Tag Archives: Mental Health

When Intense Emotions Take Over My Mind

Okay, this year’s #AtoZChallenge didn’t work out. I knew it would be tough writing about autism and related disorders when myself undergoing re-assessment for autism. It didn’t help that, from the E-mail I received on the day I posted my theme reveal, it became clear that I will not have an answer before the end of April. That wasn’t the reason I haven’t written at all since April 1 though. The real reason was my mental health.

Like I mentioned, I have been rather anxious and depressed lately. It however got extreme over the past two weeks. This likely isn’t a worsening of my depression as much as it is emotional dysregulation. That doesn’t make it less real though.

About two weeks ago, I started being more irritable and having more dark, death-related and suicidal thoughts than I had before. I had had almost-daily dark thoughts for a few months, but now they became more than daily. I also started making more concrete plans for a final step. Before then, there had been bizarre images in my head of how I’d die by crucifying myself over the staircase at home and such. These had appeared a bit laughable even to my twisted mind. Now, I started making plans and the before then bizarre-sounding thoughts didn’t seem that ridiculous anymore.

I wandered out of the house at home last week Saturday. Thankfully, my husband came back from where he’d been within aobut fifteen minutes and I was fine. Then on Sunday I had a very bad argument with my named nurse that ended in me melting down.

On Monday, I decided I’d stop taking my medication. I didn’t take my morning meds other than birth conrol and vitamin D (because I wanted to take birth control and couldn’t tell the two apart) on Tuesday. I spiraled out of control that same afternoon. This, for your information, can’t have been from withdrawal yet.

The reason I quit taking my medication was that I’d been having these dark thoughts for a while already and yet I felt I was too drugged up to express them. I don’t mean that I wanted to tell the world, like I’m doing now, but I wanted to be able to cry. And cry I did. I also felt like maybe, if I stopped taking my meds, I’d feel some kind of motivation again. I take a high dose of an antipsychotic, which admittedly the psychiatrist says can’t cause flat affect. I also take an antidepressant, but I’d forgotten why I’d been prescribed it (in 2010!) and it had never been reviewed.

Admittedly, there was also a part in me that wanted to signal to my staff that I wasn’t coping. That didn’t really work. My psychologist said that, if I wanted to be taken seriously about my mood, I needed to take my meds. Not that she’s ever taken me seriously about my mood, unless writing depression NOS into my diagnosis counts, which I don’t feel it does. She also told me that I sabotage the independent assessment if I don’t take my meds. I don’t like to admit it but that was one reason I started taking them again on Saturday. I hate to admit I give in to authoritarian manipulation, but I do.

on Wednesday, I started experiencing what I believe are brain zaps – a kind of weird dizzy spell caused by antidepressant withdrawal. I at first thought they were a side effect of a failed attempt at an overdose. They weren’t. By Friday, they occurred about every minute. I was then ready to start my antidepressant again, but wasn’t sure I could safely go back on it after five days. The nurses had to ask the on-duty doctor or some kind of head nurse or whoever and I didn’t get an answer till Saturday afternoon. Now I feel so stupid for havng bothered the nurses with this question on a week-end. I am glad for no more brain zaps though. I did also start back on the anitpsychotic. Not because I want to be on it, but because it seems I need to.

Since late Thursday evening, I’ve felt relatively well. I still experience anxiety and depression, but my emotions aren’t as out-of-control as they were before. Some things that helped were one nurse taking me on walks and allowing me to use her boxing equipment to blow off some steam. It sucks that I can’t do this at home.

Anxiety and Depression in Children With and Without Autism #AtoZChallenge

Welcome to day one on the 2017 #AtoZChallenge on neurodevelopmental disorders. I experience a great deal of anxiety around this challenge particularly because, like I said in my theme reveal post, I am currently in the re-assessment process. On the day I published my theme reveal post, I received an E-mail from the clinical neuropsychologist in charge of my second opinion answering questions I had taken to my psychological assessment. One of them concerned depression. I have suffered from depressive symptoms since childhood. I pointed this out, in a way to reassure her that depression is somewhat normal for me and hence she didn’t need to pull out the major depressive disorder criteria. A reaction i did not expect, was that depression presents itself differently in children and for this reason it might be that in fact my challenging behavior was a symptom of childhood-onset depression.

I share this story because, for today, I am focusing on anxiety and depression as they relate to autism. I will start by sharing a bit about how these conditions present themselves in typical children, as it might be I’m not autistic or suffering from any neurodevelopmental condition after all.

Depression and Anxiety in Typical Children

Depression and anxiety are serious conditions that are different from normal sadness or worry. Common symptoms in anyone with depression or anxiety include negative thoughts, excessive worrying, diffculty concentrating, feelings of hopelessness or worthlessness. Particulalrly in youg children, depression and anxiety are however hard to recognize, as they may present differently than they would in older children or adults. For example, depression may show as irritability and anger, withdrawal, vocal outbursts or crying, or physical symptoms such as headaches or stomach problems. Anxiety can also present with physical symptoms or it may show as developmental regression. Some children with anxiety disorders may become clingy, fidget a lot or go to the toilet frequently.

It may be tempting to label a child who displays disruptive behavior, such as irritability, as “naughty”. However, treating behavior related to anxiety or depression like it is willful defiance, will only make it worse. Rather, if a child shows significantly more behavoral issues than their peers, it is advised to seek professional help.

Anxiety and Depression in Autistic Children

Many of the signs of childhood anxiety and depression are common in autistic children. It may therefore be hard to tell whether a symptom is due to anxiety or depression or it is due to autsm. For example, many autistic children (and adults) fidget as a way of regulating sensory input. Treating this and other sensory difficulties as anxiety will make it worse, as treatment for anxiety might include exposure. If a sensory stimulus is physically uncomfortable or painful rather than feared, no amount of exposure will cure this.

Social withdrawal is also a common sign of both childhood anxiety and depression and autism. However, to autistic children and adults, social interaction is often overwhelming, so again, withdrawal may be a coping strategy rather than a symptom.

Interestngly, some autistics may appear less autistic when they’re depressed or anxious. This may be the case if the autistic’s normal social interaction style is “active but odd”, eg. talking on and on about a particular topic without regard for the other person. For example, I once read about a teenage boy who usually kept on talking about trains. When he stopped perseverating on this topic, his carers assumed he was doing better. After all, he was showing less socially disruptive behavior. In reality, the boy was seriously depressed. He was, for him, withdrawn and had lost interest in what used to be a favorite topic of his.

My Achievements in 2016

The year 2016 is almost over and I feel pretty disappointed. It should’ve been the year in which I finally left the mental institution, but I didn’t. I mean, I’ve been resolving to leave the hospital every single year since 2008, but this time I thought I was so close. It’s even worse, because I get blamed for not having achieved this goal. My psychologist tells me I never want to leave and that I try every single trick to delay my discharge. This to her proves my dependent personalty disorder. Well, it wasn’t me who took four months to come up with that diagnosis. It wasn’t me who still hasn’t referred me to outpatient treatment and it wasn’t because for whatever reason I blocked this – I didn’t.

In many other ways, this year has been a disappointment. Still, I need to focus on the things that I did achieve in 2016. They may not feel important to me at this point, but that is only a matter of perspective.

1. I have not been in seclusion all year. I tend to think that, because I’m supposed to leave and there’s no seclusion outside of the institution, staff are less likely to ask me to go into seclusion. There is likely some truth to this, but I also have been acting out much less over the past year than I used to. It isn’t over yet – I broke a mug and self-injured only a few days ago. It’s better though.

2. My daily medication has been stable all year. I did finally get a prescription for a benzodiazepine to use at most twice a week as-needed. I hardly need it though.

3. I managed to binge eat less than I did last year. Though I resolved to get my BMI under 30 and this was a massive fail, my weight remained stable over the year.

4. We got an elliptical trainer at home. Though I didn’t use it as regularly as I’d have liked, I enjoyed exercsing when I did.

5. I found a craft that I enjoy. This is one of my biggest wins of 2016. Though I don’t make soap or skin care products as regularly as I intended to anymore, half a year in I still enjoy the craft. I also finally felt confident enough to make soaps and skin care products for other people. I never quite felt as self-confident about my other crafts. Recently, I experienced some setbacks, in that a few soaps I made over the past few weeks turned out worse than even my first soaps. However, I’m not about to give up (yet).

6. I didn’t give up blogging, even though I was tempted. I kept up one Dutch blog from early June until now, although December was a bad month. Consistent with more posts here, as always, my posting on there declined. I’m not about to give up eithehr blog though.

In short, my theme for 2016 has been “persevere”. I faced many setbacks and disappointments, but I didn’t give up. I hope that 2017 will be better than 2016, but if it isn’t, I hope I will keep on persevering.

You Baby Me Mummy

Disappointment #WotW

This week was a lot less exciting than last week. It was really a big disappointment. That’s why I choose this as my word of the week.

On Monday, I had an okay day. I went to day activities and made a simple soap. There was only one activity staff so I had to be able to do the soaping mostly independently. The staff complimented me on the fact that I was able to be relatively independent indeed.

On Tuesday, I was supposed to leave for the potential new day activity place at 10AM. Since I got up really early, I wanted to go to day activities at my unit for a bit before the cab arrived. Unfortunately, the day activity room was closed because there was no staff available. Both of our regular staff are on vacation and apparently all subs had to work someplace else. An E-mal had been sent out notifying the nursing staff that the day activity room was closed, but only the nurses at the locked ward had received it. I was early, so my nurse went to morning report or something after dropping me off. Twenty minutes later, I panicked because no activity staff had shown up. A nurse from the locked unit came by and informed me that the day activity room was closed. Fortunately, someone was able to call my unit so that a nurse could come pick me up.

The cab arrived exactly on time and drove me to the supported employment building in the city where the day activity place is. Supported employment has largely been discontinued, so the building now houses other services, like the day activity place. The cab driver at first couldn’t find the entrance. Once he found it, I announced my arrival to the receptionist. It turned out the day activity place was in a faraway corner of the building and you had to walk through many corridors to get there. I was nearly run over by a supported employment person on a forklift truck. Those long corridors and the forklift truck gave me the impression that I would never be able to get from reception to the day activity room independently. Quite a bummer.

I arrived in a cafeteria where a large number of people were drinking coffee and chattering. I was seated by a day activity staff and we chatted some. A consumer got seated across the table from me and tried to chat me up. Not what I wanted that moment. Finally, my independent consumer advocate arrived and we got talking about what I expected out of day activities. I mentioned my new hobby of soap making, but we didn’t go into that. The staff member talked about ceramics and such. I couldn’t follow half the conversation by now, because I was overloaded.

We went to check out the actual arts room, which was quite crowded too. It was a disappointment. Next Tuesday, we’re going to have a look at a day activity place that’s part of the same organization but in another city. This place is supposed to be a little less overwhelming. I hope so.

My mother-in-law came to pick me up and offered to have lunch together. We ate a delicious chicken salad at what my husband later said was quite an expensive restaurant. My mother-in-law had gotten the idea of eating out there and I wasn’t there when she paid for us, so I won’t let myself be consumed with guilt. When she dropped me off at home, I gave her one of the goat’s milk soaps with honey that I’d made last week. She did allow me to use the pic she took, but I wasn’t able to get it off Facebook. I slept the entire afternoon.

On Weednesday, I had a meeting at home with a person from the mental health agency’s home support team. Two people came by and they hardly introduced themselves. That set the tone for the meeting. The whole meeting was one big disappointment. It turns out they can only offer two hours a week of home support and you don’t get to be able to phone someone if needed inbetween appointments. I can’t remember much else, except that they asked me how I see myself in two years’ time. I couldn’t answer that question right then and they talked about how it’s my life and I need to be able to get meaning out of it and stuff. As if I don’t know that.

Finally, they said that I might benefit from the assertive community treatment team helping me and then home support coming by twice a week to unburden assertive community treatment. I’m not sure I want anything to do with this home support team at all, given how they treated me in this meeting. They were truly all patronizing and yet telling me I need to be able to do this and that and whatever. Since my current treatment provider is already trying to get me signed up for the assertive community treatment team, I’m not interfering with that. When the people left, I was so disappointed I had destructive urges. Thankfully, I got to go back to the institution that afternoon.

Thursday and Friday went by in a blur. I only went to day activities for a short while on Thursday, because a male sub who didn’t know stuff was there. My named nurse sent an E-mail to my psychologist asking her to schedule an appointment with me. I’d done the same early that week, but still my psychologist replied that if I wanted an appointment, I could contact her. Go figure.

Altogether, this whole week was filled with smaller and bigger disappointments. I am really hoping next week is better.

The Reading Residence

A Thank You Letter to a Bus Driver

This is getting old, but I have been extremely uninspired lately. It’s like everytime I try to do blogging in Dutch again, I neglect this blog. It wasn’t even so much that I didn’t want to write, but I didn’t kow what to write about. A few days ago, however, I saw a blog post in which a person wrote a thank you letter to their genetic counselor. Other people were invited to write thank you letters to people you wouldn’t expect they’d be thankful for. This got me thinking. At first, I wanted to write a thank you letter to the psychiatrist who admitted me to hospital in 2007. While writing this letter, however, I thought of another person who was important to me that night: the bus driver who overheard me make a suicidal threat and called the police. I am writing a letter to him today.

Dear bus driver,

You may have forgotten about me. At least, I hope you have. Thhat’d mean you didn’t experience too much stress from what I did while on your bus. I haven’t forgotten about you. I don’t know your name, but I want to thank you anyway.

I was the person who threatened to kill herself while sitting on your bus on the evening of November 2, 2007. I told someone’s voicemail the details of my suicide plan. You overheard me, although a fellow passenger said you merely heard me cry. She probably just said that to quiet my mind. I heard you tell the police that you would be at the train station by 8:15 PM. By that, I judged I’d got onto the 8:01 bus at the bus stop near the training home I used to reside in. You dropped me off at the train station and the police took over and took me to the police station, where I was seen by the mental health crisis service.

I want you to know that I’m well now. I’m not fully recovered from my mental illness, but I’m a lot better than I was back then. I remembered you for years, which was causing me to find it hard to travel the bus in your city. I feared I’d run into you. Now, I know that you did your job and you did it well.

I could bore you with a long story of my mental illness and recovery, but that would probably stress you out. In case you’re wondering, however, I want you to be assured that I’m happy that I didn’t kill myself that evening. Now I know that, somewhere between the bus and where I wanted to kill myself, someone probably would’ve stepped in before I would actually be dead. However, you happened to be that person to step in. Thank you for that.

Astrid

A College Memory

Last week or the week before, one of the prompts from Mama’s Losin’ It was to write about a college memory. Since just yesterday I shared on my Dutch website about studying with a mental illness, I thought i’d write about it here too. It’s been 8 1/2 years since I dropped out of university, of course. For this post, I’d like to share about my first day of university.

My first day of university was September 3, 2007. I took a ParaTransit taxi to the building where I’d have my first class. As I approached what turned out to be a large lecture hall, I was immediately overwhelmed by the huge number of students. Until that day, my idea of a large group of students was my psychology class at college, where about 35 students were in the room. I had expected the same number of students in my university classes, because only about fifteen to twenty students enroll in the linguistics program each year. Turned out the class was a combined linguitics, business communications and language and cultural studies class and there were over 200 students in attendance. I had the most spectacular meltdown right there and ran off. I don’t remember much of what happened next. I think I called my home support worker, because the team manager, who also acted as my support worker, came to pick me up. She drove me to the office of the organization I received care from. This was the first time I was in such major crisis that the team manager decided to call mental health services. She later told me I was “not crazy enough” to be admitted.

I must say here that a meltdown whilst in a lecture hall is of course not in itself a reason for a mental admission. In this sense, the mental health agency was right that I was “not crazy enough”. Maybe if they’d knwon that I had meltdown after meltdown almost on a daiy basis, they could’ve offered some help. Now back in the day my only options were an admission or no help. Today, most mental health crisis services offer more varied help.

The professor for my first class – the only class I even attempted to go to that first day – was by the way one of the most supportive people in the university. He offered to have me listen to the lectures in a room attached to the lecture hall that is often used for recording lectures. I was able to attend his classes up to the moment I landed in my final psychiatric crisis in late October. His class was also the only one I took an exam for – three days before my hospitalization. This professor was the first to notice I wasn’t at university anymore and I don’t think it was solely because he was the professor for my Mondaya morning class. The director of studies E-mailed me the Monday after midterm that said professor had been missing me in his class, so had I quit my sutdies? I didn’t read this E-mail till I was home on a visit the next month.

I don’t have the greatest experiences with accommodations for me as a mentally ill, multiply-disabled student at university. I remember being told a number of times that I had a bad attitude and “we’re not a therapy center”. Though this is true, I badly did want to continue my studies for as long as I could. This one professor was, without even talking much to me, one of a few people who kept me going. He instilled a continuing interest in language composition and univesal grammar in me.

In Between Mental Illness and Wellness

I have often talked about recovery on this blog. Particularly, I have talked about recovery from my disordered eating habits and to a lesser degree self-injury. I wanted to get rid of my binge eating and stop self-injuring. Today, as I gave this some more thought, I took recovery one step further. So what if I stop bingeing and self-injuring? Would that then mean I’d be cured of my mental illness?

Of course, strictly speaking it wouldn’t. However, what if it did? What if I were cured of my mental illnness? After all, I exhibit far fewer destructive and aggressive behaviors than I did years ago. If I were to check mysel finto a mental hospital just as I am now, with no history of acute mental illness, the registrar would laugh at me. I wonder even if I’d be sick enough for outpatient mental health care if I presented with jut the symptoms I’ve been having lately. My overeating may or may not meet the criteria for binge eating disorder or eating disorder NOS. My self-harm does meet the criteria for non-suicidal self-injury, but then again these crteria are quite vague. My mood does not meet the criteria for a disorder. Heck, even when I was suicidal in 2007 and was clearly in need of acute psychiatric care, the only diagnosis the psychiatrist could come up with was adjustment disorder. Adjustment disorder is no longer covered by health insurance. In other words, under DSM-IV, which doesn’t include binge eating or self-injury as diagnoses, I would hardly if at all qualify for psychiatric care.

Of course, I do have borderline personality disorder and Asperger’s Syndrome – I still meet the criteria for these. However, no general practitioner would come up with the idea that I’d have these if I asked them to refer me to mental health services, and the vague referral letter my GP wrote in 2007 would not be enough now. So if I’m not sick enough at first sight for mental health care, am I then recovered? I don’t think so.

Mental health care has in recent years been more and more reduced to mere crisis intervention or other interventions directed at averting people becoming a pain in the neck. Now I won’t say I can’t be a pain in the neck, but a GP writing my referral letter from scratch now would not know. If you aren’t a danger to yourself or others, you most likely won’t get mental health services paid for through insurance. As such, mental health treatment is focused on curing the symptoms of severe mental illness (which is in most cases impossible), whereas recovery is more than that. Recovery, after all, is getting your life back on track.

As a long-term institution patient, I struggle with this. I am relatively well mentally speaking – probably not as well as I describe in the above paragraphs, but still -, but I don’t have a life. When I was admitted to the mental hospital in 2007, I was a university freshman in a new city. Now I’m nearly 30 and have little that could fulfill my life. I have my blog, but that’s about it. It makes me depressed. Not suicidal-type depressed (or should I say “adjustment-disordered”), but it does definitely make me slightly depressed. If I am not sick enough for mental health services and not well enough to get my life back on track without help, then where do I find help in recovering my life?

I hope that outpatient mental health services aren’t really as bad as I now think they are. I can only hope the recovery model still hasn’t been killed by the push for budget cuts. It however makes me sad to read in memoirs of mental health consumers about the recovery model and using mental health services to get your life back on track. After all, I’m afraid you can’t get mental health care for that now even if you’re severely mentally ill like myself.

Z – #AtoZChallenge on Mental Health

Welcome to the last day in the #AtoZChalleng eon mental health, dedicated to the letter Z. I am just in time to publish my post, as I was at my parents’ two hours way all day. I did take my computer, so don’t worry, this post was not my reason to leave. Anyway, today’s words are all on a common theme. Here goes.

Z-Drugs

Z-drugs are a few medications, most of whose generic names start with Z, eg. zaleplon, zopiclone and zolpidem. Besides the letter they start with, they have in common that they work similarly to benzodiazapines but are not benzos. There are three subgroups of Z-drugs, all of which are GABAA agonists, meaning they increase the availability of this neurotransmitter. Z-drugs are used in the treatment of insomnia. Some have advantages over benzdiazepine sleeping pills.

Zombie

Many psychiatric patients, especially those on long-term units, seem a bit zombielike to outsiders. I discussed this when discussing lethargy in my letter L post too. Negative symptoms of schizophrenia and other psychotic disorders may cause people to act like “zombies”, but so do many psychiatric medications, including antipsychotics, anti-anxiety medications and certain antidepressants.

ZZZ

Last year, I discussed sleep in my post on the letter Z for ZZZ. To finish off this year’s challenge, I am going to discuss the same topic. Sleep disorders are common among people with mental illness and of course can be a mental illness themselves.

There are two forms of sleep disorders. Dyssomnias are disorders in the quantity, quality or timing of sleep, such as insomnia or hypersomnia. Parasomnias are characterized by unusual physiological or behavioral events that limit sleep, interfere with certain stages of sleep or with the transition from sleeping to waking. Sleepwalking is an example of a parasomnia.

Like I said, sleep disorders can occur on their own but can also be part of another mental illness. For example, many people with clinical depression experience insomnia, usually waking up way too early in the morning. Some people with depression conversely experience hypersoomnia, sleeping far too much.

Y – #AtoZChallenge on Mental Health

Welcoe to the letter Y post in the #AtoZChallenge on mental health. This was definitely the hardest letter of all. In fact, I cheated a little, because I have only one word and it’s practcally unrelated to mental health. I use it to talk about an important topic in mental health though. Here goes.

Ypsilon

Ypsilon is of course the Greek letter from which the Latin Y is derived. However, it is also the Dutch organization for family members of people with schizophrenia and other psychotic disorders. Like I said, it’s a little out of left field, but I want to use this word to discuss the importance family plays in severe mental illness and recovery from it.

A few years ago, there was some debate that revolved around the question whether organizations of families of patients should receive government funding, or whether it should only be organizations of patients themselves. Ypsilon spoke up, saying that people with severe mental illness cannot necessarily advocate for themselves. Never mind that there’s an organization for people with schizophrenia and related disorders too, called Anoiksis.

Some other organizations, like the Association of Manic-Depressives and Relatives (that’s the literal translation of the Dutch name), allow both patients and family to be active members in the organization. I don’t know how each group is represented on the board of directors. However, this organization makes it clear that patients and family should really work together towards a common goal. Note that bipolar disorder is often as severe a mental illness as schizophrenia, so Ypsilon’s argument that people with severe mental illness can’t advocate for themselves, holds no ground.

Family are, of course, important in people’s mental health recovery. However, it’s still the patients who have the first-hand experience of mental illness. As such, they should always be at the center of their recovery process. Ypsilon is an okay’ish organization in this sense, often cooperating with Anoiksis and having destigmatization as a goal. Other organizations, however, often do not value patients’ input.

X – #AtoZChallenge on Mental Health

Welcome to the letter X post in the #AtoZChallenge on mental health. I have two words for you today, so this is a short post. Here goes.

(E)X-Patient

I have said this when discussing “survivor” in my letter S post, but many patients have endured traumatic experiences while in psychiatric care. As such, many are happy to be freed from psychiatry. There is a movement called the C/S/X movement. The C stands for “consumer”, ie. those still in psychiatric care. The S stands for “survivor”. Once consumers/survivors have completely freed themselves from psychiatry, many feel comfortable only with the label “ex-patient”, which signifies they are no longer involved with psychiatric care.

Xanax

Xanax, the brand name for alprazolam, is one of the strongest benzodiazepine tranquilizers. Xanax is commonly used to treat anxiety or panic. Other benzodiazepines are also used as sleeping pills, but I’ve never heard Xanax being used for this purpose.

Benzodiazepines are highly controversial drugs because they are often overused and they can become addictive. In the Netherlands, for this reason, people can only get benzodiazepines covered by insurance if they have epilepsy, an anxiety disorder for which they’ve tried at least two antidepressants, or if they have severe mental illness requiring high doses of benzodiazepines (for chemical restraint). On this last ground, many severely mentally ill people take benzos on a daily basis. Worse yet, people without mental illness can get only one prescription for ten sleeping pills, to be used over the course of ten weeks, and even then they have to pay for them out of pocket. People in the psychiatric hospital almost always take sleeping pills much more frequently and many take them everyday. When patients are in the psychiatric hospital, benzos are paid for by insurance. I wonder whether I’ll get my benzodiazepines covered once I leave the institution. Depends on whether my condition is seen as a severe mental illness requiring high doses of benzodiazepines.