Earth Day, And I Am Alive And Well

Earth Day  has always been a challenge for me.  Some of you may be old enough to remember the very first Earth Day, April 22, 1970.  It was a big deal: there had been an environmental consciousness movement rumbling beneath the earth’s crust, and suddenly it broke through in fire and smoke into a real above-ground popular movement with a “Day” all its own!

But that’s not what was happening for me.  I was a misfit 16-year-old, lonely and depressed, and somebody liked my legs, and I got dragged into a dark musty basement and violently raped.  The physical and psychological (not to mention sexual, oh no) consequences have followed me like an unwanted companion all of my life.

Hence, every April 22 since 1970, that would be 42 of them not counting this one, I have had a relapse of the off-the-charts PTSD symptoms that I got courtesy of the events of that day, plus a large dose of depression to go with them.

But.

This year I have been hard at work writing my novel, which is based on the events of that day and the seven months following it.  I have written that scene many times, minutely, going over and over it to make it perfect.  I have submitted it to a few contests as a short short fiction piece, and had it rejected because it was too graphic.  Victory!  I am not pulling punches.  I am not turning away in fear or disgust.  I am writing it like it is, like it was.

And today is once again April 22nd, “The Unhappiest Day of the Year,” as I used to dub it.

But guess what:  I’m not unhappy!  I’m not keyed up with the tension of waiting for the “big one,” the giant wave of PTSD to hit, pulling me under and keeping me inundated until it decides to leave me bedraggled and panting on the sands of release.

I just feel normal.

I grant you, I am a little suspicious of this, but I’m going with it, you betcha.  If this means that all of the agony of describing that day in living color time and time again has allowed it to flow out of my head via the miracle of touch-typing, then I thank all the gods and goddesses there are, even the ones I don’t know about.

Happy Earth Day, people.

Walking Wounded: Betrayal and Stigma

Even a few days later, I’m still stung and hurting.

A (former) friend whom I have known for years started a Facebook instant message conversation, and asked me what I’m up to.  I said, I’m up to my ears writing a novel, authoring two blogs of my own, participating in a group blog (A Canvas Of The Minds), and guest blogging for others on mental-health related topics, specifically bipolar disorder.

She comes back, bipolar disorder?  Are you bipolar?

Yes.

Are you on meds?

Yes.

Were you on meds when you lived here (with her family for three months, six years ago, while apartment hunting)?

Yes.

Huh.  Well, good luck then.

Click.

A Shrike Impales its Dinner

A Shrike Impales its Dinner

I should have just walked away from it, counted the loss of another person I had thought was my friend, but I felt like I would be betraying myself, as a campaigner for mental health parity and erasing stigma, if I just let it be.  So I sent her a couple of private emails to see if we could sort it out.  No deal.  Door closed.

The pang of that injury took me back to my very first attempt to disclose my private battles with mental illness.  I was at an American Academy of Pediatrics conference.  I am a lifetime elected fellow of that venerable organization.  The conferences are huge, held in gigantic conference centers or spread across multiple hotels.  EVERYONE is there.  So I am navigating a crowded lobby, and I run into an old mentor of mine from my residency.  We had been quite close, and she had always been a shining light for me.  How have you been, she asks kindly.  Well, I return, if you want to know the truth, I’ve been struggling with depression.  She turns on her heel and walks away.  I watch her back receding into the crowd, burning up with shame and racked with the chill of fear: what have I become, that friends and colleagues and teachers just turn and walk away as if I were a leper ringing a bell and calling out, “Impure, impure”?

Years later, I became very close with a neighbor on our street who was also a physician, and like me, an herbalist and energy healer.  We felt a deep kinship and hung around whenever we weren’t at work.  Our kids played together, our husbands liked each other.  It was relaxed and fun and warm.

Even more years later, I had moved away and decided to add acupuncture to my medical toolbox, so I enrolled in an acupuncture school.  First day there, who shows up, but my dear neighbor from before!  We were so thrilled to be on parallel paths.  She and her husband had also moved to the state where I now lived, and she had also enrolled in the acupuncture course!  We switched rooms so we could be roommates; back home we started a seminar group for physician acupuncturists in the area; we stayed close.

Then I had my breakdown.  I won’t go into the details here.  It’s enough to say that I was immobilized by depression, catatonically immobilized, and had to be transported to hospital where I stayed for a couple of weeks.  There was talk of ECT, which I adamantly refused.  I got better enough to discharge; or actually, my insurance ran out and they decided I was better enough to discharge.  I spent the next year completely incapacitated on the wrong meds and racked with guilt over losing my medical practice and putting my two employees out of work, and anything else I could find or manufacture to feel guilty about.

The phone rang one day and I idly picked it up: I wasn’t answering the phone that much in those days.  Why bother?  Who cared?

“Hello?” an eager voice greeted me.  It was my friend the acupuncturist-herbalist-physician!  I was so glad to hear her voice.

“Hi, D_,” I managed, trying to sound chipper.

“Well, what’s the matter?  I’ve been calling and calling you but you never answer and haven’t returned my messages!”  D_ could be fiery.

“Well, D_, the problem is I’ve been struggling with depression.”

“Oh.” (beat) “Good luck then.” Click.

I guess that was probably therapeutic in its way, because ever since I’d gone into catatonia I had not been able to cry.  When D_ snubbed me because I was sick, I fell on the floor convulsed with sobs.  I screamed, I howled, I kicked things, I looked around for something I could afford to break but found nothing so I screamed some more.  I felt more betrayed at that moment than I did when I found out my husband had been cheating on me.  Husbands are one thing; bosom friends are another, and being betrayed because of who I am, and the fact that I was ill, by a fellow doctor whom I loved, was just too much.

So when last week brought me another dose of betrayal, I had a flashback to the last time I was dismissed due to my illness.  It is enough to be one of the walking wounded warriors, without having to endure the betrayal of stigma.

I bless us all, and bless me back, that our friends should be loyal and true friends, as loyal and true as the biblical Jonathan and David, who watched each other’s backs and took care of each other through all the ups and downs of life, loyal till death.

It’s Not Easy Being Brilliant

Last night I had the strangest dream.  I was walking down alleys in some foreign country–it might have been Morocco, judging from what I saw in store windows.  I have never been to Morocco, but I went to the Moroccan restaurant in Disney World and had some fantastic food.  And a store that I frequent in Jerusalem, Rika’s, carries Moroccan stuff, everything from clothing to solid brass mortar and pestle sets, which I regret not getting when I moved to the States.  Never mind, I’ll get one when I move back :-)

Anyway.  Back to the dream.  I was consumed by anxiety because I was supposed to meet with someone at a restaurant somewhere around there, and I couldn’t find it and my cell phone had turned into a wristwatch, courtesy of Dick Tracy I’m sure.  So I had no way to locate the place, or to tell the people I was going to meet with that I would be late.

In my growing state of panic, I turned out of the narrow lanes and found myself in a cityscape not unlike the South Side of Chicago, which is where I did my undergraduate work.  Dreams, right?  I decided to just let my intuition guide me, since I had no other guidance, and found myself in an underground mall full of fast food joints and cheap clothing stores.  I wandered through the passages in the mall until I found the restaurant: a shiny, upscale place full of chrome and stainless steel, very unlike the people I was going to meet.

And those people were:  my ex-husband, his wife, and my ex’s sister’s husband.  I joined them and apologized for being late, but they were very understanding.  We got right to the reason for the meeting, which was:  my ex was having a breakdown because of the guilt he suddenly felt for how he believed he had treated our son when our son was little.  I was shocked, because although they didn’t have a lot of contact for a few years, I didn’t think he had done anything more than most parents do in the way of mistakes, and he had already been forgiven for those.  But there he was, crying and begging me for forgiveness.  I didn’t know how to feel.  Ah, dreams.

In a few days we will celebrate our son’s 28th birthday.  In the Hebrew system of numerology, 28 is the number for “strength.”  I bless our son to have lots of strength, for now and for many, many healthy years to come.

He was not an easy child to raise.  The brilliant ones never are.  He always wanted more, and better, and faster; but at the same time he would get overloaded and have classic melt-downs, needing to be bear-hugged until he calmed down enough to go to his room and totally wreck it.  And he wasn’t so good with children his age.  In kindergarten he absolutely refused to participate.  I went to the child psychologist he had been seeing since age three, and together with the teachers we worked out a behavioral contract: for each five minutes that he cooperated and participated in class, he got to do whatever he wanted for fifteen minutes.  At first that was reading to himself in a loft they had in the room (he had taught himself to read when he was three).  Then he discovered the laminating machine in the office, and fell in love.  All of his out-of-class time was spent laminating things for the teachers and staff.  I joked that they should have paid him.

First grade was a wash-out.  It was a lovely Quaker school, and each morning the children had a meeting to cooperatively decide what they would learn today.  No dice: my son staunchly refused to participate, and stationed himself in a corner like a wooden Indian.  But somehow managed to get perfect grades on the tests.  Countless phone calls from the sweet young teacher later, I said to him, why don’t you just give him a job?  How about giving him a tape recorder and making him the class documentarian?  It worked.  He followed the class everywhere with his tape recorder.  That was his role.

Second grade was better because the new school had a pull-out Gifted Student program, and not only did he get one-on-one instruction, but he had peers with whom he could interact, that were on his wavelength.  They did stuff outside of school together too, like observing our goats having babies and speculating about how the babies got in there.  Then they observed our stallion in action, and that answered that question.

But then there was the constant bullying, because my son was weird.  Time after time he’d come home crying with a new bruise he’d acquired on the playground or the bus.  Countless phone calls to and meetings with the school principal bore no fruit, as they insisted that the incidents had to be witnessed by an adult, and of course the bullies were smarter than that.

So one day when we were at wit’s end, I said to him, look, the next time someone hits you, you hit ‘em back!  And indeed the next day some kid whacked him upside the head while standing in line to get off the school bus, and my son turned around and decked the little bastard.  Oh, didn’t that precipitate an uproar!  The kid’s parents called the principal and threatened to call the police (on a seven-year-old?), and my son was suspended for two days.  But the bullying stopped.  That time, anyway.

After a few years of relative peace, we moved to another state, and there the bullying started anew, and my son stopped doing school.  He went, yes, but once again he stopped participating.   There was a dominant religion there, and the boys used to follow my son around yelling “You’re Jewish and you’re going to hell!”  One day my son turned around and said, “Fine, at least you won’t be there.”  Suspended again, two days.

Things progressed from bad to worse.  He was in seventh grade; I took him for educational testing and he turned out to be working at college sophomore level in reading, and college freshman level in math.  No wonder he wasn’t interested in seventh grade.

But he began to have behavioral issues similar to what he had had as a three year old: tantrums, but now with a simmering anger that frightened me, as he was literally twice my size.  His alternating angry outbursts and silent gloominess had me worried about depression.  We have a long family tradition of depression, and he certainly had both situational and genetic reasons to be depressed.

So I took him to a psychiatrist.  He would not say a word.  The psychiatrist recommended a psychologist, but the same thing happened:  arms crossed, staring at floor.  After five iterations of this, I gave up.  But then I found the suicidal note that “just happened” to slip out of his notebook.  Terrified, I got him into the car by means of screaming threats of calling the ambulance, and drove him to the emergency room, where I showed the note to the doctor and they sent for the psychiatrist on call, who read the letter and asked him if he felt suicidal now.  He shook his head.  Question repeated, response repeated.  Recommend follow-up with regular doctor in the morning.

Please, I pleaded, please just admit him for a 24 hour observation.  This note is really serious.  (As a pediatrician myself, I was trained that there are two kinds of suicide threats:  serious, and more serious.  And this one was more serious, because it specified a plan.)  They sent him home.

Then, it seemed moments later now, the Columbine school shooting happened.  Panic shot through every school in the country.  Some went on lockdown, some installed metal detectors.  Many started conducting regular routine locker searches.  Our school was one of those.

When they searched my son’s locker, they found it stuffed with papers.  Most of them were his homework papers that he never turned in: all done perfectly.  Some of the papers were more concerning: images of guns and missiles and ominous, dark poems about death and mayhem.  They called me in, showed me all the stuff, and threw him out.

It was at this point that I sent him to a wilderness therapy program, one that he couldn’t get out of until he started seriously dealing with his “shit.”  That is a whole ‘nother story, but it was the first of many outpatient and residential treatment programs.  He got into drugs, much more seriously than I had any idea of, as he told me later.  At the age of sixteen he had failed many programs and torn up the family, and his step-mother–I had sent him to live with his father because I couldn’t handle him anymore and thought that being with his dad might help–threw him out.  He went to live with a bunch of gangsters and sold drugs until they thew him out, and then he crashed where he could and ate cold pizza out of the dumpsters.  Somehow we got him into an adolescent psychiatric hospital, and they drugged him into a stupor, and there he lay on couches listlessly watching TV, until some kid started bullying him and he picked the kid up and threw him into a refrigerator, and they threw him out.  So he went to live in a homeless shelter, back to dealing drugs.

Then, serendipitously, he got busted for a small amount of pot.  I called the judge–I worked with the courts in that county a lot and knew all the judges–and begged him to remand my son to long-term residential therapy.  I knew that if I didn’t do something before he turned 18 that he would be lost, in jail, or dead.  The judge did me that favor, and I found a wonderful therapeutic boarding school that helped him find his way out of the hole he had fallen into and discover his wonderful talents.  He also got started on the right antidepressants, and thrived.

And now, bli ayin hara (a Jewish prayer against the Evil Eye, just ignore it), he is working on his Ph.D. in Medicinal Chemistry, doing things with the insides of cells that no one else has done before.  I am so proud of him!  He has taken charge of his mental health issues, working with a therapist and doing DBT.  He consciously cultivates hobbies that round out his life so that he’s not spending all his time in the lab, which he knows he would do if he didn’t do something on purpose to change it.

Looking back on this post, it’s amazing to see how many paragraphs of difficulty and heartbreak it took, to get to this last paragraph of triumph over desperation and despair.  And what I’ve told you is just the tip of the iceberg.  And he still has to work constantly to keep himself on an even keel, and living a healthy life.  But he’s doing it, thank God.  It isn’t easy being brilliant.

 

 

After the Hypomania Attack

Now I am exhausted.  I’m trying to do some research for an article to post here, but my brain won’t work.  I have to force myself to read each word, and then I can’t put the words together; and if I can, they seem meaningless.

What happened?  Only a few hours ago I was all fired up, making lists of topics to write about, designing an actual syllabus that I wanted to cover.  I still love the idea, but even the act of typing is wearing me out.

That’s how it is with me.  I guess it’s called ultra-rapid cycling.  Rapid cycling means you switch between depression and hypomania/mania several times a year.  Ultra-rapid means more often than that.  I think there’s even a term for people like me, who cycle several times a day.  It’s really a drag.

I did manage to do some reading on circadian rhythm and bipolar, and sure enough, there’s a gene (or more) that regulate circadian rhythm, and if you take mice that have been designed to have mutations on those genes, their circadian rhythm is messed up.  If you then give those mice lithium, they go to sleep and wake up when they’re supposed to.  So the authors concluded that there could be a connection between genetic malfunction of circadian rhythm and bipolar illness, which may explain the sleep problems many bipolar people have.  Maybe if I was one of those mice I could get some sleep, because the lithium does help with the cycling, or at least with the emotional reaction to the cycling, and that’s a good thing.

I also found out that I’m probably Bipolar I instead of BP II, because when I was untreated and working nights, I was also going to 6 am aerobics class, then going skiing for a couple of hours, then riding my horse for a couple of hours, then going back to work, and sometimes taking a nap.  I have never held a job for more than two years in my life, because they have all ended the same way:  I knew way, way, way more than the people in charge, and it always came down to “I quit/you’re fired.”  And I have never had a successful relationship either.  They’ve all ended in different dramatic ways, though, even though I don’t consider myself a drama queen, particularly.  The article said that BP I is characterized by hyperactivity, grandiosity, dysfunction at work, and dysfunctional relationships.  Oh, and hypersexuality.  That was fun, but since the relationships were fucked up it was just another battleground.  So I guess I’m BP I.  It was obscured, I think, by the treatment-resistant BP depression I had before rTMS.  Not that I’m no longer depressed; it’s just that the volume has been turned down on it (thank G-d), and now I can see all the other stuff that had been overrun by the enormity of the depression.

Ah me.  I am so tired, and yet I can’t sleep.  I think I might watch a movie, since I finished the four-volume set of Mary Stewart’s wonderful series on Merlin and the rise and fall of King Arthur.  Maybe tomorrow I’ll be coherent again, and get a decent start on what I hope to write.

Blog For Mental Health 2013!

I am proud and humbled to have been pledged by Ruby Tuesday of A Canvas of the Minds as a Mental Health Blogger for 2013.  It’s not an award, but a commitment to keep on blogging with the aim of erasing stigma and creating community among those of us who live with mental illness.  Our Mental Health Blogger community is a place where people living with mental illness as well as their families and loved ones can come together in mutual acceptance and support.  It’s awesome!  So here’s the pledge:

I pledge my commitment to the Blog For Mental Health 2013 Project.  I will blog about mental health topics not only for myself, but for others.  By displaying this badge, I show my pride, dedication, and acceptance for mental health.  I use this to promote mental health education in the struggle to erase stigma.

Here is where I’m supposed to write a short summary of my own journey with mental illness.  Where to begin?  I’ve had issues all of my life with PTSD and dissociation.  Likewise, I cannot remember a time when I was not depressed.  I ran away from home, permanently, when I was 16 and only by the grace of G-d did not die or end up trafficked to Mexico, although there were some close calls.  I didn’t know I had a mental illness till I was in college and desperate to make money.  There was an ad in the student newspaper: take drugs and get paid!  No, really, it was a study that the Psychiatry part of the medical school was doing.  So I went and applied, and had to take a whole day’s worth of psychological testing before they would give me the drugs.  Some guy called me the next day and said, “You have to go to Student Mental Health right now!  Your testing shows you are Severely Depressed.”  Humph.  I didn’t feel any different than I always felt, but if I had to go to Student Mental Health in order to get my drugs, that’s the way it was.  I went.  There was a nice lady behind the desk in a cozy room.  She smiled beneficently and asked, “Why are you depressed?”  ”I’m not depressed,” I said. “Then why are you here?” she asked.  ”The Psych Drug Study made me come,” I said.  She shuffled through my slim chart and said, “Your testing shows you are severely depressed.”  She looked up at me with that saintly smile and said, “You get good grades.  You have a good job.  You’re good looking.  So why are you depressed?”  I stood up, thanked the lady, and walked out.

The next time I got an inkling that I might be depressed came when I was in medical school, married, with a baby who never slept.  I adored him, and many years later I still adore him, but the fact is, he never slept through the night until he was five.  So at that time I think he was maybe ten months old, and I had not slept since he was born.  I was in the middle of my Cardiology clinical rotation.  Everyone had gone to lunch, but as usual I had no appetite and was uninterested in hanging out with people, so I was sitting in a study carrel reading EKGs.  My Cardiology attending came over and said, “Aren’t you going to go get some lunch?”  And I said, “No thanks, I’m not hungry,” avoiding eye contact by studying the EKG.  ”Look at me,” he said, and I did, mechanically.  ”You’re depressed,” he said.  ”I want you to go home and get some help.  You need to see a psychiatrist.  Please call me tomorrow and tell me what you have done about this.”  And head hanging, I went home.  My ex-husband came home and said, “What are you doing home so early?” since I usually stayed late studying.  ”I’m depressed,” I said.  He turned on his heel and walked out.  ”Let me know when you’re better,” he said on his way out the door.  I called somebody at the medical school whom I trusted, and told him the situation.  Five minutes later I got a call from a psychiatrist, who gently demanded that my (ex) husband accompany me to an appointment on the following day.  He did.  The shrink explained to him that I was physically incapable of doing what I was doing, taking care of our son all night and being a medical student all day (and sometimes all night too).  He explained how to give the baby a bottle.

He also gave me my first psych drug, imipramine, which not only knocked me completely out, but gave me a horrible itchy rash from head to toe.  Then he gave me antihistamines for the rash.  I dimly remember lying on the cool hardwood floor wishing I was dead but having no control over my body and therefore being unable to act on it, which was good.  After I got over that, he gave me some other drug, which allowed me to make it through med school in one piece.

Then I got to my residency in Pediatrics, where the standard work week was 120 hours.  More sleep deprivation.  And still with the non-sleeping child, who, bless his heart, sleeps like a baby now that he’s in his 20′s.  And then there was the husband who needed attention too.  So I went to a shrink and got Wellbutrin, which is very good for some people, but me it tipped over into hypomania.  Only nobody in the medical world in which I lived seemed to know about Depression and Mania and those kinds of nervous system brain sorts of things.  They only knew about Show Up For Work And Keep Your Mouth Shut.  I had this private joke: if one of us residents died, they wouldn’t give us time off to go to our own funeral.

As it happened, three of us residents DID die, and another one got taken out of service for accidentally giving someone the wrong medicine, which caused their death; so instead of every third night call, we had every other night, and sometimes “every every” night, which meant we didn’t get to go home much.  I really don’t know how the program directors thought that flesh and blood human beings could tolerate that for three years and not kill themselves or die in car accidents falling asleep on the way home, both of which things did happen in our little corner of Hell.

Anyway.  Fast forward from the late 1980′s-early 1990′s when all this shit was going down, to Y2K.  That’s right, the nearly infamous Year 2000.  Well, it WAS infamous for me, because a whole conflagration of disasters hit me that knocked my pins right out from under me and I ended up in the hospital.  And I became disabled, just like I am now.  The only good thing was that some shrink finally noticed that I’m bipolar, and put me on Lithium.  But by then my medical practice was in ruins, my family life in tatters, my finances non-existent, and worst of all, I had lost my identity.

I’ve wandered around some more since then, and although I’ve just been declared permanently and totally disabled by a Federal Social Security judge (and that feels pretty rough), I’m writing more than I ever have.  I’m blogging, and have become part of this wonderful community that is centered around A Canvas of The Minds.  I’m FINALLY writing my book, having used NaNoWriMo for the past two years to give me the kick-start I’ve needed to get two of the volumes well into progress.  I’m slowly redefining myself, and even though I still have attacks of  ”the mentals,” I’m bumping along, and that’s OK.

Oh all right, that was not short.  I am Incapable Of Writing Anything Short.

Now comes the part where I am supposed to pledge five other Mental Health Bloggers.  OMG.  How am I supposed to choose????  I’ll just start, and when I get to five I’ll stop.  Maybe.

PAZ, of Melancholically Manic Mouse

Lunch, of Lunch Sketch

Nicolas, of Puncture Repair Kit

bpshielsy at The Pipolar Place

survivor55 at Bipolar and Breastless

I hereby pledge to remember to let all of the above know I’ve pledged them.

Lastly:  I am supposed to remember not to forget to link back to Canvas, so here it is.  I think I’ve linked back to Canvas about six times in this post, but I’m feeling kind of wacky today so if I’ve messed up in some of this stuff I hope everyone will forgive me.  And feel free to let me know!

Love to everybody and sending good juju for staying healthy this winter, and looking forward to another wonderful year of Mental Health blogging together!

Soul Survivor

Disabled, or Handicapped? What's the Difference?

Reblogged from A Canvas Of The Minds:

Click to visit the original post

One of my medical school guest professors, let's call him Dr. X, came to class in a wheelchair.  He had not used it all of his life.  In fact, he had only begun to use it in the past couple of years.

Dr. X was a normally functioning medical student with a wife and two children when one day he woke up, got out of bed, and fell on the floor.  

Read more… 811 more words

Here's a post I wrote on the wonderful mental health group blog, A Canvas of the Minds, that published today. I'm interested to hear y'all's comments on this issue. Myself, I go back and forth between feeling disabled, and feeling handicapped by my disability. Some days (minutes, hours, days, weeks, months or years) I feel paralyzed. Other times (seconds, minutes, hours, or, rarely, days) I feel empowered, and not the kind of grandiose power that comes with mania, but the feeling and, yes, knowledge that I can act, from my little corner of the world, to help others and create or at least catalyze change. Let me know what your thoughts are.

There’s a Princess in My Bed

It’s a rainy, dismal morning: the sort of morning when you don’t want to get out of bed.

Noga refuses to get out of bed on a rainy morning!

Noga refuses to get out of bed on a rainy morning!

 

As most of you know, Noga is my Psychiatric Service Dog.  She helps me deal with the ups and downs of having Bipolar, PTSD, and a a few other DSM diagnoses.  She takes care of me at night when I get stricken with the Blind Terrors, and she torments me mercilessly when the time for my evening meds rolls around and I am still furiously writing.  When I get depressed she cuddles up to me and when I dissociate she pulls at my pants leg till I come back.

Her payoff–well, part of it, anyway–is that every morning she gets kisses and hugs.   She waits for me to wake up, and is usually snuggled up in the snuggly place between my left shoulder and my ear, which has been wonderful in the cold season; I think I shall have to put in air conditioning in the summer, though, so that the snuggling can continue unperturbed by sweatiness.

Back to the hugs and kisses part.  Noga will not get out of bed without her hugs and kisses.  And by some unit of measurement known and determined  only by her, she must have a certain quantity of hugs and kisses before she will get out of bed.  And there is a specific sequence to the ritual:

1.  Hugs and kisses, especially tummy rubs and kisses on the head, preferably between the eyes.

2. Stretches, with hugs and kisses along with.

3.  Scritches and playful tugs on the hind legs and tail, accompanied by little love nibbles on the active hand, given by the Princess.

4. Standing up and prancing about in the bedclothes, and “killing” some of them with fierce shakes.

When we get to this point, it is time to get out of bed and go outside to “do our thing,” since Noga does NOT use the Electric Toilet (see previous post).

Today was an exception.  Noga awakened, opened one eye, saw through the glass slider that it was pouring rain, and went back to sleep.  I tried kisses and hugs in vain.  She enjoyed them, yes, but she was not about to be moved.  Bed was where she planned to stay.  I could see it in her eyes:  I will stay here all day if need be.  You see, Noga has a morbid fear of getting wet.  She is rather like a cat in that respect.

I really could not believe that after ten hours in the sack she could not have to go potty; so I picked her up and cuddled her for a while, just to get her going.  Then I set her down in the bed, and as you can see in the picture above, her answer was: “No dice.”

Lhasa Apsos are arguably the most stubborn dogs in the world.  They make Corgis look like boot-lickers.  So I snatched her out of her warm bed and bundled her up in her Paddington Bear raincoat and carried her outside in the rain.  She looked like this:

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She was not happy, and indeed she refused to look at me the entire time we were outside.  But we got the job done, and when we came inside and took off our raincoats we played chase and had breakfast and everything was lovely again.

Psychiatric Service Dogs

Everyone knows about guide dogs for the blind.  Most people know about “Hearing Ear” dogs for the hearing-impaired.  A few people know about assistance dogs for the physically disabled.  Even fewer know about service dogs that assist diabetics by detecting high or low blood sugar, or Seizure Detection Dogs that can sense changes in brainwaves before a seizure occurs and alert the person so that s/he can get to a safe place and/or take preventive medicine.

Almost nobody knows about Psychiatric Service Dogs.  There has been a bit of a flurry in the press about PTSD dogs for returning veterans,  While the Veteran’s Administration has been vocal about acknowledging the benefit of PTSD Dogs in mitigating the disabling and sometimes disastrous sequelae of combat-induced PTSD, they have nevertheless refused to pay for the dogs, preferring instead to underwrite expensive medicines that often do nothing but sedate the sufferer, without providing any definitive remedy.

The Americans With Disabilities Act (ADA), which is an arm of the U.S. Department of Justice, has recently clarified its position on the legitimacy of Psychiatric Service Dogs: 

Service animals are defined as dogs that are individually trained to do work or perform tasks for people with disabilities. Examples of such work or tasks include guiding people who are blind, alerting people who are deaf, pulling a wheelchair, alerting and protecting a person who is having a seizure, reminding a person with mental illness to take prescribed medications, calming a person with Post Traumatic Stress Disorder (PTSD) during an anxiety attack, or performing other duties. Service animals are working animals, not pets. The work or task a dog has been trained to provide must be directly related to the person’s disability. Dogs whose sole function is to provide comfort or emotional support do not qualify as service animals under the ADA.

I have been using a PSD since 2002.  When I first acquired Ivan, I didn’t know if he was going to work out or not.  Psychiatric Service Dogs are not like Guide Dogs for the Blind, in that their training is not so much task related as it is intuitive perception of its human partner’s mood.  Not every Guide Dog makes the grade, for one reason or another; and many fewer PSDs have the focus and the attentiveness to tune in to its partner’s state of being and respond appropriately when needed.

My PSD partner, 2002-2007

My PSD partner, 2002-2007

Ivan almost didn’t make the grade.  He was a wild and cantankerous puppy, but he had an intensity of focus that made me stick with him.  We got involved in some dog sports that gave him an outlet for his energy, and by the time he was a year old he was cuing in on my moods and literally dragging me back from episodes of dissociation resulting from severe PTSD.  When I retreated to my bed overwhelmed by depression, he climbed up and stood over me, licking my face and looking into my eyes with such a concerned expression that I couldn’t help but laugh.  He somehow knew when it was time for me to take my meds, and if I was zoned out he would tug at my sleeve.

The ADA is very specific about the requirement that a PSD must be trained to do some specific task.  I take issue with this, in that mental illness is not something nuts and bolts like physical disabilities are.  You can train a dog to open the fridge and take the laundry out of the dryer (which, by the way, Ivan loved to do for fun, and he could put it in the basket too), but how do you train a dog to respond to an incipient attack of mania by signaling the partner to take a pill?  Training a dog for a specific response requires exposing the dog to the situation over and over.  You can teach a dog to pull a wheelchair, but the wheelchair has to be present at all training sessions.  Guide dogs for the blind go through extensive training in many situations, over and over.  So how can one respond to the ADA’s insistance that the dog be trained for a specific task?

To further muddy the waters, the ADA position statement distinguishes between Emotional Support Animals and Service Animals by the same requirement that Service Animals must be specifically and specially trained to perform a task, whereas Emotional Support Animals are there to comfort and support:  ”Dogs whose sole function is to provide comfort or emotional support do not qualify as service animals under the ADA.”  I think that is a very fine line, when it comes to distinguishing an ESA from a PSD.

Bottom line, though, PSDs share the same access rights as any other service animal: exactly the same as a Guide Dog for the Blind.  It is a federal offense for any business establishment, public or private, to deny access to a PSD.

I never had one single bit of access trouble with my Ivan.  He was a German Shepherd, a breed universally associated with service animals.  We flew all over the country.  He took up a lot of room at my feet on airplanes, which sometimes inconvenienced other travelers, but for the most part everyone was good natured about it.  We stayed in hotels, and he came with me to restaurants, where he lay down under the table and none of the other patrons even knew he was there.  He went to movies and the theatre and museums.  He accompanied me to a ship museum in Baltimore and amazed the sailors by running up and down the ladders between decks!  He loved playgrounds and would run up the ladders and slide down the slides.  He loved everyone, and everyone loved him.  He died at age 5 from kidney cancer, in 2007.  I will miss him forever.

I couldn’t bear the thought of trying to replace Ivan, so I did without a dog until two years ago, when I bought a Lhasa Apso, Noga, for a pet.  I never expected anything from her except being cute and fuzzy and comforting.  But to my great surprise, she started tuning into my moods, and doing specific behaviors related to how I was feeling.  For instance, I often start into a hypomanic attack in the late evening, when I should be taking my meds and going to bed.  If I don’t, she jumps at my legs and bops me with her feet, over and over, and if that doesn’t work she jumps into my lap and flings herself on top of my computer (which is what I am always doing if I am in that state at that time).  If I am depressed she comes and licks me till I laugh.

Noga the Wonder DogNow, as you can see, Noga does not look like what people generally think of as a “service dog.”  She is cute and fuzzy.  She weighs twelve pounds.  I don’t have a picture of her with all her Service Dog gear on, but even with her vest that has PTSD DOG, FULL ACCESS on it in big letters, people still give me the “oh yeah, right” look.  I have been denied access to hotels in the middle of the night when my flight was cancelled.  Oh, and I forgot to tell you, she is registered with a national Service Dog Registry and has the appropriate documentation for that.

The ADA provides specific instructions for businesses that have any doubt that the animal is a service animal.  They are permitted to ask if the owner has a disability, and what specific task(s) the animal performs to mitigate that disability.  They MAY NOT ask anything about the nature of the disability.  All they may do is inquire IF the owner has a disability.

Unfortunately, I have been repeatedly hassled by business owners about Noga, and one hotel desk clerk demanded to know exactly what my disability is, in front of several other customers waiting to check in!  I made a huge scene and threatened to call the police, which I would have done because I was hypomanic as hell after having been turned away by two other hotels.

When I had Ivan I actually carried a prescription from my psychiatrist, which I had stashed among the other papers in his vest (rabies certificate and such).  The very few PSD organizations found around the Internet discourage that, though, because they feel it might cause a precedent for businesses to hassle PSD handlers, since the ADA is very specific that no special documentation is necessary.

If a prospective PSD handler were to ask my advice on what kind of dog to look for as a potential partner, my advice would be something like this:

1.  Steer clear of organizations that purport to sell trained PSDs.  They ask a pile of money and there is no guarantee that any particular dog will partner with you.  The best PSD is an owner-trained one.  Go for a breed that is usually identified with Service Dogs: German Shepherd, Golden Retriever, Labrador Retriever.  But be VERY careful about breeders:  do your research and ONLY purchase a puppy from a reputable breeder of WORKING DOGS, not show dogs, and definitely NO “hobby breeders.”  The money you spend on a quality puppy will save you thousands in vet bills and heartache.

2. Go to obedience school.  Both of you.  If you get a puppy, make sure you go to Puppy Kindergarten Training (PKT).  I advise people to train their dogs all the way through CGC, Canine Good Citizen, which is a program administered by the AKC.  CGC training assures that your dog will be safe in any public situation, including with other dogs, children, elderly people, wheelchairs, everything.  Not only will you come out of it with a “safe dog,” but the bonding experience of training with your dog is invaluable.

3.  Do fun stuff.  Find out what your dog thinks is fun. Ivan would retrieve a ball or a stick until he died (luckily I got tired first)!  Some dogs love to swim.  Noga is a hike-o-maniac, despite her fluffy exterior.  Not only will you bond with your dog this way, but you’ll have fun too, and maybe get outside more.

4. Give your dog time off.  Nobody can stand being on duty 24/7.  Many dogs get upset about “standing down” from duty, but they need it.  Use a crate if need be, to give your canine partner an hour here and there, when you’re feeling steady.  Mine just knows when I don’t need her and goes off and lies down somewhere else.  But she’s always got an ear pricked for me.  She knows my brain waves better than I do.

5.  Join an online PSD community.  Unfortunately, the main one fell apart some time ago, and there seems to be only one left here.  It is not PSD specific, but does have a PSD message board/forum where you can meet other PSD partners and ask your questions.

In summary, Psychiatric Service Dogs are a valuable resource that can help us cope with our disability more effectively, helping us to lead happier and more productive lives.  Mine have saved my life many times, and I suspect that if more people had them, the morbidity and mortality from psychiatric illness would decrease dramatically.  Anyone who is interested in more information about any aspect of PSD partnering is welcome to contact me.

PTSD and Depression: Strange Bedfellows

For the past few days I have been feeling progressively more jumpy, irritable, and triggered by “minor” things like slight changes in my mother’s tone of voice, or “minor” putdowns, expressions of devaluation, etc.  Concurrently, I have been sinking into an episode of major depression complete with suicidal thoughts and plans (don’t worry, I won’t do it: I have promised myself to stick it out, as long as I can).  The whole thing has been complicated by my mother’s birthday, which was yesterday, and the plethora of expectations that go along with that.

Last year was her 85th birthday.  I made her a surprise party, complete with a band and 200 people.  She was very satisfied with that.  Then, come to find out (I don’t know how), her birth date turns out to be wrong and she’s really 85 this year.  I told her, if you think I’m going to do that again for you, you’d better have another think, because I’m still tired from last year.

Last night we were supposed to go out to dinner, which is always stressful for me because I only eat kosher food and my parents always get upset if I don’t eat, even though it’s been that way for eight years already (there are no kosher restaurants in Western North Carolina).  Lucky for me, there was a pea-soup fog and no chance of driving anywhere, so I got off the hook and had a rain-check until tonight.

Meanwhile, my anxiety, depression, hypervigilance, and out-of-control anger was building.  I took my meds at 8:30 last night and was asleep by 9.  I took an extra 25 mg. of Seraquel, at my doctor’s suggestion, and it knocked me out.  I slept until 11:30 this morning, and woke up feeling as if I hadn’t slept at all.

I usually call my mother at 11 am to check in with her and see how my father’s night had gone (he often falls at night), but today I couldn’t muster the strength to do it until around 2.  She said she’d wondered what had happened to me (although it would never occur to her to call), and said something sarcastic, a cheap shot which I blotted out immediately, but it still put me into a blind rage that only subsided when I told her I wasn’t feeling well and she said, well in that case you should stay home tonight.

I really question my sanity (hah!) at coming back here from my beloved Israel to help my parents.  My therapist tells me over and over that it’s life-threateningly detrimental to my health to be here.  I’m sure she’s right, and yet I can’t bring myself to leave my dear old father, who gets more demented day by day.  The only way I keep myself even marginally right-side-up is by reminding myself that I have an unbreakable agreement with myself that as soon as he leaves this life I am back home in Israel, period, new paragraph.  My mother has a huge and very supportive social network that will gladly take care of her.

In the meantime I don’t quite know what to do with this awful perfect storm of PTSD and depression triggers.  I’m taking more meds.  I’m gaining weight because of the meds.  I feel shitty about that. I do need to exercise more: maybe that is the key.  I just have to find ways of staying alive, is all.

Mental and Physical Block

Reblogged from rmott62:

It has been too hard to write, for finally I am coming into life.

I will be 50 on Monday, and this landmark is bringing out my grief and a rage that is blocking my words.

I feel I cannot understand what age is, for I do believe I came into life without rape, torture and wanting death until I was 30.

Read more… 517 more words

Rebecca Mott's courageous voice screams in agony against the routinised torture that is prostitution.
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