Thursday, June 21, 2012

But the day things turn sweet - for me won't be too soon

Sometimes even when the cell door is flung open, the prisoner chooses not to escape. ~the Tibetan book of living and dying.

Finally, an afternoon off where I don't have to study. Week 2 of Abnormal Psych is over and I am markedly less exhausted than I was at the end of last week, even though I read through an enormous amount of material. Lucky for me, but not really, I'm still hypomanic but pin-needle irritable in a mixed mood episode triggered by the enormity of studying LAST week.


Ack. Another night passed where Luke had to forcibly put me to bed. I was dog tired and really out of it, but I wanted to keep going--my mind was still racing and what seemed perfectly lucid to me was babble to my son. He wouldn't let me out of my room, told me to GET into bed and turned my light out. I fell asleep seconds later and woke up refreshed at 4:45 am, wrote for a while, got ready for and went to school. Like I've said before, that's too much responsibility to give a 12 year old, but he's got the tenacity and strong presence of a veritable, mature person, and he is physically stronger than I am, so his pushing me into my room was no great feat for Luke last night. I protest but don't resist, more often than not. My usual diatribe is "" only to wake up the next day and find that I'd, in effect, typed jibba-jabba.

It's annoying, when lingering hypomania during an episode won't allow me to shut down and just go to bed, which neither my family nor normal people can comprehend. My family will argue, "Why can't you just GO TO BED and stay there, and tell yourself you're going to sleep at a certain time?" If it were as simple as looking at a clock and saying to myself, "I'm tired. I will go to sleep now," don't you think I would, you know, DO that?  But instead, I think of all these things to do or ideas to generate, after I've taken my meds for the night (which, unless I'm out or want to stay up late, I take at 8pm specifically SO I can be ready for bed around 10-10:30pm) and have become sleepy and disoriented. Frustratingly, I couldn't find my glasses this morning, as I didn't remember where I left them last night. (I searched my whole room and almost woke Luke up to ask him if he knew where they were. Turned out they were in my bed, thankfully not-smushed.)

Over dinner last night, Luke reminded me (and I wish he wouldn't do this in the presence of my mom) of the story of the other night, when, at 10:15 pm, while he hadn't gone to bed yet, in a half-dream state, I went into his room and told him to go "back to bed" and that it "wasn't morning yet." He was like, "I haven't even GONE to bed, Mom. YOU go to bed." All of which I remember. This cycle is repeating itself at an increased rate lately, and I'm not sure what to do about it, other than to talk to my therapist about it tomorrow. Luke and my mom are exhausted over the stress of, let's call it politely, "managing" my bipolar disorder episodes with me. I'm on the right doses of all my psychiatric meds and usually perform just fine on them, as I have for 3 years, but I think external stressors (like the recent addition of school) drove me into symptomatic behavior.

In hindsight, undergrad work was no different symptomatically overall when I was in my early 20's, long before I had any idea what was wrong with my brain. Far less controlled or predictable than the typical young person's habit of "pulling an all-nighter" studying, I would have periods where I didn't attend any of my classes for days, barely made it to the cafeteria to eat or would have Craig just bring me food, and told my on-campus boss (first in the library, then in the Mac lab) that I just couldn't come into work, and slept, all symptoms of a depressive episode. Contrast that with either level-headed behavior or what was a real trip, when I was hyper-vigilant about my studies (particularly my writing courses, which I always seemed to pull A's in) and was capable, for example, of feats beyond pure necessity due to procrastination (that was Craig's problem, which had something to do with chronic depression but more so, he was honestly lazy...he still writes his record reviews and magazine pieces at the last minute).

Thus in contrast, senior year, I took this 300-level sociology elective, Media and Society, which was supposed to be a blow-off but wasn't, which I attended very sparsely, to the point where, when I *did* show up, the professor would say "Oh, the Phantom Student is here!" Our final was to write a research paper on, um, God knows what media or society criteria, but I wrote my paper on The Beatles. Using a few books from my personal library (there was no internet on which to research back then, kids), and my personal knowledge as my reference points, I composed a 35-page, double-spaced, APA-style, cited paper exclusively on the recording process of "Sgt. Pepper's Lonely Hearts Club Band" (actually beginning with "Strawberry Fields Forever" and "Penny Lane," the unofficial start of the "Sgt. Pepper" sessions), the afternoon/evening before it was due, acutely manic, in 3 hours, without a break. It seemingly took longer to save the damn paper to a "floppy disc" (remember those?) and run to the Mac lab to print it out. It wasn't edited, there was no first-or-second draft process, and I handed it in the next day. I got an A on the paper and an A in the class, my many absences notwithstanding. (In stark contrast, I took Western Civilization sophomore year, went the first day and never again, and flunked, which is the setting of one of my most frequent school-related anxiety dreams even today.)

Later last night, after dinner, as I was explaining to my mom some of the possible biological theories as to why one of her aunts became a paranoid schizophrenic shortly after menopause (yesterday's topic du jour in class), my mom and I got to talking about what would happen to me if I lived alone. "How will you ever take care of yourself after you move out in a few years?" she asked. "Just fine," I answered. She looked at me with predication.

My mom, despite my usual level of functionality, has serious reservations about my capability of eventual independence. I forget the original context of my mother's statements after dinner, but she said something to the effect of "We have to tolerate the way you are." It was the word "tolerate" that I found offensive and made that known to her, who accused me of overt defensiveness and an attitude problem, while I accused her of poor word choice and told her that it's more a case of helping me "manage" my mental disorders when I'm symptomatic. She brushed the statement off as her being "bad with words," when in reality, it's a situation she needs to bring up with her own therapist, who should help her with her co-dependency, regarding my alcoholism and my mental illness. (She tries to avoid therapy as much as possible, only going every month/month and a half, and has been on the same dose of a mild anti-depressant since menopause, which has clearly plateaued and does her absolutely no good in my opinion. When I advised her some time ago to talk to her doctor about switching meds, all I got was "I don't want to have to take any more pills," which is silly, because it'd just be swapping one pill for another.)

When Luke and I *do* move out, God, he might be heading to college by the time I get my doctorate...I worry about my mother's own mental stability too, because she will then have nobody she *needs* to "take care of," which is one of her most prominent daily responsibilities/tasks now that she's effectively retired, and she suffers from depression. While she still wishes I would channel my mania into cleaning the house instead of creative pursuits, she cleans and cooks for us all the time, and we truly appreciate it. I seriously just don't have the emotional or physical carrot-and-stick impulse to be very helpful around the house, again, not out of sloth or not caring. Furthermore, the way *I* would choose to do things like clean the house would be different than her "system" and rigidity, and it wouldn't matter if I left the house sparkling MY way. It wouldn't be the *right* way and we'd both end up frustrated. Our methods are too different. (At least I do laundry for Luke and myself, and keep our rooms clean, er, as "clean" as a preteen boy's room would ever get, and I help dry and put away dishes after dinner every night unless I'm studying. I try to cook once a week but school's not making that very conducive and Fridays are my only day off.) But there will come a time, I'm afraid, when Luke and I *will* leave. She's going to have to prepare herself for that eventuality someday. It will be nothing if not bittersweet and a little scary for all parties involved. (Unless my Prince Charming rides up and swoops me away in the meantime on a hybrid horse (and please, I could be talking about any number of men I know), then hooray!)

To say that the people who love me supposedly merely "tolerate" my symptomatic behavior is, actually, a grave insult to me and makes me really sad, whether that's family or friends. My mom got really defensive herself when I said I didn't like that word associated with brain/psychiatric disorders and neurotransmitter mix-ups over which I have little control, knowing full well that the meds mellow out my symptoms MOST of the time. She asked me if I get tired of "tolerating" my own symptoms.  I told her from my perspective, I don't "tolerate" my symptoms; rather, I recognize them, acknowledge them, stay med-compliant, and go to therapy once a week. That much is all my responsibility. There is no miracle "cure" out there. Brain chemistry is complicated, delicate, and inherently imbalanced in bipolar disorder. I don't recall, when she had breast cancer and I'd take her and pick her up from chemo, that I ever said "I have to tolerate your cancer." It was an intrusion in my own routine and schedule, as is any family illness, but it was never a burden to me, nor did I ever complain. I helped her out because I loved her and that was my responsibility as her child. Cancer wasn't her fault. Mental illness isn't my fault.  Stigma-a-go-go.

I've tried to destigmatize bipolar disorder, anxiety disorder, depression,  PTSD, OCD, NSSI, & situational anorexia as best I can with my family and friends, though I realize that, as my "caregivers," to those who live with me, I can be a real handful sometimes, as anyone close to me will attest. I don't define myself by my diagnoses, though I sometimes have no remedy other than to laugh at my insanity. I'm a person with lots of complicated feelings. I don't rationalize my symptomatic behavior by simply saying "Well, I'm crazy, what do you expect?" just to get preferential treatment or get out of doing chores, or bullshit like that.

This is what I'm talking about, here:

When I was living independently with Luke, after the separation/divorce but before we moved back in with my mom, I had a spotless house, a taken-care-of son, and met my obligations, though I was not yet working a job or going to school. Half of that time, I was still drinking, from March of 2007 until February of 2008, when I went off to rehab (and spent that time in the psych ward). It wasn't until the beginning of March of 2009, shortly after we finally lost our apartment, that I was properly diagnosed and medicated for my bipolar disorder & depression, and not until 2010 that I was treated for the anxiety disorder. (St. Joseph's, the hospital where I was an inpatient, referred to me not as having "co-morbidity," both DSM-IV recognized multiple psychological disorders coupled with substance abuse. Rather, they termed it "dual-diagnosis.")

I might jest about my time spent in the "loony bin," but in studying psychology and the state of mental institutions historically and even in America, 2012, the crisis of mental health treatment is still gravely under-funded, under-staffed, and generally quite poor, even in private hospitals. St. Joe's had a perfectly lovely, welcoming, enriched substance abuse center for detox/rehab called Harborview Recovery Center, overlooking Lake Michigan, downtown. At the time, I had excellent insurance, so it wasn't a matter of me being relegated to the lowest echelon of medical treatment. I called my family and a couple close friends and bid adieu for an undetermined length of time, my 8-year old confused and scared, Craig driving me to St. Joe's.  That's where I *thought* I was going, Harborview, after spending the day in the ER and doing what a social worker TOLD me to do...arrive as drunk as possible, as early in the morning as possible, and declare myself a danger to myself and others, though not necessarily homicidal or suicidal. I was neither manic nor depressive, but edgy and going into delirium tremors, for which they mildly sedated me, hooked up to a couple of banana bags of IV fluids enriched with nutrients especially for chronic drinkers whose livers were pickling, like mine.

The only glitch? Harborview didn't have any available beds, or so I was told by my intake coordinator, so I would spend my time detoxing and rehabbing in the psych ward. (Some of you have heard some of this story before.) St. Joe's psych ward was split into an East side and a West side, each housing the aggressive/violent/threatening patients vs. those who were a little less critically ill, let's say, each side locked towards the other. It was a hospital-like setting with 2 patients per room. I was stripped of anything I could use to harm myself, like my shoelaces, had to write crucial phone numbers from my cell phone down on a piece of paper to use during approved phone-time, but allowed to keep my Curious George, my eyebrow ring and they gave me a pen (which, come on, I totally could've stabbed myself with!) and blank paper, because I said I wanted to write. (Those writings are in my storage unit, and I'll pay someone like $1000 to dig through all my crap to find them, because they're GOLD. I journaled what each day was like and what I did, how I felt, etc.)

My first roommate was a delirious, elderly woman who's mental diagnosis was unclear to me. She wore a hospital gown, not clothes like me, and urinated in the garbage can next to my bed on the first night, that I remember, though I was being moderately sedated for the withdrawal the whole time. Horrified, I asked for her to be moved the next morning, and she was. My next roommate, who would stay longer than I did, was an Asian woman, I'm guessing in her early 40's, was also an alcoholic, who'd been involuntarily committed, and either so heavily sedated for withdrawal that she was incapacitated or just totally resistant to the treatment being offered.  Therapy and activities started early in the morning, after breakfast, which was bedlam, as was every other meal we ate in a cafeteria-like setting, en masse. (I joke about the food tray throwing, but at the time, it was really fucking frightening, as were the outrages of the other patients against the staff, whereupon patients would be forcefully restrained or shot up with something. Good times!)  I was all spry and hip to showering, dressing and working my program, perpetually trying to get my roommate engaged, and she stayed catatonic for the most part, until nurses physically dragged her to group therapy, where she wouldn't talk.

I fully engaged in group and individual therapy. I took all the medications without a fuss. I did the homework. My mom brought me sanctioned clothing (zippers were ok, drawstrings were not, and she brought my Uggs) and requested toiletries. I stayed in touch with everyone that mattered when it was my turn to use the phone. Chris came to visit, brought me magazines, and told me in the course of the week, he'd already slept with another woman, because that's really fucking healthy to spring on your girlfriend while she's in a psych ward. Luke and Craig were allowed a psychiatrist-supervised visit, at which, by all accounts, I seemed relatively normal to my son and not overtly "sick". I wanted to work out, but the exercise equipment was all on the dangerous side of the ward, and I was advised not to attempt going over there, or I "might get hurt."

In group therapy, there were other co-morbid patients present. In retrospect, the scars I had from cutting paled in severity from those I saw on another patient in session, who took off his shirt and had deep knife marks all over his torso and arms. Many of the other patients felt senses of doom, were delusional, suicidal, and hopeless. Many would explode in hostility when asked triggering questions. Again, I was neither manic nor depressive in the hospital, though deemed co-morbid because of past suicidal ideations, a history of anxiety/depression and multiple substance abuse. But I looked and felt like a fish out of water, comparatively. As the therapist went around the room, asking each one of us how we were doing that particular morning, I think I was the only one who would say, "I actually feel quite well, thank you." Some patients had literally been in the ward for months, reduced to robotic states of systematic compliance, either still too dangerous to be released or seemingly, if I recall, otherwise homeless. Most patients were stinky, unkempt, unshaven, or otherwise disheveled. It was very sad.

After about a week/week and a half of medical detox in the psych ward, I'd grown more than weary of the St. Joe's experience, I was physically stable and asked my assigned psychiatrist when I could go home. "How about tomorrow?" he said.  I was discharged into Chris' care under the auspice that I would complete the rest of my rehab as an outpatient the next evening, ripped off the nicotine patch and had a big, fucking smoke that nearly knocked my ass to the ground, and went for Chinese food, Chris buying me the litany of anti-alcohol medications and anti-depressants necessary for my continued care, which I would take for the next year until my personal psychiatrist deemed them no longer necessary. The efficacy of Campral for use in recovering alcoholics after one year hadn't been proven, and Antabuse, which was a really useful drug for me, gave me nearly crippling peripheral neuropathy in my feet anyway.

(8 out of 10 alcoholics in rehab relapse within the first year of sobriety. I was determined to be one of the two who would stay sober, and my case manager told me, in his estimation, that I had "about a 90% chance of making it." And I did. For 4 years straight, minus a week and a half on NyQuil, which, when I ran into my old sponsor last week and told her, she broke out in hysterical laughter, as has every other recovering alcoholic who knows about it, because it's just so fucking pathetic and was so unnecessary and such a stupid thing to do. "Not even VODKA, ANNIE?" she said, "You dummy!" Meh. I've been "sober again" since February 13th, 2012.)

That, my friends, is what "the loony bin" is actually like. It's NOT fun and I DON'T recommend it, unless you want fodder for a great book, which is, again, in my damn storage unit! I do, sometimes, wonder whatever became of my fellow patients, all of those crazy characters, who's faces I can still see in the back of my mind. Sadly, I'm afraid not all of them "made it." Some were probably discharged to the streets, others to halfway houses, or to sympathetic families or friends. Others yet may have gone on to fates far worse than that. It's not like we hold reunions or something. I was very lucky, at the time.

In reading about schizophrenia specifically this week, at least, multiple studies have shown that patients who are discharged to live alone (instead of with family members or even a spouse) are significantly less likely to relapse than those who return home, either to a spouse or to family members, who's own emotional reactions to the patient are too often heightened or overtly exaggerated, which causes the patient stress, which can result in relapse. I don't see why bipolar patients would be any less likely to experience said outcome. Sometimes I feel that living in such an emotionally-charged household is actually detrimental to my condition overall, not that I'm ungrateful to have a place to live and food to eat. I don't ever want my mom to feel she's unwanted or unloved, and we enjoy our talks together, but what 40-year old woman with an almost-teenager wouldn't want to live independently?

Being a person with bipolar disorder and other mental illnesses (plus staying sober) is no easy task. Functionality takes WORK. It takes an enormous amount of ENERGY. (Not to mention a giant amount of different kinds of DRUGS.) It's physically and emotionally taxing. Between that, school and a kid to raise, my leftover energy is in small supply, and I channel it into writing or music, or by seeing friends, not scrubbing the bathtub. It is the way it is. Lord Byron said it best:

Or maybe it was Hemingway, who was also a bipolar writer, though he was driven to suicide:

I read a case study last week about a bipolar patient who'd lost everything due to his chronic instability; including his wife, home and career, and he hadn't been diagnosed or treated until his mid 40's. When he expressed interest in finding a new job once he stabilized and was discharged from a mental hospital, now homeless and trying to get financial and medical assistance from his state, his old car his sole possession of value, he was told, "Don't worry about going back to work. People like you DON'T go back to work." (The folks at the state told him to sell his car and live off the proceeds, and to re-apply when he was truly indigent.) Stereotypical labeling, for sure. There's no valid reasoning behind a line like that. "People like you." Ouch. I joke around plenty about being insane, but is it any wonder I grow bitter of people stereotyping or assigning a stigma to conditions like mine?

After my rehabilitation, diagnosis and treatment, I *had* a job for a few years and lost it. As a matter of fact, any career endeavor I've ever attempted has ultimately tanked, but that could be due to a number of factors throughout my life. And no, it's not because I'm a loser. And we all know I'm not stupid. (Though I got a fucking B on my psych exam, which was only worth 80 out of 800 points for the course. WTF? That's totally unacceptable!!!! That said, I got B's on my tests in Intro to Psych and wound up a high A.)

While my mom hasn't expressly said so, I think she also has reservations about me achieving my career goals of getting my doctorate and practicing psychology. Had this been 1972 and not 2012, it's likely my family would've had me institutionalized for the rest of my life, instead of managing my symptoms as an outpatient, with psychotropic medications combined with psychotherapy. I'm fortunate to live in the present, on the breakthrough, latest drugs, though my mom's threatened to institutionalize me on more than one occasion when I have funky reactions to my meds or have an extended phase of mania or depression. She has absolutely no idea what a statement like that means, the threat it's perceived as, having spent time in a psych ward. Which is why I wrote this on my psych ward hospital bracelet, and had given it to Chris to hold onto, until we broke up:

All psychotropic medications have their litany of side effects, some mild and some very interfering. It can't be helped. One side effect I've learned about in school finally gives me an explanation as to why Luke frequently says that I talk in a monotone, disengaged voice. It's called mental affect, or how we express emotion. It's a typical, expected side effect of anti-psychotic drugs, like Geodon, which I take. I honestly had no prior rationale for my manner of speaking. It wasn't that I was in a depressive state, or that anything was necessarily bothering me. It's just the way I come across occasionally when I talk, and it has little, if not nothing, to do with my present mood. I hadn't noticed it and neither had my mom. (Luke pointed it out once while we were piling into Craig's van to go to Luke's therapy one night. Maybe I talk in monotone when I'm around Craig, which would explain a lot!) When I'm hypomanic or manic, though, I often am noticeably animated and sound elated. That's not a side effect of my drugs, that's a symptom of my disorder. Big difference. (Or it just could be that I'm really, really happy to talk to you.)

Virginia Woolf, who was also bipolar, left this as her suicide note, though in my mind, it's really a love letter.

The loved ones of a mentally ill patient need to be more compassionate, in my mind, of learning to accept and understand that person and also to embrace education about disorders, not merely "tolerate" them. I believe that there's a grander plan in God's mind than to simply afflict individuals with mental illness, just like any other illness, i.e. cancer. Or Crohn's Disease. Or epilepsy. My feeling is that God chose to afflict me with mental disorders specifically so that I could someday assist others with mental disorders or addictions. The "divine plan" I talked about in my last blog.

I've always had a really soft spot for The Style Council's "My Ever Changing Moods." To me, anyway, and I don't know Paul Weller's songwriting intent, I have always identified with this song as being akin to what it's like to be mentally ill, bipolar specifically, with a twist.

Daylight turns to moonlight - and I'm at my best 
Praising the way it all works - gazing upon the rest 
The cool before the warm 
The calm after the storm 
I wish to stay forever - letting this be my food 
But I'm caught up in a whirlwind and my ever changing moods 
Bitter turns to sugar - some call a passive tune 
But the day things turn sweet - for me won't be too soon 
The hush before the silence 
The winds after the blast 
I wish we'd move together - this time the bosses sued 
But we're caught up in the wilderness and an ever changing mood 
Teardrops turn to children - who've never had the time 
To commit the sins they pay for through - another's evil mind 
The love after the hate 
The love we leave too late 
I wish we'd wake up one day - an' everyone feel moved 
But we're caught up in the dailies and an ever changing mood 

Evil turns to statues - and masses form a line 
But I know which way I'd run to if the choice was mine 
The past is knowledge - the present our mistake 
And the future we always leave too late 
I wish we'd come to our senses and see there is no truth 
In those who promote the confusion for this ever changing mood

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