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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31 Days of Bipolar: Day 16. My best possible treatment strategy

Day 16: If you could plan the best possible treatment strategy for your bipolar self, what would it look like?

abstract

The only treatment strategy that I’ve ever had for my bipolar self is medication. I’ve never had a psychiatrist monitoring my moods. I’ve never had a psychologist offering me sage-like wisdom and I’ve never had a team of nurses keeping an eye on the intricacies of my mental ill-health. For some reason the powers that be decided that I have to deal with bipolar affective disorder all on my lonesome, not that I’m bitter or jealous, it has proven to me countless times how strong (and stubborn) I am. But there are times I wish I didn’t have to go it alone, that I had someone to help me with the roller-coaster moods that make up my life, which is why my best possible treatment strategy would start with a psychiatrist.

Now, after my last appointment with a psychiatrist, I’m not exactly overflowing with warmth and trust for people in this particular profession. In fact, you could go so far as to say I despise anyone who pulls on a white coat and decides that their opinion is going to govern someone’s life, but I can’t hide the fact that I believe I need a psychiatrist. Not just someone to correctly monitor my medication intake, but someone with whom I can discuss the intricacies of my life in the hope of finding answers and insight to all the niggling things that nag at my inner-being. Or maybe I just want a psychiatrist because other people have one, and find their input toward their mental health, to be invaluable. Either way, a psychiatrist that I admire and trust would be the starting point to my best possible treatment strategy.

A best possible treatment strategy that would continue with a support worker with whom I had a valuable and trustworthy relationship. A support worker with whom I could discuss things outside of the psychiatrist’s control. A support worker who could accompany me to appointments, advocate on my behalf and help me fight the demons that plague my soul. A support worker who could assist me with DBT, mindfulness and exposure therapy. If I were designing my ‘perfect’ treatment strategy, I know who this support worker would be, because for a short time in 2013-14 she was my support worker, but a funding cut ripped her out of my life and left me the poorer for it.

The next part of my best possible treatment strategy would be a medication regime that worked; not one that has just been throw together because it has worked for other people. A medication regime that included anti-depressants, anti-psychotics and mood stabilizers. A medication regime similar to the one I was on prior to the mood stabilizers causing acute pancreatitis, a side effect that resulted in them being torn from my life and replaced with nothing.

The fourth part of my best possible treatment strategy would be a series of psychosocial rehabilitation groups. A program of activities that would prevent me from being socially isolated, teach me new coping mechanisms and allow me interaction with other human beings who were facing similar issues to myself. This would be an intrinsic part of my treatment strategy, and one that my support worker would assist me in undertaking should my anxiety prove too strong or uncontrollable.

Lastly, my best possible treatment strategy, would contain something that has been missing from my life for so long I’ve all but forgotten what it feels like; friendship. I’ve long believed that friends are more potent and powerful than even the strongest medication when it comes to fighting mental illness. Having one person talk to you, spend time with you, show an interest in your life, can re-program your brain chemistry and make everything you battle on a daily basis feel worthwhile. Having that one person care, having that one person show you love, can work miracles.

But like I said, I have been deemed unworthy of having these things. I have been sentenced to battle bipolar affective disorder and other mental illnesses all on my lonesome. So writing about what treatment I would like is painful, it tugs at my very heart and renders me in physical pain, for I know deep down that I will never receive it. Any of it. It’s just the way things are for me.


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31 Days of Bipolar: Day 05. Six of the best treatments for bipolar

Day 05: What treatment, therapy etc do you do?

Lucy-Therapist

Most people who I’ve spoken to that are afflicted with bipolar have a psychiatrist monitoring their progress, medication and moods. In fact, I would go so far as to say that having a psychiatrist is pretty much a prerequisite for someone suffering from an illness as serious as bipolar. However, as the last appointment I had with a psychiatrist went so badly, I no longer have any trust for people in this particular profession. Thus, I am left to navigate the ups and downs of bipolar all on my lonesome.

But that doesn’t mean I don’t undertake treatment, I do, and here are six examples to prove it:

Medication

First and foremost, there is medication, something that pretty much everyone who is diagnosed with bipolar has to contend with. I say contend with because some of the side effects of psychiatric medication can be pretty brutal, as I discovered this year, but regardless of these side effects, medication is quintessential for dealing with bipolar.

At this point in my life my medication regime is: an antidepressant (Fluoxetine, 40mg/daily), an anti-psychotic (Solian, 100mg/daily) and a second anti-psychotic (Abilify, 10mg/daily).  For those who have some knowledge of bipolar, or medication in general, you will notice something pretty obvious is missing from this chemical cocktail…and that is a mood stabiliser.

I had been taking Sodium Valproate (aka Epilim) at 1000mg/daily, but this was immediately cessated in January 2015 after it caused a particularly nasty bout of acute pancreatitis that saw me hospitalised for two and a half weeks. Since then, I have had numerous conversations with my GP about starting an alternative mood stabiliser, as my mood as been rather unstable over the last three months. He ruminated over starting me on Lithium, a drug that works exceptionally well for me, but because it negatively interacts with the Fluoxetine he decided against it. Whether or not I will ever be back on a mood stabiliser is beyond my control. Personally, I would be happy to stop the Fluoxetine in favour of Lithium, but my opinion is neither here nor there. All I do know is that without a mood stabiliser, my moods will continue to fluctuate wildly, and it’s doubtful I will be able to stabilise myself, regardless of how many anti-psychotics I’m taking.

Support Worker

My only form of real-world contact comes from the weekly appointments I have with my support worker. In all honesty we don’t do all that much, mainly because my anxiety prevents me from opening up to her. So our appointments are basically her battling to get me to say anything whilst occasionally recommending a particular course of action for me to take.

This is yet another example of how my anxiety impacts on my life. It would be wonderful to have an open and honest relationship with my support worker, but no matter how much effort I put in toward achieving this, anxiety rears its ugly head and prevents me from saying anything. It’s frustrating. It’s annoying. It’s all manner of badness. In fact, more than anything, it’s gloriously ironic. Here’s a person who could potentially help me manage my anxiety, but I can’t talk to them because of my anxiety. Grrrr!

Talking Therapy

Okay, I’m being a little cheeky here. As I write this I’m not technically undertaking any form of talking therapy. I don’t have a counselor. I don’t have a therapist. I certainly don’t have a psychiatrist. But I am hoping that I will soon have a psychologist with whom to examine the intricacies of my life.

During my last visit to my GP I informed him of how difficult it is to deal with my anxiety, to deal with my PTSD and to deal with the fluctuations of mood that bipolar causes. He suggested I see a psychologist (it’s been several years since I last saw one) and dutifully referred me to someone.

I’m still waiting to hear from them about my first appointment (if I haven’t heard by tomorrow, I’ll be calling them next week) so will keep you abreast of developments in this area of treatment.

CBT and DBT

Without someone to help me with these forms of therapy, I am left to navigate them all on my lonesome. This may sound difficult, and it is, but I have a number of books on both subjects that have helped me understand the basics of each form of therapy and allowed me to partake in them as and when I’ve been focused enough to do so.

I have to be honest, I am hoping that the psychologist I’ve been referred to will be a practitioner of DBT, as I believe it would be of tremendous value to have someone assist me in working through this particular form of treatment. Fingers crossed!

Acceptance and Commitment Therapy

This is something I’ve been practicing since I first learned of its existence in 2013. Back in that heady year of mayhem, busyness and fun I undertook an ACT based psychosocial rehabilitation group and learnt  many of the exercises and metaphors that populate this method of treatment.

Some posts I’ve written on Acceptance and Commitment Therapy (in case you were interested!):

Writing Therapy

Although my blogging isn’t as prolific as it was in 2012-2013, it is still one of the primary methods of therapy that I undertake. There is something gloriously cathartic about writing about your life, feelings, emotions, moods and thoughts before sharing them with the world. Even if no-one reads, likes or comments on a post, I am still proud of myself for having the courage to put it out there in the first place, especially as my anxiety often interferes with my blogging and works to prevent me from posting anything at all.


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Why are mentally-ill children tied up and tormented?

“If he was extra bad they would then chuck him on the floor there and then and put him in like a hand restraint, usually with his arms behind his back. And two people would sit side by side, sometimes with a towel over his head.”

In Australia, one of the leading news and current affairs shows is called ‘7.30’. Tonight, they featured a story that revealed a new report is warning Australian children in psychiatric care are suffering from out-dated practices of seclusion and restraint. In a country such as Australia – which is often referred to as ‘the lucky country’ – treating anyone in the manner described in this report is deplorable, let alone children as young as seven years old.

Hopefully this report will help bring the abuse of those in psychiatric care to the public eye and force the government and health services to change their archaic policies and adopt a more therapeutic, understanding approach.

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Clicking the above image will transport you to the 7.30 website, where you can watch a video of the report

“Just about every parent knows the angst of having a child throw a noisy tantrum in a supermarket or on a crowded street.

But some families struggle daily with much more serious behavioural problems, especially when their children suffer from mental health issues like anxiety or depression.

How to deal with those children is a major dilemma for health workers too. In some extreme cases, children with psychiatric disorders are physically restrained and placed in seclusion – something that can be deeply traumatic.

A new report has highlighted the unacceptable use of those practices on disturbed children and health professionals say it must stop.”

Watch the complete video of the report or read the transcript here >>>


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Day 03: What treatment or coping skills are most effective for you?

Apologies for the slight delay in the latest installment of the 30 Days of Mental Illness Awareness Challenge, I had scheduled the post to publish yesterday (hence the Thursday Thirteen format I decided to use) but a wee gremlin must have invaded the system as for some reason it didn’t publish. Hopefully we will have better luck today!

The prompt for day three is: what treatment or coping skills are most effective for you?

keepyoureyesopen

Thirteen treatment or coping skills that are most effective for me

(in no particular order)

1. Acceptance and Commitment Therapy [Treatment]
Acceptance and Commitment Therapy (ACT) is a behavioral therapy all about creating a rich, full and meaningful life whilst accepting the pain that inevitably goes with it. I have written more about this method of treatment here.

2. Distraction Techniques [Coping Skill]
One of my primary coping skills is the simple act of distraction. Whether it be curling up in front of a movie, moshing to some great music, kicking Ganandorf’s ass in the The Legend of Zelda video game series or even cooking up a treat in the kitchen. Anything that can take my mind away from the trap of negative thinking and heightened anxiety is quite wonderful.

3. Self-Efficacy [Coping Skill]
…aka the measure of the belief in one’s own ability to complete tasks and reach goals.

4. Writing letters to younger self [Coping Skill]
I write so many letters to my younger self that I’m seriously considering putting together a book entitled “Letters I Wish I’d Received When Young” For me, they are a glorious way of showing myself compassion, understanding and self-love. They are also a way for me to vent frustration and focus on the positive aspects of my life.

5. Grounding Exercises [Coping Skill]
These coping skills involve grounding you in the current moment. A popular exercise is taking a few moments to name five things you can see/hear/smell/feel and focus on these senses as you do so. I have taken to, after advice from a friend, performing this activity when I wake up to start my day in a relatively relaxed and grounded state.

6. Integrated Brain Mapping  [Treatment]
This is a process devised by Rita McInnes for people who have difficulty dealing and living with trauma. I have every intention of writing about my experiences of it in the future, but more information can be found on her website for those too impatient to wait! :p

7. Personal Responsibility [Coping Skill]
Something I learnt when I was a teenager is that the only person who can change me is myself. If I wait for someone else to do it I will be waiting the rest of my life. As such, I dedicate myself to putting in the hard work so that one day I will be able to lead the life I want to live.

8. Medication [Treatment]
I am not a huge supporter of medication and for many years was without any form of psychiatric medication. However, I cannot deny that taking medication does help control my moods and, to a degree, dulls the self-harm and suicidal ideation I experience.

9. Self-Harm [Coping Skill]
Please note that I am not in any way advocating self-harm. I ummed and ahhed about including this coping skill on my list but ultimately decided to go with it because, over the last twenty years, it has been one of the most powerful and consistent forms of release that I can think of. In fact, sometimes it is the only thing that has the power to calm me when I’m heightened.

10. Random Acts of Kindness [Coping Skill]
These fall into the ‘higher self’ category on Indigo Daya’s wonderful Coping Skills worksheet. Basically, there is nothing more wonderful in life than helping other people, so much so that it can often override your own stresses and negative feelings. Why not try it sometime?

11. Art Therapy [Treatment]

12. Laughter Therapy [Treatment]

13. Self-Love [Coping Skill]
I’ll be honest, I’m still not very good at this, but I think I’m (very slowly) getting better! :p


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Mi Recovery: The Biopsychosocial Model

At the culmination of the first week of Mi Recovery we played the warm-down ball game I have become so familiar with courtesy of the Hearing Voices Support Group. The moment Meadhbh suspected this was about to happen she squealed in girlish glee and prepared to intercept the rolled up Velcro (apparently the budget wouldn’t stretch to an actual ball) whilst I sighed in apprehension about having to say something worthy and meaningful about what I’d taken from the group; which was plentiful!

In approaching this series, I have decided to focus my weekly review around whatever I say during this warm-down game. Yesterday – and this is a direct quote – it was…

“…the biopsychosocial model.”

__Biopsychosocial Model

For those unfamiliar with the biopsychosocial model (BPS), it is a model that was created by psychiatrist George L. Engel in 1977 that posited a combination of biological, psychological and social factors play a significant role in human development. Which is in contrast to the traditional model of medicine that suggests every disease can be explained in terms of an underlying deviation from normal function; such as a pathogen, developmental abnormality or injury.

It was this model that we used to examine the theory of mental illness, and the causes, symptoms and treatments we (as individuals) have experienced on our life’s journeys.

As everyone’s experiences of mental illness are unique, our diagnoses (whether that is a Mood or Anxiety Disorder, a Psychotic Illness, a disorder resulting from alcohol/drug use or a combination of all four) are largely irrelevant. It is our life experiences that determine the course of our mental illness and the symptoms/treatments thereof.

The biopsychosocial model allows us to look at our lives from three perspectives in order to determine what events have been most relevant and, in turn, how we can use this knowledge to take control of our lives and find new paths on our road to recovery.

My Biopsychosocial Model

The core component of the biopsychosocial model is how it allows us to see how experiences through our lives our linked. As such, the model is approached from three viewpoints:

1. Causes

These are all the elements that can be/have been attributed to be the cause of our illness. For example, some people believe mental illness is genetic (which would be a biological cause) whereas others believe some of the root causes of mental illness are isolation (which would be social) and trauma (which could be considered psychological).

The following is my own personal BPS model of the causes of my mental illnesses. Yours, should you wish to write one, may look very different:

__Biopsychosocial Model (CAUSES)

Notes on my model:

  • Some may argue with my overlapping of homelessness as being biological, psychological and social. But having spent a large period of my life homeless, it was the only place that fit for me.
  • I have placed sexual minority in the overlap of psychological/biological because it has both a biological (I was born with it!) and psychological (if you have the password, I’ve explained this here) component.
  • The most contentious placement would probably be “abuse” which many at the group believed should be placed solely in psychological; I however believe it has a HUGE social component, hence my placement of it in the overlap.
  • If you have any questions regarding the items and their placements, don’t be afraid to ask! :)

2. Symptoms

The second viewpoint is ‘symptoms’, which are all of the symptoms we experience as a result of our mental illnesses. For example, the butterflies in the stomach or sweaty palms of anxiety (which would be biological), an increase in destructive voices (which would be psychological) or isolating behavior (which could be seen as a social symptom).

As with both the causes and treatment of our illness(es), these symptoms are unique to the individual. This is what I came up with when approaching my symptoms via the BPS model:

__Biopsychosocial Model (SYMPTOMS)

Notes on my model:

  • I have placed victim-blaming in the social/psychological overlap as I believe it has both of these components. The victim blaming we receive from others (social) and the blaming abuse victims place on themselves (psychological).
  • Over-indulgence relates to me as: excess alcohol consumption and over/comfort spending.
  • Personally, I believe self-harm begins as a psychological symptom that becomes a biological one, hence the overlap between these two factors.
  • The most contentious placement (and one which I mulled over for nearly two hours) was hypersexuality. Although many may see this as predominantly a social or psychological symptom, based on my own experiences of this state, it can become a biological one.
  • If you have any questions regarding the items and their placements, don’t be afraid to ask! :)

3. Treatments

One of my biggest (and longest standing) issues with the mental health and psychiatric industries is the “one-size fits all” approach to mental illness treatment. Everyone’s experiences of mental illness is unique, so why do people persist in believing that a singular course of action (be it medication, talking therapy etc.) will have the same effect on everyone?

Perhaps this is because I have (obvious) issues and grievances over how I’ve been treated by mental health services, perhaps not. Either way, treatments that may find their way onto your BPS are medication (being biological), talking therapies (being psychological) or support from family/friends (social).

In my personal opinion, one of the most important treatments (and one that is noticeably lacking from my own BPS) is nurture; the physical love we receive from those around us can have a significant impact on our ability to deal with the stressors and pain of mental illness.

I hope one day to be able to add it to my own biopsychosocial model:

__Biopsychosocial Model (TREATMENTS)

Notes on my model:

  • Given the MASSIVE overloading of psychological treatments, is it any wonder I am teetering on the verge of a massive psychological breakdown?!?
  • I believe distraction comes primarily from the distraction we can find on our own (psychological) and the distraction our friends/family can offer (social); hence the overlap.
  • HVSG stands for the Hearing Voices Support Group I attend (I was being lazy!)
  • I have included Meadhbh (and occasionally Audrey) as psychological treatments because when they’re behaving themselves, they can be a source of great comfort, support and love.
  • Mindmapping is a self-help therapy designed to interrupt and sooth triggers. I’ve been working with it for a couple of months now.
  • I’ve long believed endorphins can have a massively beneficial effect on managing mental illness.
  • The all-overlapping kimnyk is something I have discussed in my password protected pages and relates to a part of my sexual-personality that I’m not comfortable sharing in detail with the world due to the abusive, ignorant and damaging comments I’ve regularly received about it in the past.
  • Once again, if you have any questions regarding the items and their placements, don’t be afraid to ask! :)

Once you have written your own biopsychosocial model, how can you use it to assist in managing your condition and working toward recovery? By comparing the three viewpoints and identifying the wheres, whats and wherefores of your life, you can begin to see links between the symptoms, causes or treatments you may wish to explore further.

Personally, I have already realized the immediate need to begin balancing  how I treat my illnesses as the overload of psychological treatments is already becoming a cause – and, if a breakdown occurs – a symptom.

I’ve also noted (as I have in the past) the enormous detrimental effect my tendency to isolate myself during periods of distress has had on my mental wellbeing and recovery. I need to allow myself to believe that asking for help is not only acceptable but doesn’t mean I’m weak, worthless or not trying hard enough. This was hammered home yesterday afternoon, following the worst reaction to a trigger I’ve experienced in months!

As I continue with the Mi Recovery group and learn more about myself and my illnesses, I fully expect to refer back to my biopsychosocial model on a regular basis. Not only to add any new items but to use the connections I’ve highlighted to assist in my journey toward recovery, forgiveness and acceptance.

Perhaps you should try writing one of your own (in a supportive environment, of course) as you may be surprised by the things you discover.