Friday, April 27, 2012
For this blog, I decided to do something a little differently. Because I am a research analyst by trade, I really enjoyed looking up this information and learned SO MUCH from this blog post!
For anybody whom has not toured Williamsburg, Virginia’s Asylum for the mentally ill, it is very enlightening and I highly recommend the visit.
In 1773, known as the Eastern State Hospital, the first public building in colonial Williamsburg Virginia, devoted to treatment of mentally ill, opened. On October 12, 1773, the first patient was admitted. The "Public Hospital for Persons of Insane and Disordered Minds" was the first building in North America devoted solely to the treatment of the mentally ill. The Hospital was situated on 500 acres and consisted of two patient care buildings, and had a staff of over 900 to care for the 300 patients.
By then the popular theory of the colonists, entailed mental illnesses being diseases of the brain and nervous system, in which the mentally ill “chose” to be irrational. Another theory was these “lunatics” were possessed by the devil, and removal of these types of individuals from society into an asylum was essential and off the street society would be safer.
Prolonged and often permanent confinement in an asylum was not uncommon. In the beginning, patients were subjected to immoral procedures and often subjected to horrific treatments. Some patients were continuously restrained in straitjackets and were treated like criminals rather than individuals with a “sickness.” Additional treatments consisted of the use of strong drugs, plunge baths, and cold "shock" water treatment until the patient passed out, which caused bleeding, and blistering salves. Colonists felt that if these “insane” individuals bled, the draining of the “bad” blood would lead to a cure.
In Europe around the turn of the 19th century, Europeans created a new treatment approach for individuals diagnosed as mentally ill. This approach was known as “Moral Management,” which embraced the belief that environment played an essential role in treating mental illness. For example, creating a more relaxing atmosphere for confined patients would help to “calm” them. By placing pictures, decorations, and providing comfortable beds, it was more likely recovery could occur and patients would feel more at ease because these surroundings would mimic the comfort of their home. This was not really an effective tool!
Between 1773 and 1790, about 20 percent of the inmates were discharged as cured. However, there still was severe overcrowding of these asylums, and how and what to do with these patients was an important issue. The overcrowding led to a decline in the patient care and use of the harshest treatment methods were once again utilized to keep patients sedated and quiet. Around this time, the lobotomy was introduced. Surgeons would open up the patient’s brain and separate neural passages. The desired outcome was for patients to forget their depression or tendencies. The result was horrible. Many patients became comatose, had no memory, or died.
Thankfully, through the years an increased understanding of emotional and mental illnesses has lead to further ethical and civilized procedures.
It was not until 1808, the German physician Johann Christian Reil formulated the term “psychiatry.” This term literally means the “medical treatment of the mind.” Translated from ancient Greek, psych=soul or mind; iatros=healer.
By 1840, in the United States, there still were only eight mental health asylums for the “insane.” Around this time a woman by the name of Dorothea Dix started crusading for the establishment and enlargement of many more mental health facilities and removing from jail patients that had a mental illness and where not just thought of as “crazy”.
In the 1930s, a treatment method, known as Electroconvulsive Therapy (ECT), was developed for treatment of schizophrenia. This included the use of electrodes place on the head, and use of an electrical current that would create a seizure. Today this procedure is more refined, while back in the 1930s patients were not put to sleep for the treatments.
In 1949, Lithium was discovered to treat and reduce symptoms for folks diagnosed with bipolar disorder. In the mid-1950s the development of additional psychiatric medications for treating mental illness was developed. For example, in 1952 Thorazine, one of the first psychotropic drugs, known as an antipsychotic, was produced. This medication assisted those with severe psychosis, such as delusions and hallucinations. Unfortunately, the initial medications came with unfavorable side effects, which were often unpleasant, and included patients looking like over sedated “walking zombies.”
Unfortunately, because this field was slowly emerging, there was a severe lack of medical professionals and funding to further understanding of the treatment of those with mental illnesses.
By 1946 politicians, such as President Truman got on the bandwagon to aid in funding mental health research, and created the National Mental Health Act. For the first time in the U.S., this was the most significant funding to date. Truman created a course that continues to present day. He put mental health on the radar and now funding, research programs continue to grow, and advancement in psychotropic medication is constantly evolving.
Over the years, fortunately, the development of psychotropic medications has advanced, and research on medical treatments continues to transpire. Inpatient treatment as well has changed over the past several decades. In the beginning, patients were kept sometimes in the asylums for a lifetime. Over the past 30 years, psychiatric patients were often hospitalized for six months or more. At present, the average length of stay in a psychiatric facility is one to two weeks, and psychiatric hospitalization is used as a last resort if outpatient therapy is not working.
Unfortunately, for me I have been hospitalized at least 18 times, and usually spend a month at a time in the hospital. Due to strict guidelines set now by health insurance companies, the length of stay for individuals needing longer hospitalization is less likely to be approved because the insurance companies always find “the need” for continued inpatient treatment as unnecessary. Even times when I have been severely suicidal, with back up documentation from my psychiatrist, my insurance has booted me.
As mentioned above many folks receive psychiatric care on an outpatient basis. This usually includes the use of a psychiatrist, for prescribing the medications, and a psychotherapist “for talk” therapy. I have chosen not to go into the history of psychotherapy in this blog. Please look for further blogs on the history of the involvement of this type of treatment as well as the various types of treatment options.
In terms of diagnosing mental illnesses, in 1952 the creation of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was developed. Since then this manual is used as the basis for establishing the diagnosis of all mental disorders. Every few years the manual is updated and new diagnosis are added or revised. The fifth addition is schedule to be published in 2013.
Fortunately, at present, individuals who have a severe and permanent disability can receive Social Security Disability Income (SSDI) and Medicare. While I am on both of these, I feel the federal government can do more. Last year I spent over $18,000 on out of pocket medical expenses, and only a portion I was able to write off on my taxes!!
Additionally private health insurance companies are slowly being required to provide additional coverage for individuals with mental illness, such as being required to set the same prices on psychiatric care as they do on general Medicare care. In my opinion, this process has been slow going, and even though legislation upon legislation is passed, we have such a long way to go! I am sure many of you can relate and have come across these issues and barriers as well!!!
There is so much more history I did not include, I included the points, and information I found interesting. There is so much additional information on current funding, various research, as well as the production and trials of new psychotropic medications. As mentioned above I chose not to discuss types of additional treatments, unrelated to medications, such as psychotherapy, etc. look for this topic in a future blog, as well as an in-depth discussion of the various categories and types of psychotropic medications.
Thursday, April 26, 2012
Unfortunately, 15 years ago I received a diagnosis of bipolar, which happened to be the type of bipolar which is the most difficult to treat. In 1998, three years after initial symptoms developed, the diagnosis of bipolar I, mixed state, ultra rapid cycling, with psychotic features was made.
Having mixed state bipolar is different from being diagnosed with “bipolar” or “major depression.” The reason is a mixed state involves being in a polar opposite symptomatic state. With bipolar and depression, a person is either happy or sad. Being in a mixed state, equates to being happy and depressed at the same time.
So what symptoms for me emerge during a mixed state? When destabilized life becomes a living hell and I would not wish the symptoms on a worst enemy. There obviously are different characteristics of mania and depression. Depression for me is straightforward, I want to sleep all the time, unmotivated, can get very suicidal, and want to be left alone. During a mixed state, I become depressed and manic at the same time! Literally, I can be crying, depressed, and bouncing off the wall manic. My bipolar is not a euphoric mania but a dysphoric mania; I become highly paranoid, agitated, and aggressive. In the past, I have experienced psychotic episodes, and when my mania is severe I have a heightening of senses, I see colors brightly, almost in 3-D, noises are very loud, and there is increased creativity.
Personally, mania emerges in different ways with different types of symptom combinations for each individual. For example while one of the characteristics of bipolar can be going on shopping sprees, this behavior has never happened with me. My bipolar needs to be monitored closely or severe destabilization can occur when symptoms are not monitored. For me, when I am hypomanic, I get hyperfocused on project-oriented tasks that I see as very important to others or myself. This blog is an example of this, it has become an important mission for me to research topics and to help and bond others with mental illnesses together. This blog has also been therapeutic because I am getting everything out in the open in a positive honest venue.
While on one side of the line I am manic, I usually stay closer to the hypomania side and closer to stable (cross your fingers and knock on wood). When I am in the hypomania stage, it is usually not as severe and can be controlled with medication adjustments. Unless in full-blown mania, hospitalization can be avoided. In the past, I have been hospitalized in a psychiatric unit at least 18 times, two of which were in an eating disorder clinic called Renfrew. I once tried to estimate how much of my life was spent in a hospital, and it added up to approximately 3 years!
Because I have tried to commit suicide 4 times in the past, it is important to monitor my suicidal thoughts. To continue my path of stability it is also important that my psychiatrist, therapist, family, and friends keep a close eye on my symptoms because I do walk a fine line between mania, hypomania, and depression. Sometimes I need an outsider’s perspective since it is easier for folks to observe and notice symptoms that I do not notice.
During hypomania, I get very talkative, whether with my friends, family, or even random folks in public! Along with racing thoughts and jumping from topic to topic, pressured speech and an increase in activity and energy levels. That is why I have been able to write successfully with this blog….I cross my fingers everyday that I do not crash and become depressed and withdrawn and continue on this positive path that I have started.
Even though I received my bipolar diagnosis over 12 years ago, I still ask myself sometimes why me? This disease is highly genetic yet all other members of my family are completely healthy. My husband is bipolar as well, and we have gone back and forth about starting a family. Statistically if one parent has bipolar disorder the odds of a child, being diagnosed with it is 10%. When two parents have bipolar the odds jump to 55-65%!
One of the many questions I have struggled with for years “who am I apart from my bipolar?”Originally, for years I felt treated like Bipolar Betty by friends, family, and not Betty with bipolar. It was frustrating because I did not want to be defined as my mental illness.
Another initial question I asked my psychiatrist was “will I have to take medications the rest of my life?” The answer was ‘yes”. While he did state in the future he might be able to wean me off some of the medications, the fact I have treatment resistant bipolar makes it highly unlikely, and if anything, more medications continue to be added to the medications that I am already taking.
I know I have come a long way with acceptance but sometimes when I am taking my eight psychotropic medications in the morning and evening it gets to me. How can it not? Right?
So let me tell you about my medication regimen. This ironically makes me depressed!
Due to treatment resistance, I have consulted with three of the best psychiatrists in the country who specialize in bipolar disorder, specifically pharmacology. Different doctors have different theories and approaches. It has been so frustrating and many tears shed because I have felt so helpless. I feel sometimes I am knocked down time after time. Luckily, I am a fighter, but after 15 years, it gets harder and harder to bounce back, which doesn’t help with depression.
Currently for my bipolar and other psychiatric issues I take eight medications. These medications include Clozaril, Pristiq, Wellbutrin, Lamictal, Liothyronine, Zaleplon, Clonazapam, and Adderall. These medications facilitate in keeping various symptoms of my bipolar, ADHD, and OCD in check.
The Clozaril and Lamictal are mood stabilizers, which help keep my moods from going up and down, and rapid cycling.
The Pristiq and Wellbutrin are both anti-depressants and assist with preventing depression. It is important to note that unless an individual with bipolar disorder is stable, use of an anti-depressant is risky. Especially the class of anti-depressants known as Selective Serotonin Reuptake Inhibitors (SSRIs).
The Zaleplon is a sleep medication that aids helping me stay asleep, as well as the Clonazapam, which is an anti-anxiety medication, but it helps me sleep as well.
For my ADHD I use Adderall, which can be risky to use for a person with bipolar. This medication if not watched closely, could cause rapid cycling and severe mania. My psychiatrist is constantly monitoring my moods because multiple times in the past after only a week of use I ended up in the hospital destabilized. This medication really helps me focus, and wake up especially since some of the medications cause drowsiness throughout the day.
Lastly, I take Liothyronine which is a thyroid medication I do not have a thyroid problem, so I need to make sure my thyroid stays just below hyperthyroid, but the goal of the thyroid medication is to aid the other medications to work more effectively, with the thinking those with hypothyroid tend to be more depressed.
Of all the medications, the Clozaril is the harshest. If I do not take this medication around 6pm, I will sleep in late. Over the past two years, my dose has been decreased from 400mg to 150mg and I still sleep 12-14 hours a day. It also requires monthly blood work to make sure that my white blood cell count is normal. This is due to the fact Clozaril can cause deadly reactions.
I once made a list of all psychotropic medications I have been tried on. Of about 50+ medications, I had been tried on all but approximately eight! Some medications I have tried were rough. When I was given Zoloft, I was ready to attack, I was so angry and aggressive it was horrible. Abilify made me feel like I was about to have a seizure. Since Lithium is a salt it made me feel like a marshmallow, I gained 60 pounds, and it was horrible.
I would be lying if I do not get depressed when I am putting my medications into my weekly pill container and when I swallow these medications daily. In addition to my eight psychotropic’s I take seven others for other health issues including asthma, allergies, acid reflux, seizure disorder, and chronic pain, which includes morphine and a muscle relaxer. Because of my chronic pain, my depression is intensified.
So there you have it a brief synopsis of my psychiatric issues! While this blog is about my diagnosis of bipolar disorder, please check back for specific blogs on my other issues, such as my eating disorder, ADHD, and OCD.
Thanks for Reading,
Love Bipolar Betty
Wednesday, April 11, 2012
Sunday, April 1, 2012
The reason a pseudonym was created, is due to the fact there are folks I have told about my mental illness, and some I have kept my mental Illness secret from. Unfortunately, the latter I have found is the easiest route. It is risky, extremely risky, to tell folks who will judge you from that day on. If you cannot see it, it is not there. Obviously, the choice is personal and the decision to tell has to be an individual one. However, the question is whom should we tell and whom not? In what situations should we tell? Why should we tell and what will happen if we tell? Is there a right or wrong way to tell them?
When I first, started this blog I was terrified about asking individuals I know, to view it. Since the individuals know my name, I had to take the gamble that these folks would not judge and remain the same with their interactions. Fortunately, for those who do not know my name, I was able to call myself Bipolar Betty. I am hoping this blog reaches out to those who have been diagnosed with a mental illness and those persons whom need education. Although much of society out there is naïve, judgmental, ignorant, and stigmatizes mental illness, I took a leap of faith, with the hopes I will not lose individuals I know to the majority of society!
The problem regarding revealing is there’s not exactly a right or wrong answer, I feel for me it usually falls in between the two during which I hold my breath waiting either for an understanding reaction, or a “oh” response. I have found in the past that folks, who know about my mental illness, are closer to judge when I am moody or upset. I see their wheels turning “it’s just her bipolar acting up”!
While talking about the diagnosis is an opportunity to educate others, is the education worth the cost of potential judgment? Additionally some other questions to think about are would it benefit you by telling someone? What is the circumstances for telling, the reason, and is it enough of one to tell? Lastly if you do not experience any personal or professional benefits, why tell at all? Luckily, for me, I have some friends I have known for a while, whom have supported me for 16 years upon being diagnosed with bipolar disorder, ADHD, and an eating disorder. It is the relationships in my life that are not lengthy that concern me. Some folks are not as lucky. However, because mental illness is not uncommon, depending on the diagnosis, you may be surprised to find some of your friends have the ability to relate.
I was very fortunate when my parents found out; they were standing right by my side. They also signed up for the NAMI Family-to-Family group, which met for 6 weeks to educate family members about mental illness. It is also beneficial that my husband has bipolar disorder and ADD so together we ride the waves.
When it comes to physicians, if it is not essential to disclose my psychiatric diagnosis, or list my psychotropic medications, I usually avoid it. Surprisingly the majority of professionals today do not get it. Even among those in the healthcare field.
The World Health Organization, which is the directing and coordinating authority for health within the United Nations system, predicts that by 2020, mental illness will be the second leading cause of disability worldwide, after heart disease. With this said, will revealing become easier, or remain static. Unfortunately, 2020 is eight years away.
So what are the pros and cons, about disclosing your mental illness? I have found that I have run into many cons. Prejudice and stigma about any mental illness is still very prominent in society. Disclosure to coworkers and employer’s can really be harmful. I have experienced this. Especially when you trust, a coworker and they decided not to keep it confidential, and prove untrustworthy and reveal to coworkers. Thus, revealing to another coworker, etc. At this point, every move I feel was analyzed. Questions such as, “is she late because her medications make her tired”? She seems withdrawn, “is she depressed?”, and the comments and questions go on and on.
For me some of the instances were unavoidable, and I really had no choice. For example, when I was employed, there were times that I had to take a leave of absence because I required hospitalization. This being said, my coworkers wanted to visit me or send me flowers to the hospital! No way in getting around that, without disclosing where I was being hospitalized. Additionally, there have been times when prescribed new medication’s, which may hinder job performance, due to sedative side effects. Alternatively, what about when you need to file paperwork through human resources, that too is a difficult situation for avoiding disclosure.
While discrimination is illegal, is hard to prove, it continues. I have also found chances for a promotion are really hindered. You cannot “untell” a secret. While each and everyone’s situation is different, it is important to sit down and write a list of pros and cons for revealing your mental illness to others, and to also assess the type of relationship you have with the person you may or may not tell. This is a personal decision, which has to be made alone.