Sink or Swim

One of the things that has been weighing really heavy on my mind lately is the process of recovery in Bi-Polar people. John and I have a few close friends who are Bi Polar as well, (imagine that, similar disorders find comfort in proximity) and at least two of them are in constant cycles of "okay" and then "really not okay" with no real indication they will break out. One friend, in particular, has really been on my mind a lot lately. He's just not coping. At all. It's not that he doesn't have the tools or support. He blames it on a lack of self worth, and is perfectly willing to let his shitty self esteem be the reason that his cyclical behavior produces the predicted and tragic results. It's a catch 22 that I can't get him to comprehend as being a mere excuse. If he feels shitty about himself and feels worthless, he doesn't need to take the steps to take care of himself because the effort to spend on himself is "not worth it" in his eyes. So he cycles. And he crashes. And he feels worse, i.e. more worthless. And the effort it takes to feel better, by making better choices, is unimaginable, because he doesn't deserve it, so why should he try?

It's a victim mentality. Complete and total. No matter your chemistry, no matter your synapse relay, choosing to stay sick because it's easier is just another version of self serving pity partying. I used to put it to John like this: If you try, and fail horribly, and fall several feet, I will still tell you HOORAY for the incremental progress you managed to make, even if it's only measurable in nanometers, because when you are making a commitment to your health and to managing your disease when you are well, you never EVER fall as far or as hard when you are sick. If you have a routine that becomes second nature, the crash that comes may disrupt your routine, but it's still there, like muscle memory. You take your meds because you always take your meds and you know you have to take your meds. You eat real food because you always eat real food and you know you have to eat real food. You look at your lists, you have your network help you identify your flags, and you take the hands that are offered to you when people who love you reach out for you, to keep you from hitting the ground.

Our friend doesn't see it this way. He doesn't want to confront his disease or his triggers when he is more stable because he fears that examining his triggers will in and of itself trigger a cycle. He lives in fear, and so reverts to self pity and blame game. "It's not me. This is just what I do. It's what I know how to do. It's how I was raised."

It is frustrating, to know that he has this potential, to have seen him more happy and more healthy, and see him now, angry and barely coherent. I hate this disease. I hate it so much. I hate what it does to my sweet teddy bear of a husband, to our soft and giving friend, to the other remarkable people I know that fight their own brains, every minute of every day. I hate that I can see the pain in John's eyes on days when he just CAN'T do it, when he can't face people and cannot make himself get out of bed. I look into his face, and I see the small line between his eyebrows, I see this weary and cautious soul. I see it in our friend, too. He has this big love of everything, a childlike glee in beauty and nature, an adoration for all things living, a deep and abiding chest ache for injustice, or people he cares about being hurt. He is sore in his heart parts, lost, and instead of choosing NOT to let his disease define him and NOT to allow himself to wallow in a self-created Hell, he is falling away from us. I can't get through. He spent last night on my couch. I needed to know that he was safe, that he was around other people. I told him to pack a bag and I left a message for his psychiatrist that he was seeing today about his crash. I told him that until he is past this crisis, and still seeing his shrink daily, he should be here at night so we can be sure he is okay.

I'm doing it, and it feels just like starting over with John, at square one. I do not love this person as much as I love my husband, but I sure do care about him a great deal, and it is anguish to watch him flail out like this. I need to set boundaries. I need to keep a safe space for John, and for me. (Too much more like this and we will need to set up another place for our friend to go, because this eventually will push John into a cycle, too.)

So, I told our friend last night a version of what I tell John: Ultimately, the battle to be healthy comes down to a choice: You can choose to be healthy and make steps in that direction or your can choose to not be healthy and live a broken life forever. Choosing to be healthy means taking responsibility for your choices and actions, even when they're not what you intended and you're not proud of them. It means when you get set back and you crash, you go to your routine to pull up, and you do it over and over and over and over again. Living a broken life means you wallow in your misfortune and you end up hospitalized. There is no middle ground for a person who has this disease as badly as our friend, or as badly as John. You either choose to learn to swim, or you sink. I told our friend that I will be here and be support if he wants to be well, but if he just wants to be sick, well, then he needs to do it elsewhere, because I won't watch it and won't stand for it.

I am hoping that in the next couple of days, he will take a turn for the better, and that John helping him out will actually help John level out instead of going from our friend crashing to John crashing.

Ed. note: This was written by my beautiful and brave daughter in law and swiped without her permission... One of my favorite sayings: What if all the dragons in our lives are really princes waiting to see us once beautiful and brave? Love you, Sweetness.

The Americanization of Mental Illness

AMERICANS, particularly if they are of a certain leftward-leaning, college-educated type, worry about our country’s blunders into other cultures. In some circles, it is easy to make friends with a rousing rant about the McDonald’s near Tiananmen Square, the Nike factory in Malaysia or the latest blowback from our political or military interventions abroad. For all our self-recrimination, however, we may have yet to face one of the most remarkable effects of American-led globalization. We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad.

This unnerving possibility springs from recent research by a loose group of anthropologists and cross-cultural psychiatrists. Swimming against the biomedical currents of the time, they have argued that mental illnesses are not discrete entities like the polio virus with their own natural histories. These researchers have amassed an impressive body of evidence suggesting that mental illnesses have never been the same the world over (either in prevalence or in form) but are inevitably sparked and shaped by the ethos of particular times and places.

In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.

That is until recently.

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.

Read the rest of this fascinating article here.

Lack of Health Care Killed 2,266 US Veterans Last Year: Study

WASHINGTON - The number of US veterans who died in 2008 because they lacked health insurance was 14 times higher than the US military death toll in Afghanistan that year, according to a new study.

The analysis produced by two Harvard medical researchers estimates that 2,266 US military veterans under the age of 65 died in 2008 because they lacked health coverage and had reduced access to medical care.That figure is more than 14 times higher than the 155 US troop deaths in Afghanistan in 2008, the study says.

Released as the United States commemorates fallen soldiers on Veterans Day, the study warns that even health care provided by the Veterans Health Administration (VA) leaves many veterans without coverage.The analysis uses census data to isolate the number of US veterans who lack both private health coverage and care offered by the VA.

"That's a group that's about 1.5 million people," said David Himmelstein, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program who co-authored the study. Himmelstein and co-author Stephanie Woolhandler, also a Harvard medical professor, overlaid that figure with another study examining the mortality rate associated with lack of health insurance.

"The uninsured have about a 40 percent higher risk of dying each year than otherwise comparable insured individuals," Himmelstein told AFP."Putting that all together you get an estimate of almost 2,300 -- 2,266 veterans who die each year from lack of health insurance."

Only some US veterans have access to medical care through the VA and coverage is apportioned on the basis of eight "priority groups.""They range from things like people who were prisoners of war, who have coverage for life, or who have battle injuries and therefore have coverage for their injuries for life," said Himmelstein.

Veterans who fall below an income threshold that is determined on a county-by-county basis can qualify for care, but many veterans are "working poor" and fall just above the bracket."The priority eight group, the lowest priority, are veterans above the very poor group who have no other reason to be eligible and that group is essentially shut out of the VA," according to Himmelstein.

The study comes as the US Senate weighs health care reform legislation and whether to offer government health insurance.Himmelstein warns that congressional proposals could still leave veterans uncovered and favors a national health care program similar to those in Britain and Canada.

precipice

I'm standing on the edge of the world. Been standing here as long as I can remember. I guess we have. I wonder if you'll fall. I wonder if you'll take me with you. I wonder if I can stand waiting any longer.

I breathe in. I breathe out. I don't look over the edge. But then I do. I breathe in for you. I breathe out for her. I don't look over the edge.

She would be fine without me. I don't want to leave her, but she would. You... I'm not so sure. I breathe in. I don't look over the edge. But then I do.

Sometimes I dream. But then I watch the edge. Breathe in, breathe out. I wonder if I can stand waiting any longer. Breathe in, breathe out.

If only you'd step away from the edge...

the day after I wrote this I found this in a John O'Donohue book -

"When near the end of the day, life has drained
Out of light, and it is too soon
For the mind of night to have darkened things,

No place looks like itself, loss of outline
Makes everything look strangely in-between,
Unsure of what has been, or what might come.

In this wan light, even trees seem groundless.
In awhile it will be night, but nothing
Here seems to believe the relief of dark.

You are in this time of the interim
Where everything seems withheld.

The path you took to get here has washed out;
The way forward is still concealed from you.

'The old is not old enough to have died away;
The new is still too young to be born.'

You cannot lay claim to anything;
In this place of dusk,
Your eyes are blurred;
And there is no mirror.

Everyone else has lost sight of your heart
And you can see nowhere to put your trust;
You know you have to make your own way through.

As far as you can, hold your confidence.
Do not allow your confusion to squander
This call which is loosening
Your roots in false ground,
That you might come free
From all you have outgrown.

What is being transfigured here is your mind,
And it is difficult and slow to become new.
The more faithfully you can endure here,
The more refined your heart will become
For your arrival in the new dawn."

Every Stinking Year

Clinton 'Asylum of Terror' haunted house angers N.J. mental-health advocates
By Veronica Slaght/For The Star-Ledger

CLINTON -- Every fall, the Red Mill Museum here hosts a haunted house. But this year’s "Asylum of Terror," has angered mental health advocates who said the theme perpetuates ugly stereotypes. The show, which ends today, warns visitors of hopeless, mindless and deranged patients lurking in dark corners ready to lunge.

"Dementia, paranoia, violent sociopathic behaviors, physical abnormalities and deformities ... these are but a few of the afflictions that torment the wretched souls imprisoned within the walls of the Asylum," reads an advertisement for the haunted house. It continues: "In 1942, the doors of the asylum and the grounds were abruptly closed to the patients and the public after the inmates of the asylum overtook the staff and in one devastating night, tortured and then slaughtered all 200 staff members on duty ... Come if you dare."

Nearly 60 cast members put on the elaborate show, performed every weekend in October at the mill, which is located along the South Branch of the Raritan River in Hunterdon County. Celina Gray, executive director of the Governor’s Council on Mental Health Stigma, said she has heard from dozens of people who are upset by the show’s portrayal of the mentally ill as violent and scary.

"So many people white-knuckle through mental illness and don’t realize how it’s impacting their life," she said. "There could be people out there in the audience who are struggling with a mental illness and will not come out and say a word to anyone now." "I look at it this way," Gray said. "I love Halloween ... but there must be another way to celebrate it."

Responding to a letter about the "Asylum" from the council, Charles Speierl, executive director of the Red Mill Museum, said in an email that he forwarded concerns to event organizers and the museum’s board of trustees. Calls to the museum, which is run by a non-profit organization, were not returned.

Mental health advocates at the national level have also gotten involved. The National Alliance on Mental Illness issued a nationwide alert about the Clinton haunted mill.
"It’s trick or treat time again. We don’t mind ghosts and goblins, but when ‘haunted house’ attractions become ‘insane asylums,’ featuring ‘mental patients’ as murderous ghouls, we protest," reads a message on www.nami.org. The alliance is asking people to e-mail the mill to tell them mental illness is a national, as well as local, concern.

According to the U.S. Surgeon General, stigma is the number one reason why people don’t seek treatment for mental health, said Phil Lubitz, associate director of the New Jersey chapter of NAMI. "There are real consequences for perpetuating this kind of stigma," he said. Clinton Mayor Christine Schaumburg said, "I’m sure there were no bad intentions on the part of the mill." She hadn’t been aware of this year’s theme, she said. Gray agreed. "I’m unbelievably encouraged about the conversation that’s happening ... I think this came out of good people not understanding what it is and what the impact is."

Heard this morning... sorta fits

"Rain" by The Wreckers

You never give up
I can't believe anything you say
And it must be my luck
'Cause no one else gets treated this way

And I wanna know
What goes on in that head of yours
Yeah, I wanna know
'Cause I don't think I can take much more

Rain
You must be sick or something
I can't take another day
Rain
Is falling down
But will the sun come out again?

I never speak up
I just try and stay out of the way
But I must have messed up
'Cause that's all I hear you say

And I wanna know
What on earth makes you act like this
Yeah, I wanna know
'Cause I don't think I can take this shit

Rain
You must be sick or something
I can't take another day
Rain
Is falling down
But will the sun come out again?

Accepting the Diagnosis

Many factors influence how well a consumer is able to adapt to bipolar. These include the severity of the illness, level of self-awareness, one’s attitude about mental illness, availability of a support system, and access to quality health care. Some consumers are able to accept their illness after one or two manic episodes. Others remain in denial for years, burning through relationships, jobs, and money until they hit rock bottom.

“Bipolar is one of the illnesses people have the hardest time accepting,” says Sagar V. Parikh, MD, deputy psychiatrist-in-chief at the University Health Network in Toronto and professor of psychiatry at the University of Toronto. “Maybe one third accept [the diagnosis] right away. At least a third totally reject it, and a third believe it, but when they are better for a while, begin to doubt it again.”

“It’s common for acceptance to take years,” agrees Evette J. Ludman, PhD, a clinical psychologist and researcher at Group Health Cooperative in Seattle and coauthor of Overcoming Bipolar Disorder: A Comprehensive Workbook for Managing Your Symptoms and Achieving Your Life Goals (New Harbinger Publications, 2009).

Fully accepting the diagnosis is “almost like joining the priesthood,” Parikh says. “The commitment to treatment is a major one that involves going to the doctor regularly and paying a lot of effort to regulating one’s lifestyle. It’s not just a commitment to medication, but a way of life.”

In his research, Parikh found that consumers with bipolar II have greater difficulty acknowledging the diagnosis than do those with bipolar I, which is typically characterized by clear-cut episodes of mania and depression.

The symptoms of bipolar II are subtle, he explains, making it difficult to perceive the hypomania as a symptom of the illness, rather than part of one’s identity. “Your highs are mild, your brain is working faster, you have more confidence and energy, you need less sleep—it’s the ideal human condition,” says Parikh. Because the symptoms of bipolar II tend to be sporadic, “it is difficult to conceptualize it as an illness,” he adds.

excerpted from the Sept. issue of Bipolar Magazine.