There’s a Wired article called Anakin Skywalker: Borderline Personality, Bipolar or Narcissist? that I found via stir-crazy, they found via Mind Hacks, and they found via Omni Brain. I’d especially recommend reading both the Wired story and the Mind Hacks post.

I only have a few comments to make:

1. Hee.
2. Hey, I’ve been told I have bipolar disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder, just like they’re saying about Anakin Skywalker. This can mean one thing, and one thing only: I AM DARTH VADER!
3. The article reminded me right away of a humorous article I’d read years ago in the Canadian Medical Association Journal, “Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne”, so I was extremely happy to see that the Wired story linked to it.

Admittedly, though, I don’t actually think I’m borderline, and I know I’m not histrionic or narcissistic.

According to the authors, who reported their findings at the American Psychiatric Association’s annual meeting in San Diego, Skywalker meets the criteria for the condition: He has difficulty controlling anger, stress-related breaks with reality (after women in his life die or leave), impulsivity (dangerous pod racing), obsession with abandonment (those women again) and a “pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of ideation and devaluation” (hello, Obi-Wan).

In another sign that he’s borderline, the authors argue that Skywalker suffers from an “identity disturbance.” After all, he did become Darth Vader after being “very unsure of who he was and what he wanted.”

I don’t have difficulty controlling anger, obsession with abandonment, an identity disturbance, or a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of ideation and devaluation. I am impulsive and have had stress-related breaks with reality. Well, I can live in hope that those two things are enough to MAKE ME DARTH VADER, can’t I?

What is the best treatment for one who has been drawn to the Dark Side of the Force? The opinions of professionals are mixed:

Study co-author Bui said psychotherapy — “long term,” he added with a laugh — would be the best treatment for Skywalker, although he might prescribe a drug to help him sleep.

Bui had mixed feelings about prescribing an antidepressant like Prozac and said he’d avoid tranquilizers like Xanax that could leave Skywalker addicted or send him into “disassociation” (a rupture with reality).

But would Skywalker even go into therapy? “Because of his narcissistic tendencies he would perceive himself as ‘above’ that,” said Sultanoff, who thinks Skywalker also suffers from narcissistic personality disorder, at least in Star Wars Episode II.

I’m going to assume that by “disassociation,” Randy Dotinga means “dissociation.”

Not that there’s much point in trying to help Anakin at this point. He’s dead, yo. Remember?

thememoryartist recently made an excellent post, A new proposal for the DSM, which “outlines and categorizes the features of Mental Health Professional Personality Disorders.” It’s funny because it’s true. Which also, of course, makes it sad. I’ve seen plenty of mental health professionals whose behaviours and attitudes are outlined very well by those criteria.

In a comment, Gianna mentioned that the post might be educational for mental health professionals. I’ve met some MHPs who would appreciate it very much… but they’re not the ones who tend to exhibit any of the listed behaviours. I think the ones who actually exhibit the “symptoms” would see that piece of writing as an example of a patient being narcissistic and overly hostile, and would never recognize themselves in the criteria.

There are also a lot of interesting comments on this post about PTSD misdiagnosed as BPD.

I am doing okay physically with the Zoloft and Epival withdrawal. I didn’t even have any of the brief dizzy spells yesterday. I was, however, staring at a word on a computer screen when I saw it suddenly jump several inches to the left, even though this did not really happen. I am hoping that this is just a regular hazard of the twenty-first century, as opposed to a withdrawal thing.

As I mentioned in a comment on my last post, medication withdrawal has made me kind of stupid lately, though. I can’t remember anything, my attention span is even worse than usual, and… um, I already forgot what I was going to write in the last part of this sentence. Oh, yeah, I’m constantly almost late for stuff. Since none of this has been interfering with my work performance, it’s not really all that important. It just bugs me.

Tomorrow I get to see my GP and I hope I’ll get my prescriptions. I have to pay forty freaking dollars for the cab ride there and back, because there’s a shortage of family doctors here, no bus service to the neighbouring town where my doctor is, and I don’t have a car.

The main annoyance that is occurring since I am currently off my meds is that I’ve been having very brief dizzy spells. I also have even less of an attention span than usual. It’s hard to settle down and read books or web sites. Disorganized, forgetful, etc. My mood is very good, though. Except for when it isn’t. It happens suddenly, without warning, and goes away suddenly, too, and the rest of the time I am quite peppy.

It turns out I shouldn’t have been sulking about my one-day weekends, because next weekend I personally get a zero-day weekend. It’s not as if I have to work eight hours every day, but still, it’s just nice to have an entire day where you know you don’t have to be at work for any of it.

I am thinking that I should be more Organized and learn how to Manage My Time, so maybe this will be my newest obsession that I will research, and maybe I will try systems and labelling and colour-coding and be very gung-ho for a month and then forget about it. Or maybe it will work. You never know.

I haven’t been around for a while. I’ve been trying to use my scant amounts of free time lately to do things like reading, crafting, and interacting with people offline. I am bummed that most people around me just had a three-day weekend and I had a one-day weekend. I am not physically tired, but I still wish I had some time to relax lately, which I don’t. I am also so disorganized that I didn’t really notice that I was running out of my medications, and I won’t be able to see my doctor and get my prescriptions until next Thursday. I am used to having doctors who will phone in prescriptions, but since my current GP doesn’t, calling my doctor when I had three days’ worth of medication left was as useless as calling after I’d run out completely. I’m on such a low dosage of Epival that I don’t know if it’s possible for anything horrid to happen to me if I abruptly stop taking it for a bit, but I’m taking those last three days’ worth every other day instead of every day, just in case that will lessen my chance of suddenly having a seizure or something. I don’t have a seizure disorder, but stopping Epival cold turkey can make people have seizures even if they’ve never had one before. Whee.

Everybody has already read about this study and its claims that there is something called “subthreshold bipolar disorder,” and as far as most of us can tell, SBD equates to “simply being human, but big pharma thinks you need antipsychotics for it anyway.” I’m lazy, though, so I haven’t commented upon it until now.

CL Psych posts about the incredibly loose criteria for SBD and the media’s claims that there is “appropriate” medication for it in Subthreshold Bipolar: The Giant Sucking Sound and Subthreshold Bipolar: Media Blitz and Lilly.

Philip Dawdy has also written several posts about subthreshold bipolar disorder, including Name The New Bipolar Disorder, in which he urges people to come up with a better name for SBD. I haven’t come up with anything yet, or rather, I haven’t come up with anything that no one else hadn’t thought of and posted already!

I am vastly confused by the stats from the article in the Archives of General Psychiatry. No, they’re not too complex for me to understand; they’re too stupid for me to understand. Only a 2.4% prevalence of Americans who, twice in their lives, meet half of the criteria for hypomania? I would expect it to be more like 99% than the 4.5% it winds up as in this study once you add the 2.4% to the 1% prevalence for bipolar I and the 1.1% for bipolar II.

I am more of a fan of the bipolar spectrum than some people in the blogosphere are, but this subthreshold nonsense is taking things way, way too far. Honestly, sometimes I like the things that Akiskal has to say, and he’s one of the authors of this study. Some doctors overdiagnose bipolar disorder, and most people who diagnose it overmedicate their patients. But there are still plenty of health care professionals who don’t recognize bipolar disorder. Sometimes, it’s not their fault — they don’t see the patient when he or she is hypomanic, and even if they do ask him or her about past symptoms of hypomania, the patient, in the middle of a depression, is pretty much unable to remember ever feeling okay, let alone hypomanic, and doesn’t — can’t — answer accurately.

Then sometimes there are shrinks who think you’re not manic-depressive if you haven’t, like, married someone you’ve just met and then bought five cars. Doctors who think mania equals euphoria and if you’re having a dysphoric mania, you’re just an asshole. Who think that mixed states or rapid cycling must always be borderline personality disorder instead, and even, believe it or not, doctors who are always going to assume that if you’re psychotic, you’re schizophrenic.

Yes, this “subthreshold” stuff is ridiculous, but within limits, I like the idea of the bipolar spectrum because it makes people aware of things that actually are bipolar symptoms but aren’t necessarily the most classic ones. It’s when you start pathologizing mild things that occur infrequently that it gets to be harmful.

No, I don’t know where the line should be drawn. But I’d say somewhere way before “subthreshold bipolar disorder” as defined in that journal article, anyway.

Nearly two weeks ago, there was a post at intueri, Suicide by Overdose Is Not Painless, that I’ve been meaning to link to, but kept forgetting. It’s a good overview of what overdosing can do to a person, since so many people assume that taking an overdose of nearly any drug will make you unconscious instantly and dead soon afterward, which is of course not the case.

It is also nice for someone to recognize that many people who overdose haven’t done their research and think that overdosing on pretty much anything has a good chance of killing them. There are plenty of health care professionals who assume that since they know that a particular dosage of a particular drug has no chance of being lethal, the general public must know this as well. This leads them to believe that all suicide attempts with low chances of lethality can’t possibly be “real” suicide attempts, that they’re all “cries for help,” manipulation, or pleas for attention, and that these people don’t really intend to die. Some people who take what seem to be obviously non-lethal overdoses truly do intend to die, though, and the only thing saving them is their own ignorance. If they were taken seriously and provided with proper help, maybe it would lessen the chances that they would attempt suicide again.

On the other hand, there are also doctors who have no idea that the amount of drugs a patient overdosed on is likely to be lethal. Or at least there is one doctor like this, because I saw him. That’s a story for another day, though, when I have time to tell it. Since I often seem so down on mental health professionals (and I have seen some good ones, although I’ve seen more bad ones), I’d like to be an equal-opportunity whiner and mention that he was not a mental health specialist, but an emergency room doctor.

I’m still rapid cycling. At first I was keeping things under control so well that no one could tell there was something wrong. Now I’m keeping things under control so well that only my boyfriend can tell there’s something wrong.

I don’t want to lose any more control than this. I don’t want friends or coworkers or random strangers to know that there’s anything wrong.

Last night, irritated as hell by everything, wanting to knock down pyramids of cans displayed at the grocery store, just because they were there, but not, of course, doing it. (I say “of course” as if it’s a given that I wouldn’t do such a thing, but I guess it’s not. Just because I haven’t before doesn’t mean I wouldn’t ever. Although I don’t think I would.) The night before that, crying and crying and crying and thinking that there was no point to anything.

Tonight? Happy and peppy. Tra la, tra la. Hey, maybe I’m finished with the rapid cycling for now. Maybe it’ll stay this way. Hey, maybe I’ll be happy for the rest of my life! Tee hee hee.

I am doing better with the eating thing, mainly because I seem to be getting some of my appetite back. So now I am eating food and feeling guilty about it, which I guess is progress from eating almost no food and still feeling guilty.

There were plenty of Important Topics that I would have liked to post about in the past few days, but I could never manage to unscramble my brain enough to actually do it. Now I can barely even remember what they were. Maybe tomorrow.

I have to take my Zoloft with food. If I don’t have enough food with it, I get this horrible feeling in my throat, like choking to death, only I can breathe okay. I realize that this description makes no sense unless you’ve had the same feeling yourself, but that’s what it’s like. It’s not exactly pain, but it’s extreme discomfort. This particular discomfort feels a lot worse than some things that cause actual pain, and when I experience it, it’s all I can think about until it goes away, which usually takes about two or three hours.

The first time this happened to me, which was over eight years ago, I didn’t know what was going on and I was terrified that I was going to stop breathing and die. Luckily, when it happened again the next night, I quickly figured out that I should probably eat more food when I take my Zoloft. This was a completely random guess, a shot in the dark, but it turned out to be correct.

Occasionally, the amount of food that is generally enough to prevent the choking feeling will not work, and I will still be in extreme discomfort, despite having eaten the same amount that I usually do before I take my Zoloft. Tonight, I ate more than I usually eat before taking my Zoloft. I ate more today than I’ve eaten on any other day in the past two months, without throwing any of it up, and I was all proud of myself for my progress with the eating disorder thing. I ate lunch. I ate supper. I ate a good-sized snack and then took my Zoloft and Epival. And I still feel kind of like I’m choking. It’s not as bad as it usually is when it happens, thank goodness. Moderate discomfort as opposed to extreme discomfort — if it was the extreme choking feeling, there is no way I would be able to type this right now.

When I have a really bad night with the choking feeling, then I really don’t want to take my meds the next day. Or any time in the near future, really. There’s all this trepidation and uncertainty. Usually, I eat something and take my Zoloft and I feel fine, but other times, I eat something and take my Zoloft and feel like there’s a giant hand closing around my throat.

Does this happen to anybody else? I once had a doctor tell me that this side effect that I was experiencing did not exist. If he traded esophagi with me and took some Zoloft without food, he would never say that again.

Philip Dawdy’s post Texas Teen Commits Suicide After Taking Lexapro contains a link to a streaming video of a newscast. At one point in the news story, the dead girl’s father talks about how Kayla was going from highs to lows, typical of most teenagers. Then the newscaster’s voiceover says, “But when the highs became higher and the lows lower, a doctor placed Kayla on Lexapro.”

Now, it’s very likely he could have gotten this wrong. The media gets quite a lot of things wrong. But if he’s right, and Kayla was vacillating between abnormally low lows and abnormally high highs, then it’s not just Forest that her parents should be thinking of suing. Prescribing an antidepressant alone for someone who shows signs of being manic-depressive is criminally stupid, especially if you don’t provide them with adequate information and follow-up care.

I am tired of tragedies happening to families all because of people who should know better, or who should care, and don’t.

“My head is killing me, my throat is killing me, my stomach bubbles with toxic waste. I just want to sleep. A coma would be nice. Or amnesia. Anything, just to get rid of this, these thoughts, whispers in my mind. Did he rape my head, too?”
~ from Speak by Laurie Halse Anderson

Last night it occurred to me that I should mention there is an additional reason for my recent rapid cycling. May 7 is the anniversary of the first time I was raped, and I don’t do well with anniversaries. “Last night” I couldn’t fall asleep until 8 a.m., and I have been all over the place — tearful, then relaxed, then snappish, then hyper, and so on. I’m at the point where I wouldn’t even mind being depressed and staying that way for a bit, because it’s so jarring to keep abruptly going from fine to Definitely Not Fine.

I am expecting tonight to be bad, but maybe things will ease up somewhat in the next couple of days.