RealMental

Reading Belinda’s thought-provoking post about forced commitment and medication, and the thoughtful comments people have since made, caused me to think a little bit more about how medication, while a lifesaver when appropriately prescribed, is only the first step.  Once you’ve gotten past the big ifs of a proper diagnosis and a proper prescription, you’ve got to be willing to use the equilibrium that the meds bring you to eradicate the mindset that meds are a “cure,” rather than merely a means toward maintenance and repair.  It’s my personal opinion that even the mentally ill person whose “only” life trauma is the toll of the disease itself has serious mental work to do, adapting to the concept of being “mentally ill,” redefining their sense of self around the diagnosis, and adapting to the medical and emotional features of their long term diagnosis.  The grief, regret, relief, anger and confusion that come with a proper diagnosis can’t be overstated, and it’s not something to be gone through without the aid of a therapist.  Too, medications don’t work forever– even once you’ve hit on a good combination, it may not work indefinitely– and being able to identify that your mood is changing despite being good about your meds is crucial.

From my own experience, I’ve built up a variety of coping skills to deal with my anxiety, depression, and need to people-please that are very unhealthy and counterproductive as I approach the worst end of my depressive spectrum, and it’s hard for me to recognize, when I am in the midst of a depressive phase, what I am doing.  But once I’ve recovered some stability, I can use that solid ground as a base to look back from the corner I’ve worked myself into this time.  I can look back and try to figure out when I first started the most recent downslide, and see if there were any causes.  I can then try and map out what I did and didn’t do during that period, identify whether anyone tried to warn me (and if they didn’t, possibly why not), and look at what coping mechanisms came into play, and what resulted.

There are lots of good books on the subject of eradicating bad mental habits out there, but I think a good therapist is really key.  (The subject of finding a good therapist, with whom you can work, is a whole post unto itself.)  Working with friends or family to identify your “bad behaviors,” your mood cycles, your triggers, just won’t be complete, because they’re not objective, and inclined to either overlook unhealthy or exaggerate healthy behaviors.  While friends and family can be the best first defense against a recurrent episode, and have the concrete experience of your past episodes to guide them, you need these folks to be focused on the micro level, not the macro/meta level.  A therapist outside your circle, however, is objective, has training, and is someone in whom you can confide and to whom you must be accountable.

Support groups outside your circle can also be therapeutic– because they don’t know you, and take you at face value when you take part, there’s an objectivity there that allows a freedom of expression you might not have with friends or family.  Hearing others say they’ve gone through something similar, and come out on the other end, is tremendously encouraging.  And knowing that someone else understands the swirl inside your own head lends credibility to their advice and encouragement that a “normal” source doesn’t have.

The most important thing to be gained from therapy is a firm sense of your self, knowing what you need and what you don’t need.  Personally, I’ve never joined a bipolar support group because the way my bipolar has manifested itself has been primarily anxiety and depression, and the course of my illness was and is usually very different from that of others in the groups I’ve tried.  Having never been frankly manic, psychotic, or delusional, much less hospitalized, I knew I didn’t “need” what these groups are offering.  But depression and anxiety sufferers?  I crave their company, search regularly for a group that meets after the end of the business day, eagerly read posts by others suffering from the same symptoms– because in hearing their stories, I learn something new about myself.  And by collecting these tidbits, I can hope that the next episode won’t be as long, as bad, as deep, because the work that I’ve done will allow me to see that it’s coming, and know that it’s arrived.  The meds provide the viewpoint, but I’ve still got to be willing and able to look around me– the therapy allows the rest.

I’ve been thinking a good bit this weekend about the issue of “forcing” treatment upon mentally ill people, particularly those who are in immediate and ongoing danger of being hurt by their illness, or at risk of causing others to be hurt. OK, I confess–“Grizzly Man” is playing on cable this weekend, and Treadwell‘s story rips at my heart, because when you watch the footage of him, he is so obviously ill. Brilliant, creative, with a big heart…but sick. He was diagnosed with bipolar disorder and other things, but always refused treatment, and, I feel, ultimately died as a result of that refusal.

Have you heard or read about “Kendra’s Law?” If not, go check out this story, and see what you think. I’m really interested in hearing others’ thoughts on this topic. When I hear the term “forced treatment,” my mind immediately conjures up images from Ken Kesey’s novel “One Flew Over The Cuckoo’s Nest”, and Jack Nicholson’s consequent film portrayal of its main character, who has “treatment” forced on him right up through lobotomy. But from what I can see right now, it apears that the goal of Kendra’s Law is just about the opposite of the nightmare created in”Cuckoo’s Nest.” It’s not about institutionalizing people, locking them up and keeping them in chemical straitjackets. It seems to seek to help people live connected, fulfilling, and maybe ironically, independent lives.

Consider the very nature of disorders like bipolar disorder and schizophrenia…they deny their own existence. That is actually a diagnostic criteria sometimes, which boggles my mind: “Oh, you don’t think you’re sick? Well, that PROVES you are.” Yikes! But in bipolar support groups, I have seen more heartache than I can stand to reflect on much, coming simply from the sick person’s lack of insight. I don’t really even like that term, “insight,” because it implies something you can choose to have, and for many mentally ill people, that choice just does not exist without medication. And to complete the catch-22, without insight, medication is never going to be chosen. So there you are, stuck in a truly vicious cycle. I’m not talking about people who don’t like meds, resent having to take meds, etc. I mean the greater-than-80% of affected people who cannot recognize that they have an illness. If you could, somehow, get proper medication into these people, then they would be able to achieve the insight they would need to recognize the need for the medication…see the problem, here?

So, what say you all? At what point do we have the right to step in and mandate that someone else take medication–of any kind? Do we wait until they’re harming themselves and/or others? That seems to be what happens currently, and results in involuntary commitments…what if we could get to the problem and treat it before someone had to crash hard, possibly taking other people down with them? And at what point do “we” step in? I’m wondering how you get a diagnosis on someone who is totally non-compliant in the first place. Seems like someone would have to have run up against “the system” at least once, resulting in, at the very minimum, a 72-hour hold, in order to be diagnosed with a mental illness. I can easily see a “slippery slope” argument here, too. If we can mandate treatment for one thing, then why not another, and another, until we’ve reached Brave New World status?

But then, I see so many people homeless, sick, miserable, addicted to drugs and/or alcohol, having lost everything…when just straightening out some brain chemistry might have given them completely different lives, if only.

It’s a good topic for discussion, and I’m going to be doing some more research into Kendra’s Law, to try and figure out the details. I don’t know what kind of “teeth” it has, or what the consequences are for non-compliance, or what criteria must be met to have it put into play. I thank God regularly that my husband is one of the “lucky” ones (Yeah, I know–funny, huh? Ha, ha.) who doesn’t have any compliance issues…but you know what? When he was undiagnosed, unmedicated, and unstable? He didn’t HAVE any insight, wasn’t capable of recognizing his illness. He had to first “hit bottom,” and be involuntarily hospitalized and medicated first. Even then, he was not initially treated correctly in the beginning, and suffered a relapse, and yet another involuntary hospitalization. That was the one that saved his life, and he’s been pretty stable for almost 4 years now. And I have to ask myself, is what he went through back then really that different from what Kendra’s Law proposes? The only real difference I can see is that once my husband was released from the hospital, there was nothing in place to ensure that he kept taking his meds–he was free to get off them and start cycling again at any time, as he is now. Fortunately, he doesn’t misinterpret “feeling better” with “being well.” But he’s not in the majority there.

If you have someone in your life who suffers from a mental illness, but who can’t recognize that fact, and it drives you to distraction, there are two sources I strongly recommend, both from Dr. Xavier Amador. One is his fantastic book, “I Am Not Sick; I Don’t Need Help,” and the other is this amazing lecture on the topic of anosognosia (lack of insight). This video can honestly change the way you look at mental illness, and in my opinion, applies in good measure to addiction, as well. Amador is inspirational, and speaks not only as a healthcare professional, but as the loving brother of a schizophrenic who refuses treatment. Do yourself a favor and block off a couple hours of time to view this lecture. Heck, even if you have to view it in 15-minute chunks here and there, it is SO worth your time.

Nauseous
Dizzy
Too many smells
Sweaty
All backed up
Got the runs
Spaced out
Shaky hands
Shaky legs
Shaky handwriting
Thirsty, always thirsty

Sleep
Laugh
Smile
Write
Think
Do
Feel
Nightmares are gone
Tears have dried
Rage subsides
Calmness resumes

Life returns.

There is an article re-affirming the existence of Seasonal Affective Disorder in the NYT today, and discussing the various treatments, including a new one called Negative Air Ionization. I don’t own a lightbox or dawn simulator, but I do use a humidifier and full-spectrum spot lighting. Bipolars tend to suffer from SAD a lot, and I am cat-like in my ability to lie in the sun and soak up the light. I’ve actually noticed an uptick in my mood this last week at home, because I’ve been able to work in my lovely sunny living room.

There are lots of folks who haven’t had SAD who don’t think it’s real, but it is all too real for those who feel it settle on their shoulders like a lead apron as soon as the light starts getting dim.  It seems so strange that we’d respond to light so drastically, that one’s mood can wax and wane with the sun, that one can respond like a plant to a bit of sunlight, and droop in its absence– but there it is, and to have it scientifically proven is something, at least.

It drives my husband nuts when we’re out driving, and the empty tank warning noise comes on.  “Why do you do that?  It’s so easy to fill it earlier!” he fumes.  The short answer would be that in my brain, it’s not time to fill it yet– it’s not yet necessary.  Our definitions of when refueling needs to to happen are just different.  He’s worried I’ll run out of gas– I think that I’ve managed it fine so far, and that I have some emergency gas in the back anyway.

But now I’m at an emotionally empty point, and I realize that the way I treat my car is the way I’ve been treating myself.  I push myself to the very limit before stopping to refuel– and why?  I’d readily agree my car needs gas to run.  I wouldn’t argue that running out of gas is mightily inconvenient, and potentially dangerous, especially if I run out someplace deserted, or unlit, or in the middle of a snowstorm.  Of course, in the abstract, I think I’d know enough to fuel up before such a trip, but there’s a difference between life and a road trip.  Road trips are usually planned– you have some idea of where you’re going, and how long it will take.  Life?  Not so predictable– you can’t always tell when you’ll run out of gas in the middle of the wilderness.

I haven’t been maintaining myself well. I don’t know when I last did yoga, despite the fact that it contributes mightily to my emotional equanimity, and makes me feel less like a pretzel.  I haven’t been reaching out to friends in hard times, and taking comfort from the love they’re more than willing to give me.  I haven’t been saying no to too much work, because I want to prove myself capable– even though once taken on, I have no one below me to delegate other work to.  I haven’t been telling people when they’ve crossed the line, emotionally or professionally, and have been allowing myself to be walked all over– except when I have a temper tantrum after things have gone too far, and that’s not effective boundary-creation– kind of like shooting the unwanted house guest after leaving the doors and windows open.

I almost found myself stranded in the wilderness at work this month.  It’s a close call, and I don’t know yet what I am going to do next– but I am currently taking some time off to try to recharge.  I mostly have lots of sleeping, reading, and taking baths on the agenda, but I am also planning on doing some yoga and walking, and trying to restore myself mentally and physically.  Hopefully I will find myself in the process, and internalize the lesson of regular refueling.

I’m posting this from an airport terminal in Little Rock, where our flight to Orlando has been canceled because we’re fogged in. I can’t access the post I had prepared for today, so I thought I’d pop in and just ask for some feedback.

One of the challenges of keeping things on an even keel for us is STRESS MANAGEMENT. So, events like this can really put us into a tailspin. Alex does great during the crisis, but sometimes, after the fact, when the immediate distress is over, it kind of catches up to him and bowls him over, and we get what we just refer to as a “crash.” So right now, I’m hoping to avoid that. He’s already been pushed into what I’d consider a pre-hypomanic state by all the frenetic activity of the last 24 hours, and these new complications are just prolonging that, which is not good. The number one thing that is difficult for us but so important is the ability to remain FLEXIBLE. And my husband is a planner, so while he absolutely “takes care of business,” rolling with the punches when things get shaken up takes a lot out of him.

So, what are some stress management techniques that y’all have found to be successful, particularly as relates to managing a mental illness and preventing potentially stressful situations from throwing you all off-kilter?

The problem of mental illness is its invisibility– no wheelchair, no boils, no external signal that proves the existence of the condition.  Like a pain syndrome, or a dormant allergy, mental illness exists to the beholder only to the extent that they are willing to behold it—to believe it exists.  The other part of the problem with mental illness is its very mentalness—meaning that mental illness manifests itself it through words and deeds.  Trying to explain what’s going on in your head, to someone who’s not inside with you, makes no sense– literally.  There’s an underlying assumption that our thoughts and actions are under our control—such that the products of our thoughts, our words, our deeds, are intended.  From the beholder’s end, the crazy person had to have meant what she said, what she did, because why else would she have done it, unless she was trying to be cruel/mean/whatever? 

“Because I am crazy” ends up sounding like a lame excuse, but it’s true–  unless you are inside the crazy person’s head, you can’t understand that there is a lack of control, a lack of connection between what you intended, and what manifests itself externally.  When the crazy person is expressing thoughts, and acting on thoughts and feelings that are what she felt and meant at the moment, but which are based on a misperception of reality—psychosis, delusion, disassociation—how to explain it away when the episode is past, and say “I meant it, but it wasn’t real?”  How to explain that your lies, your accusations, your hurtful behavior, were based on an unreal paranoid perception, or an anger so overwhelming that the whole world is colored red—but again, that it wasn’t real, you didn’t mean it in the sense of intending to hurt, now that the episode is past?  Add into it the denial, the shame, the fear that we feel when we realize it’s happening again,  and we lie about what were are thinking, what we are feeling before the episode really begins, because we know you won’t understand.  It’s easier to pretend like your feelings and thoughts are connected to your words and deeds, and to not try to express, to in fact suppress, the swirl of emotions, the cycling thoughts, than to try to make you explain what you can’t.  Which can only lead to more explanations of words and deeds to untangle when the world is right side up again.  There’s an enormous leap of faith, of trust, that the outside observer is being asked to take—to believe what the crazy person is saying, afterward, even though the crazy person sometimes can’t trust their own mind.

I wish there were a flash animation online to show how increasing and decreasing hormone levels affect the map of the brain—your insight and memory, speech centers, emotions.  Likewise with neurotransmitters, the electrical impulses that misfire when the crazy brain isn’t working properly.  The analogy of serotonin to insulin works a little bit, and I’ve tried likening the misfiring impulses of the brain to a downed, live electrical line—who would go near it?  No one.  But the crazy person can sometimes lack the low blood sugar signals or the caution tape of the downed wire—making the “I can’t explain what you won’t understand” into a problem of “I can’t warn you about what I lack the insight to perceive.”  Therapy can help, but it can take years to identify the warning signals, to become self-vigilant enough to seek help at the critical point.  It’s better if you believe, and you watch with me, and you tell me I’m getting crazy again.  That is, if I am lucky enough not to have ruined our relationship last time.