Tag Archives: mental illness

Medication Holiday and Why I Can’t Go There

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I made an announcement a week, or so, ago. My plan was to take a medication holiday from a mood disorder meds I have been on and off of since the age of nineteen. My courage has left me.

In the past, I was taken off meds to process through my education, or to carry my children. The meds slow thought processes (a compromise to learning new things), along with body metabolism. There is a numbing down of emotion and with that a deep and cutting loss of the ability to feel.

Being an extremely empathetic person, the loss of the ability to feel is not necessarily a bad thing. It does, however, pose limits to the experience of emotion. Sometimes those limits are good. Rage is in check. Anger is minimized. But so is joy, and happiness. On the meds, there is a numb sort of existence devoid of any extremes. Without the extremes, I made an excellent nurse for more than thirty years. I have a portfolio of commendations. Until the emotions began to bleed through due to stress.

I witnessed and contested some serious abuse and neglect in a pediatric long-term residential facility I was working in and up against a huge and powerful corporation and a gang of despicable people. Some of the abuse resulting in loss of limb or death. It was a two year battle. The place is closed now, if it’s any consolation.

I wrote a long and thoughtful post last evening but did not publish it.

I was recalling all of the times that I have gone over the edge and what happened. They were exciting times, filled with emotion, creative energy, and productivity. I had volumes of imaginative, expressive, original writing. I painted gorgeous pictures in oils and water colors, made fascinating jewelry, and had nearly a hundred ceramic creations that I ultimately smashed against my plaster walls in a fury.

You see, therein lies the problem.

At the end of any one of those glorious manic episodes of profound self-discovery and accomplishment were days and weeks filled with hallucinations, delusions, isolation, darkness and despair. It was frightening…no, it was horrifying. The crash that eventually came caused me to either fight the ones closest to me, or to fall into catatonia so deep that my soul wasn’t present anymore. The depressive loss of the spiritual self so profound that I not only didn’t care whether I lived or died, I didn’t even know if I was alive or dead.

Say I am exercising good judgment to stay on my meds.

Say I’m a coward for not being willing to try.

Can I live in constant state of fight or flight?

I don’t want to know.

The torment of sanity can be worse than insanity.

I’m just afraid of going over the edge and not being able to get back.

There is some sweet sorrow in the fact that the meds make me better controlled.

 

Writing on the Edge of Insanity

In the Western world, there has always been some hopeful connection between genius and mental illness, between creativity and insanity.

quote-for-me-insanity-is-super-sanity-the-normal-is-psychotic-normal-means-lack-of-imagination-lack-jean-dubuffet-53418Famous Quotes:

“I became insane, with long intervals of horrible sanity.”
― Edgar Allan Poe

“Men have called me mad; but the question is not yet settled, whether madness is or is not the loftiest intelligence– whether much that is glorious– whether all that is profound– does not spring from disease of thought– from moods of mind exalted at the expense of the general intellect.”
― Edgar Allan Poe

“There’s a fine line between genius and insanity. I have erased this line.”

― Oscar Levant

“THE EDGE, there is no honest way to explain it because the only people who really know where it is are the ones who have gone over.”
― Hunter S. Thompson

“The difference between genius and stupidity is that genius has its limits.”–Albert Einstein

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The truth is…no studies prove any correlation between creativity and mental illness. In fact, to the contrary, psychosis and poor mental health seriously compromise the ability to function.

http://www.huffingtonpost.com/dr-r-keith-sawyer/creativity-and-mental-ill_b_2059806.html

However, the medications used to treat mental illness can also seriously compromise the ability to function.

I have not been totally satisfied with my writing since Red Clay and Roses in 2012. Lately, since I started on a new medication in 2013, my writing seems stilted, choppy, not nearly as fluid as it once was and I’m not able to readily pull up words that once came easily to me.

To enhance my writing capabilities and overcome some of the hindrances of my bipolar meds, my psychiatrist and I are undertaking a huge joint project.

I’ve kept no secrets about my bipolar disorder. I’ve been in treatment since the age of nineteen, and unlike most, have always been compliant. There were times in my life when my psychiatrist worked with me to reduce side effects of meds…to get through my five chemistry classes in school, to carry my three children, and so on. It has been a very long time since I have been off meds.

Altered thought processes can be a blessing or a curse.

When my thought processes are mildly altered, my creativity is greatly enhanced.

But that is a fine line to walk.

I have been stable for the most part. I am grateful. I have had some breakthrough episodes where the meds became ineffective and had to be changed.

To understand what goes on with the bipolar brain, you have to understand the role of norepinephrine and how the meds work.

Norepinephrine  is a catecholamine with multiple roles including as a hormone and a neurotransmitter.

As a stress hormone, norepinephrine affects parts of the brain where attention and responding actions are controlled.

Along with epinephrine, norepinephrine also underlies the fight-or-flight response, directly increasing heart rate, triggering the release of glucose from energy stores, and increasing blood flow to skeletal muscle. Norepinephrine can also suppress neuroinflammation when released diffusely in the brain from the locus ceruleus.

In the bipolar person, the norepinephrine floods and causes the person to be in a constant state of fight-or-flight. That’s a hard way to live. Moods swing from rage to withdrawal.

Mood stabilizers, like Latuda and Zyprexa, don’t stop norepinephrine from being produced, but block the reuptake of it in the brain.

Instead of a constant flood of this neurotransmitter, there is a more balanced stream.

So what’s the problem with the meds?

Remember when I said attention and responding actions were affected?

While in the sick person, slowing the attention down can prevent scattered thought process, delusions, and paranoia…it also slows down the ability to think, to call things up from memory.  It helps to keep thought processes connected, but can hinder creativity and cause sedation. Everything slows, including response time, so thinking can become more difficult. Reading and writing are affected. Finding the right words for expression of ideas can be inhibited. Imagination is severely stifled on psychotropic medications.

Anything that slows the brain also slows metabolism. People gain weight on these drugs.

There is also a very narrow window that allows most lucid thinking without any of these side effects.

That’s what my psychiatrist and I are trying to do. He’s willing to work with me to find that window.

It is a tedious process for the physician to titrate these drugs and can only be done with those patients who have very good insight and intuition, because it is done based on subjective responses.

Our emotions and behaviors have to be monitored by those close to us.

It’s a high wire act that involves removing the balancing pole and learning to walk the wire with less assistance. The consequences can be devastating, even life-threatening.

I’m going on a pharmaceutical drug holiday!

So, if I start acting really weird(er), let me know.

This physician has followed me since 2002. It has taken more than a dozen years to build up the sort of mutual trust to be able to proceed with this experiment.

I’m both excited and scared.

 

Novel Reading as a Mental Illness: circa 1864-89, Time and Treatment Modalities

In my research for “Surviving Sister”, a novel that tells the stories of two sisters in the 1950s afflicted with mental disorder, I ran across a very interesting article with photographs. Which you can see here: http://www.cracktwo.com/2014/02/scary-asylums-of-past-31-pics.html

I am finding many obscure medical references to treatment modalities. Very little is explained, even in medical journals, about what these modalities actually involved. For example; “immersion therapy”, sounds like deep thought, but what they actually did was immersing hysterical patients into a bath of ice cold water. It was believed to cool the core body temperature down, calming the nervous system.

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Another interesting photo on this web site lists the reasons that patients were admitted to the asylum. I would have most likely never found my way out if ever I found my way in. Read down the list and see if you fit anywhere. When you get to “Novel Reading” stop and think about that. I’m terribly afflicted.

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Sheesh! No wonder so many folk ended up in these places without any medical justification. Families often sent “undesirables” for simply being “lazy” when they showed signs of depression. Many were locked away for the remainder of their lives, even buried on hospital properties.

Treatment modalities were given long, complex terms like, “Lateral cerebral diathermia treatment,” a method using a galvanized current to jolt psychosis sufferers.

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Different facilities around the nation employed various “treatments” and there was no uniform guide for consistency by diagnosis. Controlling symptomatic behaviors was the expectation of facility staff. No one was ever cured, they were reformed or recovered.

Very hard to get a handle on exactly what was going on inside of these places except through tales told by survivors. Documentation is limited. Scary, huh? And we think facilities are bad now. Certainly not ideal, but a vast improvement over what I am seeing from yesteryear.

I believe the biopsychsocial model used during the 1980s was the closest we have come to ideal. The State hospitals cleaned up their act. Facilities were equipped with swimming pools and gyms, walking trails and jogging tracks, offered art and music therapies and took patients out into the community to introduce these “clients” to vast community resources. We went to art shows, bowling, support group meetings, theaters. There was much more individual and group “talk” therapy.

The typical stay during that decade was thirty days to six months. People took advantage of the system, malingering for months into years and insurance companies caught on quickly reducing lifetime maximums and days allowed per episode. Now they are strictly medical model, shoving a few pills at patients and sending them to community outpatient services in a matter of a few short days…before the meds (which usually take two weeks to thirty days to reach effective therapeutic level) even have a chance to kick in. Only the sickest and most psychotic are allowed more than a two week stay.

In many ways it is good to have patients treated in their own communities rather than as inpatient, but most communities simply don’t provide the necessary resources and that’s sad.

What do you think about mental health resources available in your community?

Story Not Forgotten

Whatever happened to that other WIP, “Melody of Madness: Surviving Sister?”

It surfaces for air every few weeks. It is a painful process, slow and tedious. It is a difficult thing to write on an issue that is so very personal. How two sisters grew up in the same household and community and suffered from the same psychiatric malady, but share their perceptions through entirely different personal life experiences and develop entirely different personalities.

Claudette, the older, the pianist, appears strongest at the beginning, suffers and struggles through extraordinarily difficult situations that weaken her resolve, but stores the lessons away soulfully, strengthening the marrow that supports her frame.

Carol, the younger, the ballerina, appears weak and frail initially, defies all odds to achieve lofty goals, surpasses everything she ever dreamed of…lilting her way along, and then the perfection is ripped away, shattered, and she is sucked into a vortex she can never escape from.

The relationships they have with their parents, each other, and the ones they come to love crumble as a result of their illness, but one finds ways to triumph and one is forever lost to the emotional waves of manic-depression that crash the spirit against jetties of life.

They love each other as much as they grow to despise each other. Each has three daughters of approximately the same ages.

The sequel parallels the lives of the two middle daughters who are manic-depressive, subsequently dealing with their malady differently and resulting in totally different outcomes.

My word count on Book One is at 15,300. But it moves along like a sailboat on the sea with no wind. There is so very much research required, and the subject matter during the time period does not lend itself to quick searches on the internet.

This is a black and white 8X10 I have of my mother during her youth. Standing in the water, she is showing her friend, one of the Strickland girls, a water lily.

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This is a 1957 Chamber of Commerce brochure of the small town of Pine Mountain (Chipley), GA, the inspiration of the fictional town of Southbridge, GA, in the book.

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More photos of the pages in the brochure showing the local attractions. I found this in my mother’s scrapbook. You should be able to click on the pic to read the detail.

 

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Small southern towns are very proud of the little things that put them on the map, like Callaway Gardens, Roosevelt’s Little White House and State Park. Even my Uncle’s Standard Oil Company and the various hotels family members owned got into the brochure, and of course, both the Methodist and the Baptist Church…every small southern town has those. The only industry in town was Dacula Shirt factory…it has long been gone, Arrow took them over and it is nothing but a warehouse and offices today.

This is still a pet project that has not been abandoned but can only receive occasional attention.

Do you have any pet projects hiding in the wings?

Mental Illness in the DSM-V, Character Development, and Damnation Hospital

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I am writing a book about my mother and my aunt, two sisters who both suffered from bipolar in an era when there was even more stigma, and less effective treatment…one committed suicide and the other survives. I hope to be able to represent the familial genetic component, in an honest and realistic observation of mental illness, without contributing to the negative stigma of the disorder.

Kristen lamb wrote a blog post today recommending many books to aid writer’s in learning about structure, character development, motivation, and social media. She stresses continued self-education and I can’t agree more.

One book I was surprised to see in the character development list was DSM-5 (Diagnostic & Statistical Manual for Mental Disorders 5th Edition) Helpful for characters, dating, the workplace, and family reunions ;).

This is a book, a Bible, if you will, for categorizing mental disorders. It was originally complied for two basic reasons: 1) To aid physicians and research scientists in their practice, and 2) For labeling purposes for insurance companies to use in strategizing reimbursements. I never really thought of how useful it would be for character development.

I had to learn this book from cover to cover when it was DSM-III, and again when it was DSM-IV, so I am feeling one step ahead. It has grown by thousands of pages since it first started out as the wee DSM-I in 1952. Not because we became sicker, though that may be true, but because science fine-tuned research and the labeling process. I know psychiatrists who proudly exclaim that they could attach a DSM-5 label on any living breathing human. Just so you know, we’re all a bit unwell.

I usually have volumes of research books that I use when I am writing, not so many about writing, but about the topics I research when I am writing.

One I am reading now, “Damnation Hospital” is very interesting.9781257193646_p0_v2_s260x420

It is a two book collection, “But for the Grace of God” by the late Peter G. Cranford. This is a look at the history of Milledgeville GA’s Central State Hospital that opened its doors in 1842. World’s Largest Mental Institution and one of the nation’s oldest, located in the center of my home state. Peter G. Cranford was a chief psychologist there in 1952, and along with the institution’s history, there is a diary of his daily experiences. There are many patient profiles, but little about actual treatments…which has been disappointing, as there is so little documented about the era.

Also included in the Collection is a fascinating little story titled “Posey with the Insane and Sane” by Lois W. Lane (yes, that’s her real name). It is about a young black woman while she was a patient (inmate, they called them) at Milledgeville’s hospital (not sure of the time period, I have a letter out to the publisher now, trying to find out), a long time ago. As the story progresses, she gets released, and lives the rest of her life outside of the institution.

I believe there will be much useful information to be gleaned from these two books.

Here is a postcard image of the hospital from the 1950s: Struck me as odd to see a postcard image of a mental institution. Not exactly like visiting Niagara Falls or Yosemite.

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Surviving Sister: A Melody of Madness

This is a tattered photograph that I have carried around for 43 years since the age of ten. It was retrieved from a scrapbook that my grandma had in an old trunk that held my mother’s personal effects after she died in 1969. The scrapbooks were filled with the sorts of things teenaged girls and young women collect, postcards from places visited, movie and theater tickets, coupons for dancing lessons, pressed corsages, letters exchanged between friends and lovers. On the back it is signed, “Love, Carol.” I don’t know who the intended recipient was supposed to be, but it became the only tangible image of her that I possessed for thirty years.

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My aunt, my mother’s only sister, had a few photographs. They were mostly small pictures taken in their childhood years and there were only a couple that my aunt had of her sister as an adult. There were other pictures, but they were given to my older sister for safe keeping and we became estranged over the years of separation that followed Mama’s death.

In 1997, after coming to Florida and connecting with a cousin, the one who owns Cypress Cove Nudist Resort and Spa, I learned that my uncle, his father, who started the resort back in 1964, had been a photographer with the Miami Herald during the 1950s. When my Aunt Pete, his wife, died in 2000, my cousin was cleaning out boxes in their home and ran across some photographs of my mother and her sister that were taken in their teen years. There is now a vast treasure of black and white 8X10s, and smaller photos of the two sisters. I was overjoyed to be gifted this collection and shared them with my mother’s sister, who was also thrilled.

I want to ask you to take a look at two sets of these photographs that hang on my wall. You don’t know the story of these sisters, Claudette and Carol, but I would like to ask you to tell me if you see anything that hints of a story in these images.

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The images alone demonstrate the differences in these two sisters.  My mother, Carol, a ballerina and dance instructor died of suicide at the age of 26, and Aunt Claudette, a pianist and horticulturist, is 74 years old now.

Carol was a hopeless romantic and a dreamer, and Claudette was a hopeful realist and pragmatic. Carol was cosmopolitan and sophisticated. Claudette was countrified and domestic. Carol, a soprano. Claudette, an alto. Carol was open and free-spirited. Claudette was closed and restrained. As young adults, Carol was dressed in stockings and heels, and Claudette wore jeans and penny loafers.  Both were well educated and cultured in their youth, but their childhoods, teen years, and young adult lives were tumultuous. Music and dance were where they mutually sought solace.

That side of my family is riddled with mental illness and addiction.  Of all the many cousins and aunts and uncles on my maternal side of the family there are geniuses who became entrepreneurial millionaires, and there are paupers who suffered epilepsy, neurological conditions, psychiatric disturbances, multiple tragedies, became institutionalized, or died trying to overcome the obstacle that is madness.  There is a fine line between madness and genius. Mental illness and neurological disorders were cloaked in a veil of secrecy in their era and still have a degree of stigma associated with them that needs to be overcome.

Very few were able to walk the middle of the road, but the strength found in faith, time, and modern science and medicine has made a huge impact. My aunt is one of those who did, although she had severe issues with bipolar and addictions.

I had a brief adventure with drugs and alcohol between the ages of 17 & 19, but addiction was never a problem for me. I was hospitalized for an acute psychotic episode when I was 19, and have been on medications for bipolar and in therapy ever since that event. I drink socially on rare occasions but the experiences of me and my aunt have paralleled many times…either on a personal level, vicariously, or through my patients in my nursing career. My moods are relatively stable now. I am still “driven” at times and “depressed” at times, not to extremes, but such has not always been the case. I would like to tell my story someday, but not before I tell the story of the two sisters, my mother and my aunt.

When I wrote “Red Clay and Roses”, I was telling a story that was wrought with historical tragedy and the serious issues of racial tension and reproductive rights and responsibilities. I wrote passionately about events I witnessed personally or events that had been shared with me by others who had lived the experiences. I did not set out to write a novel by a specific formula or template. I documented a harsh reality. It was open and candid. I have never been one to shy away from that which is painful or shameful. A wounded society does not heal itself by looking the other way, and neither do individuals. At the same time, I tried to be as unbiased as possible and approach these unapproachable issues with sensitivity. On that level, I feel it was successful.

In addition to numerous short stories, I have three works in progress. One is a crime novel. I am about 30,000 words into it and my husband, who reads them daily, loves it. I feel that it is superficial and shallow, amusing and entertaining in its own way, but I am not certain that it carries the weight that makes me comfortable in my own writing skin. Another is a murder mystery. It is more a psycho thriller than a crime novel and I am about 15,000 words into it. I liked the beginning of it, but it doesn’t seem to be going in the direction that I planned for it. Sort of hard to explain, but it, again, doesn’t flow with the passion from the pen that I feel most comfortable with…it feels forced and I am beginning to see that in the way that it reads.  At any rate, I am not so sure that this genre of crime/murder is where I need to be right now. I don’t feel like I am in my element. Perhaps this is something that I can come back to at some future point. The final work is an autobiography of sorts that is almost unbelievable as a memoir.  It is a complex life that I have lived in foster care, an orphanage, on the street, in the islands, small town USA, the countryside, the nudist resort, and the big city. So I am not sure what to do with this either, whether to continue it or shelf it for a while.

Which brings me to questions that I need your help with. It seems to be the passion that I felt when writing “Red Clay and Roses” that I am missing.

For those of you who have read “Red Clay and Roses” (A fictionalized true story set in the 1950s-60s, but involving relatives on my father’s side of the family), you already know that Carol is mentioned twice in that story…once by Hannah in relating her memories of her mother and her mother’s death, and again by her cousin, Sybil, in relating the death by suicide of her cousin, Henry’s, wife, leaving three little girls with no mother.

If I decide to write this book, I would approach the writing process much differently, not as a fictionalized true story being told to a narrator, but as pure fiction (which is always, in part, based on some truth).

Without knowing the details, do you think the story of Claudette and Carol is one that you would find interesting? Particularly, how Claudette coped in the long run to turn her life around. I have been all over Amazon reviews this past week and there seems to be quite a market for this sort of thing as well as the era…people are saying that they are too old to enjoy the drama of Paris Hilton, and too young to relate to the 1930s and 40s, about which so much is written.  Finding and connecting with these people will be another challenge.  People my age and ten years older are beginning to retire, have the time to read, and they are dissatisfied with what is on the market.

As a family saga, beginning in the mid-fifties and moving into the mid-nineties, do you think this story would make a worthy sequel to “Red Clay and Roses”?

For those who have not read “Red Clay and Roses”, what are your thoughts about “Surviving Sister: A Melody of Madness”?