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Introduction to Mental Illness. The Brutal Truth

May 21, 2018

So someone in your family just got diagnosed with a severe mental illness. Let’s call him Adam.

I should mention. I’m not a doctor. I’m mentally ill. This is my experience. Whatever medical waiver I need to declare to not get sued for my personal advice. Consider this it.

First, let me say this flatly. If you think this is a life threatening emergency, stop reading and Dial 911.

I’m. Not. Fucking. Kidding. (Yeah, I know, I know. I used bitch tone. This is nothing to play around with)

If Adam feels unsafe. Dial 911. In the future if Adam is suicidal, dial 911. If you feel Adam is a danger to himself or others, but he won’t go, and you are scared: suck it up and dial 911. Adam will forgive you when the danger has passed.

It can be the hardest thing you do in your life. You might weep, soul crushed as he’s taken in whatever emergency vehicle is used. (My county has a smart car and paramedics dedicated to mental health, and a mental health emergency room). But you just saved Adam from hurting either himself or someone else.

Sufferers do not be afraid to go to the emergency room, it is scary, but be bold this is to help you. Everyone there is there to help you. Do not be afraid to go to the hospital. They are safe spaces.

And if you find a bad one, have your family complain about your treatment until they are sick of their nagging and transfer you.

Adam has rights (covered further on). Hospitals on the most, are places of healing. (Forget everything you see in TV or movies unless compassion is the heart of treatment) The nurses are there to help Adam. They’re not there to hold him. They’re there to pick him up in an emergency, and get him through to being at home at least. Many hospitals are connected to social workers who will help guide Adam.

On dialing 911 because you think Adam might be a threat to others. Please understand this is his symptoms. This is not him. If I hit rage and my back-off button was pushed too many times, I would get violent because I would lose control. If Adam seems frightening. He’s probably not in control. Forget forgive, there’s nothing to forgive. There is only healing.

I’ll say it again. Adam is not his symptoms.

Next, as this is new, please get a book on Adam’s diagnosis and read it cover to cover. There’s usually one that’s always recommended by others with a given illness. For mine (Bipolar I with Psychotic symptoms): It’s an unquiet mind. An account by a psychiatrist of about her own mental illness. It’s a bit stuffy but it’s the go-to book. There are others. Unfortunately I know an amazing book on schizophrenia but I can’t fucking remember it at the moment. They exist. Find one that gives a compassionate account and resonates with you, then study up. You will both be living with this for the rest of your lives.

With diagnosis must come treatment. Let me make that absolutely clear. Adam has to take his medication every fucking day for the rest of his life. If he doesn’t like it, he needs to change it. If he’s on several and he’s been medicated for about ten years, maybe yeah. Then he might know what he is doing. But he needs to have a good trust system with his doctor first. But make sure he does not stop. He will also need therapy for the rest of his life. But sometimes that’s a battle further down the line.

As far as I can tell the first thing that happens to most people seeking treatment is is a cognition crash. I’m talking about a specific line of illnesses. I have to talk a lot from personal experience here. But there's more information stuffed around personal details.

Bipolar and Schizophrenia are on a spectrum with Schizoaffective disorder in the middle. I am very close to that middle line. And depending on how close Adam is to the middle, part of his experience could be a mood crash. A natural part of the wave, deepened by medication. If it’s that, he needs antidepressants. But some psychiatrists are rigid assholes and won’t prescribe them to anyone middle line or to the bipolar side. Even though every patient is different, and some get better with them.

Please make sure you and and Adam are very aware of his patients rights. He does not have to take medication he doesn’t want to (but change it, don’t stop it). He can demand to change medication. And He can shop for older psychiatrists who tend to know a lot more about what they are doing. There are more rights, have everyone in the family get to know them https://www.webmd.com/mental-health/rights-mental-illness It’s a shitty resource but it would take serious digging to find my copy of the proper one. Watch for a posting of patients rights. That’s a sign of a better practice.

Also, if you are both concerned Adam is too impaired to be able get sufficient help from the doctor, he has the right to bring you in. I had my mother come with me at first, then I was fine. Years later I had my spouse come during a dip in cognition. Then my spouse gave me notes. Then I was fine on my own.

If it’s medication causing the dip, that’s complicated. Different medications respond very differently to pretty much everyone. I’m at max dose for everything I am on, and for two of them I am technically over max dose. My body metabolizes medication very fast. So depending on how he metabolizes it, he could be on too much or too little. Or he could be on the wrong medications.

He might need to try one that has off label uses. I’m on medications that send some people into sleep, while for me? I need them for my ADHD. And if my ADHD isn’t treated I get depressed. I had an arse-tonne of learning disabilities long before bipolar showed up, and still have them to varying degrees, some made worse by medication, some improved. I had learnt ways of coping with ADHD. But co-morbid with bipolar (as is frequent) I need medication now.

Also on medication. Please be in for the long haul, because getting it right can take a lot of incremental experimentation. Progress is slow. But be fierce, do not let his doctors settle for just no hallucinations or voices. Or no mood swings. Force them to get his cognition back too. Or if you must, form a balance.

I still hallucinate once in a while. But we live with it because it causes no harm. They used to creep me out but usually don’t anymore. With the exception of ants. If I see ants I will start seeing them everywhere. Ugh. Mostly I see wood turn to liquid, shadows move, sound hallucinations and sometimes voices. (Voices can be internal).Patients suffering with voices will sometimes get louder to drown them out. Please be kind to them.

After a while, us grizzlies who have been at this a while, start to form peace with certain symptoms or degrees in order to have the life we want. But we still take medication. Frankly with what I’m on, there’s only so much we can do.

A word on doctors. I’ve been treated by a lot of doctors over the years. My current one is a genius. The most compassionate man I have ever met. And will treat anxiety with education if that's what you need. He keeps up on the latest research, and new discoveries on old drugs. That’s what you really want.

But some of them are morons. Intelligent enough to pass medical school, but lazy in their thinking. In general I recommend going for older doctors. Or if you really can’t find one in your plan, pay out of pocket. Or see if a low income medical facility will take your insurance. A lot of very intelligent and kind people donate their time.

Indeed over quick-thinking the one thing you should value most in a psychiatrist in genuine kindness. Next feature you should look for is a doctor who isn’t dumb enough to think that just because Adam pulled it together to show up, doesn’t mean he’s not suffering. Depression has many faces, some of them are smiles.

A lot of people don’t know this. But Bipolar can cause brain damage. I don’t know how the rest of the spectrum stacks up.

If it’s brain damage or brain damage and medication, causing cognition loss, that can be fought through. But the first time is the hardest. It takes longer and causes anxiety and frustration. I was a 99th percentile genius in mathematics at college. Before treatment. And the day I realized I couldn’t even multiply fractions anymore I broke down sobbing. I remember mathematical concepts. But if I want that part of my brain back I would have to rewire and I don’t have the spoons for that.

By the way, if you don’t know spoon theory. Get cozy with it. You will both be living with the concept for rest of your lives. https://en.wikipedia.org/wiki/Spoon_theory Sorry if that sounds harsh, I’m kinda low on spoons at the moment myself, but this is too important to ignore.

During my first cognition loss, I was reduced to catatonia and that was a combination of mood crash, medication, and an abusive relationship I would never have fallen into without the first two. How bad? I watched “Charlies Angels” three times and still didn’t get it. Friends later generously told me it was because there was nothing to get :P

But when I stopped taking the drug that squashed me. I still needed to rebuild, rewire. I had to create new pathways to old knowledge. And create entirely new pathways and lines of thinking.

I would push my boundaries a little each day, taking rests, and adopting a new mantra. Dream small and let big things happen. Honestly it’s the healthiest mantra I know. For anyone, but particularly someone with a mental illness. But only try to master one thing as a time.

If trying to rewire causes anxiety I lean into that as much as I can, then take an anti-anxiety or treat it with indica or an indica dominant hybrid. Now that it’s legal, my doctor can finally talk to me about ways to treat my illness with cannabis. It has been very helpful, particularly as getting mania under control was a bumpy road.

Start to get used to the idea that taking a shower can be an achievement. And sometimes that’s all Adam need or can do. He can still succeed in the greater world, but through time and perseverance. It’s a longer road. The daily, weekly goals are to survive or even thrive. It’s not lowering the bar. It’s pragmatism. Some days, weeks, months, years, are just a fight to stay afloat. And that needs to be okay. And I’m speaking for both of you.

If Adam does decide to use Marijuana to treat anxiety it’s very helpful. But make sure he sticks to an indica dominant strain. Unless his body is counter intuitive and he finds sativa relaxing because brains are weird. But if he is going to do so, he will need to experiment to find the right one. AND he should not do so if his cognition is so impaired that it will cause increased distress. I vape so I know a few good hybrid cartridges. But I have the tolerance of an ox. Again some strains are stronger than others. Do not start Adam on grand daddy purple.

Usually my progress goes like this. Outloud: “I can’t do this, I can’t do this. I fucking hate this. Fine I’ll try. This sucks I can’t do this. I don’t want to do this.” Panic attack. Rest. Repeat of words except this time I get a little done. Then “I fucking hate this. I can’t do this anymore. I don’t want to do this anymore. This fucking sucks.” Rest. Repeat within reason, before I'm exhausted.

Then I do it the next day. And then I do it the fucking next day. And then one day I stop complaining to no one. It's still hard, I still have work. But it's progress.

My spouse has gotten used to me dressing to go out while constantly bitching that I couldn't do what I then went out and did like a boss. I'm English, so maybe it's a cultural quirk. But I find it easier to fight my fear if I express it, and then fight it with deeds.

Pathways in your brain are formed a little like ball-bearings rolling across dough. The more you roll those ball bearings the faster and easier they go. Wee! But if part of you has been blocked off you have to start over. And it’s harder because suddenly all your experience means squat and it causes performance anxiety and imposters syndrome. But if Adam keeps pushing those ball bearings, he will get those pathways back.

Now, keep this ball bearing example in mind. Because everyone’s pathways are like these little ball bearings. So, if he’s depressed, ball bearings will go that way. And the longer negative thoughts rattle down those paths, the harder it is to get them to go somewhere else. The process of change is somewhat similar.

Adam will backslide. Or might lose the connections again. But he needs to keep fighting and sometimes recovery is faster than others. Even if it gives him a whollaping headache in the process, Stay positive. And for both of you. Never, ever fucking lose sight of Hope.

I did. I gave up. I didn’t see the point in fighting. I was almost destroyed and it broke my families heart. I needed another six years to climb my way back into feeling like a person again. Which needed a lot of therapy. (See I told you)

So if Adam gives up, call down to your soul and grind on, and don’t give up on him. Because with enough love and the right treatment, or environment, he might come back.

It took me ten years to just try again. But my mother never gave up.

I'll say it again: Never lose hope.

There is also stigma, and I will address that in another post. Because that's a whole lot to unpack, and it's late. And I don't want to right now.

As a side note. I share a lot about mental health on my facebook page. Many of my readers just look over once in a while to see if I have anything new. Please have Adam read the pinned post at least. Depending on spoons I post about mental illness when I have something fierce to say. You don’t have to follow me, you can ignore my books. I’ll share to my private wall so those of you who know me can find out that way. But I mention it because sufferers have thanked me in private for some of the things I’ve said. So please, use me as a resource. Being public is my advocacy.

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