Mental Health Awareness Month - mental health for people with weakened immune systems and the Eight Questions series
Q&A with Amanda Adams
Launched in May 1949, Mental Health Month was an early attempt to support people suffering from mental health problems and connect them with medical and social resources in their community. It has since grown substantially.
In late April, President Joe Biden issued a Proclamation on “National Mental Health Awareness Month” that reiterated his commitment to “transforming mental health care for all Americans.” Prefacing Mental Health Awareness Month 2022, he referenced “The American Rescue Plan (which) laid the groundwork for this effort, investing nearly $5.5 billion nationwide to strengthen mental health and substance use care.”
The concerns surrounding the unique needs and challenges people with compromised immune systems face, has yet to gain a parenthetical mention —let alone a place— at this important table. Some of the specific distribution channels mentioned, like mental health funding distributed through schools, may not even reach the K-12 students who are immunocompromised and may end up having to be home schooled if their region of the country is hostile to masking.
In order to look more closely at the immunocompromised-mental health intersection, Immunocompromised Times is launching our Eight Questions series with a Mental Health Awareness Month interview about the mental health needs of the immunocompromised. Our first eight question interview series features Amanda Adams, a licensed professional counselor practicing in Philadelphia and surrounding areas as well as nationwide via telehealth.
As an immunocompromised individual with chronic conditions, Amanda offers clinical support through an empathetic and personal perspective. Utilizing concepts of cognitive behavioral therapy and additional evidence based treatment, she specializes in treating adult individuals with chronic illnesses, ADHD, anxiety, depression, and addiction/codependency. Amanda strives to promote normalization, empowerment, confidence, and healing through her work with her clients.
This interview has been edited for length and clarity.
Before the deep dive into the heavy–what are examples of positive ways your immunocompromised clients' friends, family and community members have been good allies to your immunocompromised clients?
Amanda Adams: Often it's the combination of small changes that genuinely impact immunocompromised clients. Some examples I can think of is offering rides so an individual does not have to take public transportation, considering any dietary restrictions that an individual may follow to help manage their illness, nail techs or hairdressers making house calls, restaurants offering outdoor seating, non contact delivery/pick up, and access to COVID home tests have all contributed in a positive way.
How have the lives of immunocompromised people you began treating before the pandemic changed over the course of the pandemic?
In a way that may be ironic to some, a lot of individuals have claimed that the pandemic has made things easier for them. Many immunocompromised individuals have greatly welcomed the mask mandates, social distancing, limits of amount of individuals allowed in a space, no contact delivery, and drive up ordering options as it has allowed them to increase their functioning and independence. Many individuals that I was treating prior to the pandemic also have increased therapy attendance after the pandemic due to telehealth allowing for increased access to therapy. The pandemic also caused an increase in prioritizing social interactions online, which has allowed for many individuals to connect more readily rather than having to meet in person and needing to navigate inaccessible spaces or worry about contracting illnesses. There have been some downsides to the pandemic, such as decreased access to in person care, fear of contracting COVID, and restriction of certain medications that were being used experimentally to treat COVID, however most individuals agree that in general the pandemic has impacted them in a positive way.
What advice do you give immunocompromised people who express feelings of isolation and abandonment due to the pandemic?
You are not alone! In the beginning stages of the pandemic, society seemed to rally together, but in more recent times it's easy to feel left behind as others are eagerly trying to return to "normal". Many individuals may not have live-in supports which can also be very isolating. Thanks to technology, there are so many ways to become part of and engage with a chronic illness community. I'd suggest searching the social media apps you are on for groups or communities with other immunocompromised individuals to connect with. There are also apps such as Wana or Likewise that are designed to connect those with chronic illnesses. Thanks to telehealth, it's also easier now than ever to join therapeutic or support groups for those who are immunocompromised to gain additional support.
What are the biggest mental health challenges immunocompromised people now face?
This can vary depending on the illness causing a compromised immune system, but I would say that anxiety and PTSD are among the most frequent comorbidities that I see in individuals who are chronically ill. Many immunocompromised individuals experience chronic symptoms-when the brain experiences a chronic symptom such as pain, this is interpreted in the brain as a chronic stressor, which changes the neurological pathways in the brain and contributes to symptoms of PTSD, anxiety, and depression. In addition, many immunocompromised individuals have experienced both passive and active trauma/neglect at the hands of the medical system, and this is often invalidated or downplayed. It can often feel like immunocompromised individuals are living in an alternative world that a majority of society knows little about, which can be further traumatizing and ostracizing.
How do the mental health challenges of immunocompromised people in urban communities differ from the mental health challenges of immunocompromised people in rural communities?
While the basis of mental health challenges remain the same, the ways to tend to these challenges are limited in a rural community. Many individuals who live in a rural setting need to travel long distances for appropriate treatment and may find it more difficult to connect with others, increasing feelings of isolation. In rural communities there are less options to choose from, sometimes leading to feelings of helplessness or contributing to an individual not feeling empowered, which makes it more challenging to treat PTSD or other mental health challenges.
What kinds of treatments are your patients with compromised immune systems most responsive to?
In my practice, I utilize an individualized approach for each individual based on their needs, but I have found that CBT from a trauma-informed perspective has been the most helpful for a majority of my clients. The thought patterns that individuals with chronic illnesses experience are often not disproportionate, irrational, or incorrect but they often do not contribute to an empowered stance. Teaching clients how to recognize their automatic negative thought patterns and challenge them in a way that leads them to feel empowered drastically decreases the impact that mental health challenges have, therefore improving overall health and wellness as well. This also improves the client's ability to feel confident in advocating for themselves and their health. The key is treating the whole individual-not just their diagnosis. We need to consider the mental, emotional, physical, and spiritual impact that immunocompromised individuals face and address those concerns holistically. This often means working in conjunction with a client's other providers and having at least a generic understanding of the individual's illness.
What is the impact of misinformation campaigns on your patients?
Misinformation campaigns can sometimes lead to invalidation, uncertainty, doubt, or lack or proper medical care/treatment/prevention for all individuals, not only those who are immunocompromised. This often can exacerbate existing mental health symptoms and contribute to an already existent mistrust toward the medical community.
Sarah Wildman's New York Times Opinion piece, "In the Rush to Return to Normal, What Happens to the Vulnerable," talks about the range of responses people have when learning about a vulnerable family member, saying "In my life, I sometimes sense a distancing from others that ranges from pity — a murmur of that poor family, they’ve gone through so much — to active avoidance. To be unwell is to be other." Do your immunocompromised clients experience the pity, distancing and othering that Wildman describes? If so, can you recommend ways to prepare for and to recover from these experiences so they don't end up reinforcing the fear and isolation they are already having to deal with?
"To be unwell is to be other." I'm not sure that a single one of my chronically ill clients would disagree with that statement. In one way or another, most clients have experienced an otherness described by Wildman. One way to combat this is to consider who we have in our support systems. In the case where family or friends are not understanding or supportive, do we continue to expect compassion and care from them? Do we continue to expect others to change despite them showing us repeatedly that they are not capable or willing to be a support? We cannot control how others respond to our illness, but we can choose (in most cases) who we seek support or guidance from. In times where we cannot choose who are caretakers are, can we adjust our expectations so that we are not disappointed and seek alternative supports elsewhere? We cannot control how others may perceive us, but we can choose to reject the pity and attempt to not internalize it. Our truths are valid, and we have to right to set boundaries with those who do not believe so.
I really love this article, and hearing from someone who has spoken to many immunocompromised people, as it makes me feel that our voices are getting heard and it is possible to communicate these issues with others who are understanding. I especially identified with: "Many immunocompromised individuals experience chronic symptoms-when the brain experiences a chronic symptom such as pain, this is interpreted in the brain as a chronic stressor, which changes the neurological pathways in the brain and contributes to symptoms of PTSD, anxiety, and depression. In addition, many immunocompromised individuals have experienced both passive and active trauma/neglect at the hands of the medical system, and this is often invalidated or downplayed. It can often feel like immunocompromised individuals are living in an alternative world that a majority of society knows little about, which can be further traumatizing and ostracizing."