Surprisingly, nothing horrible happened over the holidays. A “Christmas miracle,” if you will. I’d been afraid that my brother would do something dumb, because he’d been saying all along that he was going to call his ex-girlfriend on Boxing Day and it never goes well when he calls her, but he didn’t call. Whew.

He’s on Seroquel. He’s gained forty pounds and he’s tired all the time.

“It can’t be making him tired all day, though,” my mother said to me. “His psychiatrist said that if he took the Seroquel around ten at night, he shouldn’t be tired anymore by the time he gets up in the morning.”

Maybe it was wrong of me to laugh at her, but I couldn’t help it. I have told her twelve million times that antipsychotics can make you very, very tired. This psychiatrist is someone who I kind of know (I know his family), so I’d thought he wouldn’t be dumb and he wouldn’t act like a jerk. But here he is, saying that the side effects that one of his patients is experiencing from a drug do not exist.

I had more faith in this guy than that. This is disappointing. It makes me want to scream. My brother is possibly the least motivated person in the world — I can’t see how antipsychotics are supposed to change that for the better.

Oh, yeah. They’re not.

I’m going to visit my family for a few days over the holidays, and this year I’m even more worried than usual about it, because my brother is completely unwilling and/or unable to consider anybody else’s feelings, ever. He wasn’t always like this. I can’t picture visiting for a few days without him marring it by, at best, starting arguments and running off. I don’t even want to think about any of the worst-case scenarios. Maybe I’ll be lucky and nothing too bad will happen, just the normal petty squabbles that everybody’s family has. You never know. It could happen.

Via Liz Spikol, I came across this article: Lawyer defends firm’s decision to dismiss worker with bipolar disorder.

Stephen Bird, who represents ADGA Group Consulting Inc., said the company discussed employee Paul Lane’s condition with him after he revealed that he had bipolar disorder and researched the condition on the internet before making the decision to dismiss him.

According to the written human rights tribunal ruling, what managers learned convinced them that Lane, who was hired to test artillery software for a Department of National Defence contract, would not be able to meet the rigours of a stressful job with tight deadlines.

Ooh, tight deadlines! Sooo scary! Look, some people can handle tight deadlines and some people can’t. Having bipolar disorder does not necessarily mean that you can’t.

Liz says, “are you kidding?” re: the company researching bipolar disorder on the Internet and whatever they learned there apparently being a deciding factor in the decision to fire Lane. Which I totally have to agree with when you consider these paragraphs from the article:

Not only does the company believe the tribunal erred in its decision, but Bird alleges that it also over-stepped its jurisdiction in the way it handled evidence in the case.

For example, the tribunal heard from experts on bipolar disorder who didn’t even know Lane, he argued during the case.

“The evidence should either not have been accepted at all, or should have been accepted for very limited purposes,” he said.

Okay, so ADGA looking up stuff on the Internet about bipolar disorder in general, presumably all written by people who didn’t know Lane, and not liking what they found is an okay reason to fire the guy, but when subject experts who also don’t know Lane have their say about bipolar disorder, that shouldn’t be allowed?

On the basis of that article and a previous article about Lane, it would seem that he hadn’t actually had any problems at that particular job; the company just assumed he couldn’t handle it based on what he told them about his illness and whatever the hell they read on the Web about it.

According to the facts presented in the ruling, Lane was dismissed in October 2001, eight days after he started work as a senior test analyst as ADGA. He had told his supervisor that he had bipolar disorder and his behaviour should be monitored.

I am lucky that I’ve always been able to do my work without any special accommodations whatsoever. It wasn’t the case with schoolwork, but it’s been the case with work-work. (Wow, what a mature phrase… “work-work”… clearly someone of my maturity level should have no problem handling a career!) Thus, there’s never been any reason for me to disclose my manic depression to any employers I have had.

The company denied that it discriminated against Lane on the basis of his disability. It alleged he was dismissed because he was not capable of performing the essential functions of the job for which he had been hired. It also said he had lied about the amount of sick time he had taken during a previous job that would have alerted the company to his illness.

However, tribunal adjudicator David J. Mullan found the company did not, as required, make a significant effort to accommodate Lane or properly assess the situation to determine whether it could accommodate Lane’s disability without “undue hardship.”

Lane was hospitalized almost immediately after being fired. I know being fired due to discrimination is a lot more stressful than merely having tight deadlines, but I’ve got to say that I’m pretty sure that if I were fired tomorrow, I couldn’t see myself winding up being hospitalized because of it. It’s really easy to say what you’d do in a given situation when you’re not actually in that situation, so maybe I’m being way too harsh here. Or maybe he actually isn’t a guy who can handle a lot of stress, but still: you should actually give someone a chance to see what they can do before you fire them, and if they have a disability, you do have to take appropriate steps to see if it can be accommodated without undue hardship. Lane didn’t think he’d need much in the way of accommodations.

I know I’m getting just south of coherence here, but mainly I’m frustrated at not knowing nearly enough of the particulars of this case and realizing that it’s my own damn fault that I don’t know. I’ll read the actual tribunal report after the holidays. I don’t have time now.

Although my brother finally more or less accepted that his girlfriend needed to work this summer, when she took a trip elsewhere just for fun, he freaked out because she was having a good time instead of being with him while he was miserable. He stole my parents’ car a few weeks ago so he could drive across the country to her, but came back after driving for two hours when he realized that this plan was not actually going to work. He said his mind wouldn’t stop racing, but none of the people who were supposed to be treating him considered that it might be related to the fact that he had just started taking two different antidepressants and had gone nearly three weeks without follow-up treatment. A few days after that, he wound up in the hospital for the second time. He “escaped” once (he was on an unlocked ward, so it’s not like it was hard to escape) and the police brought him back, but he’s been out again for a while now. He was on Seroquel for a while in the hospital, but even the doctors admit it probably made him worse, and took him off it.

His ex-girlfriend, if that’s what she is, has cut off some forms of communication with him, but they’re still emailing each other, and every time he gets an email from her, he gets upset. A few days ago he smashed the glass door of a cabinet. I know this girl has problems with depression, but she’s always seemed much more stable than my brother throughout their relationship, even though they’ve always fought a lot. Now, though, she’s seeming nearly as unstable as he is. She keeps telling him that she loves him but can’t be with him, and mixed messages are the last thing he needs right now. He’d prefer if she were supportive, of course, but I think he could even handle a breakup better than he can handle what’s going on right now. Not that I’m saying this is her fault — I know he’s not easy to deal with, but she’s really making things worse, even though she’s not doing it on purpose. Apparently she has also been sending weird emails to my parents.

Previously, my brother had planned to attend a day programme soon. Now he says he doesn’t want to bother trying to get better unless his ex(?)-girlfriend is supportive of him. That’s just him being completely pigheaded. His shrink, though, did say that nobody can help him “until he gets over that girl.” Um, his main problem is that he doesn’t know how to get over “that girl,” and if he knew how to do that on his own, he probably wouldn’t need a shrink.

My younger brother is like the poster boy for borderline personality disorder, but since mental health professionals seem to be looking only for BPD poster girls, none of them had ever considered this diagnosis for him. No, I’m not sure whether I think BPD is a useful construct, but he does fit the criteria to a T (except, as far as I know, the last one, “transient, stress-related paranoid ideation or severe dissociative symptoms”).

Last week, I kept mentally writing a blog post in which I would describe all the ways he fit the criteria for BPD, but refer to him as “she” until the end of the post, where I would say that there was one major lie in the post and to switch all the pronouns, I’m actually talking about a guy, not a girl. My brother can be awfully exasperating, but what really bugs me, and what that post would have really been about, is sexism in the mental health profession. About how I, a girl, have been called personality-disordered simply because I used to cut myself or because sometimes I’ve disagreed with doctors’ opinions about something, but someone who very obviously fits eight of the nine criteria for BPD isn’t diagnosed with it because he’s a guy. I’m not really interested in amateur diagnosis of anybody other than myself, but it seemed appalling that behaviour that would get a female slapped with the BPD label was ignored in a male. I never did write that post, because 1) it would have wound up being awfully long and I’m lazy, and 2) it seemed malicious to write a post delineating all of my brother’s very worst qualities when he is one of my favourite people in the world and one of my best friends.

Now there is another reason to never write that post, which is that a doctor has finally considered that he might have BPD. Until the other day, my brother’s official diagnosis was generalized anxiety disorder, but he’s been in the hospital for a couple of days because of suicidality. One doctor is saying bipolar spectrum disorder and another is saying borderline personality disorder.

As for how he is doing in there, it varies. He went voluntarily, but then when he said he wanted to leave and it was stupid and he should have just killed himself instead of going to the hospital, of course they changed his status to involuntary. For a while he was really mad that he’s stuck there because he wants to go online and see if his girlfriend is terribly worried about him, as he wants her to be. He was doing a countdown online to the day he planned to kill himself and dramatically telling his friends that it would be his “last day on Earth.” His girlfriend has a good summer job on the other side of the country and he is upset about that because he would prefer that she come home to her apartment and work at the part time waitress job that she had before she found the better job. He thinks that her wanting to make money to pay the rent for her apartment, where he sometimes lives with her for free as he has no job, means that she doesn’t really love him. My mother said today, though, that he is feeling less angry about being in the hospital now because he thinks he should stay until he feels safe.

Feelings can shift so rapidly in the hospital sometimes, can’t they? Most of the time, it’s very boring, so when anything at all happens, sometime it seems monumental and you can overreact.

This is not an anti-BPD post. My brother behaves like a stereotypical, worst-case-scenario borderline, and of course I’m going to vent about that. I realize that most people diagnosed with BPD aren’t actually like him, and I’m hopeful that whatever the hell is wrong with him, whether it’s BPD or something else or BPD and something else, he will soon get some appropriate help and will feel better and not be such a pain in the ass. Even if he is bipolar without BPD, I’m glad that somebody has finally noticed that something other than GAD is going on.

Lately I’ve been having too many ideas to sit down with any one of them and see it through. This includes blog posts, which I compose while trying to fall asleep at night or while pacing around my apartment, but not while actually at the computer. Today I decided that writing something short is better than nothing.

Reading about Reconcile, the doggie Prozac, reminded me of a sentence I recently came across on Borderline Personality Today’s page about BPD criteria:

Individuals with this disorder may feel more secure with transitional objects (i.e., a pet or inanimate possession) than in interpersonal relationships.

I thought it was a pretty poor choice of words. Yes, you don’t have the same sort of relationship with a pet that you do with another human being. I get what they’re trying to say here. But not being a person doesn’t make a pet an object. If a pet is an object, though, then it doesn’t matter to you if you use a quick fix for their behaviour that is convenient for you as opposed to seriously thinking about what solution is best for your pet. Note: I’m not talking here about people who have been diagnosed with BPD, even though this sentence happened to be on a site about BPD. I just mean that people who would refer to an animal as a “transitional object” seem to have the same mindset as people who would drug Muffy for piddling on the rug.

I’m not saying unequivocally that psych drugs for your pets are always 100% wrong, because I really don’t know enough about the subject. I know people who had their cat on kitty Prozac because of its OCD-like behaviour. It actually did physical harm to itself with excessive grooming and biting itself. They were worried about its physical health and obviously couldn’t be with the cat every second to keep it from hurting itself. Medication was not the first thing they tried, and their cat was only medicated on a short-term basis. The cat is now off SSRIs and is fine with only behavioural training. They also have another cat who has never had these problems.

What I am saying, though, is that the Reconcile site scares the crap out of me with paragraphs like this one:

Separation anxiety is a clinical condition in your dog’s brain. Your pet is not a bad dog. Your pet’s behavior is the result of separation anxiety.

Wow, “a clinical condition in your dog’s brain.” Isn’t that just the most specific thing you’ve ever read? What the hell does it even mean? It means “We want to convince you that your dog has a biologically-based medical condition but we don’t have evidence to support this, so we will be alarmingly vague. It is your duty to treat your dog’s clinical condition, damnit. You are a bad pet owner if you don’t get them the medicine they need.”

Does separation anxiety in dogs exist? Hell, yeah. And in cats, too — that’s what caused the excessive grooming and self-injurious behaviour of the cat I mentioned previously. But is separation anxiety “a clinical condition in your dog’s brain”? Umm…

My parents’ dog has very bad separation anxiety, but they’ve never considered drugging her because of it. They just use behavioural training, which works most of the time, and on the occasions when the dog pees on the rug or gets into the garbage anyway, well, then they just have to clean up after her.

I’m glad that Eli Lilly at least emphasizes the importance of behavioural modification in addition to drugs, but I’m sure that some pet owners will just ignore the entire training idea because medication is, you know, easier. For you, if not for your pet. Of course, just like meds in humans, the side effects of Reconcile are often the very things the drug is supposed to treat:

The most common adverse reactions recorded during clinical trials with Reconcile™ were calm or lethargy, reduced appetite, vomiting, shaking, diarrhea, restlessness, excessive vocalization, aggression and, in infrequent cases, seizures.

If you look at the product label or this journal article, you’ll see that some of the side effects were quite common, especially calm/lethargy/depression. I guess if you’re not satisfied with doping up and numbing out your children, you might want to move on to your pets, too.

Well, this wound up being longer than I expected.

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.

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.

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.

I have an appointment with a new psychiatrist tomorrow. I’m nervous about this. The last time I saw a psychiatrist was about eight months ago. He was a complete asshole who pronounced me borderline, histrionic, and narcissistic after watching through a two-way mirror as a medical student interviewed me for about forty minutes and only speaking briefly with me himself. (By the way, the last mental health professionals who had dealt with me, who saw me nearly every day for seven weeks, had said that I definitely do not have any personality disorders.)

When I asked him why he thought I probably had these three personality disorders, he said it was because I showed no emotion whatsoever and denied the fact that I even had emotions. This is patently untrue, as I am pretty much the exact opposite. (And although I also don’t have histrionic personality disorder, I’d still like to point out that “shows no emotions” certainly doesn’t describe a histrionic, either.) He said that he could tell I had personality disorders because I didn’t talk about my feelings, just about things like the dates that certain things happened to me, and about every medications I had ever taken and at what dosages. Um, the reason I was talking about those things was that I was answering the questions the med student asked me. I thought a lot of them were tedious myself and I would have preferred to talk about other things, so why the hell was he basing my diagnosis on his dislike of the student’s interviewing style?

He didn’t have access to my previous files, in which my diagnosis of bipolar disorder is confirmed by multiple doctors, but I’m sure it would have made no difference to him if he had.

He also said some other bizarre things, like that I should tell my mother that I hate her. I don’t hate her, so I don’t know what purpose that would serve, but when I asked him why I should tell her I hate her, all he would say was that I should tell her I hate her and he wouldn’t give me any actual reason. He said that it wouldn’t kill her or anything if I told her I hated her, and I said, “Yeah, I know that. I’ve gotten angry at my mother plenty of times and it didn’t kill her, but I don’t see why I should tell her I hate her when I don’t.”

Who died and made him Freud?

He said that the best thing for me would be “fairness focused therapy” or something like that. I don’t remember the exact term, but it involved the words “fairness” and “therapy.” I haven’t really done extensive searching on the topic, but I have tried doing some Google searches and some journal searches, and as of yet, I have seen nothing that would indicate that this particular type of therapy even exists, let alone that it would be the best treatment for me. He told me I should go to some “fairness” program at the hospital three times a week, and when I asked if it were possible for a person to attend that program and still hold down a job, he seemed to think this was a completely unimportant consideration, despite the fact that I was stable at the time and there was nothing else that would prevent me from working.

So I figured he could fuck off and die. I didn’t say that to him, though. I was polite and decided never to go back to that hospital again because whatever crazy shit he must have written about me in my chart would totally bias anybody there against me.

I am seeing a shrink elsewhere tomorrow, not at the hospital, but you can see why I’m nervous. At least I think I’m seeing a shrink. My GP referred me to a shrink and I’ve got an appointment at a mental health centre, but I don’t know if I actually get to see the shrink tomorrow or if I see a social worker first or what.

In addition to being mega-nervous about this appointment in general, I’m also worried about my recent eating-disordered behaviour. To the best of my knowledge, I’ve never been officially diagnosed with an eating disorder. This is mainly because I am — okay, I want to say “a big fat liar,” but that is so not appropriate here. Let’s just say that I’m a liar, okay? And a really good, sneaky, convincing one, as far as eating disorders are concerned. The other reason is that whenever I do come clean about my eating-disordered behaviour, it’s always about things I’ve done in the past and never anything I’m currently doing.

“Officially” diagnosed or not, however, in the past I have met full criteria for anorexia nervosa. This would have been in 2001, when I lost over 20% of my body weight, had a BMI of 15.2, and still managed to convince most people that I wasn’t doing it on purpose. I didn’t fool my mom, but I fooled everyone else. I started losing weight when I was in the hospital in December 2000, following my suicide attempt, because I was physically weak after the overdose and hospital food sucked, and after that I just kept losing weight on purpose, because starving yourself is a more socially acceptable form of self-injury than cutting, I was manic so it was easy to lose weight, and I think I had developed a weird addiction to it.

I’ve never been overweight. I’ve always been thin. I have the extreme good luck to not even gain any weight when on anticonvulsants and atypical antipsychotics. I do not think my appearance would be improved if I lost weight. I know it actually makes me look worse. Eating-disordered behaviour is purely a form of self-injury for me. Well, eating disorders have all sorts of complex causes, but I can assure you, mine has nothing to do with me wanting to look pretty. (I know a lot of other people’s don’t, either, but I know it is a factor in some people’s EDs.)

Anyway, I’ve been restricting my food intake way too much lately (and since I’m naturally thin, any time that I restrict my food intake at all instead of eating whatever I damn well please is a sign of disordered eating for me) and worrying about my weight. For about the past two months, I hadn’t been feeling as hungry as usual… so a few weeks ago, I just sort of took that fact and ran with it. The less I ate, the less I decided I should eat. Now I’m purposely restricting instead of just eating less because I haven’t been hungry. I know I’ve lost a bit of weight. I’ve been eating one meal a day, but now I’ve even started worrying about exactly what that one meal contains, counting calories and all of that.

It was in 2002 that I may have met full criteria for bulimia nervosa. Maybe not, though. I’m not sure I binged enough for that, but I sure as hell threw up a lot. Binged and threw up, ate normally and threw up, restricted and threw up. Most of the weight that I had lost previously, I gained back in late 2001, and then lost it again in 2002. Purged once or twice a day, got nosebleeds from throwing up so much. If your eating disorder is mainly a means of self-injury, then you love the immediacy of bulimia. Binge right now, then purge a few minutes later! Relief right now, or self-torture right now, or both, whichever you want, but right now! No waiting like there is when you’re starving yourself, instant results! It’s mercurial and intense and appeals to short attention spans.

I’m managing to stay away from it now, though. It might have even been years since I’ve purged. I’m tempted lately, but I’m not vomiting and I’m not taking laxatives (yeah, I did that, too, although mostly back in 1999). Maybe my self-control has gotten better. Heck, maybe it’s gotten a little bit too good, what with the restricting.

I have had food issues, mostly in an ED-NOS sort of way, on and off for at least eight years, probably longer. It never lasts very long. Never more than six months at a really serious level, anyway. It always goes away, but then it always comes back. Socially sanctioned self-destruction. Eating-disordered behaviour is always the last card I have up my sleeve when everything else is gone, and I keep playing it again and again and again.

And I’m getting fucking sick of it. I’d thought I was better, because it had been away for so long this time. I thought it wasn’t coming back. I thought it could just go away on its own without me working to fix it, because I thought it wasn’t really serious, you know, not like eating disorders that other people have. That other people have real problems and deserve real help and I don’t.

This time, I would kind of like to tell somebody about it so I can start working on this for the first time in my life and make some real progress on it. But I’m scared that people will think I’m just making a big deal out of nothing. So I’ve been on an unnecessary diet for a few weeks, so what? Haven’t most people been at one time or another? Don’t I have enough real issues to deal with, without getting all bent out of shape over this? I really am scared that no one will take me seriously if I ask for help with this.

Also, at the same time, I kind of don’t want to get better.

Just out of curiosity, I recently looked up information online about the nearest eating disorders clinic. It’s not really near at all and I know my problem isn’t severe enough that I’d need the programme there, but having been in a partial hospitalization programme last year, I just had an idle curiosity about such things. I noticed when I read the referral criteria that even if I wanted to participate in the programme, I couldn’t, because my current BMI is lower than the minimum allowed (they want participants to be at a healthy weight before they work on their psychological issues). This pleased me.

I am seriously sick in the head.