Tag Archives: Mental Health

Issues Surrounding Psychiatric Medication

Yesterday, Lydia of On The Borderline wrote an interesting piece on the stigma surrounding psychiatric medications and opioids for chronic pain. Today, I am going to add my own two cents to the conversation on meds.

Like Lydia says, many people, including patients, fear that psychiatric medications will change the person taking them, turning them into a zombie. I must say there is some truth to this. However, it’s hard to tell whether the medication is at fault or it’s the person’s illness. For example, as regular readers know, I spent a long time in a psychiatric hospital, including on a long-term care unit. Most people there have severee, treatment-resistant schizophrenia spectrum disorders. Most people who fall into this category were indeed heavily sedated and could be seen as “zombies”. However, the term “zombie” is a rather derogatory term for any human being, mentally ill or not.

When I started medication in 2007, I was indeed afraid of the antipsychotic I got prescribed turning me into a “zombie”. I was on a low dose of an atypical antipsychotic (which seem less sedative than classic antipsychotics) and it didn’t sedate me that much. It did keep me somewhat calmer than I was without medication, though I still felt pretty much as miserable.

This brings me to another issue that I touched upon in my comment on Lydia’s post: medications aren’t there for behavioral management. Okay, that may not be entirely true, in that severely aggressive people may benefit from medication for behavioral management if nothing else works. However, it’s a last resort and care must be taken to assess whether the patient actually feels better or they’re just too drugged up to make their feelings known. In this sense I, being a former long-term psychiatric hospital patient given medication for behavior control, have a different perspective to Lydia. She, after all, seemed to assume in her post that it’s stigma that keeps people from taking medications that could make them feel better.

Not that this didn’t happen in my own case, but in a different respect. I was taught in my years in inpatient psychiatric treatment, that medication is pure behavior control and how I felt didn’t matter. This not only got me to take medications I feel I didn’t need, but it also kept me from getting medications I did need. This is the case with my antidepressant. I was finally diagnosed with recurrent, moderate major depression in 2017 when I sought a second opinion on my diagnosis. I’ve probably been suffering depression off and on since at least age ten, but it was masked by my challenging behavior. Because I with good reason didn’t expect anyone to care about my mood if it wans’t bothering the staff, I was never treated for depression while in the hospital. Finally, earlier this year, I got a psychiatrist’s appointment to discuss my mood and was prescribed a higher dose of my antidepressant. (I had already been put on an antidepressant several years earlier, but don’t ask me why.) It seems to be working now.

Increase in My Antidepressant Dose: Is It Working?

Tomorrow, I will see my psychiatrist for a medication review. Last month, the dose of my citalopram, an SSRI antidepressant, was increased. Do I truly feel it helps?

When I started on the higher dose of citalopram, I had no idea what to expect. I’d originally been prescribed this medication in September of 2010 and had never had its effecacy evaluated. I seem to remember I was put on citalopram after the dose of my Abilify had been increased twice in a few months’ time and I was still very irritable. Abilify is an atypical antipsychotic commonly used for irritability and emotional dysregulation of all kinds. Citalopram is primarily used for depression and anxiety, but it can also help with emotional dysregulation, or so I seem to remember my psychiatrist having said.

Even before I started on my higher dose of citalopram, my mood started to lift a little, possibly because of anticipation. Once I started on the higher dose, my mood remained relatively good for a short time. Things were looking up in the day activities department, so that also helped.

One thing I have clearly been noticing, is that I’m more active. I have less need for sleep during the day. I am also a little more motivated and inspired to get things done. Though I obviously did’t complete the #AtoZChallenge, I did write far more regularly on this blog last month than i’d done in almost two years before.

Another positive that I’ve noticed is that I am more able to keep myself from engaging in self-destructive behavior. I do still have urges, but I’m more able to reach out for help first.

Though these are all very positive changes, I must say that if I’m truly honest, my depressed mood is still the same if not worse. Same for my irritability. I still experience this feeling as though a heavy weight is on my shoulders. I still get agitated very easily. I still experience suicidal thoughts.

Then again, these are most likely more symptoms of emotional regulation issues rather than major depression. Unfortunately, there’s no medication that targets these specifically. I won’t have my first appointment with my new treatment coordinator till the 17th, and I assume we won’t be diving back into dialetical behavior therapy right then. I try to use the skills I’m learning through self-help groups and apps, but it’s all rather hard.

Keys: My Time on a Locked Psychiatric Unit #AtoZChallenge

Welcome to day 11 in the #AtoZChallenge of random reflections. The letter K is really hard for me. It was everytime I did this challenge. Somehow, each word that comes to mind starting with K doesn’t seem right. For example, the 397 journal writing prompts and ideas eBook says “Kindness”. In the A to Z of me I chose “Kids”, but I wrote about my childless life already. Now that I write this, something pops up in my mind. In 2016, when I did the A to Z of mental health, I posted among other things about “Keys”. Today, I am picking up this word and reflecting on my sixteen months on a locked psychiatric unit.

It was never intended by the psychiatrist who admitted me to hospital in 2007 that I go to the locked ward at all. However, the open ward was full at the time of my urgent admission, so I was placed on the locked ward. This was in my parents’ city and I only was there for a week-end. When I was transferred to my own city, I wasn’t even told what unit I’d be placed on, but I ended up on one of the two locked units. It was the “least restrictive” locked unit, which didn’t have real isolation rooms. It did have time-out rooms in which you could be locked up, which aren’t much better.

Two weeks into my stay, my doctor informed me that I could in his opinion transition to the open unit. He however soon made up his mind, as I had terrible meltdowns. This was in fact what kept me on the locked unit for sixteen months, because the open resocialization unit initially didn’t want me.

For the first three months of my hospital stay, I had almost no privileges, which meant that I could only leave the unit accompanied by an adult. These three months were a long time, considering that most people don’t even spend that long in a psychiatric hospital. In the grand scheme of things though, it sounds like a very short time. Within a month from getting some unaccompanied off-ward privileges, I had full privileges and they were never restricted again.

I didn’t really mind being on a locked unit, but it’s still pretty strange. I mean, now that I live independently, I still struggle to leave the house without someone else even to sit in the garden. This is in part due to my terrible orientation and mobility skills, but it may also be a form of continued institutionalization syndrome.

Emotions: Dealing with Emotion Regulation Issues #AtoZChallenge

Welcome to day 5 in the #AtoZChallenge of random reflections. For my letter E post, I focus on emotions. In this post, I’ll explain what it is like living with emotion regulation issues and how dialectical behavior therapy helps. Both I and my treatment team prefer the term “emotion regulation difficulites” over “borderline personality disorder traits”, as my emotion regulation issues are likely in part due to my autism. Also, borderline personality disorder is very stigmatized. Now I know the solution to that is not to avoid the term, but I do feel I’m not the “classic” borderline.

First, I have difficulty understandign my own emotions. This is called alexithymia and is relatively common in autistic people. I can usually tell whether I’m feeling “good” or “bad”, but not whether “good” is joy or love or “bad” is anger, sadness, etc.

I feel “bad” far more often than I feel “good”. This may be because I suffer with depression too. I however tend not to express my depression as sadness. Rather, I express all “bad” feelings as irritability. Over the years, I have gotten slightly better at knowing when I’m genuinely angry and when it’s another feeling that I express as irritability.

In dialectical behavior therapy (DBT), the treatment I follow for my emotion regulation difficulties, we learn to counteract emotions by acting opposite to how the emotion “makes” us act. For example, one skill that I’m trying to practice is to half-smile, accepting the situation as it is even if I don’t like it. I initially thought that acting opposite to emotion was acting cheerful whenever a cheerful mood was expected. For example, I’d greet my husband enthusiastically when he’d come home even though I still felt like crap. Now I know that you’re not supposed to “fake it”, but that acting opposite from your initial impulse might help you achieve your goals. For exaple, if I feel like crap and want to stay in my room all the time, it may be more effective if I reach out to my husband instead.

Dialectical behavior therapy also teaches me about the misconceptions about emotions I may have. One of them is that some emotions are just stupid and shouldn’t be felt. Another is that emotions come up for no reason at all. In fact, emotions all happen for a reason and as such have value. Now that I write this, I realize this is the strongest argument against fake cheerfulness. It is important to acknowledge an emotion without judging it, but also without dwelling on it too much. Mindfulness, as such, is the first skill of DBT.

Changes

This week has been rather eventful and yet, nothing really did happen. A lot of changes are on the horizon for me, yet nothing has really changed yet.

First, I found out a few weeks ago that next week, my primary day activities staff will be leaving the day center. It is great for her, as she’ll embark on a new and challenging path in her career. For me though, it’s quite hard. Some of my other staff and family have been askign whether I mind at all, since I’ve been struggling at day activities and she was the one who filed the incident report that led to my day activities hours being cut. Yes, I do mind, since despite this, I like this staff a lot.

Then on Thursday, I found out that my CPN is leaving too. It’s also to embark on a new and challenging path in her career, but it’s sad nonetheless. My CPN and I have had quite a few misunderstandings over the ten months so far that we’ve worked together. However, I’ve noticed that I did make progress. It seems odd, since both my husband and my psychiatrist have been commenting on how I didn’t get far on the DBT course yet and it’s apparently my CPN’s fautl. Apparently, she should be limiting my bringing up only indirectly related topics.

I know the nurse practitioner who will be replacing her already from my intake interview last year. It is a slight disadvantage that he’s male, but other than that, I think I could get along with him just fine. However, it’s still a bit stressful that so many people are leaving at the same time. After all, my nurse will also be taken off my case. We’re not yet 100% sure who will be replacing her.

On Friday, I had a meeting with my psychiatrist. We discussed my progress on the DBT course, my medication and I mentioned I’ve been rather depressed lately. I did say it’s been going on for half a year already, so if I can hold it together for that long, it must not be that bad. She ignored this comment and proposed to increase the dose of my citalopram from 20 to 30mg. It’s a bit scary, since I’ve been on 20mg ever since 2010 with no med review whatsoever and I didn’t even know why I’d been prescribed it. IN this sense, I like it that my psychiatrist did ask to see me in a month’s time for an evaluation. I really do hope the med increase will help with mood improvement.

Suddenly I Am

Sometimes, I am the wise woman. Inside, I am a college sophomore, though on the outside, life has moved on. I call myself Clarissa. I can talk up a storm about psychology and psychiatry, arguing that, yes, in fact autistic people can have multiple personalities. It’s a shame people tell me they can’t just because that person’s psychiatrist has told them so. It’s nowhere in the DSM-IV or DSM-5. In fact, autistic people are quite a bit more likely to suffer from trauma-related disorders like this.

Then suddenly, I am that autistic teen. Inside, I am 19-years-old, though on the outside, life has moved on. I call myself Carol. I am not your typical intelligent Aspie. In fact, I am quite severely autistic. I use repetitive language and engage in self-stimulatory behavior all the time. I can barely function at a day activities center for people with severe intellectual disabilities, even though I’m not intellectually disabled. I’m not gifted either, no matter what some people like to believe. I’m just average intellectually, but emotionally, I’m severely impaired.

Then suddenly, I am a little girl. Inside, I’m a shy and scared five-year-old, though on the outside, life has moved on. I call myself Little. By the time I first emerged, it was thought I was the youngest alter. I am not. I can’t breathe sometimes. Sometimes, I have to color inside the lines, and I can’t, because I can’t see very well. I am very scared.

Then suddenly, I am a precocious seven-year-old. Inside, I take care of the baby self (with help from the inner mother figure), though on the outside, life has moved on. I call myself Suzanne. As much as I want to help the baby,I also want my stuffie sheep meh-beh and beh-meh.

Then suddenly, I am that mother figure. Inside, I am 28-years-old, though on the outside, even now life has moved on. I call myself Esther. I sometimes go on Mommy forums as a child advocate, even though in real life, I don’t have any children. I grievethis fact, but don’t let it show.

Then suddenly, I am a childfree woman. Inside, I am 35-years-old, t hough life hasn’t caught up with me yet. I call myself Annemiek. I like to craft and like my childfree life with just my husband and Barry, our cat.

I don’t know whether switching several times a day, like I described above, is common in people with dissociative disorders. I don’t have a diagnosis of a dissociative disorder anymore, after all. To be honest, I don’t care. I have been told, when I write on this blog about my parts, that I’m obviously a really bad case of borderline personality disorder (BPD( trying to fake having dissociative identity disorder (DID). I don’t care. This is my experience and I don’t care what label best describes it.

This is not always how switching happens either. Usually, one of the functional adult parts is out in the body or “in front” about 80% of the time, though it depends which of the functional adult parts is. I didn’t describe either of the two current main fronters in this post.

It is also possible that multiple parts are out in the body at the same time. This can lead to what psychiatrists call identity confusion and also depersonalization and derealization, where you feel as though your body, mind or the world around you is unreal. The switchig I described above is called identity alteration. Then there is amnesia, which is a hallmark syptom of DID we don’t experience that often at all (so I don’t believe we actually have DID).

With this post, I didn’t mean to give you a thorough overview of dissociation. In fact, it was what randomly popped up in my mind when reading today’s prompt on The Daily Post, which is Suddenly. Like I said, I am not claiming that my experience is representative for those with dissociative disorders. It is just a tiny part of my experience, too.

Considering Getting a Psychiatrist’s Appointment on My Depressed Mood

Tomorrow, I have an appointment with my community psychiatric nurse (CPN). Part of our appointment will likely be about where to go from here regarding day activities. My CPN already E-mailed me that she’d contacted the Center for Consultation and Expertise. They will hopefully take on my case and help me and my staff assess my needs. That will hopefully help us find a new place or get me the right support at my current place.

I also intend to ask her to get me an appointment with my psychiatrist. I feel too embarrassed to schedule one through the secretary. It’s been 3 1/2 months since my last appointment, so in that sense I could request one just for a catch-up. However, I want to discuss something specific with the psychiatrist and I feel incredibly ashamed of it. I’m finally coming to the conclusion that my depression symptoms are getting worse and to a point where I don’t know how to handle them anymore.

I was more or less by chance diagnosed with major depression last year. This came to light when I had my autism-related independent assessment. I had to fill out a screening tool for depression as part of the intake procedure. I scored as severe on that one. I was then evaluated further and was diagnosed with recurrent moderate depression. Because this was an independent assessment, my psychiatrist isn’t affiliated with this hospital and doesn’t need to take over the diagnosis. I don’t know whether she has.

I do take an antidepressant and have since 2010. Same medication, same dose all these years with no med review whatsoever. I don’t even know for sure why I was put on this medication, except that my Abilify (an antipsychotic) had been increased twice in a few months and I was still irritable.

This is the main reason I feel embarrassed about asking my psychiatrist to evaluate my mood. I mean, irritability bothers other people and ttat’s always been the main reason I was in care. Like, in 2007, when I was admitted to the mental hospital, it was really because of suicidal ideation but my staff always said it was because I’d been having public meltdowns.

I don’t know whether I truly believe that psychiatry’s job is to keep people, or me specifically, from being a pain in other people’s asses. I don’t think it should be. However, I’m rather afraid that my psychiatrist thinks so at least in my case. I’m not exactly sure why, as so far she’s been pretty understanding. I guess they may be left over feelings from all these years being treated like a cumbersome waste of resources.

Keep Calm and Carry On Linking Sunday

Day Activities: Why Do I Seem to Have High Support Needs?

Yesterday, I had a meeting with my day activities and home support staff, my comunity psychiatric nurse (CPN) and the social consultant (local authority person who decides on care funding) in charge of my case. My mother-in-law also attended. The reason for the meeting was my trouble functioning at day activities.

I go to a day center for people with intellectual disabilities and attend a group within the center for people with severe intellectual and multiple disabilities. I don’t have an intellectual disability, but did seem to do best at this sensory-based group up until recently. Then, three new service users joined us, leading to increasing stimulation, stress and staff workloads. I was increasingly overloaded and irritable, which led to the staff cutting my hours because they couldn’t deal with me on top of the other high-support service users for a full day.

The problem is there’s no clear-cut diagnosis to back up why I function best at a low-stress, sensory-based, high-support group. I mean, yeah, I’m blind, but most people who are blind can work regular jobs. Yeah, I’m autistic, but only diagnosed with autism spectrum disorder level 1 (ie. “high-functioning” autism or Asperger’s Syndrome). Yeah, I have mild motor impairments, but my doctor doesn’t know or can’t tell me to what extent they’re diagnosable (as mild cerebral palsy or something else). Yeah, I have mental health issues, but no-one has a clue to what extent these affect me and what they’re even diagnosable as.

As a result, some professionals and non-professionals choose to deny I have high support needs and tell me it’s all dependence, manipulation or attention-seeking. I was lucky that, with one of these professionals being my former psychologist who got me in touch with my current day center, the day center staff and management were up until recently more than willing to accomodate me. For instance, I started day activities at the industrial group at this center, but was soon moved to the sensory group despite, like I said, not even having an intellectual disability, let alone a severe one.

Now that I’m even falling apart at this group, I hear different opinions on where to go from here. At one point, my home support coordinator said maybe the gap between myself and the other service users at the sensory group is too wide, so we need to look at a different kind of place, like a sheltered art shop. I disagreed and not just because my art-making skills are mediocre at best. At more “job-like” day activities places like this, there’s usually more pressure and less support. My day activities staff agreed, adding that I’d tried the industrial group already.

My CPN’s coworker suggested a care farm. As much as I love animals, I know I won’t even be able to navigate a farm without a sighted guide, let alone care for the animals without one-on-one. My mother suggested I look for day activities tailored to the blind. These don’t exist in my area. Besides, I could barely function at the leisure groups at the blindess training center I attended in 2005. My mother said I may be able to now, but I think it unlikely. These places expect a level of independence I don’t have. I mean, I’ve seen my partially sighted friend make soap completely independently after being instructed by me just once, while I still need practically hands-on support after many attempts.

I’m on the verge of crying as I write this. I completed grammar school, for goodness’ sake! Granted, I burned out the minute I left, but I did it nonetheless. Why can’t I even function at a group where people with profound intellectual disabilities can? Or am I really one giant dependent, manipulative, attention-seeking waste of resources?

My CPN is going to contact the Center for Consultation an dExpertise on me. In 2010, they were briefly involved in my case. The consultant wrote in her report that she thinks it’s weird that I’m so cognitively capable and yet cannot do simple activities of daily living such as prpearing my own breakfast. She also wrote something in the report about not knowing whether I’m eliciting care. In other words, she couldn’t say whether or not I’m just one giant dependent, manipulative, attention-seeking waste of resources either. Sigh.

First Week of 2018

Oh my Gosh, it’s beginning to get boring: I haven’t written on this blog in almost a month. I want so badly to write more in 2018, but instead of wrting on this blog, I’m writing brief entries in my journal on my phone. I love it, don’t get me wrong, but I love my blog too.

It has been on my mind for a while to start writing in diary style on my blog. Of course, I can’t share everything I can in my private journal here, but I can share some things. I love the personal mental health bloggers who share what it’s like living with mental illness on a day-to-day basis. So for this purpose, I’ve created the “Diary” category on my blog. Feel free to skip these entries if you’re not interested in them, but if you are, I’d love to hear your thoughts. Today, I’m sharing about the first week of 2018, obviously.

The year didn’t start out that well. I was a bit overloaded and stressed out. I was perseverating on finding a good journaling app for my phone, because I badly wanted to start journaling privately again in 2018. I’ve tried a few apps on the computer and a dozen websites, but I can’t find any that work. By 12AM Monday, I said a quick “Happy new year” to my husband and sister-in-law, who was celebrating with us, only to return to my phone again. In the end, I found a great app: Dyrii. Still, judging by how easily I write this post versus my journal entries, I’m finding using Notepad on my computer is still easier than my iPhone.

I had been going to day activities as normal between Christmas and New year’s, so I only had Monday off, but it felt rather strange to return on Tuesday. I had been informed before the holidays that we’d be getting three new clients in my group at day activities in January. For those who don’t know, I go to a sensory-based group for people with severe intellectual and multiple disabilities. All clients except for me need help with their personal care. The reason this group still fits me is that I’m very easily overloaded and prefer the sensory way of learning. We currently have one group of six clients, including me, in the main room and two clients who are very easily overstimulated in the adjacent room. Come January, I and two of the other current clients would move into the adjacent room with these two clients who are already there. As it turned out, that hasn’t happened yet, because the new clients aren’t there yet.

The total group size will grow from eight to eleven. We won’t get extra staff. This was a stressor to me, as was all the talk about the one-on-one for two clients that needs to be well-arranged in order to make this work, as well as the talk about a client needing one-on-one for meals. It was suggested there’d be no more activities but just meals and personal care moments. This suggestion was made on Wednesday, when I was already pretty badly overloaded and stressed out. I tried to calm myself by thinking I could use my computer or phone if I wanted to do something but there’d be no support available. So I retreated into the adjacent room to use my phone, only to be overwhelmed by people yelling in the corridor. This sent me into full-blown meltdown. I mean, if I can’t use the adjacent room without being overwhelmd now, how will I do so once my two fellow clients join me? I know these are the quietest clients, but still.

Looking back, I am lucky that my staff didn’t see the entire event. I banged my head against a wall, which my husband later asked about whether it got me suspended from day activities. I only then realized that it could have. The only part my staff witnessed was me trying to run away and being pretty irritable. My staff took me to the snoezelen (sensory) room and I had to stay there for fifteen miutes. Then she returned and we talked stuff through.

I called my mental health team, which is a kind of team that always has a community psychiatric nurse on call during office hours, as soon as I got home. The on-call CPN advised me to always have a PRN Ativan with me. I used to always have one with me until my last overdose, when my husband took them away. I haven’t needed it since. The on-call CPN also advised me to call the out-of-hours phone number I’d been given last week whenever I need it. I had been hesitant to call them during the new year’s week-end, as I reasoned my husband was home so I should be able to work out things with him. I haven’t needed to call them since speaking to that CPN though. In fact, I’m pretty calm now. Maybe I needed to melt down in order to calm down again.

Succumb

I often feel like I want to succumb. Especially in the weeks after my first overdose last July, and again now, I find a form of peace and comfort in the thought that I could do it again. Note that I don’t want to die and the fact that apparently I could have died, makes these thoughts scary at the same time. I still envision myself coming out of a possible suicide attempt alive each time. It’s really hard to imagine anything else, as, you know, when I’m dead, there’s no longer me, so nothing to imagine for me. I mean, yes, I sometimes imagine what my funeral will be like, but the very fact that I can imagine it, means I’m alive.

I rationally know, these two times that I did something that could’ve cost me my life, that quite frankly there’s nothing positive about this. I mean, at the end of the day, each time, I still returned to my life as it was before my overdose. I didn’t even want to be taken to the psych unit and there was no need for it either.

How different were these events from my major crisis of 2007? At the time, I didn’t even take any actions that could’ve cost me my life – I just threatened suicide. However, I badly wanted, needed even, to escape the life I was in at the time. This was effective, as I went into the mental hospital and didn’t leave institutional life for almost a decade. Now I’m in the community again and it’s proving hard, but I must say, not as hard as I’d expected it to be. If things had gone as I expected them to, I would’ve been in chronic crisis mode. I’m not now. I don’t make any plans to end it all. Not that I did so back then, but I did run away from my home each day for a week before I finally crashed and threatened suicide.

I don’t know what makes my current thoughts that I can, if I want to, take my life any less serious than the thoughts I had back in 2007. After all, I did have these thoughts for several months following my crisis. Still, they feel less serious now. Is it because now, I don’t dramatically over-express them (unless this blog post counts)? Is it because, other than having these thoughts and being in a pretty depressed mood, I still go about my business as usual? Then again, I did most of the things I had to in 2007 too, up to taking an exam at university three days before being hospitalized.

I think honestly, the difference is that, back then, I was over-emotional, whereas now, I am under-emotional. Back then, I experienced and expressed quite intense emotions, whereas now, if anything at all, I feel numb.

I don’t know whether this is better or worse. I have a feeling that it is less serious, as I’m not emotionally dysregulated like I was back then. I don’t go about having public screaming and crying fits. I barely go about expressing myself at all, unless again this blog post counts. I don’t go about making suicide threats to random people. I don’t even know what I want to avoid or achieve anymore. As such, I don’t make any actual suicide plans, but I don’t know whether I care if I died right now either.

This post is linked up with The Daily Post’s prompt for today: sucuumb.