Am I Still a Mental Health Blogger?

Self, Wife, Mother, Caregiver, Writer, Blogger, Mental Health Advocate

What defines being a blogger, specifically a mental health blogger? Must I write regularly or frequently? Must I always write about mental health? What if that is not my focus ALL the time? What if I’m so busy that living with bipolar disorder is not in the forefront of my mind? What if I’m overwhelmed by my life circumstances? What if I’m simply taking a break?

I’m not the most disciplined writer. Never been one for discipline; though, I do brush and floss my teeth every night. My house is a mess – dusty and cluttered. I bathe or shower (I prefer to bathe) at least once a week. (You are probably disgusted by this admission. I try not to move too much, so I don’t sweat and get stinky. Yes, I know I should exercise daily. And, eat better. Just because I know better, doesn’t mean I do better.)

Followers of my blog say they miss me when I write once a month, and not more often. Not sure if it’s nice to be missed, or if it’s stressful, if I have an obligation to write.

No, I have no obligation to write.

That’s why I blog.

It’s mine. All mine.

Yes, I interact with others here and enjoy doing so. I respond to those who comment.
Recently, though, I’ve been busy with life. My illness, bipolar disorder, hasn’t been the focus of my blog. I’m fairly stable. My symptoms are more or less in remission. But, the concepts of remission and recovery can mislead. Serious mental illnesses, like bipolar disorder and schizophrenia, are chronic, lifelong brain disorders. You can live with them. Medications can help you treat the symptoms. But, the brain disorder remains.

To stay stable, I must be careful. I must plan for how certain circumstances affect me.

Last month I presented and next week I again will present as an individual living with mental illness for NAMI Provider Education at the hospital where over a decade ago (12 years now) I was treated two weeks inpatient and for a few months in their partial hospitalization program until I got bored.f

I get overstimulated in social situations and must recover. I cannot sustain that level of social functioning without paying a high price – psychiatric instability, hypomania and subsequent depression, mood cycling. So, I must keep in mind that I will need downtime afterwards – time to recover.

So… I started writing this piece wondering about the effects of my recent lack of “mental health” blog posts. I’ve also slacked off reading and commenting on others’ blogs. Sorry, folks.

I’ve been too busy doing taxes (scanning tons of receipts), driving my son to and from school and numerous doctors’ appointments (unfortunately, he isn’t motivated to get his driver’s license anytime soon & knows we didn’t get ours until we were 18 & 19), and making sure my parents are happy.

When I haven’t been busy, I’ve been exhausted – too exhausted to write, to read, to do anything verbal. Instead, I took up doing jigsaw puzzles on my iPad – enjoy that they are visual, non-verbal, and engage my mind.

Yes, I’m a Math Geek

yes-its-that-time-of-year

By January 22nd I had scanned almost every home improvement receipt my parents kept since 1978 to help the CPA, my old boss, adjust the basis of their house to calculate capital gains. I scanned over 625 receipts!

There is more work to be done, more information to be gathered, for my parents’ income taxes. I’ve also started the easier tasks for our own income taxes.

I enjoy managing money, working with numbers and spreadsheets. Always been a math geek. Enjoy the patterns, the stories, that the numbers tell.

Warning: Here, I Boast

In my youth, I was more a lover of math concepts than numbers. No longer do I get to use my beloved unit circle or calculus. My one regret is not continuing math past honors calculus – a class I loved. I love to boast (yes, I’m still proud of this achievement) that I, at 18, got 100% on the math placement exam at UCLA.

Today, at 53, I’m far from that sharp as a tack, hypomanic young woman. Wiser, perhaps, but time (and neglect) has taken a toll on my mind and my body.

Time to Care for Myself

Yesterday I saw my internist. In the last year and a half, I’ve gained twenty pounds and my triglycerides are high. Haven’t been eating well, especially for my needs, as I have SIBO – small intestinal bacterial overgrowth. Trust me, you don’t want the details. Many people with IBS (irritable bowel syndrome) have SIBO. To control my symptoms, I must keep to a restrictive low FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), which involves not eating many healthy foods, like onions, garlic, pit fruit (who doesn’t love peaches?).

Time to get moving, too, for I haven’t been exercising. Both exercise and diet are important for mental and physical health. My mother and my maternal grandmother both had strokes, which puts me at risk. Exhaustion keeps me from exercising, which reinforces the feeling of exhaustion.

My focus has been on caring for others – my parents and my son.

Time to care for myself.

Good News – NAMI Provider Education

Last month I enjoyed teaching NAMI’s Provider Education course along with four other great panelists. This time I presented as an individual with mental illness. Last year I presented as a licensed mental health professional (no longer in practice) with lived experience of mental illness. Scheduled to do so again in mid-February.

Yay!

Unlocking the Mind #Writing101

How to get at the good stuff? Cannot even think of a better word for stuff! Yes, I can look for a word using a thesaurus, which I probably will end up doing. But, for now, I’m very simply frustrated, for my mind has either been erased or is under lock and key. I’m reminded of what happens when I cannot recall a password and try time and time again to log on. After multiple tries, I’m locked out. No longer can I access a wealth of information at my fingertips. Locked out.

Writing 101 First Assignment

To get started, let’s loosen up. Let’s unlock the mind. Today, take twenty minutes to free write. And don’t think about what you’ll write. Just write.

Caveat: I must admit I edited what I wrote in the 20 minutes. Just cannot keep myself from rewriting…

Since I already started writing and making an image for this assignment before I had even started the assignment, I guess I cheated. I also thought about what I was going to write and how I was going to go about it. Once again, not the assignment. Basically I saw myself writing with interruptions. Interruptions because the dogs miss me, though they are sleeping on the floor right now. Interrupted expecting my son to ask for something, yet he now remains ensconced in the guest room playing Xbox. He asked both last night and this morning whether and when I’d move the TV into his room because my sister and her family are visiting us tonight and tomorrow. But, they won’t be here until well after dinner, so we have plenty of time.

I imagined that my writing would somehow reflect my hypomanic mind. My mind is racing, but my writing tends (for the most part) to be organized. One reason is that I rewrite and rewrite and rewrite. Not for this project. This is stream of consciousness writing (I guess). Actually, I do not recall the exact meaning of stream of consciousness writing. Sounds rather hoity toity and intellectual. This exercise and fingers flying discussing the mundane feels more like what the assignment calls free writing.

Okay, first interruption, quickly ignored. Poodle Coco nudged my left arm with his nose. He wanted to be pet. No pets right now. I’m FREE WRITING. I’m being quite writerly. He circles me like a great white shark circling its prey, and then settles for kibble.

This morning I took a break – an interruption after my initial writing and before I copied and pasted the actual writing assignment up above. During that break I went to my local Starbucks to meet up with a fellow NAMI volunteer, mental health advocate and mental health provider. Starbucks was crowded and loud, so I invited her over to my house. As it’s messy and filthy, I’m actually proud of myself. Usually I’m too ashamed to have company over.

My timer just went off. 20 minutes are up.

NAMI Provider Education – Week Three

NAMI Provider Education

Saturday I attended the third class of NAMI’s Provider Education. Here I summarize, paraphrase, and quote the handouts from the NAMI Provider Education Course Participant Manual 2013. In the third week course we learned about the cascade of secondary traumas which occur when a family is left to cope with mental illness alone.

Kitt’s Note: Stage I was Dealing with Catastrophic Event. Stage II is Learning to Cope. Both families and individuals diagnosed with mental illness need support when coping with the illness. 

Cascade of Secondary Traumas which undermine Family Coping Capacity in Stage II

  1. Families get the most of it: Patients’ rights laws mean that people with mental illness can refuse hospitalization and medication, and reject some (or all) of the necessary care the system provides. This “free choice” not to seek help results in their becoming totally dependent on their families for shelter, financial support and daily sustenance… Without any preparation, families are cast in the multiple roles of doctor, warden, case manager, nurse, police officer, crisis worker, therapist, etc.
  2. Families get the worst of it: When a family home is the asylum, everybody works a 24 hour shift, 7 days a week. In this isolated setting, behavior problems are magnified and family dislocation is intense… Family anguish is also magnified by the pain and grief of witnessing such terrible, unrelieved suffering in a family member who is not getting the help s/he desperately needs.
  3. Families remain “in the dark”: Many families have no prior knowledge of mental illness and cannot recognize or understand its symptoms. To them, it looks like their relative is willfully “out of control”, immature, lacking character (lazy, stubborn, weak), taking drugs, or (depending on their religious beliefs) even sinful.
  4. Families go on emotional overload: Great distress brings feelings of entrapment which introduce the painfully disloyal wish to detach from the source of all the trauma. It is difficult to remain connected to a family member with mental illness who has lost the capacity to reciprocate a family’s love and concern, and cannot appreciate the efforts that family members are making.
  5. Families get no “rescue” when they turn to the system: When families turn to the system for help, they are routinely told that providers cannot discuss anything about their loved one on the grounds of confidentiality. This convention places families in the excruciating situation where seeking refuge creates more trauma.

RESULT: BURNOUT

  • Emotional and physical exhaustion
    • Headaches
    • Muscle tension
    • Depression
    • Boredom
    • Apathy
  • Absenteeism
  • Decline in Performance
  • Signs of Emotional Stress
    • Insomnia
    • Irritability
    • Increased Anxiety
    • Hopelessness
  • Increase in “Escape” Activities
    • Smoking
    • Over-eating
    • Drinking too much
  • Signs of Lowered Self-Regard
    • Self-doubt
    • Self-blame
    • Blaming others

Top ↑

Adverse Side Effects of Psychotropic Drugs (by Drug Class)

Kitt’s Note: NAMI provider educators are not MDs or pharmacists (nor am I), so they do not provide detailed medication information. Ask your MD, pharmacist, or reputable sites such as WebMD or Mayo Clinic.

Anti-Cholinergic Side Effects (blocking action of acetylcholine)

  • Blurred vision
  • Dry mouth
  • Drowsiness
  • Gastrointestinal disturbances (nausea/diarrhea/constipation)
  • Inhibition of memory, attention, vigilance
  • Orgasmic and erectile dysfunction

Anti-Adrenergic Side Effects (blocking action of adrenaline)

  • Dizziness/decreased blood pressure
  • Tachycardia (rapid heartbeat)
  • Sedation
  • Weight gain

Anti-Histamine Side Effects

  • Substantial weight gain
  • Drowsiness

Increase in Serotonin 2A at Post-Synaptic Receptors

  • Diminished libido
  • Orgasmic and erectile dysfunction

Extra-Pyramidal Dopamine Blockade

  • Dystonia Akinesia/Akathesia (movement disorders)
  • Tardive Dyskinesia (neurological disorder)
  • Sexual dysfunctions

Glucose Dysregulation

  • Increased risk for new onset Type II diabetes
  • Increased risk for cardio-vascular disorder

No one person has all these side-effects, and some of these adverse effects fade over time.

Cost-Benefit Dilemma: Are the potential side effects of a drug (that’s the cost) worth tolerating to gain the symptom relief the drug provides (that’s the benefit).

Top ↑

Stages of Medication Adherence

  • Lack of Insight: Over half of those who voluntarily go to the hospital do not acknowledge that they are ill. Anosognosia in schizophrenia and psychotic mania is common and considered diagnostic. Lack of insight seems part of the mental illness process, and may persist.
  • Protective Denial: Others realize something is wrong, but are not yet ready to deal with this painful recognition. During this denial period, “accepting” drugs is an admission of illness; refusing them maintains the protective illusion that “nothing” is wrong”.
  • Avoiding the Subjective Pain, or Boredom, of Sanity: If someone’s mania or psychosis is grandiose and exciting, medications bring a painful return to the colorless world of “having a mental illness”. Although antipsychotic drugs restore sanity, people complain that these drugs interfere with their sense of perceptions and feelings, making them distant and inhibited.
  • Rebellion against Patienthood: Some refuse long-term treatment. Taking medication “forever” is like admitting you are chronically ill and will never get better.
  • Reluctant, or Partial, Acceptance: When people work their way through acceptance of their illness on some level, medication non-adherence ceases to be an ever-present worry and danger. They have come to accept the trade-offs, albeit reluctantly.

Top ↑

Co-Occurring Brain and Addictive Disorders

50% of people with mental illness have two co-occurring, potentially fatal conditions – a serious brain disorder and a relentless addictive disorder (dual diagnosis). Both are biological illnesses, both diagnoses are primary and interactive, both require intensive treatment.

When individuals with mental illness become addicted, they can no more resist using alcohol or drugs than they can willfully “cure” themselves from their biological brain disorder. This places an enormous added risk for outcomes which greatly intensify family burden – homelessness, refusal of treatment, violence, trouble with the law, repeated relapses and re-hospitalizations, suicide.

Kenneth Minkoff, MD, specialist in integrated treatment of dual diagnosis, asserts that we must expect substance abuse in mental illness, rather than consider it an exception. Treatment requires trust-building, the establishment of safety, stabilization fo the mental illness, and finally sobriety, with empathy and compassion, rather than moralizing.

Top ↑

The Trauma of Criminalization and Suicide

Jails and prisons have become holding cells for thousands of men and women with psychiatric conditions, while suicide rates among people  with mental illness show no signs of abating.

Close to 50% of individuals with schizophrenia attempt suicide, over 10% of which complete it. Rate of completed suicide is higher in bipolar and depressive disorders, while people with panic disorder have the highest rate of attempted suicide.

Just about every other person with mental illness has experienced some kind of extreme secondary trauma, and must bear the added weight of this emotional burden. Understanding this will also explain why so many families act and react the way they do – out of mortal fear that something terrible will happen to their relative.

Top ↑

NAMI Provider Education Course Participant Manual 2013