Playing the Diagnosing Game

I do it and a lot of other people do it as well. It’s a game we play where we see if someone fits a certain mental disorder, whether it’s a personality disorder or a mental illness. I used to do it only very occasionally, because I only had a single class of psychology behind me. I knew some of the requirements and I also knew some DSM IV requirements, but I was not well versed in the material at all. But in the past year and a half, my knowledge has grown considerably as my interest in psychology has also grown. I don’t think I’m even proficient in it, but I know most of the groups now for diagnosis of major disorders and also what separates them. It’s a fun game to play because it’s like putting a puzzle together. There’s only two things to watch out for.

First is that I don’t take it seriously at all. It only becomes a language that I can use to predict actions and understand some behaviors. Even then, I allow the person to just be an individual person. This is because individual traits almost always fill out the gaps of how someone operates and behaves. Classifications in the DSM IV are simply the similarities that individuals display that align with structural/chemical disparities in the brain. And it’s the individual idiosyncrasies that inform me to a greater extent about when to cut the person some slack and when something needs to be said (which is next to never in my case unless you’re a real dick).

Second is that I don’t force anything. Often, people are just weird without anything being “wrong” about them or needing medication or therapy. They’re just weird and that’s all that can be said about them. It isn’t a negative thing at all, weird people are often the most interesting people. It gives them flavor over the usual vanilla that I’ve encountered in a lot of people here on campus. The point is though, that unless there are absolutely clear behaviors or communications about behaviors, I don’t jump to any conclusions. To do any more would be pigeonholing them based on bad evidence. And readers of this blog know that I tend to be big on evidence.

Above is a fun game, and an interesting intellectual exercise of recalling definitions, applying, understanding, and afterwards I usually know the person better even if I’ve just come up with the answer that they’re weird. The game makes me think of them and try to understand them, which in my case, promotes a lot of empathy on my part. Empathy doesn’t come naturally to me, but looking at behaviors helps me see into another person’s head.

However, the internet sucks at playing by these rules.

Again, trolling through message boards last night (which was really a bad idea now that I think about it), revealed that a lot of people play this game. The only difference is that they play it for stakes and judge people based upon it. What makes it worse is that it’s usually very misinformed ideas about what actually constitutes the diseases that create the “diagnoses”. There are a lot of the ways that it takes form. Yahoo message boards are flooded with this type of material. Material where people as “is X bipolar?” or “X is crazy, is s/he Y?”. Or of course, there’s the wonderful comments, where people, based on a paragraph of material, feel well informed enough to pronounce a judgment. It’s actually disgusting after you read enough of it, and even more disgusted when you realize that actual people are making these snap decisions on things they know nothing about with barely any evidence.

Now it might seem strange that I would bring this up, since this seems to be relatively isolated to the internet. The internet, as we all know, is a cesspool of idiocy. But I like to see it in another light. Through anonymity, it doesn’t necessarily show what we are consciously doing, but what we unconsciously do, or do without thinking much of it. And in real life, I’ve known several other people who play this game, but again, it’s for keeps instead of fantasy and fun. This is all very interesting and mildy disturbing.

It’s interesting because it means that dialogue and discourse about mental illness, and even tangent awareness of mental illness, is relatively high. People without knowledge are aware enough about disorders to ask about particular ones. And that’s good, because it encourages people to see their own behavior or see other’s behaviors and possibly provide the encouragement to seek a therapist. And even in the naive and misinformed comments, I still see some light that psychological discourse has penetrated deep into American society. Though it’s distorted and not necessarily correct, that’s a long ways from where we were 50 years ago. To summarize, as a nation, we are becoming more aware of mental illness as an ailment to be treated and diagnosed. And with more and more resources about mental illness coming out on the internet, the proper information will start to trickle in and more people will get the help they need.

That’s about as positive as I can be.

The negative side that came out is that people make snap judgments about people’s mental health. Mental health is a difficult puzzle that takes years of schooling and experience to really nail down. The most an amateur can do is get an obvious case in a ballpark range of a diagnosis. Along with this is that the attitudes that come after making a diagnosis can be very ugly and prejudiced. It doesn’t take very long to find some horrible remarks on the message boards. There is also a sense that came out of the multitude that mental illness offers an excuse to dismiss the person. A weird person needs to be understood and worked with, a mentally ill person needs to take their meds. In this sense, psychiatry has penetrated the collective consciousness with its vocabulary, but it hasn’t penetrated it with its understanding.

Driving During Withdrawal And Other Things

First of all, don’t unless you have to. It is a very very bad idea. I had to make the journey up to my parents, which is usually around a two hour trip. I’ve done it many times and I know the route to the point that I don’t even need to read the signs any more to find my way onto the correct back roads to cut 20 miles off the google maps suggestion. There’s some construction here and there, but it’s pretty easy driving. But this time I started to have withdrawal while driving.

The reason is rather simple, I didn’t want to be comatose while driving, so I took my klonopin early in the day, quite early. I had to wake up early anyways, so it wasn’t a major task. But that put my dosing time at 7am, and withdrawal sets in about 9 hours after that. I left at 3pm. Didn’t time that one very well, but I had packing to do and a strong lack of motivation. So my agitation set in half way through, just when it started to get hairy anyways. I was stuck behind a slow driver. And by slow, he was on a two lane high way and was going about 10 mph under the speed limit. And there were 3 cars ahead of me that weren’t passing him. During the passing lanes, it just got jammed with lazy drivers and nothing happened for about 30 miles. I’m not prone to road rage, but I desperately wanted to ram everyone ahead of me. Even savoring the images of the car wrecks. I was not in a good mood.

Then I hit the main highway again, and it was backed up and not going anywhere. I got within 1000 feet of the off ramp and I took my chance and used the shoulder to get to it. A lot of people had that idea. Just get off the highway and take the residential roads until you connect in another 10 miles and see how the traffic is up there. The idea paid off in the end, but in the mean time I was tailgated for a few miles. That usually irks me, but this time I stopped my car and started screaming at the gal for tailgating me in a residential neighborhood. I could have easily snapped and started a fight. The other driver, thankfully, went pale and drove off leaving me alone. But the adrenaline was high, I was shaking with it. I decided that it would be a good idea to pull over and have a cigarette before heading on. It worked and the rest of the journey was uneventful.

That’s the thing that I’ve noticed about the withdrawal and the agitation associated with it. There is both a violent nature to it and an explosive one. Violent thoughts come very naturally and I don’t have the natural impulse to push them aside. And that’s coupled with sudden fits of adrenaline that just surge through me and I lose it. There isn’t much warning either, it happens in minutes at most, sometimes within seconds. So I might be mildly annoyed at one moment, which will often pass, and the next I’ll erupt. And it’s not for lack of trying to stop it. Obviously, the best idea is to challenge any ideas and talk myself down, ultimately just removing myself from the situation. But when driving, it’s harder to do that. In addition to that, when annoyed, my thoughts tend to narrow and I don’t think straight enough to step back and challenge anything.

Basically, driving when in withdrawal is a bad idea in a number of ways.

However, there is some good news on the withdrawal front. I was taking klonopin every 12 hours, which meant mornings and nights were not pleasant. I went to the pharmacist to finally refill my prescription and she noticed that it took me a while to get it in. But also noticed that I was not in very good shape because I hadn’t taken my klonopin yet. So I talked to her a little bit about it, how I have problems in the morning and at night, but also early afternoon, when I get knocked out by the klonopin. It’s a lose-lose-lose way of taking the drug. She told me to take the drug first thing in the morning and an hour or so before bed so I could sleep. And then for those few hours that I would be in withdrawal, have a single beer or a single glass of wine. Sip it, not guzzle it. Apparently the alcohol, since it too is a CNS depressant, will take the edge off if it looks like it’s going to be too much. But I’m not drinking enough or for long enough to form any dependency on it. It worked last night. I didn’t feel great, but I felt more like myself. And that was something that I usually did before going off of klonopin. I like my microbrew beer in madison, and would often enjoy one with dinner or sitting down for a movie. Never getting drunk or even close to being buzzed, just as something to drink. I won’t do it all the time, just as needed.

Today, so far, I can see that the shift is working well. I have my afternoons back, and I’m groggy before noon no matter what time I wake up. I honestly feel much more like my old self. I’ve spent the past 5 hours just listening to music and doing various things around the house. I’m also looking up new artists to listen to. It’s been fun, and I feel like I’m having fun. I’m ultimately not afraid of trying something and not liking it or failing, I’m adventurous again. I can’t wait until I’m completely off klonopin and start my summer fresh and ready (and mildly manic).

Watch Out For Food

This isn’t a diatribe about the merits of good nutrition and mental illness. It’s just a simple PSA. Watch out for the food you eat. Make sure your vegetables are refrigerated and smell and taste everything before cooking it. And trust your senses, we’re hardwired to detect problems through our nose and taste due to a long history of evolution. Why do this? Food poisoning.

Yesterday I was hit hard by what is almost definitely food poisoning. I’ve recovered fairly well and today I’m feeling around 60% ready to do things. I’m no longer as weak today. But believe me, food poisoning is really easy to avoid and it hits hard. There are a lot of gory details about what it did to me. I left my vomitous mark in one of the local parks when I tried to get some air. And all day I was sweating for no reason. Also, for most of the day I not only didn’t have the energy to do anything, but was so weak at times that I couldn’t even hold a pencil to draw. I just spent the day watching the first season of Mad Men (great show, always worth a repeat).

But it’s also really important for those of us taking lithium to avoid this at all costs. It wasn’t something that I thought about before, but it’s a dangerous factor. I lost a lot of fluids yesterday. So my usual one to two gallons a day was upped tremendously by me losing this without absorbing it. The last thing one wants when vomiting up their dinner is to then deal with lithium toxicity.

So do yourself a favor, just take an extra 10 seconds to test your food. And if it’s iffy, just get rid of it. I’m thankfully stabilized while this happened and I have felt no change in mood. But if I wasn’t on such a total regimin of mood stabilizers (4 at this point), I could be in mood hell since food poisoning devastates electrolytes that are key to brain functioning. Food poisoning was never something I really thought about before, but now I realize that I could have been in a hellish situation simply because I didn’t do something simple. But being medicated up to my ears does give me some insurance against stupid mistakes.

Whew… Hectic Two Days

It’s a double post day, so it’s not just Dear Diary. But I thought I should do it to keep up with my mission to keep blogging once a day. Still, it’s been a whirlwind of socialization and coming down from that. Which is a good thing since I’ve been rather non-social for the past few weeks.

It started off with running my girlfriend around to various places and  then back to a friend’s house. There, we met an old friend from Cambodia who was in the states for a conference. It was her last day here and we wanted to see her again. One last time before she went off. It was fun, I hadn’t seen her in nearly 2 years. I felt old thinking that it was actually 2 years and how young I was back then. A lot has happened in the past two years and it made me see myself in a much different light. I’ve grown much harder and darker since that time and a lot less frivolous in terms of my cares.

But she was off to a dinner and I was then off to a CD release party. It was a four band line up with a good crowd, maybe 60 people. Not as much as Control’s release that I ran, which drew in 85, but still a good one. There were libations and music, and tons of people that I knew. Working as a head of Project Lodge, I never realized how many people I was connected to in one way or another. About half that evening (due to the poor sound engineering) was spent just talking to old friends who had come into town for the show. It made me feel a little like I was home here in Madison. Not just that I can cruise a crowd and rub elbows with half the people there (most were musicians), but that I filled an old dream of mine. I helped establish a groundwork that kept these people playing and helped local music gain a unique venue for their art. In a sense, I felt that I mattered. I wasn’t just another college kid getting his degree and going off to grad school somewhere, I did something good for a lot of people. I never felt that before and it was nice.

I also got to show my girlfriend part of what I do. Not the engineering stuff, she’s seen that, but the parts afterwards, when the music is done. I had the image, and so do a lot of people, of musicians just partying and having this wall of separation around them. There’s a mystique around them, like what painters and artists try to cultivate. An ethereal quality of otherness. It doesn’t exist. And it was fun to show that to her. Musicians like to have fun, but they are incredibly ordinary.

Still, we stayed out till 4am having food with them (we were done with drinking at that point and just wanted to sleep on a full stomach). And I’ve discovered that I cannot stay out that late. Ever. It’s thrown my sleep cycle for a loop where I sleep too late now. I’m also very edgy and mildly depressed at times. A simple little thing like sleep can do a lot to one’s moods. I’m recovering still, but the depression seems to have gone away. That only took a day to deal with. Yet, as something to keep in mind, even getting 8 hours of sleep, just at a different time, can do very bad things for one’s moods.

That’s it for now. I’ll try to get another post up about my relationship with science and how I think that it keeps me stable. But I also have a lot of errands to run, so maybe later tonight. Hope you’ll enjoy it (as well as the above).

Living With Someone New

This August I’ll be moving in with a second roommate. She’s a very nice person and we lived together at the co-op for a while before. I believe that she’s vaguely aware of my mental health, but since the last time that I saw her, it’s become more pronounced. My mood swings are much more apparent and I have psychotic episodes. And there lies the question, just how much should I tell her and what sort of responsibilities should be forced on her? I’ll explain more of what I mean by these two things.

I have no problems with telling her the details of my current health. I’ve gotten used to the idea that I need to inform some people of the goings on in my head so that they don’t take everything I do seriously. Personally, I think that it would be a very good idea to tell her so that she doesn’t take my irritable moods seriously. I’m fairly good at controlling them with medication, but that’s never 100%, it only takes off the edge. In that sense, I’m in favor of informing her of some of the details just so she doesn’t get caught up in my bizarre swings and why I can seem like several different people in the same day. So in that sense, I think that informing her about my mood swings would be very good.

But then there’s the other aspect that she doesn’t know about, my psychotic episodes. To the best of our knowledge, they’re under control, so there is less of a need to inform her. Still, they might erupt out of nowhere and she should know what could happen. It could also make an episode far less frightening if she knows what is going on and that this is almost “normal” for me. The hesitation that I have with this is that psychotic episodes are perceived by and large differently than extreme moods. Even though I find that psychotic episodes are no more scary than something like a dysphoric mania. In fact, I’d rather have a psychotic episode than a dysphoric mania as my psychotic episodes seem comparatively kind and complacent. But back to the point, revealing the psychotic side of myself might make things uncomfortable in our friendship.

The other aspect to this is something that is sadly obvious but never talked about. It’s that living with someone new means that I’ll force a certain set of responsibilities on my new roommate. It isn’t that much, but little things, like having my psychiatrist’s phone number on file in case something goes wrong. Telling me to take some of my medications if I’m starting to act out of character. For instance, if I’m becoming very manic and becoming very bothersome, it does us both good to tell me to take my klonopin. But things get more iffy with psychotic episodes. I need to take certain medications but not twice (as I seem to try to do). It’s also a great responsibility to deal with someone completely delusional for the 2 hours until the medication works. There are other things that need to be done as well. Keeping me away from all medications and knives, and possibly ledges (we’ll be on a second floor), are some of the things that just need to be done when I’m in those moods.

In all fairness and likelihood, I’d like to be told by my roommate if she had such circumstances, so I’ll tell her. It would be much worse if the event would arise that I did have a psychotic episode and she was unprepared for it. And I don’t need to reveal every last detail of it. I need only tell her that I can become delusional and hallucinate, and that I’m safe to be around as far as is known. The only danger that is present is me taking my pills twice or cutting myself early on. And that my medication takes care of the problem very quickly. And as for the manias and depressions, if I start to seem hyper and irritable, tell me and I’ll take some medication. And if I’m depressed and things need to be done, just give me one task to do so I don’t get overwhelmed and get nothing done.

Sick, Uncreative, and Mood Swings

I’ve been sick for the past few days. It’s one of those colds that comes and goes so I never really know when it was going to be over. Yesterday seemed like the last of it. I slept about 5 hours during the day and by the evening I was feeling fairly good. So that should be the end of it, hopefully.

The dangerous part of any cold, for me at least, is first trying to just sleep it off and not do anything, then by the time that the cold is finished, that’s what I’ve programmed myself to do. I was on an exercise regimin and was ready to do a host of things, even in my slump, but that just all went out the window and now I’m back to square one in rebuilding my habits. It just interrupts life and I completely hate it.

It also does a number on my mind. Being sick, I often have a period where I’m completely uncreative. No matter how I try, I cannot think of anything interesting to say or to do. I just lay around and do nothing. I guess that’s what it means to be sick, but it’s dangerous to my moods. Periods of time where I’m too far removed from creativity is due to push down my moods. I need that creative push to get things done and feel better. Sickness just takes that away from me. And after a time, I don’t even want to be creative, which makes things even worse.

This is all on top of fairly rapid mood swings. I can be depressed in the morning, hypomanic in the afternoon, and back to being in a general muck by evening. Sometimes it can go even quicker than that. Last time I was seriously ill, even on these current mood stabilizers, I was just all over the place. It was not a pretty sight. However, this time around, I had lots of klonopin to help me out. It evened me out and kept me fairly stable. It was just that added push to keep me sane, even if it probably contributed to me sleeping all the time.

But now that I’m well again, I feel that I need klonopin all the more. It’s been programmed into me that I should be missing out on doing things, even though I haven’t. Now that I’m feeling better, I’m just overwhelmed by anxiety over little things like signing up for classes or making it to the psychiatrist. The little things have now become blown way out of proportion and mindfulness is just not helping. I’m trying some critical assessment through cognitive-behavioral therapy, but it’s just not working. Right now, all I want to do is curl up in a ball and not leave my bedroom. Which is probably not a good sign in terms of moods either. I might be coming out of this thing in a slump, which I’d rather not have to deal with.

It’s always been something that I’ve done, but never noticed it until I had my diagnosis, but I obsess and spend ridiculous amounts of energy on little things, like signing up for classes. It’s something that I don’t think that even my girlfriend realizes. Where, in certain moods, everything is a monumental hill to climb, regardless of how it really is. And the time and energy that it takes to get some daily chores done can be immense. It never ceases to amaze me how much energy this takes at times.

I could really go for a hypomania right now.