Treating the Whole Person

This article was the feature article in the NAMI Advocate Winter 2018 edition: Putting the Pieces Together on Integrated Care.

“She’s just anxious, Allison,” said my mother’s physician.

Nathalie White

I had called in desperation to report Mom’s intensifying symptoms: cold sweats, difficulty breathing, low-grade fever, no appetite. In return, I was dismissed. I reported her labored breathing and her inability to force herself to eat—how she wrinkled her nose to once-favorite foods, how sweat rolled down her face, even when our car’s air conditioning was turned up too high. Despite her physician’s lack of concern for all this, Dad rushed Mom to the ER one day anyway, where her excessive coughing delayed a necessary lung biopsy.

The next day, Mom’s physician (now involved in her care) met me outside her hospital room and quietly said, “I’m sorry, Allison. Your mom has lung cancer.” I slowly entered her room and sat down. The words continued: “Late stage … little hope … chemo immediately.”

Devastation. Anger. Disbelief. The physician left me with nothing to hang onto. As Mom gasped for breath, her anxiety showed; she finally knew what was growing inside her, what she tried to treat with antibiotics and antihistamines. It was like being trapped in a nightmare. Mom was only 45 years old, was never sick, had never smoked, never even had allergies—and she loved life.

When I returned the next day, I walked into an empty room. I ran to the nurse’s station. “We’re sorry… Your mom had a stroke and is unresponsive. She’s been taken to the ICU.” Within hours, my family gathered to make “the decision.” I watched as my dad struggled to make the final call. I was numb. I watched the doctor’s lips move, but I didn’t understand. We gathered around her bed as Mom took her last breath. It had only been two weeks since my phone call asking the doctor for help. Now she was gone.

I later found in Mom’s datebook that she tracked her temperature for months and scheduled appointments with specialists who gave her various medical diagnoses and prescriptions. However, the elephant in the room was always her diagnoses of depression and anxiety. Her mental health diagnoses somehow managed to overshadow the underlying cancer that had been quickly invading her body. “She’s just anxious, Allison.” No… my mother was simply never heard.

I was 23 when my mother died. I’ve never really gotten over her death, but over time, I’ve learned to move through grief and turn it into something else. At the time, I’d been unsure of my career path. But after her death, everything became crystal clear.

Stigma cost my mother her life. I never wanted to see that happen to anyone again.

So, I obtained my master’s degree in social work and swore that I would always listen to my clients. I worked with people who had mental illness and often observed their physical symptoms being neglected due to their predominant mental health diagnoses. They would frequently call their doctors with symptoms that could be related to anxiety or depression and would have their psychiatric medications increased before having possible physical conditions evaluated.

People coming in for mental health services often lack a proper education about how their physical conditions impacted their psychiatric symptoms. For instance, I once met with someone before she met with her psychiatrist. She stated she was going to request an increase in her antidepressants since she was experiencing low mood and decreased energy. But I observed that she was drinking a regular soda and eating chips. Knowing she was diabetic, I talked with her about the importance of letting her psychiatrist know about her eating habits and blood sugar levels before defaulting to an increase in antidepressants. She had no idea that her food choices might be impacting her mood and energy and her psychiatrist had never mentioned it, either. As a clinician, it was frustrating to see.

That’s why I was excited when the organization where I had been working for years decided to become part of Missouri’s Healthcare Home pilot program. This program spearheaded the path to integrated care for our most vulnerable populations: people diagnosed with mental illness and major physical health issues. Research from the program showed that people with mental health diagnoses die, on average, 25 years earlier than people without mental illness—due to things like lack of health care integration, health literacy, poor nutrition and other social factors that impact overall health and wellness. When this program was initiated, I worked on its treatment team and referred many clients to the program, so they could have the medical oversight needed as part of their overall care.

When practicing integrated health care, an ongoing challenge is to coordinate care across all providers to ensure treatment plans are focused on health, wellness and preventive care. There are many barriers, which often keep doctors treating patients in a silo-approach (focused on our own areas of expertise). But the benefits of integrated care are innumerable—including decreased trips to the emergency department, decreased hospitalizations and reduced cost of health care thanks to preventative care. Having a whole team of professionals across various disciplines improves outcomes through early detection, monitoring and care coordination.

Programs like Healthcare Home show these effective interdisciplinary teams in action. Doctors, nurses, dieticians, occupational therapists, therapists, social workers, etc. meet to consult with each other and coordinate care using knowledge from each area of specialization. That way, when someone with physical health symptoms and a history of mental illness or substance abuse is being treated, they are heard—without stigma or judgment.

In the 32 years since my mother’s passing, progress in medicine and psychiatry have drastically and positively influenced health care. Thankfully, advances have also been made in integrated care, but we have a lot of work to do. We must break down the silos that separate physical and mental health because everything is connected: Physical symptoms affect a person’s mental health and a mental health diagnosis may increase the risk for physical health-related issues. Listening to a patient’s every symptom will lead to proper treatment and better quality of life.

As doctors and mental health professionals, it’s our job to dig deeper, peel the layers of the onion and address the core issues that keep people from living life to their fullest. Whether that’s uncovering childhood trauma that hasn’t been addressed or substance abuse that helps numb overwhelming symptoms or pushing past a mental health diagnosis to see a possible physical health diagnosis, addressing “one side” of a person’s care is just the tip of the iceberg.

If my mom’s cancer had been caught earlier, she may have been cured, but just as important, she would have been heard. It was only when my mother was diagnosed with cancer that her health care professionals gathered to formulate an integrated treatment plan. But by that time, it was too late.

I will never forget those words: “She’s just anxious, Allison.” Losing my mother changed my life, but it also inspired me to make changes in health care, so everyone—regardless of mental health diagnosis—gets the whole-person, integrated care they deserve.

 

Allison White, ACSW, LCSW, CCDP-D is a licensed clinical social worker with over 25 years in the field. She works in a community mental health integrated health care program. An important part of her work is recognizing and addressing all aspects of a person’s life and working with other health care professionals to integrate and coordinate their care. Visit her website at www.wellnessalley.com.

The Art of Mindfulness

It’s becoming more challenging trying to live a balanced life when there are so many obligations and so little time to get them all done. We plan for the future, while ruminating about the past. It’s easy to allow things to spiral out of control as we get caught up in the business of everyday life. But there is hope.

When thinking about my vision of calm within the storm, I remember the movie “A River Runs Through It,” which shows how the art of fly-fishing demands stillness, creativity, concentration and balance for one to be successful at it. A main character in the movie often struggled to control his emotions, except when he was practicing his skills at fly-fishing. He found solitude on the river, where he learned to regulate and calm himself through what we refer to as “mindfulness practice.” Through the rhythmic, intentional casting of the line, he retained balance while standing on the rocks in the midst of the raging river. The fishing line flew with wild abandon above the water, but the fisherman maintained control as he stood solidly on the ground, keeping his focus.
This is the extent of my fly-fishing knowledge, having never experienced it, but the movie left an impact on me because it mirrors what we experience in daily life. We allow our thoughts and emotions to lead us, like the fishing line whipping wildly above the current – up, down, sideways, back, forth – with nothing to guide them in the right direction. Our thoughts can hijack our ability to think clearly and with purpose. No guide, no focus leads to feeling out of control, and increases stress, anxiety and depression, making it difficult to enjoy life.
It’s easy to get trapped in the chaos – the raging river – which can easily sweep us downstream. I’ve experienced the drifting; it leads me further from my goal, while zapping my energy as I fight to regain control. I’ve also had to tread water while searching, sometimes blindly, for that rock to hang on to in the current. It’s during those times that I force myself to focus: There are ways to catch myself before being swept away.
I learned the power of finding balance while practicing mindfulness. Just as in fly-fishing, it takes skill, practice and patience. When our thoughts leap around aimlessly – media blasts, cell phone calls, to-do lists – just like the fisherman, we must remain still, notice where our thoughts are leading us, then gently guide them back to stable ground. Breathe deeply; then reel them back to center.
Mindfulness is the practice of paying attention to the moment, without judgment. It seems so easy until the first wave of emotion hits. This is why it’s called “practice.” When life happens, we react, turmoil ensues – and the cycle continues. Mindfulness is the stabilizing force to help guide us back to stable ground.
Distractions – “I should have …” “If only I had …” or “What if …” – keep us stuck, unable to move, frozen in time, stagnant. They set us up for anxiety and depression, and quickly deplete our energy. So, you ask: How do I stop being hijacked by my thoughts and emotions? The first step is to notice the signs of tension or stress in your body. Whether you feel tightness in your shoulders, body fatigue or headaches, your body stores your emotions before you attach meaning to them or are able to name what you’re feeling. Notice changes in sleep patterns, which are clues to your need for mindfulness. Listening to your body’s needs creates the base necessary for overall well-being. Then, you can work on mental health to maintain balance.
Practice mindfulness every day, until it becomes a habit. Focus on your five senses, breathe deeply, listen to music, play with your pets, guide your mind’s imagery, mindfully eat healthy food – all ways to refocus on the things that matter and the moments you can experience right now. These are things you can control that will help regulate your moods.
Your mind and body are interconnected, so caring for your body is essential for good mental health. During times of low mood, increased stress or anxiety, reflect on how your body is feeling, and listen to what it’s telling you through symptoms such as headaches, muscle aches, tension, fatigue. The easiest place to start when you’re struggling is to focus on just breathing; that will ground you while your next steps become clearer. This is practicing mindfulness. Through this practice will come peace, and with this peace comes the ability to handle anything that threatens to knock you off your feet. If you do get knocked down – and you will – return to the practice. Breathe deeply again. Focus again. Stay grounded, and ride out the storm. The storm will pass – again – and in its place will come renewed strength and a sense of mastery over life’s obstacles.
We don’t get stronger by avoiding our obstacles. We learn from our failures and our weaknesses, and we gain strength through our ability to overcome them. It’s only then that we are able to live life to its fullest and enjoy what it has to offer.

Allison White, ACSW, LCSW, CCDP-D
Wellness Alley, LLC
www.wellnessalley.com
314-899-7140

Access Your Inner Child and Have Fun!

Life’s simplest moments are experienced watching kids play. When young, we played outside until bedtime, with few cares in the world except responding to our parents’ calls.  Wonders of youth were lost between childhood and the responsibilities of adulthood. Exercise helped shed pounds accumulated during college, raising families, and our careers.  Health was equated with boring food, endless hours at the gym, and drinking water until we drowned.  I miss the activities from childhood.  So, I decided to relive some of them.  I mean, exercise doesn’t have to be boring, does it?  I pictured myself as a child, active with endless free time.  What will I choose?  Aha…..I’ll buy a bicycle!

Fun, exercise, and surprise benefits……

Buying the bike was an adventure.  At the bike store, I revealed my desire about riding again to a young salesman.  A very “fit” young salesman.  I  admitted my fear of crashing and breaking bones at “my age.” Then, something unexpected happened…..instead of cracking a smile, he praised me for this brave venture to be healthier.  Wow!  Then, he had a game plan.  In preparation for my test rides, I was measured for proper fit and safety.  This was a new experience; similar to buying tennis shoes at New Balance.  I jumped on the test bike, hung on for dear life, and conquered my fear of crashing.   Away I went…..  My childhood memory took over and my fears went along for the ride.  It was like I had last ridden only yesterday.  I smiled after realizing I had overcome my fear.

Choosing the bike and assortment of accessories, invoked the child-like excitement as years before.  I had a helmet this time, strictly for safety – no fashion statement here – and decided Creve Coeur Lake would be the perfect place for my first ride.  The trails were level and the weather was perfect.  My excitement mounted as I started pedaling.  I admit that there was fear, but this quickly disappeared on the trail.  I was surrounded by people having fun.  Their energy was contagious.  I experienced a sense of mindfulness and the power of being  in the “here and now.”  I had no watch; time was suspended like when I was a child.  What a fantastic feeling.

Mindfulness is focusing on the present moment as it is, without judgment or worries about the past or the future.  I was focused on not crashing or falling.  No cellphone, no “to do” list.  Just right now.  I relaxed into the ride, noticing the sailboats, the rowers, families riding together, family reunions, the smell of grilling, ducks swimming, birds and bees buzzing by.  I was in nature, I was relaxed, exhilarated.  I couldn’t get lost here so I focused on myself, the trail, and my surroundings.

Being lost in the moment is something we should add to our lives.  The energizing music in Spinning class gives me a similar feeling.  How often do kids lose track of time, even when they are being called for dinner?  Their activities relax them, reduce their stress, give them peace. What do we do?  We get caught up in spreadsheets,  “to do” lists, time.  Balance is so important.  Our responsibility to ourselves is to find activities that lead us to peace, to healthier lifestyles, to enjoying life, like children.  Keep this mindset  and… surprise…. you won’t know you’re exercising!

What was your favorite childhood activity that you can incorporate into your adult life?

Allison White

My first bike helmet. I look like a Storm Trooper from Star Wars!

My first bike helmet. I look like a Storm Trooper from Star Wars!

Live For The Moment

Hi!  Writing this blog is a whole new experience for me, but one I’m looking forward to sharing with you!  I believe in the importance of living for the moment, practicing mindfulness, expressing gratitude and compassion. I value all aspects of my life including my friendships, family, pets and career. My hobbies include music, writing, spending time in nature, traveling and just hanging out…… I hope to share some thoughts that you can relate to.  If so, please let me know!                    

Allison