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!

Warning Signs

Oh okay, did I maybe speak too soon with regards to my mood? It’s been escalating over the last few days. I am annoying, bouncy, unfettered but still in control. I can sit still and settle to tasks. But does it really matter if my mood skips up a bit? As long as it doesn’t skip out of control and stop me functioning, surely it’s okay, normal even? It’s not a ‘normal’ mood, as much as I want to normalise it, I don’t see other people doing the things I do and thinking like I think (unless they’re hypomanic/manic of course), but it is not hypomania. Let’s call it sub-clinical, if we have to call it anything.

The crucial point here is that I, with my ‘support network’, can deal with this without having to call in the cavalry (which is a word apparently from the Italian for ‘horse’ – cavallo), I just need to stick to the lists and keep taking the meds. I hate having to take them, because of course I don’t need them do I? But I do, I know I do, I need to learn from history. I need to think about that diagram from the last post. Break the cycle and avoid the triggers. The problem being that cold I had of course, but if I keep avoiding triggers but also avoid aggravating factors like physics, poor sleep hygiene (bleurgh), and oh wait I think I have four or five large projects on the go right now, so let’s shelve some of those for now. I am sleeping still, around six hours a night which isn’t too bad, but still less than I would consider normal for me.

I have alerted Husband to the fact that convincing myself to take meds is getting more and more difficult, so he is helping (mostly by nagging until I take them, but that is what is needed right now). I haven’t told him about the headnoise, mostly because I’m not sure it’s anything to worry about, and if I tell him he will worry. It’s not all real words, and the rest is nonsense. I’m not even properly ‘hearing’ most of it, more feeling it. I think I have heard the term pseudo-hallucinations in relation to this state of non-hearing. The problem is that this is what has preceded every single manic episode I can remember, which have all resulted in full on voice-hearing, messages from the TV and so on. Phase one doesn’t always result phase two, but phase two is always preceded by phase one. For now, being aware of it is sufficient.

On Stigma

The last time I was brave enough (read: well enough) to walk through my local town centre on my own I was anxious, watching people oh-so-closely, jumping at sudden movements and avoiding everyone in high vis (just in case).

The voices were talking me through, telling me who I should hide from, who was injecting thoughts into my brain and who was just monitoring me.  I caught myself in a particularly reflective window at one point, talking back.

I did my shopping, sort of, in no particular order – mostly just as I remembered what I needed.  One thing at a time, minding my own business, not talking to anyone, not even making eye contact.

Some teenage boys surround me, I feel trapped, the voices start shouting to run, get out.  They don’t hurt me of course, public place and all, but they laugh, jeer, taunt – ‘go back to the loony bin, schizo‘.

And things of that nature.

Considering I was already terrified of the town centre I think I handled myself well.  I walked straight through them and went straight home.  I cried for an hour, and I am not one to cry much at all, even in the grips of severe depression.  I mostly cried out of fear, shame and humiliation – this is my town, as much as it is theirs; there is no reason I should be any less welcome than them, there is no reason for them to make me fear being in it more than I already am.

I also cried because here is mental illness stigma alive and well.  Here is ignorance.

I don’t have schizophrenia.  There are many reasons why I might be talking (apparently) to myself.  I might have bipolar disorder, I might have a dissociative disorder, I might have any number of diagnoses.  It’s possible that I was just thinking out loud.  What marks someone as having a mental illness?  Maybe it was because I was in four-day-old clothes and looking a bit dishevelled, but that’s still no excuse for what is essentially abuse.  And isn’t that half the problem?  If I can’t identify what it is that happened then how am I to address it in the wider world?  How do we educate people when we’re not 100% sure about why they’re quite so… nasty.

The whole incident got me thinking about stigma, naturally, and the thought occurred that there are so many kinds of stigma that I didn’t even know where to start.

Brainstorm time!  I had a few ideas based on stigma I’ve experienced, and from what I’ve heard from other people these things are fairly typical.  I feel stigma can be broadly separated into two categories: positive and negative.  By ‘positive’ I mean these are kinds of stigma, actions or beliefs, that are meant kindly but ultimately have a negative impact.

Positive Kinds of Stigma Negative Kinds of Stigma
From family and friends From the public
GP overreacting From health professionals
Government budget cuts

I am very lucky in regards to my family and friends – when I first told them about my illness and diagnosis they were very supportive and have continued to be throughout.  There are a few other sorts of problems I have encountered with a few of them, which is not unexpected given that we are all human.

My mum tends to overreact to any display of symptoms.  She’s very alert to my triggers and early warning signs, which is fantastic and has saved a descent into crisis more than once, however it does mean that she makes mountains out of molehills.  If I don’t sleep very much for one night she panics, thinks I’m getting manic and tries to talk me into taking a sleeping tablet.  If I buy one frivolous thing, she panics and thinks I’m getting manic.  If I am just a bit sad she thinks I’m depressed.  She’s a mother and wants to keep her child safe (because even though I’m 27, I’m always her little girl apparently).  I’m not sure how to deal with this issue.  It’s a delicate one.  I have told her that she needn’t be quite so alert and responsive but it didn’t seem to do the trick.  I think it’s all caught up in her own neuroses around not having spotted me (and my sister for that matter) starting to get ill when we were in our mid teens.

My friends and other members of my family tread on eggshells around me.  I hate people walking on eggshells.  I have told many of them that it just makes it worse – that what I really need is normality and to feel like the world is still turning.  I am guilty of getting too stuck in my own head, so life carrying on is so helpful in terms of keeping me out of it.  If they want to ask questions, they should ask.  I will always tell them if they’re pushing too hard or if I don’t want to answer.  They know this.  I have told them.  I am not a delicate little flower.

The other kind of ‘positive’, well-intentioned stigma I have encountered is with my GP.  Now my previous GP was appalling; she had no bedside manner and was completely incalculable.  By sheer chance I saw a different GP on one of the many, many days my old one was off and he is amazing.  He specialises in mental health and had done stints with the crisis team.  He bent over backwards to get me what I needed and even offered appointments if I just needed a chat.  I am so impressed – I didn’t even know his kind existed.  But like my mum, he overreacts.  When I was manic in August (or whenever it was, I’ve lost track of everything now), he wanted me in hospital when despite everything (superpowers, etc.) I was mostly functioning.  He’s also continually been wanting my quetiapine increased to something massive.  On reflection, he might be right about increasing it, even if only by 50mg or so.  Again, overreaction is not a helpful kind of stigma – just because I have this illness doesn’t mean small things are going to become big things.  In fact they quite often don’t.

Good intentions aside, we’re left with the more traditional kinds of stigma – most notably the example I gave at the beginning.  Those boys probably knew virtually nothing about mental illness, let alone the esoteric nature of voices.  It’s possible that they have encountered someone with mild depression or anxiety – one in four and all that – but not anyone with anything dubbed a ‘serious’ mental illness.  I hope no one in their circle of friends ever gets unwell, I think they’d be unlikely to find any sympathy.  The boys clearly didn’t understand the differences between schizophrenia, psychosis and hearing voices, and why would they?  The differences are really only things you find out about if you have some stake in them – your own illness, someone close to you, or it’s your job.  I’m happy for them that they’ve probably never experienced that level of illness close up, but at the same time they need to learn.

Members of the general public can show ignorance in their own ways; anything from a passing comment to a full-blown belief.  Is it okay for people to describe the weather as ‘bipolar’, or to have had a ‘manic’ day?  Personally I think the colloquial, non-clinical uses of these words are ultimately positive because they normalise mental illnesses and make them less of a taboo.  I do recognise, however, that it needs to come alongside recognition that they are illnesses and no laughing matter.

At the other extreme you get the aforementioned boys and other venomous attitudes.  A close friend told me about a man she worked with who had commented that people with mental illnesses should be sterilised.  Which smacks a bit of a certain dictator’s eugenics policies.  It’s the attitude that is intolerable rather than the ignorance.  Knowledge is easy, changing attitudes is hard.

Then of course there’s a kind of stigma we face even from health professionals.  I mentioned my wonderful GP before, and how excellent he is when it comes to my mental health.  Unfortunately, he’s not so great when it comes to my physical health.  The last time I saw him was the last time I felt able to have any contact with health professionals (I’m now rather too muddled about phoning and exactly the process of getting there and what have you), and I saw him about my mental health then.  I mentioned that I had ruptured two or three ligaments in my ankle back in August and that my ankle was still swollen and painful now, six months later.  My mum (a fully qualified and experienced podiatrist) thinks I’ve got some bone chips floating around in there so I’d asked for an x-ray referral.  In his wonderful GP flakiness he couldn’t manage to deal with more than one thing per appointment, so my physical health takes a back seat.  I’d also asked GPs countless times for an ECG referral but my reports of an occasional fast heart rate and feeling like it’s missing beats is always put down to anxiety or paranoia.  I finally got one last year when I was an inpatient on a mental health ward and everything was fine on it – but of course this is an intermittent problem that I wasn’t experiencing then.  I admit, it very well could be anxiety or whatever, but there’s also a chance that it isn’t, and really that is a chance they should not take.

My psychiatrist is completely uninterested in me.  That’s fine – bipolar is boring, he’s seen it ten million times before – but I would still quite like to be treated like a person not a statistic.  Hello, medication, goodbye.  I haven’t actually seen him in over a year, everything is done through my CPN (who is great).  Is that stigma?  Or is he just an arse?  Am I not the ‘right kind of mental’ (a problem the lovely Mental Political Parent has discovered time and time again)?

And finally on my list, we have stigma from the government.  There are many notable people blogging about the injustices of government policy (notably Diary of a Benefit Scrounger), so I won’t go into it here.  I’ll just say that it seems that the cuts to benefits and services target the most vulnerable and those that are least able to fight for basic human rights (heating should not be turned on for a ‘treat’, everyone should be warm).  How can we accept that mental illness is not our fault, and not something we deserve when the leaders of the country treat us as non-people?

And now my brain has run out of go-juice so… that’s all folks.