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.

Apparently, in this town you only deserve to see a psychiatrist if you’re in crisis. I guess there’s no such thing as seeing one every three months just to check in.

I didn’t actually get to see a psychiatrist today, but that didn’t surprise me. What did surprise me was that the mental health nurse I saw thought there was no reason to refer me to a psychiatrist, even though that was what my GP had requested. My GP had, in fact, requested a specific psychiatrist.

I have been completely stable for months now. I feel better than I have in years. And this is the problem. I feel fine, my medications are working for me, I finally have a GP in a nearby town, and technically I have a therapist but I only saw her twice, in January, because bus service near their office is very limited and I can’t really afford $16 for a cab there and back.

I filled out some forms and then the nurse asked me some questions for about half an hour. Mainly very basic stuff — describe my family, how is my relationship with my boyfriend, what is my level of education, what medications am I on, etc. She asked me about being assessed at the hospital in the fall, and she mentioned that the particular shrink who had seen me was going to be at the mental health centre that day. I looked at the door, kind of freaked out, as if I expected to find him walking right by, right then, because I kind of did. But he wasn’t. She clearly has a higher level of respect for him than I do, and I’m pretty sure she’s going to get my file from the hospital so she can see what he thought of me. And presumably believe him over me. Yeeha.

She asked me if there was anything about my life that I was unhappy with and wanted to change. I said there wasn’t anything, really, only that I’d like to be a bit less shy and a lot more organized, and that sometime I’d like to work on issues related to past trauma.

“What kind of trauma?” she asked.

“I was raped twice.”

“How old were you?”

“Twenty and twenty-one.”

She asked me how that currently affects me. I told her that sometimes it makes me sad and scared. She asked me if it affects my relationship with my boyfriend, and I said, “Only that it makes him worried about me.”

Then she changed the subject.

I definitely didn’t want to bring up the eating disorder thing. I was afraid she would think I was overreacting.

The mental health nurse said that the only thing she was worried about was my level of anxiety. She didn’t believe me when I assured her that I was only anxious because of the appointment and that I don’t usually have anxiety problems (which was true), but she said it was to up me to decide whether I thought it was a problem I needed to do something about.

“I don’t think it is a problem,” I said, “but I’m open to other interpretations. If I did have an anxiety problem, what should I do about that?”

“Well, we have an Anxiety and Mood Disorders Group,” she said, “but they just had their last spring session. It should start up again in the fall.”

The fall? WTF? It’s a good thing I don’t have an anxiety disorder. Imagine if I actually had one and I asked what I should do and she told me to come back in the fall. I can only hope that they have other anxiety disorder treatment options and she just didn’t feel like telling me what they were.

I hate how I’m going to keep replaying this appointment in my head, over and over and over again, wondering what I did wrong and what I could have said differently so that I could have actually gotten some help. I don’t know what I should have asked for. I don’t know what I should have said that I didn’t say, or what I did say that I should have left out.

Fuck! Fuck! Fuck!

I hate this town. Hey, last week I was looking at buttons at a record store and they had one that said “I hate this town” on it. I’m totally going to buy one and put it on. That’ll make me feel better.

When in doubt, shop.

I left the appointment thinking, I wish I were dead, I wish I were dead. Then I came home and cried for a while. It was kind of nice to cry. I’ve been so stable and so genuinely happy that I almost never cry anymore. And I’m very used to crying, so it feels kind of weird not to do it anymore.

but i’m a modern woman baby
ain’t gonna let this get me down
i’m a modern woman
ain’t gonna let this get me down
gonna take my master charge
and get everything in town
~ Nikki Giovanni, “Master Charge Blues”

Gah, even when I’m not talking about Virginia Tech, I’m still talking about Virginia Tech.

Not really “everything in town,” though. Just that little pin, and some books (which I have gift certificates for), and THE NEW TORI AMOS CD. Must. Go. Shopping. I don’t even have a MasterCard, by the way.

Haha, I was just checking my email and the web clip near the top of the screen in Gmail is Ask Yahoo! - Who invented the shower? It’s there because I went to a wedding shower the other day and a couple of my recent emails mention that, but it’s still funny.

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.

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.

There’s a post at Furious Seasons today commenting on the Portland Identification and Early Referral programme in Portland, Maine and an Associated Press article about the program. My personal favourite part of the programme’s web site is the line “Mental disorders are diagnosed in the same way as asthma, diabetes and cancer.”

Ah, so mental disorders are diagnosed with a pulmonary function test? No? A blood glucose test? No? A biopsy? No? Is there any type of biological test that can conclusively prove someone’s particular psychiatric diagnosis? Again, NO.

I was in an early psychosis programme when I was nineteen. The psychiatrist I was seeing for depression when I was eighteen thought I might be schizophrenic, so she prescribed me Risperdal, only saying that it would “help my concentration” and not bothering to tell me that she thought I had schizophrenia. Six months later, she moved away and my GP referred me to the psychosis prevention programme based on whatever was in my file. The next summer, another psychiatrist I saw told me that my file said the first shrink thought I might be schizophrenic because I had told her that I was bullied in junior high school and sometimes I still worried that people might not like me. That was the basis upon which she had prescribed me an antipsychotic: she somehow mistook my occasional worries caused by past trauma for delusional paranoia. The best part is that the bullying was something I had mainly worked through and it bothered me so little at that point in my life that I didn’t even remember mentioning it to her. It was just something I’d said in passing.

During the psychosis prevention programme itself, I saw a psychiatrist and a psychiatric nurse and talked to them about my depression. I knew the programme had something to do with psychosis, but didn’t know why I was in it. Nobody told me that my previous psychiatrist thought I was psychotic. Nobody told me I wasn’t psychotic. Nobody told me they thought I might become psychotic. Nobody provided me with any education about psychotic disorders. Nobody thought they should take me off my Risperdal, so I stayed on it (and my Zoloft, which has been nearly ever-present in my life for the past eight years). I think I just quit seeing the psychiatrist and the psychiatric nurse on my own without them referring me elsewhere; I think my psychologist eventually referred me to my next shrink.

So I wound up in a psychosis prevention programme because I made an offhand remark about sometimes worrying that people might not like me. Even before I was in the programme, I wound up on an atypical antipsychotic because of that same remark. I was not schizophrenic then, and I’m not now, although I was tentatively diagnosed as such at the time. I was not psychotic then, nor was I showing any signs of psychosis. I didn’t get psychotic until years later. My worst psychotic episode was when I’d been off all of my medications for months, but I’ve been more mildly psychotic while on antipsychotics, too. I was misdiagnosed, unnecessarily prescribed heavy-duty medications, and kept in the dark about everything. I don’t believe AAPs caused my eventual psychosis (although such a thing is not impossible), but I sure wish I hadn’t been taking drugs with such serious side effects for years before there was ever any real sign that I might need them. In the long run, being prescribed antipsychotics at eighteen didn’t stop me from getting psychotic at twenty-one or twenty-two. I’ve also been off AAPs for over a year and a half without having any serious episodes of psychosis in that time.

Years later, I reread some old journal entries from the three weeks I was taking Zoloft but hadn’t yet started taking Risperdal. I seem pretty damn hypomanic in them, which I didn’t realize at the time. Although my behaviour shortly before being prescribed Risperdal wasn’t entirely normal, it appears that the only rationale for the prescription that my psychiatrist actually bothered to write down was that one comment I had made. Either that was her entire basis for considering me a possible schizophrenic, or she mistook my hypomania for schizophrenia and did a really sloppy job documenting it.

P.S. I should have knocked on wood while I was writing yesterday’s post. I didn’t sleep very well last night.

I saw a new GP today. Her practice isn’t actually in my city, but it’s much closer to it than the GP I was seeing before that. No, I can’t find a family doctor in my city who’s taking new patients. There are none.

I really like her. The written medical office policy there states, “We will treat everyone with respect.” I thought, How nice that it says that. If they mean it, it’ll be even nicer. I think they do.

Although I also liked the doctor I was going to previously, it’s so much more convenient to find someone closer to where I live. She is also going to refer me to a psychiatrist in town. Since I trust her, I am actually hopeful that this psychiatrist will listen to me and treat me with respect instead of contempt. I had some very bad luck with psychiatrists last year and I had been finding it hard to be hopeful about these things.

Man, it’s so nice when somebody actually listens to what you have to say. Seriously, how hard is it to listen, and why do so few people do it? Why do so many psychiatrists not bother to take the time to listen to what you are actually saying, and instead make assumptions about what they think you’re thinking?

For the most part, I feel lucky today. Grateful and all of that. I don’t know if I can actually see a psychiatrist who doesn’t work in the hospital, though. I have no health plan, I don’t know if my boyfriend’s health plan will cover this, and I do know that I can’t afford to pay out-of-pocket. Sigh. We’ll see what happens, I guess.