All that I am, all that I ever was…

I am more than my mental health. I am more than my homelessness. I am more than any one aspect of me. I am Addy. And this is…


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Days 12 & 13: Diagnostic criteria (and all that jazz!)

bipolar

Bipolar | Unknown Artist (found on Google Images)

For the last few days – ever since Friday’s anniversary of 2007’s major suicide attempt – I have been feeling very flat and out of sorts. Focusing has been incredibly difficult and feeling anything other than ‘over it’ has been just as difficult to attain.

In fact, meh seems to have been my mood of choice today, with barely a millisecond spent outside of this most horrible and despicable of emotions. However, I’m fighting the urge to curl up in a ball and cry so as to answer a couple of the 30 Days of Mental Illness Awareness Challenge, which has been getting away from me of late.

The prompts I’m answering in this post are days 12 and 13, which ask:

  • Day 12: What do you think about your diagnosis in general? 
  • Day 13: If you know the criteria of your illness(es) which ones do you think you meet?

The Diagnostic Criteria for Bipolar (Type I)

Diagnostic criteria for Bipolar I Disorder, Most Recent Episode Unspecified

A. Criteria, except for duration, are currently (or most recently) met for a Manic, a Hypomanic, a Mixed, or a Major Depressive Episode.

B. There has previously been at least one Manic Episode or Mixed Episode.

C. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. The mood symptoms in Criteria A and B are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

There are several different variations of the diagnostic criteria for Bipolar Affective Disorder, which depend on whether the most recent mood has been manic, hypomanic, depressed, etc, but I have chosen to reproduce the criteria for ‘most recent episode unspecified’ as it was ultimately the one that was used to diagnose me.

My original diagnosis occurred in late 2007, several months after a manic episode, shortly after a depressive episode and in the midst of a hypomanic episode – this meant that A and B were covered. Given I was homeless and socially isolated at the time, criteria C was covered, especially considering I was barely functioning on a day-to-day basis whilst E –given my relative dislike of prohibited substances and alcohol – was easily checked.

The only item that was really debated at the time (and for years afterwards) was D, as I also showed signs and symptoms for a variety of other illnesses, including Schizophrenia and Borderline Personality Disorder.

Today, my most common symptoms are depressive and hypomanic periods. In fact, to my knowledge (and I’m pretty sure I’d be aware after if not during the fact) I haven’t experienced full on mania since 2008, although given the months of lost time in 2010, there is a debate amongst my support workers that I was manic during this time.

How do I feel about my diagnosis?

My major issue has been the constant ‘tweaking’ of my diagnosis, and with it, the support I received. Over the years I have been un-diagnosed, mis-diagnosed and re-diagnosed so many times that I’m surprised I’m still alive.

From the immediate cessation of my medication (lithium, which I’d been taking for a few months), being told I wasn’t bipolar but unspecified personality disorder (after just seven minutes in the psychiatrists company) to being told that there was nothing wrong with me mere hours after a suicide attempt.

All treatment like this did was further alienate me not only from society but the mental health system and myself. It made it impossible for me to trust psychiatrists and receive the treatment I knew I needed to manage my condition. In fact, it has been nearly two years since I allowed myself to be part of the mental health system, purely as a result of the shocking treatment I’ve received from psychiatrists over the years.

Since excluding myself in this manner, I have found peace with the Bipolar diagnosis. I am properly medicated (despite my dislike of medication) and have numerous coping strategies in place for the occasional violent mood swing that occurs.

Whether as a result of removing myself from the psychiatric profession or just something that has happened organically, I realise now that I’m more than my label. I know that it makes me unique, because no-one’s mental illness presents in exactly the same fashion, and that this label will never be all that I am.

I am so much more.

Wow, dragging that post out of me was hard work! Hopefully this mood will not last much longer…but until then, I’m gonna go curl up in that ball I mentioned! Have a wonderful day/night everyone! :)


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Day 02: How do you feel about your diagnosis?

Due to extremely high anxiety blocking most of my writing skills, the only way I could find to write an answer to today’s prompt in the 30 Days of Mental Illness Awareness Challenge is through freewriting. As such, please forgive any spelling or grammatical errors that may appear, for they are merely part and parcel of this style of writing.

For the record, the post was freewritten between 5:59pm and 6:14pm.

Day 2: How do you feel about your diagnosis?

dsm

My feelings toward my diagnosis have changed in the six years since it first came. Back then I was lost; lost to my breakdown, lost to my suicidal desires, lost to self-harm and lost to myself. I had no idea who I was, what had been happening to me or what would become of me. All the years I’d spent hiding my mental health problems from everyone around me had got me nowhere. I was nothing; a broken man with nothing to live for.

But then came the diagnoses. Someone had named what that broken part of me was. It allowed me to look on my life with a different set of eyes and offered me a reason (not an excuse) for my behavior. In essence, my diagnoses provided me a solace, a hope for a future. After all, it’s easier to fight something you can see than something that is invisible.

But things change.

Six years later, I honestly don’t give two hoots about any of my diagnoses; whether it is the bipolar, PTSD or social anxiety. In fact, the only times I ever name them outside of this blog are when I’m completing forms or visiting a new GP or medical professional.

Over the years I’ve learned that they are merely labels. The solace they once gave has become obsolete, lost to a better understanding of myself and a firm belief that no label can define me. The only thing that can provide me with hope for the future is myself, not a DSM approved name-tag.


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Matters of the Mind: starting a conversation about the DSM

For those outside of Australia who have yet to discover The Conversation, you don’t know what you’re missing.

The Conversation is ‘an independent source of analysis, commentary and news from the university and research sector — written by acknowledged experts and delivered directly to the public’.

Or as they declare in their tagline: “academic rigour, journalistic flair”.

This week The Conversation has been publishing an excellent series examining the DSM – the clinician’s bible for diagnosing mental disorders – and the controversy surrounding the forthcoming fifth edition, due to be published in 2013.

Regardless of my own (at times negative) opinion of the DSM and the changes I’ve read about in regards to the fifth edition, given many media organisations still consider mental illness too complicated and sensitive to discuss, I admire The Conversation’s continued dedication to publishing articles dealing with this subject matter.

So far there have been five articles published in this series, which I assume will continue until the end of the week:

Part one: Explainer: what is the DSM and how are mental disorders diagnosed?

For those who don’t know what the DSM is, this is the place to start. An excellent explainer on the diagnostic and statistical manual of psychiatric disorders, and the controversies surrounding it.

“The DSM itself states that the application of its diagnostic criteria requires extensive clinical training and judgement to make appropriate diagnoses. But many clinicians argue that the complexity of patients’ presentations cannot be adequately summarised by these limited diagnostic codes.”

Part two: Forget talking, just fill a script: how modern psychiatry lost its mind

Looking at the DSM and psychiatry from a historical perspective.

“Psychiatric research indicates that things are more complicated than the manual leads us to believe. In reality, many diagnostic categories overlap. Over the years, many new diagnostic categories have been proposed. As a consequence, many individuals now fit several diagnostic labels. Should their different disorders all be treated separately, or at the same time?”

Part three: Strange or just plain weird? Cultural variation in mental illness

A brilliant article on cultural variations of mental illness and how the DSM tries to deal with this aspect of mental health.

“Many non-western cultures recognise states of mind that look like mental illness but which do not fit the categories of the Diagnostic and Statistical Manual of Mental Disorders (the DSM).

Wacinko is one such illness, found only among the Oglala Lakota people (who are part of the Sioux nation). Wacinko is a state of withdrawn, mute anger, directed at someone else, which may last for years. The Oglala live in the United States, but their culture is not shared with most Americans, and neither is wacinko.”

Part four: Don’t pull your hair out over trichotillomania

An interesting article on Trichotillomania, a psychological disorder where individuals feel the urge to remove their bodily hair, to the point of obvious hair loss, and the difficulty in classifying this disorder.

“But trichotillomania has had trouble finding a suitable “home”. Since its first listing, it has been categorised as an impulse-control disorder not elsewhere classified. Although its inclusion itself was important, this category – which contains everything from pathological gambling to pyromania – is a residual category with limited acceptance and validity.”

Part five: When stuff gets in the way of life: hoarding and the DSM-5

An article looking at the complexities of hoarding; what is it, where does it fit in diagnostic terms and how the DSM-5 will be classifying this condition.

“The DSM-5’s OCRD category brings together a range of complex disorders, such as anxiety, impulsive-compulsive and somatoform, a mental disorder that manifests in physical symptoms; inclusion of hoarding disorder within the OCRD diagnosis recognises its distinctiveness from related disorders.”

Disclosure: I am not affiliated with The Conversation in any way, shape or form. Nor do I endorse the opinions presented in the linked articles. Some I agree with, some I disagree with and one I downright despise on a primal level. I provide them merely because I consider them important articles on the subject of mental health that may be of interest to some of you, my dear readers.