On Things that Ground

Mental illness seeks to kidnap me. To take me to that nightmarish state of psychosis, to disconnect me from reality and the things that would help me. To this end, it’s important for me to have grounding techniques, things I can do to keep myself firmly planted (i.e. grounded) in reality, in the present moment. These techniques keep my malfunctioning brain from taking control and leading me into the ethereally terrible places it’s wont to take me.

Outlined below are the 8 most effective techniques I have. They include: writing, the Mandatory Bi-hourly Break, smoking, walking, music, playing with physical objects, coffee, and medication.

My dog, Kerrin, is probably the ultimate tool. Having her sit in my lap and lick my face usually lifts me from the grips of psychosis almost immediately. Different things work at different times and there are practical considerations to make. I’m limited to feeling objects when I’m at church and it’s hard to brew coffee when I’m sitting in a car during rush hour. It’s good to have as many grounding techniques as possible because of this and because sometimes a particular grounding technique will work and other times it won’t. Generally speaking, the more tools you have at your disposal the better off you are. Sticking to just one means you’re more likely to be taken by the grips of mental illness when your tool fails, and they do fail.

Some notable things that don’t usually work for me are drawing and painting, playing video games, reading, and working on computers. These things take a certain amount of intellectual prowess; something I don’t often have when I’m sick or about to become sick.

When I’m sick, they frustrate me and can often makes things worse rather than better. Video games remove me from reality and can cause me to lower my defenses. Still, it can be good for me to play them as a distraction technique as long as I’m firmly rooted in reality. Drawing and painting are somewhat unique in their not helping me, given that art is a passion of mine. I’m extremely anal about making art so, if it doesn’t go well for me, if I’m not making the lines I want to make, it can drive me toward psychosis or dissociation even faster. For this reason, I only draw and paint when I’m feeling healthy and rarely as a means to ground myself.

It wasn’t always like that. When I was in college, making art was one of the only ways I knew of to ground me. I would make drawing after drawing on large pieces of newsprint while my brain tried so desperately to remove me from reality. Somewhere along the line, though, it became detrimental to my mental health because I became so obsessed with making every drawing perfect.

1. Writing

Writing remains very grounding because I have a much healthier attitude toward doing it. I don’t seem to require myself to be perfect at it – I can allow for crummy writing. Perhaps because I know I won’t necessarily be sharing it with anyone, I have the attitude that I’ll only share what’s good instead of wanting to share everything. Or perhaps because I realize (on a deeper level than with drawing or painting) that even crummy writing can serve a useful purpose. I’ve given myself permission to write terrible things as opposed to drawing/painting where I feel I have to make every piece perfect.

I’m probably still a little self-conscious about my drawing. I’m a good artist, but I’m not the best and having a sketchbook full of bad drawings can be embarrassing for me. It’s important for anyone to have a means to express themselves and it’s especially important for people with mental illness to have such an outlet because we experience some truly horrendous things.

Psychosis is like a poison, it has to be syphoned out, it has to be removed. And making art is the perfect way for me to remove that poison.

To remove that poison as quickly as possible I carry a notebook and pen with me wherever I go so I can write down what comes to my mind. It’s useful not only for helping me manage my illness but also because inspiration can come at any moment and being prepared for that moment is crucial.

Writing is one of the main things I do – I feel as though I were put on this planet to write. So there’s a certain security in knowing I can write whenever I want to. I think I’m more a writer than I am a painter or draftsman. Drawing and painting so often frustrated me that I wonder if my hiatus from it hasn’t been one of the reasons for my drastically improved mental health of late.

2. The Mandatory Bi-hourly Break

My Cognitive and Behavioral Therapist (CBT) is the one who instituted this rule. When I’m awake, I take a break from whatever I’m doing every two hours to give my mind a rest and to allow myself to reset. I usually smoke during these breaks (more on that in the next section). Sometimes I’ll take Kerrin for a walk around the block but most often I sit on the stoop outside my apartment and watch the world go by as Kerrin lays in the grass.

I have the tendency to become obsessive about what I’m doing. My tenacity is useful when I’m working on a particularly difficult computer problem or when I’m writing something that’s particularly hard to express clearly. My tenacity is essential for me to live with my illness, but that tenacity can backfire on me if I don’t take my Mandatory Bi-hourly Break. The Break gives me space to think about other things, the Break allows me to experience the world outside and enlargens my awareness of the world around me. Living in a 350 sq. ft. apartment, the world can seem mighty small; so sitting outside and watching the people go by is especially helpful.

I’ve been trying to institute the rule of getting outside of my apartment for at least 30 minutes once a day as my schedule permits. I’m right next door to one of my favorite coffee shops so it’s incredibly convenient for me to lock up my apartment and go over for a cup of coffee and focus on being present. It’s proven difficult at points, going places can be especially difficult for me sometimes even with the convenience of such a short walk to Pablo’s. It’s hard to explain what’s so hard about it – it just is and it’s one of the many things I’ve had to accept about my life with schizoaffective disorder.

“Being present” is one of the keys to grounding exercises. Mental illness wants to tear me away from reality, to inject me into this “other” place that’s often traumatizing. The Mandatory Bi-hourly Break is a way to prevent my illness from taking hold of me, it’s a way to stay on top of the illness and avoid psychosis altogether. I stick to the Break almost religiously – it doesn’t matter what I’m doing; I could be writing, listening to music, reading, or hanging out with a friend but, every two hours, I roll a cigarette and head outside to experience the world beyond my apartment.

3. Smoking

Smoking is a filthy habit – it leads to all sorts of health problems: heart disease, cancer, and emphysema being only a few of them. But I have my psychiatrist’s blessing when it comes to smoking. I have this blessing because cigarettes help calm me down so effectively and it’s the perfect thing to do during my Mandatory Bi-hourly Break from whatever I’m doing. I’m by no means saying everyone with a mental illness ought to take up smoking – my intention is merely to point out something that helps me.

There’s a ritual to smoking – getting my tin of tobacco down from the shelf in the kitchen, rolling the cigarette (which is a ritual in and of itself), getting Kerrin ready, and going outside, lighting up and inhaling and exhaling while watching the world go by. Going outside, more than the nicotine fix, is probably what helps most. It reminds me there’s a whole wide world out there and gets me talking with my neighbors or the maintenance people in my building. I’ll oftentimes end up talking to passersby – they’ll comment on Kerrin or ask for directions to a place to eat, or ask me how much money I spend on rent (which is probably the most frequent question).

Smoking, on a chemical level, reduces stress – it’s a quick pick-me-up which allows me to center myself and forget about the car ride I just experienced or the doctor’s appointment I’ve just had.

Living on my own means it’s so easy for me to get trapped in my own little world. Reality starts to become skewed and I forget the order of things. I forget there’s even a world outside my door at all. Getting outside by smoking has become especially helpful after I got rid of my Facebook and other social media accounts. No longer having such a huge distraction on my phone means I can focus on the daily hum of activity in my neighborhood. So, much more than smoking, I would recommend getting off the phone and getting outside.

4. Walking

Walking was one of the earliest things I discovered that helps ground me. Every day, I take an hour long walk – about two miles worth of walking.

One of the reasons I wanted to get a dog was to walk by myself. Prior to Kerrin, I was only able to go on walks with other people and so I depended on my dad to walk with me when he got home from work. It often backfired and I’d turn into an anxious mess, desperate to get outside but unable to because my dad wasn’t home yet. Since getting Kerrin, I’ve been able to walk by myself where ever I need to go – even if I don’t have her with me. Kerrin served as my training wheels for walking by myself. Successfully walking with just her taught me that it was totally possible for me to walk by myself and since then I haven’t always needed to take her with me wherever ever I go.

My dad and I still walk together, he works 4 blocks away from where I live and it’s nice for us to see each other.

Exercise releases endorphins and those endorphins help people feel happier. My psychiatrist has told me that 30 minutes of exercise (even something as low key as walking) three times a week is beneficial for depression and managing mood for those with bipolar disorder.

But, beyond the exercise are all of the “side effects” of walking. Walking takes me places, it expands my world. I get to see other parts of the neighborhood I live in. Sometimes my dad and I walk to a nearby park and hang out and chat for a few minutes, other times we try to walk as far as we can in the hour we have before my dad has to be back at work.

Going different places and experiencing different parts of the neighborhood, meeting different people (hardly a walk goes by that someone doesn’t comment on Kerrin), and seeing the sights of my rather interesting neighborhood all help ground me. Life can get pretty narrow being relegated to my apartment, so expanding that to include the surrounding neighborhood is hugely beneficial.

There’s also the rhythm of walking. It’s meditative, that beat, that rhythm – it’s calming and oftentimes just what I need to ground myself. There’s also the fresh air and sunshine. Colorado usually has pretty fantastic weather, with lots of sun to be had. Sunlight stimulates the production of Vitamin D, which helps with mood. I have a therapy light that simulates sunshine to use during the winter when there isn’t as much sunlight, but nothing beats real sunlight.

Finally, there’s the quality time I spend with my dad and Kerrin. It’s an opportunity for us to bond as well as an opportunity for him to check in on me and make sure I’m okay. Walking with him also gives me someone to talk to, which I don’t always have throughout the day as it’s hard for me to get out of the house most days. That social contact with someone I’m very much close to can make all the difference between a good day and a bad day and it’s thanks to our habit of walking.

5. Music

I have a rather extensive music collection, well over 1,000 albums in almost every genre of music. Listening to music has been one of my passions since I was in high school. Rather than spending time watching TV (which is a risky thing for me to do given its ability to remove me from reality) I typically wind down my day listening to an album or two while drinking a cup of coffee or a root beer with Kerrin on my lap. My dad, who shares my love for music, made sure I had a good pair of headphones when I went off to college and, upon returning, I invested in a decent turntable, speakers, and receiver. I have ears that can discern the difference between high quality music (such as a high bit-rate MP3 or an LP vs. CD) so spending the extra money on making sure I have good components makes a huge difference in the experience. I’m maybe a bit of a connoisseur and treating my ears to great music is an awesome way to ground myself.

Music is also helpful for me when I’m not feeling well. Music can generate any number of emotional reactions: I have music that will pump me up, music that will make me more likely to get my work done, music that will make me tear up, and, most importantly, music that will calm me down. I’m particularly fond of Blues music for helping me with anxiety or depression, but my go to album is usually Portrait by Arvo Part. It’s classical music and was described as “healing music” by my friend who introduced me to his music. It lives up to its description and does a good job of calming me down when I start getting stressed.

Stress can happen at almost any moment – getting stuck in traffic, a text message or phone call at the wrong time, a lack of a text message or phone call, frustration while trying to write, etc. can all deteriorate my mental health and drive me towards psychosis. And as such, I’m prepared to combat it with music. I’ve subscribed to the iTunes Match service ($25 a year) so that I can stream my entire music collection from my phone if I need to. I keep my iPod in my bag along with a good pair of headphones, at all times, so that I can listen to music if I need to while I’m out of my apartment. I have a pair of earbuds on my person at all times so I can listen to music on my phone if the iPod or headphones aren’t available.

It pays to be prepared – I can’t always walk when I’m not feeling well, I can’t always brew a cup of coffee. But music is easily accessible for me. So I’ve made sure I can listen to any of my music whenever I need to and it’s made a huge difference in my mental health. Having a boy scout mentality (“always be prepared”) when it comes to mental illness is crucial to dealing with it effectively.

But beyond the music itself is the means by which I listen to music. When the voices get particularly bad, listening to my headphones is particularly useful. I can turn the music up as loud as I need to to drown the voices out. The voices can’t yell as loudly as my stereo can pump out music, so it gives me a chance for reprieve from what can be a brutal and relentless assault on my person.

When I purposefully listen to music (e.g. when I’m not working on something and listening to music at the same time) I sit in what I’ve come to call my “comfy chair”. It’s right next to my stereo and very comfortable. I turn an album on and Kerrin usually joins me by hopping up on my lap.

I have my stereo hooked up to one of my computers and I can remotely access the computer through my phone so I can change music with her on my lap without disturbing her. The act of sitting and listening to music is an important ritual – a cup of coffee is usually involved, I’m sitting in a comfortable position, Kerrin is on my lap, and I’m listening to something I truly enjoy. It’s calming, forcing me to slow down and concentrate on the moment. And concentrating on the moment is incredibly important to making it through life with a mental illness.

6. Playing with Objects

Even music isn’t always available, especially if I’m in church or in a lecture-type environment. It would be rude and draw unwanted attention to break out my headphones and start listening to music, so my CBT taught me to carry around small objects in my pocket to play with when I’m not feeling well and can’t do something more overt such as writing, drinking coffee, walking, or listening to music. In the past, I’ve carried around small stones or coins. Nowadays I rely on my lighter to help me. The process involves being mindful of the lighter in my hand. I concentrate on the shape and feeling of the lighter – feeling for variations on its surface, for smooth areas and rough areas. I feel the coolness of the lighter and notice it heating up as my hand warms it up.

It’s grounding because it reminds me I’m holding a real object, something that’s tangible and exists in the world I want to be a part of, the world that my brain is trying to tear me away from. It’s useful in a bind, when there isn’t anything else available to me.

Kerrin is especially good for grounding me in this way – petting her and feeling the differences in the texture of her fur. The rough parts on the top of her back to the exceptionally soft fur on her chest, neck, and face. She also responds to my touch, usually in a positive manner. Just having her sit on my lap when I’m not feeling well is a huge help and she gives me plenty of kisses when she hops up on my lap and her kisses can bring me out of psychosis almost immediately. She’s a living creature and so the tactile experience of petting her is fundamentally different than touching my lighter. I can feel her weight on my lap or chest, I can feel her chest rising and falling, and I can feel how comfortable and trusting she is to be in my lap.

I had a variation on this idea a while ago – a small vial of peppermint extract that I could smell when I needed to ground myself. It would pull me back to reality by drawing me somewhere more tangible and legitimate than the place my brain was trying to take me. It was a little attention grabbing though, the smell of peppermint travels quickly and people would notice me sitting there in church smelling this small vial of liquid and didn’t know what to think of it. It worked well initially and might work for you or your loved one, I just found much more effective means of grounding myself.

Another variation that I use is a collection of photographs from when I was little. I have photos of myself as a baby, of my sister, and my parents – all happy memories. Memories I don’t necessarily share with them, but they remind me of days when I didn’t have a care in the world, they remind me that I’m loved and cared for and that there are people out there rooting for me.

Mental illness so often wants to tear you away from the people who love you, from the people rooting for you. Mental illness wants to drive a wedge between you and your loved ones, it wants to isolate you before it consumes you. So, having these photographs of the people who love me is a powerful reminder of how many people out there are on my side and of how many people I can go to for help when I’m in trouble.

7. Coffee

When I’m at my parents’ house and I sit down in “my” chair in the living room, it’s usually a signal to everyone that I’m not feeling well. We’ve developed a routine to help get me out of that mindset as soon as I sit down. Dad usually sits down with me and starts talking, trying to keep me engaged, he gets Kerrin in my lap so that she can help me, and mom goes to the kitchen to make a pot of coffee. Like everything else that helps ground me, coffee is something I love and, because I love it, it’s uniquely positioned to help me get out of psychosis or dissociation or, at the very least, help ground me to reality when I come out of it and am in a particularly vulnerable mindset.

The smell, the taste, the heat of the coffee all serve to ground me.

When I get together with my friends it almost always involves getting coffee. It’s one of the few places I’m capable of going as they’re usually not very crowded or noisy and I’ve spent a lot of time in coffee shops studying, reading, or drawing when I was younger so they’re a familiar and comforting place to me. Bars are terrible places to go and restaurants can be just as bad in terms of the crowd noise and how overwhelming they can be. It’s important for me to get out of the house, so a coffee shop it is.

I’m not quite sure if it’s the connection I have between coffee and spending time with my friends, or if it’s because of something inherent in the smell and taste of coffee. Coffee not only reminds me of hanging out with the people I love, it also reminds me of camping with my grandma and grandpa in the Black Hills, and it reminds me of Sunday morning brunch with my family when I was younger. Smell is the sense most closely tied to memory and my childhood memories are few and far between, but to be reminded of happier times is a good feeling.

Coffee also has a certain complexity to it – brewing it in different ways brings out certain flavors and it can be enjoyed and profiled much like a wine would be. I don’t go so far as to go to cuppings (which are similar to wine tastings), but the complex flavors of the coffee give me something to concentrate on other than my feelings of psychosis or dissociation.

8. Pills

Medication can be awful to take, but it’s sometimes the only effective means I have to take care of myself. A good piece of advice I received was to have a cache of extra pills in case something goes wrong. So, I carry a bottle of my milder antipsychotic and medication that helps with anxiety in my bag, as well as one days worth of my pills, my emergency pills, so that if I end up spending the night away from my main collection of pills I don’t suffer for it by missing a dose. The emergency pills are crucial and have saved me on numerous occasions. I don’t usually stay out late, I try to be home by 9:30p so I can take my pills, but life happens and sometimes it’s necessary to stay out later. They’ve proven most useful when my parents have to take me back to their place because I’m not feeling well. Having that emergency dose means we don’t have to go back to my place to get pills, preventing me from getting worse because of how stressful car rides can be.

Medication certainly isn’t the final or only solution to mental illness, but it is the backbone of my treatment. As such, carrying around extra pills has often meant the difference between a good night and a terrifying night. It’s that boy scout mentality again – always be prepared.

It’s important to note that you need to keep your pills in their original bottle. If the police happen to stop you and find you with a collection of pills outside their original container you can be arrested (I’ve had it happen to several friends as they were traveling). I have 10 prescription medications, so it isn’t practical to carry around 10 bottles with one day’s worth of pills, so I took two empty pill containers and had my psychiatrist write down each pill that was in there along with what they looked like, followed by his signature and contact information. I have no idea if this makes me less likely to be arrested or not, but it gives me peace of mind to know that I’ve at least tried to do something to demonstrate the pills I have on me are my own pills.

I’ve also created a spreadsheet detailing which medications I take and when I take them. I keep it in the lovely pill box my mom made me so that anyone can prepare my pills for me. Once in the throes of psychosis, I’m rarely capable of doing something as challenging as preparing my pills. So the printed copy of my pills is crucial for someone to be able to prepare my pills accurately for me. I take 50 pills a day and it’s easy to screw up, especially if I’m not able to tell anyone how much of what medication I take. I also keep a copy of the spreadsheet on my phone, so if I end up in the hospital I can tell the staff what kinds of medications I need. My iPhone also has a function where I can input my medical information, much like a medical ID bracelet – only with more detailed information. All someone needs to do is hit the “Emergency” button on my phone and my diagnosis, pill regimen, and contact information for people who can help me is available to them.

“Always be prepared.”

One of the biggest themes with what helps ground me is that they’re all things I enjoy, they’re things I’m passionate about. If someone isn’t passionate about music it’s not necessarily going to help ground them (though virtually anything is worth a shot, you never know what’s going to help). In every instance of grounding, Kerrin is especially helpful and I can’t stress enough how important she is to me or how essential she is to my treatment. I would recommend anyone get a pet to help them deal with their illness. But it doesn’t have to be a dog. It could be a cat, or a hamster, or a bird, or a guinea pig, or a snake or lizard. It depends on what you respond best to and what you’re capable of taking care of properly. A dog fits in with my life so well because I’m capable of taking her on walks, I’m capable of remembering to feed her, and because I’m usually around my apartment all day so she isn’t left alone for long periods of time. Being on SSDI is advantageous in that regard, it’s allowed me to bond with Kerrin such that we’re closer than many people are with their dogs. I’m also passionate about Kerrin. She loves me unconditionally, her loyalty to me is unfaltering, so I know she’ll always be there for me when I’m sick. We have such a close bond that she’ll lead me safely home when I’m not feeling well and she will often get on my lap when I’m not feeling well without having to be told; which is important given my inability to communicate when I’m sick.

It’s important for you or your loved one to identify what they’re passionate about, what they enjoy doing, and use those things to help ground them. It could be the same as my grounding techniques, but they’ll most likely be completely different. Different things work at different times.

I once told my parents it would be a good idea to give me a pencil and my sketchbook and have them instruct me to draw – that’s when I figured out how anal I am about drawing. Writing helps me express myself and it can’t be stated enough how important it is to have a creative outlet. Popular culture has the stereotype of the artist being a “mad genius”. Artists aren’t mad geniuses, it’s just that the mentally ill do so well when they express themselves. It’s the reason that art therapy is so helpful for many people. It’s important to focus that destructive energy into something positive – many of my most painful images have been transformed into pictures I’ve drawn or painted and many more of them have been expressed as poems or short pieces of prose. And being able to take such an ugly, terrifying experience and turn it into something beautiful almost makes the whole experience worthwhile.

Psychosis and dissociation are an overload of energy. As I’ve expressed here before, I don’t believe I go through anything that’s necessarily unique to schizoaffective disorder. It’s the same emotions, same experiences, only greatly amplified and more complicated. It’s important to channel that overload of energy into something. Whether it’s writing about it or listening to a particularly good album, the goal of my grounding techniques is to create a bypass of sorts for that energy. It took a number of years for me to develop my grounding techniques and it took quite a while for me to become proficient at using them effectively. But the time was well worth it. These techniques, and especially Kerrin, have helped me avoid countless psychotic episodes, and have made them easier to handle and much less traumatizing.

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