More on Looking for Employment

Dear Kayla,

I would like to write a little more about going back to work.

It can be difficult to choose precisely what sort of job or volunteer work to look for. I have heard a lot of people say that they don't even know where to start. It can be very difficult to know what you do and don't need, what you do and don't like, what you can and can't handle, until you try it out. People close to you might have some suggestions, but no one really knows for sure what they can and can't do until they try it.

I suggest starting with whatever interests you. Try to think of some sort of work or activity you would like to try. Don't worry about whether it is possible to find a job with that interest, financially viable, or any other limitation. Just think of things you would like to do.

Then go on a large job or volunteer site such as www.craigslist.org, www.monster.com, www.indeed.com, www.idealist.org, or www.volunteermatch.org. Read through different job or volunteer notices. Don't apply to jobs or do anything other than read the notices. Try to figure out which posts interest you.

Try to look for themes. What do these interests and notices have in common? What could you reasonably do now?  What do the posts which most interest you require? What could you work toward in the short term?

Once again, you need to start with what you can do. Once you start you can gain more of a sense of what you can and can't do and what to work toward in the future. Starting is the most difficult piece. But hopefully if you look carefully both within yourself and at websites and possibly other material from the outside world, you can work to start bridging these gaps.

On-line Courses

Dear Kayla,

I have recently been taking some of the new MOOC's (Massive Open Online Courses) and finding them extremely helpful. I have been working to build my academic skills for a while now. I had considerable psychiatric difficulties both in college and in graduate school. While I was able to fix the psychiatric problems, I had missed developing some academic skills. Right now the MOOC's are really helping me.

The courses are offered on-line, which means I can do them when I can focus and concentrate (as opposed to traditional classes where you attend on a set schedule). Most of the lectures are broken up into smaller segments (usually not more than twenty minutes). That is a considerable advantage for me even now.

If you want to try it I would suggest you start with one course. Pick the one course that sounds most interesting to you and do it for at least two weeks before adding any additional courses. It takes a little while to grow used to being back in school, even on-line courses, and to understand and accommodate what the course expects. Also, for your first class, choose what is most interesting to you, not what you most need. You need to grow used to taking these courses first. Once you know what to expect, you can focus on other needs.

I think the largest selection of courses is at http://www.coursera.org. Another site with good courses is at http://www.edx.org. A comprehensive (but overwhelming) list is at http://www.class-central.com.

Good luck!

Waiting

Dear Kayla,

Some parts of improvement can be extremely exasperating. There are some times when you are working on a major step and slowly building it piece by piece. That can be repetitive and tedious, but you cannot really move on to next steps without mastering the one you are currently working on. And often you can only concentrate on that step for a few hours a day (or even a week). It can be very annoying to have to wait, especially when you can see further ahead.

There is not much you can do about the tedium. Many major steps require careful and repetitive practice. If you rush through them you will most likely have problems down the line.

Don't take breaks. Spend as much time as you can handle on building that step. Tell yourself again and again that you will move through it - that you are doing your best to move through it as quickly as possible.

If you can, try to think of some smaller, unrelated step you can take in addition to the major step you are working on. Even if it is not what you need, as long as it is in the right direction you will benefit from it. And it can help you deal with the tedium. But the #1 rule is: Don't distract yourself from your primary step. As soon as you think these additional steps are distracting you from your main goal, stop them immediately. You can try to add more eventually. But your top priority is moving toward your main goal.

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.

12/5/11

Dear Kayla,

One piece which I found invaluable to my growth and development is Toastmasters.

Toastmasters is a club designed to practice public speaking skills. The club is designed to make people better and more confident speakers. People can start with very basic activities such as telling a joke or introducing a new vocabulary word. When you are ready, you will give a 4-6 minute speech where you basically tell the club about yourself. After that, you do more speeches working on different points such as organizing your speech, body language, vocal variety, and using visual aids. You can go at your own pace and give speeches whenever you are ready. There is also the opportunity to practice speaking without preparation; an extremely important skill which many people are lacking.

There is another part of Toastmasters which is less known. Toastmasters also provides a manual to work on your leadership skills. Like the speeches, you can work on most of the skills one at a time while fulfilling club roles. You start out with very basic roles and gradually add more and more complex tasks. Some people don't like to work on their leadership skills, but I have found that to be extremely useful -- probably more important than the speeches. There were many essential pieces of leadership which I had never had the chance to practice before. I was able to accept feedback of my work, but at first I found giving good feedback to other people's work to be very difficult. When I started practicing that I became better. I also slowly learned to facilitate sections and keep people interested, to run meetings, to run special events, and to mentor other people. All those are skills I would never have had the opportunity to do otherwise.

I am writing about what worked for me. Toastmasters was incredibly helpful to me and to many other people.

11/26/11

Dear Kayla,

For me, I needed to go through a very long process to learn how to learn. I was never very good at processing information I learned at school or otherwise. I could memorize the information but not apply it. There were many interventions I needed to address this. I will be writing about some of them here.

Often, the first step to making changes or learning is to examine your attitude. I was bringing some bad habits into my work without even being aware of it. I needed to look very closely at the details of what I was doing and try to find patterns or beliefs which were harmful. Often they were routines which I had never questioned. But they were holding me back from learning or doing tasks well.

Once I identified thought patterns or attitudes which I needed to change, I address that head-on. The first day or first session I would concentrate only on changing my thoughts and attitudes. And only that. I would not try to do anything differently. I would just focus on going through the day or the session thinking differently.

Sometimes I needed to do that for more sessions. It depended on the task. When I was used to thinking differently, eventually I would start to see different ideas and patterns. At which point I would give the same advice I keep giving to you and Tony: Start small. Find what small things you can and fix them. In reality, there are very few big things out there. What looks big from a distance is often really about five thousand small steps.

11/13/11

Dear Kayla,

One critical piece you are probably thinking about is becoming more involved in your community. That is a great step, a critically important one for many people. That also means you need to be very careful.

I would recommend starting very slowly. For most people, I would suggest starting with volunteer work. Think about what you do well and what you enjoy doing in your day-to-day life. Could you bring those skills into a role which could help other people? Don't worry about a job right now. Just think about what you can and can not do. Working or volunteering is demanding and straining enough by itself. It is likely to be overwhelming if you are not familiar or comfortable with the job.

Also try to imagine where you have failed or succeeded in the past. Are any of those conditions still in place today? If so, you will need to honor them. When people are starting out, they often don't have much flexibility. Do you need to limit work to a few hours a day or a few days a week? Are you able to regularly work in the early morning or afternoon or evening? Again, those issues could be problematic at first.

Do the best you can. I know the current economy has limited most peoples' choices. But you need to decide which of these issues is most important and push for that. That is an individual decision which no one else can make for you. You cannot completely subvert your own needs to your employer's for very long.

11/1/11

Dear Kayla,

I want to write a little bit about taking responsibility.

Most people say it is essential. I agree. Taking responsibility for your life and your treatment is critical. You cannot improve in the long-term relying totally on others. While most people are well-meaning and may be able to help you, no one totally and perfectly understands you and your life. No one can completely understand another person; we are far too complicated for that. Add to that that these well-meaning people may die, retire, or have a crisis of their own, and you will see the need to learn to rely on yourself.

Taking responsibility is a very strong, powerful concept. Like most powerful concepts it has some dangerous applications. Some people use it too broadly as an answer to everything. The assumption seems to be if a person accepts responsibility s/he will immediately achieve enlightenment.
Second, and more troublesome, defining your responsibility can be difficult at first. One trait I had growing up — which I later read was common in disturbed children — is that I held myself responsible for everything that went wrong, including the weather.

For me, the first real step to taking responsibility is therefore to define what I was and was not reasonably responsible for. As I just said, that was not easy. I finally learned to start with what I already knew. I made two columns in my mind: One for things I was clearly responsible for and the other for things I was clearly not responsible for. At first I could only categorize the clear-cut black and white; the rest I ignored. As I grew more used to those two categories, I started to interpret more shades of gray.

I have found that general technique to be useful much of the time. In order to make sense of something, I generally categorize the two clear-cut extremes. Once I have done that, I am gradually able to understand more complicated and nuanced issues.

Good luck.