I'm not weighing in on this

As you may have noticed I do my best to stay out of the news, so this will be the last mention of Charlie Sheen. I feel for the man. Whether it's addiction, bipolar, or just arrogance, the man has ruined a lot of his life and embarrassed himself completely. Sure, the Sheen Quote Generator going around is hilarious (I have tiger blood?) but it's sad all the same.

Anyway, Liz Spikol over at the Philadelphia Magazine writes about how there are some armchair (not hyphenated) diagnosis going down, and that's harmful for the rest of us.

"But it’s damaging to those of us who fight every day to educate people, to retool their expectations, to battle against the stigma that mental illness imposes. People who deal with mania are assumed by many to be unpredictable people with checkered lives, whose best hope is a degraded hardscrabble survival and then an early death."

If people look at Sheen and others as examples of people with bipolar, how will any of us ever be able to come out of the closet? Bosses will imagine we're unpredictable and could damage the reps of our companies. Friends and family will think they have to watch out for us quitting our jobs and dating supermodels. Wait, maybe not that part, but you know what I mean. Having a breakdown in public does no one any good. Just look at what bald-headed Britney Spears went through when she had a manic episode a few years back.

I thank God I can fall apart out of the public eye.

"With medication, support, hope...."

"Eating right, sleeping well, taking advantage of innovative cognitive behavioral therapy that sets goals and monitors behavior, and using new medicines that target problems without the debilitating side effects help people recover, says King, who looks and acts younger than her 59 years.

'Mental illness has been good to me,' King says with a chuckle. She says she treats her mental illness the same way people with diabetes treat their illness — with medication, support, hope, advocacy, personal responsibility, education and spirituality."

SAMHSA says....

"Recent data from SAMHSA indicate that 45.1 million adults (19.9 percent) in the United States had mental illness in the past year. Of those, nearly 20 percent of adults (8.9 million) also had a substance use disorder."

That's a lot of us who are sick. And amazing that there's still such a stigma when it's so ingrained. Imagine, almost 20%. That's (I have no idea, but let's call it) one in 5 people you know has a mental health problem, whether it's post-partum depression or schizophrenia. Look around you. That's a lot of people you know who are either hiding it or disabled by it. And of those people, another one in five has a substance abuse disorder.

Amazing that we still discriminate and have so much stigma against those two illnesses when so many people are affected by them. Imagine, it's not just you who is affected by your depression. It affects your family, friends, co-workers. You can't help but make a difference in other people's lives whether you're trying to or not. So all those people are affected by mental illness and yet we're still ashamed and afraid. Amazing.

Danger to self or others

Pete Earley tells us the story of why we have to be a danger to self or others before commitment. As you can probably guess, it comes down to a man who was involuntarily committed for years because of his illness, though he wasn't dangerous. He fought back, and eventually won freedom.

There had to be something done. Back then, men and women were committed because of mental illness, but also some people were committed because they were a pain in the butt. There are all sorts of horror stories about wives thrown into institutions because the husband was cheating and wanted a "free" life of his own.

But only putting people in hospitals when they are "dangerous" has become a dangerous proposition on its own. Sometimes you're not obviously a danger to self or others, but it's truly obvious you need help. My mom used to walk naked around the city walking an invisible dog, but I couldn't get her committed. She was always so eloquent before the judges. She never seemed sick, but there was a history of bizarre behavior. Or she would try to kill herself but be released because she was no longer a danger. Made so much sense.

"Over the years, states began to lessen criteria, in part, because persons who were clearly mentally incapacitated where literally dying on the streets because they were not dangerous and they were not getting any meaningful treatment or services. This is where criteria, such as “gravely disabled” or “unable to care for self or others” came into play. The court’s “without more” ambiguous language provided the states with a opening that could be used to add these lesser criteria.

As the Fairfax father discovered, many judges, especially those with a strong civil rights background, refuse to consider anything but dangerousness when an ill person is brought before them– even if it means releasing someone who is clearly psychotic — even if it means putting their lives in jeopardy."

Yep.

Dance, dance, revolution

I'm sure by now you've heard about the dance team in Wisconsin that did a "crazy" routine, complete with fake straitjackets labeled "Psych Ward." There's a huge uproar in the mental health community over it. Twitter is all a fuss. So what happened here? It's nothing new. People just don't see mental illness as something that needs advocacy or understanding. It's still cool to call someone schizo or bipolar when they're doing something you don't like. It's still ok to portray the mentally ill as violent. Not that that's what these girls were doing, but they weren't helping. My favorite quote:

"It's such a contradiction, to have such compassion for cancer, and no compassion for mental illness. How many people sitting in that audience might have had a mental illness or had a loved one with a mental illness? And to have to sit through that ... It's not funny when you know somebody who's suffering."

It's nice that people are standing up and saying something. It's hard to say something about things like this, because you, or at least I, feel like a jackass speaking up. "Don't call people crazy!" seems like a battle cry that's not going anywhere but harassed for being too politically correct. Hell, I use the word crazy all the time. I'm not sure how I feel about it, but I hate when people misuse bipolar or schizo.

I'm glad to see these girls changed the wardrobe, but I hope they actually learned something. It doesn't seem like their coach did. She still says she doesn't see where we're coming from.

Read me

Book review in the New York Times today for a new memoir called "Henry's Demons." It follows a family through their sons' diagnosis with schizophrenia. In the review, they quote one part of the book as saying, “Jan and I were upset, but we both thought cannabis was fairly harmless. It wasn’t until Henry was in the hospital that we learned of its possible devastating impact on somebody genetically predisposed to schizophrenia.”

Wait a minute. Are they saying they think smoking pot can bring on schizophrenia? I'm sure it doesn't do anything good for a developing brain, especially one prone to mental illness. There is some research out there on pot and schizophrenia. So I guess it is a statement that has truth behind it. I always wondered what all those drugs did to my bipolar....
"
Another interesting thing in the review, the author is quoted as saying, “We, as a family, will always have to cope with the consequences of his schizophrenia. But that, after all, is what families are for.”

Ponder that one.

Mental health screening

What would have happened in your life had you been diagnosed with mental illness earlier? I was lucky to have been diagnosed and begun treatment in my early teens, but most people don't get treatment until their 20s. So how would your life have been better?

There's a movement brewing to get mental health testing in schools. From Pete Earley's blog: "David L. Shern, Ph.D, the president and CEO of Mental Health America, made a statement that I found interesting.

Half of all people with a mental health diagnosis first experience it by age fourteen, but will not receive treatment until age twenty-four…Just as we have tests for hearing and vision, we need to have mental health check-ups with effective follow-up to reduce the prevalence and disability associated with these developmental disorders."

There's also apparently a movement against testing.

Earley also points us to a link for Mental Health First Aid.

Screening and first aid sound good on the outset, but what if it just creates more stigma? What if people start identifying mental illness everywhere? You get what you look for, you know? And teenagers are all mentally ill. It's part of the process. With kids who are obviously ill these kinds of programs can surely help them get help, but what about the ones who wobble the line of angsty teen vs bipolar? Will this start us on a path of drugging more kids? We don't even know how the meds effect adults long-term, let alone how meds effect a growing body.

You also have to worry about our litigious culture. What if a teacher identifies a student as possibly having a mental illness and the parents sue for "branding" their child? Or will these children be moved into special classrooms? What if it just creates a whole new load of stigma?

Education is better than ignorance, though, so I'm pulling for mental health screenings in schools and teacher training to identify these things. I think I would rather know something is up with my child than have it hit me out of the blue one day.

Don't cut our budget

In the late nineties, early 2000's I worried a lot about hospital bed availability. My mom was constantly in need of one, and it seems that she was always able to find a place just for a night. I never really worried that they take her in; she was always dripping blood by the time it came to that, but I always knew they would release her before anything good could come of that visit. She was homeless and unable to pay anything, and so she would usually just stay overnight. She was never stable when she left.

And now more states are cutting mental health funding so there will be less places for people like her to go. "Budgets for mental health services in some 30 states were slashed an average of almost $19 million in 2009 and more than $24 million in 2010." That's hundreds of beds gone, nurses out of work, and mentally ill people still out on the streets with no where to go to get stabilized.

I don't know what's happening with cuts in our area, but I'm sure it's a lot different than it was. Just look at all the buzz in Texas about cutting their mental health services, again. Lots of states are following that trend, even after the tragedy in Arizona brought mental illness back into the light.

Where do the acutely mentally ill go when they're released prematurely or can't get in to treatment? They go back to families who can't handle them, back to suffering in silence, and often back to the streets.

That's where my mom would go. Back out to the streets or into housing my family paid for, when she could tolerate housing. Luckily, we had the resources to help her. But what about people without resources? Who've alienated their families, or have no family? Without the help of the government, these people end up homeless, in jail, or dead.

So go ahead and cut the mental health budgets. See what happens. Don't say I didn't warn you.

Tragedy in Arizona

I alluded to it before, and after this I'm not going to touch the Arizona shootings at all, but this is a great article about the treatment of mental illness in the press and what we can learn.

Problems with the DSM-5

"The new volume is an 'absolute disaster,' it could cause a seismic shift in the way mental health care is practiced in this country."

I've heard a lot of buzzing lately about the DSM-5 (Diagnostic and Statistical Manual) and all the issues it is having. According to this article in Wired, there are some people close to the DSM that are having second thoughts. Allen Frances, the man who "wrote" the DSM-IV, has an op-ed, too, on what he sees is wrong with the new version.

He recommends an abstract by a colleague, John Livesley, which says "The proposal (for DSM-5) totally reformulates the way personality disorders are classified so that there is virtually no continuity with the previous system.... Implementation of the proposal would have serious adverse consequences for patients, treatment, research, and administrative and legal applications, especially in the area of psychological injury and law."

Ouch. So what's really wrong with this DSM? From what I can gather, they're changing the way they define mental illness, and the way they diagnose. I've heard mumblings that soon no one will be "normal," and everything is a disease. One thing that's worrying a lot of people is the severity criteria. They're going to use the new criteria to put people on a scale of illness; kind of like saying you only sort of have the flu. I'm not sure what they think the purpose of that is. I can see a lot of problems, though.

Imagine, you meet the criteria for bipolar - you've been manic, you've been depressed - but you've never been psychotic on either end of the spectrum. You've maintained relationships and jobs, you've been ok. So you're probably a on the low end of the crazy spectrum, right? Well, does that mean your health insurance doesn't have to cover meds? I mean, you're doing fine, right? Or therapy. Can you get by with less? It all seems like a slippery slope to me. By any sort of scale system I'm just suffering, not sick. I can manage to work and interact with people. So does that exclude me from the right to services?

I'm not sure I understand all of it, but there is some interesting dissension amongst the rank and file.

Here's what they're doing with bipolar disorder.

Short end of the stick

There I was, just innocently reading along this article about mental health care, and getting a little angrier about the lack of coverage, and I came to this blanket statement:

"The life expectancy for someone with serious mental illness is 25 percent lower than that of the average person, according to Nordal, in part because of metabolic problems resulting from the long-term use of powerful psychotropic drugs."

Um, first I've heard of this. I'm sure it's got some basis of truth, but I've sure never heard it before, and you all know how much research I do on a daily basis. And, of course, you find what you're looking for.

"Patients with psychiatric disorders are not only at risk for psychiatric complications, but are also at greater risk for medical illness, and at an increased risk for more complicated medical disease and worse outcomes."

We lose about 4.5 years, apparently. Heart disease is still the number one killer (it's #1 in the US population, too), but of course they think people with bipolar have increased risked already, and a lot of meds mess with your heart.

You just can't win.

The debate rages on

You know how I wonder all the time about meds, but now there's a debate raging in the academic world.

"Why do we, as a society, believe that these drugs fix chemical imbalances?” Why do we believe new drugs are better than older ones?"

There's a new book about meds from Robert Whitaker called "Anatomy of an Epidemic: Magic Bullets, Psychiatric Durgs, and the Astonishing Rise of Mental Illness in America." It's pretty controversial right now, and I haven't read it yet, but from this article one person said: "Whitaker’s message seemed clear and convincing: psychiatric drugs do seem to have a purpose for specific cases, but the current practice of 'long-term treatment' may have consequences that do significant harm to the patient."

You always hear about the good that meds do, but in the mental health community (i.e., those of us who take the drugs) you hear a lot about the side effects, too. My favorite site, Crazymeds.us, has a lot of information on all the weird side effects you will and won't get that have been reported from psychiatric medications. And many of them are doozies. There are flesh-eating rashes and kidney failure, blood toxicity and all sorts of sexual problems.

I wonder all the time what 16 years of medicating my illness has done to my body. How do those internal organs look? Has it made my body stop producing it's own helpful chemicals because it knows it can rely on pharma? Will I ever be able to have children or is my body so toxic that they'll end up having no serotonin for themselves? Science doesn't know. In the decades since psychiatric medications took hold, they still don't know how they work, why they work, or what they're really doing to the body. Sure makes me a little paranoid.

So are they doing more harm than good? Does taking a medication for life make the illness a long-term problem? Could we just take meds for acute episodes instead of constantly? One day maybe we'll know. I know I would donate my body to science if weren't an organ donor, first (if they'll take me). I want to know these answers. I want to know if it's worth saturating my body with chemicals in the name of "normalcy." And what is normal? I suppose not feeling like this is normal.

Once an addict...

“Caffeine-induced psychosis, whether it be delirium, manic depression, schizophrenia, or merely an anxiety syndrome, in most cases will be hard to differentiate from organic or non-organic psychoses….

The treatment for caffeine-induced psychosis is to withhold further caffeine.” Duh.

If you're a conspiracy theorist, I think this site is awesome. "Thousands are in mental institutions today because of no greater matter than that of the use of caffeine." I mean, they're right, caffeine isn't so hot for crazy people. It exacerbates your symptoms by making you even more anxious, but I don't know if I believe that people get themselves hospitalized because of it. I know all the caffeine I drink has got to be bad for me, but screw it, I've got nothing left. I'm not going to limit myself and be one of those people who takes in no toxic substances (I would have to quit meds, too). I just want to enjoy my life, and coffee makes me happy. Sure, I could cut out soda, and I will someday. Not right now. Look what happens when I cut out all my crutches? I go crazy and have nothing to lean on.

Let's not demonize everything. I understand, everything in moderation, and I suck at moderation, but let me have my caffeine! I suppose no one but me is talking about taking it away. There's no one out there pressuring me to stop drinking coffee. No one is saying, "Anne, you've obviously got a problem with caffeine." There's no support group for coffee-heads. I'm just all up in my head about everything. Feeling crazy and need something to blame? Let's look at your caffeine intake.

Sometimes the internet isn't good for me.

A little withdrawal

So if you don't really get any withdrawal symptoms when you come off your meds, were they working anyway? I had sleep disturbances, headaches, and moodiness, but none of it was as bad as a lot of people say. It felt like a return to depression, not a withdrawal. There was the weepy, suicidal bit, but that was about 2 days.

So here I am, a week or so off all drugs and at least 2 off the Abilify, and I feel... the same. Lazy, insomniac, eating too much, you know, the same as I always do, drugs or no. My memory is notoriously bad, so I'm having trouble thinking of "real" manic and depressed episodes I've had that didn't have something to do with drugs. Now that I'm off drugs and alcohol, perhaps its time to see what this whole mental illness thing is all about?

That's right, folks, here we go again! The crazy questioning whether or not she actually has a mental illness. But hell, I'm off all meds, I feel down but not suicidal, I'm able to leave the house, I don't know. Maybe it's time to not be on meds for a while? Nothing in my system but caffeine? See if it all balances out?

Dual diagnosis here I come

I just noticed what time it is. I was going to go to a meeting tonight. Damn. Last one is at 8:30. I suppose tomorrow I can get up at a decent hour and go to a meeting before my interview. I need to find a sponsor. It would be nice to have one, and it would be especially good right now that I'm having thoughts of medicating with substances. Julie and I agreed that if the urge gets too overwhelming to self-medicate that I should have a cigarette. Just the thought of smoking stops me in my tracks, though, since it's just so gross to start again. It smells so bad, and tastes so bad, and is expensive, "And there are over 200 chemicals in it." Gross.

My old sponsor out west has been sending me a gratitude list everyday, as have a few other women on this listserve. It's been really nice to see what is keeping everyone else sober. I think I may ask her to continue to sponsor me until I can find someone. I really like her, and she's easy to talk to.

What I need to do is hit the dual-diagnosis meeting in the city and see if I can find a sponsor there. It would be nice to have someone who understands the ups and downs of bipolar coupled with alcoholism. It is kind of a different beast to be one of the people with "mental and emotional problems."

Mental illness isn't cool

Ok, I hate "I can haz" cats anything, but this one caught my eye over on If You're Going Through Hell. She's got a great blog over there, and tonight she was talking about how teens in England think it's cool to be mentally ill. I can see where they're coming from. There's a lot in the news about cutting and anorexia. Every actress has admitted to it already. I can see where they would think it's a way to be popular, to fit in.

But it's just not as cool as it seems. There are some horrible things that come with mental illness. You can lose everything and everyone in your life. Money flies out of your hands (if you're manic), or you can't physically force yourself out of bed (depression). I've been weeks without a shower before because I just didn't have the energy to do it. It was just too overwhelming. That's not cool, that's stinky. And when you have cuts all over you you do nothing but worry people and invite infection. And you end up with horrible scars. My friend Lisa has huge scars all over her thighs and it's just horribly depressing.

What worries me are those pro-ana websites. I worry about girls who think that kind of thing is attractive. I've never met a man who thought so, or a woman. It's just scary and sad. It's a horrible mental illness that can lead to death, so please don't purposefully do it to be cool. God, having daughters would be so hard. Having kids will be hard.

Stop the stigma

"...people diagnosed with alcoholism at some point in their lifetime were more than 60% less likely to seek treatment if they believed they would be stigmatized once their status is known." And that's just alcoholic stigma! Imagine if you have an inkling that you're mentally ill, too!

"The percentage of people who said they are unwilling to work closely with someone with major depression was 46% in 1996 and 47% in 2006. The percentage of people who considered people with schizophrenia to be a danger to others was 54% in 1996 and 60% in 2006."

That's right. Read it again. 47% if people wouldn't want to work closely with someone with depression. Just plain old depression. Now imagine people thinking about working with people with bipolar (which a lot of people equate with schizophrenia, even though they aren't the same thing). So now just sit back and imagine you have alcoholism AND bipolar disorder. Imagine you're trying to find a job, or a partner, and you know those statistics. Will it make you more afraid to disclose yourself to your boss or your partner? Will you be more likely to stop seeking help because you don't even want your partner to know, or your health insurance? And what happens then?

We know what happens then. We know why we need to stay on our meds, and why we need to take them even when the side effects suck. Not that we're all violent or shouldn't be let out of our cages when we don't take our meds, but I would bet the stories of mentally ill folks hurting others are stories of non-compliance.

If you're reading this and you are just hear for the sobriety, take a minute to think about mental illness. Do you know anyone who is? Are you afraid of them? Are you stigmatizing mentally ill people every day by calling someone who acts out "bipolar" or "schizo?" I know I call others, and myself, crazy all the time, because I think it's lost its power, but I hate when people use bipolar to degrade someone.

Take a minute and go help out NAMI. They're fighting stigma every day. Hey, it's Christmas, make a donation.

Being a teen is hard

Another study on those poor rats. They found that kids who binge drink in high school, or who smoke pot before the age of 16, have higher levels of cortisol, which is associated with high stress levels.

“That is the same type of profile that we see in adult patients who have been diagnosed with post traumatic stress disorder” and other mood disorders, says Pak. “They are not able to get used to stressors and they have very exaggerated responses to mild stress....Stress can pull the trigger on the genetic gun.”

In other words: that high stress life in childhood might just be the trigger that set off your genetic pre-disposition to depression, bipolar, schizophrenia, or other diseases/disorders.

I know I had a lot of drug/drink use in high school, as well as a lot of external family stressors. They know kids who are lonely are also predisposed to this kind of disorder, and I sure had 2 years in public school where I had one friend, and I was absolutely miserable. I had a boyfriend who was just with me to make his ex jealous, and I still think that some guys are tricking me. Especially with Adam. I thought it was too good to be true.

I wonder all the time if a lot of my bipolar symptoms are actually the result of all that LSD I did in high school. I was up to maybe 16 tabs, which is past the "legal limit" for sanity. I wonder, too, what my brain looks like. And what my poor liver looks like. I should donate my body to science.

Insulin rocks the brain

"Defects in insulin function -- which occur in diabetes and obesity -- could directly contribute to psychiatric disorders like schizophrenia."

Interesting! So besides the usual suspects like dopamine and serotonin, your insulin levels might have something to do with your mental illness. I wonder if there is a higher incidence of diabetes in people with mood disorders?

"We know that people with diabetes have an increased incidence of mood and other psychiatric disorders." And there it is! But diabetes alone can increase mood swings. Apparently insulin has a lot to do with mood.

So why is it that a lot of the drugs we take to make us less crazy actually cause diabetes? I have to get tested every 6 months because the lamictal can cause it. So is it helping my mood swings to take medication that may mess with my insulin? There's so much about our bodies that we just don't know, and yet we keep pouring chemicals into them in hopes that something will work out. In fact, we're all just test mice.

Nature and nurture

Stress can cause psychiatric disorders later in life, they think.

"'Previous studies have shown that kids from at-risk families are at higher risk of having a psychiatric disorder in their lifetime,' says Ellenbogen. 'We know that they're not just inheriting these traits but they are also being raised in environment that is stressful, chaotic and lacking in structure.'"

So is it nature, or nurture, or both? Genes, as we've seen, play a big part in whether or not you have a tendency towards psychiatric disorders, but living in stress seems to be the trigger that starts the whole process. I don't know about you, but I had enough stress in my life to set off whatever genetic issues I may have had.

So can you provide a supportive, stress-free environment for your kids? No. At least, I can't think of any way to do it. Life is stress. There's no escaping the fact that life is hard, even when you have the "perfect" family, there's always something else going on out there. Kids get bullied, some are just hard-wired for stress anyway. So can you avoid getting an illness if you're genetically predisposed? It sure doesn't sound like it.