Tag Archives: Psychiatrist

Self-Destructive

So #Write31Days didn’t work out, but not because I couldn’t be motivated to write. The reason was that, on Wednesday, I landed in crisis, took an overdose of medication and had to be taken to the hospital. I spent the night on the internal medicine ward and was medically cleared the following day. However, it took till around 5PM before I could see the consulting psychiatrist. She was a nice woman. I knew her nurse from the other time I’d taken an overdose last July. Nothing much has yet been decided, as the psychiatrist will speak to my CPN on Monday, but I was cleared to go home.

Today, I want to talk about harmful and self-destructive behavior as it happens in various mental disorders. Particularly, I want to relate it to what I assume are my current diagnoses: autism spectrum disorder and borderline personality disorder. Unlike what many people believe, the reasons for harmful behaviors are not either fully due to autism or fully due to BPD.

In autism, self-injury and aggression are common, but are seen as steretypical behaviors. For example, some autistics hit themselves as a form of self-stimulation. However, there is a common behaviorist phrase that says all behavior is communication. As such, autistics often also engage in self-injurious behavior to communicate pain, overload or frustration.

Here is where the lines between autism and BPD become blurry. After all, unlike what is commonly believed, borderlines don’t self-destruct “for attention” or “to manipulate”. Most self-harm to deal with strong emotions that they perceive as overwhelming. Whether these emotions come from within the person themself (as is often the case in BPD) or from external sources of frustration, may seem to be important, but it isn’t. A situation doesn’t make you self-destruct, after all. It’s each person’s choice, within the limits of their mind’s capacity at that particular point.

The reason I took an overdose on Wednesday, isn’t fully clear to me either. I do remember feeling sensorially overloaded with cold. I tried to warm up by going on the elliptical trainer. After all, I needed my exercise too, as I hadn’t worked out all week. I couldn’t find my sneakers or my sports clothes, so I tried for a bit to work out in my regular clohes, except for my vest. I was shivering though and this overloaded me even more. From that point, I don’t rmemeber much. I was feeling rather unreal, though I must’ve had some awareness of what I was doing, as I retrieved medications from various sources. Once the first pill bottle, which was the easiest to find, was down, I didn’t feel there was a way back.

So is this typical borderline behavior? Yes, in that it’s not stereotyped and was rather purposeful. It certainly wasn’t the stereotypical “cry for help” type of BPD behavior though. I didn’t want to call the out-of-hours GP and I had zero interest in being admitted to a mental hospital. I do think I need some more guidance, but not in the sense of somemone providing me emotional nurture.

In the sense of what caused it, it’s more autistic sensory overload and difficulty handling unexpected situations and frustrations. The help I requested when talking to the consulting psychiatrist was of such nature: I need some practical guidance on getting more structure in my day and dealing with unexpected situations. It may be my home support worker could provide this, or I may need my nurse from the assertive community treatment team for this. I also remember just now having discussed with my nurse a prescription phone call. This means that you can call (usually I think a max number of times a week or month) to a psych unit for support if you’re about to go into crisis. I will ask my CPN about this.

I’m Officially Home!: The Road to My Discharge from the Mental Institution

It’s official: I am home. Yesterday was my formal discharge date from the institution. It would’ve been May 1, but got delayed one week because I needed mroe time to make arrangements for my after care. Today, I’ll share my journey to getting the care I need and living in the house I want to live in with the man I want to live with.

Like I said, my original discharge date was May 1. However, a week before that, nothing had been arranged in the way of after care yet. I’d have my first appointment with a psychiatrist from the community treatment team that Friday, April 28. That was all my psychologist said she was required to do in terms of making sure I am in care once discharged. Apparently, she and the social worker had deliberately handed me the responsibility of making sure I’d have day activities and home support, only without telling me I had been handed that responsibility. I didn’t find out about this till April 26, when I had my “exit meeting”, as my psychologist called it. Call me a cynic, but I immediately thought of the Swiss end-of-life clinic by the name of Exit.

After my “etit meeting”, I was very much in distress. I called the patient advocacy person, but she couldn’t do anything for me, as I’d be in the community team’s hands. I called my husband, who was on the road. Desperate, I called my mother-in-law. She asked for my psychologist’s number and somehow convinced her to give me that extra week. It was suggested to me that all it’d take to make sure I’d have day activities was a phone call to the day activity place manager, who was on vacation during the last week of April and would be back May 2. It wasn’t exactly that simple, but in the end it was close to that simple indeed.

On April 28, I had my intake interview with the community treatment team psychiatrist and nurse practitioner. They were much more supportive than anyone in the institution had ever appeared to be upon first meeting them. I suspect this psychiatrist has never worked for a long-term care unit, as she was surprised I didn’t get any therapy there other than day activities. “But it’s a psychiatric hospital,” she said. There she nailed the reason I’ve called it an institution for years: there is very little in the way of actual psychiatric treatment. In fact, a student nurse at one point referred to clozapine, the last-resort antipsychotic the majority of the patients on my unit take, as palliative care. I know for some people it’s a miracle drug, but for many on my unit, all it did was keep them just about stable enough that they could handle an unlocked door.

Like I said, my meeting with the community psychiatrist and nurse practitioner went well. We discussed my syptoms and needs. They would be contacting the home support team, which is with the mental health agency, on my behalf. If no day activities had been arranged by May 12, when I’d have my next appointment, they would also work their arses off to get me day activities.

Last Thursday, May 4, I had appointments at two day activity places. One is for traumatic or acquired brain injury survivors, while the other is for people with an intellectual disability. I had my doubts regarding the first one, which I’d visited in August of last year. This was only confirmed when I went back for an intake interview. It was all very formal. Though this could’ve been because I had already visited the place, it made me feel a little unwelcome. When I disclosed I was also going to look at the other place, the staff at the first place said this might be more suitable indeed. I’d still be welcome at the brain injury place. However, I felt there was too little I could do independently enough there.

I had a taxi drive me to the other day activity place. When I opened the door, some clients welcomed me. They found a staff member, who seated me in a spare room and poured me a cup of coffee while I was waiting for the head staffer to come see me. I talked to him and to one of the staff at the group I’d be placed in. The “orange group” is a group of relatively capable intellectually disabled people who do simple manual labor tasks like packaging, sorting etc. Fortunately, there is no pressure to be quick or do it perfectly. I was a little worried the tasks would be incredibly boring and too difficult at the same time, but I realized it’d either be this or no day activities. Besides, the staff and other clients were very enthusaistic and welcoming. It looked like I might actually have day activities right after my discharge.

Yesterday, however, I had a meeting with the social consultant in charge of my case. The day activity place had already made all arrangements so that I could start “working” there and in fact, yesterday morning I was awoken by the taxi driver ready to drive me there. I had clrearly told the day activity staff that I’d first meet with the social consultant and start “working” on Tuesday, not Monday. For a bit, as I met with the social consultant, it seemed as though it’d all been one big mistake and I wouldn’t be able to start day activities today. However, late in the evening, I received an E-mail from her saying she had pre-approved me for day activities and I could in fact start “working” today.

Diagnonsense, Oh Diagnonsense!

A few months ago, I wrote about my changing diagnosis. My autism diagnosis that’s been confirmed three times since 2007, was removed. That left me with just borderline personality disorder (BPD) as a diagnosis. If you thought I gracefully accepted this, you do not know me. I consulted with the patient liaison person at my institution, who recommended I seek a second opinion at another hospital. Now, three months on and we’re back at square one, and it’s not because an independent provider agreed with my psychologist.

On August 15, I talked to the patient liaison person, who on that same day E-mailed my psychologist asking her to make the necessary arrangements for me to get a second opinion. Instead, my psychologist told me she wanted to contact a psychiatrist at the brain injury unit first to inquire about the diagnosis of autism in people with brain injury. This doctor told her that indeed autism shouldn’t be diagnosed in people with brain injury, but the same is true of BPD. My psychologist would need to diagnose personality change due to a general medical conditon instead. I stupidly agreed with her changing my diagnosis herself rather than sending me to an independent psychiatrist or clinical psychologist.

My psychiatrist, who is the head clinician responsible for my care, however, disagreed with my psychologist’s diagnosis. My named nurse said they were throwing around all sorts of diagnoses at my treatment plan meeting last month. Eventually, my psychologist informed me they’d settled on dependent personality disorder, borderline personality disorder traits and a developmental disorder NOS. I hate the DPD label, but can see how I might have some of its features. I needed to see my treatment plan to see what they’d meant with developmental disorder NOS, which isn’t a diagnostic code in DSM-IV unless prefixed by “pervasive”. That would essentially mean autism. As it turned out, they hadn’t settled on this diagnosis, as the developmental disorder was gone.

Instead, I now have DPD, BPD traits and depressive disorder NOS. I asked my psychologist whether this was a coding typeo, but it wasn’t. Her explanation was that I may formally meet the criteria for this, but the main reason for the diagnosis is for insurance purposes. You see, I can’t be in the mental hospital without a diagnosis on axis I (anything that isn’t a personality disorder). A nurse even twisted my psychologist’s actions like she’d done me a favor.

Last week, when I found out my final diagnosis, I lost it pretty much and was considering checking myself out of the institution. My psychologist was called, because the nurses thought I said I was definitely leaving, which I can’t remember having said. My psychologist encouraged me to leave right then, which I refused. My husband instead came to pick me up thee nxt day for a night at home to have some distance.

Today, I spoke to the patient liaison person again. She was not happy at the fact that my psychologist had failed to cooperate with me in getting me a second opinion. This essentially means we’re back at where we started and I’m probably going to ask my psychologist to get me a second opinion again soon.

P – #AtoZChallenge on Mental Health

Welcome to day 16 in the #AtoZChallenge on mental health. Todays’letter is P. There ae many obvious mental health terms starting with P, but also some you may not know.

Privileges

Privileges are what freedom of independence and movement someone has while in the mental hospital. In Believarexic, the book by J.J. Johnson I read a few months ago, the main character rightfully says that what are called privileges in the mental hospital are basic rights in the real world. For example, every adut in the real world is allowed to shower independently, whereas some people in mental hospitals need to do such basic tasks under staff supervision.

Of course, restrictions to someone’s freedom even in the mental hospital need to be motivated. If a person isn’t a danger to themself or others, they should really be allowed to go wherever they want unless this is a hindrance to their treatment. What I mean by this is of course even a person with full privileges should show up for their treatment appointments. Usually, even people with full privileges need to ask for permission from their clinician to leave the hospital overnight.

Psychiatrist

A psychiatrist is a medical doctor specializing in mental illnesses. NOwadays, they’re commonly seen as human pill dispensers, because prescribing medication is their primary task. However, in the Netherlands every psychiatrist is also a qualified psychotherapist. A psychiatrist is usualy a person’s head clinician. Head clinicians are the only ones who can open diagnosis-treatment combinations in the Netherlands. Diagnosis-treatment combination is insurance lingo for the patient’s diagnosis and the treatment that is suited to that diagnosis according to protocols. As such, a head clinician is the only one who can change a patient’s formal diagnosis. By the way, clinical psychologists and psychotherapists can also be head clinicians.

Psychologist

Psychologists do most of the talk therapy part of mental health treatment. There are three levels of psychologists employed by mental health agencies in the Netherlands. Basic psychologists are fresh out of college with a Master’s degree in psychology. We have a basic psychologist employed at my unit but I’m clueless as to what his duties are. Anyone can call themself a psychologist. Then there is the health care psychologist, which is in fact a protected title. Only someone who has completed two years of additional trainign after college and is licensed can call themself a health care psychologist. This is the most common type of psychologists employed by mental health agencies. They can do basic psychotherapy but cannot be head clinicians. Last are cliniical psychologists, who’ve got two more years of specialized training and many also have a Ph.D. These people can be head clinicians and do more specialized psychotherapy too. Clinical psychologists are often assigned to the more complex cases. My unit currently does not employ a clinical psychologist.

Psychotherapy

There are many forms of psychotherapy, both individual and in a group. Psychotherapy usually employs talking to help the patient recover, though some psychotherapies are partly non-verbal too. In many countries, the term psychotherapist can be used by anyone who so desires. Not so in the Netheraldns: psychotherapists are psychologists who’ve had I believe it’s four years of training in psychotherapy techniques. They are bound by the same laws as doctors and health care and clinical psychologists. A psychiatrist is registered separately as a physician and as a psychotherapist. As such, they can lose one license but keep the other. I once read about a psychiatrist who mostly practised psychotherapy and due to abuse of power lost his license, but only his physician license at first.

Six Discoveries Made on a Psychiatric Unit

On The Mighty today, there’s an interesting article on little discoveries made at a psych ward. I seriously thought I had invented playing card games as a life saver, but apparently I haven’t. Having spent eight years on one psychiatric unit or another, I can add a few more discoveries to this list.

1. The smoking area is the coziest spot on the ward. I don’t sit in the smoking area nowadays anymore, because I don’t want to associate with my fellow patients that much. On the acute unit though, I spent hours in there as a non-smoker just because it was the best place to have good conversation with patients.

2. Not just picky eaters like me despise the food. We had relatively good food when I was first admitted in 2007, but as budget cuts took over, the quality of the food declined sharply. Now we’re lucky if we have noodles, because they are pretty much the only food that isn’t too bland to be real. If someone with a specil diet or who is a vegetarian is admitted to our unit in the middle of the week, too bad. Food is delivered in bulk quantities, so no-one gets to choose what they want to eat anymore. If you’re a vegetarian or have a special diet, you can only hope that the staff will remember to order your food specifically. By the way, the vegetarian food is the worst of all kinds.

3. “Therapy” means you’re stuck with an adult coloring book. “Work” means going to the industrial arts department. I still don’t understand how people can call day activities their “job”.

4. On most wards, you can’t access the kitchen cupboards with food in them or even get a drink outside of meal times. I am fortunate to always have spent time on wards where you could get food or drink freely, except for coffee, but an increasing number of units are locking patients out of the kitchen or its cupboards. The reason is patients often make a mess. I remember a long time ago this locking of kitchen cupboards being discussed at the intensive care acute unit (not a unit I ever resided at). One nurse rightfully said that the patients on this unit have hardly anything they can control, so why should the times they eat be controlled too? Unfortunately, he didn’t get his way and the cupboards were locked.

5. People manage to argue over the remote even though everyone has a TV in their room and there are three TVs in the day rooms. Seriously, a fund founded by one patient’s parents provides TVs for everyone in their rooms, and still oftentimes the same soap opera is on on each of the three shared TVs.

6. Every doctor has their favorite prescription medication. I am still surprised the psychiatrist at the resocialization unit didn’t prescribe Ritalin to me, because he prescribed it to practically everyone. Benzodiazepines, of course, ar handed out like candy, except to me, because I told the psychiatrist I have a family history of benzodiazepine addiction and personal experience of its withdrawal. I am 100% confident that most of the other patients on benzos are effectively addicted, but apparently they’re too unwell to ever get off their pills anyway. Did you know that “severe psychiatric illness which requires high doses of benzodiazepines” (ie. chemical restraint) is one of only a few grounds to get the drugs covered by insurance. The other three are epilepsy, anxiety disorders when a person has tried at least two antidepressants unsuccessfully, and last but not least, palliative sedation in end-of-life care.

Tips for Coping with Suicidal Thoughts

Screw you, #BEDN. I screwed up the day after I planned to continue writing everyday this month. Yesterday was a bit stressful. I baked an apple pie to remember the eighth anniversary of my psychiatric institutionalization, but I also felt overwhelemd with memories from the day of my crisis. In addition, yesterday was designed to be plan your epitaph day by the inventors of weird holidays. I only found out through this week’s #TuesdayTen. I was originally planning on writing a post on tips for coping with suicidal thoughts for #TuesdayTen, but the pressure of having to think up ten coping strategies and the doubts as to whether it’d fit in, made me skip the occasion. The idea stuck around though, so I’m going to write down some coping tips today.

The first important key is realizing when depression or despair sets in before you reach rock bottom. When you are acutely suicidal, most of the tips I’ll mention below will sound completely useless. However, if you’ve realized you are depressed or otherwise severely distressed, you may be able to enlist the help of others in staying safe. Here are some tips that can help you through some suicidal ideation. When you are actively planning suicide, these tips may no longer work and you’ll need to go to the emergency room or psychiatric crisis service.

1. Enlist the support of family or friends. Like I already said, supporters, such as family may be able to help you remember why you want to live. If not, they may be able to intervene to keep you safe whilst getting a mental health professional involved. When I was in my crisis in 2007, I had no support in the city I was in at the time. That is, I had my parents, but they weren’t particularly helpful (and I honestly can’t fully blame them) at the time.

2. If you don’t have family or friends to support you, there are support sites and telephone hotlines for people in crisis around the world. While again, if you are in acute danger, you need to go to the emergency department or psychiatric crisis service, when you are still able to talk it through, do so.

3. Think of what your goals are, what you want to get or avoid with suicide. Obviously, religious beliefs about an afterlife aside, you won’t gain anything from suicide. That doesn’t mean it doesn’t seem like it. Some people believe: “At least I’ll be able to rest then.” In this sense, what you want to avoid through suicide is important too. Discuss with your family or a mental health professional how you can reach this goal while remaining alive. For example, I knew as I was talking to the crisis service psychiatrist in 2007 that I didn’t really want to die – I mean, who wants to? -, but that I couldn’t cope with my life as it was anymore.

4. Think of the people you’ll leave behind. No, I don’t mean thinking of them having to make funeral arrangements and how selfish you are for leaving your family with the financial burden. That is not going to be helpful. Just for your information, as a family member, don’t ever burden a suicidal relative with this kind of crap, no matter how confident you are that they are “just doing it for attention”. However, if you do have people you still care about when you’re in despair, thinking about them can help lift your mood. Despair is an incredibly lonely feeling, but there are people who care about you.

5. Be careful about chanigng medications or other treatments for depression while you are actively suicidal. Though electroconvulsive therapy (ECT) is relatively safe for severely depressed people, antidepressants carry the risk of increasing suicidality. Always be sure to discuss suicidal ideation with your mental health professional and don’t change your medication regimen without close supervision, preferably from a psychiatrist.

Breakdown: My Crisis of 2007 #Write31Days

31 Days of Mental Health

Welcome to day 30 in the #Write31Days challenge on mental health. Today, I discussed the details of the mental crisis that I had in 2007 with a nurse. This helped me feel heard but it also was a bit unsettling. I vividly remember many of the details. I feel compelled to share my story here, but I don’t know how safe a public blog on the Internet is to do so. I shared the details in a post on my old blog (which can still be more easily found by googling my name than this blog) about a month after the crisis happened. I published the raw story back then, complete with every detail of where I was and what I did. I edited it more than a year later for fear it’d ruin my chances of ever having a normal life. If future employers (of which I think I’ll have none) ever read that I’m a nut case and spent eight years in a mental institution, they’ll reject me no matter how vividly I describe the crisis that led to said institutionalization. That being said, the original story was quite badly written. I don’t want to read even the edited version now. I’ll just share what I feel like sharing now.

I remember the crisis state started right after daylight saving time ended on October 28, 2007. Of course, I was spiraling down into crisis from the moment I started livign on my own in August and I had a minor crisis about once a week. The week of October 29, I started completley losing my mind. I wandered about in the dark each evening. The police took me to the police station a couple of times that week and called the crsis service, but they couldn’t do anything.

In the afternoon of October 31, I was called by the crisis service. I still remember the name of the crisis service nurse calling me and if I ever run into her again, which is unlikely, I’m not going to be pleased. She told me that I just had to find ways to distract myself and that a hospitalization would mean I needed to go back on medication. (I’d quit an antipsychotic three weeks prior. No-one later on drew the connection.) I didn’t care about going on medication one way or the other, but I couldn’t mutter a proper response.

On November 1, I took a trip to my parents’ city to collect a landline phone. I don’t have a clue why I had to sleep over there for a night just to collect a phone. On the way back to my city the next day, I had a huge meltdown. This wasn’t unusual for me when returning to my city from my parents’, but for the first time, the railroad service employee who was assisting me to get on the train back to my city, called the police. I hardly realized I was speaking to the police when they told me to leave the station. I wasn’t sure what to do at first, so wandered around. I remember somoene, no clue who, told me that if I could behave, I could come back to the station and get on the train to my city.

I decided to go to the training home which I’d been a client of before going into independent living. I was allowed in, but once the staff found out the police had been called on me, they asked me to leave. I can’t remeber what I did throughout the afternoon. I was supposed to have an early train, but didn’t end up in my ultimate crisis till 8:00 PM. I remember getting some French fries at a cafeteria near the training home and calling my independent livign support worker that I’d forgotten to pay my rent for November the day before.

A housemate from the training home offered me to stay with her for the night so that we could find a solution the next morning. The staff went into her apartment and told me to leave. They initially gave me some time, but I left instantly and had the hugest breakdown I’ve ever had. I was hardly aware of my surroundings as I told some people’s voicemails that I was going to commit suicide. I inferred the time from what the bus driver, on whose bus I’d embarked, told the police. It was the 8:01 PM bus around the eastern part of the city (in that city, buses go in circular routes or at least they did back then).

I was taken to the police station by the police again. This time I was in my parents’ city so the route to crisis services was even longer. The police had to call a community physician who was the most umempahtetic jerk of a doctor I’d met by that time. (I later was treated by an authoritarian psychiatric resident, but she never had to talk to me in the midst of a crisis.) The doc told me I was making people feel responsible. While I can see eight years on that he was right, I couldn’t grasp this back then. I don’t remember my response. The community physician called the crisis service. I have recurrent dreams about the psychiatrist, the only one whose name I remember. In my dreams, I run into her again as I get treated at the mental health agency near the tiny village I’m moving to.

I am a million times thankful that this psychiatrist didn’t stick the BPD diagnosis on me, even though in retrospect my crisis could be interpreted as a typical BPD thing. Instead, she talked to me – she showed much more empathy than the community physician and eventually labeled me with adjustment disorder, which basically means an extreme response to stress. She suggested I be admitted and right away clarified that a suitable living solution would need to be found for me while I was in the hospital. No-one could’ve known back then that it’d take eight years and I’d be going to live independently once again after that.

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Seeking Mental Health Help for the First Time #Write31Days

31 Days of Mental Health

When you feel you may suffer with a mental health conditon, you may want to seek mental health help. This is a very hard step that takes a lot of courage. I mean, there’s still a lot of stigma surrounding mental health problems, so you may feel awkward asking for help for something that’s “all in your head”.

When I took my first steps into the mental health system, it wasn’t by my own initiative. People with more severe mental illness relatively often find themselves being dragged into the system by other people. In my case, it was my staff at the training home for disabled people I resided at who took the initiative to send me to a psychiatrist.

In most countries, you’ll need a referral from your GP or another medical doctor (or sometimes a psychologist) to see a psychiatrist. I went to my GP for the referral, but couldn’t speak at all. I was totally locked up inside. It was my staff member who asked for the referral.

Once you see a mental health professional, the next step is telling them why you are seeing them. This may be hard too. Some people with more severe mental illness do not have insight into their illness. I didn’t when I was first seen by a psychiatrist, and that’s while I studied psychology at the time. Even if you do think you know what’ss wrong with you, it may be hard to articulate. Yu may feel shame, but you also may feel like you have trouble looking at your mental processes. I did. Many mental health professionals, especially those working with the severely mentally ill, will be understanding of this.

The mental health professional may ask you whether you have any idea of what type of help you’d like yourself. Don’t worry if you don’t have an answer to this. Most mental health professionals will understand that you may not have a clear understanding of what help you want, let alone what’s available or most effective with your problems. Particularly when you are severely or acutely mentally ill, the psychiatrist may have to give you limited options or recommend a particular treatment. For example, when I saw a psychiatrist about going on medication in the summer of 2007, she offered me two choices, one I’d come up with myself and another that she felt would be better suited. I chose to go along with her recommendation. Remember, as the patient, you have the right to informed consent, but you aren’t the expert on mental illness and its treatment. You know you best, but the psychiatrist knows what tends to work with your particular type of problems.

Mood #WotW

The past few weeks have been rather hectic. I started out last week in a creative, elated and slightly impulsive mood. I spent days and nights finally reading a book I’ve been wanting to read for a while. I hardly slept at all. Needless to say, after four or five days of this mood, I was exhausted and crashed. I spent some days in bed being a bit depressed and not having much energy for anything.

Then on Tuesday I had an utter meltdown and started spiraling down into crisis. I wanted to quit my antipsychotic because, I believed, it made me dull. At that point, however, I was quite irritable. I ended up self-injuring on early Friday morning after a sleepless night. At that point, I realized this pattern of mood lability is very common for me, repeating itself roughly once a month.

I had asked the staff to schedule an appointment with my psych doctor because of my wanting to quit my antipsychotic. However, between me asking to get an appointmnet and the actual appointment, I had this realization I described above. I decided to discuss this with my doctor and she suggested I enlist the help of my named nurse in adapting my crisis prevention plan to acknowledge this longer-lasting pattern. The current version has it look like I melt down out of the blue. She also suggested I may’ve done just a little too much during that four to five days of increased productivity. Many people with mood disorders and borderline personality disorder cope with their affective lability by acting opposite to how they feel. For example, when depressed, they drag themselves out of bed and do something. When they feel elated, on the other hand, it’s time to wind down.

Because I also have a very poor sleep/wake cycle, the doctor suggested I try a sleeping pill for a bit to help me get to sleep at night. Of course, this means I do need to stay up during the day as well. I have now gotten Restoril, a benzodiazepine sleeping pill, as-needed for a week, to be evaluated next week. I tend to develop tolerance to benzos very rapidly. To get me back in sync, I agreed with my named nurse that I’d be taking the medication for three nights and see how I do on Monday. Last night, I got okay but not great sleep.

I hope I will be back to stable soon. I hope this state of stable means I still have some of the creativity I have during my elated moments.

Because I am not too inspired to blog lately, I decided to participate in Word of the Week again. I contemplated for a bit what word to choose for this week, and I’m settling on “mood”. After all, this refers to my affective lability as well as my realization of it.

The Reading Residence
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Diagnosis: Finding Out About Autism #AtoZChallenge

Welcome to the A to Z Challenge, day four. Today, I have a bit of a personal post for you. I am going to share what it was like for me to get diagnosed with autism. My experience will hopefully empower adults who suspect they are autistic to make the right choice for themselves.

First, I was “self-diagnosed” for several years at around age sixteen. I didn’t like the term “self-diagnosis” at the time, because I didn’t feel a layperson (or even a professional) could diagnose themself with autism or any such condition. I’d rather say that I suspected I was on the spectrum.

My father’s comments both caused me to start suspecting I’m autistic and to stop suspecting it again – at least openly. One day in June of 2002, he came to my room at night yelling whether I was autistic or something (in the tone of voice that parents use to discipline their children). I wasn’t sure what being up late at night playing music, which bothered my father, had to do with autism, but somehow soemthing clicked with me. Maybe I was autistic after all.

A little under two years later, my father read me a newspaper article on fashionable disorders like PDD-NOS, and said he knew I had one of those conditions too: I had an asparagus addiction (bad wordplay on the pronounciation of “Asperger’s”). I decided that day that I wasn’t autistic after all.

Many adults nowadays suspect they are autistic long before they get formally diagnosed. There are many reasons why a person might seek a formal diagnosis, such as:


  • Getting professional confirmation of their suspection.

  • Having less trouble getting accommodations at work or in school (they can prove that they have a disability and are protected by the ADA or similar laws).

  • Getting disability-related services, such as independent living support.

  • Being able to pursue treatment.


There are also many reasons why people might decide not to seek a formal diagnosis and stay self-diagnosed. For example:

  • They may have negative experiences with psychiatrists, psychologists or other healthcare professionals, whom they will need to see in order to get diagnosed.

  • Some people don’t view autism as a disorder, so don’t believe they need to be diagnosed with it by a mental health professional. They just know are autistic.

  • A diagnosis may lead to an increased risk of discrimination, for example for health insurance or in employment situations.

IN late 2006, I myself was pretty much falling apart and hardly able to function in the independence training home I lived at. It wasn’t my decision to get me formally diagnosed, it was the staff’s. In fact, I couldn’t communicate to my GP that I wanted a referral to mental health services. It wasn’t even until the staff said they were wanting me to be assessed for autism that I started believing I might be autistic after all again.

The process of getting diagnosed may vary depending on the person’s age, cognitive ability, etc. In my case, for my first assessment, I had some meetings with a psychiatrist and then my parents were asked to come over to answer questions about my early development. If parents aren’t available, a sibling or other relative who has known the person being assessed for a long time, will be asked to complete this assessment.

Because the paperwork got lost, I had to be reassessed half a year after my initial diagnosis. This assessment consisted of the AQ-test (which stands for either autism quotient or autism questionnaire). This is a fifty-item questionnaire which asks about autism symptoms. I do not feel this questionnaire is worth much, as it can be completed by anyone online and someone who’s suspected they have autism for a while, can easily answer the questions in their favor. I also had to complete a DSM assessment. The DSM is the psychiatrist’s manual with criteria for each disorder. In a DSM assessment for autism, they walk you through the criteria and ask you to explain whether you meet them and if so, why. Lastly, my parents had to complete a developmental assessment again.

For a reason unbeknownst to me, I had to be assessed yet again in 2010, three years after the second assessment. I was this time given the AQ-test again plus the Dewey Story Test and something similar to a DSM assessment. The Dewey Story Test is a test of social awareness. It consists of a number of scenarios about human interaction. The person being assessed has to rate the person’s behavior at certain points in the scenario, with ratings ranging from “normal” to “shocking”. This test, too, at least used to be available online, though I can’t find an English version right now. I scored quite poorly on this test and again scored high on the AQ-test.

Other elements of an autism assessment might include IQ testing, neuropsychological testing or specific observation or interview instruments for diagnosing autism. An example of this is the Autism Diagnostic Observation Schedule (ADOS).

Unfortunately, the paperwork from my second diagnostic assessment, which was the most comprehensive, got lost last year too. Because I am going to get a consultation at the country’s top notch center for autism, I fear I’ll need to be assessed once again. This is because they require a clinical psychologist’s or psychiatrist’s diagnosis and the third assessment was by an educational psychologist. Besides, my parents weren’t asked for a developmental ssessment this time, because firstly they wouldn’t want to come over again and secondly I didn’t want them to. Unfortunately, because I badly do need services and treatment, I have no choice but to get reassessed if that’s what they want.