Tag Archives: grief

Triggering

4 Apr

I think I pegged what is triggering these hypomanic episodes: the stress of trying to organize the social event of the NAMI Walk, along with the on going unknown of the ASD evaluation plus the grief of not being able to attend San Diego State University and it’s nearing the end of the semester.  That’s enough to drive anyone crazy, right?

BPD Extreme Emotions

25 Jun

I sort of thought I had my emotions more controlled than it turns out I do.  During periods of depression my moods only fluctuate from extremely depressed to apathetic depression.  After my long depressive episode last year I felt a couple months of true stability.  Then life started happening and my emotions got all over the place again.  I could give you an exact reason why for each and every change though they may have seemed minor to anybody else.

The emotional episodes in the last week have been the extremest in at least 2 years maybe more.  Also I haven’t been able to assign each episode to a specific trigger.  Yesterday with my case manager we just talked about grief and change; well mostly I cried and she mentioned those things.  Also, when I get on these rolls all the changes that are up and coming hit me at once, but at the same time I’d say they’re always looming so I wouldn’t call it a trigger.  Anyways, I’m still confused as to what is setting these off.

I had an appointment with the therapist today, she seemed more personable which was odd for me.  She’s usually very ‘blank slate.’  We talked about trying to be in wise mind with all these changes that are coming up and the growth I want.  Maybe to write them down so when I get those episodes I can look at it, though I’ll probably be too irrational and emotional.  But at least it’s a suggestion.  I’ll have to look at my other emotion regulation and distress tolerance skills.

As with BPD, I’m flying high today and nothing is wrong with the world other than my eyes still burning from all the crying yesterday.

What brought it on this time?

14 Jul

I’ve always been frustrated and feel like I got a raw deal because I’ve never really had a normal life. The average person is not this sad and hopeless. The average person doesn’t go long periods of time feeling nothing and numb just void. The average person doesn’t hear voices. The average person doesn’t self harm and isn’t as suicidal as I am. The average person can handle stress, relationships, friends, and responsibilities. The average person doesn’t need the mental health system to save them or protect them from themselves. The average person doesn’t hate themselves this much. There’s not so much split. The average person does not feel this alone. And these are things that have been and are pretty constant in my life.
Being dependent on other people.
Feeling so alone and different.
Not being able to work, difficulties staying out of the hospital.
The dual desire to live and die, fighting it out everyday.
Not being able to sustain relationships.

Specifics of this time:
*some voices gone, hope but fear and expectations.
*realization some of this illness is just me.
*realization with some symptoms gone life is still real hard.
*new found sexuality and possibilities of relationships and how much work it’ll take.
*realization of how much time and opportunities I’ve lost from bring mentally ill.
*finally having friends and in my opinion with one connecting piece that may weaken soon
*sister less available
*everyone moves on/ahead but me

2014 I’m Blogging for Mental Health: Treatment Program

14 May

APA-BlogDayBadge-2014

 

 

I can’t believe I almost missed it but today is mental health blog day.  This year I am going to blog about treatment programs specifically the Partial Hospitalization Program I am currently in.  Years Past: 2013, 2012.

I have a specific section under my menu about different treatment options where I briefly describe the treatment and the pros and cons of it and then my experience with it.  This post will be more specific but if you want more general information on different treatment options, and there are quite a few, check out that topic under the menu bar.

I am in a Partial Hospitalization Program, it meets from 9 am-2:30 pm Monday through Friday includes 5 different groups and lunch.  All partial programs that I have been to take place on the site of the hospital, usually in an adjoining building, and this one is no different.  We  eat at the hospital, yeah yuck hospital food, but not with any of the inpatients.

People usually attend a Partial program in an effort to prevent hospitalization or as an adjustment after being hospitalized.  When I did my orientation the program I am attending says they have a 70% success rate with people graduating the program and not needing hospitalization or re-hospitalization.

This particular program focuses on a DBT (Dialectical Behavioral Therapy) Approach.

The program I go to also has an IOP (Intensive outpatient program) aspect with people who are attending that program go home at noon, or only attend 3 groups and they only go 3 times a week.  The first group is a check in group where we all fill out a morning report.  Here re rate our anxiety, depression, irritation, and pain.  The form asks about what we’ve done since the last time we were in program, how long we have been sober for, if we have appointments ready (with an outside psychiatrist and therapist) after program ends, sleep, questions regarding self harm urges, and questions regarding medication issues.  We fill out the form and the leader goes over what’s in the form and asks us what we would like to work on that day.  This first group is the same every day!

After the first group we usually split up into two separate groups, in two separate rooms.  The people are split up by what they want to work on or similar issues.  It is very rare that the groups are split in the same exact way each day.  One usual division in the program that I am currently in is that those who have had substance abuse problems are generally all in one group sometimes with non-substance people depending on the number of people.  Some days, like today, we don’t split up because there was only 10 people.

Our 2nd Group was on “Learned Optimism.”  It was an educational type group, but time for participation.  Each group is about an hour long. The group was about cognitive restructuring or turning learned helplessness into learned optimism.  One of my key “take-aways” was that pessimism has three characteristics: pervasive, permanent, and personal. “It’s not just this, it’s everything.”  “It’s not just now, it’s forever” and “It’s all because of me and my personal failings.”  So a way to restructure those thoughts and put a more optimistic twist is to think of it as specific, temporary, and having multiple causes.

Our 3rd Group was on Grief and I have been requesting this group and was honestly disappointed.  The group again had an educational type and the handout repeatedly referred to death.  My grief is not related to a death but is a loss none the less, so I kept feeling invalidated and had to ask for clarification on how this applied to me and my situation.  We also didn’t get all the way through the group, the handout was on 7 stages and typically there are 5 stages of grief, and the handouts also kept referring to using drugs and alcohol to deal with grief.  So I didn’t get much out of this group.

After this group the IOP people went home and there were only 6 of us left, which is about the usual number in Partial.

Our 4th group was a continuation of a group we had prior in the week.  The topic was interpersonal effectiveness and it was a myths and challenges sheet.  I didn’t care for the group this time or prior in the week.  The sheet just had statements that are myths and we are suppose to write a challenge to them.  The statements were things like: “I don’t deserve to get what I want or need.”  “I can’t stand it if someone gets upset with me.”  “Obviously, the problem is just in my head.  If I would just think differently I wouldn’t have to bother everybody else.”  It is clear to see that these statements don’t have an absolute truth to them but just writing a “challenge” to it does not help me and it’s a waste of time.

After our 4th group we take a break and go to lunch at the hospital.  Today’s lunch was Teriyaki Chicken and Rice, I went to Subway and Jamba Juice instead because most time I don’t like the hospital food and won’t eat it.  Also between each group we get a 10 minute break.

Our 5th group and last group of the day was an extension of the 4th group.  We received a handout on cheerleading statements (another thing that isn’t effective for me!)  This group turned more into a process group that focused on me :/ A process group is different in that it when you take information and process it and relate it to you, probably the typical thing when you think of support groups or group therapy.  We had the majority of our 6 were non-talkers and so the leader called on me and I said these statements don’t work for me.  I gave an example of “If I say no to people and they get angry, that doesn’t mean that I should have said yes.”  I explained that sometimes it’s more effective to just say yes (even if I don’t want to do it) to spare the anger and all the effects it will have on me.  This turned the last group, which is usually shorter because of getting back from lunch, mostly about me which made me uncomfortable.

So today specifically wasn’t a very helpful day in the program, only one group really resonated with me and I felt I learned something and I could apply it.  However, going to Partial has other benefits such as having to stay out of bed for 5 hours, needing to get dressed, need to eat, and needing to interact with other people.  So even if I don’t always get something out every group, and it’s impossible that every time the group will apply to me, I still get at least one or two things and the structure the program provides.  Plus there is always tomorrow!  The groups range anywhere from 2-4 weeks and I am not sure how long I will be in this Partial Program.

Grief

29 Apr

Since Thursday I have been down and on the verge of tears, actually crying a number of times and straight out bawling a few times.  Today I went to support group, I didn’t want to.  I just wanted to stay in bed, but I know that wouldn’t have been good for me.  It’s difficult to put my finger on exactly what is bothering me because it is a number of things.  I’m feeling really vulnerable in general so anytime something small goes wrong I just have a real hard time holding it together.  The first half of today was good, sort of a leftover good feeling from spending time with 20 something’s friend last night; then it just wore off 😦  I’ve only got teary once today and that was at support group so I guess that is good.

I am coming to a lot of realizations that are painful and causing me grief.  One is the whole medication thing and TD.  Another is that I am not well enough to move out to family friend’s house.  Another is that my 20’s were horrible and they are suppose to be the fun years, I missed out on a lot I will never get back.  Being “better” is only better from certain symptoms specifically the depression and psychosis.  Although if this mood continues I might rescind my assessment of being better from the depression.  That I still have so many issues, and like an onion I’m just peeling back layers and it feels like it won’t end.  I lost so many years that I can’t get back and I still have at least a couple years more of healing to go.  The task seems daunting right now and I am losing hope.  I am still moving forward though, or at least not going backward.

A bigger problem is no one really knows what is going on so I am processing this all on my own right now.

A plan, I’m set

28 Jan

Yesterday I made an extra appointment to see my case manager.  I had to leave my Italian class a half hour early because she only had one opening, but I need to put my mental health first.  It really helped just having some where I could be real and safe.  I’ve been reading a bunch of blogs I relate to recently, but haven’t had energy to comment or re-blog with my thoughts.

Today is my free day this week, no class or appointments.  I’ve spent most of it in bed.  My parents are back home.  I was able to do a couple blog posts today that I have been meaning to do.  I have this whole to do list of things “I have been meaning to do.”  I will be unable to take one of my prescriptions one day this week because of not refilling the prescription in time.  I haven’t done any homework for math yet, but he isn’t collecting the first chapter since everyone may not have the book yet.  Side note: yes I do have the book.  I’ve been meaning to edit a friends book.  I’ve been meaning to move more of my stuff over to family friend’s.  And the list goes on.

I am so exhausted from taking care of myself, and I mean at a very basic level recently.  I may go inpatient sometime next week, for a break and some of the symptoms under control.  Both professors I have will not have issues with absences like my math professor last semester.  It’d be nice if I could count on someone to take care of me, hold this burden while I catch my breath, but that’s not my reality.  Case manager suggested that maybe the voice crying is my heart crying/grieving childhood.  I don’t know what to think but I will think about it.  Maybe by next week the symptoms will relent enough, I will feel more in control, or maybe some hypomanic energy. Either way I have a plan, and even just having that plan in place gives some relief.

To look forward to:  Vlog coming Thursday

Post with SMASH Journal progress, probably coming before Thursday

A whole lot of randomness, while I take a break from hmwk

17 Oct

I live, breath, everything mental illness.  It effects my entire life in one way or another.  I have issues with control as mentioned in a number places on this blog.  Growing up in an out of control environment, having physical health issues that were out of control, and dealing with mental health issues that are a lot of times out of my control.

I try to grab tight and control every aspect of my life as best as I can.  People say to let go and I have in some regards.  Self harm used to be away to control powerful emotions, especially if I needed to appear controlled elsewhere like at school or work.  The control is good in some ways: I need to control the symptoms I have control over otherwise I’d be completely nuts, locked up, or dead.

As most people with BPD I struggle with the middle ground.  When is it okay to just throw my hands in the air and say “this just isn’t with in my control.”   Or I can’t control this all on my own anymore I need help.  I go between the extremes of letting the symptoms take me over (or they just do and I can’t control it) OR micromanaging everything and trying to control it (which can also lead to symptoms taking over.)

And even recognizing and accepting the things I don’t have control over.  I always felt in control of my self-harm, I never worried about going to far, it being a danger to me, or anything.  Others may have had their worries but I didn’t.

It’s scary dealing with all that I do, some of which is unknown and can be dangerous or severely limiting.

Admitting that to yourself and accepting that, I’m not there yet.  Grieving over the things that have happened.  Accepting the uncertainty and unpredictability, also not there yet.  Some most of my worst times are right during or after uncertain or unpredictable things, just another reminder I’m not in control of my life.

———

And the randomness:

  • Just read an article that a research study in the UK was giving “‘modest’ financial incentives to patients receiving maintenance antipsychotic treatment by depot injection can encourage them to adhere to the regime.”  Found here.  Makes me wonder if I could stop taking me meds and they’d give me money to take them.
  • A NAMI blog about the stigma and Halloween topic that is pretty big right now.  My favorite quote and very insightful:

    …but noted that the problem is bigger than Halloween: “If you want to be an insensitive jackass, you’re always going to have plenty of opportunity,” wrote Mary Elizabeth Williams. “If you think it’s cool to parade around in a manner that’s racially tone-deaf or clueless about mental illness, chances are you’re not confining your idiocy to one night a year anyway.”

  • Had my appointment with the therapist today and she said something that has me thinking about the people who are too emotionally invested in me that can’t see things accurately due to some magical thinking.  Lots of psych words there so I’ll sum it up: some people who are close to me and care about me can’t see my limitations or my reality because of how it would effect them, magical thinking also can mean denial. (this isn’t meant in a selfish way; an example would be wanting me to be well and therefore thinking I’m well)
  • And back to the dead horse I am beating about having to deal with multiple diagnosis/multiple different symptoms and how difficult that is.  Recently a reality TV star killed himself after being diagnosed with schizophrenia, he had just begun accepting a diagnosis of bipolar disorder:

    His mother said that the determination of schizophrenia was the proximate cause of his suicide: “He couldn’t bear the thought of another diagnosis,” Paulette Mitchell told the Chicago Tribune. “He was just coming to accept the diagnosis of bipolar.”

  • And an article from psych central talking about trying to differentiate bipolar disorder from borderline personality disorder.  One thing I want to say is you can have both, I do, but there is a common misdiagnosis/overdiagnosis some kind of diagnosis problem between the disorders and recieving appropriate treatment.

My thoughts on the DSM 5

7 Jun

There has been a lot of controversy last month about the release of the DSM 5, which is a manual that is used in the US to diagnose mental disorders and code them for insurance coverage.  The terms you hear like OCD, Bipolar Disorder, Autism, Schizophrenia, etc are found in this manual with criteria that must be met, background information, and other important information about the disorder.  The 5 in the DSM 5, means this is the 5th Edition (more or less, there was a DSM IV TR which was a Text Revision.)  And the DSM stands for Diagnostic and Statistical Manual of Mental Disorder.  The first edition was publish in 1952 and the last publication before this new edition was in 2000.  There has been a lot of things that have changed since 1952 in regards to recognizing and treating disorders, classifying disorders in similar “families” like Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder, and Cyclothymic Disorder which fall into the Mood Disorder category or family.  Changes in how disorders are named such as Manic Depressive Disorder which is now Bipolar Disorder and Aspergers Syndrome which is now an Autistic Spectrum Disorder.  The removal of disorders when culture and society changes, examples are Homosexuality and Gender Identity Disorder (if you considered yourself transgender, you could have been diagnosed with this.)  The number of disorders has also changed as things have been removed and other disorders added, much more being added.  Another reason for the increase in disorders is the fact that some disorders that professionals have found to be prevalent in the population which were before thought of as under an umbrella diagnosis; an example of this is the new skin picking disorder and hoarding which were formerly thought of as sub types or symptoms under Obsessive Compulsive Disorders.  So now that you have a little history on the DSM and how and why they make changes I will explain what I think of some of the new changes both ones that are controversial and others which may have not gotten as much press.

One of the biggest stories was when Thomas Insel, the director of the National Institute of Mental Health (NIMH) publicly stated that their orginization would no longer be using the DSM for their research methods.  He went on to say:

Patients with mental disorders deserve better. But what exactly is better? What alternative do we have to categorizing patients according to their symptoms? Where are the hard data, the blood test, the biopsy, the EKG for diagnosing troubles of the mind?

Insel wants the government funded agency to instead focus on symptoms that may be part of different disorders rather than specific diagnosis and a focus on evidence based tests.  For example, allowing people with depressive symptoms that may be diagnosed with different diagnosis (example: Major Depressive Disorder or Bipolar Disorder) to participate in the same research studies in hopes to find brain based research that ties to the symptom of depression.  With this hypothetical new knowledge, researchers believe they could make better medications that could target specific symptoms; and maybe even later see (as in brain imaging or gene sequencing, etc) differences between agitated depression and say catatonic depression to make specific medications for those symptoms.

My response to this is:  That I think this idea is great in theory but that we haven’t made any head way in it in the past.  I think we should definitely try to find evidence based tests that can help us recognize symptoms and disorders and help with effective treatment. However, I think we aren’t there yet and to change the entire focus on to biological research of specific symptoms is just not possible at this time.  In my opinion they should spend some time researching based solely on symptoms, some time on disorders as they are classified now, and other time figuring out how and why the treatments that do work work.  I also believe that him being in such a public figure and some would assume spokesperson for the NIMH that he would be careful what his opinion is and how the words he says may be taken.

An excerpt from an interview with NPR:

FLATOW: Well, what is your problem? Tell us what your problem – why you’ve decided to not use that book so much.

INSEL: We’re not saying that clinicians shouldn’t use it. One way to think about this is DSM is really what we have, along with ICD, but those are really for the bedside. And I’m talking to an audience in the biomedical research community that’s at the bench, not at the bedside, most of the time.

And so, for the bench, we’re looking for some way to do just what Jeff Lieberman said a moment ago: finding a way to deconstruct these classifiers and to say hey, yes this is what we currently call schizophrenia. This is what we currently call autism spectrum disorder, but perhaps that’s not one problem, but multiple, five, six, seven, eight different diseases that are contributing.

Let’s do the science without the presumption that it’s a single disease. Let’s do the science with the assumption that we have to actually pull this apart and begin to understand the subtypes if we’re going to get to more selective treatments

Which kind of reinforces my point of being careful with his words, because he is specifying here he meant it just not be used by researchers but as you can tell people assume he means everyone even mental health professionals. Also another reason I am in favor of the DSM is that it puts common names to groups of symptoms that lead to some understanding, though obviously not perfect.  If my therapist, case manager, psychiatrist, and primary care physician are talking and here the term Borderline Personality Disorder or Depression they have a general idea and understanding.  Also, hearing a diagnosis helps your problems seem real and meeting others with similar disorders can create a sense of community and support- things like this happen daily at support groups for things like OCD, addictive behaviors, and even non-specific diagnosis, but symptoms like codependency, grief, or specific stressers.

 

The removal of Aspergers Syndrome from the DSM where there are now Autistic Spectrum Disorders.  With this topic I go both ways in some regards.  Aspergers Syndrome is commonly refereed to a less severe version of Autism or high-functioning Autism in some cases, I don’t like this and never have.  When you say your child has high-functioning Autism you are implying that most Autism is low-functioning- I think with the symptoms that would normally classify you for a diagnosis of Aspergers Syndrome now falling on the Autistic Spectrum many more people will use terms like high-functioning and low-functioning to determine where the person falls on the spectrum.  I prefer terms in severity, duration, and intensity that have less stigma attached to it.

 

Another big issue the change in grief or bereavement in the diagnosis of Major Depressive Disorder.  Prior to the DSM 5 bereavement was an excluding factor, meaning that if you had the symptoms of Major Depressive Disorder for 2 weeks or more you could not meet the criteria on a bereavement exclusion.  There are a couple things that could over ride this that I didn’t learn about until reading this from a post on World of Psychology:

An exception could be made only in certain cases; for example, if the patient were psychotic, suicidal, or severely impaired

I think allowing bereavement to be added is a positive step.  I believe some people who may have a predisposition to Depression may get their illness triggered by a loss, in a similar way drug use can trigger schizophrenia in people who are predisposed.  Also bereavement affects everyone different, you can tell by the quote above some reactions that can happen.  Also many people need therapy services when dealing with the loss of a loved one and just because you get a Depression diagnosis doesn’t mean you have to take medication it could get you eligible for counseling services that may not be covered unless you have a diagnosis.

I am happy about the removal of Gender Identity Disorder from the manual this year and think it’s a great step for the LGBT community, especially youth who are more susceptible to be diagnosed and treated for this disorder.

I approve of gambling being added into the section on Addictive Disorders, I have seen first hand the damage a gambling addiction can have on people and am glad with the addition people more people will be treated and covered my insurance.  Some people fear with this inclusion of an addiction being based on a behavior that eventually other behaviors will be added like internet addiction or video game addiction- I am not sure if this will happen or not but people should focus on the now rather than speculating about the future.  If the internet or video gaming becomes a prevalent and disabling addiction that it may be added at a latter point and I think both those descriptions can apply to gambling addiction.

I have talked in a prior post about my views on the addition of Disruptive Mood Dysregulation Disorder (DMDD) to stop or redirect childhood bipolar diagnosis, I also talk about the personality disorders not being changed at this time and a little about the changes in the Autistic Spectrum.

Counseling & Other Stuff

29 Jul

Today was my counseling appointment it appears 1:30 on Friday will be my normal time slot.  I’m dealing with quite a few different things right now and am constantly crying or on the verge of tears it seems.  I always used to be the one who held back the tears who wouldn’t let anyone see any weakness in me, otherwise they would take advantage.  It started with the prior therapist when I just couldn’t keep the facade up any more, plus she was new to me so she didn’t even really know the facade.  I had two scheduled appointments with her before my case manager came back, one was next week that I canceled the other one is at the end of the month and I’m not exactly sure what I will do about that one.  I also see my psychiatrist at the end of the month, I’m supposed to be going off the Depakote at my own pace, so far have only made it to 500mg, 250mg less and don’t think I’m stable enough to go down more, not even sure if I should have went down the 250mg.  I get frustrated everyone seems to think I have this “trauma” but they have no guesses as what it is as neither do I.  She seemed concerned about me making it through the week, maybe I showed too much emotion, I don’t know.  I’m trying to figure out how to get through this spell and function more so in the future.  I’m getting terrified of the future more and more, I think that’s because I have some what ruled out suicide as a solution. I need a mix up of things to cope, not sure what and how I can do it without feeling terrible when I don’t do it. 

Anyways, her son just passed away from cancer and she is dealing with a lot herself.  It somewhat helps because when someone understands your pain, at least on some level, it is comforting and you don’t feel so alone.  The worst part for me, is that when people are grieving it is expected they will “be having a hard time” and this is perfectly accepted.  There is no tangible reason (at least that I can find) of why I am this way.  Neither is it really accepted let alone understood.

She mentioned something about helping others. It’s always been something I’ve been interested in sometimes I feel, okay a lot of times I feel, that if I’m so messed up how on earth can I be helping others?  She mentioned I’m good at it even when I’m in pain myself.  Interesting thought.

I’ve always had a problem when people say positive things about me.  I doubt it is true and usually believe they are making things up to try to make me feel better.  I accept the “smart” compliment, I agree I am and it is definitely a strength.  Others I discard easily even if sometimes I agree with them. It’s real uncomfortable when someone is saying these to me, what do I do?  Argue?  I normally just stare off and dissociate, as I do when I’m in uncomfortable situations.

DBT skills is back next week plus a counseling appointment.  The next week I will not be able to do DBT skills class because of my colonoscopy.  Also I will have to figure out a different day to do counseling because I’ll be going to Idaho to visit a friend, or go without that isn’t a smart thing to do I think.  School starts up in 4 weeks, looks like I’m going to survive the summer without summer school.