For now, my “journey” through both civilian and veteran mental health systems is at the maintenance phase. I have graduated IOP as of the end of the year. I could have done more time and the VA likely would have paid for it, but I felt ready, and I also liked how it closed out the year. I will see Dr Black less often and will check in with her every few months. I see Derek, my prescriber, every two to three months as well, for medication management.
In a way, I am just beginning this journey. All over again. I have been up and down this road. Despite familiarity, there are always new dangers, new and unexpected challenges pushed up against my ability to cope.
I have never experienced intensive outpatient treatment for my mental health post-discharge from a psychiatric hospital, and I put everything I had into it. I was overwhelmed, discouraged, unsure, and very worried about my ability to truly learn and incorporate all the different skills and lessons. I still felt this nagging sense that I was beyond all help, that in fact, western psychiatry has not advanced enough to help me. I saved everything the therapist handed out. I put together a “DBT” manual, a book of everything I was given, and I keep it handy on my bookshelf. There are moments in my life I see all this as bullshit, I got my own degree in psych just to learn from the back end how it is all bullshit. But sometimes you just gotta throw shit at the wall and see what sticks.
Some of the skills and lessons came easy, like building mastery for a sense of self-efficacy and distraction for management of overwhelming emotions. Others are much harder, like mindfulness. There are people who make mindfulness and meditation a whole way of life. The eastern Buddhists laugh at the western shrinks who go “hey, they might be on to something here.” I was first exposed to it while still in college and taking an elective called Stress. It was a little meditation, a little bit of stress management, but mostly a class about how living poor in the US is just as a severe and chronic condition as type I diabetes or heart disease. Living in general is just as lethal as anything else, but the ways we die shine a light on stress and class in a country that sees the largest class and healthcare disparities in the developed world.
I was really lucky compared to those in the hospital with me, those in IOP with me. In the hospital there were people who were so sick, they would likely never be able to work or live independently. I even said it once, in a moment of overwhelming emotion – I have nothing in common with these people.
But I do. I have more in common with the patient in restraints than the nurse I work alongside, trying to keep him safe.
I have more in common with the detained patient than the nurses and aides enforcing the doctor’s order, and the DCR rep coming to enforce the law.
I have more in common with that patient hearing voices than I do the psychiatrist trying to find the pills that will make them go away.
No matter how ill the most ill patient, I still have more in common with them than any coworker.
That is a strange place to be. I haven’t been hearing voices; I don’t have any delusions of persecution or paranoia. But I know what that’s like and I have spent the last four months getting a lot better at recognizing my triggers, signs of decompensation, and what to do when things start going south. I spent time in IOP and with Dr Black on my safety planning and I have a bullet point list for what to do when I’m hearing things, feeling suicidal, feeling too manic, not sleeping, or feeling like I should stop taking my meds.
That last one is a major challenge for those of us with mental illness. We feel better so we stop. But that is when we should be more med compliant than ever.
I’ve quit my psych meds before, overnight. That culminated in me nearly dying, hearing voices and strapped down in a psych ward. I like to think I have learned from that, that I would never do something so foolish again. Never say never, but if I’m so much as thinking about changing or stopping meds, I have to call my doctor right away.
For the first time in a long time, I am essentially on my own. So now the journey truly begins.
The Journey Never Ends
7 responses to “The Journey Never Ends”
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Excellent description and explanation of how it really is for people who are suffering. I was told at my very first appointment with the psychiatrist that I should become an expert in myself and my bipolar. As I didn’t know anything really about it I started looking at the medication used and how it worked and then went backwards to see how the medication was working and how my brain was working to produce these imbalances of monoamine levels. I found it so interesting to learn about it. I also agree with you about how it comes at you in a variety of different ways that impact your mental state and it never seems to have a pattern of symptoms for your fluctuations in mood. I haven’t had similar experiences with my bipolar episodes at all. Always a new experience as if it is morphing from one version to the next.
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Yes exactly…as soon as I feel like I’ve figured out the latest phase or cycle, it changes. I’ve gone through so much whiplash as I’ve had both suicidal mania and the glorious rush of pure manic bliss. I still also cannot seem to maintain insight and do what needs to be done when I am manic and feeling good – see the doctor. I feel a lot of other things until I crash and lose all functioning.
The drugs have mixed effects on me. How they work is uniform and yet every brain is different. I know what happens if I don’t take them – I get delusional, paranoid, suicidal, depressed, and eventually attempt suicide. Depakote did not work well to keep me from going into full mania and eventual crash. Lithium works well but it’s disabling. And now I’m on lamictal, my mood stabilizer. If I don’t take that dose every 12 hours, I’ll feel the bipolar mood swings. In diet form.
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I understand you completely. I take 600mg of Lithium at night along with 15mg of Olanzapine and 40mg of Fluoxetine in the morning. I know full well that if I don’t adhere to taking them, I’d be a whole world of pain and problems. I’m currently very lucky to be able to say im functioning. I think being a bit manic helps you function. If you take a scale of 1-10 with 1 being depression and 10 being mania, im about a 7. So im manic but I can see myself in this state and comprehend the situation. Does this mean mania is linked to functionality?!? I don’t know but I’d agree that it definitely could be the case. With the depression I no longer spend days in bed as I tried years ago to find something that distracted me from the pain of being in bed for days. I started writing down my thoughts when I felt like I was being impacted by it. It was a word initially I wrote but I persevered and it grew to sentences and words I put together and I eventually wrote 3 short books and 27 songs from what was actually a negative experience. I think it is down to you to decide your own level of involvement and how much you may be struggling, know people like me are testament to prove that you can be successful in beating this shit affliction we have to live with day in, day out. 👌
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I found writing to be the most helpful so far for processing and trying to understand why I feel the way I feel. Mania absolutely does mean we are more functional! I have to believe that. If I am a 7, yes I’m elevated, but I’m also functioning. I have awareness. The hard part is how to know when I’m losing that awareness, how to know when to hold onto insight right when it wants to leave me. This haunts me.
The book I wrote was so cathartic. There is even an interested publisher.
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Absolutely right. I found that not trying to fight against the change when you’re going low is a great help. It is something that you can’t control and if you know the saying “control what you can and stop trying to control what you can’t” (I may of misquoted that but you get the gist), is a great way to look at things.
I have to say from your blogs and your writings that im not surprised that there is interest in your book. It’s presumably a candid account of your experiences and a real story about how the world is to you. I myself have written 3 short books now about my opinions on the world from the perspective of someone who has bipolar and experiences of my bipolar too. I have no aspirations to be a published author and have a interest in the books, but if you have someone willing to share your work with the world, I would say “GO FOR IT!” What you have written has interested someone and it can potentially interest many more people 👌
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I don’t know how you would market it either. I guess it would be a case of plugging it on the magnitude of social media sites.
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Documenting my journey through the mental health system 
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