I went to see the psychiatrist yesterday

I went to see the psychiatrist yesterday

Written by a lady I respect enormously, this is about the bipolar disorder that affects her. Incredible honesty and understanding, she has asked to remain anonymous.
This note is being written as part of mental health awareness week. It is an article I have contemplated writing for sometime mainly to educate and give non sufferers and insight into what it is like to live with Bipolar Disorder.
Firstly the title, I went to see the psychiatrist yesterday. It is a measure of my change in attitude towards this illness, that I can announce this and not feel I shouldn’t be telling people. This illness is not one I want, not one I can control and certainly not one to be ashamed of. Sad to say some have made me feel as though it is and one by one I rid those people from my life. The reason I am back to see the psychiatrist is whenever mood becomes unstable I get referred back to see a psychiatrist. I was referred back via my GP in February as I told him quite how bad I was feeling. I actually managed to remain quite cool calm and detached as I told him, almost envisaging it was someone else telling him not me. One question he asked me caused that mask to crack I was inconsolable as I told him I had enough of this illness and did not want to live with it anymore. There is no cure, the periods of wellness between episodes seems to be decreasing the older I am and in the last 18months I have becomes very mentally unwell 3 times. This is not a life, it is an existence I plan things look forward start living as I want and bang I am struck down again. I sat crying and saying I have truly had enough. I think that is the quickest the mental health system has ever kicked in big time. Referral and seeing a pysch within 2 days and immediate support from the Community Mental Health team. I washed my hands of them 10 years ago because to be frank they were bloody useless. I will say this time my care has been excellent . Her diagnosis at the moment is depressive episode but I know myself I am well on the road to recovery, when I read my awful mood journal entries for March. I am having very few bad days, and funnily enough one of them is today where I do not feel as well motivated and feel tired…..but hey infinitely better than where I was. This time I have been tried on three new medications, none of which could I tolerate due to side effects. The upshot of all this is I am now on less medication than when I started. The psychiatrist was ready to discharge me yesterday as she said how well I was, it was lovely to see me smiling and joking with her. The thing which stopped her discharging me was my honesty. I said despite feeling well now, deep down I no longer want to live with this illness for this is not what I call a quality of life. She asked me to explain. I said how I had been relatively stable for a number of years then bang 3 horrendous episodes in the space of 18 months. I said I have been ill more in that time than well, I am concerned the nature of the beast is changing and I am finding it more and more difficult to cope with depressive or mixed mood episodes ( I will explain those later). I came out of that psychiatrists office yesterday with something far better than medication, the thing she gave me was hope. For she explained to me that sometimes with BP if you have had a prolonged well spell you can get what is called a cluster of episodes. The fact that I expressed my opinion she decided not to discharge me but to see me again in 3 months to check I am in remission. This is the term used when the illness is non symptomatic, there is no cure the chances are I will become ill again and sometimes this very uncertainty does my head in. I have always been a great planner, a great organiser…..I plan things I look forward to things but the last 18months I have become almost frightened to plan and look forward knowing I could be hit with another episode out of the blue. So damned frustrating for a driven person.
Bipolar disorder (which used to be called manic depression) is a recognised mental illness, which is a mood disorder. Everybody has ups and downs and it is part of life that we all have things which make us happy or sad. With bipolar disorder you experience a change of mood sometimes without any recognisable event to trigger it. These mood changes are sometimes sudden and the mood has to be consistently down or up for longer than 2 weeks to be deemed to be an episode. There are 4 classifications of bipolar disorder. Bipolar type 1 where the individual experiences the full mood range from severe depression up to mania (sometimes with psychosis). Bipolar 2 (which is my official diagnosis) which experiences the severe depression but only naturally elevates to hypomania, cyclothymia which is a type of rapid cycling bipolar ( I think DSM states 4 episodes per year ) there is finally unspecified bipolar where the sufferer has bipolar symptoms but does not fit clearly into one of the three categories. Last time I did a literature search on the disorder there was some debate as to whether seasonal affective disorder (SAD) should be brought under the bipolar umbrella, indeed I can clearly identify a seasonal element to my moods.
Episodes can be classified as depressive, hypomanic/manic or mixed. Psychosis can be experienced by some suffers where they have completely lost touch with reality. I have had what is sometimes called pseudo psychotic features. I have heard voices and I have seen things which I know are not real…..the fact that I am able to distinguish real from non real means it is not true psychosis, still it makes it no more easy to live with.
Before I go on to talk about the illness I want to point out that no two people with bipolar disorder experience exactly the same thing. We may have certain features in common but every individual can have a slight difference. The more I talk with fellow sufferers the more evident this becomes.
So what is depression, generally it is classed as feelings of persistent sadness, low self esteem, loss of interest in things you usually enjoy, lowering of energy levels, alteration of sleeping and eating patterns. Many report loss of appetite in low mood me I have the opposite problem, can’t stop eating. That said early on in this bout I had zero appetite until put on meds which gave me the appetite of several elephants. The eating problem has never been addressed probably where I have not high lighted quite what a problem it is but in low mood I literally have an almost compulsion to eat, I have zero self control and for some reason that craving is sugar. A seasonal weight variation of 2-3 stone is not uncommon for me. It is something I am now trying to address as I have started to talk to a nutritionist with bipolar disorder .
Now for the bit they don’t tell you. When severely depressed, which I was in late Feb early March, I become almost non- functional. I slept and slept. I would wake thinking I must get up and that very thought was enough to make me cry. I got so low my target for several days was just to get out of bed. Oh showering is a different matter it isnt that you dont want to remain clean, you are just so tired things you usually do automatically shower gel on shower puff shower on towel at ready absolutely no chance. The concentration span of a squashed gnat. A few times I have showered using Lord knows what not shower gel, as afterwards realised my skin has a strange aroma( possibly shampoo possibly creme cleaner which I had on the side to clean the bath) During severe depression I cut myself off, I am really ill tempered. I get angry and frustrated with my inability to perform the most basic of tasks. I hate people seeing me in a mess and I actual feel the need to be alone to sort things out. Even conversing seems a tremendous effort. My cognitive slowing is such that I can not physically walk or talk fast and my speech was actually slurred when I presented myself to GP in Feb, my energy levels being so low John drove me to the doctors. I also experience a strange left right reversal in low mood and my brain struggles to work out which knob or button operates which ring on my cooker. I experience a great intolerance to noise especially repetitive mechanical noise and screaming babies/children. To get over this I am often found plugged into my MP3 player. I often find I start a job and my mind has gone off on one and I”find myself “ in a different room no recollection of how I got there but very often pacing up and down.
I am now going to be really open honest on several topics which are taboo subjects to many those of suicide and self harm. I have often heard it said suicide is a thoroughly selfish act and to be fair I can see why people think that. I have in my lifetime seriously contemplated it about a dozen times and on one occasion tried, obviously not successfully. It frightens me still how close I came to ending it all just over a year ago while I was having a horrendous mixed mood episode and again earlier this year. I had got as far as planning what I would do and what I would write in individual letters to my family. It is strange I found those letters quite easy to write to son and husband the one I struggled with was my daughter Laura I had the gut feeling it would impact on her more than anyone. The mind can play funny tricks for in that episode I started to google the lethal dose of a particular drug. (not that that was my final method of choice) As clear as anything I heard my daughters voice shout at me just one word “Mum” !! That voice startled me, it was as though it jolted me back from somewhere I did not want to be. The mind plays havoc in depressed mode it played over and over certain horrible things people had said about me which showed me in bad light, I had overwhelming guilt sometimes I knew why sometimes not. My mind almost blew up and distorted certain events, I felt so bad I genuinely believed I was the most evil creature that ever walked this earth. I believed I was wrecking my beautiful family’s lives seeing me a mess them pussy footing around me, I was a burden. Yes I knew my death would upset them but that they would eventually get over I genuinely believed they would be better off with out me. Now turn round and tell me someone committing suicide is selfish…..no they are not, they are merely acting on deluded irrational thought. I know it does not make it right but I do want to try to make people understand suicide is not a selfish act it is a desperate and very sad act, sad that the person felt unable to reach out and realise they could be well again. In suicidal frame of mind I get this feeling I want to escape, mainly from the wretched way I am feeling. Funnily enough last time I felt in that frame of mind I started to contemplate life after death. That horrendous thought then dawned upon me what if I were to commit suicide I died, to find then there was an afterlife in which I was still bipolar. Oh my God mentally I was like a trapped animal I wanted to escape but my only way had been cut off. I felt so angry it felt like I was forced to live this hell and yes I do not use that term lightly because it is my minds hell. I have no control over those intrusive thoughts which plague me. I have not control of negative thought/voices, I feel as though I have no control over anything. At times when I am very unwell I am convinced I am paranoid schizophrenic. I recognise my paranoid thoughts and it is an indicator all is not well. So you may be wondering why I think schizophrenia when unwell. I get this odd thing of two parallel thought trains my own 2 voices arguing opposing viewpoints in my head. One is rational one is not, the danger point comes when I am no longer able to recognise which is irrational. I have discussed this with my psychiatrist and she said no definitely bipolar. As an aside I spent a spell in a psychiatric hospital the first time I had some sort of breakdown (due to taking antidepressants when not diagnosed bipolar) I was invited in as a voluntary patient with the implication if I did not comply it would be enforced, for the psychiatrist saw me in uncontrollable fits of hysterical laughter to sobbing and saying I wanted my life to end in the space of an hour. I remember while in the hospital reading a leaflet on manic depression and thinking oh crumbs some of this is me. I asked a psychiatrist at the time do you think I have manic depression, his answer haunts me still “No Linda I do not, now go and get that intelligent brain of yours working properly else it will play games with you”. I did not understand what he meant at the time and I did not have the opportunity to ask, but I think I know now. I think he knew I was, I think he also realised a mental health diagnosis would devastate me. I think he realised my untamed bipolar mind had served me well giving me my flashes of brilliance while studying for my PhD, I think he knew that that would largely go when medicated…….
Now for the next taboo subject that of self harm. I am not going to lie and say I have never self harmed because in my younger years on a couple of occasions I did, again when severely depressed but when the depression lifted the behaviour stopped. Self harm is often classed as attention seeking behaviour. I will tell you at the time I felt great shame in what I did and went to great lengths never to be found out and certainly not to have any lasting reminder. It is odd I actually felt I was being very deceitful in hiding it. I will tell you exactly what was going through my mind at the time. I was experiencing great mental pain, I do not wish to go into the whys or wherefores and it was by chance that I found that physical pain deadened that mental pain. Whether actually hurting yourself causes endorphin release I dont know. Sorry family if this has shocked it was a long time ago. So do I think self harm is attention seeking no I do not, it is a manifestation of a mental illness.
Now for the flipside of mood that of hypomania/mania. I am classed as bipolar type 2 so experience hypomania and not usually mania, that said prior to my diagnosis in 2005 I was yet again placed on anti depressants a catalog of errors by GPs and ignoring my husband when he said you do know the psychs at Salisbury did say they felt Lin was bipolar. If a bipolar person is placed on anti depressants without a mood stabiliser, it can cause the mood to elevate too far. I had said I had reservations about taking anti depressants I had taken them once before and they had caused some sort of breakdown and they altered the way I thought, my mind was obsessed with religious thoughts and ideas. Sure enough this started to occur again, I returned to the Drs he doubled the dose, I began not sleeping. My husband came with me to the doctors they gave me another drug. I became worse still unable to get an appoint the doc advised by phone to double the dose of the seconddrug. After 7 night on no sleep I was climbing walls almost literally. I had this obsession with writing down all this weird stuff streaming through my head so fast I could not keep up with it. After one horrendous night mood swinging everywhere I got GP appointment. I had entered some kind of multiphobic state, I was not sure what had really happened, what I had dreamed or what I had imagined. I truly felt I was going mad, I was holding some very strange deluded belief and I have never felt agitation like that. To cut a long story short a psychiatrist appeared at my home and I was immediately sectioned. It was then I was diagnosed bipolar disorder and what I was experiencing a manic episode…damn I wasn’t superwoman and couldnt fly!!! At the time I was ambivalent about my diagnosis as I had never felt that way before I took anti depressants. The psych explined to me the fact I went manic I must be bipolar and when you havent experienced it it is called masked bipolar.
So what are the characteristics, marked rise in energy levels, decreased need for sleep, racing thoughts, delusions. It is said that some bipolars go on mad spending sprees, gamble and get into debt and become sexually promiscuous. I can say I consider myself fortunate for my mood to only naturally elevate to hypomania, in the early stages it is a really rather nice place to be . I have good ideas, I am enthusiatic ambitious and the life and have a cracking sense of humour! The problems start when the mood elevates too far the mind does not switch off. Last time my mood went a bit high I was laid in bed unable to sleep and I spotted the wardrobe, my mind went into automatic pilot making words out of the letters in wardrobe, it was racing out of my control I couldnt stop it.
As I think back I think possibly I had bipolar traits as a child and they were missed. I know I saw things and when I told my mum she said I must have been dreaming but no I know I was awake. Even as a kid I couldnt sleep and have a very vivid memory of my mum getting up at 6am to find me in the kitchen knitting a poodle dog. I had no pattern to work from. How to do the pattern came in my head in the early hours and it was nearly complete when she came downstairs.
I also seem to get an obsession with codes when the mood is high. At one point I had this manic idea that Beethovens 5th symphony was a coded message with each note representing a letter, I spent some time trying to crack that code. One time I had what I thought was a brilliant idea for writing an uncrackable code (err deluded) strangely though every time I hit that higher mood I get another idea how to refine it and maybe one day……
The last thing I can experience in low and high mood are hallucinations both auditory and visual. Many report voices being threatening. Some of the things I have heard are really quite bizarre for instance on one occasion I clearly heard a woman announce the black trousers and tea towel are on the line, on another I clearly heard my older sister shout mind that plate….strange eh? Only once did I ever hear a threatening voice a male voice with a thick Geordie accent telling me to kill myself, my reply to him f*** off you aren’t real. The worst auditory hallucination as far as sleep is concerned is what I call the gunshot/loud metal tray often happens as I am falling asleep wakes me up with a jolt and that is sleep out of the window for another few hours ( I get this one when well too, thinking I was going crazy I googled it, it is called exploding head syndrome)
Visual hallucinations are a very mixed bag sometimes it can be something like a colour being brighter and somehow making it stand forward from where it really is. It is an odd effect which I can not verbally articulate. When my mood is high by brain can see something add 2+2 to make five. I once caught site of a tomato stalk on the side I said omg look at that spider despite someone saying it was a tomato stalk the more I tried to see the stalk the more I could see a spider. The most horrendous hallucinations I have ever had where my brain has superimposed someone I knows face on a complete stranger. That one really did make me lose confidence to communicate with anyone I saw, in case it was not really them. Another horrible hallucination I got just prior to a hospital admission was this black nodding skull with bright red eyes it would suddenly appear on a wall. If I stared hard at it hoping it would go away then look quickly to a different white wall I got the contrast image just as you do if staring at a real image. I got no respite from this one for it got so bad I would even “see” it on the inside of my eyelids as I closed my eyes to sleep. I have also had odd effects reading a newspaper an odd word can appear dark and jump out at me and strange as this may sound it seems like it is trying to give me a message. Also my mind has suddenly picked up on something being said on a radio, which seems to have particular relevance to me. This is not a medicallly recognised term but I call it quasi schizophrenic the radio isnt quite talking to me but heading in that direction.
The last type of episode is called a mixed mood episode. To me these are the worst type for I know with straight depression I get some respite with sleep and rest. Mixed mood is a different kettle of fish. A mixed mood episode is one that has some features of mania and some features of depression. Usually with me I get racing thoughts and delusions which are manic traits but those actual thoughts are depressive in nature. This for me it the mood episode in which I call my myself considerably at risk. The overriding outward appearance is depression but I get little sleep with my mind racing these depressing thoughts and memories. My mood begins to drop very precipitously I can go from feeling quite well to suicidal in a very short time frame. I started this year by bagging up loads of meds that had failed and took them to the chemist for disposal. At that time I was feeling really well and thought right there are enough drugs in there to kill a baby elephant get rid of them while you are well. Daft as though it seemed, I felt I owed it to my family to protect myself as well as I could. It is interesting that as I am emerging from this depressive episode having amassed more drugs, I thought earlier today I owe it to my family but I also owe it to myself. I have much to look forward to do not take an unnecessary risk.
Well I have rambled somewhat and this has probably left you either gobsmacked feeling you really don’t know me at all. I still am unsure whether I am doing a really brave or really stupid thing in writing this article; but it is me, take me or leave me if you decide to leave as a result of reading this adios been nice knowing you, close the door quietly behind. Seriously this is why I always say you have no idea what battles others may be fighting….you now have a very good incite to mine thank you for reading hope you have found it informative.
ENTREPRENEUR, PSYCHOTIC OR PSYCHOPATH

ENTREPRENEUR, PSYCHOTIC OR PSYCHOPATH

A lot has been written about entrepreneurs, psychosis, and psychopaths especially more recently in the context of corporate and national leadership and success.

What traits differentiate someone who is a psychopath from an entrepreneur? And what about this other word we hear about – psychosis; where does that fit in? If I go into business for myself do I have to become a psychopath to be successful?

Let’s look at these three individually and then have a look at the links or similarities, where and why.

 

ENTREPRENEUR

An entrepreneur by definition is a person who starts a business (sees an opportunity or potential), invests their time taking on financial risk in the hope of a making a return. In the entertainment industry, an entrepreneur sees talent (opportunity and potential), invests time and money (the risk) in hope of a reward – financial and making the talent into a “star”. As another example in the third or charity sector, a person sees a need (the opportunity), invests time and effort raising awareness (and support funding) and reaps the reward of resolving /meeting the need and the satisfaction of having done so.

Characteristic Traits of Entrepreneurs

According to Ruchira Agrawal, CEO of Inner Veda Communications, the characteristics of an entrepreneur can be summarised as follows (I have shortened her article published in Monster):

  1. Motivated: Enthusiastic, optimistic, future-oriented, believe they’ll be successful; risk their resources in pursuit of profit, high energy levels, sometimes impatient, always think about their business and how to increase market share.
  2. Creative and Persuasive: Have the creative capacity to recognize and pursue opportunities; possess strong selling skills, persuasive and persistent.
  3. Versatile:  Will wear several different hats, including salesman, telephonist, secretary, book-keeper and so on.
  4. Superb Business Skills: Able to set up the internal systems, procedures, and processes to operate the business. Focus on cash flow, sales and revenue; rely on their business skills, know-how, and contacts.
  5. Risk Tolerant
  6. Drive: Proactive to everything, a doer, willing to take the reins.
  7. Vision: To decide where your business should go.
  8. Flexible and Open-Minded: Facing a lot of unknowns, ready to tweak any initial plans and strategies.
  9. Decisive: No room for procrastination or indecision.

 

PSYCHOSIS

Psychosis is a mental disorder where the affected person perceives and/or interprets events differently, their thought processes and emotional well-being are impaired and they lose contact with reality. A notable point about psychosis is that our main source of information about it tends to be the media. We hear and read stories of the behavior of people having a psychotic episode who have injured or killed other people. Then there are the films based on mentally ill people like Psycho and Silence of the Lambs. The truth is that people having a psychotic episode are more likely to be the victim of violent crime than the perpetrator.

Looking at statistics the charity Mind refers to a report that suggests that only 0.7% of the population was affected by a psychotic disorder in the last year and 7.7% of people may be affected by bipolar disorder, antisocial personality disorder and borderline personality disorder in their lifetime – of these 25% recover completely after the first episode. It is important to remember that early treatment enhances the chance of a full recovery but affected people usually have no idea they are actually very ill.

Someone suffering a psychotic episode may show some of the following symptoms:

Hallucinations Sight, hear, feel, smell or taste
Delusions – an unshakeable belief in something that is not true Muddled thoughts; confused, disturbed thoughts, strong beliefs not shared with others or based on reality (such as being watched, or a conspiracy to harm them), paranoia
Changes in behavior Hyper-focus, social withdrawal, lack of functioning in everyday tasks, lack of personal hygiene, not eating regularly, altered sleep patterns, not going to work. Emotionless, flat. Short fuse, get angry. Anxious
Lack of insight and self-awareness Jumbled or rapid speech making conversation difficult. Not in touch with reality

 Types of Psychosis

  • Bipolar disorder (formerly called manic-depressive disorder) – Bipolar 1 Disorder, Bipolar 2 Disorder, Cyclothymia
  • Schizophrenia, Schizophreniform Disorder, schizoaffective Disorder
  • Borderline Personality Disorder
  • Mixed Affective Disorder
  • Delusional Disorder
  • Post-natal Psychosis – extreme post-natal depression

 PSYCHOPATH

The word psychopath is not one usually used in psychology. It is certainly used in the judicial system and in the media. It is a mental disorder, more specifically an antisocial personality disorder (hence the term sociopath). It may be sub-clinical (as in un-diagnosed) or clinical (diagnosed). It is a chronic (persisting for a long time or constantly recurring) mental disorder showing abnormal and/or violent social behavior. Psychopaths seek opportunities for personal satisfaction (the end justifies the means and the fall out is irrelevant).

Symptoms of psychopathic behavior revolve around three key behaviors – boldness, disinhibition, and meanness. Examples of each of these are included in the following table.

BOLD DISINHIBITED MEAN
Motivated Flexible Driven
Decisive Vision Risk tolerant
Persuasive High risk taking Paranoia
High Energy Not in touch with reality Social withdrawal
Delusions Hyper-focused Emotionless, flat
Egotistical Lack insight and self-awareness Lack empathy
Low anxiety Have issues with “truth” Aggressive
Disregard for the rights of others Above the law No guilt or remorse
  Impulsive  

  Key: Entrepreneur Psychotic

 

 This table is where the behaviors get interesting due to their overlap into the behaviors of both entrepreneurs (blue) and those suffering a psychotic episode (red).

Stress is usually found at the route of psychosis. So it is important for an entrepreneur to remain grounded and remember to take enough time off for rest and recuperation.