Category Archives: OCD

Healthcare Held Hostage

I apologize for not posting in the middle of this week, but to be frank… some crazy shit went down.

I got a call on Tuesday from my therapist who told me the clinic I go to was going to allow me to have three more sessions before I was going to be cut off. This would be remedied only in the instance that I sign up for insurance via the (already mentioned in several emails and sessions) Washington state healthcare reform website.

Now, to say I was flabbergasted by this threat would be an understatement. To think that a reputable community resource is no longer allowing sliding scale clients is heartbreaking (at the very best) because it will be putting many homeless, and the remaining uninsured cliental out in the cold. What felt much worse was the way my ongoing mental health treatment (via talk therapy) was being held hostage and would be taken from me if I didn’t comply.

The truth is, I would have signed up for the low-income, no-cost insurance before now if it meant I could continue seeing the psychiatrist I have had for the last 3 years. Unfortunately, his clinic wont take that insurance. By signing up for this insurance I am forfeiting my right to see the team of doctors I want to see, the team I have hand selected over the last four years.

First I cried. I cried and cried. Then, I got angry. I told my therapist, in a nutshell, to fuck off, and that “there are other therapists I could see.”

When it comes to psychiatry and prescribing mental health professionals, this man (my psychiatrist) is the first and only one I’ve ever trusted. When it comes to thinking about my life and the handful of people who have constantly gone out of their way to help me, even when it wasn’t called for (and possibly might even be breaking the rules to do so), this psychiatrist is one of the very few.

So if it was a choice between the two, therapist vs. psychiatrist, I’d side with the psychiatrist any day of the week.

The clincher is that I’m currently able to see my psychiatrist through a charity program at a local hospital. They’ve expressed that they will not be continuing this program for much longer (due to the healthcare reform) so if my coverage ends suddenly, I am without therapy and my prescribing doctor (not to mention my general practitioner and dermatologist).

It seems that my only option at this point is to sign up for one of the plans that are available to me. I’ve been researching for three days and barely feel any closer to figuring out which one… the internet seems to be devoid of information and every phone number I call has an automated message on the other end.

With all of this crammed into my puny mind I made the trek yesterday to what I expect will be my last appointment with my current (or ex-current now) psychiatrist.

I stepped into his office crying and on the verge of a panic attack. Within minutes he had me calmed down and talking about how screwed up everything has become. After all, the best time to leave your supportive psychiatrist and find a new one is when you’ve been suicidal for a month… right?

As usual, he was overwhelmingly helpful. Printing me documents, giving me extra lengthy prescriptions so I wouldn’t have to worry about my medications running out in the meantime, and giving me tips on a couple of the plans that might work best for me.

I have such a hard time trusting doctors (psychiatrists especially) that I felt heartbroken (for lack of a better word) walking out of his office. Our relationship always felt more like having a powerful friend than being subjected to some kind of overbearing taskmaster.

After all of this, it isn’t the emotional depression that stays with me, or the anger about being forced into a bad situation, or the anxiety about not knowing what to do next… it is the sense of loss and emptiness knowing that there is something of a hole where a good, strong support system used to be. The fear of finding myself in crisis and having to scramble to get help instead of knowing who to turn to.

Though the SSDI hearing last month was one of the most terrifying days of my life, this insurance situation is really much more detrimental to my overall mental healthcare. I’m starting over from scratch at a time when I am in a very fragile state, and there is still a lot more I need to research and determine before I can start putting the pieces back together.

The Initial Aftermath

Yesterday was the SSDI hearing. Turns out I was dealt the most difficult judge, and despite my intense anxiety I went in feeling more confident than I expected to be going in (which is slightly laughable, considering I was on the verge of a panic attack at any given moment).

I couldn’t tell for certain, as the man was straight-faced and tight-lipped, but I’m about 98% certain he didn’t like what I had to say. I laid everything bare, even things I haven’t told my therapist at this point… all of these horrible questions making me say things I didn’t want to say (but needed to). I answered the questions as best as I could, and despite the anxiety felt a stillness of emotion for the hour I was engaged.

I’d be lying if I said it was anything less than traumatizing. The sense of relief I felt when I walked out the door (feeling as if I’d done and said everything I possibly could have) lasted about an hour. As soon as Corey and I got on the bus, it began. My mind started replaying every little detail, every moment that made me cringe. Every instant I have suddenly began second-guessing. All of this has made up some horrible loop in my mind, giving me only a 15-60 second window of being able to think about anything before my thoughts automatically cycle back to the hearing. The hearing. The hearing. The hearing.

“Alan Tudyk will be at comic con this year… what about when you said you’d only posted your blog once last week? It looks suspiciously like three posts. But I did technically only post once! One was a re-blog and the other two I wrote at once and scheduled to be posted on the same day. That’s one day’s work, it just looks like three!”

Gahhhhhhhhhhhhhhhhhhh.

I got in bed early last night and took an Ambien to silence this obsessive inner monologue. I felt sneaky, like maybe I had beaten it, when it started up again at 4 o’clock this morning.

I’ve been trying very hard to look at this hearing like I might look at a job interview. The way I feel about most jobs is that I am not particularly interested at first, I’ve even been wary about the amount of stress the job would put on me. Then, after thinking about it a little, I become interested. As time begins to pass, my enthusiasm begins to grow, and I move from being interested, to wanting the job, to passionately wanting the job, to feeling like I need the job and ultimately feeling like I can’t live without it.

In the last year, my mind has moved from a place where “it would be nice” to have SSDI benefits to, “there is no point in living if you don’t have them,” (which I understand is untrue, just the way my brain tends to exaggerate sometimes). Undoing this thought is difficult, and doesn’t really lend itself well to helping me not frantically obsess over this for eons.

The truth is that I’ve been obsessing over this for a year. I am ready, really ready, to obsess over something else. Wrestling with this situation has been extremely difficult, so please refrain from calling/texting me right now in an attempt to find out more detail about how things went. That’s why I’m writing this post.

Luck was not on my side. I will find out “for certain” in a few weeks, but I can say with some assurance I really don’t believe I won.

The Global Assessment of Functioning (GAF) Scale

Every once in a while I am faced with paperwork concerning my mental health. This has happened with insurance companies, state programs I have applied for, and even the medical records I have requested and snooped through (hey, I should be allowed to know what they’re saying about me, right?). Upon looking at this paperwork, I am generally surprised by what I find -not due to the content (though sometimes I am) but because of the paperwork itself. The way the questions are phrased and answered, the way sections are broken up, entire ranking scales I knew nothing about… obviously there is a system that I have been completely unaware of. I mean, heck, I’m no doctor, I’ve never been trained on what all of this means, and if I didn’t go back and read the paperwork attached to my diagnosis I would never have even known such scales existed.

I thought I would take a little time today to talk about one scale which I have seen several times in various situations, but never really knew much about until recently. You know me, I am all kinds of interested in different ways to quantify my bipolar experience, so I found this scale particularly interesting.

It is called the Global Assessment of Functioning (GAF) Scale. I guess Global suggests it is used throughout the world, and it came to my attention because I noticed this scale popping up on several of the items I have rifled through in the last five years.

So what is the Global Assessment of Functioning Scale?

The Washington Institute On-Line Training and Assessment contracted by the Washington State Mental Health Division calls the GAF scale:

A 100-point tool rating overall psychological, social and occupational functioning of people over 18 years of age and older. It excludes physical and environmental impairment.

Which means this ranking scale is a tool used to rate functioning (not symptoms) in three areas (psychological, social, and occupational).

Since the GAF scale is used to rate functioning (and not symptoms) your score could potentially be constantly changing (that is, if you’ve got bipolar disorder, for example, and have been having symptoms intense enough to change your level of functioning). Generally, the closer you are to 100, the better you are functioning. The scale is also used to quantify disabled-ness, as the closer you are to zero, the more disabled you are considered.

The GAF scale is broken down like this:

91-100
Superior functioning in a wide rage of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms.
90-81
Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range or activities, socially effective, generally satisfied with life, no more than everyday problems or concerns.
80-71
If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning
70-61
Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.
60-51
Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning.
50-41
Serious symptoms OR any serious impairment in social, occupational, or school functioning.
40-31
Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood.
30-21
Behavior is considered influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas.
20-11
Some danger or hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication.
10-1
Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death.

Your doctor or clinician might be asked to rate you with this scale in situations of requests by your insurance, if you are going through an intake at a hospital, if you are applying for state or federal disability programs, and the like.

I recently had an insurance agency ask my psychiatrist to give the highest GAF score he would attribute to me for the last year, and that was how my curiosity became piqued by this scale. I had also seen this in passing on medical records from when I was hospitalized. They gave a GAF score for when I entered the hospital, as well as what my score was when I left. Obviously at that point they want to see some kind of improvement on your part in the scale.

The GAF scale is found in the Diagnostic and Statistical Manual – IV TR (or just DSM as many of us lovingly refer to it) in the section on “multi-axial assessments”. You can also find the whole scale online by just googling it, or by following the link here for the Washington Institute On-Line Training and Assessment.

I wondered for a bit if this rating scale is generally supported globally, and I did find an article in the British Journal of Psychiatry about a study done to test the validity of the GAF scale in 1995 (which you can find here). They concluded;

GAF proved to be a reliable and, within the limits of the indicators used, a valid measure of psychiatric disturbance in our sample of the severely mentally ill.

There are other versions of the GAF scale that have been modified, but apparently don’t stack up quite as well as this original scale.

In conclusion, this was really just something that I find interesting personally, but I also think it is important to understand things like medical records and paperwork that has been filled out by your doctor. I don’t think knowing about what tools our doctors are using is important because we should interfere with their work, but because understanding how our doctors operate can help us maintain a better relationship and get the best care possible.

NAMI Walk

Hey folks,

So NAMI (the National Alliance on Mental Illness) is hosting a series of walks across the country. The Seattle area walk is happening Saturday, October 27th at Marina Park in Kirkland (for people in the area who are interested in signing up, you can find more details at this website), and I’m planning on attending.

The goal of the walk is to raise both funds and awareness in regard to mental illness. NAMI uses funds for anything from hosting peer-to-peer support sessions, general weekly support groups, family-oriented classes for those who have someone in their lives living with mental illness, as well as provide all kinds of support for folks who may not otherwise be able to receive it. They are a non-prophet organization ran entirely by unpaid volunteers.

The awareness factor is what I am most interested in, and I’m hoping that by spreading the word, others will learn a bit more about mental illness and will help take down the general stigma that surrounds it.

There are a lot of people out there who are experiencing debilitating symptoms and are either afraid to seek treatment, can’t afford to seek treatment, or both. In my experience, NAMI has been an excellent resource for people in the Seattle area to learn more & get help.

You can bet this is the only time I’ll do this, but if you are able to give anything to help support those with mental illness, I’d encourage you to consider it. For more info or my fundraising site, go here!

 

Thanks!

Choosing Hurdles

I was over at My Year To Thrive yesterdaya blog written by despitemyself with some pretty rockin’ insights. It seems we have something of a similar background and it really caught my attention that she mentioned always wanting to have joined track in high school to run (specifically) the hurdles. 

Now, I was in track in middle and high school, and my event of choice? Hurdles.  

It struck me a little bit that the most obvious symbolism for living with hurdles in life would probably be (yep) hurdles. I mean, if you think about it… I could have any choice of events to run in a track meet, and I chose the one with the most physical barriers between myself and the finish line.

As someone who has lived with the waxing and waning of OCD traits over a number of years I am someone who feels inclined to do things a certain way. By that, I really just mean my way. And it should come as no surprise that my way probably has more hurdles than any other way.

Why?

despitemyself suggested this action is due to being raised in chaos. My therapist has told me something similar, that people who were raised around a lot of drama often create more for themselves constantly because that is what they’re used to.

And I have, to be completely honest, had moments of boredom (for lack of a better word) where there should have been contentment in my life. For a while I surrounded myself with the most intense people I could find -because there was never a dull moment, and I felt at home there.

Recently someone said, “I think she just likes it that way,” in regard to myself making everything into a problem that needs to be solved. A solved problem presents closure, it presents a challenge to stimulate the brain. I do need both closure and challenges, and to some degree I see that as a positive. I am stronger for it, I think, to have run the gauntlet over and over again and survived.

It is only now, as I look at the price of stress directly in the face that I am able to cut out as much drama as possible. Stress from drama has caused me to have innumerable meltdowns, and I’ve suddenly found myself fleeing from it rather than embracing it.

As someone who needs a problem to solve, can I get it out of my system in other ways? By doing puzzles? By building a bridge out of match sticks? By running a stretch of track littered with hurdles? Can I channel this need for drama into something harmless, or will that defeat the purpose?

OC87; A Personal Story of Mental Illness

Do you ever find yourself thinking, “man, my life would make a good reality tv show (or) documentary, wouldn’t it be great if people could look at what living with mental illness is actually like?”

I have, admittedly, and I sometimes fantasize about being followed around by cameras when I’m bursting into tears for no reason at the grocery store or attempting to convince doctors or other health providers to see me for free. Does the general population understand what many of us go through to try to receive care or improve our situations with these various disorders?

I think the answer is decidedly, “no”.

Well, this is apparently a pretty widespread idea, and a man named Bud Clayman is the focus of a new documentary called “OC87: The Obsessive Compulsive, Major Depression, Bipolar, Asperger’s Movie.”

I know I mentioned OC87 in passing last week, but I wanted to take a bit of a closer look at it.

The film, currently open in New York (but said to be soon opening more widely across the country) follows 51 year old Clayman for two years as he receives treatment for Obsessive Compulsive Disorder, and actually is diagnosed for the first time (over the course of filming) with Asberger’s Syndrome as well.

The LA Times article says that Clayman first wrote an essay about how therapy has helped him, then decided to make a documentary about it.

So far OC87 has gotten some great reviews, so if it comes to Seattle I know I would definitely be interested in checking it out. I think I am curious, more than anything, about how someone would present these sorts of behavioral issues on film.

As far as the trailer goes, I was really impressed with it. I would definitely suggest checking it out if you haven’t yet!

For more on OC87 you can read more in the LA Times here, as well as check out the trailer here!

A Biopsy, Emotional and Otherwise

About a week ago I visited the dermatologist for the first time. I wasn’t really sure what to expect (getting poked with cold metal sticks? A giant skin magnifying glass? Maybe I watch too many science fiction films…) but I knew I wanted to ask a few questions.

After my general skin questions were answered (yes, the dermatologist said the most likely cause of my acne was the lithium I have been taking the last two years, surprise surprise) I asked about moles. Who should get them checked? When should they be checked? How does it work?

Instead of telling me she just began to look at them, and then quickly decided (though I am not at big risk for skin cancer, living up in Seattle where the sun never reaches my skin anyway) there was one mole that she wanted to biopsy.

For those of you (like me) who have never been to a dermatologist, biopsy just means they want to cut it off and study it, apparently.

I had no problem with it, jumped up on her table, she did her thing, and I walked away with one less mole.

The thing was, though… as I walked to the bus I found myself feeling increasingly alienated.

This is the first physical piece of me, I quickly concluded, that has ever been removed. Well, apart from teeth. But really, how often is a slice of your physical being removed?

Nausea crept in, and by the time I reached the bus stop the world began spinning and I had to collapse on a bench, sharing it with a silver life-size cast-iron statue of a naked man.

Over the course of the last week, this horrified feeling about a portion of me being taken has returned any time I needed to clean the area and replace the dressing.

After thinking long and hard about it, I don’t know that this is necessarily an unfamiliar feeling. True my horror and slight up-chuck reflex is a bit more present on the physical side of things, but that mental feeling of something being taken is what really bothers me the most.

I can’t help but wonder if anyone else has associated this feeling of loss, or damage to one’s being in response to receiving a diagnosis of mental illness?

I don’t remember many of the moments where I have been handed a new diagnosis of mental illness, bipolar disorder, OCD (which I remember slightly I think), PTSD, the anxiety disorder… but I do remember a range of different feelings upon hearing these things.

Initially;

  • Disbelief
  • Skepticism
  • Excitement (as weird as that is, I found it exciting to have potential explanations to what I was dealing with)

The same reactions I had when I heard the dermatologist wanted to remove my mole.

It wasn’t until the moment I’m alone and faced with whatever obvious wound remained after the discussion;

  • Racing thoughts
  • Depression
  • Panic Attacks

Suddenly I could see it in the face, this oozy, gross place, uncovered by the emotional biopsy done by whatever psychiatrist, Doctor X. 

And my response is the same as looking at the place where that mole was. Horror, a grimace, and the overwhelming nagging feeling like I have just been robbed of a piece of me. A piece of what would have been a normal life, perhaps.

What confuses me the most is that I’ve had time to look at this yuckiness enough to get used to it. The emotional yuckiness, anyway, -the mole thing still grosses me out. Over the last 10 years, I’ve had time to adjust (though, somewhat slowly) to living with this “missing piece” or “wrong piece” or whatever one might call it (maybe just an odd piece), and it is something I’ve integrated into my life.

So I admit, when the mole biopsy happened I didn’t think right away of that old emotional biopsy of a mental illness diagnosis. My thoughts went straight for the idea that there may be one day I could go to the doctor who would do an emotional biopsy that slices off my bipolar disorder. They will check it in the lab, and I will receive an envelope in the mail that says everything went well.

If these irregularities in me are removed, would I react in horror? Would I feel overwhelmed with the notion that a part of my being was now lost, the way I felt about a little meaningless brown piece of skin?

They say the mind grieves when a diagnosis of mental illness is given because of the loss of a life and many dreams that will no longer realistically happen. We have to adapt, to evolve as our lives continue -with whatever comes our way.

So would the mind grieve the loss of mental illness if it was suddenly removed? Absolutely.

Part of me feels terrified to think about that, but the answer is just the same as in the opposite situation. We adapt. We evolve. Life continues.

So I will adapt and evolve with my (minus one) mole situation. Maybe I’ll be gifted a really cool scar, but until then I’ll just keep cleaning it and throw a dab of ointment on there.