Starting to Organize

Dear Kayla,

Organization. That is one key piece which you will eventually need to move ahead. Most people with mental illness are not very good at it. But it is a critical area which you will need to learn in order to move forward.

It takes years to learn how to properly organize things. By definition, organization is the ability to arrange things to meet your needs and fit the requirements of your own life. No one else can give you organization skills. You need to develop them yourself.

Also, organization takes numerous forms. Organizing your physical space is only one small part of it. My apartment is not well organized even now. Frankly, I haven't learned to do that one well yet. When I started to learn to organize, I worked toward organizing my time and my diet - not my physical space. But I can tell you what I have learned thus far.

My basic advice is the same advice I give over and over: Start with what you can do, not what you need.

Organizing your time means figuring out the details of what you can and cannot handle. You are probably - hopefully - working on some larger interventions even now. But you can't do that all day every day. Try to think of productive ways to fill some of your downtime. You will probably need to start small - maybe only ten minutes a day doing something productive. But once you learn how to do it you can start coming up with more and more strategies to use your time better.

The details of these interventions are specific to you and your needs. No one else can tell you what you can and can't handle.

The most important piece is not to compromise your main intervention. If your primary intervention starts sliding, put everything else on hold. This may well take some trial and error to figure out the details of what you can and cannot handle.

Organization is a major topic. I will be writing more on it later.

Going Off Medications

Dear Kayla,

Not many people are aware that I have successfully managed to go off psychiatric medications. When people do find that out, they urge me for advice or suggestions. I actually do not have that many suggestions. But I wanted to tell you the little I have learned.

My last psychiatrist realized I was over-medicated. He took me off some psychiatric meds within months or a year or so after I started seeing him (I forget the exact time frame). At the time, I did not realize how unusual this treatment was. I have since learned that most doctors will insist their patients remain on medicines regardless of what the patient wants. I did not personally encounter that situation, and I am not sure how to advise people about it. I apologize for that.

After a while my psychiatrist decided to take me off my primary antidepressant. I knew it was not the right time - I despised the place I was working at the time - but I was too meek to speak up. That was a considerable mistake. I grew increasingly miserable and ended up going back on a higher dose of the antidepressant than I was originally taking.

In theory, the doctor was supposed to wait a year after that before trying to take me off medicines again. Eight months after that failed first attempt I was in a much better job, feeling better about myself, and essentially told my psychiatrist, "Take me off these things now." He agreed on the condition that we go slowly. I think (it was about five years ago and I don't remember all the details perfectly) we started at a dose of 300 mg and reduced it by 75 mg each month. When we first started cutting the doses it would take a day or two for my body to adjust and then I would be hit with depressive symptoms. I would need to withdraw from activities as much as possible and figure out ways to cope. After a few days both my body and my mind would start to adjust and I would be able to function more fully. Usually after a month I would be more than ready to reduce the dose again.

One time I asked to postpone our scheduled dose-reduction because I was dealing with considerable external stress and knew that I could not deal with both issues at once (the changes while reducing the dose and the external crisis). That proved to be a very wise decision. After two weeks I was able to continue going off the medication. I think if I had tried to keep the schedule I would have relapsed.

After a few months I started being able to anticipate and plan for dose-reduction problems ahead of time. After that it grew much easier.

My antidepressant was the most difficult medicine to stop taking. There are a few lessons I can give you from my story: (1) Do not attempt to stop taking medicines unless you are reasonably satisfied with your present life. I think waiting a year - the psychiatric recommendation - is excessive, but you need to be fairly happy with what you are doing and what you are feeling at the present time (2) Go slowly and give your mind and your body time to adjust (3) Don't hesitate to postpone reducing the dose if your life circumstances change and/or you have a crisis. Going off medicines is difficult enough. If you add outside stress it can be overwhelming.

I hope this is helpful.

4/9/12

Dear Kayla,

I have been working toward learning to interact more with the world.

When you are interacting with someone you don't know well, it is easy to feel slighted. When people don't know you well, they don't understand how you will feel and react to certain small things. Chances are they don't even know what bothered you. I know I have done that to other people on numerous occasions. But it can be really difficult to tell: When is someone's slight genuine and when is it your imagination?

Part of many people's mental illness is a difficulty distinguishing between the two. Some people ignore legitimate threats, and a greater number interpret insignificant nuances and coincidences as intentional threats. I can't tell you how to distinguish real threats from misinterpreted ones in a single letter. That takes years: Frankly, I think that NO ONE, with or without a psychiatric history, is able to perfectly distinguish real threats from imagined ones. But I can give advice.

I have learned that if someone slights you or seems annoyed at you, one thing to examine is whether they are treating everyone that way or just you. Other people have their own problems, they have their own bad moods, and as I said before they can slight people without even knowing it. If you can, watch them closely as they interact with other people. Try to emphasize with the "other people," not the person who upset you. Do your best to imagine how those "other people" feel as they are interacting with this person. Would they feel slighted or upset or put off, too? That is a really clear sign it is not just you.

As I said, social interactions are extremely complex and take a long time to learn. But I can share what works for me.

2/29/12

Dear Kayla,

I forgot to add a piece to my last letter.

When I was first working on my reading comprehension, I started with short stories. I thought if the materials were shorter they would have fewer pieces and would hence be easier to follow. I still read slowly, and with short stories I could read them in less time; I could read them over and over again; and I could figure out the pieces.

I have since realized that I was wrong. I needed longer novels with more clues and more opportunity to develop the story. In longer novels there is more of a margin for error and more chances to correct misinterpretations. Also, it takes me a while to grow used to a writer's style, which means I need more opportunity to organize and process the story. Short stories are simply too short to provide that opportunity.

Of course, I needed to be careful not to err on the other side. Books which are too long are often very complex and can become overwhelming. But I learned that I needed some time to grow used to the writing style and the story. Right now I try to work with novels that are about 150-300 pages.

It has also helped me to go back and read some of the literature which was assigned to me in high school. Now that my comprehension and interpretation is improved, it helps me to go back and try to pick up some of what I missed then. Those books were chosen for a reason, and they are likely at the difficulty level I need right now.

Again, this is just me. I don't know what worked for other people.

1/15/12

Dear Kayla,

There were many dimensions of learning how to learn, probably because there are so many ways to learn. As I said before, I am still working on that myself. But I can tell you what I do know.

Learning how to read was a large project in itself. In retrospect, I wish I had pushed myself more aggressively in that area.

To be clear, I was always able to read the words well. My mother, an elementary school teacher herself, said I learned to read right with the system. But I had considerable problems with comprehension. In hindsight, that makes sense; if I couldn't comprehend the world I observed around me, I certainly couldn't comprehend someone else's world I was reading. I watched the same television show over and over again until I was better able to follow situations and pick up cues from the broader context. I expanded to watching several seasons in this same television series and watching longer movies. But learning through reading was a separate skill, and I wish I had worked more on that.

Eventually I started reading at a level I could comprehend. For me, I needed to go back to upper elementary school books (grades 4-6). I read some of the books I remembered reading as a child, some of the books I wanted to read as a child and never did, and some more recent childrens' books which looked interesting. After a while, I moved to young adult fiction and then to easy adult fiction. It took an enormous amount of trial and error, figuring out which authors worked for me and which did not. (For a brief period afterward, I went back to childrens' books so that I could focus on speed.)

All this was for reading fiction. Nonfiction took even more potential for trial and error and error and error. I eventually learned that different subjects require different approaches and forms of concentration. The skills you need for reading history are different from the skills you need for reading biology. Obviously, in the beginning you need to start with topics you know and enjoy. For unfamiliar topics, I start with the Great Courses lectures. Once I watch or listen to those lectures in a particular topic, it is no longer unfamiliar. That being said, it can still take a while to find appropriate books and learn how to focus on them.

All this comes down to the lesson I give to people who are just starting a task or who are stuck: Do what you can do, not what you most need. If a book looks unappealing or it is a struggle to follow the author's style, then in the beginning you cannot learn from it. Later on, when you become more skilled, you will probably grow more flexible. But in the beginning you simply need to start simply and slowly.

12/27/11

Dear Kayla,

I needed to learn how to learn. I personally could not restore my capacity to learn -- I never had much to begin with. In school, I could memorize information but not apply it. I could not concentrate enough to think through abstract concepts. I did well through high school, but had a great deal of trouble in college where simply memorizing information was not enough.

I am still working on that one now myself. But I know enough to give you some advice.

There are multiple pieces which I will need multiple letters to describe. One easy piece was some of the educational video and audio materials. I can personally recommend the Great Courses series. They are available but expensive at http://www.thegreatcourses.com/greatcourses.aspx; many of the courses are also available in libraries. The Great Courses series has university professors lecturing on a large variety of topics. Admittedly, there are other competing companies doing the same thing which might be worth looking into. But the Great Courses is the only one I can personally recommend.

There are no tests. All you need to do is watch television or listen to your ipod and absorb what you can. When you are just starting out, that is a good thing. Your brain can take in as much or as little as it can handle without pressure. Eventually, it will become more used to learning and processing more and more.

I would suggest you start with a topic you already know something about, i.e. a topic you studied in school or had a personal interest in in the past. You can recover some of your knowledge and skills from before and add to it. If you start with a totally new topic, it would probably be an overwhelming amount of information. Later on I found these courses a great way to learn about new subjects. But in the beginning I would have found it overwhelming.

As I mentioned, there were many strategies I used to improve my learning over time. But this was good for me when I was still starting out because it required no testing or follow-up. Later on these courses helped me expand my education as well as my learning skills.

12/13/11

Dear Kayla,

I was moving forward myself, then had a setback. Why did this happen?

I was pushing and doing great. I was growing more and more excited. I was steadily building skills. Then things started to fall apart.

I wasn't pushing too much. I wasn't moving beyond what I was capable of doing. What happened was that my external life changed. I became too busy preparing for the holidays and some other events. I wanted to keep building skills, so I kept working on them at the same rate. But the combination of the two became overwhelming.

Setbacks can be external or internal. They do not even need to be problems -- even good things can be stressful. It is easy to grow excited about building skills and push to continue. But you always need to keep an eye on external stress and see if you need to make accomodations. If I had made accomodations earlier, I could have gone back to work much more easily.