I Spoke in Public!

Thank you Belmont High School for inviting me to speak on mental health

Thank you, Lianne Sauvage, for inviting me to share my mental health journey at Belmont High School’s Mental Health Assembly!

For my speech, I adapted content from My Bipolar Thoughts, my memoir work-in-progress. The speech was scheduled for 25 minutes!

Honored to speak in front an auditorium of Belmont HS students!
Honored to speak in front an auditorium of Belmont HS students!

I plan to refine these speaking notes and use them again for future speaking engagements:

My Mental Health Journey

Expectations

  • When my parents introduced me as a child, they always said, “Kitt is going to go to Harvard medical school and become a doctor when she grows up.”
  • High school, I aspired to become a brain surgeon. Total overachiever. Medical Explorer Scout. Emergency Medical Technician training. Active on campus. Drama geek. School newspaper. High GPA.
  • Applied to colleges with the highest acceptance rates into medical school.
    • Didn’t get into any of those schools.
    • Receiving rejection letter after rejection letter hit me hard.
    • I had always been told I could go to school anywhere I wanted and could do anything I wanted. Wrong.
    • Instead of attending an East Coast Ivy League school, I started my freshman year at UCLA as a biochemistry major.
  • Letter from UCLA saying I had to take remedial summer courses since my SAT scores totaled under 700.
    • Back in the 80’s the math portion totaled 800, the verbal portion 800. My math score alone was 720 (yes, I was once a math geek).
    • Apparently, the Educational Testing Service (ETS) incorrectly reported my scores to UCLA.
    • When I showed UCLA my SAT scores, not only did I not have to do remedial work, but I was eligible for College Honors, in which I became active as a freshman.

College Student

  • As a freshman at UCLA I fell into a deep depression,
    • believing that my parents, my sister, the whole world would be better off without me alive.
    • When I told my friends of my suicidal thoughts, they made me promise to get professional help.
    • I saw a UCLA psychologist whose cognitive therapy, which works on rewriting your thoughts, helped me with my suicidal thoughts.
    • Still, my underlying mental illness remained.
    • Very active on campus, I volunteered in UCLA Medical Center’s emergency room, participated in College Honors’ Social Committee (glorified party planner), and trained as a peer health counselor.
    • For all but my closest friends, I hid behind a mask of competency, social skills, and overachievement.
    • But I was miserable and wanted to get quit.
    • The August before my sophomore year I came down with mononucleosis and used that as an excuse to quit UCLA.
    • For the next year and a half, I visited family and friends, worked part-time, and attended community college part-time.
    • Then, I transferred to UC Berkeley as a legal studies major, an interdisciplinary program I loved.
  • During my junior year at Berkeley, symptoms of depression returned.
    • My mother was diagnosed with non-Hodgkin’s lymphoma. I was devastated to learn of my mother’s diagnosis. At the time, studies indicated a five-year prognosis, that she would die in five years. She’s still alive thirty-five years later thanks to clinical trials at UC rival USC Keck School of Medicine.
    • That same academic year, my maternal grandfather died. My grandfather always held a special place in my heart. He was a kindred spirit as a gifted orator (I’ve always loved the stage) and storyteller (here I am telling you my story). When he died, it hit me particularly hard. My mother’s family asked me to give his eulogy, which was a huge honor. In speaking at his memorial mass, I was carrying on his legacy.
  • On my way home from the funeral, as I was driving over the San Francisco Bay Bridge, I fell into a trance state.
    • I felt a tingling all over my body, an energy pushing out, and a warm cleansing energy replacing it. The fact that I was driving over a bridge at the time disturbed me. At the time it seemed safer to continue off the bridge than stop on the bridge in the middle of traffic.
    • Now, I see that experience as a euphoric state of hypomania. At the time, given my history of depression, I knew if I went to a mental health professional and described the experience, they would diagnose me with a mental illness. But I found the experience meaningful, as somehow related to my grandfather’s death, and did not want the meaning dismissed.

Working Adult

  • Having graduated from Berkeley as a legal studies major, my first profession was as a legal assistant in Los Angeles and San Francisco. Working twelve-hour days six days a week, I crashed after a year on the job. What looked like over-achievement was a symptom of unrecognized, undiagnosed hypomania that came with a steep cost – my mental health and stability.
  • After working two years as a legal assistant, I quit, took time off, and applied for graduate school in psychology. While in graduate school, I worked as an administrator at a battered women’s shelter and completed my field placement doing play therapy with severely emotionally disturbed children in day treatment.
  • I got my master’s in psychology and became a licensed therapist. I worked with pregnant and parenting teens and severely emotionally disturbed adolescents in residential and day treatment.
  • Though my career as a psychotherapist was short-lived, only five years from ages twenty-five to thirty, it influenced how I think about mental health. My understanding is colored by both my experience living with depression and bipolar disorder and treating others living with mental health issues.
  • At thirty, my grandmother died, a dear friend from high school died, and a client threatened to rape me during session. I had a complete major depressive breakdown and found myself unable to get up out of bed and return to work. For the first time, I sought medical help for depression, seeing my regular doctor and then a psychiatrist for medication. Up until then, I had managed my depression with psychotherapy alone.
  • Rapid changes in prescribed antidepressant medications triggered mania. I ended up spending a week awake, thinking simultaneously at rapid speed in binary with ones and zeroes streaming through my head like I was a computer, about chaos theory, and about mystic saints. At the time, I wished that there had been a way to record my thoughts, so later I could decipher them and see if any made sense.
  • Though I clearly had a manic episode, I was not diagnosed bipolar at the time. Those who knew me then find this fact shocking. Since the episode was likely precipitated by antidepressants, I was not prescribed a mood stabilizer. My psychiatrist prescribed a three-day regime of antipsychotics which stopped the racing thoughts in their track and allowed me to sleep, which I needed.
  • After the manic episode, I was unable to function on my own. I would fall asleep driving to my temporary job. When at work, I couldn’t even read. The words were all jumbled. I appeared competent. No one could see that I, a highly educated and articulate former professional woman, COULD NOT EVEN READ A SENTENCE.
  • To my parents’ home and care I returned. They were supportive and encouraged my recovery. While living with my them, I received psychiatric treatment and psychotherapy. My new psychiatrist carefully administered an antidepressant, slowly increasing my dose. I remained stable on a low dose of antidepressant for almost a decade.
  • Once I was up for it, I returned to work, starting as a temporary file clerk for a commercial real estate firm. What followed was a decade long career in commercial real estate. It was a welcome change, not emotionally draining as helping severely emotionally disturbed youth, and it used my analytic and problem-solving skills.
  • Still, I continued my pattern of overdoing it, working long hours and neglecting myself, leading to repeated burn out and cyclical depression. As a result, my résumé lists numerous short stints at various jobs — shooting high, crashing hard — time and again.
  • Soon after moving back home and starting work as a temporary file clerk, I met my future husband. Three years after we met, we married and later had a son. I found being home with an infant difficult. At the same time, I found being at work, away from him, heart-breaking.

Mother

  • Depression during pregnancy and after pregnancy poses risks to both the infant and the mother. With my doctor’s blessing, I took an antidepressant when I was pregnant and nursed my son.
  • After my son was born, I returned to the workplace part-time. My job consumed more and more of my time. I went from working two days a week to four days a week until 7PM. At that point, I decided to quit work and stay home with him.
  • Staying home with my son full-time lasted a year and a half. Then symptoms of hypomania returned. I thought that God was calling to one church for spiritual direction and another church for bible study. Though going to church wasn’t “bad” for me, I recognized the feeling of religious euphoria as hypomania.
  • To be a good mother to my son, I sought treatment for symptoms of bipolar. Finally, at the age of thirty-nine, I was diagnosed with bipolar disorder type 2.
  • Fearing that I was now an unfit mother, I proceeded to put my son in daycare and reenter the workforce.
  • Once my diagnosis changed from depression to bipolar, my internalized stigma reared its head. As a clinician, I knew bipolar is considered a serious progressive mental illness. I believed that I could be a danger to my son and he’d be better off in the care of someone else.
  • I was wrong. I was the same person before and after the diagnosis. The only change was my treatment. Instead of only taking an antidepressant, now I was also taking a mood stabilizer.
  • Despite the challenges of bipolar disorder, and those challenges are real, I’m a good mother. I work hard to be a good mother.
  • Keeping with my history of hypomanic workaholism, I worked increasingly long hours until I once again fell apart. I broke down crying in the parking lot at the office and found myself unable to pull myself back together and return to work. To get myself stable, I had myself voluntarily hospitalized when my son was four and haven’t returned to work since.

Acceptance

  • For me, acceptance has been an ongoing process. I’ve overcome denial and internalized stigma about what it means to live with bipolar disorder. I’ve owning my diagnosis and allowing others in to help me.
  • I had been a high achiever, a perfectionist. Accepting that I have a mental illness involves accepting myself as broken, as imperfect, as fallible, as human.
  • That acceptance has allowed me to forgive myself for not living up to early life expectations. I never became a doctor or a lawyer.
  • But I did get my bachelors, a master’s in psychology, and much later even attended graduate school studying religion twice after my psychiatric hospitalization.
  • Given my history of mental illness, I’ve questioned my sense of calling, of having a higher purpose. My mental health journey has led to purposeful mental health advocacy.
  • I am not weak. I am vulnerable. There is strength is being vulnerable. I accept that I’m not perfect and flawless. I am loved, lovable, and loving the way I am. My life has meaning.
  • My life experience gives me purpose in helping others. I am grateful that I can speak and write to share my journey with others, hoping that it inspires others to accept themselves and others living with mental health issues and to get help if they need it.
  • Thank you.

Who, Me, Dating?

DatingNews.com
interviewed me about dating and marriage while living with bipolar disorder.
Here’s how the article starts:
Kitt O'Malley: Love, Learn & Live with Bipolar Disorder. Blogger Kitt O'Malley Opens Up About Her Experiences Living, Loving & Laughing with Bipolar Disorder

At age 30, Kitt O’Malley moved in with her parents after treatment for debilitating depression resulted in psychotic mania which left her unable to do her work as a licensed marriage and family therapist. She left her career aspirations behind, and she started seeing a psychiatrist and a therapist who treated her for what was still thought to be chronic depression.

So when the guy she was dating said “You’re the most independent woman I’ve ever met,” Kitt couldn’t help but laugh. She had never been more dependent in her life, but he didn’t see those circumstances or her mental illness. He saw her, and that in itself was a small miracle…

Read the rest of the interview here. Thanks!

Lynn Nanos Guest Post: Revolving Door of the Mental Health System

Thank you, Lynn Nanos, LICSW, author of Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, for this guest post.

Can We Slow the Revolving Door of the Mental Health System?
“When hospitals release seriously mentally ill patients too soon without outpatient follow-up, the patients can end up homeless, jailed, harming others, or even dead.”
— Lynn Nanos, LICSW

As a mobile emergency psychiatric social worker in Massachusetts, I evaluate many patients who have learned that getting psychiatrically hospitalized is more likely when they don’t take their medication and attend psychotherapy sessions. Too many patients are repeatedly readmitted to emergency services before inpatient is secured, despite that they needed this level of care months ago. Among those whose treatment implementation was delayed because they were not transferred from emergency services to inpatient care when this was needed, would they have become stable sooner if inpatient access was not delayed? For those who were repeatedly admitted to inpatient, could this have been prevented if they were discharged at the appropriate time? 

As a mobile emergency psychiatric social worker in Massachusetts, I evaluate many patients who have learned that getting psychiatrically hospitalized is more likely when they don’t take their medication and attend psychotherapy sessions. Too many patients are repeatedly readmitted to emergency services before inpatient is secured, despite that they needed this level of care months ago. Among those whose treatment implementation was delayed because they were not transferred from emergency services to inpatient care when this was needed, would they have become stable sooner if inpatient access was not delayed? For those who were repeatedly admitted to inpatient, could this have been prevented if they were discharged at the appropriate time? 

Not encountering a couple of patients who I previously evaluated in any given week is rare. I describe the revolving door of the mental health system in my newly published book, Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry

Breakdown: A Clinician's Experience in a Broken System of Emergency Psychiatry by Lynn Nanos, L.I.C.S.W.

While the inpatient course lengths have declined since deinstitutionalization, the rate of readmission to inpatient units has increased.[1] The revolving door in the mental health system refers to the rapid cycling of admissions to and discharges from inpatient units and hospital emergency departments, jails, and prisons. It is common to see psychotic patients cycle through hospital emergency departments five times in less than two months before they are moved to inpatient units.

The nationwide shortage of inpatient beds creates a backlog of patients waiting excessively for placement in emergency departments. Many sources indicate that the number of inpatient beds has declined by approximately 96 percent since deinstitutionalization, despite the population increase.

If a patient who meets inpatient criteria is prone to violence, doesn’t want any help, has no health insurance, or is expected to present extremely challenging barriers to discharge from inpatient, the wait for an inpatient bed will be longer than average because inpatient units discriminate against patients with these characteristics. I evaluate a highly psychotic young man, Fred, age 32, at the hospital. He doesn’t want to be there and had been brought there by police officers after he threatened to assault his cousin. Due to his history of assaulting hospital staff members, no inpatient unit accepts him. Colleagues, including myself, consistently confirm he qualifies for inpatient daily. After a couple of weeks, the emergency physician discharges him to the streets. Did he receive any psychiatric help other than the interviews we employed? No. Would he continue to deteriorate and pose a risk of danger toward others because of his psychosis after discharge? Yes.

Involuntary hold law is especially needed for some patients who lack insight into being ill and dangerous. Like most states, Massachusetts’ involuntary hold law emphasizes the risk of imminent danger while neglecting to prevent danger. When I find that patients do not meet this stringent standard, there is usually no choice but to discharge them home or to the streets.

Craig, age 25, presents to emergency services with his mother, Vera. They have been living together for years and she knows him better than anyone else. Craig immediately reveals to me he has no interest to meet with me. Vera clearly pressed him to come. She urges me to use her written journal to get him hospitalized. It shows his deterioration in functioning over the last year. He has increasingly isolated himself socially from others, dropped out of college, often been found mumbling to himself when no one is around, and once in the last month told his mom that he planned to cut his wrist in a suicide attempt.

As I refer to the above-noted concerns reported by Craig’s mom, he acknowledges most of them but minimizes them. He is not psychotic and states he never hallucinated. Nor is he suicidal. He clarifies that he had told his mother he wanted to kill himself approximately two weeks ago in the context of an argument they were in. He stated this with much more intention to upset her than to die. He easily lists reasons to continue living – love for his mom, dog, and brother. He lists coping strategies that he plans on using. He doesn’t qualify for inpatient.

What could I offer to Craig? He does not qualify for a state-funded residential program because he has not been deemed eligible for state-funded care. Even if he were receiving state-funded care, a residential program would probably not be available to him because there aren’t enough. And the state would hypothetically not prioritize him because he is not homeless. He cannot fund a private residential program. Partial hospitalization programs (PHP) involve a daily series of structured group psychotherapy sessions and a chance to see a psychiatrist. But many insurance companies, including Craig’s, do not cover this level of care. If he were covered by the “correct” insurance, would he follow through with this? I cannot predict the future but would guess not. Massachusetts, fortunately, has Community Crisis Stabilization (CCS) units in all areas. People in crisis sleepover in CCSs for a few days, where they receive ongoing support, the structure of psychotherapy groups, individual psychotherapy, nursing, and psychopharmacology adjustments. Although it lacks the supervision possible on inpatient units, it helps thousands of people who don’t qualify for inpatient. But it is a voluntary level of care, which Craig is not interested in.

Solutions can be implemented to slow the revolving door. More inpatient beds are needed. Inpatient units that discriminate against the most challenging cases should be held legally accountable. Legislative changes are needed to enable professionals to invoke involuntary emergency and inpatient care with less difficulty. Treatment options for patients who are not finding basic outpatient treatment enough, but who don’t qualify for inpatient care have to be easily accessible.

Lynn Nanos, LICSW
LynnNanos.com


[1] Appleby, L., D. J. Luchins, P. N. Desai, R. D. Gibbons, P. G. Janicak, and R. Marks. “Length of Inpatient Stay and Recidivism Among Patients with Schizophrenia.” Psychiatric Services 47, no. 9 (1996): 985-90. doi:10.1176/ps.47.9.985; Appleby, L., P. N. Desai, D. J. Luchins, R. D. Gibbons, and D. R. Hedeker. “Length of Stay and Recidivism in Schizophrenia: A Study of Public Psychiatric Hospital Patients.” American Journal of Psychiatry 150, no. 1 (1993): 72-76. doi:10.1176/ajp.150.1.72.

I Got Out of the House This Week!

Outside

My major achievement this week was to get out of the house TWICE for ME – not just driving my son to and from school or caring for my parents.

Monday: OC Writers Write-In

Monday I attended an OC Writers write-in where I wrote 3282 words freely. The words need editing. They need shape. They possibly need to be fictionalized. Not sure.

Wednesday: Brain Disease Advocacy

FEDUP4Brain_Cropped
Yesterday I had a lovely lunch with Mary Palafox of FEDUP – Brain Disease Advocacy. FEDUP4Brain advocates uniting mental and physical health under ONE health care delivery system. Stop treating serious mental illnesses such as schizophrenia and bipolar disorder differently than other brain disorders.

Folie à Deux

As for the writing I did Monday, my focus was a delusion shared (folie à deux) by my parents. The delusional thoughts originated from my mother, but my father backed her up, and in doing so failed to protect us from verbalized delusions better not shared with one’s children. The delusional thinking was and still is disturbing.

Understand that delusional thoughts are a SYMPTOM of mental illness, of a brain disorder. When a couple reinforces each other’s delusional thoughts, they get stuck in a reinforcing feedback loop. In isolating themselves from others, they fail to test their version of reality against outsiders’ views.

My mother lived with an unacknowledged, undiagnosed mental illness. As her daughter, I’m in no position to diagnose her. Loyal and devoted – adoring, in fact – my father always backed my mother up. He might agree (in secret) with us, but then he would make us apologize to our mother for something SHE said, explaining to us that our mother didn’t feel appreciated and it was up to us to give her the attention she needed.

Not a healthy dynamic, but by the time we were teenagers, we knew it was not healthy. Thank God, my sister and I had each other to tether ourselves to reality.

As an adult, as a mother, in many ways I identify with my mother. I can see myself in her. I can see my illness in her illness. So, I feel compassion for her. But we differ in how we have dealt with our disordered brains. I had insight and sought treatment early.

As it turns out, since my mother had her stroke, I learned that she was being treated for depression. She told me a few years ago that she took an SSRI for anxiety, for panic attacks, but she told me she stopped cold turkey (dangerous). I was unaware that she went back on them for depression.