Where to Start

Description

A comforting and useful resource for anyone who’s struggling emotionally and looking for help―from the nation’s leading community-based nonprofit that addresses the needs of those living with mental illness

It can be extremely hard to figure out what’s going on in our own heads when we are suffering—when we feel alone and unworthy and can’t stop our self-critical inner voice. And it’s even more difficult to know where to go for answers.

This book is a perfect first step. Here you’ll find clear, honest, reassuring information about all the most common mental illnesses and what you can do to find help and to practice self-care.

Where to Start features:

• jargon-free information about all the most common mental illnesses, including a first self-assessment test;
• tips on how to get professional help and how to talk about your mental health with friends and family;
• essential tools, including handy worksheets and DIY mental health content; and
• insightful, funny drawings by acclaimed cartoonist Gemma Correll.

“The warm, conversational tone and straightforward, accessible language welcome readers to explore the text as they wish and establish autonomy over their wellness. Readers will find an abundance of beneficial information . . . A valuable, comprehensive manual for navigating mental health struggles.” —KirkusMental Health America (MHA) is the nation’s leading community-based nonprofit dedicated to addressing the needs of those living with mental illness and promoting the overall mental health of all. Their programs and initiatives fulfill their mission of promoting mental health and preventing mental illness through advocacy, education, research, and services. MHA’s national office and its 200+ affiliates and associates around the country work every day to protect the rights and dignity of individuals with lived experience and ensure that peers and their voices are integrated into all areas of the organization.

Gemma Correll is a cartoonist, writer, illustrator, and pug-owner. Her books include A Pug’s Guide to Etiquette, The Feminist Activity Book, and The Worrier’s Guide to Life. Her comics appear on The Nib and Tinyview Comics, and she has created cartoons for Hallmark, The New York Times, Evernote, and Mental Health America. Her merchandise is sold by Badge Bomb and Ohh Deer.
 CONTENTS

HOW TO USE THIS BOOK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

PART ONE: AM I OKAY?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Signs and Symptoms of Mental Health Problems. . . . . . . . . 9
Mood Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Anxiety Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Disorders of Attention           . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Trauma and Post-Traumatic Stress Disorder. . . . . . . . . . . . . . 38
Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Mental Health Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

PART TWO: TALKING ABOUT MENTAL HEALTH. . . . . . . . . . . .59
Prepping to Talk to Others About Mental Health. . . . . . . . . . . 64
Talking to Parents and Caregivers. . . . . . . . . . . . . . . . . . . . . . . .73
Worksheet: Preparing to Share. . . . . . . . . . . . . . . . . . . . . . . . . . .80
Worksheet: Sample Letter to Help Start a Conversation . . .84
PART THREE: GETTING PROFESSIONAL HELP. . . . . . . . . . .87
The What, Why, and How of Therapy. . . . . . . . . . . . . . . . . . . . .90
Online Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Therapy Apps       . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
Text Lines, Hotlines, and Warmlines. . . . . . . . . . . . . . . . . . . . . . . 106
Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

PART FOUR: DIY MENTAL HEALTH. . . . . . . . . . . . . . . . . . . . . . .120
Getting Out of Bed and Struggling to Leave Your Room . . .123
Coping with Panic Attacks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Battling Loneliness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Dealing with Self-Hate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Dealing with Suicidal Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Worksheet: Feeling Safe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Worksheet: Practicing Radical Acceptance. . . . . . . . . . . . . . 153
Avoiding Thinking Traps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Worksheet: Dealing with Worst-Case Scenarios. . . . . . . . . . 168
Managing Difficult Emotions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172
Escaping Toxic Influences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Worksheet: Detoxify Your Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

Final Thoughts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187
Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189

How to Use This Book

There’s no right or wrong way to read this book. Start anywhere you want, and don’t feel the need to read straight through. There might be one section that’s really important for you. It’s okay to go there first.
Read small chunks at a time, and give yourself a period afterward to think, or rest. It takes time to learn new information, so be patient with yourself.
You may want to keep a journal as you read. If you do, write down your thoughts, feelings, and especially your questions.
Skip and skim at will. Read out of order. Focus on the section that interests you the most, or targets the problem or question you’re struggling with.
This is not a how-to book with specific steps to follow. It’s a guide, and the best guides are the ones you come back to at different times for different reasons. In other words, keep it on your shelf for later.
Share it with people you care about, especially sections you think could help a friend or someone you trust to understand and support you better.
Make this book your book. The margins are wide on purpose! Write notes or pictures in them. Highlight the parts that speak to you, or the ones you might want to revisit.
INTRODUCTION
Dear Reader,
Maybe it’s too hard to believe right now that other people can understand what you’re going through. And maybe it’s even harder to believe that they can actually help. It’s hard to trust, especially when others haven’t earned your trust, or when you’re feeling bad and don’t know what to do. But if you’ve picked up this book, you already believe in the possibility that there’s someone out there who can understand. There’s someone out there who can help.
This book is made up of four parts. Each part answers a question. The first question is “Am I okay?” This part of the book will give you accurate information about the most common mental health problems. It’s designed to tell you what you need to know in plain language, without mystery and confusion.
The second question is “How do we talk to one another about mental health?” This part of the book prepares you for having difficult conversations with the important people in your life. Having these kinds of conversations is a gateway to getting help. It’s also a good way to lessen the loneliness and isolation that happens when you suffer in silence.
“How do I get professional help?” is the question answered in part three. Here you’ll learn about different kinds of treatment and who is the right person to provide it. You’ll learn all about therapy—how to find a good therapist and get the most from your sessions—medication, and hospitalization. And you’ll learn about therapy apps, text lines, hotlines, and warmlines.
The last part of the book answers the question “How can I take better care of myself?” In this section, you’ll learn general things like managing difficult emotions and avoiding thinking traps, and specific things like what to do if you can’t get out of bed and how to cope with a panic attack.
A Note on Language
Words matter. Language matters. In this book you’ll find plain language that affirms who you are as a unique person. You won’t find a lot of psychological jargon, and you won’t find research citations or clinical terms. There are plenty of other books that are written that way, and they have very different goals. The goals of this book are simple: to give you good information on how to start taking care of your mental health, and to empower you to take the first steps on your journey to feeling better.
Throughout this book we will use person-centered language. Person-centered language places the whole person above any illness, disability, or label. We will say a person living with schizophrenia, rather than a schizophrenic. We will say a person living with a substance use disorder, rather than an addict. Person-centered language values the dignity and uniqueness of all people. And most importantly, it discourages thinking that a person’s disability or condition is a characteristic of their identity.
A Note on Beginnings
Reading this book means you are taking a step toward healing. You are starting the journey from isolation to connectedness, from feeling lost and hopeless to the beginnings of self-confidence and stability. The journey may be long and difficult. You may need to work through painful emotions and learn new skills. At times, you may feel like the work is too intense, too challenging. But you can do this! And remember: Positive changes happen when we speak honestly about what we are feeling and what kind of support we need. The journey is worth it. You are worth it!

          PART ONE

AM I 
OKAY?

Signs and Symptoms of Mental Health Problems
For a moment, try to think about your mental health the way you think about your physical health. We all have good days and bad days, and ups and downs in our physical health. This is totally normal. Some days you might feel a little tired, sore, or under the weather. That doesn’t necessarily mean you’re sick. You know you’re physically sick when you notice that something has changed for the worse—you were feeling fine, but today you have a high temperature and you’ve lost your voice. Something prevents you from functioning properly. Things that are normally easy now feel a lot more difficult. Maybe it’s even bad enough that you can’t make it to school or work.
Mental health problems are similar. Good days and bad days. Ups and downs. The difference is that instead of looking for physical symptoms, like a runny nose or an upset stomach, you’re looking at your thoughts, feelings, and behaviors. Here are some examples of things that might tip you off:
You used to be really cheerful and outgoing, but lately all you want to do is sit in your room.
Things you used to enjoy have lost their appeal. Food doesn’t taste as good as it used to, and all your favorite music sounds boring.
You’re falling asleep in class or at work. It’s hard to pay attention, study, and keep track of your assignments.
Your friend is talking and you’re trying hard to listen, but you can’t concentrate. All you can think about are bad things that might happen to you.
You’re having thoughts of death, or of hurting yourself, or of killing yourself.
You can’t leave the house without organizing and aligning your shoes and clothes. You do this so much that it’s making you late for school.
You’re always irritated, and you can’t stop snapping at people.
Recently you started hearing voices that no one else seems to hear.

Maybe just one of these applies to you. Or none of them. The important thing is to notice any change in your thoughts,feelings, or behaviors that makes it harder for you to go about your daily life.
Getting Better
Before we go any further, it’s important to remember that no matter what kind of mental health problem someone is facing, it is always possible to get better. Don’t forget this! Finding help is important. Connecting with others is important. So is being kind to yourself and trying not to judge yourself too harshly.
Do I need to put a label on it?
Let’s talk about labels, or what to call the different kinds of mental health problems.
The label a mental health professional uses to talk about a specific mental health condition is called a diagnosis. An example of a diagnosis might be “generalized anxiety disorder” or “bipolar disorder.” There are a lot of diagnoses that describe different mental health conditions—they go way beyond just “depression.” Some people feel comforted to know that there’s a name for what they’ve been experiencing. Other people don’t like it; they might feel that the diagnosis is too medical and doesn’t leave room for who they really are as a person. Both views are okay, and you can decide for yourself where you stand.
This part of the book discusses the symptoms of the most common mental health conditions, but keep this in mind: You don’t need a diagnosis to get help. Some therapists actually prefer not to diagnose their clients. And even people without a diagnosis or even a serious mental health problem can benefit from therapy. But for many people it can be helpful to have a name for what you’re going through. Labels are there to help you, not limit you or keep you in a box. With the right diagnosis it can be easier to find helpful information online, to get the right kind of treatment, and to connect with other people who have had similar experiences.
So how do I find out what I have?
Sometimes people can get a good sense of what condition they might have from reading about it online and talking to people who have had similar experiences. But it’s easy to get carried away. Ever use WebMD to check your physical symptoms and come away thinking you must have some rare disease? Mental health conditions can be the same way.
A good starting point is to take a mental health screening test, and we’ve included one at the end of this chapter. You can use your results to start a conversation with your friends and family, and to monitor your progress over time.
Eventually, if you want to be officially diagnosed, you’ll need to meet with a doctor or therapist. They’ll ask you questions and use their training and experience to determine whether your symptoms meet the criteria for a specific diagnosis. If you want to do this, try to meet with someone who specializes in mental health, like a psychiatrist, psychologist, or a therapist. Your regular family doctor can diagnose common conditions such as depression, anxiety, and ADHD and can refer you to a specialist if they think it’s needed.
Keep in mind that even mental health professionals aren’t perfect. If you’ve been diagnosed and you don’t think it’s accurate, it may be a good idea to get a second opinion. And remember: A diagnosis doesn’t define you—it’s just a way of connecting you with more specific help.

Mood Disorders
DEPRESSION
Feeling sad is a normal human experience, but feeling sad too much of the time can cause distress and major life problems. You might withdraw from your family and friends, have a hard time in school or work, or feel overwhelmed by activities. When too much sadness affects your life, you might have depression.
Depression is a type of mood disorder. Mood disorders occur when changes in mood go way beyond the normal ups and downs of everyday life. Episodes of depression last at least two weeks at a time, but sometimes they can last for months or even years.
One of the difficulties in talking about depression is that it shows up differently from person to person. When you read through the following content, you’ll see that one person with depression may sleep too much, while another may sleep too little. Don’t let this confuse or overwhelm you. It just means that everyone is different, and mental health conditions are caused by many different factors. Thus, they can present differently.
Many people make the mistake of thinking that depression is a choice, or an expression of someone’s personality. While making good healthy choices is important, there are many other factors that determine whether or not someone develops depression, such as genetics, trauma, medications, or medical conditions. It can be difficult to pinpoint the cause of depression because sometimes it’s not just one thing that is triggering your mood. Depression can affect anyone. Regardless of your life circumstances, if you think you might be depressed, the sooner you seek help, the better off you’ll be in managing it. You may feel undeserving of the help or that other people are worse off than you, but that’s flat-out incorrect. You totally deserve to get help and feel better.
How do I know if I’m sad or depressed?
Depression is about being sad, but it’s much more than that. Depression involves a lot of other symptoms, like feeling exhausted much of the time, losing interest in activities you normally enjoy, or thoughts of death and suicide. Episodes of depression last at least two weeks at a time. They can be triggered by a sad or disruptive event or they can come out of nowhere.
Sadness, on the other hand, even extreme sadness, can be a normal reaction to things like a breakup or losing a loved one. That said, regular sadness can turn into depression. If the feelings don’t get better over time, or if your mood starts to get in the way of your daily life, you might be developing a case of depression.US

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