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Tag Archives: behavioral therapy

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.

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Roatcap Fire Smoke

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! 🙂

 

 

Sorry to write another pissed off post.

A prisoner againI am very upset by today’s sermon. This was my SECOND time back to church in-at least-over a year, –after months of being immersed in scripture and praise– and now I have almost no inclination to return. I feel that the pastor said he condemns (or strongly implied that God condemns)  people who lack self-control (are “out of control”) because they are crazy-makers. No argument there, but it was also directly stated that “people with no self-control are trying to defy God’s relational law of physics.” (read: purposly, frowardly spitting in God’s face).

So, because at times I lack more self-control than others, being bipolar, I am therefore worse than others. There was no tolerance expressed for people like me who cannot control themselves. At so many times. What am I to do, be grateful to God that I have to work 3x as hard as other Christians to do so?

Romans 3:13 was used “Let us behave decently as in the daytime, not in carousing and drunkenness, not in sexual immorality and debauchery, not in dissension and jealousy.” That was the scriptural basis for “OUT OF CONTROL: OUT OF BALANCE BECAUSE OF CONTROL ISSUES.” This was not a sermon to help people such as this. It was a sermon for how people can protect themselves from someone like this. I am not saying such a sermon is not important, or has no application, but I am saying that a sermon that blindsides people with problems and blames them for other Christians’ troubles is unacceptable to ME. A major example that was given was the difficulty of dealing with alcoholics, who just “CHOOSE not to deal with it” or are “in denial.”: Giving no quarter to anyone with an ADDICTIVE DISORDER. By extension, us who live with bipolar illness must only be exhibiting our symptoms because we just CHOOSE not to repress them and intend to use them to control others and/or are in denial. What about everyone else with mental/emotional challenges? Where is the compassion? Nowhere to be found here.

This is bullshit and may have just nipped my joyous returning to church in the bud.

There was also a lot of talk about setting up boundaries against people like me, even though no one seems to have the least iota of respect for MY boundaries. Galatians 6:25: “Carry each other’s burdens, and in this way you will fulfill the law of Christ…each one should carry their own load.” I have been told more than once that this disease is my load to carry, not a serious burden that needs to be helped and shared by others. If this is true, well I suck at carrying my own load and should be “loved without rescue.”

Proverbs 19:9: “A hot-tempered person must pay the penalty; rescue them, and you will have to do it again.” Well all I can say to that is extreme thanks and appreciation of those wonderful people who have rescued me in the past and will do so again, because I need rescuing; I have not chosen for God to give me this disease; I am not in denial about it; and I am doing my level best to recover and not be a burden to others. So thank you for your superpowers of rescue, good loved ones, but by all means change your behavior now because this sermon has shown you that I am just a piece of crap who needs not to be helped but to be reprimanded: Matt. 18:15 ‘ir your brother or sister sins, go and point out their fault.” Otherwise, you will have to rescue me again and will be an enabler of my sociopathic behavior. Yes, please confront me and point out my faults, because I don’t know that I’m a sinner and I could give a crap that I hurt you. I just sin wantonly.

That I pray for forgiveness to God, and pray forgiveness of others, apologizing to them, confessing my sin, every time it occurs, is irrelevant, for now I find that I’m actually commiting these sins of bipolar illness on purpose, for I am a crazy-maker.

I do not want to go back and listen to this pastor’s crap anymore. this is the first time I have EVER responded to a sermon that “convicted me” without being pissed off. I did not choose this. I do not use my symptoms to control others. Every time I hurt someone inadvertently I apologize. I do EVERYTHING I can not to hurt those around me to the extent that I am able. And then at church to be treated in the sermon as one to be Boundaried against because I am a bad person is just too effing much.

So- I sin now with my bitterness, my tongue, my lack of self-control, and in coming to bed so I can “govern my tongue” against saying angry words makes me also guilty of the sin of sloth and not being a good woman who “worketh willingly with her hands” (Prov. 31:13) and “girdeth her loins with strength and strengthenist her arms.” (Prov. 31: 17)

Plus, I haven’t yet found a Word condemning this yet (but I know it’s out there), yet I have taken 2 whole clonazepam tablets, knowing full well they will NOT help me with my depression or anger, but after the desire to be knocked out so I will not be governed by my bitter tongue and cause further grief to my loved ones thereby, as I do so very often.

Now I thank God for revealing this stuff and clearing my head through his Word. I should be convicted in a constructive healing way by the sermon but I am just pissed off. I have begun, after weeks of being immersed in scripture, to harden my heart again.

Prov. 28:14 “Happy is the man thart feareth alway; but he that hardeneth his heart shall fall into mischief.” Yay.

That being said, I do not blame God, am not mad at God, and continue to immerse myself in his Word, both to become a better person in Him and to live gracefully with my bipolar disorder. But I’m back to “screw church” sorry.

Cow

I have been fighting depression and anxiety a great deal of late, and hard at that.  As the behavioral-ists say, as if I were a cow, “Have you been ruminating again?” Because, they say, “ruminating” upon feelings, occurrences, or memories that have me really pissed off, frightened, or saddened reduces my chances for victory. Well, yes, excessive obsessing can do that.

Yet I find that having these feelings, occurrences, memories, or whatever else cycloning around in my racing thoughts makes the sedentary, passive activity of “rumination” quite impossible.

Me no moo.

Rather, focusing those preoccupations through writing actually can help. Writing is not a form of “distraction” found in a Distress Tolerance list; neither is it a “pleasant activity.” Most especially, it is not rumination. Writing is looking hard for the splinter in your hand and stabbing it with a needle until the splinter comes out and you realize why you couldn’t see it without going through the pain: it was a tiny sliver of white wood, burrowed in there, invisible.

Sometimes you’ll do it through poetry (even if the esthetic results are dismal, the process is the point).

Sometimes through fiction.

I highly recommend writing in a journal (that’s what I do; I write in a journal). I don’t recommend “journaling”.  God, no! “Journal” must never, ever, become a legitimate verb! Please don’t help it to be so.

Or, and this is no new thought either, you could puke your guts out in a blog, which sometimes edifies, but usually just embarrasses. And yet we keep on doing it anyway! Go figure.

It may not solve your problem or cure your depression, but it’s bound to occupy your mind and could help you work through something, stall a suicidal impulse, become a prayer, slow the racing thoughts, ease the anxiety, be the only entity in the universe in whom you can confide the real you. . .whatever it does, it’s better than “ruminating.”

I may be obsessive, but I am NOT a cow.

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.

o

Behave, or you’ll end up here.

I have reached a conclusion, and it is this:

Beware of all therapies with the word “behavioral” in them.

While in some certain aspect, Dialectical Behavioral Therapy is useful (all people, mental-health patients or not, benefit from understanding the dialectic), behavioral therapy in general has its own hidden agenda.

To brainwash the patient in order for other people not to be inconvenienced by the patient’s illness.

Behavioral therapy teaches the patient how to exercise appropriate behavior in a variety of situations. This behavior suppresses the expression of the patient’s true feelings and the symptoms of their illness, not for the patient, but for the convenience and comfort of others. This is all good and fine up to a point. Most of us are not considered brilliant or indispensable enough to be tolerated for being unapologetically who we are.

But the other thing behavioral therapy does, the brainwashing and ultimate damage, is more insidious.

It puts back on the patient the responsibility for having any symptoms for their illness. That’s right. It’s our fault for having symptoms, if we don’t practice the skills, whether or not the skills work or help at all. That’s what I was taught four months ago at the institution where I receive treatment. The problem there, of course, is we’re right back where we started: being stigmatized. If we cannot exhibit the right behavior, it is our own fault. We are mental cases. We are nuts.

I have the institution where I receive treatment to thank for this revelation. I was nearing a crisis, and my husband rushed me to the treatment center for help. We knew it was a matter of medication adjustment, partly because I was on Seroquel, which was giving me terrifying cardiac symptoms; and partly because my new “behavioral” symptoms were frightening ones that I had never experienced before.

Instead being allowed to see my doctor, we were told I must see a crisis counselor. I explained to this person that my “skills” (DBT, mainly), were no longer working for this alarming condition I was in. In response, she mildly asked me what skills I could use to deal with this. I explained again that I had tried all my skills and none of them were working or else were inaccessible to me in my current state. Again, she responded by asking what skills I could use. This went on and on, trying my patience, and hers. I begged her for help. To no avail. At last the effect of her mounting contempt and annoyance at my mounting emotionalism reached a breaking point.

I began screaming and banging my head on the wall.

I am not proud of this. Nor did I choose it. It chose me, I suppose, my crisis, which I had arrived there in a responsible manner to avert, precipitated by the excellent and flawless job this therapist was doing. Who knows. In retrospect, I have to think, perhaps with tongue in cheek, that banging my head against a figurative wall was not effective, and so my disease directed me to bang my head against a literal wall.

This did not end well for me, as you can imagine.

The therapist had the police called.The staff’s single objective was to be rid of me, my symptoms, and my behavior. Mind you, the staff of a mental-health institution that is supposed to help people wanted to be rid of the crazy person. Call the police!

My poor husband tried to get ahold of me. No one stepped in to help. That in itself is understandable; physical involvement in situations like that are not allowed. However, a group of staff people simply stood around me, staring down with disgusted, fascinated, or shocked looks on their faces at my disgusting behavior. Not one person offered a comforting word to my husband throughout the whole incident.

Or to me, though it might have helped to resolve the inconvenient symptoms I was having, panic being among them.

Then I saw the police officers. I froze in instinctive terror. I had been severely abused by that city’s police officers, and still suffer flashbacks of the shameless humiliation they inflicted.

The staff took this instinctive freezing to be self-control, apparently, and seemed to have concluded that the crisis was resolved.

Far from it.

Pain is not the same thing as behavior. Pain is pain.

So why is all the “therapy” available around here “behavioral” therapy of some kind?

Does “behavior” manage pain? Really? Or does it just make  “behavior” safer and more appropriate in spite of pain, much like intolerance training of horses makes them run and perform while they are in silent agony?

Huh? Am I stupid?

Has pain made my cognitive function below acceptable standards?

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