Archive for March, 2009

March 31, 2009

Mending

One of the consequences that often happen in people with BPD’s lives is that they screw up and break apart perfectly good relationships with other people. I can certainly attest to that statement. In the waiting room of my psychiatrist’s office last week, I browsed through the winter 2009 issue of bp Magazine and found an useful set of suggestions at the end of their cover story, “The Power of Amends” that addressed that particular issue. I happen to find that  list on their web site:

TIPS FOR HEALING
The following tips for seeking forgiveness and making amends come from Daniel L. Buccino, a licensed clinical social worker and clinical supervisor at the Adult Outpatient Community Psychiatry Program at Johns Hopkins Bayview Medical Center and assistant professor at Johns Hopkins University.

  • Bipolar disorder is what you have, not who you are. You still must live with it, stand up to it, accommodate yourself to it, resist it, accept it, manage it. Separating yourself from the problem in this way will allow your true character to help you decide how you want to live with your illness and its consequences. Stability begets stability.
  • Apologize—genuinely, sincerely, deeply, specifically, and directly.
  • Make reparations as best you can.
  • Try to accept responsibility.
  • Redouble your efforts to do the right and virtuous things to show that whatever behaviors you exhibited were the exception, not the rule.
  • Remain humble and well-connected to treatment and find the best treatment providers you can.
  • Everyone makes mistakes, but avoid repeatedly making the same mistakes.
  • Strive to demonstrate good character by being responsible, reliable, trustworthy, competent, and focused.
  • Recognize that rebuilding trust is a process, a staircase to climb at times, not an event.

(Note: I took this list to think about making amends rather than the forgiveness part.) In my own life, there is no question that many, many relationships have dissolved, broken apart or abandoned on the account of my past behavior. While the suggestions above make it sound as though the illness is what caused those torn connections, I must also point out to myself that those mistakes’ entire weight cannot be placed on saying, “I wasn’t myself.” Because the thing is, it would be dishonest of me to leave out my own responsibility for those occurrences.

After having ECT, I sometimes find myself trying assess only what those little sparks have done for me. But in this time of convalescence, I must remind myself that this is also the time to re-evaluate and re-set what I personally can change in order to rebuild this life. In fact, I think that, in order to maximize the effects from this treatment, it’s crucial that I start to examine what I could do to take better care of myself. Of course, this is so much easier said than done, mostly because the symptoms of depression and mania sometimes make it impossible to even attempt to get out of bed and take a shower, much less bother to keep up a friendship.

That ‘little spark’ only starts up the fire for the new life. I need to figure out how to stoke it and keep it lit.

More to come on this thought…

March 29, 2009

Questions & Ambiguous Answers

For nearly two months, the familiar faces that I worked with at my weekend retail job were replaced with those of the doctors and nurses at the hospital. It has been five weeks since that 15th little spark. Gradually, the faces of those nurses, the hospital receptionist and the doctors have changed back to those I saw until two months ago as I finally began going back to my 4-hour shifts last Saturday.

I had told some friends at work about this journal prior to the ECT, so though my face, visually-speaking, wasn’t around at work, etc., they knew where I was and what I was doing (and perhaps now know more about me that they ever wanted to know).  But for others, it must have been a bit of a surprise to see my face back at that stock-area of the store, wrapping those gifts and fetching for those items.

Where have you been?  How have things been?

Several have asked me these questions. This afternoon, a surprised “Amber” asks me what’s been going on when she sees me for the first time in  months.

I pause for a moment. What do I say?

It’s odd. This journal is not private. There are some things I’ve thought or have happened that I’ve only scribbled out in my other, paper-based journal, but for the most part, anyone is able to access the basic personal facts like: a) I have bipolar disorder, b) I’ve been suicidal, and c) I chose to have electroconvulsive therapy. Wasn’t my original idea to write this stuff was to bring mental illness ‘out of the closet’? I guess using this inanimate object to disseminate information makes you feel like you’ve become more open.

Yet, I couldn’t tell  the truth. Instead, I give a casual answer to Amber that I was “out of commission.” So lame, like when Charlotte tells Mr. Big, “I curse the day you were born, ” in that Sex and the City movie. The obvious follow-up from Amber is asking whether I’m okay or if I’m better now. I crack that little Japanese laughter and just force out a “yes.”

I don’t know if I really mean it, but I just say it. Yes, I’m better…I think.

I don’t think I’m ashamed by my illness or the treatments.  But the last two months can’t just be explained away by, “Oh, I had ECT, ” as if everyone knew what that was and why one would be having such procedure that can be shortened to an acronym. In addition to the lack of people who immediately know what ECT is, trying to be even opaque to others and perhaps more critically, to myself, is a very new type of action to me. All of these concerns and experiences all get jumbled up. I also wonder, how much stuff about others do people really want to hear? They don’t want your life handed to them on a platter. Should I just say that I had ECT, and let that determine the rest of the tone of the conversation?

To borrow from Denise Richards, It’s Complicated.

March 28, 2009

Mood Indigo

On the way to my weekend job, I loaded up some music I haven’t listened to in many moons, the Indigo Girls. It’s the one group I can actually understand what they’re saying. If anyone gets to go to an Indigo Girls concert, it’s like a giant sing-along.

here is this lyric in the song “Watershed” that kind of reflects what I need to be telling myself:

Up on the watershed, standing at the fork in the road
You can stand there and agonize
Till your agony’s your heaviest load.
You’ll never fly as the crow flies, get used to a country mile.
When you’re learning to face the path at your pace
Every choice is worth your while.

I’d like to write something about my thoughts on some of the Girls’ lyrics, but my head just feels stuck. I think I’ll just leave them be. The rest of the lyrics (and song clips) can be found here.

This entry shouldn’t be a wasted set of words, so here’s some pretty good news. I made it to that elliptical machine everyday this week. It’s just for 30 minutes and the ‘carrot’ for me to get there is so that I can read a book, but at least I made it there. I’ve gone to that place more in the last week or so than I have the whole time I’ve lived in this complex. The news articles and the Mayo Clinic site do point out how exercise eases depression symptoms, so this hope-to-be-a-habit couldn’t be a bad thing.
I also didn’t flake out on going to a little birthday dinner at a restaurant. That’s actually a huge thing on a personal level.

I did do some standing and agonizing this week, but that doesn’t change the fact that I did the other tasks in spite of the tough times.

March 26, 2009

Abilify: The Abilify for the week

Though I commented in an entry last week how much I did not like Abilify, it seems that time has come for me to give it a second chance.

I need to find another mood stabilizer for the long haul. Though there are many on the market, weight gain is a huge side effect in a lot of them. A good personal example: I gained what equaled to about 20-25% of the initial body weight within the first three months that I took Depakote. Since it’s been six years since the first Abilify and ECT sometimes changes the way one reacts to medication, I’ve agreed to try Abilify at 1mg per day.

So, Abilify really is my Abilify for the week. Dr. A (my great Dr. Melfi) and I are trying to assess my response to the ECT -and whether a maintenance ECT (one little spark each month) should be an option to consider in the long term.

March 25, 2009

Could a ‘bipolar gene’ come to help like the ‘breast cancer gene’?

DISC1 gene (short for Disrupted in Schizophrenia) has already been recognized as the set of proteins that plays a role in the development of mental disorders, though more for bipolar disorder than schizophrenia. A recent study from the University of Edinburgh indicates that the DISC1 proteins may indicate how some patients respond to certain medication.The results, which were published Public Library of Science One, suggest that it may become possible to develop specific, effective drug treatment for people whose main cause of their respective mental illness is the DISC1. This news reminded me a bit about how BRCA1 and BRCA2 gene in women could determine the course of treatment one should take regarding breast cancer.

The BRCA gene was on my mind mostly because Rep. Debbie Wasserman Schultz (D-Fla.)was talking about the BRCA gene and how that changed her own treatment options once she knew that she had the gene. By the way, this week Rep. Wasserman Schultz introduced a bill called the EARLY Act, which “will teach both young women and medical professionals alike about risk factors, warning signs of breast cancer and predictive tools such as genetic testing that can help women make informed decisions about their health.” (A little side note: Rep. Wasserman Schultz is the one with blonde, curly hair who is so articulate and effective in delivering her points when she goes on TV shows and debates. She just blows me away with that amazing combination of sharp intellect and toughness.)

Could it be that a simple blood test could come to help guide the course of treatment that I may have as someone with a mental illness?

March 24, 2009

Old Habits

For the last two months or so, there are some activities that I rarely engaged in, like watching The Daily Show, The Colbert Report or my childhood idol Dave Letterman (Mom made sure I was getting to sleep around 10:30). I certainly did not drink any alcoholic beverages during that time. It’s not that I’m much of a drinker, but the owner at a certain wine store does know me by name, if that means something.

So, what have acts have I engaged in the last two days? On Sunday, I cracked open a bottle of red wine and watched “Girl,Interrupted” til about two in the morning. As I type this little entry, a half-empty bottle of that wine sits near me as I switch channels between Mr. Colbert and Mr. Letterman. It’s true that I couldn’t fall asleep even with the aid of some extra zolpidem (Ambien) in my system on Sunday night. But there’s really no good reason for getting back into swirling and sipping that garnet-hued elixir. I just wanted a drink. To accompany that, I guess I also decided to eat through an entire box of really good chocolate that had just sat untouched for the same amount of months.

It wouldn’t be much of an issue, except for that because I rarely go out, I’ve often drank bottles of wine alone (trying mix stuff takes too much work). The quantity of the liquor is negligible, but the fact that this act often took place at night by myself isn’t a great thing. Then, adding a movie like “Girl, Interrupted” to the mix only exacerbates any unsteady feelings you may be holding at the time. Food somehow always enters the mix, so you end up gaining weight. The sad part about that is that you barely even remember that you had eaten all of that food until you wake up the next morning and find empty packaging strewn about.

There are aspects of my life that have changed which can be traced to the effects of ECT, but what I did really has nothing to do with ECT. I simply chose to bring back an old habit, a bad one for any individual.

Just reminding myself that these types of behavior will not help me in the post-ECT recovery period.

March 23, 2009

The Family Inheritance

My interest in Sylvia Plath started when I had to read “Mirror” in middle school. Over the years, I’ve read more about her life, The Bell Jar, and her many poems. In one of my depressed moments, I went by myself to the movie theater at night to catch the movie, “Sylvia.” I hate that I am so intrigued by her, sometimes having reached an unhealthy point, but I am. Today I saw the headline: Nicholas Hughes, Sylvia Plath’s son commits suicide. I never knew much about Nicholas Hughes until I started reading his obituary and other articles, but it was just so sad to read that he came to share the same fate as his mother’s.

Mr. Hughes, a prominent fisheries scientist, and his death did bring back to my mind something I’ve thought about: is suicide hereditary? This question was so deftly addressed by The Guardian’s Ian Sample’s article: Death in the Family. In this article, Sample points out the following:

One of the most stark insights into depression and suicide comes from scientists studying bipolar disorder, formerly known as manic depression. People with the condition experience periods of intense mania, and will often feel themselves compelled to attempt grandiose tasks and projects, but fall into a deep depression once they are completed. The condition is thought to be strongly linked to specific genes.

“If you look at a population of people diagnosed with bipolar disorder, a fifth of them will attempt or succeed in committing suicide,” said David Porteous, professor of human molecular genetics at Edinburgh University. “Also, if you look at families where someone has committed suicide, the chances are that you will find another case in the not-too distant family,” he added.(from The Guardian, 24 March 2009, by Ian Sample)

    I personally don’t know of any completed suicides in my family tree. But I do know of some suicide attempts that have happened in the family-tree branches not so high above me, with undiagnosed mental-health illnesses scattered about. Understandably, just because the ‘suicide gene’ might be in my veins, it does not bring much, if any comfort, to parents who had to hear from their daughter about her attempt (the plural can’t be used here because I never told them about the other hospital visits I made since that time. Saying something about one is enough; and the ECT thing makes it more than enough).

    I do like looking up facts, stats and studies. And on a minor level, reading about the genetics of mental illnesses do give me some comfort-if one could call it that-about this element of myself. But those numbers reflect something much more grim in real life, and when I become depressed, start believing that I’m going to be Maureen Dowd the next day, or decide that I need to kill myself, it doesn’t matter that there might be some hereditary cause for it. Those numbers won’t save me.

    After I came out of the psych hospital the time I was told I had bipolar disorder, one of the first things my psychiatrist said was that I should notify my sister of this diagnosis because this disorder has a very good chance of running in the family – including to any children that she might have.

    What a thing to have to inherit from your big sister. A mental illness for the kids!

    March 23, 2009

    FDA approves expanded use for Zyprexa/Prozac combo drug

    Symbyax, a combination drug of Zyprexa and Prozac, has been approved today by the FDA for treating treatment-resistant depression. According to Eli Lilly, the makers of this new pill, it’s the first approved drug for treatment-resistant depression. Symbyax had been approved for use in bipolar disorder a few years earlier.

    I wonder if Symbyax would be another option for anyone who had failed before with Zyprexa and/or Prozac by itself.

    March 23, 2009

    30 days later.

    Yesterday morning, my mother left Nashville to go back to the homeland. She was actually here long enough to see the seasons change. When she came, those trees in our condo complex were just branches with dormant buds. By the time she left, they had all bloomed and those petals are the ones blanketing the parking area like snow. I never noticed they were cherry blossom trees. How appropriate.

    Yesterday was also my first day back at my part-time retail job that I’ve had since I’ve been out of college. In fact, it’s really the only work that I’ve been able to hold down. Going to work meant that I needed to drive to get there, so I got to drive by myself for the first time since January. Though it’s a very short distance, it was nice to get in the car and turn on the radio so I can listen to “Wait, Wait. Don’t Tell me” as I drove into work, something I used to do every Sunday right before my shift. It’s been fine listening to Kelly Clarkson’s new CD every time I was in the car with my sister, but I just need more variation that hearing “Life would suck without you” on a loop. I almost missed the one turn I have to make, but otherwise, I know I can at least drive this distance.

    It was nice to be back to doing something outside of my house. I also really hadn’t interacted with anyone outside of my family for the last few months, so going to work obviously forced me to do so. I’ve understood the importance of social support and forming relationships as a concept but have never applied it to my own life. I have been more inclined to be like that “Rock” in that Simon and Garfunkel song. But it wasn’t until some people welcomed me back to my workplace and then chatting for a moment that I realized I already had relationships with other people. I just never chose to value or be grateful to any of those types of bonds in the past. I guess you can only successfully aspire to be that ‘rock’ or an ‘island’ in a song lyric, but doing that in real life will only come to end up hurting yourself, and oftentimes others around you. Clearly, this behavior has not gotten me anywhere, because rocks and islands, by their respective nature, can’t go anywhere.

    I really should learn this lesson.

    On the drive back from work, I got to listen to “Car Talk.” I think I feel better than this whole past week, thank goodness. I do feel bad for Pat Summitt and the Lady Vols, though.

    March 21, 2009

    Mother

    It was bound to happen. Mother and I had a long conversation on her last day here. She’s been here for over two months and I am so thankful that she has been able to be here, and am grateful for both my parents for their support. While my mother was with her daughters, my father was all alone in the homeland, and working hard to provide for the whole family, including their two grown children.

    Mom’s having to come to the States for this chunk of time was not a easy thing for her at this point in her life. She was diagnosed with stage 3 colon cancer in fall 2007, had surgery and then endured about a year-long course of chemotherapy. Mother finished up with the chemo less than six months ago.

    There’s much to say about our long chat, which I’m sure I’ll figure out later how to put it coherently into sentences.

    My mom’s projected five-year survival rate is not promising, and she did ask me to promise that while she’s alive, if I could start building the life that I could be proud of, and moreover, that I would not die by my own hands. I really hope that I can keep that promise, if not for her sake, then for mine.

    Thank you, mom. Even though she was here under a hard set of circumstances (and we don’t always agree on everything), I am so glad I was able to spend this much time with her.

    March 19, 2009

    David Frum and the elliptical: the Abilify for the week

    There’s been a TV commercial running where this person says that s/he’s been taking antidepressants but not all of his/her symptoms have been alleviated. The narrator then suggests that they should ask their doctor if s/he could add Abilify to their drug regimen. I would be tempted to ask my doctor for this seemingly miracle drug, too, except I was prescribed Abilify six years ago when it was only labeled as an anti-schizophrenic. Within hours of taking it, I almost collapsed at work. I hate this drug (for me; I’m genuinely glad for anyone who has had success with it), and these TV spots and their print ads remind me just how horrible I felt that day I took that medication.

    Nonetheless, this week so far is making me wish that Abilify was right for me. But I’ve found a temporary non-prescribed antidepressant add-on for the week: David Frum and the elliptical. I finally got to read that article in Newsweek written by David Frum about why Rush Limbaugh is not the answer to their party’s current problems. It was so well-written, so much so that in fact, David Frum’s arguments made me think for a moment that maybe I could join the conservatives. Then again, I’ve been infatuated with Tucker Carlson for a long time, but I am an actual card-carrying Dem.

    I will also admit that I’m starting to understand why people are into exercising regularly. I still might be using that elliptical time only so I can catch up on some reading, but those 30 minutes do feel pretty good during that time.

    March 17, 2009

    Examining life through the lens of the Sopranos (prologue)

    My mother is leaving on Sunday. She’s, in that last 2+ months, decided that the Sopranos is her favorite television series ever. So, I handed her the Sopranos complete series DVD set sort of as a thank-you gift. Because you can’t watch those DVDs in Japan (regionalism), it’s been like some Sopranos marathon at our house. Maybe it’s because I’ve already seen much of the series before and can pay attention more to the nuances this time, but the little scenes, conversations, etc. now have begun to unearth similar scenes from my own life episodes, ranging from those benign ones to others that are a bit disturbing.

    Obviously, all the ‘shrinkage’ scenes between Tony and his psychiatrist Dr. Jennifer Melfi get me thinking about my relationship with my own Dr. Melfi. (Btw.watching their sessions repeatedly also made me realize that I somehow memorized the wrong date and missed my own Dr. Melfi appointment this past week. Not that I would die without it right now – and thank goodness that’s not how I feel -but this isn’t the time to miss these appointments. )

    Tony saw Dr. Melfi for six seasons; Dr. A, my Dr. Melfi, has been my psychiatrist nearly every week for almost six years. Their conversations have certainly stirred up the ones I’ve had in Dr. A’s office, though rest assured I’ve never had to make her relocate her practice to a motel room, break her table or threaten her.

    And I must continue this journal entry later. This laptop doesn’t seem to enjoy the act of someone typing on it…

    March 16, 2009

    Whether(ing) Patterns

    I don’t doubt ECT as a procedure. But I get afraid that it’s not going to hold for me when any single aberrant feeling seems to come over me. I’m well aware of the relapse rate, and I know that ECT is only a treatment, not a cure. So, when I felt this emotional distance, detached from everything and everyone around me, take over today and the day before, I began to count down those days against the number of consecutive days that you would have to have those sort of feelings in order to be considered clinically depressed, according to DSM-IV.

    When you’ve been depressed/hypomanic (or whatever people consider as mentally-ill thought process) for most of your life, you don’t really have a gauge of what it’s like to be of normal mental state. I mean, what’s a normal emotional pattern? Just how up is too up, and how down is too down when you’re ‘normal’?

    Various shades of gray have been the familiar scenery for the last four days in the sky. And that’s clearly not helped. I was so ready to just whine in the journal this afternoon. Then, that gray faded away and the sun showed up out of nowhere. Later, I begrudgingly followed my sister to the fitness room. She watched “Cash Cab” while she did her routine, as I caught up on TIME magazine as I trotted on that elliptical. I admit the column I read was about the Real Housewives of New York City (but the author does use words like schadenfreude). As my feet went round-and-round on those pedals, I actually began to feel a little calmer, as if some sun finally showed up in that gray mindset of mine.

    On a side note, I am a bit annoyed with my six-year-old laptop. Maybe it’s not good for the plastic cover to start showing cracks…

    March 14, 2009

    Down because of the weather? Don’t blame the ECT!

    We all have our ups and downs, and I think I’m just having one of those down days, not because ECT didn’t provide me enough spark for me to stay happy the whole time, but because it’s not that easy for anyone to stay peppy while the sky is gray and rain is pouring down for three days in a row.

    So, I watched that Will Ferrell as Dubya live show on HBO tonight as I sipped a nice, brown tea from a Double Old-Fashioned in my hand.

    I usually take my generic Xanax (alprazolam) for my hand issues, but today, I popped one for the anxiety part. I came across an article in Newsweek about America’s first “Mother’s Little Helper” Drug, Miltown, invented in 1954. By 1957, one-thirds of all scripts were for this little ‘peace pills.’ I never new how mass-marketed psychotropics already were in the early 20th century.

    March 13, 2009

    21 Days Later.

    It’s Friday. It’s been three weeks since my last ‘little spark.’ Fifteen of them…sixteen, if you count that day when they had to shock me twice. There are few physical marks left that show from those treatments. The same right-arm area where they inserted the catheter those fifteen times has no visible scars. The only signs left are these itchy spots by the opposite sides of my hairline where the conducting gel must have been for five weeks. But those bumps are starting to recede.

    So, two months have now passed since the very first treatment. I don’t know where the time went, mostly because I do have the ‘luxury’ here of not being able to recall every detail. The burden of having to be able to account for every single second of this time belongs to my mother. She’s the one who sat in that ECT waiting room for hours as other patients and their families came and went. Books and my doctor had told her the average number of treatments is eight. She got to sit through fifteen, or five weeks, and actually remember all those hours. And on top of that, she got to celebrate her 30th wedding anniversary and her 60th birthday during this time.

    There’s a lot more to say about today, but I can’t seem to put the rest into written words. At least there are more days for me to be able to write because of ECT. Oh, there is one thing I need to write down: ECT did give me three more weeks (or the last two months, really) that I planned on never having.

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