Wednesday, 28 January 2009

I saw the shrink today. The usual questions "what have you been up to?". I tell her about the lifestyle advisor and how I've been exercising like a complete twat on my wife's old dancemat and going for a walk everyday. How I've been eating healthy foods. Moonstone praises me for all this then asks if the advisor talked about alcohol. I tell her yes she did mention it but it wasn't something I wanted to address at the moment and the woman was happy for me to concentrate on making small changes in two areas rather than take on too much and fail. Dr Woodstock then questioned me at length about alcohol. Do you know???.... Yes I know it contains lots of calories, yes I know it's a depressant, yes I am aware of the long term physical health risks. Yes, I'm quite happy drinking 50-70 units a week. Do I know the recommended levels? Yes, 21. For fucks sake, she knows in my last post I specialized in alcohol problems, is she just trying to fucking annoy me by treating me like a child? She tells me it's her clinical responsibility to inform me of the risks and to advise me accordingly. I remind her that like many smokers who decide to smoke despite being well aware of the risks I choose to drink as I find it effective in reducing stress and anxiety (unlike prescribed medications) and am prepared to accept the consequences.

I distract her with the 4 year mood/medication chart I've drawn up. She is surprised by the winter peaks and the summer lows of my annual cycle which is the antithesis of what you'd expect. It's certainly in contrast with SAD and most typical depressions. She wonders if any other bipolar folks share this pattern. Anybody out there have winter highs?

I show her the pitting oedema on my legs and we discuss my request for Aripiprazole again. Looking at my chart and noting that my moodswings have been milder since staring Depakote in March 2007 she is loathe to change it unless I feel very strongly about it. I tell her while I don't want to remain an oversized depakote whale, I will continue to take it a bit longer.

She gets back onto the demon drink and drones on... well it would be interesting to see how your mood was without alcohol. Hmmm. Even if you could reduce it by one unit a day. I have been mostly monosyllabic throughout the meeting and my eyes have been focused on a dodgy looking stain on the carpet. Now I decide there's probably not much point in participating further. She is not motivating change. She is not doing the old textbook stuff like rolling with resistance. She is only annoying me, Christ I could use a drink right now! So I sit silent like Elton John doing his finest prima donna, albeit in a more subdued manner.

So she moves on to my mood which is 4/10 at the moment. What can I do to prevent relapse? I explain I feel quite fatalistic about it, my mood goes where it goes regardless of my actions. Don't my daily walks help? No they help me burn calories but I still hate going out and feel anxious and pukey throughout, there is certainly no sense of mental well being on return. What about friends, is there someone you could meet up with. No, apart from the odd email I have very little contact with any of my old friends, I haven't been to the pub for over three years. How about music, could you plan to spend time writing and playing. No, these things happen spontaneously when I'm feeling good and I have no inspiration when I'm down so nothing comes out, I have complete block. I tell her it sounds like I'm being deliberately awkward (half expecting a comforting rebuttal)... "Well, are you being awkward?" ... "errr, no". I don't elaborate as I was just trying to be honest. In retrospect I don't think I should have been so honest, I could easily have lied, told her what she wanted to hear and said something like "yeah, that's a really good idea, I'll go home and play my guitar every day". I've often misjudged situations and hurt people by being honest in the past. I'm not sure how to get the balance right between engaging and sounding positive while trying to give truthful responses. Positivity and honesty are not mutual entities for me, how do you chose which card to reveal?

Thankfully there is a silence indicating that we're done for today then Moonstone pulls out her diary. When shall we meet again, she ponders, she says she's busy for the next 3 weeks so it's 4, 6, 7 or 12 weeks from now. Which is best she asks... I don't mind... well pick whatever suits you... I'm happy for you to decide... come on, this is team work... Ok, four. What Moonstone says next takes me by surprise "Four what? Months, years?". Silence... she stares at me waiting on an answer... is it just me or is that not just the height of sheer fucking rudeness. I felt like telling her to fuck off for four fucking lightyears but I am acutely aware that I have just abandoned my last shrink and inside my head I hear a well known phrase for paranoids bellowing through my head "There comes a time when you have to accept the whole world can't be wrong". So I swallow my obscenities and smile sheepishly replying "four weeks". I feel pathetic, I envisage John Wayne sneering down on me "call yerself a man, yer yeller!". And with that parting thought I crawl home on my belly.

I am now starting to wonder if maybe Moonstone was just breaking me in gently and now the honeymoon is over. Is she in cahoots with the pirate? Are they all out to get me and make my life hell? Am I paranoid? Am I just not cut out to engage in any form of therapy? I am certainly starting to have doubts about what I thought was going to be a positive step in treatment for me.

"You get down, real low down
You listen to Coltrane, derail your own train

Well who hasn't been there before?"

Saturday, 24 January 2009

I have been asked by Gabriel to write something about recovery for a project he his putting together on his site. Just a short post about what has helped me deal with the disease that is bipolar disorder. The problem is, I tend to be very negative about my illness, I let it define me and see little future for myself. I am not someone who is religious or drawn to alternative therapies. I’m not into support groups and have a history of paranoia around health professionals. Medication and ECT have not cured me so I tend to dismiss them. The only thing that seems to alleviate my condition is alcohol and that is not generally considered a positive form of treatment. So what encouragement can I give others?.....errrr?

After some head scratching I have eventually managed to identify three things that have definitely had a positive influence on my wellbeing. So here goes…

Three things that have helped me cope better with bipolar disorder.

1) Getting Diagnosed: Getting a formal diagnosis was of great benefit to me. I had always known I was different but I just presumed I had a personality disorder. Between depressions I had always been an extrovert, loudmouthed, gregarious, pain in the arse. My outrageous personality caused authority and mediocrity to loathe me whilst open minded folks thought I was hilarious (albeit in small doses). I excelled in imaginative roles and failed in prescriptive roles. However, once diagnosed bipolar, doctors who had previously been irritated by me, viewed me with sympathy (oooh such a bad word nowadays) and I was subsequently more able to engage. Authority figures now positively discriminate against me (I’m the poor chap who lost his mind). My principles tell me I should hate this but in practice it makes my life much easier and for the first time in my life I am happy to work the system. Being diagnosed has been a good thing for me.

2) Getting the right psychiatrist:
I am now on my third shrink. The first one was a good guy but very cautious and reluctant to change anything. Despite his good intentions he didn’t really help me and I stayed in a state of inertia for months. My second and longstanding doctor, “the pirate”, treated me like a specimen on a Petri dish, coldly and arrogantly prescribing me treatments while he played with his palm pilot. After a long period of virtual clinical abuse I refused to see him again and demanded to see another consultant. This was the best thing I ever did as regards treatment. My third and current shrink is excellent. She is very empathetic and inclusive. She basically provides me with expert information and allows me to make informed decisions. Getting the right doctor was a huge step for me and for the first time in my life I am starting to engage with professionals and starting to listen rather than fight.

3) Having a loving partner:
Without my wife to support me I would not be here. My wife has supported me through thick and thin (mostly thin) since we were in our teens. We have now been married 29 years. She disciplines me when I’m over the top, she laughs with me when I’m high, she ignores me when I’m hyperirritable, she supports and encourages me when I’m down, she cares for me when I’m bed bound. She loves me all of the time. I’ve gone missing, I’ve tried to kill her, I’ve embarrassed her, I’ve gone to bed for months, I am a bastard. Still she loves me. There is no type of formal support or treatment that comes close to this. I do not deserve her. She is way above me. How people cope on their own is beyond me and I can only admire them. She has been the most important factor in me surviving bipolar.

Well, that’s the three things that have helped me live with bipolar disorder.

Friday, 23 January 2009

Despite feeling miserable I've really been trying to focus on my grossly fat body and do something about it. I've taken the lifestyle advisor's advice and been up in the loft to get my wife's old PlayStation dance mat out, I've drawn the curtains and got a bit of exercise by busting a few moves in front of the TV.

My wife has also helped me by accompanying me on walks in the evenings. I had planned to take my nephew's dog out daily, it's a great excuse for being out without looking like a creep but I dread meeting people and so won't go out during the day. I really miss the neighbour's dog which I used to take out daily before they moved away. We already have a profoundly neurotic rescue cat so a dog of our own is out of the question.

I'm managing the diet side of things OK as I haven't got a sweet tooth. I have started recording what I eat and it all seems fine, I think the only thing I have to watch is the amount of olive oil I add to stir fries. I just need to exercise more.

A few months ago I dismissed my family doctor's comments regarding schizophrenia and bipolar as the same disorder. Now I must eat my hat as it seems his words were prophetic. Although up until now, schizophrenia and bipolar disorder have always been viewed as two distinct entities, a recent Swedish study published in The Lancet concludes that both diseases share a common genetic cause. An increased risk of schizophrenia was found in relatives of people with bipolar disorder. According to the study, brothers and sisters of people with both these conditions were nine times more likely to be schizophrenic and had eight times the risk of developing bipolar disorder.

With all the recent controversy around embryo selection which allows parents to discard embryos with potential diseases like cancer rather than definite genetic disorders such as Huntingdon's disease, it makes you wonder if people like me will be allowed to live in the future or perhaps just be discarded after fertilization as imperfections. I'm glad I was born when I was. Although there may be times when I don't want to live, at least the decision is mine to take. Gattaca is no longer just a vision of the future.

Wednesday, 21 January 2009

Yesterday was a momentous day in American history as Barack Hussein Obama was sworn in as the 44th president of the USA. It's hard to believe that during my lifetime the United States has moved from a country of racial segregation to a country with a black President. It was a profoundly emotional moment, not just in the US but all around the world, as people like me watched history being made live on our TV screens. Most of us have loathed the past eight years of Bush's presidency, yesterday we all wanted to be American.

There is no doubt he will be a great icon of the 21st century but I hope Mr Obama is remembered not only for the colour of his skin but for bringing great change to the world. He has been handed the reins in the midst of a deep recession and has inherited a global pile of shit from George W Bush. Sadly his egalitarian vision to bring healthcare to every American seems to be opposed by all but the poor. Fortunately he has charisma and presence in abundance and is a hugely inspirational figure for all Americans and for the world there is (excuse the Star Wars quote) a new hope.

While the world watched Washington it turned it's back on Gaza where UN secretary general Ban Ki-Moon was appalled by the "outrageous" attack on the UN compound he visited.

The other day I was fed up hearing biased news about "the war" on the BBC and for the first time I watched Al Jazeera news. I couldn't believe what I was seeing. They showed the bodies of dead children with bullet holes in their heads allegedly shot by Israeli snipers. I had to quickly turn over. It was horrifying. I pray this is over ASAP. I hope Obama brings something more constructive than his recent comment "If somebody was sending rockets into my house where my two daughters sleep at night, I'm going to do everything in my power to stop that. I would expect Israelis to do the same thing". I find all this impossible to understand, it's as if when the IRA bombed London, the UK government had responded by flying bombers over Ulster and wiped out Belfast, Newry and Derry, killing innocent men, women and children.

Anyway, meanwhile back in my little insignificant world. I saw the lifestyle advisor on Monday and have made a start on eating a bit less and exercising a bit more, well not a bit more as I don't do any but I'm starting to exercise a bit.

Wednesday, 14 January 2009

The shrink was running late this morning but at least had the courtesy to phone the health centre to let me know she was behind schedule. Rather than sit miserable in the waiting room like Satan trapped in the Ninth Circle of Hell...

...I went down the shops and bought a pint of milk to pass the time. But soon I was back amongst the hoard of the living dead, all groaning and moaning about backpain, how the pills make them dizzy, the collapse of the banks, the price of bread, all the druggies, all the immigrants and of course how long they have been waiting to see the doctor. Surprisingly none of them mention the current massacre in Palestine.

Thankfully the psychiatrist arrives and we escape to the sanctuary of the dietician's room. I tell her how I was a bit down over Christmas and took to my bed for a few days but am better now. She asks what got me out of bed and I tell her my wife asked me to help to cook a meal one evening (the missus does not excel in the kitchen). The next day I had a bath, shaved then things slowly got better. After confirming I was housebound again she asked what had got me out in the past. I explained initially we had gone out for short walks at night where we wouldn't bump into anyone, then daytime walks in the country. She suggested I use these strategies in future to get me out of bed and out of the house (a nice wee bit of informal CBT).

She asked what the plan was now. My main concern is still getting my weight down and I mentioned Henry's suggestion of Aripiprazole as an alternative to Depakote. She agreed that it didn't have the weight gain associated with valproate and that if she had to be prescribed an antipsychotic then Aripiprazole would be her first choice (how come the doctor's drug of choice wasn't seen as the primary drug to prescribe to patients?). Anyway, she decided she'd rather not change anything at the moment as she thinks I'm doing relatively well. But should things go downhill my next drug will be Aripiprazole. I see her again in two weeks. In the meantime she's asked me if I can merge the drugs I was on into my 4 year mood chart as it would be much easier to grasp than studying my voluminous notes. So I spent the afternoon doing that.

Friday, 9 January 2009

Things seem to have flattened out now and to quote Bill Bryson, I'm neither here nor there.

I have a couple of appointments next week, the cardiovascular clinic on Monday and the psychiatrist on Wednesday, so will have to venture over the doorstep which may not be a bad thing.

Today I looked back over my blog and updated my long term moodchart. So here's the last four years of my life as a red line.

It looks like a fekn E.C.G.

I can't believe I haven't been to work since April 2005. That's almost 4 years now but it only seems like a few months. I still can't believe I'm not going back... but neither can I envisage ever getting my shit together enough to ever participate in the real world again.

Saturday, 3 January 2009

I''m not really sure how I feel at the moment other than anxious and irritable. I'd like to thank all of you for your kind words and support.