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Category Archives: Mental illness treatment
Reasons why Bipolar is difficult to diagnose:
It has different components, which manifest at different times, so often the doctor has only what s/he sees at a given time to go on, eg:
– has similarities to other illnesses such as major depressive
– when presents as psychotic, any disorder which includes psychosis
– may present as a normal, well person, etc.
This can also apply to someone who is seeing a psychologist for crisis evaluation or a psychiatrist for emergency med management, you can seem normal then too. How? Read on if you wish. (Be warned, it’s another of my personal horror stories, very recent)…
All few of you who read this blog know I’ve been struggling for some time now with a great depressive epoch, and have recently found that some of the symptoms of my “depression” are actually more symptoms of mania. . .. therefore I’m rapid cycling like the wheels of a bicycle racer near the finish line. (please forgive the obvious metaphor, I’m not too creative at the moment, heh).
My life is unpredictable, my family never knows what will happen next. I don’t either. I know something is wrong with my meds, yet I’m reluctant to have them adjusted, especially by a doctor who no longer is familiar with my case, because of the release I’ve experienced on my current meds from cognitive dysfunction, and having regained a lot of my lost memory on the current regimen.
Yet, I sensed a crisis impending so my husband, who also sensed it, did what we both had sworn we’d never do. . . call that place for crisis help again. In this oddly rare instance, a “crisis counselor” was not available, though we’d expressed our reluctant understanding of the need to jump through that deplorable hoop before seeing a psychiatrist. It turned out that we were referred to the main crisis guy, over the phone, who mysteriously was able to produce an opening in the psychiatrist’s schedule on the spot!
Wonderful, we thought. So we saw her, and she, after only a few minutes, pronounced me normal and doing well and no adjustment of my meds was needed and she would see me again in 6 months. No opportunity to dispute that was apparent. Period. Then (unbeknownst to us) she canceled my previously scheduled appointment with my regular psychiatrist, which had been coming up fairly soon. A week later, I had the crisis my husband and I had feared.
Something triggered my destructive half, and I knew I was losing it fast. I felt rage and frustration and knew I was going out of control. So I went to an area where someone had stacked T-posts without consulting me and where I did not want them, and began heaving them out of there. What I was doing appeared like random destruction, to observers, but I had every intention of re-stacking them in a more appropriate place when I was done heaving them out of the stupid place. The kind of thing I had been counseled to do, take out my feelings in a safe way without hurting myself or exposing my family to my “episode”.
The observers (hubby and daughter) did not know what I was doing or why, and so hubby attempted to interfere with my work. Well, he successfully interfered with it, and there I went, set off. An argument ensued, which quickly escalated into something beyond my control and I began to self-harm in my usual way when out of control, which is to start bashing my head into things.
I was being yelled at to “just stop it! Please stop!”
What my interferer didn’t know was just how hard I WAS trying to stop it. I was bashing my head into the horizontal 2x4s of the horse stall wall instead of the 8×8 cemented support post that I FELT COMPELLED to bash my head into. For example. Also, how when I was smashing the bowl in the kitchen, my body/brain was screaming at me to smash WINDOWS. And other things, which I was given to understand made me a bad person who was acting out on purpose. It ended up hours later with me lying on the thin, softening ice of our stock pond trying to “cool off” but preferably go to sleep there and actually perish of hypothermia.
Unfortunately, my crying kids found me there and begged me to get off the ice. I was heartbroken, for them, but could not move. Then my husband showed up and was a little more belittling than I felt he need be. I felt, soon after I had been gotten into the house, that I was being treated the way Therapist K had treated me all those months ago, calling the police to the mental-health facility, like I was a sub-human animal who was acting out on purpose.
The horror of the whole thing for me was that I had all these self-harm/suicide prevention strategies hard-wired (I thought) into my brain. And yet they were not sufficient.
All this about a week after the psychiatrist had pronounced me normal and in no need of a medication adjustment. Boy were we glad I had another appointment already scheduled with my usual psychiatrist (who was to be leaving the institution soon).
The next day, of sound mind, it occurred to me that I’d better check that. Make a call to confirm that appointment, since I already knew the system was broken, the front desk people were overworked, and the policies were often stupid and usually detrimental to the mental health patient.
So I called to confirm the appointment and surprise, surprise, there was no appointment. My recently-visited psychiatrist had cancelled all other appointments in favor of the one six months away. I was a bit disappointed about that, considering what had happened last night, and insisted the appointment be rescheduled since I had been suicidal. Oh, no, that appointment was already filled, did I want to be put on a cancellation list?
I explained how important it was that I see a psychiatrist immediately, so I got an appointment for three weeks hence. And I was told I am on the cancellation list, although I’m pretty sure that if I were, I’d have gotten in by now.
My husband has tried very hard to get through to them. Not even my new therapist, who had replaced Therapist K on my case because she was of a more appropriate age and qualification, had anything at all helpful to offer him. So he went to the head crisis guy, who found him to be in crisis himself! My poor husband, doing all he can with what he has, and has been doing so for 19 years! What greater love can there be from a mortal than that I am blessed with from him???? ❤ ❤ ❤
So, there’s an example of how bipolar can present in ways that result in incorrect diagnoses with potentially disastrous results. In my case, I had the diagnosis, but my status was incorrectly evaluated, or rather, not evaluated at all, because of how I seemed when I walked into the consultation room. So a patient, with or without a diagnosis, should be very sure to make certain the doctor hears the whole enchilada and doesn’t have to go only by what he/she sees in the consulting room.
I pledge my commitment to the Blog For Mental Health 2013 Project. I will blog about mental health topics not only for myself, but for others. By displaying this badge, I show my pride, dedication, and acceptance for mental health. I use this to promote mental health education in the struggle to erase stigma.
I would like to thank Bipolar 2 Dad for pledging me and turning me on to this project!
I don’t even remember when I was diagnosed with Bipolar 1. I believe I’ve had it all my life, but my first diagnosis was clinical depression. I was finally diagnosed bipolar in early my 20s. I’m bad with dates, but I’ll never forget the words spoken, by my boss, on the phone, the night I lost my job as a medical technologist a few years ago:
“You don’t have to come back to work.”
Thank God.
Since my diagnosis, I’ve been on almost every medication in the book. Some combos worked for awhile, then stopped working. I believe I am on such a coctail now. It has only seemed to work. Unfortunately, after decades, even as a Christian, I am still searching for the peace and acceptance that so many fellow bloggers seem to be able to achieve.
A few fellow bloggers that I would like to offer to pledge to the Blog for Mental Health 2013:
Well, after all that whining I did a while back about how there is no support system for people living with bipolar illness in my area, a wonderful thing did happen. A new therapist came to town, and decided that starting a bipolar support-or therapy- group would be a good idea. And boy, was I happy. I’ve been to every single one so far, because it is so wonderful to sit and talk with others who know exactly what it is like to live with bipolar disorder, things that people without it simply cannot understand, no matter how willing they are to let you try to explain it to them.
I thought I was alone. I thought no one could possibly understand how it is to feel trapped by this illness, powerless (at times) to control thoughts or behavior or decisions. . .we’ve been exploring what it means to be manic, depressed, psychotic and found that we can all relate to the ways in which bipolar illness has affected one another’s lives. We may not share the identical circumstances, or have had the same experiences, but yet we can all relate. We can all understand what the other person was going through at the time. It is impossible to express how refreshing that is.
It has also been a wonderful time of learning. There are so many things to know about bipolar illness, and no one knows it all, not even veteran sufferers like yours truly, who has had the diagnosis for decades and been on every medication known to science. . .there is always something new to learn.
For example, I had a psychiatrist who, for many years found my happiness to be signs of hypomania and therefore took me down with more mood stabilizers. This went on for so long that I began to long for “hypomania” just so I could function like a “normal” person, do things, finish them, make plans, be happy.
Over the years, I began to think of mania as a positive state. Okay, maybe not a safe one, but a positive one. Famous actors, writers, other accomplishers of great things operated in this state. Great periods of creativity and grandiosity. These seemed terribly desirable to me. I longed to be manic, despite the dangers.
And I stayed just on the up end of depressed for, it seemed, forever. I came to group thinking, I must not be Bipolar I anymore. I must be Bipolar II, because my disease doesn’t swing toward mania at all. No mania, just deep depression. Periods where I experienced irrational rage or horrible sobbing misery I called “Mixed Manic” states, not sure what that clinically meant either, but applying it to myself.
So when we in group went around and said what mania was, I was enlightened.
Mania is not necessarily positive at all! Good and bad news for me, I guess.
The handout says: 1. Profuse and rapidly changing ideas, exaggerated sexuality, impulsivity, gaiety, or irritability, and decreased sleep.
2. Violent abnormal behavior.
3. An irrational but irresistible motive for a belief or action (been there!)
and at least a week of psychotic behavior.
Characteristics of mania as complied by our group included:
- Anger
- impulsivity
- poor judgment
- No self-control
- Racing thoughts
- Paranoia and delusions
- Inflated ego, sense of self, or abilities
- Hallucinations
- decreased need for sleep
- talking more
- unforgiving, can’t let go of things
Wow. Mania comes in many flavors, and even more than these. . .and some of these symptoms also overlap with depression. I am sure that if you are bipolar and reading this you can think of more characteristics of mania.
I have lived with many of these things for most of my life. Not positive at all. On the mood chart I would mark times of fear, paranoia, anger, impulsivity as “very depressed” when actually I was manic. So I do experience mania, a lot. It’s just not the good kind. I wish I knew how to get ahold of the good kind, heheh.
When I am manic, I tend to talk more, laugh more, become more social, become more consumed with paranoia and negativity, make plans I can’t keep, set unattainable goals for myself, think I have better ideas than I actually do, believe my writing is better than it actually is, and am absolutely sure I am right about everything. I am also absolutely sure I am wrong about everything, and everything is my fault. I get highly emotional, and anger has become a problematic emotion for me. So has anxiety. I become extremely anxious and full of doom. So when I think of mania now, I see that it encompasses a greater part of my life than I ever thought before.
These symptoms affect the people around me as much or more than my depression symptoms do. My husband wants me to come up with a “safe word” or an “off button” that can be pushed when he sees my symptoms getting out of control. Unfortunately when he sees that, I’ve already noticed it too, and have sadly realized (with that bit of rationality that sits in the corner watching myself in horror) that there is no “off button.”
Usually I can break myself out of it, but not before I’ve said or done at least one regrettable thing. (such as post last night’s entry on this blog!)
The best cure for a manic episode that I have found (and I am talking about the kind I have) is to get off by myself as fast as possible, drink a bottle of water laced with homeopathic aconite, slather myself in calming essential oils, and/or write in my journal until all those feelings are down on paper. If I find myself on the cusp of an epic, grandiose gesture, I picture the cliff I am about to step off of and flash forward to what it will feel like, for me or for my family, when I land. That usually does it for me.
Well, I don’t know what else to say, and I’m getting a migraine here, so quitting now. If anyone reading this has any more insights on mania, I would love to hear them. Good night! 🙂
–
The psychiatrist leaned forward as she asked, her legs crossed, her expression giving me the impression of one who is in the process of chain-smoking while awaiting a subway train.
I’m sorry, what? My “mooooood,” (for that was how she said it)? I did not know what to answer. It meant about as much to me as “how’s your penis?” or, “whatcha know?” or, “how’s the moon?” Looking back, I guess I’d say my mooood, at the moment, was hirrrritated. That question could only come from someone who had no idea what she was asking.
I was on Effexor at the time. Then and since, I’ve had a problem with the word, mood. I think of a mood as a passing thing, coming and going like clouds over the sun or waves on the ocean; that is, everyone’s sun, everyone’s ocean. Not mine.
What is mood? A current attitude toward the world? A snarky comment curling about your brain? A jumping and laughing, a reaching for the sky while others look on, dumbfounded? A dull fuzz that covers everything? An irresistible desire to dispense hugs like toilet paper? The moment of “ouch” after stepping on a rock because your shoe has fallen off, only, for a protracted period of time? Vertigo?
While I was cogitating on this, the psychiatrist wagged and tapped her feet.
“Uhh…” I said, stricken stupid. I had no answer for her, and perhaps it was then that I first recognized some deterioration in my cognitive function. Without recognizing it, of course.
Bipolar is identified as a mood disorder. Maybe I’d be happier if it were defined differently. Maybe it should be defined instead as an emotional disorder. Maybe I think I’m special. Maybe I’d have been happier if she had asked, “How extreme would you describe your epic fluctuations of emotional storm over the past month?”
electricity
How’s my mood? Yes, fluctuating. Of course it is. I’m bipolar. And I was unhappy with my psychiatrist at the time, whom to see I had to drive an hour. I’m sure I eventually began rambling on about some trouble or other in my life, just to fill the void, if not answer the question. I was irritated because her question was not specific enough.
Call me picky, but “mood disorder” doesn’t sound like a debilitating thing when the term is looked at objectively. It just seems trivial. Being bored when I should be excited. Being sad when I should be sympathetic. Being happy when I should be glum. Whatever it is, I’m doing it wrong. And I am trivial because of my inappropriate mood. And that’s exactly (one of) the sort of trap(s) that lead to self-esteem so low that, well, something or other is triggered, at least in me.
I think the emotional rollercoaster of bipolar deserves a better definition than mood disorder. Why? I don’t know. I am a semantics quibbler, been one all my life. What a fun person, huh. Maybe “emotional disaster disorder”…no, that’s more of a label, not a definition. I thought by writing about it I would understand the word “mood” and why it serves as a topic of conversation with an expensive psychiatrist who has me on the wrong meds to begin with. I certainly seem to lack the faculties to come up with a new definition of bipolar illness here. Maybe that’s not my job, because I’m too self-involved.
But it’s that “everything is my fault” mentality that almost always used to stuff me into that funnel that squeezed out a crawling-in-the-slime creature. I know that soon after that session I either attempted, or made an unworthy bid toward, you-know-what. I don’t even remember when that was or what the issues were. I just remember that the psychiatrist was on the clock, and didn’t want to know how I was doing, she wanted to know “How’s your mood?” simply to see if she needed to adjust the meds on one particular bipolar guinea pig.
I have wrestled and wrestled with this one. To write about it or not to write about it.
Why, during a crisis precipitated by a therapist at a mental-health institution this past August, with all the staff staring down at me as if I were a disgusting animal, did I become suddenly still–or, “less escalated”, as they call it there–at the sight of the police officers? (for backstory see Part 1 & 2)
It was not, as staff apparently believed, because I suddenly wanted to quit my tantrum and behave to avoid punishment. It was, as I previously said, an instinctive visceral reaction to past abuse by police officers in this town. I was no less “escalated” EXCEPT in my “behavior”–which was all they cared about.
OK, the “abuse” occurred over 10 years ago; it was not being overly tazered or beaten by night-sticks; so why should I be complaining about it? Because I still feel the trauma, that’s why. Thinking of it sends me into acute anxiety attacks. The mere sight of a police car, a cop reality show on TV, or driving past the jail all trigger these attacks. Trauma, pure and simple.
I have had very little experience with police. I’ve gotten speeding tickets, been pulled over because my purse was on the roof of my car, been led out of an Intensive Care Unit in handcuffs, and so forth. So when the police arrived, from the call made by my husband at the time, after I had shoved him away from me because he was frightening me by looming over me and screaming two inches from my face (we had some issues; I was sick; police were called because we needed help), I stupidly, naively, calmly, admitted to having shoved him. Both of us believed the police had come to help us.
I was semi-clothed, in years-old, rather un-modestly torn, men’s thermal underwear. They did not allow me to put clothes on. I don’t remember having my rights stated to me. They cuffed me, took me away, and locked me up in one of those cinder block holding cells, still clad only in this underwear. I wonder what they would have done if I was naked?
One of the officers found a black-and-white striped shirt which was too short and extremely baggy, but gave me no pants. I was not allowed to be warm (it was midwinter); they would give me nothing, because it was “not a hotel.” They joked and jeered at me and my behavior, I was crying and upset, and they no doubt get a lot of “crazy” people to torment in there on the graveyard shift.
All the while, I was given to understand later, my husband followed them and demanded they release me, that he was not lodging a complaint and they had no reason to take me in. I do not understand the system, but it appears they just wanted to take me in and would not be dissuaded by reason. I was a domestic violence criminal, guilty until proven innocent and treated as the foulest of scum.
They did give me my meds, and a pen and paper when I asked for one.
The next morning, they still gave me no pants, but locked me in a chain gang with a bunch of giant, overweight men (who all were wearing jail clothes and stinking of alcohol) and took me, still chained to them, into a courtroom that was open to the public–still in torn longjohns and no pants–and put me up in front of everybody, and said stuff. I don’t know what it was. Then they chainganged me away back to the jail. I was pretty mad and still in shock and told them I had used to have respect for the police.
I had nowhere to go and no one to call. I was not allowed to speak to my husband and he was forbidden from speaking to me. I had no vehicle or place to go and my husband was not permitted to supply me with either. I was advised by legal counsel to plead guilty (to what??) because I would have little to no chance in a jury trial.
The story goes on from here, but there it is. The Incident that stopped my “escalated behavior” at the mental-health institution this past August, the sight of the big fat uniformed men I would never before have referred to as “pigs.”
Thus was the conduct of this particular city’s finest 10 yrs ago, and if I had had the money, I would have sued the city.
Laugh if you will, that I call it “abuse,” say I deserved it, say I am overreacting more than a decade later…I’m sure that’s what the compassionate staff at the mental-health institution would do and say about my “behavior” this past August since they displayed no interest in my actual mental state or safety.
I later found out that the purpose of the police who had been called by the therapist in August to the mental-health facility was NOT to take me to a place of treatment. They would have taken me to the cinder-block holding cell at the jail, conveniently located across the street. Since I had been banging my head uncontrollably on the wall and the floor, and had reached a self-harm state of being with very little thought whatsoever (staff could have cared less … they were only concerned with my behavior), my being put back into that cinder-block cell with the specter of its remembered trauma would not have ended well…for anyone…
I have the right to remain silent. If I choose to waive this right, everything I say will be used against me in the Court of Life.
I don’t, really don’t, understand these things. AM I overreacting? Was this, or was this not, abuse?
I am one of those pathological, chronic self-examiners. A form of self-centeredness that concerns itself with worrying that things I said and did will affect others who have long forgotten about, or did not even notice, what I did, said, or thought; and also with analyzing every thought and feeling I have to examine and judge my motivations and their truth or falsehood. It may arise from all those inappropriate behaviors I “acted out” (God, do I hate that term) and said and thought in the past that were NOT forgotten, were held against me, swung around to bite me in the ass, and so forth.
In any case, were I to have been truly ashamed of what had occurred in the crisis assessment, that tendency toward self-examination would be the reason that after a week or so of self-flagellation, I would fall over myself apologizing to everyone concerned for the scene I caused. Which, of course, did not happen. To begin with, I did not cause the scene.
It was later denied by the therapist, and in a so-called investigation of the complaint I lodged, that she was yelling at me and my husband as we left the building. Well, yes, she was. A trained crisis counselor. Yelling out the glass doors into the cold, polished and windowed lobby in front of God, the receptionists, the pens with giant flowers on them, and everybody else: “You had better be back here on Monday morning!”
Very professional.
I arrived at that institution for responsible reasons; to seek treatment for my condition before a crisis occurred that would have a damaging impact on my family. Instead, the crisis was initiated there in the therapy session. It was by no means over when I was thrown out, or as they call it, “left voluntarily.” I was in far worse condition than when I arrived. Truth be told, I struggled into my old, deteriorating car, whose door is literally falling off, in a truly suicidal state of mind. I was ready to kill myself. There was no help, no hope.
There was the list of things, embedded in my mind, that I had planted there myself to automatically prevent suicide. They were MY safety, which I invented, with no help, suggestion or input from their behavioral therapy, whether dialectical or cognitive.
Why was she yelling? Maybe it was indirectly because I froze when I saw the police officers. That instinctive reaction to past trauma and abuse may have been interpreted as me subsiding from my “tantrum” at the prospect of “punishment” by the authorities, which of course would lead one to the conclusion that I had “worked myself up to it” as she put it, for the purpose of creating a scene, flouting every behavioral skill that I had ever been taught. This is only speculation on my part. A mere crazy person cannot fathom the sublime workings of the vast, disciplined minds of her betters, even if her betters are just kids.
When one breaks apart as I broke apart, the one thing they need is tolerance and competence from their therapist(s). If an institution’s “trained professionals” cannot discern the difference between a real breakdown and a tantrum thrown for the purpose of making a scene, but the institution stands with moral certainty behind their employee’s incompetence as professional, appropriate and effective handling of the situation, then that institution needs to be nuked.
I of course filed a grievance, instead of engaging in the more favored behavioral skill of “Opposite Action” by apologizing and sending them roses. They responded to the grievance with what they called an investigation, which, as described in the Resolution of Grievance they sent me afterward, consisted of interviewing the therapist about what happened. They did not interview my husband, who was there, the only witness throughout the farce.
Throughout the Resolution of Grievance, the language referred to everything the therapist said and/or chose to write down during the session as factual and honest. Throughout the same document, the language referred to everything I reported that I experienced, observed, felt, and heard, as mere “belief.” As in: ‘[Therapist] did (or said, or said you did) blah blah blah. You believed that blah blah blah. So the therapist was correct, and you were incorrect, because you merely believed, while whatever the therapist said is what actually occurred.’
This language conveyed quite clearly that they held nothing I said as credible. It demonstrated total lack of respect for the patient as an intelligent human being. It revealed that the patient’s point of view is insignificant to them, because they view the patient as insignificant and, indeed, crazy.
Do I want this institution nuked? I don’t want this institution nuked because it is my only treatment alternative in this tiny, redneck town. So, what do I do? Protest their “Resolution” of my grievance? Their Grievance Resolution invites me to. Or should I bend over and take it up the ass because if I would only practice the skill called “Radical Acceptance” my ass would hurt less.
In the end, I wrote out my entire dispute to the “Grievance Resolution” and then employed the behavioral skill of “Opposite Action” by not sending them the disputing response. Now I practice the behavioral skill of “Interpersonal Effectiveness” by being as sweet as sugar, or at least as sweet as I can be, whenever protocol and hoop-jumping require me to be in their office. So you see, the behavioral skills as practiced save me from alienating the guardians of my only avenue to my doctor who prescribes the live-saving medications. Isn’t behavioral therapy beautiful?
A couple of days after the incident, the medical assistant called and told me that my doctor had prescribed a change in my medication. I noticed INSTANT improvement (which is rare). I had gone in there seeking just this kind of treatment–medical–and had I received it when needed, none of the rest of this would have happened.
Within three days of the incident, people from Social Services invaded my kids’ school, ripped them from their classrooms, and threw them into closed, lonely rooms and interrogated them. Then they came to my house and tried to be disarming. They found no danger to the children, only love and an uncommon maturity and intense loyalty to their mother on the part of the children.
The one thing I have learned from all this is that the mental-health institution is NOT a safe place to go when I am in crisis or in imminent danger of crisis. All crises must be worked out on my own now, as there is no safety, respect, or confidentiality extant in the institution any longer, if ever indeed there was. I go to the treatment center only as needed in order to continue medical management by my very competent and respectfully-behaving psychiatrist.
Siege of the Spirit 