Why “crazy” is lazy

Paul Nuttall is a crazy, myth making liar.

Donald Trump has a troubled mental status, and we should feel free to used the terms “nut case” and “mentally ill”. Indeed, he probably has Narcissistic Personality Disorder.

The climax of Piers Morgan’s mental breakdown is imminent and should be sent to The Priory.

Not my words, but ones I have pulled from social media the morning.

I get where this is coming from. I really do. It’s so tempting to write off repeated bad behaviour as “mental illness”. Because why would a rational, sane person make self-evidently bizarre and authoritarian claims? Why would anyone repeatedly tell huge, discoverable whoppers unless something pathological was going on? Why would someone display their most unpleasant character traits on social media unless they were disinhibited by their mental state?

There’s a process of “othering” going on. People with mental health problems are usually “other” because they might think differently and/or behave differently to the norm. They might seem embarrassing, laughable, or even frightening and so it’s comforting to the general population to maintain a belief that those people are not like “us”.

But when the Trumps and the Nuttalls and the Morgans take centre stage, mental illness suddenly becomes the lesser of two evils. It is difficult to accept that awful behaviour could come from a place of being a not very nice person, that unpleasant and sometimes damaging ideas might simply be part of the human condition. Because what then does that say about the the rest of us “normals”?

Of course the kind of behaviour we see from Donald Trump goes beyond merely damaging and into downright dangerous, so the othering has to be stepped up. Personality disorders, perhaps the most stigmatised of mental health diagnoses, are especially useful here. They might lead to troubling behaviour, but some of them are also “evidence” of pathological awfulness. It’s a convenient way of seeing Trump’s behaviour as evidence that he is both unhinged and bad to the bone. Many people, including health care professionals who do not work in psychiatry, have been quick to remotely apply the diagnostic criteria for Narcissistic Personality Disorder and declare that Trump is a match, rubbing their hands with glee at being able to stick him in the “other” box.

Aside from the unethical nature of public armchair diagnosis, the association of dangerous/embarrassing behaviour and mental illness impacts on people who genuinely have a mental condition. Othering gets taken to a new public level, as the association between mental health and awful behaviour are further cemented in the public mind. If Donal Trump is “crazy” because his wild ideas can be downright dangerous, “crazy” people must have wild ideas and their thoughts might be dangerous – especially those people with more severe conditions.

Pulling The Priory (a well-know British privately-run mental health hospital) into the discussion downplays the seriousness of admission to a psych unit, and makes admission the logical consequence of bad behaviour. Both mad and bad people ought to be inpatients, tucked away out of sight. It is effectively a punishment which conveniently removes offending ideas from the public domain.

Here’s the news flash: some people are just plain obnoxious. They probably don’t have a personality disorder, and even if they did, nobody could be sure other than a qualified psychiatrist who’s spent sufficient time with that person to make an assessment. They’re probably acting as they are not because they are mentally unwell. Their behaviour isn’t the result of disinhibition or panic – it’s a choice. Their lying is situational and calculated, a deliberate means to an end, not the result of someone whose untruths are pathological or “crazy”.

A simple plea, then. By all means acknowledge that Trump is narcissistic, but don’t go ahead and pin a stigmatising label on him. Call Paul Nuttall out on his lies, but don’t frame his personal myth as mental ill health. Don’t identify repeatedly rude or unpalatable behaviour as evidence of an imminent breakdown, and don’t threaten admission as a way of dealing with bad (or mad) behaviour.

Just accept it: some people are repellent, and that’s probably all there is to it.

 

 

Posted in Activism, Hospital, Politics and current affairs, Psychiatry, Social media, Stigma and discrimination, Uncategorized | Tagged , , , , , , ,

Semantics

Warning: this post contains detailed descriptions of suicidal thoughts and feelings

Semantics

The branch of linguistics and logic concerned with meaning

1.1 The meaning of a word, phrase, or text:

  1. such quibbling over semantics may seem petty stuff’ (Oxford Dictionaries )

“I will always have an abnormal level of anxiety, but it isn’t all bad,” tweeted author Matt Haig a few days ago. “It keeps a mind sharp. Sometimes it feels like a superpower.”

There was an intake of online breath from anxiety sufferers. A superpower. A superpower?Yes – “those moments when you rise up, out of panic but massively alert, feel very empowering.”

Haig, who often appears mildly baffled by reactions to his views on mental health, offered clarification. “The main thing is: no two experiences of life or illness are the same. To me anxiety can sometimes tip upwards into an intense excitement.”

Of course he’s right that no two experiences of any illness can be the same. But I was among those wondering whether something that felt like a superpower, that was a kind of excitement, that had anything at all positive going for it, could match my personal understanding of anxiety. There was a flurry of tweets as people rushed to explain why the debilitating nature of their anxiety made the suggestion offensive, and a flurry of counter-tweets validating Haig’s right to describe his anxiety any way he likes. Now I’m left chewing on the question: when you say you have a condition, and I say I have that condition, how do we ever know that we are referring to the same thing?

Let’s take a look at the criteria for a diagnosis of depression:

Reduced pleasure in activities 🔹 Feeling down, depressed or hopeless 🔹 Trouble falling or staying asleep, or sleeping too much 🔹 Feeling tired or having little energy 🔹 A poor appetite or overeating 🔹 Feeling that you’re a failure or let yourself or your family down 🔹 Trouble concentrating on things like reading the paper or watching TV 🔹 Moving or speaking slowly, or being very fidgety, so that other people can notice 🔹 Thinking that you’d be better off dead or hurting yourself in some way

“But wait a minute!” people cry when I get to this point on training courses. “Sleeping too little and sleeping too much are both on there! Are you saying someone might have depression if they are eating too much or too little? If they are unusually fast or slow? How can two opposites lead to the same diagnosis?” Well…

Clinical criteria impact on how people with mental health problems describe their own symptoms. I’m bipolar, that’s my diagnosis, and it resonates. And that diagnosis means that I swing between two opposites, yes? So if one of the poles is elevated, high mood, then the other must be low mood. And low mood = depression. I mean, that’s what it must be, it says so in the manuals. Manic depression, (hypo)manic mood alternating with depressed mood. Right?

Except what if it isn’t? What my experience at the low pole isn’t depression as other people understand it?

I sometimes hear people speak of their depression and/or suicidality as an emptiness or numbness. I have no means of relating to this. It’s like we are speaking a different language. I have no reason to disbelieve them, yet when comparing their description with my own experience I hit a total block. I cannot imagine not feeling. It seems implausible. And if I did, I wouldn’t see that as depression.

Because depression, to me, means pain. Active, urgent pain, the kind of pain that must be stopped. Ultimately the only certain way to do this is by suicide, so even when the pain fades for a while the fear of it coming back means I never really rule out killing myself as an option.

Right now I am somewhat depressed. There is a hole in my soul and the cold is creeping slowly in. This edge of pain is bearable, but if it progresses to severe depression, it won’t be. That hole, somewhere around my solar plexus, will expand and I will find myself hunched cover, my body curving around the void until my spine aches. The muscles around my mouth will ache too from the twist of something beyond crying, something more like keening, forced out of me by the anguish.

By the time I get into crisis the emotional pain is such that I sometimes cannot stand. I promise I’m not making this up. I end up on the floor, or leaning over the kitchen counter, as if someone has just punched me in the stomach. The whole time my mind runs over the same refrain: I can’t stand this agony, I can’t live in such acute distress, please let me die, please don’t try to stop me, if you knew, if you knew how much pain I am in and you really loved me you would not try to stop me, you would give me the pills yourself, you would take me to a Belgian clinic, you would sit beside me and hold my hand and stroke my hair until I was finally released.

Is that what other people mean by depression? How can I know? If it’s not your depression, if there is a massive gulf between our experiences, then how much use is the word?

I am emphatically not saying that my depression is more important or of more value than the depression of someone who experiences an absence of feeling. Objectively, that sounds horrible, not being able to connect with any feelings at all. It sounds like it would be hard to feel like a human. And yet as I curl up on the floor in the corner by the door, I feel that I would happily ditch my humanity if I could trade my despair for numbness. I am sure that if I got my wish I would regret it in a heartbeat. But sometimes, just a little, I envy those who are cut off the from the feelings that I am unable to bear.

I suppose for medicine and public health there is the issue of outcomes. Intolerable numbness and intolerable pain may both in the end lead to attempted or completed suicide. They are both incapacitating, interfering with partnerships, friendships, work, ability to enjoy what life has to offer. But the focus on the observable tells us nothing about the inner experience. Stroke and dementia can both cause loss of speech, but we would not expect the internal worlds of the stroke survivor and the person with dementia to be the same.

Maybe we need a new vocabulary, although I’ve no idea how this would be achieved. Cultures that end up with numerous words for what we might perceive at the same thing do so through shared consensus about things that everyone can see. It’s just not feasible for largely subjective experiences.

Perhaps it’s more realistic to recognise and acknowledge that it’s not just the diagnoses attached to a person that may be problematic. The personal meaning that those with mental health problems bring may be radically misunderstood by professionals and indeed peers. Perhaps we need to move away from simply asking whether service users tick enough boxes to merit a diagnosis, to a focus on the quality of the experience. What does “down, depressed or hopeless” mean to that person? What does it feel like? If they struggle with the idea that they would be “better off dead” what emotional resonance, if any, does that idea have? In order to help helpers to understand, should we be offering a range of adjectives (including numb, empty, detached) to pick from, instead of a menu of recent thoughts and behaviours?

I have no idea how to answer my own questions, or indeed if any work is being done in this area. But if we don’t try to cut through limiting language and our personal assumptions, we may never really be in a position to connect.

Posted in Anxiety, Bipolar, Depression, Hypomania, Mental health, Mental health services, Mood disorder, Psychiatry, Social media | Tagged , , , , , , , , , | Leave a comment

A life in the day of bipolar mixed mood

It would be so nice if being hypomanic and depressed at the same time meant that they cancelled each other out, if the high would make peace with the low so you could find a place in the middle. Instead they antagonise each other, taking it in turns to yell or descending into a muddled bicker.

This is day ninety six million of mixed mood.

Your husband is already up, phone in hand, checking his work emails in his dressing gown. You look at his bare legs where they rest on the foot stool. “I really love your feet,” you tell him. You are completely sincere. How have you not noticed how beautiful they are?

“Okay,” he says. “Feeling chipper this morning, I see.”

Of course you love your husband – you only got married last year – but right now you really, really love him, so much that you can’t stop telling him. Last week in the car you said, “I keep looking at you and thinking that I love you so much I might be sick.” Almost every time you see him it bubbles up out of you – iloveyou. You can see that it’s a bit overwhelming to be told so often, to have random parts become objects of adoration, to be nearly thrown up over, but you can’t stop saying it. You mean it every time.

Despite all the lurve you are kind of keen for him to leave for work. You are desperate to get dressed, get out, go shopping, and you don’t want him to try and stop you. You do not wish to be told sensible things, things like, “Slow down” or “Don’t stay out too long” or “try not to spend too much money”.

You feel fast, agitated, whirling around the bedroom grabbing any old thing to wear because you need to be out. Except when you go to get your bag you suddenly don’t know if you want to go after all. You feel inexplicably exhausted, defeated by life, and you sit down. You stand up again because you still want to go. Or do you? You repeat the sitting down and standing up thing then take your clothes off again and get into bed, needing to hide, needing to shut down.

Half an hour’s dozing and that inner drive, that pressure has returned, so you leave on your mad hypomanic mission. On the bus you are buffeted by anxiety. Why did you rush out so fast? Did you lock the door? Have you even got your keys? You go through your bag, putting everything on the seat next to you: phone (good), travel pass, purse, keys! Everything is all right. You glance around and notice there is now only one other person on the top deck. You are glad that she is there. You, on the top deck alone; that would’ve been… unauspicious. It would have felt dangerous, and not the kind of danger that comes from other passengers. It would’ve felt like a message, and there have been more and more messages for you lately.

Your prime objective is to gather items for what you are calling a “festive branch” – an inexpensive alternative to a Christmas tree. You found the branch itself in the park and now it’s in the kitchen, waiting to be made pretty. There is so much useful stuff in this shop! A vase etched with bare trees, echoing the branch itself. A great base. Glass beads to weigh the vase down – they’re inexpensive, so you throw eight bags into the basket. White LED lights on copper wire, prefect. All kinds of beautiful little silver and white ornaments. You are steadfastly not bothering to add all this up. Who cares if you’ve already spent more than you would have done on an actual Christmas tree?

You wander the rest of the store, picking up a stocking filler here, a joke present there. It’s the middle of the day so your teen daughter’s at college but you text her anyway, laughing aloud in the aisle, to ask if you should buy a piñata. “Um mum? 😂 Why? I meaaaaaan…” You’re not sure. It just seems like an important idea.

You’ve a lot to unload at the checkout. The woman behind you tuts and fusses. “I ain’t waiting around for all this lot,” she says.

“I’m entitled to buy whatever I want,” you snap, and when she continues to grumble, “Oh fuck off.” Instantly you are terrified. Why did you do that? What if the assistant won’t serve you and you lose all your precious stuff? What if someone calls the police? “Some people are so rude,” says the woman the till, but you realise she’s jerking her head at the other customer.

The journey home is hard. Everything is too much, too loud, too busy. You have had enough of other humans. You just want to get home and look over your stuff. It pleases you for a moment, but then you freak out. You cram it all back into the bags and shove them right under the bed. You take the guilt about all the money you have spent and try to shove that right away too.

Dinner happens. Watching TV happens. Nothing out of the ordinary, but you begin to feel sad. You begin to feel beyond sad. Your mood has plummeted with shocking rapidity. “What’s the matter?” your husband asks, seeing you crying, taking your hand.

“I feel awful. It’s happening again, isn’t it? It’s all happening again. This is it, this feeling is my whole life. The drugs aren’t working and I’m going to end up in crisis and I’m going to end up back in hos-”

“Ssh,” your husband says, kissing you on the forehead. “You’re over-thinking things.”

“I’m not. I’m not! I can’t live like this. I feel so terrible, oh God, what am I going to do?”

“But this morning you felt great, remember?”

“I remember what I said and what I did. I don’t remember how I felt. I’m so frightened!”

You take a diazepam to take the edge off the pain. You cuddle up closer to your husband, wrapped in a purple blanket, and try to lose yourself in the TV programme and not think, although you are thinking, you are thinking, “Wow, my teeth are really pointy.”

When you clean them you take a peek but they don’t look weird. You hum a little tune as you swill the mouthwash around. When you’ve finished your husband is already in bed, waiting for you to turn the light off. “Are you sure you want to go to sleep?” you say plaintively. “You don’t want to stay up all night and talk to me, do you?”

“Aren’t you tired?” he asks, opening one eye.

“Not at all.”

“You seem pretty chipper,” he notes. “Oh God.”

 

 

 

 

 

 

Posted in Anxiety, Bipolar, Christmas, Depression, Family issues, Hypomania, Mania, Mental health, Mixed mood, Mood disorder, Psychosis, Rapid cycling, Self-management, Social media, Uncategorized | Tagged , , , , , , , , , , , , , , , ,

An office #TwistmasParty

 

At the time of writing there are just sixteen days and 15 hours to go until Christmas, well inside the period when the spectre of the Office Party looms. They’re a strange thing at the best of times, a night of enforced jollity with people you might not otherwise socialise with, too much alcohol, inappropriate liaisons, the pressure to dress up. I guess they can be enjoyable when you’re in the right mindset, but when you have a mental health problem it can be really hard to set your mind to “party”.

There are so, so many mental health reasons why an office party might inspire dread. Without even really trying I can generate a whole list. Being too depressed to get dressed up and/or get yourself there. Social anxiety. Issues around eating in front of other people or fear that food may be contaminated. Body image. Needing to discreetly take meds to a schedule. Discomfort about being around copious amounts of alcohol. Worrying about making a fool of yourself because you are hypomanic. Maybe you have non-mental health conditions which cause other hidden issues with parties. Maybe autism makes you hypersensitive to noise, maybe you are uncomfortable with the rigid gender expression these events tend to enforce, maybe you are dyspraxic and worry you’ll be pressured to dance.

And yet the whole thing can stir some longings. Workplace bonding is something we can’t have if we have lost jobs or could never obtain work because of mental health disability. We all know that colleagues can be awful, but some can be a huge source of support and even become lifelong friends and I will freely admit that I am lonely without them. So I’m probably misremembering or over-romanticising office parties, but I kind of wish I had one to go to.

Where do I turn? To my Twitter friends. In a way, they are my colleagues. We all share an interest in the same field. Twitter is the water cooler where I discuss what happened over the weekend. It’s where I debrief after a work event, where I share a research paper or my learning from a conference.

So that’s where I want to have my office party, and I wondered if you’d care to come? It’s a cliché to say that an event is “what you make of it”, but in this case it really is.

You can tweet wearing your PJs or you can dress to the nines in your own living room. You can pick a picture that you like to represent a party version of you, take a pic of yourself at that moment, or keep your appearance private.

There is no pressure to eat or drink, because there isn’t any except what people “bring” (describe) – but I would ask participants to start food-related tweets with a content note (CN) to give people a heads up to skip that tweet if reading about food is difficult for them. It’s like a trigger warning, but less strong. I do it something like this:

cn-example-2

You can stay for one minute or the full hour, talk to anybody or nobody, tweet once or tweet as many times as your fingers allow in 60 minutes.

If you’re up for it, I’m happy to host for an hour on Wednesday 21st December at 6.30pm. All you have to do to join is use the hashtag #TwistmasParty within that time slot. I’ll be “DJing” via Spotify so that you can all point and laugh at the cheesiness of my Christmas playlist.

Who’s in?

C

 

(Usual caveat: this is all assuming I am well enough. I’d love someone to be a backup person, just in case. Do let me know if you think you could help. Also full credit to @skingers for coming up with the hashtag!)

 

 

 

 

 

 

 

Posted in Christmas, Employment and benefits, Mental health, Uncategorized | Tagged , , , , , , , , , ,

Mixed mood

I can’t think of a snappier title for this blog, because mixed mood is where I am at and my brain feels scrambled. For four weeks now my functioning has been disturbed, my mood fluctuating but not actually euthymic (normal) at any point.”How are you?” my Care Coordinator asks, and all I can say is that I am “up and down”. When pressed I think harder and say that I am more up than down, but definitely with down bits stirred in. So – mixed?

It’s maddeningly difficult to get anyone to agree what a mixed affective state is and I have of course met different psychiatrists with different views. Is any bipolar mood state that has some features of the other pole necessarily mixed? Is it useful to separate out predominantly depressed mood with hypomanic features from a predominantly high episode with some features of depression? How do you know whether the swirling pool of emotions is a mixed state or in fact “ultradian” (incredibly rapid) cycling?

A “mixed affective state” use to be viewed as one of the four presentations of bipolar: bipolar I, bipolar 2, mixed affective state and rapid cycling (all boxes I have been put in at one point or another). When the DSM-5 came along it switched to the “mixed features” approach, so any major mood episode can be diagnosed as having mixed features as part of its makeup.

 

It’s all a bit of a mish-mash from a service user point of view, and when you are in the grip of swirling emotions being able to tease out and articulate what you think is going on can be very hard. Just as I have had to learn what hypomania means for me (depression’s pretty easy to identify), I have had to learn what mixed mood entails. It matters that I am able to to identify mixed mood. It matters a lot. I was in mixed mood both times I was hospitalised. I was in mixed mood the only time I took a major overdose. Here’s what I have pieced together in recent years.

If I don’t know what mood state I am in, but I am unwell or distressed, it’s probably mixed mood.

If my moods flutter and flicker rather than snapping smartly back and forth, it’s probably mixed mood rather than incredibly rapid cycling.

In mixed mood my thoughts are very “loud” with competing viewpoints vying for attention. I can be in two or even three minds about something, for example: I need to die; I want treatment because I don’t want to die; there is nothing wrong with me and I don’t need anything. One thought can immediately follow another so that I don’t know what I feel, want or believe any more, sometimes wanting multiple conflicting things in any given moment.

If I am tired, yet raring to go, that’s a sign I may be in a mixed state.

If I experience eight different emotions, ten, maybe even more, in the course of a day then I must be in mixed mood.

Today I have been irritable, angry, lethargic, agitated, sad, tearful, awed, elated, guilty, terrified, ashamed. I got up desperate to go out and shop (hypomania) but returned to bed feeling exhausted before I could go anywhere (depression). I went out in the end and spent too much money (hypomania). I was hypersensitive to noise at the shops and felt hostile towards other people who had the gall to get in my way (hypomania). When I came home I sat on the sofa and cried because a song was so beautiful (hypomania). Then I cried because I couldn’t cope with household tasks and I felt aweful about the money I had spent (depression).

I have given up for the day. The washing will have to stay wet in the machine until Tom gets home to deal with it. I have cancelled the gym class I was really looking forward to because I have no idea whatsoever whether a cardio workout to loud music will be beneficial or detrimental to my wellbeing. I will have a bath. I might take some diazepam. It’s all uncomfortably like implementing a crisis plan.

I am seeing my psychiatrist tomorrow and I am going to ask about a medication increase. The level of mood disturbance has been creeping up and up in the last four weeks and I’ve been having the same old paranoid thoughts about my tech being misused by dark forces and the same old feeling that I am being menaced by banana skins. I can’t take the risk that things will get any worse and anyway I am getting very, very tired of the big bipolar mixing bowl.

 

 

 

 

 

Posted in Bipolar, Depression, Hypomania, Medication, Mental health, Mixed mood, Psychiatry, Rapid cycling, Self-management, Uncategorized | Tagged , , , , , , , ,

How not to annoy your patient

Today I saw a rather old Independent article on Twitter. I’m surprised I haven’t come across it before – it’s been out there since 2010 – but now that I’ve seen it, I can’t unsee it. Entitled How not to annoy your doctor, it’s a rather unpleasant little piece detailing groups of patients that GPs find particularly… annoying. Some of these categories are really quite hurtful, especially for people with mental health conditions who are often accused of displaying the kinds of traits this doctor finds irritating such as dependency, manipulation or self-destruction. I will admit that I took this article somewhat personally.

This post is my coping mechanism. You see, doctors may think that dealing with “heartsink” patients is a particular burden for them to bear, but guess what, service users have “heartsink” clinicians that we end up stuck with too. So here are my top five types of psychiatrist guaranteed to annoy a patient.

The File Flicker (now superseded by the Screen Scroller) “Hummty tummty tummm,” murmurs the  Consultant File Flicker, deeply immersed in a cream coloured folder. “So your GP says that you are depressed… and he has put you on 75mg of venlafaxine… How are you finding that?” You are surprised to be asked a question, as so far he has not once looked in your direction. You tell him that it’s early days, and he nods, still glued to the paperwork. “So that seems like a reasonable course of action… I’ll see you again in three months.” He stands. You stand. He looks you briefly in the eye as he shakes your hand and the appointment is over. Next time he should probably just spend some quality time with the file as it’s clearly more enthralling.

The Family Guy “It’s understandable that you’re worried about your son leaving for university,” nods Family Guy. “It’s bound to be a source of anxiety. I remember when my daughter went off to Oxford I found it very stressful.” He listens carefully when you tell him that you had a bad episode when you had your second baby. “New babies are really hard work, aren’t they?” he empathises. “No one quite understands how the lack of sleep grinds you down unless they’ve been there.” By the fourth session you feel like you know FG’s whole household, except his wife, who remains strangely absent.

The DSM Delver No one else’s clinical opinion is good enough for The DSM Delver. Maybe she has trust issues. Maybe she believes that she, and she alone, has all the answers. It’s hard to tell. Whatever label you show up with, she will better it. It doesn’t matter how solid the prior consensus is, she will make her mark, delving into the diagnostic manuals for a new interpretation. “Aha!” she thinks. “Maybe she doesn’t have bipolar after all. I can do better than those three previous consultants! Maybe she has major depressive disorder with clinical anxiety. No, no, wait! Maybe she has MDD with borderline personality traits!” Having exhausted the more obvious explanations the DD goes further, coming up with arcane labels the rest of the team has never even heard of. “Adjustment disorder! That’ll get them all thinking!” Sometimes, for extra fun, the DD will keep their epiphany to themselves, burying it in the notes without sharing it with the patient. Because feeling that you’re right and everyone else is wrong is all that really matters.

The Checklist Slave You wait for the duty doctor all afternoon. When she finally arrives she asks you what is wrong and out pour all the details of the current crisis: the thoughts of self harm, the preoccupation with suicide, the inability to sleep. “OK,” she says. “Now I just need to ask you a few questions. Do you currently have any thoughts of harming yourself?” Um, yes. Did you not just say that? “And do you have any thoughts of taking your own life?” Hello? Yes! “And how is your sleep?” You realise that this psychiatrist is using a list, and she’s checking it twice. After a while you begin to doubt that you said anything at all, maybe anything in your life, before the checklist began. You had thought you were in a bad place before you saw the doctor. Now you really have lost the will to live.

The Internet Denier “So you should take your new antipsychotic in the morning.” You are surprised. The consultant has never prescribed this drug before. Neither of you really know what the side effects will be, so in case it turns out to be sedating you had planned on taking it at night. “Yes, pharmacy suggest you should take it in the morning.” Yes, but in the absence of clinical experience, you have been reading around on the internet and everybody says it makes them sleepy. So you want to take it at bedtime. “Well, I’ve written it up for the morning,” persists the ID. Well… look, the only information either of you has on any sedative effect comes from patients. So given that the only information you have suggests it’s sedating, isn’t it better to start off taking it in the evening? “I suppose it doesn’t really matter as long as you take it at the same time every day,” (this seems like a major concession) “but I think it’s best if you take it in the morning.” You take it in the evening.

 

Posted in Bipolar, Crisis care, Depression, GP, Medication, Mental health, Mental health services, NHS services, Psychiatry, Social media, Treatment planning, Uncategorized | Tagged , , , , , , , , , , , ,

Who cares?

There is a little note on my phone. Depressed me made it a couple of days ago in an attempt to remind the rest of me – the high, the normal, the mixed bits – that I need things to be different, that I need to be well, that what I do impacts on how I feel and upon others. That my behaviour matters.

It’s a prescription advising me to do all the things I was doing before I started to wobble. Of course it’s far to simplistic to say that my mood is now less secure just because I deviated from my plan to keep well through meds, diet and and exercise, but that’s how it feels. Just before I came unstuck I stopped eating five a day when I had been eating 6-9, and I allowed sugar and caffeine back into my life. I know I can’t have lost my stability just because I didn’t make the effort to meet my Apple Watch fitness goals, there has to be more to it than that. But certainly things began to deteriorate around the time I stopped making the effort.

And so the logical thing, the note reminds me, is to get back to on track. If I don’t want to feel awful – and the low bits have been becoming progressively more awful – I need to take action. If I put that effort in again and it doesn’t work, well, it doesn’t work. But there’s no point in not even trying and them complaining that I feel awful.

And yet… I don’t care. Logically, of course, I do. I don’t want to get any more unstable than I am. I remember the pain, I remember being able to think about nothing other than how much I hurt, how much I wanted to take my own life, and I remember how the despair I felt in hospital was beyond what I could ever put into words. But I can’t really connect with it. It’s like the way I remember Alice’s birth, how much worse it was than Max’s, yet part of me still feels that it can’t have been that bad.

Every bad day is followed by a good day or a hypomanic day and I think about the note, and then I think, “Meh.” Today, I am high so I don’t care about anything much other than running all over the town centre taking up shop assistants’ time chattering away and spending too much money. I don’t have time for self care!

When I am low, I don’t care either. It is too much effort. I have realised that it is almost a relief to sink into mild-moderate depression, because I have spent so much time there over the course of my life. In a bizarre way I have even been a little happy to be depressed, because it is so much easier than doing all the “shoulds” that trying to stay well entails.

But if I don’t care for myself and I get sicker, Tom will end up being my “carer” again. I hate this thought. Being the carer and and the cared for is not a great dynamic for a marriage so I have loved the fact that since I started the lurasidone we have been on more of a even footing again. Partners. I dread becoming ill because I know that earlier this year it was taking a terrible toll on him. So now I worry that the wobble goes beyond that and it all comes tumbling down it could make him sick, and the worry about this is making me even less steady. Yet do I do the things to try and prevent this? Somehow… no.

Despite enjoying greater balance within the relationship, in some ways slipping back into the cared for role would be so easy – just like sinking into the soft bed of depression. Having Tom attend appointments with me and make excuses for me, put me to bed, drive me places because I can’t go on my own, manage my meds – I shouldn’t want any of that, but part of me does. I have become so accustomed to being looked after, and it’s hard to break free from that. I miss the nurses and doctors of the Home Treatment Team. I miss the ward staff. I would like to be cared for my them again. I crave the feeling of having no responsibility. I know that is fucked up.

Before I went to sleep last night I read the note and resolved that today would be different. Today I had cake crumbs for breakfast. By 1.30pm I felt that I should eat something, but I was out and busy and I wasn’t able to think of a single thing I wanted to eat, although I couldn’t stop thinking about having Coke. A contrast to the start of the week, when I was low and constantly wondered what I could eat next, except I wanted a Coke then too. In the end I grabbed a hugely calorific sandwich because it was next to the aforementioned caffeinated beverage. I have eaten no fruit or veg today and hardly any protein and I don’t care. I did go to the gym, and I was restrained enough to make sure I didn’t inure myself, but I can’t be bothered to hit all my fitness goals.

Depression and hypomania make people not care about things. That is part of how they are diagnosed, so my thinking and behaviour make a certain kind of sentence. But I am frustrated because I cannot seem to connect logic with those thoughts and actions.

Don’t care was made to care, and if I don’t get things back to where they should be, I probably will be too.

 

Posted in Bipolar, Depression, exercise, Hospital, Hypomania, Mental health, Mental health services, Mood disorder, Rapid cycling, Self-management, Uncategorized | Tagged , , , , , , , , , , , , ,