Going to Extremes

I am an addict.

Managing my addictions is not quite as simple as managing my ‘drug of choice.’  I can turn anything into an addiction.  Drugs and alcohol?  Certainly.  Been there, done various kinds of that.  But I can turn anything into a drug.

It’s not an intentional thing, but I am vulnerable.  I am blessed with a genetic pre-disposition for both addiction and mania.  And even when I try to manage the known enemies — when I try to avoid excesses of drugs, alcohol, coffee, sugar — my brain has a way of filling that void.  Of turning interest into obsession.

Anything to turn up the charge.

I am never clear on whether it is the mania that grows from the obsession, or whether obsession breeds mania.  I only know that the second I become immersed in a thing and once it captures my undivided attention, there is no turning back.  I become consumed.  I cannot pace myself.  I can’t not do it.  Time away from that thing is an irritation and makes me anxious.

I do it with people.  I do it with activities and projects.  Until the inevitable day that I crash and burn.

Some of these episodes are short-lived, like the time I pulled an all-nighter in my early 20s determined to build a scale model of my boyfriend’s motorcycle for his birthday.

Others can go on for months:  What started out as a half-hour on my exercise bike a few times a week rapidly became spinning for 5 or 6 hours a night, anorexia and a 30-lb weight loss in the space of a few months.  And then there was the time I renovated a rental house from top to bottom, including ripping out all the carpets, tearing down wallpaper, refinishing the floors and ripping out the kitchen cupboards.  I was also rescuing, (hoarding) and refinishing furniture at the same time as part of what I imagined to be my way of making the world more beautiful and solving the landfill crisis.

I have done this with people too, and it’s one of the things that keeps me from forming close friendships.  Whether romantic or platonic, when that rush of adrenaline starts, I am prone to go to extremes.  I struggle to hold back my feelings.  I have made mix tapes, sent flowers, bought gifts and written long elaborate letters.  In my overzealous determination to get to know everything about the other person and drink them in, I can be (I imagine) quite intimidating.

And so I have to take care.  I have to take care not to take notice.  Not to over-examine.  I struggle to remain casual about things.  Not to check my weight on the scale.  To move, but not to exercise.  To be crap at housecleaning.  To let people take the lead in relationships.  To not keep lists.  Because focus becomes hyper-focus and it tips the scales into obsession and mania.  And mania can kill.

But.

There is always a but.

Writing is an obsession.  And it’s when it becomes obsession that I get results.  Where I suddenly have drive.

I don’t know how to resolve those two things.  

I know that mania is unhealthy.  I know that obsession breeds mania.  But the high that comes from writing is what keeps me going.  Writing gets me high.  Writing is the high.

And it’s more than that.  Writing at this point is both necessary and inevitable.  I have been writing for decades even when I wasn’t writing.  Even when I resisted putting my thoughts down on paper out of fear and some misguided deference to my journalist father, the words were still writing themselves in my head.

The obsession was still there.  It didn’t disappear or waver.  I wasn’t controlling anything by locking it inside.  The dam had to burst sometime.

So now I write, and play a dangerous (and dangerously satisfying) game of control — letting the stories out one-by-one, controlling the rate of flow, so none of us drown.

/rk

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What’s Up Pdoc?

It’s difficult for me to speak positively about the psychiatric profession.  In spite of my own negative experiences, I see therapists on television who seem wonderful, dynamic and caring.  Gabriel Byrne’s Dr. Weston on “In Treatment” was fascinating.  Even when he made ethically questionable decisions and recommendations to his patients, there’s a man I’d enjoy talking to.  And Vanessa Redgrave on “Black Box” has already demonstrated in one episode that she is able to unflinchingly tackle her patient’s flawed thought processes head-on, while still managing to remain kind and compassionate.

But those aren’t real people.  Real psychiatrists generally aren’t like what you see on television.  I’d like to believe that those types of practitioners exist — because it’s hard to remain hopeful if you believe an entire field of medicine is a sham — but I have yet to meet any of them.

I know I’m probably being somewhat unfair in my expectations.  One of the reasons television pdocs have the right answers is because they’re written by the same people who ask the questions.  It’s not real life.  In real life you have to think on your toes and answer off-the-cuff.

Except… not really.  Psychiatrists are supposed to be trained for this sort of thing.  It’s their job.  They have scripts and scenarios.  They are supposed to know the warning signs.  They are supposed to know what to say and what not to say.

And yet in my experience, most of them say almost nothing at all.

Getting a referral to a psychiatrist is no small feat.  If you’re lucky, you might see one within a year of a referral from your family doctor.*  At the time when I first asked my doctor for help with my mood, her only option while awaiting referral was to diagnose me with suspected depression and anxiety and to prescribe me antidepressants.  They only made me more anxious, so she increased the dose.  This induced mania and psychosis.  I still had no referral.

In a moment of clarity between psychosis and the ensuing crash, I returned to the doctor’s office and told them I thought I might do something bad.  They insisted I go to the ER, whether by ambulance or they could call my mother.  I opted for my mother.

pay attentionThey left me alone to wait for her in one of the examining rooms.

Alone.

I went through the (unlocked) drawers and cupboards.  I found a box of razor blades.

Razor blades.

I took one out.  I stared at it for a long time.  I put it in my purse.

We waited for several hours in the ER.  Eventually a doctor from psych came to talk to me.  We discussed how I was feeling and the fact that I had been suffering from insomnia for several months and that I had lost more than 20 lbs.  She confirmed that I had a referral to a psychiatrist.  She told me it would be best to wait for the referral.

I told her again that I was feeling suicidal and I asked to be admitted.

She said that wouldn’t be possible as the psych ward had no beds.  She said it would be best to wait for the referral and she could give me an emergency hotline number and a bottle of sleeping pills to help me sleep.

A bottle of sleeping pills.

I asked her if she thought giving a bottle of sleeping pills to someone who says they are suicidal was good medicine.

She said she would only give me 3 or 4 instead.

I removed the razor from my purse and put it on the table.

I was admitted to the hospital.  Because there was no room in the psych ward, I was admitted to one of the regular floors with a security guard posted to sit in the room with me for the first 24 hours.  The next morning I saw a psychiatrist.  He offered to prescribe antipsychotics and change the antidepressant I was on.  But only on the condition that they would give me one-third the dose of the narcotics I was on for pain.

Their strategy to turf me was bitterly transparent.  They would give me what I needed — the drugs for my as-yet undiagnosed bipolar — but I’d have to be willing to go through narcotic withdrawal.  The fact that I had been legally and justifiably prescribed those narcotics by my doctor didn’t make any difference.  Ultimately they knew I’d either refuse and sign myself out of my voluntary committal or I’d accept and bail after a few days of withdrawal.  I lasted about 3 days.  But at least I now had the medications I needed to bring me out of mania.

happy cartoonWhen my referral appointment finally came, I met with the psychiatrist at the Royal Ottawa Hospital.  She reviewed my history.  She reviewed my medications and asked me if I felt they were working.  (No.)  She upped the dosage.  I saw her several more times.  Every time, she asked if I felt there was an improvement.  There was no counselling.  (Unless you count “try to think positive thoughts” and “try to focus on what makes you happy”)  She just continued to make changes to the medication and say “these things take time.”  Then I got transferred to a different psychiatrist.  Same thing.  Then a third.

There was no therapy.  There were only drugs.  Antipsychotics, sleeping pills, antidepressants, anti-anxiety pills, lithium.  I stopped going.

When it comes to mental illness in Canada* there is a certain pattern of triage that consistently occurs.  If you suffer from depression, maybe you stand a chance.  You’ll see either a psychiatrist or a psychologist and the chances are good that eventually you’ll get talk therapy or behavioural therapy to change any faulty thought patterns that you need to go along with any drug cocktail they deem necessary to change your brain chemistry.  Someone will ask you about your trauma.  Someone will help you deal with your abuse.

But if you have bipolar disorder or schizophrenia, you become a medical patient.  Drug therapy is the only perceived solution.

And that is incredibly short-sighted.  The human mind is complex.  In the same way that my bipolar has shaped my experiences, my experiences have shaped my bipolar.  Why wouldn’t I benefit from therapy?  When the voices in my head haunt me and taunt me, why shouldn’t I be prepared with the tools to fight them?  With all the studies that show links between trauma and mental illness, it is completely irresponsible how the mental health industry fails certain categories of patients.

I acknowledge that it’s a complicated issue.  First and foremost are the restrictions placed on mental health treatment by the government.  Under OHIP, there are limits to coverage for mental healthcare as well as limits to the number of visits that are covered (which might make sense for things like situational depression or seasonal affective disorder, but not for a great majority of permanent and lifelong mental illnesses).  Compounding the problem is the unhappy marriage of the fields of Psychology and Psychiatry.  They are unwilling bedfellows at best.  Disagreement (and occasional outright disdain) between the two professions stands in the way of patients receiving possibly more effective combined therapies.

I try not to be pessimistic.  I don’t always succeed.  At a time when mental health organizations are pushing social media campaigns to remove stigma and encourage an open dialogue about mental health with things like Bell Canada’s “Let’s Talk” and ROH’s “You Know Who I Am” (and weirdly named “Friends with Benefits”), there is still a more important area of dialogue that I feel is missing.

And that is the one between mental health professionals and their patients.

You have a responsibility that extends beyond your prescription pad.

/rk

*For reference, I am in Ontario, Canada in a fairly large city.  Referral times for other locations certainly vary, but it seems to be a common theme in most places that referral times are one of the things that pose the greatest risk for patients with mental illness, especially those at risk of suicide.

To Dream, Perchance to Sleep

Nighttime is when I live my other lives.

It’s not a time of rest — at least not mentally.  I’ve always been a bit mystified by people who wake up fresh and new in the morning.  The first time I encountered someone who said they hardly ever dream, I was astonished.  I do nothing but dream all night.  I wake up exhausted.  And that’s when I sleep at all.

Most nights it takes an hour or two to fall asleep.  My mind turns over conversations I’ve had during the day.  I re-examine every interaction, turning them over in my mind.  I question my choices.  I see myself through other people’s eyes in those interactions and paranoia sets in.  And the only way to calm the anxiety that builds is to continue to play those moments over and over in my head.

clownswilleatmeOf course there are nights when sleep doesn’t come at all.  It’s not an unpleasant experience, necessarily; since my mind is abuzz with ideas and sensations and for the most part I don’t feel tired at all.  I have grandiose ideas.  I write long novels and poems and play movies in my head.  I look back on these times with regret that I didn’t get up and write them down and preserve them, but I doubt very much that I would be able to transcribe them effectively.  The visions flow faster than speech or thought and I don’t want to get up in the middle of the experience lest I disturb that feeling and lose my place.

It’s very tempting to stay in that place.  Around 6 years ago, when in the midst of a very serious manic phase, this is how I spent most of my nights.  An anti-depressant I’d been prescribed combined with a walloping 30 mg a day of hydromorphone (Dilaudid) for pain (and a diet that consisted most of coffee) left me sleepless and occasionally even hallucinatory.  I felt brilliant and sleep was largely a waste of time.

But I know the ensuing crash is inevitable, so when I get those days now, I know it’s a warning sign.  I take note.  If I get more than one or two of those days in a row, I know I will need to take steps and tell someone.  And so far, I don’t seem to get to that point.  Within 24-48 hours, I do sleep, even if it’s not terribly restful.  And so I figure at least I’m probably staying on this side of danger.

My dream life is just a variation on consciousness.  I know that it holds far too great a position of status in my perception of reality.  I know this because I get them confused sometimes.  Much in the same way that I hold odd beliefs that combine both reality and delusion, events that occur in my dreams spill over into my waking life.  Arguments that I have in that world cause resentment, anger and hurt to build within me towards loved ones because of slights they have committed towards me.  Because even if I can rationalize that the events weren’t real, I am still left with the feelings and emotions that they have elicited in me.  Those are harder to dismiss.  To dismiss them, I have to at first acknowledge them.  Then I have to search within myself to determine what insecurity seeded the thought that sprouted into the dream.  It’s possible to do, certainly, but it requires a lot of mental work and introspection.  Multiply that by several dreams a night and combine it with all the other mental work I need to do every day just to keep an even keel and it’s exhausting.

While other people believe in God and heaven because they fear the black nothingness of death, there has always been that part of me that finds that kind of finality reassuring and comforting.  It’s not healthy, I know.  But when you live a life haunted by unwanted thoughts and memories, the absence of thought and the end of being is alluring.

I can count on one hand the number of times in my life where I have slept without dreaming.  While undergoing surgery, for example.  It is a strange sensation and I’m not sure how to relate to people who experience this type restful sleep on a regular basis.  Waking up feeling rested and energized is fantastic.  But without the dreams, there is no sensation of the passage of time.  I find that odd.  But maybe that is why I feel so old and worn so much of the time.

I am living a thousand lives.  It wears on the mind and body.

/rk

Unfinished Business

Since it is apparently a day for not finishing things, it would seem the only proactive solution would be to write a post about not finishing things.

I had the opportunity today watch the first episode of “Black Box,” a new tv show about a neuroscientist with bipolar disorder.  As a new show it shows promise, with great actresses (Kelly Reilly, Vanessa Redgrave), a fairly good premise and interesting cases.  But the characterization of the lead actress’ manic episodes reflected that common cliché — that mania is all elation and magical feelings.

I don’t deny that there are moments like that.  But it’s a bit like any drug — that type of high is fleeting.  You can spend much of your time chasing that high — and maybe you’ll even achieve it from time to time — but you’ll spend a heck of a lot more time on the cusp and frustrated.  The reality for most people tends to be a lot closer to what you’ll see on “Homeland” with Clare Danes’ character.  Sleeplessness, disordered thinking, angry outbursts, erratic behaviour…

Today is one of those days.  Well, not one of those days — I am medicated against such an occurrence.  Instead of elation, I am stuck in limbo.  It’s not that I can’t write — I’ve already started two other posts besides this one, and I have about five more in my head trying to fight each other for supremacy.  I just can’t stay focused on one of them long enough to finish before I lose interest and start another.  Ideas for writing flood my mind, but so do thoughts of a million other things all at once.  I am acutely aware of the clothing against my skin, my heart beating and the air filling my lungs.  I am hyper-sensitive.

If you’ve ever surpassed your coffee threshold or taken stimulants of any kind and reached that point where you feel sort of sick and spinny and irritated, it’s like that, but worse.  Because coffee and stimulants wear off fairly quickly.

Like most people with bipolar, I’ve developed tactics for dealing with these episodes.  I used to find a glass of wine effective in taking the edge off.  It’s not just me that I worry about, it’s the people around me and my relationships with them.  Because when I feel like this, I pick fights.  I get angry for no reason.  I quit things.  This is where my bipolar tends to look like a lot of other different mental illnesses combined:  ADHD, generalized anxiety disorder and borderline personality disorder with a little PTSD thrown in for good measure.  Unfortunately, as solutions go, self-medicating with alcohol is a poor decision as it tends to sling-shot me backwards into depression.

There are actually several different kinds of bipolar, and I am blessed with what is considered the most severe form:  mixed bipolar with rapid cycling.  Personally I think each form presents with its own unique and special type of hell, but it cannot be denied that the treatment of mixed bipolar is the most challenging and the prognosis is poor.

I’m not certain of the value in writing when I’m in this state.  The end product (should there be an end product) is bound to be scattered and incoherent.  I find myself routinely cutting and pasting pieces of sentences into google to make sure they even make sense grammatically or if I’m just making up words or expressions.

I do think writing is better than not writing.  Not all writing is about creating perfection.  How I write is maybe as important as what I say.  My writing is about more than just relaying the ideas within the words.  It is also about showing the person and experience behind the words.

And sometimes that person and their experience is messy, disjointed and unfinished.

/rk