I cannot tell you how good it feels to be done with exams! I haven't been in this good a mood for ages. It really is a good mood, too, not a scary good mood.
I took all the rest of last week off from pretty much everything. I slept (a lot) and ate real food and took some walks in the sun and read a bunch of novels and called friends in the States and went to some parties and just generally enjoyed myself. The fun has continued into this week - I'm off to Oxbridge later on and have a picnic and a garden party coming up - but I'm back at work on the dissertation.
I have been learning a lot about mental disorder from my dissertation research. I'm actually really quite excited about it - so much so, that I have decided to subject all of you to the best bits of it. My aim, for the next month or so, is to put up one or two posts a week on the things I've found out or that I'm thinking about that I consider to be the most interesting. Hopefully, this will have the double effect of preserving this blog from a slow death and keeping me going in my work.
I hope that everyone's having a good month!
Showing posts with label psychiatry. Show all posts
Showing posts with label psychiatry. Show all posts
22 June 2010
28 April 2010
Research Tidbit #1
I am in the thick of secondary dissertation research. We have a initial ten or so pages due on Friday, which I have just started writing because I am a very organised person. Yes.
I found a new article yesterday that was a research report into a sociological study (very well set up) that was initiated to determine what the actual deficit in ability to give informed consent was for persons hospitalised for mental disorder. I'm not going to go into the results just now because I want to keep this brief but in reading the study I found out something new to me that apparently is common to depressed persons. That is, a distinct deficit in capacity to make decisions successfully. As I was reading their description of what this meant, I did absolutely recognise myself.
According to the study, depressed persons typically were less able to communicate a decision and once a decision had been communicated, they were much more likely to experience distress or regret - often on the presumption that the decision must have been the wrong one. I do this all the time. I had assumed that it was just a part of my character - I still tend largely to think it is - but it is interesting to see that it is a characteristic correlated with depression. I know that it gets worse when I'm depressed but as almost everything seems to get worse when I'm depressed I didn't think of it as having any special relation.
This has, of course, started me wondering whether a diminished capacity to make and communicate decisions is also a reverse predictor. That is, if depression predicts a diminished capacity to make and communicate decisions, does a diminished capacity to make and communicate decisions predict depression? Obviously, that couldn't ever be a single predictor of depression - I can think of other things it might predict - but I wonder whether it might constitute another way to confirm or disconfirm a diagnosis of depression or perhaps be a good indicator of severity.
What do you all think? Does this reflect your experience? Had you heard about it before?
I found a new article yesterday that was a research report into a sociological study (very well set up) that was initiated to determine what the actual deficit in ability to give informed consent was for persons hospitalised for mental disorder. I'm not going to go into the results just now because I want to keep this brief but in reading the study I found out something new to me that apparently is common to depressed persons. That is, a distinct deficit in capacity to make decisions successfully. As I was reading their description of what this meant, I did absolutely recognise myself.
According to the study, depressed persons typically were less able to communicate a decision and once a decision had been communicated, they were much more likely to experience distress or regret - often on the presumption that the decision must have been the wrong one. I do this all the time. I had assumed that it was just a part of my character - I still tend largely to think it is - but it is interesting to see that it is a characteristic correlated with depression. I know that it gets worse when I'm depressed but as almost everything seems to get worse when I'm depressed I didn't think of it as having any special relation.
This has, of course, started me wondering whether a diminished capacity to make and communicate decisions is also a reverse predictor. That is, if depression predicts a diminished capacity to make and communicate decisions, does a diminished capacity to make and communicate decisions predict depression? Obviously, that couldn't ever be a single predictor of depression - I can think of other things it might predict - but I wonder whether it might constitute another way to confirm or disconfirm a diagnosis of depression or perhaps be a good indicator of severity.
What do you all think? Does this reflect your experience? Had you heard about it before?
06 January 2010
Disorganised New Year
It's always a disorganised new year here at my house, I've realised. I enjoy putting off things that I don't want to do and the endless bank holidaying when nothing is open for days on end is an ideal time to do so. It never fails to catch up with me and send me into a tizzy but I have this year officially declared said tizzy to be a holiday tradition, which means it is now my duty to be display as appalling a lack of organisation as I can in the first full week of postal delivery in the new year. I am, so far, doing a bang up job of keeping the tradition.
I'm in a terrible mood at the moment but for once I'm fairly sure that it's not due to mental health conditions that are beyond my control. Yes, similar symptoms but in its totality it feels different. This is absolutely not a scientific distinction. It is an instinct that may be wrong. However, I can see actual reasons and circumstances that I know are making me unhappy and may of which I can actually do something about. I don't have enough energy to do anything just at the moment but happily some of these circumstances will come to a natural end with the start of term. I don't have to do anything to bring about the start of term, just get myself through the next few days. I can do that.
So this is my new year's first project: to try to sift out how and whether I can successfully distinguish between a bad mood due to circumstances and a depressed mood due to bipolar disorder and wherein the difference lies. I'm going to get back to Foucault, too, I promise.
Happy New Year!
I'm in a terrible mood at the moment but for once I'm fairly sure that it's not due to mental health conditions that are beyond my control. Yes, similar symptoms but in its totality it feels different. This is absolutely not a scientific distinction. It is an instinct that may be wrong. However, I can see actual reasons and circumstances that I know are making me unhappy and may of which I can actually do something about. I don't have enough energy to do anything just at the moment but happily some of these circumstances will come to a natural end with the start of term. I don't have to do anything to bring about the start of term, just get myself through the next few days. I can do that.
So this is my new year's first project: to try to sift out how and whether I can successfully distinguish between a bad mood due to circumstances and a depressed mood due to bipolar disorder and wherein the difference lies. I'm going to get back to Foucault, too, I promise.
Happy New Year!
23 December 2009
Continentalist Blithering - Feel Free to Practice Your Textual Hermeneutics
I feel obliged* to warn you all that this post has a high content of continental philosophy, pseudo-structuralism and a dash of queer theory tossed in for "funsies".
After the last post, I have Foucault's Madness and Civilisation on the brain. The question I keep returning to is how one might live out one's madness as a valid instantiation of being in the world whilst also not doing so in a manner that is alienating.
My reading of Foucault comes through the filter of the bias footnoted below and I make no claim as to it's being particularly the best reading. Because of this, I intend to stick to the ideas that reading Foucault has given me rather than trying to elucidate the text. Here endeth the disclaimer.
Rights talk is more than a little incoherent philosophically but it is a very useful way of talking about the privileged space that should be accorded the individual within a society. Because of the way human rights play into the way in which the mad are treated, it is perhaps the most appropriate way for me to approach this question of how to live out madness validly.
Oh God: It has just become stunningly clear and perspicuous to me that this is going to take much longer to write than I intended and it's late. I'm copping out.
I will stop with a question. Might the mad have a human right to be mad insofar as it is subjectively desirable and does not lead to harming others? If so, how would this work? The axiom I take for this is that madnesses are unique, that they are not total and as such are a valuable, non-fungible individual experience. Our current ways of treating madness implicitly devalue madness and deny that the content of madness has in it anything relevant to the human experience. Is this right? Does this infringe on the right to self-expression?
No, this is not going to be an anti-psychiatry rant. Psychiatry has done great things for me. But it's not perfect and it's worth using new ways to analyse it as a whole.
More soon and in the meantime, I welcome everyone's thoughts on the matter.
____________________________________________________________________
*I am obliged by my increasing Anglo-American Analytic Philosophy bias - the LSE tends to entrench any such tendencies. In real life, these distinctions matter less and less but they do persist in that we study the philosophers who wrote when the distinction was more real.
After the last post, I have Foucault's Madness and Civilisation on the brain. The question I keep returning to is how one might live out one's madness as a valid instantiation of being in the world whilst also not doing so in a manner that is alienating.
My reading of Foucault comes through the filter of the bias footnoted below and I make no claim as to it's being particularly the best reading. Because of this, I intend to stick to the ideas that reading Foucault has given me rather than trying to elucidate the text. Here endeth the disclaimer.
Rights talk is more than a little incoherent philosophically but it is a very useful way of talking about the privileged space that should be accorded the individual within a society. Because of the way human rights play into the way in which the mad are treated, it is perhaps the most appropriate way for me to approach this question of how to live out madness validly.
Oh God: It has just become stunningly clear and perspicuous to me that this is going to take much longer to write than I intended and it's late. I'm copping out.
I will stop with a question. Might the mad have a human right to be mad insofar as it is subjectively desirable and does not lead to harming others? If so, how would this work? The axiom I take for this is that madnesses are unique, that they are not total and as such are a valuable, non-fungible individual experience. Our current ways of treating madness implicitly devalue madness and deny that the content of madness has in it anything relevant to the human experience. Is this right? Does this infringe on the right to self-expression?
No, this is not going to be an anti-psychiatry rant. Psychiatry has done great things for me. But it's not perfect and it's worth using new ways to analyse it as a whole.
More soon and in the meantime, I welcome everyone's thoughts on the matter.
____________________________________________________________________
*I am obliged by my increasing Anglo-American Analytic Philosophy bias - the LSE tends to entrench any such tendencies. In real life, these distinctions matter less and less but they do persist in that we study the philosophers who wrote when the distinction was more real.
20 December 2009
Failings
It's a Sunday and I have therefore been thinking over what I'm doing in my life; not that I don't think about it on other days but Sunday is a particular prompt. Over the past three days I've had my semi-annual semi-collapse, something that seems to happen irregardless of my general health, in wet weather years and in fine. For a few days to a week, I hibernate, skip bathing (embarrassing but true), eat unhealthy food and avoid talking to people. It's exhaustion and nerves and while it feels like a waste of time, it seems to be an inexpungible part of my constitution.
The result of this is that I have come to the conclusion that I have been failing to take myself seriously. I have not given myself much credit for anything, I have doubted my own agency, I have abrogated to others my opinions of what is good and of what I ought to do. This has not been a total state - I have got myself off to grad school despite other people's best, well-meaning and insidious advice, after all. However, I can see that I have often done things by half-measures and deliberately obscured myself in order to avoid seeming to think too much of myself when I ought to have let myself try my talents and tested myself by truer measures rather than let the expectations of others dictate how far I should pursue success and enjoyment.
I know where this started. It was when I started school here in London at the beginning of tenth grade. My parents enrolled my sister and myself at a school that follows the American curriculum. All my life before, I had gone to public schools, which is American for state schools but the school I went to here was independent, which in American would be called private, and private schools have a tendency to look down on the quality of education available in a state school. I had all my life been in honors classes and moved up grade levels in maths and English. However, this new school automatically placed me in mainstream track classes and when I queried this, they informed me that it was because this school had very strenuous high standards and they knew that I would not be prepared for their honors classes. This happened during orientation; they held it in the library and I remember quite clearly sitting on the round table in the front of the library where I later spent much time studying with my friends after school, and thinking that perhaps they were right. After all, I had never done well in school before. No one, neither I nor my parents nor my teachers, had ever thought this was because the work was too hard for me: on the contrary, I was always told that I was more than smart enough to be attempting the classes I was in.
I never had been able to complete more than half the homework I was assigned, much to the confusion of myself and all the relevant adults. I still struggle to make myself do all such things in vaguely timely fashion. I now think that this is part due to the strain of mental illness and part due to the fact that it's just not interesting to do - I have much less trouble when the assignment is at all substantial or challenging - and largely due to bad habits. I think that the first two led eventually to the last: as a child, I rarely had recourse to any defense but withdrawal and refusal. But at the time I didn't know why I found it so hard to be like everyone else, I only knew that I had never been able to do it.
By the time I reached tenth grade I was, as you might imagine, very discouraged over the whole school situation. So, when it was suggested to me that the honors classes I was used to might be too hard I was ready to take this advice - it was a new idea about why I did not do well and I wanted an explanation and I wanted a release from the constant strife with teachers and with my parents. Perhaps I had been setting my sights too high and perhaps I wasn't as smart as I thought. Apart from pressing them into putting me in French 3 (I had already completed French 2 and languages have always come easily to me - French was one of the two classes I could usually actually do my work for), I gave up the battle and accepted their judgement that I wasn't good enough for their honors classes - disregarding entirely the fact that I started school a year early, that I had always been above grade level hitherto and my consistently high standardised test scores.
I'm afraid that that sounds quite snotty but it is the plain truth of the situation. Besides, pretending that I am less than I am is what has gotten me in to this particular mess in the first place. I may as well stop doing it now as at any other time. Why ought I to be modest to the point of feeling ashamed about having the abilities I am lucky enough to have? I am very smart and quite good looking and I have a nice dry wit in conversation and I know it. I don't think it makes me better or more worthwhile than other people - it's an accident of birth and as such has nothing to do with whether I'm a good person or not. It doesn't cancel out my less desirable qualities, such as being very untidy and a mediocre cook and lazy about schoolwork and turning library books in on time. Nor does it cancel out my slatternly tendency to digress when I'm writing. . ..
My point is that I have believed other people who tell me I cannot do things that I reasonably think I am able to do. Since that initial concession at the start of tenth grade, I have given in on innumerable things, large and small and let myself be guided by other people's expectations. There are several important instances where I have not given in but plenty where I have and still more where I have equivocated. I am obedient when I ought to be stubborn. The worst of it is that I moderate my ambition - instead of aiming to do well, I aim not to fail. Sometimes not failing is the best I can do but I apply the same remit to situations where I could do much better. I ought not to do this. I especially ought not to give up without trying; I especially ought not to just fail to do anything at all.
All this is by now compounded with my mental ill health and what various people think I ought to do or refrain from doing in order to protect it. Foucault, I must admit, was largely right in his assessment of the effects of the moral management of mental illness - that the unique experience of madness was denied and devalued and with it, the agency and personhood of the mad, that it creates an internal police state within the individual (he didn't put it quite like that but that is how I take it) that makes the mad individual her own oppressor, her own restraint and a restraint ultimately more insidious and cruel than chains because it disintegrates the individual and makes all herself, her feelings and attitudes and actions, invalid. He argues this more strongly than I would personally but I do concede his point in the main and I'm digressing again.
O for brevity! O for clarity! O for the ability to be succinct and to use fewer parentheses!
This is where doubt strikes me, whence fear springs forth. If I want to do anything with my life and if I want make it through without being bored half to death, I must stop listening to others at the expense of listening to myself.
The result of this is that I have come to the conclusion that I have been failing to take myself seriously. I have not given myself much credit for anything, I have doubted my own agency, I have abrogated to others my opinions of what is good and of what I ought to do. This has not been a total state - I have got myself off to grad school despite other people's best, well-meaning and insidious advice, after all. However, I can see that I have often done things by half-measures and deliberately obscured myself in order to avoid seeming to think too much of myself when I ought to have let myself try my talents and tested myself by truer measures rather than let the expectations of others dictate how far I should pursue success and enjoyment.
I know where this started. It was when I started school here in London at the beginning of tenth grade. My parents enrolled my sister and myself at a school that follows the American curriculum. All my life before, I had gone to public schools, which is American for state schools but the school I went to here was independent, which in American would be called private, and private schools have a tendency to look down on the quality of education available in a state school. I had all my life been in honors classes and moved up grade levels in maths and English. However, this new school automatically placed me in mainstream track classes and when I queried this, they informed me that it was because this school had very strenuous high standards and they knew that I would not be prepared for their honors classes. This happened during orientation; they held it in the library and I remember quite clearly sitting on the round table in the front of the library where I later spent much time studying with my friends after school, and thinking that perhaps they were right. After all, I had never done well in school before. No one, neither I nor my parents nor my teachers, had ever thought this was because the work was too hard for me: on the contrary, I was always told that I was more than smart enough to be attempting the classes I was in.
I never had been able to complete more than half the homework I was assigned, much to the confusion of myself and all the relevant adults. I still struggle to make myself do all such things in vaguely timely fashion. I now think that this is part due to the strain of mental illness and part due to the fact that it's just not interesting to do - I have much less trouble when the assignment is at all substantial or challenging - and largely due to bad habits. I think that the first two led eventually to the last: as a child, I rarely had recourse to any defense but withdrawal and refusal. But at the time I didn't know why I found it so hard to be like everyone else, I only knew that I had never been able to do it.
By the time I reached tenth grade I was, as you might imagine, very discouraged over the whole school situation. So, when it was suggested to me that the honors classes I was used to might be too hard I was ready to take this advice - it was a new idea about why I did not do well and I wanted an explanation and I wanted a release from the constant strife with teachers and with my parents. Perhaps I had been setting my sights too high and perhaps I wasn't as smart as I thought. Apart from pressing them into putting me in French 3 (I had already completed French 2 and languages have always come easily to me - French was one of the two classes I could usually actually do my work for), I gave up the battle and accepted their judgement that I wasn't good enough for their honors classes - disregarding entirely the fact that I started school a year early, that I had always been above grade level hitherto and my consistently high standardised test scores.
I'm afraid that that sounds quite snotty but it is the plain truth of the situation. Besides, pretending that I am less than I am is what has gotten me in to this particular mess in the first place. I may as well stop doing it now as at any other time. Why ought I to be modest to the point of feeling ashamed about having the abilities I am lucky enough to have? I am very smart and quite good looking and I have a nice dry wit in conversation and I know it. I don't think it makes me better or more worthwhile than other people - it's an accident of birth and as such has nothing to do with whether I'm a good person or not. It doesn't cancel out my less desirable qualities, such as being very untidy and a mediocre cook and lazy about schoolwork and turning library books in on time. Nor does it cancel out my slatternly tendency to digress when I'm writing. . ..
My point is that I have believed other people who tell me I cannot do things that I reasonably think I am able to do. Since that initial concession at the start of tenth grade, I have given in on innumerable things, large and small and let myself be guided by other people's expectations. There are several important instances where I have not given in but plenty where I have and still more where I have equivocated. I am obedient when I ought to be stubborn. The worst of it is that I moderate my ambition - instead of aiming to do well, I aim not to fail. Sometimes not failing is the best I can do but I apply the same remit to situations where I could do much better. I ought not to do this. I especially ought not to give up without trying; I especially ought not to just fail to do anything at all.
All this is by now compounded with my mental ill health and what various people think I ought to do or refrain from doing in order to protect it. Foucault, I must admit, was largely right in his assessment of the effects of the moral management of mental illness - that the unique experience of madness was denied and devalued and with it, the agency and personhood of the mad, that it creates an internal police state within the individual (he didn't put it quite like that but that is how I take it) that makes the mad individual her own oppressor, her own restraint and a restraint ultimately more insidious and cruel than chains because it disintegrates the individual and makes all herself, her feelings and attitudes and actions, invalid. He argues this more strongly than I would personally but I do concede his point in the main and I'm digressing again.
O for brevity! O for clarity! O for the ability to be succinct and to use fewer parentheses!
This is where doubt strikes me, whence fear springs forth. If I want to do anything with my life and if I want make it through without being bored half to death, I must stop listening to others at the expense of listening to myself.
31 August 2009
Terms
I'm at my parents' now and spent yesterday assembling and doing the wiring for their new stereo. (I am blessed with the shelf hanging, fixing of minor plumbing problems, wiring, picture hanging kinds of abilities). They have a new blue-ray disc player (my father gets very excited over these things - it didn't rub off on my sister nor I - we both keep our very small analogue televisions in our closets - they come out during election seasons and similar). The abbreviation for blue-ray disc players used in all the manuals and on the remotes is BD. Every time I look at it, I involuntarily read it as body dysmorphia.
26 August 2009
Life Right Now is Bland, Tasteless and Rather Squishy
After two days spent not changing out of my pajamas and/or leaving the house I have had to admit to myself that I am just plain depressed. I don't seem to have any motivation to do anything besides read and knit and I can't seem to make myself stay on top of all the fun governmental paperwork I'm trying to do.
It's hard to tell whether this is 'real' depression in the DSM sense. After all, that's supposed to go on for at least two weeks (yes) with a marked change in appetite (no) and change in sleep patterns (hard to say). The main criterion, in my mind, is whether or not it interferes with your daily life (I can't tell).
I can't tell because I don't have much of a daily life at the moment, not because I'm avoiding people or too panicky to go anywhere, but because all I have to do at the moment is move and work on my visa application. I don't have to be anywhere. There is no particular reason for me to get up at any specific time, nor to get dressed and it's hard for a schedule like that to be interfered with by anything. I do feel melancholy but I think that's more to do with breaking up my home than anything else.
Everything is flat right now and that is the case for me when I'm depressed; that complete lack of desire that makes it almost impossible to choose one thing over another even when there are no particular consequences (such as picking out a book to read).
Another possibility is that I am extremely bored. I rather hope that that's it. Usually, when the semester is over and I have sixteen weeks ahead of me with no requirement to do anything, go anywhere or see anyone, I feel a huge sense of relief. This year, I woke up on that first Monday morning and thought, dammit, I have nowhere to go and no one to see: I took that to indicate that I wasn't depressed.
Right now, I feel like I have some sort of interior dimming, a grey-out of desire and interest. I have plenty of time to do some work (e.g., write a post that has actual content instead of navel-gazing) but I don't seem to be able to summon the concentration or will to do so. And time keeps folding up in strange ways so that some days feel like weeks and some weeks feel like days and two hours will pass agonisingly slowly until I look at the clock and notice that it's three hours later than I thought.
I do hope it's just boredom. I suppose I'll find out soon, when term starts.
It's hard to tell whether this is 'real' depression in the DSM sense. After all, that's supposed to go on for at least two weeks (yes) with a marked change in appetite (no) and change in sleep patterns (hard to say). The main criterion, in my mind, is whether or not it interferes with your daily life (I can't tell).
I can't tell because I don't have much of a daily life at the moment, not because I'm avoiding people or too panicky to go anywhere, but because all I have to do at the moment is move and work on my visa application. I don't have to be anywhere. There is no particular reason for me to get up at any specific time, nor to get dressed and it's hard for a schedule like that to be interfered with by anything. I do feel melancholy but I think that's more to do with breaking up my home than anything else.
Everything is flat right now and that is the case for me when I'm depressed; that complete lack of desire that makes it almost impossible to choose one thing over another even when there are no particular consequences (such as picking out a book to read).
Another possibility is that I am extremely bored. I rather hope that that's it. Usually, when the semester is over and I have sixteen weeks ahead of me with no requirement to do anything, go anywhere or see anyone, I feel a huge sense of relief. This year, I woke up on that first Monday morning and thought, dammit, I have nowhere to go and no one to see: I took that to indicate that I wasn't depressed.
Right now, I feel like I have some sort of interior dimming, a grey-out of desire and interest. I have plenty of time to do some work (e.g., write a post that has actual content instead of navel-gazing) but I don't seem to be able to summon the concentration or will to do so. And time keeps folding up in strange ways so that some days feel like weeks and some weeks feel like days and two hours will pass agonisingly slowly until I look at the clock and notice that it's three hours later than I thought.
I do hope it's just boredom. I suppose I'll find out soon, when term starts.
21 August 2009
Final Run-in With State Run Mental Health Services in North Carolina
For those of you who live in more civilised countries, let me first explain that in the US, state run mental health services are only for the uninsured and poor. In my home state, they were disastrously privatised in 2003 with more or less exactly the results one would expect.
I have been lucky that by pitching battle with them I have managed to stay under the care of a single psychiatrist for about a year and a half. He turned out to be a good one, which is more than I can say for some of his colleagues and co-workers. You can read, if you like, about one specific case worker I had who was worse than useless and more generally about the difficulties of engaging with these people. All of my readers in the UK may feel free to laugh at me but I am really looking forward to having access to the NHS next year. However bad it might be, and it doesn't sound idyllic, I have often found myself agog with envy at various descriptions even of being in hospital (they're allowed outside? they are allowed to go to the shops? they have crisis intervention teams? they have the option to see a therapist, even with a long waiting list?)
That short list of my own incredulity should give you some idea of what it's like here. Am I now a potential target for BNP anti-immigrant attacks for expressing an interest in the NHS? Or will they hold off because I'm white and English-speaking? Oh dear. I can't imagine, though, that anyone would wonder at it if they had to deal with the state of things in this country - or maybe I don't need to imagine it, just read the papers and see what the Republicans have been up to lately. It does seem to me that as I grow saner, the world has gone a bit farther off its rocker.
Anyhow, all I need do now is swing by there to pick up a copy of my chart (that will be interesting to see) to take with me and I'll be done! No more worrying that they will drop low need patients such as myself, no more worrying that the agency I'm currently enrolled with will go bankrupt (as happened last December - it took me six weeks and repeated phone calls that I would not have been able to make had I not been more or less well to get into a new one), no more worrying that I'll get a job only to have to pay for all this myself since most health insurance policies in the US don't cover mental health at all, or, if they do, have a lifetime limit that I would get through in about six months, a year at the outside.
I'm not going to miss this part of life in the US.
I have been lucky that by pitching battle with them I have managed to stay under the care of a single psychiatrist for about a year and a half. He turned out to be a good one, which is more than I can say for some of his colleagues and co-workers. You can read, if you like, about one specific case worker I had who was worse than useless and more generally about the difficulties of engaging with these people. All of my readers in the UK may feel free to laugh at me but I am really looking forward to having access to the NHS next year. However bad it might be, and it doesn't sound idyllic, I have often found myself agog with envy at various descriptions even of being in hospital (they're allowed outside? they are allowed to go to the shops? they have crisis intervention teams? they have the option to see a therapist, even with a long waiting list?)
That short list of my own incredulity should give you some idea of what it's like here. Am I now a potential target for BNP anti-immigrant attacks for expressing an interest in the NHS? Or will they hold off because I'm white and English-speaking? Oh dear. I can't imagine, though, that anyone would wonder at it if they had to deal with the state of things in this country - or maybe I don't need to imagine it, just read the papers and see what the Republicans have been up to lately. It does seem to me that as I grow saner, the world has gone a bit farther off its rocker.
Anyhow, all I need do now is swing by there to pick up a copy of my chart (that will be interesting to see) to take with me and I'll be done! No more worrying that they will drop low need patients such as myself, no more worrying that the agency I'm currently enrolled with will go bankrupt (as happened last December - it took me six weeks and repeated phone calls that I would not have been able to make had I not been more or less well to get into a new one), no more worrying that I'll get a job only to have to pay for all this myself since most health insurance policies in the US don't cover mental health at all, or, if they do, have a lifetime limit that I would get through in about six months, a year at the outside.
I'm not going to miss this part of life in the US.
17 August 2009
The Grand Mentalisms Reference Project
The Grand Mentalisms Reference Project is something I have had in mind for a while. At the moment of starting, I am stuck in omphaloskepsitis (navel-gazing-itis) and I am glad to have thought of something to offer up that's more in tune with the original purpose of this blog.
I am asking all of you who read to save up and share any and all references you come across in literature, journalism, blogs, television, magazines, movies, day to day conversation, scholarly articles, academically dubious articles and sources: in short, anything that reflects a popular conception of the nature of mental illness and especially the perceived nature or character of those who are mentally interesting, negative or positive. I would also welcome more selective contributions from older (pre-1970) psychiatric and psychological texts.
My aim is to build up a database of popular references to mental illness so that, in true pragmatist philosophy mode, I can gain a fuller idea of what exists in the minds of the living, the influences that shapes these perceptions and the historical discursive context of current understandings of mental illness in the popular social dialectic. With this understanding, I hope to be better able to address mentalisms philosophically in a more relevant way.
If you're not sure whether a reference you have come across is relevant to this project, just go ahead and stick it up anyway. I need your help and I welcome and appreciate any and all contributions.
When posting a reference, please try to give sufficient citation in whatever form. Sufficient citation for anything in print would consist of the date of publication, author, publisher, page number and title. For blogs, as much as can be gathered of the publication citation plus a link would be great. For conversational references, date, time, local and a brief description of the relationship between the participants (e.g. psychiatrist to patient, parent to child who is mentally interesting) would be appreciated. Names and personal details are not requested or necessary. If you do not have all of the information requested, don't worry, just give as much as you are able.
I am particularly interested in anything that strikes you as a recurring conception and particularly interested in anything that strikes you as unusual.
With your help, I hope to make a useful contribution to political philosophy and, eventually, public policy for the greater good of the mentally interesting and the benefit of greater understanding to the non-mentally interesting. Thank you in advance and know that I will faithfully give due credit to any aid you can afford me in this project.
I am asking all of you who read to save up and share any and all references you come across in literature, journalism, blogs, television, magazines, movies, day to day conversation, scholarly articles, academically dubious articles and sources: in short, anything that reflects a popular conception of the nature of mental illness and especially the perceived nature or character of those who are mentally interesting, negative or positive. I would also welcome more selective contributions from older (pre-1970) psychiatric and psychological texts.
My aim is to build up a database of popular references to mental illness so that, in true pragmatist philosophy mode, I can gain a fuller idea of what exists in the minds of the living, the influences that shapes these perceptions and the historical discursive context of current understandings of mental illness in the popular social dialectic. With this understanding, I hope to be better able to address mentalisms philosophically in a more relevant way.
If you're not sure whether a reference you have come across is relevant to this project, just go ahead and stick it up anyway. I need your help and I welcome and appreciate any and all contributions.
When posting a reference, please try to give sufficient citation in whatever form. Sufficient citation for anything in print would consist of the date of publication, author, publisher, page number and title. For blogs, as much as can be gathered of the publication citation plus a link would be great. For conversational references, date, time, local and a brief description of the relationship between the participants (e.g. psychiatrist to patient, parent to child who is mentally interesting) would be appreciated. Names and personal details are not requested or necessary. If you do not have all of the information requested, don't worry, just give as much as you are able.
I am particularly interested in anything that strikes you as a recurring conception and particularly interested in anything that strikes you as unusual.
With your help, I hope to make a useful contribution to political philosophy and, eventually, public policy for the greater good of the mentally interesting and the benefit of greater understanding to the non-mentally interesting. Thank you in advance and know that I will faithfully give due credit to any aid you can afford me in this project.
14 July 2009
Radioland Visits Broadmoor
I am a regular listener to This American Life on the public radio here in the US. Their last show, titled Pro Se after the legal term for representing oneself in court, really caught my attention. The first long story in it is about a man, here given the pseudonym Tony, who faked mental illness to avoid prison for committing grievous bodily harm. He ended up in one of the highest security units at Broadmoor and has been there for twelve years.
The story goes into detail about the difficulty of shaking a psychiatric diagnosis, especially within the context of a psychiatric hospital. There was a well known study done about the 'stickiness' of psychiatric diagnoses back in the 70's; I can't remember who just now but there is a copy of it somewhere in my research folder and I will find it. The story also includes something new to me - perhaps I've been under a rock and this isn't news to anyone else - which is the Scientologists' campaign against psychiatry. Now that I know about it, I wonder whether that might be behind some of the comments I've seen.
Anyhow, I can't write a proper post about this just now because I am off to my parents' today and I won't have the necessary books with me to write what I want to about it. The reason I have gone ahead and put this up is that This American Life will let you download their shows for free for one week so I thought I'd give anyone interested the chance to do so. If you're reading this after Saturday, you can always listen to any of their shows for free by streaming.
"Brian says Tony's story demonstrates that no two psychiatrists can agree on anything and they basically just make it up as they go along. I think his story demonstrates that it is a huge mistake to screw with psychiatrists and you should be careful not to tell people you're crazy, because you might turn out to be way too convincing about it."
Tony's story is told by Jon Ronson.
The story goes into detail about the difficulty of shaking a psychiatric diagnosis, especially within the context of a psychiatric hospital. There was a well known study done about the 'stickiness' of psychiatric diagnoses back in the 70's; I can't remember who just now but there is a copy of it somewhere in my research folder and I will find it. The story also includes something new to me - perhaps I've been under a rock and this isn't news to anyone else - which is the Scientologists' campaign against psychiatry. Now that I know about it, I wonder whether that might be behind some of the comments I've seen.
Anyhow, I can't write a proper post about this just now because I am off to my parents' today and I won't have the necessary books with me to write what I want to about it. The reason I have gone ahead and put this up is that This American Life will let you download their shows for free for one week so I thought I'd give anyone interested the chance to do so. If you're reading this after Saturday, you can always listen to any of their shows for free by streaming.
"Brian says Tony's story demonstrates that no two psychiatrists can agree on anything and they basically just make it up as they go along. I think his story demonstrates that it is a huge mistake to screw with psychiatrists and you should be careful not to tell people you're crazy, because you might turn out to be way too convincing about it."
Tony's story is told by Jon Ronson.
27 February 2009
Epistemic Injustice
I have taken to listening to a podcast called Philosophy Bites. It took me a while to get around to it, though many people had recommended it to me. However, it is quite enjoyable.
One of the ones I have listened to so far was given by Miranda Fricker, who is a professor at Birkbeck, which has made me all the more excited about applying there. She talked about epistemic injustice and credibility deficits. Epistemic injustice is also called testimonial injustice and it refers to a situation in which a speaker is not accorded the appropriate authority as a giver of knowledge. This might sound a little frivolous on the face of it but when one considers its instantiations in the real world, the dangers become obvious.
Take, for instance, a situation which she uses as an example and which has happened to me in my real life. Let us suppose that there is a meeting and a woman participant offers a suggestion that is overlooked. Subsequently, the same suggestion is offered by a male participant and greeted with enthusiasm. Each of the two has offered the same information and yet only one was taken seriously.
Another example of testimonial injustice that I can think of is the psychiatrist's office. As a patient, no matter what one says, one's credibility is only granted at the whim or opinion of the psychiatrist or any other mental health practitioner. Because one has the label of being insane (or whatever designation you might prefer) and because one is in an environment that reinforces that label, the psychiatrist or similar as the audience is the sole determiner of credibility because they have the label and position that accords them superior epistemic authority. Depending on the practitioner, this can be more or less of an issue. However, I would be willing to wager that anyone who has ever received treatment for mental health has experienced the frustration of being awarded a credibility deficit in the doctor's office because of the very fact of having a diagnosis. I myself find it unbelievably obnoxious, the more so because the doctors, when confronted about it, claim that such an imbalance does not exist. You can see where it will go from there.
Anyhow, I heartily recommend listening to the podcast itself. Dr. Fricker does a much better job of explaining this than I do. I found that it was a great relief to get a nice new descriptive term for the phenomenon; such terms help me think more clearly about things.
One of the ones I have listened to so far was given by Miranda Fricker, who is a professor at Birkbeck, which has made me all the more excited about applying there. She talked about epistemic injustice and credibility deficits. Epistemic injustice is also called testimonial injustice and it refers to a situation in which a speaker is not accorded the appropriate authority as a giver of knowledge. This might sound a little frivolous on the face of it but when one considers its instantiations in the real world, the dangers become obvious.
Take, for instance, a situation which she uses as an example and which has happened to me in my real life. Let us suppose that there is a meeting and a woman participant offers a suggestion that is overlooked. Subsequently, the same suggestion is offered by a male participant and greeted with enthusiasm. Each of the two has offered the same information and yet only one was taken seriously.
Another example of testimonial injustice that I can think of is the psychiatrist's office. As a patient, no matter what one says, one's credibility is only granted at the whim or opinion of the psychiatrist or any other mental health practitioner. Because one has the label of being insane (or whatever designation you might prefer) and because one is in an environment that reinforces that label, the psychiatrist or similar as the audience is the sole determiner of credibility because they have the label and position that accords them superior epistemic authority. Depending on the practitioner, this can be more or less of an issue. However, I would be willing to wager that anyone who has ever received treatment for mental health has experienced the frustration of being awarded a credibility deficit in the doctor's office because of the very fact of having a diagnosis. I myself find it unbelievably obnoxious, the more so because the doctors, when confronted about it, claim that such an imbalance does not exist. You can see where it will go from there.
Anyhow, I heartily recommend listening to the podcast itself. Dr. Fricker does a much better job of explaining this than I do. I found that it was a great relief to get a nice new descriptive term for the phenomenon; such terms help me think more clearly about things.
21 February 2009
And I Shall Sing as I Push the Rock Back Up the Hill
One thing that I had forgotten about feeling well is that one doesn't always feel well. I feel rather rotten most of the time, being stuck, as I am, in a corner of the world for which I am not suited among friends whom I love but with whom there is so much I cannot share.
This sounds like pretentious weltschmerz from the mouth of an ingrate but it isn't meant that way.
What I do mean is that I often feel almost as bad as I do when I'm depressed but the trick of it is that now I only feel that way for an hour or five minutes and not two months. I'll feel unbearably anxious but whenever the reason for the anxiety is removed, it fades away, quickly. It's amazing.
I have worried, as I know that others do, that the medication could only ever take away from me; that I would either be artificially happy and well or still miserable and sick with side effects. I thought that it could only be a compromise between how much depression I could stand and how much medication I could stand. There was, indeed, no reason for me to think otherwise. I had learnt from experience that medication would make me not-depressed, which is not at all the same as well. As it turns out, that's not what has happened this time.I've not turned into a smiling shell of myself. I'm not a morose lump either. I seem to have as complete a range of human emotion as I ever have had. I think that this is what it's like when the medication works.
Good job it finally did.
It only took twelve years, two hospitalizations, three depressive episodes so bad that I had to drop out of school, two so bad that I had to stop work, three pronounced periods of hypomania, years of insomnia, years of horrendous anxiety, and more than a decade of seeing various psychiatrists, psychologists and so on. It's only taken up the past seventeen years of my life.
I'm laughing though, it's absurd, but I'm laughing like Sisyphus. I'm glad something finally worked.
02 February 2009
Time for My Pills
Yesterday I did something I probably should not have done.In the late afternoon all the anxiety that had been building came to the point of being unbearable. So, I took a klonopin. Half an hour later, no difference. I thought, well, take another and I did. Still nothing. So I took another.
Finally, everything began to ebb away and I could at least sit still and stop picking on myself. I finished up a few things and headed off to bed where I fell blissfully asleep.
I was more than a little hungover today, bumping into things and walking from one end of the apartment to another for reasons I couldn't remember. I made myself walk to church because I though that it wouldn't be a good idea to drive. I dropped my music at least six or seven times this morning; I'm glad none of it went sailing down from the choir loft onto unsuspecting parishoners' heads. I've been fatigued and wobbly all day but quite relaxed. I sang much better this morning than I usually do - less worried about accidentally squeaking on the high notes, I suppose.
Then, too, I've had the less fun side effects. They don't always pop up when I take klonopin but they did this time. I kept getting tearful over all manner of things in the afternoon. I felt leaden and a little depressed for a few hours. I don't know why that will sometimes happen with klonopin and sometimes not. Most times not, really, now that I've been taking it a while.
When I was first out of the hospital I took 2.5 mgs a day, spread out. I could hardly walk but for the first time in years I wasn't eaten up by anxiety and self-loathing. Since then I've weaned off to the point of taking a half milligram every now and again. I take it in bursts, usually. I took one every day for the first week and a half of school to stop myself building up place-associated anxiety. Now that school is familiar again and not full of fearful recent impressions, I've stopped taking it.
When I took three of them yesterday (ssh. . .don't tell my psychiatrist I did that) I reasoned to myself that I used to take more than that on a daily basis and that therefore it was unlikely to have too much of an effect. I was so wrong. My tolerance did slip away; very, very far away. I will not be doing that again in a hurry. I suppose I might if I really enjoyed the 'stoned' feeling of it, but then, if I did enjoy such feelings I would probably have continued to take seroquel or geodon!
Was it worth it? I don't know. I did run through most of my first response anti-anxiety activities: bath, mint or other herbal tea, walk, pleasant errand, and the usual cure-all of distraction by dvd or NPR. However, I was too distracted to be distracted and I let the kettle boil over. I also tried the phone a friend option but it being Saturday night, I hadn't much luck with that.
It was worth it in that I didn't get to the point of a full blown, banging on the walls, decorating my legs with insults in ink kind of panic attack. It was too much hangover/side effect-wise.
Now I just wish I could figure out where that one came from.
26 January 2009
16 Things
There's a "16 Random Facts About Me" thing floating around on facebook these days and I feel inspired in my fretful sleepless on a school night state to make my own version, which I shall call:
16 Random Things About My Madness
1. Medication-induced acne on previously unblemished skin will eventually go away if you use heavy-duty Clearisil face scrub long enough; in my case, three months.
2. Baking is very relaxing provided you remember to set the timer.
3. Any spending urge caused by the hypomania (or proper mania, if you have it) can easily be satisfied by the constant need to buy larger clothes as the medication continues to help pile on the pounds.
4. You don't have to do anything but smile prettily at looks of confusion when you tell someone you have a chronic illness and they try to puzzle out how that can be true when you look so young and physically healthy.
5. The standard of care with Nurse Practioners is highly variable.
6. Sometimes klonopin is the best choice.
7. I like having a psychiatrist who is younger than I am (only by a year but I find it tremendously amusing for some inscrutable reason.)
8. Most books on coping with bipolar disorder are enormously depressing.
9. There can be a fantastic rush when going out at four in the morning for a cigarette while very hungry and looking up at the stars.
10. Pretending that you are someone else who had a mental illness can take the strain off and provide mild entertainment on depressive days: sometimes I like to sit in my armchair and pretend I'm Virginia Woolf; sometimes I like to lie in bed and pretend to be Anais Nin; sometimes I walk to the next neighborhood over and pretend I'm Zelda Fitzgerald. That's actually a bit strange, isn't it?
11. Ancient Greek and hypomania are a great match for each other.
12. Chasing pills with mint tea soothes the nausea.
13. If you are depressed long enough, at some point you will realize that you have memorized all the lines of at least three of your favorite movies.
14. Much to my annoyance, my father turns out to have been correct in his assertion that if I would just keep the house tidier I'd feel better.
15. It is worth calling as many people as you can when you have happy news.
16. It is easy to cause a landslide in the minds of state-mental health services personnel when making your next appointment if you take out your day planner and have your own pen. They will look at you in awe, as though you are a creature from another planet.
So that's my 16. What are yours?
16 Random Things About My Madness
1. Medication-induced acne on previously unblemished skin will eventually go away if you use heavy-duty Clearisil face scrub long enough; in my case, three months.
2. Baking is very relaxing provided you remember to set the timer.
3. Any spending urge caused by the hypomania (or proper mania, if you have it) can easily be satisfied by the constant need to buy larger clothes as the medication continues to help pile on the pounds.
4. You don't have to do anything but smile prettily at looks of confusion when you tell someone you have a chronic illness and they try to puzzle out how that can be true when you look so young and physically healthy.
5. The standard of care with Nurse Practioners is highly variable.
6. Sometimes klonopin is the best choice.
7. I like having a psychiatrist who is younger than I am (only by a year but I find it tremendously amusing for some inscrutable reason.)
8. Most books on coping with bipolar disorder are enormously depressing.
9. There can be a fantastic rush when going out at four in the morning for a cigarette while very hungry and looking up at the stars.
10. Pretending that you are someone else who had a mental illness can take the strain off and provide mild entertainment on depressive days: sometimes I like to sit in my armchair and pretend I'm Virginia Woolf; sometimes I like to lie in bed and pretend to be Anais Nin; sometimes I walk to the next neighborhood over and pretend I'm Zelda Fitzgerald. That's actually a bit strange, isn't it?
11. Ancient Greek and hypomania are a great match for each other.
12. Chasing pills with mint tea soothes the nausea.
13. If you are depressed long enough, at some point you will realize that you have memorized all the lines of at least three of your favorite movies.
14. Much to my annoyance, my father turns out to have been correct in his assertion that if I would just keep the house tidier I'd feel better.
15. It is worth calling as many people as you can when you have happy news.
16. It is easy to cause a landslide in the minds of state-mental health services personnel when making your next appointment if you take out your day planner and have your own pen. They will look at you in awe, as though you are a creature from another planet.
So that's my 16. What are yours?
24 January 2009
Healing Dialogue
This is a very close rewrite of the conversation I had this afternoon with my new caseworker. It was the second time I'd seen him. I'm just going to let the dialogue, which is foreshortened but remains representative and is in many parts verbatim, speak for itself, as it were.
I have changed the names.
Scene: a rabbit's warren like office building containing dark, narrow corridors set at illogical angles, dark amber glass, industrial carpet. Inside are three different mental health agencies, a pharmacy service and the office of the local congressional representative. Enter a young woman (that is, me) tired and a bit harassed looking.
Receptionist slides open glass panel
Me: Hi, I’m here to see Owen.
Receptionist slides closed the glass panel and nods dismissively
The young woman sits down on the plastic covered lobby couch and picks up one of the medication leaflets and starts reading it. Five minutes goes by.
A man in his approximate forties opens the door to the sanctum sanctorum of mental healing, revealing employees indulging in what can only be described as loud yakking and ferrying reams of paper from one closet-like room to another.
Owen: Hi, there. Not late this time!
Me: No. Hello.
thinks: wasn’t late last time, either
They walk around the corridors for a minute trying to find an unoccupied office. One is located and several foot high stacks of papers are rearranged to make enough room for two people to sit down.
Owen: How are you today? [shuffles papers]
Me: Doing well, doing well. A little stressed out. A little tired.
Owen: Well what’s up that you’re tired and stressed?
Me: It’s been a long week. The semester started last week. . .
Owen: Semester? But I thought Local County Tech started this week?
Me: They may have. I’m up at the state university, though, and we started last Wednesday. We talked about this last Friday.
Owen: Ah, that’s right. Philosophy. I took a philosophy class in college. That was when I didn’t know what I was doing with my life. You don’t need to know what you’re doing with your life yet when you’re still in college, as you know. My professor, oh man, he was a character. You know those people who always answer all the questions, with their little hands up in the air?
Me: Yes. I am one of those people. But I try to have a sense of humor about it.
Owen: Oh.
Me: It’s okay. Don’t worry, it’s not like I don’t know what . . .
Owen: Well one day the professor said “Whoever answers this next question will get a jawbreaker.” Like a candy, you know. So this guy raises his hand and answers the question and the professor like, you know, just slugs this piece of candy at him and it hits the wall, and oh man, it just like breaks into a bunch of pieces and I mean just like this huge thwack, BAM! Yeah, I still don’t know what that was about.
Me: Hmm. Neither do I.
Owen: So let’s see. [shuffles papers] And you’re graduating when?
Me: Well, that’s part of why I’m so exhausted this week. I’ll be graduating…
Owen: It’s not a race, you know. You’ll get there when you get there.
Me: I know. But I’m going to graduate this spring. I just got the registration worked out yesterday morning. And I think that having borne with all the stress of it this week and still sleeping and going to class and getting my work done, I really think that I’m going to be able to get through the semester.
Owen: That’s great. And you’ve been doing the mantras like we talked about last week?
Me: Well, no, because like I told you last week, that doesn’t really help me very much. But I have been doing other things to relax.
Owen: The great thing about mantras is that they center your breathing which is at the core of the way you feel. You have to say them breathing in and breathing out and it just takes you out of yourself. In fact, I spent about ten minutes doing that this morning and it was amazing. I was kinda still half asleep, kinda drifting in and out of being awake, you know, and it was like I just left myself, I really got outside of myself. And that’s all related to what this guy I know’s brother in law who was in a monastery in Vermont, real religious guy but he died real young, like fifty-two or something. Anyhow, he said in a poem that I can’t really remember how it goes, but it’s about how the core of everything is love. That that’s the real truth about everything. With your philosophy, I guess, you’d call that the meaning of life, right?
Me: Well, the idea that love is at the center of everything is certainly a very religious idea about the essential nature of the world.
Owen: Yeah, yeah. Well, that’s why the mantras are so important because they take you out of yourself. And this guy, this monk guy, said that hell is full of all the boring people, the people who never get outside of themselves and what they’re thinking and that’s why they go to hell.
Me: Hmm.
Owen: But you don’t use the mantras. What do you do?
Me: Taking baths, reading. . .walking, when it’s a bit warmer, or sitting in the sun. Sometimes I… Owen: And you take [peering down at file] klonopin?
Me: Yes.
Owen: How often do you take that?
Me: [sighing internally] Not very often.
Owen: Once a week, or?
Me: Well, it depends on the week. This last week, I’ve taken it pretty often. But when things are less stressful, maybe once a month or something.
Owen: You have to be careful with that. Those pills can be addictive. But you’re only taking half a milligram?
Me: That’s right. And I really don’t take it often enough to get dependent on it, though I realize, believe me, that that’s something to worry about.
Owen: I was talking to my officemate, you met her, Rachel, and we’re not sure that you need to be on CST. In fact, another of my colleagues overheard us talking last week and asked me whether you really needed to be on CST. Do you think about stepping down to med management?
Me: I have been, but with school starting and having had to change agencies, I thought it would be best to get to know things here before stepping down to med management.
Owen: I can see that. But what with all the restructuring we’re doing, I’m not sure that we’ll be able to keep you as a CST client. And they’re talking about doing away with the med management program because we can’t get any money from the state for it.
Me: What?
Owen: Yeah, well, I guess they expect you to get your own doctor.
Me: Well…I can’t afford that. That’s why I’m here. Psychiatrists are expensive. I have no health insurance. What am I supposed to do if that happens.
Owen: Oh, don’t get stressed about this. I didn’t mean to stress you out.
Me: Well, it’s a little late now.
Owen: Nah, they’ll never do away with it. I’m going to go ask Beth. [stands up, sticks head out of the door and shouts] Hey Beth? They’re not going to stop the med management program are they?
Beth: [offstage] No. I mean, they want to and they’re going to review it in February but we’ve got 112 clients in it and I don’t think they’ll be able to get rid of it.
Owen: [to Beth] Thanks! [to me] See, they’re not going to do away with it. So don’t stress.
Me: Well, with all due respect, I have heard that before. It was the same at the last agency and then they went out of business and gave us only two weeks’ notice and then it took me eight weeks to get in over here after they told me that they would take care of the transition work for me. It was eight weeks of people not returning my phone calls or saying that they will call me and then not calling me and being given misleading information. Even if you’re going to find a private doctor it can take a couple of months and for me to find someone I could afford to go to would take at least that long. So if they’re even thinking about stopping that, I have to wonder whether I should go ahead and start looking around now.
Owen: Well, that might not be a bad idea. But they’re not going to stop the program. But people do go through a lot to find a doctor. When I was first out of college, a friend of mine got me a job in a mental institution and, I was telling you about this last week, about how everyone was being involuntarily committed and I got to see all kinds of crazy diagnosisses [sic], man it was crazy out there. [laughs ruefully] Well, there was this pregnant girl, pregnant and fourteen, fifteen and psychotic and they had her on all kinds, just all kinds of different drugs – thorazine and neurontin and all that – and none of it was working so her parents just took her out and said they were going to take her to the root doctor. You know what a root doctor is? Like, there was a band called the Root Doctors? You must have heard of them.
Me: No, I haven’t, I don’t really know all that…
Owen: Man, why am I even telling you about this? This is your time, you should be doing most of the talking. But you don’t know what one is?
Me: No.
Owen: Never heard of a root doctor? It’s funny who does and who doesn’t. Well, they’re like witch doctors, like voodoo doctors. And they put these things in like cheesecloth, well I don’t know if they really use cheesecloth, but they put these things in and her parents took her out and said that if it worked, they’d bring her back and if it didn’t work, they’d bring her back. So after a like long weekend, they brought her back and she was fine. No problems anymore. I’m not saying it worked but it did have an effect and I guess you with your philosophy would say that it was about belief.
Me: Well, the placebo effect has been very well-documented in a number of well run drug studies over the past century, so yes, I suppose that could have been about…
Owen: Now when are you seeing Dr. Perry?
Me: I think it’s the 16th.
Owen: I have, let’s see, the 19th.
Me: I’m willing to bet you’re right. I have it in my planner but I don’t know it off the top of my head.
Owen: I’ll just look it up. [taps at the computer] The 19th. Well, that philosophy’s great stuff. One of the most interesting classes I took, although I thought it was a whole lot of bull at the time you know. See you next week. Good to talk to you.
Me: Yes. Next week, then.
I have changed the names.
Scene: a rabbit's warren like office building containing dark, narrow corridors set at illogical angles, dark amber glass, industrial carpet. Inside are three different mental health agencies, a pharmacy service and the office of the local congressional representative. Enter a young woman (that is, me) tired and a bit harassed looking.
Receptionist slides open glass panel
Me: Hi, I’m here to see Owen.
Receptionist slides closed the glass panel and nods dismissively
The young woman sits down on the plastic covered lobby couch and picks up one of the medication leaflets and starts reading it. Five minutes goes by.
A man in his approximate forties opens the door to the sanctum sanctorum of mental healing, revealing employees indulging in what can only be described as loud yakking and ferrying reams of paper from one closet-like room to another.
Owen: Hi, there. Not late this time!
Me: No. Hello.
thinks: wasn’t late last time, either
They walk around the corridors for a minute trying to find an unoccupied office. One is located and several foot high stacks of papers are rearranged to make enough room for two people to sit down.
Owen: How are you today? [shuffles papers]
Me: Doing well, doing well. A little stressed out. A little tired.
Owen: Well what’s up that you’re tired and stressed?
Me: It’s been a long week. The semester started last week. . .
Owen: Semester? But I thought Local County Tech started this week?
Me: They may have. I’m up at the state university, though, and we started last Wednesday. We talked about this last Friday.
Owen: Ah, that’s right. Philosophy. I took a philosophy class in college. That was when I didn’t know what I was doing with my life. You don’t need to know what you’re doing with your life yet when you’re still in college, as you know. My professor, oh man, he was a character. You know those people who always answer all the questions, with their little hands up in the air?
Me: Yes. I am one of those people. But I try to have a sense of humor about it.
Owen: Oh.
Me: It’s okay. Don’t worry, it’s not like I don’t know what . . .
Owen: Well one day the professor said “Whoever answers this next question will get a jawbreaker.” Like a candy, you know. So this guy raises his hand and answers the question and the professor like, you know, just slugs this piece of candy at him and it hits the wall, and oh man, it just like breaks into a bunch of pieces and I mean just like this huge thwack, BAM! Yeah, I still don’t know what that was about.
Me: Hmm. Neither do I.
Owen: So let’s see. [shuffles papers] And you’re graduating when?
Me: Well, that’s part of why I’m so exhausted this week. I’ll be graduating…
Owen: It’s not a race, you know. You’ll get there when you get there.
Me: I know. But I’m going to graduate this spring. I just got the registration worked out yesterday morning. And I think that having borne with all the stress of it this week and still sleeping and going to class and getting my work done, I really think that I’m going to be able to get through the semester.
Owen: That’s great. And you’ve been doing the mantras like we talked about last week?
Me: Well, no, because like I told you last week, that doesn’t really help me very much. But I have been doing other things to relax.
Owen: The great thing about mantras is that they center your breathing which is at the core of the way you feel. You have to say them breathing in and breathing out and it just takes you out of yourself. In fact, I spent about ten minutes doing that this morning and it was amazing. I was kinda still half asleep, kinda drifting in and out of being awake, you know, and it was like I just left myself, I really got outside of myself. And that’s all related to what this guy I know’s brother in law who was in a monastery in Vermont, real religious guy but he died real young, like fifty-two or something. Anyhow, he said in a poem that I can’t really remember how it goes, but it’s about how the core of everything is love. That that’s the real truth about everything. With your philosophy, I guess, you’d call that the meaning of life, right?
Me: Well, the idea that love is at the center of everything is certainly a very religious idea about the essential nature of the world.
Owen: Yeah, yeah. Well, that’s why the mantras are so important because they take you out of yourself. And this guy, this monk guy, said that hell is full of all the boring people, the people who never get outside of themselves and what they’re thinking and that’s why they go to hell.
Me: Hmm.
Owen: But you don’t use the mantras. What do you do?
Me: Taking baths, reading. . .walking, when it’s a bit warmer, or sitting in the sun. Sometimes I… Owen: And you take [peering down at file] klonopin?
Me: Yes.
Owen: How often do you take that?
Me: [sighing internally] Not very often.
Owen: Once a week, or?
Me: Well, it depends on the week. This last week, I’ve taken it pretty often. But when things are less stressful, maybe once a month or something.
Owen: You have to be careful with that. Those pills can be addictive. But you’re only taking half a milligram?
Me: That’s right. And I really don’t take it often enough to get dependent on it, though I realize, believe me, that that’s something to worry about.
Owen: I was talking to my officemate, you met her, Rachel, and we’re not sure that you need to be on CST. In fact, another of my colleagues overheard us talking last week and asked me whether you really needed to be on CST. Do you think about stepping down to med management?
Me: I have been, but with school starting and having had to change agencies, I thought it would be best to get to know things here before stepping down to med management.
Owen: I can see that. But what with all the restructuring we’re doing, I’m not sure that we’ll be able to keep you as a CST client. And they’re talking about doing away with the med management program because we can’t get any money from the state for it.
Me: What?
Owen: Yeah, well, I guess they expect you to get your own doctor.
Me: Well…I can’t afford that. That’s why I’m here. Psychiatrists are expensive. I have no health insurance. What am I supposed to do if that happens.
Owen: Oh, don’t get stressed about this. I didn’t mean to stress you out.
Me: Well, it’s a little late now.
Owen: Nah, they’ll never do away with it. I’m going to go ask Beth. [stands up, sticks head out of the door and shouts] Hey Beth? They’re not going to stop the med management program are they?
Beth: [offstage] No. I mean, they want to and they’re going to review it in February but we’ve got 112 clients in it and I don’t think they’ll be able to get rid of it.
Owen: [to Beth] Thanks! [to me] See, they’re not going to do away with it. So don’t stress.
Me: Well, with all due respect, I have heard that before. It was the same at the last agency and then they went out of business and gave us only two weeks’ notice and then it took me eight weeks to get in over here after they told me that they would take care of the transition work for me. It was eight weeks of people not returning my phone calls or saying that they will call me and then not calling me and being given misleading information. Even if you’re going to find a private doctor it can take a couple of months and for me to find someone I could afford to go to would take at least that long. So if they’re even thinking about stopping that, I have to wonder whether I should go ahead and start looking around now.
Owen: Well, that might not be a bad idea. But they’re not going to stop the program. But people do go through a lot to find a doctor. When I was first out of college, a friend of mine got me a job in a mental institution and, I was telling you about this last week, about how everyone was being involuntarily committed and I got to see all kinds of crazy diagnosisses [sic], man it was crazy out there. [laughs ruefully] Well, there was this pregnant girl, pregnant and fourteen, fifteen and psychotic and they had her on all kinds, just all kinds of different drugs – thorazine and neurontin and all that – and none of it was working so her parents just took her out and said they were going to take her to the root doctor. You know what a root doctor is? Like, there was a band called the Root Doctors? You must have heard of them.
Me: No, I haven’t, I don’t really know all that…
Owen: Man, why am I even telling you about this? This is your time, you should be doing most of the talking. But you don’t know what one is?
Me: No.
Owen: Never heard of a root doctor? It’s funny who does and who doesn’t. Well, they’re like witch doctors, like voodoo doctors. And they put these things in like cheesecloth, well I don’t know if they really use cheesecloth, but they put these things in and her parents took her out and said that if it worked, they’d bring her back and if it didn’t work, they’d bring her back. So after a like long weekend, they brought her back and she was fine. No problems anymore. I’m not saying it worked but it did have an effect and I guess you with your philosophy would say that it was about belief.
Me: Well, the placebo effect has been very well-documented in a number of well run drug studies over the past century, so yes, I suppose that could have been about…
Owen: Now when are you seeing Dr. Perry?
Me: I think it’s the 16th.
Owen: I have, let’s see, the 19th.
Me: I’m willing to bet you’re right. I have it in my planner but I don’t know it off the top of my head.
Owen: I’ll just look it up. [taps at the computer] The 19th. Well, that philosophy’s great stuff. One of the most interesting classes I took, although I thought it was a whole lot of bull at the time you know. See you next week. Good to talk to you.
Me: Yes. Next week, then.
18 January 2009
Knitted Together
Before I had my diagnosis, I always thought that the euthymia that I experienced was the Holy Spirit. Even though I will use the technical term now, I still think it's the Holy Spirit. I don't mean that in a delusional, I think I'm the second coming way; I mean that it feels like the Holy Spirit.
I do strongly believe that mental illness has a physiological basis. I have no doubt that the extraordinary mood swings I experience have their root in a neurological defect. However, I also believe that God is everywhere, which means that there is no reason that He can't be in illness as well as health.
It seems a little perverse to me sometimes that a very, very good mood could be a symptom of illness but the way it comes on does seem to suggest that something has been triggered in the brain. I can feel it happen and it comes on the way the effects of a drug come. One minute I'll be sitting there feeling nothing out of the ordinary and fifteen minutes later I'll be filled with a luminescing joy that has come from no discernible place and that will not go away nor change in degree. It just is.
It's not strong enough to be called hypomania but it's not an ordinary state either. It might last a day, or it might last a month. It's a wonderful feeling.
The advantage of knowing Greek is that one can parse all these psychological/psychiatric terms. Euthymia comes from 'eu' meaning good, lucky, happy. The -thymia part comes from 'thumos' meaning spirit, heart. Euthymia is closer to 'high spirits' than 'good mood.' So it seems not incompatible to me that euthymia could be an experience of the Holy Spirit. By suffering are we made holy and by the Holy Spirit, Christ's own first gift to the faithful, is not called the eternal comforter as a joke. (Although it does conjure up the image of an enormous fluffy duvet sometimes.) Euthymia does feel like God's peace and comfort and a kind of earthly compensation for the rest of it.
It's not an accident that I have bipolar disorder. I wouldn't have chosen it but that doesn't mean that I have to experience it as a meaningless invasion of what would otherwise be a more ordinary life. I don't always know what exactly to do with it but it is mine to do something with. It is part of me, in my inmost self, and though it has a pathology (laws or order (logos) of suffering (pathos)), it takes its form from me and not mine from its.
We had Psalm 139 in church today - one of the really lovely ones - and it put me in mind of all this. And really, am I not, are we not all, marvellously made that even an illness can bring me joy?
Domine, probasti
1 LORD, you have searched me out and known me; *
you know my sitting down and my rising up;you discern my thoughts from afar.
2 You trace my journeys and my resting-places *
and are acquainted with all my ways.
3 Indeed, there is not a word on my lips, *
but you, O LORD, know it altogether.
4 You press upon me behind and before *
and lay your hand upon me.
5 Such knowledge is too wonderful for me; *
it is so high that I cannot attain to it.
6 Where can I go then from your Spirit? *
where can I flee from your presence?
7 If I climb up to heaven, you are there; *
if I make the grave my bed, you are there also.
8 If I take the wings of the morning *
and dwell in the uttermost parts of the sea,
9 Even there your hand will lead me *
and your right hand hold me fast.
10 If I say, "Surely the darkness will cover me, *
and the light around me turn to night,"
11 Darkness is not dark to you;the night is as bright as the day; *
darkness and light to you are both alike.
12 For you yourself created my inmost parts; *
you knit me together in my mother's womb.
13 I will thank you because I am marvelously made; *
your works are wonderful, and I know it well.
14 My body was not hidden from you, *
while I was being made in secret and woven in the depths of the earth.
15 Your eyes beheld my limbs, yet unfinished in the womb;all of them were written in your book; *
they were fashioned day by day,when as yet there was none of them.
16 How deep I find your thoughts, O God! *
how great is the sum of them!
17 If I were to count them, they would be more in number than the sand; *
to count them all, my life span would need to be like yours.
I do strongly believe that mental illness has a physiological basis. I have no doubt that the extraordinary mood swings I experience have their root in a neurological defect. However, I also believe that God is everywhere, which means that there is no reason that He can't be in illness as well as health.
It seems a little perverse to me sometimes that a very, very good mood could be a symptom of illness but the way it comes on does seem to suggest that something has been triggered in the brain. I can feel it happen and it comes on the way the effects of a drug come. One minute I'll be sitting there feeling nothing out of the ordinary and fifteen minutes later I'll be filled with a luminescing joy that has come from no discernible place and that will not go away nor change in degree. It just is.
It's not strong enough to be called hypomania but it's not an ordinary state either. It might last a day, or it might last a month. It's a wonderful feeling.
The advantage of knowing Greek is that one can parse all these psychological/psychiatric terms. Euthymia comes from 'eu' meaning good, lucky, happy. The -thymia part comes from 'thumos' meaning spirit, heart. Euthymia is closer to 'high spirits' than 'good mood.' So it seems not incompatible to me that euthymia could be an experience of the Holy Spirit. By suffering are we made holy and by the Holy Spirit, Christ's own first gift to the faithful, is not called the eternal comforter as a joke. (Although it does conjure up the image of an enormous fluffy duvet sometimes.) Euthymia does feel like God's peace and comfort and a kind of earthly compensation for the rest of it.
It's not an accident that I have bipolar disorder. I wouldn't have chosen it but that doesn't mean that I have to experience it as a meaningless invasion of what would otherwise be a more ordinary life. I don't always know what exactly to do with it but it is mine to do something with. It is part of me, in my inmost self, and though it has a pathology (laws or order (logos) of suffering (pathos)), it takes its form from me and not mine from its.
We had Psalm 139 in church today - one of the really lovely ones - and it put me in mind of all this. And really, am I not, are we not all, marvellously made that even an illness can bring me joy?
Domine, probasti
1 LORD, you have searched me out and known me; *
you know my sitting down and my rising up;you discern my thoughts from afar.
2 You trace my journeys and my resting-places *
and are acquainted with all my ways.
3 Indeed, there is not a word on my lips, *
but you, O LORD, know it altogether.
4 You press upon me behind and before *
and lay your hand upon me.
5 Such knowledge is too wonderful for me; *
it is so high that I cannot attain to it.
6 Where can I go then from your Spirit? *
where can I flee from your presence?
7 If I climb up to heaven, you are there; *
if I make the grave my bed, you are there also.
8 If I take the wings of the morning *
and dwell in the uttermost parts of the sea,
9 Even there your hand will lead me *
and your right hand hold me fast.
10 If I say, "Surely the darkness will cover me, *
and the light around me turn to night,"
11 Darkness is not dark to you;the night is as bright as the day; *
darkness and light to you are both alike.
12 For you yourself created my inmost parts; *
you knit me together in my mother's womb.
13 I will thank you because I am marvelously made; *
your works are wonderful, and I know it well.
14 My body was not hidden from you, *
while I was being made in secret and woven in the depths of the earth.
15 Your eyes beheld my limbs, yet unfinished in the womb;all of them were written in your book; *
they were fashioned day by day,when as yet there was none of them.
16 How deep I find your thoughts, O God! *
how great is the sum of them!
17 If I were to count them, they would be more in number than the sand; *
to count them all, my life span would need to be like yours.
16 January 2009
First Day Back
As I sat in my first class this morning, I couldn't believe my eyes. The light was clear. All around me were students from different years. Some of them were happily chatting to their neighbors, two behind me were bemoaning the lack of party opportunities in our fair city and talking of transferring to one of the other state universities. Some were silent, as I was. It was warm in the classroom and I sat comfortably at my desk.
It was not at all what I remembered.
One year ago I had my first class of the semester in this same classroom, taught by the same teacher. But that day it was too dark to see properly in the classroom so that the edges of things blurred and crackled against one another. That day, the air was sharp and rough, and made me cough. That day, the desk felt too small and I sat squeezed uncomfortably while my fellow students made a chorus of raucous guffaws and descant whispers. My hands were numb while I was damped with sweat and shivering.
It was not that the heating system had been redone, nor the building remodelled, nor the desks changed nor the students. It was me.
The stark difference between my memory and my immediate perception was startling. I had new eyes!
We rely on our senses for unmediated knowledge. Our modern sciences are based in empricism, i.e. the idea that knowledge must come from direct observation. This has led to many innovations: the helio-centric theory, evolution, calculus, even our dear friends psychology and psychiatry. Empiricism as a code of action and of evaluation has reached into history, political thory, philosophy, art. It is always with us, even in such hackneyed sayings as "I can't believe my eyes." This expression would carry no great meaning if we did not understand that our senses were our best conduits to understanding. Divine Illumination it is not.
I thought that I was entering the port of an earthly purgatory; imagine my surprise when I found a welcoming place instead.
It was not at all what I remembered.
One year ago I had my first class of the semester in this same classroom, taught by the same teacher. But that day it was too dark to see properly in the classroom so that the edges of things blurred and crackled against one another. That day, the air was sharp and rough, and made me cough. That day, the desk felt too small and I sat squeezed uncomfortably while my fellow students made a chorus of raucous guffaws and descant whispers. My hands were numb while I was damped with sweat and shivering.
It was not that the heating system had been redone, nor the building remodelled, nor the desks changed nor the students. It was me.
The stark difference between my memory and my immediate perception was startling. I had new eyes!
We rely on our senses for unmediated knowledge. Our modern sciences are based in empricism, i.e. the idea that knowledge must come from direct observation. This has led to many innovations: the helio-centric theory, evolution, calculus, even our dear friends psychology and psychiatry. Empiricism as a code of action and of evaluation has reached into history, political thory, philosophy, art. It is always with us, even in such hackneyed sayings as "I can't believe my eyes." This expression would carry no great meaning if we did not understand that our senses were our best conduits to understanding. Divine Illumination it is not.
I thought that I was entering the port of an earthly purgatory; imagine my surprise when I found a welcoming place instead.
12 January 2009
Symptom, Sin, Circumstance or Psychology: I lost the thread on the way out of the labyrinth.
I have been having a great deal of trouble with motivation lately. I can't seem to get past it and I'm not sure where it's coming from.
I first taught myself back in 2002 to like cleaning my house, which was a big leap for me. That was the same year that I started looking after my eating habits. Then in 2004 I finally got a handle on keeping my clothes tidy. I got television watching under control in 1999. I have long had good spending habits. I developed the discipline to finish sewing and knitting projects somewhere along the way, I think in 2004, maybe 2002. Perhaps it just took a couple of years for it to really take hold. I learned how to talk to people, that is to overcome my shyness - I still come off all wrong sometimes, in 1998 and again in 2003 and again in 2006. I made a good habit of timely bill paying in 2003. I learned how to keep up with schoolwork in 2005. I seem to be developing a new understanding of how to give and receive help as I write, which feels like the only thing I have going at the moment.
Everything else seems to have slipped out of control. I have piles of unsorted clothes on my closet floor. I have two outstanding bills. The television seems to have taken me over. I have one unfinished sewing project and one unfinished knitting project. I've gone all shy again and my spending habits need reform for the first time I can remember. I haven't been able to properly keep up with the housekeeping for a good six months now. I cannot keep up with the schoolwork nor feed myself properly.
It took me a long time to develop good habits, which is a bit embarrassing. Some of that is due to never having been prepared to look out for myself once I no longer lived at home. Some of it is due to the disproportionate anxiety due to the bipolar. There are assorted secondary reasons for it as well. But bit by bit I pushed myself past it.
Now I seem to have lost it all and that is very discouraging.
Part of the current problem is that I'm not sure what has brought it on. One possibility is that I need an additional 100mgs of Lamictal. Another is that my routine is so loosely scheduled that I can't use my time effectively because it feels like there will always be time tomorrow - acres of time in front of me. The possibility that worries me most is the dreaded akedia. (Also known as accedie and accedia but I have done too much Greek to bear with the badly pronounced Latinate form of the word: it grates.)
I've had some rather flummoxing moods lately, the kind I look back and fret about. It's odd, though, because I am by and large on an even keel. I have been since September 6. (I know the date because I keep somewhat meticulous track of these things. That was the first day I felt well since October 2006.) Now the eveness has lasted more than three months and I am beginning to trust that it will stick around. So where has this deep lack of motivation come from? Why do I abandon all these good habits now when I was able to keep them up while I was severely ill?
If I were to tell my case worker or therapist about this they would immediately be on my case, saying that I should go to the hospital. But I'm not ill, not in a way that a hospital can help. Going to the hospital when I did is one of the best decisions I have ever made: it helped me to find appropriate medication quickly; it got me away from friends who didn't understand what depression is and were doing their level best (one of them, anyway, whom I was sharing an apartment with at the time) to make me feel incredibly guilty for not being able to behave as they wished I would; it kept my family at a distance; it stopped me having to do things like cook my own meals; it cured my insomnia for a good five months; and it gave me a chance to be around a whole bunch of people who were going through the same problems, so that I no longer felt as weird and isolated. But there's no opportunity for sustained counselling there. It's not the appropriate place for me to get to the bottom of whatever it is that has demotivated me.
This is the difficulty with the psychiatry/psychology part of things: they read everything as a symptom and automatically assume that the sufferer is having an irrational reaction to external circumstance, an attitude that has been shown to be distinctly unhelpful in several well conducted studies over the past sixty-odd years. It seems more likely to me that the cause lies in some psychological difficulty that would require some time for discernment or in some reaction to external circumstance, neither of which would be solved by playing around with medication.
If only I could figure out how to start figuring this out! Any ideas?
I first taught myself back in 2002 to like cleaning my house, which was a big leap for me. That was the same year that I started looking after my eating habits. Then in 2004 I finally got a handle on keeping my clothes tidy. I got television watching under control in 1999. I have long had good spending habits. I developed the discipline to finish sewing and knitting projects somewhere along the way, I think in 2004, maybe 2002. Perhaps it just took a couple of years for it to really take hold. I learned how to talk to people, that is to overcome my shyness - I still come off all wrong sometimes, in 1998 and again in 2003 and again in 2006. I made a good habit of timely bill paying in 2003. I learned how to keep up with schoolwork in 2005. I seem to be developing a new understanding of how to give and receive help as I write, which feels like the only thing I have going at the moment.
Everything else seems to have slipped out of control. I have piles of unsorted clothes on my closet floor. I have two outstanding bills. The television seems to have taken me over. I have one unfinished sewing project and one unfinished knitting project. I've gone all shy again and my spending habits need reform for the first time I can remember. I haven't been able to properly keep up with the housekeeping for a good six months now. I cannot keep up with the schoolwork nor feed myself properly.
It took me a long time to develop good habits, which is a bit embarrassing. Some of that is due to never having been prepared to look out for myself once I no longer lived at home. Some of it is due to the disproportionate anxiety due to the bipolar. There are assorted secondary reasons for it as well. But bit by bit I pushed myself past it.
Now I seem to have lost it all and that is very discouraging.
Part of the current problem is that I'm not sure what has brought it on. One possibility is that I need an additional 100mgs of Lamictal. Another is that my routine is so loosely scheduled that I can't use my time effectively because it feels like there will always be time tomorrow - acres of time in front of me. The possibility that worries me most is the dreaded akedia. (Also known as accedie and accedia but I have done too much Greek to bear with the badly pronounced Latinate form of the word: it grates.)
I've had some rather flummoxing moods lately, the kind I look back and fret about. It's odd, though, because I am by and large on an even keel. I have been since September 6. (I know the date because I keep somewhat meticulous track of these things. That was the first day I felt well since October 2006.) Now the eveness has lasted more than three months and I am beginning to trust that it will stick around. So where has this deep lack of motivation come from? Why do I abandon all these good habits now when I was able to keep them up while I was severely ill?
If I were to tell my case worker or therapist about this they would immediately be on my case, saying that I should go to the hospital. But I'm not ill, not in a way that a hospital can help. Going to the hospital when I did is one of the best decisions I have ever made: it helped me to find appropriate medication quickly; it got me away from friends who didn't understand what depression is and were doing their level best (one of them, anyway, whom I was sharing an apartment with at the time) to make me feel incredibly guilty for not being able to behave as they wished I would; it kept my family at a distance; it stopped me having to do things like cook my own meals; it cured my insomnia for a good five months; and it gave me a chance to be around a whole bunch of people who were going through the same problems, so that I no longer felt as weird and isolated. But there's no opportunity for sustained counselling there. It's not the appropriate place for me to get to the bottom of whatever it is that has demotivated me.
This is the difficulty with the psychiatry/psychology part of things: they read everything as a symptom and automatically assume that the sufferer is having an irrational reaction to external circumstance, an attitude that has been shown to be distinctly unhelpful in several well conducted studies over the past sixty-odd years. It seems more likely to me that the cause lies in some psychological difficulty that would require some time for discernment or in some reaction to external circumstance, neither of which would be solved by playing around with medication.
If only I could figure out how to start figuring this out! Any ideas?
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