A Little Psych Humor…
Ever since I was a child, I’ve always had a fear of someone under my bed at night.
So I went to a shrink and told him, “I’ve got problems. Every time I go to bed I think there’s somebody under it. I’m scared. I think I’m going crazy.”
“Just put yourself in my hands for one year,” said the shrink. “Come talk to me three times a week and we should be able to get rid of those fears.”
“How much do you charge?”
“Eighty dollars per visit,” replied the doctor.
“I’ll sleep on it,” I said.
Six months later the doctor met me on the street. “Why didn’t you ever come to see me about those fears you were having?” he asked.
“Well, eighty bucks a visit, three times a week, for a year is an awful lot of money! A bartender cured me for $10. I was so happy to have saved all that money that I went and bought me a new pickup!”
“Is that so!” With a bit of an attitude he said, “And how, may I ask, did a bartender cure you?”
“He told me to cut the legs off the bed! Ain’t nobody under there now!” 
Former AstraZenica Employee Was Pressured to Lie About Seroquel Weight Gain
Furious Seasons recently posted an article about a former AstraZenica employee who was pressured to bury evidence about the extreme weight gain associated with the mood stabilizer Seroquel.
This isn’t all that surprising, although it is still beneath contempt. I guess “possible side effects include morbid obesity and type 2 diabetes” doesn’t have quite the same ring to it as “possible side effects include weight gain.” After all, people hear “weight gain” as a possible side effect of medication and generally think 10-15 lbs. I’ve seen people on mood stabilizers literally gain upwards of 100 lbs in the course of one year, probably doomed to a lifetime of judgment from doctors and bystanders who wonder why they just don’t have the willpower to put down their fork.
When drug companies and medical professionals grossly downplay this severe and potentially fatal side effect, patients are unable to make an informed decision about their treatment, or, if their medication is compulsory, they aren’t at the very least warned that a few hours after taking Seroquel, regardless of whether or not they are the least bit hungry, they are probably going to feel a compulsion to binge eat like a vampire thirsts for human blood. (This is experience talking. In fact, in the hospital we all experienced en masse what we came to refer to as the “Seroquel Munchies.”) For reasons unknown- because no one entirely understands how psychiatric medications work- antidepressants and mood stabilizers seem to block the brain’s “I’m full; stop eating” signal, causing people who are taking them to keep eating long after they are full.
Abusive (or at least unethical) medication falls under the category of things the general public doesn’t think are part of modern, compassionate mental heath treatment. As with nearly every other psychiatric horror story, I can assure you it is alive and well, particularly in the public health care system. (The grayish-green shells of human beings who could barely speak or write their own names from all the drugs that were forced on them in the state hospital will haunt me to my grave.)
To some extent, I think involuntary overmedication is pretty much inevitable in treating psychological crises, and I know I was given more than therapeutic doses of my meds while hospitalized for good reason- to keep me alive- but there are limits. For example, a friend of mine, who is the nicest person you could ever hope to meet, (I’m talking Mother Theresa nice) was a patient while I was in the crisis center, and though he was as far as humanly possible from harming himself or anyone else, he was kept on the maximum security ward about 90% of the time, and every time he insisted on leaving the center, the psychiatrist increased his dose of Abilify. Abilify is usually a very stimulating drug, but for whatever reason people with ADD sometimes have the exact opposite reaction to psych meds, and combined with the fact that he had been homeless and probably weighed a buck ten at the time, eventually he became so lethargic (“Abilified” as he called it) that he would fall asleep and wet his pants during group therapy. This was a person who never so much as raised his voice to anyone, much less made any physical attempt to escape the building; all he ever did was repeatedly insist he didn’t belong there because he wasn’t suicidal or an addict (the two reasons people are generally admitted to the crisis center). He was manic, and he needed to be stabilized, but there was no justifiable reason to medicate him to the point he completely lost control of his bodily functions. Mostly I think he just annoyed his psychiatrist. (Even I will admit that when he kept trying to convince me biblical verses proved Job was a Buddhist and wouldn’t shut up about it, it got on my nerves.)
Overmedication isn’t the only issue with inpatient treatment. From all I’ve ever heard from people who have been involuntarily committed, psychiatric hospitals will generally choose the newest drugs possible to treat their patients. This may not sound like a problem; it might even sound like a good thing to people on the outside looking in; (newer is better, right?) but there are actually two things seriously wrong with this.
When I was in the hospital, pretty much everyone was on Effexor and Seroquel- two medications that, at the time, were just this side of FDA approval; which meant they were years away from being available in generic form. Since most of the patients at the state hospital were unemployed and/or homeless, it’s likely to assume they didn’t have top of the line insurance policies waiting for them on the outside. Basically, they had become dependent on medications they could not possibly afford out of pocket, and for which they would have to move a mountain to convince Medicare or whatever crap prescription coverage they had to cover them. Low income prescription plans will never cover brand name medications without a fight so long as there is a generic alternative, which, in the case of new generation antidepressants is completely asinine, because they were formulated specifically for people who haven’t benefited from drugs that have been on the market long enough to have generic equivalents.
Even worse, however, is the fact that it usually takes a few years and a class action lawsuit or two for all of a drug’s side effects to come to light. Perhaps a hospital uses the pharmaceutical kickbacks to offset its operating costs, but the side effects and long-term consequences of using the latest medications to treat its patients is impossible to predict. I was in treatment with one woman whose bladder completely shut down and had to be catheterized. Her doctor merely said, “Wow, that’s interesting. I’ve never heard of that before.”
As If There Wasn’t Enough to Worry About…
Contrary to what the almighty FDA and the shady, bottom of the barrel health care plans insist, generic drugs may NOT be as good as brand name medications. Basically, there is a tug of war between the FDA’s- let’s face it- pretty much inept research (a host of birth defects due to antidepressant use during pregnancy is just the latest public health clusterfuck that happened on their watch) and anecdotal evidence. Studies have suggested that generic antidepressants and anti-seizure medications/mood stabilizers are not as effective and have led to numerous relapses, raising concerns about poor quality control standards to keep costs down, however the FDA maintains that generic drugs are just as good as their more expensive counterparts. Incidentally, this is the same FDA that requires a generic medication to contain the same active ingredients as the original formula but allows as much as a 20% difference in potency; and because generic versions of the same drug can be made by several companies, and pharmacies will readily switch to a less expensive manufacturer without warning, this can carry serious risks for people with chronic illnesses.
The last time I filled my prescription for Clonazepam (generic for Klonopin) I noticed the pills were a different color. I also noticed they had a very different texture. (Basically they immediately fell apart in my mouth, even though they were not quick-dissolve tablets.) Because I only take them as needed, they sat on my shelf for a couple weeks and, though I was a little concerned about the change, I didn’t think it was worth causing a fuss.
Then last week I got really sick. As sick as I’ve ever been in my life. At first I thought I had food poisoning, but because no one else who ate the same dinner got sick, I figured I had the flu and didn’t give it a second thought. Then a week later I got sick again. This seemed odd; and that’s when I did the math. Both times I got sick coincided with a really stressful day when I took a Clonazepam.
I called Walmart and the pharmacist told me the store had switched to a new manufacturer, but he didn’t think that could be what was making me sick. However, today when I visited my psych nurse practitioner, she told me she had received numerous complaints from patients (one of whom ended up in the hospital!) who had recently filled their Clonazepam prescription at the same pharmacy. Not only did they relapse but their blood work came back negative for Clonazepam.
Basically, what I have sitting on my shelf is a bottle of placebos from god knows where containing god knows what. And because Clonazepam is a controlled substance, I can’t fill my prescription until the first of the month. Fortunately, I still have a few of my old pills that I keep on my keychain for emergencies, but what if I didn’t? Three days may not be a long time but it’s plenty long enough to have a crisis that could land me in the hospital.
The moral of the story is that if you suspect something is wrong with your meds all of the sudden, there may very well be. Leave nothing to chance.
Sleight of Hand
Crazy Mermaid’s account of her psychological crisis and involuntary hospitalization is the most articulate and candid narrative on the subject I have read in a long time, and once my head stopped spinning I realized I needed an entire post to comment on it.
Despite her eloquence and clarity I can only begin to imagine what it must have been like to be captured and caged like a wild animal, least of all while in a psychotic state. Although being taken to MT State Hospital in a prison transport vehicle in full shackles was archaic and demoralizing (and completely unnecessary, considering I had never so much as raised my voice to any health care professional) I had been duped into believing I was far less screwed than I actually was, and so I participated in my evaluation and hearing without any resistance. In other words, I went through the commitment process with absolutely no idea what was happening or was about to happen to me, and I didn’t dig in my heels like someone about to dragged into the lowest common denominator of mental health care. Consequently my commitment was far less traumatic than it could have been because I was still under the illusion I was in control of my circumstances. (Of course if I knew then what I know now, I would have been beyond terrified.)
If you heard the name “Warm Springs,” and saw this, you would probably think it was an excellent facility- nice new building, beautiful landscaping, panoramic view of the Rocky Mountains, etc. And if you are determined to see only what you want to see, you could easily convince yourself it would benefit those in your care to send them to it.
The staff members at the crisis stabilization center weren’t lying to me when they said I would receive a higher level of care at the state hospital and that I would only have to stay there a couple weeks. They just didn’t have the moral courage to peel away the veneer and take a cold hard look at where they had been sending their patients for so many years. And I, in my naïveté, didn’t question them.
There is a nice, modern, landscaped building where patients are admitted to the hospital, (and where their families come to visit them) but most of them don’t stay there long. The considerably older, considerably more dilapidated buildings where most of the patients actually stay are away from plain view. The Warm Springs where I spent three months was definitely not the one on the postcards. It was old; it was dirty; there were six beds to a room; (in my particular room there was a window that wouldn’t close- in Montana- which is why I was sleeping under 4 extra blankets by the middle of October) and I was there a full two months before I ever saw a psychiatrist.
I spent most of the first two days alone in my bed, crying, unable to process what was happening. Reality didn’t set in until I was forced into the common room and started to interact with the other patients. Of course, the first thing I couldn’t help but notice was that many of them had, under the “care” of the hospital staff, managed to pick, burn, and/or cut themselves from head to toe. The second thing I noticed, once I started to speak to some of them, was that most of them had been at MSH for 9 months at least.
As it turns out, “a couple weeks” only refers to the holding, not the actual commitment. Patients are held at Warm Springs for a week or so before they can dispute their commitment at their court hearing. Unfortunately, since I had already cooperated with the courts, I was committed to the hospital before I set foot in it and by the time I realized what I had allowed to happen to me it was too late.
The first commitment to MSH lasts three months; and then each recommitment lasts six. In fact, it was facing that additional six months in the hospital that turned my suicidal ideations into a suicide attempt. I literally would have rather died than stay at Warm Springs another six months, which I hope says more about the power of bipolar depression than it says about my character. I know that people fight long and hard to survive in conditions far worse that MT State Hospital. Clearly, I am not one of those people.
Is It Ableist of Me Not to Want Children?
BipolarConnect.com is pretty hit or miss. (Seriously, who funds these studies? Antidepressants can make people “more extroverted and less neurotic?” Really, dumbass?!) But its most recent poll of women with bipolar disorder, asking if they had ever considered not having children due to their illness, has piqued my interest because this is something that weighs heavily on my mind at times. (In fact, I’ve even considered a hypothetical scenario in which medical science could test for mental illness in utero and whether or not I would carry a bipolar baby to term.) Personally- my lack of functionality, relationship status, and financial security aside- my answer is yes; I have considered not having children because I have bipolar disorder; and with the poll holding steady at 75% of women saying yes and 25% saying no, clearly I’m not alone.
In fact, my emotional, gut reaction to the question is a resounding “yes.” I’ve never seriously considered otherwise. In principle, however, I’m a little more ambivalent on the subject. Although the article that accompanied this poll was primarily focused on the risks of not taking mood stabilizers during pregnancy (hence the fact that the poll was directed entirely toward women… hopefully) it also touched on some other apprehensions bipolar women may have about motherhood, all of which veer toward some pretty ableist and antifeminist land mines- genetic discrimination, stigmatizing mental illness, violation of reproductive rights, classist healthcare pitfalls; all the biggies.
The first time I offended someone by saying I didn’t want to pass my illness on to a child, I was shocked. Frankly I could not fathom an opposing viewpoint at the time. As time goes by, however, and I become more involved in mental health activism, I may not share that viewpoint but I can at least see the logic in it. If I don’t want to have children (at least partly) because I don’t want them to be bipolar, is that tantamount to saying people with bipolar disorder are better off never being born? God knows there have been plenty of times I’ve wished I hadn’t been. I wasn’t even diagnosed until I was 26; and at 29 I feel like I’m only beginning to receive effective treatment. Then again, my parents didn’t know what they were looking for. I’m reasonably confident I could spot the warning signs in my children and get them into treatment much sooner, and thereby give them a much better chance at recovery. That is, after all, the core of mental health activism: to establish early, effective, and proactive treatment of neurological disorders; and though it changes nothing I can see how people would wonder how I reconcile that ideology with my personal feelings on the subject.
Are You Drawing Lines Today…
…May seem like a peculiar question.
On Saturday my mother noticed I was drawing mazes on graph paper and said, “Uh oh. Are you drawing lines today? Are you ok?” And as odd as it may seem, she’s right to be concerned. Drawing mazes is one of those coping strategies I use in a crisis- basically as a last resort to cutting myself. There are numerous reasons why it soothes me; basically it’s a way of creating something I can solve when I am unable to fix something major in my life. It’s something I started doing in the hospital without really thinking about it, later to discover it’s an actual DBT skill mental health professionals recommend for people who self-harm.
This has been a bad week for me. Really bad. In fact I am allotted two milligrams of Clonazepam a day, and most of the time I take one or two mg- if any- in a week. There have literally been three days in the past year I have taken the full 2 mg allotted, and two of those days have been within the past week.
Why the crisis?
Basically, my caseworker didn’t consider it worth her time to tell me if my Medicaid and food stamps were re-approved for this year. And so, with 25 dollars in my bank account, I have been suspended in a limbo in which I didn’t know if I would be able to pay for my medications or even food. It’s astonishing enough to know there are people on this planet whose job it is to fill out a form letter and mail it to another human being to let him or her know things like, “You won’t be able to buy groceries,” or, “You won’t be able to treat your life-threatening illness.” What can be said about someone who doesn’t even feel the need to warn you not to buy any groceries for the first week of the new year because you have absolutely no balance, for some fucking reason, on your EBT card until the 4th? (My EBT credit is always added to my account on the 4th, but I always have a remaining balance from the month before.) Thank god I checked my balance before I went to the store!
As it turns out, my benefits have been reinstated, although I still don’t know if my food stamps have been reduced for this year. I kind of expect them to be (even though I’ve been barely breaking even as it is) because I haven’t paid as much for heating this year, and maintaining extreme poverty is such a delicate balance after all.
I wish I could say it gets easier, but it never does. Getting public assistance is a grueling battle but the war is never ending. And no, I will NOT concede that all this scrutiny and intimidation and invasion of privacy is necessary to keep people from scamming the system. The fact is: thievery is an inevitable part of society- always has been; always will be. Constantly raking people over the coals who are barely able to pay for the necessities of life through no fault of their own is not.
Mental Illness Stigma Bingo: Version 1.0
These troll bingo cards are all over the blogosphere and I figured I should create one, too! (Mind you, these are only my first or secondhand experiences of stigma; there are god knows how many more statements I could add to this.) The point, of course, is to be tongue-in-cheek about the prejudicial comments you receive by earning a “bingo.”
The “Free Square” is intended to represent that one judgment, comment, stereotype, or piece of unsolicited advice that just gets under your skin like no other. Personally, my ex telling me I was “too crazy to love” (after he cleaned out my bank account and got arrested for dealing my benzos, no less) was certainly the most venomous thing I’ve ever heard, but, hey, breakups are ugly. I’d say the most obnoxious thing anyone has ever said to me with the intention of- I don’t know- relating to me was: “Yeah my son/daughter is the same way. He/she just doesn’t want to work. He/she would just rather live at home,” followed by a shrug and some flippant laughter. Yeah. Kids these days.
So… what’s in your “Free Square?”
Happy Solstice… FINALLY!
Thank god the days are going to start getting longer! The winter solstice marks both the shortest day of the year and the peak of winter depression, at which point all the vitamin D and full-spectrum lighting in the world could barely make a difference.
My depression this past week has been severe; and the resulting lethargy has made me think about that piece of unsolicited advice I always find particularly maddening (especially when it comes from a health care professional who should know better): “You need to get more exercise!”
Yeah. I know exercise can help me cope with my depression; I know it can further benefit me in all aspects of my life; but it does me a fat lot of good when I am so depressed it literally takes all that I have just to do my laundry or take a shower.
In fact, I was managing my health really well this year, and until about a month ago I was exercising every day. I was even losing weight, which, as anyone on psychiatric medications can tell you, is no easy feat. (Being on psych meds is kind of like being infested with parasites: no matter how much you eat, some alien presence inside you keeps insisting you are never full.) However, despite my best efforts, my depression eventually reached a critical mass and exploded. Now I’m back to square one, so drained of my energy I have to muster every ounce of willpower just to brush my teeth at night.
Of course, the skeptic’s reaction to that statement would be: “How dare you! There are people out there who really can’t brush their own teeth!” All I can say is that many illnesses have to be experienced in order to be believed, and bipolar disorder is definitely one of them. As anyone with firsthand experience will tell you, the physical effects of depression are every bit as real as the emotional, whether or not they can be seen under a microscope.
Unfortunately words like “depression” and “anxiety” get tossed around so much they have all but lost their meaning, giving way to quasi-medical professionals hawking snake oil cures for mental illness and people devoid of all compassion making snide remarks like: “Hey, I’m depressed too! Can I get paid to just sit at home and watch soap operas all day?”
Well, this is only my layman’s opinion, but if your depression was “cured” by flushing your colon or if you can be a flippant asshole about psychiatric disability, I can pretty well guarantee you have never really been depressed. Not in the clinical sense.
It All Descends On Winter
Like most if not all people with bipolar disorder, I also have seasonal affective disorder.
So, Murphy’s Law dictates that because I’m already at my most depressed and vulnerable, every other little thing in my life should go fantastically and even comically wrong. Last winter my car broke down; my pipes burst and my cabin flooded; my satellite dish, cell phone, and iPod all died; and then my identity was stolen. So far this year my troubles are minor by comparison. First there was this ridiculous battle trying to get my prescriptions filled; then yesterday I woke up to discover my pipes were frozen thanks to the 20 below temperatures and the packrats chewing apart my insulation under my cabin (which probably makes no kind of sense to anyone who isn’t poor white trash living in a cold climate). I have no running water in my house for who knows how long, depending on how much ice there is in my pipes, but, hey, at least they didn’t burst again!
Suffice it to say, winter is my least favorite time of the year by a wide margin. However, even if I stacked these calamities on top of each other, the stress caused by all of them put together wouldn’t even remotely approximate that which is created by my annual DHHS reaming. Just getting all that paperwork in the mail, just allowing the possibility- however remote- of losing my benefits to enter my consciousness, pretty much erases all the progress I have made throughout the year.
A few months ago I was so excited to tell my psychologist that I had written a “to do list” and stuck it on my refrigerator. I’m not talking about some broad-spectrum self-improvement, life goals list, either. I’m talking about a list of simple things like “buy light bulbs” “vacuum the car,” that sort of thing. You would have to live in my head to know just how titanic this was. I’m an extremely private person; and I have a phobia about other people going through my belongings, even something as benign as a to do list. I’ve also been passively suicidal for many years and I have always fixated on the idea that dying would be the ultimate loss of privacy, because other people would sort through my personal effects and there wasn’t a damned thing I could do about it. Posting a to do list in plain sight demonstrated that for the first time in I don’t know how long I felt like I would be alive long enough (as in a week) to finish the list and throw it away before anyone got to read it. For the first time since my early childhood, I felt like I was actually living in my home, not just waiting to die in it.
But when I got my paperwork in the mail, and I had to reapply for Medicaid and food stamps, all that went out the window. Before my mind even caught up to my actions, I had gutted my living space once again. I had removed all trace of life from my home. All the evidence that I even exist- not the highly controlled and edited part of me I show to the outside world, obviously, but the intimate and vulnerable core of my being- once again went on lockdown, password-protected on my computer.
Just to clarify, I’m not suicidal. I’ve been this way for most of my life whether I was suicidal or not. It’s more that I want to erase myself, as if I can hide from fate by making myself invisible (“Before the devil knows you’re dead,” as the saying goes). The possibility that I could lose my benefits is such a terrifying, hideous notion that I just can’t exist in its universe.
I just hope the day will eventually come when I don’t feel like I’m standing on a precipice, waiting for the slightest nudge to push me over.
