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.

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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?

Dreaming

I’m not one for symbolic analysis of dreams; none of this bullshit, like a dream about a frog with red feet doesn’t mean I’m going to be lucky but if it has green feet it means the shower is going to break.

But last night I had three nightmares that were pretty indicative of what’s going on in my head right now. First, I was at school and the teachers kept making us do weird things like collecting chalk from all the buildings. Second, I was running around the local shopping centre like a nutjob. And third, I was trying to drive my car from the back seat and failing.

The theme was very clear in my nightmares – loss of control. I am losing control, I don’t want to lose control, I fear loss of control. I don’t know how to keep control.

But because there’s always a bright side – at least I slept long enough to have three whole dreams!

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.