Category Archives: Psychology

When The Sandman Leaves

One of the strongest indicators of being in hypomania and feeling it grow stronger is the sudden inability to sleep.  Routine sleep is critical for those with bipolar disorder, and I make every effort to keep a regular schedule.  I take my medication at 8pm and it kicks in around 10pm.  Once, I lie down, it takes about 30 minutes to sleep.  However, when hypomania appears the sandman leaves.  When the sandman leaves, I stay awake until the sun rises.  Since I am in hypomania and not mania, I do not spend my evening painting or writing; rather, I just lie in the dark.  Thoughts of the day run through my mind and other hours I just lie in bed with a quiet mind.  I keep my eyes close, but sometimes I open them and look at my hands in the dark.  Stare off in the veil of darkness that cocoons my room safe and warm.  I do not know how I lie in bed for hours til dawn.  I just do.  I suspect I do go into a light sleep, but in the morning, I wake exhausted for a few hours.  The exhaustion passes and I become alert again.

I did not sleep last night and suspect tonight I will stay awake.  I feel very alert right now.  This is the other indicator.  I am not dragging at all, but I do make it a practice to lie in the dark to allow my body to rest.  When the morning comes, I have to go to work.  When I go to work, but do not sleep, I can function at work, but I can not exercise afterwards because it seems to daunting.  Tomorrow, I had planned to play against a tennis wall, but I do not think I will have the energy.  I come home and try to stay calm and peaceful since I know I am in hypomania.  Back in the day, I would have gone out and drank alcohol.  Nowadays, I am more disciplined in my self care.  Human interaction can become intense, and I am able to maintain a calm distance and protect myself until the hypomania wanes.  It crashes into me in waves even on my low dose medication treatment.

Tonight, was different.  I ended up pleasantly talking on the phone with my boyfriend until we started discussing politics and the recent debate.  It became very uncomfortable and intense.  We disagreed on the presidential nominees and voiced our opinions strongly.  I kept saying “let us agree to disagree,” but he would not let it go.  I felt negatively judged and really bad for how I was thinking.  It was horrible.  I came crashing down left in shock.  My eyes felt like the size of giant saucers making the lights brighter.  My mouth went dry and I lost my appetite.  I was in a kind of shock.  Hypervigilant and uneasy was how I was left.  This is what happens when you lose sight of how your mood is affecting you.  I knew I had not been sleeping and should have immediately and politely hung up or changed the divert with some levity.  These are lessons learned.  I had not been sleeping and new I was vulnerable.  It is during these times that I really have to not say much or engage in charged topics.  During these phases, I have to stay vigilant but not hypervigilant which causes mayhem too.  It is a delicate balance, but I do know when I do not sleep, I have to lie low.

After I hung up, I cried and then sat staring at the TV.  Just feeling so bad about a conversation that went so wrong.  I could not eat nor drink.  I just sat there.  Now, I cannot sleep.  My blogging is a nice escape.  I am not concerned with destabilizing because of my med, but I am in distress. For the rest of the evening, I will listen to my favorite comedian Bill Burr podcast and hope my words for this blog will flow.  I have many thoughts running over and over in my mind about what we said about people who do not even matter.  The shock.  Tonight, I will not lie in the dark.  I will allow my shock and hypomania to engulf me and stay busy, but I will not drink alcohol.

 

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The Wicked

How did I end up self admitting into a psychiatric institution for the first time?  I can still clearly see myself signing my rights away.  I remember the ilegible scrawl that scratched from the pen, which represented my signature, as I signed the official documents. I remember how at that moment in the emergency room, I felt surprised and oddly interested that for someone with beautiful penmanship, my messy signature was unrecognizable.  I was losing control of my mind and my body, and I was slowly losing the will to combat this insipid side effect called Akathisia.

To give some background, I had unknowingly lived with untreated bipolar for quite a number of years.  I barely sought medical treatment in September 2015 because the mania was swallowing me up one day at a time.  I was medically diagnosed and entered the realm of antipsychotic medication and therapy.  When I was prescribed 80mg of Geodon — 40mg in day and 40mg at night, I refused the prescription because I wanted to start at the lowest dose possible before moving on.  It is the way I think.  I wanted to titrate up and watch all the changes.  I wanted control.  So I refused the day med and only took 40mg at night.  I continued on 40mg at night for two and a half months.  This dosing only at night caused my side effect.  Apparently, some doctors believe Geodon should be taken two times a day; otherwise, one dose is spiking your brain.

Taking Geodon one time at night caused a side effect called Akathisia which caused me to end up in a psychiatric institution.  The horror of it all still lingers.  A memory that has yet to fade.  I watched myself lose a grip on reality over a three day period.  It was not like experiencing psychosis.  It was different because it did not hit me like a ton of bricks like psychosis where you cross a line and cannot see where you came from.  When I experienced Akathisia I could see my mind crossing a sanity versus insanity line that I could not control and then return back to me.  Each time was more powerful, and the restlessness, that it is known for, occurs in waves.  It rolls through your body.  You cannot stop the urge to move, to fidget, to walk, walk faster and then to run.  You cannot settle your mind.  You just want to move faster than your mind is capable of doing.  The mind and body are disconnected.

At the time, I did not know what was happening to me and this occurred over a three day period.  I survived three days of Akathisia and two minor episodes before this.  When I experienced it before, I called it “The Hurt” and I wrote about it in my blog in a short story titled, “The Hurt.”  The episodes that occurred on the first two days started two hours after I took Geodon and lasted one hour.  I dealt with it by putting myself to sleep with Benadryl. I did not know it was Akathisia until the third day of my episodes when it started at 8:00 in the morning during work.  I googled my symptoms and came to the conclusion that this was what I was feeling in addition to the wretched anxiety that presented mortality to me in ways that I never thought of before.  In ways only those who are terminal or in the gallows probably feel.  The anxiety was smothering me a little at a time and left me gasping for air.  For mercy.  It lasted a few minute but then returned for longer and longer periods.  It dragged me through a dark, chasm of helplessness.  I wanted to jump out of my skin and run full speed down the street away from it.  I realized that I could possibly end up running down the street – screaming.  I was convinced this would be my outcome if I did not get help.  These three days were no longer ‘The Hurt.’  They had become ‘The Wicked.’

Akathisia causes a distressful restlessness of the mind and body.  In the third day, as it progressively got worse, it made me walk circles around my office, around my building and then outside the building.  I got up and walked every 30 minutes for 15 minutes for eight hours on the third day.  I was worried that the security guards would notice me and this caused me to change my pattern of walking so that I was not so obviously and oddly walking the building.

So you see, I could still think things through.  I even read my crises plan that I had in my phone.  My doctor asked me to photograph the crises plan we wrote together, and it was in my iphone.  The photo was a list of things to do in crises and one item read “go to the emergency room if in psychosis.”  Although I was not in psychosis, the words “emergency room” jumped out at me.  I just knew then… I just knew this was my safe haven.

After work,  my boyfriend was driving me home and as calmly and as rationally as I could through the waves of Akathisia rolling through my body, I told him that I was not well.  At the same time,  I was willing myself not to jump out of the moving car.  Like in a major way.  He said we would go home, and he would take care of me.  I came to the conclusion in front of him that this episode was bigger then the both of us.  We were entering unchartered territory – the emergency room for a mental health crises.  When the ER Psych doctor asked me why I was admitting myself, I told him because I knew that when I started running out the door screaming, they would stop me.  With that, my first formal admission to a psychiatric institution was complete.

 

*I stayed in a psychiatric ward for six days while adjusting my medication.  My final treatment plan was Geodon 20mg day and 20mg night.  In order to stop the acute Akathisia, I was given Cogentin 1 mg which worked.  I titrated off Cogentin after one month and the Akathisia stopped.  I am still take Geodon.

 

 

 

 

Psychiatric Institution

Here are funny things I heard while in a Psychiatric Institution adjusting my meds with 32 other detox and/or adult psychiatric:

  1.  “How do you lose a cane up in this bitch?” – One patient wondering out loud how the old man misplaced his cane in the milieu.
  2. “Hello babycakes” – what some of the detox patients called me.
  3. “I’m not staying here. I’m going to escape” said my roommate as she tapered off the bottom of her pants while the other roommate was helping her escape by shoving personal items down her pants.
  4. “I shaved my head because my boyfriend broke up with me. I was in mania” me:”that makes sense”; her: “the problem is it makes sense to us in here but not to people out there.”
  5. okitee dokitee – a form of okay
  6. “come here baby. I’ll talk to you and your teddy bear”
  7. “Come here baby. Let me wipe off that little bit of soap off your face”

Irritable Depression and Mixed State

This is a very important discovery for me because the part of bipolar disorder I detest is the irritable depression that occurs with mixed state.  It is the rattlesnake part of my disorder.  The more I learn about it, the better I can manage and reduce it.  For instance, I started taking Vitamin D3 and Magnesium supplements because deficiency in these minerals is linked to depression.  I have been diagnosed as vitamin D deficient in the past.  Hypomania is fine but not irritable depression. It causes me to snap at loved ones which leads to a horrible guilt.  It is a nasty cycle.  I hope this article helps those who havent figured out that depression does not only present as a sadness but can present as anger as well.  Click on the link below for more information.

Irritable Depression

sillIfied

We walk together in an uplifting mood cause of our closeness. He discusses his day at work in a more serious tone of adults. Me on the other hand, feel the giddiness bottled up inside.  Like a child, I want to skip and sing outloud, but  do not in this professional setting. I keep a lid on it and do good by staying quiet.  I imitate his mood. I answer, “uh huh” and say, “interesting” at the right moments. It seems to get brighter outside, and I put on my sunglasses. I become cozy again with my giddiness.  Silly thoughts with strings that go to funny places play through out my mind. His words go on in my background  until he  says something playful about my sunglasses. He pulls my silly string…

I become sillified by his certain single statement sidewinding to my sternum.  His words hit dead center and release me. My giddiness bursts into the open.  It shoots up into the air and burst into fireworks.  Glints of falling sparkles come down and settle on my crown.

My exhale heaves out a hearty laugh.  Finally, my surroundings are in sync with me, and we are one.  I get to be silly and silly I become. Playfully,  we make each other smile.   The pace of my words pick up speed , and I say whatever I please.   They are my silliest of thoughts and dreams.

When we are together, and you look at me, know that I am wishing for you to sillify me.

My Periphery

As I walk through the gentle sway of trees, the greenest movement of the leaves tug at my sleeve. Each tree passing into my periphery and keeping its clarity in a space others call the background.

Vibrant, singing colors if you please from each blade of grass that I have become. From the front, they are a great sea of plants and then into the periphery they wander bursting asunder into a space that many dismiss as a less distinct place of vagueness.

The hypomanic path is one of distinction with colors and intensity existing to the front and the sides. Hugs of tone and value fill my entire field of view.  I feel like I am walking through a snowglobe of poppy fields. Flowers dance and plants wave hello to this captive audience.  Into my periphery they go but do not fade away into the space others call the background.

How to Be on Antipsychotics.

This young lady, who calls herself “the misadventures of me” wrote the funniest post on Antipsychotics.  It’s my favorite.  Enjoy her good writing.

Recently I was told I may have bipolar disorder and was promptly put on, you guessed it, antipsychotics. Now something about the name makes antipsychotics sound really scary, or rather, the person …

Source: How to Be on Antipsychotics.

A Not So Tough Pill to Swallow

Treatment for Bipolar Disorder is based on a menu of medications.  They Are a diverse group from Lithium, antieliptics, antianxiety to antipsychotics.  Depending on where you lie in the spectrum of your disorder, the med menu will change.  You may be challenged with having to take a polypharmacy and manage the side effects of many pills or be on monotherapy and contend with much fewer side effects.   I am one of the lucky ones because monotherapy has been successful for me.

My treatment was determined by the bipolar symptoms I told my psychiatrist.  This is very difficult because, in my first visit, I could not remember all the key things to tell my doctor.  I did display some pressurized speech so that was a clue that I was in acute mania…again.  But this was my first visit so it was not definitive.  Maybe I was a chatty person.  The doctor did not know.  Determining your mental illness is similar to a treasure hunt. The psychiatrist discusses  your behaviors, looking for bipolar indicators, and determining where you exist in the spectrum.  Do I exist in the spectrum? Or does the spectrum exist as a sliver in me?  We only had one hour to figure this out because one thing was for certain-I was in an episode of some sort.  I sat in the doctor’s office laughing, hyperactive, and certainly mentally ill.  There, I said it…mentally ill.  My initial diagnosis was Bipolar Disorder II but later on it changed to Bipolar Disorder I.

Did I behave a certain way because I was tired, stressed, anxious or because I was in a bipolar episode?  Some behaviors are evident such as manic and depressed behavior, but they have to be witnessed by a medical team in an inpatient setting to be certain; otherwise, they are considered subjective.  In the beginning, my mental health picture had not formed.  So you start with the moving target, and if you do not get it right, you start a “chance” of a med.  The next time, you now have to explain to your doctor why you behaved a certain way but on a psychiatric med.  Layers start to form from the side effects.

Once you are prescribed your med, the waiting game of seeing which side effect will occur begins. Do you need another med to counter a side effect? You have to wait and see if the new med stops mania or if it pushes you into mania.  Bipolar Disorder is push and pull of your mind. You can stabilize, but now you have to be on the look out for break through episodes of mania indicating the med did not work. All this while you are living your daily life, interacting with loved ones, and trying to keep your career from imploding. Exploding. Side winding.  The name of the game is to hang on while snowboarding an avalanche.  Hang on. With your eyes open.  Hang on.

Treatment is not a sure bet in the beginning which caused me great unease.  Some people in our community are treatment resistant which means the menu of meds does not treat the disorder.  Mentally, I was not prepared for the reality of psychiatric meds because of the uncertainty but more importantly, I had this idea that meds were my last resort.  What if they did not work?  I still had a long life ahead of me.  Initially,  I thought I would need them in my twilight years.  Just in case,  you know?  Because now, I am strong, young, and could handle this through pure willpower, but I was oh so wrong.  I since learned that this thinking is backwards.  In order to not be the crazy later on, I have to be on a med plan now.

The uncertainty of it all was disconcerting. I wanted to hold on to something that was a sure thing because I could no longer hang on to my foundation since it was crumbling.  Cracks a mile long were forming.  Mentally,  I was hanging on a cliff and could feel my fingers slipping.  Just hang on.  I wanted certainty.   For instance, I know I can take an aspirin for a headache, and the headache goes away. There is a definite cause effect that can be experienced.  When I realized that my med was not a sure bet, I became scared and opted out the first time.  I was not ready to contend with the “possibilities” of “might” getting well or more worrisome that my med would not work. I stopped Lithium cold, and two months later succumbed to another manic episode.  This one was fast and furious.  I remember each one sort of. There was the one in Salinas, which was a drug and alcohol fueled binge; the second one was a flashback of Iraq and my first psychotic episode; and the third one I call Utah, which was my second psychotic episode. I am a rapid cycler and like clock work, I experienced my third episode in nine months.

During Utah, I called my doctor and well..I was in Utah and refused to voluntarily admit myself to an Emergency Room so my treatment could not start until I returned home.  I have a short story on Utah called, “The Poop Story and Other Tales of Love.”  The good thing about Utah was that I displayed very distinct bipolar behaviors such as psychosis that gave us the ammunition to pick a more precise med. Initially, I was on Lithium, and although this is known as the gold standard, it was not for me.  I felt…like…the sound you make when you place your tongue on the roof of your mouth and click it.  That sound.  For me, that sound was how Lithium felt on my mind.  After I made the click sound with my tongue my doctor asked, “You mean you feel blunted?” Her training and experience was good because that was the word for it. Blunted.  For me, blunted is the sound of your tongue clicking off the roof of your mouth.  After this episode, my diagnosis changed from Bipolar Disorder II to Bipolar Disorder I with Psychotic Features.

I was prescribed an antipsychotic that has worked well for me. Up until today,  I have been in denial and embarrassed that I have to take an antipsychotic.  It is the word is it not?  A med that clearly states that I can become psychotic.  This is a tough pill to swallow.  However, the antipsychotic is helping me by allowing me to be mentally free.  It keeps me somewhat in hypomania which is where I want to be.  I am more of my creative self then mania ever allowed me to be.  My med also helps me manage my daily stressors, which I am not so good at anymore.  Stressors mentally fatigue me in ways I never could imagine.  I am on a new path in my journey. It use to be that I was a “mental mountain.” Now, I need help.  Even though I am managing my disorder, my core being is changing.  It has to change I think.  Not so much outwardly that people might notice right away. Certainly, your thoughts change; therefore, be and then become happens.  You become a new normal.

The good thing about meds is, when you get the right kind and dose, the effect isolates the mood disorder. This enables you to see the paths to managing a stable daily life.  You can separate from the disorder.  It helps you discern trigger effects on your mood and behavior.  Enables you to develop stress release actions and form crisis plans.  Also, they reduce the cycles of bipolar episodes and protect my beautiful, sweet brain, which I love so much.  Meds can be effective.  It is what I call my good, hard work.  My goal is to swallow this pill and stay of healthy mind, peaceful, and loving of heart.  For this, it is not such a tough pill to swallow.