dbt

Dialectics and Putting Your Life on Hold

As humans, our vitality and existence depend on our ability to create passion and meaning in our lives, and also our capability to form and nurture social connections.  It is when we cannot do so that we diminish, we shrink smaller and smaller on this earthly plane.  Thus life purpose and the holding of worthwhile, sustaining relationships are necessary ingredients in a recipe to human happiness.  In our lives, circumstances often inhibit the cultivation of these factors.  These can include family difficulties, job loss, or poor or compromised health and general wellness.  While we may have no control over these issues, there exists an interesting perspective concerning what we, as individuals, can do to mitigate and lessen the negative effects and find self worth and purpose once again.  

Marsha Linehan discusses the concept of dialectics in her pioneering mental health treatment modality called Dialectical Behavior Therapy, or DBT.  Simply put, a dialectic proposes that two seemingly contrary things can be true at the same time, not existing independently of or in conflict with one another.  For example, I cannot be unemployed and still experience happiness and have positive experiences.  A dialectic approach would say that yes, while you may be unemployed, that does not have to hinder your ability to be happy and enjoy life.  Dialectics often keep us from engaging in life in the ways important to our health and wellbeing, as discussed above.  We are waiting for one end of the supposed spectrum to reconcile the other, and this is the inhibitory factor.  By accepting both as true and congruent, such reconciliation is not necessary.

I have been struggling with dialectics in my journey through the world of mental illness.  My crash into depths I previously could not have fathomed has created a state of mind in which I believe I cannot both have a debilitating bipolar disorder and also have a meaningful and purposeful life – such as finishing college, interning and volunteering, having a social life, and engaging in activities I once found pleasurable.  Severe circumstances with hospitalizations, ECT, and medications have certainly contributed to the  neglect of these areas of my life, but they do not have to define me.  My therapist recently pointed out that I have put my entire life on hold for my illness – I have become its keeper, its slave.  It is unknown when I will recover enough to personally deem myself ready to reenter the world.  Why must I wait?  I have hidden in the darkness and depths too long.  Overcoming this dialectic – I can both suffer from a mental illness and participate meaningfully in life – is extremely necessary to my wellness and may improve my prognosis as a whole.

Dialectics have the power to put our lives on hold, to cause us to exist in stagnancy.  Such a state only hurts and hinders.  It is not a matter of reconciliation, but of embracing the ways in which different components of our lives come together.  

More to the Picture

For much of my treatment career – yes, I am indeed calling the taming of the beast these years have evolved into a “career” – I have painted a two dimensional piece, whether it be a Monet, a Picasso, or an unintelligible charcoal-smeared creation.  The point is, these pictures are flat.  For the last eleven or twelve years, I have relied oh-so-heavily on the powers of psychiatric medication.  I was once again recently hospitalized for bipolar symptoms, and during a visit with my mother following a highly frustrating and disappointing meeting with my inpatient psychiatrist, we made a list of the treatment options I had tried thus far.  First came the list of medications – lithium, depakote, risperdal, lamictal, clozapine, haldol, trilafon, thorazine – the list is endless, and nearly so.  We calculated an approximate trial of 20 to 25 different medications I had endured over the past years.  Next we tracked treatments I had undergone, including naturopathy, acupuncture, electroconvulsive therapy, and twelve inpatient hospital stays.  Is it time to paint a Van Gogh?

The use of psychiatric medication has drastically altered my life.  In fact, I can confidently say it has saved my life.  But then, what is left over?  There is only so much a psychotropic drug can do in the recovery of a person with mental illness.  It propels the car down the interstate, but there must be another driving force to push pass the border.  There must be more to the picture.  Effective coping skills.  Do not undermine the power of the mind to alter a mood state, thought pattern, or to deescalate a crisis through the implementation of learned skills and behavior modifications.  My greatest experience with learning and engaging in coping skills has been through Dialectical Behavior Therapy practice.  I have had much interaction with DBT, mostly beginning with the three week completion of an intensive outpatient program.  For three weeks – three weeks! – I ate, breathed, and slept DBT.  Yet I did not implement the principles into my life – mindfulness, acknowledgment and acceptance of painful emotions, distress tolerance, emotion regulation.  The invaluable things I learned in this program could have served to begin to possibly alter my art into three-dimensional pieces, had I been doubly persistent.

I also received intensive DBT exposure and training in the four hospitalizations I have experienced in this past hospital.  Our days were centered upon groups led explicitly in the informative and practical application of DBT principles.  Yet, I come home and once again fail to implement them into my life.  A few days ago, I came upon my medical records of my hospital stays at UCLA and documentation with the Department of Mental Health in Los Angeles.  I was shocked, disturbed, and distressed reading through the records, realizing how long and arduous a road this has been.  Medication after medication, unsustained improvement.  I suddenly realized that these medications are getting me only so far.  I must begin to exercise my inherent powers to alter my life, use my mind, thought processes, and cognitive abilities to effect change.  It is the only way I will cross the border and enter the adjoining state without disregarding or disparaging the gas the psych medications have fed me.  There is a possibility to work to control my neuroses and obsessions, to combat my suicidal urges, and to attack and smack down the thoughts of self harm and punishment that often plague my mind.

I am slowly working through the practice of these skills.  It is a process – an extremely slow process – to effectively learn and implement them, but I believe they are as valuable as my psych medications.  Perhaps in the future I will be able to exclaim the power of my mind and thought processes in their imperative role in the dismantling of the current and historical blockade inhibiting my path to recovery and the rescuing of my life.  No more Renoir.  Shall I try a Michelangelo?

Another Stint

Unfortunately circumstances necessitated that I make a slight disappearance this past week.  I had been anticipating this trip in seriousness for several weeks, mentally preparing myself each day should the occasion arise.  My last psychiatric hospitalization was in August of 2013, and I set myself on a personal endeavor to avoid future hospitalizations at all costs.  I have successfully done so up until now.  I built such an aversion within my mind to the possibility of requiring a higher level of care in order to ensure safety and promote emotional stability.  Over the past few weeks, I began to chip away at this aversion and allow the notion of the need to seek inpatient care creep into my mind, acknowledging the benefit and worth I could derive from such a stay.  My moods have been vacillating between significant mania and significant depression, consisting greatly of mixed episodes (episodes in which one experiences mania and depression simultaneously or within short periods of time.  These episodes are especially difficult to treat).  Intellectually I saw myself approaching hospitalization, but emotionally I adamantly resisted it.  However this past Monday, the barrier was broken.

As per my mother’s suggestion, I have had a bag packed for several weeks containing essential clothing and toiletry items, my journals, and The Hunger Games: Catching Fire, also an essential item.  I brought these items with me to each of my electroconvulsive therapy treatments at the hospital these past few weeks, should they decide to admit me.  Well, this past Monday a collective decision was made between the doctor, my mother, and myself.  I could no longer contract for safety and my moods were debilitating and all-consuming.  The greatest determinant for my admission, for me, was that I was tired.  Tired of battling these ups and downs constantly, of battling the constant slew of appointments and the exhaustion that arises from receiving electroconvulsive therapy treatments, and from just battling life.  I needed a rest and a safe place to be.

Following my electroconvulsive therapy treatment, the psychiatric unit sent a nurse and a wheel chair to transport me to the unit.  I was pretty drugged up at that point from general anesthesia, a paralytic, and major sedatives, but I was determined to make sure Puppy made the trip from the surgical prep area to the unit closely in my care.  Puppy is a stuffed dog that has been with me to each of my thirty-two electroconvulsive therapy treatments.  After arriving and completing my intake, life resumed to as I recalled it to be from past stays.  Treatment at this center has far surpassed in quality the treatment I have received at the three others hospitals at which I have stayed.  The program is DBT – Dialectical Behavior Therapy – based, focusing on distress tolerance skills, mindfulness, and how to manage our emotions and symptoms effectively and to the best of our abilities.  The days consisted of class after class, all varying in content.  The basis for many classes were DBT topics, but there were also meditation classes, outdoor activities, and cooking classes.  I learned how to make fruit nachos, so if you are ever curious for the recipe, please send me a message!  One of the greatest highlights of the program was the camaraderie I developed with my fellow patients and the experiences we shared together, especially rousing games of Apples to Apples and Pictionary.  My greatest regret was the unavailability of the vegan lentil soup each day I spent there.

Most puzzlingly, during my stay, I experienced what appeared to be a miraculous recovery.  I was bubbly, chatty and talkative – albeit probably too much, a possible harbinger of moods to come – and quite amicable.  I believe the electroconvulsive therapy provided an emotional respite and residence in the unit provided a much-needed rest and an environment in which I could be safe and unable to act on self-destructive urges I may have.  Since being home, many of my symptoms have returned, possibly in less intensity, but I feel rested and better equipped to tackle and address them head-on.  While no medications were changed, I received a reinvigoration and condensed refresher on my DBT distress tolerance skills.  

I needed this rest.  Yes, self-destructive urges have reared their ugly heads once again and I am cycling pretty quickly, but my body and mind are rededicated to my seemingly endless fight.  I know I can never rid myself of this illness, but I can ardently commit to the fight – both for the sake of myself and for the sake of those around me whom I love.  I have been closely monitoring numbers – numbers of medications I have been on, for how long, and their doses, or the number of hospitalizations I have had, which now has reached eleven.  However I believe this may be both productive and counterproductive.  I know I must acknowledge the worth in closely following my progress, but I also must ground myself in the here and now and do what I can to win this battle.  I will not concede to my disorder.  It must face my ironclad box of skills I have developed, and I know, with a certainty, it will not win.