The Stigma of Co-Occurring Disorders

 

Originally published on Psych Central
https://blogs.psychcentral.com/triple-winner/2017/03/the-stigma-of-co-occurring-disorders/

There is a great deal of stigma attached with both mental illnesses and addictions. That is one reason I talk about my experiences. So, others won’t feel alone, and, to put a face to these conditions. It is scary to get a diagnosis of a life-long mental health condition that all you have heard are extreme negatives. People can lose hope. And, people fear what they don’t know.

I also have shame, or self-stigma. I have worked on accepting the schizoaffective diagnosis and at this point am okay. There was a time when I felt, less than, because of the severe symptoms. Now, I know I could not control what happened in the past, and just work on staying stable.

Social anxiety is something I contend with daily, and I cannot seem to prepare enough. I don’t know if I can ever accept how limiting it is for me. There are some things, like volunteering at my children’s school events, that are just too busy for me. I cannot enjoy shopping or parties, I just want an exit. I have worked very hard on this and work with people now and even do public speaking, but it is difficult.

The alcohol addiction label is new to me. In the program I am doing, SMART Recovery, they don’t give labels. But, I need to call it something. The drinking is not new, just the acknowledgement.

There are choices of programs for changing addictive behaviors. Some people work more than one at a time. This was just one that seems to fit my philosophy. It uses cognitive behavioral therapy (CBT) principles and I already learned some of those for my anxiety.

I haven’t had serious consequences from drinking. No DUIs or jail time, No relationship problems. But, I drink more than I would like  and it is hard for me to abstain completely.

I decided I would like to write about the alcohol component along with the mental illness. So many of us have co-occurring disorders. I was excited, and then, I paused. What will people I know think when they see ‘alcoholic’?

I couldn’t decide which was the worst of 2 stigmas. It doesn’t matter.

Info on SMART Recovery
http://www.smartrecovery.org/

Info on Alcoholics Anonymous (AA)
http://www.aa.org/

An external change: The War Inside

In 1992, I went to former Yugoslavia to help the peace movements there instead of getting another soul-ripping job as an administrator. Twenty five years later, I still wonder if I did the right thing, if I did any good in the world. I wrote about my experiences in the way that I like to write, walking around what I saw and thinking about what it meant. People wanted me to go back, but I raised money for the peace groups so they could have offices, supplies, and the like. It did not seem right for me to finance any more “vacations”.

In the end, I never went back. I fell into a depression that lasted for nine months before I had the faith and the courage to admit that I had a problem. I turned to Lynn and said “I’m sick.” Sickness had not begun that day or that year. It had been with me a long time. It was like the guns booming and the machine gun fire I heard in Croatia. Loud. But I could ignore it. Background noise. My illness was background noise that I could shove aside. But the booms never stopped the war inside kept raging, and there was debris all over the streets of my inner city. I wasn’t going back to Osijek. I had a new form for my illness, a new, sick metaphor.

Creativity, Mood Disorders and Treatment

Modified from my post on PsychCentral
link

It has been noted that there seems to be a correlation between mood disorders and creativity. Many great artists, poets, writers, musicians have been troubled with mental health issues: Ernest Hemingway, Carrie Fisher, Kurt Cobain, to name a few.

Jim Phelps, M.D. writes on his website how some evolutionary biologists believe that there is an advantage to having a small dose of bipolar genes (similar to having a trait), advantages like: creativity, courage, productivity. 1 The idea of having a bipolar trait is one theory.

There are people who worry that treating their disorder will cause them to lose their creativity. But, if you are manic you can have disorganized thinking and jump from project to project, which would have a negative impact on your art. There are other consequences of mania which I will discuss further, along with the typical depressive episodes.

The questions revolving around medication, mood disorders and how it impacts one’s creativity have been pondered, and displayed in movies, like, “Touched With Fire”, which follows 2 hospital patients with bipolar disorder and how they come to grips with losing mania through treating their disorder.

Mania or hypomania may sound appealing. That is unless you have dealt with them and the aftermath.

Some symptoms of mania include:2

• Feeling unusually “high” and optimistic OR extremely irritable
• Unrealistic, grandiose beliefs about one’s abilities or powers
• Sleeping very little, but feeling extremely energetic
• Talking so rapidly that others can’t keep up
• Racing thoughts; jumping quickly from one idea to the next
• Highly distractible, unable to concentrate
• Impaired judgment and impulsiveness
• Acting recklessly without thinking about the consequences
• Delusions and Hallucinations (in severe cases)

With impaired judgement one can run up bills they cannot afford, gamble away savings, have affairs, and other problems, that must be dealt with when the mania subsides.

I don’t just have traits of a mood disorder. I would not be able to function without my medication. It is not even a question; the risks of medication are worth the benefits for me.

I do have periods when I have increased energy. The thoughts flow faster. The ideas come easier. I usually have a lot of fatigue, so it is a change for me when it occurs . But, I have hit a roadblock now. My mind has stalled. I can get things done, but new ideas don’t come easily. There is nothing I know of that I can do. I just must try harder and wait for my mind to clear.

There is plenty of hope for treating mood disorders and for being creative while treatment compliant.

One reader posted that the art goes on but it’s form may change.

1. http://psycheducation.org/the-biologic-basis-of-bipolar-disorder/chapter-5-the-big-picture/

2. https://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-signs-and-symptoms.htm

Trusting Your Moods with a Mood Disorder

First published Psych Central

https://blogs.psychcentral.com/triple-winner/2017/03/trusting-your-moods-with-schizoaffective-disorder/

I have a thought and mood disorder called schizoaffective disorder. It is similar to bipolar disorder, in that I have mood swings with periods of mania and depression.

When I was treated for my first severe manic episode I was heavily sedated and slowly titrated down on the medications. When I got to a dosage where I was no longer sedated, and my symptoms were under control, I started to feel okay, good even.

 

It scared me. “Would I feel too good?” I voiced my concerns to my psychiatrist and he reminded me I usually have other symptoms that precede mania. I think most people do.

You could go through a list of symptoms and see which ones are typical for you that would be noticeable.

Do you spend a lot of money?

Are you impulsive?

Do you talk fast?

Do you start lots of projects?

A lot of people monitor their sleep. I often have trouble with insomnia, so that isn’t a particularly good indicator for me. One thing is that I get irritable. I am usually pretty mellow, so if I start snapping at people that is a good sign that something is off. My psychiatrist also told me if people are looking at me strangely that is a warning sign. I am not sure if he meant I do strange things or I get paranoid, which I do, and get suspicious.

Isn’t everyone entitled to an off day, though? Sometimes when I am upset at someone, it is for a good reason. A lot of people imagine others think poorly of them, once in a while.

It would help to have someone I trust, tell me if I didn’t seem right. I have trouble with trust, though, when I am symptomatic. I think everyone else has the problem and I am fine. I am working on that, because I know it is important. Otherwise, you can have a great list of warning signs, but deny them. “I’m not talking fast, you are just listening slowly”.

Once you notice these warning signs, what do you do? That is a million dollar question.

This is where it is best to consult with your doctor and find out when they want you to contact them.

It is also good to come up with a  Wellness Recovery Action Plan (W.R.A.P.) to prepare.

It is good to catch things early, but you don’t want to be worrying every time you have a bad, or good, day.

To the Couple Who Asked About Bipolar Disorder

I occasionally submit posts to The Mighty, a webpage for people with disabilities. They have a section for mental illness.This is my latest submission about a DBSA meeting I went to last night.

You wanted to know information about your son’s bipolar disorder. At first you asked specific questions about the illness and I did my best to answer them. You told me about your son and I was impressed with his accomplishments and sorry to hear where he was at right now.

One of your questions stuck with me. Is there a physical test? Is the diagnosis just based on observation? It is a common question. I wish I had an x-ray or blood test that would show that my diagnosis is real. People can understand a broken arm or diabetes, but not brain disorders.

It was what I didn’t hear that struck me. I have heard parents with children who won’t get treatment, desperate for answers, trying to figure out how to help them get better. Instead, you sounded like you doubted he really had an illness. I could picture you using the “tough love” approach to get him to be more productive.

My mind went back to my own brother. He had a psychotic illness starting in the late 70s. My father didn’t believe in mental illness so he didn’t really get treated. He died young in an act that was either a reckless accident or intentional, I don’t know.

I told you about my brother. I feel guilty that he didn’t have the chances I do.

I pleaded with you to be gentle with your son. The words slipped out of my mouth that suicide is so common. It has been reported up to 20% of people with bipolar disorder complete suicide. I felt like I said too much and second guessed myself when I came home.

Now, that I have had time to think, I am glad I said something. I did not want to make you feel bad or scare you. I have not met your son and I don’t know where he is at mentally. But, you wanted information and that is a valuable piece of information.

My Family History of Mental Illness

I remember my grandmother in her baggy dresses that covered every inch of her body like the shrouds that covered the furniture when the summer folk had left for the season. My cousin Heidi was surprised when I told her that my grandmother — her aunt — had spent many hours of each day lying in bed.

“But she was always so jolly, so friendly.”

“Yes,” I said. “She could be like that. Like so many of us she knew how to fake happiness.” I do not mean that as a slander. I admire how she could pull herself together despite her suffering and be there.

I know my grandmother loved me. When I was young, she used to get in big fights with my mother for the way she mistreated me. The rows were long and loud — I would go to the very back of the yard so that I could not hear them.

My mother had her own problems: there was a deep-seated meanness in her. She disparaged my grandmother when we were alone together, complaining about what she thought as Stella’s laziness. When I was depressed, she was panicked at the thought that would do the same, so she hectored me about getting a job — any job — no matter how inappropriate or soul-killing it was. Once, when she was in the hospital with roof-busting high blood pressure, I told the doctor about our family secret. A psychiatrist prescribed Prozac. For three months, she was a nice person.

Where are you in “recovering” a life that is meaningful to you?

The biggest loss after I was diagnosed was my poetry. Before my diagnosis, I wrote a lot — I filled a ring binder with it. Two inches of verse, mostly free. Then I stopped because I believed that going to readings and writing it made my condition worse. And I believed that I lost the ability to write it. I did not stop, but my output was meager and sparse. One poem a year. Some years I wrote nothing. But a part of me yearned for the truth and beauty of a fine image. So last spring, I conducted an experiment. Thanks to a psycho-stimulant that gave me a renewed ability to focus, I cautiously began to compose free verse and haiku. To my joy, I did not explode into mania. I was not writing long intense blogs as had been the signature of my mania and I did not lapse into consequent depressions. So I have begun thinking: If I can handle poetry what about spirituality? Could I attend a church without turning into a prophet? Could I handle being a member of a congregation and not its priest? So I have been contemplating where to go, what denomination suits my temperament. That is the next signpost.

The Benefits of Bipolar Disorder

When I am manic, I get things done. That is as long as I am not running to the top of the inside stairs and down again seeking something that I cannot remember. Then it is The Great Eater of Time. My depression helps me to see what projects I have taken up that are pointless wastes like the schemes of making a million quickly by stuffing envelopes at home. I can detect what is rigged: I will not spend hours trying to win games that cannot be won or spend money on hobbies that I will never get around to finishing. I have ships in a bottle that I have not pulled the rigging up. I bought these in hypomania.

Depression has a wisdom about it, bitter at times, with a predictive power and insight into the motives of some men and women. I do not trust certain people when I am in depression: This often proves a smart thing.

Then there is the stillness that comes, a beautiful blue film that falls gently over my consciousness calling for silence and appreciation of the moment. If I shut down the voices that hector me for a moment, I find the peace that the racing thoughts of mania do not permit. I may feel fatigued, but I am not agitated as I am in a mixed state. Depression is a better place in the mind than mania or the vicious mixed state.

Reminded of Algernon

Not sure what triggers so proceed with caution

I have 3 brothers and 2 sisters. I used to have 4 brothers. Pat passed away over 30 years ago. For a long time I didn’t speak about him. Everything upset me too much. I speak some now. But, it is I sad story and I don’t want to discourage people. Different times, different people.

Pat had a breakdown at 20 when he was at college. He came home a different person, first he would just stare. Then he was obviously mentally ill. He claimed he had been brainwashed by a cult,.he was also the soccer player Pele’ and other people. He was unpredictable and scared me. He would try to act ” normal” mimicking others, which was even worse. My father felt Pat could just stop it if he wanted and would yell and even hit him.

my father didn’t believe in mental health treatment and the only help my brother got was when he was picked up on 72 hour holds. They would give him typical antipsychotics, this was the late 70s, and send him home. He would be psychotic and sedated which just made his differences more apparent.

then, in 1985 he was picked up in a different county. They tried a different medication. lithium. Everyone told me he was back like his old self again. It was as close to a miracle as I could imagine. But, when I went to visit he wasn’t well. He was looking at me suspiciously. He was talking about the bible excessively and was hard to understand. My mother said they were having trouble finding the right dosage.of medication.

he took off that night. I never saw him again. He went to Yosemite. He fell at a large waterfall and died. Suicide or risky behavior? I am not sure.

I have all kinds of mixed up feelings. Mainly guilt. That I didn’t try to understand more and be closer and not so afraid, that I didn’t do more to get him some kind of help, that I am fine and he wasn’t.

and just sad that he was fine for a little while and then started to go back into the psychosis he had been trapped in for years.

(About how the title: my children were talking about ” Flowers for Algernon”. I know the story is about intellectual disability, but the idea of improving and then going back to the old state hit me as similar and sparked the memories)

 

A Letter to My Illness

You moved in when I was very young, shoved me into your corner, made me cry and when I cried you caused the kids to laugh at me, taunt me saying “Don’t cry Joel.” Sister Annette told me to buck up, to learn to be a man and hold the tears back. Damn you and damn her. I couldn’t say it at the time. Two years of living under the threat of her ruler, but the taunts were worse, hurt worse. The more they called me names, you and my parents reasoned, the stronger I would become but this practice was flawed. I played alone or with other losers. My mother criticized my choice of friends, calling them slow, hinting that they were retarded. Even among them I lived in a shell and the kids continued to wear at my head, trying to produce the streams of salt water they loved so much to see. I don’t know what brought you to make a home in my head. I don’t know why you made me sensitive to the twist in their voices. Was it the arrival of my two cousins who stayed for a year? If it was, you stayed beyond a year, brought me suffering. I looked at Jesus and wondered what was worse: crucifixion or this hell I was going through? If I was on the cross with Him, it was an absurdity.