I went to Shoppers tonight to get a prescription filled, and while I waited, I read their HealthWATCH pamphlet on Emotional Health. I was flabbergasted by the following excerpt, which I am not making up:

Doctors refer to conditions that affect emotional health as “mood disorders.” They include:

• depression
• anxiety
• stress
• bipolar disorder (manic depression)

Seriously, what the hell? Were people high when they wrote this pamphlet? Since when is stress a mood disorder? Or anxiety, either, but labelling stress a “mood disorder” is particularly stupid, since that would mean that every single person in the entire world has suffered from a mood disorder at one time or another. Sure, stress affects emotional health, but that doesn’t make it a mood disorder. An especially baffling thing about the wacky pamphlet is that there is a section on the Shoppers Drug Mart web site about emotional health, expanding upon what is in the pamphlet, and it doesn’t include a ridiculous statement about stress being a mood disorder, but does include a subsection called More than just stress which contains the line, “Because some signs of depression are similar to those that occur with stress, having some of these signs does not necessarily mean that you have depression.” Which, you know, actually makes sense.

Maybe people realized that whoever was in charge of their Emotional Health stuff was doling out very obvious misinformation and it was a lot simpler to fix the site than to fix the pamphlets?

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.

If people are going to be diagnosing Anakin Skywalker and Winnie-the-Pooh, then why not Diagnosing Lear, right? This article from The New Criterion is actually a fairly serious piece of literary criticism focusing more on things like personal responsibility and expression of emotion, but the bits at the beginning that actually are directly about psychiatric diagnosis are pretty funny:

Doctors have been trying to diagnose King Lear for more than two centuries. They haven’t succeeded, of course, for a couple of reasons that are not mutually exclusive: first, King Lear does not exist, and second he is not available for tests or examination. The latest technology, no matter how sophisticated, will never settle the matter. No imaging studies for King Lear: he was born much too soon for them, and now will never be diagnosed properly.

Not, of course, that that puts doctors off, far from it.

I know it’s not at all uncommon for people to try to diagnose fictional characters, but when a friend of mine sent me the link to this article today, I just felt like sharing it.

Psychoanalysts perceived in Lear a case of thwarted incest (they would, wouldn’t they?). A variety of diagnoses have been offered from senile dementia to manic-depressive psychosis. (No one has suggested General Paralysis of the Insane, the last stage of syphilis.) Dr. Truskinovsky, writing in the Southern Medical Journal in 2002, makes a powerful case for mania, and suggests that Lear had been suffering from bipolar affective disorder all his life.

Personally, I am against all this diagnostic effort. It is not just that, as Dr. Truskinovsky dryly remarks, it is not altogether easy to decide what constitutes the symptom of grandiosity in an absolute monarch like Lear, so few of us having either experienced or witnessed that condition of man. It is rather that the medicalization of Lear’s behavior deprives it of moral significance.

I don’t see King Lear as being manic-depressive, but then again, it’s been an awfully long time since I’ve read the play.

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.

Yesterday somebody asked me, “What happened to your arm?”

It is both sad and funny that I had to ask him to clarify. “Which arm?”

“The left one,” he said.

I felt slightly relieved. The right arm is the one with the four-inch-long scar on the forearm. No one has ever asked me about it, probably because 1) it’s not as noticeable as the scars on my left arm, 2) it hasn’t been there as long, and 3) uh, it’s kind of obvious that I slashed my wrist a bit. The right-arm question isn’t one I feel like answering.

Neither was the left-arm question, apparently, because I just said, “Oh, that’s from years ago.” Which is true, but doesn’t answer anything. The last time someone actually asked me, which was in 2002, I said, “I cut myself with a razor blade.” No one has asked since then. The actual scars are from 1999. There are about twenty of them, on my upper arm. They’re short and not extremely noticeable, especially since they’re high enough up that I have to be wearing very short sleeves for them to even be visible.

I don’t think I was actually ashamed to answer truthfully. I think I just didn’t feel obligated. It’s hard for me to remember that not wanting to tell everybody doesn’t necessarily mean I’m ashamed of myself. The person who asked was a coworker I’ve never even had a conversation with before.

Is it just me, or is it kind of rude for a person you have never exchanged any words with other than “Hi” to ask what happened to your arm, when they’re not even doing so to express some sort of sympathy for a recent injury, as the scars have clearly been there a long time?

It’s been a year since I was in the hospital. Although there were nearly five years between my second and third hospitalization, last year, in the space of six months, I had two brief inpatient stays and spent seven weeks in a partial hospitalization programme, which I completed last June. I’ve also gone exactly sixteen months without cutting myself, which doesn’t really seem like a big deal because I pretty much quit and have only cut myself three times in the past six years, anyway.

My mood has been fairly stable lately, and, for a change, it is holding steady at “Very Well, Thank You” rather than “Rock Bottom.” So of course I’m being dogged by insomnia again. You know that saying, “It’s like putting an octopus to bed?” As soon as you’ve got one thing under control, another tentacle pops out from under the covers. It’s always something, isn’t it?

After several days back on my medication, my cognitive functioning is finally better. I am able to read books, I am not constantly forgetting things, and I’m not confused about what time or day it is.

I remembered to put the bathmat back in the tub after I took a bath, which I don’t think I have ever done since I moved in with my boyfriend, despite the fact that he reminds me to pretty much every day. I remembered to water the plant. Using these things as proof of my cognitive functioning seems kind of lame, and reminds me of a part in Anne Sexton’s poem “Hurry Up Please It’s Time.”

Interrogator:
What can you say of your last seven days?

Anne:
They were tired.

Interrogator:
One day is enough to perfect a man.

Anne:
I watered and fed the plant.

Although my last seven days were not particularly tired, I have been working extra hours lately, which is vaguely annoying even though I really need the money. Tired in general? No. Tired of working? Un peu.

I wish that I had been a bit more with-it the last time my boyfriend and I went grocery shopping, because today I opened the freezer door and was very surprised to see a box of Thick & Juicy Bison Burgers inside. I kid you not. Wow, I guess I wasn’t paying any attention at all to what he was putting in the cart. Not that I’m necessarily saying there’s something wrong with bison burgers, not ever having tried one before, but I can’t believe I didn’t even notice that we had acquired them.

I got my prescriptions filled tonight, so I am hopeful that my stupidness from medication withdrawal will go away soon. Seriously, it’s not good when you’re sitting in the doctor’s waiting room reading a poster on the wall about signs of Alzheimer’s disease and realizing that you currently have most of them. If my attention span improves soon, then I’ll be able to post more, as well as read other people’s blogs and respond to their posts. You would not believe how many times lately I have read other people’s posts, clicked on “Post comment,” and then completely forgot what I was doing and never got around to actually posting a comment.

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

I only have a few comments to make:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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