Tag Archives: dbt

Coping with Coping

Of all the things I’ve read and researched and talked about in terms of coping with mental illness I don’t think I’ve ever quite been prepared for the notion of coping with what comes next. Having poured my full attention (alright, we’ll say about 75%) into how to cope with living with treatment resistant bipolar disorder I’ve found which strategies have been helpful for me (DBT, ongoing therapy, group therapy, limited drugs and herbal remedies) and which haven’t (CBT, psychiatric medications -though my doctor is now trying a new approach which I’ll discuss later on, and the old fashioned I’m-going-to-stuff-all-my-feelings-down-and-ignore-them trick, to name a few).

In the time I have spent with the majority of my focus on mental health related topics (about 5-6 years) I often found myself growing in helpful ways, but then sort of falling behind every time I had a major episode. I would say that in that time I very rarely felt like I was able to get ahead of the curve when it came to my mood swings or anxiety and even when I was able to rebuild my own sense of self and self-worth from the ashes of a major depressive or psychotic funk my treatment resistant symptoms had a habit of pulling the rug out from under me all over again, requiring me to start at square one.

While I don’t like the idea of calling myself self-absorbed or self-involved, living this way (without continuously going full ass-over-tea-kettle) has meant spending a LOT of time crawling my way out of the dark corners of my mind with nothing but a spoon and a flashlight, or untangling myself from the intrusive thoughts that pop up, or needing to ask people to help me by doing things that seem strange to them, to say the least, in order to keep from constantly triggering me. I’m fully aware that this sort of living probably doesn’t look good to those on the outside looking in, and having to spend so much time focusing on my own issues has meant having a hard time with personal relationships (wait, when is your birthday again?) and generally seeming like a distant asshole.

That life, though, that sort of living and coping with the constant need to pay attention to every little detail inside myself in order to keep from being overwhelmed by it, that is honestly where I have built a (we’ll say -though not exactly) comfortable existence for many years. This is the world I know, the world that is 75% me dealing with my own mental health issues and having 25% of my time and energy and interest left over for things like relationships with other people, doing housework, leaving my apartment, having a job, and being creative. Showering. Playing with my dog. Discerning which banana has reached peak ripeness. Important things. If you consider it, 25% of my time isn’t a lot to try and do all of those things and I’ve had to cut out a lot of them, especially since that 25% has encompassed when I’m feeling at my best. In a full blown episode I might have only 5% of my brain available for all of those things, so obviously taking advantage of every resource available to me to try and increase that number has been my main priority.

Alright, so if that is a general approximation of how things have been the past 5 years, what does it look like when the numbers begin to change?

Even without a medication to help stabilize me my doctors and I are beginning to realize that I am more stable when not subject to a constant barrage of new medications to try. My system is simply too sensitive to keep playing medication wheel of fortune on repeat, but given the proper amount of down time to sweat out all those side effects I can function better without them (go figure). It isn’t the difference between being totally stable and in crisis, more like 25%-30% stable or in crisis. I’m not suddenly a rocket scientist or anything, but every little bit helps.

After that important discovery, DBT (dialectical behavioral therapy) coming into my life has made a huge impact. Again, not cured or totally stabilized by any means but I’m learning to cope more effectively. Instead of having to crawl through the dark recesses of my mind with a flashlight and a spoon it’s like I’m learning where all of the light switches are. When I’m getting tangled in obsessive or anxious thoughts I’m learning that the less I struggle, the less hold they seem to keep on me (like that plant in Harry Potter, oh, you know the one). With all of the things I am learning, I am definitely making changes in my life that are allowing me to go beyond having that limited 25% external focus.

But here’s the kicker. I’ve found that working on coping with my mental health issues isn’t enough. No, there is actually a subplot here where I am rapidly discovering that having time to focus more on the world around me, and particularly the people in that world, has meant having to learn a whole new set of skills to cope with the clarity that my newfound perception is affording me!

Being in a position to improve my own mental health has made it difficult for me to watch the people in my life who may not be coping with their own situations very well… and I may not have noticed how frequently many of them were struggling until I was able to look away from my own problems enough to see it. In a sense, I’m having to find ways of coping with the realizations and discoveries brought on by my initial coping and it feels like the most bizarre twist life has thrown me in a while (and I’ve had psychotic episodes so that’s really saying something).

Somehow… being more self aware has led to me needing to spend less time being self aware, and all that extra focus I’ve been able to put on the people around me because of it has made me see things I really didn’t notice before. The most maddening part of all of it is discovering that most people aren’t even aware these issues exist, or are quick to deny them, or cope in ways I know are wildly self deprecating and dangerous.

In that way, the coping that has been afforded me through DBT really started out as all hearts and stars (and horseshoes, clovers and blue moons… pots of gold and rainbows, and the red balloons!) but I’ve concluded that with the knowledge I’ve gained I inadvertently stumbled upon a double edged sword. I never asked to be able to use this strange, newfound mental health x-ray vision on others… I only wanted to use it on myself! Damn.

I’m doing the only thing I can do (or at least, what I can do and keep the relationships) and try to practice being nonjudgmental and accepting and all of that exceptionally difficult stuff, but there seems to be a natural shuffle where many aspects of my life (including my different relationships) are currently up for reevaluation because I’m seeing everything in a whole new light. I want a healthy life that will help reinforce the positive strategies I have been learning because without the aid of medication, they’re one of the only tools I’ve really got. At the same time we’re all human and I can respect the fact that no matter where I go or who I meet, the vulnerable flaws of humanity are not escapable.

As always, I’m working to find the balance between these things, even if the ride has been wholly unexpected.

 

 

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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!”

 

DBT; Subscribing to the System

I’ve now been through three quarters of the DBT (Dialectical Behavioral Therapy) program and I have started my final chapter; Interpersonal Effectiveness.

That means I’ve been through Emotion Regulation, Distress Tolerance, and Mindfulness. I’d say I entered this program feeling rather skeptical (I hated CBT – Cognitive Behavioral Therapy, and generally disagreed with several of their claims about how the brain works) and while I didn’t know anything about DBT before, I quickly found myself sinking into a system of techniques that only added to my current ones without taking anything (useful) away.

As it turns out, I’ve been “practicing” several DBT techniques for a long time, things like distracting myself through immediately unsolvable emotional crises, or using changes in body temperature to calm myself or bring myself out of a slow depressive stupor. For the most part, I would say at least three quarters of what I’ve learned has been useful in some way -including new ideas, like working not to suppress negative emotions but to sooth myself through them instead. Overall I would say the subject matter has been presented in a very organized way which I really appreciate, and now, 75% of the way through the program, I feel a bit like this system is something I can really subscribe to.

I am really slow to jump on bandwagons, I tend to be too curious about what makes them tick to be able to adapt to them well. I like when I can see results quickly and know why they are happening, I like efficiency, and organization, and have a hard time putting all my chips into something I don’t understand.

So… what’s the problem, right? Up to this point, things with DBT have gone swimmingly! The trouble is that last week we started on Interpersonal Effectiveness. Communication and relationships with others are by far my Achilles heel, so at first I was really excited to get to this section.

The group was instructed to go through a series of statements and pick out which ones were myths and which were facts. I wasn’t born yesterday, the page was clearly headed, “Myths in the Way of Relationship and Self-Respect Effectiveness” and “Myths in the Way of Objectives Effectiveness” (fancy talk for convoluted thinking that keeps people from asking for what they want, saying no, and generally maintaining healthy relationships). So they’re all myths (you tricky teachers you!). I sat feeling quite superior at this realization.

But then, then I started to read them. Confusion began to rise as I chewed on my lip and skimmed through both blocks of text. I admit, I glanced over at the papers of my peers who had checked two or three of the boxes as things that rang true to them, but after everything was said and done I’d checked off at least half of the entirety.

“These are myths,” said my brain. “So why do we (brain and I) believe they are true?”

I sat there, confounded, rationalizing some of the statements.

“Well, I mean ‘everybody lies’ may not be an absolute truth, because… well… maybe some people don’t. I find that hard to believe, but in 6 billion people there might be a few who never lie, so I can accept that as a myth that feels true.”

“How about number 21? ‘Revenge will feel so good it will be worth any negative consequences.’ Well… that one usually feels true but having some experience in the revenge arena I can tell you it doesn’t always feel spectacular, so I can accept that as a myth that feels true.”

When the teacher called on me I joked my way through my response, did a small song and dance, and handed the imaginary baton to someone else. I was still quite disturbed at the discrepancy between the sort of general beliefs that had got me to that point and the fact that they were labeled myths on the page in front of me. It was like someone had told me my green shirt was actually called “orange” and I’d been wrong all along in believing “green” existed.

More seriously than the ones I described were others I could not seem to contradict. Statements like:

“I shouldn’t have to ask (or say no), other people should know what I want (and do it).”

“They should have known that their behavior would hurt my feelings; I shouldn’t have to tell them.”

“Other people should like and approve of me.”

“I should be willing to sacrifice my own needs for others.”

These were all things I could hold in one hand and look at saying, “perhaps this isn’t true,” but in general, when I got down to it, they were all ideas that have shaped the way I interact with others.

I left class last week thoroughly wigged out. My first reaction was to throw DBT under the bus and conclude it didn’t know what it was talking about. I couldn’t understand it, and so I had little ability to trust in it. At the same time (as I mentioned), Interpersonal Effectiveness is definitely the thing I struggle with the most so it seemed more reasonable to assume I am the issue in this situation.

I brought it up in therapy at the beginning of this week and my therapist (one of the teachers of the DBT group) told me to “think of it as an opportunity”. There have been so many areas of my life that I have been willing to experiment on, trying over a dozen new psychiatric medications, trying new techniques to help with mood swings, or falling asleep, or my general health. However, with all of this kind of experimentation I only lost a day, a week, my mental or physical stability for a brief period.

It takes an extraordinary amount of effort on my end to maintain an even vague sort of relationship with another person, so these relationships are extremely precious to me. Frankly, in many ways I am terrified of experimenting with them, it seems that the risk of losing a friend by suddenly behaving differently is more significant to me than losing a day to depression, or a week to hugely swollen lymph nodes. This notion that only bars my better judgement; I know I need to improve at communicating.

I took a French class at a local college in high school and almost failed the class. I had been a straight A student up to that point, but for some reason the very act of having to speak aloud, speak strange sounds and arrangements of words I didn’t fully understand, well it freaked me out. Being able to communicate in a way other than I’m used to is something I aim to learn, but, like French, don’t be too surprised if there is a lot of hacking and gagging involved before I get it right.

 

Revenge

Over the weekend I went to see The Revenant, and though I am not typically interested in dramas or anything relatively violent I am interested in stories about mountain men and stories about revenge.

I’ve been thinking a lot about revenge and why it is so interesting and even consuming, at times, to me. True that in a heightened state of emotion revenge can seem that much more gratifying, but most of these stories about revenge (or my experiences with revenge) well… they never quite end well.

The thing that interests me the most about revenge is how my own mental health has been able to completely warp this concept in different situations. For example, I started having my first full-on panic attacks in elementary school in P.E. when our teacher had us running around the track. He told us that we were not allowed to stop for any reason, not even to get a drink of water. When I asked him if I could stop to tie my shoe (which had become untied) he said no. I was supposed to keep running.

Now, this might seem totally mundane in terms of “personal threats”, but I have always been a somewhat awkward being who is able to trip on a line in the road. Having my shoe untied was a serious invitation to biff it on the track, and I was both pissed off and terrified. However, my fear quickly turned into something else as I found myself desperately wanting to trip on that shoelace, fall, and get hurt enough for some kind of punishment to befall my P.E. teacher.

It didn’t happen, but there have been many situations where my apparent inability to do anything about a perceived injustice has left me believing that the best form of revenge would be to take that revenge out on myself and subsequently whoever I meant to get revenge on would be forced to watch me withering away… potentially causing them inexplicable amounts of pain. At times I have thought that my younger self may have wandered into believing herself some kind of witch-doctor, capable of performing voo-doo. Of course, that almost never, ever worked out the way I expected it to, and while I admit the idea of hurting oneself to exact revenge on someone else seems totally ludacris there have been times where the act of revenge seems to completely outweigh the act of living. Watching any number of “revenge” themed movies will typically suggest the same.

I fought this notion a lot via the church. The act of forgiveness being the total opposite of revenge, I figured that might help me shy away from a lot of the odd, convoluted notions I had about punishing others or using myself to do so. Unfortunately, I found myself living in the opposite extreme, constantly in a state where the people around me were taking advantage of me and I would be ushering out forgiveness in a never ending revolving door of pain.

As it turns out, forgiveness without any sort of boundaries can be just as detrimental as revenge.

The road since then has been awash with many different theories and attempts to live a healthy life. I would say I have made significant progress on that front, but as a profoundly emotional individual it still swells up, from time to time, and revenge becomes something shiny and wisp-like begging me to chase after it. Even if I can withstand chasing it, it isn’t hard for my imagination to take the bait and for days, weeks, or even months I become trapped, seeking this thing out -if even only in my mind.

I am hoping that one day I will have replaced that inexplicable pull with something as simple, but as important, as acceptance. While it is something that seems distant to me now, I hope that little by little, inch by inch, it will become a more central part of my life and my future.

One day I will be able to sit with my life as it is as opposed to being haunted by the notion of what it should be.

Looking Back, Looking Forward

With the new year fast approaching I am excited to say that I will be starting 2016 with a new therapist and a new psychiatrist. I will also be continuing the DBT group I have been participating in for a couple months now which is great because so far I would say it has been helping me make a difference in my reactivity and emotional rumination.

Of course, it helps that Emotional Regulation was the first thing we covered because that is one of the more challenging things I have been facing. The funny thing is that now that I’ve got a few skills to help me see the big picture (instead of a pure emotional reaction) in situations it has been made clear that my other biggest challenge is communication and Interpersonal Relationships. That module of the group definitely can’t come soon enough!

That doesn’t mean I am miraculously cured, or that I am not continuing to lose my shit on a semi-regular basis. But… I may lose it for a shorter period of time, or only two or three times (instead of 12-16). Frankly I am willing to consider any and all progress progress.

Ultimately the way my perspective has been shifting around because of this class highlights an issue that I’ve known for a while but may not have given enough credit to. Stress makes a huge difference, in terms of the timing and magnitude of a lot of my emotional episodes. Stress is like… my death star. I might think it is a friendly moon at first but really it is a fully operational space station of mass destruction.

What does that mean, exactly? I am not sure, but I know I need to be addressing stress more aggressively (eh, not me being aggressive but more seriously) and not fail to recognize it or deal with it before all the firing sequences have been completed and it becomes a giant laser heading straight for me.

I can’t control the stress, but I am hoping that if I can recognize it early enough there will be time for me to react before the laser hits the fan.

Anyway, even with the intense illness and surgeries of 2015, spending summer in bed, and most of my plans being totally pulled out from under me this was somehow a better year than 2014. While 2014 was almost a year of being comical because of how many things could go wrong, 2015 was great because “at least it isn’t 2014.”

I don’t know if it was because I spent 2014 operating on a totally empty tank but this year it was like I could feel parts of my brain beginning to operate that hadn’t been used in ages. I can’t make a final word as to if I should be chalking that up to hypomania or simply 2014 acting as a hard-reset of my brain but it leaves me hopeful that in 2016 I might be able to dust off a few more parts and put them to good use again. We’ll see.

Ultimately, this year I learned that there is still a lot of improvement to be had in terms of the treatment of people with mental illness and mental health crisis. It bewildered me that so many people were willing to reach out and to respect my space when I was having surgery (for a physical problem), but the treatment I have received both just having a mental health problem or during a mental health crisis is wildly different. I am hoping that going forward I can learn and discern new or better ways to communicate this problem and what we can all do to help solve it.

In the mean time, however, I will wish you all a happy new year! Thanks for reading!

My Intro to DBT, Breaking the Bucking Bronco

For just about as long as I can remember, my emotions have been akin to a bucking bronco that I was plopped on top of at an early age.

For several years the best I could do was hold on, but in the last ten I have gotten to know the bronco a little bit. Every once in a while I can feed him an apple to win his favor, and I can do a better job of riding all of the ups and downs (instead of just holding on for dear life).

It always unnerved me when people would tell me to get the bronco under control, and that the task should be relatively simple. That I could harness it and use it to ride faster and further than other people. In response to most of those people I simply sat back and, though willing, rather spitefully responded by asking, “how? If you can tell me how, I can do it.”

That is when whatever adult/therapist/boss would get flustered and I would sigh unapologetically. I didn’t need someone to teach me how to ride a bucking bronco, I already knew how to do that. I needed someone to teach me to tame it enough that I could dismount and spend some time on solid ground.

Needless to say I was pretty pleasantly surprised when my first meeting with the DBT (Dialectical Behavioral Therapy) group at my local clinic (finally!) did just that. Within two hours there was discussion on how to change from a harmful emotion to a positive one, and all I could think was, where was this group ten years ago?!?

Frankly, I am really excited to have the opportunity to try strategies for managing my bipolar and anxiety symptoms as well as work on my abilities to communicate with others because those are the biggest barriers in my life. DBT might just be the horse whisperer I have been looking for… heck, it practically came with a saddle and a bit!

I am not expecting a miracle, but being desperate for ideas and answers for quite some time I am the sort of person who will not scrimp on doing legwork to get to where I am trying to go. Ultimately I think this group will help me do some great things, and I am excited to absorb as much information as I can to implement some much needed positive changes.

Personal Progress (well, maybe not exactly) on the ECT Front

After a series of uncomfortable phone calls and leaving voicemails for everyone in Seattle capable of administering ECT, bits of useful information started to trickle in. The information was useful because it let me know that my options are extremely limited (many hospitals here that provide ECT have apparently moved away from treating patients with medicaid) but I was able to set up a consultation with one of the leading psychiatrists at Northwest Hospital’s ECT unit.

While I’ve been interested in ECT for a while now, previously my mood swings were not in a position (predominantly depressive or manic, more ultradian cycling and mixed) to lend themselves to the immediate requirement of electroconvulsive therapy. Having my symptoms take a much more noticeable downward turn into depression lately made this seem like the perfect time to look into it again.

Beyond that, though, I wasn’t sure if I would be a good candidate for ECT right now. After all, I have just undergone some pretty significant physical health problems and two surgeries, one being relatively major. Ultimately, the consultation was to learn if I could even undergo the treatment right now in addition to finding out if it might help me.

I tried my best to explain this to the receptionist who tried to schedule me for ECT the following week before my consultation had even began.

The consultation itself was… uneventful. I’d already gone through one of these before at another hospital, but I wasn’t really expecting this psychiatrist to have a significantly less optimistic view on how ECT would probably go for me. While he said he wouldn’t tell me absolutely not to try it, it seemed unlikely the treatment would help my symptoms (based on the point I have reached trying almost every medication available with no improvement). He said that each medication I have tried and been resistant to has made the next subsequent medication more likely to fail. I don’t know if that is true or not, but that is the word on the street.

He also told me that he would suggest I (here’s the baton) seek treatment through DBT (and the handoff) first before trying ECT. Unfortunately this proves to be a program even more difficult to get into than ECT in Seattle as it requires a lengthy wait on a waitlist (I’ve actually already been on the waitlist for two months before last weeks consultation) or about $5000 and a somewhat shorter wait on a waitlist.

I left the facility feeling surprisingly optimistic despite the news. I guess it was just nice to have someone tell me that even if they don’t know if what they have to offer will help me they could suggest something else. Normally people just tell me I’m screwed and do I “have any questions?”

For a while now I’ve kind of felt like “all roads lead to DBT” -at least, given my symptoms and everyday problems with human interaction, working, mood swings, etc. This time I am hoping that seeking out a case manager might be a better option than trying to do all the footwork myself. People don’t respond well to my… aggressive tone on the phone, and I don’t respond well to dickheads on the phone either.

At any rate, I will be shifting focus to moving toward DBT. The hospital said they would keep my file open and get all the necessary paperwork ready in case I changed my mind about doing ECT in the next month or two if I can’t get in to DBT.