Tag Archives: alternative medicine

Alternative Mental Healthcare for Severely Psychotic

An article came out this month in the New York Times about an organization called the Hearing Voices Network. The Goal of the Hearing Voices Network is to create support groups where the symptoms of those with psychotic symptoms like hearing voices and having hallucinations are explored to understand where the voices or visions might be coming from and find ways to cope with them mentally and emotionally.

I’m not doing the article or network itself much justice so I would definitely recommend reading about this alternative form of therapy here (at the New York Times Article) or here (at the Hearing Voices Network homepage).

Without going into too much detail I wanted to mention that this topic stood out to me because in a way it reminded me of the type of therapy I have been undergoing with DBT (though certainly not the same thing). The similarity in my mind comes from my experiences the last six months having to address my internal dialogue, generally stop abusing it and being afraid of it, and allow myself to learn where these thoughts and feelings are coming from so that I can cope with them in a healthy way.

Having treatment resistant symptoms of bipolar 1 (which can include psychosis at times) has rendered other types of treatment (like psychiatric medications) useless for me up to this point so my experiences with talk therapy and particularly a group that could help me address those aspects of my illness has been paramount to helping me cope and feel more comfortable in my own skin. I’m excited to see that an exploratory type of alternative therapy like this is being offered to those with severe psychosis because the more types of treatments available mean the more people that will potentially be able to improve.

Of course, both websites mention that this type of therapy isn’t right for everyone, but as someone who has experienced what mental illness is like living as an outlier, having options of things to try before falling into the hopelessness that all else has failed is potentially making a life-saving difference.

Stepping Stones; Stepping out of PTSD

Trigger Warning – my brand of PTSD came from situations involving sexual assault, and this post may contain loose details about that situation or other sexual topics regarding my recovery. Nothing super graphic though, don’t be gross.

Post traumatic stress disorder seemed to come into my life like a flood. One minute life seemed totally normal, and the next it began to deteriorate rapidly.

It was sort of like, if you could imagine, every time you bought a smoothy someone would walk up and take that smoothy away from you after a couple sips. After a while, you sort of just know to either avoid buying smoothies or, if you do buy one, only expect two sips. This is just the way things are, and because you haven’t known much else there are no real expectations otherwise.

Now imagine someone sits down with you and tells you that we live in a world where you could have (and you deserve) that entire effing smoothy. I mean, more than two sips. And that these people who have been taking this delicious fruity beverage away from you are a-holes who have done something profoundly inappropriate.

Well there’s shock. And anger. And definitely some horror associated with the fact that people can be so awful to one another, and that you’ve let this smoothy-snatching business go on for so long. There is guilt for not knowing things could have been different, and fear that this cycle is something that will never end.

But, maybe you feel a little empowered too. Like maybe now that you know this business about the smoothies you can buy one and enjoy the entire thing. You can break the cycle! So you go out, you buy a smoothy, and after two sips someone walks up, takes it, and walks away.

This time it feels different though, doesn’t it? This time you know you’ve been violated, that the other person is in the wrong, but maybe you just froze and didn’t know what else you could do to stop it. The anger is much bigger, much more difficult to contain. The fear becomes profound, because now you know that people seem cavalier about hurting you and that it can happen anywhere at any time. The shock leaves you frozen, bringing guilt because, somehow, you knew this would happen, didn’t you? Maybe the horror is so overwhelming you decide to pretend the whole thing never happened, just to put it all out of your mind, and ultimately blame yourself. After all, you really just can’t be trusted with a smoothy.

For me there was a series of moments like these that were like seeds being planted. I pushed the memories and my reactions down into the dirt as far as they would go, and once they were there I didn’t feel a need to address them because I thought I won. I thought I put them somewhere that was somehow equivalent to them not-existing, and if they didn’t exist I couldn’t be upset, right?

I admit, it is easy for me to look over this whole process when it is about a deliciously fruity blended beverage or something as seemingly harmless as seeds and connect the dots, but even now, years later, thinking about this process in terms of sexual assault there is a whole host of emotions that come up making it difficult for me to see through the fog that they create.

For several years I did a great job of putting the whole thing out of my mind and ignoring it. Then, after enough time had passed, those seeds that had been planted began to grow.

They broke through the soil and I suddenly began having panic attacks in crowded places. I became physically ill when someone, anyone, would touch me. I couldn’t leave the house without getting into arguments with people, so I didn’t leave the house. I felt powerless and depressed, but also angry and very afraid. Every time I closed my eyes I could sense someone standing next to me waiting for me to be vulnerable, like any moment I was happily unaware or in the shower or asleep.

The most infuriating part of this process for me was not being able to see how one person could get from the situation I was in to something better. My PTSD symptoms (mostly the anxiety and panic) were just as treatment resistant as my bipolar symptoms so I couldn’t rely on any anti-anxiety medications to help with the panic attacks and fear I was having. My doctors suggested deep breathing and reading boring case studies about PTSD, and while the deep breathing only really helped keep me from constantly screaming the reading seemed to trigger my symptoms over and over again.

Having said that, (spoiler alert) I am sitting here today really feeling like I have finally made a big dent in untangling myself from those awful PTSD plants and I found myself wondering just what I did to make it here. I thought that perhaps sharing what helped create a makeshift ladder for me might be useful to others in a similar situation, and while I am not suggesting you go out and do any of the things I am about to share I can honestly say they helped me, and all of these things were done with the consent of my healthcare team (including my therapist and psychiatrist).

For Anxiety and Panic Attacks

Basically I needed to desensitize myself to being around people and sort of re-learn that people (in general) aren’t trying to hurt me. The real trouble was that any time I was in a more crowded place (the bus, downtown, the grocery store) it would just trigger the panic attacks over and over again. Even at house parties of people I knew and loved I felt overwhelmed and would panic, so I entered into the realm of medical marijuana.

I realize this might not be a popular idea, but totally legal here in Washington State. Also, like many of the medications I have tried, it turned out there are some forms of cannabis that actually made my anxiety and panic symptoms worse, so the process of narrowing things down was a little frustrating. Thankfully, as someone with treatment resistant symptoms I have a lot of experience trying treatments that either aren’t effective or have some rough side effects so I already had a system for taking detailed notes on the effects I was experiencing.

I wont lie, I felt pretty weird about this idea at first. Growing up in a time where I was led to believe that the slightest proximity to any and every “drug” out there (D.A.R.E!!) would immediately make me an addict or banish me to hell or make me lose everything I loved made me initially totally recoil from the idea.  The legalization of medical cannabis only dampened this mindset slightly, but after speaking with three different psychiatrists and four separate therapists, all of whom who told me [given the nature of my treatment-resistant symptoms] I should proceed with anything I found that was helping, I felt a little more comfortable. Even so, it took some time for me to feel ok when other people were being judgmental about it but the fact that my doctors had my back (and heck, even my grandmother agreed) made me feel less squeamish about the whole thing.

Once I was able to pinpoint a couple strains that helped alleviate the anxiety and panic I was feeling (without sabotaging something else, like my mood for example) it was a matter of using it strategically (not all the time) to introduce me into settings where I might normally totally freak out, but because the cannabis removed the elements of anxiety and panic I was able to experience triggering situations in what felt like a non-threatening way.

Basically, cannabis allowed me to remember what it was like to be around people and feel safe, or at-ease, and after long enough it became the default setting for my brain again.

For Regaining a Sex Life

This has been very tricky, and while the cannabis was helpful enough to get me to the point of being able to be touched in general (like a back rub or foot massage) I had a big blinking red stop light in my brain around sex for a long time. Not super helpful, considering my PTSD symptoms didn’t actively show up until several years into a committed and safe relationship! Even though it had been years since I was in a place where I was in danger, once those seeds sprouted it didn’t matter.

I am sure it will sound a little funny, but the most helpful thing to removing fear and panic around sex for me was when I had surgery and my doctor told us we weren’t allowed to have sex. That’s right! Having even the possibility of having sex taken off the table made me feel more comfortable because then it wasn’t this awkward thing (or an obligation) I felt compelled to dodge constantly because I felt uncomfortable. Effectively we had to almost start our physical relationship over at square one (I recognize I am really lucky my boyfriend is the most patient person I’ve ever met) and in doing so we re-built the trust that I knew was there, but couldn’t feel because of my anxiety and panic.

For Fear and Paranoia

First I would say going to therapy and spending a lot of time talking about being assertive about boundaries helped me feel a bit more confident, but I was still really afraid that if something happened again I would freeze up and be unable to assert myself.

Something that really helped solidify a confidence in my ability to protect myself was taking a self-defense class with a friend at Fighting Chance Seattle. The staff was really knowledgeable and our male instructor made me feel very much at ease and did not require us to practice defensive moves with him, instead with anyone we felt comfortable with. Being able to connect a physical action to a feeling or desire to protect myself made me believe that if there was ever another situation I knew what to do and would be less likely to freeze in the moment. The class was only one day, but it really helped me feel like I was moving forward.

Another milestone was getting a tattoo that would act as a reminder that the fear I was feeling was coming from me, not from threats around me.

Over the last few years I have tried to keep my apartment feeling like a safe space for me. At first that meant coming home and looking behind every curtain and in every closet to be certain it was safe, but now that I have made some progress with my fear and paranoia I try to talk myself through the fear and visualize every detail of the apartment when it is dark to remind myself it is empty and safe. It is funny to me sometimes to think that my brain wants to imagine all kinds of horrors waiting for me when I close my eyes, but I spend a lot of time actively un-imagining them!

***

While I can’t sit here and say, “and that’s how I kicked PTSD in the face! It is gone forever!” Things have gotten significantly better.

I still get triggered from time to time, but I’ve got enough tools to keep myself from replanting that same seed over and over again. After taking that self-defense class I felt quite empowered when I was faced with a situation on a city bus, a creepy dude next to me put his hand on my leg.

Initially I started to freeze. I could feel myself starting to shut down as I had in the past, but somehow I managed to turn things around and do the total opposite of the cowering I felt like doing.

“Excuse me?!?” I yelled in his face and then stood abruptly, pushing past him to sit in another seat. He looked over at me and I scowled, shaking my finger at him. Even though my hands were shaking and my heart was racing I turned away to look out the window and my scowl turned into a faint smile.

I was free.

Controlling the Wave vs. Riding It

For several years I fully believed that if I controlled everything around me I could also control my bipolar symptoms, and that by eliminating all possible triggers I could also eliminate the possibility of intense episodes.

By controlling things like diet, sleep, exercise, and more I found that things were significantly improved, but at the same time, attempting to control everything around me was exhausting. Trying to control everything at the same time felt like a torturous juggling act that would never end, and that is one of the biggest reasons I began trying the traditional pharmaceutical route again a couple years ago. Any help I could get to manage my symptoms became a welcome notion, trying to do everything myself left me wiped out and unable to keep fighting.

It seems like just as there is a spectrum of symptoms for people who are diagnosed with bipolar disorder, there is a spectrum of views on how to manage it.

Living in the realm of intended total control put me at one end of that spectrum, but I have also witnessed the other end up close and personal as well. When I was younger I spent a brief period of time with a religious congregation that believed that my symptoms and subsequent episodes had little, if nothing, to do with what was going on around me, and that by relinquishing all control to God I would be freed of bipolar disorder.

I’m sure most of you know I am not here to condemn any view, belief, or way people with mental illness seek solace -in fact, I definitely encourage people to learn as much as they can about different views on the notion of mental illness and then make their own decision based on what feels right for them.

Saying that, I have to admit that relinquishing all control did not seem to make things easier for me. At the same time, attempting to control absolutely everything had the same outcome; it was not making things easier for me.

For a while I wasn’t quite sure what that meant, if wrestling a beast left me so tired I couldn’t get back up to fight its second wind, and trying to ride it by simply just holding on meant being bucked off over and over again before it was finally subdued, what strategy can I use?

By now I’ve really fallen into a place where controlling those elements around me is helpful, but needs to be met halfway with the idea that if I can’t subdue the tidal wave when it is beginning, it is sometimes more realistic to just batten down the hatches and ride it with what strength I have left. Once the wave becomes a certain size it is important for me to step back and say, “alright, I don’t think I can control this thing anymore, it is time to ask for help wherever I can and ride it out until it finally breaks.”

I can’t say that this has been a magical fix-it solution, in fact I’m really just giving this theory a go the past few months for the first time. I don’t think that just because neither of the extremes of these notions worked well for me it means there isn’t something in them that is helpful and important to learn. It just means that each person is an individual, that our beliefs and the ways we take on the world are all different, and sometimes they change as we do.

Cannabis Use Linked to Higher Cognitive Performance in Bipolar I Patients

Someone sent me a link to this article several weeks ago actually, but I wanted to track down the source before writing about it. It took me quite a long time, but there is an original abstract for the research document here. 

The abstract is for a paper written by a team led by Raphael J. Braga, associated with a series of Hospitals and teams in New York state. The study was done on a series of patients with Bipolar type I, 50 of whom had a history of cannabis use, and 150 of whom did not. These two patient groups are said to not have differed in age, age of onset, or global assessment of functioning.

The group with history of cannabis use did, however, have more male patients, and patients in this group also had a higher instance of history of psychosis.

But here’s the kicker; patients in the cannabis use group demonstrated significantly better performance on measures of attention, processing speed, and working memory. 

“The history of CUD (“cannabis use disorder”) is associated with history of psychosis, suggestive of poorer clinical prognosis. Interestingly, bipolar patients with history of CUD had better neurocognitive performance as compared to patients with no history of CUD.” (Pulled from the paper abstract.)

Ok, so what does this mean?

It doesn’t surprise me that cannabis users were found to have an increased occurrence of psychosis. After all, I’ve heard accounts from perfectly rational, mentally healthy people who used cannabis and experienced psychotic-type symptoms; anything from intense paranoia, to visual or audible hallucinations. If this is something that can occur for a mentally healthy individual, I would expect it to be more likely to occur for anyone who has experienced psychosis on their own. At the same time, it is possible that the state of relaxation cannabis use can put someone into might make psychotic symptoms seem much less threatening or overwhelming… which is something of a trade off for someone who is experiencing them anyway.

Washington state is one of 17 states (18, if you count the District of Columbia in there) that have legalized medical cannabis use, and I think medical marijuana is one of the number one things people with bipolar disorder send me questions about.

Is it safe?

Is it helpful?

Is a medical card something bipolar disorder would qualify me for?

I’ve heard a lot about the benefits of medical marijuana for things like PTSD and anxiety, and even occasionally about depression. Solid research, however, up to this point about cannabis use and Bipolar disorder has been hard to come by.

I think a lot of research is being done lately using substances that have been found in “unlikely places” (think of the recent research regarding magic mushrooms, or ketamine) and I, for one, am glad people are willing to think outside the box for potential treatment options for things like depression and bipolar disorder, which are very difficult to live with.

Like anything else, I’ve had some people with bipolar disorder tell me that medical marijuana has really helped them, and I have had other people tell me that they didn’t like it at all and it seemed to make things worse. Like any medication your doctor might prescribe, it doesn’t effect everyone the same way. This latest research seems to show cannabis use for this group may be more helpful than many people expected, but like anything else… it isn’t a miracle cure. I think if we keep that in mind, there are many treatment options we can try that might be helpful!

Choosing an Insurance Plan

For the first time this year, I am going to be eligible for medical benefits under my new employer. This particular place of business offers three types of plans with different coverage, and at once I went to work spreading all of the papers over the living room floor trying to distinguish which would be best for an employee that needs a lot of healthcare, namely me.

Corey walked in and said,

“You know, you are the only person I know who actually reads all that stuff. I never read any of it,”

“And that is why you are shocked when you get a bill in the mail for several hundred dollars after a doctor’s appointment,” I replied.

I think a lot of people believe that as soon as they have whatever it is called benefits, healthcare is suddenly free, available wherever they want, and their benefits cover everything kind of appointment they’d like to make. I think that is the first mistake, and by not reading (or even by reading and not understanding how your benefits work) about your benefits package you’re really setting yourself up to have your pockets picked.

You should be taking advantage of these benefits, not the other way around.

I thought I would talk briefly about how you can go about getting the best care under whatever insurance plan you choose, which is something that can be difficult when you have a chronic illness or disorder (like bipolar disorder).

Looking Back

First, I’d just like to point out that for a very long time, someone with a mental illness could be denied coverage for treatment of that illness if they had it before receiving insurance coverage, or if they switched insurance providers after being diagnosed. Obviously, that is total bullshit, and I can’t tell you how many times I have been denied coverage for having bipolar disorder.

Thankfully, Obama (whether you love him or hate him) did away with that, so it is now illegal for insurance to deny coverage for “pre-existing conditions”. That is a definite win for those of us with diagnosed mental illnesses, though there are still several ways health insurance providers can deny coverage to what we need. I’ll get to that.

The Deductible

Ok, now when you’re looking at an insurance plan, they will often tell you how much it will cost you to see a provider in their “network” (one that takes that insurance plan) and how much it will cost you to see a provide who doesn’t (“out of network”). What many people skip over, though, is that chunk of money called the deductible. 

This is the amount of money that you have to pay before your insurance provider begins to chip in on your bills in many different types of situations. The higher the deductible, the more you will have to pay out of pocket before sharing the cost of your healthcare with the insurance provider.

Some insurance companies will allow you to avoid paying this if you see doctors in their network, and will only charge you a “co-pay” (a flat rate to see these doctors). However, the deductible will still need to be met for other types of care (so think about things like lab-work if you are taking lithium) or if you want help paying for doctor’s visits outside of the network.

Your Doctors

The first thing I would suggest doing is making a decision about what doctors you want to see. Do you currently have a psychiatrist or therapist who you can’t see yourself leaving, or would it matter if you saw someone brand new?

  • If you are willing to see all new doctors, you can probably use “in-network” doctors to avoid having to pay the deductible right away. If this is your chosen course of action, I would suggest going to the insurance provider’s website and doing a search for the types of doctors you want to see (to see if there are any in-network in your area).
  • If you already have a team of doctors you like, I would suggest calling each of their offices and asking if they take the insurance you are considering purchasing. If you are lucky, there is a chance that they might! If they don’t, though, that means they will be “out-of-network”, and will require you to pay for all visits until that deductible amount has been met. After that, some plans share the cost of visits (60%/40% for example).

If your doctors are out of network it may be wise to figure out if you will be paying for enough visits to actually meet that deductible.

Take your (cost of one visit) X (number of visits you plan to take in your plan year) =

If n is less than your deductible amount, it is possible you will be paying for all of those visits out of pocket. Remember, the insurance doesn’t kick in any money until this amount of money has been paid.

If is more than your deductible amount, you can expect to meet that deductible and then have insurance help pay for the remainder of your appointments.

So, if I see my psychiatrist (which costs roughly $100 per visit) once a month, that would mean $1200 annually (as I’d be in there 12 times per year). If my deductible is $500, that would be a great deal, whereas if my deductible is $1000 it would be a bit less-so. I would probably only save (in that case) about $80.

At the same time, I want to be sure to be clear that just because the amount of visits you predict doesn’t meet your deductible, it doesn’t mean you wont meet it. Other things like lab work might go toward it, or emergency visits you may not know will happen in the future, or the cost of certain types of appointments.

What do they cover?

Most of the time I have had the option of being enrolled in an insurance plan, I am provided with a booklet that outlines everything that is covered or not covered. If you were not provided this information, ask for it. Remember when I said there are still some ways insurance can deny certain things? This information is particularly important for mental healthcare, as some plans with not cover or limit the number of therapy appointments they will cover, among many other things which may be vital to our care.

What types of appointments do you expect to use? Acupuncture, massage therapy, talk therapy, inpatient hospitalization (in the event of an emergency)? Make sure you look up whether those things are covered by your potential insurance plan or not ahead of time. Some things, like therapy, may not be covered, but the amount you spend on it might be able to go toward your deductible. Other things, like massage therapy (or even psychiatry) might only be covered after a series of approvals from other doctors (basically someone signing off that you do need these services). This notion can be a bit daunting, but I’ve found that with a solid history of mental illness in place, I have never had problems being “approved” for the type of care I need. It is just another hoop to jump through, because without jumping through it they can potentially charge you without covering any of the amount for the appointment.

Personally, I’ve found it difficult to find a therapist that will actually take insurance, most of them are extremely wary (because insurance companies generally don’t pay the therapist in a timely manner). If you go to a clinic (and not an independent provider) you may have more luck with insurance and therapy fitting together better.

Annnnnd Medications…

Not all insurance plans are created equal, and not all medication coverage is equal either.

Most plans no longer have a “one-size-fits-all” approach to medication coverage, so it is no longer a question of whether a medication is covered or not. Many of the newer setups I’ve seen involve tiers, with generic drugs being in the cheapest tier. This part gets tricky, because anyone who has to be on a brand name version of a drug with a generic counterpart pays heavily for it, so if I were to need Risperdal (instead of the generic Risperidone) I’d probably pay $100 for my prescription instead of the $10 it would cost for the generic.

Mental health is one of the areas where I see this as being something of a cheat, because there are many people who either don’t have any luck with the generic counterparts of our medications or are on a medication that doesn’t have one yet.  Obviously, these drugs are still discounted, but not as deeply discounted as others.

I would suggest making a list of your medications and looking them up (most insurance companies should have a database of how much each given medication will cost). In one instance, I found that it is cheaper for me to buy Lithium at Target than it is to get it through the insurance plan I signed up for (which is a little baffling) so getting an idea of how much your medications cost now vs. how much they would cost on insurance can be an eye-opener. If you want to multiply that cost by 12 (if you fill monthly) you can get an idea of how much it will cost for the whole year.

Oh, and most insurance companies do not count medication co-pays toward your deductible, so anything spent on medications probably wont count toward reaching that amount.

Putting It All Together

Alright, so I am kind of a nerd so I usually like making up a grand total of what things are going to cost me. For those of us that need more healthcare than others, I have run across some insurance plans that would actually cost more for me to have than if I didn’t purchase insurance at all (which can be a little disheartening).

To see the difference between how much things will cost with insurance and how much they will cost without (or to compare one insurance plan with another) you can create the total cost for each situation.

First, figure out how much healthcare is costing you now:

1. The cost of your doctor visits for the year (the cost of the appointments times the number of times per year you go)
2. The cost your medications for the year (the cost of each medication times the number of refills you get per year)
3. The cost of other expenses, like therapy, lab-work, etc. (the cost of the appointment or lab-work times the number of times you go/have it done)

And add 1-3 together. For me the total is averaging about $10,000 this year and I would say that is probably a more modest estimate (compared to other years).

So next, figure out how much that same healthcare would cost with the insurance plan you are looking at. You will need to take into account everything we’ve talked about so far, so whether you are planning on using in-network doctors or out-of-network doctors (or a combination), if things like therapy are covered, and what the deductible looks like. This is a little more tricky, but here is a general step-by-step.

1. The cost of your doctor visits for the year (the cost of the appointments with insurance (either an out of network cost for non-network doctors, or the in-network copay) times the number of times per year you go). You can repeat this step for each doctor you see, or each type of doctor you see. You may also want to use this step to figure the cost of seeing your therapist, or you can wait for therapy until step 3.

Now, if the amount totaled here for non-network doctor visits is bigger than your deductible, subtract your deductible from this total cost (so if I spend $1500 on non-network doctors visits and my deductible is $1000, that leaves $500). With the amount left, multiply by the amount you are responsible for (so if your insurance covers 60% after the deductible is met, for example, you are left to pay 40% of the total amount. $500 x 40% = $200). Instead of paying $1500 on those doctors appointments, you would meet your deductible and only pay $1200.

It may not seem like this is saving much, but if your deductible is already met, that means you will have no deductible left to fill for lab-work or out-of-network therapy appointments.

2. The cost your medications for the year (the cost of each medication co-pay times the number of refills you get per year). Remember some medications might cost more than others depending on the insurance plan.

3. The cost of other expenses, like therapy, lab-work, etc. (If your therapist is in-network, multiply the co-pay times the number of visits. If they aren’t, have you met the deductible with other out-of-network visits? If so, multiply the total cost of therapy appointments for the year by the amount you are responsible for. If you go weekly and your visits are $100 apiece, you would potentially spend $5200 for the year. If insurance covers 60% (for example) after the deductible is met, you are left to pay 40%, so $5200 x 40% = $2080. If your deductible isn’t yet met because you’ve only seen in-network doctors, we would subtract the deductible ($1000) from your total ($5200) and multiply the remainder by the amount you are supposed to pay ($4200 x 40% = $1680). If you were only using an out of network therapist (and nothing else) you might still only pay $2680 instead of all $5200.

Lab work usually works the same way.

So, again, add 1-3 together and then for this total we will also:

4. add the cost of your insurance plan for the year. Let’s not forget, unless your insurance cost is covered entirely by an employer or government plan, you are probably paying weekly or bi-weekly to keep it active.

Ideally, this is when you would know if the insurance is a good deal or not, or if it covers the things that are important to you and your healthcare. 

My final suggestion is to consider the FSA.

If you are being offered insurance by an employer who also offers the option of a Flexible Spending Account, I would highly recommend it. I am not someone who has had much money, so this is the only way I’ve been able to pay for healthcare before actually saving enough money from my paycheck to do so.

The FSA deducts equal amounts from your paycheck on a pre-tax basis, and you can choose the amount you want deducted. That money, though deducted evenly through the rest of the year, is available to you immediately for using on your deductible, co-pays, medications, and a whole long laundry list of other things. The only thing I would say to watch out for is that at the end of the year, if you don’t use the money in that account you lose it. Personally, I’ve never had trouble with that (and always used all of mine very early on with the number of doctor visits I have) but it is something to consider.

I just had to decide between three different plans, and I read everything I could get my hands on and then made an excel spreadsheet to help me add everything together and compare. I requested more information on the insurance provider several times, called my doctor’s offices to ask about their relationship with my potential plan/insurance provider, and I feel confident that I know what is and is not covered.

Yes, I have bipolar disorder, and I am now working at a job that is pretty huge. If nothing else, that is a big reason to pay attention to how my new insurance works and know how it will support me and when it will not.

I think it is important for anyone to understand how insurance works, but it may be much more critical for those of us with pre-existing conditions that require careful monitoring and care. Knowing how to get the most from your insurance provider allows you to tip the scales in your favor, and might mean the difference between taking advantage of your insurance or your insurance taking advantage of you!

Chipping at Writer’s Block

Boy, I have had a massive amount of writer’s block the last few days. My mind has been darting about a million different ways at once, perhaps I’m still ridding myself of the last hints of trileptal and rispiridone that have contributed to my devoid concentration.

I suppose I can pick up where I left off and let you all know that after stopping the trileptal on friday I have had an immediate backpedaling of most of the symptoms I was having issues with. The psychotic blips, the quick shifting agitation and desperation, and the majority of the intense nausea I had been experiencing completely vanished within 24 hours after my last dosage.

Talk about positive reinforcement, the fact that my symptoms went away so quickly is a huge indicator to me that I made the right decision. I can’t imagine how bad things might have gotten if I continued taking it on Friday, Saturday, and Sunday, but it absolutely would have destroyed my camping trip.

I don’t know what kind of plans my doctor has for what to do next, but I don’t see him for two weeks. I will take that “time off” from experimentation with some very open arms, and I am not entirely convinced that I want to jump right in to anything immediately after that appointment either. The last few months have been like a punch in the face (on the medication route), one right after the other with Lithium toxicity, the Lamictal reaction, and now Trileptal. I’m really considering just taking some time to let my body recover from everything before trying to start another round.

As devastating as it sounded to me when that little bird whispered to me that there may not be a medication that will help me, I’ve had time for that statement to sink in. It doesn’t feel as devastating, but I am also not currently experiencing desperation (which can make all the difference in the world).

I am a problem solver, that is what I genuinely enjoy doing. Problems become puzzles, and I love solving puzzles. If I can fix a broken chair with nothing but a paper clip and a rubber band, I can make this work.

If the medication piece of this puzzle doesn’t work, I will just have to find another piece.

It may not be the most mainstream piece, but when have I ever been involved in mainstream anything? 

Hmm, this optimism is unexpected (even to me) this morning, I’d better find a way to take advantage of this today!

Better Mood – Fake It to Make It

I saw something on the Today Show about a week ago that really piqued my curiosity.

Apparently there is a school of thought called embodied cognition that believes our brains rely on our faces and posture to determine how to feel.

Now, I could go either way on this. On one hand, it sounds a little bit like those folks that say, (when I’m in a funk), “just smile and act happy and you’ll feel better,” but this isn’t a concept that I can entirely discredit.

There have been times where I have worked long retail hours while in a particularly nasty state when I’ve managed to eek through by forcing myself to smile at customers. I generally call this the fake it to make it route. By the end of my shift, I often found I was smiling genuinely instead of just faking it and felt slightly better.

Did I feel better from smiling? I don’t know. I might have felt better from working and having something else for my mind to focus on, moving around, getting out of my apartment, or being around other people. But the smiling didn’t hurt.

That said, I don’t think I believe anyone in depression can just will themselves out of it, because if they could I’ve definitely been talking to the wrong people. Small improvements in mood certainly don’t hurt though, and I am always looking for new ways to bump things up a bit.

The part about the segment I found the most interesting is that they talked about something called “positions of power”.

The idea is that when we are feeling closed off, our posture illustrates that feeling. I know it sure happens to me, hunched shoulders, protected chest area, and I get really tense. I will sit in an area as small as possible, arms clenched as snugly around me as I can. Apparently, this is telling my brain I am under threat, that I am submissive to whatever is going on, and that I need to be closed off. Research suggests that these small, closed off postures can actually decrease the amount of energy we have.

The suggestion on the show was to do the opposite. Arrange your posture so that you are in a “position of power” -a pose that feels dominating and powerful.

Think back to cartoons, movies, -Wonder Woman standing with her hand on her hips, the business executive sitting behind his desk with his feet up and his hands folded behind his head, or the cool guy on the bus with his arm stretched on top of the seat next to him relaxedly.

The idea is that these poses all take up a lot of space, which tells our brains that we are in a position of power and we create more testosterone. In turn that means more confidence and energy.

At first I scoffed at this a little bit, but as I sprawled casually on the couch I did detect a certain haughtiness ebbing into my being.

And really, is it so far fetched? Sure there was research to back it up, but just think about what Yoga does for people in terms of posture, helping mood, and relaxation. This isn’t exactly a new idea in that sense, it just might not have been anything we were particularly conscious of.

I’d like to ask everyone to play around with this idea a little bit. If you find yourself balled up somewhere over the course of the day, try spreading out and see if you feel any different. And if you’re walking down the street listening to your ipod, try smiling at the next person that passes and see if you feel any friendlier. I’m genuinely curious to see if this makes a difference for anyone else!

You can, of course, check out the article here as well.