Destigmatizing Mental Illness: Mental Health Facts and Myths

I never could have predicted what an amazing response I received when I wrote about hospital stays for mental health reasons. Friends, family, and strangers offered words of support, encouragement, and gratitude. It's amazing to hear that my experiences with mental illness and hospitalizations has connected with others.

Reading all those kind words made me feel that we as a society are on the right track when it comes to how we talk about and deal with mental illness. Although there is still a great deal of stigma surrounding mental health, things have definitely improved since my first hospitalization in 1998.

While there is still a long way to go, there are factors that have lead to the destigmatization of mental illness. Schools have taken steps to inform teachers and students about mental health issues. In Minnesota, teachers need to take a class every five years on recognizing early signs of mental illness in students. The internet has also broadened social circles, making it much more likely for individuals to know or read about someone with a mental illness. Additionally, the Web provides an easy opportunity to learn about mental health.

While awareness has improved, there's still a lot of work to do. Even though people may know someone with a mental illness, misconceptions and assumptions about mental illness persist. In my posts about hospitalizations, I linked to Mental Health Myths and Facts from the U.S. Department of Health and Human services. I highly recommend checking it out, especially if you feel like you don't know much about mental illness, or if you feel like you don't know what to say or do around someone who has a mental illness.

If you, your families, or your friends believe any of these myths, that's OK. It's not until we recognize our beliefs, conscious or unconscious, that we can change them. The article above does a great job at explaining and debunking myths. I've had experience with each of these myths, so I wanted to share my thoughts.

After that long introduction, here's the first myth and my experiences around it (All these myths are quoted directly from www.mentalhealth.gov):

Myth: Mental Health Problems Don't Affect Me

This myth is really two myths rolled into one. First, mental health problems are different than mental illness. We all experience mental health issues. I can remember the first time feeling really guilty as a kid. I'd lied to my parents and started feeling really guilty. The guilt gave me a sick feeling in my stomach as I lay in bed, unable to fall asleep. I finally went to my parents' room and told them what I'd done. They forgave me, and I asked, "Did you ever lie to your parents?" My dad told me about how he'd broken a rake when he was young and lied to his parents about it, and I instantly felt better.

How is that a mental health issue? Guilt can be both a contributing factor and a symptom of depression. While guilt is a healthy emotion that often leads to more ethical or reconcilitory behavior, unresolved, unnecessary, or excess guilt can be a factor in depression.

I've often felt guilty about things out of my control. I can't help having a mental illness. I can't help that I'll be hospitalized at times. I can't help that I have to take medication to keep me stable. These are not things to feel guilty about, and when I do it only puts me in more of a downward spiral.

And guilt is just one of many emotions that can negatively affect mental health. Anxiety, mild depression, loneliness, and anger are things we all experience. When these emotions linger in an unhealthy way, problems with mental health can arise. An extreme, persistent excess of any of these emotions may indicate a mental illness or a need for therapy.

We all deal with mental health problems. It's healthy to recognize this, and to be supportive and encouraging of others who deal with mental health issues or mental illness.

If you're feeling like negative emotions are getting the best of you, tell someone. There's no shame is asking for help. And if you know someone who seems to be suffering, encourage them to find help. Untreated mental illness can lead to a downward spiral,

Race Schedule: 2017 / 2018

2012 Lake Wobegon Trail Marathon

 I've been waiting for almost two weeks to see if and how the PNC Milwaukee Marathon organizers are going to adjust my marathon time based on the fact that the course was 4200' short. I've sent them an email, but haven't heard back. To take my mind off that debacle of a race, I decided to plan out my next season of races. I haven't finalized my schedule yet, but as of now here are some of the major races I've penciled in:

Eagan Parkrun:
I'm going to keep going at this one. I'm following a little training plan from McMillan Running to try and break that elusive 17 minute barrier. For a while I had the course record and then was tied for the course record at 17:14, but that was recently blown away by a runner who clocked 16:24, so a course record is definitely out of reach for me this season (and, let's be honest, probably ever). I thought about finding a flatter, faster 5k to aim for that sub-17, but the Parkrun is free and it'd be good to break 17 on a tough course.

I don't have dates set in stone for when I'm running this one again, but I'll probably shoot for the end of November and the beginning of December to aim for the sub-17.

Pensacola Beach Run:
My in-laws are renting a condo down in Florida for the month of January, so Laura and I are going to visit for a week and do a half marathon while we're down there. I don't have any set goals at this point, but based on the results of the last few years, it'd be cool to finish in the top five.

MDRA Races:
I'm hoping to get a good gauge of my spring fitness by racing several spring Minnesota Distance Running Association races: The Lake Johanna 4 Mile, the MDRA 7 Mile, the Ron Daws 25k, the Fred Kurz 10 Mile, and the Mudball Classic 4 Mile.  I'm not sure which all of these I'm going to run (I'd love to do all of them, but I doubt that'll happen). There are several that come free with the MDRA membership: The Lake Johanna 4 Mile, the MDRA 7 Mile, and the Mudball Classic 4 Mile. The others are are very reasonable -- the Ron Daws 25k is $5 with an MDRA membership, and the Fred Kurz 10 Mile is only $10 with an MDRA membership.

I'm mainly going to be racing these to stay in race shape and test my fitness, but it'd also be cool to set a PR at a couple of these distances.

Lake Wobegon Trail Marathon:
I've been looking forward to doing this one again. I ran a 3:02 at Wobegon in 2010, my first Boston qualifying time. I've said that this past year was my last try at setting a PR in the marathon, so I'm not going to approach this one as hardcore as I have in the past. This winter I'm going to train for less time -- training for a PR marathon was putting me in the ten hour a week range between runs and core exercises. So, I'm going to be running significantly less, and am going to focus more on supplemental exercises and improving my muscle balance.

Afton 50k:
This will be my third time running this race. As of now I'm planning on camping with some running friends and doing the race the next morning. I'd love to set a PR at this one, but finishing a 50k is a decent accomplishment, PR or not.

Surf the Murph 50 Mile:
If I finish, guaranteed PR. It'll be my first 50 mile, and I'm definitely looking forward to it. Since I'm no longer going to try to set a PR in the marathon due to the time it eats up, I'm going to keep my training for the 50 mile reasonable. I'm not going to commit as much time during the week as I did when I was training for a marathon PR. Instead, I'm going to bunch my training on the weekends when we have more free time, and get longer mileage in then.

I'm also planing on doing an indoor mile race this coming December -- I think the only one in the twin cities is the USATF Minnesota All Ages Indoor Track and Field Meet on December 17. I haven't given up my goal of setting a new indoor mile PR, but honestly the odds are not in my favor. I'll be coming out of marathon training where I never did workouts faster than 5k pace, and I'll only have about five weeks to get some mile specific work in before the race.

I'll probably also pace a handful of races. I really enjoy pacing -- not only do I get to help other runners reach their goals, I also get a long run in with the bonus of not having to carry water and/or sports drink with me. I'm thinking I'll probably pace two or three half marathons this year.

PNC Milwaukee Marathon: Race Report

This race report will get at least one update, but it won't be a three-parter like last year's (read them here if you're so inclined). I'll just get most of the negativity over first, then write about how my race went.

First off, I talked with a speaker at the expo about how the course would be marked since I missed the turnaround last year. "On thing we learned from last year," he said, "is that we needed to mark the course better. This year there'll be way more markers." He wasn't wrong. There were a lot of cones marking the route, but unfortunately there were several spots where it wasn't clear which way to turn.

Around mile 8.5 the course came to a Y at the bottom of the hill. A right turn brought you on a sidewalk toward a bridge and a left turn brought you on a paved path along a river. I didn't know which way to go, so I stopped, turned around, and yelled, "Do you know which way?" to a runner twenty yards behind me.

"I don't know," he said. Then he shrugged and said, "maybe right?" We turned right, and fortunately he was correct. There was at least one other spot I had to guess. The route went through some city parks, and the trails would sometimes come to an intersection and you really needed to look ahead for the next cone since it wasn't always clear which way to go. There was also a spot where a volunteer had to yell at me that I was turning the wrong way.

So while the turnaround at least had cones and a volunteer this year, there were actually more spots with the potential to get a runner off course. I read on the PNC Milwaukee Marathon Facebook page that several runners ran off course. If getting enough volunteers to direct runners at turns was an issue, most places where it was confusing could have been solved by simply having an arrow pointing which way to turn. Although there were tons of cones, I don't remember seeing a single arrow to mark a turn.

OK, negativity over for now. The actual race went well. We started at 6:30 a.m., about half an hour before sunrise. It was a little chilly waiting for the race to start due to some very gusty winds, but the air temperature was almost perfect at right around 60*. Throughout the race the temperature dropped until it was down in the low 50s -- perfect for a marathon.

The tough part about the weather was the wind. The course was a loop, so there was a decent amount of tailwind, but at some points the headwinds were ridiculous. There was one section about half a mile long that went through some buildings and it was an absolute wind tunnel.

Despite the wind, I did enjoy the course. It's by no means a flat, fast course -- too many hills and turns, but there's a good amount of variety. Although there are a lot of hills, most are just rollers and the longer ones have pretty gradual inclines.

The course also does a nice job of going through the different areas of Milwaukee. There are some great views of the lake, some nature areas, historical neighborhoods, and landmarks like Miller Park, MillerCoors brewery, and Harley-Davidson.

I wasn't sure what to expect going into this race. I hurt my right foot a few weeks previously, and had been dealing with some peroneal tendonitis in the opposite ankle that wasn't getting any better, so I finally went to physical therapy. Thankfully the physical therapist cleared me to run, but told me not to expect a PR. I definitely felt some pain in both the right foot and the left ankle, but I don't think they really slowed me down.

Although I knew my foot and ankle would hurt, I tried for a PR anyway. I went into the race with a plan to start out slower than goal pace and then speed up until I was on target by the half marathon point. My mile splits weren't perfectly even, but I generally sped up as the race went on. I got a nice pick-me-up at mile 21 where Laura and Calvin were waiting for me. They were at a great spot because they saw me right as I was headed on the out portion of the out and back section of the Hank Aaron trail, so I got to see them twice.

Blowing kisses to Laura and Calvin

I was feeling pretty good when I went by Laura and Calvin and headed for the turnaround on the Hank Aaron Trail. Unlike last year's race, this year there were a ton of cones and a volunteer at the turnaround. I went around the cones, and despite being at the point of the race where the fatigue starts to set in, my legs still felt good and I was still on pace for a PR.

My watch ticked past mile 22 and I started to wonder just how far off it was going to be on the mile 22 marker. Last year the course was long, and I was hoping that wasn't going to be the case again. Finally, I saw a mile marker up ahead and looked down at my watch. I was almost at 22.5 miles -- I didn't expect to be that far off of mile 22. Then, I got closer and noticed that it was the mile 23 marker. I hadn't seen a mile 22 marker at all.

After that, things are kind of a blur. I don't remember the scenery much, and I know I passed two other runners, but I don't remember where. I hit the mile 24 and 25 markers and they were still half a mile short. I was holding onto hope that the final distance would be correct, but it was not. When I went through the finish, my watch read 25.69 -- not even close to a full marathon distance of 26.2 miles.

I was pretty chilly after finishing, so I put on some warmer clothes from my drop bag, found Laura and Calvin, took a couple pictures, then got my post-race beer. Later, I confirmed on the race's Facebook page that many people had found the course to be short.

Today I got a email from the race organizers confirming that the course was in fact short by about 4,200 feet. There was some miscommunication about the course map and markings, and the turnaround was placed in the wrong spot.

I did some math, and depending on how the organizers decide to adjust times, I may have a new PR. I ran 2:45:03 for the short course. If they adjust the times by simply adding on the 4,200 feet and multiplying by that pace ran through the finish, then my adjusted time will be about 2:50:14, a twelve second PR.

We'll see what happens. I'll keep you in the loop

Run well.

PNC Milwaukee Marathon: It's Goal Time

After the 2016 Milwaukee Marathon

Last year I was aiming for a shiny new PR at the PNC Bank Milwaukee Marathon, and if the course had been properly marked and measured, I would have had it. I will say, however, that the race organizers did right by me and refunded my entry fee.

This year I'm giving it another shot. Here are my goals:

A. Set a new PR. That means running under 2:50:26

B. Run under three hours

C. Run under 3:05

D. Finish the race

This race is going to be interesting. There are several reasons why I feel like I can meet my "A" goal. First, my training went pretty well. I had a lot of solid workouts, and got a tempo run, speed workout, and long run in every week but one. My mileage was high, and I averaged over sixty miles a week from July 10 to October 1.

There are also several reasons why I might not meet my "A" goal. My speed workouts went well, but my tempo runs were a little slower than before I ran the Milwaukee Marathon last year. Also, I'm a little banged up after smashing my right big toe against a median, as well as having a little tendinitis in my left ankle.

So I don't know what's going to happen. I'm going to try to go out at a conservative pace and slowly speed up to hit the half marathon split right around 1:25:00.

Thanks for all the support and well wishes.

Run well.

Hospital Stays

Twin Cities Marathon the day I was discharged

One year ago this week I was in the hospital (read about it here). It was frustrating because I had been hospitalized just over a year earlier, and before that I hadn't been hospitalized for over eight years. Late summer and early fall are often difficult for me as I tend to experience symptoms of bipolar disorder. Last year it was a depressive state, and in years past it's been mixed states, hypomanic states, and manic states. Read more about it here: Bipolar symptoms and causes - Mayo Clinic.

It'd been a goal to stay out of the hospital ever since my first hospital visit when I was fifteen, back in 1998 when I was hospitalized with an unspecified mental illness. I made it from 1998 until 2002 without being hospitalized. Then, in 2002 I received an official diagnosis of bipolar I, and after being on a consistent medication regiment, I went from 2002 until 2007 without a hospital stay.

Two thousand and seven was my first stay for a major depressive episode. I didn't have health insurance, and I'd stopped taking my medication. At that time my medication cost over $300 a month, and I thought I could make it without it.

Sharing my hospital stays with others had always made me anxious and embarrassed in the past. I didn't want too many people to know about my condition, fearing they would think less of me or treat me differently. Now, I realize my amazing circle of professionals, friends, and family has been nothing but supportive. Instead of making me feel guilty or embarrassed, they've helped me feel loved, supportive, and accepted.

The stigma of mental illness is still real. Following the tragic shooting in Las Vegas, cries have gone up from celebrities and politicians to, "improve access to mental health care." While improving access to mental health care is important, we shouldn't do it because we're afraid of violence from the mentally ill. According to the U.S. Department of Health and Human Services:

"The vast majority of people with mental health problems are no more likely to be violent than anyone else. Most people with mental illness are not violent and only 3%-5% of violent acts can be attributed to individuals living with a serious mental illness. In fact, people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population." - from MentalHealth.gov

I get it: mental illness can be scary. People with depression can wind up in a place where they are hurting themselves or threatening to hurt themselves. People with schizophrenia can hear or see things others can't. People with bipolar can talk nonstop or share delusions of grandeur.

Though these things can be scary (and in some cases it's appropriate to be scared), the illnesses and the people with these illnesses need not be stigmatized. Part of of stigmatization is silence. I was ashamed of being hospitalized for a long time. I felt I'd failed at keeping myself stable, and although there are factors I can control when it comes to mitigating, coping with, and preventing episodes of  hypomania, mania, and depression, some factors are out of my control.

Higher levels of stress, seasonal changes, and medications that just stop working are all things out of my control. Anticipating and planning for these times are in my control. I'm not perfect at managing, but I try. Still, as much as I work at it, there have still been times when I need to be hospitalized, and there's always a possibility I'll need to be hospitalized again.

Part of breaking the stigmatization for me is being more honest about my condition. It's a difficult balance between oversharing and staying silent when I need help or when I hear people talking about mental illness in a stigmatizing manner--especially when I'm dealing with a high or low patch.

Thankfully, I've been blessed beyond measure with people who love and support me. A year ago when I was in the hospital, I was visited by the pastor of my church, and my wife, and received many phone calls from friends and family.

Mental illness, along with hospital stays, need not be stigmatizing. While some people may create a distance in a relationship when they find out I've been hospitalized for a bipolar cycle, most offer nothing by caring, support, and prayers.

Are there times when I get well-meaning but unwanted advice? Sure. But for the most part all people have offered is a listening ear or asking what they can do to help. And that's usually all someone wants when they're dealing with mental illness -- someone to listen and to support them.

Thank you to all my readers. Knowing you read what I write and know me through this blog makes me feel listened to and appreciated. When I have strangers come to me at a race and talk to me about my blog, it always makes me grateful. And when I hear from friends, family, running buddies, and acquaintances commenting and offering encouragement, I feel supported and cared for.

No hospital stay this October.

Run well.

Peak Week(s) Part 2 - Dances with Medians

I started writing about the second toughest week of my training cycle, but then I thought, who wants to read a glorified training log? What people really want is gore. So gore it is. I drew out the story a bit to give it some drama and stuff. Feel free to skip to the end if you're more interested in the workouts I did the two and three weeks weeks before my marathon.

My first hard workout of the week was on Tuesday. I wanted to watch the Burnsville High School Cross Country Team race that afternoon, so I decided to get my workout done before work.

My run started before 6 AM, and that means it's dark. It was also raining, so I didn't even get that predawn light. I put on a headlamp to deal with the darkness, and a hat to deal with the rain.

The workout involved running two 3.5 mile intervals at 5:55 / mile with one mile of easy running in between. I usually plan my routes to avoid as many stoplights as possible, so I ran an out and back that only had two intersections with lights.

The run was going pretty well when I came to the intersection of Diffley and Johnny Cake Ridge Road. I was about to run a section of Diffley known by runners and cyclists for its lung bursting hills. I needed to go east on Diffley, then south on Pilot Knob (don't we have awesome street names in Eagan?), so I had to cross Diffley.

I could have waited for the light at Johnny Cake and Diffley, but I was in the zone. I decided to turn left on Diffley since the light was red. Then, I could have just waited for the light at Pilot Knob and Diffley, but I figured there was a good chance that would be red too.

There was no sense in breaking my rhythm, so  when I came to a side street I looked back and forth for traffic before crossing. I turned right when I got to Pilot Knob, then turned around back toward Diffley. The light to cross Diffley was red, so I turned left again and figured I'd cross at side street again.

Halfway between Pilot Knob and Johnny Cake there was  a side street. Traffic was clear, so I started to cross. I looked across the street and noticed the side street didn't go through. There's probably a median, I thought, so I shined my headlamp in front me toward the street, but unfortunately my right foot found the median before my headlamp.

I was running fairly fast at that point -- faster than 10 mph, so I stubbed my right toe really hard. I fell face first, mostly on my right forearm, and landed flat in the street. I was able to get back up pretty quickly and resume my run. My foot hut pretty bad and I could tell I'd scraped my forearm and cut my hands.

Thankfully my foot stopped hurting after a few minutes and I was able to continue my workout. When I got home, Laura was in the kitchen. "I think I hurt myself," I said. I showed her my right forearm -- it was pretty torn up. Blood was oozing out of a patch 2.5" long and 1.5" wide starting from my elbow and then in another 3" X 1" section from the middle of my forearm to my wrist.

I also had some road rash on my thighs and scrapes on my hands, but miraculously my chin didn't get cut. My post-run shower was excruciating as I scrubbed street dirt from my wounds. The next day we discovered sand in the bathtub, and after some detective work we realized it had probably stuck to me when I fell in the street and had been rinsed off in the shower,

My running suffered a little the next few days. I did a little jogging at the cross country meet the evening after my fall, and my foot was really bugging me, which made me change my gait, which made my left knee start hurting.

I probably should have taken Wednesday off -- my foot hurt was sore that morning, so I skipped the run. That afternoon, however, my foot was feeling a little better, so I went for a very slow run pushing Calvin in the jogging stroller. I had a streak of over 80 days in a row of running, and I didn't want to break it.

The knee was bothering me through Friday, but fortunately it started feeling better by Saturday. The foot still hurt a little, but it wasn't affecting my running too much.

This past Sunday was my last hard long run of this training cycle. I made it 16 miles with the last eight at marathon pace.

Here's how my peak weeks broke down:

Week 1 Workouts

•  9.7 miles with 10 minutes at 5:50 / mile, 6 X 400m at 5:25 / mile, 10 minutes at 5:50
• 10 miles with 8 miles at 6:30 / mile
• 20 mile long run with a 5k race
• 82 miles total for the week

Week 2 Workouts

• 9.4 miles with 2 X 3.5 miles at 5:55 / mile pace and a trip and fall
• 11.5 miles with 8 miles at 6:30 / mile pace and 2 miles at 5:52 / mile pace
• 16 mile long run with last 8 miles at 6:29 pace

Endurance and Dehydration

I touched on how tough my long run was during my first peak week. The heat index was 88*-- way too hot for the end of September.

Running in the heat really got me dehydrated, and I started to feel nauseous after the run. I thought I'd drank enough -- two full 16 oz bottles of water and a 20 oz Gatorade as well as two stops at a water fountain. Still, it wasn't enough.

I make a habit of weighing myself right away in the morning and then again after a workout to see how much fluid I should replace. I'd lost around nine pounds. It isn't unusual for me to lose 4 - 5 pounds during a long run in the heat, but considering I'd drank a fair amount, nine was pretty high.

Nine pounds might sound like a lot, but elite marathons much lighter than me have lost more. Haile Gebreselassie is reported to have lost 12.5 pounds (almost 10% of his body weight) during the Dubai Marathon in 2009, and other marathoners have lost similar amounts. You can read more about it in, "How Much Do Champion Marathoners Sweat and Drink" from Runner's World.

Traditional advice has been, "if you wait until you're thirsty to drink, you're already dehydrated." In fact, it's actually more dangerous to drink too much water. Hyponatremia is a condition caused by over consumption of water. Your blood sodium can drop dangerously low, and you could experience symptoms like seizures, confusion, or even death. Read more about it in, "Tim Noakes on the Serious Problem of Overhydration in Endurance Sports."

Which brings me back to my run long run in the heat. Since I first read about hyponatremia, I started drinking more to thirst, but I found like I still wasn't getting quite enough fluid. Now, I drink just a little bit more than I'm thirsty for, and I seem to feel better. During the long run in the heat, I didn't have quite enough water to keep up with my thirst. I retrospect, I should have stopped at the water fountain a few more times.

When I got home I was planning on drinking some chocolate milk to replenish lost fluid, carbs and protein, but I didn't think milk would sit well, so I drank some water and Sprite. Unfortunately, it didn't stay down. For the next hour and a half, I tried really hard to keep from throwing up, but it just kept happening. Fortunately, the Sprite started to go down, and then I could start drinking plain water.

So the next time you're working out, remember that thirst is a pretty good indication of how much you should be drinking.

Run well.