Confronting Delusions

bi[polar] curious

The older I get, the more acutely I’m aware that my mind creates fictional situations and relationships all on its own. Once I started paying more attention to this process, I realized that this issue seems to come from my mind jumping to conclusions after stumbling upon something my mind considers to be a clue.

Here is a very simplified example.

I call my boyfriend.

Clue: he doesn’t answer.

Delusion: he is dead.

I’ve gotten better at spotting these irrational conclusions in simple situations (like the one above) but in the cases of hardcore delusions (like the one 16 months ago where I was certain my boss was trying to get me fired and sabotage the company we worked for) my delusions are made of a series of clues, usually all taken out of context, coupled with subsequent bad-conclusion-jumping.

It seems that in these situations, anything I read, anything…

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“I Have a Mental Illness” Project

Please come visit my new posting site (and podcasting site) ihaveamentalillness.com. I am a cofounder, though not the initial founder, that honor goes to another.

We are trying to educate the community. Please visit, and leave comments so that we can be a better bastion as time goes on.

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What Not To Say To Someone With Mental Illness

If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather. Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.

– Stephen Fry

Many people don’t know how to approach a friend or a family member who has depression. Many feel uncomfortable by this thought. Our society is partly in denial of suffering and does not accept that a person can suffer despite his best efforts. This discomfort and confusion may lead those around the person—despite their best intentions—to be “walking on eggshells”. This is very noticeable to the suffering persons and alienates them further.

I compiled a list of top 5 worst things and 1 best thing to say to a person with depression, with explanations.

What Not To Say:

1. “I know just how you feel.”

Possibly the most harmful characteristic of clinical depression is its inaccessibility to those who have not suffered from it. The feeling of isolation that the person with clinical depression feels is compounded by others’ inability to relate and sometimes even to merely accept that they have an illness. Unless you have tried to kill yourself or have actually been formally diagnosed with major depressive disorder, you don’t, and this will only minimize the person’s pain.

2. “Why are you depressed?”

Can be interpreted as a challenge (“are you really depressed?”). The person is depressed because he has clinical depression. And feeling depressed is only one out of dozens devastating symptoms of clinical depression. Just by asking this question you are demonstrating your ignorance of the very nature of clinical depression. The cause of depression is a mystery even in the medical field. Besides, why does it matter? Would you ask a cancer patient, why did you get cancer (bad mattress)? it’s a stupid question. Unless you care about the etiology of depression, this question will be perceived as a challenge. Only a clinically depressed person know what it’s like to be clinically depressed.

3. “You are more fortunate than some people.”

If you could just see the good in your life you wouldn’t be so miserable. The person with depression cannot control how he or she feels, just like a cancer patient cannot heal his cancer simply by thinking. Depression is the result of complex interaction of biopsychosocial factors continuously in flux. The person has no say in when or how it will lift. Saying this will make the person with depression feel guilty about his inability to feel pleasure despite having more food, money, and a better shelter than many others. Physical possessions do not determine happiness. Besides, the inability to feel pleasure is a hallmark symptom of depression. Not only does it invalidate their feelings, but also chides them for feeling this way, not to mention serving as a reminder of their inability to feel even a drop of pleasure. It’s like asking a quadriplegic person to pick up a rock. Saying, “others’ problems are worse than yours”, will only make the person feel even more guilty about feeling bad.

4. “snap out of it” / “it’s just a phase, you’ll get over it”

Try saying this to a person in a diabetic coma or with terminal cancer (the Burden of Disease for severe depression is the same as for terminal cancer). A person with depression, like with cancer, does not have control over his infliction. It’s like the person is in prison: it wouldn’t be helpful to say, “don’t worry, you’ll be free someday.” The fact is that it hurts and he needs your support and understanding.  It’s dismissive and can be interpreted as, “just accept that it sucks and don’t whine”, which leads me to number five.

5. “Stop whining about life.”

May be combined with “everybody has problems, but you don’t see them whining about them”, or “you’re being selfish”. Depression is not about whining.

Bonus: “How are you?”

Bad to ask especially when you don’t really want to know. Asking “how are you” may be done to appear caring, as if asking about your depression, but without the risk of breaching a boundary by asking about it directly. Actually responding by talking about your depression in detail would put the person off in such a casual setting, leaving you no other choice but to respond with the perfunctory “fine”. This may make the person with depression feel stigmatized and an outsider. So, only ask this question of somebody who knows you know about his or her depression or if you really want to know. Otherwise avoid it.

What To Say:

“It must be really bad for you to feel like this, please tell me more. Even though I can’t imagine what you are going through, I am here to support you.”

If you don’t know if something you say is appropriate, just say, “I don’t know what’s to say not to offend you, but I really want you to feel better. I’m sorry if anything I say hurts you. Let me know if it does so I can correct myself. Just know that I only mean the best.”

Tardive Dyskinesia

Some of you probably know what this is.

I may be developing/have developed this.

For those who aren’t familiar, tardive is a potentially permanent side effect of antipsychotics. Presents as minor mouth tics, muscle tension and generally feeling physically uncomfortable. It’s on wikipedia, you can look it up if you’re interested.

Anyway, I’m apathetic now. I just am so used to shit hitting the fan I don’t care that it’s raining shit.

I hope any of you reading this will never run into this condition. It’s a nasty bit. And any of you who have switched antipsychotics know that the process can be very, very harsh.

Good luck,

unconstructed

The Nature of the Beast

I am in a bad place right now.

I think writing some of this out will help me process, as writing tends to do.

Every rope becomes a noose and every knife because the last knife I’ll ever need.

It’s kind of funny how psychiatrists and psychologists will ask you whether you have a plan of how you would commit suicide… even when you’ve been living with a mood disorder for years.

It’s kind of like…

“Yes, I’ve had 5 years to develop plans. It’s impossible for me to say ‘no, I don’t have a plan of action for committing suicide” when I’ve been suicidal from time to time.

Every anxiety is hitting me, and I’m absorbing anxiety of others.

Sometimes there seems no way out but death.

But it doesn’t really qualify as a “way out” in that it won’t have any ability to change the situation. If there is no afterlife than death is extinction. So it’s not so much “I’d be happier dead” as “There’s nothing in this world for me, therefore I should commit myself to the grave.” Or rather commit myself to be in the grave.

Writing helps me process.

 

 

Bully and Understanding Suicide

Can we get this straight for once?

Suicide is not some simple activity that people do when they’re in a shitty situation

To say bullied kids commit suicide SOLELY BECAUSE OF the bully is garbage. It takes more than that.

It takes an environment, a total darkness that seems impenetrable.

For bullied kids this environment consists not only of bullies, but those who allow it to take place, the complete lack of support, a sense of alienation, and sometimes a mental predisposition toward some mental illness such as depression.

So what support are we giving to bullied kids? What are we doing at our schools to promote an environment that discourages bullying?

And I do not mean to take the position that we should arrest bullies and send them to jail. Recidivism rates are such that this not only makes no sense but may be worse for the child in question.

So let us please respect the dead enough to say that it was not just getting bullied.

The Square Circle: Consciousness, Mental Illness, and Local Understanding

In Dr. Sacks book “The Man Who Mistook His Wife For A Hat“, in precisely the case of the man who mistook his wife for a hat, we see consciousness.

Or at least, insofar as I can perceive consciousness.

And this is precisely the problem. We cannot conceive consciousness for, if we did, it would be akin to conceiving a square circle.

There is a mathematical analogy here, and I beg my non-mathematician readers to allow me this as I do not know how to otherwise describe it without referring to persons, but as soon as I have done that I have forgotten the possibility of a square circle, indeed I may very well be, in some sense, actively supressing the square circle.

There exists, within the mathemato-cosm, an idea known as a “smooth manifold”. These are, essentially, surfaces on which we can create a calculus, in the same sense as we “create” a calculus in 3 dimensional space. Or, for those to whom calculus does not help understanding, imagine that we could generalize speed and acceleration and distance on this body.

“Locally”, in a mathematical sense, a 3 dimensional manifold looks like our common understanding of three dimensional space. We must be careful here in explanation because “Locally” and “Globally” are vastly different and often hard to understand.

Imagine that you were walking on a road and all of the sudden your understanding of speed and distance suddenly failed you, to such a degree that you could not even tell if you were moving. But once you reacclimated yourself to this spot, everything came back into view.

This is my current understanding of consciousness. Globally we are systems, locally we are individual persons. This would seem contradictory and backwards if interpreted incorrectly, so let me explain…

When I say locally here I do not mean one in a crowd or a persons feature. I mean the entire person. By global I mean, in effect, a surveillence under which personhood cannot be understood. Like the manifold it is not real 3 dimensional space, but rather only recognizable at local understanding. Similarly, from a personal view, that is a view that assumes ones own personhood, others are visible as persons. But insofar as we cannot understand our own personhood we cannot understand or comprehend personhood in the other either.

This allows for an interesting understanding of mental illness. If we saw “ourselves” as something that does not admit a legitimate understanding of “ourselves” mental illness would be self-understood to be an abberation in nature. That is we would perceive, rather than a distorted worldview, a distorted brain chemistry which affected this being that we cannot legitimately call “myself”.

The experience of mental illness is the experience of our understanding of self fighting for legitimacy as a being in a complete sense rather than an “Ikea Disaster” (if there really is such a thing as an “Ikea Success”).

Given this understanding the necessity of psychotherapy of some sort in addition to psychiatric care is readily apparent. Should we recover from the brain chemistry error, we must also recover from the self-conception error, an error developed in defense of personhood during a time of self-crisis.

Misunderstanding Suicide

I recently heard about the verdict involving the student Dharun Ravi and the suicide of Tyler Clementi.

I will not here discuss the sentence of Dharun, this is outside the scope of my blog.

However suicide is not.

I don’t want people to cheapen suicide. And I feel that some people are by attempting to show a unitary cause-effect relationship between the invasion of privacy and his suicide.

I do not claim to know the mind of Tyler Clementi, and sadly his mind has left the communion of minds that is this world.

So I will speak from my own experience and make a suggestion.

I never attempted suicide in the strong sense, though it was constantly on my mind during the worst dredges of my severe depressed phase before being hospitalized.

My suicidal state was not a unitary cause-effect. It was the accumulation of world that I, like unto Atlas, carried upon my back. A singular world view of self-hatred and despair becoming massive and coming near the point of complete exhaustion.

And that point of complete exhaustion is suicide. The point at which I can no longer hold my world is suicide. Understand that at this point I believed that Hell was the end after death, that death was not really an escape. When the heat and stench of fire and brimstone engulf your being and yet this is preferred to the state of affairs, or when total annihilation of being is preferred we cannot be so naive as to proclaim a unitary cause-effect. Some people misunderstand it as “release”. It isn’t release. It’s extinction or worse. And yet living seems far beyond the “worse”…

To my compatriots in the depths of depression, press on, and receive the help of others if you can, you do not have to carry this alone. To my homosexual compatriots I say the same, and also say that you are not broken in your being, despite what some may say, that in fact your expression, understanding, and acceptance of your sexuality is indicative of the coherence of your being. You are you.

I wish the best for those who knew and weep for Mr. Clementi. In the great congress of minds we have lost a member, and this loss should be communally felt.

Be well,

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To my fellows on the battlefield

(I am not referring to war here, at least, not the kind of war people first imagine)

I want to send out a message of hope to my mentally ill compatriots, especially those who cannot speak about their illness for any number of reasons.

Keep fighting.

Stay strong.

I wish you the best, and hope that some day you can be relieved of the battlefield situation. But if you never do… you have my respect. And I hope that means something.

Psychiatric Medication: A Primer In Medical Frustration

Imagine you have something like leukemia.

In order to know you have that the doctor has to in effect prove that you have it. Which can be done (though I know nothing of the complexity involved in diagnostic).

Now think if the doctor had to diagnose leukemia without modern instrumentation, so he’d have to just watch you and see what happens.

Look up the signs and symptoms of Leukemia and take out all those that require physiological testing outside of visual analysis.

http://en.wikipedia.org/wiki/Leukemia#Signs_and_symptoms

“All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.”

So if you don’t have medical tests, you have nothing to go on.

Now think about the brain. How do we know what part of the brain does what? Two ways that I know of are analyzing case studies of people who had brain damage at a specific location and look for deficits or stimulate that part of the brain and analyze what the person says he or she is experiencing.

And that’s just the low level analysis.

Consider than how difficult it is to diagnose something like bipolar, which is diagnosed via the DSM IV (or V if it’s out yet).

 

• The presence of a hypomanic or major depressive episode.
• If currently in major depressive episode, history of a hypomanic episode. If currently in a hypomanic episode, history of a major depressive episode. No history of a manic episode.
• Significant stress or impairment in social, occupational, or other important areas of functioning.^[13]\

 

How many of those do you think can be explained via medical testing? The answer is, at present, none. The other problem is that it’s not at all clear that bipolar II has the same cause in all cases.

So we now approach medication.

In our leukemia example, there are treatments that attempt to control it to the point of remission. Granted, this is very very hard to do and leukemia is a terrible disease, however…

How does a psychiatrist pick a drug for bipolar II?

He can’t. Or at least, he can’t obviously pick one. Except possibly in the case where only one medication exists for the specific noted behaviors. In bipolar II this is not the case. Further consider that a few of the major drugs for bipolar were originally used for epileptic patients to keep their seizures controlled or at least lower the occurrence.

This is not to say that psychiatric intervention doesn’t work. I myself am currently on a medical cocktail that seems to work (although lately I’ve been experiencing a level of depression that I haven’t felt in a while…).

But I’m on Pristiq, Wellbutrin, Lamictal, Provigil, Adderall, Cogentin and Abilify.

That’s a lot of meds.

Now what do I do when something goes bad like it has recently?

All of those drugs are working to keep my bipolar in check.

So how do you figure out which one is failing to help? Or how do you switch out one med for another?

It’s not easy. On the patient or the psychiatrist.

This becomes extremely frustrating.

And this is all without mentioning the fact that many of these medications have extreme side effects. In many cases the patient has to decide what they’re willing to live with. Do you accept the possibility of Tardive Dyskensia? Or do you accept psychosis? Do you accept the possibility that one of your drugs will stop working, because at the moment it works pretty well?

These are all hard questions.

And I don’t know the answers.

 

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