I started this blog a year ago today, but I’m far too tired to come up with any blogiversary-worthy Deep Thoughts about What I Have Learned in the past year. I’ve been really tired all week. At first I worried that I was getting depressed, but then I realized that almost everybody I know has a cold or the flu or some virus or other. I am not sick, but it seems highly likely that trying to stay not sick is completely exhausting me. Being run-down like this is certainly better than having stomach flu, though, so I ain’t complaining. Since I am not up to spewing forth Really Deep Thoughts (not that I ever am), instead I will simply share with you what are probably my favourite lines of poetry ever:

On a razor edge of reality,
I knew I would come out of this, bleeding and broken,
and singing.
~ Gwendolyn MacEwan, “Deraa”

Speaking of What I Have Learned, yes, it’s true that a year ago, I knew that I had already come out of “this,” bleeding & broken & singing, and that I would be likely to do so repeatedly. I do become surer and surer of this fact as time goes on, though, and I guess that’s a kind of learning, too. Sometimes I forget that I’ll get better every time I get worse, but I have been remembering it more and more often in the past couple of years, and for longer and longer periods of time.

Interesting post at Furious Seasons recently (heh, as if there were not an interesting post there nearly every day!) regarding manic depression as a dangerous gift, as a personality disorder, and as something from which one can completely recover.

I know I am going out on a limb here that someone will likely chop off for me, but I believe that much of what we call bipolar disorder is in fact a personality disorder or constellation of behavioral issues.

I’m not looking to chop off this limb. I view manic depression as a dangerous gift as well, and as something that maybe at least some people can completely recover from. I also understand that Philip is not saying all a person with bipolar disorder has to do to recover is pull themselves up by their bootstraps:

I think bipolar disorder can be a personality disorder–and, nitpickers be warned, I am using the term very broadly–more often than it is a mental illness.

Depression–and here I am not discussing major or clinical depression–is widely known as having a huge personality component.

Mania itself–and here I mean the bad old wild delusions, hallucinations and declarations of Godhead mania–is not a personality disorder. When it’s in full flower, mania is straight-up insanity.

Dysphoric mania is possibly the least fun thing in the world, but there is at least one good thing about it: once you’ve recovered from an episode of psychotic dysphoric mania, it’s really hard to convince yourself that it was a character flaw. You can easily convince yourself that you weren’t depressed, just stupid and lazy, and that you weren’t hypomanic, you were just being a silly, reckless whore… but after having auditory hallucinations for a few weeks straight, once I finally stopped, I realized that something had been really wrong and that this time it wasn’t my fault.

I was aware that most of the time, medication either made me a zombie or made my moods even worse. So sometimes I would stop taking medication, be fine for a few months, and then be much, much worse than before. I learned to do things that sometimes stopped mood episodes, but more often just allowed me to cope with the symptoms I experienced, so that I functioned very well as one of the walking wounded. For quite a long time, I honestly believed that there was no such thing as getting better, there was only becoming a better liar, so that you could hide your pain from others and even from yourself. Or at least I thought that was the only option for me, because I’d read about other people who were asymptomatic for long periods of time, who claimed to experience “growth” and “healing.” I didn’t disbelieve them, but I didn’t think that anything would work for me. I tried CBT, DBT skills, family therapy, couples therapy, group therapy, exercise, meditation, hospitalization, acupuncture, journalling, medication, medication, medication, and other stuff… but the hits just kept coming. I kept getting depressed, I kept getting hypomanic, and I kept getting manic.

Some of those things helped. Some didn’t. (Acupuncture, for instance, was supposed to make me less stressed, but instead it turned me into a stressed person with needles in her ears.) For nearly a decade, though, none of them prevented me from having mood episodes, which I dealt with using a combined method of actual coping skills plus being way, way too hard on myself. I have been essentially non-syndromal for the past year, though, and it seems to be solely because I’m finally on medication that’s working for me.

I am better, and I want this to be an accomplishment. I wish this were something I could take credit for. But it’s not.

The journey to get to this point was so long and arduous that I want the current solution to be complex. (I say “current solution” because although this has been the solution for the past year, I don’t assume it will be the solution that works best for me forever.) It’s not complex, though. It’s not intricate. I-take-two-pills-a-day-and-now-I-am-well. If I am experiencing any side effects, I am not aware of them. I still have emotions. I can cry when really bad things happen, I can take joy in something as simple as seeing furry gray squirrels race across tree branches, and I can write really bad fiction.

Despite how hard I tried to get better, I still can’t take any responsibility for it. It’s true that I learned plenty of things along the way, including just how vast the extent of my own ignorance is (and how ignorant many of my doctors were), but nothing I learned was instrumental in my actual recovery. I tried and tried and tried to save myself, yet I did not.

I wish I’d fixed it. I know I should be careful what I wish for. I’ll say that I wish I’d slain the dragon myself and the next thing you know, the meds will poop out and the dragon will pop back up, all scaly and fire-breathing, saying, “You called? Here I am, bitch. Come and get me.”

But still. I wish I’d fixed it.

I’m going to assume without even checking that everyone in various mental health blog circles has read this story already. The original article was published five days ago, which in Internet time is the equivalent of about eight thousand years. I link to things I find interesting more so that I can find them again if I want to than to point them out to other people. I don’t actually want to think about this ever again because it makes me feel sick, but unfortunately it’s not the kind of thing that anybody can afford to ignore. I have way too many things to do right now to take the time to make any kind of thoughtful commentary, and really, I’m glad about that, because I suspect that words would fail me if I tried to say anything about this unfathomable cruelty.

Oh, and if you want to know the name of the vile excuse for a human being who emotionally tortured Megan Meier, you can find it in the comments on this post. Her address and phone number are there, too… that is, if she hasn’t changed her number already.

Never thought I’d see the day that I’d consider myself lucky that when I was thirteen, the ex-friend who bullied me told me to my face that I should kill myself. But I got through stuff like that much better than I think I would have if her mother had also been fucking with my mind, too.

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.

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.

Welcome to Rapid Cycling. Population: me.

(The image above is a magnet I have on my refrigerator.)

Lately I have been up-down-up-down-up-down. Usually rapid cycling is a February-March-April thing for me, and I start easing out of it around this time of year. Susan at Bipolar Wellness Writer recently wrote two good posts about seasonal aspects of depression and manic depression, Ebbs and Flows and Seasonal Affective Disorder. I can relate, as there is definitely a seasonal component to my illness.

I tend to have an overarching mood pattern of being very depressed from late September to early February, then hypomanic/manic until mid-May, then relatively normal or mildly hypomanic until late September. But I also tend to have cycles within cycles, especially in the February-to-May cycle. Then I often bounce from euphoric to dysphoric hypomania (and occasionally mania) to depression and back again, in random order, for random periods of time. The spring is my prime rapid cycling time, but that doesn’t mean it never happens at other times of year. I usually feel good during the summer, but sometimes I have episodes of depression then. I’m usually depressed during the fall and early winter, but sometimes I’ll be Doing Just Fine or I’ll have brief periods of hypomania.

For nearly five months, I have been Doing Just Fine with some ventures into mild hypomania now and then. For the past few days, though, I have been up and down frequently. I know some reasons why, of course. My current jobs have very variable hours and I don’t do so well when I’m not following a stricter schedule of sleeping and eating and working and leisure time. My problems with finding adequate treatment have also been frustrating me lately. (Experimental Chimp does a good job of blogging about his struggle to find adequate treatment, by the way.)

You ever notice that if someone already has you tagged with borderline personality disorder, then any time you admit that an actual life stressor is affecting your mood somehow, it’s seen as further confirmation that you have BPD? I know there’s supposed to be a “marked reactivity of mood,” but aren’t manic-depressives, or, God forbid, even people without any psychiatric diagnosis, permitted to have some reaction to things that have actually happened to them? And when some of those things are clearly physical reactions rather than psychological ones, too? It’s not rocket science that I’m going to be more unstable when my eating and sleeping and general living patterns are irregular.

Just an observation. I mean, I know that I currently don’t make a strong case for my own point at all, as my extreme rapid cycling as of late is actually typical of someone with BPD. I mean “extreme” in the sense of frequency/length of episodes and not at all in the sense of the behaviour that I am exhibiting. The most “extreme” I’ve been behaviour-wise lately was that Tuesday I cried a bit, and only the mental health nurse saw it the first time and nobody saw the second time.

At this very moment, I feel great, just so you know. At this very moment, I can’t imagine being depressed about anything. Don’t you love how even in the middle of rapid cycling, somehow I manage to firmly believe that whatever mood state I’m in is permanent?

I love Stephany’s post Who is a mental health advocate? Read it.

If you know where the title of my post came from without having to Google it, then I love you.

If you have not yet checked out The Bipolar Disorder Blog Reader that Jon at Living with a Purple Dog created, you really should. It’s a great way to get a quick look at what blogs are out there and who has updated recently.

Ruth at Off-Label wrote a post titled A stigma wrapped in a history inside another stigma - that will probably never make it onto a t-shirt, about the stigma of the borderline personality disorder label within the c/s/x movement, and since my worrying about being an attention whore helped trigger it, I thought I’d talk about it. On and on and on about it. My post might not make much sense if you don’t read hers first, so you should read hers first. Some of this I first posted as a comment on her blog, but when I realized how long it was getting, I decided I’d take it over here:

Oh, don’t worry. It’s already made it onto a T-shirt. If I believed I had BPD, I would be perfectly willing to wear that shirt to any place that I would be willing to wear my “BIPOLAR PRINCESS” shirt.

I don’t think I have BPD, but I am well aware that I have some BPD traits, namely that I have mood swings, I used to cut myself, I am sometimes impulsive, and occasionally psychotic and dissociative. Although I think these are better explained by my diagnoses of bipolar disorder and PTSD, I’m open to the idea that maybe I could have BPD, or am possibly a recovered borderline still exhibiting some traits, or that DBT skills might help me regardless of diagnosis. I’ve got two volumes of Linehan and a copy of Get Me Out of Here by Rachel Reiland sitting in a pile of books on my floor, that’s how seriously I take these ideas.

I often wonder if BPD is a useful diagnosis at all… but I’ve met people both in real life and online who were diagnosed with BPD, who agreed with this diagnosis, and who are wonderful people. Because they feel that BPD is a useful construct for explaining some of their feelings and behaviours, and because some of them have received treatment for BPD that they feel has been effective, I don’t feel qualified in saying it must be purely complex PTSD, or it must be purely a different form of bipolar disorder, or it must be ONLY a label docs slap on women they don’t like. Since I don’t identify myself as having BPD, who am I to invalidate the experiences of people who do identify as such?

I couldn’t say whether the stigma of being an attention whore is greater than the stigma of being bipolar in the general population, but there’s definitely a stigma in the c/s/x community against borderline personality disorder. I don’t think, however, that this is usually because those of us in the c/s/x community actually look down upon people who have been diagnosed with BPD or who we perceive to be attention whores (note the “or” there: I’m not saying that these people are one and the same). In some cases, I’d say this is true, but honestly, I think most of us, including myself, are terrified of ourselves being misdiagnosed, or even correctly diagnosed, with BPD because we know that most mental health “professionals” will see it as a license to treat us like crap.

Last year I had the particular misfortune of being seen by doctors who didn’t seem to think it was possible to suffer from personality disorders and Axis I disorders at the same time. I’ve got no problem with someone dx’ing me borderline as long as they also are willing to treat my other issues, because there are some things that are big problems for me, mainly bipolar disorder and PTSD. The first half of 2006 was so traumatic for me that so far in this blog, I’ve just skirted around every mention of it. Well, it’s partly how traumatic it was, and partly because I know I’ll have to write some long, detailed posts about it, and I’ll have to set aside time for that.

Really, I don’t think most of us who are mentally interesting are prejudiced against people with BPD, we just desperately want to avoid the diagnosis ourselves, and with good reason, since the diagnosis virtually guarantees we’ll be insulted and mistreated by some of the “professionals” who are supposed to help us. This has the unfortunate side effect of making people with BPD feel like pariahs, since we so badly want to avoid either having BPD or being told that we do. I guess we should stop crowing about how glad we are that we haven’t been diagnosed with BPD if we don’t want to make other people feel like crap. Although I don’t really mean “we” there — I’m young, female, and a former self-injurer; of course there were some speculations that I have BPD.

And okay, if I ever decide that I agree with that suggestion and I am borderline, I will wear one of those T-shirts. No, I’m not kidding.

I might be less tolerant than I should of people whom I believe to be willfully manipulative, but I have thought that about very few people I know, and none of them carried a borderline diagnosis. I guess there are some borderlines who do fit the stereotype of being purposely manipulative, but I think most are just coping in the best ways they know how and other people misinterpret their actions. People who do have contempt for anybody with a BPD diagnosis — well, they shouldn’t. It’s disgusting to look down upon people with a different psychiatric label from yours, and it doesn’t help anybody.

Honestly, the part of my shirt I was so worried about? “PRINCESS.” Because if you’re going to go to the trouble of making a shirt that says you’re mentally ill, is it right to be so damn frivolous about it? It would be nice to make a shirt with a slogan that is serious and stigma-busting and actually wear it in public and actually teach people something. But I haven’t thought of one yet, and “BIPOLAR PRINCESS” amused me. (I couldn’t afford to buy enough packages of letters for “MANIC DEPRESSION HAS ITS UPS AND DOWNS.” That has six s’s and there were only two to a package.) The word “PRINCESS” just by itself could seem snobby and spoiled, which I’m not. Don’t get me wrong — I still don’t know if I’d ever wear a shirt that says “BIPOLAR” in public, but my “attention whore” comment referred more to the “PRINCESS” part. I don’t think it’s attention-whore-y when people make LJ icons that say “BIPOLAR PRINCESS,” so I don’t know if I worried about this because it was something I did offline, or just because it was me.

I also have very different standards for myself than I do for other people. I am very shy and usually try to avoid being the centre of attention. In the past, I have been accused of attention-seeking behaviour when I was doing nothing of the sort, and it really upset me. I also hate asking for help from anyone, even though I know that my frequent refusal to do so is just another weakness.

The really odd thing is that as I am sitting here typing this, I am wearing a T-shirt that says “WHAT WOULD FREUD DO?” on it. (It was a gift from a friend. I swear I don’t have a whole stack of psych-related T-shirts, just these two. No, wait, three. I’ve got one from a university psych department pub crawl.) I can guarantee you that most things Sigmund Freud would do, I would not do… but I wore this T-shirt in public today with absolutely no qualms about it.