treatment issues

The Desperation of Mental Illness and Depression

→ May 16, 2012 - 44 Comments

The Desperation of Mental Illness and Depression

I woke up one morning in 1994 crushed with depression. The first thing I thought of that morning was how much I wanted to kill myself, and if I couldn’t do that, then how much I wanted to hurt myself. I kept cutting implements and bandages near my bed just in case the feelings were too much to bear.

Of course, this was like every morning of my 16-year-old life. I was depressed, but I didn’t know it. I only knew that I wanted to die. I needed to die. I needed it like most people needed breath. And I knew that no one understood.

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Under the Influence of Drugs – I Can Think Just Fine

→ May 14, 2012 - 39 Comments

Under the Influence of Drugs – I Can Think Just Fine

I’m on Twitter. Not a surprise there. And I have a pretty active following there. Most of the people are fans, but a few aren’t. A few quite disagree with me and what I have to say. Which is fine. People can have their views.

And recently, I was tweeting along, minding my own business when someone said this to me:

and have you been on antidepressant, mind altering drugs all these years. Making choices while under the influence

My first reflex was to reply,

and have you been making choices all this time while being an ignorant, sanctimonious ass?

Sigh.

But I’ve heard through the grapevine that wouldn’t be professional. So I said nothing. If Mr. Twitter wants to judge me for taking medically prescribed medication, that’s his right. Even if it is a small-minded, uncompassionate, hateful thing to do.

And really, I have snarky answers for many of the asinine comments people make to me. However, I don’t tend to share them as it makes people all pissy. That being said, this particular comment hit a sore spot – being under the influence of brain-bending medications.

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Compassion for Those Who Love People with Mental Illness

→ May 7, 2012 - 66 Comments

Compassion for Those Who Love People with Mental Illness

Rarely, if ever, do people accuse me of having a lack of compassion for people with a mental illness. This is probably because I am a person with a mental illness so I kind of know where other mentally ill people are coming from.

Nevertheless, this is exactly what one commenter recently did:

This is a tragic post because the writer is incapable of honoring the struggle of a human being who is in pain. Rather than muster empathy, compassion and problem-solving, she shuts out the people who need her most. There is something wrong with America when families send their loved ones to prison or institutions when what they need most is the love and support of their community.

The commenter is referring to a post wherein I suggested that sometimes the right thing to do is to say goodbye to a person with a mental illness. Particularly in cases where a person is abusive and refuses to get help, sometimes walking away is the only thing left to do in order to protect your own life. I stand by this sentiment.

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How to Tell Someone They Have a Mental Illness Part 2/2

→ April 12, 2012 - 4 Comments

How to Tell Someone They Have a Mental Illness Part 2/2

Continued from part one of How to Tell Someone They Have a Mental Illness.

Thirdly, I recommend printing out information about the disorder for the person. There are plenty of resources online that will tell you the basics about a disorder and if you have this information ready, the person with the illness doesn’t have to go searching for it. Books are another good option. But know the person with the mental illness may use this information in dribs and drabs as information overload is a real possibility and will help no one.

Fourthly, look up places and ways the person can get help. There’s no point in pointing out a problem if you can’t offer a solution. In this case the solution is help. The easiest place to get help is your family doctor so maybe you could make an appointment for the person. You family doctor can do an initial assessment and refer the person to the appropriate person (probably a psychiatrist) for a full evaluation.

Additionally, there are all sorts of mental health and addiction related resources available and they are listed by location here.

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How to Tell Someone They Have a Mental Illness Part 1/2

→ April 9, 2012 - 31 Comments

How to Tell Someone They Have a Mental Illness Part 1/2

When someone has a mental illness it can be very difficult for them to see it. The very nature of a brain illness is such that the brain itself has a hard time recognizing it. We are often so wrapped up in the symptoms that we can’t see that what we’re really suffering from is an illness and not just a bad day, bad week or bad month. This is to say nothing of anosognosia, the clinical condition wherein people don’t possess the insight necessary to understand that they are sick.

Sometimes Others Can See We Have a Mental Illness

So sometimes the people around us are the ones that realize we’re sick before we do. Sometimes it’s our loved ones that can clearly see a pattern of behavior that goes beyond unusual into pathological.

But if you know someone who you suspect has a mental illness, how do you tell them?

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How Does Electroconvulsive Therapy (ECT) Work?

→ March 26, 2012 - 38 Comments

How Does Electroconvulsive Therapy (ECT) Work?

In the book I’m writing on electroconvulsive therapy (ECT) I’ve had to address the question as to how ECT works. However, in spite of the fact that ECT has been in use since the 1930s we really don’t know how ECT works.

But recently we may have gotten a bit closer to figuring it out.

[Note: I am running a survey on real patients’ experiences with, and perspectives on, electroconvulsive therapy (ECT). If you’ve had ECT and want your voice heard, please take the survey here. More detailed information on the ECT survey can be found here.]

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Do Objective Diagnostic Criteria Matter in Psychiatry?

→ March 15, 2012 - 12 Comments

One of the criticisms antipsychiatry folks like to make of psychiatry is its lack of objective diagnostic criteria. In other words, there’s no blood test that says you have bipolar disorder or schizophrenia.

And this is true. While today we do have blood tests for biological markers indicative of mental illness diagnosis, there is no hard and fast test that can diagnose a psychiatric disorder (except Huntington’s, for which we have discovered a gene).

The fact of the matter is no matter what is written in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or what blood we draw or which scans we do nothing diagnoses a person properly except a trained psychiatric professional.

But that doesn’t mean there’s nothing objective or meaningful about it.

Blood Tests for Mental IllnessObjective Diagnostic Criteria and Psychiatric Illness

In fact, using the diagnostic criteria from the DSM or even from a clinician’s clinical experience allows two experienced clinicians to arrive at the same diagnosis for a patient. (Is this always true? No, of course not. But there are second opinions in all of medicine so this is hardly rare.)

Psychiatric Diagnosis and Treatment

However, even if two clinicians were to arrive at slightly different conclusions, for example, one says unipolar depressive and the other says bipolar not otherwise specified, I would argue that it hardly matters as alleviating suffering is the goal and the diagnosis is only a way of getting to that end.

As Dr. Joseph Pierre has brilliantly said,

. . . clinicians do not in general fret over what does or does not constitute a disease. . . . If, for example, a patient’s arm is broken in a car accident, a doctor doesn’t lose sleep pondering whether this represents ‘broken bone disorder’ or simply an expected response to an environmental stressor—the bone is set and the arm is casted . . . mental disorder or not, clinicians working in ‘mental health’ see it as their calling to try to improve the lives of whomever walks through their office door seeking help.

Similarly, it is objective as to whether a person is suffering or not and thus it is obvious the person needs help regardless as to what the ultimate diagnosis is.

Do Psychiatric Diagnoses Matter?

Yes, of course psychiatric diagnoses matter as they direct treatment, however, just because there is no hard and fast test governing that diagnosis doesn’t make it any less valid nor does it mean that psychiatry doesn’t have a place in its healing.

Why My Mental Health Opinions Aren’t Just About Me

→ February 14, 2012 - 17 Comments

Why My Mental Health Opinions Aren’t Just About Me

Let me share a little secret with you – I don’t agree with all mental health treatment. I don’t agree with all the decisions doctors make. I don’t like all the available treatments. I have had very bad experiences with some mental health treatments. I have had some very bad experiences with mental health care professionals.

But I still talk about them. And I still think they are right for some people.

Why?

Because my story isn’t your story.

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Dr. Oz Show – The Shock That Could Save Your Life – Electroshock Therapy for Depression

→ January 25, 2012 - 50 Comments

Dr. Oz Show – The Shock That Could Save Your Life – Electroshock Therapy for Depression

As many people know the Dr. Oz show, did 30 minutes today on electroshock therapy. I’m going to talk a little about the Dr. Oz show’s representation of electroshock therapy and add a few additional facts.

[Note: I am running a survey on real patients’ experiences with, and perspectives on, electroconvulsive therapy (ECT). If you’ve had ECT and want your voice heard, please take the survey here. More detailed information on the ECT survey can be found here.]

First off, the Dr. Oz show is a source of entertainment, like anything else on TV, so he added drama that wasn’t particularly necessary. That is the way of the show, and TV, however. Specifically, the show started off with scenes of electroshock therapy being given pre-1950 which is when you see people having convulsions in the bad old days before people were anesthetized during treatments. This is not the best way to start a show that is supposed to educate about current treatment, but he does balance this later on.

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Top 10 Bipolar Burble Posts of 2011

→ January 2, 2012 - 6 Comments

Best Bipolar Burble ArticlesLast year was a great one here at the Bipolar Burble and saw a dramatic rise in audience numbers, so welcome readers, new and old. This means that debates were fast and sometimes fierce here on the Burble, and mostly, that’s OK with me. Although it did require the invocation of commenting rules, it also meant that more people had their say on mental illness topics.

So, without further ago, here is the top 10 list of articles people read in 2011:

  1. Worst Things to Say to a Person with a Mental Illness – number one with a bullet two years running is this piece which is a continuation of a piece I wrote on Breaking Bipolar. Everyone, it seems, wants to know what not to say to a person with a mental illness.
  2. Bipolar Disorder Type I: Mania and Delusions of Grandeur – this piece was written at the behest of a reader and includes readers’ experiences of delusions of grandeur during bipolar manic episodes.  This is a topic not widely deal with elsewhere.
  3. Doctors Should Treat the Mentally Ill Without Consent – this highly commented-on and contentious article outlines why I think it’s reasonable to treat the mentally ill without consent in some situations. In spite of all the controversy, I still consider this position reasonable.
  4. Self-Diagnosing Hypomania – I had no idea this article would be so popular, but people are looking for this information. This piece is about how to see hypomania coming or to know once it’s already here.
  5. Suicide Self-Assessment Scale – How Suicidal Are You? – again, I didn’t realize how many people were looking for this information. However, this article is designed to point out warning signs and track one’s own suicidal feelings. It can be hard to tell how severe suicidal feelings are and this scale is designed to help.
  6. How to Get Off Antidepressants Effexor/Pristiq (Venlafaxine/Desvenlafaxine) – this is an update to an article I had written a couple of years earlier and is a huge source of Google hits. I hate to make blanket statements about antidepressants, but it really seems like venlafaxine and desvenlafaxine (Effexor and Prisiq) are bitches to get all for almost everyone.
  7. Depression, Bipolar – Feeling Along with a Mental Illness – this is a feeling that I, and I think everyone with a mental illness, has had. This piece addresses the idea that those with a mental illness are “alone” or are “freaks.”
  8. Psychiatric Myths Dispelled by Doctor – Fighting Antipsychiatry – this is one of the most controversial posts here on the Burble due to the seeming war between those who consider themselves antipsychiatry and those who don’t. This piece earned the most comments, with almost 100 pieces of feedback on this article.
  9. Depression and Lack of Want, Desire – unfortunately, may people with depression experience anhedonia – the innability to feel pleasure. This tends to lead to a lack of want for anything. It’s a devastating condition that I have battled for years.
  10. Bipolar Terminology – The Difference Between Bipolar 1 and 2 – finally, at the number 10 spot we have a piece I wrote not long ago about the difference between bipolar I and bipolar II. This answers one of the basic questions people ask about bipolar disorder every day.

As I’ve said, I consider 2011 to have been a break-out year for the Bipolar Burble and I thank you all for being a part of it.

And don’t forget, if you have questions or if there are subjects you would like addressed here at the Burble, you are welcome to contact me anytime or leave a comment. I am at your service.

Laura’s Law – Assisted Outpatient Treatment – Follow-Up

→ December 28, 2011 - 38 Comments

Well now, that was quite the number of impassioned comments. I did realize that by writing about Laura’s Law (Assisted Outpatient Treatment) there would be some contention, but I didn’t realize quite how much. Thanks to everyone who wrote in well clear, thoughtful comments. (For those whose comments weren’t of that ilk, please review the comment policy here at the Bipolar Burble.)

Due to the number of responses, I have been unable to address them each individually, but I would like to point a few things out in general.

Misperceptions of Laura’s Law (Assisted Outpatient Treatment)

To be clear, and this is something most people seemed to miss in the first article, Assisted Outpatient Treatment (AOT) in California and other states cannot force medication. While medication may be part of a treatment plan, medication cannot be given without consent without going through the normal court procedures already in place. I don’t know how frequently this is done but it seems infrequent.

“Laura’s Law,” “Kendra’s Law” vs. Assisted Outpatient Treatment

Assisted Outpatient Treatment Issues

As one person astutely pointed out, it is emotionally charged to give the law the name of a previous victim. I’m sorry to add to this as I know it’s political in nature but unfortunately people won’t necessarily know what I’m talking about if I don’t use those names.

Studies on Assisted Outpatient Treatment

Additionally, there was much disagreement on the numbers I cited regarding Assisted Outpatient Treatment. To be clear, some of those numbers come from New York where “Kendra’s Law” is in place and has been for longer (and thus has been more studied).

Numbers from California are based on a tiny population (as it turns out) and thus are of low quality.

Randomized Controlled Studies of Assisted Outpatient Treatment

A reader commented on how studies have rarely used randomized controlled samples when reviewing the Assisted Outpatient Treatment programs. This is a fair statement, but I have an issue with this concept of a randomized controlled sample in this group. How would this be possible? If a person qualifies for the AOT program, how could you include them in a study and not put them in a program? Does it not go against ethical standards to offer no treatment to a person who needs it? In short, I’m just not sure it’s possible. People who are selected for the AOT program are always going to be different than those who are not selected by very definition of the program.

An Example of One Such Study

One reader did point to a study that attempted to use randomized controlled samples to evaluate AOT-type programs in the US. While they did come up with some interesting conclusions, there are problems with their data.

What this review found is that there was no difference in those in an AOT vs. those who were not on the following measures:

  • Readmission to hospital by 11-12 months
  • Compliance with medications by 11-12 months
  • Arrest by 11-12 months

They did find that those in AOT significantly had fewer:

  • Arrests for violence by 11-12 months
  • Homelessness
  • Victimization by 11-12 months

Those look like pretty big wins to me.

However, there was a significant increase in those in AOT programs who perceived coercion in care.

However, as I said, there are issues with this data:

  • Data quality is considered “low” by study authors
  • Data does not include those with a history of violence (For some reason the studies excluded these people. I suspect their inclusion would change the numbers substantially.)

And by excluding those with a violent history, you’re actually excluding most of the people who would even be affected by Laura’s Law (Assisted Outpatient Treatment in California).

Check out more resources on Laura’s Law questions and answers.

Question for Those Who Are Anti-Assisted Outpatient Treatment

So, a question for all those who wrote in an said that Assisted Outpatient Treatment was horrible.

If I were to take a person who would fall under the qualifications for Laura’s Law:

  • The person has a serious mental illness
  • The person refuses treatment
  • The person has a history of violence
  • The person has been in jail twice in 3 years

What would you have the system do with this person? What is the right thing to do? Someone please suggest something other than outpatient/inpatient treatment or incarceration that would work. Because what I’m seeing is a person in desperate need of help and who are we if we do not offer any?

Laura’s Law – Forced Treatment, Saved Lives

→ December 19, 2011 - 71 Comments

Laura’s Law – Forced Treatment, Saved Lives

Some of you may have heard of Laura’s Law in California or Kendra’s Law (similar) in New York. These laws, and similar laws across 42 states, allow for court-ordered treatment of mental illness as a condition of community living.

In other words, they strong-arm people into treatment and this could be seen as treatment without consent. (It’s hard to argue consent when your ability to live outside a locked facility is in jeopardy.)

And this is a very good thing. It is saving lives (among other things).

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