A Second Appointment

Last week I had an appointment with the psychiatrist. She is very nice, and seems to be up for at least a bit of discussion, rather than pronouncing a mood state and sending me away with a prescription.

This was the second time I’d seen her, but I barely remember the first. What I do remember is a few strange questions, or at least questions that seemed strange at the time: have you made any new friends? Why are you thinking about the nature of the universe and infinity? Have you been taking your medication?

The answer to the first was “yes of course, why wouldn’t I be?” I’d been meeting people at bus stops, in cafes, in the waiting room at the CMHT, and just talking to them. Why shouldn’t I? I didn’t understand why not. I never went beyond just talking, never a suggestion of a second meeting, but I still considered them friends. I think, and this might be largely guesswork, that most people were happy to chat. I remember a few slightly worried or bewildered faces, but I just couldn’t process what that meant, and I didn’t want to stop talking anyway. I must have said some strange things, but no one actually walked away from me. I think.

The psychiatrist asked me again this time. The answer was no, I hadn’t met anyone new to make friends with. I’d forgotten about her asking the question the first time around, and it really threw me. I’ve been feeling like I’ve actually been faking the whole bipolar thing somehow and that actually there’s nothing wrong, but the reminder of how I was feeling and behaving then was a little bit of a shock. It wasn’t how I’d remembered the episode, if that’s what it was, what little of it I do actually remember seems like it was me as I truly am. So no, no new friends, even if I am naturally an extrovert and a fairly gregarious person.

She asked me last time why I was thinking about maths, the nature of the universe and infinity. I won’t go into too much detail as it’s vaguely triggering for me, or at least upsetting to realise I can’t think about such things without losing quite a lot of my marbles. Suffice to say, it interests me to think about what might be and what could be. So that’s why I was thinking about it – it’s interesting. What I didn’t understand at the time was why this was even an issue. Why shouldn’t I think about interesting things? It’s not like I was psychotic and planning to save the world through creating clean, cheap energy like I have done before. I’m not sure if I made that clear. She seemed to think that thinking about maths, the universe and infinity was not normal. And it probably isn’t for some, but if I actually don’t have bipolar, then maybe it’s fine to think about. Maybe it’s normal for me, the real me. I’m all in a mess about this and I can’t quite work out how I feel about it all. I’m probably wildly contradicting myself. That’s really all there is to it. I thought it was interesting, and I wanted to understand things like modular forms.

This time she asked me if I was still thinking about these things, of course. It hadn’t even occurred to me to think about them. Now I know I can’t, not without going down that path again, and I’m not sure I’d even understand it if I did. But if nothing is wrong then I can think about them. I’m so conflicted. Again, last week at least, the answer was simple – no. I’m thinking about more practical things like getting a job, making blankets for my friend’s babies, and concentrating on cooking suitable meals with burning the house down. There’s no time for the universe.

I’m sure she asked several other questions both last time and this one. I remember something about too many projects, annoying people, and my ability to sit still. Last time she asked me to rate my mood on a scale of one to ten, five being normal. I said six, so I must’ve had some insight. She put me at an eight. I’m not sure what that means for a psychiatrist. I wasn’t sectionable anyway, by anyone’s standards. I think.

The big one. “Have you been taking your medication?” The answer both times was the same. Yes. I might have forgotten once or twice a week while my mood was high, but I remembered enough. I remember about the same amount now. My brain is foggy these days. She told me I had to take it “religiously”, and promptly increased my aripiprazole dose to 30mg. I remain slightly confused by this. If I was manic, then why not increase my mood stabiliser rather than my antipsychotic? Aripiprazole doesn’t exactly bring people down fast, so why not take that time to stabilise with lamotrigine rather than maxing out my aripiprazole dose? Perhaps she was hoping it’d bring me down faster. Perhaps i should have asked. I wasn’t happy about taking more meds, and I’m not quite sure why I agreed to it. That bit is lost to the sands of time. I’m told that if I can’t remember what happened, that should give me an indication of how high my mood was. I’m not so sure. She also increased my clonazepam dose from 0.5mg per day to 0.5 twice a day, plus 1-2mg at night depending on the amount of sleep I was having. I was barely sleeping at all then. The clonazepam did mask those feelings of clarity a bit. I felt very slow, and it was frustrating. I took out though, and again I don’t know why I agreed to any of it.

And now, of course, I am still taking the aripiprazole (I dropped the clonazepam about five weeks ago). It’s an issue. I don’t want to, I definitely don’t want to take it at the dose I am taking it. So why am I taking it? It’s a good question, if I don’t want to then why should I? There is no simple answer for this one. Mostly I don’t want to piss people off – if I don’t take it people will worry. “You will get ill if you don’t take it.” To paraphrase my husband, “don’t you want to get a job and have kids and a house?” I do want those things, but I’m not sure that the meds will help with that. If I don’t need them, then not taking them would still result in all those things. I’m working on it.

People keep presenting me with evidence of my having bipolar. I don’t remember it, my mood was clearly manic and scaring my friends and family, I was climbing trees and making friends with strangers, I wasn’t sleeping, I was barely eating and yet somehow still alive and running at three times the speed of everyone else.

I don’t know what to do with this information. It doesn’t tally with what I remember. I remember everyone else being very slow, for example. I’m questioning myself – is it everyone else that had a problem, or was it just me? Is it more likely that I was fast, or that every single other person was slow? I suspect this was the case, logically. But my experience is so firm in my mind. It was like there was a time dilation bubble going on. Very sci-fi. I don’t remember taking risks like climbing large trees or driving too fast and recklessly. I can only take other people’s word for it, and I don’t know how much their perceptions are skewed by the label. It’s possible I was just a bit hyper and everyone else panicked and read too much into it.

This is the crux of it. Was I really manic or was it just the perception by others? If the former then meds are necessary, and perhaps I can reduce them or come off them in time. If the latter, then the meds are not necessary and are only causing unnecessary side effects like this god awful tremor. I don’t know how to work out which way around it is without coming off the meds, and I can’t do that because people will be angry and scared and worried, and because I run the risk of being wrong, and I’m not perfectly healthy. I could end up back in hospital, I could end up dead. I could of course be fine. It’s a mess. This post is a mess. I’m stopping now.

On Trauma

The following does not contain any accounts of emotional, mental or physical abuse.

 

I’ve never experienced any kind of trauma.

Or at least I thought I hadn’t. My first session with the hearing voices psychologist has changed my perspective somewhat. We discussed what might have caused the voices, and the long and short of it is, that while I have never been subject to any mental or physical abuse, the mood swings in themselves were traumatic.

I’m in two minds about this. On the one had I feel like it belittles the experiences of those who have experienced true trauma. What are a few (albeit extreme) mood swings compared to the kinds of trauma others have experienced? On the other hand, this is the only explanation I’ve ever had for the voices and delusions that isn’t “oh it’s just psychosis.” Because surely psychosis must have triggers outside of chemical and structural brain changes. It’s refreshing to have someone look at my childhood and teens rather than just my history of mental illness.

No one has asked me about my childhood very much, although this could be partially my fault as I’ve always described it as “idyllic”. Because it was! There was no abuse, there wasn’t even neglect. Both my parents gave us, somehow, the amount of attention we needed and no more – we weren’t helicopter parented. They both worked full time but when they were home we played games with them, or were allowed to play on our own, depending on how we felt. By “we” I mean me and my sister. I remember bad things happening, like getting in trouble at school, or arguing with friends. It was by no means absolutely perfect, but it was normal, and that, I think, is the important part.

Those early mood swings were traumatic in their own way. I didn’t understand what was happening, I didn’t realise what was happening until it was too late and I was already batshit. I was around 15 when they started. I remember not wanting to be around people, having a low mood, being anxious about people reading my thoughts – I remember yelling at my best friend for commiting this latter offence. I was depressed basically, but completely unaware of the name for what was happening to me, and that this was something that happened to a lot of people. I just thought I was breaking. Then I remember those highs, short to begin with, perhaps only a few days, before they gradually extended to what they are now – months without medical intervention. I remember trying to mumify my tongue (without embalming fluid), and writing musicals about geckos in science lessons. Maybe not too extreme, but given my personality at the time was very introverted and quiet, this was very unlike me. My friends used to say I would get high on air. So I didn’t understand what was happening. There was no one to talk to because no one else seemed to be going through quite the same thing as me. I mean, sure we were all teenagers, but the one or two times I did talk to a friend, they didn’t understand. Of course I’d never wish this on any of them, so in a way I’m glad they didn’t understand. After the mood swing left I had to mop up the pieces.

I think this is something I’d like to look at more with the psychologist – why do I hear voices that are not, say, an abuser? That would be more understandable. These are voices who don’t seem to exist in the world other people experience, these are voices who have no basis in my past. They seem so external – it’s hard to understand that something in my brain created them. I could posit ideas, perhaps one is me giving me my own advice but has got warped with the chemical imbalance, perhaps the second is the part of me with low confidence that constantly argues, perhaps the last is the part of me that tries to push me harder. I feel like they’re there to help me, and sometimes they do. But when they’re not there, when I’m well, I realise they weren’t helping. Beachy Head wasn’t a good idea in the summer, it nearly got me sectioned but it seemed like the exact right thing to do at the time. I suppose again, this is traumatic in itself. Maybe it’s a never ending cycle.

Right now the voices are telling me to kill myself. I’ve told them it’s my decision and right now I’m too scared to kill myself. Too scared of failing, too scared for those I’ll leave behind. I told the psychologist that the voices were telling me to get out of the building, that I needed to leave and hide somewhere safe. I told her it wasn’t her they were having a problem with but the building itself (the CMHT HQ) and who might be in there (MI:5 and the police). She said it was very kind of me to reassure her that it wasn’t her, and that I was a very kind person. This is very important to me. Being kind is quite an integral part of who I am – I like my friends and family to be happy and a big part of that is being kind to them. I appreciated her saying this – a boost to the ego just when my mood is down and could do with a shot of self-confidence.

So maybe this is all something to explore next week. I have to say, it was a bit of a shock – I’d really never thought of trauma like this. It’s made me reevaluate my perspective. I’m still hung up on “it’s not really trauma”, because it’s nothing like others have experienced in that it’s not verbal, physical, or emotional. There was no abuser. I really am concious of undervaluing the experience of others. That’s not the right word, but you know what I mean.

Can mental illness itself be traumatic?

We Three Kings of Orient Are: A Parody

It’s time once again to post my bipolar rewrite of We Three Kings of Orient Are. Get ready to sing along – 3 – 2 – 1…

We three voices here in your car
One plus two, too many by far
But who’s counting? Screaming, shouting
“You’re crazy, oh yes you are.”

O meds not working, eyes shine bright,
Mood: psychotic, pure delight
All these feelings leave me reeling
Through the roof and into the night

Doctor says you’re not looking sane
Normality – you really can’t feign
Take meds forever, relapse never
Let’s fix your crazy brain

O meds not working, eyes shine bright,
Mood: psychotic, pure delight
All these feelings leave me reeling
Through the roof and into the night

Lithium to offer have I
Depakote and abilify
Lamotrigine, and haloperidol
I am so very high

O meds not working, eyes shine bright,
Mood: psychotic, pure delight
All these feelings leave me reeling
Through the roof and into the night

Death is mine in gathering gloom
Feel that sense of impending doom
Feel like dying, eternally crying
Needles above you loom

O meds not working, eyes shine bright,
Mood: psychotic, pure delight
All these feelings leave me reeling
Through the roof and into the night

I’m glorious now behold mood arise
I’m King and God and Sacrifice
Alleluia, Alleluia
Bow to me, hear your cries

O meds not working, eyes shine bright,
Mood: psychotic, pure delight
All these feelings leave me reeling
Through the roof and into the night

What Next?

Following on from my previous post, a quick update. I saw my GP again, around two or three weeks later, still with suicidal ideation, and a plan, so he did in the end put me back on antidepressants for a maximum of one month and with strict instructions to come off them at the first sign of any loopiness. Within two weeks I was getting hypomanic and feeling just amazing, so I stopped the antidepressants immediately. Unfortunately the high mood seems to have stuck around and is getting out of control (this is according to Husband, I feel perfectly normal!)

I’m trying to be objective – no, I’m not sitting still, or managing to complete tasks without going off on a series of tangents. Apparently I’m talking quickly and jumping from topic to topic (although it doesn’t seem like that to me!). I don’t think I’m hearing voices but it’s so hard to tell what I’m actually hearing and what other people are hearing, and I’m not 100% sure about what I should be hearing. Does that make sense? People say it doesn’t but it does to me, maybe I’m not explaining well. I can’t tell if what I’m hearing is the same as what other people are hearing. I could ask I suppose, but Husband is already worried enough, and I don’t want to look like a crazy person. The things I’m not sure about hearing are mostly about numbers and their various levels of important, and about certain branches of physics and the associated experiments. There are also some bits about the danger of the physics from certain other people. 2058 is showing up everywhere.

Husband wants me to see my GP again – this is only five weeks after my last visit. I don’t want to be going too often, but at the moment he’s literally my only mental health support. I’m trying to tell myself that if I had a CPN, or support worker or something, a five week interval would be considered a huge break for most people. The thing is that there’s nothing he can do. He can’t increase my olanzapine as he only has the authority from the consultant to put it up to 10mg. He could refer me back to th CMHT I suppose, but I’ve managed to avoid them for over a year which has been brilliant because although they help I’m not that mental and I don’t need them. So what’s next? Husband says I’ve lost control and it’ll no longer get better by itself. But I’m still stuck on the idea that I’m FINE!

Limbo

I am not unwell at the moment, or at least as well as I’m ever likely to get. I’m encountering triggers and dealing with them well, for the most part. I did get a few early warning symptoms earlier this week – strange smells, strange noises from outside my head, slight sleep disruption – but again, I’ve managed them well and I’m not slipping too deep into an episode. It’s really bizarre! It’s like I’m walking on a knife edge, waiting to fall into mania or depression. It’s like I’m walking on eggshells, trying not to crack myself up. There’s a real feeling of being in limbo. Waiting.

I’m also in limbo in life outside mental illness. Husband is (hopefully, essay results allowing) about to start is third and final year of his mental health nursing degree, and is going to want to move out of my parents’ house as soon as possible, which means I need a job.

Jobs are difficut things because I am having to be really constrained about what I’m actually able to do without losing my marbles. I need a low stress job, so the field I originally trained in and have experience in is now off the cards. This is really disappointing – I want to be abe to do what I enjoy, but that isn’t an option anymore.

I know I’m lucky to be in a position where I can even consider employment.

I need a purpose in life, and I’m losing that with every successive episode. I’m scared my whole life is going to be a constant fight against triggers – and that’s exactly what it is going to be. Maybe this is true for everyone, but I don’t half feel alone in it.

I want a job, a house, kids. It’s getting increasingly unlikely I will get these things.

What happens if I get a job and can’t handle it? Would I qualify for ESA, housing benefit and the like? Would that even be enough money to live on? How is it affected by Husband’s job? All my care is provided by my GP – I don’t have a psychiatrist or CPN, so coud I still even apply for ESA given I’m not seeing a specialist? I suppose the answer is to go and ask CAB, but I’ve not given up on the idea of working yet.

Maybe I’m less well than I think I am. Now that I’m thinking about it. I’m going to bed at 8pm because I run out of ideas of what to do, asleep by 9, waking up 10 or 11 if there’s nothing else for me to be getting on with. It’s so hard to wake up in the mornings. It’s a bit hard to take my meds at the moment – the internal voice (the one everyone has, not a psychotic voice) is saying I don’t need them, there’s nothing wrong with me, I’d be fine without them. I’ve been quite open with Husband about this, and he’s helping out by reminding me that I do need them as I go far off the rails without them.

It just feels like one big mess at the moment. I dare not move for fear of pulling the tangle of threads tighter, knotting myself. I’m “being kind” to myself. Even though I don’t feel I deserve it.

Trigger – early warning – relapse – remission, trigger – early warning – relapse – remission, trigger – early warning – relapse – remission.

How to deal with mania RIGHT NOW

When I’ve looked around, at books and on the internet, I haven’t found anything particularly useful for dealing with mania and hypomania RIGHT NOW (except this). There is a lot on spotting early warning signs, lots about making sure you sleep well, keep a routine, and eat properly, but nothing about what you yourself can do if you’re already past that point. The articles point you in the direction of doctors, therapists, and whatnot, but what if you’re on a bus somewhere and you need to calm down, stop talking to everyone around you, and sit still (or at least still-ish).

There’s nothing you can do to stop the mania in an instant, but I thought there might be techniques around that at least allow you to get home without getting sectioned. Or techniques you can use that get you through until you can talk to mental health professional.

Paced Breathing

Now Matters Now have a series of short videos on dealing with suicidal thoughts and anxiety, one of which is paced breathing. I’ve found this technique really useful to slow myself down physically, although it can take quite a lot of concentration to do more than a few breaths.

But a few breaths is enough! It acts as a sort of reset button, so whilst your physical agitation is likely to start up again any second now, it gives you just a short break. It takes so practice, but it’s well worth it.

I found paced breathing much easier when using the app they recommended in one of the videos (Tactical Breather for Android). The addition of a graphic really helped me to visualise the breathing.

Make Lists

I have a list of short, achievable tasks stuck to my wall for when I have no concentration but I need to do something. Think about what you could reasonably achieve right now. Some suggestions:

  • tidy a small area of one room
  • do a small bit of weeding in your garden
  • paint a 10×10 cm square of paper
  • colour in one page of a colouring book
  • put together a playlist

Exercise

Subtly.

Office exercises can be really quiet and strangers wouldn’t necessarily see anything you’re doing as more than a stretch. If you have the option to stand up there are some different exercises you could do. Just make sure not to overdo it – this is just a way to fulfil the need to move without other people noticing. Keep drinking water.

Use ADHD Techniques

Sometimes techniques for managing ADHD can be useful for dealing with some of the symptoms of mania.

In one technique, you direct your verbosity towards questioning your own actions. For example if you are pacing restlessly around your house, you would ask yourself “why am I pacing around? It’s because I’m agitated, I can’t sit still. So what should I do to stop pacing around? Maybe I could do some exercise.” This questioning of your actions forces you to slow down physically which can in turn slow down your thinking. Similarly, deliberately slowing down your speech can help to slow your thinking.

People with ADHD find making a plan for the day (or the next hour or two) helpful, and this goal-orientated approach can mean that some important tasks are actually achieved, for example at 12:30 pm I am going to make a sandwich and eat all of it. This is especially good if you have trouble remembering to eat and drink.

Break things down into short, achievable tasks. When it comes to complex things like cooking dinner, I find it impossible to work out the order of events, ingredients, and the like. Things get burnt a lot. If I can write down all the ingredients, and get the exact method down on paper then things get burnt less. Obviously making the least is a feat in itself.

Write

There is often, for me at least, a need to write and write. There are lots of ways I can deal with this and actually it’s quite a good technique because it keeps me relatively still and unobtrusive. I usually start out trying to write what I’m feeling and end up just writing out rhyming couplets over and over. You can also just write out the text from any book or website, just to feel the ink go on the paper. Some people do the same but with typing.

Dealing with Psychotic Symptoms

You can also write to help deal with psychotic symptoms – if you hear voices, writing down what they say can be a really useful way of acknowledging them without alerting other people.

If you really need to talk to your voices and you’re in public, put your phone on silent and pretend someone has rung you. That way you can say what you want and people won’t think anything more of it than they would if anyone else was on the phone.

If you’re agitated, use the paced breathing technique as above.

 

 

Obviously none of these things will ever cure mania, but they might just help you get through the next minute or hour until you can see a mental health professional, or talk to someone. Follow your crisis plan (if you have one).

As always, if you feel like you want to hurt yourself of others, go straight to A&E. Disclaimer over.

Rapid Cycling

When I was at university, yeaaaars ago now, I would cycling up and down pretty much daily, which was horrible and I hated it, but as I got older my mood episodes swung towards longer and more pronounced… things, which whilst also horrible, at least I could plan around them, and it also meant that I got long periods of stability in between. So now I’ve just switched from quitealotofquetiapine to alittleolanzapine and it’s not doing its job – I’m up to my ears in voices (pun intended, or whatever it is), my mood has switched three times in the last three weeks and a do.not.like it. I saw my GP today as an aside since my blood test results came back and I’m anaemic (10, but the worst it’s ever been is 8 – I work on “can I get up the stairs without getting out of breath?” if yes, I’m not that anaemic, and as I can I thought I was probably okay, but apparently this is an ineffective scoring method probably because I’ve got so used to it. Maybe running will be easier now, I always struggled with my respiratory system giving out before my muscles) and whilst he was concerned about mood (and some other things I may have talked about but I don’t want to if I haven’t already, here anyway – just don’t want it where They (you know who I mean) can get hold of it) he just didn’t have the time to go into it properly. He’s an amazing GP, but I can see the NHS stifling him.

The olanzapine isn’t doing its job, and there’s no one to call to help – I think I’ve talked before about the lack of accessible services in my area, I’m on meds, I should be well, so I don’t get any help. I do wonder if they’d change their minds if they actually talked to me though. I’m appalled by the lack of care I’ve received – some stats: I haven’t seen a psychiatrist (outside of the hospital admission in November 2013) since February 2013; I haven’t seen a mental health professional at all since August 2014 (ish, I can’t be arsed with looking things up), and god knows I’ve NEEDED to! I’ve seriously considered making a complaint, perhaps via PALS, but to be perfectly honest I’m not sure it would achieve anything other than get me blacklisted by the CMHT, and they’re really nice people besides, they just have limited resources.

I’m looking at other options for getting help – private is too expensive, although my parents have said they could pay for 3 or so sessions to get my medication sorted, but that won’t help with things like applying for benefits/jobs and other services the CMHT have (or at least used to have). The wonderful Sean has pointed me in the direction of Together UK, which looks like it could be useful. It’s hard though, I really don’t have the brain functionality to sort this out right now and Husband and my family all have too much on their plates, I can’t ask more of them and Husband (although he feels like a dick doing it) really doesn’t like me when I’m manic (and of course I don’t blame him, I’m horrendous) I don’t want this! The Voices aren’t helping with the whole thing, I’m trying to pretend I don’t hear them but I don’t know how well it’s working. Maybe people have noticed.