mental health treatments

Breve

Coffee beans ground finely, roasted into a toasty but stringent espresso.  Over the darkness two poles are poured, milk and cream, the pauper and the prince.  The elements combine to form the color of life, discernible and livable, clouds and shadows swirling on the gentle landscape.

I had called the psychiatric emergency crisis line two nights in a row.  The therapist on the other end could feel the tickling tentacles of my demons reaching through the airwaves and requested I come into the emergency department to be evaluated.  The air in the ED was thick, heavy, and populous, yet there was not enough to sustain a single breath.  The tentacles were misbehaving, spreading to great reaches and tapping shoulders of others.  I had not eaten in close to twelve hours, my receptacle empty and my reserves slim.

The evaluating therapist tamed the tentacles long enough for me to get my story out.  The illustrations were old comic book style, bold colors and patterns, but little shading.  Little bits and pieces of our conversation stick on the post-it note covered wall of my brain.  Central nervous system suppression.  Trauma.  Maladaptive coping mechanisms and behaviors.  Apparently my story was publishable, earning a coveted spot with the exclusive board of directors at the hospital, the individuals who were the news and who told the news.

Being on the board of directors was quite interesting.  My tenure was short-lived, only six days.  Sometimes the overseers allowed respite from rigidity of the duties of formulating and planning, and the board members could dance in unadulterated bliss to the beats of Uptown Funk and shake booty to popular rap songs.

The tentacles were retreating and retracting, and the smog in my brain lifting.  Puppet strings pulled the corners of my mouth upward, an action foreign to the nerves firing to my facial muscles.  I left the board of directors well respected and soared with a proper farewell.

The darkness of the depths of the brain, where depression and the evils reside, becomes mitigated by the paupers and princes of life, the poor and rich experiences that serve to draw color to the darkness.  Through acceptance of the dialectic existence of the poor and the rich, darkness lightens.  Last week I experienced my thirteenth hospitalization.  Acceptance has the capacity to color my espresso differently and to alter the fabric of existence upon which I reside.  

Advertisements

Inertia, You Sly Monster

Asleep.  A fallen redwood in a damp forest.  Immoveable.  Unable to be roused or awakened.  A ringing begins in the distance, permeating the fog sitting heavily like a brick upon the fallen tree.  The arrhythmic ringing crescendos to deafening timbres.  The world grasps me firmly and draws me to reality.  The accosting arrhythmia is my alarm clock beckoning me to join the world of the living.  I politely decline and slip back into my alternate reality.  Depression is an ugly friend – bossy, controlling, narcissistic – and it has its hold on me.

Depression inertia is trying to move a concrete wall with simple tethers, or to wander through a thick fog, so dense each step requires the strength and agility of a Roman gladiator.  Or may it be likened unto an attempt to drag oneself through a pool of quicksand, ever hoping to reach the elusive reward resting on the far bank of the pit that controls life and livelihood.  Sleep is ever-so-enticing when in the throes of inertia, though it has a dark side.  It masks itself with promises that if you sleep just one more hour, your despair and sorrows will dissipate.  You will join the world of the active with joviality and effervescence, but, in truth, it speaks lies.  Suckle just enough of the nourishment sleep has to offer, but inebriation is a sly devil.  With each extra ten-minute snooze, a little vitality is siphoned from your energy stores, supporting the demons that keep you trapped in the world of inertia.  Sleep is restorative and enriching, but when it becomes the warden, it is quite adept at constructing an impenetrable prison.

I have fallen into a depression, and inertia has hijacked my emotions and motivations.  I sleep for hours and hours, not rising until afternoon.  Each time I reset the alarm clock, it gives me hope that in ten to twenty minutes I will be ready to face the world, but depression fibs.  Giving into the inertia guarantees that I will never be able to face the world.  Once awake I move from place to place, going through the motions, but exist solely behind the facade of a plaster mask.  The words in my books are jumbled, seemingly constructed into a language written and understood singularly by depression.  My mind perseverates on suicide as tears flow down my cheeks like water seeping from freshly broken dams.  I know I must move.  I must.  But dear inertia, you are so good at what you do.  I am bonded, shackled, wed to psychiatric treatments that cannot reach you, so I must sit.  Wrestle with my roped wrists and ankles, shake myself free.  I will not fight dirty.  We will not mud wrestle.  Rather I shall rise above you, take the higher ground.  Stumble and stutter in my tracks.  I dare you to reach me as I soar.  I will crack your narcissism with my disregard for your hostage tactics.  Yes, I am under your spell, but I am beckoned for a higher purpose.  Game on?

Hanging in Limbo

What is wellness?  Stability?  These are questions that I have oft asked myself over the last month or so. How will I know when I have achieved the coveted status, the pinnacle place of mental health wellness? I ponder the importance of this contemplation.  Does it matter or hold significance in whether I perseverate over whether I am “well” and “fit,” or rather is it more important to just “be,” to live in the moment with mindfulness and awareness?

Since the beginning, I have been highly treatment-resistent.  I have had twelve hospitalizations, been on over twenty different drugs, and have endured thirty-eight electroconvulsive therapy treatments. In the last few months, I have explored alternative routes of treatment as a supplement to my psychiatric care.  A naturopath has honed and fine-tuned a special concoction of supplements and extracts that have positively affected my mental wellness, resulting in some symptom reduction.  In fact, a significant reduction.  Natural approaches coupled with the psychiatric approach have proven highly effective.  I am still weighed down with depression, anxiety, obsessions, and agitation, but utilizing my arsenal of coping skills and treatments has created a life and existence for me that has been elusive for many years.  So am I well?

My psychiatrist recently placed me in partial remission, which was the impetus for my perseveration surrounding what it means to be well.  Initially, this instilled in me a belief that I am now healed and should act and conduct myself as such.  Symptoms I may feel should be diminished, and I should embrace a life in which I no longer have sickness.  This led solely to frustration, as I knew that my true predicament was incongruent with these notions.  Then I started to think.  Is this black and white, or is there a spectrum? Room for the vague and the unsure?  For relativity? I see this as a complex phenomenon. In a linear direction, there is the spectrum of mental instability to mental wellness.  A person may land anywhere on that spectrum at any given time, but this categorization is superficial and not the only factor in involved.  In comes the concept of relativity.  Someone may fall closer on the spectrum to the societal understanding of instability, but yet have exceptional coping skills and support, thus creating a situation in which they could cope and exist more adeptly than someone in the same position – thus possibly more well than first perceived.  Contrarily, a person may fall closer to mental wellness on the spectrum, yet be unable to effectively cope.

I feel as though I am slowly navigating my way from the instability end of the spectrum to the place of mental wellness. I am beginning to understand the ambiguities and relativity in the process, and labels such as partial remission are not all-indicative of a certain state or place in someone’s existence.  In fact, it is just a label used solely for documentation in medical records.  When considering the spectrum and the concept of relativity, I can see that while I may not be entirely well, I am walking in the right direction, and my obsessions over the worth of words and labels are insignificant. What truly matters is to live mindfully and unconstrained by one’s own psyche.  To be controlled by the spectrum is to hang in limbo, not knowing where one truly falls and whether that knowledge is important at all.

I am sitting in my new apartment writing this piece.  I am scared.  I am afraid.  Obsessions and anxiety are creeping from the darkness and grasping their sticky tendrils around the threads of my mind, attempting to draw me from my place of progress.  While I could succumb to their power and view my place on the spectrum as the be-all and end-all, I can instead draw to mind the concept of relativity and recognize that while I may have some setbacks, I am fighting with well-honed coping skills and implementing my naturopathic and psychiatric interventions, compounding the linear nature of the spectrum and allowing a more dimensional look at my wellness and stability.

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?