When I was a bit younger, I used to have really bad PMS. It was probably bad enough to be diagnosed as PMDD, but if anybody ever did diagnose me as such, they didn’t tell me. Every time I attempted suicide, I think it was just before or during my period. The worst thing about it was that my period was also extremely irregular, so I never even knew when the PMS was coming. Although there was a good side to that, too — I’d suddenly become intensely suicidal, but when my period would come, I’d be so relieved to know that there was a concrete reason for my mood, I wasn’t “going crazy” again, and I’d be feeling better in a few days. That’s an amazing sense of relief to have.

This was a major issue for me until I started taking the birth control pill. I wanted to start taking it a few years before I actually did, but I couldn’t find a doctor who would prescribe it for me. The reason? I was on Topamax, and Topamax can sometimes make oral contraceptives less effective. This only holds true if you’re on 200 mg or more daily, and I think I was on 100 mg at the time, but who’s counting?

How did I eventually get prescribed oral contraceptives? Well, one day I went to a clinic to get the morning after pill (yes, we’d been using protection, but we had a condom breakage issue) and when the doctor was asking me some questions, I told her that this was the third or fourth occasion that I’d taken emergency contraceptives (over a span of three years).

She said, “Polly, Polly, Polly, what are we going to do with you?”

She had never seen me before in her life.

I said, “Well, for starters, somebody could prescribe me the birth control pill!”

And so she did. Yes, she knew that I was taking Topamax and that it could make the Pill less effective. I should point out that the other doctors I’d asked about birth control had all been male.

I never took the morning after pill again. I have never been pregnant. A couple years later, I stopped taking Topamax.

I know that oral contraceptives cause really bad mood swings in some women, but they actually help prevent them for me. It’s also nice having my menstrual cycle regulated, so that I know when a possible time of PMS is coming up. On the other hand, since I now only rarely get depressed and irritable before I get my period, there’s still that element of surprise. If I’ve gone for many months without PMS, I’m not expecting it to happen.

Which is why last week, I spent a couple of days feeling like I wanted to go lie down in traffic, but was cheered up when I realized that I only felt that was because of PMS. Then I got a little too cheered up, because I had an insomnia thing going on, and I got hypomanic. I was so jumpy and hyper that I was seriously afraid that I was going to have to call in sick to work one day because of it. I had a cup of coffee the day before, like an idiot — I try not to drink coffee at all normally, and when I’m hypomanic, coffee is an incredibly bad idea. IT MAKES MY BRAIN FEEL LIKE IT IS JUMPING UP AND DOWN. AND IT MAKES ME FEEL LIKE EVERY NERVE IN MY BODY IS JUMPING UP AND DOWN INSIDE MY SKIN, TOO. And that’s actually a lot of fun, even if my pitiful, inaccurate attempts to describe it make it sound uncomfortable. The uncomfortable part comes because I. Can’t. Keep. Still. and any situation that would require me to stay still is horrible for me. If I’ve got free rein to climb on stuff and do whatever I want, then it’s tons of fun.

You see why this might be a problem when I’m at work, though.

I guess caffeine does this to a lot of people, but if you are not manic-depressive, I don’t think that ONE CUP OF COFFEE can make you feel like this for TWELVE HOURS STRAIGHT before you start to come down a little.

Anyway, I somehow started feeling a lot more subdued, and I was able to go to work, and it was all good.

Um, I have no idea where I was going with this. I’m still a wee bit on the hypomanic side, but not in a bad way. Oh, yeah. I wanted to mention that although I don’t eat as well as I should, for a long time now I’ve been doing really well at trying to make sure my sleep schedule is as regular as possible, because I know how important it is for me to sleep properly if I want to stay well.

Ha ha ha, I’m standing up at the computer again because I’m still not so awesome with the sitting still. Sit down, you.

Anyway, my sleep being messed up through no fault of my own and the subsequent consequences provided me with additional proof that I should definitely stick to a regular sleeping schedule. I’m so much more stable when I do. I know, duh, right? Although the insomnia wasn’t brought on by anything I did, for a few days I didn’t try hard enough to get my schedule back on track, and that only served to remind me that it is dumb not to try to get enough sleep. It is also dumb for me to oversleep, or to sleep at weird times, especially since I have a more-or-less nine-to-five kind of job.

I’m trying harder now, though. For really.

Hey, student nurse. Yes, you, the girl who recently did a rotation on a psychiatric ward. I don’t think that while you are riding on the bus, you are supposed to be telling detailed stories to your friend about the patients in the hospital. You know everybody else around you on the bus can hear you, too, right? But you don’t care at all, do you? Of course not. Most mental health workers I’ve seen don’t give a damn about patient confidentiality, so why should you be any different, student nurse? I bet you think that since you didn’t mention any names, everything is cool, right? Well, guess what. It’s not. By the way, those were human beings you were poking fun at. I understand that dark humour has a place among health care workers, to help them cope with the things they have to deal with in their work. That place is not on the bus, however.

Hey, guy from the bus a month or two ago. I overheard you when you were saying, “It seems like everybody I grew up with is dying. One guy died of a drug overdose. Another friend of mine killed herself in jail in Ontario.”

I wanted to say, “You were friends with Ashley Smith? Man, I’m so sorry about what happened to her.”

But, of course, I didn’t say anything.

It was a shock to hear the other day that Heath Ledger had died, seemingly due to an accidental or intentional overdose of pills. He was a talented actor, appeared to be a genuinely nice person, according to what his friends and neighbours said about him, and he had a two-year-old daughter he loved very much. I am also crass enough to mention that he was hot, although his death wouldn’t have been any less upsetting if he hadn’t been attractive.

It’s strange that when someone dies and nobody knows whether it’s suicide or an accident, most people’s immediate response is, I sure hope it wasn’t suicide. I’m not sure it’s any less sad if someone who definitely doesn’t want to die suddenly winds up dead. It’s easy enough to think of reasons behind this knee-jerk reaction, though, and here are a few:

• Suicide is considered a major taboo.
• It’s very uncomfortable to think of someone who is suffering and unhappy before they die, and more pleasant to think of them as having had a pleasant and rosy life up until their death.
• People feel that it’s something someone should have seen coming and been able to stop, unlike a freak accident that might have been less easy to predict.
• In a case like this, where it’s somebody who Had It All, you know that this guy had talent, money, fame, good looks, and a child he cared about, and still might have been depressed enough to purposely end his life, and you wonder what the hell kind of chance any of the rest of us have of being okay.

Anyway, suicide or accident, it’s still a tragedy.

Here’s another one for the “What the Hell Is WRONG With People?” file. I’m not sure there’s much point in linking to this entire article, since it’s from the Saint John Telegraph-Journal, and Canadaeast.com doesn’t seem to keep archived newspaper articles online for a very long time, but here you go. It’s about a New Brunswick teenager who committed suicide in an Ontario prison.

Mentally ill Moncton teenager Ashley Smith, whose death in a segregation cell in an Ontario prison a month ago has sparked several investigations, was often kept in restraints with her cuffed hands chained to a body belt that was attached by another chain to her shackled ankles, Canadaeast News Service has learned.

“We are well aware that these restraints were quite often used in the staff interventions with Ashley Smith,” said Kim Pate, a specialist in prison law and advocate for female offenders.

The restraints may have violated Smith’s human rights and raise questions about why she was in a prison at all, said Pate, national director of the Canadian Association of Elizabeth Fry Societies.

“I can’t imagine a scenario where it wouldn’t violate her human rights, and even if the correctional service perceived it as lawful in order to protect her from self-harm, if they felt the need to use it in segregation, she should have been sent for a full psychiatric assessment,” said Pate, who knew Smith and last saw her alive less than a month before her apparent suicide Oct. 19 in the Grand Valley Institution for Women in Kitchener, Ont.

Ashley Smith committed suicide by asphyxiation in her cell. Several prison staff members are facing charges of criminal negligence causing death, others are being suspended without pay, a new warden has been appointed, and a number of official investigations are being conducted, but it’s all too late for Ashley.

Smith’s odyssey through the prison system began when she went to the Miramichi Youth Detention Centre as a 15-year-old who had thrown apples at a postal worker. The offences that led to an accumulated six-year, one-month sentence were nearly all committed while she was incarcerated, says Pate, who is speaking publicly on behalf of Smith’s parents. Smith’s convictions were for assaulting a peace officer, falsely reporting a fire, uttering threats, theft and assault.

Yes, you read that right. This kid first went to jail for throwing apples at someone. And then it seems that she just didn’t get out. Almost all of her offences were committed while she was in jail, and her sentence just got longer. I can’t say that nobody tried to rehabilitate her, but I can say that it obviously didn’t work. They must have given up on the rehabilitation idea eventually, though, since soon Ashley Smith was spending up to 23 hours a day in segregation.

From an article in the Globe and Mail:

At the time of her death, Ms. Smith was on suicide watch, which called for her to be under constant surveillance, both by prison guards and by a set of video cameras. Her psychological breakdown was not a surprise: For nearly two years, Ms. Smith had been confined to segregation cells, where she lived alone, in conditions that appalled the few outsiders who knew about them.

“Her human rights and her Charter rights were violated,” said Kim Pate… “She was being treated in ways that were inhumane.”

Ms. Smith spent time in several institutions. One of them was in Saskatchewan; a male guard there was later charged with assaulting her. Ms. Pate visited Ms. Smith several times, and complained to prison officials, apparently to no avail. The last visit was on Sept. 24, when Ms. Pate saw Ms. Smith in a bare concrete cell at Grand Valley. Ms. Smith had no shoes, and her only clothing was a security gown, a prison garment that looked like a horse blanket. Ms. Smith’s mattress had been taken away, forcing her to sleep on a concrete slab. There was no blanket.

In Ms. Pate’s view, Ms. Smith was spiralling downward, trapped in a cycle of self-defeating rage against the institution, which reacted with punishments and deprivations.

“She was cold, and she was quite distressed,” Ms. Pate said. “She had been that way for several days when I saw her. Anyone being treated in that way, if they did not have mental-health issues, certainly would have developed them.”

After a suicide in the prison in 2004, an inquest was conducted and recommendations were made to prevent further suicides from occurring. A couple of these recommendations were followed. Others weren’t. A team of British prison inspectors also advised the prison to stop shackling women in leg irons, and this recommendation wasn’t followed, either.

From the Telegraph-Journal article:

CTV News, citing unnamed sources, reported last week that guards had watched her place a ligature around her neck but did not intervene immediately, believing she was not seriously harming herself.

“Rather than receiving treatment, this mentally unstable teenager spent most of her sentence in segregation,” [Kitchener-area Liberal MP Karen] Redman said in question period. “Segregation cannot be confused with treatment.

“The government has ignored several reports calling for a mental health strategy in our prisons. When will the government take action and implement a mental health strategy in Canadian prisons?”

Not that I’ve got a mental health strategy for Canadian prisons up my sleeve, but I think it’s pretty obvious that forcing a suicidal girl, prisoner or no, to sleep on a concrete slab in solitary confinement isn’t going to turn her into a productive member of society.

Speaking of productive members of society, I am working normal hours again and will finally have time to regularly update this blog.

Seven years ago today, I almost died. It was my most serious suicide attempt, and it was almost successful. Assuming you’re using the ludicrous terminology that equates being dead as being a success at something.

Today, I am employed in my chosen career field. I have two university degrees, a long-term boyfriend, and friends. I get along with my family most of the time. I have hobbies I enjoy. I am stable on low dosages of medication with no noticeable side effects. I no longer cut myself, hear voices, or spend all day sleeping. I am happy.

So there. I win.

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.

Stumbling back, blinking confusedly and wondering what happened to the past week.

My brother was released from the hospital after nine days there. My mom says he is doing okay, but she worries about him all the time. She is worried about what he’ll do the next time he and his girlfriend have a fight. They’re always fighting. He told her that if she took that job this summer, he’d kill himself. She took the job, he didn’t kill himself or try to kill himself, but he did have to spend nine days in the hospital.

I’m a bit hypomanic. Nothing extreme, mainly I’m kind of hypersexual and I’m also feeling like it’s stupid to be taking my medication. Usually, if I’m not taking my medication properly or if I stop taking it altogether, it really is because of the side effects. I am not the stereotypical “she stopped taking her pills because she thought she didn’t need them anymore” manic-depressive. (Almost nobody is, by the way. People just think that we are because they don’t actually believe us when we tell them how bad the side effects are.)

But I am that stereotype right now. Or at least I would be if I actually stopped taking my pills, which I have not. I want to, though. I feel so good right now. How could there possibly be anything wrong with me? Why would I possibly need drugs?

Twice in the past, I went off all of my meds without telling my doctor. I didn’t think that I wasn’t manic-depressive; I just thought I could handle it better without the drugs. Both times, I felt fine for a little while. Both times, things changed. The first time was a bit more gradual. It started out as mild paranoia, then moved to severe paranoia and delusions, and then added auditory hallucinations. Now, that was a fun six months. The second time was much more sudden. A case of severe insomnia turned overnight into serious suicidality and helped set off a chain of hospitalizations. All of that funstuff is why I decided that although I would try taking lower dosages of medication, and although I would stop taking Dope-a-max and atypical antipsychotics, I probably shouldn’t take no medication at all.

Right now, though, I feel like I’m talking about someone else. I have a hard time believing that I was ever ill. It feels like it was all a dream. I am fine. There’s nothing wrong with me. Why would I need pills?

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.

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.

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

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

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