic stimulation and that's TMS and it is a non-invasive form of brain stimulation

[00:32:12] that is particularly effective in treating treatment resistant depression. Totally non-invasive,

[00:32:19] they just place a magnet on the outside of your head. We took a deep dive into TMS in episode 32

[00:32:28] dissecting depression part two and take a listen to that episode for a thorough explanation

[00:32:34] of transcranial magnetic stimulation and the incredible treatment breakthroughs it has brought about.

[00:32:40] So overall, the cutting edge research in the field of mental health and new treatment methods

[00:32:46] for numerous disorders brings new hope for those with the mental health disorder

[00:32:52] to live a life and recovery based on these breakthroughs and so exciting.

[00:32:58] Yes, I think that the future is looking very bright. Now here's something that

[00:33:06] we always look, I think I always think about in terms of women and that is relationships.

[00:33:12] And in so many instances women have excellent skills at building relationships and

[00:33:18] some can be healthy and enriching and some can be unhealthy and diminishing or dangerous.

[00:33:25] Despite the strong urge to isolate and not be with people, connection is key to recovery.

[00:33:33] For the individual woman, it can be advantageous to look at the people in her life

[00:33:40] and identify those who can be trusted. I mean the support of just one trusted person can make

[00:33:46] all the difference. So let's look at some potentially enriching relationships.

[00:33:51] All right, there's the professional relationship, the therapeutic, you know, this has been explored

[00:33:57] in depth in episode four, recovery and therapeutic relationships, psychiatrists and therapists.

[00:34:03] This is a real eye opener and it's got a lot of very good practical advice in terms of dealing

[00:34:08] with your therapist. So I recommend that people visit that. Now this relationship

[00:34:14] is the bedrock of recovery for many, many women. It's invaluable to focus on the importance of

[00:34:21] finding the right person, the right chemistry. So if possible, interview more than one before

[00:34:28] making a choice. And one question that a woman can ask or some women I guess want to ask

[00:34:36] is can an abused woman work productively with a male doctor or therapist? Well, for me it's just

[00:34:43] not possible, you know, it's a lack of trust and the potential for triggering is just these are

[00:34:48] insurmountable factors. Valerie, what about you? Well I have been blessed with the 30 year relationship

[00:34:56] with the male psychiatrist and our listeners know him from the episode you just referred to

[00:35:02] and that's episode four and that's Dr. Trey Ollier and his support and guidance

[00:35:08] and medication management, you know it really helped me survive my psychiatric crisis in my 30s

[00:35:15] and to live the life and recovery I enjoy now but even Trey knew to refer to refer me to a female

[00:35:22] EMDR therapist for the intensive work I had to do on my sexual trauma and I could not

[00:35:29] have done that sexual trauma work with a male therapist. Well he was very, your doctor was very

[00:35:35] wise to know that. Now there's also personal relationships for a woman in her life,

[00:35:45] family, friends, caregivers, children that with so many women the chief caregivers it can be very

[00:35:52] difficult for them to accept care. Building a strong network of healthy support requires asking

[00:35:58] for help which can be difficult and delegating tasks and responsibilities. So what are the most valuable

[00:36:05] relationships for a woman with mental health challenges? I think that that is a good place for

[00:36:11] a woman to start is with that question, you know who can I trust? What about family and friends?

[00:36:18] As always it's highly recommended that these caregiving individuals be certain to take good care

[00:36:22] of themselves dealing with the mental illness as hard on everyone who's part of the support system.

[00:36:28] The particular concern for women with mental health issues is functioning as a parent

[00:36:35] while battling mental illness. Our award-winning episode, Parenting Skills for Symptomatic Parents,

[00:36:42] thoroughly investigates the issue and offers skills and strategies for coping in this really,

[00:36:47] really difficult area. Now another area of concern asked by many is how do I help someone in the

[00:36:56] throes of pain and painful thoughts and these horrible symptoms? Well here's what Terry Cheney

[00:37:02] recommended. After a lifetime of living with the mental illness, I've discovered that the most

[00:37:08] helpful thing someone can say to me when I'm suffering is tell me where it hurts. I don't want

[00:37:15] advice, I don't want to be cheered up, I just want to be listened to and truly heard.

[00:37:22] I can really relate to that. That's a wonderful quote. It's good advice. Yeah. Now the final

[00:37:30] set of relationships we would like to get, this is really very complicated. It's workplace

[00:37:35] relationships. So many difficulties in admitting to mental health problems exist within a work

[00:37:43] culture. How to deal with the boss or manager? How to deal with colleagues? Can a certain friend

[00:37:49] be trusted with confidences? And then there are the difficulties of getting the job done while

[00:37:54] symptomatic. This is very tricky terrain. I in the past have stopped at nothing, including my mental

[00:38:02] health to get the work done. No sacrifice was too great to do the job and do it well.

[00:38:08] And this worked for me for a time, sometime actually, until I became so sick, I hit the wall

[00:38:14] and lost my career and my mental health. You know, my path was similar in my career and

[00:38:22] Helen, you and I did what we did with our careers in work life when we were sick and

[00:38:27] 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

[00:38:32] known better, I would have done better. I mean, if I had told my boss when I was being put on a

[00:38:39] performance contract, which is the first step to getting fired, if I had said hey, I have five

[00:38:46] bottles of pills in my purse and a bottle of tequila in my glove box and I need to go to treatment.

[00:38:52] Maybe I would have gone to treatment instead of being fired. Who knows?

[00:38:57] But Helen, I was in such a deep denial and in fear of losing my job and the salary that was

[00:39:03] helping to support our family that I was like you, I just kept barreling forward until

[00:39:11] I was plowed under by my mental illness.

[00:39:16] You know, Valerie, this example that you just gave is so interesting and it's so intelligent

[00:39:27] and so informative for those of us. And I would love to hear more of your story telling it from

[00:39:34] a woman's point of view. I can do that. And you know, when I think about my story,

[00:39:41] I first think about the biological effects of being a woman and how that's impacted my mental health.

[00:39:47] And what comes to mind for me is how blessed I've been in the area of treatment. Definitely not

[00:39:53] blessed in all areas. But in the area of treatment, I have been so blessed because

[00:40:00] here's a first example. When I was in my 30s, I was continuously in my gynecologist office with

[00:40:08] acute pre-minstrual and menstrual pain and drastic mood swings at both of those stages of my

[00:40:15] mental cycle. Mental cycle. And at one visit, my gynecologist and I were talking and I don't know

[00:40:22] what I was saying, but I do know I was sobbing. And she said something like get dressed and meet me in

[00:40:30] my office. And I did. I met her in her office and she handed me her telephone and a little business

[00:40:41] card. And she said, you're not leaving my office until you have an appointment with that psychiatrist.

[00:40:47] And that was Dr. Trey Olié's business card and he became my psychiatrist at that point in 1993.

[00:40:55] And like I said, he's still my psychiatrist 30 years later. And you know,

[00:41:01] I am so grateful and fortunate that my gynecologist recognized that I had mental health issues going

[00:41:07] on with my physical issues. So it's...

[00:41:13] It was very perceptive of her. A lot of people miss them.

[00:41:18] Yeah, so here's another blessing. When I was in my 40s, Trey, my psychiatrist was super proactive

[00:41:29] very early about the possibility of hormonal changes prior to enduring menopause causing havoc

[00:41:38] with my mood disorder. So menopause could possibly cause mood swings and or affect the efficacy

[00:41:46] of my medications. And he recommended books for me to read. He ended up coordinating care and medication

[00:41:55] changes with my gynecologist when they did indeed become necessary. Yeah, I'm lucky in another

[00:42:00] way. She was still my gynecologist 15 years after that initial referral to my psychiatrist.

[00:42:09] So those are the ways I was blessed. Now, there are several ways my mental health condition has

[00:42:15] impacted me that I think are particular to being a woman. And I know men have symptoms and reactions

[00:42:21] of equal significance just different. So here are some of mine. I had intense hatred for my body.

[00:42:30] When I weighed, I don't know about 50 or 60 pounds more than I do now. At that point, I could only

[00:42:37] associate the words fat and ugly with my body and myself harm dramatically increased.

[00:42:46] When I was most symptomatic with my mental illness, you know, when I was barely functioning,

[00:42:51] I could not even have defined the term self-care. I mean, I didn't even shower sometimes for three

[00:42:59] or four days, much less good to the dentist to get my teeth cleaned. And it was such a chore to get

[00:43:06] my hair cut when I was extremely depressed that once when I did go for a haircut, I had it cut so,

[00:43:14] so short just to keep me from having to go get another haircut for a long time. And how I, oh my

[00:43:21] guy, you should have seen it. It was horrible. It was the worst look ever on me. But I did it and

[00:43:29] other things that showed my lack of self-care is I didn't exercise at eight terribly and talk about

[00:43:35] improper sleep. I would go for days with basically no sleep or I wouldn't get out of bed for a few

[00:43:41] days and I could do not. It was that extreme. So other things about my mental health impacted me

[00:43:49] as particularly as a woman is I am still cautious in situations of being alone with the man who

[00:43:57] might do not know, particularly in an isolated place. For example, if I'm alone waiting for an elevator

[00:44:05] and the elevator opens and there is one man alone in the elevator, I don't get into that elevator.

[00:44:13] My strategy is I say something like oh that's going up, I'm going down and I don't get in the

[00:44:21] elevator or I say oh oops I forgot something and I walk away. And I could give lots of examples

[00:44:27] of how I protect myself from situations like this. Since substance use disorder is indeed a

[00:44:35] mental health disorder, I would be remiss if I didn't include how my addiction came into play

[00:44:40] after my second childbirth. Again 70 pounds during my second pregnancy and I wanted that weight

[00:44:47] gone. At the time I had been clean from methamphetamines for about four years but I made a conscious

[00:44:54] decision to use speed to lose the pregnancy weight. Now I nursed my son for six weeks because at

[00:45:01] the time the medical recommendation was that it was necessary to nurse for six weeks in order

[00:45:08] to get the immunities from breast milk to be provided to the baby. Yes, at the time they said

[00:45:13] six weeks was enough so that's what I did and then after six weeks I weaned my son from nursing.

[00:45:20] And then I called my old drug dealer who unfortunately still had the same number and unfortunately

[00:45:26] answered the phone and thus began a journey. I know, thus began a journey I wish I had never

[00:45:33] taken. So while I'm on the subject of the aftermath of childbirth, I want to talk about postpartum

[00:45:40] depression which we've mentioned and with my history of depression I feel really lucky to have

[00:45:45] escaped this. I mean I went the other way and ended up being manic from going back on speed but

[00:45:51] I did not have postpartum depression but my daughter who had no history of depression suffered

[00:45:57] terribly with postpartum depression. It hit her hard and fast. I was with her for the birth of

[00:46:04] her first child and for the week after and then I flew home and then the day after I got home she

[00:46:09] called me and said you have to come back mom, you have to come back. She was terrified by how she

[00:46:14] was feeling when I got there and on the phone and a lot she would say where's the joy mom,

[00:46:19] where's the joy and then the depression hit her again with her second pregnancy and

[00:46:27] this time she was about five months pregnant when it hit but you know what pissed her off Helen

[00:46:34] when she was on the other side of it and she would share with someone about what she had gone

[00:46:40] through. She often got the response oh I went through that too and she you know she thought if

[00:46:47] the stigma of mental illness hadn't kept those women silent she would have had them to support

[00:46:53] her through her dark journey and yeah she had a lot of support from friends and family

[00:46:58] during her struggle but these were additional people in her life with wisdom and support

[00:47:04] and she needed and would have reached out to if they had not had that stigma and shame keep them

[00:47:12] silent keep them from talking about it and you know that's why we do this podcast Helen. We want to

[00:47:19] shatter that stigma, that shame and silence. Well that what a story Valerie all of it is just

[00:47:30] it's just it's riveting and I think so much of what you brought up is going to be very helpful to

[00:47:37] people you know that it's just what you said about your daughter you know you can think you're the only

[00:47:42] one that has it and then you find out later that all these other people did but just again because

[00:47:47] it's because of shame or stigma they just they couldn't bring themselves to reach out and I think

[00:47:54] that that what you've just told us Valerie is exactly why we have this podcast and what you just

[00:48:01] did was help shatter some stigma and shame. I hope so and my daughter yeah thank you

[00:48:06] and my daughter talks so openly about her postpartum depression hoping to help others and so I talked

[00:48:13] about the impact of mental illness on me as a woman and I know you as a woman having lived with

[00:48:22] mental illness for a long time and now being in recovery have your own perspective and I would

[00:48:27] love for our listeners to hear your perspective so will you share that please?

[00:48:35] Yes I will and I decided Valerie um that I think he's such a vast subject for for anyone who's

[00:48:43] trying to talk about first of all what it means to be a woman but then the moment with mental health

[00:48:47] problems and so I decided I want to focus on the impact that being a woman had in my treatment

[00:48:53] history as a mental patient and there was a pronounced prejudice based on my gender

[00:49:00] that was destructive and ongoing in many treatment settings now on the other hand most of the male

[00:49:06] professionals also were good therapists in some respects but it was their biases that

[00:49:12] disturbed me to this day the wasted time money and suffering at least in part because I was

[00:49:18] a woman in a man's treatment world now I'm going to give some examples and I'm going to talk

[00:49:23] about some doctors obviously I've changed their name so the first one is Dr. Thomas and he was my GP

[00:49:30] and the first person that I went to with these issues and when I did see him I was so thin for

[00:49:36] manorexia that my body would bruise if I lay on a hard surface and I had begun to have many

[00:49:41] convulsions because my body had no fat and was devouring muscle my periods had stopped

[00:49:46] I looked like a living skeleton so this doctor examined me and said I was the most malnourished

[00:49:53] woman he'd ever seen his only treatment recommendation was that I should eat more beef

[00:50:00] yeah that was several yeah several months later I almost killed myself and was hospitalized for

[00:50:07] the first time and one night I was at the nurse's station getting the usual ton of medications

[00:50:13] and I was so thin you my clothes were just hanging off me and someone came up behind me and put his

[00:50:17] finger in the drooping waistband of my skirt and I turned around and it was Dr. Thomas and he was

[00:50:26] just beaming at me I mean and there I was you know you know I was I was locked up in a mental institution

[00:50:32] and he he was just so happy and beamed at me and said you sure have kept that weight off

[00:50:38] mm-hmm so then when I was in treatment in in the hospital I did see some biases against women at

[00:50:47] many turns now again this has changed at the time hospitals were essentially run by men

[00:50:56] but at the time that I was there there was absolutely no interest in a woman's physiological

[00:51:01] differences or hormones or any of their impact on mental health the guys the guys the men couldn't

[00:51:09] seem to even comprehend my hatred of my body and how deeply it damaged me and disturbed me really daily

[00:51:19] then there was anorexia which I really think they just they just couldn't get it you know it wasn't

[00:51:25] because they didn't want to they just couldn't understand it and then in this hospital the

[00:51:29] oddest thing dating was considered a sign of recovery and to me it wasn't just me it was a

[00:51:37] quite a number of the other women who were my friends who were my friends there dating was like

[00:51:42] the last thing on our minds you know and for many people it would have been triggering so again

[00:51:46] there was a very strange um you know policies there now the one thing they did more than anything

[00:51:53] else in my treatment was they pushed me to show anger to show my anger because they said that

[00:51:59] depression was anger turned inward which I agree with and they pushed me and pushed me but I just

[00:52:04] couldn't let it out you know well after a year of being a leader on the unit and a role model

[00:52:10] 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

[00:52:16] attack anybody but my doctor immediately pulled me aside and said to me and I quote that I was

[00:52:23] being a bitch and my timing was lousy well it turned out that the unit was in a bit of you know

[00:52:32] as you know as an uproar and it was about to go on shutdown and he needed me to be the exemplary

[00:52:39] leader I always was my anger was just you know too bad for me it was bad timing so I never dealt

[00:52:44] with it there now it was creating speaking of being angry I'm angry no it was I don't know

[00:52:52] is my big opportunity but anyway did I you know it what can you do it's the past then there was

[00:52:58] doctor cook and he is the first person I told that I thought something sexually abusive had happened

[00:53:04] to me as a child and you know I have amnesia about my childhood almost perfect amnesia but I had

[00:53:11] started having these these vague memories of some kind of horrible things happening to me well

[00:53:17] doctor cook was a Freudian and he looked at me and he said but Helen that's what little girls want

[00:53:27] I can assure you it is not but he had embarrassed me and shamed me to the extent that I never brought

[00:53:35] it up again because I thought I was so I felt so horrible you know that that well anyway it that

[00:53:42] that was it was dropped and it's turned out to be the doctor that initiated a sexual relationship

[00:53:47] that lasted for six years so that was not a good not a good experience with him now medication

[00:53:55] um I really have had quite a run with it I've been on drug trials it's been now over 40 years and

[00:54:02] because I just added a new one so I'm still at it but again I'm having terrific good fortune now

[00:54:09] with medications and I should because I tried more than 60 little did I know that they had been tested

[00:54:17] only on men and in trials virtually all of them so the doctors had no concept of what these

[00:54:24] drugs would do to a woman you know in terms of dosage or side effects or are the physical impact

[00:54:29] on a woman's body I mean who knew and one male doctor that I had kept upping the dosage he was

[00:54:36] madly in love with this new medication it was so new that he was talking to the drug manufacturers as

[00:54:41] he was giving it to me and he kept upping the dosage above their recommendation for the top dosage

[00:54:47] he kept saying I just know if we go a little higher it'll work for you it'll work for you

[00:54:52] till finally the drug manufacturer told him he had to stop that he was gonna do me great harm

[00:54:57] and he stopped and of course the medication didn't help in any way so these

[00:55:03] are some responses again I had some you know again really dramatic symptoms one of them was

[00:55:09] cutting and the first time I did it I mean with very first time I told my doctor and I showed it to

[00:55:16] him and he just looked and he said that I was doing it to get attention and that was the only

[00:55:23] comedy ever made and oh brother I felt so bad that I was so manipulative that I would you know

[00:55:30] resort to such a such a such a terrible thing and that was that and then I also tried to tell this

[00:55:36] this man how how self-conscious and repulsive I felt in his presence you know I I was that bad off

[00:55:45] around men and he began to comment on my appearance and wardrobe regularly and he was very

[00:55:53] flattering about my appearance and he was very critical about my wardrobe and he kept saying that I

[00:55:58] wore too many clothes that I shouldn't hide my body you know he just didn't get it so you can see

[00:56:05] that my relationships to male doctors were based on my desire to please them and the incredible

[00:56:12] amount of shame I felt around men and the impact of the trauma and frankly a complete inability

[00:56:18] to trust men and you know it said I needed to learn to be more assertive in all personal relationships

[00:56:24] and stop pleasing people all the time but anger was discouraged and one of them told me he even

[00:56:30] told me he didn't like it when I cried in therapy so as a woman I have I have five diagnoses and

[00:56:39] but the two illnesses I had I have that generated the most prejudice and contempt

[00:56:46] were anorexia and borderline personality disorder both very much associated with women

[00:56:53] I was turned away from Bellevue hospital which is a really tough place because on top of everything

[00:56:58] else I had an eating disorder and the head of the program said that because of that I would be

[00:57:03] too much for his staff and trainees now borderline personality disorder is a whole different category

[00:57:10] the worst prejudice against female patients I have ever seen and the worst that I have ever encountered

[00:57:16] in a treatment universe and actually in just out anywhere in my life you see my own credibility my

[00:57:23] word my reason were shattered when I was diagnosed as a borderline it's like it happened overnight

[00:57:30] and I used the term borderline we don't use it anymore it's too pejorative but that's exactly

[00:57:36] what it was and that's exactly what I was called so after I've been in treatment for more than a decade

[00:57:42] with males a female therapist a group leader suggested that I might be better off working with women

[00:57:49] well I went into bodywork with a woman an all female group dbt skills designed in top-by-women

[00:57:56] meds from a woman although I have to say to be fair the biggest medication breakthrough I had was

[00:58:01] by a man who was so kind and compassionate I had no problem working with him but mainly was having

[00:58:08] a woman therapist where I could relax more be more candid about my body and my symptoms

[00:58:14] and benefit from just from the female take on things that point of view so for me the all female

[00:58:21] approach has been right but I'm in no way suggesting that it was perfect one of the most destructive

[00:58:28] therapeutic relationships I've ever had was with a woman so here I am you know trying to look back

[00:58:34] on this and to assess the full scope of my treatment with men and women and one thing is abundantly

[00:58:41] clear to me so much of it is about power I became so sick because I was a powerless child

[00:58:50] and I was strong enough to build a rich life in recovery because I became a powerful woman

[00:58:58] you are a powerful woman there's no doubt about that and I don't know I kind of think being

[00:59:05] turned away from Bellevue hospital is bad that you can carry with pride

[00:59:12] it you know what I'm saying that you can kind of you can kind of die now on it because it's so

[00:59:17] unusual but anyway it was yeah in hindsight it's one of those extraordinary things I've

[00:59:25] ever been through and I've had a very interesting life so yeah I mean it's definitely one of

[00:59:30] the walking out the gates of Bellevue turned away it's one of those things that is definitely

[00:59:35] only funny in hindsight exactly but it's one of those you eat the laugh or you cry that's

[00:59:40] reddarned sure well I've decided that's a lot of it a lot of this is about trying to I don't know

[00:59:47] I'm so glad I have a sense of humor but I think that one of the things that you and I always want

[00:59:52] to do and one of our goals really is to get the conversation about hope and our hope for women today

[01:00:02] so I want to start with something that just has just absolutely made my month and it's

[01:00:10] it's a study from the substance abuse and mental health services administration called SAMHSA

[01:00:17] which is a big big huge government body that works with mental health and substance abuse and

[01:00:22] so they had this new study that just came out in in September of 23 so it's just a couple of months

[01:00:28] old so what they learned is of the 58 million adults who perceived they ever had a mental health

[01:00:36] problem 66 percent 38 million that's two thirds considered themselves to be in recovery or to have

[01:00:47] recovered from their mental health problem and their definition of recovery was really a very good

[01:00:52] when it said recovery is characterized by continual growth and improvement in one's health and wellness

[01:00:59] while managing setbacks which were a natural part of life I mean Valor don't you think those are

[01:01:05] wonderful numbers their wonderful numbers and that has been SAMHSA's definition of recovery for a

[01:01:11] long time and I got to say SAMHSA is my favorite government agency and I love their definition of

[01:01:17] recovery in hell and you and I used that when we taught the peer-to-peer classes for NAMI that

[01:01:22] was one of the early exercises can you how do you define recovery and we gave SAMHSA's definition

[01:01:29] is a as an example can you read that definition for me again please I love it so much yes it's

[01:01:37] recovery is characterized by continual growth and improvement in one's health and wellness

[01:01:43] while managing setbacks which are a natural part of life there you have it there you have now

[01:01:49] another reason are one of the main reasons I'm hopeful for women based is based on my own experience

[01:01:56] and it's due to our improved status in society now there's a long way to go we all know that

[01:02:04] but today there are many more avenues for a woman to defend herself from discrimination stigma

[01:02:09] or abuse and to me this can create more strength and pride that can help a woman deal with mental

[01:02:19] health challenges I mean we just talked about this the struggle for recovery requires just one

[01:02:25] woman to keep fighting and that's for herself and to not quit in my angelou put it beautifully she

[01:02:32] said I can be changed by what happens to me but I refuse to be reduced by it and those to me that

[01:02:40] to me those are fighting words yeah what beautiful words so I was encouraged by the number of

[01:02:46] treatment centers with programs specifically for women that I discovered as I did my research

[01:02:52] for this episode there were many treatment centers exclusively for women so you know recovery is

[01:02:58] possible but treatment is necessary so any advancement in treatment whether research breakthroughs

[01:03:05] accessibility or treatment that better meets the needs of women those things make me hopeful

[01:03:16] well I I can see why you are I can see why I am and so let's let's close on these images of hope

[01:03:26] for women everywhere I mean there has been real progress in the treatment and empowerment of women

[01:03:31] in the mental health field so here's to more progress in the days and years ahead sooner rather than

[01:03:38] later yes and now Valerie would you lead us in a mindfulness exercise well I will lead us

[01:03:45] in our traditional way of closing every episode with a mindfulness exercise what is mindfulness I

[01:03:53] always give a definition mindfulness is a mental state achieved by focusing one's awareness

[01:04:00] on the present moment while calmly acknowledging and accepting one's feelings thoughts and bodily

[01:04:07] sensations without judgment today's mindfulness exercise is called tapping into our inner strength

[01:04:17] we talked about self-care today and taking time to be mindful of my inner strengths is part of

[01:04:24] my self-care this exercise is a great way for us to identify our strengths let's get mindful

[01:04:33] close your eyes if you can settle in and let's breathe together as always we'll begin with a

[01:04:44] few diaphragmatic breaths whether your eyes are open or closed let's steady our breathing with two

[01:04:52] diaphragmatic breaths when you do this on your own take as many breaths as you need to become calm

[01:05:02] and centered if you're driving or walking please adapt this exercise so that it's safe

[01:05:10] in your surroundings let's breathe in health here knows expanding an imaginary balloon in your

[01:05:19] stomach as you inhale ex health to your mouth pulling in your stomach as you do so

[01:05:32] again inhale through your nose expanding that balloon in your stomach as you inhale drop your shoulders

[01:05:45] exhale through your mouth your stomach all the way it exhale

[01:05:53] you get this slow steady breath going

[01:06:02] bring to mind an event that you felt strong about today

[01:06:09] it could be a conversation an action a relationship something you completed

[01:06:18] around what event did you feel strong today

[01:06:33] what strengthened you today was it words you read?

[01:06:42] something someone said to you prayer a hug exercise a memory?

[01:06:55] what strengthened you today?

[01:07:12] in what ways did you rely on your inner strength today?

[01:07:19] did you use resilience, self-compassion, gratitude, determination, courage, wisdom

[01:07:31] and in what ways did you rely on your inner strength today?

[01:07:42] breathe in, breathe out

[01:07:49] be mindful of these strengths you have tapped into

[01:07:54] what you felt strong about

[01:07:59] what strengthened you?

[01:08:02] the inner strength you relied on

[01:08:08] be mindful of your inner strengths

[01:08:15] if your eyes are closed please open them and gently bring yourself back to the room

[01:08:19] thank you for doing this mindfulness exercise with me

[01:08:24] oh thank you Valerie that was a great opportunity to examine personal power I really appreciate it

[01:08:31] you are welcome and before we close I want to remind listeners that both you Helen and I will be

[01:08:40] on the two lives podcast coming up quickly my episode will be available on January

[01:08:49] 30th the two lives podcast follows the theme that we all have two lives the second one begins

[01:08:58] the moment we realize we only have one two lives is an award-winning podcast and it's absolutely

[01:09:05] wonderful so again my episode will be available on January 30th and Helen's yours will be

[01:09:12] available in the next few months so please tune in to two lives it's available on all major platforms

[01:09:20] our thanks to our listeners everywhere you are the reason we are so excited to be entering

[01:09:25] our fourth year as podcasters our work is for you and the listeners that we hope to cultivate

[01:09:32] please review us wherever you get your podcast

[01:09:36] mention us to your friends on social media and share your comments and insights on mental health

[01:09:40] hope and recovery.com you are our best hope to reach those who need information and inspiration

[01:09:49] speaking of which our next two episodes will be about the condition the US Surgeon General has

[01:09:55] named a national epidemic it is loneliness besides coursing through the nation many of us know that

[01:10:04] loneliness for a person with mental health issues can be severe and sometimes lethal

[01:10:09] what can be done to alleviate loneliness in ourselves and others join us and we will find out

[01:10:17] together until then I leave you with our favorite word on word