Monthly Archives: June 2016

Self Identity & Mental Health – Pride Edition

Pride weekend is a pretty big deal in Seattle and while I tend to avoid events like parades (too much standing still with too many people for me to feel comfortable) I found myself on Capitol Hill twice during the celebration. I enjoyed having the opportunity to see all kinds of different people milling around smiling and laughing, and the attitudes of the multitude allowed me the briefest window where my self-consciousness could melt away.

Pride was, in a roundabout way, what led to a conversation where I was asked how important I think it is for us as human beings to be able to categorize ourselves in different ways. Even though I’ve only just started becoming familiar with the particulars of gender when it comes to self identity I couldn’t help but point out that this is a topic of conversation that comes up in regard to mental illness pretty frequently too.

In those instances the question is usually about diagnosing mental illness and if trying to fit our symptoms -which can vary widely even within an illness- into one category or another is more helpful or harmful in the long run. Even though opinions vary greatly on this topic I’ve found that the majority tend to see reaching a diagnosis as something helpful and can appreciate it as a tool to better understand their symptoms and how to live with them. For me being diagnosed with bipolar disorder felt more like a relief than anything else, even despite finding my symptoms don’t line up with the majority of those with the disorder.

In terms of self-identity I’ve always been curious as to how other people live their lives and what we have in common, but for as long as I can remember I have struggled with the idea of who I am. Trying to find commonalities has felt exhausting at times because I’ve had a hard time locking down what my values are, what I want my life to be, and who I am.

Issues of gender and sexuality have definitely played into that. Discovering that I might not be attracted to the same people my friends were was both alienating and isolating. Not being able to really understand why I feel uncomfortable when people address me differently than I imagine myself has been frustrating because being unable to explain this strange off-putting feeling to myself has meant being unable to explain it to anyone else too.

Self identity in that sense has had a huge impact on how I act, how I interact with other people, but also on my mental health. Feeling estranged from people I can relate to has often meant feeling depressed and isolated. Being unable to pinpoint and communicate where a lot of those thoughts and feelings are coming from and, even more, feeling the need to constantly explain myself has fueled a lot of the anger I have toward myself and other people.

While issues with gender and my sexuality have fueled issues like depression and low self-esteem I have found that living with mental illness itself, in my case treatment resistant bipolar disorder and anxiety, has played a huge role in keeping me from being able to pinpoint who I am and what I want out of life. Mood swings make a habit of constantly changing my motives and desires, so getting a grasp on what is underneath has often felt like digging a hole in the sand at the beach that is constantly being refilled by each wave that rolls in.

After six months of DBT (dialectical behavioral therapy) I’ve got a new-found appreciation for the fact that having a real understanding of ourselves and what we want in life is how we are able to find ways to make ourselves happy and move toward our goals. What can we expect if we don’t know how to make ourselves happy? Where do we go if we’re not moving toward the lives we want?

Without categorizing our needs in other ways, like the diagnosis of mental illness, how can we expect to move toward improving our symptoms? Without understanding our needs and being able to communicate those needs in a way other people and healthcare providers can understand, how can we address them?

I can understand how categorizing the elements in our lives can seem limiting to some people, but throughout history mass communication has been based on shared common knowledge. That might come from our language, or our understanding of science and theories at the time, or things we’ve learned from our friends and family (among others). Being able to communicate what we need in a way that other people can understand is a huge part of being able to be successful in both feeling acceptance from other people and moving toward what we want, and while sometimes that communication comes at the price of having to simplify things to help people understand, the understanding and acceptance is the ultimate goal.

Granted, there are big differences between something like identifying gender identity or sexual preference, and identifying a mental illness. I think it is important to remind people that our sexual preference and gender identity are inherent to who we are and to express those things comes from a lot of personal reflection and understanding of ourselves.

Conversely, most people in the mental health camp consider mental illness to be just that, an illness. I would be remiss if I didn’t say there aren’t people that disagree, but to most the symptoms of anxiety, depression, bipolar disorder, and schizophrenia, among others, are things that are keeping us from being happy and living the lives we want to.

If you consider it though, identifying mental illness is one way we are all able to be true to ourselves and to act in a way that will bring us a better understanding of ourselves and how to move toward living the lives we want. We seek treatment to try to get back to the sense of self we understand and feel that we have lost.

What is the expression and self discovery that comes with coming out, or expressing a change in gender identity but an act in the same direction? Taking steps to understand and communicate our identity is another way in which people can reaffirm their sense of self and actively move toward finding happiness and living the lives they want to live.

In both situations we fight to protect our sense of self and our identities, and though it might initially feel like an act of self-preservation both the LGBTQ and mental health communities know the value of protecting our inner-self and see that being true to ourselves, whatever that means for us, will make us happier in the long run.

I know that I’ve felt the effects of ignoring my most inner sense of self, and that whether that came from hiding who I truly felt I was or denying myself help from the constant attack on it that came with my mental illness I like to think that each day I know myself a little better. I understand myself a little better. I can keep moving in the direction of supporting who I am and what I want because I know that I am the only person who can do that for myself –and I deserve it.

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Dumbledore and the Mixed Episode

For the past two weeks I’ve been having the most substantial and intense episode I’ve had since October 2014 (that’s 20 months ago and my last hospitalization).

While I’ve had symptoms of bipolar disorder and anxiety since then pretty consistently I’ve generally found ways to cope with living with negative thoughts and urges without falling into the trap of believing them or acting on them (or, at least, not for very long). Sometimes the rapidity in which my mood swings happen help bring even just a few moments of clarity to me when I find myself slipping into a dangerous place, but when long, somewhat seamless episodes happen for me (and they do, almost always requiring hospitalization) I can easily sidestep from coping with my negative thoughts and urges to believing or acting on them -typically without even realizing I’m doing it.

I’ve written a little the last two or three months about how my depression has been getting worse and I told my boyfriend several times I was concerned that it’s persistance was signaling a long episode for me that might require hospitalization. Imagine my surprise to find that something (though I don’t know what) switched my increasing depression into a mixed episode two weeks ago.

Actually I didn’t exactly notice right away, and that’s where the downfall really started. I was having so much energy and euphoria suddenly thrown in with my depressive symptoms that I felt great at times, leading me to believe I was getting better. It wasn’t until the dreaded agitation and hostility that are usually a trademark of mixed episodes for me showed up in a big way that I felt relieved to see my psychiatrist last week.

That is how one of the most misunderstood aspects of bipolar disorder was dropped in my lap. Yep, I am definitely sick -to the point of wanting to destroy every element in my life. Even though my symptoms are treatment resistant and I am able to take very few medications in the long term I have an antipsychotic (risperidone) I typically take when psychosis or mania show up. The trouble is (and one of the reasons I don’t take it continuously) is that it is notorious for wiping out the mania and psychosis and leaving me with the remainder of the mixed episode, a sedated and faint-worthy depression. I don’t like to take it, who would like disparaging and laying on the couch all day crying and watching Charlotte’s Web?

At the same time, even though wanting to destroy my life doesn’t feel helpful and offending all of my friends isn’t a plus either, that euphoria and energy feels like such a liberation from the straight-up depression I felt before that and I find myself actively not wanting to feel “better”. At least, not when “feeling better” means having to feel worse first. After all, I have found zero treatment options to help with my depression, so having any episode switch into depression can be the potential for weeks, if not months of ongoing depression.

I am fully aware that this “logic” isn’t helpful to me or my life in the grand scheme of things, and I think that is why it is hard for people who haven’t experienced this kind of situation to understand that there is even a question of what someone like me in a position like this one should do. I know that when I feel well I like to believe that I will choose the best option for myself every time, even when I am sick. Unfortunately it doesn’t always turn out that way.

Ultimately I’ve been taking the rispiridone, but the first few times it was too low a dosage to achieve anything helpful. I tried it at a higher dosage and found myself resisting how emotionally pulverized I felt the next day.

I am really lucky that my boyfriend is so intelligent and empathetic. He kindly explained why I need to be taking this medicine anyway, which showed some extreme patience given the fact that my mixed hostility and agitation have often given way to labeling him the ultimate villain in my life, producing constant and obsessive thoughts about how I need to get away from him as quickly as possible (another reoccuring theme for me, the same issue that inspired my hospitalization in 2014).

Somehow I have become Dumbledore and while rational I have told Harry to make me drink whatever foul liquid is in that crystal podium even if I resist until we can get that damn horcrux in our efforts of defeating Voldemort. Now that I’ve drank half I’m kicking and screaming but he’s doing his best to make me drink it anyway.

Even though I dislike the situation, I have to say I find my boyfriend’s efforts quite admirable, and in those brief slivers of moments where I remember that he is kind and sweet I’m doing everything I can to remind myself that I asked him to do this for me in the first place.

Mixed episodes like this one are the worst sort of episodes I come up against. Combining the hopelessness and futility and lack of self worth of depression with the energy, euphoria, and rage of mania offers a dangerous situation where I constantly feel compelled to do whatever I want without any fear of the consequences (because they’re pointless, remember? And with mania I don’t feel anxiety or fear.). Meanwhile it doesn’t feel like I’m really doing any harm (because I feel great!) as I shuffle around and stomp on everyone else’s lego castles.

So far the rispiridone hasn’t made any dent in my symptoms (or perhaps it has and they just keep coming back with a vengeance). I pouted and told my boyfriend I didn’t want to go to the hospital (because I really don’t) but he wisely told me that the hospital “is just another kind of treatment that I might need right now, nothing more.” While I hope to make it through the week as a free woman, the instant I make a beeline to more lego-castles with the intention to stomp I’m going to have to check myself in. After all, if I don’t the cool kids might kick me out of their lego club, even if that only matters to the version of me who is stable.

 

 

Recognizing Positive Forces: Barbara Ballard

The last couple months I’ve been thinking about my high school English teacher Barbara Ballard’s retirement this week. I went to a small public high school in the town of Coupeville on Whidbey Island and she has been a fixture there for quite some time now.

I’ve always been the sort of person to have a brain like a dry sponge. It is often ready and willing to soak in anything and everything given to it which really was difficult to deal with in high school. Most of the teachers didn’t know what to do with me because I tended to be ahead of the curve in terms of their curriculum. I mostly hung out and made art, soaking up whatever new bits of new information I could get my hands on.

That changed my junior and senior year of high school when I began taking Ms. Ballard’s English classes. They were the first classes where I truly felt challenged (apart from never quite being able to get a positive score on the V-sit in P.E.), and even though I didn’t give much mind at the time to any writing skill I may have had it felt wonderful to have something other than sports I could pour my competitive spirit into (even if I was only competing with myself).

Though I didn’t recognize how honing my writing by continuously running the gauntlet in her class might help me in the future I’ve had the last few years to contemplate it. After all, finding myself in a position where living with treatment resistant bipolar disorder has kept me from being able to work a traditional 9-5 job I’ve had a lot of time at home to try to figure out an alternative that would allow for feeling even a sliver of purpose or fulfilment, and it seems I’ve found that again through the writing Ms. Ballard helped me build a foundation in.

In a way this realization has not been unlike when Dorothy finds she had the power to get home all along in the Wizard of Oz. After all, the first time my bipolar symptoms reared their ugly head was in my junior year of high school. Amidst the paranoia and psychosis, the intense mixed episode where I’d find myself feeling both amped up and tragically devastated at the same time I was enrolled in Ms. Ballard’s English class. When it came to the point where I needed to be hospitalized in order for me to get the treatment I required my mother told me that she spoke with my teachers about it to get my assignments worked out.

At 17 the idea that my teachers were aware of such an intense experience I was having, one that I desperately wanted to hide at first, was terrifying. Especially when it came to those teachers (well, there was only one really) who were demanding great work: Ms. Ballard.

I was too young and inexperienced with mental illness at the time to be able to recognize how well Ms. Ballard handled the information and how seamlessly she accommodated my situation in class. Once or twice she allowed me alternative reading from the rest of the class when she thought the content might not mesh well with my situation, and if she eased up on her critiques at all it didn’t keep me from trying as hard as I had before. She never made me beg or try to explain myself and she never acted condescendingly toward me (something many other adults were doing at the time). She simply allowed an unspoken understanding to sit between us and in doing so I felt comfortable enough to go on to complete a University of Washington English course in her class for college credit my senior year.

Like I said, I had little expectations for what writing could do for me at the time, but the treatment I received from Ms. Ballard at a very delicate time in my life left me with an enormous respect for her.

It has only been in the last few years that I’ve merged the skill of writing I’d gained with my experiences with mental illness to create a platform to help other people understand what it is like to live with mental illness and why it is important to be fluid and supportive in how we handle situations with other people. In my mind we could all take a lesson from Barbara Ballard because it seems she’s at the head of the class.

Thanks for providing an atmosphere where I could succeed and congratulations on your retirement!

 

 

 

 

How DBT is Changing the Game

I have been celebrating all week because as of last Thursday I have officially completed all of the sections in the DBT workbook and group. Apart from high-fiving myself (alright, so that’s just a clap really) for seeing this through I’ve been reflecting on how DBT (Dialectical Behavioral Therapy) has been a game changer in a life largely structured around living with treatment resistant bipolar disorder.

Before I can offer up a delightful before and after like some kind of mental and behavioral makeover I have to say that I feel lucky just for getting into a DBT program here in Seattle. I am on Medicaid and the waitlist for people receiving public mental health services here in Seattle means it takes typically months and in some cases years to get into a group. In the time it took me to get in I tried all sorts of treatments and even went to two consultations for ECT (electro-convulsive therapy). Obviously it seemed like DBT was a popular option, but after having a hard time with other types of therapy (like CBT, cognitive behavioral therapy, as an example) I couldn’t be more pleased with discovering why DBT has gained so much popularity and why I had to wait in the first place.

Me

Just so you know where I’m coming from on this I think it might be helpful to tell you a little bit about what I experience.

I have treatment resistant bipolar disorder which means there haven’t been any medications that have been able to help stabilize my ongoing mood swings or prevent new ones from happening. My mood swings range from several intense swings in a day (which can range all the way from euphoria to suicidal depression and back again in a matter of minutes) to long intense episodes that can last months at a time. I experience mania, depression, agitated and sometimes hostile mixed episodes, suicidality, homicidality, and psychosis.

Needless to say… that has been a bit of a handful both for me and for other people to deal with. I can be unpredictable around other people which means they don’t typically know if I will be excited or devastated or aggressive from one moment to the next and I’ve had too many issues with homicidality, suicidality, and psychosis at work to keep a job for the last several years to boot.

The things I have felt needed the most immediate addressing have been things like:

  • feeling strong urges of violence toward myself or others
  • feeling unable to communicate with my boyfriend or others during intense episodes
  • losing relationships and jobs because of my emotional reactivity
  • constantly relinquishing my own self-respect in attempts to make others happy and avoid confrontation or the potential triggering of more episodes
  • isolating myself due to constant fear and paranoia that someone might hurt me or I might hurt someone else
  • negative thoughts I could not seem to stop or make quieter

In addition I have experienced very intense anxiety since I was old enough to remember. This has typically caused problems like:

  • worrying to the point of causing physical illness
  • believing horrible, sometimes life-ending events are about to unfold at any minute
  • fear and panic overwhelming enough to keep me from having a driver’s license (at age 30)
  • attempts to control other people’s actions to keep their unpredictability from making me more anxious (I wouldn’t recommend it…)
  • constant obsessive thoughts that I felt powerless to stop that also often keep me from sleeping
  • Ongoing panic attacks

Sometimes I can pass as a typical stable adult to others because I am intelligent (might as well toot my own horn there but people often point that out as a reason I can be high-functioning at times) and periods of hypomania tend to dissolve the anxiety I feel when they are occurring. Unfortunately as I have gotten older my episodes have gotten progressively worse and those periods of “normalcy” have been few and far between.

Before DBT

The ways in which I have coped with these issues have definitely evolved over the last 15 years. I’ve gone through my fair share of harmful coping strategies (self-harm, alcohol, binge eating) but I have also gone through a long line of coping methods that may not have been directly harmful but weren’t exactly effective either.

Ineffective coping strategies are usually those I’ve come up with and then discarded after a period of trial and error. Without much direction (both from my doctors and therapists previous to DBT – with exception to CBT) I kind of just came up with ideas I thought would work and tried them… I’d like to chalk this up to the scientific method but it may have been equally spurred by a constant feeling of desperation. Sometimes the methods would work for a while and then I would begin to get exhausted because they took all of my focus and effort to maintain. Things like:

  • seeking approval from other people when I was depressed
  • reaching out to every person I knew in times of crisis instead of just people I could trust (resulting in sometimes landing myself in dangerous situations)
  • constantly fighting the obsessive or negative thoughts by arguing with them
  • keeping myself in a state of constant distraction so it wouldn’t get quiet enough for me to hear negative or obsessive thoughts
  • never being alone because then I would be alone with the obsessive or negative thoughts
  • changing jobs frequently in an attempt to find one that “made me happy”.

Obviously I found a few things that worked, even if I didn’t know it at the time. Writing, art, playing music, playing video games… all seemed to make things feel easier, just not enough for me to base all of my activity on them. After all, how was playing the piano going to help me maintain friendships? How could I work retail and be drawing at the same time?

When it came to CBT I could get behind the idea of doing activities like journaling but the idea there was that there was a thought that was ultimately prompting my emotion and behavior. I found many of the activities soothing for a time, but even after I managed to figure out what negative thoughts were prompting my emotions or behaviors I couldn’t find anyone who could tell me how to change those negative thoughts (or stop from obsessing) in a way I could understand and it frustrated me.

I was disheartened when therapists would simply say, “you just stop obsessing.” or “you just accept the situation,” and when I asked how one does those things (as I couldn’t seem to make them happen voluntarily) nobody could answer with anything more than a statement a golf caddy could have given me. It seemed to go against the whole idea of working toward having better mental health, after all… if I could stop obsessing or just suddenly accept a situation I wouldn’t need to ask how to do it.

Beyond that I often felt like I had mood swings that seemed to happen totally independently of what I was thinking or doing. I could be at Disneyland on a roller coaster and suddenly find myself depressed, but none of my therapists or any of my hospital workers were willing to consider or explain why that might be happening. Most of them told me I didn’t know what I was talking about which I could watch transform my curiosity into livid rage.

Needless to say, I started DBT feeling skeptical after my time with CBT but what I found was a language I could understand.

Dialectical Behavioral Therapy

I think it is import to point out that in my situation (one where every previous treatment option has failed) I have been desperate for any kind of help with my mental health for some time which means I found myself in the DBT group both ready and eager to learn as much as possible and practice the techniques. I needed relief from my symptoms and without anything that could provide that previously I was ready to throw my whole self into the class and take it very seriously. Being willing to dive in to the class helped me push through the frustrating or difficult parts I faced in the beginning.

I encountered the material in a structured weekly class with homework each week and I think in my case that structure really helped hold me accountable to practice the skills and do the reading. The previous week’s homework was reviewed each week so I needed to finish it. Being in a group also allowed us to compare ideas on what different ideas meant and discuss which coping strategies worked best for each of us.

The sections discussed were:

  • Mindfulness
    • basically how to live in the moment instead of being distracted by internal thoughts as well as how to enjoy each moment fully
  • Emotion Regulation
    • how emotions work, what goes in to working to keep them balanced, and how to change an emotion
  • Interpersonal Effectiveness
    • maintaining relationships and how to have positive social interactions
  • Distress Tolerance
    • tools for crisis situations

The thing I found most effective about the material is that it suggests that the best strategy for living a balanced life is to operate using both emotion and reason. Each section goes on to describe strategies that work to help you create that balance by bringing in whatever is missing (usually for me it is the reason element) into the situation.

While there were some aspects of the workbook I had already figured out on my own through the trial and error I mentioned earlier this style of workbook offers many different kinds of strategies and basically you keep what you like and leave what’s left. I really respected that idea because I was able to tailor my own set of skills based on my needs and everyone else in the group was able to do the same. In that regard I can see where DBT’s popularity comes from because it is accessible to a wide audience.

After DBT

The important thing to understand about DBT is that I still have mood swings. I still feel suicidal urges, I still feel most of the things I felt before. The group wasn’t a magic cure for those feelings and urges, but it helped me understand how to negate or change them in healthy and manageable ways. More than that, I’ve been equipped with an arsenal of coping skills that work for me, and that is HUGE.

The mood swings may not be gone but being able to bring reason and logic to the table when they happen tends to mean less reactivity on my part. Less reactivity means it is easier to maintain relationships. Being friendlier to people means I feel less paranoid about potential reactions to my reactions. It all starts to trickle down through all these channels because everything is connected.

The only hard part here is that it only works as long as I use these skills. That might seem like a no-brainer, but mood swings can sweep me up sometimes and I find myself swirling around with no idea of how long I’ve been there. Anxiety can leave me worrying so much that I forget to let myself rest or use the skills that might provide some relief. Yes, it takes a lot of effort, but I’m doing my best to be as diligent as I can because even though this may require more energy than if I’d found a medication that worked straight away DBT has led me to the first glimpse of relative functioning in years.

Even though I only started this class six months ago I can see changes. Three or four situations happened just over this last weekend where I found myself thinking, “wow, this really would have ruined the whole weekend before, but I seem to be able to accept and to move past these situations much more quickly now.”

I had a neighbor who kept parking in our building’s guest parking spot in an attempt to dodge paying for a spot. It went on for months, and even though I had to remind myself every time I saw it that it would be better to accept the situation (and not leave rude or threatening letters on his windshield) and to be effective than to make enemies with my neighbors I did it. They moved away and I did a celebratory dance because I was able to keep myself from being a total A-hole.

I’ve also found it very useful to distance myself from my own thoughts and remind myself that just because I’ve thought it doesn’t make it true, it doesn’t mean I will act on them, or that they will happen. I’ve got several ways of weeding out bad ideas now before I find myself doing them, which means creating a sense of self-trust and self-respect where I didn’t have one before.

While DBT has made things easier (less effort for better results) the more stress I am experiencing the less reliable the system is for me. If I am too distracted or upset to complete the skills things simply operate… well, as normal. In some respect that means I’m working to weed out stress before it’ll swamp me now, trying to be proactive about avoiding avoiding things. There are some situations though, like Corey’s broken arm, that came with an intense whirlwind of stress I couldn’t dodge and as a result I quickly slipped right back into a state of crisis. I’m still working on climbing my way out of it but each day gets a little easier.

Finally, apart from being immediately useful to me, I really respect the DBT program because it provided content that wasn’t given to me in a condescending way but made sure to fully explain why each part was important. DBT fits my personal values, and makes room for those with values that are different from my own.

The obvious take away here is that there is some serious potential for more DBT groups in the Seattle area, and I wouldn’t be surprised if that was a trend across the country.

As for me, when seeking treatment for mental illness has often meant taking one step forward and two steps back I am really glad to have had a chance to work through this program because in many ways it is changing my life for the better. Having the opportunity to change my negative behaviors while learning how to take the reigns back from mental illness has given me the footing to be able to respond with, shove off, I’m queen of the mountain now!”