Documenting my journey through the mental health system

I’ve been experiencing an upswing, an increase in hypomanic symptoms. I am not lost in the sauce yet, but I am hearing voices every day if I don’t take a PRN seroquel for it, and my libido is insatiable despite meds commonly known to kill sex drive. In my psychologist appointment with Dr Black this morning before IOP, my speech was pressured and fast and tangential as hell. At one point she asked me a question, I started to answer it, and got off on a tangent. After several minutes of that, and Dr Black just observing me, I paused and had to ask, “what was the question?”

I’m painfully aware how this must have made me look. Bordering on unstable, or slipping closer to madness. All too familiar and terrifying places. I have been med compliant. I use PRNs pretty regularly. My sleep is what really sucks.

I’ve been an insomniac my whole life. I could not even be napped as a child. In Army basic training, I was up before everyone else and getting a head start on shaving/brushing my teeth/getting dressed. Sometimes I would write letters home in these early morning hours before drill sergeants yelled their way into the barracks. In college it was easy to work all night and go to class all day, snagging a nap in the evening before going back to work that night. And now, I work all night, have my IOP all morning, and get a few hours of sleep before I’m back up getting ready for work. And I am not worse for wear. Dr Black makes me track my sleep on a sleep log and there was only one day last week where I got a whopping seven hours of sleep after medication assistance. That’s with everything – the Melatonin and Vistaril, Seroquel and Trazodone and Gabapentin and Lunesta. I try to avoid the Ativan like the mental hospital’s doctor recommended. I use it when I am kept awake by voices talking to me, or when the other meds are not putting me to sleep. My insomnia is just something to which I’ve mostly grown accustomed. But my doctors, and Dr Black, don’t like it. Less sleep, or less need for sleep, is indicative of worsening bipolar symptoms, especially mania.

I got three hours of sleep today after IOP. I’m planning on much more tomorrow, when I have all day to catch up on sleep.

I’m on my third week of IOP, just started today. We’ve started on the emotion regulation portion of dialectical behavioral therapy. “Pay attention,” Jackie said to me as the therapist started talking. “This is where you always fuck things up.”

“Not now,” I whispered back.

“Your emotions keep you a slave,” she answered.

“That’s why I’m here.”

I’m highly aware of the stigma behind hearing voices and worse, responding to them. I have worked hard to conceal it when I do. I am terrified of the repercussions if the wrong person sees me talking to voices only I can hear.

The therapist instructed us to draw a table with our emotions placed on, or near, the table, and ourselves in relation to our emotions on the table. This was supposed to help us see ourselves in relation to our emotions and more fully, help us see where we are in our emotional regulation ability. I have little confidence in my emotional regulation skills and indeed, a lot of my life has been defined by the consequences of this lack of ability. From court ordered IOP and anger management to lost jobs to complete and total breakdowns over the smallest of inconveniences – my emotional dysregulation is a hallmark of my bipolar and borderline. I recalled, as I drew my table and emotions and myself, the morning in the mental hospital I completely broke down because I was denied a shower. Crying, I asked if I could at least brush my teeth. I wept furiously in my room as the doctor came by to see me and I sobbed that not only do I get to feel like shit, I get to look like shit too. This is about the time he asked me if I’d ever been diagnosed with borderline personality disorder. These memories are still fresh in my mind as I drew a giant table and even a giant chair, like in the fairy tale Jack and the Beanstalk. I drew my emotions as frazzled words – overwhelmed, inferior, inadequate, manic, disappointed, angry – in a steaming pile on top of the table. I was a little stick figure underneath the table. I drew in my hair but that was it. I made myself small in relation to my huge and overwhelming emotions.

I am overwhelmed after today’s IOP because while I was confident with my rather rigid boundary style, and still learning to be more open in my boundary style, I am much less confident in my ability to develop better emotion regulation. It’s an intimidating prospect, trying to bring them down to size. I feel out of control.