This much I've learned: Charmaine Williams

This series was inspired by The Guardian’s column “This Much I Know”, in which well-known figures share their life lessons. Here we ask people from a wide range of backgrounds about their experiences of how to live, positively, whatever the situation, or even diagnosis.

Charmaine Williams is the Associate Dean Academic of Social Work and the Factor-Inwentash Chair in Health and Mental Health at the University of Toronto.

I first came across Charmaine through Coursera. Earlier this spring, I took her class on ‘The Social Context of Mental Health and Mental Illness’, which explored how we can position our understanding of mental health and illness within the context of evolving social attitudes and social developments.

I expected to be one of the few taking this course. It turned out there were another 27,000 students (small compared to computer programming, significant compared to social sciences). That was the first surprise. The second was Charmaine’s proactive, and positive, approach to mental health, and mental illness, even when having worked in the field for over a decade.

The following extracts are taken from a recent conversation with Charmaine:

I feel like I waited my whole life to teach the course. Part of that course was an anti-stigma project. At the very least, it starts with a conversation.

I was surprised by how many mental health professionals were in the course. There seems to be a gap, that people aren’t able to access that kind of information in one place.

I was in professional practice in the mental health care system for over a decade. My optimism derives from seeing people come from very difficult places and their lives really changing. I would never know how things could change, and when they could change. But they did. It was a privilege to see how this happened, that people can have a good life again. What is that piece that changes for people?

Most people who experience mental illness go on to recover. Many people in hospital didn’t have to come back. But what does bring those other people back? Their trajectory is different, they could do everything right but other things are happening as well.

I believe there is a biological basis for mental illness. But there are these other things around it. I really believe that the social context can be a part of what brings healing. I’m not dismissive of medications but they are not the whole picture.

The psychosocial piece can be scary for family members. Talking about social environments and psychology can be associated with pointing the finger.

I believe that mental illness can be prevented. That people may have the potential for developing mental illness but it is not inevitable, even in the case of families impacted by mental illness over multiple generations.

Early intervention work is necessary. It makes sense to be vigilant about detecting declines in mental health. Part of early intervention and monitoring is trying to prevent that first episode. I do think there are things people can do – for instance increase resilience to stress, and becoming conscious of early signs of illness, like social withdrawal. We need to think about the wider scope. What are we doing to intervene or disrupt the possibilities for developing mental illness?

Why do some people stay mentally healthy and why do some people get mentally ill? We still need to find a satisfying explanation for why people get mentally ill. Biology is one piece of the puzzle.

If someone has had an episode of mental illness, they can’t take mental health for granted. They have to be careful about taking care of themselves and not get nonchalant about neglecting their mental health, whether that’s not getting enough sleep or not getting enough exercise. They can’t be nonchalant about this, they have to be vigilant. That is the reality of their life. This can mean some grieving for a lost “normal life”. That you have to work so hard to stay well. But it also puts something in your hands. There are things you can do to make a difference.

As a social worker, my area was this social piece. Now as an academic, it’s building the evidence around this.

The position of the social worker in health care is eroding. This piece of meeting with families and people in transition isn’t valued in the same way. It’s on social workers to demonstrate the importance of their work. We need that evidence, of how people can live in communities. We need to activate, and advocate, as a field.

People are talking about mental illness more. People are probably most open about depression, less open about illnesses like bipolar disorder, schizophrenia, etc.

There are people in the field who prefer the term ‘mental health issues’, which can seem muddling, but it seems to be a term that allows us to speak of mental illness. That precision also allows us to distinguish it from physical health. But even then discussing mental health or emotional problems doesn’t seem complete, as it’s not just about emotions or cognitive functioning. It’s all part of talking about health more generally.

There is also now a tendency in the field to refer to the neurological – it’s a more acceptable language that distances mental illness from the ideas of lunatic or asylums.

How we define mental health affects people’s behavior, their attitudes towards themselves, and the way others look upon them.

The National Institute for Mental Health, the Center for Addiction and Mental Health and the Institute for Psychiatry are all doing great research and education. They make information available on what their findings can mean and are trying to create resources that can be useful to an audience.

this much I've learned

This is the first in a series titled “This Much I’ve Learned”, in which different people share how they approach their lives, the coping strategies that work for them, and the people, places or things that help with managing or maintaining emotional and psychological equilibrium. Inspired by The Guardian’s (UK) column “This Much I Know”, in which well-known figures share their life lessons, this series aims to offer a variety of very personal ways into the subjects of well-being and mental health.

The series also makes a trial-and-error nod to that cliché, ‘It’s a process’, but lets go with that here; we’re all still learning, we're all still getting through, we’re all at different stages. Ask the question in a year, and our thinking may be different, or maybe it won’t be, but that will tell us something too. The shape of our conversation around mental health is evolving, depending on who it is with and when it takes place, as knowledge, experience, attitudes and learning shift.

This week I spoke to Alaric Moore, a young writer and social entrepreneur newly based in San Francisco. She is one of the founders of WikiSeat, a maker education initiative based in the city, she contributes to Shareable, writes her own blog, and has been diagnosed with schizoaffective disorder bipolar type II. Here I defer to Alaric; in her own experience and in her own words:

Fuck You Brain/ Brian. ​Artwork by Alaric Moore

I can call myself ‘nutty’, ‘crazy’, ‘special’, or ‘touched’, though it depends on your intention whether you can use these words, too. Generally I prefer the term ‘mental misconduct’.  It insinuates that my mind operates separately from the “norms” that society expects of a mind.

‘Mad’ has connotations of Alice in Wonderland, also anger. ‘Crazy’ is used often enough; its like women reclaiming the word ‘slut’. I can use it, and take it back, like the Pink Floyd song, ‘You Crazy Diamond’.

‘Mental illness’ – urgh. ‘Sick’ is ok as it feels temporary. I get sick, right. ‘Ill’ – no, too dysfunctional, has too much longevity. ‘Mental health’ is ok; I want to be healthy but not the same kind of healthy – maybe ‘mental normative’.

I feel that I need to have enough knowledge to know what to do: If I get sick again, I want to be taken to St Francis. I’ve heard that the atmosphere there is non-violent, with people who are mildly afflicted.  UCSF Inpatient and Outpatient have a reputation for being accepting and open particularly around LGBT. In Oklahoma where I’m from, I had a good experience at the Norman Regional Facility–they let you maintain essential freedoms, like doing your own laundry, which makes you feel more normal, and gives you a sense of daily routine. These little things, that we often take for granted, are incredibly important to helping maintain mental stability.

Dr Hersevoort is a great psychiatrist. I found him on yelp; he gives the full-hour and combines an approach of medications and therapy. I believe his background is in neurosurgery / psychopharmacology. I take Abilify and Lamictal, along with the occasional anti-anxiety med (although the lamictal affects my short-term memory, I’m willing to take it because it helps me greatly).

​Artwork by Alaric Moore

I haven’t yet found a therapist that I like; I’ve looked on yelp for recommendations, visited about 12 for 2-3 times each. CBT is thought to have positive affects on bipolar. I like the more theoretical approach.

I need to remember where to go to get the best help; my mantra is ‘fight to get in’. I’ve discussed this with my roommates and boyfriend, as well my close friends, preparing them for the unfortunate.

It is up to me to help the people around me prepare for a break, to recognize the behaviours that I can exhibit, to take me in to the ER, to hold my hand, and to understand the processes. Then once I’m through the door it’s on me. But I have to make them aware, and I need to know myself, the steps to take to be safe and the best place where I can manage medications, talk about the issues that I’m having and not be judged.

Because I’m likeable, because people like me enough, I’ve found that I’m not judged in the same way as other people who might be mentally misconducting.

I wanted to come out about it; I had an environment that was supportive growing up. It is very important to be vocal about mental health. The atmosphere of millenials is more accepting.​

I’ve found reaching out to other folks on Reddit and Tumblr helpful, as well as the depression forums in the geek community (depression is common amongst these groups it seems). Also meet-ups. Sometimes I attend the Depression and Bipolar Alliance.

​Artwork by Alaric Moore

I like to weld for WikiSeat at CellSpace (Inner Mission); it’s like painting with lightning. I like the act of making, of creating something; it allows me to feel accomplished. I also enjoy burlesque, the dance, choreography, and costumes; it feels like a meditation. When I’m feeling healthy, but have a natural low, I take myself on a bike ride.

Hack-a-thons and the hacker community have been greatly helpful in enabling me to create a community and support network. Many of these people are attuned to the sort of non-normative mind, and are open to supporting differences. As well, there are wonderful, openly accessible events where one is allowed to express oneself in creative ways and to feel agency in the world. Like the Grey Area Foundation for the Arts recent art-hack in December and other similar events.

WikiSeat (http://www.wikiseat.org/about/) gives me some purpose, having things like this to focus on can be helpful. Some cause that is good, no matter how trivially good they may seem, can mean the difference between depression and contentment. 

This Much I Know

Shareable/ Alaric Moore

Alaric's blog