TW: verbal, emotional, & sexual abuse; transphobia; description of manic symptoms

I should not have allowed Ron to drive home at 2am two weeks ago. I should have talked zir into going to the hospital.

I just … I’ve read about how traumatic mental health hospitalization can be. I volunteered on a locked adult psych ward – and I was terrified they’d figure out I should be there as a patient and prevent me from leaving. Ron talked about how horrible being hospitalized was, I’m not sure if that was before or since the last time I wrote about zir. On a personal level I’m generally inclined against seeking medical help – especially going to the hospital – unless absolutely necessary, like life or death … But I shouldn’t have fallen back on that. I risked Ron’s life, allowed zir to go untreated for another week – during which zir symptoms got worse and zir behavior became a risk to zirself and others – and allowed it to get to the point where ze was involuntarily committed (by someone else).

Worse, I subjected myself to nearly 48 hours of being ranted at, manipulated, and abused. I feel like it’s set me back at least a year, maybe two, in terms of my own mental health. I’ve spent the past week on an emotional roller coaster, replaying the most painful moments over again in my mind, and debating whether I have any right to describe someone else’s symptoms on my blog. Well, those symptoms interacted with my mental health issues to make it so there are times when I feel dead inside. I’m having self-harm thoughts and urges again. That’s mine to write about!

Continue reading

Compassion / Pay It Forward

TW: mention of suicidal ideation

Ron had two really bad days in a row, and didn’t sleep in between. Ze told me ze was suicidal. On the first day I took time from my visit with Banji to have an extended phone conversation with Ron, anything to keep zir connected. On the second day I drove for five hours, successfully chaired a 90-minute meeting, reconnected with Fox after 5 days apart, then welcomed Ron into our home at 10:30pm. We decided to hang out in the back yard.

Continue reading

Hypomanic and Depressed at the Same Time

I read an article today and now my world makes so much more sense. In a Depression Bipolar Support Alliance (DBSA) “Ask the Doc” article, Dr. Mark Bauer, MD states that:

“[T]he most common mood state in bipolar disorder is a mixture of hypomanic/manic and depressed symptoms. In fact, the classic picture of bipolar disorder having a course alternating between the poles of high and low moods is an over-simplification.”

He goes on to explain mania and hypomania more clearly, basically describing them as hyperactivation – feeling “sped up” and driven. This can feel good (e.g. grandiosity), bad (e.g. irritability), and everywhere in between. In other words, mood and activation level are two different things.

Ergo, we can think of bipolar disorder as

“a condition of recurring depressive periods punctuated by periods of hyperactivation – and sometimes these periods of hyperactivation alternate with slowed down, depressed periods, but at other times they overlap.”

That. Is. My. Life. It’s very rare for me to experience a period of time with no depressive symptoms; at best my symptoms become few and mild enough that I don’t meet the criteria for clinical depression for a couple days to a few weeks. But periods of hyperactivation… just look through my blog and you’ll see my posts about “I’m going to do this new thing that will change the world,” staying up all night composing, “now I’m getting better and I’m mad at Fox all the time,” and most recently “Let’s Play Skyrim!”

I usually feel better during my periods of hyperactivation because 1) I have energy to do things and 2) I’m hyper-focused on something that’s meaningful to me, at least while the hyperactivation lasts. Sometimes I don’t feel so good because I want to Do All The Things!!! but I can’t focus on one thing to do, so my mind is a jumbled mess. I’ve also tried to be a part of too many different groups at once, which invariably results in me feeling overwhelmed, backing out, feeling guilty, and my depression symptoms becoming more severe. As far as I can tell, all of my periods of hyperactivation have occurred at times when I also met the criteria for mild depression. (Possibly also moderate depression.) In other words, I’ve never had a discrete hypomanic or manic episode.

I try not to put too much importance on labels; what’s really important is that the needs of the person with a mental health issue are being met. But having a label creates a container for my experience; I can understand it and talk to other people about it and know I’m not the only one who’s had that experience. Finding labels that accurately describe my experiences helps me feel safe. I obviously can’t diagnose myself, but the label “bipolar disorder” seems to become more accurate the more I learn about the experiences it’s intended to describe.

I know I’ve been “depressed” lately because I’ve been feeling sad and/or grumpy, isolating, having trouble eating full meals, apologizing for my existence, and thinking “I want to die” when I’m tired. I feel like it’s only a matter of time before my world starts unraveling (again): I worry about Fox’s safety, our rats’ health, my own health, the house burning down, etc. Calling these experiences “depression” helps me separate a bit from them, accept them, and engage in self-care.

On Being Wrong

I’ve been feeling more depressed than usual since my tooth was extracted on Monday. I’m more socially withdrawn, sad a lot of the time, with low energy and motivation, and more muscle aches that aren’t immediately attributable to the physical effects of the extraction. The constant dull pain is grating on me, making me irritable and impatient. I had to drag myself to class on Wednesday, had trouble concentrating, and role-played the “very loud client who remains disengaged from the group” fairly well. I’ve spent a lot of time improvising on piano in preparation for my midterm; everything I play sounds sad, melancholy, dark, surreal, and/or angry – even scales! It makes coming up with an intervention other than “Let’s sing about the crappy situation you just described” very difficult.

(In my defense, singing about crappy situations can be extremely therapeutic. Not only does it allow expression of repressed or taboo emotions, it helps one look at the situation and oneself differently, assert oneself, and heal. It is safest to do with the assistance of a certified music therapist.)

The primary reason why my symptoms have worsened can be found in this line from my post on Monday:

The extraction “felt wrong on some fundamental level”

I think anyone would feel depressed if they were constantly being reminded of something they considered fundamentally wrong!

Part of me remains convinced that “I had a perfectly healthy tooth pulled for no good reason” – even though that wasn’t the case at all. Multiple examinations revealed the tooth to be dead. The x-rays showed that there was a problem in that area. The dental professionals who examined me noted swelling in my gums and attributed it to that tooth. I saw the infection on its roots with my own eyes!  The tooth needed a root canal; I saw an endodontist who attempted the procedure but only succeeded in causing me more pain. Instead of risking a repeat experience, I chose a treatment that would be faster, easier, and possibly even more effective. At the moment I’m not happy with the results because I’m in even more pain. (I keep reminding myself that Mom regretted her knee replacement surgery when she was first recovering from it, but has since experienced improved quality of life and recommends the procedure to others.) Time will tell whether this has helped at all, or only caused more problems…

The point is, the belief that “I had a healthy tooth pulled for no reason” is irrational and factually incorrect. The tooth was not healthy, and I had justifiable reasons for getting it pulled. Extraction may not have been the recommended treatment or even the best treatment, but it was MY decision to make. Others may disagree with my decision, I may even regret my decision, but none of that makes it wrong.

I know this rationally but can’t shake the feeling that not only have I done something wrong, I am wrong. I was supposed to keep going back for endodontic treatment and thank the endodontist for hurting me, regardless of whether she was able to solve the problem that brought me to her in the first place. (Because that’s what she suggested, what Mom seemed to want, and what I agreed to at the time.) That I even thought to do anything other than conform to the protocol “you are a patient; you comply with whatever treatment your healthcare provider recommends” is proof that there is something wrong with me!

When I talked to Wakana about this on Wednesday, she asked if there was anyone in my life who taught me that I was wrong in some way. Thinking about it now, there are a lot of people whose behavior may have given rise to that belief: family members, peers, teachers and other school officials, mainstream media… but we ended up talking about our favorite topic: my mother.

I mentioned one way in which Mom has communicated to me that I am wrong: by telling me I’m like the “opposite” gender from the one I was assigned at birth, as an insult. She’s been doing it since I became a teenager. Wakana urged me to write about how that might have influenced the development of my queer gender identity. Part of me wants to comply and learn that I’m actually cisgender, which would make my life a million times easier. (I suspect it’s the same part that insists I gave up a “perfectly healthy” tooth.) Part of me thinks my desire to be cisgender purely so I can access the associated privilege is evidence that I am, indeed, transgender. Otherwise I would just identify as the gender I was assigned at birth, decide how I want to deal with some of my behaviors not conforming to my mother’s expectations, and move on with my life. Right?

I explored the topic somewhat and came to the conclusion that my mother’s expectations for the gender I was assigned at birth are limiting; I’m pretty sure her expectations for the “opposite” gender are just as limiting. I could not conform to them even if I were cisgender; if I’d somehow managed to do so she probably would have expressed disapproval anyway (of that or something else).

The problem isn’t my gender identity (which I’d really like people to accept), it’s that my mother doesn’t see me as a complete human being who is separate from her and has the right to make independent decisions. She sees everything I do through the lens of her expectations and me not meeting them. It often seems as though she goes out of her way to express disapproval, over whatever else she might be feeling. This problem originated long before my early teenage years, possibly when I was born!

Actually, I think she’s learning to see me as a separate person and respect my right to make independent decisions; our relationship has improved quite a bit since I’ve been in therapy. She hasn’t given me a hard time for deciding to have my tooth pulled; all the criticism of that decision has come from my own mind. The real problem is that I’ve internalized her (and others’) disapproval and feel on some fundamental level that it’s wrong for me to make my own decisions. I’ve internalized the belief that I must conform and go along with what other people seem to want from me.

Regarding my gender: I’m pretty sure I’ve always perceived the division of people into “men” and “women” as arbitrary. I know what the expectations for the two widely-recognized genders are – and I know that a lot of people are trying to weaken or even eradicate those expectations, so men and women can just be themselves (these people are called feminists). I know that a lot of men and women defy those expectations, to the point where one can’t use behaviors, interests, aptitudes, beliefs, or even biology to define “men” and “women” as two mutually-exclusive categories. As far as I can tell, the only universal difference is that all men identify as “men,” and all women identify as “women.” This isn’t to say that gender is a choice – if that were the case, I think we’d all be men and reap the numerous benefits. Gender is an inherent sense of self that may change over time but can’t be intentionally altered.

So, doing things that Mom associates with the “opposite” of the gender I was assigned at birth is not the basis of my queer gender identity. I could say “I am a [the gender I was assigned];” that would make things at lot easier for me, and everyone around me. No one would question it. I doubt anyone would even ask me to change my behavior to meet their expectations. I could be myself and use that label and let people refer to me using pronouns they already know…

But I’d be lying. I don’t identify as a “man” or a “woman,” I identify as a “person outside of the gender binary.” I am not a man, nor a woman; I am a person outside of the gender binary. I could allow you to categorize me as, well, whatever you’d like! for your comfort and convenience… but I can’t inherently identify with whatever you choose. It’s just not in my nature – any more than it’s in my mom’s nature to identify as a man or in Fox’s nature to identify as a woman. All I’m asking is for people to respect that.

Unfortunately, people are going to perceive and treat me the way they want, no matter what I do. They may express opinions about the decisions I make. This applies to so much more than gender and dental treatments; it’s just a universal fact of life. There comes a point where I just need to decide that I am what I am, that I make whatever imperfect decisions I make, and that other people’s perceptions of me are their business, not mine. Whatever they send my way need not impact how I perceive or treat myself.

Burn, Baby, Burn(s depression checklist)

I’ve been tracking my symptoms on the Burns Depression Checklist for another month; so far so good. (view July-August & August-September) Scores have remained in the teens on half the days, a phenomenon that was previously unheard of. My average score for the month was a 22, which is 10 points lower than last month!

A graph showing Ziya's scores on the Burns Depression Checklist from September 16, 2014 to October 16, 2014.

Ziya’s scores on the Burns Depression Checklist from September 16 to October 16, 2014.

There are several factors I believe have contributed to my improved mood. Reading The Drama of the Gifted Child inspired some profound healing in the last full week of September. The most conventionally “sane” way to word it is probably that the emotional and presenting-myself-to-the-world aspects of my psyche became more integrated, so I can acknowledge, express, and act upon my emotions more easily. This helps me to feel more alive; all the energy that went into suppressing my emotions is now available for, well, whatever I want to do. It’s wonderful and amazing and just… Wow!

I started taking the Lamictal my APN prescribed on Monday, September 29th. This is represented visually on the graph above by a vertical purple line. I’ve been taking the Lamictal consistently at about the same time every day for over two weeks. I hesitate to say it’s working just yet, but so far I’m feeling very positive about it. In addition to the Lamictal, I started taking Omega 3 and Vitamin D supplements on October 8th.

Additionally, Fox was offered a job that he’s really excited about, and not just because he finally has income! His energy levels have skyrocketed since he started working; that’s been a huge inspiration for me. I get the time to myself that I’d been craving, and when he’s home I’m thrilled to spend quality time with him. We actually have things to talk about because we’ve been having different experiences all day! There are adjustments, as always, but overall it’s been a real boon to our relationship. I wasn’t kidding when I said the sexiest thing he could do was get a job…

Finally, the dates that have a blue horizontal line under them in the graph above are days I spent with Banji. This past weekend was particularly wonderful; we got away from the stress of our respective lives and got to spend a few days talking, making art, playing music together, and enjoying the fall foliage. I went about 24 hours without using a computer or smart phone and it was amazing! I had all this time; I didn’t know what to do with myself! So I colored in my sketchpad, took a walk outside, tried to sneak around like my Skyrim character, and interacted with living breathing 3-dimensional people using spoken words, vocal inflections, and facial expressions. And laughed, oh, the laughter! I even cooked and cleaned up afterward!

By the time I got home I was a bit tired of socializing and just wanted some time to myself. I tried to play The Sims 3 – not the best or healthiest choice, I know – and ran into all sorts of crazy glitches. I got very frustrated because people kept interrupting me, especially my mother. I try so hard and I think she does too but I still find our conversations to be emotionally draining – especially when she’s hounding me about the things I still need to do for the wedding. That just makes me want to shut down and block everything out even more!

Considering the abrupt change from vacationing with Banji to feeling emotionally drained at home without her and not coping all that well, I’m optimistic to see my scores gradually climbing from 13 on Monday to 30 yesterday. It’s less disruptive than the wild oscillations I’ve experienced in the past; I expect that I can bring the score back down (representing a reduction in depressive symptoms) by practicing some of the things I enjoyed so much while on vacation: less time in front of the computer, more time engaged in creative pursuits. Another way to reduce my symptoms is to actually do the things Mom’s been hounding me about, because then she won’t feel so anxious anymore, so she’ll have less emotional garbage to heap on me. This solution has the added benefit of completing the steps necessary to successfully prepare for my wedding. Win-win!

In addition to the overall lower scores, I had a truly amazing thing happen last week. For the first time since I’ve been tracking, and otherwise for I have no idea how long, I had 8 consecutive days without suicidal thoughts or urges. It was wonderful! (My “relapse” yesterday was triggered by a very specific situation that has been dealt with and is easily avoidable; if I choose to write about it in this blog I’ll do so in another post.)

A graph showing Ziya's (standardized) scores on the subcategories of the Burns Depression Checklist from September 16 to October 16, 2014.

Ziya’s (standardized) scores on the subcategories of the Burns Depression Checklist from September 16 to October 16, 2014. There are multiple instances when the purple line drops to 0 and disappears, indicating multiple consecutive days with no suicidal urges!

Considering the presence of other, shorter periods of time with no suicidal thoughts or urges earlier in the month, I’m optimistic that this has the potential to become my new norm. And that, oh wow! It’s not just about wanting to live. It’s wanting and being able to live while also being true to oneself. It’s having multiple options; seeing the full complexity of a difficult situation instead of just the discouraging parts. It’s knowing where my toolbox is, seeing the tools when I open it, having the confidence to use them, and making creative use of duct tape.

Beyond the Burns Depression Checklist

I’ve continued tracking my depression symptoms using the Burns checklist for another month. The oscillations have been a bit less extreme: There was a period of higher (worse) scores near the end of August when we had to put Trouble (our 2-year-old pet rat) to sleep. This was followed by lower (better) scores at the beginning of September when I got to spend some time with Banji and had my first in-person session with Wakana in about a month. Then I started a new game in The Sims 3 (my current family) and, well, I think the scores pretty much speak for themselves. I’m noticing that I tend to have much better (lower) scores when I go out and socialize; this is in part because some of the items on the checklist are basically asking “Did you interact with other people today?” but I think it tends to help my overall mood, too. My average for this month is 32.

Ziya’s scores on the Burns Depression Checklist August 17, 2014 to September 15, 2014

Ziya’s scores on the Burns Depression Checklist August 17, 2014 to September 15, 2014

The items on the checklist are organized into 4 categories: Thoughts and Feelings, Activities and Personal Relationships, Physical Symptoms, and Suicidal Urges.

Thoughts and Feelings

The first category consists of 10 items describing one’s subjective experience, including: “feeling unhappy or blue,” “feeling hopeless,” “criticizing yourself or blaming yourself,” and “difficulty making decisions.” I’ve been scoring fairly high in this category (relative to the others), with no particular items standing out as more or less problematic than the others.

Activities and Personal Relationships

The second category consists of 7 items that describe behavior and subjective experience related to work/hobbies and social life. Although I feel worse on days when I withdraw from my social network, the items I struggle with most consistently with are “motivation” and “avoiding work or other activities.”

Physical Symptoms

There are 5 items related to sleep, appetite, sex, and “worrying about your health.” This is the category I seem to consistently score the highest in. Even on really good days when my thoughts, feelings, and behavior would suggest otherwise, my body seems to be depressed. Hopefully soon I’ll learn whether that’s (in part?) because of a sleep disorder.

Suicidal Urges

The final category asks 3 questions: thoughts? desire? plan? Fortunately this is the category I score the lowest in – usually.

Instead of tracking each item separately, I decided to look at my scores for overall categories. To standardize the scores, I divided the total score for each category by the number of items in said category. As a result, all the scores represented on the graph below are between 0 and 4. (Well, 0 and 3, but they could go up to 4. I really hope they don’t!)

Ziya's (standardized) scores on the subcategories of the Burns Depression Checklist from August 17, 2014 to September 15, 2014.

Ziya’s (standardized) scores on the subcategories of the Burns Depression Checklist from August 17, 2014 to September 15, 2014.

Unlike the month I tracked last year, there seems to be a disconnect among my subjective experience, behavior, physical symptoms, and suicidal ideation; the lines don’t move with any kind of pattern that would suggest they have anything to do with each other (correlation?). One thing I do notice is that my Suicidal Urges are the worst (highest) when my Thoughts and Feelings are as painful as or worse than my Physical Symptoms. I can deal with having low physical energy, but when I feel really sad, hopeless, and hating on myself on top of that, it becomes pretty tempting to just stop existing. I think it’s way past time for me to start engaging in cognitive behavioral therapy (CBT)!

Finally, as I wrote when I first posted about this in Measuring Recovery: Part One, the Burns Depression Checklist doesn’t include everything I believe is important to consider when assessing my mental health (such as symptoms of anxiety). My goal is to eventually develop a way to keep track of changes in various indicators of mental health, including signs that I am becoming more healthy and not just less mentally ill.

I’ve started tracking other symptoms that concern me, rating them on the same scale: 0 = “not at all”, 1 = “somewhat”, 2 = “moderately”, 3 = “a lot” and 4 = “extremely”. Some of them are symptoms of anxiety, others have to do with depression … it’s actually kind of confusing. I’ve heard irritability described as a symptom of depression, anxiety, and mania/hypomania! I guess the point isn’t so much to associate them with the correct disorder as to be aware of how much they’re affecting me. This is an imperfect numerical representation of my recent subjective internal experiences.

I put the symptoms into categories that sort of mirror the ones on the Burns, but I haven’t done the kind of empirical testing that’s necessary to determine whether my “checklist” measures anything meaningful. For that reason I have decided to track each item separately, even though it makes for fairly messy charts. Here’s what I have for the first half of September:

Ziya's scores on anxiety-related symptoms September 1, 2014 to September 15, 2014

Ziya’s scores on anxiety-related symptoms September 1 – 15, 2014

Ziya's scores on physical symptoms September 1, 2014 to September 15, 2014.

Ziya’s scores on physical symptoms September 1 – 15, 2014

Ziya's scores on irritability-related symptoms September 1, 2014 to September 15, 2014

Ziya’s scores on irritability-related symptoms September 1 – 15, 2014

Ziya's difficulty concentrating and communicating September 1, 2014 to September 15, 2014

Ziya’s difficulty concentrating and communicating September 1 – 15, 2014

I’m inclined to see my tracking method for the additional symptoms as a work in progress, but I do like using one graph per category and graphing each symptom separately. I think I’ll stick with it as-is for a while, and make changes as I feel inspired. For example, I originally had 10 items; I added “excessive or out-of-control worrying” and “difficulty relaxing” on September 3rd. Though the graphs don’t reflect this, I also needed to re-arrange the items to create the existing categories.

The new items use the same scoring as the Burns specifically so I can compare them. Is there any relationship (correlation?) between my scores on the Burns Depression Checklist / its subcategories and the additional symptoms I’ve chosen to track? Honestly, I have no idea.

Return to Psychiatry?

I just got back from meeting with an advanced practice nurse (APN) for a psychiatric evaluation. I like her a lot: she was down to earth and personable. I felt like I could relate to her and trust her. She made a real effort to listen to me and ensure that her understanding of my history and current situation was accurate. She took the issues I’ve had with medications in the past seriously.

She screened me for bipolar and OCD, but hasn’t made an official diagnosis. First she wants to see the results of the blood work I had done when I went to see my primary care provider a few months ago. She also gave me a prescription to get a sleep study done to see if my problem might actually be sleep apnea or another sleep disorder. It could be that chronic lack of restful sleep has been keeping my brain from functioning properly and causing (or at least contributing to) my depression and anxiety symptoms.

Finally, she sent me home with a self-report measure to fill in over the 4 weeks between now and my next appointment. Every day I get to rate symptoms such as depressed mood, mood swings, irritability, food cravings, anxiety, sleep issues, difficulty doing things, and physical symptoms. There are spaces to mark day of the week and whether I have my period. As I complete it, I’ll be making a graph; it’s pretty neat.

Perhaps best of all, she agreed to talk with Wakana to coordinate my care. I guess time will tell how well they can work together to help me.

To be honest, I have mixed feelings about the situation. There’s a part of me that’s disappointed because I don’t have medication to take and either (preferably) gain relief from or complain about. It’s basically more of the status quo, at least until the data from the sleep study has been analyzed.

The rest of me likes that the APN is proceeding cautiously and trying to gather as much information as she can before prescribing drugs that may do more harm than good. She seems to be thinking about what is best for me as a whole person, not what will be the most convenient. It may take longer than I’d like before I have a treatment plan that’s truly effective, but hopefully I won’t have any more false starts and stops with medication. I may have found a keeper.