Steve Martorano 
The Behavioral Corner is produced in partnership with Retreat Behavioral Health -- where healing happens.

The Behavioral Corner 
Hi, and welcome. I'm Steve Martorano, and this is the Behavioral Corner; you're invited to hang with us as we've discussed the ways we live today, the choices we make, the things we do, and how they affect our health and wellbeing. So you're on the corner, the Behavioral Corner. Please hang around a while.

Steve Martorano 

Hi, everybody. Welcome to the Behavioral Corner. It's me, Steve Martorano. I'm kind of the mayor of the Corner. Why not? I just made that up. What do we do on the Behavioral Corner? We talk about everything. It's a podcast about everything. Because everything affects our behavioral health in one way or another, you know, if you're working out, if you're walking, if you're at the gym, or whatever you're doing, and you're listening, stick around. We've got a good one for you. September, which we are into, even as I speak, is National Recovery Month. So what does that mean? Well, listen, in the simplest terms, we all recover from stuff. Correct? We routinely recover from everything from colds to hopefully COVID folks who also recover from very serious substance abuse issues, in fact, millions to do. Okay? So we understand the term recovery in those broad contexts. But we're going to talk about mental health disorders on the program today. Because of that, I think we got a different kettle of fish now when we talk about recovering from mental health disorders, whether they're serious or not so serious. To that end, we welcome you to the program, Kris Kurlancheek. Kris is a first-timer out. This is his rookie at-bat on the behavioral corner. He is a clinical supervisor with our underwriting partners. Retreat Behavioral Health. Kris, welcome to the Corner

Kris Kurlancheek 
Thank you, Steve, and congratulations on pronouncing my name correctly.

Steve Martorano 
I had some practice. First of all, it's phonetically even an idiot like me, but I promise it at some point. Before we're out of here, I'll screw it up. Anyway, Kris is a second-generation Retreat. A veteran, his dad, who's I guess retired now, was also at Retreat for many years. So I guess that sort of explains how you got there following in dad's footsteps, so to speak. So how long, Kris, if you've been in this field?

Kris Kurlancheek 
In the field since 2004, I started just out of college. So I guess that you know, dates myself, I started working with children and adolescents in a residential facility where they had delinquency, behavioral problems, did that for several years. I did a brief period of time working as a TSS worker, which a lot of young people going through graduate school will do, working with children with autism and their families. I did family-based therapy for a period of time, and then I came into retreat in 2011, about four months after it opened. I started out as a clinical specialist. And that's what I did for the majority of my time at Retreat. I worked with our patients here in the inpatient setting, individually and in group settings. When Retreat was primarily a substance use facility, our department focused on kind of everything else, mental health issues, relationships, and family traumas. Now Retreat has evolved into a total holistic behavioral health facility that also exclusively treats mental health as well as substance use. I've taken on different roles as retreat has evolved.

Steve Martorano 
Yeah, their mental health facility or wing is now referred to as Synergy. 

Kris Kurlancheek 
Correct. 

Steve Martorano 
And for people who might not understand, I want to make a distinction. We don't do this often enough. Kris is obviously correct in that if you come to any competent facility to be treated for substance abuse, there are going to be what are referred to as co-occurring disorders. And they are often of the mental health variety. And they have to be dealt with at some point, as well. That's routine. And as I say, you know, better facilities. What's different now about Retreat is that while they still do that, on the substance abuse side, you no longer need to be actively using drugs or alcohol to avail yourself of their services if you're having mental health issues. You can show up there just for your mental health disorder. I got that, right?

Kris Kurlancheek 
Correct.

Steve Martorano 
Okay. All right. So, Kris, you heard me do my little intro here. I'll begin with this question. In terms of mental health disorders, whatever they may be, is, is recovery even possible?

Kris Kurlancheek 
Absolutely. And I think it's important for people to be mindful and aware of the expectations and kind of what that means for the individual. One of the areas I think that people really struggle with is where they place themselves, or their families or loved ones place, with very high expectations on what that means and what that looks like. Where they will try to make attempts to get with regard to their mental health issues, get rid of them, avoid them, and control them. And that oftentimes makes them worse. Whereas recovery mental health, people that would say they're successful with it often describe it as they're reducing their issues or like the things that affect them and impact their lives. They manage them, and they learn to live with them and live with them in healthy ways. They don't become as dominant in their life when they are struggling.

Steve Martorano 
Is it accurate to say that I've read this somewhere that there are, there's a distinction to be drawn between clinically recovering from a mental health disorder and personal recovery and that they guessed come together on the issue you just mentioned? This is about behaviors, mood behaviors, that are now out of whack, whatever they may be, and that the idea is to get your expectations lined up with the outcome. In other words, as you said, manage it, rather than cure it.

Kris Kurlancheek 
Sure. And you know, behaviors are an important aspect of it, because those are the things that we see, those are the things that the world sees. But with mental health, recovery, and mental health issues in general, people will tell you to is that there are the behaviors, but there's also the internal experience that they go through, where the person that you work with might seem fully functional and capable, and competent and even happy. But inside, they might have a lot of pain that we don't see. So behaviors are one of the things that we'll see. And one of the ways that we look at symptoms and diagnose but we also really need to be aware of a person's internal experiences and how they affect their daily life.

Steve Martorano 
Yeah, that's a great take on it. The internal turmoil often, you know, manifests itself in sometimes behavior, sometimes not sometimes. Let's, let's take a moment before we get into the weeds on how these things are treated, and discuss for a moment, the types of mental disorders that people are experiencing and that you've had some experience treating.

Kris Kurlancheek 
Sure, so the most common ones that we see, and the ones that you hear about just kind of day in and day out that affect most people, are your mood disorders. So that's your depressive disorders, your anxiety disorders, and sometimes your bipolar disorders. Those are the ones that you see the most of and hear the most about. Those are the ones that are most prevalent.

Steve Martorano 
You mentioned bipolar, depression, and anxiety. When do most people begin to recognize that any of those situations require help? Because everybody gets depressed? Everybody gets anxious? Well, when do people go, "Wait a minute, something's going on here." 

Kris Kurlancheek 
Sure. So there are a couple of things with that. That's a good question. So one is to recognize that any issue regarding mental health, non-mental, we're focusing on mental health, any issue presents very differently across the spectrum with every individual. This is also true when you compare things like adults and children. Children will present anxiety very differently than an adult may. And so the way I've always worked with people and looked at when their mental health impacts them is, how is it affecting your daily life? Because if we look at mental health symptomology on a spectrum, meaning that I can have more of it, I can have less of it, that if I have it, you know, quote-unquote, "have it." Am I still able to function? Am I still able to engage with my family? Am I still able to take care of myself? Am I still able to do the things that bring me joy and peace, and contentment when those things start to become jeopardized or start to become impacted? That's when I think most people will look at I'm not living the life that I feel like I could be. I feel like the symptoms and these issues are getting in the way of my life more than they're not.

Steve Martorano 
Is it possible in that context to be, let's say, depressed for a prolonged period of time but functioning well enough so that you, in fact, don't have anything that's clinical?

Kris Kurlancheek 
Absolutely. Sometimes I've worked with people who present with depression. They present with the symptoms, they report the symptoms, and then a question that any professional asks you is, How long have you been experiencing these? And some people say I can't remember a time I haven't experienced them. Since a child since. Adolescence. It's kind of how I've always been, and they, for lack of a better word, feel comfortable with it. And that's where this kind of discussion, I think, really gets interesting because, well, then, here's a person that I've known for a brief period of time. And I'm telling them that what they feel comfortable with is not right is not correct. And that's up to the person. It's up to that individual to make that choice for themselves. Do they want something different in their life? And sometimes they do, sometimes they don't.

Steve Martorano 
Yeah, I want to get to that in a bit. Because that's a key point about mental disorders when the person who presents with the symptoms is being defined by other people, rather than yourself, because I guess there's such a thing you tell me, you're the pro here. It seems to me likely that there are people who are sort of depressive personalities. I mean, they're gloomy. They're always seeing the glass as half-empty. But they're okay. I mean, that's who they are. Is that true?

Kris Kurlancheek 
Sure. Yeah. I mean, I think, again, across the spectrum, there are some people that seem to be like the glass half empty kind of people, which might be this is where the discussion of personality versus mood comes in, you know, personality, something that is pretty, you know, crystallized it might change over time, slightly. But moods change a lot more. They're, they're like the weather, you know, some days are hot, some days are cold, you have seasons with them. I think what is an important distinction to make, though, is that just because someone is comfortable with something doesn't mean that it shouldn't attempt to be treated. Let's talk about physical pain because sometimes that's a little easier to understand that if you have physical pain, that could be treated, but you've just learned to live with it. You know, where do we say that that's like, you know, if you fixed your injured shoulder, you know, you might be able to enjoy your life more. You might be able to do things around the house more. You're like, "Nah, it's okay. I've had it for so long. It doesn't really bother me." Yeah, but if you could live without that pain, would you? "Yeah, but that's a lot of work. And I've just gotten used to it." So just because someone's comfortable with it, I don't want to tell somebody how to live their life. But I also want to at least give them the opportunity and the choice to be made so that they can change it if they would like to.

Kris Kurlancheek 
Sure, you also run the risk, I would guess, of avoiding something hit. Why would you like to be a little cheerier? I mean, you got a great family, you got a good job, people sort of like you, but you're not a lot of fun to be around. That's a great way of looking at this. It's because I know I've had conversations with people who go get somebody on and talk about depression because I don't know whether I'm depressed or not. I mean, I've got wheat, some days, it's worse than others. But this would apply also to people who suffer from anxiety disorders, and everybody's anxious from time to time, and everybody's depressed from time to time. What you're looking at is how it affects your life.

Kris Kurlancheek 
Sure, and what I'll say, too, with that, is the difference between talking about emotions and then mood disorders. So anxiety is a normal, natural, healthy emotion to have. We need to have anxiety. Anxiety is what gets us to work on time. Anxiety is what prepares us for important events. But when it becomes too intense or inappropriate, at times, it becomes a problem. Just like depression, feeling depressed is a normal, natural, healthy emotion. If you go through a loss or you experience grief, depression should happen. You know, you should experience a depressed mood. It would be very odd and unhealthy if you didn't. But when we again, if we have them for prolonged periods of time, and they happen at inappropriate times, that's where they can become very impactful and unhealthy ways. And so I think it's important to have that language to say like, these are not bad words, these are not dirty words, having anxiety, having depression, like those are normal, natural emotions.

Steve Martorano 
There's still a big stigma. You know, we've talked about stigma a lot and have over the years working with retrieve on the Behavioral Corner, to a great extent, in terms of substance abuse disorder, the public seems to be getting it begrudgingly. And this is not a character flaw but a disease, and there's still a huge stigma attached to mental health, isn't there?

Kris Kurlancheek 
I agree with you. I think it's slowly turning in the right direction. It's often seen as a weakness. You know, people who struggle with mental health issues will say, "Well, you know, I feel weak, or I'm worried that people are going to look at me as weak or inept, or just not able to be a person, and...

Steve Martorano 
Crazy. I mean, you know, the old model was, "Well, they're crazy."

Kris Kurlancheek 
A question I often get is about trends that we see. So do we think there are more mental health, you know, incidents currently than there were, say 40, 50, 60 years ago? I mean, I'm, you know, I'm wasn't around back then. But I can say just that the research, that we just didn't ask those questions. So there's a good chance that a lot of those things were there. We just didn't talk about them. We didn't, you know, we didn't have discussions about them. They were they weren't in the news. You know, we didn't have professional athletes talking about their mental health struggles, again, of that stigma. So, again, we don't know. But chances are these things have been around a long time. We're just now turning into a more nuanced discussion about them.

Steve Martorano 
Our guest from Retreat Behavioral Health is clinical supervisor Kris Kurlancheek. And we're talking about recovery in the context of mental health issues and mental health disorders. So to go through just one other item on the checklist of types of disorders, some are more serious than others. I would suspect that on this on a spectrum of disorders, schizophrenia is probably the scariest and most severe form, I guess. But there are gradations of that as well. The thing that's more and more in the news and in history, when you think about it, is something called bipolar disorder. And tell us about that. That's a disorder that really does manifest itself in behaviors, doesn't it?

Kris Kurlancheek 
Yes, the statement still applies as before about internal experiences being relevant as well. First, I would like to clear up some misconceptions about bipolar disorder. So sometimes people will say, "Well, I'm nine, and 9 am, I'm happy, and at 10 am, I'm sad, and 11 am I'm angry. And then 12 pm I'm sad again. I'm so bipolar. That's just being a human being, having mood swings that way. Bipolar, which used to be called a manic depressive disorder, which I personally think is a better name, but no one asked me if you think about by meaning to and think polls, meaning North Pole and South Pole, the South Pole is the depressive episodes. And so, thinking about emotions and moods in terms of periods of time, so you can have a depressive episode that will last days, weeks, and sometimes months. Then what gets a lot of attention is what we call the manic episode. That's the North Pole. And then the manic episode is like the high that's where a person will have increased goal-directed behavior, their mood is elevated, they don't need as much sleep, they'll talk really fast change from subject to subject, they'll be often very impulsive, a lot of thrill-seeking behaviors. A lot of grandiosity will come with bipolar disorder as well. So a person will, you know, they'll think they can drive 130 miles down the highway because they think they can because they think they're the best driver. There's also another presentation of mania, that's the more irritable and angry side of mania that can come out as well.

Steve Martorano 
So um, so what does recovery in the context of bipolar disorder look like? Is it...is it even a real thing?

Kris Kurlancheek 
Oh, absolutely. So I know we're going to talk. We might talk about this in a little bit. But with regards to medications, one of the most effective ways to treat bipolar disorder is through medication management. I've had patients say when they are taking their medications and they're working, that it feels like they have the floor and ceiling. So they still have ups and downs, but they're not as extreme as they are when they are unmedicated. Research shows that with any kind of mood disorder, that then most mental health disorders, I would imagine, as well that when you combine medication management and therapy and counseling, those are the two components that create successful treatment and successful recovery.

Steve Martorano 
This notion of medicine assists someone, and by the way, a lot of mood disorders are treated with medicine. Bipolar is not unique in that regard. As I understand it, what is prescribed or obviously by professionals, is more art than science. I mean, they know where to start on a scientific level, and this has been successful. But people who have suffered from bipolar have to really try and test medications, don't they?

Kris Kurlancheek 
I do not envy medical professionals or their patients, what they on the work and the patience that they have to go through some time. You know, patience with a "c." That if you get a medication that is effective right off the bat, you've kind of hit the lottery. It's, it can take time for the medication to take effect. Now, depending on what we're treating here for bipolar disorder and the class of medications they might use for bipolar disorder, effects can be pretty quickly, you know, a matter of days. But if we're talking about like antidepressants, like, you know, SSRIs, things like that, they can take weeks to take effect, then you want to build up to a therapeutic level. Then if you find that the therapeutic level is not what a patient needs and that what a person needs and the doctor agrees, then they will have to titrate them off, wean them off of it, and then start a new one, which can take a matter of weeks on both ends. So it can take a long time to find something that works effectively.

Steve Martorano 
Yeah, it takes an enormous amount of concentration and commitment on the part of this the person suffering from bipolar disorder to hang in there because it can be very frustrating. So before we move to another chapter, the final topic in terms of disorders, or what might cause them, just as one last point about bipolar, or any of these other melees, how should the people the support group, the family, the friends, co-workers, surrounding somebody, in these conditions? How should they behave? Should they ignore it? Should they you know, or should they accept it and talk about it? What's the role of family and friends here?

Kris Kurlancheek 
Sure. So it's a great question. So first off, you know, specifically with bipolar one of the chat...larger challenges with treating Bipolar disorder is that for the individual, often they will like their mania. Their mania can feel very powerful. They feel, for lack of a better word, they feel good, especially contrasted with depressive episodes. When people are in their mania, they can feel productive, they feel happy, they feel connected. Why do I need to treat this? I feel great. The first question that I will often ask somebody that will have that type of narrative, I'll ask them, "Well, how does it affect your relationships? You know, when you're in a manic state, you know, what is your family say about being with you? What are your friends say about being with you." And if they're honest, often people say, it's really hard to be around me. I bring a lot of energy into the room. And so that will be one of the good external motivators for somebody to try to get help for something that they feel that it's good for them.

Steve Martorano 
When they're out of the manic stage, are they aware of their behavior while they are in the manic stage?

Kris Kurlancheek 
Hopefully, that is one of the things that we would try to do in counseling is work on a lot of mindfulness and mindful awareness, which is a good foundation for any therapy, to know where you are at with your moods. People who live with bipolar disorder or any mood disorder can tell you...you know when it's about to come and what it looks like. And sometimes it will kind of sweep them away, and before they realize it, but if they're practicing those mindfulness skills, they can kind of take some steps to manage it a little bit better.

Steve Martorano 
Two points, there are triggers that can trigger a manic episode. And people should be attuned to what they are, maybe avoid them. But the second one, I want to be clear on this during a man...I know it's, it's not a universal rule. But generally speaking, during a manic episode, the person experiences, and I understand what you're saying, "Don't harsh my mellow. What are you crazy? Take the drugs? Well, I'm having a great time." But are they aware? That that is that's the wrong attitude to be having, and are powerless to stop it? Or does that have to come after the episode goes away?

Kris Kurlancheek 
If persons into it, you know, like just like anything, there's mild, moderate-severe, many cases, when they're in the moderate to severe, that awareness goes down. It's...it's especially when with something that's specific with mania, that when you have this grandiosity component to it, it's so hard for a person to have an awareness that they're in this state until they kind of come down to that mild state, and they can kind of bring some awareness to kind of what's going on around them. I would like to answer your family question too if that's okay.

Steve Martorano 
Yeah, good. Sure.

Kris Kurlancheek 
I kind of...I kind of skirted around it. So with family, coworkers, and friends, it's really it's a balance. And one thing I always encourage when I work with families is to, you know, really have an expectation of what your role is, and your family with your friends. Because, you know, when we have people in our lives that are suffering, that are struggling, you know, we want to help them, and so people often try to turn into their therapists will try to turn into their doctors. And the intent is noble, you know, the intent is they're really trying to help, and I don't fault people for trying to help. But then the problem is, is that it kind of you get these dual roles that can create problems. I mean, look, I'm a trained clinician and therapist. I'm not a trained clinician or a therapist for my family. You know, people will ask my opinion on things, and I will always say why you should go see a therapist. Well, you're a therapist. Yeah, but you should see one on your own because I'm gonna want to be your family member. I don't want to be your therapist. And so understanding those roles and then asking the individual what you need from us. What can we do to support you? What can we do to help you? And even if they push away, we give them that distance, and we can love from a distance. If you ever have concerns, this is important to say, if you ever have concerns about a person's well-being their safety, it's not a wrong thing to err on the side of caution to call professionals to call crisis to call them to help them get into the hospital, if you're afraid that they're going to hurt themselves or somebody else. Never second-guessed those things.

Steve Martorano 
That's a great point, Kris. I want to move into this area of trauma. Trauma is not one thing it can be many things can be physical, it could be psychological, could be events that you're you know, you witness, it can be a number of things. I speak a little bit about the mental health consequences of having suffered trauma.

Kris Kurlancheek 
Sure, often people will have this question of "Why in do I have these issues, I have these symptoms, why do I have them?" No one else seems to have them what happened to me or what's wrong with me, and a lot of energy will be put into a kind of searching for that "why question," and some people will find answers, some, some they won't. We do know that people who experience adverse childhood experiences are ACE...aces, that they are more likely to develop mental health issues, physical issues even. It's also important to be said that people can develop mental health issues without trauma. Those present themselves. But then also we get into the present state where someone going through a mental health issue that is an instrument...that is traumatic itself. A person who's going through substance use or addiction that's traumatic in itself. But we do know that people who experience any kind of, you know, abuse, bullying, neglect, exposure to violence, exposure to life-altering critical events, those can certainly impact a person at that time or later in life, whether they're aware of that or not.

Steve Martorano 
Kris, thanks so much. It's a big topic, and we could talk about it for a very long time. We had...we focused, as I said at the beginning, on this issue of recovering from it, and I come away from what you said hopeful for people who have these problems, because again, at the end of the day, if I understand you correctly, recovery, which is possible, looks different in different situations. 

Kris Kurlancheek 
Yes. 

Steve Martorano 
The bottom line is whatever is troubling you. Recovery means being able to have a full and happy life, in spite of it now. Anyway, great. Appreciate it. I know that you told me when before we did this that you said I've been avoiding having to talk publicly. You should do it more often. Kris Kurlancheek of Retreat Behavioral Health, a terrific kind of introductory speech, as it were on recovering from mental health disorders. Appreciate it, Kris.

Kris Kurlancheek 
Thanks, Steve. Thanks for having me.

Steve Martorano 
And thank you guys for your time and attention. Don't forget to push the button that says subscribe. We appreciate that. Push that. Follow us on Facebook and wherever else you follow us. Follow us in your car that's possible to Behavior Corner, and we'll see you next time. Take care.

Synergy Health Programs 
Millions of Americans are negatively affected daily by their mental health. Retreat has served the community for over ten years, offering comprehensive mental health programming through our mental health division, Synergy Health Programs. To learn more about Synergy, please reach out today at 855-802-6600.

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