Diagnosis: labels, pigeon-holes and frameworks

Hello.

As I see it mental illness comes with a greater amount of hang-ups than physical ill-health.  This is, as best I can tell, due to mental illness being so intimately involved with who we are.  I cannot imagine the situation when a perpetually tired, overweight man who pees a lot is told he has diabetes and he replies in a plaintive wail, “Oh God, it has a name.”.  Diagnosis is a huge topic to deal with completely in one post but I’ll try to keep it brief.  Oversimplification is going to occur here but you are smart enough to know that although I am describing the poles that this thing is a spectrum.

Largely you are going to fall one of two ways when you are first given a diagnosis, you’ll either 1, be happy that the thing has a name and you are not just crazy or 2, be freaked out that you have this mammoth illness to contend with.  I, was both 1 and 2 (see the comment about the spectrum), I was both happy to know that I was not just wired up a little different and in fact had a mental illness that could be treated but I was freaked out when it turned out to be an illness, manic depression, that is treated over years not weeks.

There are some things to bear in mind about being diagnosed.  Firstly, and most importantly, you have a diagnosis but you are not your diagnosis.  You might have schizophrenia but calling yourself a schizophrenic doesn’t help anyone; I have manic depression but I am not a manic-depressive.  This is admittedly easier to do with mood disorders, less so with personality disorders and even less so with developmental disorders; however having that degree of segregation between you and the illness has a range of benefits.  The segregation makes dealing with other people’s prejudices easier,  it is significantly more difficult to shrug off someone saying you have a weird voice than it is shrugging off them saying you have a crap tee-shirt; the tee-shirt comes off.   If you incorporate the illness into your identity then it is more difficulty to deal with ignorant people talking about the illness.  Incorporating the illness into your identity also makes it easier to use the illness as a crutch, this isn’t something which happens to everyone but I know a couple of people who use their illness as the excuse for anything bad that happens which only serves to stagnate your recovery.

Diagnosis is at best a framework for treatment.  When it comes to treating manic depression, for instance, the options are wide and varied.  There are two true mood stabilisers and around half a dozen other medications that are licensed as having mood stabilising properties, there are three broad categories of antidepressants and in each category there is around a dozen or so medications, and there is a huge number of anti-psychotic medication.  Manic depression comes in various flavours, someone with rapid-cycling bipolar type I with psychotic features might respond really well on a low dose of lithium alone whereas someone with bipolar type II might require three of four different drugs to keep them managed.  No diagnosis is yet accurate enough to also pin-point the exact treatment regimen, it does help narrow down the options though.

Diagnosis is a double-edged sword.  Much as it awesome that you can now say with some degree of certainty that the weird stuff going on in your head is happening for a reason it does pose a couple of issues.  There is no point in being coy about it there is a degree of stigma surrounding mental ill health.  There are very few positive tales of mental ill-health equally though there are very few tales of diabetics, migraine sufferers or people with hypothyroidism.  There are however plenty of negative tales of people with mental illness, this is due to the way mental illness is intimately involved with who we are.  I have yet to see a report about a headache-y murderer.  It is only that we are scared of the dark and if someone happens to have any way by which we can try to better understand their motive then it is reported.  Mental illness is not a pre-cursor to crimes or heinous acts.  Mental illness is just an illness.

There is an equal but opposite lean towards the idea that mental illness is cool.  Hemingway, Van Gogh, Poe, Plath, Cobain, and countless others who can be identified by surname alone have all been touched by the creative fire that mental illness can bring, or so the mental illness romantics say.  Bad news is that just as people with a mental illness are not all committing crimes, people with a mental illness are not all churning out epic poems, scintillating novels and art exhibits that will astound by the score.  Having depression doesn’t make you deep or thoughtful just as having mania doesn’t manic you fantastically creative.

Diagnosis is just the key to starting treatment.  It is a framework for your recovery.  It is your recovery, you were an individual before your diagnosis just as you continue to be after your diagnosis.  Apparently one in four people experience mental ill health during their life.  We can all see that there is a greater degree of variance than 25% of people being exactly the same.  Use the diagnosis only as a framework to treatment and if needed a basis for explaining your mental ill health to someone else; it is never who you are.

The next post will be about telling other people you have a mental illness.

Until next time.

BC

Calling in the specialists

Hello.

To talk about all the different types of specialists involved with mental illness would take far too long.  Additionally there is only really one specialist involved with the diagnosis part of things – the psychiatrists.

If you were diagnosed by your GP then you will have likely been prescribed some sort of treatment; that treatment is probably medication, counselling, therapy or lifestyle changes.  Being treated by your GP alone does not mean that you are “not that ill”.  If you were not diagnosed by your GP then he either told you that there was nothing to worry about or he referred you on to a specialist.

There are two ways that you are likely to end up seeing a psychiatrist, 1 by sufficiently worrying the GP that they decide you need immediate admission to hospital or 2, by waiting a couple of weeks for a consultation.  The first instance is unlikely because you went to see a GP which shows at least some degree of insight and also, despite popular belief, people are not thrown into hospital for mental illness at the drop of a hat.  Just as a very short note, should your GP suggest seeing the psychiatrist immediately don’t panic, you are not going to be trussed up in a strait-jacket and carted off, all that has happened is your GP wants more specialised treatment to start quickly rather than waiting a couple of weeks.

I am saying a couple of weeks but in some cases it is months and in some days.  The length of time is not really related to how ill you are but is related to how many people are ill.  Bide your time, be patient, speak to your GP if you think it is taking too long to see the psychiatrist.  There is a good chance that your GP will start you on some sort of treatment whilst waiting on the consultation anyway.

Use the time between seeing your GP and the consultation to prepare.  The questions will be more in-depth than what your GP asked you and the consultation is likely to last from thirty minutes to an hour.  Your GP may or may not tell you why they think you should see a psychiatrist.  Some fall into the school of thought that a diagnosis is helpful and some believe that if a patient is told it might be something they will either worry needlessly or spend too much time reading up about it.  Whether you know what the GP thinks your diagnosis is or not it is helpful to know what it is that made them refer you.  Knowing why they referred you means that you can prepare better for the consultation.

There are various grades of psychiatrist and the grade you see will depend upon how busy your area is, the perceived seriousness of your illness, the way in which the referral process is structured and the staff available.  If you end up being referred to a consultant it is possible that your continued care will be overseen by someone lower down the scale, the reverse is also true and you may initially be seen by a junior psychiatrist and be passed up to a staff grade or consultant.  Spending time fretting about who you first see is not going to help anyone, least of all you.  The system is set up so that you get the help you need.

Seeing the psychiatrist is really about getting a diagnosis and then starting treatment.  I was not a normal case study as I saw my first psychiatrist roughly weekly and he oversaw my treatment.  Most people will be diagnosed by the psychiatrist and treatment will be managed by a lower grade psychiatrist or a community psychiatric nurse.  This is not to suggest that the psychiatrist are not interested in your care, far from it, but out-patient treatment is not measured in hours, days, or weeks but months.

Some mental illness have changes in symptoms that happen as rapidly as hours but there are very few that respond to treatment in anything less that weeks.  It is true that sedatives work quickly but it takes a while to see the difference in treating the underlying causes.  Both you and the psychiatrist can’t do much more than wait.

I am straying into talking about treatment here and I want to save that for another post.

Seeing a specialist should not be especially more nerve-wracking than seeing your GP.  It is just more in-depth to allow for better diagnosis and in turn a better targeted treatment.  All of the advice about seeing your GP is equally applicable to seeing a specialist.

The next post deals with telling other people about your illness.

Until next time.

BC

Asking for help.

Hello.

Once again “you” is both me and you, the reader.

You’ve decided that you need help.  Doesn’t matter that you kept delaying it by months or until you were cutting four times a week or five people said you were unwell; you have decided you need help and that’s where recovery starts.

There is almost always a delay, for whatever reason, between feeling that help would be a good idea and knowing that help would be a good idea.  There is no point blaming you or anyone else for that delay, ditch any notion that it might have been better if you got help earlier now – it will help further down the line.

Now to the bulky bit actually asking for help.

The being human thing is going to come into play here, with a hefty dose of the mentals.  In my experience we are largely crap at asking for help.  How many times have you find yourself trying and struggling to open a jar, eventually relented and given it to someone else, and then when they promptly open it quip that you loosened it.  There seems to be a deep-seated notion in all of us that asking for help is bad thing.  This seems to be in some way related to the idea that needing help makes us weak.  I am not going to spout a lot of clap-trap about asking for help for making you a strong person because it doesn’t.  It does however mean that you 1, did something that most people are crap at and 2, aren’t stupid – you ask for help when you need it.  Generally I dislike the idea of strength and weakness being attributed to non-physical things but that is off topic.

So being human you are telling yourself that asking for help is not a good thing, the side dose of the mental works on that and tells you that you are weak or stupid or wasting people times by asking for help.  This, simply, is not true.  You are dealing with an illness, which is not easy, by doing something sensible.

You could ask a friend, parent, sibling, extended family member, doctor, pastor, therapist, counselor, teacher, scout leader, coach, helpline call-taker or countless other people.  This is a huge choice, don’t let yourself get caught up worrying about who to ask.  Without doubt the best idea is your doctor.

Doctors are a good place to start because they are 1, trained to deal with ill people, 2, are good at sending you along to the right people and 3, if the first one isn’t helpful finding another is easy.  We’ll come back to the other people in a couple of posts.

A good doctor is knowledgeable, patient, non-dismissive, helpful and many other positive adjectives.  Not all doctors are good doctors.  When I eventually talked to a doctor I didn’t talk to my doctor as he had in the past been quite unhelpful and this time things were “serious”.  Don’t freak out or panic about your doctor not being a good doctor.  If you feel like you weren’t taken seriously or were dealt with unfairly in any matter go and see another doctor, if it happens again see another, if it happens a third time then you should maybe consider just how ill you think you are and then play it by ear but three opinions is not terrible.  If you do go the second opinion route absolutely do not tell the second doctor just how crap the first doctor was – this 1, eats into your time to ask for help and 2, could make you seem stand-offish which won’t endear them to helping you.

So that’s what to do if the following goes a bit wrong.  Remember though it is not the end of the world, or worse  -your recovery, to get a bad doctor to begin with.

Firstly, make the appointment and keep the appointment, if you know you can’t keep it (or haven’t kept it) reschedule it.  That is the easiest thing to do, it also gives you a constraint and people largely work better with constraints – see deadlines, haikus and twitter updates for examples.  You have given yourself a period of time to work out what you need to say to the doctor and it is amazing how an impending appointment focuses the mind.  Don’t try and figure out what you want to say before making the appointment or you’ll just delay the appointment until you know exactly how you are going to say it – procrastination is just a refuge from doing something you find scary, boring or both.

You should tell the doctor these things:

• How long ago you started feeling ill, even better if you can say when roughly each symptom started.
• How long symptoms last.
• What those symptoms are, you do not need to use medical terms – just describe in a way that isn’t fluffy what is wrong.
• Why you are asking for help.

Scripting this part is no big deal.  You can bullet-point it, write it out in fine script using a calligraphy pen, use a crayon and a napkin, type it as a letter; so long as you have a good memory jog of what you are going to tell the doctor.  This is particularly helpful for those who are depressed as sin when they make the appointment and then are mildly hypomanic on appointment day.  Don’t lost sight of what is wrong, how long it is wrong for, how long it has been wrong and what you’d like to change – these things are the crux of the information needed to set you on a path to recovery.

The why you are asking for help thing probably seems really difficult.  A generic “to not feel this way” is a good start and perfectly adequate.  Having a target can be helpful but try to make it a direction rather than a destination.  For an easy example: “cutting no more than twice a week” can set you up for a fall because if you struggle with that then you can say your goal is impossible and give up on the whole recovery thing; instead “cut less than I currently do” is a rolling goal, a direction and not a destination.

You’ll then be going off script.  The doctor is going to ask you questions.  It will be about expanding on certain aspects of what you have told him, asking how you feel about certain aspects of your life, maybe even treatment options.  These are not tricks or tests, this is an open book exam and the book is your brain.  Now in fairness you brain screwing up is why you are here, if you struggling to find the right page or there is a smudge on it, or it has been highlighted in a garish colour that it hurts to look at that is not just fine but pretty normal in mental illness.  You’ll learn to get better about reading the book but until then answering you don’t know or you aren’t sure is okay.  The better you are at knowing at what is wrong the easier it is to target help, insight is great for helping you out the hole but it is not the only thing.  Getting better happens with time.

Congratulations, that is how you ask your doctor for help.  Hopefully you are either now a diagnosed crazy or you have an appointment with a specialist coming any day now.  The post on diagnosis and specialists will be coming soon.

Until next time

BC

Getting better ain’t going to be easy

Hello.

To be clear when I say “you” I mean both you the reader and me

As best I can tell the biggest thing stopping anyone from starting on the road to recovery is themselves.  I was the biggest thing stopping me, twice.  And largely this stopping yourself thing is not about mental illness, it is just about being human and being worried about attempting something.

The way I see it is if you are unwell, particularly with a mental illness, you wait too long to deal with it.  There is a sweet spot in getting all illnesses diagnosed – early stages where it is still easily managed – but with mental illness comes lack of insight.  There can come a point when you get so unwell that you force yourself into recovery, probably by doing something very dangerous, very stupid or both, due to a lack of insight.  However before being so manic you are orbiting Jupiter, or so depressed you lie paralysed in your bed for weeks, or so floridly psychotic , or so scarred, or so thin that you do the dangerous or stupid thing you still retain insight into the illness.  Unfortunately you are human and the normal, not-ill, part of your brain is doing the normal human thing when it is faced with attempting something important and difficult.

You can’t help yourself when you are too ill.  When you are not too ill you’ll find excuses – never mind the number whatever flavour of mental you have is doing on you.

We excel at not doing things that are scary and find excuses for not doing things that are important.  We have all been there, a school assignment or a work report or cookies for a coffee morning or improving your golf handicap, when you have something important to you that needs you to do well you’ll self-sabotage yourself.  You’ll never undermine yourself enough to not turn in the assignment but you’ll not have given yourself enough time to have got it perfect.   You got swamped with a call from the city office so had to put out that fire before working on the report.  You couldn’t find the nutmeg in time to make the cookies taste just like they should do.  You haven’t got the right set of clubs to improve your swing yet.  This sort of stuff is understandable because it protects us from the fact that doing something and not doing it well is scary.

Truth is recovery is scary and to begin with you’ll suck at getting better

Chances are, unless you are over-confident/manic, some of these things will ring a bell.

• I can’t begin to get better without knowing I’ll get better
• I can’t begin to get better until I know what better is
• I can’t begin to get better because there is this other thing I have to do
• I can’t begin to get better without knowing when I’ll be better
• I can’t begin to get better until I know that I will be able to see myself getting better

Though you probably haven’t thought of it exactly like that those fears of how it will work, when it will happen, will it happen, will I know it is happening are probably there in some flavour; if not those then you own personal playlist of self-sabotage.

This is understandable.  When you take something that is just an idea and make it real it is a game-changer.  That perfect idea of whatever can no longer have limitless possibilities when it is outside of your head.  Ever thought you had a good idea for a novel?  Ever write it?  I am willing to say that you have done the first, that you’ve had the idea but not written it or something equivalent.  You need to remember though that a writer writes.

You are going to need to get used to the fact that for a while you will suck at recovery.  Harper Lee was writing stories for years before she was eventually published.  Laurie Halse Anderson has more than ten rejection letters for the first novel she submitted for publication and she is now really successful.  How many hours of practice and crappy garage bands do you think your favourite guitarist / bassist / singer was in before they hit the big time.  The people who are really good at creating things, stories, songs, art, dance routines, kick-ass photos, engaging non-fiction either are pulling some Jedi-master prodigy stuff or have a really high tolerance for sucking some of the time and putting the work in – I for one don’t believe there are many Jedis in this world.

You’ll maybe relapse, or not find a great doctor, or have a crappy state-approved psychologist, or not do well on meds and need to try 1, 2, 5, 10 different medications.  Maybe you will be a Jedi and get a great doctor, a great psychologist, and respond wonderfully to the first and only medication you try.  Thing is you will never know until you try.  And trying is probably going to mean some fairly crappy days but y’know better days than suicidal depression and intrusive psychosis and bankrupting yourself after a manic spending spree.

Yes it is scary because there is a doctor to speak to, and maybe medication, or therapy, or changes to diet, or lifestyle and that all seems like an awful lot of things to do.  Very quickly make a list of things you have to do tomorrow that are not part of your daily routine – feed the cat because your parents are on holiday, get the groceries, go to the gym, download that new song by your favourite band, do that English essay you’ve known about for almost a week.  So how many things did you have to do?  More than one?  That’s rubbish, you only ever have one thing to do and if you get that thing done then you have another thing to do and so on until you complete the list but you can’t complete it all at once.

You, without doubt, will not become recovered in one step.  First thing is accepting that something is wrong and then it is asking for help.  Asking for help is the next post but we will tackle something is wrong here.

There is a good chance that you’ll know you are ill unless you did one of those dangerous or stupid things.  There is a degree of insight to things.  You will know you are ill but you will tell yourself you aren’t.  Part of this is just being human, we don’t do well with being broken.  We might kid ourselves that we like people who are a little rough around the edges, a bit tarnished, but in truth we are crap with people who don’t just have an illness but are ill.  If you are not on the path to recovery you are ill.  It is entirely possible that a depression will lift or whatever else will leave of its own accord but it is valuable to learn to deal with it if it returns.

Nobody wants to be ill and you are probably convincing yourself that it is not all that bad.  You’ll maybe stick a time limit on it and if you still feel this way in a month then you’ll get help.  You’ll maybe say if you start cutting yourself more than twice a week you’ll get help.  You’ll maybe decide that unless someone asks if you are okay then you’re not ill.  Those types of thoughts are fine in measure, they prevent you turning into a hypercondriac but mental illness tends to prey on those types of thoughts delaying you seeking help.  Next month will become the next month and it will become thrice a week and it will be three people rather just one.

If you think something is wrong you’ll need to silence that self-sabotaging part or start praying for a friend to march you to the doctor’s office.  I strongly suggest that you do it of your own volition.  Having a friend or family member march you to the doctor’s surgery is going to result in a large feeling of the whole recovery thing being foisted upon you and that can be used an excuse when it is going badly as after all you didn’t want it or you weren’t ready for it; it also makes it easier to resent you doctor which doesn’t help anyone.

Don’t get me wrong this is going to be really difficult.

You are trying to stop things falling apart or un-weaving  or cracking or whatever metaphor you want to use, mental illness does not suffer from a lack of metaphors, and part of that is trying to convince yourself you are not falling apart.  I am not suggesting you lift the mask or uncork the bottle and let the crazy all rush out but getting better at knowing what the truth of the situation is, not keeping everyone at arm’s length and becoming more receptive to recovery is more than a good idea.

That’s step zero really – stop trying to convince yourself of how you are, just be honest.

Step one if you need help ask for it with worrying about how everything is going to pan out, knowing that it will not be easy and you’ll likely suck at getting better for a little while.  After all none of us with a mental illness really needed to learn the skills to piece ourselves back together again.

So, be honest with yourself, if you need help ask without worrying too much.

The next post is about the asking for help.

Until next time

BC.

A difficult birth

Hello.

This post is summed up by the sentence in bold at the bottom.

Most good stories don’t start with a heap of back-story, it gradually gets filled in, or out,  over the course of events.  I think this blog should be no different.  I also think it needs at least a small post to act as a starting block.

This blog is born of some failed attempts.  I started writing about mental health from a young age, initially in a diary, then a mental health online support forum, in two aborted blogs and then the one that I am sticking with.  The finally blog is the most consistently maintained place I write it is there and can be found with a little searching but I am not going to name it.  It was read, all 18 months of posts, over a couple of weeks by a friend who previously didn’t know the blog existed; the friend suggested that I polish some stuff up and post it again.  This became another blog that didn’t really work out.  But the one that has worked well is really just a diary with some good salient stuff in there.  This blog is that salient stuff.  It is about the distillation of:

• 12 years of being some degree of crazy,
• 9 years of depression,
• 3 years of bipolar,
• 3 years untreated,
• 3 years reading and absorbing all I could about recovery,
• Countless more about things related to recovery/mental health/things that makes us human

Those numbers suggest that I 1, like bullet-points and 2, don’t have qualifications or substantial amount of experience.  I 1, kinda do and 2, might not, but I am writing this down any way.

This blog will not:

• It is not going to be about tracking someone’s mood swings -I have that other blog for that
• It will not have posts of a “Dear diary, today I feel . . .” type – that is not conducive to helping others
• It will not run to a regular schedule – at least not big posts but links to good stuff on other blogs is likely to happen.

But to be positive:

• The posts will be longer – not little paragraphs about feeling crappy or manic
• And in turn be less glib/abrupt/flippant/depressing/triggering – as can happen when feeling crappy or manic
• Will be more advice based – because I want to do something other than moan about mental illness being crap
• Will be copy-edited – because the other blog is not

So in a line.

This is going to be a blog, with direction, about recovery from mental ill health.

BC.