Monthly Archives: March 2014

Confronting Delusions

The older I get, the more acutely I’m aware that my mind creates fictional situations and relationships all on its own. Once I started paying more attention to this process, I realized that this issue seems to come from my mind jumping to conclusions after stumbling upon something my mind considers to be a clue.

Here is a very simplified example.

I call my boyfriend.

Clue: he doesn’t answer.

Delusion: he is dead.

I’ve gotten better at spotting these irrational conclusions in simple situations (like the one above) but in the cases of hardcore delusions (like the one 16 months ago where I was certain my boss was trying to get me fired and sabotage the company we worked for) my delusions are made of a series of clues, usually all taken out of context, coupled with subsequent bad-conclusion-jumping.

It seems that in these situations, anything I read, anything that comes up in conversation, as well as physical clues (mail, clothing, you name it) all begin working together in a web of total fiction. The more clues I stumble upon that seem to lend themselves to my theory only make a stronger case for the delusion, and makes it more difficult for me to break the spell.

Generally, when I begin having delusions like this, I tend to make things much more complicated by talking to different people about it. I might easily find myself talking about the clues or suspected theory to friends, family, or my therapist even… and though one would think this might help (and it does occasionally) most often people take what I have to say at face value. Usually if I believe it, it isn’t totally unreasonable to suspect the people I tell will believe it as well.

There have been a few situations where I was contested about what I mentioned, but it wasn’t enough to “break the spell” until almost a month later. No, realistically what I’ve learned is that it is best to go straight to the source.

I had a delusion almost a year ago now that one of my friends was having an affair with another friend of mine. In that situation I knew I couldn’t completely trust myself and the conclusion I had come to, so I did the only thing I could… I confronted one of them and asked about it.

NOW, confronting someone you have a delusion about in an attempt to find the truth has been one of the most uncomfortable things I’ve ever had to do. In some cases it has actually been a bit rewarding (not having to continue obsessing over the delusion anymore is nice) but generally, you need to know that it really puts people off.

I’ve only done this sort of thing with people who are pretty close to me, people who already know about my (somewhat questionable) mental health. Even then, starting the conversation with something like, “so, I have a question for you, and I don’t want you to get upset because it is going to sound totally crazy -but that is only because I think I may be delusional. I just need to know what is real and what isn’t!”

Yes, people get offended. Or distraught. Or very silent.

(I guess this is starting to sound less and less like a good idea, but I swear it can be very helpful!)

The thing is, the way my brain functions, I need to be able to walk up to someone I trust and ask if something happened, or didn’t. If something exists, or it doesn’t. If they saw or heard something or if there was only silence a moment ago.

There are so many layers of things going on in my mind that sometimes I need to be able to ask if I’m the only one experiencing something, or if everyone else saw/heard/knows it too.

Though mildly concerning to the people I’ve asked of this before, the result on my end has been extremely helpful. By going straight to the person I’m having delusions about and asking them about the situation I am essentially bypassing days, week, maybe even months of delusional thoughts and “clues” that riddle my brain with no real point (apart from distraction), as well as averting potential crises (like setting a huge HR investigation in motion).

I’ve also had to consider what this does to my reputation. After all, it isn’t particularly common for people to be sharing their delusions (let alone confronting people about them) and it probably looks a little… weird. Since I embrace the fact that I’m a bit of an oddball, it doesn’t bother me much at all.

I guess the best advice I can give is to tread carefully.

No. Wait.

The best advice I can give is to have one person in your life that you can trust and be honest with who will tell you (gently) that you have no idea what you’re talking about. If you can find more than one, consider yourself very lucky!

Sometimes it is better to go straight to the source when it comes to delusions. If you can risk talking to the person about the delusional situation you could ultimately save yourself a lot of time and trouble down the road.

Hypomania and Loss of Appetite

A few weeks ago I wrote about loss of appetite and depressionbut realistically loss of appetite is something I experience much more often during periods of hypomania.

Noticing a change in mood when hypomania comes on isn’t always the first thing on my radar, and that is why I try to keep close tabs on symptoms like insomnia and loss of appetite. These are symptoms that tend to show up in my episodes early on and are good indicators that things have changed.

The loss of appetite I associate with depression is both one of not feeling like eating, but also of feeling dissatisfied with food in general.

The loss of appetite I associate with hypomania (on the other hand) is one of not feeling like eating, but out of a sense of contentment or forgetfulness. Most of the time eating during times of hypomanic loss of appetite, my stomach will welcome whatever it is I eat, whenever it is I decide to eat it.

This can be a dangerous situation because it becomes entirely too easy to live off of a box of Hostess cupcakes, or the remnants of a pizza that has been in the fridge a few days. Eating doesn’t feel necessary, but when I do it I generally feel satisfied after eating anything. That satisfaction appears present whether I eat or not, and it can become easy to jump on the back of that satisfaction and ride it all the way through the episode.

I think the biggest problem I have with hypomania and loss of appetite is trying to determine whether it is better to force myself to eat regular meals at mealtimes, or if I should only eat when I’m hungry. Often hypomanic “logic” dictates I should only eat when I am hungry… but honestly I have had more luck eating small meals at normal mealtimes because otherwise my blood sugar has a tendency to crash (at which point I become a very abrupt, mean person).

This happened to me yesterday, and I went from eating eggs and toast at 8 am to suddenly realizing at 6 pm that I felt very irritable and needed food immediately (due to super low blood sugar).

It can be easy with the increase in energy, associated projects, and increased social time to find myself wondering, “well when do I have time to eat, anyway?” I find this easiest to combat during hypomania if I combine eating with social situations. Grab lunch with a friend! Make breakfast for my boyfriend (and myself)! Pop in with a friend for happy hour sushi!

Combining food and social situations while hypomanic can greatly improve on how healthy the food is you’re eating during an episode (sushi = way better than a box of Hostess cupcakes is for you) in a way that makes remembering to eat rather seamless.

I would also note that spending money during hypomanic periods can be particularly easy, and spending money on food is (for me) doubly so. If you’re short on cash, it can be more cost effective to throw a small dinner party, or have a few friends over to your house/apartment for a home-made meal. It can be fun to cook together, or just ask everyone to bring something to contribute!

It can be easy to feel like it isn’t a big deal not to eat (especially when it doesn’t feel bad to go without food). Realistically, our bodies need nourishment… so at least being mindful of this fact when the loss of appetite hits can be good news for a more well-balanced mind and body.

The Hypomanic Ascent

My episodes are not always straightforward. Instead of looking like a game of tetris (lovely solid interlocking chunks), my mood charting the last two weeks looks more like the work of a seismograph.

One day of depression. One day of mixed symptoms. One day with a depressed swing and a hypomanic swing. Two days of hypomania. One day with a depressed swing. One day with two depressed swings. One day with a hypomanic swing and a depressed swing.

And so on.

Around the first day of spring, I knew things were beginning to change for my mood because I was experiencing increased insomnia. That, and Corey (my boyfriend) was heading out of town, and I wasn’t pulling my usual hysterical, “I’m going to die without you,” bag of tricks.

Actually, for the first time in the six years we’ve been dating (and countless projects he’s gone across the country to work on) I felt fine about his absence. Confident. Relaxed. Awake. Giggly. Awake.

It wasn’t until I was dancing around the grocery store with a cart full of tater tots, laughing wildly and scaring the other customers that I realized it had come.

Hypomania!

I was elated (well, literally) about finding myself feeling so good. Despite almost wanting to talk in whispers (as not to scare it off) I shouted loud, animated, boisterous jokes.

Despite being as careful as I could about my sleep schedule (and taking Ambien without it doing anything except causing me to black out and wake up with paragraphs of nonsensical, albeit passionate writing on my phone) the hypomania stuck around for a few days.

Going, in a matter of days, from a deep place of loathing toward everything to suddenly loving everything can be a very interesting experience. After all, depression has this obnoxious ability to make it seem as if it will last forever. It seems like every couple years I reach a point where I begin to believe it, and this has been one of those years.

Having said that, it might be doubly frustrating to experience things in the opposite direction, as I did Monday. Going from feeling great, to crashing miserably in hysterics and despair, another instance of those mood tremors I was talking about.

At this point I am grateful for a change, even if it is an erratic one. Feeling great (even for a small fraction of the time) is preferable to feeling great none of the time. If my ascent out of deep depression into hypomania involves a lot of peaks and valleys I don’t feel like I can complain, because at least I feel like I’m moving forward again.

One Week of Open Enrollment Remaining

These times, they are a’ changin’. I’m sure you’ve probably seen the buzz around wordpress regarding enrollment in health plans through the affordable healthcare act (though probably more widely known as “Obamacare”). Since only a week remains in the open enrollment period (the time in which you can sign up without being docked the tax penalty for being uninsured) you might find yourself scrambling to figure out what exactly you need to do next.

Be prepared for change.

I know many people (like myself) who have needed help with the cost of mental healthcare while uninsured and have gone to places like charities, local hospitals with financial aid programs, sliding scale clinics, and patient assistance programs through medication manufacturers. I knew that the affordable care act would impact these services, but (as I found out quite abruptly this month) most of them are dissolving in lieu of being replaced by low-cost state medicaid plans.

That means signing up for insurance by March 31st!

What this also means is that the insurance you qualify for or can afford might not include the doctors you have previously been seeing. Personally, I am having to start over again from scratch… which isn’t a good feeling, mind you, but the alternative is to not have any insurance at all and go further into debt.

I put up a big fuss about it the last couple weeks because it is hard to leave a team of healthcare professionals you trust. I know, I am in the same boat. Unfortunately, as I mentioned, everything is changing. I’ve talked to several doctors who intend to begin adding more plans they will accept in the future, so there is still hope of things evening out a bit more, but in the meantime we are living on the healthcare frontier. Rope and hogtie whatever doctors you can get your hands on at this point!

Consider all your options.

Can you afford to get coverage through a private insurer? Can you get insurance through your job if you qualify? Can you get insurance through your family? Can you get insurance through a partner? I’d be lying if I said I didn’t momentarily consider the notion of getting married for the sake of Corey’s benefits… but realistically I don’t think the situation is quite that dire.

All I’m saying here is that there might be a way to lump coverages together, and you might find that is a better option for you than spending money on a plan that may not cover the things you need covered.

Talk to your doctors.

If you’re planning on signing up before March 31st I strongly suggest you give your primary doctor, your specialists (including your psychiatrist), and anyone else (like a therapist) a call and ask what insurance plans they will be accepting. In some situations, it might be easier to ask which plans they aren’t accepting, as that list might be shorter.

You may even want to tell your doctor your current situation, as I’ve had doctors who had professional friends in other hospitals and clinics around town they could suggest to me (at places that would take my new insurance).

If keeping your current team is important to you, find out what insurance providers they work with and see if you can afford (or if you qualify) for one of those plans.

See what you qualify for.

This is the government website that will link you to each state’s official marketplace website. Going to your state’s website and creating an account will allow you to use your personal information and financial information to see what insurance providers you qualify for.

There are some issues with the system you might want to be aware of before moving forward (at least, issues I had with the Washington State Healthcare site).

First, the site doesn’t allow you to see all of the options, only the options you qualify for. I like to give myself a little wiggle room, a window of what I would feel comfortable paying, if you will. This website did not allow for that kind of search, and (to make matters worse), once I submitted my information I was automatically sent to a page that said, “great! you signed up! We’re sending you a coverage card in the mail!”

The website didn’t ask me if I wanted to sign up. I simply was signed up when my search only returned one possible match to the parameters I entered.

Honestly, I was a little pissed off. I mean, at least give me the illusion that I am entering into this by choice!

Anyway, I don’t know what happens if you qualify for several plans, but I imagine in that situation they give you a choice. That would make sense (fingers crossed) anyway.

Pick a plan.

Another problem I had with this system is that it can be difficult to find any in-depth information on what any given plan covers. Why would I pick a plan when I don’t know if it covers what I need? Obviously I want to choose the plan that is best for me and my own situation.

I think at the very least, these plans will show you the monthly cost, as well as the deductible for the plan. It is important to note that a deductible is the amount you have to pay BEFORE the insurance begins paying for your healthcare. For people like me (who have a lot of expensive doctor’s visits) you want the smallest deductible possible.

Sometimes doctor’s visits and medications don’t count toward the deductible (depending on the plan) but keep in mind that if you need lab work for lithium labs or any other blood screening this often falls in the category of pay the deductible amount before insurance will chip in.

On top of this, if you’re able to, I would do a little research to see the situation as far as their coverage specifically for mental healthcare. How many therapy visits are covered in a year? What percentage of inpatient hospitalization is covered? Does this plan require referrals (your primary doctor authorizing your need for mental healthcare)?

This research step is one area I really hope will be improved upon in the coming years for this system, as I am a big believer in not paying for a service that hasn’t disclosed to me how it works or what my coverage is. Unfortunately, I’ve had a very difficult time receiving answers about coverage, and if possible, try calling the insurance companies themselves. That’s who I’ve had the best luck getting through to.

Once you choose the plan best suited (hopefully) for you, you’re done! Of course, you can’t really begin setting up your new health care team until you get the paperwork in the mail with your insurance card and ID number. Remember, each plan is different, and some will require you call them before being authorized for mental health care, while others will require your primary care doctor to do it for you.

If in doubt, be prepared for higher cost services and fewer financial aid resources.

Ok, so let’s say you’ve read all this and feel appalled. Horrified. Maybe you’re stubborn (like me), or maybe you don’t like being forced into things (um, also like me!). What happens if you don’t sign up?

Well, for starters there is a fee taken out of your tax return, that’s 1% of your income for individuals who make over $10,150 per year, or $95 per person, per year (whichever is higher). You are exempt from paying this fee if you do not earn enough to file taxes (there are a few other exemptions you can check out here).

Realistically, as I have pretty much zero income I wouldn’t have to pay the fee, however the other consequence of being uninsured is that you are responsible for paying 100% of your healthcare costs. As I mentioned earlier, the programs that were in place to help people who couldn’t afford care are rapidly disintegrating, and for those that need regular care (like mental health care, for example) these bills can quickly add up and lead to all kind of exciting debt, possibly even bankruptcy. 

Have you ever had collections agents calling you five times a day to try to collect on medical bills? They are there all day, every day, reminding you of what you owe until you go completely mad. Trust me. It isn’t a life I want to relive, that that’s why, despite all the funky, backwards scrambling that is going on right now in regard to healthcare, I would rather be covered than not.

For more in-depth information on the consequences of not signing up for healthcare, you can visit the Government’s page about it. 

Bridges; To Burn or Not To Burn

If there is one ultimate truth regarding those of us with bipolar disorder, it is this: we are emotional. Granted, humans generally are, but we are more so.

Because of this it isn’t uncommon for us to find ourselves in situations where we need to, want to, or are being forced to sever ties with not only the people around us, but the communities we find ourselves in or the jobs we hold.

I’ve burned a lot of bridges at jobs I’ve held, and even some in communities, but the bridges I’d like to focus on today are ones of friendship.

In the past, friendships were very difficult for me. As I mentioned, I’m a tad emotional, and there has been more than one occasion where I have exploded in a fiery cataclysm, denouncing all ties of friendship and loyalty.

The trouble with bipolar disorder is that I can have feelings for hate for something or someone one day, and feel reasonably loving toward them the next. Before I realized this, there were a lot of friendship bridges burnt, so I started a new methodology. That, and, I realized that my actions were hurting people… which isn’t really fun for them (and, you know, were apparently even a bit emotionally scarring). That’s not the sort of person I want to be, so I implemented the new plan.

Don’t burn the bridge.

I’m sure you’re thinking that this might sound easy but we both know that acting it out can be quite difficult. That’s why I developed a strategy to help.

Ignore the friggen’ bridge.

There have been several friends in my life that I found myself growing apart from. Sometimes that is just the way life works, people head off in different directions. After finding myself in situations where we’d both sit and awkwardly stare at our drinks without really talking for our usual social time, I could tell it was time to part ways.

And that’s when I’d start to get the itch. The bridge burning itch. The aggressive, intrusive, I’m going to call them and tell them never to talk to me again itch.

For a while the friendships in my life were neatly book-ended. There was a clear beginning and a clear end of each one (thanks, in part, to my bridge-burning). What I discovered in my adult life was that friends would sort of just start to fade away. I’d see less and less of them (and inevitably want to friend-dump them).

Let’s not forget, I didn’t want to be that person. I don’t want to be that person. Instead of burning the bridge, I work very hard to ignore it. I let it fade away until it seems to be gone, and in one situation I was even rewarded for this. A few years later my friend came back into my life and our friendship was suddenly better than it had been before.

This hasn’t happened with the others, but that one successful re-friendship has taught me that people learn and grow at different speeds. Sometimes when we aren’t synced up, we lose touch and part ways, but that isn’t a good reason to cut off all ties with that person forever. They could always have a life event that brings them closer to you than ever somewhere down the line!

On top of that, I’ve learned that what I say (and don’t say) to other people is really important to me. It’s true that some people have pushed my buttons on purpose, or given me the ol’ friendship backstab move, but that probably isn’t a good reason to unleash the raging, fiery cataclysmic beast that dwells inside of me. As it turns out, when people hurt me, I am often capable of hurting them ten fold. After all, I never do anything half-assed.

Big Changes for Psychiatric Experiments

I know many people who are furious at the method in which psychiatric drugs are prescribed (generally at random until we find one that alleviates our symptoms) and are also extremely concerned that doctors and researchers don’t understand more about the brain (and our disorders).

This month, things are changing. The National Institute for Mental Health based in Bethesda, Maryland is changing its grant process for psychiatric drug research.  Research can no longer be focused on just alleviating symptoms, but must also help us learn about the brain and psychiatric disorders.

“The new rules, which will apply to the grant cycle that begins in June, also seek to increase transparency by requiring faster online registration of trials and stricter guidelines for reporting results.”

The full article from scientificamerican.com can be found here and is quite interesting, I urge you to give it a read!

Warm Yellow Globe!

Yesterday I experienced a day with my mood chart recording my mood in all zeros. That is a great thing, because that means my mood was stable all day.

I am hoping (rather wildly) that this means I am coming out of my most recent depression finally. It has been a pretty solid two months (if not longer, I’d have to check), but those two months were at the very least horrific.

Though part of me feels hopeful that I’ll be awarded (for my patience) a short, sweet stretch of hypomania, I am perfectly happy with my mood doing nothing for a little while. That sure would be nice!

My luck, otherwise, certainly hasn’t changed. Every day I seem to get more and more bad news, yesterday included. Somehow my mood just seemed to skate past it yesterday, which I wish I could understand better because generally that response is unusual for me.

As much as I’d live to believe all of this is a product of things just bouncing back or working themselves out, I think it has something to do with the fact that the sun has finally started coming out in Seattle again. Hooray! Warm yellow globe!