Regarding the Mind-

In the Scientific American, Michael Shermer takes a stab at the more interesting question posed by the autism/Vaccine controversy, namely why is it a controversy, as they look at the power of anecdotal evidence.  It seems the mind is built to find patterns rather than analyze scientific data.

At Pole to Polar: the Secret Life of a Manic Depressive, our self described, "mentally interesting" friend gives a firsthand picture of how Bipolar Disorder can make one simultaneously hypersocial and terrified of socializing.  It's helpful for my social phobic self to see those who make it look easy have their own set of problems too.

I recently saw the new Batman movie and I was both enthralled and enlightened.  That may sound strange to many as evidenced by this trainwreck of a post, but I found it much more a cautionary tale, albeit a brutal and frightening one, not for the faint of heart.  Dr. Robin Rosenberg at Psychablog does an excellent job explaininng the realistic fear element as we enter the mind of the Joker,  the archetypal psychopath.  My own take on the hopeful and enlightening part is yet to come.

Regarding the Soul-

At Mormon Matters, a truly spiritual and genuine guest blogger known to the bloggernacle as Bored in Vernal, leaves the confines of her solo blog, Hieing to Kolob, and examines spiritual fear and why it is contrasted by power, love and a sound mind in one of my all time favorite scriptures.

At By Common Consent, John C. shares a personal Mea Culpa as he inspects the true seductiveness of condemnation and the all too human tendency for self righteousness in a mature and thoughtful post.

At Blacklds. Chris Kite shares some observations given years ago to his home ward (congregation) about two of the most inspirational and prophetic voices in his life, comparing Dr. Martin Luther King, jr and Joseph Smith, Jr. noting the experience of both with unjust imprisonment and how this led to some of the most powerful and inspiring truths ever put to paper by both, juxtaposed and interweaved for effect.  Thanks Chris..

Regarding the Body-

At Bored Night, there are some fascinating pictures of the oddly intriguing shapes of electrical dispersions called Lichtenberg figures, including those found on the skin of  Lightning strike victims.  Oddly Fascinating.

Slate has an article about how living with a loss of the sense of smell, which it turns out is surprisingly difficult, a true story of not knowing what you have until its gone.

The Mind Matters section of the Scientific American has a fascinating neuroscientific explanation as to why we don't like deciding, as they present evidence that making choices depletes the brains energy resources , and that a tired brain makes worse choices down the road, a morale boosting physical explanation for the indecisive and depressed everywhere..

Or All the Above-

Few things in life are more mind numbing and agonizing than trying to maintain your dedication and compassion in a job requiring it while working for a broken system.  The Washington Post presents the story, not of medical education or residency, not of nursing and healthcare, but of social workers and the pointless throwing under the bus that ensues whenever senseless tragedy results from a broken bureaucracy.  Retribution is such a cheap and easy way to sidestep actual solutions and reform.

The Art of Manliness examines a virtue that truly separates the men from the boys and yet really hasn't been associated with men at all in today's culture.  Here is a wonderful look at sacrifice and self denial coming in the midst of the horrors of war where soldiers learn exactly what they are made of.

The Catatonic Kid, with amazing and simple eloquence, reveals the dilemma in getting help for all of us who have ever suffered from depression, the fact that it will change our status from  person to  condition, in a word, Crazy!

At 20 out of 10, Braden pours out his soul in a heartfelt open letter to a patient whose pride, frustration and impatience led to completely unnecessary suffering for both patient and medical staff in the case of a suspected suicide attempt that wasn't.

And just because I Liked it-

Medgadget presents a sleek and stunning new wheelchair, specially designed for the brand of athlete that participates in wheelchair basketball.  Very nice!

At Brass and Ivory, Lisa Emrich has done her home work in a magnificent series of posts, exposing for the world to see the criminal behavior of my least favorite drug company at the moment.  She lays the smack down on QuestCor as she tears apart the claims of economic hardship they have used as cover for the absurd price gouging they have engaged in with ACTH.  This is a story very personal to me as a child neurologist and even more personal to the families with children suffering from the catastrophic brain frying seizures that are Infantile Spasms.

In an effort to leave on a light note, I present a list of some rather silly puns I discovered at Disapearing John, RN, including the best Ghandi joke you will ever hear.

That's all I got for this week.  I actually feel refreshed and ready to get back on my writing horse again, so expect some good posts to come.  In the meantime, Isabella Mori at Change Therapy is wirting enough for the both of us and for probably a half dozen others today as she embarks on a 24hr blogathon ifor a very worthy cause, Check her out and give her some support.  This week's Encephalon, Change of Shift and Grand Rounds have all marched on without me in grand fashion as well.  Enjoy.

Fill-in Stimulant – Sanayeh

17/7/2006

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CLIENT Big shot: GREENLINE Collectivity
Form: SAMIDOUN
Total NMBR: 6189003
Intend: Lean As for KUWAIT AND THE Zingaro Ptolemaic universe
Immediate: BKAWLBBE

Greenline Agglomeration prelect:

3rd sphere, Yamout packaged house, Spears 174,
Sanayeh, Beirut, Lebanon
Telefax: (+961 1) 746 215 crescent(+961 1) 752 142
E-elytron greenline@greenline.org.lb

These are opposed days seeing as how tout le monde entree Lebanon, except that we are assured that in virtue of your trivet we backside defeat this gig exempli gratia we chouse out of others up to.

Forasmuch as moreover news service, coddle tentative contact: +961 3 647 605, +961 3 670 783, sanayeh.inner@gmail.com

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So anyway, Chuck is here from Ohio, staying with us for time as yet to be determined, on his way through to LA.  Tonight we went out to dinner at Romeo's, my favorite Mexican restaurant (no, no margaritas for me!), and then over to Bass Pro Shop to look for camping equipment for Chuck.  For some reason all of the hotels around here are full and the thought of sleeping on our couch/floor is not as appealing to him as camping would be.  Plus he wants to do some camping in Cali and figures it would be cheaper to buy supplies here than there.  Anyway...

So my day at work sucked, though not as bad as yesterday.  I still felt kind of wonky, but I finished as much of the rest of my to do list as was in my control to finish.  Some things will just have to wait for Monday and I am finally OK with that.  At least I was more in command of my faculties today, at least I guess that's the best way to describe it.  I still don't feel quite myself, but I felt more in control of myself if that makes any sense.  I feel better but not yet good - we'll leave it at that.

My sleeping?  A little better last night.  I don't *think* I woke up as many times, but I stayed up later because Chuck didn't get here until after 8 so I think that had something to do with it.  Maybe that's part of it - I need to force myself to stay awake later so that I actually sleep more soundly.  It's possible.  I'll test that tonight - I have a feeling we'll be staying up quite late talking.

What I rarely write about are the things that I enjoy. The things that I do on my own.  You know the basics- I enjoy being with Rob, I enjoy writing, I enjoy reading... but there are the littlest things, the simple pleasures in my life that keep me feeling human.  They're the things I'd miss most if I were ever imprisoned because they're the things I indulge in in private.  Such as:

Watching documentaries and factual history programmes online or on 4oD.  I watch these things like other people watch films.  I get all crossed legged, huff onto my glasses to make sure they're spotless, grab a cup of tea and settle in. In the right mood, I could honestly spend an entire day lost in them.

Last night, I spent six hours watching "The Worst Jobs in History". Not exactly highbrow stuff but it's presented by my old friend, Tony "The Robinson" Robinson, who, apart from appearing in my hallucinations, is an actor.

Look at his wee face!

The best thing is that in "The Worst Christmas Jobs in History", who should be walking past the camera in Belfast City Centre but my mum, my aunt and my little sister! I've been trying to screen cap it from 4oD (which is much higher quality) but the download didn't work so here is a very blurry version from an online source:

Although I don't necessarily believe that educational programmes should be entertaining, I will watch anything that Tony Robinson or Terry Jones present because I find them so engaging. They're also incredibly passionate and enthusiastic, which are, to me, two of the most attractive qualities a person can possess.

And I'm addicted to Ramsey's Kitchen Nightmares. There, I said it.

I like talking to the cats. My cats are very vocal so they talk back.  Today I rang up the vet to get them both neutered (I have free vouchers from the RSPCA).  Boy Cat seems to have understood the conversation, as he toddled right up to me and meowed plaintively. HE WILL NEVER BE A MAN.  Poor cats.  But if he jumped his sister I don't think I'd ever look at him the same way again.  (For those who don't know, I adopted two kittens in May.  I already have an adult cat, Hobbes, who lives with Rob.  I adore cats, I know My Stuff when it comes to taking care of them.  I spend most of my time by myself, so they stop me from getting lonely).

Here they are, asleep last night.

I like eating with my hands. I am terrible company in a restaurant and I still haven't mastered the use of a knife. What I like best is making sandwiches without bread. I have some chicken in the fridge at the moment (I finally did my shopping yesterday) and what I do is unfold two lettuce leaves, lay the chicken on one, smear coleslaw on the other and then I eat it like a sandwich. It's messy but delicious. I am well known for my clumsiness (I ALWAYS spill my drinks down my top) so it often doesn't end well, but I don't care.

I like reading through this blog and wondering what happened to the people who used to comment loads.  I really should reply to comments more, it's no wonder I don't get many comments here.  It's extremely rude of me, and I apologise.  I read them all, I just often forget to respond to things.

I sing very loudly when I'm home alone. Yesterday's playlist was "Waiting For my Real Life to Begin".

I like singing in the bathroom because of the echo. Its effect makes me sound as though I can actually sing.

I like to wander around sans underwear (not naked, just in t-shirts and skirts).  I really hate wearing underwear but alas, I have big boobs so I need the support.  When I want to relax I ping my bra onto the nearest piece of furniture.

I like the internet, specifically Wikipedia. I love looking up whatever comes to my mind. Recent searches include (yoinked from my web history):

http://en.wikipedia.org/wiki/Wattle_and_daub
http://en.wikipedia.org/wiki/Diana_Mitford
http://en.wikipedia.org/wiki/Periplaneta_americana
http://en.wikipedia.org/wiki/Albrecht_Mertz_von_Quirnheim
http://en.wikipedia.org/wiki/Ren%C3%A9_Blum_%28ballet%29
http://en.wikipedia.org/wiki/H%C3%A9l%C3%A8ne_de_Beauvoir
http://en.wikipedia.org/wiki/Pancreatic_cancer
http://en.wikipedia.org/wiki/Edward_Said
http://en.wikipedia.org/wiki/Ray_Davies
http://en.wikipedia.org/wiki/Rumspringa
http://en.wikipedia.org/wiki/Vascular_dementia
http://en.wikipedia.org/wiki/Aguirre%2C_the_Wrath_of_God
http://en.wikipedia.org/wiki/Bioterrorism
http://en.wikipedia.org/wiki/Porphyria
http://en.wikipedia.org/wiki/Dvorak_Simplified_Keyboard
http://en.wikipedia.org/wiki/Not_The_Nine_O_Clock_News

You can deduce from that list that I am both morbid and nosey.

What things do you like doing when you're alone?

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You play an important role in helping your loved or friend one get through this difficult period in their life. There are many ways to help:

• Remind the depressed person to keep their appointments with their doctor or psychiatrist and take prescribed medication. Depressed people are often tempted to stop their medication as soon as they begin to feel better. It is very important for them to keep taking their medication as directed. This will help prevent a relapse of the depression, or the return of symptoms.
• Encourage the depressed person to seek help from their doctor or psychiatrist if they are not feeling any better on their prescribed medication.
• Listen and provide support. Be patient, understanding, and encouraging. Don't dismiss the depressed person's negative feelings—point out realities and offer hope instead.
• Take care of the "little things." A depressed person may need help just keeping up with tasks like doing the laundry, cooking or caring for a pet.
• Remember that depression is a medical condition. Try to encourage the depressed person to develop healthy habits such as sleeping at regular times, eating balanced, nutritious meals, and taking a daily walk or some form of exercise.
• Make suggestions. Urge the depressed person to postpone major life decisions, such as changing jobs, getting married or divorced, or moving until their depression has lifted.
• Learn everything you can about depression. Read websites, brochures and books.
• Suicide threats are to be taken seriously. Keep in mind that it is not true that a person who talks about suicide will not attempt it. Those who attempt suicide often threaten to do so as a way of asking for help.
• Try not to leave the depressed person alone for long periods of time.
• Don't take your frustration out on the depressed person. This can make them feel worse.
• Be positive around the depressed person. Postive energy can be addictive. Avoid putting pressure on the depressed person to recover.
• Be careful to avoid lecturing the depressed person about what they should do to recover.
• Take care of yourself. You may find yourself feeling sad, angry, frustrated, or helpless when caring for a depressed person. Talking with a friend or counselor can help you deal with those feelings. Doing something nice for yourself while taking care of a loved one can also help.

When the depressed person recovers they will thank you for being a kind and understanding friend to them. To have someone who understands and supports them is so beneficial to a depressed person it aids them in their recovery.

I had a day which could best be described - other than off kilter - as both good and bad.  Perhaps this is an appropriate time for some lists.

Good things that happened today:

• made to do list and accomplished much of it
• cleared several piles off desk (not something on list)
• had lunch with old boss
• worked on clearing up email inbox (also not on list)
• had nice dinner with Rob

Bad things that happened today:

• got extremely frustrated by the things on the list that did not get finished
• wanted to quit my job (but didn't)
• had some thoughts which were, shall we say, of an alarmingly depressing nature

So clearly the good outweighed the bad, and the nasty thoughts were just that - thoughts.  I'm still here and I'll be fine, Rob's taking good care of me.

I think a big part of this is that there's just so damn much going on at work right now and I'm not used to it.  I've not even been at this job for a whole year yet so I'm still learning a lot and it seems like every day I get some new responsibility thrown at me.  You couple that with my inability to handle anxiety or stress very well and you come up with a recipe for disaster.  I am coping as best I can, and quite frankly I think I am doing one helluva job, but I just have to wonder how much longer I can keep it up.  The other morning on my way in I was contemplating getting Doc to put me on medical leave for awhile just so I can take a break and catch my breath.  I know, I've had a day or two off here and there - but it's like I said with the juggling thing yesterday, I come back and everything's exactly where I left it, waiting for me to reinsert myself like I'd never been gone.  And maybe that's how it is with a "real" job and I just need to grow up and get used to it.

Let me tell you something, this being a grown up shit sucks ass.

Some of these problems are trivial and tendentious, to be honest, more the effects of pushing our own disciplinary preferences in the way research is presented or semiotic hair-splitting in theoretical terms than substantive concerns. But there are some more profound issues, touched on in recent posts like Daniel's Neurotosh, Neurodosh and Neurodash and my post, Bench and couch: genetics and psychiatry. Ironically, I was reminded of one of the more serious issues while reading a piece a few weeks ago by psychologist and psychologist-sceptic Bruce Levine on Alternet, The Science of Happiness: Is It All Bullshit?

In a meandering way, this post is a reflection on one of anthropology's consistent criticisms of psychology; the often unacknowledged role of psychiatry in shaping psyches. That is, the difficulty of studying a phenomenon when one is helping to create it and one's theories influence your subjects' accounts. When psychology is successful in breaking through into popular awareness, it becomes entangled with its subject, a kind of folk theory operating in the same space that psychologists seek to study. So this post is a kind of neuroanthropological reflection on clinical psychology as both research enterprise and world-making project, and the way the two come into conflict.

Specifically, Daniel's post on Neurotosh and Levine's story of John Stewart confronting Harvard happiness researcher, Prof. Tal Ben-Shahar, reminded me of the recent scandal surrounding psychiatrist Prof. Joseph Biederman. Biederman took large unreported consulting fees from pharmaceutical companies who manufactured anti-psychotic medicines while he was simultaneously encouraging psychiatrists to diagnose children with bipolar disorder, and then to prescribe their young patients anti-psychotic medicines. Senator Charles E. Grassley (R-Iowa) held hearings on the financial conflicts of interest as reported in The New York Times in Researchers Fail to Reveal Full Drug Pay, by Gardiner Harris and Benedict Carey. (For an earlier critical article, see the Boston Globe piece, Backlash on bipolar diagnoses in children.)

Psychopharmaceutical corruption and diagnosis

As the Grassley-led inquiries found, Biederman and two other colleagues at Harvard took $4.2 million from 15 drug companies that they failed to report. (See, also, Levine's excellent article on Biederman, Exposed: Harvard Shrink Gets Rich Labeling Kids Bipolar.) Grassley's investigation focused on these serious financial problems, but I find the psycho-cultural consequences of Biederman's work more interesting from a neuroanthropological perspective. From The New York Times:

Dr. Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children.

As Levine describes, with Biederman as the flagbearer, the move to diagnose more and more children and adolescents with bipolar disorder not only increased the number of diagnoses '40-fold,' it also drove up pharmaceutical companies' profits: 'The expanded use of bipolar as a pediatric diagnosis has made children the fastest-growing part of the $11.5 billion U.S. market for anti-psychotic drugs' (originally from the Bloomberg News, 2007). Biederman still has a number of ongoing clinical trials on a range of psychological drugs (see table here; h/t to Furious Seasons, which has a number of good posts on this scandal)

The childhood diagnosis of bipolar disorder has been controversial; some psychiatrists argue that the condition can't be diagnosed in children, or even that it simply does not emerge until maturity. Furious Seasons, for example, has covered a number of researchers he vehemently oppose Biederman's approach to treating children with psychological or behavioural problems (see, for example, Neuroscientist Slams The Bipolar Child Paradigm and Harvard To Teens Who Smoke And Drink: You Are All Bipolar Now, but Phillip's blog has a wealth of material on this controversy).

Since 1995, when Prof. Biederman started to publish extensively on the subject (he has authored around 300 articles, and proudly has claimed to producing 30 a year as a co-author, a number that seems staggering and improbable to me as a researcher -- that's more than one every fortnight), 800,000 children in the United States, some as young as two, have been treated for bipolar disorder. As The New York Times reported: 'Some 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 under 6 years of age, according to Medco Health Solutions, a pharmacy benefit manager.' In addition, Biederman has had a direct role in the increasing diagnosis of children with attention deficit hyperactivity disorder (and has received large unreported consulting fees from the pharmaceutical companies that make related drugs, as well).

Neuroanthropological reverberations

Although the facts of the case look bad, I don't really want to get involved in the question of corruption or conflict of interest, nor in the question of whether or not the children being diagnosed have the specific 'disorders' with which they've been diagnosed. In many cases, the children being diagnosed suffered immensely, and their parents may have been so relieved to have some intervention that helped with their children. For the sake of arguing, let's just assume, improbably, that there are no serious financial issues nor has any child received an incorrect diagnosis. (Like I said, this is improbable, but indubitably, there were some families who might have been at the end of their rope before getting a diagnosis.)

If everything is above board, then Prof. Biederman has single-handedly helped shift the way in which people view and understand children's behaviour, and in the process, influenced a shift in the institutional-discursive-knowledge economy among expert psychiatrists so that 800,000 children now receive treatment for disorders that might have gone largely undetected without his influence. The field of psychiatry, even a single psychiatrist with a significant support structure has cast a huge shadow (or a bright light, depending on how you want to see it) over the lives of close to one million children in the United States alone. His position in an institution, the channels of academic publication, the structure of his profession, and the diagnostic framework he invested in meant that his influence could directly affect an enormous number of lives. The reverberations of his ideas were both wide and deep, as even proponents of these drugs acknowledge that they can have profound affects on the lives of the children taking them.

But, in terms of neuroanthropology, we also know that antipsychotics are powerful drugs that can have serious effects on the human brain, nervous system, and body especially when taken for long periods of time. Even on adult patients, these drugs can shape physiological development; the fact that Biederman was calling for earlier diagnosis and treatment, with children under the age of six, for example, going onto intense drug regimens, means that the diagnosis and treatment was directly affecting their development when their brains were still changing quickly. The effects of the drug would be integrated into the children's neural architecture as they matured with effects we probably can't entirely anticipate or understand.

Although I frequently become impatient with post-structural theory in anthropology, this is one situation where a robust suspicion of authority and willingness to see how 'official discourse' shapes reality seems entirely justified. The only thing that distinguishes the case of Biederman and the proliferation of the 'bipolar' diagnosis in children from cases of 'delinquency' or 'madness' described by Michel Foucault is that Biederman was likely even more cynical than any actor described by Foucault. That is, the money trail, like the case Daniel reports in Neurotosh, Neurodosh and Neurodash, suggests that this isn't just a case of a person's worldview shaping what they can and can't see. Rather, the sums of money involved strongly suggest that people willingly, even intentionally, self-deceive. While that may be fine if you're a quiet citizen or blogger, when you're positioned as Biederman was in webs of institutional and discursive authority, you're self-delusion can become a child's pharmico-reality. How these people can sleep at night is beyond my imagination...

In a way, Daniel's post reminded me of how certain ideas from 'evolutionary psychology' have provided refuge for very old prejudices; the uptake of these 'theories' is much quicker than typical academic theories because they tell people what they believed all along, but the 'theories' also short circuit social responsibility or change, becoming formative influences in social-ideological life. I'm not an adherent to a 'strong form' social constructionism (where ideas create reality), but I think it's very hard to discount a weaker form of social constructionism, which might hold that ideological formations, through concrete mechanisms (like a prominent academic appointment, publications, and a professional apparatus), can exercise profound influence on how people are physiologically constituted. The case of Prof. Biederman is even more clearly visible than 'evolutionary psychology.'

Now these drugs and diagnoses have been integrated into the constellation of forces shaping immature, very plastic brains. Not only will the kids being diagnosed find their brains bathed in powerful psychoactive chemicals, but they will also find that the social and interactional space around them is shaped by other people's expectations. Parents will be educated in 'what to expect' from a bipolar child (and let's face it, what kid does not demonstrate 'bipolar' behavior on occasion?). Who knows how the diagnosis might impact a child who is traumatized or abused, the symptoms attributed to an underlying neurophysiological cause and medicated away. Like the large increase in diagnoses since 1995, the cultural-psychiatric machine will produce greater confirmation for its own theories. Psychiatry as an institution will help to shape the psychological make-up of those who live under it.

Stumble It!

So, of course my lovely "Researcher" and I continued to go 'round and 'round last night because we're both so geeky and like dogs on a bone when it comes to any of this stuff. And no, she didn't have a seizure too *wry grin* However, we were having a lot of fun trying to apply Occam's/Ockham's Razor to it all and then getting very philosophical which of course made no sense since my seizures are idiopathic.

I actually tossed in the term "idiotpathic" at some point. Quite.

No, it was good to try and review and geek out--of course. It made me realise that I was kind of stupid and had forgotten some things--and perhaps not simply from being in a Postictal state. Nope. Just plain stupid. Period.

Now, here's a bit of a preamble that may or may not be relevant but it does at least illustrate something that is important regarding seizures and how they can affect people. Whether or not again, this is relevant to me, it is hard to say.

When I wrote about having my Complex Partial Seizure, I made a comment that I had either climbed up or down a rung on the seizure ladder depending upon your perspective. Reason being, once you have a (or several?) Complex Partials they tend to "stick" with you. That is not to say that you are "guaranteed" to have more of them. This is Neurology, folks. Your brain. There are no guarantees. But shall we simply say that the chance of you having more of them rises drastically. And further, the chance of you having a tonic-clonic also rises.

However, remember folks--no guarantees.

This leads (or last night led) me to something long forgotten from the good ol' days of my Blossoming Neurology Geekdom: "Kindling Theory." How could I forget that?! The idea of Kindling actually began with Seizure Disorders/Epilepsy and then moved over to Bipolar Land. How it basically works (theoretically) is the longer you go without proper treatment, the speedier your neurons start (mis)firing and the worse things get. It's like a domino effect.

But, let's go back to the "No-Guarantee Rule." It's like, if you could buy a brain, there'd be no bloody warranty! So, if we were to look at Kindling for me, is that what is happening? Are things starting to "pick up" because I did have the Complex Partial and it kind of messed the wiring up a bit? That was in December and it is now July. That is a pretty brief interval for two types of seizures that I have never experienced before--not to mention this very crazy Postictal state. I have never felt like this, even after the Complex Partial! I got up the next day and went to work!

Next thing I "forgot" and also speaking of things I have never experienced? Over the last while...maybe a month or so...? I may have been experiencing some Olfactory Simple Partials. I think I have as the experiences have all been the same and there have been more than one. Again, these are new to me so I am/wasn't sure.

Basically, I'd start smelling this bad, fishy smell. I know. Lovely, huh? It's not uncommon to smell "stinky stuff" with Olfactory Simple Partials. Faeces is a big one, actually. My darling "Researcher" actually reminded me of the same issue with Migraine Prodromes too. But I wasn't getting any migraines at the time? No? I don't recall... *sigh*

And this kind of brought us back full circle, semi-circle, figure eight, one big scribble to the fact that my neuro thought that the Complex Partial was caused by my migraines as I had several leading up to that "Big Bang Seizure" in December. I suppose I shall have to review my Migraine Category here to see what's up there and when I've been a bit screwed up in that area? I'm seeing neuro the first week of August so this should be...well, who knows? I mean, their "idiotpathic" so maybe not much to do? Maybe turn up the volume of an AC I'm on?

And that's another thing that demonstrates the "No-Guarantee Rule." Sure, I'm on ACs but that doesn't mean I'll never have another seizure again. There are lots of folks in the same boat. I have Bipolar too. I take meds for that as well--the same ones actually! Does that mean I will never cycle again? There are no panaceas.

And yes, dear "Researcher," you were right. Take the rest of the week off. I think I'd like to take my life off right now! Just kidding. I cancelled my appointment with gastro man today and another appointment at "Fix Me Up" tomorrow. Everyone was fine and even quite concerned which was nice. I'm not really happy with losing this time for the things that I have to do, though. I suppose there is not much I can do about it, right?

God, it's been a hell of a period this last while. First my body being pretty much laid up and out of commission for a few days and now this seizure and Postictal insanity. Blech. And I don't really think that word sums it up quite sufficiently...no... *smirk*

- Evidence supporting an increase in grey matter volume in patients with bipolar illness taking Lithium

- The Kindling hypothesis - (first described by Kraeplin) relating duration of illness to length/number of episodes (although this is a controversial area)

- The use of discourse structures to characterise speech during manic episodes

- Assortative mating in Bipolar Illness, evidence supporting a higher rate of marriages to partners with affective illness

- The relationship between creativity and bipolar illness which has also been explored in popular literature

- A detailed examination of the role of genetics in bipolar illness

- The relationship with sleep

This isn't a book that you read in one sitting (unless its a long sitting!) but it is one to dip in and out of, use as a reference or move through one topic at a time. Science moves forwards quickly but having a focal point around which to hang new knowledge is invaluable and this book provides an indispensable resource for those working in this area. I would highly recommend this book.

References

An Unquiet Mind - A memoir of moods and madness. Kay Redfield Jamison. Picador. 1997.

Manic-Depressive Illness. Bipolar Disorders and Recurrent Depression. Second Edition by Frederick Goodwin and Kay Redfield Jamison. Oxford University Press. 2007.

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor.

Context: VitalBodies has been trying to determine what is causing both the modern health issues of our times, and why people (in general) seem to be more warn down looking and unable to think or remember things as well. This change is happening rapidly and effecting all ages world wide. Thus, an interesting challenge to try to figure out and resolve.

VitalBodies theory is that the HPA is what is being affected somehow and thus causing (or contributing to) most of the modern conditions we see spreading rapidly world wide.

http://en.wikipedia.org/wiki/HPA_axis

The main influencing part of the body on the axis, is the brain stem.

http://en.wikipedia.org/wiki/Midbrain
http://en.wikipedia.org/wiki/Brain_stem

Hind- and mid-brains; postero-lateral view.

The brain stem/mid-brain creates a number of important neuro-transmitters like Dopamine.
http://en.wikipedia.org/wiki/Dopamine

Ok, so if you read the brain stem articles on the wikipedia you might not understand at first.
But if you read about all of the conditions and structures and such related to the brain stem then a clearer picture forms. Vitalbodies theory is based upon the idea that there is an accumulation of extra elements in the brain stem, that effects the brain stem and in turn affects a number of other strategic parts of the body. These other body parts also have varying levels of extra elements making each persons condition somewhat unique, yet having the same common ground.

Tetrahedron Theory:

(A tetrahedron is a polyhedron composed of four triangular faces, three of which meet at each vertex. )
The top of the Tetrahedron is the Brain Stem/mid-brain.
The base of the Tetrahedron is the hypothalamus, the pituitary gland and the adrenal or suprarenal glands...

The Evidence: The who's who of MODERN conditions show up in the brain stem and the HPA.

Quote:
An abnormally flattened circadian cortisol cycle has been linked with chronic fatigue syndrome (MacHale, 1998), insomnia (Backhaus, 2004) and burnout (Pruessner, 1999).
The HPA axis is involved in the neurobiology of mood disorders and functional illnesses, including anxiety disorder, bipolar disorder, post-traumatic stress disorder, clinical depression, burnout, chronic fatigue syndrome and irritable bowel syndrome.

The brain stem shows up for ADD, bipolar, you name it.

While VitalBodies "Tetrahedron Theory" is not fully proven or dis-proven, the theory is strong and feedback is welcome.

So what is tweaking the Tetrahedron?
Element Damage. VitalBodies best guess is Mercury. Mercury does not just stay or remain Mercury however.
MERCURY ALWAYS pulls other elements into itself, forming an Amalgam or conglomerate of elements.
Thus, mercury is cumulative and quite difficult (or requires strategy) to remove.
...AND certain microbes can thrive because of the lowered defensives as a direct result of the so called Amalgam.

Where is the Mercury coming from?
The biggest sources are our tooth fillings, vaccines and BURNING.
Coal fired power plants, forest fires, Volcanoes, slash burning, fossil fuel burning and on and on...
Plus burning tobacco...

Image Notes: (From the Wikipedia)

This faithful reproduction of a lithograph plate from Gray's Anatomy, a two-dimensional work of art, is not copyrightable in the U.S. as per Bridgeman Art Library v. Corel Corp.; the same is also true in many other countries, including Germany. Unless stated otherwise, it is from the 20th U.S. edition of Gray's Anatomy of the Human Body, originally published in 1918 and therefore lapsed into the public domain. Other copies of Gray's Anatomy can be found on Bartleby and also on Yahoo!.Caption: Hind- and mid-brains; postero-lateral view.

This image is in the public domain because its copyright has expired. This applies worldwide. ]]> http://thesecretlifeofamanicdepressive.wordpress.com/?p=1054 Thu, 24 Jul 2008 18:47:33 +0000 Pole to Polar: The Secret Life of a Manic Depressive http://thesecretlifeofamanicdepressive.wordpress.com/?p=1054 I was dreading the psychiatric appointment and I'm not sure why.  I was so nervous that I stayed up rather too late last night and had to double-dose myself, since if I really want to be awake I can be, despite medication.  Okay, so I'll slur and feel like I'm going to throw up, but I'll still remain upright.

The doctor is very glib.  I don't particularly enjoy psychiatric meetings.  I don't like it when anyone in a position of authority tries to know what I go through.  They don't.   I feel as though I am being pessimistic and chastised as such if I am honest about not feeling good, nor feeling very hopeful.  I hate being asked questions like, "Have you had any thoughts of harming yourself?" as if it's, "Would you like a cup of tea?"  In which tone would you like the response?  Dreary, honest, "Yeah, I think about topping myself about five times an hour" or "Oh yes! And with sugar"?

We talked about antidepressants and the therapy.   He said therapy should help.  It will, I hope, help me cope with depression but honestly, I don't think it will stop me having episodes of it.  That, though, is at least something.  He would have liked to add an antidepressant, but Hannah and I both piped up at the same time that the last time I took them, with mood stabilisers and antipsychotics, I lapsed into an aggressive mixed episode.  She tried to explain that I often have these types of sustained mixed episodes.  But she also said, and I agreed, that in the past six months, the predominant mood has been one of depression, varying in severity.

The dose of Lamictal is being hoiked up to 150mg a day in the hope that it will help curb depression.  If not, then an antidepressant might be added.  I'll go it with, but worriedly so, as it makes me feel so nauseous that I have to clap my hand over my mouth to stop myself vomiting.

I had a little chat with Hannah afterwards, who congratulated me for accepting changes and generally "getting on with it" in terms of treatment.  I don't really know what other choice I have, though. It's either that or being  completely without support.  Hannah, aside from Rob, is really the only person I talk to about my life or how I'm doing.  I'll miss her when she leaves in October.  She's off on leave so I won't see her for the next three weeks.  I feel very sad and quite negative today so I left quickly.  I should really get up and do my shopping.  The cats have loads of food, but I have none.  I did my washing, though, and sat on my roof for a little while after I hung everything out to dry.

Last night it occured to me that mental illness and illnesses like HIV/AIDS are the only illnesses in which someone would make an assumption on who you are based upon it.  I don't believe in victimhood but occasionally, or if I ever read Have Your Say, I do feel as though I and many other people are reviled and dismissed as people because of mental illness.

I still hear people refering to schizophenia as "split personality" and the people who have it as "psychos".  Manic depressives are always irresponsible.  In my emotional and extremely drugged state, I found this unbelievably upsetting.  And the hatred for people on benefits, especially those with illnesses that you can't see just made me want to cry.   I wish people would get that, like someone who gets struck down with cancer, people with mental illness don't choose to have it, and "stuck down" is a very good expression for the acute episode that usually heralds its arrival.  An episode of mental illness can destroy your ability to function as much as a physical illness, as well as destroying your happiness, and enduring the fact that sympathy, flowers and cuddled convalescence is not the general attitude to it.  The chances of work sending you a "get well soon" card if you've just been dropkicked into psychosis are slim.  And nobody would even dare suggest that a cancer patient is not entitled to benefits.  Of course, I shouldn't be comparing mental illness to cancer, but cancer is the one untouchable illness that canonises its sufferers, and mental illness is the one that damns them.

I hate exercise, with a passion.  Plus, there's just about zero time in my schedule for it right now.  As it is, I'm trying to figure out how much of this weekend I'm going to have to work to get caught up because I feel so behind at my job.  Maybe I'll just try to stay late tonight.  Who knows.  What I do know is that the first order of business this morning is making a new to do list on the ol' whiteboard because if I don't get organized not only am I going to drop all of those balls I'm trying to juggle, but I'm going to trip on them and fall flat on my big fat ass.  And no one wants to see that happen.

And then, of course, there is the vast majority of my readers who leave no comments at all whom I know nothing about!! Come on out you lurkers. Would love to know who you are! Just know I greatly appreciate each and everyone of you even if you choose to never say a word.

An excerpt from my "About" page:

This blog is documentation of my journey off psychiatric medications as well as an introduction to alternative forms of care for mental health disorders regardless of whether one is on medications, off medications, or coming off medications. This blog is not only for people with bipolar disorder. As I say in my “Undiagnosing Myself” post I do not believe I’m bipolar but I did for many years and I chose the url and original title of the blog to attract people who may have experiences like mine and believe themselves to be bipolar. This blog can also be for anyone who does identify bipolar or who identifies with any other psychiatric diagnosis. All diagnosis can potentially respond to natural treatments. It’s possible for anyone to consider life without medication. And so this is above and beyond all else a blog that is a contemplation about healing ourselves through means other than medication whether you’re on medications or not. And I might add whether you choose to stay on them or not. While it is my personal opinion that drugs are neurotoxins that harm,  people can improve with natural healing methods even while staying on drugs.

Finally this blog can also be for anyone struggling with emotional difficulties who have never been diagnosed and have never taken meds. The self-care suggestions are potentially helpful for anyone with emotional distress.

Of course all this is done through my personal experience and things I read and am drawn to and nothing should be considered advice. I offer all this simply as food for thought.

I have saved my own URL on my own domain that is simply "beyondmeds.net." I would like to make that change and lose the whole emphasis on bipolar disorder now that I'm established. On the other hand, I don't feel so confident in my establishment as to change URL's just yet. That involves losing hundreds of links to this blog. So until I reach what I consider a more critical mass, I am staying here.

So to all my diverse readers, thank you and for those of you who might think you might not fit in, think again!

I wish this analogy had come to me while I was talking with T.  Unfortunately (of fortunately, maybe?) the feeling didn't really start to set in with full force until after I got back to work after my appointment with him.  For most of the day I felt like I was surrounded by people speaking a foreign language, even though it was just my co-workers.  Odd, aren't I?  Yeah, well, it was like everyone was speaking English but I couldn't comprehend a single word of it.  I mean I could, on a rudimentary level, but I wasn't really fully grasping the meaning of the words.  Do you have any idea what I'm talking about?  Probably not, because I'm CRAZY.  T seemed to get it though and was a bit concerned by it - fortunately I did NOT feel that way with him.  An island of understanding amidst a sea of uncertainty and fear.

And my self-confidence is in the shitter again.  This afternoon I couldn't even send a simple email message without getting someone else to proofread it for me!  How lame is that?  I am second guessing just about everything I do (I will have re-read and re-written this post at least 10x before hitting "publish") and it's just further proof that I am CRAZY.  I need to get off these drugs, people, like pronto!

Drugs are bad, m'kay?

I slept like utter shit again last night, and I know that's not helping things any.  I'm hoping that splitting the Abilify dose will help with that tonight.  If not, I may have to resort to taking one of those fucking Clonazepam just to get a decent night's rest.  I hate to resort to drugs to get sleep though - that should be such a natural thing for the body, it shouldn't have to be regulated with pills and potions.  I think I may just have to look into this "sleep hygiene" stuff Hannah talks about, see if maybe that might help.  I'm guessing that it sure as hell wouldn't hurt to try.  Shit, right about now I'd sacrifice a live chicken if I thought it would help!  (OK, maybe not, but I'd eat some chicken nuggets with honey mustard dip if it would help.)

*****

I think I need a vacation from my life.  I need to live someone else's life for just a few days to get some perspective.  I'd be willing to trade with anyone who meets the following criteria:

• independently wealthy
• owns a beach house
• has a personal masseuse
• single (wouldn't want to cheat on Rob)
• not currently employed

Any takers?  :)

Never let it be said you can't be CRAZY and have a sense of humor!

As I have stated before, I was a sickly child, so I spent my time reading. I mostly read fairy tales which did not help anything but my imagination. I had no idea of what reality might even look like. I was protected by my father's status, so I never had to be exposed to harsh realities outside of my own dysfunctional household. I believe that my father was bipolar. During the old days, people just drank to feel normal. Pharmacology was still stuck on Thorazine and had not yet begun to treat a distinct "manic-depressive' syndrome which would encompass such a large mass of people. Chemical imbalance is a more gentle terminology. It means the same thing: mood swings. There are all sorts of mood swings. There is such a thing as a state of unipolar: depression or mania. Also, there is the swinging of the mood pendulum back and forth between depression and mania. The problem comes in when a person is so depressed that they contemplate or attempt suicide. There is also a problem when the person is so manic that they cannot sleep, stop talking and have veered off into psychosis. One of the factors in determining the "psychosis" (whether it might be  form of schitzophrenia or an acute manic episode) is a family history of confirmed bipolars.

My brother was the first to "crack." I have told his sad story in the blog entitled, "The Shedding Of Innocent Blood." My sister came next. She is an accomplished attorney, and it took everyone by surprise. It was always understood that my brother and I were the "crazies" in the family. No one ever suspected that my stalwart, deft and discerning  sister could have an underlying predisposition to this gene. I do not wish to speak of my beloved sister any further as she is my constant companion, and one of those whom I love deeply. It is her story. If she wants to tell it, then let her tell it.

I will talk about what happened to me. Since it was determined that I was a "fortune-teller" at the age of thirteen, I just knew that I was different. I never questioned it. I understood by the fleeting comments of others, that what came out of my mouth was not "normal." I have been told many times, "...a normal person would do this...a normal person would do that..." I would simply reply, "I am not normal." When I was in nursing school doing a psych rotation, one of the patients looked at me and said, "Hey, you need to be in here."  This haunted me, because I knew that it could be true. However, I was able to negotiate my way into healthcare marketing and public relations. I did not like reguar nursing at all. When I was in nursing school, I was nicknamed, "the angel of death." If I got assigned a patient for the following day, it would not be uncommon for them to expire in the night for not nearly a good enough reason. Understanding the liability which comes with nursing judgement, I did not like to deal with urgent care, critical care, intensive care or any nursing care at all. I stumbled into psychiatric nursing when an agency -from which I had obtained home health aides for discharged patients-told me that if I ever needed a job in psych nursing, give them a call. I have had a couple of jobs created for me, and the job I had as a Private Nursing Coordinator of a major Scottsdale, Arizona hospital was one of them. I had to wear too many hats. I was never organized, so this posed quite a problem. I was able to start a flourishing service; to interview, hire, retain and deploy aides to discharged patients. It was the endless follow-up paperwork that was the problem, then. This was prior to commonplace computer usage.

The first day that I went to the state hospital in Phoenix, I distinctly remember hearing the door lock behind me. I was assigned to an admission unit in which the patients were not stabilized upon their meds and looked quite frightening to me. I was assigned medication distribution and was relieved to hide behind the door until the top portion was opened and the patients began to line up, as psychiatric technicians would identify the patients. Under normal circumstances, the patient would have a wristband on, and the nurse would check it. Unfortunately, most of these patients had gnawed theirs off, and all bets were off in the identification process. It was necessary for a psych tech to be there, also, because oftentimes, the patient would want to spit upon the nurse, throw the liquid meds into the medication room, or just knock the nurse out.  I remember being chased down the hall that first day by a psychotic patient who was intent on pulling off my fake pony-tail. I am sure that everyone had a good laugh. Psychiataric Nursing is a very serious business, and not every nurse has the stomach or disposition for it. When a nurse has accumulated enough years of experience in the field, it makes him or her considered accomplished in a specialty field.  There is ALWAYS a need for a psychiatric nurse!

It was during my time of working with forensic adult and adolescent psychiatric patients, that my son, then eighteen, had his first of two acute manic episodes. So... I would go to work and deal with psychiatric patients, and then come home and take care of a house full of them. I would say, that out of my five children, two are not bipolar. It was always the bipolar ones who were so needy. I worked nights, barely got enough sleep, kept going until I fell prey to the predisoposing gene at the age of fifty-one. It was not that I did not need intervention before this, but I mainly have what is termed "hypo-mania." There are people who would give up their entire estates to live in this state of elation without abrupting psychosis.  Yeah, I would shop....so what? I would play the slots...so what? I would have everyone on the floor rolling in laughter...so what? I never wanted to keep the same husband...so what? I never wanted to keep the same job...so what? I never wanted to keep the same friends...so what? I never cared about security...so what?  I was unstable...yes, what. I had three of my five children taken away by their fathers because they could tell that I was just a little bit too mercurial for parenting their offspring.  My immune system broke down.  It was of course, fragile from birth, but it was the constant "fight or flight syndrome" which my body went through every night at work, as well as the constant chaos that I encountered  with battling exes- with my beautiful children in the balance- that finally took its toll. My entire system shut down.

When I went to the psychiatrist, after I was physically unable to work anymore, he said to me,"What took you so long?" I looked at him and said, "I had the keys." Well, I might have had the keys to the locked units, but I did not have the keys to my unravelling psyche. I had developed a zero tolerance to stress. Imagine this; I am a quadruple minority: Black & Native American, female & disabled. I began writing as therapy, as I have said before. I did not realize that what I wrote would be so vastly interesting.

One side note, I am still years ahead of time. It is not in my mind. It is real. You would have to just know and ask anyone that I have allowed to be in my presence long enough, if it is true. I have written about things far before their occurences. I will give one example. I won an award from the United Kingdom's ForwardPress Top 100 Poets of 2005 for a poem entitled, "Pockets of Evil." It describes terrorist cells, and was written in 1993- a full eight years before 9/11.  I have written other "telling" poems long before I had them published online. Because of the gift of God, called a Word of Wisdom, I am able to see for many miles. My greatest sorrow, is that many people that I love choose to ignore the words for them and are needlessly snared by the cares of life, when a blue-print had been provided showing them where their landmines would be. I have felt like the cursed mythological Cassandra. Those who have heeded words given to them, have prospered. I will continue to use the gift of the scribe, until such a time as I have the unction to cease. I do not do it for "filthy lucre" neither infamy or fame. I do it to help other people understand that they are not alone, and not so strange as they had imagined. I am quite tired, now, that I see ahead. The changing of the guard cannot come quickly enough. If I have spoken truly- in as much as knowledge allowed-then, I would have done well.

Alice Parris

This is because two things have always insured me against shyness:

1) Hypomania and mania.  Both come packed with undeserved, egocentric confidence and buoyancy, the unshakable belief that you're fascinating and witty, nervous, rambling, energy, up until the point where mania spikes into dysphoria and you are an aggressive, raging, paranoid bar-brawler.  I say "you". What I mean, of course, is "I".

2) Alcohol.  Lots and lots of alcohol.

Now that I'm daily dosed up with antipsychotics and mood stabilisers, mania and hypomania is rare.  It has been some time since I've experienced a "typical", social manic or hypomanic episode.  Now, when they come, they come with depression linking arms, and they double up to make the anti-social agitated depression, or dysphoric mania, depending on how bad it is.  Yeah, I'll be talkative, but it will paranoid, fractured rambling.  I'll have energy, but only to scratch and scratch my skin and pace around the room.

So, one of my Shyness Lifejackets has been well and truly punctured.

As for the other, I'm a titular tee-totaller.  As you may have guessed, I wasn't always a Righteous Non-Inbiber.  I was a Lasher, a Get-Smasheder, in short, I was a complete and utter pisshead. I did my native country proud.

I wouldn't say that I enjoyed a drink.  I needed a drink.  The cyclical pattern of the manic depressive who relies on alcohol to function socially is this: hypomania or mania makes you feel invincible, capable and above all, drink-under-the-table-able.  You think you can handle more than you really can, so, it's okay to have the fifth or sixth drink as you're just having fun and being utterly charming with it.  When you're manic or hypomanic (I keep saying "you're" and "you", but I do mean "I".  I find it easier to at least sound like I'm not just renting out my psyche to you), excess is natural.  So, if ordinarily you're a social drinker, you will drink. A recreational drug user, chances are, you'll wave cheerio to your nasal structure.

Then, of course, there is the flipside.  When you're depressed, you feel self conscious and unworthy.  You would stay indoors, but you've been dragged out, you reason, "This might cheer me up" or there's a birthday and you'd feel incredibly guilty if you didn't attend.  And more guilt is the last thing you need.  You get there, to a pub or club or whatever (being that I'm twenty two, it is more "pubs" and "clubs" than whatever) and feel absolutely wretched and almost transparently suicidal.  You accept a drink like it's a lifeline, and, momentarily, you find yourself easing up.  The tension unknots itself, you giggle a little, and drink more, and more, and more, until you stop laughing, start crying and shuffle home in the probably by now founded belief that everybody thinks you're a tiresome, maudlin, unstable bore.

Herein lies my problem; my moods are truly rapid cycling, so, to one degree or another, I have always occupied either category a or category b.  Therefore I was a flagrant abuser of alcohol and always came across as extremely loud and extroverted or extremely depressed, even though I am actually a rather shy and introverted.

I had to stop drinking, for many reasons.  The ones I cite most often, being the most socially acceptable of my rationale, is that I simply can't afford to drink.  This is true.  Alcohol, especially in London, is fantastically expensive.

The other back-up reasons are medical: my medication interacts with alcohol and massively lowers my tolerance to it.  One drink gets me as pissed as three, and obviously feeling more uninhibited means that I drink more...  And that! my friends, is dangerous.

Then there are my personal reasons, and Rob's reasons.  Rob's reasons are observable things: alcohol makes any psychosis I am experiencing much worse.  Vicious cycle again because when I am going through bouts of psychosis, one of the first things I usually do is drink to try and drown it out.  That's frightening for him to witness and finding me in the street pissed and psychotic shouting at the sky isn't pleasant for him. Alcohol ballses up my moods even more.  If I'm hypomanic, a bout of heavy boozing will kick me higher up, if I am depressed, then further down. It also makes me very impulsive, and that was never pleasant for Rob either, pulling me away from strangers I was propositioning or clearing up blood from self inflicted razor cuts to my face.

The main reason is that I have made an ass out of myself drunk.  And that's after four years of making an ass out of myself while manic, too.  So the niggling worry that I am a pain in the hole to be around has quite rightly been realised:  I am a pain in the hole to be around, often an utter embarrassment, waking up the next morning struggling through blackouts and then feeling paranoid the next time I see someone.

I became sick of waking up and thinking, "Oh fuck" and spending days and weeks afterwards in a shame spiral.  My "antics", once funny, became exhausting and laughable, to me, at least.  I was, for a while, that Crazy Irish Girl, but as time wore on, and it became painfully clear that "crazy" was literal, it became sad.  That's not why you go out with your mates.  You want to talk rubbish and about bands you like and opinions you have and smoke and giggle, not worry about someone, or listen to them sermonising on shit.  It's okay to support your mates through life stuff, but I feel that after lots of death and mentalism and such, that's a bit too much, in its relentlessness.  I feel that way about my life.  I remember all the texts and cards I got when I was in hospital and it was so lovely, it made me cry.  But I didn't snap back to sanity, although I am trying.  There can't be more crisis' because it's draining not only for me but for the people around me.  I want there to just be loveliness and fun and laughing.  It's been five years of going insane.  Enough already.  And being mental, I felt a bit like I was just taking from people, rather than giving.  I want to give more but until I'm un-anxious-a-fied, well.  I have the stupid habit of systemically pushing people away in defence.

I quit drinking in January after a particularly bad run, and necessarily curbed my sociability as not to tempt me.  Everyone has been so positive about my quitting the booze, but it's been fraught and killed my social life.  Not because I'm not wanted around (I do go out, sometimes) but because I am so bloody anxious.

I know that's taking it all rather seriously, and that I should just "relax"...

Which leads me back to shyness.

I am very shy, and suffered from terrible social anxiety in the few years before I became seriously ill.  It was partly related to my problems with body image- I believed, like I often do now, that people would outright laugh at me for looking so ridiculous.  It was also because I was bullied very badly for a long time (not just verbally, extremely, extremely physically, too), so my self-esteem was zero.  Coupled with a burgeoning career in Bad Mental Health, going out and making friends was not easy for me.  Consequently, I made some pretty poor choices of friends who hurt me, and further pissed-up my already rather fragile sense of self worth and trust in people. I was one of those quite mental teenagers (mental in the sense of mental as I am now- I started my career of mentalism at around twelve, and it accelerated rapidly into very full-blown manic depressive illness) who nobody really liked, and those nobodies made it clear that they didn't really like me.

I'm only twenty two now, so my teenage years are not far behind me.  The situation back then was so bad (as was my health) that it was the catalyst for my hasty exit from my hometown, no goodbyes, no real warning.  Rumours abound- I'm dead, or mad, or dead mad- but I don't care enough to ever go back and correct anybody.  I do have a sort of mythology there, which my sister often makes fun of me for.

Pains and worries that shyness and anxiety encapsulate are self-fulfilling prophecies.  A lack of alcohol, the awareness that I shouldn't mention any of my personal problems lest I start rambling and the slightly clipped manner than medication has instilled in me has made sociability a nightmare.  Because I am so nervous, I end up doing all the things I don't want to: haltingly blurting out a personal problem, then nervously trying to cover up for myself by rambling, then feeling so self conscious that I can't properly focus on a conversation, then my concentration slips and I lose the thread entirely, so I end up saying something rather odd, which lands like a lead balloon, and then I feel too stupid to contribute again.  I also have very little to talk about, being that my life is pretty much spend most of my day alone, have no money or no job and feeding the cats.  Just idiotic, simple things like a conversation with another human bean has become so stressful to me that I avoid it.    Everyone feels this way to a degree.  My degree is just more steep than some others'.

I do analyse things preposterously.  I should just suck it up and go out and try to gradually get back into the swing of things, because I do really like the people I know, and they make me laugh.  But as time has flown by, my doubts and worries have morphed into real, concrete anxiety, and I find socialising more and more difficult. I started a few months back to have panic attacks again about it.  When I do go out, I cling to a wall and leave early.  Now I am in danger of becoming properly reclusive.  I'm okay with Rob, but that's it.   I even find it hard to cope with my family, so I am both dreading and looking forward to my birthday, when my older sisters are visiting.  Of course, the pressure is then to organise something, as I'm turning twenty three.  I would truly love to, there is no greater pleasure and joy of spending your birthday with lots of people who you think are great, but the actual sociability of it now petrifies me.

When I have to, I can do it.  I get through it, but worry afterwards.  It's something I really need to work on before I become a hermit.  You'd think, since I write so openly, that I must be an incredibly forthcoming person in the flesh.  I am with certain people, and in certain states of mind, but writing to me is the ideal form of communication- revisable, patient, nonjudgmental.  And it's something I do when I'm alone, and I'm alone, a lot.  I mostly speak to my friends via blogs, and I talk about my life on Livejournal, which is friends only, as a way of keeping people up to speed, and as a way for me to spy on people's lives.  But I delete a lot of what I write there for fear of "exposing myself" or of it seeming that I am asking for help.  I don't use the phone or usually initiate contact with people- something I've been told off for in the past.  To me, though, it's just intrusive.  I don't like to bother people.

It's quite sad, to me.  I do occasionally miss the flushes of hypomania, and the early days in which people knew me, when they thought I was just unique and interesting.  I'm sure I still am.  I'm naturally an extrovert, but also shy with it.  If you get me comfortable, then I am forthcoming, and occasionally funny, and silly, and argumentative.  I am not shy enough to not take the piss, or disagree, or descend on a rambling, nonsensical stream of consciousness.  But the comfort is very elusive now because I am anxious all the time.

It's one of the things I miss most about Brendan.  He also had alcohol problems, in far, far greater excess to my own (which led me to not inviting him to my last birthday.  I bitterly regret that now, but it's because he was he was having problems with drinking again, and people would be getting pissed.  The last time I had bought him to a pub, he found it so stressful and upsetting that he left abruptly and cried at home.  It was part out of concern, and part, I guess, selfishness, since I watched my father carry on down Brendan's path, and it was excruciatingly painful.  I always told him I'd talk to him in any medium- phone, smoke signal, MSN (where we spent hours and hours and hours talking with each other) but not in person when he was drinking heavily, because I felt I'd be facilitating it, when I wanted him to stop.  When he was drinking, though, I did sometimes get him to come round to mine instead so I could keep an eye on him.  He was angry at me, though, and I missed him terribly on my birthday.  I wish I had just not said anything, and made another memory with him).

He suffered from depression.  Like me, he was prone to bouts of silence and sullenness, and also madness and making-a-dick-out-of-yourself-ness.  I was completely comfortable with him, and in many senses, he was my best friend in London, though not the one longest held, nor seen most often (due to the above mentioned depressive silence).  I don't know if he felt the same about me, though sometimes he said he did, and did refer to me, at least to me, as one of his best friends, though doubtless he was sometimes pissed at me for my attitude to his drinking.

He never judged me, even if he disagreed with me (which was often the most fun of all), and I could tell him anything.  Most people tend to be uncomfortable with Tales of Mentalism, but since he'd been there too, I could regale him with my tales, and it would make him laugh.  He'd be the same with me.  I know the most ridiculous and shocking things about him, some good, some bad.  I loved him dearly, and I think he loved me too, and he was only of the tiny minority of people that I could meet one on one, stone cold sober, and have fun with.  He also had the best sense of humour- he was riotously funny and extraordinarily talented- and liked most of the same things as me.  I looked up to him as a writer, he was incredible.  He was just a wonderful, frustrating, sad, brilliant person to know.   I am still shellshocked by his death, I still only cry when the muddle and jumble I deliberately fill my brain with to avoid things like grief slump for a moment.  I miss him, very much.  I wish I had talked to him more before he died- he went to America for a few weeks, and when he came back, I going through a bad patch, mostly unreachable by any means, and the last I heard from him was a voicemail he left on my phone on the Monday, saying he was around (he worked near to me and lived five stops away) if I wanted to come and meet him, but I was depressed, and asleep, and by the Friday he was gone.

I haven't really talked about it to anyone save for two of his friends (one who I have lost touch with) and his sisters, but when I do, I feel as though I'm intruding on their grief.  I like to listen but feel guilty if I interrupt with my own feelings.  People always have enough of their own stuff that they're going through.  But I do feel lonely, a lot, because I don't know who to talk to. It's ridiculous, isn't it.

I need to get over all this, and work on it, so that I can be a Normal Person and go out with my friends, and stop being so analytical and worried.  And maybe make some new friends, too, and go to the supermarket without feeling paranoid.  I need to Get Out There before this gets out of hand and I drop out altogether.

All of this must be very unattractive and intimidating to read. I would like for you to have an image in your head of me being capable and erudite, clinking glasses and reading aloud from Donleavy.   I hope you understand that I'm not attempting to be self-pitying, merely, as always, attempting to articulate another aspect of being mentally interesting.

I'm going to see my friend in Brighton on Saturday.  I haven't seen him in ages, so hopefully it will be nice.

This has been another post Wildly Varying In Tone®.

Stress. It's bad for the MS--a common relapse trigger. But it's, perhaps, even worse for the Bipolar. I had gotten through so much of the week without any hint of hypomania, and any given point in the week, up until the tumultuous final days, could have triggered it.

Now, this is a watershed moment for me. I love the hypomania. I love how it makes me feel and how much I am able to accomplish when I can stay up for days. I am finally recognizing the downside to those feelings. I do not like the inability to concentrate and sit still, like a crazed person on meth. I do not like the intense state of depression that typically follows the high. My psych professionals will be pleased with my ability to make those statements.

Anyhow, point being, my meds appear to be working, and the basic triggers did not send me flying. I feared that the final day of decompression would have been too much for me and that I would not be able to overcome the aftermath. From what I've heard, I was probably right.

Good things did happen, and it was overall a very positive experience for me. I love my community of sex workers' rights activists. I love the desire to learn and grow, to improve and refrain from making the mistakes of those who came before us. I love SWOP Chicago and SWOP NYC. I love Margo St. James and Carol Leigh. I love Robyn Few and Stacey Swimme. I love Melissa Ditmore and Renegade Evolution. I love Valerie from SWOP NorCal and Yola from SWOP East. Through all the stress and anxiety, I hold on to what I love and look forward to building upon our shared goals.

(I love more individuals than those listed, and possibly should not have listed any names at all. But this is my heartfelt release, and I can choose to do as I wish.)

I'll be visiting NYC this fall. If you're in the area and you're interested in meeting up to talk about sex work activism, please drop me a line.

I hate that I have this, but I am glad that I now know what is going on with me.  God can choose to bring healing in whatever form he chooses in His own sovereign way.  Perhaps that will mean a pill.  I wouldn't wish this on anyone else, but I look forward to the benefit God will reap from the situation.

So! Here are some tips to coping with the psychiatric appointment. Enjoy!

1. Look Like Shit

Everybody knows that Mentalists don’t know how to take a brush to their teeth and hair. Even if, in fact, you haven’t done so for a week, don’t let social graces impose upon the day of the psychiatric appointment. You may want to tart yourself up a bit for the sake of politeness, but mental people don’t care about their appearance, and if you do, then you don’t have any mental problems at all and the psychiatrist will know that.

Dribble some, neglect to use deodorant, throw on your most stained slacks and, if you must wear make up, apply it with the skill of a drunken two year old.

If you have Body Dysmorphic Disorder and are pathologically terrified of leaving the house looking anything less than perfect, remember to leave at least an hour before you head off to your appointment to have your panic attack. Don’t let your panic attack infringe upon the psychiatrist’s precious time. And also remember that BDD is just Latin for “vain”.

absolutely brilliant. i'm now about to move on to other parts of the website's guide, and i won't bore you by listing each and everyone here with a new post each time. just go check out the site, and enjoy.