psychiatric treatment

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.  

Yes.

Two years ago.

It’s cold.  So cold, cold enough to cause tissue necrosis on the very tip of my nose where the cold bites, and I say okay.  My toes move little, my mouth less.  I am slow, my tongue drawling, words dripping like molasses.  I pull on my woolen socks, then a second pair.  Long underwear.  Snow pants.  Boots.  Mittens, a hat, and three scarves.  Readying myself for a day which I will never be ready for.

One year ago.

It’s still cold, roads plowed and salted.  I can taste the salt on my tongue, strange as it may be.  Taste is foreign; I cannot remember the last time the world tickled the little bumps on my tongue.  The cold still bites, and, wrinkling my nose in burgeoning annoyance, I mutter okay.  Just one pair of wool socks today.  I toss the other pair across the carpet.  Long underwear.  The snow pants dance a jig as I retire them for the first time in over ten years.  Jeans today.  Mittens, a scarf.  Maybe no hat.  I can take the bite; I can take it.  

Six months ago.

The ice covering tears captured by frost has melted.  They flow.  An escape.  I do not call the warden.  Let them flow.  I wipe the smudged tears from my face and notice a wetness on my body, a collection of small droplets within my creases, my underarms.  Sweat.  I had not noticed the change in weather.  The sun’s stealth and deception amuse me.  I chuckle.  I pull on a light pair of khakis and a cashmere sweater, deeming myself presentable for the day.

One month ago.

The sun is shining.  My lips reach out to kiss it.  Chuckles raise to symphonic laughter.  The sun is shining, and I cannot believe it.  I pull on some shorts and a cotton shirt and skip my way down the mossy path.  

One day ago.

A cloudless sky.  The sun tints my nose, and I say yes.  My clothes lay in a heap on the bedroom floor.  

Partial

Approximately four months ago, my psychiatrist placed my Bipolar 1 Disorder in partial remission.  Since, I have struggled, grappled, with the word “partial.”  How is it possible that I am only partially towards remission?  Where is the line drawn in the division of these categories, where does the curtain fall – symptomatic, partially symptomatic, fully asymptomatic?  The application of “partial” poses discomfort for me on several levels, the very first being my perceived lack of control.  As the entity experiencing the disorder, how can an outsider peer in and see the inner clock working, ticking, turning of my mind and know, with a certainty, I have progressed up the ladder?  I feel quite wary of such a distinction.  I see mental illnesses as fluid disorders, not remaining in exact, crystallized forms for extended periods of time.  Thus, as I continue to have episodes of mania and depression, I squirm with angst and frustration that such emotions should have been annihilated by now, as I am in partial remission, correct?  I am constantly flowing in and out of states, and these two words attempt to hit a fragment of my existence like a dart to a bullseye and obliterate all outlying symptoms.  At least this is how my mind perceives it to be.  Rather, as I have discovered in the medical world, labels are just an issue of semantics, present only for clear and consistent communication among medical professionals and for the direction of effective treatment.

If I can entertain the notion of casting all labels aside and truly examine my progress, there rests marked improvement.  One year ago, I was still receiving electroconvulsive therapy treatments, and much of my episodes surrounded suicidal thoughts and intrusive thoughts of self-harm.  Episodes lasted weeks, even months, despite aggressive treatment.  If asked what my greatest worry for the future was, I most likely would have answered suicide.

I had my final official meeting with my psychiatric nurse case manager yesterday.  We were discussing my progress and impending ability, due to vast improvements, to be discharged from the intensive care program.  She posed the question, what are you most worried about in the coming year?  My immediate, knee jerk response was “not getting into grad school programs.”  What a departure from a year ago, twelve months ago, three-hundred sixty-five days ago.  It was in this moment that I could see how significantly my perspectives have changed, have shifted.  Instead of contemplating the unsure existence of life in the near future, I imagine a place in which I live, I am successful, and I humanly exist.

To battle words is a futile battle.  One must recognize that words only hold the power that you allow or wish for them to hold.  And why can words not be fluid as well?  In consideration, can the word partial possibly be considered fluid and dynamic, for does it not imply a sort of limbo?  How more advantageous it would be to see it as a realm of existence where I can experience a spectrum of differing symptoms, yet still exist in a space of reduced symptomatic expression.  I do not have to imagine lines and curtains, theatrical representations of the process of remission.  The underlying, driving emotion in this wrestling match is fear, in two parts.  As I progress into partial remission, does there lie an impending regression into severe illness once again?  Or alternately, as I move from partial remission to a possible full remission in the future, will I lose the mind I have and hold so dearly, or my depth of experience, as well?

I can take a shower and perform morning ablutions without washing my hands repeatedly to avoid contamination.  When things do not occur within increments of four, I no longer freak out.  It only takes me a few minutes to leave my apartment, checking all faucets and appliances and the door only a few times.  These rituals, but a small part of my cornucopia of symptoms, were all-consuming.  The other day I realized I did not massage my scalp to the count of four as I was shampooing, and that was okay.  Anxiety had abated, and I could wash my hair without the abacus clicking within my head.  Instead of focusing on semantics, I vow to focus on my improvements, my victories in the face of crises.  Why get hung up on words when I can drink the sweet wine of life?

Memory and Blank Spaces

This term I am taking a wonderful women’s studies class entitled Women, Writing, and Memoir.  The first two classes of the term involved the completion of free writes on the prompts “I remember…” and “I don’t remember…” My responses were highly reflective and raised my intrigue for these exercises.  I have decided, for this blog post, to combine the exercises and complete a free write just to see, out of pure curiosity, where it goes.

I remember the way I existed in a constant zombie, absent state as I progressed from class to class in that fiery October when I was mysteriously, unprecedentedly called to the high school administrative office for my mother to pick me up.  To the hospital, she said we were going, and all I can remember is the relief that I can finally sleep, sleep, sleep.  Sleep away the demons rooting residence within the fabric of my brain, quickly signing their renewal leases, tenants disruptive and unforgiving, destined to never leave.  I remember the discovery that no, I was to be imprisoned in a psychiatric ward where sleep was a commodity, a rarity, a luxury to be bartered for.  It was Halloween, the mountains of Southern California were ablaze, and they painted my face, me a child, the color strokes not indicative of the fourteen years of age I carried. Visitors presented, yet I was absent, my ties to the world severed, floating in catatonia.  I bowed my head, unaware of the forces struggling to break the barrier and draw me from the depths of hell in which I resided.  I remember smuggling broken tiles from occupational therapy, feeling deftly for the sharpest edges and drawing the points across my forearm until they drew blood.  There was a girl there.  I did not know her well, nor did I express the choice or will to, but I remember the ways she tried to touch me and the protests of discomfort and intense dislike I offered.  I remember the day I was allowed to leave, realizing the broken way in which these two worlds attempted to collide.

I don’t remember the white hot flashes that surged through my mind and danced their bruises across my mother’s arms, her hiding them at work to avoid the questions she knew would be asked.  I don’t remember the rages that possessed me and elicited horrific acts, only that they occurred and that I collapsed in confusion and unknowing.  While I remember the breaking of the glass, I cannot recall how it felt to pull the shard across flesh, nor the specific hue of red that emerged and trickled like a slow-flowing creek carrying away garbage cast afloat by a desperate teenager seeking cleansing and catharsis.  I do not remember the first time I prostrated to pray, but only how I ardently seek to replicate the feeling of connection I felt to God in that moment – the worlds beyond being opened to me and offering solace and forgiveness to and an understanding of the monster residing within me. I don’t remember the first time I contemplated suicide, only that the urge has never left.  I have little recognition of childhood, of a semblance of normalcy, a state in which my mind was quiet and not disruptive, sadistic, or cruel.  Most of all I do not remember familial happiness, a time in which the devils did not dance, the connecting ropes strained by illness and marriage, a time when sisters partnered rather than eschewed.  I do not remember every tear shed from red eyes, but I remember in vividness the ones which I caused.

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.

Loosen the Barbed Wire, Please

Carrying obsessions is one of the most painful things I endure.  I do not speak of a penchant for designer shoes and purses, but rather a demon so powerful, so insidious, one that wraps barbed wire around my soul and refuses to let go.  My focuses of attention shift with time.  The patterns of the responses surrounding my obsessions may likened unto an EKG monitor recording a heart rhythm.  There exists the baseline, and then there are spikes and plummets that dance around the baseline, neither staying for very long.  There are times when the obsessions/compulsions flare up severely, like a firecracker shooting into the sky, and I burn and burn until all that is left are ashes indicative of a fight I have lost.  The performance of each compulsion is never enough, never satisfactory, and never will be.  The demon demands more and more, with each request tightening the hold on the ever-constricting barbed wire.  I ask my mother repeatedly, please look and see if I have degenerative gum disease, please look, and with each answer of “no” I receive, there grows a greater impetus to ask again, because no matter how many times I receive the answer I am seeking, my brain refuses to believe it as truth and deems it to be a lie.  There is but a fraction of a second where my mind considers the validity of the answer before the impulse to ask again ensues.

During the summer a little over a year ago, I lived in a special place of hell.  I was in the throes of two obsessions that worked to destroy what little existed of the life I was attempting to live.  I had just moved back to Portland to return to school after living at home for a few months following one of many psychiatric hospitalizations.  The building was old – historic, they call it – and it terrified the living daylights out of me from the get-go.  I was dipping into psychosis as well, and from the minute I began to move into the building I became thoroughly convinced that it and my apartment were infested with bedbugs.

The unpacking process never really happened, as I became obsessed with the infestation and spreading of bedbugs in the apartment.  I had places designated in the apartment for contaminated and uncontaminated items in order to slow the infestation.  Upon arriving in the apartment, my shoes were placed in a specific spot that prevented bedbugs living in the hallways from entering my apartment any further than the door.  I then had to place a special pair of socks on my feet that allowed me to walk through the apartment.  As clothes became contaminated, I collected them in a plastic bin, and when it came time to wash the clothing, I could not allow the bin nor the clothes to come into contact with the building in any way between my apartment and the laundry room, and then between the laundry room and my apartment in order to prevent contamination.

My cat was living with my at the time, and I became very afraid of her.  I began to see her as another vessel in the apartment that was capable spreading bedbugs.  I attempted to eschew all contact with her, because she was “contaminated” as well.  Then I started seeing the bedbugs everywhere (which is probably where some psychosis comes in).  My special socks started to be covered in them.  I could find them all over the floor, my bed.  I would tear my bed apart repeatedly looking for evidence of bedbugs.  I forbid my cat from coming into contact with my bed, and each time she did, it initiated a storm.  It came to the point where no place remained uncontaminated.

It was also during this time that I became obsessed with having a degenerative gum disease.  I spent literally hours in front of the bathroom mirror, with a second hand-held mirror to maximize the angles, studying and dissecting what I saw before me.  I thought the periodontal tissue was deteriorating and with such rapidity that I would soon lose all of my teeth.  Even after seeing doctors and being told otherwise, my fears could not be assuaged.

The barbed wire gripped my soul so tightly and strengthened its grip with each attempt I made to break free through performing a compulsion.  I bled and bled and bled that summer.  I came home one weekend during this time and had an especially distressing flareup with my degenerative gum disease obsession and ended up cutting my arm very badly in attempts to escape the hellish world in which I was trapped.  What I call “the nightmare” ended with a hospitalization and a strong dose of lithium.

In Brain Lock, Dr. Jeffrey Schwartz discusses the neuroscience behind obsessive-compulsive disorder.  The parts of the brain in the orbital cortex fail in their ability to initiate change from one thought or behavior to the next with fluidity.  Thus thoughts and behaviors get “caught in gear.”  Hence why compulsions are performed repeatedly to no avail, and thoughts perseverate uncontrollably.  I have found that, personally, the most successful way for me to detach from the obsessions and compulsions and free myself from the tightening grip is to defuse.  I recognize the thoughts for what they are – information coming from my brain that cannot be held as undeniable truth – and let them go.  One by one, over and over again.  Only when I can recognize the thoughts as pathological and not veritable can I detach from the vicious cycle.

I am still struggling with obsessions daily, but I have made some strides in being able to defuse and let go of troubling obsessions that may arise.  I strongly recommend the work of Dr. Jeffrey Schwartz, and specifically his book Brain Lockin better understanding obsessive-compulsive thoughts and behaviors.  Perhaps the most painful aspect is that a compulsion is never enough.  What little fleeting relief one may feel is immediately replaced with the flood of fear, anxiety, foreboding, and it truly will never, ever be enough.