Today Is Another Day: Rapid Cycling

As you may remember, yesterday I was painting my toenails in the middle of the night.

Alas, that was not to last.  I woke up this morning with a feeling of dread in the pit of my stomach.

After I finally went to sleep last night, with the aid of more Seroquel, I woke up a bunch of times because my arms were numb and tingling.

Fuck, you know, this has been going on in one form or another for several years.   I’ve been writing it off as probably due to my arthritic collar bone, but this is different.

My medical experience gives me all kinds of terrible fears.  MS is the main one these days.

I remember the day in medical school when they taught us all the bad things that can possibly happen to breasts.

My then-husband came home to find me huddled in the bed hysterically crying.

“What’s wrong?” he asks.

“My breasts!  They’re a ticking time bomb!  I want them off right now!”

“There there,” he said, not knowing what else to say.

The next day I ran to the Student Gynecology Service to get a pre-operative exam.  The kind Nurse Midwife examined me and assured me that at the moment my breasts were not explosive, and offered to re-check them whenever I started feeling breast-anxious.

I felt rather foolish, but relieved that at the age of 29, nothing was wrong with my breasts.

Why do I make these digressions when I’m depressed?

Maybe it’s because I don’t really want to engage with the depression.  I know it will pass, and something else will take its place, but when it’s on me, it’s literally on me, and all over me, and in me, and I can’t shake it off.  All that happens is I start crying and feeling like someone is trying to rip out my guts, and doing a pretty good job at it.

Then it passes, just as quickly as it came.  What follows might be a period of “normality,” meaning, neither hot nor cold, and this is heavenly.  But it never lasts.

Hypomania, or frank mania with psychosis, tends to raise its ugly head at night, about bedtime; which for me is at 9 pm because my meds take 12 hours to wear off.  Actually they take 13 hours, but that is an embarrassing amount of time to sleep, so I actually set an alarm for 9 am.

I can tell the (hypo)mania is on its way because my bedtime knockout cocktail doesn’t do a thing.  I’m awake playing Solitaire on my iPad, which usually bores me to sleep, except now I’m totally awake: uncomfortable in my skin, twitching, restless.  I don’t want to look up because sometimes my wallpaper turns into ugly faces.

I follow the protocol my shrink and I developed for these very occasions: more Seroquel.  Another 50 mg till it knocks me out.  And a double dose of my benzos for good measure.

Sometimes it takes a couple hundred more milligrams of Seroquel to do the job.  I have an incredibly low tolerance for Seroquel, so my maintenance dose is only 100 mg.  I know, I know, some of you take 600-800.  That would put me to sleep for several days.  I usually get to 300 before it’s knock-down time.

The good thing about hypo/mania is that it can be controlled, if recognized early enough.  Depression, though…that’s another beast.

Bipolar depression is different from “regular” depression for reasons I don’t know.  I was treated with regular antidepressants for years, and was pretty much suicidally depressed the whole time.  Vitamins “L” (Lithium and Lamictal) saved my life, quite literally.  Blessings upon the quirky head of my neuropsychiatrist, who was on call when I was hospitalized the first time, and got my bipolar figured out.

The only adjustment we can do for the depression part of the roller-coaster is to up the Lamictal by 50 mg, which puts me at 200.  More than that pops me over into mania.  It’s a delicate balance, as you can see.

So the only thing I can really do with this depression is to wait it out.  Sometimes it does get suicidally bad, and then I have to think about my dog and my son, and what my suicide would mean for them.

I put them in that order, because my dog is helpless without me (although yes, I could put her in Rescue, but that thought makes me cry harder) and my son second, because even though it would tear him to pieces, he is at least able to provide for himself, unlike my dog.  I know that makes no sense but that is how it happens to fall out in my brain.

I’m starting to feel tired now, which means this part of the wave is coming to a close–I don’t know exactly when–and what happens next I cannot guess.

OH NO!!!!

Hello, dear readers.  I think I have flipped.

I caught myself giving me a pedicure at 11:45 PM.  And really enjoying getting artistic about it.  It came out brilliantly, if I may be so obnoxious.

Hm.  Something does not feel quite right.

So I smoked half a joint, meditatively.

That’s when I got it.

I have been a slump since last Wednesday.  Well, not exactly a slump.  I would call it a triggered, dissociated, PTSD’d mess.  But it seems that under that pile of oozing slime, the Black Dog was lying relaxed, head up, tongue hanging out and dripping, waiting.

As I was enjoying my joint it hit me:  Silly silly, you have been depressed all week.  I mean, you have felt terrible, am I wrong?

But now have no fear, because Hypomania has made her entrance.  What fun!  Actually it is, if I don’t ruin anything important in the process.

Who knows how long I could stay up tonight, answering mail since last fall and calling Israel to check on the abysmal state of my bank account, since I haven’t been back in almost a year.  I could, in fact, put away the unspeakable piles of **stuf** that has collected on every flat surface.  I have to push objects away on the table in order to have space to eat.

No, not really that bad, most of the time.  Just during the down spells, where I have no interest whatsoever in that big envelope that promises instant gazillionair-hood.  I throw it all on the table.

Then if I’m lucky I’ll have a nice productive flip.  If I can stand still enough I can get all sorts of things done.  But **sigh** there is little danger of that.  Plenty to do in the big world!  Now, if I can just find a way to stay in this pleasant condition and not get into a mixed episode (shudder) or pop all the way into mania–not fun……..but now for the extra dose of Seroquel so I can get some sleep tonight….

Mania Strikes Again

Why does it always happen the night before I have an appointment?  Not even an anxiety-inducing appointment, just a regular one that I simply need to get myself to and show up for.

Last night I took my bedtime meds at the usual time, did my whole pre-bedtime ritual: take meds, brush teeth, give Noga the Wonder Dog her brief nightly training session and resultant treats; get into bed with a book.

In general, by the time I make it into bed, I’m crashing, and sometimes don’t even make it through the “putting on pajamas” stage, but wake up in the morning to find myself half naked and freezing. The nights here are still chilly and I might not have got to far along as to pull up the covers.

The important part out of all of this is sleep.  I have never been good at sleeping.  Even as a child I spent many nights wide awake reading by flashlight under the covers.  At about dawn when the birds were waking up and sleepily cheeping, I might fall asleep for the two or three hours before it was time to get up for school.

Last night there were warning signs.  An hour after my bedtime cocktail of 50 mg. Seroquel, 1 mg Clonazepam, 1 mg Lorazepam, 10 mg Ambien, plus 300 mg Lithium, I was not remotely sleepy.  Not good.  I waited another hour.  No dice.  The book I was reading became hilariously funny, and I convulsed with laughter.  My Psychiatric Service Dog, Noga, alerted, and left her spot at the foot of the bed.  She peered into my face, assessing my condition.  She parked herself nearby, keeping an eye on me.

Noga, the Angel Puppy

Noga, the Angel Puppy

I started my prescribed protocol for incipient mania.  First try to knock it down with benzos: a couple more milligrams of Lorazepam, another milligram of Clonazapam.  Wait another hour.  Nothing.  I’m starting to look for a wall to climb.

Time to pull out bigger guns.  Another 50 mg of Seroquel.  Wait another hour.  Nothing.  Another 50 mg.  Nope.  Another 50 mg.

All this while, I am feeling like I have bugs under my skin.  Antsy, fearful that this is going to go into full-blown mania with hallucinations and everything.

It has started to pour down the rain, buckets.  By morning my rain gauge would measure two inches, and the river below my dwelling raging out of its banks.

My whole-body arthritis, aggravated by the weather, is making it hard to play solitaire on the iPad.  That’s my usual ticket to boredom leading to sleep, but after a couple hours of painfully tapping cards, I give up and take a pain pill–a very mild one, ten mg. codeine and 500 mg. acetaminophen.  Not enough to dangerously interact with the piles of pills I have already ingested, but by this time the only thing that concerned me was what would happen to my dog if I died.

Meanwhile, Noga the Wonder Dog has glued herself to my side and won’t budge, even when I jockey for more room in the bed.  I move her over and slide over myself so I won’t fall out when the drugs finally (hopefully) hit. She immediately sticks herself back in position against my body, licking whatever parts of me are exposed.  We snuggle and smooch for what seems hours.  She loves snuggles and smooches.  She is my Angel Doggie!

I send my morning appointment an email apologizing for canceling.  Of course I lie, saying that I was sick due to something I ate.  I turn my alarm off.

It’s three o’clock and I’m finally slowing down and getting sleepy.  Noga is cuddled up by my head.

I wake up around noon.  Fine, except that I really do have to go into town today (town is an hour away) to get some things for Friday night dinner.  I struggle out of bed, make a strong cup of coffee, get into my recliner under my “happy light.”  I’ll go as soon as I’m safe to drive, when the muzzy druggy feeling wears off.

Noga starts vomiting.  Why do they always have to throw up on the carpet when there is a perfectly good expanse of bare floor available?  I catch her before it comes up and place her on the floor, petting her while she pukes.  Lhasa Apsos routinely vomit when their stomachs are empty for a long time.  She’s been watching over me for 14 hours now, setting her own needs aside in favor of taking care of me.

After she gets done puking I call her over to the “treat station” and put a few yummy things into her tummy.  Her food is in her dish, but she ignores it until her dog treat hors d’oeuvre piques her appetite. She gobbles down her breakfast and hops up to her usual place on the left arm of my recliner, where she is now firmly established.

She literally stuck with me all night, watching over me and caring for me as if I was a sick puppy (I was).  And now she’s back on the job, after a bit of breakfast and a drink.

Through depression, through mania, she is my Psychiatric Service Dog, always on the job. She takes her job seriously.  I would love her anyway, even if she weren’t my Service Dog Angel, but the psychic connection between us is so strong that she’s like an extension of me.

I wish everyone could be so blessed.

Sleep, Precious Sleep

Yesterday morning my phone rang way too early.  It was a friend who probably though I get up at a normal time for a human being; but I don’t.

You see, my meds last twelve hours, and I have to sleep them off if I want to be functional the next day.

More than that.

If I don’t get the right amount of sleep, I turn manic.  Pretty simple, eh?  Meds>sleep>functional.  Not enough sleep (even with meds)>manic.

I needed to get up earlier than usual today, because there is a lot to do in preparation for Passover, and I needed a full day in which to do it.  This can usually be engineered by taking my night-time meds early.

So I did.

But nothing happened.  I didn’t get sleepy.  Instead I started feeling wired.

Uh-oh.

I thought, maybe I actually forgot to take my meds.  I looked in my pill box: tonight’s meds gone.  So I did take them, after all.

So I did what my shrink tells me to do under those circumstances: I took an extra Seroquel.  That usually knocks me down.

But not last night.  May as well have taken a sugar pill.

I took another, and a milligram of Ativan to keep it company.

Nothing.

By the way, in case you’re wondering, I left an hour between doses, sufficient to feel the effects of the drugs.

I was getting very concerned by this time.

So I took yet another Seroquel, an Ativan, and another Ambien (those are in my usual bedtime hammer cocktail).

Not one fucking bit of “sleepy” coming my way.

So I got out of bed, where I had been passing the time by watching Betty Boop flicks on Youtube, and began doing my Passover chores, since it was clear that I was going to have a short and shit day.  I got everything ready for cooking, chopped mountains of veggies, did all my prep work so all I would have to do is throw the brisket in the slow-cooker, throw the veggies on top, and not worry about it.

Finally the sledge-hammer anti-mania drugs took effect (oh for a few milligrams of Haldol, for quick knock-down) and I managed to get in bed before the blessed drugged sleep overcame me.

I still had to wake up earlier than usual this morning, to call the clinic and cancel my 11 am appointment for ER follow-up with my primary care doc.  I woke to my alarm, made the call, and lay back down to go back to sleep for a couple hours, since I’d already done my prep work and had the time for a longer sleep.

Nothing.

Not gonna happen.

So I got up, feeling cross and speedy, and made my oat matzah (gluten free), singed the meat, sauteed the veggies, made a sauce, threw it all in the slow cooker and sat down to write this.

I really want a beer, but now they’re assur, forbidden, because of being made with yeast.  Anything leavened is forbidden for one week.  Damn.  Oh well, maybe I’ll get up and clean.

 

And Now For Something COMPLETELY Different (really)

I guess most of you don’t know that I’m an Old-Time Clawhammer Banjo player.  Well, I am, have been since I was 19 (a long long time ago), and always will be, until my hands just quit on me.  That banjo has pulled me out of some dreadfully dark places.  I have clung to it like a life raft, and it has never let me down.

Last night was horrible.  I woke up with a just-shy-of full-blown manic attack at two AM.  After a total of 5 mg of Ativan failed to stop the racing squirrels rushing round in their cage (read: my head), and by now it was 5 AM, I took some more Seroquel and at last managed to at least lie down and close my eyes for a couple of hours.  Now I just feel gross and exhausted and can’t do anything.  I’m supposed to make Friday Night dinner for my family, but now I just don’t know how I could possibly manage that.  So I’m going to have to call my mother and disappoint her, but there’s only so much I can squeeze out of myself.  I guess that’s the “disability” part of it, eh?

But back to the banjo part.  There’s this outfit called Number One Music, an internet radio station, that I apparently signed  up my one existing album for, without paying any attention to it, some years back.  I guess.  I really don’t remember. Forgot.

It’s an international, well, worldwide, you know, because of the Web, thing.  Radio station.  They send me weekly emails, which I ignore.  But this morning with my vision pretty hazy, I opened today’s email from them instead of throwing it in the trash.

It seems that on this week’s charts I am numbers One, Five and Six in the Top Ten in the Acoustic genre.  EH?  How did that happen????  That’s kinda...BITCHEN, really.

Durn, I better start working on that second album, if people seem to like the first one so much!

If you want to listen to all the tracks for free you can go to their site.

If you wanna buy my music (nice stocking stuffer!  Shameless plug) you can go to CDBaby, where ALL my music is half-price thru Dec. 31, including digital downloads and single tracks, but if I were you I’d go for the physical disk because it has awesome photos like the one you see here, and a jewel case liner with very sparse but present liner notes.  I was so sick when I made that recording that I listen to it and go, how in the hell did we manage to squeeze that one out???

Now to return to the interesting task of trying to walk straight after all those drugs.  I might use my cane to keep from falling down.  Again.

me n my ol' banjo

me n my ol’ banjo

Turn the Lights On, Will You?

Hey everybody, this is Chattery the Chipmunk here with an Arctic News Blast from Canada.  No, really!  Some of you may know that I’ve been down in the Black Hole for a long, long, long, long…..time.  I keep going to my psychiatrist and he manages to make me laugh somehow, so he knows I’m not hospital material yet.  But since I’m maxed out on the meds, there really hasn’t been anything to do except for hang on tight and think about my son and my dog and some other people who might be seriously bummed if I checked out.

Last week, though, Shrink-O-Matic had a brilliant idea!  Light therapy!  He gave me a “prescription” for a 10,000 Lux blue spectrum light made in Canada, where they really know from Seasonal Affective Disorder.  It mimics the light of a beautiful blue sky!

Now, I am so sensitive to light that my mood changes for the worse if a cloud even covers the sun for a few seconds.  I think one of the reasons I love to be in Israel (one of the many, many reasons) is that if I’m feeling down all I have to do is step outside into the Mediterranean Middle East blue sunny skies and I’m much better.

The instructions that came with the lamp say to use it for 20-30 minutes once a day in the morning.  So I’ve been doing that, and it has been helping some.  Then my therapist on Thursday had the bright idea that I should try using it twice a day.

So today I used it first thing in the morning, and again around 2 pm.  So far I have gone for a long walk with The Dog, swept and vacuumed the entire house (if you can call this a house–it’s actually an unimproved barn-like structure, but it keeps the rain out and has heat), and redid my fan page on ReverbNation, and tried to learn something about investing in stocks, and…I am not at all tired, and it’s 10 pm, and I don’t think I’ll do that again.

It feels something like being on steroids, which is why I hated being on steroids when I had to take them because of inflammation.  I think it could definitely lead to mania if continued.

So, tomorrow will be a one-dose day.  Nevertheless, it is such a relief to NOT be depressed–you know what I mean–that I’ll take a hypomanic episode every now and then if that’s the way it has to work.  I just have to write it on the inside of my eyelids: don’t buy stocks when hypomanic!!! 

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

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.

Teenage Runaways and Bipolar Illness: Related?

By now most of you know that I split from home when I was sixteen.  I shall not go into the “why” of it here.  That is treated on my “secret blog.”   Anyone who wishes to have access to that blog is welcome to write to me at moxadox@gmail.com, and I will send you the link.

My question for today is: what proportion of teenagers who really run away from home, and by that I mean not just for a day or a few days, but more or less permanently, have Bipolar Illness that is undiagnosed or untreated?  And not only Bipolar, but PTSD from childhood abuse, especially sexual abuse, or schizophrenia, Borderline, Major Depression…mental illness in general.  

My own experience on the streets put me in contact with many fellow runaways.  Most of them had some kind of what I would now categorize as psychopathology that predated their running away.  Certainly running away and the sometimes horrific experiences and conditions that one encounters can do nothing but aggravate any underlying condition.

Runaways are often witnesses to violence, victims of violence and predation, subjected to homelessness and various forms of degradation.  All of these set them up for PTSD, whether this was a precondition of their running away or not.

I have seen kids bullied, either at home or at school, who found the predictable privation of life on the street preferable to life at home or in shelters, where the bullying continues.  Aspergerian kids fall into this category because of their odd appearance and often stereotyped behaviors.  So do overweight kids, or even dyslexic kids because of their difficulties with reading and writing.  Life on the streets does not depend on one’s aptitude for written language, but only on the ability to survive in an environment that uniquely combines routine with chaos.

I myself fell into a number of these categories.  I was terribly depressed, when I wasn’t having bouts of extreme clarity where I found myself deeply engaged in the study of physics; and sometimes, ever since childhood, I emerged from my depressive state into a wild grandiosity, which was sometimes satisfying but mostly disturbing and dysphoric.

I was thoroughly bullied at school for being “weird,” and avoided human contact, interacting with dogs, cats, horses, rodents, birds, reptiles, and amphibians, but not fish, because they always died on me.  I wore sandals and clothes from the Indian store in the nearby city, fragrant with incense.  They rooted for the football team;  I dug roots and made medicines from them.

To these high class bumpkins from rural coastal Massachusetts, who went with their mothers to Daughters of the American Revolution meetings and Order of the Eastern Star while their fathers and sons went to whatever meetings they went to, I was a witch and an outcast.  Their children were not permitted to play with me, and they teased me relentlessly about my differences.

Worse yet, the teachers considered me a distraction in their classes since I dressed differently and even wore my hair differently.  They lobbied to get me out, and finally figured out a way to do it.

Being different in a homogeneous society is considered unacceptable.  Anthropologists have written books about this.  We the bipolar, the borderline, the ADD, the PTSD, the schizophrenic:  where do we fit in?  We don’t.

Many good studies are now looking at the creative and innovative advantage of the “different” brain.  We who have them have always known that; yet we have historically been anathema to society.  I cringe every time there is some kind of random killing or other act of violence and the first thing the press asks is: does the person have a history of mental illness?  This, when there is solid research that shows that the mentally ill have no greater incidence of performing violent crimes than the general population; but we do have a greater tendency to be victims of violent crimes: no surprise there.

I hope the generation of children who are coming up now will find a more welcoming, better informed public in general, and a constructive school environment in particular, so that we don’t have to run away in order to not be abused, and to have to seek a kindred society of “misfits” on the streets.